HomeMy WebLinkAboutDrain Layers Permit 67 Lisa Drive (2) s'
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 3467 Contractor COX COMMUNICATIONS
Location IVE Address 801 PARKER ST.
Type Work CABL MANCHESTER,CT
06040 CT 06040
(860 )432-5211
Date Insp Needed s 11
Time Insp Needed '4 III
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Inspected By
Work in Progress
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C411\ -- Date 7 �a Y(��_
Pe.rfl -. 3467 Town of South Windsor, CT
Date 04/23/2003 Street Excavation Permit j
Expiration Date 04/22/2004
Descrip: 3
Applicant41. Location I
Name COX COMMUNICATIONS S IVE
Addr. 801 PARKER ST.
06040 CT 06040
ABLE
Phone (860)432-5211
Applicant agrees t t i or the amount of bond
required and to reim h r r any expenses
incurred by the Town ai connection with this
permit and that appli a a **,a ide by the rules and
regulations for permit f th Windsor's Street
Cut Permit Manual .
p 0
* * PERMIT TO ALL TIMES.
Issued by Y'Y'� o-�-QSOR- e / la D
Date Completed Inspected By
,Apr 18 03 06: 19a Witch Ent. Utilit�j Div 4138210955
APPLICATION FOR STREET
EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT 'n
TOWN
HALL
- 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm C�)G
Q
Ad ress Phone No.
tl of Firm ,
L ocatian of Proposed'wark
Describe fully nature of permit requested 3 T Liu E
Starting date ears t Approx.time for completion
Cal! Before You Dlg N Traffic services Control No.
twosketch of proposed work or famish To be filled out by Town of So tth Windsor
two copies of Separate drawing
v me C
Indicate North Prop. size of cut
n No,cuts
Amt. of Deposit$ by
Cash(}Check #
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
i
Amt. Due Town $
Applicant is responsible for contacting b
the Police Dept. and C.B.Y.D. Y date
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE TOWN OF
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN CONNECTION WITH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
S g,i ed 'ADate:
Title: KMA D.L#:
PERMIT SHALL.BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit,doc _
,Rpr 18 03 06: 19a Witch Ent. Utility Div 4138210955 p. 2
Mass: 888-344-7233
Dlg3a(e.corn Pswrd DIG SAFE �]oO 502 �� CLEARS
17930 Mess ID# [` �/
17sso NUMBER ON iQ:(o
Conn:800.922.4455'
CBYD.Com Psw1w
W1 CHEQUIP Contractor#1167 CITY * � `a
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STREET f
' v I03 ADDRESS
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NGEIF DIFFERENT 24" CATV WORK MARKED ? YES
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