HomeMy WebLinkAboutInstall/replace CATV Street Cut Permits 700167 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 10/02/07
GIS ID: 74100178
FEE: 25.0
0
MUNIS APPLI
CATION
ION# 200
701604 4 0
TION DATE:
10/01/08
APPLICAITT
NAME: TELE-NETWORKS <:.f.
4.LOCATION
s' s" ��y):�; SS: <,.,: 178 U;A�2RY BROOK DRIVE
k. �:AN�GR�BE JAMES&ADDRESS: 31BAKEWELL COI7RT, £:
CRASTO N)RI0292>i79 Y
Q
T,A�tR BROOK DR
{3 JT-H. SOR V�IND CT 06074
P),
PHONE 01-461-4 842 0
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WORK DESCRIPTION: '
INSTALL/,R 'PT;AE CATV : s
;flak,
APPLICANT AGREES TO FURNISH THE TQ )MI.-D..... :3 'i` '0.,NT:°f BbND REQUIRED Q RED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANI=J Xt'ENSES'I3V C to ',`T ;: b VN VOW-MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE':XPPL&A-NT„IS" 4IV1 # VITH-AI .'"ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SIJTI1 VR' SRE :CLjTE12MIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
10/2/20073:10PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: `7 OC �-� CONTRACTOR:_
LOCATION:_ /
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: L/V/�D
INSPECTED BY: ZD
WORK IN
PROGRESS:_
-�--
- -
AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm_{e LE N tWG KK.S Phone No. -$4S-Z302-
Address of Firm 3 L&1:7_-_WC-LL C 1 rt N eX 02G$2 I
Location of proposed work 004 Z,-
Describe fully nature of permit requested_ IAjS 71A (2-P(AC.p cATV
Starting date y(/ Approx.time for completion_ / 90 j
Call Before You Dig No.200L 3I 03/ Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing Indicate North This section to be filled out by
0,6,E AITAC-14,01 Town of South'Windsor
Pavement Cut
No.cuts
Est Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cash( )Check# .
Permanent Patch
No. Cuts
Size of PatclXs)
Final Billing
Amt.Due Payee
Amt.Due Town
By
Applicant is responsible for contactigg
the Police De t.and C.B.Y.D. —
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 1 AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMITMANUAL.
S' ed: w i J Date:_
Tit Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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