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HomeMy WebLinkAboutReplace existing CATV between 275 and 30 700122 MIIT TOWN OF SOUTH WINDSOR PERRMIT NUMBER CT STREET CUT PERMIT DATE: 08/08/07 GIS ID:39000275 "> UNIS APP LIGATION# 8 E: 20070123 '" FE ``r _ 25.00 IRATION� DATE : ` 08/07/ • AP P L I C A N T-i. NAME: oRKs TELE—NETW '' :i LOCAT ION ADD RESS: ,::.f:,. . ,� RES: >'_ ..2.`�< 31 BAKEWELL CO .� � :..� ,. "i T`,..°"' ,`:� <r<;>r.�rt�,•�:.,.,>,.::;.:>::..: : ��:;GRIFF�N ROAD .::.; i. TON,RI 02921 J' AT ANTHONY&AMY ELIZABETH I�IF ITT PH �' RD O N E 4 ...1— — 4 6 H>:' 1 8 §4 2 0 IDS O C T 0 60 7'�'x R 4 WO RK .J { RK DES CRIPTION: C RIP T I ON. E :wr L5>: FIN RD APP .i. LICANT A GREES TO FURNISH THE THE TOWN OF S IDC3 ?> O .':: OUTH WINDSOR FOR ANI'::EXINS'E3: ': REQUIRED AND TO REIMBURSE CONNECTION WITH THIS PERMIT AND THE`' PpGgT„S F :; TENANCE OR REPAIR WORK IN FOR PERMITS AS OUTLINED IN THE TOWN OF`S jFJI j y.T'- 't , - ' U s `� AND:-IL 'ABIDE BY THE RULES AND REGULATIONS .. RI�ZII MANUAL. G «: ` ISSUED BY DA `` ' PC° EDf 8/8/2007 9:30 AM *** INSPECTED BY PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES*** r TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.:_ `-7d© 1 CONTRACTOR:_ 1r1etW O Y LOCATION:_ y-r4 TYPE OF WORK: 'Ro p(Cc PJ CAIN DATE INSP NEEDED: DATE INSP: 21S"/©t INSPECTED BY: QZ> y' WORK IN PROGRESS: t,,)o V-k AS-BUILT: INPUT: C� DATE: W/2007 Town of South Windsor INPSECTION REPORT 07 IlkAPPLICATION FOR STREET EXCAVATION PERMIT ®c� lam c TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT Permit No. TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT 06074 FEE $25.00 Name of Firm '_e(Sc Ne\Nlj?_ S Phone No. ' �4� z30`Z Address of Firm '31 12o t'lSTOty Location of proposed work_ a 5- 30 I C; l FF1/N �7yj Describe fully nature of permit requested I& EX�S'i I NGy CF} y Starting date "0 Call Before You Dig No.�OC� 7�00 3� Traffic� Approx.fictime for completion_ f rJ� Services Control No. Show sketch of proposed work or fumish two copies of separate drawing Indicate North This section to be filled out b Town of south Windsor Pavement Cut No.cuts Est.Size of Perm.Patch(s) Est.Pvt.Thickness in. Est.Unit Price$ Amt.of Deposit$ Total Due$ by ( )Cash( )Check# . Permanent Patch No. Cuts Size of Patch(s) Final Billing Amt.Due Payee Amt.Due Town By Applicant is responsible for contacti qg the Police Dept.and CA Y.D. Da 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. Signed: C, U(a�1. Date: �` 1 - � Drivers License#: PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES