HomeMy WebLinkAboutInstall/replace CATV Street Cut Permits (3) 700168 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER
;., v.:.. STREET CUT PERMIT
DATE: 10/02/07
GIS ID: 852 �.00005
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FEE
:
MUNISPLICATION# 2007O15
25
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TION DATE:
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SCRIPTION:
S C RI PT I ON•
. INS'I'AL<If.REP�A":
APPLICA
NT AGREES TO FURNISH THE
THE TOWN OF SOUTH WINDSOR FOR AN(:EXPENSES> I\J [ tR. ypJ FOk MAINT NUUID AND ANCE OR REPAO REIMBURS
IR WORK INE
CONNECTION WITH THIS PERMIT AND THE 4I?PL CAN�I�"F � NTH q It�TLL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUT�T W L��'R'SPERMIT MANUAL.
11
ISSUED BY 0 DATE INSPECTED INSPECTED BY
10/2/20073:12PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: 7 0 0 16-9 CONTRACTOR: f 'I �- V l e7�Jc)(
LOCATION:
TYPE OF WORK: C A-�
DATE INSP NEEDED: DATE INSP: a 4 (0$
INSPECTED BY: 1,))
WORK IN
PROGRESS: A
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AS-BUILT:
INPUT: DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
APPLICATION FOR STREET EXCAVATION. PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
'Name of Firm_TE L NEt'WO KKS - Phone No. -84-S-2302.
Address of Firm 3 MKEWI~(1, CT. C ZAtJSZN ZZ
Location of proposed work STf1NLcq DZ
Describe fully nature of permit requested_ ISIAt /(IC--P(A CA 7V
Starting date 63-j�q-01
Approx. time for completion t 04 H
Call Before You Dig No.&Q-- 5 - e� Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of South'Windsor
Pavement Cut
No.cuts
Est.'Size of Penn.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
)Cash( )Check#
Permanent Patch
No. Cuts
b - Size of Patch(s)
5 Final Billing
k" C (2-t° S 1 ' Amt.Due Payee
{ Amt.Due Town
By
Applicant is responsible for contactiggate
the Police Dept.and C.B.Y.D. —
I AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE THE
CONNECTION WITH THIS PERMIT AND THAT 1 AM FAMILIAR WITH AND WILL
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN
PERMITS AS OUTLINED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT P ABIDE BY THE RULES AND REGULATIONS FOR
ERMIT MANUAL.
S' t,
Date:_
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES