HomeMy WebLinkAboutInstall CATV line Street Cut Permit 44 A Perm, No. 3303
`De ► 05/30/2002 Town of South Windsor, CT
Street Excavation Permit
Expiration Date 05/30/2003
Descrip: INSTALL CATV LINE TO HOUSE
Applicant
Location
Name COX COMMUNICATIONS 9a AND LANE
Addr. 801 PARKER ST.
06040 CT 06040 :
Phone (860)432-5211 4 CABLE
Applicant agrees
required and to reim u oh n th i1fd or the amount of bond
incurred by the Town x r any expenses
permit and that appli a an pai i connection with this
permi
regulations for an ide by the rules and Cut Permit Manual . th Windsor's Street
r` ,
* * PERMIT T .
T L TIMES.
Issued by 5 ESA t ��o�. ��G•
Date Completed
Inspected By
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3303 Contractor COX COMMUNICATIONS
Location Address 801 PARKER ST.
Type Work MANCHESTER,CT
06040 CT 06040
e (860)432-5211
Date Insp Needed s r o
Time I nsp Needed 1A
Inspected By "
Work in Progress
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n Date �0�
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APPLICATION FOR STREET EXCAVATION PERMIT 33 P3
LSD TOWN OF SOUTH WINDSOR ---
�,'� PUBLIC WORKS DEPARTMENT
1�a TOWN HALL
Q� 1540 SULLIVAN AVENUE
SOUTH WINDSORf CT
FEE 29.00 Wr+tVC d
Name of Firm a 4 Phone No. 90 +S 12 " 5 219-Q
Address of Firm M '
Location of proposed work J41 /U141 rAt%r
Describe fully nature of permit requested :i.L;�;T-Ari_L S 611ki
Starting date Appmx.time for completion
Call Before You Dig Na. ,Lawty Traffic Services Control No. - -
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Paygment Cut
Indicate North Prop.size of cut
No.cuts
Amt.of Deposit$ by
�� ( )Cash(}Check #
Q �
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting by date
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 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: - Date:!2 a a /. sZ'604�—
4
Title: �� � � D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
., r . T-ra wir�cn tnt. utility Div 4138210955
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Mass: 721-04.7233 222pOg45 EA b/1
Fx 781.721-OOM17 DIG SAFE �OO� CLEARS 7:00
Mass 10#17930 NUMBER LJ AM
Conn:800-922-4455
448
Fx 20actor 9 116
Contractor#1167 CITY
DATE --SS
IO2 STREET ADDRESS
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CROSS ST (—,A0V
u� CHANGE IF DIFFERENT CATV WORK
24,E
k AREA MARKED . YES
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