HomeMy WebLinkAboutElectric Street Cut Permits Brightman Ci Permit No. 4089 Town of South Windsor, CT
Date 09/22/2005 Street Excavation Permit
Expiration Date 09/22/2006
Descrip: TRENCH FOR PHONE, ;ELECiRICi&::_CATV,'',:;
Applicant
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Name J & H SLATER CONST CO
Bt-IGHTMAN CIRCLE
Addr. 75 COMMERCE WAY;`
SOUTH WINDSOR CT 06079LECTR3C
Phone (860)528-5252
Applicant agrees to ftrxn�sh the T4t"7n q Sp7#t Winciq tfie amount of bond
required and to reimburse that Townvu r fnr x
incurred by the Town. f:ra mas2i't.enance""'or' r "`ar" k;< .. " rases
s;k, p
»:. with this
permit and that appli:caht 3._s :fatjiliar>.�ay�k�. rules and
regulations for permits a .._ 64t': 1rie;". h _>TpyC .4af` Sou`_Yi In sor s Street
Cut Permit Manual.
* * PERMIT TO BE K'EP' O1V 3OE I AT ALb,,,,TI.MEG.
Issued
by ----`r`—_ice— ------- — itTe' f �{fr=�,6-in—
Date Completed Inspected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
r
Permit No. 4089 Con. rdctor ..J....& .H SLAT ER CONST CO
Location BRIGHTMAN CIRCLE A'ddxes, :' ',=:75 C:QM9-kRCE WAY
Type Work ELECTRIC yOU.TH,>wTND OR CT:..:_06074
Phone Ida (80-b..)-1-528 5252
Date Insp NeededDane Trfs
-----
t
Time
I nsp Needed7.
Inspected By f' -
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Work in Progress A1,Tf'o-clove
1 $,
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LevAC InpYitMj'"' '„Date _ iG _/�_C'" _-`
' APPLICATION FOR STREET EXCAVATION PERMIT 4
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm .! `i J ( L. I�+>�. Phone No Z
Address of Firm
Location of proposed work k'(1:-C. (2,X,kt�W--(L 14-V ((A d)J C OL O-`-
Describe fully nature of permit requested
Starting date 1��f 'ti� Approx. time for completion
Call Before You Dig No. "�; �-'� `�`ty i`�`I"`� Traffic Services Control No.
Show sketch of proposed work or furnish This section to be filled out by
two copies of separate drawing Indicate North Town of South Windsor
Pavement Cut
No. cuts 1
Est.Size of Perm. Patch(s)
22Z'� h' = 13'ZZ
Est. Pvt.Thickness in.
Est. Unit Price$
Amt.of Deposit$ 4.0
Total Due$ 6 •{� by
Cash(O�Check#
Permanent Patch
No. Cuts
Size of Patch(s)
,C'
Final Billing
.-1 $
Amt. Due Payee
$
( ' Amt. Due Town
By
Applicant is responsible for contacting 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 SQU_TH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed /2- ��' Date: 4'w
Title; Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
TOWN OF SOUTH WIND(OR '
ENGINEERING DEPARTMENT
ADDRESS PERMIT N0. SHEET •'
OF
UTILITIES INSPECTOR TEMP.PATCH DATE
1
gyp? INSPECOR COMPLETION DATE
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