HomeMy WebLinkAboutCAble Street Cut Permits 500 Clark Stree Permit No. 3090 Town of South Windsor, CT
Date 04/23/2001 Street Excavation Permit
Expiration Date 04.../23/2002
Descrip:
Appiicant :> Location
Name COX COMMUNICATIONS � a5p'4 t:LARK STREET
Addr. 801 PARKER ST.
06040 CT 06040 Type of Work CABLE
Phone (860)432-5211
Applicant agrees to fur�l,'sh"ths ,Tt9�t'h of South "Windsor the amount of bond
required and to reimpurse the, T0146 cif oath W'iridsor" for any expenses
incurred by the Town "f,o " connection with this
permit and that appl i'cant` i ; tare; iar` .rait# and: Will -abide by the rules and
regulations for permits:.�§lcuti.i-ned,. ,i .the Tbwtt of-South Windsor' s Street
Cut Permit Manual .
* ` ERMIT T E KEPT 'ON ;JOB SITE 'AT ALL TIMES.
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Issued by Title
v J 1
Date Comp l t d Inspected By C___,A�
--ter
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL O ��
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm Cox CCnr-tl_kQ Phone No. 19 l00 - 21,70
Address of Firm
Location of proposed work �� n4 rlt I.0 Ste.
Describe fully nature of permit requested ' LipiE
Starting date e-l- U 1 Approx.time for completion
Call Before You Dig No. IC_Qj i Ja 0 1 2, Traffic Services Control No.
Show sketch of proposed work or fumish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement
Indicate North Prop,size of cut
No.cuts
m
Amt of Deposit$ by
D, �� ()Cash()Check#
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: 't 1� �i� e �, Date:
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
Mass: vn: uaa344-/z33
Mass ID#17930 Fax 781-721-0047 20011 L� 6 35/�
• �►- DIG SAFE NUMBER
Conn: Ph: 800-9224455 DIG SAFE CLEARS ON qJ01 S AT 7:00 AM
Contractor#1167
Date y//1 /01 EMAIL CITY
STREET ADDRESS
ILr 5 i A C rn on lw T `16&
CROSS STREET
CHANGE IF DIFFERENT: WORK: Installing CATV DEPTH: 24" AREA PREMARKED ?: YES
Utilites Notified: Ck,Y C L CrCya x
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