HomeMy WebLinkAboutCAble Street Cut Permits 39 Cornerstone TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 'N Contractor COX COMMUNICATIONS
Location Address 801 PARKER ST.
Type Work , ., , . . .
Yp rk CABLE MANCHESTER,CT
06040 CT 06040
SEPton ,0 0. (860)432-5211
Date Insp Neededn
Time Insp Needed km
Inspected By
Work in Progress
r
�_ Date
Pere No. 3418 Town of South Windsor, CT
Dg( 10/21/2002 Street Excavation Permit
Expiration Date 10/21/2003
Descrip: INSTALL CATV LINE
Applicant 0 N Location
Name COX COMMUNICATIONS RSTONE DR
Addr. 801 PARKER ST.
06040 CT 06040 CABLE
Phone (860)432-5211
Applicant agrees th in sor the amount of bond
required and to rei T uth or any expenses
incurred by the Tow ten epa n connection with this
permit and that appli n a bide by the rules and
regulations for perm t q' outh Windsor's Street
Cut Permit Manual .
a � c
* * PERMIT ALL TIMES.
Issued by ' 31 00 SORi e _
Date Completed I nspected. ByR-� D -
\
c, !G 02 02: 59p Witch Ent. Utility Div 4138210955 p, 1
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APPLICATION FOR STREET EXCAVATION PERMIT _
TOWN OF SOUTH WINDSOR
-� PUBLIC WORKS DEPARTMENT
" 1y TOWN HALL
�p 1 1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
Name of Firm U C5 Address of Firm Phone No.
Location of proposed work r 4
Describe fully nature of permit requested Lr
Starting date s 1
� -• _4 Approx.time or cmpletoCall Before YouDig No,ao �re mC{-�t
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing o e filled aut b Town of South Win Sor
Indicate North av me C
_-- Prop.size of cut
No.cuts
Amt of Deposit$ by
()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 REGULA77ONS FOR PERMITS TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. AS OUTLINED IN THE
Signed:
• Dater 1� 0�--
Title:
D.L.#:
PERMIT SHALL BE KEPT ON JOBSiTE AT ALL TIMES
Standard FormskPermits\Street Excavation Permit.doc
7c_ 16 02 03: 00p Witch Ent. Utility Div 4138210955 p. 2
Mass: 88"44-7233
Fx 721.0047 DIG SAFE �� CLEARS
Mass 1 O/
MassD#17930 NUMBER 1 7:0
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Conn:800-922A455 O N AM
Fx 203 248.6448
Contractor#1167 CITY
DATE
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