HomeMy WebLinkAboutCAble Street Cut Permits 68 Old Farm Roa TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3382 Contractor COX COMMUNICATIONS
Location IcAt Address 801 PARKER ST. .
Type Work CABLE MANCHESTER,CT
06040 CT 06040
h No. (860)432-5211
Date Insp Needed
Time Insp Needed
tj: +0 AM
Inspected By
Work in Progress ' ' a
" Date
Aug 26 02 02: 54p Witch Ent. Utility Div 4138210955 /33 �g -01 p. l
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR --
�,°� PUBLIC WORKS DEPARTMENT
` v
�� TOWN HALL
p� 1S40 SULLIVAN AVENUE
SOUTH WINDSORF CT
W14IVE ;S
Name of Firm COX073 Phone No. 17�20 —
Address of Firm t-t
Location of proposed work
Describe fully nature of permit requested ;; i—i Aj
Starting date Approx. time for completion a rM 41 n
Call Before You Dig No. 6 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
Pavement Cut
Indicate North 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 REGULATIONS FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
Signed: Date: Q�-
Title: L� q-,MZA D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard FormWermits\Street Excavation Permit.doc
Fug 26 02 02: 54p Witch Ent. Lltility Div 4130210955 p. 2
Mors: 88a.344-7233
Fx 781-721-0047 DIG SAFE CLEAR 7:00
Mass IN 17931) NUMBER 2002 3402914 ON s 8/28 AM
Conn:800-922-4455
Fx 2o3 248-6448
Contractor#1167 CITY 50 e.-JY 11 1.11"lako.l-
DATE
STREET
102 ADDRESS
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CHANGE IF DIFFERENT CATV WORK 34,6d-
2411
AREA MARKED ? YES
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Permit Nd.A' ' " 3382 Town of South Windsor, CT
Bate 08/28/2002 Street Excavation Permit
t
- Expiration Date 08/28/2003
Descrip: INSTALL CATV LINE
Applicant Location
Name ` COX COMMUNICATION FARM ROAD
Addr. 80i PARKER ST.
0604071CT 06040 o k CABLE
Phone (860)432-5211
Applicant agree h W ndsor the amount of bond
required and to re a ou for any expenses
incurred by the To " int re in connection with this
permit and that ap iTi h abide by the rut( and
regulations for pe u i of South Windsor's Street
Cut Permit Manual .
C7 0
PERMIT 1 T ALL TIMES.
Issued by
Date Completed Inspected Byn ,�� �