HomeMy WebLinkAboutTelephone Street Cut Permits 103 Palmer TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 3258 Contractor . WETHERSFIELD CONST CO
Location Address 1 WELLS ROAD
Type Work PHONE WETHERSFIELD CT 06109
Phone No. (860)529-5224
Date I nsp Needed AU CA 61
Time Insp Needed Ti, rte .Insp. l:�,0 �1(1
Inspected. By
Work in Progress _!4 vty"r- P CB'-eu F
Input Date
Perm t' N°ems 3258 Mown of South Windsor, CT
Date 03/26/2002 Street Excavation Permit
Expiration Date 03/26/2003
Descrip: INSTALL TEL FOR CLOUTIER SUBDIVISION
Applicant Location
Name WETHERSFIELD CONST CO ►j03 PALMER, DRIVE
Addr. 1 WELLS ROAD
WETHERSFIELD CT 06109TYO ,tif "Work TELEPHONE
Phone (860)529-5224
Applicant agrees to ,furnish =the 'Town 6 South'':Windsor the amount of bond
required and to re i mbur: a..,the 'Town'.' f South W'i»dior for any expenses
incurred by the Town for tj enance or' ;,Opai r ,work in connection with this
permit and that applicarlt "7 am'tli.`a;r vtith, and, w ..11 abide by the rules and
regulations for permits as_ Windsor ' s Street
Cut Permit Manual .
*.* PERMIT TO BE XEPT-0N J.C31 SITE AT .ALL TIMES.
Issued by Title _ 2r�-=fC57i
Date Completed At-52_O'e, Inspected By
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm _T—c. _ Phone No. YeO/s, y- 2,2
Address of Firm / A ELL t /tOA D C T 0610 9
Location of proposed work /02 /,74c F n 7 9
Describe fully nature of permit requested I—s r4 c f 14-C i.- ¢" 19vc- sZ; 7/
lZU-1 7- ci' DIZI-C1, 1 r/A;-- CIVOSJ
Starting date ,/"o z Approx.time for completion 2 7 HI
Call Before You Dig No. 2 Do 2/ Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
%v3 Pavement Cut
Indicate North _ _ _ Prop. size of cut
u Al �iP�� No. cuts
[ Amt. of Deposit$ by
i
o Poc. Sv7/ O Cash O Check#
-- ----- Cut size after Perm. Patch
No. Cuts
®�lMivt �12r�� Final Billing $
-- Amt. Due Payee$
Amt. Due Town $
/t-1
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.
')j vo C. 4^1-?rus,-
Signed: -��j� �� Date:
Title: U/ Q��J /�.^ T D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc