HomeMy WebLinkAboutCAble Street Cut Permits 174 Skyline Dri Permit No. ' 3095 Town of South Windsor , CT
Date- 04/24/2001 Street Excavation Permit
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Expiration Date 04./24/2002
Descrip; INSTALL CATV LINE UNDER DRIVEWAY
Applicant _ Location
Name COX COMMUNICATIONS
Addr. 801 PARKER ST.
06040 CT 06040 Type.
#, or CABLE
Phone (860)432-521 1 `
Applicant agrees toI�u� j h 7 f butte Windsor the amount of bond
required and to re i mturse tie-= 'own of,,, h �nd&fl for any expenses
incurred by the Town ;fQt^ �nene epa ,rk,. i t� connection with this
permit and that app1 cartT a M I 11, and: , 1 abide by the rules and
regulations for permute-""a "Out T r i. the Town, df`South Windsor's Street
Cut Permit Manual .
* PERMIT 70'' BE,`-K ", 4N ; j,"0 '-S'ITE AT, ALL TIMES.
Issued byG-� � T1 t l e" 2 ;
Date Completed D� Irl'spected By
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3095 1-,3 Contractor COX COMMUNICATIONS
Location 0174 SKYLINE DRIVE Address 801 PARKER ST.
Type Work, CABLE MANCHESTER,CT
06040 CT 06040
I,hane No. (860 )432-5211
Date Insp Needed3aite 'Thsp::
Time Insp Neededime tnsp�.
Inspected By
Work in Progress
Input Date 'd 9
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No,. 3095 1 � ' Contractor COX COMMUNICATIONS
Location ;' ;0174 SKYLINE DRIVE Address 801 PARKER ST.
Type Wank CABLE MANCHESTER,CT
06040 CT 06040
Rhone No, (860 )432-5211
Date Insp NeededTime I nsp Needed _ 'f i me -;I tlsp`
Inspected By
Work in Progress
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Date
Input C�t
W 3�95
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm COX e1cC5 Phone No. -S�� - �Q
Address of Firm
Location of proposed work
Describe fully nature of permit requested Li E
Starting da Approx. time for completion 1-3 QA..l A Call Before You Dig No.alkocr(t-l(w, Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement -��
Indicate North Prop. size of cut
No. cuts
m
Amt.of Deposit$ by
()Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing,;
Amt. Due Payee$
Amt. Due Town$
.- Applicant is responsible for contacting by
the Police Dept. and C.B.Y.D. date
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: e$, � dli Date: A-I's—d�
v
Title: D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
DIG SAFE NUMBER ZUU I / I L)Uy t�
Conn: Ph: 800-922-4455 = DIG SAFE CLEARS ON AT 7:00 AM
Contractor#1167
Date EMAIL CITY
STREET ADDRESS
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CROSS STREET t
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CHANGE IF DIFFERENT: WORK: nstalling CATV DEPTH: 24" AREA PREMARKED ?: YES
Utilites Notified: C (_4-P �(,J�. �
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