HomeMy WebLinkAboutCAble Street Cut Permits 111 Spinners Ru Permit No. 2811 Town of South Windsor, CT
Date 08/11/1999 Street Excavation Permit
Expiration Date 08/10/2000
Descrip: CABLE SERVICE
Applicant Location
Name COX COMMUNICATIONS 0ti,1 SPINN,ERS RUN
Addr. 801 PARKER ST.
06040 CT 06040 Type .of:' W6r1 C CABLE
Phone (860)512-5280
Applicant agrees to furs sty .the`-',,Town of $0uth„ ihdsor the amount of bond
required and to reimburse 1�h < 1`owl�we,o' youth W11�disor--for any expenses
i ncu r red by the Town for tijj ntenance' 01�; epa I r work 'in connection with this
permit and that appl1,cant .is fa T i°th, and >at l 1, Abide by the rules and
regulations for permits .T, wn,"Of-,"South Windsor's Street
Cut Permit Manual .
xc * P RMIT TO . KEPT 4,"0 `-rTE. At ALL TIMES.
Issued by s - " Titled
Date Comp 1 et�d �-'� I nspected By
d�s1+
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of FirmdX C Phone Address of Firm a No.
Location of proposed work y J
Describe fully nature of permit requested c
Starting date 13
� Auu�a�a time for completion
���
Call Before You Dig No. Traffic Services Control No.
d
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North Prop.size of cut
t No.cuts
Amt.of Deposit$ by
O Cash O Check#
Cut size after Perm.Patch
No. Cuts
L-3 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: Date: Z7 l [
Title: D.L.#•
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
6k
BOND TOWN OF SOUTH WINDSOR
Am't Req. PUBLIC WORKS DEPARTMENT Date
TOWN HALL
m't on File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE $10.00
f ; r
Name and address of applicant e c)Phone No. w
Location of proposed work .4 "a Flo
Describe fully nature of permit requested f c i"
Insurance on file with Town t,'ye� no Date policy expires
Name of Insurer `-,.__
o Approximate time for completion / �f , Desired starting date
a Call before you dig ticket 110. E
U
Show sketch of proposed work or furnish 2 copies of;separate drawings
04
o cx
O
�o
AW 4
a.
E
O
U
O
2-
U
. 4
04
QApplicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
I agree to furnish to the Town of South Windsor the amount of bond or deposit 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 (Pavement Cut Regulations.)
Signed
APPROVED: DATE APPROVED: '` DATE ;
Supt. of Highways . - Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
'Inr't�ec_tor