HomeMy WebLinkAboutCAble Street Cut Permits 21 Stoughton Dr TOWN k = SOUTH-i 'WiNDSOR ;.rNISPEGTION REPORT
Permit No. 2940 (ontractor COX COi,3MUNICA"f?:'.i,-J
Location 0021 S I'c.7tJGH I'OrI I-R7+/E Address 8q 1 PART•:; R Si
Tvpe Work: GA'F3i_.E. MANGF1ESTC=R i
S iiolle No . : 4U 1 18L' 1 i 1 !
Date Insp Needed t_ r< Insp.
Time Insp Needed _-_ ''ime Inso.
Inspected By
Work in Progress
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Permit No. 2940 f own Soux.n W i nci.sor
Date 04/07j '000 Street Excavarion Per niit
Expiration Date 04/07/2001
Descrip: GAi-V FROM HOUSE TO CABLE PED
Aop1icant Locati0ri
' 4
Name COX COMMUNI CAT I?JI S +s02 ( Si C:}UG(ti Orr D IVE
Addr .. 801 PARKCR ST .
06040 CT 06040 TYDe '61- Wof k vCAbi_E
Phone ( 401 )821 - 1919
Applicant agrees tO turn sh t-ie Town of South Wind or the amOunt ro.{ bond
required and to reimburse the Town of South Windsor for, any expenses
incurred by the Town for maintenance' or repair work. in connection w i tti this
permit and that applicant is familiar with and wi i abide by the rules and
regulations for -)Hrrniis as outtined in the Town dT Soot,h Windsor ' s Street
Cut Perm-1t Manual .
* PERMIT TO BE k"EPT ON JOBI SITE AT ALL 'TIMES,
Issued by
Crate Comp 1 eted -.__,- --.._-- ------ --_____ Inspected fsy
Q-
APPLICATION F
OR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm -
Address of Firm Phone No. T1'0%����
—�► _ �of��
Location of proposed work
Describe fully nature of permit requested
.
Starting L
Call Before You Dig Now loa i Approx.time for completion — —
Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of arate drawing To b fills out b To n of south Windsor
Indicate North Pavem nt ►t
l Prop.size of cut
No.cuts
�D
Amt.of Depo§it$
OCash OCheck#
Cut size after Perm. Patch
No. cuts,,--.
Final Billing
Amt. Due Payee$
Amt.-Due Town$ ,
Applicant is responsible for contacting
the Police De t. and C.B.Y.D. by date
I AGREE TQ FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED.A
SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE OR REPAIR WORK IN C
PERMIT AND THAT I'AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATION ND TO REIMBURSE THE TOWN IS
S FOR PERMITS AS OUTLINED IN THE
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. ONNECTION WITH THIS
Signed: .
Date: 7-0�
Title:
D.L.#:
PERMIT SHALL BE KEPT ON 7OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc