HomeMy WebLinkAboutCAble Street Cut Permits 388 Strong Road 4 TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3213 Contractor COX COMMUNICATIONS
Location � x y Address 801 PARKER ST.
Type Work CABLE
MANCHESTER,CT
06040 CT 06040
Phone, No. (860)432-5211
Date Insp Needed pate Insp. �/�
Time I nsp Needed " I n,sp
Inspected ByY1 '
Work in Progress -Z80211'.ii,' plif „LA
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Input. �% Date
Permit,,No. '3213 Town of South Windsor, CT
Dade 1,10/11/2001 ` Street Excavation Permit
Expiration Date '10/11/2002
Descrip:
k App,i i cent
Location
Name COX, COMMUNICATIONS 03.86: 5 'RONG ROAD
Addr. 801 PARKER ST.
06040 CT 06040 Type ,of Work OYE/�
Phone .(860 )432-5211
Applicant agrees t o � ' S tt� W"hdsor¢ e amount of bond
� �
required and to re i mbure the expenses
incurred by the T$wf aTr work. in' connection with this
permit and that appl id�r „S. fa ;I �a Wi th
� andi.i � l aEide by the rules and
regu l,�l i�ysq#� ?; ► -*�-3 with Windsor' s Street
Cut Permit Manual .
/
0 * * PERMIT TO `CEl: E AT Al b T �CS
Issued byt11'�, �
Date Completed _, Inspected By
` APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm 6 Phone No. 17(00 -S
Address of Firm ML
Location of proposed work 8 S�1Z,s�.g 2u40
Describe fully nature of permit requested_.,: ?;;7 4 1 C1 I-V, L_ A;C
Starting date 10- I'► -0 Approx. time for completion l
Call Before You Dig No. AM1410-0-11-7 Traffic Services Control No.
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavement Cut
Indicate North _ Prop. size of cut
No. cuts
Amt. of Deposit$ by
D S ( )Cash ( )Check #
G"� J 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:
Title: D.L.#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
Stanaard Forms\Permits\Street Excavation Permit.doc
Mass: Ph: 888-344-7233
Y Ma`srD#17930 Fax 781-721-0047 j
DIG SAFE NUMBER 20014im 7,;? 7
Conn: Ph: 800-922-4455 �id DIG SAFE CLEARS ON IQ 1 AT 7:00 AM
Contractor#1167 (�
Date ;I - /01 EMAIL CITYL
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STREET ADDRESS
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CROSS STREET
CHANGE IF DIFFERENT: WORK: Installing CATV DEPTH: 24" AREA PREMARKED�j /YES
Utilites Notified: aAz,L- C L-{p Li-W&,6u (dvx
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