HomeMy WebLinkAboutCAble Street Cut Permits 37 Sycamore Roa r y TOWN OF SOUTH WINDSOR INSPECTION REPORT G 7
Permit No. 3131 Contractor COX COMMUNICATIONS
Location "FF Address 801 PARKER ST.
Type Work CABLE MANCHESTER,CT
06040 CT 06040
Phone No. (860)432-521 1
Date Insp Needed Date Insp. `��Z��(��
Time Insp Needed '' Tim , Iip
Inspected By
Work in Progress 6//. 0
Input -- Date
Permit No. 3131 Town of South Windsor, CT
D to 7A O6/12/2001 Street Excavation Permit
Expiration Date 06/12/2002
Descrip:
Applicant Location
Name COX COMMUNICATIONS 0037""`,SYCAM,ORE ROAD
Addr. 801 PARKER ST.
06040 CT 06040 Tyke of, Wdrk".CABLE
Phone (860)432-5211
Applicant agrees to f urnish;--t he 'Town 'af youth Windsor the amount of bond
required and to reimburse the 7twn b- South W-ridssr for any expenses
incurred by the Town fof- mallm on�rtc�'� rr repair . ark "i,n connection with this
permit and that app l i pant;" s� fam'i l i,a:r vwj"th and wJ11 abide by the rules and
regulations for permits 'as'"'o,ut1 ''1`4' n h�"" Towfi., o South Windsor' s Street,
Cut', Permit Manual "
�x * PERMIT TO" 8E" KP~T CN> J(36 1T "AT ALL TIMES.
Issued by _ --�--� Ti t l e
Date Completed � �'� �� " Inspected By C-e
APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Name of Firm OK ad j,11 Q (��
Address of Firm Phone No.
Location of proposed work !1
Describe fully nature of permit requested
Starting date (o — ! 4—v ( Approx. time for completion (— .Call Before You Dig No. Traffic Services Control No. DA-4`C
Show sketch of proposed work or furnish To be filled out by Town of South Windsor
two copies of separate drawing
Pavemen Cut
Indicate North
_ Prop. size of cut
No. cuts
Amt. of Deposit$ by
( )Cash()Check#
Cut size after Perm. Patch
No. Cuts
Final Billing$
Amt. Due Payee$
Amt. Due Town $
Applicant is responsible for contacting A
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 MAI CTI IT
NTENANCE OR REPAIR WORK IN CONNEON WH THIS
PERMIT AND THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR PER
TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL. MITS AS OUTLINED IN THE
Signed:`-- n „
Date:_ -Q
Title:_t) % Q
D.L.#:
PERMIT SHALL BE KEPT ON]OBSITE AT ALL TIMES
Standard Forms\Permits\Street Excavation Permit.doc
,# MOSSID#17930 Fax781-721-0047
DIG SAFE NUMBER 2001 a? �bQ
Conn: Ph: 800-922-4455 DIG SAFE CLEARS ON c AT 7:00 AM
Contractor#1167
Date�/o 1 EMAIL CITY S'
STREET ADDRESS
2� s;
CROSS STREET 4 j�;f'6(1: � � 1/(;,j/J
CHANGE IF DIFFERENT: WORK: Installing CATV DEPTH: 24" AREA PREMARKED ?: YES
Utilites Notified: C-0 K
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