HomeMy WebLinkAboutStreet Cut Permit Bayberry Trail 800151 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE:
GIS ID: 08109999 j . ...
FEE: 25.00
MUNIS APPLICATION# 200801343
J 'PIRATION DATE: 08/28/09
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APPLICANT X' x LOCATION
NAME: TELE—NETWORKSBAI'BEIRY TRAIL
ADDRESS: 31 BAKEWELL COYJ&T ' ;tsEC1LJf VINDSOR TOWN OF
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CRASTON,RI 02921
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', WITI?SfJR CT 060742711
PHONE 401-461-842
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WORK DESCRIPTION: REP¢LAI�I
APPLICANT AGREES TO FURNISH THE OF SOUS ND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANzEXIzTSISsS,IN1VIAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE:16PL.CANfi'I < I>kl'WIT I ND}?S ILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF 4ti r sR'' ST tEI iIT P TIMIT MANUAL.
ISSUED BY D E NSPECTED INSPECTED BY
8/28/200811:56AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: ' CONTRACTOR:
LOCATION:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: ('Iz�?Cv�
INSPECTED BY:_ 9-T)
WORK IN
PROGRESS:
AS-BUILT:
INPUT: f DATE:
W/2007 Town of South Windsor INPSECTION REPORT 07
Mr-171, 11t*A I IUN t-UK STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
0 1640 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm.... tq-�-Gjoo:/ S
Phone No. �t��,"� � — 3 6,2—
Address of Fi
Location of proposed work �"%�
Describe fully nature of permit requested /' CCA
Starting date �/'rfi
Approx.time for completion f �
Call Before You Dig No Traffic Services Control No.
Show sketch of Proposed work or furnish
two copies-of separate drawing Indicate North This section to be filled out b0 y
Town of South Windsor
Pavement Cut
No.cuts
Est..Size of Perm.Patch(s)
Est.PvL Thickness In.
Est.Unit Price$
(Yee a jqa Ct1'eCif Amt.of Deposit$
Total Due by
( -)Cash( )Check#
Permanent Patch .
No. Cuts
Size of Patch(s)
- _.-- Final Billing .
$
Amt.Due Payee
$
Amt.Due Town
By
Applicant is responsible for contacting 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.
�gned: Date- '�t
t .
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES