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APPLICATION FOR STREET EXCAVATION.PERMIT 80� 01q
TOWN OF SOUTH WINDSOR Permit No.
. PUBLIC WORKS DEPARTMENT
TOWN HALL
1640 SULLIVAN AVENUE
SOUTH WINDSOR,CT 06074
FEE $25.00
Name of Firm_Lij.NETTWOKK-S _Phone No.S$a•�.ZS02.
Address of Firm :��d
'T N N Z�t2 I
Location of proposed w
Describe fully nature of permit requested_ ullS / t'Cg G C�T\t
Starting date f - 0 q''d -Approx.time for completion
Call Before You Dig No. ()OR j>�S Q Traffic Services Control No.
Show sketch of proposed work or famish This section to be filled by two copies of separate drawing Indicate North 1'ovvn of SQutfj'YYind
sor
0,6a ATT'ACH-G-D Pavement Cut
No.cuts
Est.'Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
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
licant is re nsible for contactingate
the Police Oe t.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 O INED IN THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
C:ed. �. �— Date:
Driver's License#:
PERMIT SHALL BE KEPT ON dOBSITE AT ALL.TIMES
i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.:- zo ( 3 CONTRACTOR: +f-I C - vle+ decks
LOCATION: `� 3
TYPE OF WORK:_ 1 n S`I f(f 'I CA \I
--DATE-INSP NEEDED:
DATE INSP: II361 of
INSPECTED BY:
WORK IN
PROGRESS: „�„ S"P
AS-BUILT:
INPUT: G DATE:_ o?
W/2007 Town of South Windsor-INPSEMON REPORT 07
PERMIT
P -- TOWN OF SOUTH WINDSOR CT
PERMIT NUMBER
STREET CUT PERMIT
,e
DATE: 11/05/08 o p� ¢5 S. {
GIS ID: 78300009
MUNIS APPLICATION# 200801742 fw t� u � ' ' ' ° FEE: 25.00
srt ; RATION DATE: 11/05/09
APPLICANT .>f
NAME: TELE-NETWORKS ¢ ,>, d � 4 2LOCATION
ADDRESS: 31 BAKEWELL CO R � '. I LANE
` � ` n .
CRASTON RI 0292`
' ._..°sE �ELF A KENNETH J&MICHELLE A
.. ,: �..
<:.: M IJCC LANE
WINDSOR,CT 06074
PHONE 401-461-8420 g'
WORK DESCRIPTION: INS
'
APPLICANT AGREES TO FURNISH THE
OFFS T , I�fiJN1 FpbND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR AN . T"? E I.. F
TSS Q� 'MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE1 I1,
A? ND WILL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF Q:
G ` ' S . VlTi7TRMIT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
11/5/20089:44AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***