HomeMy WebLinkAboutStreet Cut Permit 76 Wentworth Drive 800192 TOWN OF SOUTH WINDSOR, CT
P,RMZTNUMBER STREET CUT PERMIT
DATE: 11/05/08 :£ .k« ..
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GIS ID: 93300076 �. .'�;,r •, ;.! °
MIJNIS APPLICATION# 200801741>" xell
' xhQ. '�RATION DATE: 1 5/09
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APPLICANTyp•LOCATION
NAME: TELE-NETWORKS "
WORTH DRIVE
ADDRESS: 31 BAKEWELL COI
CRASTON,RI 0292 ^r WAN J&HELENANN T
# bw TWORTH DRIVE
TI-I WINDSOR,CT 06074
PHONE 401-461-8420
WORK DESCRIPTION: INSIcppp BETWEEN 76+90
APPLICANT AGREES TO FURNISH THE `"; ` "'" ` `
F� fUL�TYF:F�OND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANIENC UFQ MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE if. LL ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF
ST :. it RMTMANUAL.
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ISSUED BY DATE INSPECTED INSPECTED IRY
11/5/20089:38AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: dO c�— CONTRACTOR: L
LOCATION:_
TYPE OF WORK:
DATE-INSP NEEDED:
' � DATE INSP:
- T INSPECTED BY:
WORK IN
PROGRESS:_ hp�,
AS—BUILT.-
INPUT: G DATE:
W/2007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR STREET EXCAVATION-PERMIT $°O ��-
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL.
1640 SULLIVAN AVENUE
-SOUTH WINDSOR,CT 06074
FEE $25.00
-Name of Firm IELENETWOKKS Phone No.S89•844>-2302.
Address of Firm 31 6AMWC-Li, C t rRAOSION el 02AZ I
Location of proposed work ,
Describe fully nature of permit requested_ IAISTWt t. f CC'G-PIAf. CR't y
Starting date 1 b"d Approx.time for completion L
Call Before You Dig No.2009 0 0'St Traffic Services Control No.
Show sketch of proposed work or f wnIsh
two codes of separate drawing Indicate North This-section to be tilled out by
Town of South'indsor
See AITACHPD Pavement Cut
No.cuts
Est'Size of Perm.Patch(s)
Est.Pvt.Thickness in.
Est.Unit Price$
Amt.of Deposit
Total Due$ by
)Cash( )Check#_
Permanent Patch
No. Cuts
Size of Patch(s)
rm
Final Billing
Amt Due Payee
AML Due Town_
By .
�ppllcant is responsible for contac Ate
the Police Dept and C.B.Y.D. —
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
PERMIT$. SOU D N THE TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.
S• �"" Date• 0 L c 04- 0e.
Title: Driver's License M
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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