HomeMy WebLinkAboutStreet Cut Permit 76 Gray Road 1000087 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 05/20/10
GIS ID: 38100076 �' j' �� FEE: 25.00
MUNIS APPLICATION# 201000595 i � � IRATION DATE: 05/20/11
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APPLICAN' LOCATION
NAME: CABLE CONSTRUCT I 9 INC� -ice RED A &8810RAY ROAD
ADDRESS: 405D NEW STATE R = NI PAUL C&MARY E
MANCHESTER,CT If % = r > A ROAD
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JT-TfWINDSOR,CT 06074
PHONE
WORK DESCRIPTION: TREIa ,5 F �ILI (IN GRASS)
AMOTI ND REQUIRED AND TO REIMBURSE
APPLICANT AGREES TO FURNISH THE T(VFTII `
THE TOWN OF SOUTH WINDSOR FOR ANI XIwN-st I�TCLJ) C yl T O IAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THE�'L Ziwa A L ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF S �JT�LV IW-PI'5 5 f� I? VIIT MANUAL.
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ISSUED BY DATE INSPECTED INSPECTED BY
5/20/201011:21 AM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: /Q(M0A CONTRACTOR:
LOCATION: Q2
TYPE OF WORK: 1Y'r0(_h Zak .S ✓�P ,�CG l�t-T G �1
DATE INSP NEEDED: DATE INSP: S Ir
INSPECTED BY: 6A
WORK IN
PROGRESS:` L�
SEPTIC TANK PUMPED, SMASHED, FILLED wrrNESSED ❑ YES ❑ NO
AS-BUILT:
INPUT: C All- DATE:
W12007 Town of South Windsor INPSKTION REPORT 07
APPLICATION FOR STREET EXCAVATION PERMIT c0064 7
TOWN OF SOUTH WINDSOR Permit No.
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
FEE $25.00
Name of Firm ✓I 5�U C ( o — C_ Phone No. ^13 y�- ea 19
Address of Firm_ �ff����
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Location of proposed work
Des 'telly nature of permit requested ��►�C�-} (Q k a��' I o 1 _ ��
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Starting date Approx. time for completion-'-- -Mt ,
Call Before You Dig No. ag/a i O I 3 Traffic Services Control No.
Show sketch of proposed work or furnish
two copies of separate drawing Indicate North This section to be filled out by
Town of south'Windsor
Pavement Cut
No.cuts
EsL*Size of Penn.Patch(s)
Est.PvL Thickness in.
Est.Unit Price$
Amt.of Deposit$
Total Due$ by
( )Cast►( )Check# .
Permanent Patch
No. Cuts
Size of Patch(s)
Final Billing
Amt.Due Payee
a
Amt.Due Town
By .
Applicant is responsible for contactigg 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 P R T ANO THAT I AM FAMILIAR WITH AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
PERMITVTLIE1 WN OF SOUTH WINDSOR'S STREET CUT PE MIT NUAL.
Signed: Date: OTitle .
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES
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