HomeMy WebLinkAboutStreet Cut Permits 77 Rugby Lane (2) 1100178 TOWN OF SOUTH WINDSOR, CT
PERMIT NUMBER STREET CUT PERMIT
DATE: 11/14/11 _=
GIS ID: 78000077 FEE: 25.00
MUNIS APPLICATION# 201101337 AmwEXPIRATION DATE: 11/13/12
APPLICANT k LOCATION
NAME: TELE-NETWORKS ADDRESS: 77 RUGBY LANE
ADDRESS: 31 BAKEWELL COURT FIORI FRANCIS &PAMELA
CRASTON,RI 02921 = 77 RUGBY LA
" SflUTI VINDSOR,CT 06074
PHONE 401-461-8420 "
WORK DESCRIPTION: REPIJ C CATS "
APPLICANT AGREES TO FURNISH THE TOWN OF SOUTII"'VmSE>R THE AMOUNT OF BOND REQUIRED AND TO REIMBURSE
THE TOWN OF SOUTH WINDSOR FOR ANY E TENSES IN URRIyD$Y-TH-E TOWN FOR MAINTENANCE OR REPAIR WORK IN
CONNECTION WITH THIS PERMIT AND THI AI? UlC - IS FAMILIAR WITH AND WM-1 ABIDE BY THE RULES AND REGULATIONS
FOR PERMITS AS OUTLINED IN THE TOWN OF SOUTI•I WINISSR'S STREET CUT P- 'IT MANUAL.
ISSUED BY DATE INSPECTED INSPECTED BY
11/14/201112:29PM *** PERMIT TO BE KEPT ON JOB SITE AT ALL TIMES***
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: I 04 CONTRACTOR: 'T—Ele)
LOCATION: 7
.TYPE OF WORK:_ Gl y
DATE INSP NEEDED: DATE INSP: //Z
INSPECTED BY:_
WORK IN
PROGRESS:_
SEPTIC TANK PUMPED, SMASHED, FILLED WITNESSED ❑ YES ❑ NO
'AS-BUILT:
INPUT.-----C v DATE:
W12007 Town of South Windsor INPSEMON REPORT 07
APPLICATION FOR PERMIT
CALL 1-800-922-4455
Permit Number TOLL FREE-BEFORE YOU DIG C.B.Y.D.# ,V\W�mk "
To Be Filled In By Municipality
INFORMATION TO BE FILLED IN BY APPLICANT
TYPE OF PERMIT: Walk Curb 0 Street Excavation Driveway _
Drain Layi•n� 7 Grass El Explain
Applicant's Name lve- n C Explain Other
Address 19004to(Aw Contractor's Name
e OUt ' C O 0 Z 03 Address
Tel.No. During Hrs. S(00 ' �-7,Z- yCi5Ll
Tel. No. Aft Hrs. (Emergency) 4)1 4l Ulo Tel.No. During Hrs.
Location of Work 1bl - I�1 ILL (i Tel. No. After Hrs. (Emergency)
Starting Date 7AW Approximate Date of Completion
Show Sketch <See AkkG,\Cl'I
Sig d Date 0 See Conditions On Back
A licant
(certify that I ave read &understand the conditions stated on the back of this permit and agree to all of those conditions.
INFORMATION TO BE FILLED BY MUNICIPALITY
Is The Contractor Licensed? Yes No Special Conditions
Is Bond on File? Yes No
Is Certificate of Insurance on File? Yes No
Is Permit Fee Required? $ Yes No
Permit Issued -date
Permit Expires
INSPECTION INFORMATION
Date Work Began
Date Work Inspected
Date Completed
Name of Inspector
Type of Repair Permanent
Type of Repair Temporary
Date of Permanent Repair
Name of Patching Co.
PERMIT APPROVED BY: DATE
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