HomeMy WebLinkAboutWater Street Cut Permits 20 Baker Lane (_rim 1 '14 1
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 2965 Contractor SADOW EXCAVATION
Location 0020 Baker Lane Address 115 ELDREDGE RD.
Type Work WATER WILLINGTON CT 06279
Phone No. (860)429-2769
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APPLICATION FOR STREET EXCAVATION PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
/ 2 I FEE $25.00
Name of Firm_ GTc(C�n� / X C' 0 cJrY-'bn Phone No. !�� ' ,2 - c7�O �Z Z
Address of Firm ZI
Location of proposed work F_
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Describe fully nature of permit requested L 'cam
Starting date 4 s 0> Approx.time for completion T
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Call Before You Dig No. I Traffic Services Control No.
Show sketch of proposed work or furnish To o be filled out by Town of South Windsor
two copies of separate drawing SAS. Lug
Pavement Cut &f_//v i �; ,y U
Indicate North Prop. size of cut z (v X 6' l c,1 r{err- �'� � 6
No. cuts
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Amt. of Deposit$ by
Cash ( )Check#
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��� Cut size after Perm. Patch
�joaG�►�`� l� No. Cuts
Final Billing $
Amt. Due Payee$ Z I C6 I
Amt. Due Town $
Applicant is responsible for contacting by 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.
Signed: W/W s4z Date:
Title: �rCS D.L.#: (0O 77 'y
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PERMIT SHALL BE KEPT ON 70BSITE AT ALL TIMES aCDD 1`F 1 Z0
Standard Forms\Permits\Street Excavation Permit.doc �f,
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
f�OsoR.CO TELEPHONE (860) 644-2511
June 20, 2006
Certified Mail
Sadow Excavation
115 Eldridge Road
Willington, CT 06279
Re: Street Excavation Permanent Patch Fee
Permit #2965, 20 Baker Lane
To Whom It May Concern:
When the Town of South Windsor issued the above referenced permit to you, it collected a total of
$1589.84 for the permanent patch deposit based on available estimates at that time. The actual
cost of the patch work performed on this permit, however, was a total cost of $1117.00.
Therefore, the balance of $472.84 is being refunded to you.
If you have any questions, please contact me at (860) 644-2511, extension 244.
Sincerely,
Av--Zi�_
Jeffrey Doolittle, P.E.
Town Engineer
cc: Melanie D. Crucitti, Director of Finance
SAENGINEER\Joy\2006 Cut Patch Letters\Cut Patch Joy Sadow Refdoc
REFUND OF DEPOSIT REQUEST FORM
STREET EXCAVATION PERMIT
Request Date: 42
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Issue Refund in the amount of $ ,
From Account# 001-0300-0205-059
To:
Permitee: �� UD
Address 1115 El d r'1d t E2cy
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Number Location
Number Location
Number Location
Number Location
Number Location
Submitted By:
Nan a Date
Check Issued:
Number Date
Processed by Finance
Name Date
&WNGINEERWORMS1Office Foans\Patch Refund Fonn.doc