HomeMy WebLinkAboutPermanent Patch Street Cut Permits 400 D h
Permit No. 3776
Date 06/30/2004 M.,,,,h Town of South Windsor, CT
Street Excavation Permit
Expiration Date '+ , M•,f
Descrip: PERM PATCH FEE RC':D SEES .r�.'..
PERM'
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Applicant
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Name LEO BOND INC. PLGTON I€ MBIN
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Addr. 1071 ELLIN f: <5RYIING„< REEIP,
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S. WINDSOR, CT s �s
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Applicant agrees: tot vixlx the
E,•r,. � Windy required and to reibureory � the'` mo nt of bond
�:t:3:� - ?:.:: 'an..' dam- n s e s
incurred b the Town;' ;h�:..:' .'. x,^` ��.:;>...>.,' P
Y m ''e ance o:�: .epair wo 1�:-
permit and that a 1' % %ijg ::r oxnie5n with this
regulations for permits a " ' ' ^�"�"""a' ad ,bY. tkte rules and
1 e&..i w>;Cut Permit Manual. � s .`4 Sor's Street
* * PERMIT TO
Issued by a. ;,: � ..E
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Date Completed
--------------- Inspected By
r TOWN OF SOUTH WINDSOR INSPECTION
Permit No. REPORT
Location 3776
0400 DEMING STREET Cont
Type Work WATER e 'o.1 .1 gp >C,, "."k.C. PLUMBING
1'dclres .°g 071Ag : MBING HE
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5; :»:IINDS'ORs°' 6074
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
OSOR'CO TELEPHONE (860) 644-2511
June 20, 2006
Leo Bond Plumbing and Heating Certified Mail
1071 Ellington Road
South Windsor, CT 06074
Re: Street Excavation Permanent Patch Fees
Permit#3776, 400 Deming Street
To Whom It May Concern:
When the Town of South Windsor issued the above referenced permit to your organization, it
collected $1,475.00 for a permanent patch deposit based on available estimates at that time.
The actual patch work has been completed and resulted in a total cost of$724.50. Therefore,
the balance of$750.50 is being refunded to you.
Permit Address Deposit Cost Refund
3776 400 Deming Street $1475.00 $724.50 $750.50
If you have any questions, please contact me at (860) 644-2511, extension 244.
Sincerely,
R
Jeffrey Dolittle, P.E.
Town Engineer
cc: Melanie D. Crucitti, Director of Finance
SAENGINEERVoy\20G6 Cut Patch Lettas\Cut Patch Joy Bond Rddoc
s
REFUND OF DEPOSIT REQUEST FORM
STREET EXCAVATION PERMIT
Request Date:
Issue Refund in the amount of $'� o
From Account# 001-0300-0205-059
To:
Permitee: _� �i I j; 4-- 4i nl
Address E/hoa` -nn a d
C � Ui ,_ r t CT-" C)l00-
Permit s-7Cp L- Do
Number Location
Number Location
Number Location
Number Location
Number Location
Submitted By:
NaTADate
Check Issued:
Number Date
Processed by Finance
Name Date
SAENGINEER\FORMS\Office Forms\Patch Refund Form.doc
wlv t-(JK STREET EXCAVATION PERMIT 7r6
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074
Name of Firm
U -) 0 tti�0 FEE $25.00
Address of Firm / 7 -u j� Phone No.
Location of proposed work (� e /�.� r 1
Describe fully nature of rmit requested t 1 44 c� - G
10
xile
Starting date
Call Before You Dig No. APProx.time for completion
Traffic Services Control No.
Show sketch of proposed work or fiimish
two copies of separate drawing Indicate NorthF
tion to be filled out by
of South Windsor
ut
/
enn.Patch(s)
kness in.
EsL.Unit Price$ S oo
Amt.of Deposit
Total Due lSov,oo by
( )Cash(,-I Check# 706'6
Permanent Patch .
No. Cuts
Size of Patch(s)
---_. Final Billin
Amt.Due Payee
$�rso . (�
Amt.Due Town
By
Applicant is responsible for contacting
the Police Dept.and C.B.Y.D. Date
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: ��-...
Date:
Title:
Driver's License#:
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIMES