HomeMy WebLinkAboutWater Street Cut Permits 100 Strong Road TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 3755
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Location 1// ntxactpp 'Q'UALIEy PAVING CO.
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Type Work WATER S ;;MAIIF.;.$TREET
EAST WINDSOR 'CT 06088
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Time Insp Needed
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Permit No. 3755 Town of South Windsor, CT
Date 06/11/2004 Street Excavation Permit
Expiration Date 06/11/2005
Descrip: INSTALL WATER SERU:T'CE
Applicant Locat'i'q.n
Name QUALITY PAVING CQ 0Ql7 STRONG 1tOAD
Addr. 194 S. MAIN STREET
EAST WINDSOR GT 060$,8 "Ipe'of Weak WA&?Ei
Phone (860)523-4182
Applicant agrees, to the Town o South Win do u
,r the; amnt of bond
required and to reimburse lthe SdW txf ;yout :or fbrs: y e cpenses
incurred by the Town fQr e ''or rep'ai'r work 1n. 6nnection with this
permit and that appl caht ''I s w431 abiele by he rules and
regulations for permits as ouCli fte, d ri the Tara ,o'f South Wiridaor s Street
Cut Permit Manual.
* * PERMIT TO"">.:BE TC :PT OIT :?OB SIZfi,:t$1 ALTa TIMES.
Issued by ----�7. —��/�//?._— Ii'tle /7�. e a
Date Completed -------___—__— Inspected ByQ �c� ,.
Ivim rr-KM1T 7.5-
. TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT Permit No.
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT 06074 ll
FEE $25.00 CA . 9 b b 51 b
Name of Firm . C
Address of Firm 1 q 15 a �-- Phone No. 0�N
Location of proposed work / 60 fb
Describe fully nature of permit requested
Starting date gyp" —O
Call Before You Dig No. APProx.time for completion (D- j -0-
Traffic Services Control No.
Show sketch of proposed work or famish
two copies of separate drawing
Indicate North This section to be filled out b
Town of South Windsor
Pavement Cut
No.cuts
Est.Size of Perm.PaWs)
x 2,6
Est.Pvt Thickness �_in.
. Est Unit Price$ ,
U Amt.of Deposit$ -7$®.ea
Total Due O�
�� by
)Cash N)Check#
Permanent patch .
f A$
No. 'Cuts
' Size of Patch(s)
- - - - Final Billing .
. 54� P,
Amt Dye
$ ��SC7ayee
Amt Due Town
Applicant is responsible for contacting BY
the Police De t.and C.B.Y.D.
Date
1 AGREE TO FURNISH TO THE TOWN OF SOUTH WINDSOR THE AMOUNT OF BOND REQUIRED O TO REIMBURSE THE
TOWN OF SOUTH WINDSOR FOR ANY EXPENSES INCURRED BY THE TOWN FOR MAINTENANCE
CONNECTION WITH THIS PERMIT AND THAT I AM FAMILIAR WITH
PERMITS AS OUTLIN D IN THE.TOWN OF SOUTH WINDSOR'S STREET CUT PERMIT MANUAL.AND WILL ABIDE BY THE RULES AND REGULATIONS FOR
OR REPAIR WOE IN
Signed:
Title:
Date: _ /u
Driver's License
PERMIT SHALL BE KEPT ON JOBSITE AT ALL TIME
S
TOWN,OF SOUTH olmiN Soo
EfvGiNcEWO MAIRTMOT
FADORESS
UTtLIMES --____._< �._____—�.__ __ —_ OF--•____-- .—_.._.__._..___-_=__.______ _.____�_..__..—. —_______— iIAISPE>D_—_..--____.�-_TELdP.PATCH DATE
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COMPUTATION SHEET
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1540 SULLIVAN AVENUE • SOUTH WINDSOR, CT 06074
�OsoR CO TELEPHONE (860) 644-2511
June 20, 2006
Quality Paving Co. Inc
Certified Mail
114 South Main Street
East Windsor, CT 06088
Re: Street Excavation Permanent Patch Fees
Permit #3755, 100 Strong Road
To Whom It May Concern:
When the Town of South Windsor issued the above referenced permit to your organization, it
collected $780.00 for a permanent patch deposit based on available estimates at that time. The
roadway was overlaid therefore, the deposit of$780.00 is being refunded to you.
Permit Address Deposit Cost Refund
3755 100 Strong Road $780.00 overlaid $780.00
If you have any questions, please contact me at (860) 644-2511, extension 244.
Sincerely,
effrey DoiTttle, P.E.
Town Engineer
cc: Melanie D. Crucitti, Director of Finance
S:\ENGINEERVoy\2006 Cut Patch Letters\Cut Patch Joy Quality Paving ReUx
REFUND OF DEPOSIT REQUEST FORM
STREET EXCAVATION PERMIT
Request Date:
Issue Refund in the amount of $ �
From Account# 001-0300-0205-059
To:
Permitee: y I � � Cb
Address
�cSDr a� CT
Permit 00 Z�&M fqo [;��Da ct
Number Location
Number Location
Number Location
Number Location
Number Location
Submitted By: /�✓l�4
Na a Date
Check Issued:
Number Date
Processed by Finance
Name Date
S1ENGINEERTORMS1Office FoansTatch Refund Fonn.doc