The URL can be used to link to this page

Home My WebLink About2995 Eugene's Rd Highway Department Town of Southold Peconic Lane Peconic, N.Y. 11958 RAYMOND L. JACOBS TeL 765-3140 Superintendent -734-5211 DA TE: 1/)..1/tJ). TO: CASE NUMBER: / <(0 ;).. ~3 This is to notify you that Bell Atlantic and L1PA have been notified in respect to the application for an Excavation Permit in the Town of Southold. cf~ If. ~ Signature of the applicant J., & M. Long Island Inc. POBox 2507 Southampton, NY 11969 Received $ 55.00 ELIZABETH A. NEVILLE, TOWN CLERK Town of Southold Southold, New York 11971 Phone: 631-765-1800 . . RECEIPT #158 1 - Permits on 02/04/2002. Thank you. '" 10) Permit No. /SIJ File No. IS!3 TOWN OF SOUTHOLD HICHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (i0$6) 765- 3140 "-31 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the Code of the Town of Southold, Suffolk County, New York, and other applicable laws, ordinances or regulations for the excavation herein described. The applicant agrees to comply with all applicable laws, ordinances, codes and regulations, and to permit authorized inspectors to make~ necessary inspections of the job site. Print or Type 1) ~11 Lo>\ JT/':;lId c. ~a I]~ )..f'07 Sc."~4J>1 i kY. /19C Name of pplicant A dress 2) 7),6111<'.u Go-e//,,. ;:>'0,&. //<f'it. C...tcJ.&>jV~1 MY. //93!i' Name of Owner of Premises ' Adaress 3) (; ''iel. '"hiD tM"d~ rC<f(d 4t J.99s E" t.,; Il.d .lOGl/f /}C. ork Description and Location (Street Number, Hamlet, Cross (a) I s construction located within 75 feet of tidal wetlands? *y es _ No \( *If yes, other Town permits may be required. 4) Builder's License No. Plumber's License No. P4/ /?I" Electrician's License No. Other Trade's License No. 5) a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or public streets or areas, and giving a detailed descrip- tion of layout of excavation. b) Attach all other necessary permits and licenses for this project. c) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk. /CltX'/ - t><f '7 - 0 3 -;..0 I Tax Map: Section , Block ., Lot 6) 7) 8) Starting Date: .2/3/0;;'" Work Schedule: Completion Date S'IMIZ d<::..y 9) Phase Completion Date Excavation......................................... I.t/c,r/.... ..,; /I (c.mMJltc4' Facility Installation................................. ">'leA he u.":f1I(?t~ Backfill & Compaction.............................. G". re, nI Q d ~)/ _ Pavement Replacement............................. '~C.J oa ve hi. e^' f ' IN ,'lI 4E> , (..1 Under which authority is the application made: Estimated Cost of Proposed Work: $ 6~OO~ f/.ir /ur';;,f~;IJ h~ a , ~rvll~ ...., 1 Tv f, t. ,(de. ~'" p/" w,-; J'e 11) Remarks: Tit! ...."rh cDvpr.f1P{ ,-1 r~r/d~AI,,f / Co" "p/",< ft ..,.. i tj 7'b rA~ rOt( D-39 Page 1 of 3 ~ 12) Insurance Coverage: (Attach copy) a) Insurance Company: ;::;"/J'_ld~~c.p!A/q rJ"^.f1(,;. b) Policy # C ~05r-~'7 q f c) State whether poli~YI of certification on ~i1e with theJ I-!ighway Depart- ment: c./lr-f.l'lC.ll.1t t;.rt:~)>o.n'lJtyl., 'IJ..t 4/1/J/'i."r'<<1\ , I , , d) Coverage required extended to the Town: Bodily injury and property damage: $300,000/$500,000 Bodily Injury, and $50,000 property damage. 13}J Security: " a) Surety Bond total amount of $ _- b) Maintenance Bond provided: or Certified Check provided in the 2 years or 3 years 14) Fees for applications and permits: A 1. I IService Connections ~ Basic Application Fee........ $25. 00 excavations @ $20.00 = $ ).0.00 A2. I IAdditional Excavations same service @ $10.00 = $ 10.ocJ ~ B. Excavations 18" in depth or less: 0-100 I.f. = $10.00 I. f. @ $0. 10 - $ t i . Additional C. Excavations 18" in depth to 5' in depth: 0-100 I. f. = $30.00 I.f. @ $0.30 = $ Additional D. Excavations 5' in depth and over: 0-100 I.f. = $50.00 I.f. @ $0.50 = $ Additional E. No. Utility Repair Excavations @$10.00 = $ Additional Repairs same service @ $5.00 = $ F. Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. * * * Authorization is hereby granted to the Town Clerlj; of the Town of Southold to issue a Highway Excavation Permit to: 9 I Yr) ~!! J.,,//--1~' ~ ; in accordance with this application. SUPERINTENDENT OF HIGHWAYS TO~SOUTH~ NEW YORK 0~ ~ . ;W dc2-CJ/- cJ~ Date Received by the Town Clerk cf} / <J~ 2- , ate Permit Issued '10/ ID 2- ~, Date Permit No. / S 8 Note: Permit expires one (1) year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways. Permit must be available for inspection. D-39 Page 2 of 3 '-.) ~~ i ~'''~ I ~ ~ Iw).~~1 (\ L ~I:!"': ...,.......... I~'fw~ I ~~... 3 ~,jH ~ .~~~l ; '; ....... i~U ~~~~l \i.':!!~~ I ., N .J" -.-....... ....--..------.-. ~ I L --- __....-....-------- - I - -.-------- ,_..--.1 . \ \ ! :c 00" E' i ' ~~ I ~ ~~ !.. (.) I '- ~ ..., ~~ ('..l - '" ~I ... II --- \~ I , - ..... . "'" / ,....'...:.. _ J. 0.'" ,\'-1 " , ., - ' " :J.:~'~:' I ( ;t- ""cP(;srr.,-'--"'~- .. '" i-' , ' __ ' ll"':I[ Y -- "'" --, ,\t l ----...- .~' ;\ hi I___~;;;~'er:- --- ,.~.,,, . \ I', \ ~~ t1ii' _< >,J I .It. ~, ~ ~~ ~_" ~_ . " '71 CI~ C Y (. . I ...... ---"-- /.)' ::", .:.) . ' \' _.::-.7:-::'~""-" , '0" .J . ""\"'''''''' I . ~i:i ~\.\\1 . ~-"" c!i !! \~~ " ", \ C-~ !~ (,:1 I I' ,>,,>~~~i5~i>6'>/>fI >< ..../ .r I \ d;: _.~.. ' I.. .... I I :,. ... ~-~..../ ~ '\ . ~ 'yJ1#JNG. Q / '. \, J " / \,' '" /~. / \ I I / - ' . I ~ / \ I . ......~ :, ,I ....... .r /. /............... /J II - -~ ~ .II / \ /~' I III I ", I I I I .I --1..' . \ I " ).( 1'._........ ' , .a ~ ! I ~ /r-"".",i'!iI.'!!.: ' 'i! 1" \ .~ rr-/~\ "/ \ \ I I ~ I .; i' .. \ \ . " f; ,\ \ .8s' (,,"!') 3' ~' :0\ l .... .. .., ..... Q:I cj "w I, I ... .- ./" .~. :~'" ~ ~).- ~~ c<<; ~u :t:~ -- ----- ~ V I .~ " ... ~ ~ '<: \ j ."..."..,',..,.".,.."..'....".'...'.. i A r;.()Flf)~ "":.,.':.....4....,,:.....:.:.,:.:.....:.c':.:.c':.:,:.:.c,:.:,:,:.:,:,'. ..........~i;IIIII.lil..........I.......IIIIII........1illl..~.....j.' 1........1./.\1.. I.............................................)........... ....vJ; .,. " ,. , ,',. ,Wi".""."'."'."'."."".".''''W''''''''''''''''''..'.'..'.'..'....'..,..'.',.".,.'.',. ',., ...,..,.,...,...,...,.,.,.,.,..,....,..,..5'-.,. .,....... ........" ,".......,....,.. ..:....,:-:.:-:.,::,'.:-:,;::,::,':,::,,:,;,:,;:,,:,;::,.',;':,::;':":,,::::,,:::::.,.;.:.:::.:.,....,.,,;.,,,.,.,.",...,.,...,....,....,....,.,....,....,...,."..,..,..,.....................,.........................................,..,..,.......,..................,....,....,....,.......,.............,...,..... PRAETOR MAGURK ROMANO 732 SMITHTOWN BY-PASS SUITE 300 SMITHTOWN INC DATE (MMJDDtvy) 01/24/02 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE PRODUCER NY 11787 COMPANY A PROVIDENCE WASHINGTON INSURED J & M LONG ISLAND INC COMPANY B STATE INSURANCE FUND BOX 2507 SOUTHAMPTON COMPANY C NY 11969 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LlR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXP1RATlON DATE (MMIDDtvY) DATE (MMJDDtvY) 10 24/01 10 24 02 LIMITS GENERAL LlABIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE [X] OCCUR OWNER'S & CONTRACTOR'S PROT CX0568795 GENERAL AGGREGATE PRODUCTS. COMP/OP AGG PERSONAL & ADV INJURY EACH OCCURRENCE FIRE DAMAGE (Any one fire) MED EXP (Anyone person) 02,000,000 02 , 000 , 000 01,000,000 01,000,000 o 100,000 o 5,000 500,000 AUTOMOBILE LlABIUTY X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS X NON.OWNED AUTOS AX0563583 10/24/01 10 24/02 COMBINED SINGLE LIMIT o BODILY INJURY (Per person) o BODILY INJURY (Per accident) o PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTO WORKERS COMPENSATION AND EMPLOYERS' UABILITY 8671190 . 4/27/61 AUTO ONLY. EA ACCIDENT 0 OTHER THAN AUTO ONLY: EACH ACCIDENT 0 AGGREGATE 0 EACH OCCURRENCE $ AGGREGATE 0 0 4/27/02 ER EL EACH ACCIDENT 0 100,000 EL DISEASE-POLICY LIMIT 0 500,000 EL DISEASE.EA EMPLOYEE 0 100,000 EXCESS LIABILITY UMBRELLA FORM OTHER THAN UMBRELLA FORM ----_..- THE PROPRIETOAl PARTNERS/EXECUTIVE OFFICERS ARE: OTHER INCL EXCL DESCRPTION OF OPERATlONS/LOCATlONSIVEHICLES/SPECIAL nEMS TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WIll. ENDEAVOR TO MAIL ~ DAYS WRITIEN NOTICE TO THE CERTIFICATE HOLDER NAM TO THE LEFT, PECONIC LANE PECONIC NY 11958 OF ANY KIND UPON THE AUTHORIZED REPRESENTATIV C LB A ..l'i&ij!ll'i&1!~QiiA1iQiiljl!@! , . '. New York State Insurance Fund ' Wo1'ke7:t C~tm &- Disability 1klIejiJs Speciali$t!l8;nce 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE J & M LONG ISLAND INC POBOX 2507 SOUTHAMPTON NY 11968 POLICYHOLDER J & M LONG ISLAND INC POBOX 2507 SOUTHAMPTON NY 11968 CERTIFICATE HOLDER TOWN OF SOUTH OLD PECONIC LANE PECONIC NY 11958 POLICY NUMBER I 867119-0 CERTIFICATE NUMBER 526571 PERIOD COVERED BY THIS CERTIFICATE 04/27/2001 TO 04/27/2002 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 867119-0 UNTIL 04/27/2002, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/27/2002 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND d~>>I7f1d1t...,.71 DIRECTOR, INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https:/iwww.nysif.com/certlcertval.asp VALIDATION NUMBER: 1053315109 U-26.3