HomeMy WebLinkAboutSchembri Homes - Westphalia & Cox Neck Lane
Schembri, Homes Inc
30-2-75
Po Box 163
Wading River, NY 11792
ELIZABETH A. NEVILLE, TOWN CLERK
Town.of SoutJliold
Southold, New York 11971
Phone: 631-765-1800
RECEIPT #67
Received $ 70.00 for 1 - Permits on 09/26/2000.
This receipt covers the following Permit/Sticker(s):
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K is always our pleasure to serve you.
BY~~:t-da1(J(...d
at / .'. -:s ft>"'>
(time of d) .
21.1.1.19 . 1.11.1 wED 11: J6 FAX 516 i65
~72A ~
Permit No.CJ.oL{~
6U5
SOl'THOLD CLERK
~001
File No.
. ~,-<,eL . ~ ./1~ /
TO N~ S THOLO ~
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
. (516) 765-3140
\$ RECEIVED
7t1.~ ~At<J;;7t7
SEP U 3m
APPLICATION {PERMIT
FOR HIGHWAY EXCAVATION AND REPAIR
SOItbol. Tow. a.rk
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 TJ'E'O
1) A~'1s(~ 0CAIr.bvi clJ2d:l ,Ju. Godnf,,/Id,tl>>,j;,{
~7 of A~g9cant Address T f?1~
2) ~'~~I<m~ r,))~J.. iJu. rPJrLlr~r<d..(,[.),~d-'~~~
Name of Owner ~remi5e5 Add S5
W~~ Qd, ~ ~y /JMLla^--L-, Hu't4~L
Work Description and Location (Street Number. Hamlet, Cross Street)
3)
(a) Is construction located within 75 feet of tidal wetlands? 'Yes No
'If yes, other Town permits may be required. - --.
4) Builder's License No. Plumber's License No. ..3.9 S 1.. P,
Electrician's License No. ?-/ h:5LI. C
:~p(
of Applicant
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.
6)
7)
8)
Starting Date;~..
Completion
..--
. Lot \'J
Date~_
Tax Map: Section
\1)
Di\:W
Block \ 0
Work Schedule:
Excavation.~~~~~................................... com~f;/~;-
21 't
Facility Installation................................. ,1-/) (y) .
Backfill & Compaction.............................. !cYJ-JJ-l()-t)
P~vement Replacement..............................~
Under which authority is the application made; ~ f2.. wit
9)
10) Estimated Cost of Proposed Work: $
11) Remarks:
20.'09 '00 WED 11:48 FAX 516 765 6145
SOUTIiOLD CLERK
~003
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S
RECORD
I nspection Date
Findings (use code)
,
Applicant Notified
15t
2nd
3rd
4th
(To Permit Clerk)
REMARKS
CODE
IS - Improper barricades
IL - Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
SUC - Building under Construction
WIP - Work in progress
DB - Improper backfill (too high) (not sufficient)
HFS - Jnspector holding for final settlement of excavation
RFR - Ready to repair
.
20,09 '00 WED 11:47 FAX 5167656145
SOl'THOLD CLERK
~002
12)
Insurance Coverage: (Attaeh j~
a) Insurance Company: 11
~ (, -/;;- fl C
b) Policy # 0,) 1"-- c::; ,::A ?yc 6
c) State whether polley of certification
ment:
,~U-l/t1J (' J... -: P( 1111 'yl.atU;utz(ittI4(
orr file with the Highway Depart-
d) Coverage required extended to the Town:
Bodily injury and property damagw; $300.000/$500.000 Bodily Injury.
and $50.000 property damage.
13)
Secu rity :
a) Surety Bond
tota I amount
f)
.
or Certified Check
C)
provided in the
of $
------
2 years or 3 years
Basic Application Fee...., ~
excavations @ $20.00 " $
b) Maintenance Bond provided:
14)
Fees for applications and permits:
A 1. /Service Connections
~
A2. /Additional Excavations same service @ $10.00 " $
~
B.
Excavations 18" in depth or less;
0-100 I.f. " $10.00
I. f. @ $0. 10 - $
C.
I\cid1tional
E~tions~l " in~ epth to 5' in depth:
-100 .f. $3Q.OO
t' CIO
+ So I. f. @ $0. 30 '" $ I S
Additional
# ~
161,!\L- 70
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 Clerk of the Town of Southold to
issue a Highway Excavation Permit to: '.:)CHeme<Kl HQr~)~_ :r:\.JC-
in accordance with this application.
H IGHWA YS
. NEW YORK J
(oe.lh Y(1JONJ. Acc16)
Ra ond L. Jacobs
S~ef!. Zb, 2CXX)
Da te I
Received by the Town Clerk 9 iP~ -00
ate '
Permit Issued q t~~ //):;1--- Permit No.~ Cz
Note:
Permit expires one (1) yea,r from Date of ,Issuance.
No work to start withOut 48 hour notice to the Superintendent of Hiahwavs.
20:'0900 WED 11:48 FAX 516 765 6145
SOl'THOLD CLERK
~ 004
Highway Department
Town of Southold
.. Peconic lane
Peconic, NY 11958
RAYMOND L. JACOBS
Superlntenoent
Tei. 765.3140
734-5211
DATE,
Cilc2l> I (){)
TO,
CASE NUMBER: c9.5l0 5cXU
This is to notify you that Bell Atlantic and L1PA have been:.ndtified .in
respect to the application for an Excavation Permit in the Town of
Southold.
/ti~
Signature of the applicant