HomeMy WebLinkAboutSilver Sands Motel - Silvermere Road
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JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTH OLD
September 11, 1992
Edward P. Jurzenia, President
Silver Sands Motel, Inc.
Silvermere Road
Greenport, New York 11944
Dear Ed:
Town Hall, 53095 Main Road
P.O. Box 1179
Soulhold, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1801
The Town of Southold has been holding $150.00 of your money as a
Maintenance Bond with respect to your Excavation Permit of January 31,
1989. Effective September 11, 1992 this bond is hereby released and your
$150.00 is refunded herewith.
Very truly yours,
~~
Judith T. Terry
Southold Town Clerk
Enclosure
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i~1 OROER OF .
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TOWN OF SOUTHOLD
AGENCY & TRUST
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THE BVFFOLK COVN'IT NATIONAL BANK ~~ //1--=--...............--.)
MAIN "0100 . CUTCHOOUIE.NIEW YORK 1111.
FOR
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JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
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Town Hall. 53095 Main Road
P.O. Box 1179
Southold. New York 11971
Fax (516) 765-1823
Telephone (516) 765-1801
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OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 4, 1992
To:
John Cushman
From:
Judith Terry
Re:
Refund
You are holding $150.00 maintenance bond in your Agency & Trust Account
with respect to the Silver Sands Motel Highway Excavation' Permit.
Effective September 11, 1992 this bond amount may be returned to Silver
Sands. When you draw the check, please submit to me so I may transmit
same to them with an explanation. Thank you.
~~
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JUDITH T. TERRY
TOWN CLERK
REGISTRAR Of VITAL STATISTICS
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Town Hall, 53095 Main Road
P.O. Box 1179
Southo1d, New York 11971
FAX (516) 765-1823
TELEPHONE (516) 765-1801
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 13, 1989
Edward P. Jurzenia, President
Silver Sands Motel, Inc.
Silvermere Road
Greenport, New York 11944
Dear Mr. Jurzenia:
Returned herewith is your $1,000.00 Security Bond with respect to your
Excavation Permit of January 31, 1989, all in accordance with the recommenda-
tion of Superintendent of Highways Jacobs.
Your $150.00 Maintenance Bond will remain in effect until September 11,
1992, at which time it will be returned to you.
Very truly yours,
~~
Judith T. ~
Southold Town Clerk
Enclosure
cc: Supt. of Hwys. Jacobs
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mOtun of l!>oltt~ol~
ACCOUNTS PAYABLE
9/13/89 Release Security Bond for Highway Excavation Permit
$1,000.00
$1,000.00
(Uown of ~outl101b
Southold, NY 11971
THE SUFFOLK COUNTY NATIONAL BANK
CUTCHOGUE, N.Y. 11935
07248
5O~546
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PAY TO THE ORDER OF: SILVER SANDS MOTEL, INC.
DATE
9/13/89
AMOUNT
*******1,000.00**
Silver Sands Motel, Inc.
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TCMlN TREASURER
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JUDITH T. TERRY
TOWN CLERK
Rl:::GISTR....R 01-' VITAL STATISTICS
JOHN:
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Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
FAX (516) 765.1823
TELEPHONE (516) 765.1801
Please issue a check in the amount of $1,000 to Silver Sands Motel, Inc., which
.
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Permit No.8.
sum represents the release of the Security Bond with respect to their Highway Excavation
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
September 11, 1989
Thank you.
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Highway Department
Town of Southold
Peconic Lane
Peconic, N.Y. 11958
RAYMOND L. JACOBS
Superintendent
Tel. 765-3140
734-5211
September 11, 1989
RECEIVED
SEP 1 1 1989
Judith T. Terry, Town Clerk
Town of Southold
Main Road
South old , New York 11971
Southold Town ('t..-!t
Re: Highway Excavation Permit Silvermere Rd.
Greenport, for Silver Sands Motel, Inc.
Dear Judy:
I have inspected the area on Silvermere Road that had
been excavated and find it to be repaired satisfactory.
I recommend that the Security 80nd be released.
Very truly yours,
RAVMO~~COBS
Sup't of Highways
cc: Edward P. Jurzenia
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Permit No.L .
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JAN 31 1989
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic. New York 11958
(516) 765-3140
Town CIeI1l fOllll1nl/l
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
1/'7- (Jull (; ~1-.0._ OOD
9' eJ CU--a-<-.::t:L
APPLICATION IS HEREBY made to the Superintendent of Highway~ 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 m!ake. necessary inspections of the job site.
Print
or Type I'V( _
S/ LiEf! J/f1t/uS I}J~ Tf:L
",VLIIFkml:7?k f(/) ClJEk/Vr(J~ NY
Address
1)
Name of Applicant
Sf}f1lF"
Name of Owner of Premises
2)
Address
3)
if UfP mE/f J;; If!) - C-I?t:"GN;J()/f I Z5/fT.
Work Description and Location (Street Number Hamlet. Cross Street)
(a)
Is construction located within 75 feet of tidal wetlands? *Yes
*If yes, other Town permits may be required.
No
/
4) Builder's License No.
Plumber's License No.
Electrician's License No.
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.
6) Tax Map: Section /00 Block (}/fS ,Lot 6, 7, // g
, / J
7) Starting Date: /.3)' zr Completion Date 2..:($?, f'er
8) Work Schedule:
Phase Completion Date
Excavation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2, 7 - g'l
Facility Installation................................. z' 7. %1
Backfill & Compaction.............................. 7-- 7-gr
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Pavement Replacement.............................. St/8JccT m 1{/L:-4 r;Ii!:/l
('<1/VLJI;--/ t14S.
9) Under which authority is the application made: /V" 49/2~ 1'#"=/1/ .f/'/?Ii. /S!t-
10) Estimated Cost of Proposed Work: $ /05'aO
11) Remarks:
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Page 1 of 3
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12)
Insurance Coverage: (Attach copy)
a) Insurance Company: COJ1t;/)~t1-tQ I .J;,.sb"Q..t!~
b) Policy # ()If (!B? &().3(.,l./-:7.2.
c) State whether policy of certification on file with the Highway Depart-
ment:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13) Security:
a;
S~.e~y Bond
total amount of $
Maintenance Bond provided:
=r (:~~~:~::l~ C'~::::x.
/OC)8(tO;J~ovided ir. the
b)
:sQ,
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2 yea rs or 1St:). (l() 3 yea rs
14) Fees for applications and permits: Basic Application Felt........ $25.Jl0
A 1. ---e- lService Connections excavations @ $20.00 = $ :<~~I ~__ RY:
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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.
Additional
Excavations 18" in depth to 5' in depth:
0-100 I. f. = $30.00
I. f. @ $0. 30 = $
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Additional
Excavations 5' in depth and over: f}7J
C{J -
0-100 I.f. = $50.00 -' ",-c
67() I.f. @ $0.50 = $ c3% -'" \
Additional
D.
E.
Utility Repair Excavations @$10.00 = $
No.
Repairs same service @ $5.00 = $
Additional
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
issue a Highway Excavation Permit to:
in accordance with this application.
SUPERINTENDENT OF HIGHWAYS
TOWN 0 SOUTHOLD, NEW YORK
Jacobs
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Date
Roc.;v"" by <h. T~" <I.,. ~~
~ Date",
Permit Issued (/..$1/0'-" Permit No. I
I Date
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.
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D-39
Page 2 of 3
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Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S
RECORD
I nspection Date
Findings (use code)
Applicant Notified
1st
2nd
3rd
4th
(To Permit Clerk)
REMARKS
CODE
I B - Improper barricades
IL - Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
BUC - Building under Construction
WIP - Work in progress
DB - Improper backfill (too high) (not sufficient)
HFS - Inspector holding for final settlement of excavation
RFR - Ready to repair
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Page 3 of 3
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Highway Department
Town of South old
Peconic Lane
Peconic, N.Y. 11958
RAYMOND L. JACOBS
Superintendent
DATE:
TO:
CASE NUMBER: 3/- /5
.
This is to notify you that New York Telephone Company
and Long Island Lighting Company have been notified in
respect to the application for an Excavation Permit in
the Town of Southold.
,
Signature of th
Tel. 765-3140
'734-5211
t"Ollcy NU. ----
Policy
Issued by
qmfoi~.Insurance 0::Irpany
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Producer's
Name and
Address
Named
Insured
Mailing
Address
Policy
Period
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04 CBP 6036422
McMmn-Price 1ttJercY, Inc.
828 Front Street
Gr:eenpOrt, NY 11944
General Offices 180 Maiden lane NY NY 10038
Producer's Code' Renewal of
81 310 013 CBP 37814
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js 7-21-88
Sil__~""".;~;., ~.
Silve.riim:e lbad -
Gr:eenpOrt, New York 11944 "I j (
I /f:m::~I;J~;CI:rations
From 13 2J~811 , to .. S-'3-119', at Comprehensive Business Policy
12:01 A.M, Standard TIme at your mallmg address shown above, D 'I R rt
at y epo
Business Description:
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO All THE TERMS OF THIS
POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS
POLICY CONSISTS OF THE FOllOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED.
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT, c~)/,)o cu. ",,( ,
Premium
NYFIF= $17.04
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Premium for this oli
Add for attached com
Total remium
Premium shown is payable: $12,809
at inception; $
/7,,:' ,; ,(. "~"
each anniversary,
Any premium shown in the Declarations for a Policy Period extending beyond one year was computed
based on rates in effect at the time the policy was issued. On each renewal, continuation, or anniversary of
the effective date of this policy, we will compute the premium for each Coverage Part in accordance with
our rates and rules then in effect. Exceptions, if any, are:
Audit required for: fl Gl 0 Auto 0 Inland Marine 0 Other
Annual or
Form(s) and Endorsement(s) applicable to all Coverage Parts and made a part of this policy at time of issue:
COUNTERSIGNED
BY
(Authorized Representative)
(Date)
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART
DECLARATIONS, COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, ISSUED TO
FORM A PART THEREOF, COMPLETE THE ABOVE NUMBERED POLICY.
5DEC 1 DR Ed, 11/85
Printed in U.S.A.
PRODUCER'S COPY
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~ommercial General Liability
Coverage Part Declarations
Daily Report
Policy No. 04 em> 6036422
Umits of Insurance
General Aggreg,lIe limit (Other Than Products - Completed Operations) .,
Products -- Completed Operations Aggregate Limit
Persona' and Advertising Injury Limit
Each Occurrence limit
Fire Damage Limit " f. . ..,.,
Medical Expense limit
$ ',onn,onn
$ N/71
.
$ ',Ooo,nnn
$ ].OOO,(\on
$ so,onn
$ s,onn
Any One Fire
Any One Person
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Retroactive Date (For Claims Made Coverage Only)
Coverage A of this Insurance does not apply to "bodily injury" or "property damage" which occurs before the Retroactive
Date, if any, shown below;
Retroactive Date:
(Enter date or "None" if no Retroactive Date applies.)
Form of Business and Location of all Premises
[ ] Individual [ ] Joint Venture
[X] Organization (Other than Partnership or Joint Venture) CorfOratiDn
Location of All Premises You Own, Rent or Occupy:
[ ] Partnership
saIIB
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Premium
Advance
Rate* Premium
Code Premium Products/ All Products/ All
Classification No. Basis * Compl. Ops. Other Compl. Ops. Other
$ $ $ $
M:ltel 45190 (s) - t Incl. Ine1. Incl. Incl.
Vacant Land 49450 acres Incl. Incl. Incl. Incl.
Cabins 63010 (u) Incl. Incl. Incl. Incl.
Boat 40117 (u) Incl. Incl. Incl. Incl.
Total Advance Premium $ IIIcl.
*Premium Basis - Rate. Indicate:
"(a)" for Area (per 1,000 sq. fl.)
"(p)" for Payroll (per $1,000 of payroll)
"(5)" for Gross Sales (per $1,000 of gross sales)
t: - b7maiHnn .~app1ies
"(e)" for Total Cost
"(m)" for Admissions (per 1,000 admissions)
"(u)" for Units (each unit)
c
Forms and Endorsements
Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue;
CG 0001, XL 0021, CG 2005, CG 2104, SCG 22503, CG 0163, CG 2412, CG 2245
.DEC 20 OR Ed. 11/BS
Printed in U.s.A.
PRODUCER'S COPY
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CL 242
(11-85)
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04 em> 6036422
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 05 11 85
ADDITIONAL INSURED-CONTROLLlNG INTEREST
\
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
/
Name of Person or Organization:
'!he Iong Islam Railroad ar:rl Metropolitan Transportation Authority
347 Madison Avenue
New YOJ:X, NY 10017
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
1. WHO IS AN INSURED (Section II) is amended to
include as an insured the person(s) or organiza-
tion(s) shown in the Schedule, but only with respect
to their liability arising out of:
a. Their financial control of you: or
b. Premises they own, maintain or control while
you lease or occupy these premises.
2. This insurance does not apply to structural altera-
tions, new construction and demolition operations
performed by or for that person or organization.
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Copyright, Insurance Services Office, Inc., 1984
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