HomeMy WebLinkAbout3800 Duck Pond RdTown Of Southold
P.O Box 1179
Southold, NY 11971
Date: 11/26/08
* * * RECEIPT * * *
Receipt#: 30895
Transaction(s):
1 1
Permits
Reference Subtotal
594 $170.00
Check#: 49674
Total Paid: $170.00
Name:
A~o, Contracting Corp.
207 Knickerbocker Ave.
Bohemia, NY 11716
Clerk ID: LINDAC Internal ID: 594
Penmt No..-- , .
NOV 2 4 LJb¥
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
P,O. Box 178
P=conic, Now York 11958
(631)765-3140
APPI.ICAT~ON / PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPI~i~-~;~i~ iS I-LER.EBY made to the Sup~in~'endcnt of Highway~ of the Town of Southold for the issuance of an Exc. avotion Pcrmit
pursuant to Cliapter 83 of the Code of the Town of $outhold, Suffolk Coeur/, New York, and oilier applicable laws, o~dinances or
regulation~ for the excavation herein described. 'rhv applicant agrees to comply with all applicable laws. ordinances, cod~ and
regulations, and to permit authorized inspee[ors lo nmke necessary inspeetiom of the job sit~.
P ri~.~ or 'l'yp~
Name of A~liemt
N~ of O~er of Pries
We& D~ipti~ and Loca~oa (S~[ Nn~, H~et Cross SUeet)
*if yes, o~ To~ p~ may b~ ~q~refl.
4. Builder's Licel~e No.
Plumber's License No.
Electrician's License No.
Oiler Trndc's License No.
Date
$. (a) A~ached plot plan showi~g location of proposed excavation and glafions~p to ~joi.~ p~ or public street or a~, and
giv~g a de~iled descri~on of~yout ore.ration.
(b) At~ all o~ nec~ p~g ~ lic~ for ~is
(c) Work cove~ by t~s appUcalion ~y =o~ co~ce before issuan~ cfa Hi.way Excavation P~t by ~ To~ Clerk,
7. Sl~ti,~ Date: [ ~ -Z~ ComplcfionDate:
Work $cheduJe;
Excavation
Facility Installation
Backfill & Completion
Pavement Replacement
Completion Date
9. Under which authorivJ is application being made:
10. Estin'~tcd Cosl of Proposed Work: $
D-39 1 of 3
12: In'u fanuc Co¥¢rage: (Attach Copy)
(a) l~uraoce Company:. __
(b) Policy #:
(c) Stale whcther policy o£cer~ification on file wilh Ihe Highway Depalllllant:
(d) Coverage ,'cquirud ¢~.(ollded tO the Tow'n:
Bodily injuly and properly damage: $300,000 / $500,000 Bodily hljurY, and I50,000 ptopegy damage.
13. Security:
(~) Surety Bond __ __
or Certified Check
(b) Maintenance Bond provided: 2 y~ars or
14, Fe~s for Applications and
13asic Application
AL ~/Se~ice Co~ecfiom ~cava~olu ~ $20.00
~o.
A2. / Additional ~xcava~ i~lle se~ice ~ $10.00
No.
B- Exca~t/ons I g" ~ deplh or
0-1~ i.i = ll0.~; Addlfio~l . i.i ~ i0.10
provided in the total Amount nfs
3 y~ars.
$150.00
$
l~xcavations 18" in dup~h lo 5' in dupth
0.100 i.f. -: $30.00; Additioinl __
i.£ ~ $0,30
Excavations 5' In depih and eve-
0-100 i.£ ~ $50.00; Additional
i.£@$0.50
Additional
Utility Repair Excavations ~ $10.00
R~pain same sen, icc C~ $$,00
$
$
TOTALS
No'dce to public u6litics proof mint bc p~ovidcd and attached to this appli~iott prior to issuance
of p~rmlt.
Authorization is hereby granted to the Town Clerk of the Town of Soulhold to ir~ue a Highway Excavation p~rmil In:
in accordance with thii application.
Date Received by thc Town Clurk __
Dale Permit lssund / / - ~(,, - D ,F
SU?ERINT~IqDE'NT OF IIIGHWAY$
- Peter W.
__
D~te
NO'Ii:
permit expires one (1) ye:,' from date ofisauancc.
No work to start without 48 horst ~oticc to Superintendent of Highways.
Permit must be available for inspection,
D-39 2 o~' 3
° Coby Distributioz~:
ilighway Departmont
Enginee. r (with page 3)
Applicant
Town CIt~rk (Original)
1$[
3~1 .
ln~eetion Date
INSPECTOR'S RECORDS
Findings (use code)
REMARI(~
Applicant Notified
(To ?c~.Jt Clerk)
coloF,.
IB Improper Bartloadez
IL Improper Lights
ST 8m~ken Trench or Excavation
UTM Unable to M*amre (due to bacldilliag)
BUC Boilding IJader Construction
W'IP Work In Pt0gr*za
DB Impropcr Bnckfill (too high, not suffici~n0
HFS Imp¢ctor Holding for Final So~lcm~nl of Excavation
P,.FP-. Ready for Repair
D-39 3 of 3
ACORD. CERTIFICATE OF LIABILITY INSURANCE
PRODUCER Phone: Bl6-733-9200 Fax: 516 6S1 7390 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Allied North America Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Brokerage of New York, LLC ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
390 North Broadway
Jerictio NY 11753
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURERA:Travelers Indemnity Company 25658
Adjo Contracting Corp. ~NSURERB~Travelers ProD. Casualty Co. 25674
207 K~,ickerbocker Avenue
Bohemia NY 11716 ~NSURERC~New Hampshire Insurance ComDa 23841
INSURERD:Navi~ators Insurance Company 42309
INSURER E:
COVERAGES
~THE POLICIES OF INSUP~ANCE LISTED BELOW RAVE BEEN ISSUED TO TBE INSURED N~JMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR eTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED MEREIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS.
A ! GENERAKMASlLITY )TNYCO829K0555IND08 7/14/2008 7/14/2009
X COMMERCIAL GENERAL LIABILITY PREMISES (Ea cccurence) $300, 000
L] CLAIMSMADE X~ OCCUR MEDEXP(Anyoneperson) $ 10 , 000
! PERSONAL&ADVINJURY $ I , 000, 000
GENEP. ALAGGREGATE $ 2 , 000, 000
'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2
B AUTOMOBILE LIABILITY :3T810829K0555TIL08 7/14/2008 7/14/2009 COMBINED SINGLE LIMIT
~ ANYAUTO i (Eaacddenl) $ 1, 000, 000
, SCHEDULED AUTOS ! (Per pers°n) $
X~ HIRED AUTOS ; ! BODILY INJURY
Ix NON-OWNED AUTOS (Per accident) $
(Per accident) $
GARAGE LIABILITY AUTO ONLY - EAACCIDENT $
AUTO ONLY: AGG
C : EXCESS/UMBRELLA LIABILITY 5716634 7/14/2008 7/14/2009 EACHOCCURRENCE $ 5 · 000. 000
X~ OCCUR L~ CLAIMSMADE AGGREGATE $ 5, 000, 000
I ~ DEDUCTIBLE $
RETENTION $10, 000
WORKERSCOMPENSA'~ONAND I TORYLIMITS I I ER
I SPECIAL PROVISIONS below I E.L. DISEASE - POLICY UMiT $
D OTHER ]NY08EXC155850NV 7/14/2008 7/14/2009 )cc: $5,000,0o0
EXCESS Liability %gg: $5,000,000
E&C Property, 3800 Duck Pond Road, CutcAogue, N.Y. 11935~
Town of Southold, Highway Department.
Following Endorsements Apply:
Additional Insured: CGF276 06/03
CERTIFICATE HOLDER CANCELLATION
Town of Southold, Highway Department
P.O. Box 178
Peconic NY 11958
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C~2~CELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 39 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO THE LEFT, BLFf FAILURE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
TEE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHOR~EDREPRESENTATNE
ACORD 25 (2001108)
®ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, cedain policies may
require an endorsement. A statement on this cedificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108}
~O0'g ~AOi
New York State Insurance Fund
Worlt~'~' Cempen.~.e' n & Diz~bility Bxn~'tt~ SpxeJ~lls~ S~ce 1914
rig9 CHURCH S~E~, N~ YO~ N.Y. 10007-110O
CER~FICATE OF WOR~RS' COMPENSA~ON INSU~NCE
LOVELL SAFETY MGMT CO., LLC
110 WILLIAMSTREET 12TH FLR
NEW YORK NY 100:38
POLICYHOLDER
ADJ0 CONTRACTING CORP
207 KNICKERBOCKER AVE
BOHEMIA NY 11716
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
P,O, BOX 178
PECONIC NY 1i$58
G 1051 937-7 431597 .J. 04/01/2008 TO 04/01~Z009 11/24/2008
THIS IS TO CERTIFY THAT THE POLICYHO~0ER NAM~'D A~OVE 18 IN~UR~D WITH THE NEW YORK ~A~ INSURANCE
FUND UNDER POMCY NO. 10~1 ~37-7 UNTIL 04~I/2009, COVERING THE ENTIRE O~LIQATION O~ THIS POLICYHOLDER
FOR WORKER~' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW W~H RESPECT TO ALL
OPERATIONS (N THE ~TATE OF NEW YORK. EXCEPT A~ INDICATED BELOW,
IF SAID POUCY IS CANCELLED, OR CHANGED PRIOR TO 04/01/200g IN SUCH MANNER Aa TO AFgEC'I' THIS CERTIFICATE,
30 DAYS WRITTEN NOTICE OF SUCH CANCEU. ATION WILL BE GN~N TO ?HE CERTIFICATE HOLDER A~OVE.
NOTICE BY RSGULAR MAL SO ADDRESSL~D SHALL BE SUFFICIENT COMPLIANCE WffH THIS PROVI~ON. THE NEW
YORK ~TAT~ INSURANCE FUND DOES NO?ASSUME ANY Uo~BF. ITY IN THE EVENT Og FAILURE TO GIVE SUCH NOT)CE.
THiS CERTIFICATE OOl~$ NOT APPLY TO BUILDING DEMOLITION.
THIS CF--RYIFICATE DO~$ NOT APPLY TO THOSE JO~ SiTES WHH~H ARE COVERED BY OTHER INSURANCE AND ARE
~SCIFJCA~.y EXCLUDED BY ENDORSEMENT.
THIS CER~FICAT~ IS ISSUED Aa A MATi'ER OF INFORMATIONONLYANDCONPER$ NO RIGHTS NOR INSURANCE
COVERAGE UPON THI~ CERTIFICATE HOLDER, THIS CERTIFICATE DOES' NOT AMEND. g=XTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
DIRECYO~JNSURANCE FUND UNDERWRITING
This ced~f'm, ate can be validated on our web eite at htt~s:/lwww,nysif.com/¢eft/c, ertvaLa,%o or by calling (888) 875-5790
VALIDATION NUMBER: 587078012
U-26.3
//
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SEE DETAIL:
xx,
EX I ~TII
EXI.'
EXISI'INO SINGLE PHASE
O.IL PRIMARY EXPAND
TO THREE PHASE AS
PART OF THIS PROJECT
SEE
PLAN
GRADE
7-
0
4'
RUN (2) 4"C PVC FOR
TELEPHONE AND CABLE IN
WITH POWER,
\
EXISTIN~ TREE
LINE (TYp)
(~]rlNo TRIE~ LINI~
*d~i CONDUITS FOR POWER, TELEPHONE. CABLE, FACP
AND INTERCOM.
EC TO RUN THE FINE ALARM ANO INTERCOM
CABLE FROM CABANA TO WEST WINO (OFFICE.).
/
"(2 EC TO PROVIDE TEMPORARY ELECTRICAL SERVICE
FOR CONSTRUCTION UNTIL THE NEW SERVICE EQUIPMENT
IS INSTALL.rD.
/
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,/
/
/
/
/
/
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LAND NO~ OR FORNDRLy OF
NICHOL~ ALLIANO
ELECTRICAL SITE PLAN
SITE
3800 DUCK POND ROAD
R
THREE PHASE O.H.
~~':~fE N~ i ~:~ PLAN
EAST WING FAST WING WEST WING
PANEL I PANEL 2 PANEL 5
2 SECTIONS 2 SECTIONS 2 SECTIONS
INCOMING
& CT
2OO
100
~OA
MAIN
F~P
15'-0' MIN.
WEST WING
PANEL 2
2 SECTIONS
4 FOOT MIN.
WORKING CLEARANCE
WEST WING
PANEL 1
2 SECTIONS
HOUSE PANEL
GENERAL NOTES
1. COORDINATE WITH SITE CIVIL DRAWINGS.
2. LOCATION OF GENERATOR TO GE DETERMINED.
9
7
6
5 07.29,08 ISSUED TO BLDG. DEPT. PTB
4 07.10.08 ISSUED TO OWNER PTB j
3 08.24.08 ISSUED TO OWNER PTB
2 (]5,09.08 RE-ISSUED TO BLDG. DEPT. PTB
, 1 03.17.08 ISSUED TO BLDG. DEPT. PTB
~REV DATE DESCRIPTION BY J
IA/VIES, LASALA &
ASSOCIATES, LLP
11 OVAL DRIVE
SUITE 129
ISLANDIA. NY 11749
TELEPHONE: 651.592.2650
FACSIMILE: 631.2,t2.1536 JOB t 08AE-OO014
ARCHrmCTa P.C.
43t CONKLIN STREET
FARMINGDALE, NEW YORK 11735
itEL:(516)420-8383 FAX:(516)420-0q g5
(THESE PLANS ARE AN ~ ( ~
/INSTRUMENT OF SERVICE I/T"'~ ~-~ ~'1'/
AND ~ THE PROPERTY n= =nn
T.ELC.,TECT
/INFRINGEMENTS WILL BE/J Y--,[.~[17-J
(.PROSECUTED ,)1~ J
· PROJt=C I
SANTORIN/BEACH
I~-.SORT
3800 DUCK PO~FD RO/~
DATE ';,~5/O1
SCALE AS-NOTED
PROJECT
DRAWN BY
CHECKED BY Nm
SHEET Of
DRAWING NO.
02