HomeMy WebLinkAboutAckerly Pond LnTown Of Southold
P.O Box 1179
Southold, NY 11971
Date: 08/12/08
* * * RECEIPT * * *
Receipt: 27400
Transaction(s):
1 1
Permits
Reference Subtotal
576 $150.00
Check#: 190
Total Paid: $150.00
Name:
Verizon, Communications
501 N. Ocean Ave, 1st FI
Patchogue, NY 11772
Clerk ID: LINDAC Internal ID: 576
TOWN OF SQUTHOLD
HIGHWAY DEP,&RTMENT.
peconlc Lane
pc~orgc: N. ew York 119SB;
ApPLICATION/PE,R~..IT FOR HIGHWAY, F_~CCAVATION AND REPAIR~
t9o
I$o. od
APPLICATION IS HEREBY made t~.t~e ~uperlnte~dent af Hlghemys of ~e Town
~ld for t~ is~mn~ 9f ~ ~m~lioh P~it 'pu~mnt to Chair 83 of ~e
~ nd oth~ a ~e laws,
Pri~e or
~mc of A0~l~nt Addre~
all y~, ot~ Town ~1~ ~Y ~ r~ulr~.
' Signature of A~lmcant
a) Attach p~ot plan sha~lng Iocat~o~ o/:.~r~ecl e~.covation end r~etio~hlp'to
fl~ of la--'of ~vatlon. ·
b) A~ch all ot~r ~es;~ permi~ and ll~s~ for ~is'pmJ~t.
' c) ' ~A .,~et~ by ~b appli=~ mY ~t ~mm~ before ~j~n~ of a Highway ~vaHo6 Pe~lt ~ ~e Town CI~.
Tax Map: S~I~ , BIo~ .., ~t
Work S¢h~uJe:
Fa~l]~ Ins~llaUoh ..................
~v~nt Replacer.. ..............
g) Und~ which au~or]ty Is ~e appIl~h ~d~: .... R;CEIV;D
10) Estimated Cost of P~p0S~ ~or~: ~ ....
. .) ,UC 1 2 2008
· S)
7)
· . · ° .t.14 Town Clerk
D-39
N~R 24 2006
F~g~ I ~F 3
PAGE.04
1/0,3 *06 ~D 1~:56 FA.~ 631 ?$$
SOUTHUL~ 'iUwN CL~,V.A
· 12) Insuraflca Coverage: (Attach copT') a) /nsurance Company;
c) S~te whe~er ~l[;y of ca~i~.~tlofi on fil~ with ~e H;ghway ~a~-
d) ~ge r~uircd ~t~d~ W the Town:
and ~so, oo~ pratt? damege,
_Security:
a) Surety Bond or Ccr'Ufie~ Che~k. pro~id~l ]n't~e
tot-al amount of $
b) Malnte~ar~:e Band provided: '2 years or . ..~ years
Al. I~wi~ Carmel,s ~vations J S20.00; ~
0-100 l,f. = $10.0G'
C. ~vatloAs la' in d~th to ~ in
~loo hr, ;
Add[tion~ '
~o.
AuthorJzaiUon Is here. by granted to the Town Clerk of the ToWn of Sdutho~d to
Is~.ue ~ Highway Exc~vatlo~ Permit 'to:
In'accordance wU.h thls'appllcaUofi.
SUPERINTENDENT OF HIGHWAYS
TO~U~_OF SOUTHOL~). NEW YORK
I~eter W. Harris
· Oate
Receded by the Town Clerk
ate
pormit I~$ued ~'~ / ~ ~ Per,it Ne.
Date
D-3S
Permit c~plra$ one (1) ¥c~r fr~m Da~e of Issuance.
No work to st~rg without ~ ~o~r notice to the .~;uperlnte~d~nt of Highways-
Permit-'mus~ be available for InbpecUoh.
Page 2 of 3
M~ 24 20~6 15:3G PAGE.05
01/03 '06 WED 13:57 FAZ 031 765 6145
$oL~oL~ TO~N CLERK
copy Dictrlbutlo~,:
Highway Department
Applicant
Tc~n Clerk
I H S P E C T O R '.-~ R E C O R t7
Insp~ctJon Date Findings use code)
Applicant Notif;od
-- (1'o p=mit ClerK)
REMARKS
(:ODE
18 - Improper barri~d=~
IL -Improper lights
~T - Sunken trench ~ ~Y~tion
UTM - Unable to m~u~ (due ~ ~c~]ling)
BUC - Bulld;n~ und~ ~n~
WlP - Work in'p~m~s
HFS -, In=p~ h~ding for final s~t of ~vat~n
RFR - R~ to repair
0-39
I~ge 3 of 3