HomeMy WebLinkAbout1115 White Eagle DrTown Of Southold
P.O Box 1179
Southold, NY 11971
Date: 06/09/08
* * * RECEIPT * * *
Receipt~: 21237
Transaction(s):
1 1
Permits
Reference Subtotal
565 $150.00
Check#: 167
Total Paid: $150.00
Name:
Verizon, Communications
501 N Ocean Ave, 1st FI
Patchogue, NY 11772
Clerk ID: LINDAC tnternal ID: 565
Permit No.
TOWN OF SOUTHOLD
HIGHWAY DEP/J~,TMENT ·
Peco nio Lane
p=oordc: ~ew York 1.1958
.(611) 765"31q0
~AppL[CAI~ION/PERMIT FOR HIGHWAY, F_XCAVATION AND REPAI~
~pLICATIDN IS HERE~Y ~de te.~e ~upednt~d~t of Hlgh~ys ~ ~e ~o~ ~'
of ~ld for the is~nm of ~ ~tloh P~;t 'pum~nt to Cha~r 83 of ~e
~ ~e t~' Ta~n of S~t~ld, Suf~k c~. H~ Yo~, and other appfi~· laws.
to ~mp~ wi~ all appii~ble laW~, or~n~s~ ~ a~ ~la~s. and ~ pe~
~H=~ Insp~ors ~ ~ke~ ~ry msp~mns ef ~e job ~
~ ~c of Appllont A~dre~ : ' '
2)~NSme of Owner of p~Rmises , ~dc~re~s
a) ~lnln~ p~
U~ of la--'of ~vatlon.
b) A~ch all ot~r ~es~ per~ and Ij~s~ for ~is'pmJ~t, :.:
Highway ~va~o~ Pe~it ~ ~e /own CI~K-
, 6) Tax Map: $~l~ .
7) Sta~;ng Date: C~pletloh
8} ~ork Sch~ule:
· p~. ~do~ D~
~vatio~
Fa~[l~ Ins~lle~oh ..................................
~v~nt Replacer ................. ,, .
und~ whi~ au~ori[y
E~timated Cost of
~o)
.11]
Pa§~ I of 3
1/03 '06 W~D 13:58 FA3~ 631 ?85 6145 SOU'r~OLD 'lUwa UL~Y~ ~*~ ax~uwa~ ue~
Insurance Coverage: (,kttach a) Insurance Company;
S~te whaler ~11¢y of ca~jfl.~tloa on fil6 with ~e Highway
~ge r~ulrcd ~t~d~ W :he Town:
B~IIy InJu~ and papery ~ge: $30g. 000/$500.000 E~il~ ~nJu~,
and $50,00~ pretty damage,
~j _security:
a)
b)
Fees for
Al.
B.
Surety 8end , ,.or C~rtlfie~ Che~k provld~d In'the
total amount of $
Maintenance B~nd provided: '2 years or ~ yeara
appllcatlohs and permjt~: eaalc AJ~pIIC~don Fee ........ $150.00
/~rvic~ ConnectioNs cxc~vation= ~ $20. U0 = $
/Addi~al ~x~vations ~me se~[~ ~ $I0.~0 ~ $
Ex~va~S18" in d~.or
I.f. 0 $o.~o-
C. ~vatio6s lO' in d~th to ~ in d~th; F10O I.f. = $30.'00
E. ~U:~I~ Repair Ex~v~ons
~is'appli~tlo6 prior ~
Receded by the Town Cterk__
Date
Authorlzatlo~ Is hereby granted to the Town Clerk of t. he ToWn of S~uthc~d to
Is~.ue = Highway Exc=vatio~ Permit 'to:
In'accordance with th~s'applica~lol~.
SUPERINTENDENT OF HIGHWAYS
T~F SOUTHOLt), NEW YORK
-- -I~ete~ W. Harris
Dat~
Not,e.:
0-39
Permit expires one (1] year fr~m Da'ce of issuance.
No work 'co ~t~r~ wlChc~zt q~ heu~ notlce to the Y;uperlnte~de-nt of Highwoys-
Perm~'mus~ be avai[able for' ingp~ctJon.
Page 2 of 3
. 03~1,~/2006 FRI 16:28 FA&
01/03 '06 WED 13:57 FA[ 031 765 6145
SO%~Ci~OLD TOM CLERK
~.003
Cop'/Dj~trlbutioh.:
Highway Department
inspector
Appll¢=nt
T~n Clerk
i N s p E C T O R',S R E C O R ~
Findings (use cc~e)
Applicant Notified
2nd
--(To p~mit C:lerl~{
CODE
18 - Improper barr}~d~
IL -.Improper lights
ST - Sunken trench or
UTM - Unable to measure ~due to backfi{llng}
BUC - gui]al{nil under Constructlo~
WlP - Work
DB - Improp~' backt'{ll' (tO0 high) (~t sufflcJent)
HFS -' irt:~{~ec~r holding for finil
RFR - Reedy to repair
13-39
Page 3 of 3
Notification of Request For
Emergency Pm~dt
_ -
Vil~e:
~ Eme~ ~ Out ~ ~w~ ~mp ~w~
IDislanee to nearest ;ross sheet / ~ ~/'" ....
4. Excavat~ng on: (check one) [~Sid'ewalk L~ Road [
5. Cailed for Tone & Mark [;;;~esr--] No Case# ,, R~f.#
Exact loud,on M ~pllm, pit ( Front of h(wse/~) c~ ~
sPECIAL CONDmON$:
~<~< TOTRL PRGE. 07 **