HomeMy WebLinkAbout235 Latham LnDate: 06/26/07
Town Of Southold
P,O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt: 477
Transaction(s):
1 1
Permits
Reference Subtotal
512a $150.00
Checkfk 477
Total Paid: $15000
Name:
Verizon, Communications
501 N. Ocean Ave
Patchogue, NY 11772
Clerk ID: LINDAC Internal ID: 512a
S HER£BY male t~ the ~uperlntendent of Highways of' the Town
~.PPLICATION ! ...... -'-,--~. =~-~:a 'e muent to Chapter 83 of the
of Sout,~old for the issL~ance ot ~n .=.T.c~_d~,.,-'~;,_.~... v~_u..t. ..,,,4 ether aoollc~ble laws,
Cede of th~ Town of So~thold, Suff~mK _,~._..fl~.-.~.~'.~.'.u~'~aL~:- rF~e al~flc=~nt agr:e~
to ~mp~ wi~ all ,ppiimble laws, or~n~s, ~ a~ ~ula~ohs, and ~
~Hz~ Insp~ors ~ tokai n~rY inSp~ions ef ~e job ~.
2) Own~ ~ P~is~ Addr~s
r~ipt~n'a~ ma~on [s~eet ~r, Hamlet, Cr~s StrUt) ~,
(a) Is ¢~mc~o~ I~t¢ ~;t~'TS f~t of ~¢1 ~e~a~f ~ -- ~ OO~ ~O
7)
· 11]
· Signature ~ Appll~nt
~lnfng p~ ~ publlc'S~ or a~s, a~ gi~ng s de~ll~ de~
fl~ of la--'of ~vatlon. ·
b) A~ch ali at~r ~es~ per~ and Ij~ns~ for
Highway Ex~va~ofl Pe~lt ~ ~e Town Cl~k.
Sta~ing Date= C~pletioh ~te, ,.
Work Sch~ule:
E~tlmated Cost of P~po~ ~ork: ~ ,,.
PaD9 1 of 3
' 42)
a}
b)
d)
(Attach
~n~'.urance Company:
State whe:her policy of ce~ifl~tlo~ on filb with ~e Highway ~a, :-
~mge r~uir~d ~t~d~ w :he Town:
B~IIy tnJu~ snd p~pe~y ~gc: ~300,000/$~00,0g0 5~ily lnJu~,
and ~S0,00E pretty dameDe.
_Security:
a} Surety 13end or ccrt. lfie~ Check Pr°~id~d In'+5~e
to~l amount ~ S ,-
b) ~lnt~e~e ~nd provide: ',2 y~rs or ,
for appl[~tlohs and perm~: Beale ~pll~n F~ ....... ~150, 00
Al. /~i~ Conne~iohs ~vations e S20.00 = ~ ..
A2. /Addi~al Ex,rations ~me se~l~
Ex~va~S lB' in d~.or less:
0-100 l.f. = St0. oa '
A~dlUo~al
C. ~vatio~ le' in d~th to
E. U:ili~ Repair
~ls'appli~tlo6 prior ~
Authorl2~tlon Is hereby grant~:l to the Town Clark of [he Tow~ e¢ S~tho~d to
IsSue = Highway Ex~¥atlo~ peri,lit 'to:
In'accor'dance with th~s'eppllc,l*Jofl,
SUPERINTENDENT OF HIGHWAYS
TOWi~j~O~OUTHOLD. N,E~Y YORK
Rece~cl by the Town
pe~;t Issued Permit 'Ne. Date
Note: P~it ~plres one (1} ~ f~m Da~e
' No work to s~ Wight ~ ~u~ ~O[ICe to the ~upertnt~d~t ~ HIghway~-
Pe~'mus~ be available for
r, la~ 24 2~86 25:.35
03/24/2006 FRI 16:28 FAd
01/03 '06 WED 13:57 FAI 631 785 61~5
$OLF~[OLD TO~'~
Hlghway Department
Inspector
Applicant
To~n Clerk
I H.S P E C T O R'.S R E C O R D
InspecUon Date Findings {use code]
Applicant Noti~od
2nd
--(To pcn~it ClerKJ
~REMARK$
CODE
lB - Improper barri~.~dcs
IL -.Improper lIDhts
ST - Sun~n ~ or ~yetlon
UTM - Unable te m~u~ (due to ~¢~lling)
BUC - 8u~ldln~ under ~n~
WlP - Work in'p~¢~
HFS -' I~r h~dlng for ~n~l s~z of ~vat~n
RFR - R~ to repair
F~ga 3 of 3
Notification of Request For
Emergency Permit
EHzabeth 3r~dy
Specify: ~ad
Emergency
'IT # or Job #:
Central
~-~ State Road ~ County Road r~Village Rea
~ Out of Service ~ Temp Service
InformaUon Required:
1. Nearest cross street e~a.~_. ~_-
2. Distance to nearest cross street
3. Approx. size of ex=avatlon ~ '..<: y -' .~,. ~/'~
4. Excavating on: (check one) C--'] Sidewalk F~-'~'~ad [ ]Gra~
5. Called for Tone & Mark ~ YesC-'-~"~o Case # Eel. #
6. Exact location of splice pit ( Front of houae
NOTE"'
,,,I
,'-or[~'orX being pe~c,r,~ed Jn the town of :Srookhaven,
D/ease ,'ndic~te :ustomer$ ,~ro~er~y /ine.
SPECIAL CONDrTIONS:
Town Of Southold
P.O Box 1179
Southold, NY 11971
Date: 06/25/07
* * * RECEIPT * * *
Transaction(s):
1 I
Permits
Reference
512
Subtotal
$0.00
Cash
Total Paid:
$0.00
Name:
Verizon, Communications
501 N. Ocean Ave
Patchogue, NY 11772
Clerk ID: LINDAC Internal ID: 512
, ZUN 20 200? 89:4? FR SUFF SUPPORT GROUP
RECEIVED
~,~pL?A.T. IOHIPEPJalT FOR HIGHWAY. EXCAV,AT. IO~ AND REPJ, Z~
JUN 2 5 2]07 - . .... ~rinb~.n~t .f Hlgh~¥, of ~'.T~"
Prin~r TY~ [ ~t ~ _ ~....
elf y~. ~ T~n ~ ~ '~
- Ill
D-3~
Page, 1 of 3
M~ ~4 2~0~ LE:36 PAG~.04
,, 5UN 28 2{~? 09:48 FR SUFF SUPPORT GROUP 6316878512 TO 97651750
L/03 '06 ~ 13:$6 ~A~ 63L 786 61~$ SO~t'BU}.O 'LUW~ ~t~ ~. n~t:wa~ uHW~
P.03/05
a}
B~IIy InJu~ and p~p~Y ~gc~ ~3Q~Q001$SOO,O~0 8~[1~ ~nJu~,
and ~S0, oo~ p~ ~ma?. ,
~ln~a~ ~nd provld~; '~ y~ 6P . ,
Re~eNe~ by the Town Clerk ~ -~'~--' ~
elate: P~t ~plr~ oM (~) y~r from ~e of tss~fl~. . ~ Hl~ys.
JUN 20 200? 09:48 FR SUPF SUPPORT GROUP 6~16878512 TO 97651750
03/2~/2006 PR! 16:28 F~L
P.04/0S
i H see c'r oR, '.~ ,,R £c OR ~
Insp,~on D:~te Flndlr~e Cu~e code)
2nd.
Ap~/Icant Not~ed
_REMARKS
iL -,Im~l~opcr ll~
UTM - U~ble ~ m~U~ (due t~
WlP - Work in'p~mc~ . ,~ zuffld~t)
DB Imm ~1'[~ high) t ~ . --
-' P ~ · · - zo~Vat~n
RPR - ~ t~ r~lr
P~ga 3 of 3
SUN ~0 21~? 09:48 FR SUFF SUPF:gRT GROUP 6~$68785~2 TO 976~$"7'50 P.05/05
Date;
Notification of Request For
Emergency Permit
Suffolk, MUST ~ax :omplatod I~orm -',e;
Info~m_~on Requited.'
Z. Pl~afl~ m ne~t em~ ~
4. ~cavatln. on: (ch~ ~e
6. ~a=t I~on ~ ~li~ pit { Fren~
,=or[work ~eing pe~rmed ~n ~e :own ~ f ~rookhavan,
SPECIAl. CONDITION~:
t
TOTAL PAGE.OS **
JUN 28 200? 09~47 FR SUFF SUPPORT GROUP 6316878512 TO 97651750 P,01/05
(Formerly Bell Atlantic)
NORTH OCEAN AV~
PATCHO~UE, NEW yORK 11772
TEIX T~-!,lr-COPIE, R TRANSMISSION WHIClt I~LLOWS I~, ADDI~88ED TO:
NAME: LORE'I'FA
FAX// 76,5-1750
FROM:
NAME: KAREN CAMPAGNOLA
DEI'T.' Right of Way Dc-pt.
PUO~m ~ (Gl) 68~-8429
FAX #: (6~1) 6gi-8512
NUMBER OF PAGES $ (INCLUDING COVER SHEET) DATE SENT 6/20/07
LORETTA ....
HERE IS THE EMI~RGENCY PERMIT,,,,.THE CHECK WILL FOLLOW IN THE MAIL.,,
COULD YOU PI.EASE FAX BACK TO ME ONCE IT'S SIGNED,..,.THANK YOU!!!
FAX # 687-8512