HomeMy WebLinkAbout790 Willis Creek DrDate: 04/06/06
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#: 305
Transaction(s):
1
Permits
Reference Subtotal
438 $150.00
Cash#: 305
Total Paid: $150.00
Name:
Verizon, Communications
501 N. Ocean Ave
Patchogue, NY 11772
Clerk ID: LINDAC Internal ID: 438
Per~lt No.__
TOWN OF SOUTHOLD
HIGHWAY DEP/LRTMENT.
~_~PLICATION/PERM!T FOR HiGHWAy. EXCAVATION AND REPAIR
~on, ~v nH I< "~RF. BY made to.the Superlntende~t of Hlghumys of
~r~' .......... ~ of = ~iioh P~it 'pu~nt to chair 83 oz u,e
of ~ld for the ~ss~,~ . .~,b e...~ N~ Yo~, an~ ot~ applique laws.
~ of ~ TO~ of S~t~,o,.au,?- ~1._~_ d~b~. The ~pll~nt
o~i~nc~ oe ~atlons f~ ~e ~v~n
te mmp~ wi~ all epplidble laws, or~n~s, ~ a~ ~ula~m, and ~ pe~
~=~ lnsp~ors ~ ~ke~ u~ry {nsp~iOnS ~f ~e job
Print or Ty~ ~
. ~mc of Appli~nt ' Addre~
2]rNama of Owner of ptemi~s Address
al~ y~, ot~ Town ~l~ my ~ r~uir~.
Other Trades
~ of la--'of ~vatlon. .
b) A~ ail et~r ~es~ per~i~ and U~s~ for ~is'p~J~t,
High~ay ~vaUofi Petit ~ ~e Town C[~k.
· $] Tax Map: Section__ , Block , L~t
7) Starting Date: ~cenpletiOh Date ..
8) Work Schedule:
Phase. _Compietlo~ O~ta.
Excavatlo~ .........................................
Facility Ins ~al}at~oh ................................. ,,,
Pavement Repla~ent ..............................
Under which Uu~orlty [~ tho applicdt~or~ made:
lo)
113
Estimated Cost of Fr~posecl ~ork: $~
Pag~ I of 3
' ~2) Inaurofle= Coverage: (Attach co~T) a) Tnsurance ~mpany;
c) S~te whe~er ~llcy of comifl=tlon on file' with ~e Highway ~a~-
d) ~ge r~uir~d ~t~d~ W the Town:
B~lly tnJu~ and p~pe~y ~ge: $3~0,000/$500,000 8~il~
and ~S0, 00R pr~gty damage.
1~ _Seeurlt~:
a)
Fees for
Al.
A2.
' Surety Bond or Cc,'tiffed Che~k provld,~-4 ln't. he
total amount ~ $
~lnt~e~e ~nd pravld~: '2 y~rs or
appIJ~tlons a~d perm~: Basic ~pIl~n
/~i~ Conn~i~s ~vation~ e
~vatio6s I~~ in d~th to ~ in
F10I l.f. = ~30.oo
__UtlJi~ Repair ~V~oh$ e$~oe,
~di~o~l '
H~t~ to p~Hc'~iGEi~ pr~f must ~ p~id~ and a~
Aut~orllatlon Is hereby granted to the Town Clerk of the ToW;q of S~uthoid to
IsSue = HIsIhwa¥ Exc~¥atlofi permit 'to:
In'ac~an~ with ~s'appii~Uoh.
5UP~I~TENOENT OF HIGHWAYS
TO~N OR ~UTHOL~, ~EW YORK
~ ~eter W. Harris
Date
Receded by the Town Clerk
Date
Date
Note: P~it ~plras one (1) y~r
No work :o s~ wight ~ ~ur notice to the ~uperlnt~d~t ~ Highways-
Pe~'mus~ be available
D-39 Pa~ 2 of 3
01/03 '06 'i~..'D 13:$? FA.~ §31 76:- 61
$ 0 k~l~O LD TOWN
Highway De~
Copy Dictrlbu~loA:
H~ghway Department
Appli¢=nt
i N.S..p E C T OR,.e. R E C O R D
Insp~c+Jon Date Findings (use code)
Appllcan[ No'zi~ od
2nd
~d
REMARKS
CODE
lEI ~ Impro~er barrio,~dr-~
UTM - Unable to measure (due ta backfilling)
BUC - Build:nd under ~onstruct~o~
WIP - Work in'progro~s
DB Improper ba~kt'itl' [t~o high) (not sufl%$e~t)
HFS -' IIl~e~r holding for final setthu~a~ of m~.cmvat~n
RFR - Ready to repair
Paga 3 of 3
h1~R 24 200~ 20~16 FR SUi~i~UPPORT GROWP ~3[Ga?E512 TO 9"j~.75~ P.04/04
EMERGENCY PEF~MI.T REC~UEST'
Mark dig tocafian .with an X
Note:
Send revision if addittona~ pits are dug.
** TOT;=L PRGE.04
MAR 24 20~& 15:36 P~GE.03
02/04
24, 2006
501 North Ocean Avenue
patchog, u~, New York 11772
Town of Southold
P. O. Box
Feennit Lane
Feconic, New York 119S8
ATTENTION: Ramond L. Jacobs
Superlutendcnt of Highways
SUILI-ECT: Road opening p~rmit
Willhs Creek Dr. Malt~tuck
EM~.~GENCY PEI~N41T (06-0203)
LOCATION: Dig 4 z 4 splice pit in dirt area along the t/fro Wffiis Creek Drive
1000' s/o l~endow Bench Lane possible missile under Wills Creek Drive.
Dear Sir:.
I enclose a sketch showing approximately our proposal for providing service
facilitie~ at the above voted location in the Town of Southold,
I oho enclose our standard permit form, requiring date and signature, The
permit i~ standard wheflcvr~ our pole and anchor facilities are located on Town
property. There are no charges for the work involved.
PleaSe remember to return one signed and dated copy which is e~ential for our
records. Thank you for your courtesy and cooperation in this matter, If you should
have any questions, please feel free to call me on 631-687-g450.
B. Brady
Mgr. R/W Suffolk
Verlzon
BB/kc
M~R 24 20~6 i5:36
,MOOR 24 2006 10:16 FR S$SUPPORT G~JDUP 63168785i2 TO 1758
The plan submitted is approved with the understanding that the work is to bc
performed subj~t to the conditions of thc permit dated.
P.0~/04
Supexinte~dant of ~lighways
MAR 24 28~6 15:37 PAGE.OD