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Home My WebLink AboutChang, Jae I/NY University r �y •J �+k TOWN CLERK'S CHECKLIST FOR FILMING PERMIT NOTE: All payments must be cash or certified check Applicant: —J6,(Z- C.,h -n P, Date Received: (,I i (L Uy (oma Vwx ✓ Completed application $100 nonrefundable application fee Certificate of insurance that evidences a public liability insurance policy covering the town as an additional insured in the amount of$1,000,000 (one million dollars)per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all liability for and will indemnify and hold the town harmless of and free from any and all damages that occur to persons or property by reason of said filming or still photography. Forward completed application to Chief of Police for approval or disapprod determination if Traffic Control Fee is required Approved Disapproved No Fee Required / Fee in the amount of$ required Forward certificate of insurance and indemnification agreement to Town Attorney for pproval Approved Disapproved COLLECT FEES AS FOLLOWS: Permit Fees (Prior to issuance of permit): Film Fee - $100 per day of each day covered by the permit I'sV Cleanup deposit: Separate certified check for$2 0 for each day covered by the permit. W \ by i riS-k-wo CkeckS ce �SOU Traffic control fee- $1000 for each day covered by the permit if required by the Chief of Police. NOTE: Additional funds may be required by Police if it is determined that$1000 per day fee will be expended prior to the �\ n of the permit period. \V� Beach Parking fee- $10 per vehicle, per day between May 1 and September 30. ISSUUED PERMIT `/ Countersign application Issue permit with name of applicant, locations(s), date(s), and time(s) NOTIFICATION of ISSUED PERMIT 1� Chief of Police Chief Building Inspector ✓ Fire Marshal Code Enforcement Officer Superintendent of Highways Superintendent of Parks and Recreation RE ST FOR EXTENSION OF PERMIT Forw d extension pe request to Chief of Police If granted, co t additional $100 per day filming fee Ame permit to indicate granted extension period COMPLETION OF PERMIT PERIOD Chief of Police to provide applicant with statement of cost for providing Traffic Control and police coverage. (Refund overpayment or collect for additional costs within 30 days of termination of permit) Superintendent of Highways inspections locations listed on permit and determine if cleanup efforts by town personnel is required. *If cleanup is required, Superintendent will provide Town Clerk with a statement of actual costs. (Refund overpayment or collect for additional costs within 30 days of termination of permit) *If not cleanup is required, Superintendent of Highways will notify Town Clerk and Town Clerk will remit the$250 certified check to applicant. �SODg ��r- - Czy �ya�� a/o � � � � ¢- EY LS1� o�g�f f0��►�QG ELIZABETH A.NEVILLE _� y� Town Hall, 53095 Main Road TOWN CLERK o P.O. Box 1179 co Southold,New York 11971 REGISTRAR OF VITAL STATISTICS 0-0 MARRIAGE OFFICER ,y !� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER jog! a� Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Peter Harris, Superintendent of Highways From: Lynda M Bohn,Deputy Town Clerk Dated: June 22, 2004 Re: Film Permit No. 014 Cleanup Deposit In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 daily Cleanup deposit may be returned to the applicant; if not, please provide a statement setting forth the actual cost to the town of providing said cleanup/service. Cleanup was not required at the location(s) identified on the permit. The deposit may be returned. Cleanup was required. Actual cost statement is attached. �S Signature Date JuP-16-04l02 :01P Southold Police 631 765 2715 P_ 03 ft LOCATIONS AW TIMES FOR FILMING IN TOWN OF SOUTHOLD Joe- Location 1: Mill Lane Manituck,NY 11952 June 19 (From 9:0Opm— 3:00am) Location 2: Oregon Road+Duckpond Road MattiNCk,NY 11952 June 20(From LOOpm—4:OOpm) d :(631' 74 c9 16- �o�S0Ff01,tcoG c k'I � cc)�ea-A--, ELIZABETH A.NEVILLE �� Town Hall,53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICSO Southold,New York 11971 MARRIAGE OFFICER 'y • �� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER �Ol `1►a Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK RECEIVED TOWN OF SOUTHOLD A-5 D D gp� JUN 18 2104 FILMING/STILL PHOTOGRAPHY Southold Town Cleri PERMIT Issued to: Jae I. Chang(NY University) Location(s),Time(s) and Date(s) LOCATION#1 MILL LANE,MATTITUCK,NEW YORK SATURDAY,JUNE 19, 2004 9:00 PM TO 3:00 AM LOCATION#2 OREGON ROAD & DUCKPOND ROAD, CUTCHOGUE,NEW YORK SUNDAY,JUNE 20, 2004 1:00 PM to 5:00 PM Permit No. 014 Issue Date: June 17,2004 Elizabeth A. Neville Southold Town Clerk (Town Seal) Jun-16-04 02 :01P Southold Police 631 765 2715 P-02 J LN 0400 Ir-• .lv • _vv TOWN or SOUTNOLD APPLICATION FOR F1LMINCJSTXLL PHOTOGRAPHY rt�ssa r.snr oa u�lr >,rrvrsea21460 b& a_ to t 1e ,Oy paw"? Mo: toes or 11"Lzcwr• a+- Crux meq,, M&SLZAG iifpMMS; l �P I 1 L�C '�)00►� Jr rues, ev9tKe.• Vr 0661 eas wwewasATZC r. CaeswNr- ••,,•�••e .tiaesse: Tai 8r..�'y N _ lJr•�Y .�. C O Q o� sam e. �s,•�/off� 7b37� sus. aha • 9 95-,qQ6j .._......................_..._...._._ ............................. DoaQ=7R V"N OV nCX"2TW t0.9. wOticm rietyre, CowwercL", 7�7eMieiai►, Cac^Zog, w�yoslse, .CC.I : S±mer, �':��,,� (N wssesl =>xisi or vite►osm rsaeuejmw*mcnrrKv. DD. 00� Lz"TSOM/C1 of Obeel. i.L UsetOOisT Mor or ca"0 as sem, Mochas oT re"ars XT Lom vpw 1Cas= s tap damoel Lm TY►tr or V10mcims hT Lo"Tiom. rrrs on 8*90"Z L 5402ONWr. _,..._.Cxow-,rq s�gMtato Re to; Southold Town Clerk Southold Town Flail 5309S MsiA Road P. O. Dox 1179 Southold, NY 11971 Jun-16-04 02 :01P Southold Police 631 765 2715 P_03 co c i LOCATIONS ANI)'TIMES FOR FILMING IN TOWN OF SOUTHOLI) Fyn; woe Location 1: t S � o Mill Lane Mattituck,NY 11952 June 19 (From 9:00pm— 3:00am) Location 2: Oregon Road+Duckpond Road Mattituck, NY 11.952 June 20(From 1:00pm—S:00Pm) ELIZABETH A.NEVILLE �`1` �� Town Hall,53095 Main Road TOWN CLERK P.O.Box 1179 REGISTRAR OF VITAL STATISTICS Southold,New York 11971 MARRIAGE OFFICER Fax j, �'� Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER ��l �aTelephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Peter Harris, Superintendent of Highways From: Lynda M Bohn,Deputy Town Clerk Dated: June 22, 2004 Re: Film Permit No. 014 Cleanup Deposit In accordance with §44A-5 of the Southold Town Code,please advise if the $250.00 daily Cleanup deposit may be returned to the applicant; if not,please provide a statement setting forth the actual cost to the town of providing said cleanup service. Cleanup was not required at the location(s)identified on the permit. The deposit may be returned. Cleanup was required. Actual cost statement is attached. Signature Date Jun- 16-04 02 : 01P Southold Police 631 765 2715 P_03 r p Gr COCK e LOCATIONS AND TiMFS FOR FILMING IN TOWN OF SOUTHOLD Ch� Location 1: �vS Mill Lane Martituck,NY 11952 June 19 (From 9:00pm— 3:00am) Location 2: Oregon Road+Duckpond Road Mattituck, NY 11952 June 20(From L 00PIn—5:00p'm) fz+ f�31' 7G5 cV71 Bohn, Lynda From: Bohn, Lynda Sent: Thursday, June 17, 2004 3:41 PM To: 'jic213@nyu.edu' Cc: Cooper, Linda Subject: Filming Permit This is to serve as a reminder. Per our phone conversation at 2:45 pm today, Thursday, June 17, 2004. You will need to provide two(2)certified checks in the amount of$250.00 each as a clean-up deposit before the filming permit will be released to you. These checks will be returned to you after a site inspection by our Town Highway Department providing no clean-up is necessary. Tracking: Recipient Delivery Read 'jic213@nyu.edu' Cooper,Linda Delivered:6/17/2004 3:41 PM Read:6/17/2004 3:43 PM 1 POLICE DEPAQ-TMENT TOWN OF SOUTKOLD CARLISLE E. COCHRAN,JR. Chief of Police Telephone Emergency Dial 911 MEMORANDUM TO: Linda Cooper,Deputy Town Clerk FROM: Chief Carlisle E. Cochran,Jr. ear DATE: June 17, 2004 RE: Application for Filming/Still Photography As per Local Law No. 6-2001, Section 44A.3, it is the recommendation of the Chief of Police that application dated June 17,2004,New York University by Jae Chang,be APPROVED. As per Section 44A.4,Traffic Control Fee,there is NO FEE recommended at this time as there is no need for police assistance. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 r . FO(,f-�O ELIZABETH A.NEVILLE _� Gy� Town Hall, 53095 Main Road TOWN CLERK y Z P.O. Box 1179 REGISTRAR OF VITAL STATISTICS OSouthold, New York 11971 MARRIAGE OFFICER y • O�� Fax (631) 765-6145 RECORDS MANAGEMENT OFFICER �01 `1►a Telephone (631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Southold Town Attorney's Office From: Linda J. Cooper Dated: 6/17/04 Re: Filming Permit In accordance with the Southold Town Code, Chapter 44A, Section 3, Subsection D, the Certificate of Insurance and Indemnification Agreement for a Filming Permit Application for New York University by Jae Chang are attached hereto. Please review and advise whether these documents meet with your approval. Thank you. Approved as submitted Disapprove for the following reasons: Ir A.4 ignature fat 1 e x�� 7- C�/ C_ A1.0 CCat�- eq S2t�a��iG�- A CORD DATE(MMIDD/YY) Minimal06/17/04 PRODUCER Serial#: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DEWITT STERN GROUP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 420 LEXINGTON AVENUE,SUITE 2700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEW YORK,NY 10170 COMPANIES AFFORDING COVERAGE COMPANY ST PAUL FIRE&MARINE INSURANCE COMPANY INSURED RE: HORIZON OF LOVE COMPANY B NEW YORK UNIVERSITY COMPANY 7 EAST 12TH STREET C NEW YORK,NY 100034475 ATTN: THOMAS D.LAWRENCE COMPANY D THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICON Y TYPE OF INSURANCE POLICY NUMBER DATE(MMIDONY) D (MWD ) LIMITS GENERAL LIABILITY CK04510153 07/01/03 07/01/04 GENERAL AGGREGATE s 2,000,000.00 A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 1,000,000.00 CLAIMS MADE F—X]OCCUR PERSONAL&ADV INJURY $ 1,000,000.00 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S 1,000,000.00 FIRE DAMAGE (Any one fire) $ 50,000.00 MED EXP (Anyone person) $ 5,000.00 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Par Pelson) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKER'8 COMPENSATION AND W VA4511143 07/01/03 07/01/04 X X A EMPLOYERS'LIABILITY For Evidence Only EL EACH ACCIDENT $ 1,000,000.00 THE PROPRIETOR/ INCL PARTNERSIEXECUTIVE EL DISEASE-POLICY LIMIT $ 1,000,000.00 OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1,000,000.00 OTHER A THIRD PARTY EN04502394 07/01/03 07/01/04 LIMIT:$2,000,000.00 PROPERTY DAMAGE DED:$2,500.00 DESCRIPTION OF OPERATIONS&OCATIONSNEHICLES/SPECIAL ITEMS It is agreed that coverage is provided for all NYU Film Students through out the policy year. Certificate Holder is added as an additional insured/landlord or manager of premises. SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF SOUTHHOLD EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 53095 MAIN ROAD 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SOUTH HOLD, NY 11971 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY IGND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHO D RESENTATNE OF DEWITT STERN GROUP .fin-1.6-04 02:02P Southold_ Police 631 765 2715 P .04 INDEMNIFICATION AGRESS UEW TOWN OF SOU'I IOIID M.MWG/STII L PHnTOCWHY PV-RIGT TIKe AppUCsnt sbaliad=wify and bold darmless cbe TOO [tato sad a9Iiost aU JWU,cloitsa,da &or actionl for aay damage abdJor mjttry sastlincd(or aUcted to be sestaaed by W pagq or patties in coaseedDA with t%c perrormascc or !filming or stM phowgropity by the ApplkseL bis emptayep or a*eats or Hwy sobcon •actor and in case of say tach acdoa bromOt agsinst the Towro,th* applicswt al►sU immeeiatety take charge of and defend the same■t tris oWD coat aad *Armse. to addl4oa,the Applicant will aamo the T'oas,as an addldOsal insured an any apyllcastt polities. Sipasa,re Date Primod ttaa►c �-- Tidt TOTAL P.03 MEMORANDUM TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, Jr. DATE: June 17, 2004 RE: Application for Filming/Still Photography As per Local Law No. 6-2001, Section 44A.3, it is the recommendation of the Chief of Police that application dated June 17, 2004,New York University by Jae Chang, be APPROVED. As per Section 44A.4, Traffic Control Fee, there is NO FEE recommended at this time as there is no need for police assistance. Jun-16-04 02 :01P Southold Police 631 765 2715 P _02 J UI 1—1 O txr, a_-v i _ _ - .�- v.s a i P 1&♦ -L TOWN Or SOUTHOLD APPLICATION PAA FILMING/STILL PHOTOGRJU'HY roost rsarr of rnR e*rt,=cAZX4 r *&ta: (.Jl ie &q Amm OF wass4mr. "Maws avi- 2q1 r 06 6 1 eamea, ^+,� )• OH• 763 3,Aav Q/2 • 9 95 •� �� .._....---._...._.,.._......._...---- .,........ ............... assCZZ= %WE Or AG72Y=1 r (e.g. slot*ora ric"re, COMercifil, 7aloftaLon, CwL41 g, •a04*3s.e, .cc.It b.1ts f a 1 >1I� =I>Itf 101 e[ ?>«oro s as rs>ucsrc!s>to1,o onus. asq�l�eoitaP LbcJnrioWiei us ed&LtYnoil obcoe. ;.1 n.Cc00;asY 10r or ram -zp c2aw0 as sirs= ,- UNWOUR O! ra"ers XT. XAPMV ,0V 1c"T i CPO* =12,00M1 Q MIUMM JNM "011; OP vsIRCLii bl Loi.+iYOY: 7i-IL I _{v C&10 rrrs air at1r-2aL 54 =1f>lIMPr, OQL� _ .lr5levl Mfi 'fYextL asayssmrlrs• /10 Tom.. -� s�grwtvro RR to., Southold TOWn 00rk SouLhaid Town Hall 53095 Main Road P. O. Dox 1179 Southold, NY 11971 Jun-16-04 02 :02P Southold Police 631 765 2715 P _ 04 Jl2 1V "- " INDEMNIFICATION AGREEINENT TO", OF SOMILOLD F LMWG/STILL PROTOGRAPHY?ERl9I The Applicant*ball indemnify and hold darmless the Tows [rota 2nd against au sem,cWtm,dva ds or aetlnai for nay damage sddlor tojttry sustained car sale*ed to be sastaimed by w 9&M or partie#is cemneetm with tate parfort uce of filming or still ph"ftrapAy by the AppllcaaL bis empteyees or agents or xsy swbceetracto►mad is case of any tacb action brougbt against ase Towns, the appucawt aAau inowdiately take charge of sad dofa ed the sante at b6 own cost and expense, tis addiden.the Applicant will game the T6wa as an additional ieisured an any appucabte policies. Signe Date Printed aamc Title TOTAL_ P.03 A CORDDATE(M WDDIYY) 06/17/04 PRODUCER Serial#: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DEWITT STERN GROUP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 420 LEXINGTON AVENUE,SUITE 2700 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NEW YORK, NY 10170 COMPANIES AFFORDING COVERAGE COMPANY AST PAUL FIRE&MARINE INSURANCE COMPANY INSURED RE: HORIZON OF LOVE COMPANY NEW YORK UNIVERSITY COMPANY 7 EAST 12TH STREET C NEW YORK,NY 10003-4475 ATTN: THOMAS D.LAWRENCE COMPANY D ', � aePr u ro ,„Ve F'4r x '.w.ir. `"I� THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED B Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS coTTYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITYCK04510153 07/01/03 07/01/04 GENERAL AGGREGATE $ 2,000,000.00 A X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 1,000,000.00 CLAIMS MADE FX]OCCUR PERSONAL&ADV INJURY $ 1,000,000.00 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000.00 FIRE DAMAGE (Anyone fire) $ 50,000.00 MED EXP (Anyone person) $ 5,000.00 AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKER'S COMPENSATION AND 07/01/03 07/01/04 X TORY LIMITS ER A EMPLOYERS'LIABILITY W r Evidence 143 EL EACH ACCIDENT $ 1,000,000.00 For Evidence Only THE PROPRIETOR/ INCL EL DISEASE-POLICY LIMIT $ 1,000,000.00 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 1,000,000.00 OTHER A THIRD PARTY EN04502394 07/01/03 07/01/04 LIMIT:$2,000,000.00 PROPERTY DAMAGE DED:$2,500.00 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS It is agreed that coverage is provided for all NYU Film Students through out the policy year. Certificate Holder is added as an additional insured/landlord or manager of premises. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF SOUTHHOLD EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 53095 MAIN ROAD 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SOUTHHOLD, NY 11971 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHOR D RESENTATIVE OF DEWITT STERN GROUP 40. �. dr I"��il. .::..hili y,... .=,.7��.i","I„�711�I��lii�w^w�'. r I �,d1�1.ib,,«r,Ati: ii ar d� �O�SpfFO�,��o ELIZABETH A.NEVILLE CD Town Hall, 53095 Main Road TOWN CLERK y = P.O. Box 1179 REGISTRAR,OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICERFax(631) 765-6145 RECORDS MANAGEMENT OFFICER �aO�� Tel phone(631) 765-800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper, Deputy Town Clerk Dated: 6/17/04 Re: Filming Permit Transmitted herewith is the application of New York University by Jae Chang for a Filming Permit. In accordance with Section 44A.3 of the Town Code please review the application and advise of approval or disapproval of the application and whether a traffic control fee is required and the amount needed. ELIZABETH A.NEVILLE Gy� Town Hall,53095 Main Road TOWN CLERK y Z P.O.Box 1179 REGISTRAR OF VITAL STATISTICS O Southold, New York 11971 MARRIAGE OFFICERy • � Fax(631) 765-6145 RECORDS MANAGEMENT OFFICER l `1►a Telephone(631) 765-1800 FREEDOM OF INFORMATION OFFICER southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Southold Town Attorney's Office From: Linda J. Cooper Dated: 6/17/04 Re: Filming Permit In accordance with the Southold Town Code, Chapter 44A, Section 3, Subsection D, the Certificate of Insurance and Indemnification Agreement for a Filming Permit Application for New York University by Jae Chang are attached hereto. Please review and advise whether these documents meet with your approval. Thank you. Approved as submitted Disapprove for the following reasons: Signature Jun-16-04 02 :01P Southold Police 631 765 2715 P_01 SOUTHOLD TOWN POLICE DEPARTMENT 41404 ROUTE 25 P.O. BOX 911 PECONIC, NY 11958 (631) 765-2600 FAX (631) 765-2715 Fax TO: Lynda Bohn v^^ ^From: Pat Gamik �_— Fax- 7656145 Palleet a including cover pho m Data: 6/16/2004 He: Film Permit Cc- C3 G❑Urgwlt ❑ For Review ❑Please Cornmeal p Please Reply ❑ Please Recycle e Cornmerrtn: Here it is. IF YOU DO NOT RECEIVE ALL PAGES,PLEASE CALL(631)765-2600 AND ASK SENDER Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/17/04 Receipt#: 0 Transaction(s): Subtotal 1 Application Fee- Non-Refund $100.00 Cash Total Paid: $100.00 Name: Chan, Jae 67 Frederick Street, Floor#1 Little Ferry, NJ 07643 Clerk ID: LBOHN Internal ID:96069