Loading...
HomeMy WebLinkAbout60 Great Peconic Bay Blvd * * * RECEIPT * * * Date: 06/02/14 Receipt#: 171120 Quantity Transactions Reference Subtotal 1 Excavation Permits 935 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#5031 $170.00 Rossano, Berti Construction Inc Name: Rossano, Berti Construction Inc P0Box 1103 Wainscott, NY 11975 Clerk ID: LINDAC Internal ID: 935 0002/005 05/12/2014 Mom 12, 30 FAX Ponni\ No. _ rl~^ TUWNUF80OTB0LD ~ \ ~ HIGHWAY DFPAR,[mENT Pezmmiclanc , [u �o � Pconuiu,Y4cvv York 11958 Vk (6-)1)705--)140 APp\ I[AT)0N |8H[K[8YmodctothcSuprrio,rndro/u[High%kxyso[\kcTonoo[Soo[hu|dhorthcissoxnceo[xo6xcovmk`uPcnnit puao-'nt to Chapter 237 ofthe Code oftheTown OfSouthOld, Suffolk County.New York,and other applicable laws, ordinances or rct-o|-ioosk`rthe excavation herein described, Theapplicayn a0rees to comptv%vith all applicable laws,ordinances,codes and 000| ioos.the oo "General oeceam! Inspections o[thcjob site. RECEIVED Print orTNJ)e \ 05sa*10'- \��-���_L�_ ----�1MJ—~� '--- Name o(App}imnt Ph � ��* �mnArr Address °"'` - _ � Z. ~� / /3 _____ Townrk_______ mamco/ Contmcw, Phone Number Address- --'r-- 3. ... ...��������'����������������..... �� Name vf'PnpN Owner Requesting Service(i[opp|icahc) Address of Ownerion ai d Location Work Descripi 'S I lam let,C1 Yes No _ -Oss Street*if ves, otliel-vown permits may be required. �W� � Ahnrmuuon � mm gucxo ���m ~v, '—' NOTE,: All Application/Permit Form is Required for acomplete application! Date 5 (x) Attached plot plan to reasonably and adr4oum�doo � proposed � work. Provide accurate �osd�mu site plan xhowin&Lhc \ucxhonn[xUprupn�dexcavations and o|mionshiptn adjoiningp 'm\yos.poh|�ooermcvur�a.xnd8jvcodomU*dd*surp/kmof all site and pavement restoration work. (h) Attach all other necessary permits and licenses for this pnqicu. db T*� Clerk. (c) YYorkcovomdhyth� mm opp|ic �oomu?ncommencrbc0orcisauunocofoHi8h*xy2xouvmiuuPcnnkby theTown . u lax Mal) No.: District 1000 Section ' Blnnk 7. SuninuDxu: Completion Date: -__-._--____--- - 8. Work Schcdo|cCorul)le I tion Date Work Schedule �� ~ Excavation \.`L^ Facility Installation "^�= ~~r~`~^~~ ---��� f��oono�uru,�uwxu Buck0)6LCump}o\km Pavement Replacement _ Complete Application. V Under which authority iuapplication being made: __ in�modi�nd�Seelo*oCodrChxp^er2]7 (E)' Pnuvidc Rceo|u000by, nruodhwity 0nm.the Utility be / |0. [sti n1ated Cost o[Proposed Work: J | ! Kv marks: _L J� ' / | (�� ��~~ fr ���� � /°-^`*x ` �`�«^«~-~` /-~ �� /=�--�`=+ � ' � I o� J |)'�4 � � � � os/zz/zozo MO -1-2--30m � ruo �� �� � � 00 03/005 |2. Ins omocrCoverage: (Attach Copy ) (x) }nso,mucCompany: (h) Policy ­- _................ _____� (c)State whether policy of*certification on 01u nith tIn Higim,ay Depmmew: (J)Co'onecrequired extended'othe Town: ------------------------------- AoyLox �dodio&Bodily injury, propcnycvcommercial hnJurycaused hyorattributable tothe work perhunncd: 01,000,000 per 0cconeouc and S 2.000.000 general o,, regxn. |l Sconi/ y: (o) SoroyBond orCcniUcdCheck provided hnthe total Amount o[$__________________. (h)Maintenance Bond provided: _ _2ycxnor ------_______ ] years. N. [ecs0or Applications and permits: 8u Sicaiion [c* S150.00 Al. �� �er,icrConnections excavations $20.00 S No . A2. /Additional Excavations same service(,i�,$0.00 No. B, Excavations 18^ in depth or bo 0-100 |0.00; Additional L[ 6hso.\O $ ________________. C. Excavations 18^ indepth to5' in depth O'|OOLF. : $30.00; Additional $0.30 D. Excavations 51 iodepth and over 0'100LF. ~ S50.00; Additional LF.@$0j0 S _________________ E. ------ _ Utility KcpuirExcovotioos D10.08 No. Repairs same service @$5.00 $ Additional ��~~ TOTAL$ "^ |� Notice mpublic Utilities proo/muahoprovided and Shall 6eattached tothis application prior toissuance o[pcnxk. Authorization ishereby granted m/hcTo»oClerk o[thcToxoo[Southold missue xHighway Excavation permit to: ____ inuxcnn]uucc,,hh UhisnnpGcmion and subject tuthe Conditions"and"Special Conditions"o[ponnit(if vny)attached heroo. A YS — � W1. 0d�ndo ���--- _ ___--___- -__- _— Date Received hythe Town Clerk_ 6-02 — Il ^~^ Date Permit Issued / 0?, — /( Permit No. NOTE: Permit expires one(/)year Uomdate o[bam000. No work, 1nStart vithov|24 hour notice/o8opohmcndomot'Hiphwxyy. Permit most be ovoi}oh|c at all times |o,inspection, on site, during construction. D39 _ 2 o[ 3 �l(o)311 .�59Z /(he Ifb5saoo�°I 4,,e- Pka lot ce- -_ - _ epi ` zCo6,)6 of � MNI D � N i � �u