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Home My WebLink AboutTurtle Gobal MediaL O�iryJ ��'•KLIST m N CLE S CHEC unTF,: All payments must be cash or certified check' Completed application ,1/$ 100 nonrefundable application fee Certificate of insurance that evidences ublic liability insurof $1,000 olio covering the town as an additional insured ,000 (one million dollars) per occurrence for the duration of the filming or still photography. Indemnification agreement stating the applicant agrees to assume all ree liability for and will indemnify and hold the town harmlesspof and f reason of from any and all damages that occur to persons or property by said filming or still photography. Forward completed application to Chief of Police for approval or disapproval and determination if Traffic Control Fee is required Approved Disapproved No Fee Required re uired Fee in the amount of $ aool q Forward certificate of insurance and indemnification agreement to Town Attorney for approval Approved Disapproved COLLECT —FE —ES AS FOLLOWS: permit Fees (Prior to issuance of permit): 00:0 Film Fee - $100 per day of each day covered by the permit Cleanup deposit: Separate certified check for $250 for each day covered by the permit. Traffic control fee - $1000 for each day covered y smaythe permit if rebe required byired by the Chief of Police. NOTE: Additional fund AW. 11 police if it is determined that $1000per day fee will be expended prior to 6 the termination of the permit period r Beach Parking fee - $10 per vehicle, per day between May 1 and September 30. ISSUED PERMIT Countersign application ./ Issue permit with name of applicant, locations(s), date(s), and time(s) NOTIFICATION of ISSUED PERMIT �/ Chief of Police Chief Building Inspector l Fire Marshal //Code Enforcement Officer Superintendent of Highways Superintendent of Parks and Recreation REQUEST FOR EXTENSION OF PERMIT Forward extension permit request to Chief of Police granted, collect additional $100 per day filming fee Amend 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. Check # Town of Southold BILL OF Turtle Golbal Media, Inc.. Vendor No. . . . . . . . . .. . . . . Invoice No. . . . . . . . . . . . . . . Invoice Date .5/.3/01 .. . . . . . . . Y Amount Claimed $ . .251;.,50. . . . Purchase Order No. . . . .. . . . . For Services and Disbursements as Refund for Traffic Control ...F....ilming .P...ermi.t..N..o. 00... 2.... Fund and Account ......... . Entered by . .. ... . . ... . . . . Allowed, $ ............ . Audited .. May ..8... , 19c 2001. ............... I....... Town Clerk Too Southold, New York - Stand"ucher PAY TO: Payee Tax Identification Number Payee Name: or Social Security Number: Address: Turle Global Media, Inc. Payee Reference 12833 Chalon Rd Pay Invoice Number Los Angeles, CA 90049 Invoice Date 513101 Purchase Order Number P.O. Date Phone No. (_ Vendor Contact Cash Discount Item Number Description of Materials / ServicesUnit Quantity Price Amount Refund for Traffic Control _ Remitted 1200.00 • actual cost 256.5 was Total Net Payee Certification The undersigned (Claimant) (Acting on behalf of the above named claimant) does hereby certify that the foregoing claim is t�ue and that no part has been paid, except as therein stated, and that the balance therein stated is actually due and owing. Signature Title Dated 256.50 and correct Department Certification I hereby certify that the materials above specified have been received by me in good condition without substitution, the ser ices properly performed an t the quantities the f en verified with the exceptions or discrepancies noted, and payment is Sig tnre le Town Clerk Dated 5/3/01 ELI TH A. NEVILLE, TOWN CLERK Town of Southold Southold, New York 11971 Phone: 631-765-1800 RECEIPT #002b Turtle, Global Media Inc. Lawrence Elmer Fuhrmann, Jr. 184 Franklin St., #10 New York, NY 10013 Received $ 1,200.00 1 -Traffic Control Fee on 04/27/2001. Thank you. 0 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD May 3, 2001 Turtle Global Media, Inc. 12833 Chalon Rd. Los Angeles, CA 90049 Dear Sir or Madam: Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 Enclosed herewith is a copy of the cost statement from Chief Cochran of the Southold Town Police concerning the Traffic Control fee for the filming that took place on April 27 and April 28, 2001 in Southold Town. A total of $1200.00 was collected for the Traffic Control fee, but only $943.50 was actually required. A refund check of $256.50 will be issued within the month. Very truly yours, Linda J. Cooper Deputy Town Clerk • 0 POLICE DEPA MENT TOWN Of 6OUTOLD CARLISLE E. COCHRAN, JR. Chief of Police Telephone Emergency Dial 911 V t. ,( MEMORANDUM MAY 3 2M *Qurtw60 19Wn C &lk TO: Linda Cooper, Deputy Town Clerk FROM: Chief Carlisle E. Cochran, DATE: May 3, 2001 RE: Filming Permit No. 2-2001 - Lawrence Elmer Fuhrmann, Jr./Turtle Global Media The actual cost for the police detail with reference to Permit No. 2-2001 is SH3.51. 41405 Route 25 - P.O. Box 911 - Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 - Fax (631) 765-2715 • • O • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper, Deputy Town Clerk Dated: May 2, 2001 Re: Traffic Control Cost Statement Just a reminder that a cost statement is due for the Filming Permit No. 002 issued to Turtle Global Media • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Received by: °�OS�FFO(,�COG y< CA Z • OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Returned to: Turtle Global Media Inc. $250.00 Cash Deposit for Cleanup 'Y4?zl� Date JessI 01+J V/9 -IS Print Name and Title Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 S 04/30/2001 MON 23:03 FAX 30/04 'ol MON 08:51 FAX 516 760145 ELIZA=TH A. NEVI.LLE TOWN CLERK REGISTRAR OF vrrAL STATISTICS MARRTAGE OFFICER RECORDS MANAGEMENT orFICER FREEDOM OF INFORMATION OFFICER SOUMOLD CLERK OFFICE OF THE TOWN CLEKE: TOWN OF SOUTHOLD To: Raymond Jacobs, Superintendent of Highways From,: Linda J. Cooper, Deputy Town Clerk Dated: April 30, 2001 Re: Film Permit No. 002 Cleanup Deposit Z001/001 HiShwa-4 Dept 14001 Tvwxi Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6146 Telephone (631) 765-1800 In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 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) idcntified on the permit. The deposit may be ,returned. Cleanup was required. Actual cost statement is attached. 0 -41-— L30 — el Date C] ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o�OS�FfO(,�coG o� y� Go Z OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police Mike Verity, Senior Building Inspector Fire Marshal Ed Forrester, Code Enforcement Officer Raymond Jacobs, Superintendent of Highways Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 From: Linda J. Cooper, Deputy Town Clerk Dated: April 27, 2001 Re: Filming Permit No. 002 In accordance with Town Code 44A-9 you are being notified that a Film Permit was issued to Turtle Global Media, Inc. See following page for a copy of the permit. ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 FILMING/STILL PHOTOGRAPHY Issued to: PERMIT TURTLE GLOBAL MEDIA, INC., Lawrence Elmer Fuhrmann Jr. Co-producer Date(s), Time(s) and Location Friday, April 27, 2001 and Saturday, April 28, 2001 6:00 A.M. to 10:00 P.M. Soundview Avenue between Kenny's Road, Southold and Mill Road, Peconic Permit No. 002 Issue Date: April 26, 2001 1�� Elizabeth A. Neville Southold Town Clerk 0 0 '01 MON 08:51 FAX 516 765 6145 TRANSMISSION OK TX/RX NO CONNECTION TEL CONNECTION ID ST. TIME USAGE T PGS. SENT RESULT ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER SOUTHOLD CLERK x� TX REPORT 2454 7651750 Highway Dept 30/04 08:51 00'34 1 OK OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Raymond Jacobs, Superintendent of Highways From.: Linda J. Cooper, Deputy Town Clerk Dated: April 30, 2001 Re: Film permit No. 002 Cleanup Deposit 2001 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 Cleanup deposit may be returned to the applicant; if riot, 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 retumed. Cleanup was required. Actual cost statement is attached. Signature Date • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o��S�FfO�,�cOG s� H Z Town Hall, 53095 Main Road P.O. Box 1179 IS LJ OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 To: Raymond Jacobs, Superintendent of Highways From: Linda J. Cooper, Deputy Town Clerk Dated: April 30, 2001 Re: Film Permit No. 002 Cleanup Deposit In accordance with §44A-5 of the Southold Town Code, please advise if the $250.00 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 • 0 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR. OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o��g�FFO�,�cOG co y� to Z OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD RECEIPT $1200.00 Traffic Control All Cash Lawrence Elmer Fuhrmann, Jr. of Turtle Global Media, Inc. Film Permit No. 002 Received by Z Dated: April 27 2001 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD RECEIPT $1200.00 All.Cash Lawrence Elmer Fuhrmann, Jr. of Turtle Global Media, Inc. Film Permit No. 002 Received by Dated: April 217 2001 P Town Hall, 53095 Main Road P.O. Box 1.179 Southold, New York 11971 Fax (631) 765-6145 Telephone'(631) 765-1800 POLICE DEPA MENT TOWN Of (�,OUTKOLD Telephone Emergency Dial 911 MEMORANDUM CARLISLE E. COCHRAN, JR. Chief of Police TO: Linda Cooper, Deputy Town Clerk FROM: Carlisle E. Cochran, Jr., Chief of Police DATE: April 26, 2001 RE: Filming Permit - Lawrence Elmer Fuhrmann, Jr/Turtle Global Media The application for filming is approved. After a review of the area, it reveals that they will need one (1) Police Officer at approximately $1,200 for the two (2) days of filming. 41405 Route 25 • P.O. Box 911 • Peconic, N.Y. 11958 Administrative (631) 765-2600/2601 • Fax (631) 765-2715 0 • 0 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR, OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER $100.00 $200.00 $25.0.00 All Cash OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Application Fee Daily fee Clean up Deposit RECEIPT Lawrence Elmer Fuhrmann, Jr. of Turtle Global Media, Inc. Film Permit No. 002 Received by 1 A Dated: April 26, 2001 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New.York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 ____ ___ T • • 0 ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATIS'T'ICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER 0 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 To: Southold Town Attorney's Office From: Linda J. Cooper Dated: 4/26/01 Re: Filming Permit In accordance with the Southold Town Code, Chapter 44A, Section 3, Subsection D, the Certificate of Insurance and Indemnification Agreement for Lawrence Elmer Fuhrmann, Jr. of Turtle Global Media, Inc. . is attached hereto. Please review and advise whether these documents meet with your approval. Thank you. Approved as submitted Disapprove for the following reasons: �G Signa t e 4-2f�-01 Date ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Chief Cochran, STPD From: Linda Cooper, Deputy Town Clerk Dated: April 26, 2001 Number of Pages (including cover): 3 If total transmittal is not received, please call 765-1800. COMMENTS: Film permit request. Will send hard copy by interdepartmental mail. • ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER o��Spf F0(cz ,�coG N Z aye ♦ o�I-In • OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD To: Chief Cochran, Southold Town Police From: Linda J. Cooper Dated: 4/26/01 Re: Filming Permit Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 Transmitted herewith is the application of _Lawrence Elmer Fuhrmann, Jr. of Turtle Global Media, Inc. 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. INDEMNIFICATION AGREEMENT TOWN OF SOUTHOLD FILMING/STILL PHOTOGRAPHY PERMIT The Applicant shall indemnify and hold harmless the Town from and against all suits, claims, demands or actions for any damage and/or injury sustained or alleged to be sustained by any party or parties in connection with the performance of filming or still photography by the Applicant, his employees or agents or any subcontractor and in case of any such action brought against the Town, the applicant shall immediately take charge of and defend the same at his own cost and expense. In addition, the Applicant will name the Town as an additional insured on any applicable policies. ;tU Signature Date L c-WIPnCf r::,WCO nn �f Printed name CD - aaoca Title Client : 125447 TURTLEGLOB CERTIFI TE OF LIABILITY INS ANCEDATE(MMIpWyY) 03/29/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Near North Insurance Brokerage ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE of New York, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 777 Third Ave. 17th Floor ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. New York, NY 10 017 INSURERS AFFORDING COVERAGE INSURED INSURERA: Mass Bay Insurance Company Turtle Global Media, Inc. INSURER B: Hanover 12833 Chalon Road INSURER c: 184 Franklin Street, #10 INSURER D: New York, NY 10013 INSURER E: COVERAGES 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DA POLICY EXPIRATION DA LIMITS A GENERAL UA131UTY B I NDER2 8 3 7 2 3 03/29/01 06/23/01 EACH OCCURRENCE $1 000,000 X I COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR FIRE DAMAGE (Any one fire) $100,000 MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $1,000,000 HGEN'L GENERAL AGGREGATE s2,000,000 AGGREGATE LIMITAPPLIES PER: POLICYPRO- LOC PRODUCTS-COMP/OP AGG $2,000,000 A AUTOMOBILE LIABILITY ANY AUTO B I MER2 8 3 7 2 3 03/29/01 06/23/01 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ X X HIRED AUTOS NON -OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ _ OTHER THAN EA ACC $ AUTO ONLY: AGG $ ANY AUTO EXCESS LIABILITY OCCUR FICLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION AND B INDER2 8 3 7 3 3 03/29/01 0 3/ 2 9/ 0 2WC STATu- OTH- EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1 0 0 0 0 0 0 A OTHER Camera & isc. Equipment hirdPart Pro Da BINDER283723 Replacement Cost Worldwide Special 03/29/01 06/23/01 Limit/Deductible $400,000/$2,000 $1,000,000/$1,500 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS The Certificate Holder is included as additional insured with respect to claims arising from negligence of the Named Insured. HOLDER The Town of Southold Southold Town Hall 53095 Main Road PO Box 1179 Southold, NY 11971 SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3_0___DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAM ED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON TH E INSURERJTS AGENTS OR REPRESENTATIVE -w- w k-".1. U1 G {F -S 1/ U U G91 O ACORD CORPORATION 1988 TOWN OF SOUTHOLD APPLICATION FOR FILMING/STILL PHOTOGRAPHY PLEASE PRINT OR TYPE I 0Z APPLICATION DATE: qI Irl«L�` tw� PERMIT NO: L NAME OF APPLICANT: [�/��I�A�/CsC�q�-P-05- &Y ' � DQAILING ADDRESS: /� % /L �//V l�LIA �! K05- I /� &Y / oo« _- PHONE: BUSINESS CY i k JJ . �$ /r NAME OF ORGANIZATION, COMPANY: cj�R-T E 67 L � V V I l L�� / N C, . MAILING AbbRESS: 10 J J V 6/ V e/ t-6 L s AVC, PTS . rA 160y9 PEONS: - FAX 61s I . iitii Yiif if�ii M.Y•.j,j/l yr YfWilj}�1"kiYr#iYw#fw#i#w*#i1}#}}*t►t}ii}lt ttiY f�tf if DESCRIBE TYPE OF ACTIVITY (e.g. Motion picture, Commercial, Television, Catalog, Magazine, etc.): (%nDr'l p cTy kc - DATES) AND TIME(8) OF PROPOSED VILMIOG/PHOTOGRAPHY: y. , 01 -t-,q j f 3 bl Ggrn 8Pm PROPOSED LOCATION(S) OF FILMING/PHOTO(IRAPHY: attach additional abeet, it neceeeary. So tjN -I) V �J fix/, �e-rw� ��n�YS ��'l�c�..2� so��,> NAbM OF PERSON IN CSARAB AT SITE: NUMBER OF PERSONS AT LOCATION (CAST & CREW INCLUDED): q NUMHBR AND TYPE OF vENYCLES AT LOCATION, i I CC CS TYPE OF SPECIAL RQUIPMEW1 ; PP-nC r5S TFI l ej� T -S 60 IPA i La + PO L lfb BY ANY 3PECZAI, REQUIR$bSENTB: 'TkUCAK, sigr:ature Return to: Southold Town Clerk Southold Town Hall 53095 Main Road P. O. Box 1179 Southold, NY 11971 DECEIVED APR 2 6 2001 �v noia lawn Clerk