2003-08-08
PAGGI,MARTIN &DELBENELLP
Consulting Engineers & Land Surveyors
56 Main Street
Poughkeepsie, New York 12601
845-471-7898
845-471-0905 (FAX)
August 8, 2003
RECEIVED
AUG 1 3 2003
TOWN CLERK
Mr. Ron Gehrig
New York State Department of Transportation
4 Burnett Boulevard
Poughkeepsie, New York 12603
Reference: Town of Wappinger Sign and Beautification Program
Route 9 and 9D Permit Application
Dear Mr. Gehrig:
Enclosed please find three (3) copies of the Highway Work Permit Application, PERM 17, and
location maps for the above referenced signs. As you may recall, the Town of Wappinger is
proposing to install signs at two (2) locations on State Route 9 and one on State Route 9D.
Northbound on Route 9 the Town is proposing to install and maintain a sign at the north end of
the guide rail that is south of an existing sign for N & S Supply. According to our records, the
location of the proposed sign was previously investigated and is the site recommended by
NYSDOT personnel.
Southbound on Route 9 the Town is proposing a sign located on the southside ofLiss Road in
front of the Heart KIA auto dealership. The sign would sit within NYSDOT right-of-way a
minimum of 12 feet off the white line.
On Route 9D a sign is proposed on the bank and shoulder of the northbound side of the road. The
sign would be just south of the intersection with Ketchamtown Road and about 12 feet off the
white line.
If you have any questions or require any additional supporting material, please feel free to contact
this office.
Thank you in advance for your time and consideration in this matter.
Very truly yours,
hA19-~~~
9o;;:h E. Stankavage
Junior Design Engineer
JES:law
Enclosure
cc: Hon. Gloria Morse w/enc1osure
Hon. Joseph Ruggiero w/o enclosure
Hon. Graham Foster w/o enclosure
Daniel Wery, AlCP w/o enclosure
Joseph E. Paggi, Jr., P.E.
Ernst Martin, Jr., P.E., 1.5.
Charles R. Del Bene, Jr., P.E.
PERM 33 (8/01)
STATE OF NEW YORK DEPARTMENT OF TRANSPORTATION
HIGHWAY WORK PERMIT APPLICATION FOR NON-UTILITY WORK
PREPARE 3 COPIES
(photocopies acceptable)
Application is hereby made for a highway work permit:
For Joint application, name and address of Second Applicant below:
Name Town of Wappinger
Name
Address 20 Middlebush Rd. PO Box 324
Address
City Wappingers Falls State NY Zip 12590
City
State _ Zip
Federal 1.0. No. or Social Security No. 14-6002488
ApplicantTelephone No. (845) 297-2744
Contact person in case of emergency Joseph Ruggiero
Telephone No. of contact person (845) 297-2744
RETURN PERMIT TO (If different from above):
Name Paggi, Martin & Del Bene, 11P
RETURN OF DEPOSIT/BOND TO (Complete only if different from permittee):
Name
Address
56 Main St.
Address
City Poughkeepsie
State NY Zip 12601
City
State _ Zip
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1. Estimated cost of work being performed in state highway right-of-way $
2. Anticipated duration of work: From Aug. 1,
03 Oct. 31 20 03
20, _thru
, to apply to the operation(s) checked on the reverse side.
3. Protective liability Insurance covered by Policy No. S 16 74492
; expires on November 15
20 03
4. A $20.00 fee will be charged for checks returned by the bank.
Install and maintain signs and plantings within the NYSDOT right
PROPOSED WORK (Brief descriction): C ~. ii' 3:
ot way on State Koutes 9 and 9D. The Town proposes three 3 .Llu;Ld dL.LUUO Luta .
One on Route 9D North south of Ketchamtown Rd. 12'f off the white line, One on Route 9
North at the north end of the guide rail that is south of the existing N&S sign, and
Une on Route 9 South on the south side of 11ss Rd. in fruuL uf MedLL KIA.
ATTACHED: Plans X Specifications LOCATION: State Route 9D, 9 (N) , 9 ( S )state Highway
1048 - 1050 (N)
betweenReferenceMarker 9D 8203 3050 - 3051,9 8205 andReferenceMarker~ 8205 1085 - 1087(S)
Town of:
Wappinger
Dutchess
County of:
SEQR REQUIREMENTS (Check appropriate item):
-L Exempt Ministeriai _ Type 11
Ers or DEIS
LeadAgency Town of Wappinger Town Board
If project is identified to be ministerial, exempt, or TYPE 11, no further action is required.
If project is determined to be other than ministerial, exempt, or TYPE 11, refer to M.A.P.7.12-2, Appendix A SEQR REQUIREMENTS FOR HIGHWAY WORK PERMITS.
Acceptance of the requested permit sU9jects the ~miltee to the re?trictions, regulations and obligations stated on this application and on the permit.
. . /\....,(. ,t, /:/, '. ..; I. . c::./IV .,'~
Applicant Slgnature'-r"'//,-,, L~,,.- /', v'''-;? ~ ,._<-e\_~~, Date .:> .' 20 ,,__
I f~ . .
Second Applicant Signature
Date
20
PERMIT IS ISSUED CONTINGENT UPON LOCAL REQUIREMENTS BEING SATISFIED.
Permit Insurance Perm 17 Total Amount
CHECK TYPE OF OPERATION or Under of Fee and/or
Fee Fee Taking Insurance
5. 0 Single job - Permit issued for each job
a. 0 Driveway or roadway
1. 0 Residential $ 15 $ 25
2. 0 Commercial - Minor 550 175
a. 0 Home Business 100 75
3. 0 Commercial- Major - (Less than 100,000 square feet
Gross Building Area) 1400 N/A
4. 0 Commercial- Major - (100,000 square feet Gross Actual cost with N/A
Building Area and Greater) Minimum of $2000
upon permit app.
5. 0 Subdivision Street 900 N/A
6. 0 Temporary access road or street 200 150
b. 0 Improvement
1. 0 Residential 15 25
2. 0 Commercial
Check additional description below:
a. 0 Install sidewalk, curb paving, stabilized shoulder, 200 150
drainage, etc.
b. 0 Grade, seed, improve land contour, clear land of 100 75
brush, etc.
c. 0 Resurface existing roadway or driveway 50 50 rTi
d. 0 Annual resurfacing of residential and commercial ~
roadways or driveways. J:J
1. 0 Per County 150 N/A 0
2. 0 Per Region 400 N/A <=
1:1
c. 0 Tree Work ~
1. 0 Residential 15 25 C3
2. 0 Commercial (not required for pruning if utility has annual 25 50 ~
maintenance permit)
Check additional description below: :::l
0
a. 0 Removal or planting <=
b. 0 Pruning, applying chemicals to stumps, etc.
3. 0 Vegetation control for advertising signs 150/sign 75
d.~Miscellaneous Construction
1. ~ Beautifying ROW - (for Civic Groups only) NC 25
2. 0 Temporary signs, banners, holiday decorations
a. 0 Not-for-profit organizations NC 25
b. 0 Organizations other than not-for-profit 25 25
3. 0 Traffic control signals 500 175
4. 0 Warning and entrance signs 25 50
5. 0 Miscellaneous - Requiring substantial review 400 175
6. 0 Miscellaneous 25 50
6. 0 Encroachment caused by D.O.T. acquisition of property 25 50
7. 0 Compulsory permit required for work performed at the request of D.O.T.
a. CJ Building demolition or moving requested by D.O.T. NC 25
1. 0 Demolition 2. 0 Moving
b. 0 Improvement to meet Department standards NC 25
8. 0 Miscellaneous 25 25
9. 0 Adopt a Highway NC N/A
Guarantee Deposit Check Number or Bond Number PERM 33 (8/01)
REVERSE
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STATE OF NEW YORK
DEP ARTMENT OF TRANSPORTATION
Highway Permit Section
1220 Washing'to!1Avettue
Bldg. 5, Room 311
Albany. 'New York 12232-0466
(518)457-1155 1.888.783-1685
~\lED
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$UPe.~"'Of. SO:"PP\NGER
TOWN
CERTIFICATE OF INSURANCE FOR SPECIAL HAULING, DIVISIBLE LOAD \\-'EIGHT
A."m BIGHW AY WORK PERMIT INStllUNCE REQUIREMENTS
To be prepared by insurance aimt or insurance company
I
If a Permit Ac~ount 'Number na.~ btcn <::slabhshtC
tor the Permit Applicant, ;I1e AccOIlI'lI Number
mu.t be indicated aboV1!.
I, Name ofPennit Applicant: TO\llll1 of Wappinger, Attn: Joseph Ruggiero
(NAAeONlNSUl'tANCE atll.'m1CA1'IANDI'ERMi1' ARLICAnONMUSTBtIDENTIC\L- ON!!: !'lAMe ONty)
(Note: If CBA, also provide Name of l.gal entity and Copy of "Certificate .,f Conducting Business under an
Assumed NGlme; that was filed In County Clerk', OHio. - 9.g. John Jones dbe .Jones Trueklng)
2. Address of Permit Applicant 20 Middlebush Rd Wa in ers Falls NY 12590
i i"LEASE CHECK HltRE IF TillS IS A CWoNCE OF ADDRESS
3. Telephone Number of Permit Applicant: 845-297.2744
4. Name of :;Jermit Applicant Contact Person Graham Foster
Sa. Motor Vehicle Liability Pclicy Number S 1323145
Binders. (.;11; tOpie$ and unalaiigncd policy nUlnber~ valid for 30 dllY$ only
5b. Effective Date 01-22-03
Expiration Date; 01- 22-04
TIle wording "CQnlinuola Until ClIncCIJe<l" in pliQC of expiration date i~ acceptAble
6a. Protective Liability Policy Number S 1674492
!, Binders, fax eopif.ll linG unaSliened policy numbers valid for 30 days only
Expiration Date: 11-15-03
The Wording "Continuous Until C:ancelled" in plsc~ of expiranon dare is acceptable
6b. Effective Date 11-15-02
nus CERTli'(CATE Olf INSURANCE WILL SUPJi:RSEDE .'\LL OTHER CERTIFlCATES OF INstJRANCE NOW ON FD..E WITH THE
DEPARTMtNT OF TRANSPORT!\. TION; . EXCEPT FOR HIGHWAY WORK PERMIts, UNLESS SPEClFlCALL Y NOTtD.
IItbe Permit Applicant is applying for a Divisible Load Weight Permit, the information must be as it appears On the! Applicant's
Motor Vehicle Registration.
Liability insuranu must be io effect for the full term of tbe Permit. Expiration of, or lack ot~ liability insurance automatically
terminates the Permit.
Permittees are responsible for providing the Certificate or Insurance to the Department of l'ransportation, and for renewing the
requi.$ite insurance coverage 110 later 1han two (Z) week:lJ prior to its apiratioD in order to renew, to keep in t!f~t, or to obtain a
new Higl1way Permit. Altered cer1if1cates will NOT be accepted. Fax copies wiD be accepted for a period of 30 days only. FAX TO:
518-457-1036. Original Certificate must be received in this omce Within tbe 30 day period.
In aceOt'dance with Department ofT~ortation requirements (See NYCRR, Title 17, Part 154), the subscl'ib~ iIwumnce company
hereby ccrtWe$ that a protective liability insurance policy (only option tor Highway Work Permits) or, in the alternative, aIrotor vehicle
insurance policy ;md endo~ement has been issued to the pemtit applicant:
A. if a protective liability IDsuranc~ policy, tOr the protection of the People of the State of New York. all municlpal subdlvisions
thereof, and the Commissioner and Department of Thwsportation. the New York State Thruv,-ay Authority, the State Bridge.
Authority :l.11Q their officials, officers, and employees ;1S named lns\ll'ecls, (and no other eo-illSunds), r.overing bodily 4'1J1.11'/
(mcI~ rleath) with mmimwn limits of $500.000 each occmence JDd covering property damage ',vith mimmum limits , f
$100,000 each accident and mJDimum aggregate annu.a.l1imits of $500,000, against aC110DS resulting nom use of a Highway P e rmi t
by tho Pemuttee Of by Jl1Y pel~n actmg by, through or fer TM Permittee, including omissions and supervtscry ar,1Sof :my 0 f the
a.amedinsureds;or
B. if a motor 'fehicle :.nsuxance policy aIld mdorserr.ent. \vith the People of the State of New York. all municipal subdiVISions the re 0 f,
and thc.Comnussioner and DepartmontofTransponatiol1, the New York State Tbru'W8y Authority, ;:he State Bndge Authorit)' :md
their officials, otncers. and elTl1'loyees as additional insureds u.r:uierthe ;?olicy, cowmng bodily injury (bcluding death) ''11th
minimum limits 01'$750,000 each occurrence and coveriDg property damagemth rninimt.unlimits of $250,000 .each "~Ctl~.t~,nc_~_.
or $1 million dollars combined.siDgle limit eacho~UtTence. ... . _._" ..." . '-"'" '..
PERM17 60/01)
Reverse Side MUST Be Completed
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I\tVeRS~
The subscnbmg insurance company issuing a protective liability insurance policy pursuant to A or a moter vehicle
insurance policy.pursuant to B above, further certifies and agrees that the insu.-ance policy referred tom-einshall not~
changed or cancened; unless
1. all trips authorized by the Highway Per:nit have been made; or
2_ the effective period of the Highway Permit has expired; or
3. in the case ofa Highway Work Pennit. all work authorized has been completed and accepted by the Department of
Transportation; or
4. 30 days \vritten notice has been given to the Department ofTranspOrtition that the policy will be cancelled.
Any subscribing insW1U1ce company providing insurance pursuant to A or B (see front), certifies and agrees that such insurance
policy shall not be cancelled until tlllrty (30) days written cancellation notice has been given the New Yark Stlte Department of
Transportation, indicating the permit applicanfs name. permit aCcoilllt number (obtain from permit applic,mt), address, and policy
number. Notice of reinstatement must be made by a reinstatement notice or a completed Certificate of Insurance (pERM 17) ;md
sent to the Department of Transportation to the attention of the Highway Permit Section.
'This certificate is furnished in accordance with the rules and regulations of the New York State Department of
Transportation pertainiDg to Bll:~ay Permits. Using ONE Certificate of InsW'ance (pERM 11), please indicate the types
of permit(s) obtained from the . :way Permit SeetiOI1 in the Department ofTranspomtioD by ehecking the appropriate
boxlbox(es). A Certificate 'of Insurance (perm 17) is the acceptable proof of insurance. A copy of the actual poHcy is not
required. PLEASE DO NOT SEND ACCORD FORMS, INSURANCE CARDS, ETC.
PLEASE CHECK BOX(ES) FOR EACH TIPE(S) OF PERMIT(S) OBT ~"ED FROM THE DEPARTMENT OF
TR-\NSPORT A TION HIGHWAY PERMIT SECTION .
[] RESTRICTED VEHICLE PERJ\1ITS (Parkways)
[] SPECIAL HAULING PER.\1ITS (Used for Transporting Over.Dimensional or Over.Weight Non-Divisible
ltetr.s OIl Highways ex: mobtle homes, equipment. buildings. etc.)
(] DIVISIBLE LOAD WEIGHT (Used for Transporting Over.Wei~t Divisible Loads on Highways ex: sand.
gravel, etc.)
[ x ] WORK PERMITS (Used for li1stalling or Maintainmg Facilities on Highway Property - coverage in such case shall be
wri~n ouly as protective liability insurance pOlicy) and shall also include completed operations liability insurance with
respect to liability imposed by law arising between the date of fmal cessation work pursuant to the WakP\:zmit and
the date of fi1W acceptance of such work by the Stare.
CR!
Selective Insurance Co.
NlImt ot' In.uran" Company
40 Wantage Ave.
Braneh....il\e. NJ 07890
Addrtu of InSllrance Company
JohnR. Peluse. ice President
t\u*'oriRd NallM of IlUurallC. ACtl1t (phl.lie Print)
66 Middlebush Rd., Suite 200
Wa~1)ingers Falls, NY 12590-4047
Addra. Ot'WllraJlC. Acent
800.777.9656
Tcle?hone No. "C Insuranc. Company
845-297-1700
Te~pllollCl No. of Insuranc. Agetlt
MISCELL~NECUS DATA:
Operanng Authority (check as appropriate -- if penmt Applicant.h.;u DOT ~'r ICe authority to operate in New York State. 'he
a.uthority mUlt be identified by number and. ifnot so authonzed, check Private)
[] Priva te
~ j DOT Number
[ J ICe Nwnber
INSTALL SIGN WITHIN RIGHT-OF-WAY
IN FRONT OF HEART KIA 12 FT. :I: OFF
OF THE WHITE LINE. SIGN LOCATION
AS SHOWN IS APPROXIMATE.
PREPARED BY,
PAGGI, MARTIN & DEL BENE, LLP.
ONSUL TING ENGINEERS AND LAND SURVEYORS
56 MAIN STREET
POUGHKEEPSIE NEW YORK 12601
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1" = 800' 7/25/03
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FllEDEllll 'K P. t 'LAllK ASS()(,L\TES, INC,
\I ill'l'l,',tam SIW, ANlllll!:AII nFtt:ATlON I'IH)GRA~I
..II , IERI,,\lE LUCAlll)N MAP
Plannil1g. f)en;/oj1I11e.llt"Elll'il oll/IICIII j('lIHJ'(J/ldt/(J/I
r"I'Jlllf\\ldl'l'il\!;"L })lllel1":$$ COUlIl.\'_ n~w Ytllk
lJOn~
TIM. m,l\! WJ~ I"llllllllbllrolll H\ullil)l~ u.1l~5i:b wilh ditr~I<l1l1 scalt:5 and
~'lOj('~ li"ll~ ~llll Sh"ldu t'llly I....:: Il';~ll for gcnuall'hmmllg I'llTI'OSC5
SUU RCE
Digiti! acrialoIUK1pholography and IOllincs acquired from
DlltchllSS ('01Ulty GIS Lab. 2002
o
200 Feet
~
r-tll"11200l
WAPPINGER SIGN ANlJ BEAUTIFICATION PROGRAM
\l,TERNATE I,UCATlllN l\IAP - RUllt~ 9D
10WII of W:.JJlpill!;~1'. Dulchc$~ COllll!r, N~w \\)rk
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NIJlE
1111>' nlJI' v.as l.C\'llll'il-:J Ih'll\ lI1Ullll'!.:: UJIJscb with dHl"rclll scal<l$ and
projc:clil'IlS awl ~h"I.lM ('Illlr b.: It:;~cl for g~n~ral planning )Iurpo!:cs
SOURCE
Digital aerial orUlOpholograph}':md lot lines acquired from
Dutchess COlDll)' GIS Lab, 2002.
FREDERICK r. Cl ARK .~SSOl'Ii\ ms, IN('.
Planl1iI1giJJel1elopmel1f/E1l1'irmlmellfi 7/011.'1/11)1 '1(11 11m
IWIFed
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