2003-08-08 (2)
PAGGI,MARTIN &DELBENELLP
Consulting Engineers & Land Surveyors
56 Main Street
Poughkeepsie, New York 12601
845-471-7898
845-471-0905 (FAX)
RECEIVED
AUG 1 3 2003
August 8, 2003
TOWN CLERK
Mr. PatrickF. Gilheany
Assistant Right-of-Way Agent
New York State Department of Transportation
4 Burnett Boulevard
Poughkeepsie, New York 12603
Reference: Town of Wappinger Beautification
Dear Mr. Gilheany:
Enclosed please find a Highway Work Permit Application for the installation of a
historical remembrance. The Town of Wappinger has proposed to install the
remembrance in the grass triangle at the intersection of New Hackensack Road, All
Angels Hill Road, and State Route 376. This remembrance will be installed and
maintained in concert with the existing war memorial on All Angels Hill Road, MIA, and
the Village ofWappingers Falls.
Three (3) copies of the application along with the PERM 17 and location map are
enclosed with this letter for your use.
If you have any questions or require additional supporting materials, please feel free to
contact this office.
Thank you in advance for your consideration in this matter.
Very truly yours,
~~
Junior Design Engineer
JES:law
Enclosure
cc: Hon. Gloria Morse w/enclosure
Hon. Joseph Ruggiero w/o enclosure
Hon. Graham Foster w/o enclosure
Daniel Wery, AICP w/o enclosure
Joseph E. Paggi, Jr., P.E.
Ernst Martin, Jr., P.E., L.S.
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 ~ Zip 12590
City
State _ Zip
Federal 1.0. No. or Social Security No. 14-6002488
Applicant Telephone 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, LLP
RETURN OF DEPOSIT/BOND TO (Complete only if different from permittee):
Name
Address
56 Main St.
Address
City Poughkeepsie
State ~ZiP 12601
City
Slate _ Zip
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1. Estimated cost of work being performed in state highway right-of-way $
.. d . f k F Aug. 1,
2. Anticipate duration 0 wor: rom
20, ~thru Oct. 31 ,20 03
, to apply to the operation(s) checked on the reverse side.
3. Protective Liability Insurance covered by Policy No. S 16 7 44 9 2
;expireson November 15
20 03
4. A $20.00 fee will be charged for checks returned by the bank.
PROPOSED WORK (Brief description): Install and maintain a historical remembrance in concert with the
existing War Memorial on All Angels Rd., MIA, and the Village of Wappingers Falls at
the intersection of New Hackensack Rd., All Angels Hill Rd., and State Route 376 in
the grass triangle at the intersection.
between Reference Marker
376 8201 1079
and Reference Marker
376 State Highway
376 8201 1081
ATTACHED: Plans X
Specifications
LOCATION: State Route
Town of:
Wappinger
C Dutchess
ounty of:
SEQR REQUIREMENTS (Check appropriate item):
~ Exempt Ministeriai _ Type 11
EIS 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. reter to MAP.7.12-2, Appendix A SEaR REQUIREMENTS FOR HIGHWAY WORK PERMITS.
/;,cceptance at the ;eguested perm.it SUbJe~t~'1e perm, lite. €i to the ~trictions. regulations and obl:ga o:~stated on thiS application and on the permit. .
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Applicant Signature (I ";/1' '. , ..' {-<.-. ~ Date ..' 20 ~.
I." .,
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Second Applicant Sillflature Date 20
PERMIT IS ISSUED CONTINGENT UPON LOCAL REQUIREMENTS BEING SATISFIED.
STATE OF NEW YORK.
DEP ARTMENT OF TRANSPORTATION
Highway Permit $e(!tion
1220 Washington Avenue
Bldg. 5, Room J 11
Albany, New York 12232-0466
(518) 457.1155 1-888-783-1685
1- _
If:\ Permit Account Number h~s be~ est:lbli~hed
for the P~mrit Applic:\n\, :\:0;: Account Number
J!!.Y!lbe indicated above.
CERTIFICATE OF INSURANCE FOR SPECIAL HAULING, DIVISIBLE LOAD \\-'EIGHT
AND mGHWAY WORK PERMIT INSURANCE REQUIREMENTS
To be prepared by insunmcc; agent or Insurance company
1. Name of Pennit Applicant Town of WapPInger, Ann: Joseph RUl!;?;iero
(NAMi ON 1I'lSlJRANCl: ClRnnCA'tt ..\NDPERMJT AJlPLICAnON MUS1' BE IDENTICAL - 01'.;' NAME ONLY)
(Note: If DBA. also orovide Name of legal Entity and COPY of .Certificate of Conducting 8usiness under an
Assumed Nam.~ that was filed in County Clerk's Office - e.g. JQhn Jones dba Jones Trucking)
2. Address of Permit Applicant 20 Middlebush Rd Wa in ~rs Falls NY 12590
PLEASE CHECK UERtlP THIS IS A CHANGE OF ADDIU::SS
3. Telephone Number of Permit Applicant 845-297-2744
4. Name ofpemrit Applicant Contact Person Graham Foster
5a.. Motor Vehicle Liability Policy Number S 1323145
Binders, fax copies and unuait;m\G poli~ numbers valid for- 30 I1I1Y~ only
Sb. Effective Dats 0] .22.03
Expiration Date: 01-22-04
The w(ll'(jing "Continuous Until Cancelled" in place of expiration dale j~ acceptable
6a. Protective Liability Folicy Number S1674492
Binders, fax copies and unassisned poliey numbt(s valid for ~O days only
Expiration Date: 11-15-03
The Wording "CQ1ltlnuous Until Cancell"d" ill place of expiration cate is ilcccptable
6b. Effective Date 11-15-02
TIUS CE~TIFICATE 0' INSURANCE WILL S~PER$EDE Al.L OTHER CEJt.TIFICATES Oil INSURANCE NOW ON FILE WITH THE
DEP AR'I'l\tENT OF TRANSPORT ^ TION; EXCEPT FOR HIGHWA v WORK PERMITS, UNLESS SPEC1FICALL Y NOTED.
If the Permit Applicant is applying for a Divisible Load Weight Permit, the information must be as it appears on the Appli~antts
Motor Yebicle Registration.
Liability insurance must be in effect tor the full term of the Permit. Expiration of, Qr lack ot~ liabili~' insur.mce automatically
terminata the Permit.
Permittees ar~ responsible for providing the Certificate or Insurance to the Department of l'ransportation, and for renewing the
reqwsite insurance coverage no later than two (2) weeks prior to its expiration in order to renew, to keep in effect, or to obtain a
nfM' Highway Permit. Altered certificates will NOT be accepted. Fax copies will be accepted for a period of 30 days only. FAX TO:
518-457.1036. Ori~nal Certitlcate must be received in this office within the 30 day period.
In accordanoe with Dej)artment of Transportation requirements (See NYCRR, Title 17, Part 1.54). the subscribing insurance company
hereby certifles that a pro*tive liability insurance policy (only option for Highway Work PermIts) or, in the 3Itemati'!e,~nlOtrn'':",~~icie
insurance policy and endorsement'has been issued to the permit applicant: '
A. if a protective liability insurance policy, for the protection of the People of the State of New York, all n1~ipal subdivisions
thereoI~ a.Dd th~ Commissioner and Deparonmt of Tnnsportation, the New York State Tlwway Authority, me State Bridge
Authority and their officials, otfic~rs, and erlll'loyees aI named insureds, (and no other co-insureds), covering bodily alju.'Y
(incl~ death) with ;ninimum limits of $500,000 each occUI1'CQce and l;overmg property damage with minimum limitt 0 f
$100,000 each accident and m.111im:u.m aggregate an.'lual limits ofS500,OOQ, against actions resultmg from use of a Highway P crmi!
by the Pennittee or by any pason acting by, wough or for the Permittee, including omissions and supervisory acts of :my 0 f the
!lamed insureds; or
B. if a motor vehicle ms~lIUl'1ce policy and er.doroement, with the People of the State of New York. all mur.icipal subdivisions thereo t',
and the Commissioner md Department of Transportation, the New York State 'Thruway Authonty, the Sr.;.te Bridge Authonty and
their officials, otficern, and employees as additionai insureds '.mder the policy, covering bodily 'njury ':inc1uding death) WIth
rnuumum limits of $750,000 each occl.lt!ence md covering property damage WlUl l11immum linuts 00250,000 each occurrence
or $1 million dollars combined single limit each occurrence.
PERMl';' nO/OJ)
Reverse Side MUST Be Completed
. ......v.,.. .. ,"Vi"""
ItEVERSll
The subscribing insurance company issuing a protective liabihty insurance policy pursuant to A or a motor vehIcle
insurance policy pursuant to B above, fLUther certifies and agrees that the insurance policy reterred tol1r::msmn not be
changed or cancelled; unless
1. all trips authorized by the Highway Permit have been made; or
2. the effective period of the Highway Permit has expired; or
3. in the case of a Highway Work Permit, all work authorized has been completed and accepted by the Department of
Transportation; or
4. 30 days written notice has been given to the Department ofTransportatioll that th~ policy will be cancelled.
.4\ny subscribing insurance company providing insurance pursuant to A or B (see front), cl;;rtifics and agrees that such rnsurance
policy shall not be cancelled until thirty (30) days written cancellation notice has been given the New York State Department of
Ticll1spottation. indicating the permIt applicant's name, pennit account number (obtain from permit applicant), address, and policy
number. Notice ofreinstaternent must be made by a reinstatement notice or a completed Certificate of Insurance (pERM 1 i) and
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 pertaining to Higbway Permits. Usin& ONE Certificate of Insurance (PERIYI!7), please indicate the types
of permit(s) obtained from the Bipway Permit SettioD in the Department ofTransportatioJl by checking the appropriate
box/box(es). A Certificate of Insurance (perm 17) is the :.uxeptab~e proof of insunnce. A ~opy of the actual polity is not
required. PLEASE DO NOT SEND ACCORD FORMS, INSURANCE CARDS, ETC.
PLEASE CHECK BOX(ES) FOR EACH TYPE(S) OF PERMIT(S) OBTAl.1\.fED FROM THE DEP .A..RTMENT OF
TRANSPORTATION HIGHWAY PERMIT SECTION
[1 RESTRICTED VEHICLE PER.\1ITS (Park'ovays)
[] SPECIAL HAULING PERMITS (Used for Transporting Over.Dimensional or Over-Weight Non-Divisible
Items on Highways ex: mobile homes, equipment, buildings, etc.)
[] DIVISIBLE LOAD WEIGHT (Used for Transporting Over-Weight Divisible LQads on Highways ex: sand,
gravel, etc.)
[ " )
WORK PERMITS (Used for Installing or Maintaining Facilities on Highway Pro
written only as protective liability insurance policy) and shall also include co e
respect to liability impo:sed by law arising between the date of fmal cessation f
the date of final acceptance of such work by the Sta~.
rty -- coverage in such case shall be
operations liability insurance with
or suant to the WakPmnitand
Aut Ol'~ Sipature af Inlurau67&: A~llnt
Selective Insurance Co.
Name of IUllrallce Company
40 Wantage Ave.
BranchviIle, NJ 07890
Audrc5I uf IOJuranllC Company
John R. Peluse, Vice President
Alcborlzed NanN of Insurance "cent (1'1l/uII Print)
66 Middlebush Rd., Suite 200
Wappinli\ers Falls, NY 12590~4047
Addnu of Insurance Agent
800.777.9656
Tel'!)hone No. Qf Insurance Company
845.297.1700
Telephone No. or In~uranec: Allent
MISCELLANEOUS DATA;
Operating Authority (check as appropriate -- ifpemut Applk:am lUl$ DOT or ICe authonty to operate in New York State. the
authority must be identified by number and, 1f not so authorized, check Private)
r 1
, .
Private
(J DOT Number
[J ree Number
TOTHL r- .='5
DUTCHESS COUNTY AIRPORT
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PREPARED ay:
PAGGI, MARTIN & DEL BENE, LLP.
ONSUL T1NG ENGINEERS AND LAND SURVEYORS
56 MAIN STREET
POUGHKEEPSIE NEW YORK 12601
WAPPINGER SIGN AND BEAUTIFICATION PROGRAM SCALE: DATE:
HISTORICAL REMEMBRANCE
LOCATION MAP - ROUTE 376 1" = 800' 7/25/03
TOWN OF WAPPINGER DUTCHESS COUNTY, NEW YORK