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APPLICATION FOR THE INSTALLATION OF A PAY
TELEPHONE ON OR ABOVE ANY PUBLIC STREET OR SIDEWALK
135-2-B
BEFORE
INSTALLATION, A PLAN OR SKETCH OF THE TELEPHONE SHALL BE FURNISHED TO THE
DIRECTOR OF THE DEPARTMENT OF PUBLIC WORKS, IN SUFFICIENT DETAIL TO DESCRIBE
THE SIZE, LOCATION, EQUIPMENT AND MEANS OF INSTALLATION AND CABLING.
IF
A SIDEWALK OPENING PERMIT IS REQUIRED, A COPY OF SAME MUST BE ATTACHED TO THIS
APPLICATION.
135-2-D
THE DIRECTOR OF THE DEPARTMENT OF PUBLIC WORKS
SHALL BE INFORMED OF THE INTENT OF ANY PERSON TO REMOVE OR RELOCATE A
TELEPHONE. THE DATE THAT THE LICENSE BUREAU INFORMED THE DIRECTOR:
________________
135-2-E-1
BEFORE RECEIVING A PERMIT FROM THE LICENSE
BUREAU, AN APPLICANT SHALL EXECUTE AN INDEMNIFICATION AGREEMENT AS
FOLLOWS:
| THE APPLICANT AND ANY OTHER PERSONS
ON WHOSE BEHALF THE APPLICATION IS MADE AGREE TO DEFEND, INDEMNIFY AND HOLD
HARMLESS THE TOWNSHIP OF IRVINGTON AGAINST LIABILITY FOR ALL CLAIMS FOR DAMAGE
TO PROPERTY, OR INJURY TO OR DEATH OF PERSONS, ARISING OUT OF OR RESULTING FROM
THE ISSUANCE OF THE PERMIT OR THE CONTROL, MAINTENANCE OR OWNERSHIP OR USE OF
EACH PAY TELEPHONE. |
THE ABOVE AGREEMENT SHALL BE GIVEN TO THE
LICENSE BUREAU ON THE APPLICANT'S
LETTERHEAD/STATIONERY.
135-2-E-2
FILE WITH THE LICENSE BUREAU A
GENERAL LIABILITY INSURANCE POLICY OF $1 MILLION FOR BODILY INJURY AND
$50,000.00 FOR PROPERTY DAMAGE, NAMING THE TOWNSHIP OF IRVINGTON AS ADDITIONAL
INSURED.
135-5-C
NO TELEPHONE SHALL BE PLACED, INSTALLED, USED OR
MAINTAINED:
- WITHIN ANY MARKED CROSSWALK
- WITHIN 3 FEET OF A CURB RETURN OF ANY
UNMARKED CROSSWALK
- WITHIN 15 FEET OF ANY FIRE HYDRANT,
FIRE CALL BOX, POLICE CALL BOX OR OTHER EMERGENCY FACILITY
- WITHIN 5 FEET OF ANY
DRIVEWAY
- WITHIN 3 FEET OF ANY PUBLIC AREA
IMPROVED WITH A LAWN, FLOWERS, SHRUBS, TREES OR OTHER LANDSCAPING
- AT ANY LOCATION WHEREBY THE CLEAR SPACE
FOR THE PASSAGE WAY OF PEDESTRIANS IS REDUCED TO LESS THAN 6 FEET
- WITHIN 3 FEET OF ANY BUILDING UNLESS
WRITTEN PERMISSION IS SECURED FROM THE PROPERTY OWNER AND FILED WITH THE
APPLICATION.
ADDRESS
_______________________________________________________________
BLOCK #
__________________________ LOT # ________________________________
OWNER
OF RECORD, TAX ASSESSOR'S
OFFICE:
_______________________________________________________________________
- WITHIN 10 FEET OF ANY ENTRANCE TO A
RESIDENCE, STORE OR PUBLIC BUILDING
NOTE: 135-5-D DIRECTOR OF REVENUE &
FINANCE, DISCRETION.
135-D-E
POLICE APPROVAL NEEDED.
CONTINUOUS
CRIMINAL ACTIVITY AS PER THIS SECTION.
DATE I.P.D. NOTIFIED
_____________________ DATE I.P.D. APPROVED
_________________
135-5-F,G,H
THIS SECTION IS IN THE FOLLOWING
ZONE
____________________________________________________________________________
AS
PER THE ZONING OFFICER.
600 FEET __________________ 300 FEET
_________________ 100 FEET _________________
135-5-I
MORE THAN ONE
PHONE APPROVAL OF THE DIRECTOR OF POLICE AND REVENUE & FINANCE
DATE
INFORMED ____________________________ DATE APPROVED
_________________
135-2-A
THIS APPLICATION IS MADE ON BEHALF OF A
(CHECK
ONE)
INDIVIDUAL_____________PARTNERSHIP______________CORPORATION_____________
FULL
NAME OF APPLICANT
___________________________________________________
HOME ADDRESS
____________________________________________________________
MUNICIPALITY
AND STATE __________________________________________________
SOCIAL
SECURITY NUMBER ______________________ DATE OF BIRTH
______________
BUSINESS INFORMATION:
TRADE NAME
_____________________________________________________________
MAILING
ADDRESS
_________________________________________________________
MUNICIPALITY
AND STATE __________________________________________________
BUSINESS
TELEPHONE NUMBER _______________________________________________
IF
CORPORATION:
CORPORATE NAME
_________________________________________________________
APPLICANT'S
TITLE IN THE CORPORATION ______________________________________
FEDERAL
TAXPAYER I.D. NUMBER
_____________________________________________
LICENSE
BUREAU:
 DATE
LICENSED ISSUED: _______________________________________
LICENSE ISSUED:
______________________________________________
FEE COLLECTED:
______________________________________________ |