The URL can be used to link to this page

Home My WebLink About1330 Fleetwood Rd Town of Southold P O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 03/07/19 Receipt#: 251972 Quantity Transactions Reference Subtotal 1 Excavation Permits 1323 $550.00 Total Paid: $55000 Notes: Payment Type Amount Paid By CK#44187 $55000 National, Grid -Gas Permits. Dept Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: National, Grid -Gas Permits Dept 175 E Old Country Rd Bid 3 FI 1 Hicksville, NY 11801 Clerk ID: LYNDAR Internal ID 1323 -_ -_ _ - °„��;.� -.rte - -___ - ___ __ - ___--_ _ _K<•-�'_:�;.M s.�,.a.'�,. --__ __ -_---___ __ '_ W4a,.�K..v::�=..u.:'n,�.:-,_-�,:�_ -- - _ - Peririit RECEIVED TOWN'OF SOUTHOLD HIGHWAY DEPARTMENT- --MAR Peconic Lane W.O. T102185651 Peconic,New York 11958 (631)765-3140 -�- ---S'outhold” ow T n C APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of-Southold for the issuance of an Excavation Permit pursuant,to Chapter 237:of the Code of the Town of Southold,Suffolk County,New York,and other applicable laws,ordinances`or regulations for each individual contiguous excavation project herein described. The-applicant agrees to comply with all,applicable laws, r cirdinances,codes and regulations,the attached"General Conditions of Permit -and"Special Conditions",if any and to permit authorized inspectors to make necessary inspections of the job site. " Prim[? ter;, Keyspan Gas East Corp DIS/A Natbna!Gttd : Gas Permits Dept: Bldg 3 FI: 1 1 Keshia Black'`_ ' (516)545-4686 7�E.Q", { Name of Applicant Phone Number Address of Applicant Name of Contractor - Phone Number - Address of Contractor- , _ -; . • i 3-1 ` Name of Property Otivnar,Requesting S`ervico(if appiicable)-_ `Address of Owner 1330 Fleetwood Rd -- W/S, 466' N/0 East Rd =- (1) 4' x 4' bellhole- f Work Description and Locatiod(Street Number,Hamlet,Cross Street) la) Is constructioa�locafed wit ie 75 feet of tidal wetlands? Yes No X 'If yes,other Town permits may be required. MUTE: All Information requested by this _ Signature of Applicant Application/Permit Form`is Regaired-tor a"complete applteation! 3/1/19 ? Date, 5. ' (a) Attached plot plan to reasonably and"adequately describe the proposed work. Provide accurate schematic site plan showing the location oran proposed excavations and relationship to adjoining premises,public streets or areas,•and give's detailed description of all'site and pavement restoration work. (b)'Attach all other necessary permits and licenses`for this project. ; (c) Work covered by-this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk. ; 6. Tax Map No.: District 1000 ; Section Block , Lot 7. Starting Date: , 2/22/19 Completion`Date: 2/23/19 8. Work Schedule: Phase COmDletion Dale , Excavation- -Work Schedule Facility Installation Must be provided Backfill&Completion for consideration as a Pavement Replacement °Complete Application'.' 9. Under which authority is application being made: Keyspan Gas East Corporation d/b/a National Grid See Town Code Chapter 237(E)-Provide Resolution by,or authority-from,the Utility being modified. 10. -Estimated,Cost of Proposed Work: - 11. Remarks: Reconnect Gas Service D-39 1 of 3 s a, 12. Insurance Coverage:(Attach Copy) - (a) Insurance Company: (b) Policy 0: - - (c)State whether policy of certification on file with the Highway Department: (d)Coverage required extended to the Town: Any Loss including Bodily injury,property or commercial injury caused by or attributable to the work performed: $1,000,000 per Occurrence and$2,000,000 general aggregate. 13. Security: (a)Surety Bond ,. -- or Certified Check . ,__provided in the total Amount of$ (b)Maintenance Bond provided: 2 years or _ _ 3 years. 14. Fees for Applications and permits: Basic Application Fee for Each Project Location - 1 $500.00 500.00 A Project Location would include each Bell Hole an for every roa opening or excavation within any 50' Radius whether or not they may be inter-connected by open trench or directional boring. The total number of Project Locations shall be subject to the approval of the Highway Superintendent. Al. /Service Connections excavations @$50.00 $ 50.00 No. A2. /Additional Excavations same service @$20.00 $ No. B. Trench Excavations 18"in depth or less Total Lineal Footage of Excavation; L.F.@$10.00 $ C. Trench Excavations 18"in depth to 5' in depth , Total Lineal Footage of Excavation; L.F.@$30.00 $ D. Trench Excavations 5'in depth and over Total Lineal Footage of Excavation; L.F.@$50.00 $ E. - _ Utility Repair Excavations @$1,000.00/Each $ NT - _ - -Additional Repairs of Same Service @$500.00!Each $ TOTAL$ 550.00 F. Official Notice to public utilities-proof must be provided and Shall be attached to this application prior to issuance of permit. Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: in ac rdance with this application'and subject}to the"General Conditions"and'"Special Condiiions"of -ermit(if aiiy)a ched reto. SUPER;NT DE IG AYS TOWN F T O NEW YORK Date Received by the Town Clerk I Date Permit Issued Permit No. 1�OL NOTE: Permit expires one(1)year from date of issuance., No work to start without 24 hour notice to Superintendent of Highways. Permit must be available at all times for'inspection,on site,during construction. D-39 2 of 3 •f Copy Distribution: Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 1 s' 2nd 3rd 4m (To Permit Clerk) REMARKS CODE IB Improper Barricades 1L Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfilling) BUC Building Under Construction WIP Work In Progress DB Improper Backfill(too high,not sufficient) HFS Inspector Holding for Final Settlement of Excavation RFR Ready for Repair D-39 3 of 3 IJ ' -_ - '— - - ._)ice-_d� -- .. `t.'-.`i� , . _- __ - '- •- __ '- ,i_-.'f.-`��` , GENERAL CONDITIONS OF PERMIT APPLICATIONMERMIT FOR HIGHWAY EXCAVATION AND REPAIR ' , I. 1'crmitlee's t'nntraclom to Cuing!with Permit Reauirenrcnls: The Permittee'is responsible for infonii'sng its independent contractors,employees,agents and assigns of their responsibility to comply with ; this permit, including all speciallsite specific and general conditions imposed by the Highway Superintendent while acting as the permittee's agent with respect to the permitted activities,and such persons shall be required.to comply with.all permit requirements. 2. No Ri ht to Trespass or Interfere with Private Property Rights:-This permit does not convey to the',, permittee any right to trespass upon the lands of adjacent property owners in order to perform the permitted work nor does it authorize the impairment of any-rights,title,or interest in reshot personal property held or vested in a person not a party to the permit. 3. Protection of the Ilietiivav And Future Hiihwa" Maintenance: if future operations or highway maintenance projects-by the Town of Southold require an alteration in the position of the utility,structure_ or work herein authorized,or if,in the opinion of the Highway Superintendent the work performed under this permit shall cause unreasonable obstruction to required highway maintenance or endanger the health, safety and/or welfare of vehicular or pedestrian traffic,this permit shall be revoked-and the utility, strdcture,f m II,excavation,or other odification of the highway'hereby authorized shall not be completed. Additionally,the permit may be revoked if the Highway-Superintendent finds that the issuance of the' permit was illegal or unauthorized or that the applicant failed to comply with any'of the terms'and, conditions of the perm it or Chapter 237 of the Town Code. ` 4. Reyocation'of the Permit by the Highway Superintendent: If the Highway Superintendent deems it necessary to rcvoke'this permit and the project hereby authorized has not been completed,the Applicant- ' shall,without expense to the Town and to such extent and in such time and manner as the Superintendent may require,remove all or any portion of the uncompleted utility,structure or fill and restore the site to its former condition. S. Notice of Commencement: At least,24 hours prior to cornmencement,of the project,the permittee and/or contractor shall notify tin writing that they arehe Town Highway Department fully aware of and i understand all terms and project.conditions of this permit. Upon completion of the work,,the contractor shall provide photographs of the completed work.to the Town Highway Department and request'a Final_ inspection. 6, Starnge of Eauinment A Materials: The storage of construction equipment and/or materials shall be , confined within the'projea't work area-and/or adjacent areas where permission/legal access has been"'' ` obtained in a manner that does not interfere with normal highway traffic. 7. Utility Mark Outs: The Applicant/Contractor shall be responsible for verification of all existing utility mark-outs and shall take all precautions to protect same. Damage to existing utilities shall be the responsibility of the contractor and shall be repaired at the contractor's expense. 8. Road Closures: All scheduled road closures must first receive written'permissionfrom the Southold Town ' Board prior to closing a road. Temporary lane closures may be permitted with the approval'of the Highway t Superintendent. This item will.included but not be limited to the installation of appropriate signage and flag men to stop and start traffic to allow for single lane traffic. Road Closures due to unforeseen emergencies require immediate notification of the Highway Department and shall be limited to immediate and/or expedited restoration of the Work Zone, 9. No Construction Debris inROnd ShoulderAren: All Construction Debris shall be removed from the job site on is daily basis. All stockpiled soil as well as all other project materials that will be staged within the Right-of Way must.bo delineated with reflective signage or othor means to meet the minimum requirements of the NYS DOT Con'struction Standards. GENERAL CONDI'T'IONS OF PERMIT APPL.YCATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR (Continued) 10. Install-Maintain Erosion Controls: Required Erosion Control Measures(i.e.silt fencing)is to be placed on the downslope edge of any disturbed area:;,This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good functional condition until thick vegetative cover is established. 11. Clean[rill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete or demolition debris). All unsuitable soils excavated at the site(i.e.Clay.Bog,etc.)are to be removed from the site and not used to backfill any excavation within a Town Highway. 12. All Areas of Soil Disturbance: All areas of soil disturhance resulting from the approved project shall be stabilized to the satisfaction of the Highway Superintendent immediately following project completion. If the project site remains inactive for more than 48 Hours or planting is impractical due to the season,then the area shall be stabilized with straw,hay mulch and/or jute matting until weather conditions favor germination. 13. Backfill&Cornr►aetion of ail Excavations: Back Fill shall consist of clean fill or soils which exhibit a well-defined moisture density relationship's determined to be in accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve(IT)inches thick and shall be mechanically compacted to a Ninety- five(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at three-foot intervals will also be permitted subject to a project specific approval by fire Highway Superintendent. , 14. Restoration of the Ruad Shoulder Arca: All man-made improvements located within existing road shoulder areas must be protected to the greatest extent practical. Items would include but not be limited to driveway&private road aprons,mail boxes,sprinkler systems,trees and ornamental plantings. Excavations through driveways and private road pavements must be reconstructed to meet all requirements of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15. Sclrernatic Plans vitlr all Technical informs ion's nd Scope of Work: To remonabiy and adequately describe the proposed work,accurate schematic site plans must be provided to show or indicate all proposed construction activity required under this permit. All Pavement surfaces scheduled for excavation must be saw cut to-the full depth of asphalt and/or concrete pavements. Accurate size of bell holes or width of trenching must be indicated by dimension or labeling. This schematic site plan must provide details on all restoration required to meet the requirements of these General Conditions and requirements found in the Southold Town Highway Specifications. 16. PEgvement Reconstruction: All Pavement sections must be reconstructed in the following manner; (Note;'When Concrete Pavements are Present,Please review Restoration'r quirements with the Highway Superintendent) a) Complete all back-fill&soil compaction work as needed to provide a suitable sub-base; b) Over-cut existing asphalt bell hole or trench by twelve(1211)inches on all sides; c) Install a compacted lift of 4"thick Stone Blend base(RCA Blend must meet NYS DOT Specification); d) Install a two and one half(2.5")inch compacted lift ofAsphalt Base Course; e) install a one and one half(1.5")inch of Asphalt(Type 6)Wearing Course. (Provide AC at all joints) All work listed herein must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenchine of Pavement Surfaces Exceedin'.One Ilno red(1001 Feet in Len lit: All trenching of pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of item N16 as noted above. Once all pavement reconstruction is completed to the satisfaction of the Highway Superintendent,the entire road section and/or width of road over the entire length of trench shall be repaved with a two(2")inch Ilft of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). 4-4 mian, rla, 9 Ln �LOCATICN.', 7L E-UTCHOGUE, ICR T it LU it C-. 4'.x'47<Belf Hole= Cd 0 ------- 'D-"R --- L "ET .77,