HomeMy WebLinkAbout505 Skunk Ln t Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 04/17/19 Receipt#: 253103
Quantity Transactions Reference Subtotal
1 Excavation Permits 1331 $550.00
Total Paid: $550.00
Notes:
Payment Type Amount Paid By
CK#44716 $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
Bld 3 FI 1
Hicksville, NY 11801
Clerk ID: LYNDAR Internal,ID 1331
RECE'11JED_
- - - - -
'i4
'
pthfil 0.
TOWN OF SOUTHOLDAPR ' 1 7 201 �►f���
.'HIGHWA V DEPARTMENT ,
Peconic Lange
W.O. 7102200372 ' Pet:onic,Nevir'York`C19S8 j ' Southold Town
{63,1)765-3140
=.
APPLICATION/PERMIT FOR HIGHWAY,.EXCAVATIUIV AND REPAIR
AP,PCICATIOId_IS.HEREBY made to the Superintendent of Highways of theYTown of.Southold for the issuance of an4Ezcavation'Permit ;
pursuant to,Chapter 237:of.the Code of,ihe'Town of Southold;Suffolk County,`New York,and other'applicable.laws,ordinances ow
regulations for each.individual contiguous excavation,projecf herein descrilied.' The applicant agrees to,camply with all applicable laws,,
atrdinances,nodes and regulations,the attached"Genei�al'Conditions of PermW,and"Special Conditions",•if any and to permit,authorized,;' `
"inspectors to make necessary inspections-of the,jo,v site. -
:p- n.oa ,;. ; , " Keyspan_Gas,�t CDr0 D/0-Nati6nal.
;. ;.r T. Gav,Pemni S.Depk. Bldg:3 FS:"f" -
Kdsl 'ia'Black (516)545=4686 = -
Name of Applicant Phone Number, Address of Applicant
`.:Mim''.^'•m...--emm.. - � -. ..,, -
Narrie:of Contractor Pbone Number: Address of Contractor
1; -
Naine ofpro eµ `Owner lie'iiestin``Service{if a licatile}4 Adde ass of Owner - `✓'
p. Y q. g , - PP '
505 Skunk-Un' --,E/S; 6,18''SJO Main °Rd•- 1 ,4'�x 4' beIIh'ple
Work+Descrption,and Location,,(Street Number,Hamlei;'Cross,.Street) u "
•'1a),1s construction,located within 75,Feei of Lida!wetlands? •.Yes ` Na '
S *[f yes,other'Town'permlts maybe required. „
NOTE: All Inforsnatlon requested by`tAis Signature o Applicant '
Application/Permit 4/9/19
Required for'a complete appllcation! • .
_ Date ;
5. (a) Attached,plot plan t'rea"sobably and adequate'ly,describe`'the proposed work: Provide accurate schematic=site plan-showing'the, ,
location of all"pioposed:excavations"end,rMii ionsh'ip to adjoining premises;public streets,or areas,and gEve adetailed-description of',•
pail site and pavement restoration,worlt. = ^
(b) Attach all other necessarypermits aod,l'icenscs for this project.'
(c)"Work co'vered'by.this application may;not commence before issuance` of a Highway Excavation'Perinit by the Town,Clerk.
6: , TaxMap'.No. District TI400 ,4 Sectioncr;"Block
T '4/30/1 Date: e 4/30/1 b
Co ,p-• n,. ` 5/1/ .9, -
ni !alio Date
4 Work Schedule: Phase Comnietion Date
Excavation Work Schedule, °
Facility 1h tallation, Masi be provided
Backf ll&Completion. for consideration as a`
Pavement Replacement °' " Complete Application:
9. Under which authariiy is application being made:'`.Keysp811 Gas'East Corporation d/b/a fVational Grid
°See'Town Code Cfiapter237E Provide_Resolution b or authori from 'thizUtili bein modified:"
,14.'-Estimated Cost'of Proposed Work:
I I. Remarks: New gas-service
1.2. Insurance Coverage: (Attach Copy)
(a) Insurance Company:
(b) Policy#:
(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 and/or every road 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 $
No.
_ -- _-- - .Additional Repairs of Same Service @$500.00/Each $
No;
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 xcavation permit to:
in acc e
this application"and subject to the"General Conditions"and'"Special Conditions"of permit if any)a ch o.
SUPERINT D T IG AYS
TOWN OF U O O
- incen�. rl- ' o/ ___
Date Received by the Town Clerk 44 Da
Date Permit Issued 1-I — I7— l q Permit No.
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-34 2 of 3
Copy Distribution: I J
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
1 st
2nd
3rd
41h
(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
GENERAL CONDITIONS OF PERMIT
APPLICATION%PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
!. Pcrinitfce's Coiitraclorx to Cumply with Pci•mit ltcauircments: The Permittee is responsible for
infonnifil itfln"dependent contractors,employees,agents and assigns of their responsibility to comply with
this permit, including all special/site 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 sit 6 Tres•ass or Interfere with Private Pro erNRl hts: 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 docs,it authorize the impairment of any rights,title,or interest in real or personal property held or
vested in a person not a party to the permit.
3. 'Protection of the lAij lhwav and Fulure HighwaX Mniritenance: If future operalions'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 andlor welfare of vehicular or pedestrian tiaffte,this permit shall be revoked and the utility,
structure,f ll,excavation;or other modification of the highway hereby authorized shall not ba 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 permit or Chapter 237 of the Town Code.,
4. Revocation of the Permit by the Highway Superintendent: If the Highway Superintendent deems it ,
necessary to revoke 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 its 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 hour ,liflor to.eommencement of the project,the permittee and/or
contractor shall notify the Town Highway Department.in writing that they are fully aware of and,
understandall terms and'projeet 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. 'Stornee of Enuinment A Matcrialsi The storage of construction equipment and/or materials shall be
confined,withiri the project work area and/or adjaoent areas whero 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 permission from the Southold Town
Board prior to closing a road. Temporary lane closures may be permitted with the approval of the Highway
'Superintendent. This item will included but not be limited to tho installation of approptiate'signage and
flag men to stop and start traffic to allow for single lane traffic. Road Closures due to unforeseen
emergencies require inimedia*notification of the Highway Department and shall tie limited to immediate
and/or expedited restoration of the Work Zone.'
9.
No Construction Debris in-Road Shoulder Area: All Construction Debris shall be removed from the job
site on a daily basis, All stockpiled soil as well as all'other project materials that will be staged within the ;
Right-of,Way must be,delineated with reflective signage or other means to meet the minimum requirements
;. of the NYS•D0T Construction Standards: ' ;
.GENERAL CONDI'T'IONS OF PERMIT
APPLICATION/PERMIT FOR HIGI]IWAY EXCAVATION AND REPAIR
(Continued}
°10. Install.Maintain Erosion Controls: Required Erosion Control Measures(Le: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. .
IL 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(Lo,Clay,Bog,etc.)are to
'be removed from the site and not used to backfill any excavation within a Town Highway.
I2. QUI Areas of Soil Disturbance: All areas of soil disturbance resulting fromri the'approved'pioject 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. I3nckRil&C:omnActiOn ufail Excavations: Back Fill shall consist of clean fill ar soils which exhibit a ;
well-defined moisture density relationship as determined to be in accordance with ASTMD 698. Fill shall;' R
be placed in maximum lifts of twelve(12')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 the Highway Superintendent.-
;' . 14. Restoration of the head Shoulder Area: All manimade 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 mast 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. i
15. Selt`ematic Plans Ivith all Technical informa ion And Sea a of Work: To rcasonabiy Lind 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 fuq_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 Genera]Conditions and'requiremnents foetid in the
Southold Town Highway Specifications.
16. ravemeat Reconstruction: All Pavement sections,must be reconstructed in the following manner;
(Note;When Concrete Pavements are Present.Please icview Restoration requirements with the Highway superidtendent)' i
a)`Complete all back-fill&soil compaction work as eeeded to provide a suitable'sub=base;'
b) Over-cut existing asphalt bell hole or,trench by twelve(12")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 of Asphalt Base Course; ;
e) Install a one and'one half(13")inch of Asphalt(Type 6)Wearing Course (Provide AC at all joints)
All work listed herein must meet the minimum,eequiri ents of the Southold Town Highway
Specifications.
17.Trenchin of Pnvemcnt Surfuccs Is'zcecdiei .One Hundred 100' k'eet in Len ill: All trenching of
pavement surfaces exceeding 100' in length must first be reconstructed to,meet the requirements of Item
#;16 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 lift of Asphalt(Type 6)Wearing Course(Typieal,�shoulder to shoulder).
Page 1 of 1
9 �
Jill
y
'1 1,="U
Kv
i
http://metprmweb/Generic/LoadImage.aspx?sessionID=z5cie345tcxwkj45jhi5pnik&att= 4/8/2019