HomeMy WebLinkAbout615 Sigsbee Rd Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 04/22/19 Receipt#: 253202
Quantity Transactions Reference Subtotal
1 Excavation Permits 1332 $600.00
Total Paid: $600.00
Notes:
Payment Type Amount Paid By
CK#43896 $550.00 National, Grid -Gas Permits.
Dept
CK#44798 $50.00 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 1332
SE
-Permit No.
TOWN OF SOUTHOLD Fl?j-
HIGHWAY DEPARTMENT
Pecontc Lane :i
_ T102174672 Peconic,New York-11958' `
(631)765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintepdent of Highways of the Town of Southold for the issuance;of an Excavation'Permit- s
pursuant to Chapter 237_of the Code of the Town of Southold,Suffolk County,'New York,and other applicable'I,aws,ordinances or '
regulations for each individual contiguous excavation project herein described. The-applicant agrees to comply with all applicable laws,'
;ordinances,codes and regulations,the attached"General Conditions.of Permit •and Special Conditions if any and to permit authorized
mnspectors to`make necessary inspections of the job site.
Pnrft=dr' v r Keyspan Gas F.ast.CA1p•D/B/A Natl01t8!Caftd
Gas Permits Dept bIR-1
IVMargaret Faglia 516 545.4094
Name of Applicant Phone Number .Address of Applicant
• .�: a::c:, ':;�;'`t«:,°�«..r r..:, _ _ __.�.,,,,-,.; c_.�-',..
Name of Contractor' . "" Phone Number^° Address of Contractor
3. Name of Property'OWner`,lteques`tirig Service(ifapphdible)-`"
` 615 SIGSBEE RD-S/S, 616' S/0 MAIN RD, MATTITUCK
Work Description and Locationw(Stredt Number,Hamlet,Cross Street)
„ - -(a) .ls 'ons trucfior'focated within' 75 Feet of tidal wetlands? d'Yes - No X _• ,"
'If yes,other Town petmlts may be required.
NOTE: All Information requested by this Signature of App icant '
Application'!Permit Fora"is ;
Required fora complete application? 4/16/19
- , -- - Date'- • .
5. (a) Attached plot plan to reasonably and adequately-describe the proposed work. Provide accurate schematic site plan showing the
location of all proposed excavations and relationship to adjoining premises,public streets or areas,and give a detailed,description;of
all site and pavement-restoration work.
(bj 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,Tawn Clerk.
6. Tax Map No.; ' ' . ' District 1000 , . Section �_� , Block �rQLot .I Z
5/15/19, .5/16/19 • - _ . - - "
i 7., Starting Date: - Completion Date:
8. ••Work Schedule: ;Phase Co>bnletion Date
Excavation Work Schedule i
Facility Installation _Must be provided
Backfill&Completion for consideration-as a
Pavement Replacement Complete Application; rs t
9. Under which authority is application being made:" Keyspan Gas'East Corporation d/b/a National Grid
See Town Code Chapter237(E):.Provide"Resolution by,or authority from,the Utility being modified.
10. Estimated Cost of Proposed Work: S.==_a=_- _ _ _ ."„� __ ,,<<,.,-=�:`w,g - _: .,n:r,h• �.
i 1. Remarks: INSTALL GAS SERVICE
X
i D-39 ! of 3
12. 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 X $500.00 —I
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.
A 1. ��!/Service Connections excavations @$50.00 $�� �" 0V
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 $
T07'AL$` - La
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 accordance with
this application and.subject+to the"General'Conditioris""and"'Special Conditions"-'ofpermif(if�ny)attached er o.
SUPERINTEND T 1G YS
TOWN OF SOU HO E RK
V,n tOban ;
�." - •- _
Date Received by the Town Clerk "bale"_
(� -as"I
Date Permit Issued 4 - -1 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-39 2 of 3
Copy Distribution:
Permit'#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECT'OR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
,
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 FirW Settlement of Excavation
RFR Ready for Repair
D-39 3 of 3
GENERAL CONDITIONS OF PERMIT
APPLICATIONMERMIT FOR HIGHWAY EXCAVATION AND REPAIR
I. " 1'rrmilfcc's C'rnrfiacl;m to Comply with Permit Rcpuircmrnls: The Permittee is responsible for
ir&ni ing its'independent contractors,employees,'agents and assigns of their responsibilityto 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.- Nu Right to Trespass or Interfere with Private Proncrty Rights: This permit does not convey to the
perm any eight to trespass upon the lands of adjacent property owners in order to perform,the petmitted f
work,nor does it authorize the impairment of any rights;title,or interest in re.0or personal propertyheld or
vested in a person not a party to the permit.
: .1'roicction of the 1lielrivav'ead Tutgre RigtiwaicMniotenancc: 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;Upenritendent 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 Haptic,this permit shall be revoked,and`the utility, "
structure,,fill;excavation,or,other modification of the highway hereby authorized shall not W completed. _
Additionally,the perriiit may be revoked if the Highway Superintendent finds that the issuance of the
permit was illegal or unauthorized outhat the applicant failed to comply with any of the.terms
conditions of the permit or Chapter 237 of the Town Code. ;
4. °Rcync"lion,of the Permit by thi'Hinhwav Suneriniendent: If the Highway Superintendent deems it "
necessary toftherevoke-thispetmit-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,removeill or any portion of the uncompleted utility,structure or fill and restore the site to its
former condition. ,
:5.,.Notice of Conrrncucenrent: At least 24 hours prior to commencement of the project,the permittee andlor ^
contractor shall,notify the Town Highway Department in writing that they are fully aware of and i
understand all terns 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 requesta Final
inspection. ,l
6.' Storage of Enuinment&Materials: The storage of construction equipment andlor materials shall-be
confined within the project work ama•'and/or adjacent areas where permission/'legal access°has been I
obtained in-a`manner that'does not interfere with normal highway traffic. ,
„ 7• Utility Mark Outs: The"Applicant/Cantractor.shall be responsible for,veriticatiori of all existing utility
mark-outs and shall take all precautions to protect same. Damage to existing utilities shall ire the
a responsibility of the contractor and shall be repaired atthe contractor's exPense.,
8: Road Closures: All scheduled road closures�must first receive written permission from the Southold n
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 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 in Road Shoulder Aron: AP Construction Debris shall be removed from the jab
size on a daily basis,"All stockpiled soil as well as all other project materials that will,be staged within the,,.
go or othor means to meet the mini
Right-6 f Way must be delineated witkreflective signamum requs
irement
of the NYS DOT Construction Standards.
i _ __'_ - - �.,�-• - �a&:.^^,
GENERAL CONDITIONS OF PERMIT
APPLICATION/PERMIT FOR HIGIiWAY EXCAVATION AND REPAIR
(Continued)
10. Install.Maintain Erosion Controls: Required Erosion Control Measures(14 silt fencing)is to be placed
on the downslope edge of'any disturbed area:,This sediment battier 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 Fitt Only: A!1 project back-fill shall,cdnsist of clean sand;gravel of 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 withln:a Town Highway.
12. All Areas of Soil Disturbance: All areas of soil disturbance resulting from the'approvcd'project shall be E
h stabilized to the satisfaction of the Highway Superintendent immediately following project coinpiction:,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 wfth straw,hay mulch and/or jute matting until weather conditions favor
germination.
13. Backfill&Coinnaction'of all Excavations: Back Fill shall'consist of clean fill or,soils which exhibit a
well-defined moisture density relationship as determined to be in,acaordance with ASTMD 698. Fill shall
be placed in maxiiriutn lifts of'twelve(t2")inohes'thick and shall be mechanically compab to a Nin ?
five(950/*)percent maximum dry density. Suitable hydr`auiic compaction by Water jetting at thtre-Foot
intervals will'also be-permitted subject to a project specific approval by the Highway Superintendent: ;
-14. Hestorittion of the Rua ,Slioulder Area: All mawmade 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 plantings.
Excavations through driveways and private road pavements must be reconstructed to meet a!1 requirements '
of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been
disturbed durftig'construction must be replaced or repaired by the contractor to the satisfaction of the
Highway Superintendent.
IS. Schematic Plaits with all Technical information and Scone of Work: To'reasonabiy'and adequately
describe the proposed work,accurate schematio site.plant must be provided to show or indicate,all
proposed construction activity requited unilerihis permit. All Pavement surfaces scheduled for excavation
must be saw cut to the full depth of asphalt and/or conerete.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 Wighwey Specifications.
16. ravemeni Iteconstruction: All Pavement sections must be reconstructed in the following manner;
(Note;yi'iten Concato Pavements are Present,Please review Restoration regiuremonls with the Highway Superintendent)
s) Complete all back-rill&soil compaction work as needed to provide a suitable sub-base;
b) Ove;-cut existing asphalt bell hole or trench by twolve'(12")inches on all sides; ?
6 c) install a compacted lift of 4"thick Stone Blend base(RCA Blend must meet NYS DOT Speelfieatioa);,
d) Install a two and one haif(2.5')inch compacted lift of Asphalt Base Course;
e), Install a one and one half(1.5")inch of Asphalt(Type 6)Westin$Course. (Provide AC at all joints)
1;
"-All work listed'herein must'in"t,the minimum requirements of thc,Southold Town;Higbway
Specifications. „
17. Tmuehine of Pavenien(Sat tater,rxeccdinM One Ilundred(loon tact in Lenirilt: Ail'treiiching^of "
pavement surfaces exceeding 100',in length must first be reconstructed to,meet the requirements of Item
# l6 as noied 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 shell be
repaved with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder).. ' t
aCNIq3�
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_ , 'Municipality: �G�rt� Ld -- - _--_,_-.- -
(o� J f ✓ - Work Order: /U417-Ao 7.?,, 1.
Request
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Reason Fqt ExcaU,:Hon: aJS�ALL^ SAS �� V14 teci By., /rt/. ac�Z;' SIS:✓.�j-�1�" ;A LL.
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