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Home My WebLink About375 King St Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/29/19 Receipt#: 253510 Quantity Transactions Reference Subtotal 1 Excavation Permits 1334 $550.00 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#44810 $550.00 National, Grid -Gas Permits. Dept Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 t Name: National, Grid -Gas Permits. Dept 175 E.Old Country Rd Bld 3 FI 1 Hicksville, NY 11801 Clerk ID: LYNDAR Internal ID 1334 l 2 Perniit-No. j.:7 _ - _- =_- _-_, _ _ " - ;_=__rRECEIVE_ TOWN OF SOUTHOLD m'�1l►rtFa1+ HIGHWAY DEPARTMENT , Peconic Lane APR 2 5 2019' W.O. T102201528 Peconic,New York 11958 (631)765-3140 - Southold Town Clerk 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, ordinances,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. - PrtiiAar Tvrit Keyspan Gas Fast Corp DJB/A National -did Keshia Black (516)545-4686 Gas Permit Dept. Bldg:3 FI: i - rw -:175 E 0ld,,CdUhWWA--Rd H -�- Name of Applicant Phone Number Address of Applicant Name of Contractor Phone Number- - Address of Contractor ,3. - Nome of Property O+vnIZegSery e'r uesfing ice(if applicable) Addri ss.of Owner q 375 King St -- S/S, 129' W/0 3rd St -- (1) 4' x 4' bellhole Work Description and Location(Street Number,Hamlet,Cross Street) (a) is construciion' located within 75 feet of tidal wetlands? •Yes No X •If yes,other Town permits may be required. Jt� Pk_4 _ NOTE: All Information requested by this, Signature of Applicant Application/Permit Form is 4/17/19 Required for a coinplete application! ` Date S. (a) Attached plot plan to reasonably and kdequately 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. (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 Towti Clerk. 6. Tax Map No.: District 1000 ,' Section l , Block , Lot 7. Starting Date: 5/8/19 Completion Date: 5/9/19 S. Work Schedule: Phase Completion Date Excavation ____ ___ _ Work Schedule Facility Installation Must be provided Backfill&Completion for consideration as_o Pavement Replacement Complete Application. 9. Under which authority is application being made: Keyspan Gas East Corporation d/b/a National Grid SeeTown Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: 11. Remarks: New gas service - 6 D-39 1 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 - 1 $500.00 500.00 A Project Location would include each Bell Hole andior 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; d 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. ..d.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: accordance with this application and subject to the."General Conditions"and"Special Conditions"'of permit(if a y)attached here SUPERINTEN NT YS TOWN OF SO H 4'. -V ice an Date Received by the Town Clerk Date Permit issued "t cxq l 1 Permit No. I 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®RIS RECORDS Inspection Date Findings(use code) Applicant Notified 151 2nd 3rd 4'h (To Permit Clerk) REMARKS CODE IB Improper Barricades IL 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 APPLICATIONIPERMIT FOR HIGHWAY EXCAVATION.AND REPAIR 1.- llersnittec's C'oiitractors to Coni llv with Permit Reauiresnenls:1be Permittee is responsible for informing its'independent contractors,employees,:agents and assigns of their responsibility to comply with this permit,'including all speeiallsite 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 Riglst to Trespass or Interfere with Private Property Rights: This permit does not convey Co thg permittee any right to trespass upon the lands of adjacent,property owners in order to perform the permitted work nor does it authorize the impartment of any rights,title,or interest in real'or personal property held or ' Vested,in a person nota party to the permit: ; 3.- I'rotcct!on of the HieliwRv and Future HighwMt Mninteannce: 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 HighwaySuperintcndent-the work performed under this permit stealf cause unreasonable obstruction to required highway maintenance or 8ndanger the Health, ti safety and/or welfare of vehicular"or pedestrian traffic.this permit shall be revoked.,and the utility, •structure,fill,excavation,or other modification of the.high tray hereby authorized shall not be completed. Additionally,the permit may be ievoked 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 anti " conditions of the permit or Chapter 231 of the Town Code: ; 14, Reyacutdon'of the Permit by'the Highway Superintendent: If the'Highway Superintendent deems it , necessary to revoke this pen6it=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- m 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 Commcucensent: At least 24 hours prior to corrimencement of the project,the permittee and/or-' contractor shall notify the Town Highway Department,in writing that they are fully aware of and ; understand all terms-and project conditions of this permit. Upon completion of the work,the contractor steall provide photographs of the completed work'to the Town Highway Department and request,e Final ; inspection: b. Storage of Eouinment&Materials: The storage of construction equipment and/or materials shall be . confined within the project work area,,and/or adjacent areas where permission/legal access has been . obtained in a manner that does not interfere-With normal highway tralTic.. 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 the installation of appropri_ata'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 end shall be,_![mited'to-immediate and/or expedited restoration of the Work Zone, 9. lNo Construction Debris inRund 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 othermeans to meet the minimum requirements of the NYS DOT Construction Standards. , - GENERAL CONDI'T'IONS OF PERMIT APPLICATION/PERMIT FOR HIGI3WAY EXCAVATION AND REPAIR `, (Continued),, 10. Install,Maintain Erbsioir Controls-Required Erosion Control Measures(i.e:silt fencing)is to be-glaced 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 frill Only: - project,back-fill shall consist of clean sand,gravel otsoil(NOT asphalt,slag,flyash, broken concrete orrdemolhion debris).,All: nsuitable'soils excavated at the site'{i.a Clay,Hog,etc.}are to' _ be removed frornihe site and not,used to backfill any excavation within a•Town Highway. - 12 All Areas of Soil Disturbance: Ali areas of soil disturbance resulting from the approvedprojoct shall be stabilized to'the satisfaction'of the Highway Superintendent immediately following project.coinplation..If the project site remains inactive for more than 48 hours or planting is impractical due to the season,then the arewshall be stabilized with straw,hay mulch and/or jute matting until weather conditions t'avor"" 13. Brick ill&Compaction of ail Excavations: Back-Fill shall consist of clean,fill or soils which.cxhibit.a• well-defined moisture density,relationship its determined to be in accordance with ASTMD 696. Fill shall , be placed in maximum_lifts of twelve(l2')inches thick and shall be mechanically compacted to a Ninety five(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at`t'hree=foot intervals will also be permitted subject to a projecOpecifc approval by the Highway Superintendent ; 14. ltcstoratiun of the Ruad.Shoulder Arca::ATI manmade improvements located within existing,road , shoulder areas must be protected to the greatest extentpractical. items would include but not be limited,to driveway&private road aprons,mail boxes,sprinkler systems,Srees and ornamental plantings. Excavations through driveways and private mad pavements must be reconstructed to meet all requirements of Southold Town'Highway Specifications.' All p' existing- tor shoulder improvements that have been disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the , Highway Superintendent. . 15. Scbetnatic flans w#b all Technical Information:nnd'Seope of Work: To reasonably and adequately describe the proposed"work,accurate schematic site plans must be "'ided'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 bt:indicated by dimension or labeling. This schematic site plan must provide details'on` all restoration-required to,meei the requirements of these'General Conditions and requirements found in the' Southold Town Highway Specifications. 16, Pavement Reconstruction: AII.Pavement seetions must be.reconstructed in the following manner; (Note- ha,Concrete Pavements are Present,Please review`Restore tion requirements with the Highway Superintendent} tg' 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(12")inches on all sides; _ c) install arcompacted lift of 4"thick Stone Blend base(RCA Blend,must meet NYS DOT Specification); d) ,install a two and one ha1f,(2.5")inch compacted lift of Asphalt-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. I7.Trench of Pavement Surfaces tees 1<:xcccdin�One hundred(10:1'1 k'cet in Lenk1h All trenching of Pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements,of Item #-16 as noted'ebove: Once-all pavement reconstruction,is completed to the satisfaction ofthe'Highway Superintendent,the eritirt:road"section andt6uwidth of road over the entire length of trench shall be, ,y repaved with a two(Z")inch lift of Asphalt(Type 6)Wearing Course(Typieal,;shoulder to'shoulder). Page I of 1 :101 10" SWAM it ,',4z�ll I 110 -T- � ,Zft It http://metprmweb/Generic/Loadlmage.aspx?sessionID=z5cie345tcxwkj45jhi5pnik&att= 4/15/2019