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Home My WebLink About9525 Old Sound Ave Town of Southold P0Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/01/19 Receipt#: 253580 Quantity Transactions Reference Subtotal 1 Excavation Permits 1335 $550.00 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#44693 $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 Fl 1 Hicksville, NY 11801 Clerk ID: LYNDAR Internal ID 1335 Permit No. I�'�✓� _: _ __- _ -_ .- - -_T - - =r: TOWN OF SOUTHOLD �,►ff ;� HIGHWAY DEPARTMENT , Peconic Lane T1021,98855 Peconic,New York 11958 �d ,(631)765-3140 APPLICATION!PERMIT FOR HIGHWAY EXCAVATILDN'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. P Ke pan,Gas East Corp D/B/A Nadonal Wd Margaret Paglia 516 545 4094 Gas Permits Dept. �Idg:,3( : I. 75r Id- ®ii' d p, Name of Applicant Phone Number Address of Applicant - r•r. Name of Contractor Phone Number- Address'of Contractor r Name of Property Owner Requesting Service'(if applicable) Address of Owner• 9525 Old Sound Ave-S/S, 804' W/0 Cottage Way, Mattituck Work Desc4ption,and Location'(Street Number,Hamlet,Cross Street) X " #a) is construcdion°located within 75 feet of tidal wetlands? !Yes' - N *If yes,other Town permits may be required. NOTE: All information requested by this _ Signat re of Applicant Application/Permit Form is Required for a coinapleie application! 4/24/19 ( Revised) ' 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. (b) Attach all other necessary permits and licenses for this project; (c) Work covered by this application may not commence before issuance of Highway'Excavation Permit by/t�he,Town Clerk. 6. Tax Map No.: District f 000 , Section_\'21 Block ' Lot 7. Starting Date:, 5/23/19 Completion Date: 5/24/19- 8, Work Schedule: Phase Completion Date Excavation_ _ _ Work Schedule Facility Installation Most be proeided BackfiN do 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: S,:_ „g1 11. Remarks: INSTALL GAS SERVICE ***CGRASS-REVISION D-39 I 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 - ix $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 $ Na. =- 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 Exca ation permit to: _ i accordance w' this application and"subject to the"General Con ditions"and'"Special Conditions"of permit(if an att hed her o SUPERINTENDS F I H A TOWN OF SOU , Vinc nt M. Lando Date Date Received by the Town Clerk ted ' t Date Permit Issued I Permit No. I s3s 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) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 2nd 4 3rd 41h (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 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR ; 1. Periitittee's Cciutractors to Comply witli`Permit Iteanircnicnls: TfreTermittee is responsible for . informing its'independent 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.' Nu Rigirt�to Trespass ar Inteirferc witli Private Propei:ty Riahts: This permit does not convey to'the permittee any right to trespass upon the lands of adjacent property owners in order W perform the permitted work nor does it authorize the impairment of any rights,title,or interest in real or personal property held or' vested in a person nota party to the permit. ° 3. I'rotcetion',of the)ilietnvay'and Future Righiv_ ay Mnintennnec: 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 Highwayi5uperintendent the work performed under r 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, structuro,'All,excavation,-or other modification of the'highway hereby'authorized shall not be completed.` Additionally,the permit may be revoked if the Highway.Superintendent fndsthat the•issuance of the a 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. p, Reiyocatioo of the Permit by the Highway Suncrintendent 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 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. 5. Notice of Corunioiicement: At least 24"hours prior to commencement of the project,the permittee and/or ; contractor shall notify`t_h'e 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' { shall provide photographs of the completed work to the Town Highway Department and request a Final inspection. b, S orngc df Equipment&•Msteriats`i The storage ofconstruction equipment and/or materials shall be, confined within the project work area and/or adjacent areas,where permission/legal access has boon 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 shat!be the responsibility of the contractoi 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 appropriate signage and flag men to,stop and start,traffrc'to allow for single lane traffic. Road Closures due to unforeseen i emergencies require immediate notification of the Highway Deparimenf and shall be limited'to immediate and/or expedited restoration of the Work Zone. 9. No Constrirction Debris in Road Shoulder Arca: 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 othor means to meet the minimum requirements ofthe NYS•DOT Consiruction Standards, GENERAL CONDI'T'IONS OF PERMIT APPLICATION/PERMIT FOR HIGI3WAY 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. Cleats gill Only: All project back-fill shall consist of clean sand,gravel of soil(NOT asphalt,slag,flyash, broken concrete or demolition debris). All unsuitable soils excavated at the site(im.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 disturbance 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 andlor jute matting until weather conditions favor germination. 13. Bgckfrll&Compaction 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 accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve(l2")inches thick and shall be mechanically compacted to a Ninety- five(00K)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. Resteratiun of the Rud Shoulder Area: All man-made improvements located within existing toad shoulder area most 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. IS. Sclteniatie plans 1vitb all Technical informs ion and co a of Work: To reasonably 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, Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner; (Note:when Concrete Pavements arc Present,Please review Restoration regoiremenis with the Highway Superintendent) 8) 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 02")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(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. Trenching of Pavement Surfaces Exceedine One Hundred(1004 at in Length: All trenching of pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item 0 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(Typical,shoulder to shoulder). e� � r v - t; .X.R • ` Ps'IuniciNality: +°�rA�!,._�.. T+.Y D -�_� � E. ' '- ..`�f;:�•� . .__. ._ .. !I, natloi location: a: 7ai3.3: Totivn: ,os-'.;, i Requested B ..,- Reason'fa Excavation: --L�Vl�• �r[ � ,� •w�,r+wa,wrr a� w�.r wmw`n�'�:ata� +amwr��rr.sq�•_Y, r.a,e.,v,.yw`•tlsgys.�.y'..`.,'y�`� ja 4 011 dl .7�w,:::�;�„';"ry�..,..,.-. 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