HomeMy WebLinkAbout2070 Grathwohl Rd Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 05/14/19 Receipt#: 254092
Quantity Transactions Reference Subtotal
1 Excavation Permits 1338 $550.00
Total Paid: $550.00
Notes:
Payment Type Amount Paid By
CK#45000 $550.00 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 1338
. I
Permit No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT MAY 1 3 2019
Peconic Lane
T102198514 Peconic,New York 11958 10
(631)765-3140 SouthrjId To1,,mr;
APPLICATION/PERMIT FOR HIGHWAY EXCAVATI®N 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.
Pr'` arc Keyspan Gas East Cote D/B/A NatbnW._
Margaret Paglia 516 545 4094 Gas Permits Dept, ®Idg:3 F6: f
1. 175 E,_Old-Co 1: Ilei A
Name of Applicant Phone Number Address of Applicant
Name of Contractor Phone Number Address of Contractor~
Name of Property Owner Requesting Service{if applicable) Address of Owner
2070 Grathwohl Rd-E/S, 264N/0 George Rd, New Suffolk
Work Description and Location(Street Number,Hamlet,Cross Street)
(a) is construction located within 75 feet of tidal wetlands? °Yes No X
If yes,other Town permits may be required.
NOTE: All Information requested by this Signififure of Applicant
Application/Permit Form is 5/3/19
Required for a complete application!
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 a Highway Excavation Permit by the Town Clerk.
6. Tax Map No.: District 1000-, Section _- , Block Lot
7. Starting Date: 5/30/19 T Completion Date: 5/31/19
8, Work Schedule: Phase Completion Date
Excavation _ Work Schedale
Facility Installation Mast be provided
Backfill&Completion for consideration as a
Pavement Replacement _ Complete Application.
9. Under which authority is application being made: Kaysparl 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 �„IL Remarks: INSTALL GAS SERVICE
D-39 I of 3
k
'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$2,000,000 general aggregate.
13. Security:
(a)Surery-Bond or Certified Check provided in the total Amount of$
(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. '"` TR/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; u 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 Excavation permit to:
in accordance with
this application and subject to the"General Conditions"and'"Special Conditions"`of permit if any)attach her o.
SUPERINT DEN F AYS
TOWN OF UT E' O
`
in6dWYA.15il doh
- - - Date
Date Received by the Town Clerk ' 1� 1
Date Permit Issued Permit No. ? 72)
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# J�
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
1st
2nd
3 rd
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
I
GENERAL CONDITIONS OF PERMIT
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
1. e' rmittia's Contractors to Comply with pormil I2caulrauenls: The Permittee is'responsible for
infonniiig its'independent contractors,employees,agents and assigns of their responsibility to comply with
this permlit, 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. Nu Right to Trespass or Interfere with Private Proger`ty Rights: This permit does not convey to the .
permittee'any right to trespass upon thellands of adjacent property owners in order to perform the permitted
work no does it authorize the impairment of any rights,title,or interest in real or personal properly held or
vested in�a-persori not a party to the permit. -
3. Protection of the Highway and Future Hi hwa Maintenance: if future operations or highway
maintena�'Cc 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 pet formed'under
this permit shall cause unreasonable obstruction to required highway'maintenance or endanger the health,
safetyandlor welfare ofvehicular or pedestrian traffic,this permit shall be revoked,and the'utility'
structure,fill,excavation,or other madification,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
conditio i of the permit or Chapter 237 of the Town Code.`
q, Revation of the Pcrmil by the HIS Superintendent:_If the Highway Superintendent deems'it.
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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. ;
S. Notice of Commencement: At least 2A hours prior to commencement of the project,the permittee acid/or
contracto 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
shall'provide photographs of the completed work to the Town Highway Department and request a�Final
inspection) _
6. S10TAre of)Enuinment&Mater1hls: The storage t)fconstriction equipment and/or materials shall be
confined within the project work area and/or adjacent area where permission!legal access h'es'been
olitaided i'lmanner that does not,interfere with normal,highway traffic.
7. U'tifity M�rk-OutsThe Applicant/Contractor shall be: responsible for verification of all existing utility
inark-ouisland shall take all precaution's to protect same. Damage to existing utilities shall bethe ,
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 appropriate signage and
flag men to stop and start traffic to allow for single lane-traffic.-Road Closures due,to unforeseen
emergencie11 s requrre'iminediate notification of the Highway Department and shall be limited to immediate
and/or expedited restoration of the,,Work Zone.,
9. No Constractron llebrls in Rond Shoulder Area: All Construction Debris shall be removed from the job
site on a daily basis. All stockpiled soil as well as all other preject'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 DOT Construction Standards.
GENERAL CONDI'T'IONS OF PERMIT
APPLICATION/PE RMIT 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 td be put in place before an'y '
disturbance of the'ground occurs,and is to be maintained in good functional condition until thick vegetative
cover is established.
11. Clcah Nifl'Only: All project back-fill shell consist of clean sand,gravel of soil'(NOT asphalt,slag,flyash,;
Broken concrete or demolition debris)."All'unsuitable soils excavated at the site(Lo.Clay,Bog,etc.)arc to
be removled,from the site and not used to backfill any excavation within a Town Highway.
12. -All Areas of Soil Disturbances All areas of soil disturbance resultin&from the approved'project shall be
stabilized f 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
germinatI n.,
13.'Bkkfill&Comnaction of all Exeavations. ,Back Fill shall consist of clean fill or soils.which exhibits
well-defined moisture density relationship las determihato be in accordance with ASTD 698.,Fill shah
'to placed lin 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 i11 also be permitted subject to a project specific approval by the Highway Superintendent.
14. Reslomt:1 n of f lie Road Shoulder Area: 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.
Exeavaiiohs 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
distuibed,during construction must be replaced or repaired by.the contractor to the;satisfaetion of the
Highway Superintendent., _
I S.'Schenlatl{Plans 10(6 all Technical informs ton and Scone 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 out to the'full depth of asphalt andloi concrete pavements.,Accurate size of bell holes or width
of trenching must be indicated by dimension or labeling.` This schematic'siie plan must provide details on
all restoration required to meet the requirements of these Genera]Conditions and requirements found in the `
Southold Town 44ighway Specifications. .
16. Pnvemen6 Reconstruction: Ail Pavement sections must be reconstructed in the following manner;'-
(NoteF '�hen oncrete Pavements are Present,Please review Restor°tion requirements with the with Superintendent)
a), Complete all back-fill&soil compaction work as needed to provide s suitable sub-base;.
b) Over-cut existing asphalt bell hole or trench by twelve(12")inches on all'sides;
0 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 ijstod herein must mect•the minimum'requircmet>ts'of the Southold Town Highway
Specifications. _
17. Tretichin of Pavement Snrfitces i1'xeeedintt (1001)Feet iii Lcngih: All trenching.of
Pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item
N 16 asnoted above. Once all pavement reconstruction is completed to the satisfaction of the Highway ;
Superintendent,the entire-road section andior 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):
A.-Cad Ope�o 'q'—piteir a6 sf nationalgrid
Munici ahty � � _ mevx:ida'nerdat
�®k�i� Work Order:
Location. �O Grid.
Town
--Requested B
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' Reason For Excavation: 1�-O LL A 6A f-fCM12:F—
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