HomeMy WebLinkAbout18915 Soundview Ave ` Town of Southold
P O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 06/25/19 Receipt#: 256379
Quantity Transactions Reference Subtotal
1 Excavation Permits 1343 $55000
Total Paid: $55000
Notes:
Payment Type Amount Paid By
CK#7001596543 $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 1343
i
Piffnif N-6.-
TOWN OF 30UTHOLD RECEIVED �gF�fi
HIGHWAY DEPARTMENT
Peconic Lane JUN 2 4 2019
T102213482 Peconic,New York 11958 1
- (631)765-3140 ,� .fid`'
Southold,Town Clerk
APPLICATION/PERMIT EER 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.
Priaa' lc Keyspan Gas East Corp D/B/A Naftal d
Mar'aret Pa Iia 516 545 4094 Gas Permits Dept Bldg:3 Fla f
1. g g= 175-E: old' �dt I . I,. Ill0ICY 1-
Name of Applicant Phone Number Address of Applicant
Name of Contractor Phone Number Address of Contractor
Name of Property Owner lteg6esting Service(if applicable) _Address of C2wrier
18915 SOUNDVIEW AVE-S/S, 495' E/O MOUNT BEULAH AVE, SOUTHOLD
Work Description and Location.(Street Number,Hamlet,Crass Street)
(a) is construct ion'located within 75 feet of tidal wetlands? •Yes No X
*If yes,other Town permits may be required. h
NOTE: All Information requested by this ignature of App' ant
Application/Permit Form is 6/14/19
Requiredfor 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 Torn Clerk.
6. Tax Map No.: District 1001) , Section , Block Lot
7. Starting Date: 7/15/19 Completion Date: 7/16/19
1. Work Schedule: Phase Completion Date
Excavation Mork Schedule
Facility Installation Must be provided
Backfill&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, w "'
10. Estimated Cosl�of Proposed Work:
11. Remarks: INSTALL GAS SERVICE
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 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.
1605�IN5T(R/Service Connections excavations @$50.00 $ 50.00
Al.1
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."
TOTALS 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 accoJhe
this application'and subject to the"General Conditions"and'"Special Conditions"of permit(if'ny)a c
SUPERINTEN NT TOWN OF SO TH ,NVi •cent�M �/� -
Date
Date Received by the Town Clerk (P O' ^_�� h
Date Permit Issued (p• QS—`9 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)
INSPEC'TOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
1 S'
2nd
3 rd
4rh
(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
I.
Per Imittca's C'outracwrs w Cam I ,with Permit lie uircinents: The Permittee is responsible for ;
informing its independent contractors;employees;agents and assigns of their responsibility to comply with
this permit,including-all special/site s ' cifrcand 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.
24' No Right to Trespass or Interfere with Private Property Riehts: This permit does not convey to the., ;
permittee'any right to trespass upon the lands of adjacent property owners in order W ped nit 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 not s'party to the permit.
3. Protection ofIhe Iillghwav'nnd Fsilgre HighlyagMninlerirince: if future operations or,highway:
maintenance projects by theTown 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 and/or welfare of.vehicular or pedestrian traffic,this permitrshall be revoked and the utility,.
structure,till,excavation,or other modification of the highway hereby authoritied shall not be completed. ;
Additionally,the permit may be revoked if the Highway Superinteridentfrnds•that the,issuence of the _
permit was illegal or unauthorized or'that the applicant failed to eori+ply_with any of tho terms and
conditions of the permit or Chapter 237 of the?'own Cods.,
4. Rcv cation of the Permit by the Highway Superintendent: If the Highway Superintendent-deems it
necessary to revoke this permit and the projecthereby 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 Superintondent '
may require,remove all or any portion of the uncompleted utility,structure or-fill and restore,the site to its'' .
former condition.
S. ` Naticc of Commer+cen+ent; At least 24 hours prior to'commencement of the project;the petrnittee and/or„ '
contractor shall notifyrthe Town Highway Department in writing that they aro 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. S ora c of E ui nick&Matcrinls: the storage of construction equipment and/or materials shall be `
confined within the project work area and/or adjacent areas'whero permission/legal access h'as been
obtained in a manner tl% t does not interfere with normal highway traffic.
-7: Utility Mark-Outs: The Applicant/Contractor shall be responsible for venti'oatiomo all existing utility
mark-outs�arid.shall-take all precautions to protect same. 'Damage to existing utilities shat!-be the
responsibility,of the contractor and'shall too repaired at the contractor's expense.
8. Road Closures: All scheduled road,dosures must first rece'sve written perrriission'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 t- the iristallation.of appropriate signage and
flag men to stop and start traffic to allow for single lane tcaftic. Road Closures due to unforeseen
ernergencie"s require immediate notificaiion of the Highway Department and shall,be limited to immediate
and/or expedited restoration ofthe Work Zone,
9.
No Cansirucfion llclirls.in Road Shouiticr Aren: A11 Construction Debris'shall.be removed from the job.
site on a daily basis,,'Ali 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 DOT Construction Standards.
GENERAL CONDI'T'IONS OF PERMIT
APPLICATION/Pt RMIT FOR HIGHWAY EXCAVATION'AND REPAIR
(Continued)
10. Install,Maintain Crosfori Controls: Required Erosion Control Measures(i.e.silt fencing)is to'be placed'
on'tho downslope edge of any disturbed,ama.;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!till 60r•All project back-fill shall consist of clean sand,gravel oc 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 within.a Town Highway,
12. All Areas or soh isturba»ce: All areas of soil disturbance msukini from,the approved project shall be '
stabilized to the satisfaction of the Highway Superintendent immediately following project coiripfetion. 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 pnulch and/or jute matting-until weather conditions favor,..
gerittination.
13. Backfill&Compaction of all Excavations. Back Fill shall consist of clean fill or sails which exhibit a
well-defined moisture density'relationship as determined to be in accordance with ASTMD.698. Fill shall
'lie placed in maximum lifts of twelve(l2")niches thick and shall be'mechanically eotripacted to a Ninety
five(95%)percent maximum dry,density. Suitable hydraulic compaction by water jetting at thme400t
_ intervals will also be,peimitted subject to a project specific approval by the Highway_Superiritendent.
14. Restoration orthe Ituad,Slioulder Area:-All jnt w-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;spnitkler systems;trues and ornaritenfal 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 contractorxo the satisfactionofthe
Highway Superintendent.
;15.Sclternatic P1ans with all,Technic Vfnr—oration 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 cut to the full depth of asphalt and/or concrete pavements: Accurate'size of bell'hofesor width`
of trenching must be indicated by dimension or iabeling. ,This schimatic tite plan must provide details an
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 '
must be'reconstlucted in thg following manner;
(Note''hen Concrete Pavements are Present,Please're'view Restoration icquirernents with the Highway Superintendent);
a) Complete all back-fill&soil compaction work as needed to provide esuitable sub-base;
b).Ove out existing asphalt bell hole or'treisch by twolve(12")inches on all sides;
c} Install a compacted lift of A"`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-(I.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:Treuehine of Pavement Sur fitees rhe One Ilundred(1001 k'ccl in Lenxlfi: All trenching'of
pavement surfaces exceeding 100'in length must first be reconstructed to meet the requirements of Item
#A6 as noted above. Once all'pavement reconstruction is completed to the satisfaction of the,Iiighway
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).
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(C) National Grid 6/14/19 9:13 AM