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HomeMy WebLinkAbout17235 Sound View Ave Permit No. TO- i'J t3P SOIFI OLS HIGHWAY DEPARTMENT Peconic Lane _ CGQ NT?_r Vn;l: 4 3 Quo (631)765-314 AL rCAT1DN i PERMIT FOR I3C ?1rA3'EC.a��,iT,s� A� ;3R APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Perinit pursuant to Chapter 237 of the Code of the Town of Southold,Suffolk County,New York,and other applicable laws, ordinances or regulation:fir each individual centioti-o1s excavation project herei_tt decrrihT -r� aa -ad. -r,2- ^-ntgar?eeLrrry/ * ai � ?ir ,' ! ia ;; ordinances,codes and regulations,the attached"General Conditions of Permif'and"Special Conditions",if any and to permit authorized inspectors to make necessary inspections of the Job site. Print or Tyne 1. w G&I® G 1 - & 6 6 L9 5 1 bNF. nnor W&A aa6, 1 u i t Name of Applicant Phone Number Address of Applicant V& las 0\1 Name of Contractor Phone Number Address of Contractor X, _,C61 III.2 S Aix. , SparouD Name of Property Owner Requesting Service(if applicable) Address of Oyvner (� , 4. iZbP(D ©�L ).�`Z3S 3WAID qS� Ne _ els N�{l , Sa 1�C Work Description and Location(Street Number,Hamlet,Cross Street) (a) Is construction located within 75 feet of tidal wetlands? *Yes No *If yes,other Town permits may be required. aT^�a�, els �_.--_ �s _ _,.,a v_.aLa_ C,_. r?._.,1: 1`I i9 i E. L.LSSSUe iaidfi'_4)33 request 0 tall 471=,ilaLtlre V1 tSiJ�llca.Lt ripQ9196.sS d.Eoii/ PGH Y0776 T Vi age AJ 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 excayaticns and relationship to adioinirig premises,public strPets or areas,and give a detailed deSeription of ali 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 I Lot i. Stai l7li-Date: �+�Z�1281 ` Cuiitj�lZiGn Date' -- 8 Work Schedule: Phase Completion Date Excavation `2ey-2vi`Y Work Schedule Facility Installation 'L`?—?V 1 Must be provided Backfill&Completion 2-2Ct-26m for consideration as a. Pavement R e1lacement Ca-msadete Applirwkm3 9. Under which authority is application being made: See Town Code Chapter 237 (E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: $ 1 W6, LU 1 l. Remarks:ebn B1_;_ - 1Rtfk� CP r\( C`f 4.J`..� —ALL. ecmu eCf �l, �Lnl� P G�2 55I c�i1�l A T) C) 1 of 3 12. InsuranceCoverage:Coverage: (Atrach Copy) (-41LJ Ul C�11VV'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 pro;erty or commercial injury caused by or attributable to the work:e:fo�I ped. "t,0Gv,00.3 Pei' ccurt'et.cc and $L,Ou"0 v 0 ,.era. a;g'egatc. 13. Security: (a)Surety Bond or Certified Check provided in the total Amount of$ (b)Maintenance Bond provided: 2 years or 3 years. 14. Fees for Applications and permits: Basic Application Fee for Each Project L ecation - �51W.�� 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. Thetotalnumber of Project Locations shall be subject to the approval of the Highway Superintendent. Al. 1 !Service Connections excavations @$50.00 $4LSO`8L iV a_ A2. /Additional Excavations same service(a-,$20.00 No. B. Trench Excavations IS"in depth or less Total Lineal Footage of Excavation; L.F.@$10.00 $ C. Trench Excavations 1 S"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 AS S6.06 F. Official Notice to public utilities-proof must be provided and Shall be attached to this application prior to lssirance of permit. Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: in a ordance with this application and subject to the"General Conditions"and"Special Conditions"of permit(if any) cached hereto. SUPERINTENDEN O G_ TOWN OF BOUT SUPERINTEND/ Y Vin ent M.Orl Bate Date Received by the Town Clerk, I 2 Date Permit issued l 0 Permit No. J,U NOTE: Permit expires one(1)year from date of issuance. No work to start v ttlicut 24 hoaIr nattee to Superintendent c&Highways. Permit must be available at all times for inspection,on site,during construction. D-39 2 of 3 Copy Distribution: 2 Prat# J Iiigi��vay Department Engineer(with page 3) Applicant Town Clerk(Original) INS-ECTCR'S RECORDS Inspection Date Findings (use code) Applicant Notified 1 St u 3rd 01 (To Permit Clerk) REMARKS CODE M hmprope.B-m—neades IL Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfilling) BUC Building Under Construction WIP Work In Progress T)B Tinproper BackfiIt(too high,not sufficient) HFS Inspector Holding for Final Settlement of Excavation RFR Ready for Repair D-39 3 of 3 GENERAL CONDITIONS OF PERAUT APPLICATION/PERAUT FOR HIGHWAY EXCAVATION AND REPAIR , 1. Permittee's Contractors to Comply with Permit Requirements: 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 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. No Richt to Trespass or Interfere with Private Property Rights: This permit does not convey to the .permittee any right to trespass upon the lands of adjacent property owners in order to 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 not a party to the permit. 3. Protection of the Highway and Future Hiehwav Maintenance: 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 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 permit shall be revoked and the utility, structure,fill,excavation, or other modification 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 conditions of the permit or Chapter 237 of the Town Code. 4. Revocation of the Permit by the Highway Superintendent: 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 Commencement: At least 24 hours prior to commencement 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 shall provide photographs of the completed work to the Town Highway Department and request a Final inspection. 6. Storage of Equipment&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 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 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 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 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 other means to meet the minimum requirements of the NYS DOT Construction Standards. GENERAL CONDITIONS OF PERIMIT APPLla.AT aONIP RM 1T FOR Ai Dp-'PAIR (Continued) ;!! InstaB,Mait:ain Ernsion Qwntrola, Required _rosier_Control MfeaslirPs (i.e. si11 fencing) is to be r.1, on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any r3ist� rhancQ f the crrn�in occurs and is to be maintained in good ���ctional coedit;--r 1a ti7 /nick vd?otathle C+ n -� L._. - -- - C ✓es is eJtab ishe,' .11. Clean Fill Only: All project back-fill shall consist of clean sand, Gravel or soil (NOT asphalt,slag„flyash, broken concrete or demolition debris). All,.L'lsulitable soils exca7vated at the site(i.e. Clay Bog, e P.)are to be removed from the site and not used to backfill any excavation within a Town Highway. 12. ,mil Areas of Soff�pistueh ante : Fill areas of soil disturhance resuiting from the approved project chai i he stabilized to the satisfaction of the Highway Superintendent immediately following project completion. If the project site remains inactive for more than 45 hours or planting is impractical due to the season,then the area shah be stabilized vvitii stra`v`v, hay mulch aiiW juti.illattiiig uCitii•vveatii'vi CoIldii.BoiiS favor germination. 1-3. Baclr?ill1&r Compaction of aU Excavations: Back Fill shall consist of clean fill or soils�Flhich Px_hihit a well-defined moisture density relationship as determined to be in accordance with AS T iMD 695. Fill shall be placed in maximum lifts of twelve (12")inches thick and shall be mechanically compacted to a Ninety- live (915%)percent iliaxiil7t'Lill dry density. Suitable hydfaullic compaction by WaLGi)Gtt111g at 611reG-A'U4'Jt intervals will also be permitted subject to a project specific approval by the highway Superintendent. 14. Restoration of the 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. Fxc;avalions through driveways and privdte road pavements must be reconstructed to meet all requir Dents of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been disturbed during construction mast be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15. Schematic Plans with all Technical information and Scone of Work: To reasonably and adequately describe the proposed work, accurate schematic site pians 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 delith 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; ("Mote:When Concrete Pavements are Present.Please Levtew Restoration reauuements with the IIig-tLway SuneLiatendent► 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 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`v`vvork listed herein must tneet the mminimum requirements of the Southold To`v`v'n Highway Specifications. 17. Trenching of Pavement Surfaces Exceeding One Hundred (100')Feet in Length: All trenching of pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item # 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). I ! 1 I �I I Rr- Ll ( II� I I � I I I 1 ) I 21 - -- _ �►�,� 07fr - li 1 II I1