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Home My WebLink AboutRyder Farm Ln Town of Southold P0Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 10/16/19 Receipt#: 260745 Quantity Transactions Reference Subtotal 1 Excavation Permits 1357 $600.00 Total Paid: $60000 Notes: Payment Type Amount Paid By CK#83088 $500.00 Pseg, Li CK#85411 $100.00 Pseg, Li Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Pseg, Li 117 Docotr's Path Rlverhad, NY 11901 Clerk ID: LYNDAR - Internal ID 1357 9 1'41:�- , ,Ln V. d&k 9- g-l q N i Tk, /;Z9g1q ' Permit No. TOWN F SOUTHOLD L� � HIGHWAY DEPARTMENT ��d�dSgFFQ(,,�c�Gy G lb I Peconic Lane � , x Peconic,New York 11958 0 ^* (631)765-3140 APPLICATION/PERMIT FOR IiIGHWAY EXCALATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit put scant 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. Print or Tvoe C. Ci 111 61-cu5'1, 1:"ys PtyPiocAeact MV IIQ761 Name of Applicant Phone Number Address of Applicant — I 2. Nameof Contractor Phone Number Address of Contractor 3. OName of Property Owner Requesting Service(if applicable) Address of Owner 1 4. .11F lial�l r-16'II r Ll�'on�l� �' ►ae o�'RVder�rryl . brill 5}2V I- �x. 6G' ash aF Work Description and Location(Street Number,Hamlet,Cross Streetl W44i &f& Rd tart Jrl hila trl0. 6 d 1 rev�ty► it 1 lD; (a) Is construction located within 75 feet of tidal wetlands? *Yes o � *If yes,other Town permits may be required. %.W . NE& +0 2Z� Iak NOTE: All information requested by this V Signature of Appl cant Application/Permit Form is I i , 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: Completion Date: 8 Work Schedule: Phase Completion Date Excavation Work Schedule Facility Installation Must be provided Backfill &Completion for consideration as a Pavement Replacement Complete Application, 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. $--- 11. --11. Remarks: —T4—)LU n of S®l kyb I& CA e, D-39 -- - - 1 of 5 r ) 12 Insurance Coverage (Attach Copy) (a) IllSlnanee 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 ath ibutable 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 - $500.00 A Project Location would include each Bell Hole and/or evety road opening or excavation within any 50' Radius whether or not they may be inter-connected by open trench or directional boring. The total notal number of Project Locations shall be subject to the approval of the Highway Superintendent. Al. o7— /Service Connections excavations @$50.00 $ v D. 01-0 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 Sante Service @$500.00/Each $__ No. F. Official Notice to public utilities-proof must be provided and TOTAL$ 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 cavation permit to: _ in accordance th this application and subject to the"General Conditions"and"Special Conditions"of permit(' any attached a o. SUPERINTE E HI YS TOWN OF 5 ,N ORK intent .Orl�nyt$r� �(,J Date Received by the Town Clerk Date_ 0 "'� 0 Date Permit Issued \0 — =19 __v Permit No. F� 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 S Copy Distribution: Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified I St 2nd 3 rd 01 (To Permit Clerk) REAMRKS 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 5 e Request for TOWN OF SOUTH❑LD FEE Date 09-03-2019 Permit Required to open ONE OPENING 1- PSEG TO DIRECTI❑NAL DRILL FOR 170' ON THE EAST SIDE OF RYDER FARM LN DRILL TO START APPROXIMATELY 150' NORTH OF NORTH SEA RD, THAN DRILLING IN A NORTH DIRECTION FOR 170', 2- PSEG TO REPLACE POLES 22 AND 12K SEE ATTACHED SKETCH FOR FURTHER CLARIFICATION, Permit Requested By: PSEG Q.N. Cent, E1W,S, E.S. TD 1200 Type of road MACADM Service for RYDER FARM LN Work Request # 900000097412 Charge account # ❑X Disloersement to be made out to petty cash To be billed No fee Return Permit To; ED & C Dept, GD & C Dept SOUTHOLD PERMIT PSEG NOTIFICATION# 900000097412 1- PSEG TO DIRECTIONAL DRILL FOR 170' ON THE EAST SIDE OF RYDER FARM LN DRILL TO START APPROXIMATELY 150' NORTH OF NORTH SEA RD, THAN DRILLING IN A NORTH DIRECTION FOR 170 , 2- PSEG TO REPLACE POLES 22 AND 12K N 12K yys 'we 6 3 CV HSEQ1200 r Pn�EAl4 P�pn�nIFY13 ,.a RpPp �-PRcwEv POEFJI PER t5 7305 #1200 R AWRY Pats¢�u Pt�Rccs m � tE Po N� R-PfnlYeY POlD1FM PER CS 7]01 Ogg- s FOa�p �ap0 p��ny R-3 pR rtsti�yR1P�, r PRIMARY HAS 5- HORIZONTAL DISTANCE CV FROM BUILDING AND IS UNDER THE ROOF LINE O R Z