HomeMy WebLinkAbout4745 Elijahs Ln ' Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 01/31/20 Receipt#: 266342
Quantity Transactions Reference Subtotal
1 Excavation Permits 1377 $550.00
Total Paid: $550.00
Notes:
Payment Type Amount Paid By
CK#26332 $55000 Alternative, Cable
Construction Inc.
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Alternative, Cable Construction Inc.
2 Cobblestone Court
Farmingville, NY 11738
Clerk ID: LYNDAR Internal ID. 1377
e ?
HIGHWAY DEPARTMENTRECEIVED ��F��.���!_`
Peconic Lane
�T JAN 3 0 2020 ,1
PLe C C.ill C,'-'T 'r Yv-s 1 1 958
(631)765-3140
Southold Town Clerk
APPLICATION/PEPOMIT FOR HIQHIKY Y EXf"'AYATION 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
reg llattOn;for each inrlividliat contiguous excavation project herein described_ The applicant agrees to co?nply with all aprrhlira-bie la—v7s
ordinances,codes and regulations,the attached"General Conditions of Pen-nit"and"Special Conditions",if any and to pen-nit authorized
inspectors to make necessary inspections of the job site.
Print or Tyne q�
Name of Applicant Phone Number - Address of Applicant
2. G94VAIE 's 4160\11E
Name of Contractor Phone Number Address of Contractor
3. 60401(02- SH1 VN f4A fI y� /"l /y6 �t�1JL�9�5 Lat1 L� /r/IIIMIOCIL
Name of Property/ Owner Requesting Service(if applicable) Address of Owner
KbRO lbbL /�1 qJ 60-J qS LANr I MI -fi IUed S1b Cke&-0,1 Q6RO
Work Description and Location(Street Number,Hamlet,Cross Street) y
(a) Is construction located within 75 feet of tidal wetlands? *Yes No /`
*If yes,other Town permits may be required.
NOTLE: r"Aal informiation.requested by this S1c,na4Llre Uf �ippllL'at:t
___}
,tppiication/f e_.iint For-a-,-,is /-30 2
Required for a complete application! /—J0
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
9.11 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 Pen-nit by the Town Clerk-.
6. Tax Map No.: District 1000��//, Section t 0 Block G, Lot r�S
i. S t-u urig Date: �' s L�i26
ConiplZiion Date:
8 Work Schedule: Phase Completion Date
Excavation 2'(G—zc>zo Work Schedule
Facility Installation 2"6' Zo 20 Must be provided
Backfill&Completion 2-C,-20 20 for consideration as a
Pa-%,ernent Replacement Coml-leta_A,"Plieationn
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 16Lti�U llwp
1
it. Remarks: kba e&�' -rQ ReFLt� DAIMaG99/ 0 I U& Cyrl\,f CI�'nJLJE�
a LL Woo(- I VI.) U N pmeo P ao-1c. l /V b Aofa fifty,S 'o gS ormo,*�
n_q q 1 of 3
12. Insurance Coverage:(Attach Copy)
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 injurf caused by or attributa°nle to the work perrormi-d:
^^ laggregate.
,��,O00,LVV
Per Occurret}ce at}d$2,OCO,u°.v�ettera. �
i=. Jz�uriiy:
(a) Surety Bond or Certified Check provided in the total Amount of S
(b)Maintenance Bond provided. 2 years or 3 years.
14. Fees for Applications and perinits-
Basrc sppltcat;—r Fee for Each Yro; t LO--anon
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 $ J u W
Noy
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 Ltt.eal Footage of Excavattotr; L.F. @$30.00 $
D. Trench Excavations 5' in depth and over
Total Lineal Footage of Excavation; L.F. @,$50.00 $
E. Utility Repan Excavations @ S 1,000.00/Each $
No.
Additional Repairs of Same Service @$500.00 i Each $
No. 1 �^
TOTAL$ J5b r iib
F. Official Notice to public utilities-proof must be provided and
Shall be attached to this applicatioll prior to issuance of permit.
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excav tion permit to:
accordance wi
this application and subject to the"General Conditions"and"Special Conditions"of permit(if an )a hed heret .
SUPERINTEND T
TOWN OF SOU O E
Vin ent .612
&L 2ozo
1 Date
Dale Received by the Town Clerk
Date Permit issued \- k- 2.0 Permit No. a�
NOTE: Permit expires one(1)year from date of issuance.
No:work to start...4hout 24 hour notice to Super•intendent of Highways.
Permit must be available at all times for inspection,on site,during construction.
D-3y 2 of
Copy Distribution:
perr�rah-
Higllway Department
Engineer (with page 3)
Applicant
Town Clerk(Original)
I14SEE,CTOR'S RECORDS
Inspection Date Findings (use code) Applicant Notified
ist
2"d
3 rd
01
(To Pennit Clerk)
REMARKS
CODE �
IB innooperBsrr:cades
IL Improper Lights
ST Sunken Trench or Excavation
UTM Unable to Measure(due to backfilling)
BUC Building Under Construction
WIP `York In Progress
DB Improper Backfill(too high,not sufficient)
(-IFS inspector Holding for Finai Settlement of Excavation
RFR Ready for Repair
D-39 3 of 3
GENERAL CONDITIONS OF PERNHT
APPLICATION/PERNIIT 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 Right 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 Hishway and Future Hiahwav Maintenance: If future operations or highway
maintenance projects by the Town of Southold require analteration 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 07 PERMIT
APPLI ATS'O-NIPFROYTTT FORHIGMWAY EXCAy ATTIO�i ANDs�3��)JR
(Continued)
10. Install,Maintain Erosium_ Controls; Recii-ifired Erosion Control-lea-sures (i e silt f,rrinalis to be riar.ed
6.1 on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any
disturbance of the csroulndoccurs and i-to be maintained in good fLnct;onal condition until t..hic v�met&ti';'
t.^�✓er l.3 estab'Esh e: .
11. Clean Fill Only: All project back-fill shall consist of clean sand, ,- or soil (SOT asphalt, slag,flyasl,
broken concrete or demolition debris). All wns!table soils excavated at tale site(l.e. ( lay,Bow' etc.) re tC
be removed from the site and not used to backfill any excavation within a Town Highway.
i 2_ All Areas of Soil 9'ia#uFhance : All areas of scut disturbance resulting from the approved project shah 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,their
the area shall.be stabilized with strwov, hay inulc h and'orjate mat-ting until.weathier conditions fdavor
germination.
1-3. Backfill & Com?ractiotn of all Excavations: Back Fi11-hall.consist of c1ean fill or soils which eyhibi_t a
well-defined moisture density relationship as determined to be in accordance with AS T 1`✓ID 698. Fill shall
be placed in maximum lifts of twelve (12")inches thick and shall be mechanically compacted to a Ninety-
five 1 y J 'y_. 'L �y ra. p ♦ i j.. Li b 't' r�
IiVe erceri�maxii11ur11 dr--densis Sui�able� bias iC COill' aa;�ior1 u' e%Ja�ei' cttiil�at uil'eZ-toot
intervals will also be permitted subject to a project specific approval by the Highway Superintendent.
14. Restoration of the load Shoulder Area: All mean-made improvements located within ex—isting 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.
Excavations ulrougia driveways and private road pavements must be reconstructed to meet ail requireme�-its
of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been
disturbed during construction must be replaced or repaired by die contractor to the saiisfac;tion of the
Highway Superintendent.
15. Schematic Plans with all Technical information and Scope 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.fill!deiith 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 foti_nd in the
Southold Town Highway Specifications.
16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner;
("Note:When Concrete Pavements aie Present.PLease tev cew he5tQi'atlo11 requirements with the highway Sunercateadeat)
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 IPS 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 milst meet the minnim rn requirements of the Southold Town iiigIIiv✓ay
Specifications.
17. Trenching of Pavement Surfaces Exceeding One Hundred (10W)Peet 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 lengtll 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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