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Home My WebLink About505 Kayleighs Ct Permit No. TOWN Or SOUTIiOLD ,-�MllfF04,r HIGHWAY DEPARTMENT Peconic Lane ,. Peconic,New York 11958 (631)765-3140 APPLICATION/P;vlluMIT FOR MCPrWAY EXCAVATION ANb 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 regalations 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 iiispec[ots til make necessary inspections of the job site. Print or Tvoe Name of Applicant Phone Number Address of Applicant 2. 6VM1ZFt.$ 466,4 Name of Contractor Phone Number Address of Contractor 3. lMiN K / ftWN 1 n 1 Name of Property Owner Requesting Service(if applicable) Address of Owner 4 d'-- S -SD-S VAIL-969c; C--(- 06 MOIR) (Lft (5_JZ. 2C 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. NOTE: All information requested by this Signature of Applicant Appiieation/Permit Form is �-Z j3]�� 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 conur}ence before issuance of a Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 , Section 3 , Block 1 , Lot_ 7. Starting Date: l'2JI D)2D2b Compiehou Date: 8. Work Schedule: Phase ComWetion bate Excavation /'2— /D— 2nd Fork Schedule Facility Installation 10 2D?—Q Must be provided Backfill&Completion /'2- i 6 2r-A 2n for consideration as a Pavement Replacement Complete Applicatiion, 4. Under which anthdrity 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: $ 1668. 60 f 11. Remarks: i VJ 'bGf� L-rb R LA D 11 /D EFEC j -g-� Cpl if CAE>(-e- D-39 r 1 of 3 1=. Insurance y CNyove((ra��g�e�:(Attach Copy) cce (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 attri'outzble to the lvor'r, pe nned: 51,000,000 per Occurrence and S 2,000,000 general age-regate. 13. Security: (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 permits: Basic Application Fee for Each Project Location - 5500.110 A Project Location would include each]Bell Hole and/or every road opening or excavation Withifi ariy 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 No_ A2. /Additidrial Excavations same service(J-J,$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 Exurv4.ti ll,, L.F. @$30.010 $ D. Trench Excavations 5'in depth and over Total Lineal Footage of Excavation; L.F.@$50.00 $ E. Utility Repair Excavations @ S1,000.00/Each $ No. Additional Repairs of Same Service @$500.00 i Each $ No. ,,µµ TOTALS 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 w 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 perYUE attached eto. SUPERINT I AY TOWN OFYO Vincent M.Prlindo Bate Date Received by the Town Clerk Date Permit issued �al1i 1� PerrnitNo. NOTE: Permit expires one(1)year fiom date of issuance. Na work to start without 24 hour notice to Superintendent.of Highways, Permit must be available at all times for inspection,on site,during construction. R-. 11 n 2 of 3 i Copy.Distribution: Highway Department Engineer(with page 3) Applicant Tuwm Clerk(Cries nal) Il SPECIOXS RECORDS Inspection Date Findings (ease code) Applicant Notified St 2nd 3`d ,4th (To Permit Clerk) r_ REMARKS CODE IB Emp aper Barricades ITT-1 Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfilling) BUC Building Under Construction IN'IP Work In Progress 1]I1 Improper Backfill(too high,not sufficient) HFS Inspector Holding for Final Settlement of F,-X ljop RFR Ready for Repair x.. .. GENERAL CONDITIONS OF PERMIT APPLICATIONMERNIIT FOR UIGff WAy EXCAVATION ANI D REPAIR 1. Permittee's Contractors 10 Comply with Permit Re uirements: The permittee is responsible for informing its independent contractors,employees,agents and asci this permit,including all special/site specific and general conditions imposed bygns Of their rytthe Highns i1i o ib way y comply with Superintendent while acting as the permittee's agent with respect to the permitted activities,and such Persons shall be TrMired tp comply with all permit mquifemenfs. 2. No Right to Trespass or Interfere with Private Property Ri htc• .Permittee any right to trespass upon the lands of ad'acent roe This permit does not convey to the work nor does it authorize the impairment of any rights, title,or interest tt in real or personal properers In order to perform the Permitted he d or vested in a person not a party to the permit. 3. Protection of the Highway an7.d Future Highway Maintenance If future operations or highway he maintenance projects by tTown 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, s>tMetva,fill,excavation,or other rAddifieation 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 Hipimay Superintendent If the Highway Superintendent deems it necessary to revoke this perMt Rd the project hereby authorized lies riot: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 Totem Highway Department in writing dist thdY arae 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 WCA and/or adjacent areas wherepern issioii/legaI acceshe as ben obtained in a manner that does not interfere with normal highway traffic. s 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. koad 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 f?.Pedited,:mtoration 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 CONDOMS OF PERIMIT .APPLICATTONT E.R UT FOR HIGH AY E,XCA v AT-1140ii AND REPAIR (Continued) 10. InstalL Maisetain Erosion Controls: Required Erosion Control Measures (i.e. si's_t fenreng) ie to be ;Leo 4 on the downslope edge of any disturbed area. This sediment barrier is to be put in place befor;,any disturbance of the ground occurs and is to be maintained in good fi.-nctional condition unldl thick vw_etwti=l: wou i 11. Clean Fill Only: All project back-fill shall consist of clean sand, gravel or soil( TOT asphalt,slag,#lyash, 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 of Soil Disturbance : All areas of soil disturbance resulting from the appr€tved project shall 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.-then the area shall be stabilized with straw,hay mulch and/oriute matting uCit1l.weather conditions favor germination. 13. Backfill& Comtacdoin of all Excavations: Back Fill shall consist of clear_+ill or soilswhich e_hT it a well-defined moisture density relationship as determined to be in accordance with AS TNID 698. Fill shall be placed in maximum lifts of twelve (12") inches thick and shall be mechanically compacted to a Ninety- five (95%)percent maximum dry density. Suitable hydraulic coy apaction by water jetting at three-foot intervals will also be permitted subject to a project specific approval by the Highway Superintendent. 14. Restorations of the Road Shoulder Area: All man-made improvernents located within existing read 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 omamental 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 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 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 andlor concrete pavements. Accurate sive of bell hole.%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; (Note;when Concrete Pavements are Present.PLease review Restoration requirements with the iIighway Sunerinteadent) a) Complete all rack-fill&,wil compaction work a�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 work listed'herein must meet the-,mnimum requirements of the Southold To,-,m Highway -Spccifiddti6h§. 17. Trenching of Pavement Surfaces Exceeding One Hundred (1001)Feet 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 repdVdd with a two (2")indh lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder=). I Ll LFF �--!- I_I�II—J� I_� Ll - ___, r-- r- I-�- - ! ! •! _ LSI - -I--! I- -- I f - !-! LL L h-1 I _ 1 I 1 C _ c LLQ T_ILL I 1 i�L ! i-L! 1 1 ! 1 1 1 1 ! ►-;--� I- I I - !-f--- -- - --L� �--,-�-�---'�� I I-_l-TI__' I !-CI � r-I-� _�-I-, - ��►�oc��W►�c� I I l-t- _ -T-F- 1 - I 1 56 , t��►�ftrlt�65_C -I ! -!- _( r I � I i Tlll � . ( III ! I � IIIII � I �I