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HomeMy WebLinkAboutNew Suffolk Ave Permit No. `� TOWN OF SO€TTHOLD �`' HIGHWAY DEPARTMENT ��,�`soG"� � ti Peconie Lane ; Peconic,New York 1195$ o ' (631)765-3140 APPLICATION/PEMNI<!T FOR ffIGM AY EKC A-i7ATI"ON"AN-b PAM ✓- 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 regralarions 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 td make riecessaryinspections of the job site. Print or Type rZ6 3ei "w&-,cug W1 Ulm- Name of Applicant Phone Number - Address of Applicant 2 S plag O!D 460®16 Name of Contractor Phone Number Address of Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner 4. -(1ZbK 61�, 6(' df&� GORDLL AIJe. 4 ?MA' S.N)L� 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. :TOTE: All information requested by this S V,,nature of Applicant Application/Permit Form is J Z 1 f 3 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 comrgence before issuance of a Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 , Section Block , r Lot ,\ 7. Starting Date: IZ-hol 2b2y Completion Date: Izl/o�2U2C� 8. Work Schedule: Phase Completion Date Excavation /Z-/U- 110? Work Schedule Facility Installation /2-ID 2ti'LQ Merit be provided Backfill&Completion 12-10 ZD 7-0 for consideration as a Pavement Replacement, Complete Appelscatiom 9. Under which atithdiity is applieatioh,tieing madef See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: $ ��bb ,8b (FUP— !(, A) P6 el Q 14)) 11. Remarks: �-d(ko as e -11) P QW\Ore: SeN A CE --rU D-39 1 of 3 J 12. Insurance Coverage:(Attach Copy) (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'butzble to the-vor°„nerformed: $1,000,,000 per Occurrence and$2,000,000 General aggregate. i3. 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: J Basic Applic-aVon Fee for Each Project Location - A Project Location would include each f3ell 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 $ S0 , 66 Nci_ A2. /Additidtial Excavations same service(cu,$,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 Lirzeal Footage of.Fr:,gvaPioll, 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 @ S 1,000.00/Each $ No. Additional Repairs of Same Service @$500.00 i l;ach $ No. TOTALS F. Official Notice to public utilities-proof must be provided and Shall be attached to this application prior to issuance of perinit. Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway E cavation permit to: • in accordance ith this application and subject to the"General Conditions"and"Special Conditions"of permit f any)attached eto. SUPERINT DE A TOWN OF U D Y Vincept Orlando (n ate Date Received by the Town Clerk �`b Date Permit issued I)-1j l'�Z Permit No. t q q 3 NOTE: Permit expires one(1)year from date of issuance. e work to start v.°itl=ut 24}hear notice to Superintendent of Highways. Permit must be available at all times for inspection,on site;during construction. r. .1 r. 2 of 3 Copy Distribution: Permit LiL( 3 High-wayDepartment Engineer(with page 3) Applicant To;;•n Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings (use'code) Applicant Notified lst u 3rd ,nth (To Permit Clerk) l@'IARK CODE M Iniproper Bairicades IL Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfilling) BUC Building Under Construction WIP Work In Progress TAI Improper Backfill(too high,not sufficient) HFS Inspector Holding for Final Settlement of E e y t'oq RFR Ready for Repair 'Er' -- GENERAL CONDITIONS OF PERAUT APPI,ICATI®RT/PERl YT 1{+01 GHWAY EXCAVATION AND REPAIR L Permittee's Contractors to Com 1 with Permit Re uirements: The Permittee is responsible for infomling 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 bo re --q comply with all permit regtlifements. 2. No Right to Trespassor 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 Hi hwav and Future IEliay 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, str-ucture,fill, excavation,or other hi6dification 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 ffighwU Suuerintendent If the Highway Superintendent deems it necessary to revoke this permit and,theproject•hereby authorized has net 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. S. Notice of Commencement: At least 24 hours prior to commencement of the project,the permittee and/or contractor shall notify the'Tpwn,Highway Department in writing that they are fully aware of and understand all terms and project conditions of this permit. Upon completion of th inspection. e work,the contractor shall provide photographs of the completed work to the Town Highway Department and request a Final 6. Storage of EQuimment&Materials: The storage of construction equipment and/or materials shall be confined within the project work tuna and/or adjacent areas where permission/regal access has been obtained in a manner that does not interfere with normal highway traffic. 7. UtiUtv Mark-0_ 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 efosures: 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-rcsteratioonn 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 PERMIT APPI,ICATION/PERNMIT FOR HIGHWAY EXCA- ATIO-INT ANS REPAIR (Continued) 10. Install.Mai twin Erosion Controls, Required Erosion'Control Measures (i.e. silt fencing) is to be-r.?pr=4 on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good functional Conditior,until thick ve etativ_ w �'• a PST'ts'vlr Iitii�• - 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 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 anprmved project snail be stabilized to the satisfaction of the Highway Superintendent immediately following project compledor,. 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/or jute matting until.weather conditions favor germination. 13. Bach& Compaction of all Excavations: BaCk Fill shall consist of clean fill or soils which e-YEbit a well-defined moisture density relationship as determined to be in accordance with AS T MD 698. Fill shall be placed in maximum lifts of twelve (12") inches thick and shall be mechanically compacted to a Ninety- five (95%)percent maxinauni diy density. Suitable hydraulic compaction by water jetting at taree-foot intervals will also be permitted subject to a project specific approval by the Highway Superintendent. 14. Restoration of-the?load 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. Excavations llirouoh driveways and private road pavements roust be reconstructed to meet ail rtgmrwments 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 flans 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 full depth 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; (Note:When Concrete Pavements are Ptesent.Please review Restoration requirements with the Highway Surxtintendent) a) Complete all baok-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 NO'S 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 minimum requirements of the Southold Town Highway Spedifieati6ris. 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 tVuo (2'7)iddli lift 6f Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). 74 --�- - °,,xis., z �_,�.,���.�,��,, ca'''•'.,'�,'��, j,`.1,f�• _ 73 k7268fir• _ ."_ ,'__ _ 1,46 -12 MIT LLPED771 &4wnTAP t ADDSTDUG I ROP 178 TD HOUSE Pico -45 ll rr1 igtts_- is 1 588W u< e� 495 DP FIi" i foo ©9 ® LID j OP NT s17, 21�B� CA 12 21 ��'' O G CI 755'.7X700/ •, ,\ (� B CR2P 68D F N NSTALL PED,IN LINE O &4WTERM,TAp O o ❑- ' EN ADSTD UG O•• `�_ �, I'4(yl ROP 100'TO HOUS 63 E 2 DDE,X9C112 TREET.630 DEAN OR. tJ NRS,2 RES. j MAL 0 G 1030' S BUILT UNIT IN 1 BLDG OTBUILT 7P112020,A 9fl0/15CD . r