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HomeMy WebLinkAbout690 Old Saddle Ln Permit No. l TOWN OF SOUTHOLD `' HIGHWAY DEPARTMENT ak ,o0-mv osu�fvcx Peconic Lane o Peconic,New York 11958 oAle (631)765-3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION 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 regulations for each individual contiguous excavation project herein described. The applicant agrees t6 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 Tyne 1• �iaue.l 1 UifG,ioS S b3�-b27 2328 �U �nson S� � I�i-�t�„a�Lr pJ�J /1`!72 Name irApplicant Phone Number Address of Apphcant 2• Amt L Aelawewd lA�tl es.I_r nc.--431 -6n-7-3-Z2 16 `�o�+"S-n CA, g no N-1 (I'I'7Z Name of Conti ctor Phone Number Address of Contractor i t 3 Name of Property Owner Requesting Service(if applicable) Address of Owner 4. in � ra90 olddd4 ., ���, , �X s � S;I�u C VI R},QGnc rlavnaeia C't4�n/ tclw nl- a Dave Work De.5cnption and Location(Street Number,Hamlet,Cross Street) (a) is construction located within 75 feet of tidal wetlands? *Yes *If yes,other Town permits may be required. No NOTE: All information requested by this Application/Permit Form is Signature o Applicant Required for a complete application! J/ Z 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. (e) 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 Remarks: D-39 1 of 3 12. Insurance Coverage:(Attach Copy) (a) Insurance Company:L /Iv MJnj,k (b) Policy#:__BA.SQ60 (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 attributable 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 Protect Location - $500.00 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. A]• --L/Service Connections excavations @$50.00 $ . No. A2• /Additional Excavations same service @$20.00 $ No. B. Trench Excavations 18"in depth or less Total Lineal Footage of Excavation; 90o L.F.(awl$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 $ I E Utility Repair Excavations @$1,000.00/Each $ No. Additional Repairs of Same Service @$500.00/Each $ ' No. TOTAL$ 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 to the Town Clerk-of the Town of Southold to issue a Highway xcavation permit to: this application and subject to the"General Conditions"and"Special Conditions"of permin it(i any)accce wit chednre SUPE RINTE S TOWN OF SO OL NF t Vinc nt nand , Date Received.by the Town Clerk laf dao Date ( Date Permit Issued �(��l o0 PermitNo. 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 3 Copy Distribution. Highway Department Permit# 4% Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 1st 2nd 3rd 01 (To Permit Clerk) REMARKS ? s a r' 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 3 GENERAL CONDITIONS OF PERMIT APPLICATION/PERIMIT FOR HIGHWAY EXCAVATION AND REPAIR 1. Permittee's Contractors to Com"Iv 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 wiih all permit requirements. 2. No Right to Trespass or Interfere'with Private Property Rights This,permit does not convey to the permittee any eight 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 pernut. 3 Protection of the Hi�hway and suture Highway Maintenance If future operations or highway maintenance projects by the Towu 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 obstniction 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 naodificahon 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. S. Notice A Commencement: At least 24 hours pnor'to commencement of the project,the permittee and/or contractor shall notify the Town Highway Department in writing that they are fully aware e 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 Departmentand 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 i esponsible 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. S. 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 PERMIT APPLICATION/PERMIT FOR HIGHWAY,EXCAVATION AND REPAIR (Continued) 10. Install,Maintain Erosion Controls: Required Erosion Control Measures(i.e.silt fencing)is to be placed 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 condition until thick vegetative cover is established. 11. Clean Fill Only: All project back-fill shall consist of clean sand,gravel of 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 notused to backfill any excavation within a Town Highway. 12 All Areas of Soil Disturbance: All areas of soil disturbance resulting from the approved 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/or jutc�matting until weather conditions favor germination. 13. Backfill&Compaction of all Excavations: Back Fill shall consist of'clean fill or soils which exhibit a well-defined moisture density relationship as determined to be in accordance with ASTMD 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 compaction by water jetting at three-foot 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. 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 k 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 Seo a 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 Present,Please review Restoration requirements with the Highway Superintendent) 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 o£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 minimum requirements of the Southold Town Highway Specifications. 17. Trenching of Pavement Surfaces.Exceeding One Hundred 7100'1'Feet in Length Al]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 tepaved with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). - - --- ----- - - - ` w _ .�. :.. S•w. _ _ — — _��\._. I y at•-'.5. „.h` ) r I i' ! y 1 ; a I'.'., • i_r — _;_ — , t''-=�j - .uL• —a— J-_!- _.. , i is ,,i !� ---- -- - -- - — - ..__ r ' - -�- —I- = -'^ , 4--- ^• � )� , -;� - -T-O 11+{ 1 / -, t iervi a Node XgCl 0:;, ; -Past . a Kfc:ds Health 98 30_{Past 3 va-B 98.0�5, o OOo OP 00 ry o• • f 490 • OArr� ', O � GOD •�r�'°4.�C o 4 G��G b a w@ G '�.6 Oa �� ��R•�a �'v Q G qG q�}�v �r RBC Iftir, `b.�'.Qy `nGefYf� GG • i � G'S 9. J oP C3, JJ • V O alt`Ce Referral Form T DAMnoETMGov=IlFnnnnum;= NO Facility Dopt: REFER TO:F CONSTRUCTION _ RQ RHD Els/Remedy ticket: 0012486020__ Slipeiwsor, D.Greene Techa/Cella, 122261-516-807-4869 REASON FORWORKI• CONSTRUCTION ReasonsUG Polo PS. PE9IGNINFO ON DESIGN DAMP Tap TYPE? aalan iv0e z��'-'r••+1 Residential E*I311na1NeWS6bscriber Existin Repair Location. 'LACE FROM OUTPUTOF 20 TAP TO INPUT OF 101 CORP Name: 7639 CEMENT, Phone Account 356311.3 Date: July 16,2020 CLI FEEDER REPLA --- Address- 690 POI SADDLE LANE GndaAep. x-sheet SILVER COLT ROAD lawn. CUTCHOGUE Eitats!de:Yt;R z„�ino-°a:ttrnt'?ss-a'.I Hagstrom .f•u.yri ts,-�ci7^vt, Co Haadend Node CH CH70 CM719 603 MHz ~ Tap Pra.Fault 693 MNi 747 MHz 7839 %eC102 Spliced Point Ground @tock: Tap Post-Fault A""I W o dt libt polo num bu(,)b nnarosthouanriumbedil:_ TYPE CABLE REPLACEMENT POLE 1IMS-Es LOCI(B01L.•,« ..Bo yCorn laaid�Re '�-_l �: Pbcimanti; Is than a TEMP eabta In lace et lNa time? p DRIVEDeaf Iho rcpalrmyulreAROAD CUT7� Ptd: VJAYSKOT YES �oF ORNEWAYS 2 CONSTRUCTION TYPE UNDERGROUND CABLETYPEi 625 wo7AGE 400 Is fins a house drop? What Is the drop length? Is there a spare cable? Is the drop Aedal or UIG7FE5- erground Fkbngs and equip been changed? LACE 400OF 625 UG CABLE FROM 20 T OF 10 TERM TAP.THERE ARE 2 HOTS.BIG CLI LEAK Comments. Is this a dangerous sltuabon? ) • •-� � � � - "' � - :SIGNAL'LEAF(AGEMERSUREMENTS„ lfI k lc 9onoraw fmm pint 11 u,ea CLI Lever 10 feet before repair meas 1__ swan and,opal,orwel,eamramuv/m' ftWland documentafinrarmadan affil Mtt!Edon of C.L.I.Level(8 1D feet after repair meas MO"'e T.p o.P Feeder T.M 1 .DESI REF RRAL. ' - __ Pad Value of used) kh - All desi rererralc ucthavelakeoR lesand are as Dmwin must ave esarl ovation of moble dro and folder lrneedetl ThIM uorty Damaen 1....,,..... :,trr 'b"s r8 i k n rr L. •il F' tli i' T..ha Theaw eR d 1a1T rid ech b TerJ� 4 r See Attached _ __-DateRecetved:x. '(Construction Use Only) • -Tech S)1ConVactorasslgnedto:�:' - 'NCR(notconatrelated - _-,Dato"a&9ned: - - ; NCR-GiverrBack To;•., _ - NCR-Date""Given Back,' .ALYuaI,COmP,Date:.� I 1Contractonwho'cetnplut60hoviork ' - _;1Comp10Uon.Cddw,- Construction Completion Comments: Nscdn Aebvthon YIN, •NCR,e0.+�a•mnmvM Q(0 00 33 © I