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HomeMy WebLinkAbout5415 Skunk Ln Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 11/15/23 Receipt#: 316158 Quantity Transactions Reference Subtotal 1 Excavation Permits 1694 $550.00 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#4722 $550.00 Patriot, Contracting Corp Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Patriot, Contracting Corp PO Box 351 Westhampton, NY 11977 Clerk ID: JENNIFER Internal ID: 1694 94 Permit No.. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT y Peconic Lane Peconic,New York 11958 +�► _. (631)765-3140 ¢1, ��� APPLICATION/PER T 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 I�outhold,Suffolk County,New York,and other applicable laws,ordinances or regulations for each individual contiguous excavatior project herein described. The applicant agrees to comply with all applicable laws, ordinances,codes and regulations,the attached"Gen-.ral Conditions of Permit'and"Special Conditions",if any and to permit authorized inspectors to make necessary inspections of the job site. Print or Type �akneof�Applicant � Ph neRhurnb& Address of Applicant ! / 2. Name of contractor Phone umber Address of Contractor 3. Name of Property Owner Requesting Service(i applicable) Address of Owner Work Description and Lo ation(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 th s Signa o pplicant Application/Permit Form is ihal — . - Required for a complete application! l Date 5. (a) Attached plot plan to reasonably and adequ tely 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 lice ses for this project. (c) Work covered by this application may not ommence before issuance of a Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 Sectio n Block Lo�t 7. Starting Date: (Vo Completion Date: ll� 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 Re olution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: $ 11. Remarks: D-39 1 of 5 f 12. Insurance Coverage:(Attach Copy) (a) Insurance Company: (b) Policy#: 1V AYWA (c)State whether policy of certification on file ith the Highway Department: (d)Coverage required extended to the Town: Any Loss including Bodily injury,properb,or commercial injury caused by or attributable to the work performed: $1,000,000 per Occurrence and$2,000,0(0 general aggregate. 13. Security: (a)Surety Bond or Certified heck provided in the total Amount of$ `(b)Maintenance Bond provided: 2 years or 3 years. 14. Fees for Applications and permits: Basic Application Fee for Each P oject Location - $500.00 A Project Location would includc each Bell Hole and/or every road opening or excavation within any 50'Radius whether or not they y be inter-connected by open trench or directional boring. The total number of Project Loca'ons shall be subject to the approval of the Highway Superintendent. Al. 1 /Service Connections excavations @$50.00 $ v No. A2. /Additional ExcavationE same service @$20.00 $ No. B. Trench Excavations 18"in depth or less Total Lineal Footage of Excavati n; L.F.@$10.00 $ C. Trench Excavations 18"in depth to 5'in depth Total Lineal Footage of Excavati n; L.F.@$30.00 $ D. Trench Excavations 5'in depth d over Total Lineal Footage of Excavati n; L.F.@$50.00 $ E. Utility Repair Ex avations @$1,000.00/Each $ No. Additional Repa' of Same Service @$500.00/Each $ No. �'j TOTAL$ `� F. Official Notice to public utilities-proof must be provided and Shall be attached to this applicat on prior to issuance of permit4- dV- - o13W W Authorization is hereby granted to the Town C Jerk 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 permit(if any)attached hereto. SUPERIN ENT OF HIGHWAYS TOWN O S LD,NEW Y RI ani 1 J. Goodwin Date Date Received by the Town Clerk Date Permit Issued S_ 2 Permit No. G `T NOTE: Permit expires one(1)year from date of issuance. No work to start without 24 hou•notice to Superintendent of Highways. Permit must be available at all ti es for inspection,on site,during construction. D-39 2 of 3 Copy Distribution: I r , Permit# l� Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 1st 2nd 3 rd 4"' (To Permit Clerk) REMARKS 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 I xcavation RFR Ready for Repair D-39 3 of 5 GENERAL CONDITIONS OF PERMIT APPLICATION/PERMIT OR HIGHNvAY 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/sites 3ecific and general conditions imposed by the Highway Superintendent while acting as the pe ittee's agent with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Ri ht to Tres ass or Interfere uith Private Property Rights: This permit does not convey to the permittee any right to trespass upon tl Le lands of adjacent property owners in order to perform the permitted work nor does it authorize the impain nent of any rights,title,or interest in real or personal property held or vested in a person not a party to the pl,rmit. ;. Protection of the Hi hwa and Fut re Highway 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 th 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 edestrian 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 revo ced 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 2 37 of the Town Code. 4. Revocation of the Permit by the Hi hwa Su erintendent: 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 aid 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 leas 24 hours prior to commencement of the project,the permittee and/or contractor shall notify the Town Hig iway Department in writing that they are fully aware of and understand all terms and project conditions itions of this permit. Upon completion of the work,the contractor shall provide photographs of the con ipleted work to the Town Highway Department and request a Final inspection. 6. Storage of Equipment&MaterialA: The storage of construction equipment and/or materials shall be confined within the project work are and/or adjacent areas where permission/legal access has been obtained in a manner that does not interfere with normal highway traic. 7. Utility Mark-Outs: The Applicant I Contractor shall be responsible for verification of all existing utility mark-outs and shall take all precauti ns to protect same. Damage to existing utilities shall be the responsibility of the contractor and all be repaired at the contractor's expense. 8. Road Closures: All scheduled roa closures must first receive written permission from the Southold Town Board prior to closing a road. Temr orary lane closures may be permitted with the approval of the Highway Superintendent. This item will incl ded 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 ork Zone. 9. No Construction Debris in Road E houlder 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 Stan,iards. bf_57 GENEWi,CONDITIONS OF PERMIT APPLICATION/PERMIT OR 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 ed 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-f 11 shall consist of clean sand,gravel or soil (NOT asphalt,slag,flyash, broken concrete or demolition debri ). All unsuitable soils excavated at the site(i.e.Clay,Bog,etc.)are to be removed from the site and not us 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 ighway Superintendent immediately following project completion. If the project site remains inactive for inore 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. Backfill&Compaction of 211 Ex ca ations: 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 subj ct 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,ma I boxes,sprinkler systems,trees and ornamental plantings. Excavations through driveways and rivate 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 TechnicA information and Scone of Work: To reasonably and adequately describe the proposed work,accura schematic site plans must be provided to show or indicate all proposed construction activity requi ed under this permit. All Pavement surfaces scheduled for excavation must be saw cut to the full depth of isphalt 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 r quirements of these General Conditions and requirements found in the Southold Town Highway Specificat ons. 16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner; (Note:When Concrete Pavements are Prese t,Please review Restoration requirements with the Highway Superintendent) a) Complete all back-fill &soil co paction work as needed to provide a suitable sub-base; b) Over-cut existing asphalt bell hoe 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") rich 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,Txceedinay One Hundred(100')Feet in Len the All trenching of pavement surfaces exceeding 100' i 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 two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). 5 OF.� Fel, ahs) I CT � 1 CCArp w 1p. COY"'Yl Chandra Morcerf From: ny@occinc.com Sent: Thursday, November 2,2023 9:48 AM To: billing Subject: Ticket:233060803 New York 811 Ticket No: 233060803 Original Call Date: 11/02/23 Time: 9:32 AM WEB Start Date: 11/07/23 Time: 7:00 AM Lead Time: 20 Caller Information Company: PATRIOT CONTRACTING CORP Type: CONTRACTOR Contact Name: CHANDRA MORCERF Contact Phone: (631)283-2240 Field Contact: CHANDRA MORCERF Alt. Phone: (631)283-2240 Best Time: Fax Phone: (631)283-2004 Address: PO BOX 351 PO BOX 351; WESTHAMPTON, NY 11977 Email Address: billing@patriotcontractingcorp.com Dig Site Information Type of Work: INSTALL ELECTRIC CONDUIT Type of Equipment: DIRECTIONAL BORE MACHINE Job Number: Work Being Done For: JAMES PATRICK COMPANY In Street: X On Sidewalk: X Private Property: X Other: Front: X Rear: X Side: X Dig Site Location State: NY County: SUFFOLK Place: CUTCHOGUE Dig Street: SKUNK LN Address: 5415 Nearest Intersecting Street: PINE TREE RD Second Intersecting Street: STERLING RD Location of Work: MARK BOTH SIDES OF THE ROAD TO INCLUDE THE SIDEWALK FOR THE WIDTH OF THE PROPERTY AND THE ENTIRE PROPERTY FOR INSTALLATION OF NEW ELECTRIC SERVICE. SERVICE COMING FORM POLE#48 LOCATED ON THE WEST SIDE OF SKUNK LANE Remarks: Map Coord NW Lat: 41.016261 Lon: -72.460528 SE Lat: 41.015628 Lon: -72.459021 Operators Notified: CBLRH01 - CABLEVISION OF RIVERHEAD LIL - NATIONAL GRID LIPA01 - LONG ISLAND POWER AUTHORITY SCWA01 - SUFFOLK COUNTY WATER AUTHORITY VZL - VERIZON COMMUNICATIONS EXCAVATOR RESPONSIBILITIES IMPORTANT NOTE: YOU MUST CONTACT ANY OTHER UTILITIES DIRECTLY. All facility operators are required to provide contractors with updates on their progress with marking or clearing locate requests for excavation. Once all members have provided a status, we will send the information to the email address provided on your ticket. For up-to-the minute updates, you can view status information at DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE `� 1 11/02/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Matthew Daley Farm Family Insurance PncN o ; 631-744-3350 FAX No: 631-744-3383 E-MAILmatt.dale ma#.daley@farm-family.com Echo Ave-Suite 2 ADDRESS: Y@ Y•com INSURERS AFFORDING COVERAGE NAIC# Miller Place NY 11764 INSURERA: Farm Family Casualty Ins CO 13803 INSURED INSURER B: Patriot Contracting Corp INSURER C: PO Box 351 INSURER D: INSURER E: Westhampton NY 11977 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICPOLICY NUMBER MMIDDY EFF POLICY EXP LIMBS LTR A X COMMERCIAL GENERAL LIABILITY 3102X1171 07/12/2023 07/12/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY E PRO-- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per.accident r $ A UMBRELLALIAB OCCUR 3101E3775 07/12/2023 07/12/2024 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 3103W7433 01/17/2023 01/17/2024 X S ATUTE EOR AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTNE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED7 YN/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Excavation CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Main Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold, NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. 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