HomeMy WebLinkAboutGus Dr r Town of Southold
P.O Box 1179
Southold, NY 11971
. I
* * * RECEIPT * * *
Date: 06/28/24 Receipt#: 331531
Quantity Transactions Reference Subtotal
1 Excavation Permits 1731 $550.00
Total Paid: $550.60
Notes:
Payment Type Amount Paid By
CK#275048 $550.00 PSEG, LI
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: PSEG, LI
117 Doctors Path
Riverhead, NY 11901
-\Clerk ID: LYNDAR Internal ID: 1731
PermitNo:- �3 RECEIVED
TOWN OF SOUTHOLD
Job#9-181649 t'
HIGHWAY DEPARTMENT
JUN Z 8 2024
Peconic Lane
Email permit to: Peconic,New York 11958
Gary.Dubovick@pseg.com
(631)765-3140 Southold Town Clerk
APPLICAT1011[:L RE121VI1T'FUR'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 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 to make necessary inspections of the job site.
Print&11 nc
1 PSEGLI- 117 Doctors Path, Riverhead, NY 11901
Name of Applicant Phone Number Address of Applicant,--- --
2.
Name of Contractor Phone Number Address of Contractor
3:,
Name of Property Owner Requesting Service(if applicable) Address of Owner
4 Gus Dr, East Marion---- Description of work please see attached plans
Work Description"and Location(Street Number,Haitilet,-Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes. _ No,X
If yes,other Town permits maybe required. _
NOTE: All information requested by this Signature of Applia%tit;
Application/Permit Form is
Required for a complete application! June 14, 2024
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 commence before issuance of a Highway Excavation Permit by the Town Clerk.
6. Tax Map No.: District 1000 , Section.__-.__ _. Block- Lot
June 30 2024 p September 30, 2024
7. Starting Date: � Completion Date:,.. . .
8. Work Schedule;; Phase :Com►iletioiial)ate;•
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;theUtility being modified.
10. Estimated Cost of Proposed Work: $
H. Remarks: ..
D-39 1 of 3
12.'Insurance Coverage:(Attach Copy)
(a) Insurance 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 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 Road Opening Applications and permits:
Basic Application Fee for Each Project Location
A Project Location would include each Bell Hole and/or every road opening of,,excavahot>>wttli.in,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 $ 50.00
No.
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 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 $. _
E. Utility Repair Excavations @$1,000.00/Each
-
.Additional Repairs of Same Service @$500.00/Each $;
No.F. Official Notice to public utilities-proof must be provided and
Shall be attached to this application prior to issuance of permit.
15. Fees for New or Alteration to Curb Cut:
Basic Application Fee - $50.00
A Curb Cut would include any new or alteration of an existing driveway within the boundary of the right of way.
The configuration of such is to the conditions set forth in Chapter 237 of town code.
TOTAL$ 550.00
Authorization is hereby granted to 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 permit(if any)attached hereto.
SUPERINTENDENT OF HIGHWAYS
TOWN - SQUTHOLp;:N W'YORK
I�°
Via I J.Goodwin
Date Received by the Tow Clerk �o
Date Permit Issued Permit No._
NOTE: Permit expires one(1)year from date of issuance.
No work to start without 24 hour notice to Superintendent of Highways. r
Pen-nit must be available at all times for inspection,on site,during construction:
D-39 2 of 3
1
i
Copy Distribution:; 1
Permit# `
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date,. Findings (use code) Applicant Notified
1st
2nd
3 rd
4th
(To Permit Clerk)
,REMARKS
CODE
1B 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
o
GENERAL CONDY'TIONS OF PERAUT.,
APPLICATION/PERIV IT 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. ;NbR1kht'to';Trespass:or'Iriterfere tvitt Privafe Protierty RiQtits ,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 Highway and Future 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 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,ill,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. ;Iteyocafion,offhe"permifbv:a[ie Hihway Suneri'tifendent::,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. Ngfiee.of'Cbifithentement:,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. ;Sfor.'aaeof Epuipment 8i'Nlaterialsc' 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. Utii")-k=Oivts:, 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.
l
GENERAL CONDITIONS OF PERMIT
_z
APPLICATION/PERNHT FOR HIGIIW.AY EXCAVATION AND REPAIR
(Continued)
I 0..1tistalti.'1Vlairifairi Erosion:Confi olsi; 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.
l 1. .Clean"EillsOrilyc 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 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 jute matting until weather conditions favor
germination.
13.,liackfill'&:Comnactioti•of aIhEzcavatioris 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
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 andScope bf Work:: To reasonably and adequately
'describe the proposed work,accurate sahematic 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. Pavemert 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 Iift 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 minimum requirements of the Southold Town Highway
Specifications.
17.:'I'r cif cMh d,J?hyomdnf�guffaces:Exceedint�•One--'Fluitdred(IUO')Vdtt4n1,eng&: All trenching of
pavement surfaces exceeding 100'in length must first be reconstructed to meefthe 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).
(Re,. 1 j22)
JOB NAME_ SUMMIT ESTATES ' EAST.MARION'_ _" .NQTIFIGATION
-- - - _.3_ - _ -GRID 900000181649
STREET ADDRESS GUS DR No.-- 114-08773477
PERMIT REQUIRED •No , .ivaPIT _ UCA 800000429831
RRIMaRY.OPERATING VOLTAGE 11031.2KV ❑4KV USV_800000429833
EASEMENT REO'D 0 YES II�NO OUiRICHT -
CONTRIBUTION;
ENVIRONMENTAL RE66liEMENTS SATISFIEO,;:O
PREPARED_GARY DUBwn 631-21'5-8775 opom 5/6/2024 ;AREA=ECUR Nu1XeeR 1300 ;No. 8J685
BYunioR¢Eo RICH INSERRA 516-790-8842uaowc. o YEs tirio m cro
DL9TBIBIMON DESIGN
.r. L� 11RIVEREZADON.p 1901 TREE TRIM REQUIRED 0 YES ■_NO
TRANSF. - - SEC';DY - -- lCUSTOMER-
LOAD REG:"' LOAD
''LEGEND BLUE EXISTING - RED`.-'INSTALL -GREEN REMOVE MAGENTA REPLACE
---- P 8cN .
— THIS WORK ORDER IS NEEDED TO ACCOMMODATE A NEW 300A SERVICE
— WORK ORDER INCLUDES DELIVERING A 37.51<VA TRANSFORMER,
INSTALLING A 3—WAY CTA, OPEN TRENCHING 11' TO EXTEND THE
PRIMARY LOOP TO INCLUDE THE CTA.
— TOWN OF SOUTHOLD PERMIT NEEDED.
— SERVICE ORDER TO BE COMPLETED IN CONJUNCTION WITH WORK ORDER
;&)r
I z.
' I
I
:.l GUS DRa t
I 2-#2AL XLPE STR SPLICES
I TRENCH 6' IN PAVEMENT AND
5' IN GRASS TO 3-WAY CTA
—J
INSTALL 3-WAY CTA �'(}j•. ,;I - O
3 PRIMARY TAPS IN PUBLIC,
GRASS AREA
;tJ
CONS OWNED 1
CONS INSTALLED7z! -
U.G. PRIMARY I
;I
1 a
I
1
PSEG TO DELIVER TRANSFORMER AND SET
ON CONSUMER'S FIBERGLASS PAD. I'
ELECTRICIAN TO MAKE PRIMARY AND 1
SECONDARY CONNECTIONS. PI1pIa' I < y
37.5WVA,GRP236
BUSe3477
I PARKING AREA
*MARK OUT REQUIRED"
I
"NOT DRAWN_TO :,9CALE**
ELECTRON101RANSFORMER:ORDER:FORM
ORIGIN: ❑x - Distribution Design NETWORK �" L.S.
PROTECTION AREA UG-RIV 800000429831
❑OH/UG Lines ❑S.O.D. ORDER NO. Order#
PREPARED DATE: Vault Owned By Public ❑ O.H. ❑ Notification# !
BY: GARY DUBOVICK 'Os/03/24 ❑ PSEG LI ❑x Customer Private ❑x U.G._ 0 -.900000181649
CIRCUIT# IMAP GRID(5 Digits)- CODE# TAX DISTRICT STREET NAME
6J 685 114-08 A-4 G U S DR
INSTALL 'BUS 3477 BUS "BUS CROSS STREET VILLAGE
❑Pole
SUMMIT LN EAST MARION
x❑PM/MH # 109571 # # REMOVE _ BUS_ BUS -, : BUS
❑BG Pole❑BG #
GROUP HV n 1 B (� 1 B ❑ 1 B ❑PM/MH #
'
BUSH 2%: ❑ 2.13 ; U 213 102B GROUP -
SIZE 37.5
KVA KVA :_
SIZE
PRI.VOLTS' 13200 - .._. ..KVA
_KVA :. _ _ .KVA
- V V PRI VOLTS
SECDY.VOLTS r 120/240 V ,.__V _ V,
V V V E - -
S
TYPE CONN X CSP X 0 A, CSP_ ! 0 A CSP 0 A__ CDY. V .,, V V
TO 0 CONV o B : ' ]CONV ',[ ''0_B B.
VOLTS -
ECS 42
_ o C _ �" A.
._e C GROUND MAT'L ❑ -
CONDUCTOR SIZE AND TYPE, ' Spec. Equip.,Tap WORK CODES MANHOURS(EMERGENCY ONLY),
Secondanj Setting Remarks 01_RELOCATION 06 RADIOINTER 11 LIGHTNING 16TRANSRL.A.
Primary_ Neutral Open Triplex' quad 02 POLE REP LA 07 CSP RED LITE 12 ANIMAL 17 BUSHING.
03 CUST ADD LOAD 08 VOLT COMPLA. 13 VEHICLE HIT, " 18-CSP BRK INOP
CU 04.TEMPORARY 09 FUSE BL CONV• 14 HANDLING 19 CSP BRK TRIP
AL ! #2
'' ,::.. _. �05 LEAK BOIL OIL 10 CONV B O 15 ERROR 20 OTHER EXPLAIN
CO NO.
_. CO NO.
MFR.NO.
MFR.NO
]DATE COMPLETED BY: `RECORDED` COMPLETED BY DATE RECORDED
SEND::COPY TO FIXED ASSEi`S.;.UPON COMPLETION OF ORDER
SEND COPY TO SYSTEM MAPPING UPON COMPLETION OF WHOLE ORDER
ArcGIS Web Map
'•' .,7 dim •�
_,. ��• 'ter,- �. ,<«„
Z,X
;.• tt:'' 4 .., Vas.
.1,y
t •;
• 4i�y
�.''� `,•;,tab ,`•�...- ,k�';,;", _ %,`'
,,,
+ ,V, ✓l .4
6/3/2024, 1:16:00 PM _ - — -- 1:2,257
0 0.01 0.03 0.05 mi
Es-Transmission Open Point Substation p r
I I p 1
Es-Transmission U!G Trans Line Breaker without Jumpers �'0 0.02 0.04 0.69 km
Underground Transmission Line Trans Line Breaker with Jumpers
Aerial Cable ■ Delivery/Inter-Tie Point
Overhead Transmission ."N" Fuse Sari Con+munttlr.rutapr;ConmburorG; $ultoWK-!;ounly, UConii/GTDE_EP;
;Qien5trilglMn , Mlvosbfl: }Esr1U,;S`G TS4M'.Tciu;' GarrNn:: §pWfaph.Pot Head METlA _ EPA;NPS,Ust50» 8yieau,Transmission Switch '.uson,UsFtivs"""'
ArcGIS web AppBdWer
B4 Comm*Maps Coni bulors,Suffolk County;uconn/CTDEEP,0 Opensbeetmap,.Mfaosoft., -rI,TomTom;Garrnln,.SafeGraph,.GeoTechnotobles;(nc,METIMASA,USGS,EPA,NPS,US
Request for: TOWN OF SOUTHOLD DATE: 6/3/2024
PERMIT REQUIRED TO OPEN.:
THIS W.O. OPEN TRENCHES 6' IN THE PUBLIC PAVED AREA AND S' IN THE PUBLIC GRASS AREA TO INSTALL NEW
PRIMARY CONDUCTORS AND A CABLE TAP ASSEMBLY. WORK ORDER WILL INCLUDE ONE ACCESS PIT IN THE PAVED
AREA AND ONE ACCESS PIT IN THE GRASS AREA EACH TX 3'. THIS WORK WILL BE LOCATED ON THE SOUTH SIDE OF GUS
DR DIRECTLY ACROSS FROM SUMMMIT LN. SEE ATTACHED PERMIT SKETCH FOR DETAILS
Number of Road Openings:
1) In Grass Areas.
2) In Roadway Areas 1
Approximate Start Date: 6/30/2024
Approximate Completion Date;9/30/2024
PERMIT REQUESTED BY: G.DUBOVICK DIVISION: EASTERN NOTIFICATION # 900000181649
TD TYPE OF ROAD: PAVED WORK ORDER#800000429831
RETURN PERMIT TO: GARY.DUBOVICK@PSEG.COM
` a 900000181649
PERMIT SKETCH
M C
I �
I
TRENCH 6' IN PAVEMENT AND G_.0 T,' DR, '..
5'IN GRASS TO 3-WAY CTA
WITH 36'IROUND COVER.
INC DES i2 (3 x3)ACCESS
�to' cRAss -•- f�' � - -
I I
I
f;
I I
1:.
-f
iV