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HomeMy WebLinkAboutKat's Court Town of Southold P.O Box1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/09/25 Receipt#: 341064 Quantity Transactions Reference Subtotal 1 Excavation Permits 1800 $550.d0 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#1201 $550.00 Bay, Development Group Llc Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: Bay, Development Group Lic 67A Cuttermill Road Great Neck, NY 11021 Clerk ID: MARIAD Internal ID: 1800 Permit No. 1 U 0 O _._ LD HIGHWAYU WN N D PAR O ENT �o��yFFQ(,�coGAk Peconic Lane Peconic,New York 11958 `y (631)765-3140 APPLICATION/PERMV lT 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 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 or Ttip I. --H�� GrORP LIZ 51 fo o9-t1o20 67,4 Vrr PHILL 12p , (Sreott Name of Applicant Phone Number Address ol'Applicant Aleck /V r 2. PAFTP"CC 7 LEVA10A) PAA 242 121 VERAD —ff 1V0ZV1c(,EIIO21 Name of Contr for Phone Number Address of Contractor /V y //191, 9 3. Name of Properly Owner Requesting Service(if applicable) Address of Owner ac�t 4. 10S 1 2057 b1 -1 s C(pv2i _ 67 AST Mj 0)0A/ ,_ Cnoss spa. CI t2CLE p/2 Work Description and Location(Street Number,Hamlet,Cross Street) (a) is construction located within 75 feet of tidal wetlands? W Yes No "Ifyes,other Town permits may be required. NOTE: All information requested by this ignatur of Applicant Application/Permit Form is 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 commence before issuance of a highway Excavation Perini by the Town Clerk. 6. Tax Map No.: District 1000 , Seecttioon_ 7 1. Block 7. Starting Date; W a�C u+ L. Completion Date S. Work Schedule: Phase _Completion Date Excavation Facility installation Work:Schedule Backfill&Completion Must be provided Pavement Replacement for consideration as a 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: S !I/F 500 11. Remarks:__L --f ity roo,� D-34 rOat-r VWjrC q�Oca.. 71�¢ �it.ey n- 6125 1 of 3 12. Insurance Coverage:(Attach Copy) �p�o,�f (a) Insurance Company: ���y�h�£ 'f�2°�-�I r co (b) Policy 4: C T 2IQ s?Sab� (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: S 1.000.000 per Occurrence and S 2,000.000 general aggregate. 13. Security: (a)Surety Bond or Certified Check provided is 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 - $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 tho approval of the Highway !ntendent./� Al. /Service Connections excavations @ S50.00 $ - o. A2. !Additional Excavations same service @$20.00 S No. B. Trench Excavations IS"in depth or less Total Lineal Footage of Excavation; G.F.@$10.00 S C. Trench Excavations 1 S"in depth to 5'in depth Total Lineal Footage of Excavation; L.F.@ S30.00 $ D. Trench Excavations 5'in depth and over Total Lineal Footage of Excavation; L.F.@ S50.00 S E. Utility Repair Excavations @$1,000.00/Each S No. Additional Repairs of Same Service @$500.00/Each S 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. TOTALS D. Audtorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: in accordance wilt this application and subject to the"General Conditions"and"Special Conditions"of permit(if any)attached hereto. SUPERIN DENT OF HIGFI1VAYS TOW2XT7LD rLNEW ,OR L J G odwin z Date Date Received by the Town Clerk �O 1 1 Z 5 Q' Date Permit Issued l q I)�.5 Perot No. I O O q 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: ISO Permit# U Highway Department .Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 2nd 3'd 01 (To Permit Clerk) RENIARKS CODE W 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/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR I. 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 pennit, including all special/site specific and general conditions imposed by the Highway Superintendent while acting as the peimittee's agent with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Right to Trespass or 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 pen-nit. 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,fill,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. 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 Superintepdent 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 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. 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 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. I of 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 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. 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 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 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 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 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. Trenching of Pavement Surfaces Exceeding One Hundred(1001)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 two(2") inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). Nft 1122) 5-OT5 � 1 I � � Vr►�►rY N rr " 4q r 10 ".y 550AT h149. ad c r Sty hr I N look` 453? I 50 I , o I 522 � � I m � C2:: PROPOSED UTILITY EASEMENT C52 1525 W , \525 - - W I -s1rs I 508 209 525 s toa,, S -�wa5 �4j 558 Srw- g �c � A� DATE lMMr001YYYY) CERTIFICATE OF LIABILITY INSURANCE 0312812025 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 ondorsemenl(s). PRODUCER CONTACT Barbara Darnmers NAME: Roy H Reeve Agency,Inc. PHONE (631)298.4700 AID Na: (631)298-3850 ac No EMI: PO Box 54 ADORE SS: bdammers@royreeve.com 13-100)dam Road INSURER(5)AFFORDING COVERAGE NAIL s Maniluck NY 11952 INSURER A: Merchants Preferred Ins Co 12901 INSURED INSURER BMerchants fAul Ins CO 23329 Patrick J Lennon dba Underground Water Services INSURER C: 242 River Road INSURER D: INSURER E: Manorville NY 11949 INSURER F: COVERAGES CERTIFICATE NUMBER: CL251322364 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH'fHiS CERTIr-ICA7E MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rEXP LTR TYPE OF INSURANCE INS D POLICYNUMBER MI.eDDrY MI POLICYO,4DD, LIMBS COMMERCIAL GENERALLIABILITY EACH OCCURRENCE s 1,000,000 CLAIMS-MADE a OCCUR PREMISES led—i—I s 500.000 MEO EXP iAnv one ow^onl s 5.000 A Y CTRIO10563 0210212025 0210212026 pLRSONAL&ADV INJURY S 1.000.000 CCNI AGOREGATr LIMITAPPLAES PER GENERALAGGREGATE S 2,000,000 POUCy❑Jr:OT LOCI PRODUCTS-COMPKOPAGG S 2,000.000 OTHER. s AUTOM061LE UABILfrY COMBI ED GLE MI S 500.000 IFa acndcnU SIN ANYAUTO BODILY INJURY IP6r oo7 n) S. -- B OWNED SCHEDULED CAP1058537 06/14/2024 06114!2025 BODILY INJURY tPer icc,den0 s AUras ONLY M AUTOS HIRED NON-0'NNEDAVT ONLY OS AUTOS ONLY rDar au*Cenll S UMegELLA UAe OCCUR EACH OCCURRENCE S f�tC[55 LIAR CLAIMS-MADE AGGREGATE 5 OFO RETENTION S S WORKERS COMPENSATION PE O t4 AND EMPLOYERS'LLABILITY YIN STATUTr. ER A)TY PA'i-rZIETOFbPARTJERIEXECUTIVE OFF ICERM1. "BEA EXCLUDED? � NIA F.L.EACH ACCIDENT s tMandmory In NH) it yos,ooscnta under F.L.DISEASE•FAF.NIPLOYEF. S _ OE SCRIF'rION OF OPERATIONS Dolow E.L.DISEASE•POLICY LIMIT S - DESCRIPTIOt/OF OPERATIONS ILOCATIONSJ VEMCLLS(ACORD 101,Additional Remarks Schodulo,nlay bo attachod If none space Is required) Certificate holder Is included as additional insured under Uio terms and conditions of form IICG2033(04/13)-AI.Owners.Lessees.COntr0CIors-Automatic Status When Required in Construction Agreement with you,as required by written contract or agreomont.Coverage is Primary and non-conuibulory,per form CG2001(04113)8 Form#CG2404(05109)provides a Waiver of Transfer of Rights, There are no OXCIusIOnS for action Over or NYS labor law claims under the general liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. Highway Department Pecorec Lane AUTHORIZED REPRESENTATIVE Paconic NY 11958 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD