HomeMy WebLinkAboutMontauk Ave Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 10/17/25 Receipt#: 345411
Quantity Transactions Reference Subtotal
1 Excavation Permits 1827 $1,760.00
Total Paid: $1,750.00
Notes:
Payment Type Amount Paid By
CK#95562 $1,750.00 Z&S, Contracting, Inc.
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Z& S, Contracting, Inc.
525 Fox Lane
Po Box 202
Fishers Island, NY 06390
Clerk ID: MARIAD Internal ID: 1827
Permit No.
TOWN OF SOUTHOLA)
HIGHWAY DEPARTMENT
Peconic Lane
Peconic. Nlew York 11958 A
(6311)765-31140
....... ....
APPLICATION PERMIT'FOR HIGHWAY EXCAVATION AND REPAIR
APPLICA fION IS 4HEREBY made to the SUPCt ill[endent of I linhways of the Town of Southold for the issuance of an]:xcavation Permit
pursuant to Chapter 237 of the Code ofthe l'o%vtl of Southold.Suffolk County, New York,and other applicable laws,ordinances or
regulations for each individual contiguous C=lVatioll project herein described. The applicant agrees to comply with all applicable )ziA;s,
Z,
ordinances,codes and regulations.the attached"General Conditions ofilermit"and"Special Conditions". if any and to permit authorised
inspectors to make necessary inspections of the job site.
Print or.Fvpe
..............
lb c�0.7
Name of Applicant Phone Number Address of Applicant
2. A— .............................. ......................
................
Name of mractor Phone Number Address of'Contractor
3. 0%4�t Ala- sl
..................... .....................------------
y . ..........................
Dame ofl-lr(fperv. ("if'applicable) Address of ONvner
4. Ale, iv ir%�xl rzK) el�An,4, 'fe'val'-
........ .........
Work Description and Location (Street Number. Elam let.Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? - Yes No
'It'ves.other Town permits may be required.
NO-IT: All information requested by this ignalUra oi�vrlIcatit
Application/Permit Form is
............. .................
Required for a complete application!
Date
D (a) Attached plot plan to reasonably and adequately(10(1-ibe the proposed work. Provide accurate i 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,in(] licens'Ls for this project.
jea
(c) Work covered by this application may not commence before issuance of Highway Fxcavation Permit by the Town Clerk.
G. Tax vlap No.: District-1000 Section ............................... Lo t
7. Date: > I A
Star r 076 cnov— Completion Date 6:!r .7.2, _)v—
..............
K \Vork schedule: Phone Completion Date
Excavation r c , i VVoric Schedule
........... .... ...........
Facility Installation ............1..................... -Must be provided
Backfill&Completion SsrasG for consideration as a
Pavement Replacement
... Com plete Application.
9. Under which authority is application being madc: ....... ..............................-----------
All, hvr�� !AL.4114;
See Town Code Chapter 237(E)- Provide ReSOIL16011 V.Or authority I om,the Ulility being modified.
10. Estimated Cost of Proposed Work: S �5 DUO. C,
_... ................................................ .............................................................__-_____.____..................
11. Remarks: 4� _,t4
. ..............r ...........................................................
........... ... . ................................................. ..........................................
D-39 1 of 3
12. Insurance Coverage:(Attach
(a) Insurance Company:
(b) Policy �_. ............ :........._.._..._..._.........................._.,_.-._ .. .. .__..... .-.. .
(c)State whether policy of certification on file with the Highway Department:............1_.Y_U__............._....
____.__.__.....
(d)Coverage required extended to the Tom-n:
Any►.,osS including, 13odily'iniury,property-or conurlercial 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 in the total Amount of S
(b)Maintenance Bond provided: 2 yyears or 3 years.
14. Fees for Road Opening Applications and permits:
Basic Application Pee fir Each Project Location - Ss00.00
A Project Location would include each Bell Hole and/or every road opening or e. n 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.
A1. /..__-Service Connections excavations r 550.00
No
A2 _. .Additional excavations same service S'_0.00 S
__w_.._..—_.._...._-...---........._._..._....._..
fro.
B. Trench Excavations 13",in.tfepth or less
Total Lineal•Footageof'Excavation: L.F. %510.00 S-.,,_.-,
.._. ._ ._..............._........_.....
C. Trench Excavations 18" in depth to 5' In depth
Total Lineal Footage ol'Excavation; �
t? L.F.@$30.00 S D,
o Gt3
..D.......r ..__.._..._.....--
D, Trench Excavations 5' in depth and over
..total l.Aneal Footage of Excavation: L.F.ii S>o.00- S--
E. ......._........................................ Utility Repair Elxeavations rr.';S 1.000.00 f Each• 5
Additional Repairs of Same Service(i';S500.00%Each S
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 - 550.00
A Curb Cut would include any new,or alteration of an existing driveway within the boundar} Of[lie right of�, ay.
•►he configuration of such is to the conditions set forth in Chapter 237 of town code. �p
T011.A1,S I/n),
:Authorizatian is hereby;granted to the Town Clerk of the"town of Southold to issue a High vay Excavation permit to:
in accordance with
this application and subject to the"General Conditions"and"Special Conditions"of permit of any)attached hereto.
SUPF.RINT1,". ENT OF H1GI—RkAYS
TOWN ' SO THl D.\Eye'YOR
r�
.._............. ..__........_......_.__.. .. __._....✓.....�_... .......- ............_.... l � _ _
�tl /Rwdwin
Date
Date Received by the Town Clerk_ I
Date Permit Issued ---�1L (_�,5 ---Permit No.
NOTE": Permit expires one(1)year from date.of issuance.
No work to start without 24 hour notice to Superintendent of l-tighways.
Permit must be available at all times for inspection,on site.during construction.
D-39 2 of 3
Copy Distribution:
Perm it#
f I ighway Department
Engineer(with page 3)
Applicant
Town Clerk (Ori(Onal)
INSPECTOR'S RECORDS
Inspection Date Findings (Use code) Applicant Notified
I-It ...................................... .................................................... ............................................ ........... ............................. ..............
..............................................
3rd
01
(TO Permit Clerk)
REMARKS
CODE
IB Improper Barricades
IL Improper Lights
ST Sunken"Fre1chor Excavation
U'"rM Unable to Measure MUL!to backfillino)
BUIC Building Under Construction
WIP Work In Proarm
DB Improper Backfill(too high,not sufficient)
11 FS Inspector I folding for Final Settlement of Excavation
IVR. Rcady for Repair
D-39 of 3
'Rwyo 19
.01 k-
W E"
low ,
Two
vy 1 WI
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ASKS,
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