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Home My WebLink AboutStreet Lighting NEW YORK STATE DEPARTMENT OF TRANSPORTATION Raymond T. S~huler, Comrni~ioner Region 10 Office: Suffolk State Office Building Veterons Memorial Highway, Haup~auge, New York 11 ~7 Date: Sheet Gentlemen: The site ple_us for the above noted project have been reviewed by this office. Please be advised that before a Highway Permit can be issued at this location the item(s) checked below must be forwarded to the Permit Department. Sincerely yours, Harry Regional Permit Engineer HRT:I~ ~--~-- Check or money order to the State o£ New York for $ Bond (sample enclosed) for $ ~--~ Three copies of revised prints showing zb (10/70) -pllcation is hereby mode for o highway work permit TOWN OF SOUTHOLD 425 Main Street Greenport, New York ]. Requested duration from 19 thru 2. Protective Liability ~nsurance covered by Po]icy 3. Workmen°s Compensation Insurance Policy ~-. Disability Benefits Coverage Policy No. S- 'E OF NEW,YORK. DEPARTMENT OF TRANSPOP-' TION HIG .~Y WORK'?I~RMIT A~P-PLICATION FOR UTIL WORK 11944 fENTER NAME AND MAIL~ING ADDRESS IN TH~S SPACE BOND: Waived Municipality 19 , to apply to the operation(s) checked below. ; expires on 19 expiring P ~.~E P A R E 3 COPIES L~ o. Underground PERMIT FEE Additional Fee $10 ,10 per ft. NC $10 $100 Sub-Tota~ Show Ins. Fee Total Amt. Amt. or PERM- of Fee (~') if 17 or Under- and/or Permit taking on {lie Insurance Charged 2.50 Amt. and/or Bond $10 NC $10 $1 O0 g. Telephone Booths $25 (11 Along interstate highways (2} Along State highways with controlled 17 h. Miscellaneous $10 iT c. Private re?_airof wot ......... lines -- - N~C .... [7 d. D.o.T. re0uested maintenance NC NC $25 $500 NC .fO per !~ c. Cornmerc~al service overhead connection NC NC TOTAL PAID 2.50 Work may he described briefly a, folJows: TO install and maintain street lighting fixtures on Route 25 within the limits of and on behalf of the Town of SOUTHOLDo ~ Addlt;onol work description is ottoched; [] Plans pa~s~o~nd~/or~ [~l~lapl~ls fil~-~,~ling work to be performed or: LOCATION ( ~ ~ ~ ) State HSghway No. ' U~t ..... ration PERM 32 & 33 (12/70) PON$1BILITIE~; 'OF PERMITTEE REVERSE 1. PROTECTIVE LIABILITY INSURANCE COVERAGE ~ - ' .... ..... Permittee mus_t hove pr?e.ctive liabiJity insur~ce coverage in accordance with Depar. tment~equ[~re~n-ents; (See Infor- mation on Protective LiabiJity Insurance Required for Highway ~r~ J~_e(mits and/or Special ~LauJing:Permits, Form PERM-27):~._.' ~ - . :: Expiration of, or lack of, liability insurance automatically terminates the permit. Insurance coverage may be provided by furnishing the Department with one of the following: a. A Certificate of Protective Liability Insurance for Permits on State Highways (Form PERM 17, NYSDoT). b. A $2..50 remittance (check drawn on a New York State Bank or Certified) for coverage under the Departmental Blanket Policy. c. An Undertaking may be furmshed by Public Service Corporations and Government Units only and must include the wording required by the Department. 2. COMPENSATION INSURANCE AND DISABILITY COVERAGE The applicant is required to have compensation insurance and disability coverage as notedinthe provisions of the Workmen's Compensat?o~.k-ew and Acts amendatory thereof for the entire period of the permit, or the permit is invalid. 3. NOTIFICATIONS Notify Commissioner, through Regional Office, one week prior to commencing work, except emergency work by public service utilities which should be reported the next work day. Work must start within 30 days from date of permit. Notify area gas distributors 72 hours prior to any blasting. Notify Utility Companies with facilities in work area (permission must be obtained before doing work affecting utilities' facilities) before starting work. Notify land owners of abutting lands, before disturbing trees. Notify Department of Transportation at conciusion of work and return original copy of permit to Regional Office. Annual Maintenance Permit Notifications: Notify by telephone the District or Resident Office, one week in advance, each time regular maintenance work is to be performed. In emergencies, notification by telephone should be made the next work day. 4. ' SITE CARE AND RESTORATION An Undertaking, a bond or certified check in an amount designated by the Department of Transpor'tation may be required bytheRegionalOffice, before a permit is issued, to guarantee restoration of the site to its original condition, if the Department is obliged to restore the site of its original condition, the costs to the Department will be deducted from the amount of the permittee's guarantee deposit at the conclusion of the work. The permittee is responsible for traffic protection and maintenance, including adequate use of signs and barriers during work and evening hours. No unnecessary obstruction is to be left on the pavement or the right of way or in such a position as to block warning signs during or between work hours. No work shall be done to obstruct drainage or divert creeks, water courses or sluices onto the right of way. All fa]sework must be removed and all excavations must be filled in and restored to the satisfaction of the Regional Traffic Engineer. 5. COSTS INCURRED BY ISSUANCE OF THIS PERMIT All costs beyond the limits of the protective liability insurance, surety deposits, etc., are the responsibility of the permlttee. The State shah be held free of any costs incurred by the issuance of this permit, direct or indirect. 6. SUBMITTING WORK PLANS The applicant will submit work plans and/or a map as required by the Department. This shall include such details as measurements of driveways with relation to nearest corner, positions of guys supporting poles and a schedule of the number of poles and feet of excavation necessary for completion of the work on the State right of way. A description of the proposed method of construction will be included. Plan work with future adjustments in mind, as any relocation, replacement or removal of the installation authorized by this permit and made necessary by future highway maintenance~ reconstruction or new construction, will be the respon- sibility of the permittee. The permittee must coordinate his work with any state construction being conducted. 7. TRAFFIC MAINTENANCE Traffic shah be maintained by the permittee on the highway, in a safe manner, during work and evening hours until its final c. ompletion. Suitable safeguards, to reduce conditions dangerous to life, limb and property to a minimum, must be provided by the permittee (including flagman when requested by the Department); 8. cOs'f-:6'F' INSPECTIC~I ~,ND's~PER~/iS'ION-': . ~i If,_inrthe acc~urrts ko'pt by'the Department, cosfs of ~u~er~,i~io~'~r~ ~'o~nd fo:~:~e ~ce;c~in~]y fiigh,';th'eDepart'ment re- serves the right to bill the permittee for actual expenses incurred by the supervision and inspection of the perm!ttee's project. 9. SCOPE ' ' ........., , a. ~reas Covered r L. .~ :¥F' :", Permits issued are for highways, bridges and culverts o~,er which the New York State Department of Transportation has jurisdiction. (Local governments issue permits for their own jurisdiction.) b. Legal The privilege granted by the permit does not authorize any infringement of federal, state or local laws or regulations, is limited to the extent of the authority of this Department in the premises and is transferable and assignable only with the written consent of the Commissioner of Zransportatlon. c. Commissioner's Reservations TheCommissioner af Transportation reserves the right to modify fees and to revoke or annul the permit at any time, at his discretion without a hearing or the necessity of showing cause. d. Locations Work locations must meet approval of the Department. (Additional oaaes to this ao~lication vary accordina to the ~umose and t¥~e of work to be I~ermltted)