HomeMy WebLinkAboutMarratooka Ave
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ELIZABETH A. NEVILLE, TOWN CLERK RECEIPT 07614 8
Town of Southold
Southold, New York 11971 .'/ .1 0 0
phone: 516.765-1800 DATE YlA.9-0. 1><,<;./--- 19-L-L
RECEIVEDOFyn~.<1flrv>/ (1,17-<1 ';- ~.L.JJ.</..l{"i.u~'i._l./(.,-,-_"--"_
FOR 11= IF ~ ~ fcc..v~ t1./l(l./ f- mp-
/t.) EJ T...E...',_-A1O--~.fL'I' = filt:l/NTE-NA.vce.. II ()..JJ> -----
o CASH D liJ;'Ju..~..
~ECK ~ brp 0, By:?JG l ~~
MARKETSPAN CORP.& SUBSIDIARIES
PERMIT ACCOUNT 2
448 MAIN STREET
PATCHOGUE, NY 11772
676
/1 -/ '7 -99
$. c?'y~;:-
lN321210
DOLLARS !!lEe."::"
FOR
2994/ Patchogue Office
Palchope, New York JJ 772
tll.{lt.t7' y:1 /f~ #- /17
11.000 b 7 bll. 1:0 2 lOOO :I 2 21:
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FOR YOUR INFO:
From the desk of Raymond L. Jacobs
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File No.
/8'
/,1
.
.
Permit No.
..
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic . Lane
-#fif/JJN..... .~ Peconic, New York 11958
........-:;;- (516) 765'-3140
f1J g4'" II> PO. t2>01- /76
'\()~ 2. '3A~~ICATlON/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ji-
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the
Code of the Town of Southold, Suffolk County, New York, and other applicable laws,
ordinances or regulations for the excavation herein described. The applicant agrees
to comply with all applicable laws, ordinances, codes and regulations, and to permit
authorized inspectors to make: necessa ry.. inspections of the job site.
~'-(vg7-93
Print or Type
1)
BRQok:'l\,l"-J U.J\JIO....l (r-('....s:-
Name of Applieant
4 'f: f- E' rYI t4-,..J S"l
Address
f.41-c~ r tv~
(j
2)
Name of Owner of Premises
Address
3) (Y\A{l-.c.4-TZlo~A- ~ {Y\Ai-llTl-<Ctc (:54>1' ;4TTY'l.,j~.9 cJ~.P(K-'filc)
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction los;ated within 75 feet of tidal wetlands? *Yes No
*If yes, other-town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
~~re 1(~t
II - /'1, ff"
Date
5) a) Attach plot plan showing location of proposed/eXcavation and relationship to
adjoining premises or public streets or areas, and giving a detailed descrip-
tion of layout of excavation.
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: Section Block , Lot
7) Starting Date: Completion Date
8) Work Schedule:
Phase Completion Date
Excavation.. ..... ..................................
Facility Installation.................................
Backfill & Compaction..............................
Pavement Replacement...............................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11)
Remarks:
\
0-39
Page 1 of 3
.
.
.
12) Insurance Coverage: (Attach copy)
a) Insurance Company:
b) Policy # \
c) State whether policy of certification on file with the Highway Depart-
ment:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13) Security:
a) Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
2 years or
3 years
14)
Fees for applications and permits:
A 1. ----L-/Service Connections
No.
A2. IAdditional Excavations same service @ $10.00 = $
Basic Application Fee........ $25. 00 .-
excavations @ $20.00 = $ J~.-
No.
B. Excavations 18" in depth Or less:
0-100 I.f. = $10.00
I. f. @ $0.10 - $
t f eft
.~~
Additional
C. Excavations-.l'll" in depth to 5' in depth:
0-100 I. f. =. $30. 00 v
:U,70 . I. f. @ $0.30 = $ 7)/)/.-
Additional
D. Excavations 5' in depth and over:
0-100 I. f. = $50. 00
I.f. @ $0.50 = $
Additional
E.
Utility Repair Excavations @$10.00 = $
No.
Repairs same service @ $5.00 = $
Additional
./
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
* * *
Authorization is hereby granted to the
issue a Highway Excavation Permit to:
in accordance with .this application.
Town Clerk of the Town of Southold to
73R.ooKL If AJ U,u /o,u ~A\:S
ENT OF HIGHWAYS
UTHOLD, NEW YORK
,
/f- ..(:3- ?:?
Date '
Received by the Town Clerk
11-,2.3-97'
Date
Permit Issued, J/- c>J.3 - ~7
Date
Permit No.
/t
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39
Page 2 of 3
.
.
Copy Distribution:
\
Highway Department
Inspector
Applicant
Town Clerk
INS P E C TOR '.S
RECORD
I nspection Date
Findings (use code)
Applicant Notified
1st
2nd
3rd
4th
(To Permit Clerk)
...-"
REMARKS
./
CODE
IB - Improper barricades
IL - Improper -lights'.
ST - Sunken trench or excavation
UTM - Unable to measur~ (due to backfilling)
BUC - Building under Constructi.on
WIP - Work in. progress
DB - Improper backfill (too high) (not sufficient)
HFS - Inspector holding for final settlement of excavation
RFR - Ready to repair
\
D-39
Page 3 of 3
~
REQUEST FOR PERMIT
Request for S~..";1l1-,, L 1) Permit I FEE' $ I Date 1f119/9t'
Permit required to open! J'" /)Ez;1 wls of f/lAUA{;cK-A Ml I!J nfl..-
\';6 A m.k..l. ft.t/;yl. -nt[ bMS-..f' A4/1
SiA!I:[;.Jf:r 1ft (t;~1i:L5f.e-7itm of 5. t. ~Z5 -r;; kL> ;,J A SO<-L7HE-,d'::/ 'j),/tt&:--'
.foL i1~D' -Jb IIew S vtlALf( A1Jl..1 -tht,J tJiS"(" ~ -rtIL tJ!J 01' /UJa./A (,t.C
A1/i .Iel- qf)', -flkJJ fAS'I ll"^- '11I.L ~Is of Jw! 5~,fL. i,J 111l. GLA.I'S IMEA
1-0 I.. <j 15. ' ; ,J NlIl'-rl"it ..tel.
/
Permit Requested By: Kff.J I',J St./u:1i- D Q.N. D Cent. D W.S. .t:L E.S.
TO /?:,()O Type of Road Gas Service for
Work Request # J4481.1Jo Charge account # .
* D 0 isbursement to be made out of petty cash I D To be billed I D No fee
Return Permit To: ~New Business Department D Underground Lines Department DOper. Plan. & Cont. Center
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FC-1145.6-SS
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PHONE , 51 t, ^"
NOD
WE PEIlMIT SiAn .,. 70 tA;,J
SER'I1CE REa' BY ASAP
CONNECTED LOAD DATA
HEATING /3 -00 0 eFH
WATER CF'H
Kf:YSPAN ENERGY CORP, db" 8ROOKLY
~
.1/3 I FT MAIN $j/Dt'tI"UU-
4-cJ FT SERVICES $ () CH"'~
RELOCATION $
REACTIVATION ,
SURVEY ""Kevin Schutz DAn: II I SALES TAX $
FIELD CONDITION DATA CHARCE TO APPLICANT $
&\H1J;R~~TIOH SURVEY PLANS 0 FOUNDATION ONLY 0 FRAMED CJ COMPLErE 1X1
T'f,~~ OF stwAGf.: CESSPOOLS 0 S~Pl1C ~~NKS 0 ~!:.~~g~j1,l [~-:!
WPE RESIOENCIAL D EXISTING' WATER MAIN INST AJ.JJ:D
Of COMMERCIAL 00 NEW ',_ WATER SERVICE INSTALLED
""EMISES . APT/CONDO 0 RFeUILT 0 WELL SERVICE INSTALLED
INSTALl
MAIN 0 CUTBACK D ANGOE ON RIsr.R 0
CONSTRucnON REPORT
YES D
YES "---:
YU;
RJlNGE
DRYER
OlHER
iTH
INSULATE AT
SERlneE 0
TOTAL OIJiJ
B.1. * 2330010
S^I.ES
sUP I
PA, ,
crH
GFH
CFH
CONSTRUGnON SCHEDULED WEEK Of
$TART COMPlETE
FORMAN
/\IFf TEST
OV(1V\lJ.. FOOlAGE
SCR\l1CE ORDER
APPROVED BY
SERVICE ORDER
!V>,TL
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NOTIFY ONE-CALL CENTER BEFORE DIGGING 1 800 272 4480
Brooklyn Union is not responsible for repaving or restorial costs on Private Property
:Jj.Js1P.LL .113. i' €lt t.('flfJ M"b ILs, tr1lJliJ
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Permit No.
.
.
.,
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic 'Lane
Peconic; New York 11958
(516) 765'- 3140
p.o./2>cr- t7f>'
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
~Yl(f'7fJ
.
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the
Code of the Town of Southold, Suffolk County, New York, and other applicable laws,
ordinances or regulations for the excavation herein described. The applicant agrees
to comply with all applicable laws. ordinances, codes and regulations, and to permit
authorized inspectors to make; necessary. inspections of the job site.
\ ..
Print or Type
1)
BRgo K:' l~"-l l AN \ ()>-l (' H\:S-
Name 0 Appli ant
l{ 't R- E' mll-I.J Sr
Address
(JA-1"c~ r we..
o
2)
Name of Owner of Premises
Address
3) (Y\ A- {Z.t:4-T7.l 0 ~ A- A".... _ (Y'I A- -I', l """ C Ie (s 4' (' ~e)< ~ cJ "'.P UL'fl" ")
Work Description and Location (Street Number. Hamlet, Cross Street)
(a)
Is construction located within 75feet of tidal wetlands?
*If yes, other-Town permits may be required.
*Yes No
-
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other, Trade's License No.
~ ~J; ~:\
(AJ~
Signature of Applicant
Date
5) a) Attach plot plan showing location of proposed/excavation and relationship to
adjoining premises or public' stre,ets or areas, and giving a detailed descrip-
tion of layout of excavation. ' /
/
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.
Tax Map: Section
, Block
, Lot
6)
7)
8)
Starting Date;
Completion Date
Work Schedule:
Phase\. Completion Date
\
Excavation. . . . . . . . . . . . . . . . . . ... . .. ~ . . . . . . . . . . . . . . . . . .
, \
Facility Installation . . . . . . . . . . . . . . . ;. . . . . . . . . . . . . . . . .
Backfill & Compaction.........;....................
Pavement Replacement..............................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11)
Remarks:
'\ '
\
D-39
Page 1 of 3
.
.
"
12) Insurance Coverage: (Attach copy)
a) Insurance Company:
b) Policy j/ \
c) State whether policy of certification on file with the Highway Depart-
ment:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13) Security:
a) Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
2 years or
3 years
14)
Fees for applications and permits:
A 1. I IService Connections,
No.
A2. /Additional Excavations same service @ $10.00 = $
Basic Applicatio~ Fee........ $25. 00 ..-
excavations @ $20.00 = $ .:J..tJ. -
No.
B. Excavations 18" in depth or less:
0-100 I.f. = $10.00
I.f. @ $0.10 -,$
t ? t/-/;
~~
Additional
C. Excavations---lll" in depth to 5' in depth:
0-100 I. f. =, $30. 00 ."....
:J. (, 70 . I. f. @ $0. 30 = $ g /)/. -
Additional '
D. Excavations 5' in depth and over:
0-100 I. f. = $50.00
I. f. @ $0.50 = $
Additional
E.
Utility Repair Excavations @$10.00 = $
No.
Repairs same service @ $5.00- = $
Additional
,
./
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
* * *"
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.
\
SU,PER INTENDENT OF H IGHWA YS
TOWN 0 SOUTHOLD, NEW YORK
,
1('- 023 - 9/'
Date
Received by the Town Clerk
Date
Permit Issued\'
Permit No.
Date
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39
Page 2 of 3
.
.
.-
Copy Distribution:
\
Highway Department
Inspector
Applicant
Town Clerk
INS PEe TOR '\S
R E COR D
Inspection Date
Findings-(use code)
Applicant Notified
1st
2nd
3rd
4th
(To Permit Clerk)
.,.,..~_#_<'/
REMARKS
/
-.
CODE
I B - Improper _barriEades
IL - Improper "lightS\
ST - Sunken trench. .or; excavation
UTM Unable to measure (due to backfilling)
BUC - Building under Constructi.on
WIP - Work in. progress
DB -Improper backfill. (too high) (not sufficient)
HFS - Inspector holding for final settlement of excavation
RFR - Ready to repair
\
0-39
Page 3 of 3
.
REQUEST FOR PERMIT
.
Request for :Se>lA--r1I" L 'l) Permit I FEE' $ I Date II/t'? /q9
Permit required to open! j' /JEt;1 wls o-? f'/IAUA-rc;c{(.4 A1/L ,!J rlL.
\';6 A mJ LrI.t.,p.,A. "!1t[ bMJ:J' /h<S1'I
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-f-DL i15o' -r; J'1E?w S IA-..f!ALf( At/L/ rl1t J WiS;- ~ -rtIL tJ!J D I' ;1LIJu./A
ME. .-/01- qD~ "17I-~JJ fA's! O'"^- '11iL ~1'S. ot Jw!5...J1l,L~ ;,J 1JIiG4.!'S
/-0 I.. 11. 5. ' ; ,J (VI A-"f"-rtr u..e.l-
,
Permit Requested By: K6J,"; SC)u:iL o a.N. 0 Cent. o W.S. ~E
TO l'?:.oO Type of Road Gas Service for
Work Request # M4-ff7 -1.10 Charge accou nt #
, 0 Disbursement to be made out of petty cash TOTo be bilied I 0 No fee
Return Permit To: ~New Business Department o Underground Lines Department DOper. Plan. & Cont. Ce
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S.
nter
FC-1145.6-S5