HomeMy WebLinkAbout55 Sound Rd
Brooklyn, Union Gas
444 East Main St
Patchogue, N Y 11772
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold, New York 11971
Phone: 631-765-1800
RECEIPT #36
Received $ 45.00 for 1 - Permits on 04/03/2000.
This receipt covers the following PermiVSticker(s):
tt is always our pleasure to serve you.
By:
_.U A--i~
("../<../ /4- 7:;; 7
at
(time of day)
Permit No: ~
File N'o. 3~
:;L 5 3 (., 'T- d j
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic'Lane
Peconic; New' York 11958
(516) 765'-3140
Po. (2,,,y.. /75'
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Ijighways 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, ordinar,'ces, codes and regulations, and to permit
authorized inspectors to mlake; necessary:\lnspections of the job site.
Print or Type
1) Brooklyn Union Gas East
Name of Applicant
448',East'Mai.n St. Patch6gue, N,Y, 11772
Address
2)
Name of Owner of Premises
Address
3) 55 ~,-<.J) Rei
Work Description and
'iSf
Location
^y ()' N () M I...- f!J
(Street, Number, Hamlet,
c-r1. ..... r. ..... f Q --...-
Cross Street)
(a)
Is construction located within'?S feet of tidal wetlands? *Ves
*If yes, other-fown permits ,may be required.
No XXXX
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other, Trade's License No.
1
Signature of
3t,
Date
5) a) Attach plot plan showing location of proposed.'el(c:;avation and relationship to
adjoining premises or public str'e,ets or areas, and- giving a detailed descrip-
tion of layout of excavation. '
b) Attach all ofFier necessary permits and licenses for this project.
c) Work covered by this applicatiohmay not commence before issuance of a
Highway Excavation Permit by the Town Clerk.
Tax Map: Section
Block
, Lot
6)
7)
8)
Starting Date:
Work Schedule:
Completion Date
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
,)5' 3'? 6 ')
'.12) Insurance Coverage: (Attach copy)
a) Insurance Company:
b) Policy II \
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:
il) Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
11'14)
Fees for applications and permits:
A 1 . ~/Service Connections.
No.
A2. /Additional Excavations same service @ $10.00 = $
2 yea rs or 3 years
Basic Application Fee..... ~
excavations @ $20.00 = $ C2 0., oJ
No.
B. Excavations 18" in depth or less:
0-100 I. f. = $10.00
1.f. @ $0.10 -$
Additional
C. Excavations...l8" in depth to 5' in depth:
0-100 I.f. =$30.00
.I.f. @ $0.30 = $
Additional
D. Excavations 5' in depth and over:
0-100 I.f. = $50.00
I. f. @ $0.50 = $
Additional
Utility Repair Excavations @$10.00 = $
E.
No.
Repairs same service @ $5.00 = $
Additional
.....--
F. Notice to public utilities proof must be provided and attached to
this application prior to iss.uance of permit.
* * *'
TiTi't',{
YS. oJ
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.
DENT OF HIGHWAYS
OUTHOLD, NEW YORK
Raymon
~- /~ c:0
Date
Received by the Town Clerk
I-I ()o
Date
Permit
Issued, J./. ~. LJ 0
Date
Permit No.
J6
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
KEYSPAN/6-As
REQUEST FOR STREET OPENING PERMIT
FC-6111.4
D STATE
D NASSAU
COUNTY
D SUFFOLK [(7j.---- I r
COUNTY ~ lodtJ ", JttJvfJ(04)
PERMIT I MIS JOB IDATE
NO. NO. ,:2..5301-030 j/,2g/dl~oo
SU,</]) U ,
LOCATION 55
REASON FOR dew LS--IIS ~ tI,(L
OPENING
W.O./PA FOREMAN I DATE OF 0/;2000
NO. OPENING
REQUESTED /(e/J/,J .kilu:1i DEPARTMENT ID~I~ /L670tJ 3
BY GAS CONSTR. MAINT. & SERVICES LL 0/1"
APPROVED IDATE
SKETCH
N
j
.
N
L-\'
j') ~
I
~
'"
I <..
~ 'V
~ ~'
l1\ -
tJ\~
c
~ ~~~
<..,
I"
"il-.
~~'- I- /'f ILs,," ~- -
- - - - - - -- - -- - - - ~ T~
/10 .
T
~ G\
'^ ~.
l "- I
.
/J 0 /L rl-!
/2DAl:!