HomeMy WebLinkAboutSterling Place
Date: 04/19/00
Transaction(s):
1 Permits
Check#: 828
Name:
Brooklyn, Union Gas
444 East Main St
Patchogue, N Y 11772
Clerk 10: L1NDAC
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipl#:
Total Paid:
828
Subtotal
$45.00
$45.00
Internal 10: 9194
f"e~ NO.
71/
TOWN OF SOUTHOLD
H IGHWA Y DEPARTMENT
Peconic.OLane
Peconic,. New York 11958
(516) 765'-3140
P. o. t2>o~ I 76
RECEIVED
File- No~
~
.
APPLICATION/PERMIT FOR HIGHWAy
,2SL<? 06"O~
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,
ordinimces 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: necessaryj'nspections of the job site.
<....
Print or Type
1)
Brooklyn Union Gas East
Name of Applicant
44S'East Main St.
Patch6~ue, N,Y. 11772
Address
2)
Name of Owner of Premises
Address
3) .
;" 7)-<..
escription and
U/' C'-
',?
Location (Street.
[pI ..J-~
Nu . ber, Hamlet, Cr
<"A
(a)
Is construction located within '75 feet of tidal wetlands? *Yes
*If yes, other-town 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 ~JV'-O-__
.... '. Signature of I dmt
.' . y~ t3 cJIJ
Date
5) a) Attach plot plan showing location .of proposed,"exsavation 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 other 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)
Starting Date:
. Completion Date
8) Work Schedule:
Phase
\.
Completion Date
9)
10)
11)
Excavation.................. .... .:.,:.................
Facility .Installation........... .'. ~...................
Backfill & Compaction....... .:;: ... . . . . .. . . . . . . . .. ..
"," .
Pavement Replacement........;~...................
Under which authority is the application made:
Estimated Cost of Proposed Work: .'$
Remarks:
\
D-39
Page 1 of 3
12'") Ins.ur.ance Coverage: (Attach copy)
,,) 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 dam"ge: $300,000/$500,000 Bodily Injury,
and $50,000 property dam"ge.
13) Security:
,,) Surety Bond
tot" I amoun t of $
b) Maintenance Bond provided:
or Certified Check
provided in the
2 years or
3 years
\/14) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. IService Connections. excavations @ $20.00 = $
~
A2. IAdditional Excavations s"me service @ $10.00 = $
No.
B. Excavations 18" in depth Or less:
0-100 I.f. = $10.00
I. 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
E.
Utility Rep"irExcaviltions @$10. 00 = $
No.
Rep"irs s"me service @ $5.00 = $
Additionil'
F. Notice to public utilities proof must be provided and ilttilched to
this ilppliciltion prior to issuance of permit.
* * '*-'
Authoriz"tion is hereby granted to the Town Clerk of the Town of Southold to
issue" Highw"y Excilvation Permit to:
in "ccord"nce with .this "pplictition.
SUPERINTENDENT OF HIGHWAYS
T()W F SOUTHOLD, NEW YORK
rj'lcf-03
Dilte
Received by the Town Clerk
Permit Issued\ ~~0d
Oil e
~ )7100
[jilte
Permit No.
L/{/'
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice to the Superintenden-t of Highways.
Permit must be ilvaililble for inspection.
D-39
Page 2 of 3
. . -
KEYSPAN/G-tf 5
REQUEST FOR STREET OPENING PERMIT
D D NASSAU D SUFFOLK ri\7l /' -:-7/
FC-51114 STATE COUNTY COUNTY l.)l:::I- ~6)- u- Crr-a LO
PERMIT MIS JOB DATE
NO. NO. c:!.5 0?5 -03 <0 ~ /3 OlCJO 0
LOCATION 8ue Ur:: """t /!If:. Mif. /51UJ/;";G-;2 /;.1 7/f[ Mt:-i) /f(eM 4;1!/J,,: '{)o
REASON FOR .Ie- / -"'-Ale ('""'
OPENING lf~lN C5H.;:, ...)/,
W.O.lPA
NO.
REQUESTED
BY
I,d.; J II..
DEPARTMENT
GAS CONSTR. MAl NT. & SERVICES
DATE OF
OPENING #//1 'clooo
DIVISION /.1._.__
r,4 k#o (/ tit:-
DATE
FOREMAN
APPROVED
SKETCH
N
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