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JUDITH T. TERRY
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
TELEPHONE
(516) 765.1801
THIS IS TO CERTIFY THAT THE FOllOWING RESOLUTION WAS ADOPTED BY THE
SOUTHOlD TOWN BOARD AT A REGULAR MEETING HELD ON MAY 3, 1988:
RESOLVED that the Town Board of the Town of Southold hereby waives
the Surety and Maintenance Bond provisions of the Highway Excavation
law of the Town of Southold with respect to the application of the Village
of Greenport to install a water main extension along the west side of Youngs
Avenue, from County Route 1I8 to Founders Village, Southold.
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pY~ Judith T. Terry
Southold Town Clerk
May 1I, 1988
Permit No. 1
File No. 1
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TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(516) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
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 m!a,ke necessary inspections of the job site.
Print or Type
.;13<.. ...1/t.iRJ. g-
G~""lIIflo...-t New 'fORk II"I'-I~
Address
~3l:> -th,,'-d,. sr ~ol't N'f
ClFle\..o W!. ro-,... N
Address
. ~S/de.
3) ~Tel\l~IO/l) +-C01l\Pl....'tIOW 0+ lO" wa:ter!'l'\aIlO CJYv ~OUIlXtS jq"e..
Work Description and Location (Street Number, Hamlet, Cross Street)
1)
VIJ..ha~e of &eel\lilO€i
fllame f Applicant
Ultl~e ef G-r-E'~lUftlrt
.I. eal..:
e of Owner
mises
""(POI
~'TI
2)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No)(
*If yes, other Town permits may be required. -
4) Builder's License No. Nt
Electrician's License No. ~
Plumber's License No. N/f1
,
Other Trade's License No. Iv/II
I
'~~h/ JJ~
, ignature of Applicant
ij 'c9.'7 -S'?'
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)
7)
Tax Map: Section ~O -63
Starting Date: S/,j/8~
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Block
/
,Lot H #-
Completion Date
5/cP'7/88
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8) Work Schedule:
Phase Completion Date
Excavation......................................... 4-/.:J. -.s-/c#7/fJrI
. .,
Facility Installation................................. 6'/~ - ~/~7/~
Backfill & Compaction.............................. oj.:t - ~/~'7lffl
Pavement Replacement............................. .6/:1- - 6ltP7/t'S
, ..,
9)
,
Under which authority is the application made: V/lt..a.'jC O-f GeQ~PD~T
10)
Estimated Cost of Proposed Work: $
6S. 000
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11)
Remarks:
N/A
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D-39
Page 1 of 3
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12) Insurance Coverage: (Attach copy)
a) Insurance Company: lJl""~e Gf (;fw"'po,i j:b).1 el~s IN (.'ff'E"e.:r
b) Policy # S..... Al!>ooe...
c) State whether policy of certification on file with the Highway Depart-
ment: Sa. M!).o~
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: 5eCM.\!-1 r'i <l't.oOI.Qeci- ~ U...LLeCje of ~1Vp',a.T
a) Surety 80:1= or C3:'""t:f'::::= C~::::l~ ;::--cyrdcd 1~ the
tota I amount of $
b) Maintenance Bond provided:
2 years or
3 yea rs
14)
Fees for applications and permits:
Basic
Application Fee........ $25: 00, cl
@ $20.00 = $ (/,0.00 4,ft~"/-t-L
4 G
A 1. ~ /Service Connections excavations
~
A2.
N//l /Additional Excavations same service @ $10.00 = $
rro:-
Excavations 18" in depth or less:
0-100 I. f. = $10. 00
N~Jft I.f. @ $0.10 - $
Add tional
Excavations 18" in depth to 5'
0-100 I.f. = $30.00
~fIO I. f. @ $0. 30 = $
Additional
B.
C.
in depth: ,l~
.A/luf!!'
I t/O, eo Lll
D. Excavations 5' in depth and over:
0-100 I.f. = $50.00
N/fI I.f. @ $0.50 = $
Additional
E.
~~*
o.
Utility Repair Excavations @$10.00 = $
Additional
Repairs same service @ $5.00 = $
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
c)l""~e 0+ ~12Neca.T
SUPERINTENDENT OF HIGHWAYS
TOWN F SOUTHOLD, NEW YORK
Received by the Town Clerk flPl'/f/
Date
Permit Issued ~ .1{ /~ Permit No. 7
ate / !
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
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Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S
RECORD
I nspection Date
Findings (use code)
Applicant Notified
1st
2nd
3rd
4th
(To Permit Clerk)
REMARKS
CODE
I B - Improper barricades
IL - Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
BUC - Building under Construction
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
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RAYMOND L. JACOBS
Superintendent
DATE:
TO:
CASE NUMBER:
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Highway Department
Town of Southold
Peconic Lane
Peconic, N. Y. 11958
Tel. 765-3140
. 734-5211
This is to notify you that New York Telephone Company
and Long Island Lighting Company have been notified in
the Town of Southold.
respect to the application for an Excavation Permit in
~/Ifft;:...
Signature of the applicant
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ARTCO DRAINAGE CORP.
P.O. BOX 1132 MATT/TUCK, NEW YORK 11952
(516) 298-9660
April 27,1988
Raymond Jacobs
Highway Department
Southold Town
Southold, N.Y. 11971
Dear Mr. Jacobs;
In reference to continuation of the watennain on Youngs Avenue.
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Please be advised worksite conditions will be left acceptable to
the Town Highway Department and restored to as close. to orginial condition
as possible. . .
Sincerely,
At'Li;:f Ji1v.