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Home My WebLink AboutOregon RdTown Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/30/03 Transaction(s): Permits Receipt#: 0 Subtotal $25.00 Cash Total Paid: $25.00 Name: Utilities, Plus Corp 921 County Rd 39 Southampton, NY 11968 Clerk ID: LINDAC Internal ID: 77908 TOWN OF SOUtHOLD . HIGHWAY DEPARTMENT Pecon{c: Lane Peconic~, New York 119~8, [ 51'6) 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 Gouniy, New' York', and other hpplicable laws, ordinances or regulations for the excavation herein described. The applicant agrees to comply with all applicable [aws, ordinances, codes 'and 'regulations, and to permit authorized inspectors, to' rda~ke~ necessary inspections of the job site. Print or Type I Name of Applicant Address Name ~f Owne~" of Premises Address Work Description and Loc~tion [Street Number, Hamlet, Cro~s Street} [a) Is constructioh located Within 75 feet of tidal wetlands? *Yes No ,~(, *If yes, other Town permits may .be required. Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No, Signature of AppliCant 12~ate S)' a) Attach plot plan showing location o,f,propo~ed ex,cavation and relationship to adjoining premises or public'streets or areas, and giving a detailed descrip- tion of layoutI of excavation. b) Attach ali other necessary permits and licenses for this project. c) Work covered by this application' may not commence before issuance Highway Excavation Permit by the Town Clerk. 6) Tax Map: Section , Block , Lot 7) Starting Date: Completion Date 8) 11) Work Schedule: Phase · Completion Date Facility lnstallatlofl Backfill & Compaction .............................. P.av'ement Replacement .......... Under which authority is ~he appl[~[ion made: Estimated Cost of Proposed Work: $ D-39 page I of 3 insUranCe Covera e: (Attach copy) a) .Insurance Company: , '. ,,:; :i b) PoliCY # c) d) ~ecu r[ty: a) Surety Bond total amount of $ State whether policy of certificatio~ on-'file 'with the Highway Depart- ment: Coverage required extended ~o the Town: Bodily injury and property damage~.- $300,000/$500,0,00 Bodily Injury, and $50,000 property damage, ,, , or Certified ·Check provided in the b) Maintenance Bond provided: 2 years or .. 3 years Feesfor applica~!,ons a.n~. permits: Basic Application Fee ....... Al. __/Service Connections exca.vations O $20.00 = $, __/Additibnal Excavations same service ~ $10.00 -- $ A2. B. No, De Excavations 18" in depth or less: 0-100 I.f. = $10.00 I.f. ~ $0.10 - $ Addit~6n'al ' Excavations 18" in depth to 5' in depth: 0-100 I.f. = $30.00 l.f. (~ $0.30 = $ Excavations 5' in depth and over~: 0-10o l.f. = $50.00 l.f. ~ $0.$0 = $ 'Addki~nal Additional Utility Repair Excavations Q$!0.00. = $ Repairs same service ~ $5.00 = $= F. Notice to public 'utilities proof must be provided and attached to this application prior to issuance of permit.' Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Perm{t to: in'accordance with this application. - Received by the Town Clerk Permlt Issued ~/~ 0/~ Date SUPF. J~I'N--~'-EN, DENT OF HIGHWAYS / Date Date Permit No. C~ _~ Note: D-39 Permit expires one (1) year from Date of .lssuar~ce. No work to start without 48 hour notice tO the Superintendent of Highways. Permit ·must be available for inspection, Page 2 of 3 RAYMOND L. JACOBS Supedntendcr~t Highway Department Town of Southold Peconic Lane Peconic, N.Y. 11958 . Tel. 765-3140 '734.5211 DATE: ~ ~ TO: CASE NUMBER: t~7/-~ 0%63' This is to notify you that Bell respect to the application for Southold, Atlantic and LIPA have be-¢h:,~ndtlfied ,in:.i';. .....~ :. an Excavation Permit in ,th.e Town of-. . .- - Signature of the appllcar~t JUN-27-2003 FRI 1]:03 ~N 369]236 FAX NO. P, 02/03 :.A_C_O.'RD, CERTIFICATE OF LIABILITY INSURANCE 06/27/03 PJ~QDUCEE ~'l~lS CERTIFICATE IS ISSUED AS A MA~ER OF INFOR~T~N J~es F. Sutton Agency Ltd. ONLY AND CONFE~ NO RIGH~ UPON THE C~TIFICA~ 149 E, ~in Street HOLDER. THIS CERTIFICATE ~E$ NOT AMEND, ~ND OR ~.0. ~ox 76 ~~ .... LTERTHECOVE~GEAFFORDEDBYTHEPOLICIESBE~OW. East Isllp ~ 11730 ~ Phono: 631-581-7978 Fax: 631-581-7507 INSURERS AFFORDING COVE~GE NAIC~ ]NSU~RB; ~chants ~tual Ins. ~, 204 Southampton ~ 11968 ........ COVERAGES THC POLtC:I[:~I OF INSUrC~ICE LISTED DC[OW HAVE BEEN ISSUED TO THE INEURED NAMED ABOVE FOR THE POLICY p~RIOD INDICATED. NOTWITHSTANDING LTR NSRI TYFE OF INSURANCE POLICY ,N ,[~/~ER [~ATE p*M,'DB/YY) bAr~fMMe~I UMrTS GENERAL UABJUTY E~:H OCCURRENCE S I 0 0 0 0 0 0 A X COMMERCfALGENEI~,.LLIAP, ILiTY CMP9137293 05/23/03 05/23/04 PRB.I~SU"M^~'IU"C"I~(~ ~,:ur~,~.) s 100000 I CLAIMS MADE [] OCCUR PERSONAL & ADV INJURY $ ~. 0 0 0 ~ 0 0 G£NE RAL kG C~qEC~A'II~ $ ~'00~)000 GEN'L AOGP~"GATE LIMIT AppLIES pER: PRODUCT~ -C-OMP/OPAGQ $ ~. odd~00 B _~ 0ccu, ~ c~,~s~w~E C0P9065762 05/23/03 05/23/04 AC=ORE.ATE $ 50(~09;00 ~TENT~0~ $10000 $ * WORKF. R$ COMP E NSA~ION AN D Proof of insurance, fa.x:298-0235 · 765-1750 CERTIFICA'[~ HOLDER PF~NN02 Pfennig Construction CorD PO Box 1331 Mattituck NY 11952 ACORD 25 (2001/08) CANCELLATION JUN-2?-2003 FR! 1~:03 AM 369]236 F~× NO. P, 03/03 IMPORTANT If the car[ii,cate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, cerlain policies may , require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ., ~,: DISCLAIMER .... The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, end the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108} JUN-2?-2003 F~I ~I:03 ~N 3691235 Fh×. NO, STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFCATE OF PARTICIPATION IN WORKERS' COMPENSATION GROUP SELF-INSUIL~NCE P, 01/03 921 County Road 39-Nrth tlighway b. EITuct~w Date of Membership in thu Group 11/01/02 CertificatePerio~ 01/0It03 're 1/01/04 Cmlit]cate Nunlhcr 0010143-1 {ncluded (only cI'~ck box if all parlnera, officers il~Mded) ali excluded or ccrlaio pa~.ncrs/o filters excluded L l%me and Addccss of tie: I~ntlty Requesting Proof of C. overage (Entily 19-21419 Lt. Fedcra] Employer Idcn6ficafi(m Number of Business reli:rcnccd in Box 'la' t 1-3172942 3. Nanx: and Address o{'G. mup gclf-lnsm'er Thc Elce~Cun Trust CIO 1~ CaMi,nnl Co~ 10 Bfi6$h American Bird I atham. NY 12[]0 This certifies flint the business referenced above in box "1 a" is complying with the mandatory coverage requirements of the New Yo~k Star~ Workers' Compensation Law as a participath~g member of the Group Self-Insurer listed above Ju box ".3' and participation in such group self-insunmee is still in force. The Group Self. lnsore?s Admhfist:'ator will send this Certificate of Participation to the entity listed above as the certificate holder in box "2". The Group Self-lnsurer's Administrator will notify the above certificate holder within 1- days IF the membership of the ~rticipaut list:d hi box" a" is tern'dusted. (those notices may bo sent by regular mail.) Otherwise, tiffs Certificate is valid fur a maximmn ot'on~ year from the date certified by the group self-hlsurer.** If this certificate z~ no longer valid according lo ~he above guidelines ami the bu~'ine$$ referenced in box "la' continues to be named on a permit., license or contract issued by the certificate holder, the bu$ine$~ must provide the certificaIe holder either with a ncae certificate or other authorized proof tfie busine.~s ix complying with the mandatmy toverage requirements of the Ncqv York State Workers' C~mpeasatiot~ Law** Under penalty of perjury~ I ce~i[V that I ant an authorized repr~eniative of the Group Self-lnsurer referenced above aud that th~ busln~s referenced in box "la" has Iho coverage as depicted on Ibis for~n. Ccrlified by:/~cs~F; Sutton A~ency Ltd. Cc~tifi¢(~/ (P/int namc oe au~zed r~t*senJ, a~vc ofthe Group $~l t-ln~urcr)/~ , ~~ ~f, mlt,r~, , '~ ' (Dalc) O~7~3 ~e: ~tJmri~'d Representative Telephone Number: 631-581-7978 G$I-IOS.2 (Z-02) Date: 03~05~07 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * ReceiptS: 429 Transaction(s): 1 1 Permits Reference Subtotal 493 $180.00 Check~:429 Total Paid: $180.00 Name: Verizon, Communications 501N Ocean Ave Patchogue, NY 11772 Clerk ID: LINDAC Internal ID: 493 03/24/2006 FRI 16:27 'Per. It TOWN OF SOUTHOLD HIGHWAY DEPARTMEN'~. peconl¢ Lane p=corg¢' ~ew York 1.19S8 ; A.ol~LtCATiON/PERMIT FOR i41GHWAy. E.xGA. VAT. ION AND ~e ~upe~nt~d~t ef Hlgh~ys ~ ~e ToWn . ~m¢ of App I ~ ' Addre~ 5¥ At.ch ~ pan ~1~ I~m ' ~lnlng p~ ~ of la~ of ~vatlon. b) A~ch all ot~r ~esg~ per~ and ll~s~ for ~is'p~J~t. ' c) ' ~-,~e~ by ~ appli~h my ~t ~mm~ before ~jMn~ of a HighWay ~va~O~ Pe~lt ~ ~e Town Cl~k. TzX Map: S~I~ ...... , ~1o~ , Sta~ing Oate: C~pleti~ ~e Wor~ Sch~ule = . . p~, Fa~[]~ ln~Jle~oh ................................... Und~ which au~orlty E~tlmated Cost of ~po~ · 11] MAR 24 20~6 ~5:~S F~ge. I of 3 PAGE,04 03/24/2006 FRI 15:ZS u~x 1/03 '06 ~D"13:56 PAX 631 ?86 6145 Insuraflce Covetable: (Attach caf:fy) a) b) c~ Insurance Company: State whe~lqer policy o¢ cartiflcatlofl on fili with ~e Highway ~a~- d} ~ge r~u[r~d ~[~d~ W the Town: B~lly InJu~ and p~pe~y ~ge: $3~00015S00,000 B~il~ [nJu~, and ~S0.00~ pretty damage, , a} sureW Bond pr C=~fi~ Ch~k to~t amount ~ $ ' ' b} ~lnt~e~e ~nd provide: ~ '2 y~rs or .~ y~rs. for appll~tlohs and perm.: ~ ....... ~ 1 5 0.0 0 A2. JAddi~al Ex~atlons ~me se~i~ a 510.~0 = ~ c. ~vatio~s ir in d~th to E in d~th; Add[tiofl~ Re~i~ ~me semite · $5.00 = $ RecelVe~ by the Town Clerk ~e~it I~sued Oa~e " Authorization Is hereby granted to the IsSue a Highway Exc=vatlo~ permit 'to: in'accordance with thls'applicaflor~, SUPER/NTE, DENT OF H 'C['tWAY$ TO.~SO UT H 0 LD,~41~W YORK ~ -'"~-i~eter w. Harris ' Per, it Town Clerk of' the Term of S6ut~old to Not?.: D-3g Permit expires one (1) ycer fr~m Da~e of Issuance. No work 'co star~ wlU~out ~ ~u~ ~otl~e to the Superlnt~d~t ~ Highways- pe~'mus~ be available fo~ Ingp~oh. Page 2 of 3 03/,24/2006 FRI 16:28 FiX 51/03 '06 ~E9~_13:57 FIX 631 765 6115 SOUI'tIOLD TOtVN CLERK .ghway D~P~ Hlghws~' Department Inspector Applicant To~n Clerk iH S p E CT OR LS R E C O R D, InspeCtion Date FindiNgs (use Appllcmnt Noti~o~ ~Rg~L~RK S CODE lB ~ Impro~er barri~ad~ IL -.Improper II~ht~ ~ - Sun~n ~ ~ ~v~tion .~, .... UTM Unable to m~Su~ (due to ~c~mmgJ BUC - Bulld~n~ und~ DB Impm~ ~;~fl ' [~ high) (~t HFS -' I~p~r h~ding for final ~t of ~vat~n RFR - R~ to repair 0-39 Page 3 of 3 PaGE.~S ' OVERIZON ' RIGHT OF WAY DIAGRAM O NORTH POINT 'r ~t / EoF KEy Reaeon For FI~OVIDE F~D~I( ffAClLITIE.% -to & HEvJ AA O~ELL L. L,C-, Nsmeo~u~der-mop.(~ner MoR~LL LL~,- L.~uI~ Municipality: 0 Stele [] Co.nty ]~[Town 0 Village 0 PvtProp. ROUT'*_OA FDI',J/V\ Trench Opening (Lin. Fl.} for R/W Purpose ,,,,-,.,.-, Are poles Slaked? Y es No BLOCK NO: Name ol Road or Streel involved: Wire Center: ~ Distance ID & name of nearest CroIi Slreel & Pole by No.: Locelity: J j ~...~_~ /"'~JTCH O~J.JI~ Distance Irom Curb or Property Linae Io work Perlormed: TJx Diatricl: Type Pavement & W~dlh: Erlgineer;-~T, P_. L A YToI~ Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 12/27/07 * * * RECEIPT * * * Receipt~: 3129 Transaction(s): 1 1 Permits Reference Subtotal 538 $208.50 Cash Total Paid: $208.50 Name: L, IPA 117 Doctor's Path Riverhead, NY 11901 Clerk ID: LINDAC Internal ID: 538 ".Peri, No.f LIPA REF #T100825955 TOWN OF SOUTHOLD HIGHWAY DEPARTMENT P.O. Box 178 Peconic, New York 11958 (631)765-3140 RECEIVED 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 make necessary inspections of the job site. Print or Type I. LIPA Name of Applicant 117 Doctor's Path, Riverhead, NY 11901 Address of Applicant 2. Manzi Homes Name of Owner of Premises Oregon Road, Cutchogue Address of Owner Begin trench 1610' W/O Cox Lane on the S/S Oregon Rd. trench 195' east & open 3X6 bellhole · m~il~ RO' nr~r~h ~ ~ 3wfi h~]lholo_ for a new 4 lot subdivision Work Description and Location (Street Number, Hamlet, Cross Stree0 (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. Plumber's License No. Electrician's License No. Other Trade's License No. ,/~i~i~a tt~re ~ f~pp ~i'~ca/~t Steven Aylwar~l~; Design Supervisor 7. Starting Date: 8. Work Schedule: Date 12/19/07 (a) Attached plot plan showing location of proposed excavation and relationship to adjoining premises or public street or areas, and giving a detailed description 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 No.: Section ., Block , Lot Completion Date: Phase Excavation Facility Installation Backfill & Completion Pavement Replacement Completion Date 9. Under which authority is application being made: 10. Estinmted Cost of Proposed Work: $ 11. Remarks: D-39 1 of 3 122 Insurance Coverage: (Attach (a) Insurance Company: Copy) ~'~"~"Y~- .'~"J~ ~ bt (b) Policy#: ~-"~__,~' /~'~/.~---t7.~) (c) State whether policy of certification on file with the Highway Department: (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 or Certified Check provided in the total Amount of $ (b) Maintenance Bond provided: 14. Fees for Applications and permits: 2 years or 3 years. Basic Application Fee $150.00 Al. __/Service Connections excavations @ $20.00 $ No. A2. __/Additional Excavations same service ~ $10.00 $ No. B. Excavations 18" in depth or less 0-100 i.f. = $10.00; Additional i.f. ~ $0.10 C. Excavations 18" in depth to 5' in dept~, 0400 i.f. = $30.00; Additional ~' i.f. ~ $0.30 D. Excavations 5' in depth and over 0-100 i.£ = $50.00; Additional i.f. @ $0.50 $ $ No. Additional Utility Repair Excavations ~ $10.00 Repairs same service @ $5.00 TOTALS 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. Date Received by the Town Clerk ,~/,/-"~/~ 7 Date Permit Issued joL/.~ 7'/~ 7 Permit No. NOTE: SUPERINTENDENT OF HIGHg]AYS ~/ Peter3V, Halzis Permit expires one (1) year from date of issuance. No work to start without 48 hour notice to Superintendent of Highways. Permit must be available for inspection. D-39 2 of 3 Copy Distribution: Highway Department Engineer (with page 3) Applicant Town Clerk (Original) 1St 2nd 4th Inspection Date INSPECTOR'S RECORDS Findings (use code) REMARKS Applicant Notified (To Permit Clerk) CODE IB 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 for Repair D-39 3 of 3 w.o. OH w.o. UG L S AREA NO. T-825955 NO. T-684664 58 PIG: PIC: BUDGET !TYPE M.D.: ITEM UG LINE EXT NEW RES GRID iCIR~ NO. 100-29, 30 89-951 PERMIT T.O. SOUTHOLD PRIMARY VOLTS: 13KV TYPE REQ: . TAX DIST. 1300 NUMBER SERVICE REO'D. BY - INFORMATION: r. ASEMENT REO'D YES OUTRIGHT CONTR. $ CND: CCCD: FIELD DUE DATE: COMPLETION DATE TEL. CO. V. HAGER~( NGINEER % SALES TAX: TOTAL: SALES SUP NO. TEL, CO. 9AF2TX/REF 66051 C.G. Ic.o. JOB NO. DIST. LETTER TRANSF. SECD'Y LOAD REG. IS TREE TRIM REO'D : ATTACHMENT RECORD I OWNERSHIP RECORD I INITAL ATT LAST ATT i E.L. TEL. TRANSFER m MADE TO REM'D FBOM i REPLACED AS OWNERSHIP i PROJECT/JOB DATA: NAME: OREGON LANE 1 ADDRESS: OREGON RD. TOWN: CUTCHOGUE CONTACT: UANZI HOURS PREPARED BY: D. DANEK (DESIGNER SIGNATURE) ZIP: CONTACT T£L~ 12-4-07 (DATE) APPROVED BY: (DESIGN ENGINEER SIGNATURE) (DATE) MARK OUT REQUIRED CAUllON UNDERGROUND ELECTRIC IN AREA AR PER FACIUTIES ~J~PS NOTES: 1. ALL PRIMARY CABLE TO BE 2/CN2ALXLPE 2, ALL SECONDARY CABLE TO BE 3/C3/OALCIC 3. BUILDER CHOSE OPTION 4- BUILDER DIG DISTRIBUTION, LIPA DIG CONNECT[ON 4. LEAD CO-LIPA 5. ALL SERVICES TO BE CUSTOMER RUN LOT 1 10021B799 LOT2 100219746 THIS WORX WILL INSTALL 4111' 2/CJ2ALXLPE PRIMARY CABLE, 225' OF CONNECTION TRENCHING. (30'JACKING), _ TWO BELOW GRADE TRANSFORMERS AT 75 KVA EACH WITH TWO LARGE SPLICE BOXES, 170' SECONDARY 3/C5/0CIC WITH ONE SMALL SPLICE BOX AND SINGLE PHASE PRIMARY RISERS ON POLES Jt2~2, 223 TO PROVIDE A .LOOP FEED. PRIMARY ONE-LINE CIRCUIT 8B-gS1 BG 99450 BG 99449 75 KVA 75 KVA OREGON RD. '.- P#222 PJ~223 oREGON 1/o~PE ..---1610' LOl4 LO1 3 100290760 100210704 OPEN PT. 35' sOLO Pt222 1-40'4 R-I PTP R-I STR CLP TOP POLE I-lOOA CO I-~Jk 1-3" U-GUARD I-2/C~2AL PTHD LBFj~13120 FS 25T P~223 I- lOOA CO I-~ILA I-3" U-GUARD I- 2/C,~2AL PTHD LBF~13110 FS 25T Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 04/23/08 * * * RECEIPT * * * Receipt'8: 16541 Transaction(s): 1 1 Permits Reference Subtotal 551 $270.00 Check~: 1074 Total Paid: $270.00 Name: L, IPA 117 Doctor's Path Riverhead, NY 11901 Clerk ID: LINDAC Internal ID: 551 LIPA Ref. #T100684664 Manzi Homes Oregon Rd, Cutchogue TOWN OF SOUTHOLD HIGHWAY DEPARTMENT P.O. Box 178 Peconic, New York 11958 (631)765~3140 APPLICATION / PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for thc 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. LIPA 117 Doctors Path, Riverhead, NY 11901 'Name of Applicant Address of Applicant Manzi Homes 2. Oregon Road, Cutchogue NameofOwner0fPremises AddressofOWner trench 60' s/s Oregon Road 1745' e/o Cox La. open 3'X6' bellhole on missile 30' north to 3'X6' bellhole on Oregon Rd. Cutchogue. This work Work Description and Location (Street Number, Hamlet, Cross Stteet) i s f or a (a) Is construction located within 75 feet of tidal wetlands? * Yes · If yes, other Town permits may be required. new 4 lot subdivision No Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No. //S. Ay l~a r d ~DS?;;Tne °S u~u~p eli;a:l s o r Date 12/11/07 (a) A~t~ched plot plan showing location of proposed excavation and relationship to adjoining premises or public street or areas, and g~wng a detailed description 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 No.: Section ., Block , Lot Starting Date: Completion Date: Work Schedule: Phase Excavation Facility Installation Backfill & Completion Pavement Replacement Completion Date 9. Under which authority is application being made: 10. Estinmted Cost of Proposed Work: $ 11. Renmrks: D-39 1 of 3 '12. Insurance Coverage: (Attach Copy) (a) Insmance Company: (b) Policy #: (c) State whether policy of certification on file with the Highway Department: (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 (b) Maintenance Bond provided: 14. Fees for Applications and permits: or Certified Check 2 years or provided in the total Amount of $ 3 years. Basic Application Fee $150.00 Al. /Service Connections excavations ~ $20.00 $ No. A2. /Additional Excavations same service ~ $10.00 $ No. B. Excavations 18" in depth or tess 0-100 i.f. = $10.00; Additional i.f. ~ $0.10 Excavations 18" in depth to 5' in depth 0-100 i.£ = $30.00; Additional i.f. ~ $0.30 $ Excavations 5' in depth and over 0-100 i.£ = $50.00; Additional .~,a/~ i.f. @ $0.50 No. Additional Utility Repair Excavations @ $10.00 Repairs same service @ $5.00 $ $ $ TOTALS ~.~.~ 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 perm/t to: in accordance with this application. Date Received by the Town Clerk ~/- 2~-OOF/ Date Permit Issued ~/- ~ ~ - O~C// Permit No. SUPERINTENDENT OF HIGHWAYS TO~)SOUTHOLD, N~W YORK Date NOTE: Pemdt expires one (1) year from date of issuance. No work to start without 48 hour notice to Superintendent of Highways. Permit must be available for inspection. D-39 2 of 3 Copy Distribution: Highway Department Engineer (with page 3) Applicant Town Clerk (Original) 1St 2nd 3ra 4th Inspection Date INSPECTOR'S RECORDS Findings (use code) REMARKS Applicant Notified (To Permit Clerk) CODE IB 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 for Repair D-39 3 of 3 w.o. OH L S AREAl W.O. UG L S AREA NO. T-825955 54I NO. T-684664 58 PIC: PIG: BUDGET ITEM TYPE W,O,: UC LINE EXT NEW RES GRID 100-29, 50 DIR. NO. ~O. 8B-951 PERMIT T,O. SOUTHOLD PRIMARY VOLTS: 15 KV TYPE REQ: TAX DIST. 1500 NUMBER SERVICE REQ'D. BY - INFORMATION: CND: CCCD: FIELD DUE DATE: COMPLETION DATE TEL. CO. ENGINI~I~R V. HAGERTY TEL. CO. 9AF2TX/REF 66051 JOB NO. TRANSF. LOAD r-ASEMENT REO'D YES OUTRIGHT CONTR. $ % SALES TAX: TOTAL: SALES SLIP NO. c.o. ILETrER DIST. SECO'Y REG. IS TREE TRIM REQ'D : ATTACHMENT RECORD I OWNERSHIP RECORD INITAL ATT LAST ATT I E.L` TEL. TRANSFER MADE TO I REM'D FROM I REPLACED AS OWNERSHIP E.L TEL E.L. TEL`I E.L. TEL. PROJECT/JOB DATA: NAME: OREGON LANE 1 ADDRESS: OREGON RD. TOWN: CUTCHOGUE CONTACT: MANZI HOMES PREPARED BY: D. DANEK ZIP: CONTACT TEL~ 12-4-07 (DESIGNER SIGNATURE) (DATE) APPROVE MARK OUT REQUIRED CAUTION UNDERGROUND ELECTRIC IN AREA AR PER FACILITIES MAPS NOTES: 1, ALL PRIMARY CABLE TO BE 2/CN2ALXLPE 2. ALL SECONDARY CABLE TO BE 3/C3/OALClC 3. BUILDER CHOSE OPTION 4- BUILDER DIG DISTRIBUTION, LIPA DIG CONNECTJON 4. LEAD CO-LIPA 5. ALL SER~CES TO BE CUSTOMER RUN LOI 1 10021B799 THIS WORK WILL INSTALL 4111' 2/CN2ALXLPE PRIMARY CABLE, 225' OF CONNECTION TRENCHING (30'JACKING). TWO BELOW GRADE TRANSFORMERS AT 75 KVA EACH WITH TWO LARGE SPLICE BOXES, 170' SECONDARY 3/C3/0CIC WITH ONE SMALL SPLICE BOX AND SINGLE PHASE PRIMARY RISERS ON POLES i~222, 22,3 TO PROVIDE A LOOP FEED. PRIMARY ONE-LINE CIRCUIT 8B-951 BG 99450 BG 99449 75 KVA 75 KVA · OPEN t PT. OREGON ROm P~/222 P~223 LO1 2 100219?46 oREGON LOl 4 LOT 3 100290760 100210704 i_BG~994~.9 OPEN PT. 155' sOLO Pt222 1-40'4 R-I PTP R-I STR CLP TOP POLE I-IOOACO I-~ILA I-3" U-GUARD -2/cJ2 PTHD LBFJ13120 FS 25T PN223 I- IOOA CO I-OLA I-3" U-GUARD I-2/C~2AL PTHD LBF~IS110 FS 25T SIGNATURE) (DATE) Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 05/22/08 Transaction(s): 1 1 Permits * * * RECEIPT * * * Receipt/t: 19405 Reference Subtotal 559 $180.00 Check#:164 Total Paid: $180.00 Name: Verizon, Communications 501 N. Ocean Ave, 1st FI Patchogue, NY 11772 Clerk ID: LINDAC Internal ID: 559 Pennis. No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT. Pecont~ Lane pcconic: I:le~ York 1.19SB ~AppLICAIlION/PE,RI.~IIT FOR HIGHWAY.EXCAVATION AND REPAIR,. AppLICATION 1:5 HEREBY made to.the Superintendent of Hlgh~'ays of the To~n of ~td for the isi~n~ of ~ ~ntlofl P~il 'pum~nt to Chair a3 of ~e /~',' f S~t~ld Suf~k ~W, H~ Yo~, and other applique ~ of ~' Town o . ' ....... ~ ~...1. a.=~b~ The ~ll~nt ~ to ~mp~ ~i~ all ,pph~ble laWS, ~,~, .~--_..._ :~ ~. : ~mc of El~rl~36', Utes. ,o. .. Other Trad~, Li~,~ ,o.~ 7) lO) 11) · $19na~ure~ Appllcani a) At,ch ~ot p~n ~1~ I~ ~.~ ~n and ~lnln~ p~ ~ publlc's~ or a~s, eM gi~ng a de~ll~ de~H~ U~ of la--'of ~vatton. · b) A~ch all ot~r ~es~ permi~ and li~s~ for ~is'pmJ~t. ' c} ' ~',=ee~ by ~ applim~h ~Y ~t ~mmen~ before ~n~ of a Highway Ex~va~ofl Pe~lt ~ ~e Town Cl~k. Tax Map: S~I~ ,., _, BIo~ , .., Sta~ing Date: C~pletioh ~te ... Work Sch~ule: ~m~do~ p~. - · Fadl]~ lns~lleUoh ................................. .,, ~v~nt Replacer.. Und~ which eu~orlt7 ~ ~e eppIl~h E~tlmated Cost of Pmp0s~ ~or~: Pag~ i ~ 3 M~R 24 2C~6 l~:~6 ~qGE.~4 1/03 '06 ~'E~ 't3:5~ I~,LZ 633. ?85 8L4,5 Ineuraflee Covered]a: (Attach copy) a} Insurance Company: b) PollcS' f c} State whel~er po1[¢¥ of ce~ifl.~tlon on file' with ~e Highway ~ge r~uir~d ~t~d~ W ~e Town: and ~50, 00~ pretty damage. _Security: a] Surety Bond , , or C~cuf~e~l Check pro¥1chb~ In'the to~l amount ~ S b) ~]nt~a~e ~nd provide: 'Z y~rs or 3 for appl[~tlohs and permit~: Basic ~p~l~n F~ ....... ~150.00 Al. /~i~ Conn~iohs ~vatlons ~ $20.00 = $. A2. /Addi6~al Ex~vatlons ~me se~l~ $ 510.00 = ~ 0-100 l.f. = S10.0o' C. ~vatlo~5 1~~ in d~th to ~ in Add~tiohaJ E. Nee F. __ Utility Repel r Excavat~oh$ g$~ e. 00 '-- $ Repair'5 same service Noti~ to publtc'utitiGe~ proof must be p~vided and attached to thls'applic;~tio6 prior t~ Aut~orlzatlo~ Is hereby grant-~d to the Town Clerk of the ToW~ of S0utho~d to IsSue ~ Highway Ex~vat~ Pemit 'to: In'a~an~ with ~is'appli~floh, SUPERINTENDENT OF HIGHWAYS Date Permit No, ~ D-39 Permit expires one (1) year from Date of Issuance. Ne work to s~r~ without ~ ~ur petite to the Superlnt~d~t ~ Highways- Pem~'mus~ be available for In~p~fion. page 2 of 3 03T24/2006 FRI 16:25 i-'AX 03./03 '05 ~ED 13:57 F.4~ 831 765 61,15 $ 0 UT'E OI.,~ TO~ Copy Di=t~'lbutloh.: Highway Depa~ment Appli¢=nt I~ S P E C T O R'.S R E C O R D Insp~cUon Date Findings (use code} Applicant Notifi od 2nd -- (To p=mit ClerR) . RF.~ARK$ CODE lB ~ Improper barrk.~d~ IL -*Improper 1191~ ST - SunJcen trench or ex~aYation UTM - Unable to ree~lur~ {due to backfilling} BUC - Bulld;n~ under Construct/oh WlP - Work in'pmgro=s DB - Improper backfill' {too high) {not sufficient) HFS -' IIq~peetor holding for finil =et~l~a~z of ~vati~.n RFR - Read'/ to rapalr 0-39 Page 3 of 3 ' " VERIZON - RIGH'r OF WAY DIAGRAM . AsPH. d3 ~ UNDER NOg'TH I~D. ~ Reign For Wo~ ,~ ~ LL L.L,~, I