HomeMy WebLinkAbout2120 Crown Land Ln
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I "'; II:.! II~ 1 1I~1 n 1 \.\ .", [I> 71i.j 13115
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'j1Il"I"HlJLlI (l.ERK
I"Jllll1
Pt'lll1it Nu. -d. ~.5..
rol. Nu. d<6.S_.
TOWN or SOUTHOLD
HIGIIWAY DEPAHTMENT
Pecollk Lane
Peconic. NC'!w York 11958
lc.'f11!) 765'3100
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Al'rLICATION!!'.J:.~MIT .F()Il~I!!C;!I.Wp'Y EXC~Y_~:r~ON AN.D R~PAIR.
APPLlCA1ION IS HEREOY ml.lCJp. to th~ Supcdntend~nl of Highways of the Town
"I' SlIulhulu 10. thl~ i<;Sll.uKe of em Excavation Pet"mit pUl'suanl to Chapter OJ of 11le'
C.)d~ uf tht! TOWIl 01 Southolrl, 5uffoll\ County. New York, and other" applic41.)Ie laws,
tlldlll<lnc:e~ or I eyuldtiolls for the excavation hnreln described. Thp. lIppHCanl a~lrl::!e~
lu comply with all applkable laws, ol"dinances, codes and regulations. ;'Iud to permit
,1ulhudz.;od im.pp.cltws to make l1eCCS,UI-Y In<;pections uf the job site.
UUllt... Pia Corp.
99 Martner Dr.
Southampton. NY 11.
Nriiil~()-(-^i)6ill:aill .--- .. - -'--_.-'--~Addre.ss-----~~------
P. illt OI"__T),RE:.
11
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N.11t1l~ of UWllci OfPtClnlses .. -------~"- .~. .-- Addr@ss --~---_.
]1.a'~O C_~PWNL~N[> lrfv..c_...-, H_
\Vod< Dw.c.dptloll and LOLHtion (Stl pet Numhel". Hamlet, Cross Street)
\
(<.II Is con';ll"u<.:tion loc;~ted within 75 letH of tidal w@llarlds? "'Yes
~If Yl'S, otlH~r Town pel-milS may ue ,'equircd.
_No$__
II) lJullch!ll<; L.iLPnsn No.
Plumucr's License No.
Flt.'{.lrician'~ ULCIISfl Nn. Olhe.' Trad..'s License No.
cJL ~-H.E:qbt-~- .---
Signallll"(~ 0' Applic t
....<");- 'Z.L 0
~,,_uf5;'t.f-- -
'i) ;~I ^ltach plot J.'lan showing location of propoied E".xc.ovation .and ,'eI2lthJl1ship La
..djoininq premises 01" public streets or areas, 8t'ld giving 8 detailed dP'SCI-ip-
lion of layout of eXcllvalion.
Il) Attach illl othHr 1H~c.:essary pel"mils and licensp.s ror this prolect.
c:) Work cove."eu by this applicatiol1 may not commence before issllance c.f ?J
Iligh\Va~' EXt:avallol1 Permit by the TaWil Clerk.
61 Ti,lx Moip: SE:!Clilll1_~_"__._"__, OIock_~__, Lot_~______
7) Sl'W""'1 lJ'le:~ T' 2.->_._Completiol1 Dato_.9Jc.. / ~-3.--
::) \\'cwk SCh(ldule:
1~!~I_~e
I-xcavalioll.."......... "
f..o_I1JP~~~O'~<l~~
ql
racility Installrilioll.................................
n..H.:krill c. Cornp;lctJon...... ........ ... ......... ... .________
PiJvemnnt Replacemellt..............................
Unde, which authority;, .ho applicallon ,"ade:.J~!a..B~;--h~-~~7, {! 4(5l..etlt5Io{J./
.., 0<7
l~lilll;,ted Cost or rropo~t!d Wo..-k: $ "QOO.
'(,''''a'ks"7~~~~,-:!:!A~ ~ C~. ~~; t <-/ li:1$_~ ~ 0-'!
t11.5~'-'c r::__~tt.q_"1oj;.-z.os,~/ V 1::>..::~jz.I?"/) CUT> WLL.l (!r)v!&~r (7?
"""!':'?':> ~s..! f!,?5. _"7SLL'LL.-f-"" f2 ~J<I.c7/""b th!'-:tTie::)
101
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Page 1 of 3
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II; uti n~ FRl UIl: -1.5 n.\ SIt} 765 1IL-t5
SUlTHOUl ClERK
I1JUlJ:!
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12)
.lnsuralll':~!"!,.9..~: (Attach copy) /
aJ Insur.nce comp"ny:~ro<./.fJ(,cr~ Hli2..-z.c"'It~~ ~vs{l~
bJ Policy .g.t2E__Cf..I..3";J.,q~ .
c) State whethet- policy of certification on file with the Highway Depal-t-
lIIelll:
d) Coverage ,oeqltked cxtcndecJ to the Town:
Oodily Injllt'Y and p."operty damage: $300.000/$500.000 Bodily Injury,
ilnd $50,000 property damage.
1 _~) Scc..:UX!~.'t..:
a) Surety Bond _____0_
total amollnt of $
b) ~laintenance Bond pl'Ovlded: __2 years or .3 years
1/1) ~es for appll_catl~!!._ and permits: Basic Application Fee....... ~
A 1. _:t...:.)Scr'vlce Connections excavations iI $20.00 = $ -4o~(/ .
No.
or Cct'lified Check
proviueU In the
^2.
N'o;_./Addilional Excavations same service" $10.UO = $~____~
Excavations 18'. ill depth or less:
0-100 I.r. = $10.00
I.r. @ $0.10 - $
AJtiiiional--- ---~---
C. lxcavations 1 all in depth to S' In depth:
o 100 I.f. c $30.00
I.f. . $0.30 = $
-AiJdj-f1o.'-lal--
B.
D. Exc~vati(lns 5' in delJth and over:
0-100 I.r. = $50.00
I.r. @ $0.50 ' $
II.ddHloi1a1-
---"No.
Utility Repalt. Excavations 0$10.00 $
I,.
Repairs same service ~ $5.00 = $
.-Addi"iiOi""ial
r. NoUt;e to public utilities proof must be provided and attached t.,
this application pl"lor to issuance of permit.
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Authorization Is hereby gl-anutd to the "fown Clerk of the Town o( SoulhoJJ tu
ISiue a Hlghw.i:lY Excavation Permll to:
in al:t:llI"lJurH;c with this application. ---
Iff /9:03
r Date
Rl:!'~iv(!(1 hy the Town Clerk H_lQl,,^ (Q~
~le
Permit 1""Ued_--1.D_Wo-Y.;\a::,-__ Parmlt No. ~%5
"'!ole:
Pel'mlt ,..xplrcs one (1) yellr from Date of Issushce.
No wo,-k to sturt wllhout 118 hour notice tu the Superintendent of H .ghwftys.
Perlllit must be available for inspection.
D- 39
Page 2 of 3
(17 lllj II:: nn 11\1: -113 F.B: 51ti iU5 Ul-l~
SOllTHOLO cLERK
flIUIJ-l
Highway Department
Town 01 SOUlhold
Peconic Lane
Peco",c. N.Y. 11958
TI-I. 76~-3140
734 S21 1
....
DATE:
TO:
CASE NUMIlER: 'J... qt 00 s "3>
I his is tn notify you thal Rell Atlantic and UPA have been notified In
respect to the application for an [xcavation Permit itl the Town of
Suuthold.
t~_~L
Signature of the apPlicanT .-
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Date: 10/23/03
Transaction(s):
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
1 Permits
Check#: 20698
Total Paid:
~ ~ ~5
Name: Utilities, Plus Corp
99 Mariner Dr
Southampton, NY 11968
20698
Subtotal
$65.00
$65.00
Clerk 10: L YNDAB Internal 10: 83021