HomeMy WebLinkAboutPeconic Bay BlvdTown Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 09/16/02
Transaction(s):
1 Permits
Receipt~:
16701
Subtotal
$45.00
Cash#: 16701
Total Paid:
$45.00
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 62491
Permit N6~ ~
File No. (f I
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peeonic Lane
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 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
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSViI,I,E_ NY 11801
Name of Applicant Address
2) new house on Peconic Bay Blvd~ Laurel
Name of Owner of Premises
Address
3) Open & restore a bell hole on the s/s paved area of Peconic Bay Blvd~ approx. 800' e/o Delmar Drive
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 f~et of tidal wetlands? *Y~s No X
*If yes, other Town permits may be required. '
4) Builder's License No.
Plumber's License No.
s)
Electrician's License No. Other Trade's License No.
~Sign~0~.~3.A0~2~
Date
a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or
public streets 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.
6) Tax Map: Section , Block , Lot
7) Starting Date: Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
Comnletion Date
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39 Page 1 of 3
T100199514
12) Insurance Coverage: (Attach Copy)
a) Insurance 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) [ecurity:
a)
Surety Bond or Certified Check provided in the totaI amount
of $
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for aoolications and oermits: Basic Application Fee ................. $25.00
Al. I /ServiceConnectionsexeavations~$20.00=$ 20.00
No.
A2. /Additional Excavations same service @ $10.00 = $
No.
B. Excavations 18" in depth or less:
0-100 l.f. = $10.00
I.~ @ $0.10 = $
Additional
Excavations 18" in depth to 5' in depth:
0-100 1.f. = $30.00
l.f. @ $0.30 = $
Additional
D. Excavations 5' in depth and over:
0-100 l.f. = $50.00
l.f. @ $0.50 = $
Additional
NO.
Additional
Utility Repair Excavations @ $10.00 = $
Repairs same service @ $5.00 = $
Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST $45.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SUPE~NT OF HIGHWPt'
v Peter ,W. Harris
Received by the Town Clerk {~}- /3
Permitlssued O- /~' "~)Ot~ate PermitNo.
Not__e: Permit expires one (1)year from Date of lssuance. No work to start without 48hournoticetothe Superintendent of Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
PERMIT
NO.
.,;
,
NO.
BY
APPROVEb j"
SKETCH
BU GAS DESIGN PATCH TEL:ol6 7585136
REQUEST 'FOR STREET OPENING PERMIT,
g
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 12/10/02
Transaction(s):
1 Permits
Receipt#:
17081
Subtotal
$45.00
Check#:17081
Total Paid:
$45.00
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 64563
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
ReL#T100226997
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 oftbe
job site.
Print or Type
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of Applicant Address
2) Peconic Bay Blvd~ Laurel
Name of Owner of Premises Address
3) Peconic Bay Blvd. - bellhole s/s paved area approx. 200' w/o Bray Ave.~ Laurel, to install a gas service
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) ls construction located within 75 feet of tidal wetlands? *Yes No
*If yes, other Town permits may be required.
4) Builder's License No.
Electrician's License No.
$)
Plumber's License No.
Other Tra6e~ License No.
~'Signa~'~ of Applicant
- 11-15-o2
Date
a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or
public streets 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.
6) Tax Map: Section , Block
7) Starting Date: Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
, Lot
Comnlction Date
D-39 Page 1 of 3
T100226997
12) InsuranceCovera~e: (Attach Copy)
a) Insurance 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 prope~y damage.
13) Security:
a)
Surety Bond or Certified Check provided in the total amount
nfs
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for annlications and oermits: Basic Application Fee ................. $25.00
Al. I /Service Connections excavations ~ $20.00 = $ 20.00
No.
A2. __/Additional Excavations same service ~ $10.00 = $
No.
B. Excavations 18" in depth or less:
0-100 1.f. = $10.00
1.f. ~ $0.10 = $
Additional
Excavations 18" in depth to 5' in depth:
0-100 l.f. = $30.00
l.f. ~ $0.30 = $
Additional
D. Excavations 5' in depth and over:
0-100 l.f. = $50.00
l.t~ ~ $0.50 = $
Additional
No.
Additional
Utility Repair Excavations ~ $10.00 = $
Repairs same service ~ $5.00 = $
F. Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit,
TOTAL COST $45.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SU~NT OF HIGHW,~Y/~
· / Datq/ -
Received by the Town Clerk
Date
Permit Issued Permit No.
Note: Permit expires one (1) year from Date of Issuance. No work to start without 48 hour notice to the Supe~ntendent of Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
.NOV.-1J'O2(WED) 08:25
FC~111A
NO.
REASON FOR
OPENING
W.O./PA
NO.
REQUEb~rl;D
BY
· APPROVED
BU GAS DESIGN PATCH
TEL:S16 7S8S1~6
KEYSPAN/
REQUEST FOR STREET OPENING PERMff
~-~ STATE
NASSAU '~ SUFFOLK r'~
COUNTY COUNTY
MIS JOl~
,NO.
P. 005
FOREMAN
DEPARTMENT
OAS CONSTP. ~/.,,Z, )
DATE OF
OPENING
DATE
SKETCH
N
M
Town Of Southold
P.O Box 1179
Southold, NY 11971
Date: 02/26/08
* * * RECEIPT * * *
Receipt'8: 12446
Transaction(s):
1 1
Permits
Reference Subtotal
544 $170.00
Check#: 10033
Total Paid: $170.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LYNDAB Internal ID: 544
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100847428
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 thc 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) NATIONAL GRID- GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE, NY 11801
Name of Applicant Address
2) Peconic Bay Blvd.
Laurel Owner of Premises Address
3) 780 Marlene Lane - bellhole E/s (house is on W/s) of Marlene La, 823' s/o Main Rd.
(Otw~. 25)
4) tidalwetlands? *Yes No X__
*If yes, other Town permits may be required.
Builder's License No.
Electrician's License No.
5)
Plumber's LicenseNo.
Other Trade's License No.
2-08-08
Date
a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or
public streets or areas, and giving a detailed description of layout of excavation.
b) Attach all other necessary permits and licenses for this project.
c) W~rkc~veredbythisapp~icati~nmayn~tc~mmencebef~reissuance~faHighwayExcavati~nPermit
by the Town Clerk.
6) Tax Map: Section ,Block
7) Starting Date: Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
I1) Remarks:
, Lot
Completion Date
12) Insurance Coverage (Attach Copy)
a) Insurance 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 properly damage.
13) Security:
a)
Surety Bond or Certified Check provided in the total amount
of $
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee
Al. _l~/Service Connections excavations ~ $20.00 =
$150.00
$20.00
A2. /Additional Excavations same service ~ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 l.f. = $10.00 -
l.f. ~ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-100 hr. -
Additional If. ~ .30 =
D. Excavations 5' in depth and over:
0-100 l.f. = $50.00
l.f. @ $0.50 = $
Additional
No.
Additional
Utility Repair Excavations ~ $10.00 = $
Repairs same service ~ $5.00 = $
Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST = $170.00
Authorization is hereby granted to the Town Clerk of thc Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Town Clerk
Permit Issued _~ ~/.~ _t~ ~' Permit No.
SUPER1N~.]~NDENT OF HIGJs~WAYS
Peter ~. H~i~
Note: Permit expires one ( 1 ) year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Permit mast be available for inspection.
D-39 Page 2 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
1~t
2nd
Findings (use code)
Applicant Notified
(To Permit Clerk)
REMARKS
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 ofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
;>
~trRFACE:
Macadam Ro~
DATE:
LOCATI a~':
TOWN:
WCI?.K ORDERt
Z
o
LLI
PERMIT APPLICATION SKI/TCH
Village Of
2/21/2008
780 MARLENE LN
MAI'-I'ITUCK
T100847428
(~OSS STREET 1:
(~OSS STREET 2~
MAIN RD
PECONIC BAY BLVD
78O
x 4' e 823'
4' I Hole
MARLENE LN
Date: 03/21/05
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt~: 4717
Transaction(s):
1
Permits
Reference Subtotal
376 $170.00
Check#: 4717
Total Paid: $170.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 376
P~rmit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconie Lane
Peconic, New York 11958
(631) 76.%3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Re£#T100467613
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, ~odes and regulations, and to permit authorized inspectors to make necessary inspections oftbe
job site.
Print or Type
1) KEYSPAN ENERGY- GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE~ NY llg01
Name of Applicant
2) Peconic Bay Blvd., Mattituck
Name of Owner of Premises
3)
4)
4) Builder's License No.
Electrician's License No.
6) Tax Map: Section
7) Star~ing Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
Addr~s
Address
Peconic Bay BIvd - hellhole s/st approx. 235' w/o Bay Ave.~ to install a gas service
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No X
*If yes, other Town permits may be required.
Plumber's License No.
Other Tt~d~ License N~o.
f/ ffSignat~)f Appl~ant
( ~/ (._~Q~3-16-05
~-~ Date
a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or
public streets 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 maynotcommencebeforeissuanceofaHighwayExcavationPermit
by the Town Clerk.
, Block . Lot
Completion Date:
Completion Date
,FILE No.172 03/16 '05 12:06 ID: FaX: P~GE 3/ 5
T100467615
12) ]~1~: (Atu~h Copy)
a) In.~'nnce Company:
b) Po~
c) S~ ~ ~li~ of ~fi~on on file wi~ ~e HJ~y ~t:
d) ~v~ r~ ~d~ m ~ T~:
13) ~eorav:
8) SureSt Bond or Certified
b) M~in~a~ce 1Bnnd~l provid~l'. 2 ~s or
14.) I~,~-.s Jot ~ica~o.~ M~d .~u: BsWie Anulicnffon Fee
Al. _l._.=/Savicc C. onne~ons cx~:avati~ @ $20.00 = S20.00
A2. /Additiomd l~.c. avafi,n~s san'~ .se~'vic~ ~ $10.00 --
No.
provided in ~hc total amount
B. Ex,:avafions 18" in depth or less:
0-100 I.f. = S10.00 -
.Lf. ~S0.10 =
Additional
Excavmions 18' in clepen ~oS' in cL-~:
Additional If. ~ 30 =
D. Excavacions 5' in depth sad ove~:
0-100 l,f, ' $$0,00
I.t @ $O.50 = $
No.
Utility ~ Ex;avations @ $I0.0~ = $
R~irs sarn~ s~rvic~ ~ $5.00 = S
N~i~ to public ulititi~ proof must be I~OVided md ~ In ~ al~lication wio~ to issua~e
~O T.O., COST
AoX,nfl is heflFdy gmnt~d m ~ Town ~brk o~t{~ Town of Sou{hold m issue a High'.A~y ,~votion Pcrn~! ~o:
Re, c, eiv~d by zh~ Town Gl~tk ~
p~t issu~~I~
Coov Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
Findings(usecode)
Applicant Notified
(To Permit Clerk)
REMARKS
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- lnspectorholding for final seulement ofexcavation
RFR - Ready to Repair
D-39 Page 3 of 3
PERMIT.
LOCATION
OPENING
W.OJPA
N0.'
flE~UESTEO
BY
~'~ RUSH
~ ~ KEYSPAN .0
REQUEST FOR STREET OPENING PERMIT'
'FO~UAN. ' DATE OF
,?, ,7/'-,.
"UsH
', I
TOTAL
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
F A X
To:
From:
Re:
Date:
Pages:
Janet, Keyspan
Lynda M Bohn
Excavation Permit
March 18, 2005
5 including cover
FILE No,172 03/16 '05 12:06 ~ FAX: PAGE
Energy Delivery'
To
Co./Dept.
Phone #
Fax # "': ......
NOTE:BlOOM NII~HT~
/