HomeMy WebLinkAbout945 Tuthill Rd
Date: 12/10/02
Transaction(s):
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 17058
Name:
Key, Span Energy - Gas Cont Depl
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
Receipt#:
Total Paid:
*
iJ.1
~
17058
Subtotal
$45.00
$45.00
IntemallD: 64561
.. .
Permit No.
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dl~7
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FileNo.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR HIGHWAY EXCA VA TION AND REP AlR
Ref.#T1 00224468
APPLICATION IS HEREBY made to the Superintendent of Highways ortbe Town of Southold for the issuan~e of
an Excavation Permit pursuant to Chapter 83 ortbe Code of the Town of South old. Suffolk County, New Yor~ 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 TVDe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of Applicant Address
2) 945 Tuthill Road, South old
Name of Owner of Premises
Address
3) Tuthill Road - bellhole els paved area approx. 100' nlo Mockingbird La., Southold, to install a gas service
to 945 Tuthill Road.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a> Is construction located within 7S feet of tidal wetlands? *Yes
*Ifyes. other Town permits may be required.
No_X_
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Tr.
ure o~ \\pphcant
11-07-02
Date
S) 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 Comoletlon Date
Excavation................ .........................................................
Facility Installation........................................................... ....
Backfill & Compaction.........................................................
Pavement Replacement.........................................................
9) Under wbich authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
0-39
Page 1 of3
.
T1 00224468
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 $50,000 property damage.
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for annlications and nermits: Basic Application Fee............. .... $25.00
AI. _/Service Connections excavations @ $20.00 =
A2. _/Additional Excavations same service@$1O.00=$
No.
B. Excavations 18" in depth or less:
0-100 I.f. ~ $10.00
I.f. @ $0. 10 ~ $
Additional
C. Excavations 18" 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 Repair Excavations @ $10.00 ~ $
No.
Repairs same service @ $5.00 = $
Additional
F. Notice to public utilities proof must be provided and attached to this application prior to issuance of
pennit.
. . .
TOTAL COST $45.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Pennit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Town Clerk I c2 - J 6 ~ 02. 00,;).)
Date
Permit Issued / a2 -/0 - dUoo '- Permit No.
dJ7
Note: Pennit 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 0(3
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NOV,.-07'.&2.(THUI 07:39
FC<ll11 A
PERMIT
. NO.
LOCA liON
REASON FOR
OPENING
W.OJPA
NO.
REQUESTED
.' BY
, APPROVED
SKETl;:H
o STATE
BU GAS DESIGN PATCH
TEL:516 7585136
, KEYSPAN/tfAS "
REQUEST FOR STREET OPENING PERNUT
o
O SUFFOLK.
, COUNTY
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FOREMAN
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