HomeMy WebLinkAbout390 Town Harbor Ln
ELIZABETH A. NEVILLE
TOWN CLERK
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Town Hall, 53095 Main Road
P,O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD
FAX TRANSMITTAL
To:
Attn: Janet
Keyspan
From:
Linda J. Cooper, Deputy Town Clerk
Dated:
December 10, 2002
Re:
Highway Excavation Permit for 390 Town Harbor Ln., Southold
Number of Pages (including cover): 4
If total transmittal is not received, please call 631-765-1800.
COMMENTS:
Hi,
The other day you called about a Highway Excavation Permit for 490 Town Harbor Lane, Southold.
You said the application was sent in early October. Today I received that application (along with
several others) from the Southold Town Highway Department. Since you were so concerned about this
particular one I am faxing the issued permit to you. The permit, along with the others, will be in
tonight's outgoing mail so you will probably get all ofthem either tomorrow afternoon or Thursday.
Hope this helps.
Happy Holidays,
Linda Cooper
Date: 12/10/02
Transaction(s):
1 Permits
Check#: 16835
1
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
g;~
~
Name:
Key, Span Energy - Gas Cont Oept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NOAC
16835
Subtotal
$45.00
$45.00
Internal 10: 64560
Permit No.
02d.b
c2 ~?-
(I)
FileNo.
TOWN OF SOUTHOLD
IDGHWAY DEPARTMENT
Peeonie Lane
Peeonie, N ew York 11958
(631) 765-3140
APPLlCATIONIPERMIT FORIDGHWAY EXCAVATION AND REPAIR
Ref.#T100212911
APPLICA nON IS HEREBY made to the Superintendent of Highways of the Town of Southold for tbe issuance of
an E:l:Cavadon Permit punuant to Chapter 83 of the Code of the Town of Soutbold, Suffolk County, New York, and otber
.ppDcable laws, ordinances or regulations for the excavation herein described. The applicant agrees to comply with all
applicable laws, ordinances, codes and reguladons, and to permit authorized Inspectors to make necessary Inspections of tbe
job site.
Print or Tvpe
I) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - mCKSVlLLE. NY 11801
Name of Applleant Address
2) 390 Town Harbor Lane. Southold
Name of Owner of Premises
Address
3) Town Harbor Lane - beUhole cis naved area annrOI. 246' nlo L'Hommdieu Lane. Southold to InstaU a eas
service to 390 Town Harbor Lane
Work Descripdon and LocatioD (Street Number, Hamlet, Cross Street)
(a> Is construction located within 7S feet oftid_1 wetlands? *Yes
.Ifyea, otber Town permits may be required.
No_X_
4) BuUder's License No.
Plumber's License No.
Electrician's License No.
ignature of ppl
10-07-02
Date
5) a) Attach plot plan sbowlng location of proposed e..avation and relatlonsblp to adjoining premises or
pubUe streets or areas, and giving a detaUed description of layout of eIcavatlon.
b) Attach all other necessary permits and licenses for tbis project.
c) Work covered by this application may not commence before Issuance of a Highway Excavation Permit
by the Town Clerk.
6) Tn Map: Section
. Block
. Lot
7) Starting Date:
Completion Date:
8) Work Scbedule:
Phase Comnletion Date
Excavation.. ...... ..... .... ... ........ .......... ........ .... ... ............ ........
Facility lostallation........ ........ ....... ... ..... ....... ........ .... ... ..... .....
Backfill & Compaction. ... ......... ... .......... ... ..... .... ... ..... ...... .....
Pavement Replacement.... ....... ........ ....... ..... ... ... ......... ...... .....
9) Under which authority Is the appUeatlon made:
10) Estimated Cost of Proposed Work: S
11) Remarks:
D-39
Page 1 of3
Tl00212911
12) Insurance Cover""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 $50,000 property damage.
13) Security:
a) Surety Bond or Certified Check
of$
b) Maintenance Bonded provided: 2 years or
provided in the total amount
3 years
14) Fees for aDolicalions and oermits: Basic ADDIication Fee ................. $25.00
AI. ~Service Connections excavations @ $20.00 ~ $ 20.00
No.
AZ. ----!Additional Excavations same service@ $10.00 = $
No.
B. Excavations 18" in depth or less:
0-100 I.f. ~ $10.00
l.f. @ $0.10 ~ $
Additional
C. Excavations IS" in depth to 5' in depth:
0-100 l.f. ~ $30.00
_1.[ @ $0.30 ~ $
Additional
D. Excavations 5' in depth and over:
0-100 I.f. ~ $50.00
l.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
permit.
. . .
TOTAL COST $45.00
,
Authorization is hereby granted to the Town Clerk of the Town of Southald 16 issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this applicatiqD.
Peter W. Hams
.I~~0~
Date
Received by the Town Clerk 102 - J t) - oZ 00 ~
Date
Permitlssued /02. -/0 -d!,OtJ JL Permit No.
c:?cZ6.
Note: Permit expires one (1) year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39
Page2of3
~11.4
P MIT,
NO.
LOCA liON
BU GAS DESIGN PATCH TEL:516 7585136
KEYSPAN/~AJ" '.
REQUEST FOR STREJ;T OPENING PER~IT
O '0' NA$SAU '0 SUFFOLK. 'fXJ
.' STATE COUNTY COUmY ~
~~ JOB'17o OZ /2. q II
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i~ S'D~liID~.
MAN
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OCT, -On2(PRI) 09:44
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IJ III D.<
REASON FOR , t' . .
OPENING L J. DMM,-h,'f.M. LA
W,OJPA
NO.
REQUESTED
.' BY
"
I ~ DEPARTM~
thil ...)b, ~ GASCONSTR. L".%',)
, APPROVED'
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