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Date: 10/22/02
Transaction(s):
Town Of South old
P.OBox1179
South old, NY 11971
* * * RECEIPT * * *
Receipt#:
1 Permits
Check#: 16831
Total Paid:
~)
,*J
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: L1NDAC
16831
Subtotal
$303.00
$303.00
Internal 10: 63622
Pernrlt NO'~~ "9
FileNo.
f~'
~~
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR IDGHW AY EXCAVATION AND REPAIR
Ref.#T100212127
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 ortbe Code oflhe Town or Sonthold, Suffolk County, New York, and other
applicable laws, ordinances or regulations for the excavation herein described. The applicant agrees to comply witb all
applicable laws, ordinances, codes and regulations, and to permit authorized inspectors to make necessary inspections of the
job site.
Print or TVDC
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HlCKSVILLE. NY 11801
Name of Applicant Address
2) 980 Depot Lane, Cntchogue
Name of Owner of Premises
Address
3) Depot Lane - bellholes and a 860' trench in the w/s grass area to install a 4" gas main & 5 gas services
approx. 318' nlo Schoolhouse Road
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) [s construction located within 75 feet of tidal wetlands? *Yes
*lfyes, other Town permits may be required.
No_X_
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Tr
Signature Appli ant
10-03-02
Date
5) 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
hy the Town Clerk.
6) Tax Map: Section
. Block
. Lot
7) Starting Date:
Completion Date:
8) Work Schedule:
Phase Comoletion Date
Excavation -::::::::............... ............ ................. .....................
Facility [nstallation....... ................................. .......................
Backfill & Compaction.........................................................
Pavement Replacement..................................................... ....
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page] of3
Tl00212127
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 $50,000 property damage.
13) Security:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoolications and oermits: Basic Application Fee................. $25.00
AI. ---L...JService Connections excavations @ $20.00 ~ $20.00
No.
A2. ---..-t Additional Excavations same service @ $1 0.00 ~ $
No.
B. Excavations 18" in depth or less:
0-100 1.[ ~ $10.00
1.[ @$O.IO~$
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 l.f. ~ $30.00
760 1.[ @ $0.30 ~ $228.00
Additional
D. Excavations 5' in depth and over:
0-100 1.[ ~ $50.00
1.[ @ $0.50 ~ $
Additional
E.
Utility Repair Excavations @ $1 0.00 ~ $
No.
Repairs sarne 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 $303.00
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.
Peter W. Harris
fd - ;)I-d.z
Date
Received by the Town Clerk
Date
Permit Issued
Permit No.
~: 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
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BU GAS DESIGN PATCH TEL:516 7585136
i<EYSPAN/O'oofS'
REQUEST FOR STREET OPENING PERMIT
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Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 06/17/03
Receipt#:
1587
1 Permits
Check#: 1587
Total Paid:
Subtotal
$45.00
$45.00
Transaction(s):
\J~
~
I{
Name:
Key, Span Energy - Gas Cant Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
Internal 10: 77087
Permit No.
iptl~~
~.
'I
FileNo.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100292704
APPLICA TIQN IS HEREBY made to the Superintendent of Highways orthe Town of Southold for the issuance of
an Excavation Permit pursuant to Chapter 83 of the Code ortbe 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 Tvoe
I) KEYSPAN ENERGY -GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD.- H1CKSVILLE. NY 11801
Name of Applicant Address
2) 980 Deoot Laoe. Cntchoene
Name of Owner of Premises
Address
3) Deoot La - bellhole w/s 2rass area aoorox. 1250' wo Main Road. Cutchol!ue. to install a eas service.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 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.
ignature 0 l\ppli
06-11-03
Date
5) 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 Schedole:
Phase Comoletion Date
Excavation..................................................... ..... ... ............
Facility Installation.... ...........................................................
Backfill & Compaction.........................................................
Pavement Replacement.........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page 1 of3
Tl00292704
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: $300,0001$500,000 Bodily Injury, and $50,000 property damage.
13) Security:
a)
b)
Surety Bond_
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoolications and oermits: Basic Aoolication Fee................. $25.00
AI. ~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.[ ~ $10.00
1.[ @$O.IO~$
Additional
C. Excavations 18" in depth to 5' in depth:
0- I 00 1.[ ~ $30.00 ~
_l.f. @ $0.30 =
Additional
D. Excavations 5' in depth and over:
0-100 I.f. ~ $50.00
I.[@ $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 Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Town Clerk &; - / 7 - 03
Date
Permit Issued t. - /7- 0 ~ Permit No.
,OJ r;, t{
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
Page 2 of3
JUN,-09'03(MON) 10:34
BJ GAS DESIGN PATCH
TEL:516 i585136
? 00 i
..
KEYSPAN}&AJ" ,
REQUEST F~RSTREer OPENING PERMIT,'
,0 'STAT.E
. R::4n 11.4
PEflMIT.
NO.
i.!)CA.T.I0N /)e'P, r /..A ~' ;jLL.l.;.HI..C 1.4),.J ~tlIfsS A-JLtA
~:~~OR ;W..;J . /!J.. .;,J c......:R+iO<;.u(.. ,-rc iNSfALL
, WlJJP~ OREMAR
NO.
REQUESTED
.' BY
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. APPROVED
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