HomeMy WebLinkAboutBoisseau AveTown Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 10/02/03
Transaction(s):
1 Permits
ReceiptS:
2121
Subtotal
$45.00
Check#: 2121
Total Paid:
$45.00
Name:
Keyspan, Energy- Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 82523
FILE N8.048 09/25 '03 08:17 ID: FaX: PAGE 7/ 10
APPLICAT]ON/~ERMIT FOR HIGHWAy ~XCAVATION AND REPAIR
TOWN OF SOUTHOLD
IHGHWAY DEPARTMENT
Pecouic Lane
Pecouic, New York 11958
(631) 765~3140
ReL#T100318201
APPLICATION IS H~REBY made to the Superintendent of Highways of the Town of S~uthold for the i~ua~ of
in ~nn p~mit pursuant ~ Chapt~ ~ ~f the C~e of the Town of ~u~ ~ffalk County, New Yor~ and other
appt~ble ~w~ or~na~ or ~ons for th~ ~vation h~ duc~. ~e appli~nt ~[ to comply with all
Job site,
2) ~030 Bolt'-eau Ave. $outhold
Nam~ of O~Mr of Premise~
Addr~s
W~rk De~c~ipt~a and Location (Street Number, Hamlek
(a) Ix coustruc~an located wl~in 75 fee~ oftid~ weflan&? *yes No __X__
*if ye~, other Town permits may h~ required.
4) Builder's Lice~e No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
S)
Signature of Applicant
Date
a) Attach plot plan showing Ioca~on of proposed excavation and rehtlonddp to acljnultng premlses or
public streets or areas, and givlag a detailed description of layout of excavation.
b) ARaeb all other necessar~ permits and Hcen$cs for this project.
c) Work covered by this application my not commence before L~uance of a H~gbway l~xcavation Permit
by the Town Cler~
6) Tax Map: Section , Hloek , Lot
7) Starting Date~ Completion Date:
8) Work Schedule:
~ae/llfy lns~Hallon .............................................................
Backfill & C~mpa~n .........................................................
Pavement Replncen~ot .........................................................
9) Und~ which authority is the applicatioa made:
10) ~mated Cost of Proposed Work: $
11) Rtmrk~;
FILE N¥.048 09×25 '03 08:17 II]: FaX: PPlGE 8/ 10
T100318201
12) InsnraneeCoveraee: (Attach Copy)
a} hasmanee Company:
b) Policy #
c) State whether policy ofcenificetion on file with the Highway Department:
d) Coverage required ex.'haled to the Town:
Bodily inju~ and property damage: $300,0~0/$500.000 Bodily Injury, and $50,000 property damage.
13) Security:
a)
Sm'eW Bond or Certified Cheek provided in thc total amount
ors
b) Mainteramce Bonded provided: 2 y~ars or 3 years
14) F~s for ap~liaatio~s an~ ~rmits: Basic Ala~lication Fee ................. $'~5,00
Al. ~ ,"Service Connections excavations ~ $20.00 = $ 20.00
No,
A2. /Additional Excavations sar~ sea'v~ce ~ $lO.flO = $
No.
B. Excavations 18' in depth or less:
0-100 l,f. = $10,00
1.f. @ $0.10 = $
Additional
Excavations 18" in depth to 5' in depth:
o-mo l.f. = S30.O0 =
~ 12. @ $0.30 =
D, Excavations 5' in depth and over:
0-100 I.£ = $50.00
1.f. ~ $0,50 = $
Additional
No.
Additional
Utility Rel:ngr Ex~walons ~ $10.0o - $
R~irs same sexvice @ $5.00 ,; $
Notice to public utiliti~ proof must bc provk]~l md ~h~l to this applieation prior to iauance of
permit.
TOTAL COST $45.00
Authorization is h~'~ay grant~ to th~ Town Chadr of the Town of Southold ~ isaue a Highway Ex~.va6o~ Petrol! to:
IC~YSp&N ENERGY DELIVERY in ~r4~tancc v4th this a~plieafion.
Nam: Permit o'xpires onc (1))nar from l~t~ of Issuance. No work m stan without 48 hour noti~ to rtz Sup~nt~dcnt of Highways.
P~rmit must b~ available f~ msP~tion,
FILE'B~O4S 09×2~ '03 08:~8 ~ F~X: PaGB ~0× ~0
SE~.-D4'O3(THU} '09:53 BU GAS DESIGN PATCH TEL:gift 758glS6 P,C, 02
RUSH
FILE N~.048 09×25 '03 08:17 ID: FPX: PAGE 7/ 10
permit No.~ ~ ,
Ftle No. ~
APPLICAT]
TOWN OF SOUTHOLD
H~GI~VAY DEPARTMENT
?~oui¢ Lane
Po~onic, New York 11958
(631) 765-3140
~/]~]~RMIT FOR HIGHNVAY EXCAVATION AND REPAIR
Ref.#T10031gIQI~
APPIACATION IS I~R~BY mdc to ~he Snpedmcndeut of ~Oways of ~e T~n of ~u~d ~ ~c iuuan~ ~f
an ~fi~n P~t pu~ant ~ Cha~ ~ if t~ C~e of the T~fl of ~u~ ~ffa~ ~unW, N~ Yor~ and o~er
ap~ hw~ o~ or ~ns f~ ~ ~n h~a d~ ~o a~nt ~ M ~ly with ~I
1) ~¥~AN ~NF. RG"Y - G~ CO~STR. D~lq', - ]?~ E. OLD COUNTRY RD, - ]~IC~.~/ILLF.. ~¥ ! ]~01
Name of Appilnnt Addr~
2) Zo.~o nol.e. Xv~ So,thai4
Work I)~tcfij~oa and L4~adon
(a) Is ceastrue~on Iocaad within 75 fe~ eftid~ wetlands: *Yu No __
*lfY~ oth~ T~wn permi~ may be requkad.
4) Builder's ~.ice~ No.
Plumber's License No.
Eh~'trir~au's Lk~ No.
Other Tradc's Lic*llae No.
s)
SJgtJat~re of Applicant
00.04-03
Date
a) At~ach plot plan showtug location of propaud excavation and relationship to adjoining premises or
public streets or areas, nad giving a detailed d~scripfion of layout of cat. rotten.
b) Atta~ all other necessa~ I~rmlt~ and Ilttns~ for this proj~'t.
e) Work ~ovond by this application may not comnence before issuance of a Highway Excavation Permit
by the Town Clerk.
6) Tax Map: Section
· Block , Lot
7) Staffing Date:
Completion Date:
Work Schedule:
Fac4llty I[~,Mh~n .............................................................
Buldfll & (:~n~na~k~n .........................................................
Comuletlon Da~e
9) Under wMcb outboriW is ~be application made:
lO) ExtimatedCostofProposed Work: $
11) Remarks;
FILE N~.048 09/25 '03 08:17 ID: FAX: PAGE 8/ 10
T100318201
12) lo~ur~ee C, ovem~e (Anae~h Copy)
a) Insurance Compaa~
b) ?olicy ~
c) State whether policy ofcenifica~ion o~ file ~th the Highway Deparm~nt:
d) Coverage r~:luired ex~ded ~o the Town'.
Bodily injur~ fl property damage: $300.000/$500~000 Bodily Injury, and $50,000 propcrty damagc.
13) Secm~t~:
a)
Suttty Boed or Certified Check provided in thc total amount
b) Maintenance Bouded provided: 2 y~rs or 3 yeats
14) Fees for aoolicatio.~ an~ !~-mits: Basic Aoolication Fee ................. $2t:.00
Al. 1 /S=rviceConnectionsexcavations@$20.00=$ 20.00
No,
A2. /AAditional Excavations same service @ $10.00 = $
No.
B. Bx=avations 18" in depth or let, s:
0-100 Ii = $10.00
Lf. ~$0.10 = $
Additional
F~avations 18" in depth ~o 5' in ~epth:
0-100 Lf. = $30.00 =
__ l.f. ~ $0.30 =
Additional
D. Ex~.wzion~ 5' in depth and over:
0-100 l.f, = $$0.00
1.£ ® $05O = S
Additional
NO.
Additional
Utility Rep~ur Excavations ~ $10,00 - $
R~a~rs same service @ $5.00 ~ $
Notice to public utilities proof must bc provided and aeachcd W this application prior to i~uanc* of
TOTAL COST ~45.00
AuthotL~,ion is h~m~by gran~a ~o th~ To,am Cha~ of the Towa of Southoki ~o issue a Highway Excava6ea Pe~ail ~o:
K'~,YSI~&~ ENERGY DELIVERY in ac, ooedanca with Ofi~ application.
SUP.~NTL~C)ENT OF HIGHWAYS
T~6~N~?.LD,~ YORK
- P~tcr V~.'Hams ~
Na~: l~nnit oxpi~s one (1) y~at from Da~e of hsuan~. No work to start without 48 hour notice to fl~: Sup~intandtmt of Highways.
permit must b~ available for inspection,
Pace 2 of 3
FILE N~.048 09/25 '03 08:18 ID: FAX: PAGE 10/ 10
S£?,-O4'OS(THUI 09:52 BD GAS D£SI8N P^TOH TEL:S16 7585156 P. O02
N
RUSH
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 12/03/04
ReceiptS: 4236
Transaction(s):
1
Permits
Subtotal
$45.00
Check#: 4236
Total Paid: $45.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 102043
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#T100443017
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. - HICKSVILLE_ NY 11801
Name of Applicant Address
2) Boisseau Avenue, Southold
Name of Owner of Premises
Address
Boisseau Avenue - beilhole e/s paved area approx. 150' s/o Hummel Avenue~ Southold~ to install
gas main and gas service
4) 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.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
Signature of Applicant
11-17-04
Date
5) a) Attachp~~tplansh~wingl~cati~n~fpr~p~sedexcava~~nandre~ati~nshipt~adj~iningpremises~r
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: $
ll) Remarks:
Lot
Completion Date
D-39 Page I of 3
T100443017
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)
Surety Bond . or Certified Check provided in the total amount
of $
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for annlications and permits: Basic Application Fee
Al. _l__/Service Connections excavations ~ $20.00 = $20.00
$25.00
A2. /Additional Excavations same service ~ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 l.f. = $10.00 -
1.f. ~ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-100 l.fi =
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 = $45.00
Authorization is hereby granted t~ the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
~~oRKNDENT OF HIGHWAYS
Peter W. Harris
Received by the Town Clerk / ~ - ~9 - t~ .~
Permit Issued /'o~ ~ ~--a ~t' Date Permit No. 3 ~ ~
Note: Permit expires one ( I ) 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 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
3~d
Findings (use code)
Applicant Notified
(To Permit Clerk)
REMARKS
CODE
IB - Improper bamcades
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 finalsettlement ofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
NO.
LOCATION
REASON FOR
W.O,/PA
NO.
BY
KEYSPAN
REQUEsT FOR STREET OPENING
I I CoIJt,~'r¥ COUNTY
DEPkRTMENT
GAS CONETR, MAJh'T. & SERVICES
PERMIT0
DATE OF
OPENING
DiViSION
__ £.
PE :~0 I~00~-£T-AON