HomeMy WebLinkAboutNew Suffolk Ave & Marratooka Ave
Date: 09/19/03
Transaction(s):
Name:
Clerk 10: L1NDAC
-
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 2035
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Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
1
}1
Receipt#:
Total Paid:
2035
Subtotal
$1,707.00
$1,707.00
Internal 10: 82180
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FileNo.
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TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, N ew York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100246757
APPLICA nON 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 ofthe 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
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSYILLE. NY 11801
Name of Applicant Address
2) New Suffolk Avenue & Marratooka Ave, Mattituck
Name of Owner of Premises
Address
3) New Suffolk Avenue & Marratooka Avenue - instaIlation of 3900' oftrenchinl! on New Suffolk
Avenue in the macadam and 1640' oftrenchini! in i!rass area on Marratooka Avenue. Mattituck. in
order to do corrosion control work. Sketches are included l!ivinl! all details of this proiect. Anv
Questions or concerns should be directed to Thomas Buckleman on 516-545-3465.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes
*If yes, other Town permits may be required.
No_X_
4) Builder's License No.
Plumber's License No.
Electrician's License No. Other Trade's License No.
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Signatnh of Applicant
08-29-03
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 Towo Clerk.
6) Tax Map: Section
, Block
,Lot
7) Starting Date:
Completion Date:
8) Work Schedule:
Phase Comoletion Date
Excavation....................................................................... ..
Facility Installation........................................................... ....
Backfill & Compaction.............. ........... .... ....................... .....
Pavement Replacement.........................................................
9) Under which authority is the application made:
(0) Estimated Cost of Proposed Work: $
11) Remarks:
.,
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Tl00246757
12) Insurance Coveraee: (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 $50,000 property damage.
13) Security:
a)
provided in the total amount
or Certified Check
Surety Bond_
of$
Maintenance Bonded provided:
3 years
2 years or
b)
14)
Fees for aoolications and oermits: Basic Aoolication Fee
AI. _l_/Service Connections excavations@ $20.00 = $20.00 Y(1
..... $25.00 -;fr
A2. _I Additional Excavations same service @ $10.00 = $
No.
B.
Excavations 18" in depth or less;
0-100 I.f. ~ $10.00-
I.[@ $0.10 ~
Additional
11 o? 5'
Ol-O
.it>
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c.
Excavations 18" in depth to 5' in depth:
0-100 1.[ ~ $30.00>t f
5440 I.f @ $OJO ~ / ft,32 .00 >'t.
Additional
D. Excavations 5' in depth and over:
0-100 Lf. ~ $50.00
I.[@ $0.50 ~ S
Additional
E.
Utility Repair Excavations @ $1 0.00 ~ $
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 TO BE DETERMINED
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-
-#/707.
Authorization is hereby granted to the Town Clerk of the TOVvll of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELlVERY in accordance with this application.
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Peter W. Harris
Received by the Town Clerk q II {,p / D.3
/ ;../ Date
Permit Issued q I Y; 0'3 Permit No.
(ched not 1/1<.-)
0217
Date
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.
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