HomeMy WebLinkAbout390 Oyster Ponds Ln
Date: 08/16/02
Transaction(s):
1 Permits
Check#: 16579
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
16579
Subtotal
$45.00
$45.00
IntemallD: 61557
Permit No.
J;)D
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
PeeoDie, New York 11958
(631) 765-3140
8>
FileNo.
APPLICATIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T1 00195833
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 of the Town of Soutbold, Suffolk County, New York, and other
applicable laws. ordinances or regulations for the excavation herein described. The .ppUcant 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. - mCKSVlLLE. NY 11801
Name of Applic:ant Address
2) 390 OYster Ponds Lane. Orient
Name of Owner of Premises
Address
3) Oyster Pond Lane - bellbole on tbe wls naved area annrOI. 375' slo Main Rd.. Orient. to Install a cas service.
Work Description and Location (Street Number, Hamlet, Cross Street)
(8) Is construction located within 75 feet of tidal wetlands? *Yes
*If yes, otber Town permits may be required.
No_X_
4) BuUder's License No.
Plumber's License No.
Electrician's License No.
Signatur of Ap
08-12-02
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) Attacb ail otber 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) Tax Map: Section
. Block
. Lot
7) Starting Date:
Completion Date:
8) Work Sebednle:
Phase Comnletion Date
Excavation.. ................. ......................... ...........................n
Facility Installation..... ......... .................. ......... .................. ....
Backfill & Compactlon.........................................................
Pavement Replacement.... ...... ...... ......... .......... ..... ... ...... .... ....
9) Under wblcb antbority Is tbe appUeatlon made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page 1 of3
12) Insurance Covera.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 $50,000 property damage.
Tl00195833
13) Security:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoolications and oermits: Basic Aoolicatioo Fee..... ......... ... $25.00
AI. ~Service Connections excavations @ $20.00 ~ $ 20.00
No.
Al. ---"Additional Excavations same service@ $10.00 ~ $
No.
B. Excavations 18" in depth or less:
0-100 1.[ ~ $10.00
1.[@$0.1O~$
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 l.f. ~ $30.00
_I.f. @ $0.30 ~ $
Additional
D. Excavations 5' in depth and over:
0-100 1.[ ~ $50.00
1.[ @ $0.50 ~ $
Additional
E.
No.
Utility Repair Excavations@ $10.00 ~ $
Additional
Repairs same service @ $5.00 = $
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.
-'~""'~l' -Ii:? <-
Permit Issued / ~ to L Permit No.
T
~: 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.
~- 13-0d-..
Date
eJ./lJ
D-39
Page 2of3
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peRMIT
NO.
LOCATION
REASON FOR
OPENING
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NO.
REQUESTED
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