HomeMy WebLinkAbout2300 Oregon Rd
Date: 08/13/02
Transaction(s):
Town Of Southotd
P,O Box 1179
Soulhold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 16416
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Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
Receipt#:
Total Paid:
16416
Subtotal
$1,469.50
$1,469.50
Internal 10: 61405
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TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICA TIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100183450
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 tbe Code oftbe Town of South old, Suffolk County, New York, and otber
applicable laws, ordinances or regulations for the excavation ben~in described. The applicant agrees to comply witb all
applicable laws, ordinances, codes and regulations. and to permit authorized inspettors to make necessary Inspections of the
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of Applicant Address
2) 2300 Oregon Road, Mattituck
Name of Owner of Premises
Address
3) Ooeo & restore bellhole on the slelc of Middle Rd. at Mill La. Directional drill under the roadway to tbe oleic
of Mill La.. tben a trench 2700' north on the e1s Ilrass area to Oreeon Rd. At Oree:on Rd.. trench across the
Baved intersection to the slwlc erass area. trench 1915' northeast in the sls erass area endinll with bellholes each
side of the road in the erass areas to missile under the roadwav to the BrOBertv of Kurt Weiss Greenhouses.
Mattitnck.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is 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 T
eofAp
07-10-02
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
by the Town 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 wblch authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page 1 of3
Tl00183450
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 $50,000 property damage.
13) Security:
a)
b)
Surety Bond
of$
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. _3~Service Connections excavations @ $20.00 = $60.00
A2. -"Additional Excavations same service @ $10.00 = $
No.
B. Excavations 18" in depth or less:
0-100 1.( = $10.00
1.( @ $0.10 = $
Additional
C. Excavations 18" in depth to 5' in depth:
0- 100 l.f. = 530.00
4.515 1.( @$0.30= $1.354.50
Additional
D. Excavations 5' in depth and over:
0-100 1.( = $50.00
1.( @ $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 $1.469.50
Authorization is hereby granted to the Town Clerk of the Town of Southald to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Town Clerk
Date
Permit Issued
Permit No.
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
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