HomeMy WebLinkAbout940 Westview Dr
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 07/10/02
Receipt#:
16353
1 Permits
Check#: 16353
Total Paid:
Subtotal
$45.00
$45.00
Transaction(s):
."::'
: ; ,a n:.:;~-'~ (,.
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: L1NDAC
InlemallD: 59353
permitNo'j qq
File No. _
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TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICA TlONIPERMIT FOR HIGHWAY EXCA V ATlON AND REPAIR
Ref.#T1 001181785
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 ortbe Code urtbe 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 inspedions urthe
job site.
Print or Tvoe
I) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVlLLE. NY 11801
Name of Applicant Address
2) 940 WesMew Drive
Name of Owner of Premises
Address
3) ODeD Westview Drive - bellhole on Dls 2'rass area 8oorox. 100' e/o Woodcliff Dr.. Mattituck
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.
re of A plica
07-01-02
Date
5) a) Attacb 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 tbis 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 Schednle:
Phase ComDletion Date
Excavation..... ........................ ............................................
Facility Installation...............................................................
Backfill & Compaction.........................................................
Pavement Replacement........... ..... ... ....... ..... ... .... ... ................
9) Under which anthority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page 1 of3
Tl00181785
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 $50,000 property damage.
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aODlications and Dennits: Basic Application 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 I.f. = $10.00
1.[@ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 1.[ ~ $30.00
_1.[@$0.30~$
Additional
D. Excavations 5' in depth and over:
0-100 1.[ ~ $50.00
I.f. @ $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 South old to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SUPERINTE T OF Hrko:J.
TOWN.~~W
Peter W. Harris
Received by the Town Clerk
Pennit Issued 7 ~ ~t> - 0 z,.
~- 9-D Z,
7-~--d:J...
Date
Date
Permit No.
/99
Note: Permit expires one (1) year from Date of Issuance. No work to start without 48 hOUT notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39
Page 20f3
JUN. -z5'02(rUE) 07:01
FO-8111.4
PERMI
NO.
LOCATION
REASON FOR
OPENING
W.OJPA
NO.
REQUESTED
8Y
. APPROVED
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BU GAS DESIGN PATCH
TEL:516 7585136
P. 002
KEYSPAN/&A..r
REQUEST FOR STREET OPENING PERMIT
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