HomeMy WebLinkAbout450 Soundview Ave Ext
Date: 05/09/03
Transaction(s):
1 Permits
Check#: 1431
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
>i J;~~
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: L1NDAC
1431
Subtotal
$45.00
$45.00
InternallD: 74748
F!LE No.669 05/05 '03 10:58
10:
FAX:
PAGE
2/ 5
Permit No.
TOWN OF SOVTBOLD
mGRWAYDEPARTMENT
Pecol\ie Lane
Peconic, New York 11958
(631) 765-3140
APPUCATIONIPERMlT FOR mGHW AY EXCAVATION AND REPAIR
-
RMRRGRNCV
FileNo.
Ref.#Tl00281S78
J\PPLICA TION IS lIERE8Y mad. to th. Suporintend..t of HighWllY. .r lb. Town .r Southold r.r lb. 1$...... or
.. E~cavadelll Pennit punaent to CbapUt" 83 taCtII. Code of Ut" Towft oC Soudlold. Suttoak COUlIey, NfSW York, .ad other'
.ppllcoblelawo, .rdl....... .r reauJado... ror th. """"lion berd. d...,.;bed. The .ppll..., ..,.... to comply witb all
applicablo laws, ordiaanees. codu ud regula'Cioq&, aad to petlftit authQri2ed iD5p"toN to ,"atee necessary iAtpectlOI1& of fhe
job ,I...
Print or TVIHl
1) l(EYSPAN ENERGY - GAS CONSTlI. DEPT. -175 Eo OJ.D COUNTRY RD. _ HlCKSVlLLE. NY 11801
Name of AppUcul Addr...
2) 450 SoulIIdview AVeBDe 111':t.. Southold
N..... .CO\\'.....fPr.-
Addreu
3) Soundview AVellue Ere. - hellhole sf, naved area. a.bpror:. 3251 eJo Li'l!btbouse Road. Southold. to install a
'l!U If:tvite to 'NY.
W.rt< DN<ripdo. ao. .......lI.n (Slreet N._r. Hamlet, Cr... S"""')
<a) II eollll'tna4ltioA Ioc:ated within 75 feet 0' "4&1 wedands? *V.
-((yes. otbtrTQwn penniU: may'" required.
N._X_
4) Builder', License No.
PluDlber', Llcens< No.
E1ectrieian'. UceDIO No.
Other T
Signat\ll' of canl
05-05-03
Date
S) a) Attach plot plan ""owillg loeallon of proposed ..cavatlon and relati...hlp t. adjoiDlug premises .r
public street, or or.... IOd giYlDg a detailed descrlplioa of layout of exeavation.
h) Attacb all other nec.....ry permits and li..n.... for this project.
c) W.rk covered by this appUeatlo. may not commen.e before Issuance of a Hlgbway Excavation Permit
by the Towu Clerk.
6) Tax Map: SeI1tlOD
7) Startillg Date:
8) W.rt< Scbedul.:
. Block
. Lot
C.mpletion Date:
bm ComDletion Date
Ext=avadon . ............. ...... ...... ... ............ ...... ......... ...... ...... .....
Fadll,>, loOWlalion..... ....................... ............ ....... ........... .....
aa.kIlU 40 C.mp.tdo..........................................................
P'YfmPllt Replacc.lltmt. ..... .................... ........ ............. ..........
9) UDder which auth.rity is lb. applicaliOD lllade,
10) EslImatedCooluCProposedW.rt<: $
!I) Remark.<:
D.39
Page 1 f:lf3
FJLE No.669 05/05 '03 10:58
ID:
FAX:
PAGE
3/ 5
12) Ins_nee Covera~e: (AIlacb Copy)
a) In_co Company;
b) Policy #
c) Stale whether policy of eeniticatioD,DIl file wilh Ihe Highway Depanment:
d) Coverage required extended to the Town;
130dily iqiury and property damage: $300,0001$500,000 130dily Injury, and $50,000 property damage.
TI00281578
13)~:
a) Surety Bond Or Certified Check
ofs
b) Maintenance 130llded provided; 2 years Or
provided in the lotal amount
3 years
14) Fees for aDDlications and tlefD1its; Bu!. ADDli."!!o" Fee ...... .......... $25.00
AI. ....!.-lService Connections excavatiollS @ S20.oo ~ $ 20.00
No.
A2. -'Additionalllxca""'ions same service@ SIO.OO ~ $
No.
B. Exca.vatiOllS IS" in deplh or Ie..:
0-100 Lf ~ $10.00
I.f. @ $O.IO~ $
Additional
C. Exc:avati<ms IS" in depth to 5' in depth:
0-100 I.e. ~ S30.OO ~
_1.f. @ $0.30 =
Additional
P. Iixcavationa S' in depth and over:
0-100 I.e. ~ $50.00
l.r. @ $0.50 ~ $
AdditiDllal
E.
No.
Utility Repair llxcavations @ $1 0.00 ~ S
Repairs sarne service@ SS.OO ~ $
Additional
F. Notiee to public utilities proormusl he provided and aItlIched to this application prior to issuance or
permil.
. . .
TOTAL COST 545.00
Authorization is hereby Sfln~ f.O the Town Clerk of1he Town of~thold 10 i$SUe It. Highway Ex~variOfl PelTllit to;
~Ys]>AN ENERGY DELIVERY in oecord...,. with this application.
Received hy the ~ Clerk
Permit Issued 910 :;
4 C;/IJ3
Pcrmit No.
--'
o?57
Date
.t:UuG: PemUt expires ODe (1) year from Date of Issuance. NQ work to }lwt without 48 hour nonce w \he Supc:rintendcllt of HighwaY$..
Pemrit mm. be available for iNpooaon,
D..J9
Page 2: of3
FAX:
TEL:S16 7585136
PAGE 5/ 5
p, 002
FIL~ No,669 05/05 '03 10:59 ID:
MAY.-OS' OJ(MON) 08:48 BU GAS DESIGN PATCH
KEYSPAN#AJ' "
. " REQUEST F!JR'STREE'J: OPENING PEAWT:
O "0' NASSAU.
'. . '8TAT.E, CPUNTY,
. MIS oIOIl
NO. " ,NO.
LPOA.11ON ~..:.. ~ JIJ It..J A1L EJt7': _
~ iii '3~,r': ~
, W.oJPA
'NO.
REaUSSTED '
.. JlY
'APPROmi "
"
RJ.i111.4
8KETCH
'c-
- .
G:'
,\
~"
,(1\
:~
\
\ . ..
'~ '
"
" .
, , ,
',L.$L'
f'l';:"'4S'C'
.
, "
"
"
, '
, ,
"
"
'. ',gkb-- I~ 7~dS-.3
N
.
a .
RU,SH',
'EMERGENCY ',,',
INSTALLATION, .' :",
, , NO HEAT ., A.,;. , ,
, ~,-W~'
"