HomeMy WebLinkAbout635 Kimberly Ln
Date: 03/28/02
Transaction(s):
Name:
Clerk 10: L1NDAC
Town Of Southold
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 15854
~
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Receipt#:
Total Paid:
lV/!
15854
Subtotal
$159.00
$159.00
InternallD: 51844
Permit No.
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FileNo.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peeonie, New York 11958
(631) 765-3140
APPLICATlONIPERMIT FOR mGUW A Y EXCA V ATlON AND REPAIR
Ref.#TlOOI40656
APPLlCA nON IS HEREBY made to the Superintendent of Highways of the Town of Soutbold fOf the issuance of
an Excavation Permit pursuant to Chapter 83 of the Code of the Town of South old, 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
I) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HlCKSVILLE. NY 11801
Name of Applicant Address
2) Mr. Theodor Laoudis 635 Kimherlv La.
Name of Owner of Premises
IW.O.#TIOOI406561
Address
3) ODen & restore Kimberlv La. - bell hole & trench for 380' in the w/s l!rass area startinl! aooroximatelv 75'
n10 Roxanne Rd.
Work Description and Location (Street Number, Hamlet, Cross Street)
<a) Is construction located within 75 feet oftidal wetlands? *Yes No
*Ifyes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
-,....'''~-~~ ~ .'
9d1 ~.~/C,
Signa re 0 ppli t
03-1 -02
Date
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.
5)
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: Seetiou
. Block
. Lot
7) Startiug Date:
Completion Date:
8) Work Schedule:
Phase Comoletion Date
Excavation....................................................................... ..
Facility ]nstallation.... ... ......... ...............................................
Backfill & Compaction.........................................................
Pavement Replacement.........................................................
9) Uuder which authority is the applleatiou made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
0-39
Page 1 of3
Tl00140656
12) Insurance Covera!!e: (AttaCh Copy)
a) Insurance Company:
h) 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 $50,000 property damage.
13) Security:
a)
h)
Surety Bond
0[$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoollcations and oermits: 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 If. ~ $10.00
If. @$O.IO=$
Additional
C. Excavations 18" in depth to 5' in depth: 380'
0-100 I.f. = $30.00
280 l.f. @ $0.30 ~ $ 84.00
Additional
D. Excavations 5' in depth and over:
0-100 If. ~ $50.00
If. @ $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 $159.00
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
3/.7/"/0 ).
.3-;lG -O:L
Date
Pennit Issued
:3 j.:Jtf:j () )..
Date
Permit No. I C, 7
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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OPENJl.iG
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KEVSPAN!dM
'REQUEST F:OR STREET OPENING PERMIT.
o STATE 0 0 ' S:,,~~Il'
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OEPAFlTMENT
GAS CONST!!. ~Ir.
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Date: 04/21/03
Transaction(s):
1 Permits
Check#: 1324
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
/ry/
~;J
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
1324
Subtotal
$45.00
$45.00
Internal 10: 73517
FileNo.
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-
Permit No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICA TIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T1 00239872
APPLICATION IS HEREBY made to the Superintendent of Highways ortbe Town of South old for the issuance of
an Excavation Permit pursuant to Chapter 83 ortbe Code oftbe Town of South old, 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 orthe
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - H1CKSVILLE. NY 11801
Name of Applicant Address
2) 635 Kimberlv Lane. Southold
Name of Owner of Premises
Address
3) Kimberlv Lane - bellhole cIs l!rass area aoorox. 380' n/o Roxanne Road to reconnect a eas line
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.
ignature 0 Ap
04-14-03
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 tbe Town Clerk.
6) Tax Map: Section
, Block
. Lot
7) Startiug Date:
Completion Date:
8) Work Schedule:
Phase Comoletion Date
Excavation....................... ..................................................
Facility Installation...............................................................
Backfill & Compaction.........................................................
Pavement Replacement.........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page 1 of3
Tl00239872
12) Insurance Coverage: (Attach Copy)
a) Insurance Company:
Ii) 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 $50,000 property damage.
13) Security:
a)
provided in the total amount
Ii)
Surety Bond_
0[$
Maintenance Bonded provided:
or Certified Check
2 years or
3 years
14) Fees for aoohcatIons and oermlts Basic AODlication Fee .. ... ... ... ... ... $25.00
AI. ~/Service Connections excavations @ $20.00 ~ $ 20.00
No.
A2. ---.J Additional Excavations same service @ $1 0.00 ~ $
No.
B. Excavations 18" in depth or less:
0-100 l.[ ~ $10.00
l.f. @$0.1O~$
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 1.[. ~ $30.00 ~
_l.f.@$0.30=
Additional
D. Excavations 5' in depth and over:
0-100 l.[ ~ $50.00
l.[ @ $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
pennit.
* * *
TOTAL COST $45.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSP AN ENERGY DELlVERY in accordance with this application.
Received by the Town Clerk
Permit Issued Lf,II.i--/' ~
AI /1'/0:7
Date
Permit No.
0/6 ).-
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 of 3
APR, -11' 03 (FRI) 13:22
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SU GAS DESIGN PATCH
TEL:5!6 i585136
p, 006
IKEYSPAN/cfA.r .
REQUEST FOR 'STREET OPENING PERMIT
Fc.al11.4
PERMIT
NO.
LOOATION
.REASON FOR
. OPENING '
W,OJPA
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REQUESTED
BY
, APPROVED
DEPARTMENT
GAS CONSTR. L.,z, , }
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O SUFFOLK
COUNTY
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