HomeMy WebLinkAbout1400 Westview Dr
Date: 06/20/02
Transactlon(s):
Town Of Southold
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 16292
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
Receipt#:
Total Paid:
16292
Subtotal
$45.00
$45.00
IntemallD: 57200
Permit No.
/YCf
e
File No.
TOWN OF SOUTHOLD
IDGHWAY DEPARTMENT
Peconic Lane
Peconic, N ew York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR IDGHW AY EXCAVATION AND REPAIR
Ref.#T100176902
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of SoutboJd for the issuaoce of
an Excavation Permit pursuant to Chapter 83 of the Code of the Town of Soutbold, Suffolk County, New York, and otber
applicable laws, ordinances or regulations for the excavation herein described. The .ppDeant agrees to comply witb all
applicable laws, ordinances, codes and regulations, and to permit authorized Inspectors to make necessary Inspections of the
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HlCKSVlLLE. NY 11801
Name of Applicant Address
2) 1400 Westview Dr.. Mattituck
Name of Owner of Premises
Address
3) Open Westview Dr. - hellhole els paved area approx. 275' oJo Blower Rd.. Mattituck
Work Description and Loeation (Street Number, Hamlet, Cross Street)
<a) Is construction located within 75 feet of tidal wetlands? *Ves No
*If yes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
ore of pplica t
06-14 -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.
h) Attach all other necessary permits and licenses for this project
c) Work covered by this application may not commence before issuance of a ffighway Excavation Permit
hy the Town Clerk.
6) Tax Map: Section
,Block
. Lot
7) Starting Date:
Completion Date:
8) Work Schednle:
Phase Comnletion Date
Excavation ......................... .... ......... ..... ............ .... ...... ........
Facility Installation........ ........ ...... ......... .... ........ .... ..... ....... ....
Backfill & Compaction......................... ............ .... ...... ..... .....
Pavement Replacement. .......... ..... ....... ........................... .......
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: S
11) Remarks:
D-39
Page 1 of3
Tl00176902
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 $50,000 property damage.
13) Secutitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoolications and oermits: Basic AooticatiDo Fee ................. $25.00
AI. ~Service Connections excavations @ $20.00 = $ 20.00
No.
AZ. _/Additional Excavations same service@ $10.00 = $
No.
B. Excavations IS" in depth or less:
0-1001.[ = $10.00
1.[ @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-1001.[ = $30.00
_l.f. @ $0.30 ~ $
Additional
D. Excavations 5' in depth and over:
0-100 1.[ ~ $50.00
I.f. @ $0.50 ~ $
Additional
Utility Repair Excavations @ $10.00 ~ $
E.
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 Pennit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Peter W. Hartis
tp-t9-o')..
Date
Received by the Town Clerk If, - /9 - ();LJ
/ Date
PennitIssued U> - o2!J - 0 ~ Perntit No.
/rf'r
~: 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.
0-39
Page:Z of3
JUN. -13~ 02(THU) 07:05
F~"'.4
PERMIT
NO.
LOCA TION
REASON FOR
OPENING
W.OJPA
NO.
REQUESTED
BY
, APPROVED
SKETCH
.
BU GAS DESIGN PATCH TEL:516 7585136
KEVSPANAfAJ'
REQUEST FOR STREET OPENING PERMIT
P. 004
D STATE
D NASSAU 0 SUFFOLK r\7l
COUNTY COUNTY L1J
MISJO~
NO. liOO 17b1oz
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FOREMAN
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