HomeMy WebLinkAbout385 Grathwohl Rd
Date: 06/19/02
Transaction(s):
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
1 Permits
Check#: 16213
Total Paid:
4f ri b
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
16213
Subtotal
$228.00
$228.00
IntemallD: 57064
Permit No.
JC?6
/U
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
FileNo.
APPLlCATIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100166668
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 the Code of the 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 inspections of the
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - mCKSVILLE. NY 11801
Name of Applicant Address
2) 385 Grathwohl Rd.. Southold
3) ODen & restore a 610' trench in the els erass area between FanniDIl Rd. and New Suffolk Ave. with a
missile shot across Kouros Rd. and another across Grathwohl Rd. to orivate orooertv in New Suffolk
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 7S feet of tidal wetlands? *Yes No
*If yes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
ture 0 Appli
05-27-02
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 aud Iiceuses for this project
c) Work covered by this application may not commence before issuance of a Highway Excavation Permit
by the Towu Clerk.
6) Tax Map: Sectiou
. Block
. Lot
7) Startiug Date:
Completion Date:
8) Work Scbedule:
Phase Comoletion Date
Excavation.. ............ ...... ......... ..... ......... ......... ......... ............
Fadlity Installation.. ............................. ......... ............. ..........
Backfill & Compacdon.........................................................
Pavement Replacement.... .... ...... ............ ............... ..... .... .......
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D.39
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Tl00166668
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 danoage: $300,000/$500,000 Bodily Injury, and $50,000 property danoage.
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Feesfor acolications and oermits: Basic AnnIication Fee................. $25.00
AI. ~/Service Connections excavations @ $20.00 = $ 20.00
No.
A2. -"Additional Excavations same service@$IO.OO=$
No.
B. Excavations IS" in depth or less:
0-100 l.f. = $10.00
I.f. @$0.1O=$
Additional
C. Excavations 18" in depth to 5' in depth: 610'
0-100 l,f. = $30.00
510 1.f. @$0.30= $ 153.00
Additional
D, Excavations 5' in depth and over:
0-100 1.f. = $50.00
1.f.@$0.50=$
Additional
E.
Utility Repair Excavations @$1O.00=$
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 $228.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Town Clerk ~ - / C} - () au
Date
Pennit Issued fr:, -/9 -0 .;1... Pennit No.
Date
/8"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 Z of3
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REQUEST FOR STREET OPENING PERMIT,
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