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Home My WebLink AboutStillwater Ave Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 03/10103 Receipt#: Transaction(s): 1 Permits eam,#: 1072 Cqe'd Total Paid: 1Y ~~J Name: Key, Span Energy - Gas Cont Dept 175 E Old County Rd Hicksville, NY 11801 Clerk 10: L1NDAC 1072 Subtotal $45.00 $45.00 Internal 10: 71473 '''~<N' ~ '1 J TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (631) 765-3140 A ~ FileNo. APPLICA TIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR Ref.#T100240076 APPLICATION IS HEREBY made to the Superintendent of Highways urtbe Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 orthe 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 inspedions uftbe job site. Print or Tvoe I) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - H1CKSVILLE. NY 11801 Name of Applicant Address 2) Stillwater Avenue. Cutchol!ue Name of Owner of Premises Address 3) Stillwater Avenue - bellhole in the els I!rass area aoorox. 100' nlo Track Avenue. Cutchol!ue. to install a I!as service. 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. fAppli -19-03 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 the Town Clerk. 6) Tax Map: Section , Block . Lot 7) Starting Date: Completion Date: 8) Work Schednle: Phase Comoletion Date Excavation....................................................................... .. Facility Installation.............. ........................ ......................... Backfill & Compaction......................................................... Pavement Replacement......................................................... 9) Under which authority is the application made: 10) Estimated Cost of Proposed Work: $ II) Remarks: .f" 0-39 Page 1 of3 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 $50,000 property damage. Tl00240076 13) Securitv: a) b) Surety Bond_ of$ Maintenance Bonded provided: or Certified Check provided in the total amount 2 years or 3 years 14) Fees for aDDlications and Dermit" Basic ADDlication Fee................. $25.00 A I. -L-IService Connections excavations @ $20.00 ~ $ 20.00 No. A2. _/Additional Excavations same service@SI0.00=$ No. B. Excavations 18" in depth or less: 0-100 J.f. ~ $10.00 J.f. @$O.IO~$ Additional C. Excavations 18" in depth to 5' in depth: 0-100 I.f. ~ $30.00 ~ _1.f. @ $0.30 = Additional D. Excavations 5' in depth and over; 0-100 J.f. ~ $50.00 J.f.@ $0.50 ~ $ Additional E. No. _ Utility Repair Excavations @ $1 0.00 ~ $ Additional Repairs same service @ $5.00 = $ 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 Southold to issue a Highway Excavation Permit to: KEYSPAN ENERGY DELIVERY in accordance with this application. Received by the Town Clerk Permit Issued ,;/,'13 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. 0-39 Page 2 of3 ./ FROM . R:-Ifll,A. NO. APPROVED' . SKETCH ~ ,( (WED) FER 1 9 2003 3: 35/3T, 3: 33/NO, 6303606047 P 4 !,\a.;,I.~t:"'I1.JY~I'f"') REQUEST 'FOR STREET OPENING PERMIT, , o STATE O SUFFOlK , couN'IY A,~,k~ /St.':'--- /tJ/:"'S'a<3 ' 'I. l ",,". \~, ~;.;. ""J~ c:. , j' j , .,' i '.. , I , I i CALLMl.' ~k~iD~ tJ/~7J4-6'Z5 , : ~ m,v/SI.' HiM ..JfllA, ~M,^*. HL' ' lAInIT's "To. 13€.. 14...ta:. . '".; fh..Lf ,c,u:uJ :10.::1 Lodfi~/s' H-iS WA-.m. . 'L;J1.Lir~sf!l.JtLLDu-I \. , I ~ , I ., !. : ,I , " , 1i1c/< Ih/.l N ',~ ~' . .'~' '.Us'~f.. ... ,1' ," . . N. ".. ~ ~ I I '~" """ ''': ~ ,.. \ Date: 04/07/03 Transaction(s): Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * 1 Permits Check#: 1231 i Name: Key, Span Energy - Gas Cont Dept 175 E Old County Rd Hicksville, NY 11801 Clerk ID: L1NDAC Receipt#: Total Paid: ~~ ;f 1231 Subtotal $120.00 $120.00 Internal 10: 72881 Permit No. ~~ FileNo. TOWN OF SOUTH OLD HIGHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (631) 765-3140 APPLICATIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR Ref.#T100264141 APPLICATION IS HEREBY made to the Superintendent of Higbways of the Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 oftbe Code of the Town or Sontbold, Suffolk County, New York, and other applicable laws, ordinances or regulations for the excavation herein described. The applicant agrees to comply with all applicable Jaws, 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. - HICKSVlLLE. NY 11801 Name of Applicant Address 2) Stillwater Avenue - Cutchogue Name of Owner of Premises Address Stillwater Avenue - bellhole and a 250' trench in the nls I!rass area aOOfOX. 100' 0/0 Track Avenue. to install a 1!8S main and I!as service to house #3580 Work Description and Location (Street Number, Hamlet, Cross Street) <a) Is construction located within 75 feet oftidal wetlands? *Yes *Ifyes, other Town permits may be required. No_X_ 4) Builder's License No. Plumber's License No. Electrician's License No. Other Tr Signatur of A P 03-27-03 Date S) 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 the Towo Clerk. 6) Tax Map: Sectiou ,Block . Lot 7) Starting 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 Tl00264141 12) Insurance Coverage: (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 $50,000 property damage. 13) Securitv: a) b) Surety Bond of$ Maintenance Bonded provided: or Certified Check provided in the total amount 2 years or 3 years 14) Fees for annlications and nermits: Basic ADDIication Fee........... ...... $25.00 AI. _1 ~Service Connections excavations @ $20.00 ~ $20.00 AZ. -"Additional Excavations same service@ $10.00 ~ $ No. B. Excavations 18" in depth or less: 0-100 1.[ ~ $10.00 I.f @ $0.10 ~ Additional C. Excavations 18" in depth to 5' in depth: 0-100 I.f. ~ $30.00 150 1.[ @ $0.30 ~ $45.00 Additional D. Excavations 5' in depth and over: 0-100 1.[ ~ $50.00 l.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 $120.00 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 wlth this application. Peter W. arris ~~~ Received by the Town Clerk "')-7- 03 1..) - 7 - () -" Date Permit Issued Permit No. <QlYcP 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 "FOo!ITl1A PEI'IM NO. ,; LOCATlCN p, 002 MAR, -21' 03 (FRI) 11: 58 , ~. o STATE APPRCIfED SKETCH &-tt/?;6< I()/~SO ..3' t ~ " ~ .p.' ~ '\" '\~ 'loo.. ir: ;... I!S.t~.{j._ T - ~ B I It.\ I ~'\, I F=::: I ' E 1:--\ :t>. N \ ~: ~ ~, ~~' ~,~ , V\' " s --' E:' I ' I I i ~' l"'" .. . I . ~, --(b,t K $!: