HomeMy WebLinkAbout1330 Westview Dr
Date: 04/02/02
Transaction(s):
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 15916
10
)f~
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: L1NDAC
Receipt#:
Total Paid:
15916
Subtotal
$115.00
$115.00
InternallD: 52076
Permit No.
/70
I 76
FileNo.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR IDGHWAY EXCAVATION AND REPAIR
Ref.#T100150277
APPLICATION IS HEREBY made to the Superintendent of Highways oftbe Town of South old for the issuance of
an Excavation Permit pursuant to Chapter 83 orthe Code ortbe Town ofSoutbold. Suffolk County, New York, and otber
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 ortbe
job site.
Print or Tvoe
I) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of Applicant Address
2) MR. VINCENT PORCELLI - 1330 WESTVIEW DR.
Name of Owner of Premises
MATTITUCK
Address
IW.O.#TIOOI502771
3) ODen & restore a bell hole & 300' trench in the east side erass area of Westview Dr.. aooroximatelv 300' west
and south of Woodcliff Dr.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located witbin 75 feet of tidal wetlands? *Yes No
*lfyes, otber Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's Licen~ ~ '
C(}r ~ rY?.R-t
Sign e 0 plica
04-01-02
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
hy the Town Clerk.
6) Tax Map: Section
, 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
T1 00150277
12) Insurance Coveraoe: (Attach Copy)
a) Insurance Company:
b) PoIicy#
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 aDDlications and Dermits: Basic ADDlication 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 L[ ~ $10.00
L[ @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth: 300'
0-100 l.f. = $30.00
200 L[ @ $OJO ~ $ 60.00
Additional
D. Excavations 5' in depth and over:
0-100 L[ ~ $50.00
Lf. @ $0.50 ~ $
Additiona[
E.
Utility Repair Excavations @ $[0.00 ~ $
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 $115.00
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.
Peter W. Harris
Received by the Town Clerk ..; - .J - () .;L..>
if - OL- [) tl-- Date
~ c7-d.2
Date
Permit Issued
Permit No.
/70
Note: Pennit 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
V'AR.-29',2(FR!) 1954
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