HomeMy WebLinkAbout9095 Sound Ave
Date: 03/25/02
Transaction(s):
Town Of Southold
P.O Box 1179
Southold, NY 11971
* ** RECEIPT * * *
1 Permits
Check#: 15869
1(,
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
"
~
Receipt#:
Total Paid:
15869
Subtotal
$282.00
$282.00
IntemallD: 51614
Permit No. / (P5
FileNo. /" 5"
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TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
PRIORITY
APPLICA TIONIPERMlT FOR HIGHWAY EXCA V A TION AND REPAIR
Ref.#T100147604
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 of South old, Suffolk County, New York, and other
applicable laws, ordinances or regulations fOf 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. - HICKSVlLLE. NY 11801
Name of Applicant Address
2) Porto Bello 9095 Sound Ave.
Name of Owner of Premises
Mattituck
3) Ooeo & restore a bell hole & a 790 feet trench on the south side of Sound Avenue in the !!TaSS area endine:
1.240 feet west of Factory A venue. PRIORITY - RUSH - DATE OF OPENING: 03-29-02
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No
*Ifyes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
ure 0 pplic
03-2 -02
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 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: $
11) Remarks:
D-39
Page 1 of3
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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 $50,000 property damage.
Tl00147604
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoolications and oennits: Basic Aoolication 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 1.[ ~ $10.00
1.[ @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth: 790'
0-100 I.f. ~ $30.00
690 1.[ @ $0.30 ~ $ 207.00
Additional
D. Excavations 5' in depth and over:
0-100 1.[ ~ $50.00
1.[ @$0.50~$
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 $282.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSP AN ENERGY DELIVERY in accordance with this application.
Peter W. Harris
Received by the Town Clerk 3),;( s /~ ;z.,
.B/~,s-/~ ~ Date
.
:::?-d~-O~
Date
Permit Issued
Permit No.
/bS-
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 20f3
VoAR.-22i02(FRI) 0857
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