HomeMy WebLinkAboutElijahs Ln
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 02/27/03
Receipt#:
1049
1 Permits
Check#: 1049
Total Paid:
Subtotal
$45.00
$45.00
Transaction(s):
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: L1NDAC
Internal 10: 71173
4,
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 02/20/03
Receipt#:
1049
1 Permits
Check#: 1049
Total Paid:
Subtotal
$45.00
$45.00
Transaction(s):
~l)
*~
Name:
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk 10: L1NDAC
Internal 10: 70926
~
~ ~D
~"'~
(Il
Permit No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
FileNo.
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T1 002464 71
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 urthe Code orthe Town of South old, Suffolk County, New York, aod 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 orthe
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of Applicant Address
2) Eli; ahs Lane. Mattituck
Name of Owner of Premises
Address
3) Orel!on Road - hellhole s/s e:rass area aDorox. 110' eJo Eliiahs Lane. Mattituck. to install a 2as service to a
house on Eliiahs Lane.
Work Description and Location (Street Number, Hamlet, Cross Street)
<a) Is construction located within 7S feet of tidal wetlands? *Yes
*If yes, other Town permits may be required.
No_X_
4) Builder',s License No.
Plumber's License No.
Electrician's License No.
of A
02-06-03
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
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:
ll:.'.l9
Page 1 of3
Tl00246471
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 $50,000 property damage.
13) Security:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for applications and permits: Basic ADDUcation Fee..... ........... $25.00
Ai. ~/Service Connections excavations @ $20.00 ~ $ 20.00
No.
A2. ~I Additional Excavations same service @ $10.00 = $
No.
B. Excavations 18" in depth or less:
0-100 I.f. ~ $10.00
U @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 1.f. ~ $30.00 ~
_1.f.@$O.30=
Additional
D. Excavations 5' in depth and over:
0-100 Lf. ~ $50.00
I.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 $45.00
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.
TENDENT OF HIGHWAYS
OF OUTHOLD,~rWYOR,K
-{J'~
Peter W. Harris
~/tj3
Pennit Issued
d/ ;;"O/l'J.7
q/~ofD.?
Date
Received by the Town Clerk
Permit No.
01 ?/ ()
Note: Pennitexpires 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
FEB, -'OS' 03 (WED) 11: 27
BU GAS DESIGN PATCH
TEL:516 7585136
p, 004
'.
KEYSPAN/&:AJ"
REQUEST FORS"rREJ;T OPENING PER~IT
Fc.otll.4
PERMIT
,NO.
LPCATION ~~AJ ~.-
ReASON FOR 1,..1' '. _ I
OPENING ~ ~ ,,...
, W,OJPA
NO.
REQUESTED
.' BY
- -
o -STATE
'0 NASSAU 0 SUFFOLK,
'COUNTY COUNTY
r:lf JOB77b 0 z.</.J cJ.1 J
W~'( sj.r G~ NM
-;~Y-
'~ j;u~t.d-
I ? J/ DEPAflTME!~
wi! ..JtJfti1.Z... GMCONSTFl. L..r,)
-..47-10
, APPROVED
SKETCH
,I '
-110
'~,21::J..c 1~/-~9-3
, N
o R.Mr-t; ..J ,
~,
4''/Jur.
--
~
~-
~'
-~
\.\
- '-
. "
1.~'3'.~
I
~
I~
!~
I-
I
I
:::
SD '--I
. -
'''If
l'f _.
:~7"
~
" '
o.i