HomeMy WebLinkAbout1145 Gull Pond Ln
Date: 02122/02
Transaction{s):
1 Permits
Check#: 15697
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of South old
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Recelpt#:
Total Paid:
15697
Subtotal
$555.00
$555.00
11 /(:,(
Internal 10: 50123
Permit No.
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TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peeonie, New York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#Tl00126048
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of South old for the issuance of
an Excavation Permit pursuant to Chapter 83 or the Code ufthe 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 inspections ufthe
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HlCKSVILLE. NY 11801
Name of Applicant Address
2) Mr. Fred Fra.oza - 1145 Gull Pond La. - Greeoport -
Name of Owner of Premises
!W.O. #T1001260481
Address
3) ODen & restore Gull Pond La. - bell hole els i!rass area aoorox. 350' slo Main Rd.. & trench south in the
i!rass areas for 1.700'.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 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.
~r J ~rt,litffft;:u~'
02-14-02
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 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) Startiog 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 00126048
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 $50,000 property damage.
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aODhcatIons and oermlts: Basic Aoolication Fee. ." ....... ... ... $25.00
A 1. ~/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.[ ~ $10.00
1.[ @$O.IO~$
Additional
C. Excavations 18" in depth to 5' in depth: 1700'
0-100 I.f. ~ $30.00
1.600 1.[ @ $0.30 ~ $ 480.00
Additional
D. Excavations 5' in depth and over:
0-100 Lf. ~ $50.00
I.f. @ $0.50 ~ $
Additional
Utility Repair Excavations @ $10.00 = $
E.
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 $555.00
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.
SUPER NDENT OF HIGHWAYS
OFS UTHOLD,NEW;r~ ,
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Peter W. Harris
Received by the Town Clerk 01 ~ I / tJ U
I / Date
Permit Issued OJ I fl.1 0 ^- Permit No.
. .
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.
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Date
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D-39
Page 2 of3
FEB. -09' 02(SATI li:03 BD GAS DES[G~ PATCH TEL:516 i585136
KEYSPAN/~
REQUEST FOR STREET OPENING PERMIT,
P.002
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PERM
NO.
LOCATION
IEASON FOR
OPENING
W.OJPA
. NO.
~EQUESTED
BY
o STATE
APPROVED '.
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