HomeMy WebLinkAbout165 Park Way
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 96.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold. New YorK 11971
Phone: 631-765-1800
RECEIPT #159
1 - Permits on 02/05/2002.
Thank you.
Permit No. /59' ..
FileNo. IS9
TOWN OF SOUTHOLD
IDGHWAYDEPARTMENT.
Peconlc Lane
Peconlc, New York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR IDGHWAY EXCAVATION AND REPAIR
Ret#1r100116439
APPLICATION IS HEREBY made to the Superintendent of Highways ofthe Town of Southold for the issuance of
an EJ:cava:tlon Permit pursuant to Chapter 83 of the CO,de of the ToWD of SOUtho1d, Suffolk County, New York, and other
appllcable laws, ordinanees or reguIaddns ,for the excavation herein described. The applicant agrees to comply with all
applicable laws, ordinances, codes aDd regulatloDl, and to permit authorized inspectors to make necessary Inspections -of the
Job.lte.
Print or TvDe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. '-175 E. OLD COUNTRY RD. - IDCKSVILLE. NY 11801
Name of Applicant ' Address
,
I
2) Brian Mahonv 165 Park Way
Name of Owner of Premises
Address
3) Onen & restore a 170 feet trench on the east side of Park Way from the .outh eastcoroer of Pine Neck Road
South to install'. il8S mlilfn and service.
WorkDescrlption lindLocaUon (Street Number, Hamlet, Cross Street)
(a) Is connructlonlocated within 75 feet ofddal wetlands? *Yes No
*H yes, other Town permits may be required.
4) Builder'. Llcen.e No.
Plnmher'. License No.
Electrician's Licen.e No.
ore App'
12-20-01
Date
5) a) Attach plot plan .howing location of proposed eJl:cavatlon and relationship to adjoining premI.es or
public streets or areas, and gtving a detailed description of layout of eJl:cavatlon.
b) Attach ail other n.....ary 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) Ta:s: Map: Section
7) StartIng Date:
. Block
. Lot
Completion Date:
8) Work Schednle:
Phase Comnletlon Date
Excavation .....~~... ...... ... .... ...,:....... ... .~........... ....~...... ......... ...
FaclUty lnItaIJ.atlon. ....... ...... .............. .... ...... ......... ...... ..........
Backfill &: Compaction. ............. .._... .~............ ......... ..,.............
Pavement Replacement. ...... ......... ...... .................. ............. ....
9) Under which ilUthority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-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: $300,0001$500,000 Bodily Injury, and $50,000 property damage.
Tl00116439
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for aoolications and oermits: Basic ADDlication Fee................. $25.00
AI. --1-IService Connections excavations @ $20.00 ~ $ 20.00
No.
AZ. _I Additional Excavations sarne service @ $10.00 ~ $
No.
B. Excavations 18" in depth or less:
0-IOO1.f ~ $10.00
l.f @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 I.f. ~ $30.00
170 I.f @ $0.30 ~ $ 51.00
Additional
D. Excavations 5' in depth and over:
0-100 I.f. ~ $50.00
I.f. @ $0.50 ~ $
Additional
E.
No.
Utility Repair Excavations @ $10.00 ~ $
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 $96.00
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.
SUPERlNTENDENT OF HIGHWAYS
z;:((!;:z:7
Raymond L. Jacobs
Permit Issued
ts- '1
Z/tJ/oz.--
Date
cQ -~Od.
Date
Received by the Town Clerk
.2 / ~ In-
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.
D-39
Page 2 of3
FC-SI11,4
PERMIT
NO.
.OCATION
EASON FOR
OPENING
W.O'/PA
NO.
EQUESTED
BY
\PPROVED
lKETCH
~c,'L
\.) i,. tJ
KEYSPAN
REQUEST FOR STREET OPENING PERMIT
o STATE
O SUFFOLK ,-,{ -r: o. oS,V 11"'~L.:1\.
COUNTY ~ ,,)
DATE
Il-Z,(Jp/JZ-
fflJl, /JE,.&!C..,tV j (J".f~
-.Sou-/iU{J
DATE OF
OPENING '1 - I - 0 '2-
DEPARTMENT DIVISION
GAS CONSTR. MAINT. & SERVICES?-'I
DATE
o
I7D I -r,ttNCH ON cis fJAru.
C. A~ HArtl + .Htvl t(......
FOREMAN
IOO/lb~J1
t,..IAY FI'", s/ale
,.j MA./lf?
G (J (~* lOB. -11- C;J%
N
A ..
\,..
,.- .~ .
Ref.#T100116439
Permit No.
File No.
TOWN OF SOUTHOLD
ffiGHWAYDEPARTMENT
Peeonle Lane
Peeonle, New York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR ffiGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the SuperiIit4mdent ofIDghways of the Town of Southold for the Issuance of
an Excava:tlon Permit pursuant to Chapter 83 of the Code oftheToWD of South old, Suffolk County, New York, and aliter
appDcable laws, ordinances or regulations .for the e:xcavation herein descrll:Jed. The applicant agrees to comply with all
applicable laws, ordinances, codes and regulations, and to permit authorized Inspectors to make necessary Inspections of the
jobalt<.
Print or TvDe
,
1) J(EYSPAN ENERGY - GAS <;ONSTR. DEPT. '-175 E. OLD COUNTRY RD. - mCKSVILLE. NY 11801
Name of AppUcant .. Addren
2) Brian Mahony 165 Park Way
Name of Owner of Premises
Address
3) Onen & restore a 170 feet treneh on the east side of Park Way from the south east coroer of Pine Neck Road
South to install". I!1lS mAin and service.
Work Deserlption IiDdLoeatioD (Street Number, Hamlet, Cross Street)
(a) Is construdlonlocatedwlthin 75 feet oftldal wetlands? *Yes No
*If yes, other Town permits may be required.
4) Bunder's License No.
Plumber's Lleense No.
Electrician's License No.
re Appl'
12-20..01
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.
h\ ""...G.......11 ..+h..~ n_.......PU r.uo~....J+.. ..n4'lU.....n...... ....u. thl.. ft....I.......
KEYSPAN ENERGY
PERMIT ACCOUNT
175 E. OLD COUNTRY RD.
HICKSVlLLE, NY 11801
VOID _ Lost in Transit i5 4 2 0
DATE
50-1063831
/,;? .pf l-eJ/ 214.
$19'6' "0
DOLLARS lil
=.-
_.-
2r~'
1I"I;Cj 85 1;0211" . . .
..
D-39
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