HomeMy WebLinkAbout120 Lands End Rd
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 45.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold, NewYor1< 11971
Phone: 631-765-1800
RECEIPT #157
1 - Permits on 01/25/2002.
Thank you.
Permit No.
/S'1
/57
r~
..~
FileNo.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATIONIPERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100124424
APPLICATION IS HEREBY made to tbe Superintendent of Highways of the Town of Soutbold for the issuance of
an Excavation Permit pursuant to Chapter 83 of the Code of the Town of Southold, Suffolk County, New Yor~ 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 urtbe
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HlCKSVILLE. NY 11801
Name of Applicant Address
2) Daniel Nickola - 120 Lands End Road - Orient
Name of Owner of Premises
(w.O.#1001244241
Address
3) ODen & restore a bell hole on the east side I!rass areaof Lands End Rd. aooroximatelv 150 feet north of Main
Road in Orient Point.
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 Appr
01-17-02
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 issnance of a Highway Excavation Permit
by the Town Clerk.
6) Tax Map: Section
,Block
,Lot
7) Startiog Date:
Completion Date:
8) Work Scbednle:
Phase Comoletion Date
Excavation................... ..................... .............................. ...
Facility Installation......................... ......................................
Backfill & Compaction.........................................................
Pavement Replacement................... .............................. ........
9) Under whicb authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
Page 1 of3
Tl00124424
12) Insurance Cover..e: (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 aoolications and oermits: Basic ADolication Fee.............. ... $25.00
At. i-/Service Connections excavations @ $20.00 = $ 20.00
No.
A2. -"Additional Excavations same service@$1O.00=$
No.
B. Excavations 18" in depth or less:
0-100 Lf. ~ $10.00
Lf. @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 l.f. ~ 530.00
_1.f.@$0.30~$_
Additional
D. Excavations 5' in depth and over:
0-100 Lf. ~ $50.00
Lf. @ $0.50 ~ $
Additional
E.
Utility Repair Excavations @ $1 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 $45.00
Authorization is hereby granted to the Town Clerk of the Town of South old to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SUPERlNTENDENT OF HIGHWAYS
ro~UTHOL~YO~
( '~#i.t:1 ~
Peter W. Harris
Received by the Town Clerk
Permit Issued / iJ,ftit-
I
Note: Permit expires one (I) year from Date ofIssuance.
Permit must be available for inspection.
I 1;/5 It) ~
. Date
Permit No.
/-,;;)Ij-Od
Date
IS7
No work to start without 48 hour notice to the Superintendent of Highways.
D-39
Page 2 of3
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KEYSPAN/&:AJ'
REQUEST FOR STREET OPENING PERMIT
F=C-611L4
D STATE
o
D SUFFOLK rJl
COUNTY ~
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W,OJPA
NO.
REQUESTED
BY
APPROVED
~ ,j __ DEPARTMENT
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