HomeMy WebLinkAbout2040 Calves Neck Rd
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 456.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold, NewYor1< 11971
Phone: 631-765-1800
RECEIPT #153
1 - Permits on 01/23/2002.
Thank you.
Permit No.
/53
/53
TOWN OF SOUTHOLD
IDGHW AY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
FileNo.
APPLICATION/PERMIT FOR IDGHW AY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Highways ortbe Town of Southold for the issuance of
an Excavation Permit pursuant to Chapter 83 orthe Code orthe Town of South old, Suffolk County, New York, and other
applicable laws, ordinances or regulations for tbe 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 ortbe
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVlLLE. NY 11801
Name of Applicant Address
2) Mr. Michael Henchv - 2040 Calves Neck Rd. - Southold
Name of Owner of Premises
(#T1001177031
Address
3) ODen & restore - Calves Neck Rd. - bell hole n/s I!rass area. missile under the load to the s/s I!rass then
easterlv for 1.370 ft.. startin. aDurox. 1.135 ft. oJ. Pettv.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet oftidal wetlands? *Yes No
*Ifyes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
ure of plica
01-14-02
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
hy the Towu 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:
D-39
Page I 0(3
Tl00117703
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 anolications and nermits: Basic Application Fee................. $25.00
AI. ---L-.!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
I.f.@ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth: 1,370'
0-100 l.f. ~ $30.00
1.270 I.f. @ $OJO ~ $ 381.00
Additional
D. Excavations 5' in depth and over:
0- 100 I.f. ~ $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
pennit.
* * *
TOTAL COST $456.00
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.
SUPERINTENDENT OF HIGHWAYS
~UTHOL~Y~RK
zf) )~
Peter W. Harris
Received by the Town Clerk I - <;/;; - " ;;L.
/. / Date
Permit Issued 1 a.. 3/ " ;LJ Permit No.
I I
01- /Jd- 6.;l
Date
/53
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
3~ GAS =ES[G~ PATCW.
KEYSPAN
REQUEST FOR STREET OPENING PERMIT
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