HomeMy WebLinkAbout300 Latham Ln
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 194.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold, New York 11971
Phone: 631-765-1800
RECEIPT #152
1 - Permits on 01/08/2002.
Thank you.
FileNo.
./602./
IS c!L/
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
Permit No.
APPLlCATIONIPERMIT FOR ffiGHW AY EXCAVATION AND REPAIR
Ref.#T100117760
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for tbe issuance of
an Excavation Permit pursuant to Chapter 83 urthe Code ortbe Town of South old, 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 of the
job site.
Print or Tvoe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of Applicant Address
2) Mr. William Arnold - 300 Latham La. - Orient Point
Name of Owner of Premises
Address
3) ODen & restore a bell hole on the sls erass area. a trench east for 180' in the sls SlTass area. missile across the road to the
w/s l!rass area then trench north for 250' in the w/s Slrass area & missile a I!as DiDe under the road to a new house.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No
*lfyes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No. ~-;:- .
9<3v~ ~
Sign of ppli nt
01-03-02
Date
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.
5)
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) Starting Date:
Completion Date:
8) Work Schednle:
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:
Page 1 of3
D-39
T100117760
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 aoolications and oenruts: Basic AODlication Fee.............. ... $25.00
AI. ~Service Connections excavations@$20.00=$ 40.00
No.
A2. _/Additional Excavations same service@$10.00=$
No.
B. Excavations 18" in depth or less:
0-100 1.f. ~ $10.00
I.f. @ $0. 10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth: 430'
0-100 I.f. ~ $30.00
330 I.f. @ $0.30 ~ $ 99.00
Additional
D. Excavations 5' in depth and over:
0- I 00 I.f. ~ $50.00
I.f.@ $0.50 ~ $
Additional
Utility Repair Excavations @ $1 0.00 ~ $
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 $194.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Exca .on Permit to;
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the TO~Clerk I - 7 - 0 OJ-.-
./- Date
Permit Issued f 'fc{L.... 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.
~E NDENTOFHIGHWAYS
TO OF aD, N}7YO~
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Date
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D-39
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