HomeMy WebLinkAbout240 Griffing St
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 150.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold, New York 11971
Phone: 631-765-1800
RECEIPT #150
1-Permits on 12/21/2001.
Thank you.
Permit No. /,5"0
File No. / si)
TOWN OF SOUTHOLD
IDGHWAYDEPARTMENT
Peconic Lane
Peconic, New York 11958
APPLICATION IS HEREBY made to the Superintendent of Hlgbways oftbe Town of South old for the issua
an Excavation Permit pursuant to Chapter 83 uftbe Code ortbe Town of Soutbold, Suffolk County, New York, and other
applicable laws, ordinances or regulations for the excavation berein described. The applicant agrees to comply with all
applicable laws, ordinances, codes and regulations, and to permit authorized inspectors to make necessary inspections oftbe
job site.
Print or TVDe
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HlCKSVlLLE. NY 11801
Name of Applicant Address
2) Jean Fuentes (U.S. Post Office) 240 Griffin. St.
Name of Owner of Premises
Cutcbol!ue
Address
3) Ooen & restore a trench north in the macadam of GriffinI!' St.. for 350 feet staron!! at Main Road.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes
*If yes, other Town permits may be required.
No
4) Builder's License No.
\
Plumber's License No.
Electrician's License No. Other Trade s License No
cj ~}%~~~ ~~.
12-17-01
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) Starting Date:
Completion Date:
8) Work Schedule:
Phase Comnletion 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 00113525
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 aoolications and ocnnits: Basic Aoolication Fee............. .... $25.00
At. ~/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.[ ~ $10.00
I.f. @$O.IO~$
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 1.[ ~ $30.00
350 1.[ @ $0.30 ~ $ 105.00
Additional
D. Excavations 5' in depth and over:
0-100 1.[ ~ $50.00
I.[@ $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
permit.
* * *
TOTAL COST $150.00
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
TOWN OF UTHOLD, NEW YORK
/.2-.20- 07
Date
Received by the Town Clerk
l;t-o/.../.",
Date
Permit Issued / ~ - ,.Jj"..b /
Permit No.
ISo
Note: Permit expires one (I) 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
LOCATION G/.;.t!,. oJ6- S--r -
UASON FOR ~u..IU(.6UL
OPENINCO
W.OJPA
NO,
REOUESTED DEPARTMENT ;;, t<"tJaJ[..
BY GAS CONSTR. lJ~""
APPROVED
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DEC, '14' Cl~PRI) 1327
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3C GAS DESIGN PATCE :EL 5:6 7585136
KEYSPAN!6"S
REQUEST FOR STREET OPENING PERMIT
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