HomeMy WebLinkAbout400 Eagle Nest Ct
Date: 01/14/03
Transaction(s):
Name:
Clerk 10: L1NDAC
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
1 Permits
Check#: 17234
#
Key, Span Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Receipt#:
Total Paid:
if
[)J"J
17234
Subtotal
$65.00
$65.00
Internal 10: 68536
~-
Permit NO.oZ 3 d - /
FileNo.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York II958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T1 00238636
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of
an Excavation Permit pursuant to Chapter 83 of the Code ofthe Town of Southold, Suffolk County, New York, 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
I) KEYSPAN ENERGY - GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - HICKSVILLE. NY 11801
Name of A)lplicant Address
2) 400 Ea.le Nest Ct. Laurel
Name of Owner of Premises
Address
3) ODeD Eaele Nest Ct.. - hellhole n/s erass area and a test hole over the buried electric orimarv cable in the sls
oaved area aoorox. 400' elo White Eaele Drive. Laurel. to install a eas service.
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes
*Ifyes, other Town permits may be required.
No~X_
4) Builder's License No.
Plumber's License No.
Electrician's License No.
re of plica
12-30-02
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
by tbe Town 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:
0-39
Page 1 of3
.
Tl00238636
12) Insurance Covera.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 $50,000 property damage.
13) Security:
a)
h)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees for applications and permits: Basic Application Fee................. $25.00
AI. ~/Service Connections excavations @ $20.00 = $ 40.00
No.
A2. ~/ Additional Excavations same service @ $10.00 = $
No.
8. Excavations 18" in depth or less:
0-100 l.f. ~ $10.00
l.t~ @ $0.10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 l.f. ~ $30.00
_l.f. @ $0.30 ~ $
Additional
D. Excavations 5' in depth and over:
0-100 I.f. ~ $50.00
l.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
permit.
. . .
TOTAL COST $65.00
Authorization is hereby granted to the Town Clerk of the To\VI1 of Southold to issue a Highway Excavation Permit to:
KEYSP AN ENERGY DELIVERY in accordance with this application.
ENDE ~Fr;l. GH.W. .
OF S OL, . . ~\, /.
U ILI(j
Peter W. Harris
6/ ~~~ ~
Received by the Town Clerk I / I 3/ /) 3
/ l' Date
Permit Issued / / 'i / /.) .3 Permit No.
t I
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.
ob 3 ;L--
D-39
Page 2 of3
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DEC, -29' 02(SUN) !5:4i
.
FC<ll1M
P MIr,
NO.
LPCATION
, .
D'STA1:e:
, APPflOVED
SKETCH
. ,
" '
BU GAS DESIGN PATCH TEL:516 i585136
KE:YSPAN/6A.f ,
REQUEST FOR srnEET OPENING PERf.IIlT .
p, 002
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