HomeMy WebLinkAbout2105 Westview Dr
.
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 105.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of South old
Southold, New York 11971
Phone: 631-765-1800
RECEIPT #147
1 - Permits on 12/10/2001.
Thank you.
Permit No.
/'/7
/'17
.
TOWN OF SOUTHOLD
IDGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
FileNo.
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for tbe issuan
an Excavation Permit pursuant to Chapter 83 oftbe Code of the Town of Southold, Suffolk County, New York, and otber
applicable laws, ordinances or regulations for the excavation herein described. Tbe 'applicant agrees to comply with all
applicable laws, ordinances, codes and regulations, and to permJt authorized inspectors to make necessary inspections of the
jobstt<.
Print or Tvne
1) KEYSPAN ENERGY ~ GAS CONSTR. DEPT. -175 E. OLD COUNTRY RD. - mCKSVILLE. NY 11801
Name of AppUcant Address
2) Ronald Smith - 2105 Westvlew Dr. _ Mattituck
Name of Owner of Premises
Address
3) ODen & restore a bell hole on the south side oaved. area and a 200' trench southwesterly startin2' aDorox.
97' west of WoodclitT Dr.
Work DescrlptioD and Location (Street Number, Hamlet, Cross Street)
(8) Is construction located witbin 75 feet of tidal wetlands? *Yes No
*If yes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
re AppU
12-03-01
Date
5) a) Attach plot plan showing location of proposed excavation aod relationship to adjoining premises or
puhlic streets or areas, and giving a detailed description of layout of excavation.
h) 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 Town Clerk.
6) Tax Map: Section
,Block
. Lot
7) Starting Date:
Completion Date:
8) Work Schedule:
Phase COIDoletion Date
Excavation -:::::::.. ...... ....... ......... ........................ ...... ...... .....
Fac1Hty IDstallatlon. ....... ......... ........................... ...... ...... .......
Backfill & Compaction..... ......... ........... _.. .................. ...........
Pavement Replacement.... ............ ...... .... ......... ... ..... ....... .......
9) Under which authority Is the application made:
10) Estimated Cost .fProposed Work: $
11) Remarks:
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Page 1 of3
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TlOOI08864
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 annlications and nermits: Basic ADDlication Fee ................. $25.00
AI. -1--/Service Connections excavations @ $20.00 = $ 20.00
No.
A2. -"Additional Excavations sarne service@ $10.00 ~ $
No.
B. Excavations 18" in depth or less:
0-100 l.f. ~ $10.00
1.f.@$0.1O~$
Additional
C. Excavations IS" in depth to 5' in depth:
0-100 l.f. ~ $30.00
100 l.f. @ $0.30 ~ $30.00
Additional
D. Excavations 5' in depth and over:
0-100 l.f. ~ $50.00
l.f. @ $0.50 ~ $
Additional
E.
Utility Repair Excavations @ $10.00 ~ $
No.
Repairs sarne 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 $105.00
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.
DENT OF HIGHWAYS
SOUTHOLD, NEW YORK
/2- /0..- t7/
, Date
Permit Issued
i4,
/.;;L-/o - tJr
Date
1.1/~()1 Permit No.
J if '7
Received by the Town Clerk
~: 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.
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KEYSPAN~.!
REQUEST FOR STREET OPENING PERMIT
SKETCH
o STATE
D SUFFCLX f)(l
COUNTY ~
F~111..
PER T
NO,
~OCATION
lEA80N FOR
OPENING
W.OJPA
NO,
REQUESTED
SY
APPROVED
! /'SI-751- 5140
DATE
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