HomeMy WebLinkAbout17665 Soundview Ave
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 45.00
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold. New York 11971
Phone: 631-765-1800
RECEIPT #144
1 - Permits on 11/26/2001.
Thank you.
Permit No. / tj'l
File No. / '-1</
.
TOWN OF SOUTHOLD
ffiGHW AY DEPARTMENT
Peconic Lane
Peconic, New York 11958
APPLICATIONIPERMIT FORffiGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Highways oftbe Town ofSoutbold for tbe issuanc
an Excavation Permit pursuant to Chapter 83 of the Code oftbe Town ofSoutbold, 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. - mCKSVILLE. NY 11801
Name of Applicant Address
2) 17665 Soundview Ave.
Name of Owner of Premises
Address
3) ODen & restore a bell hole on the south side oaved area aODroximatelv 680' west ofMt. Beulah Avenue
Work Description and Location (Street Nnmber, Hamlet, Cross Street)
(a) Is construction located within 75 feet oftidal wetlands? *Yes No
*If yes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
r f Appli
11-19-01
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) Attacb all otber uecessary permits and liceuses 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 Scbedule:
Phase Comoletion Date
Excavation........ ...... ......................................... .... ..............
Facility Installation....... ....... ....................... .......... ........... .....
Backfill & Compaction.........................................................
Pavement Replacement.......... ............ ................ ... ...... ..... .....
9) Under which authority is lbe application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
D-39
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TlOOI06958
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 aoohcatIons and oenmts. Basic Apolication Fee.............. ... $25.00
AI. ~Service Connections excavations @ $20.00 = $ 20.00
No.
A2. _I Additional Excavations same service @ $10.00 = $
No.
8. Excavations 18" in depth or less:
0-100 l.f. ~ $10.00
l.f. @ $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 l.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
pennit.
. . .
TOTAL COST $45.00
Authorization is hereby granted to the Town Clerk ofthe Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Raymond L. J
Received by the Town Clerk / / - .;{ t. - () (
j(-~6-()'
Date
Pennit No.
/1/ Lj
Permit Issued / / - dIG - 0 (
Date
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
NO v., -)7.' O~ (S AT), IDe 2.
B~ GAS DESIGN PA~CH
TEL 516 7585136
P 007
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KEY~PAN/6A.r
REQUEST FOR STREET OPENING PERMIT
PENRO~IT ~~ JOBl1oo lJ" '158
LOCATION ~.......l.bU/(w Ml.- &UL;!,tE.r. IIlPbix ~f7a' w/tJ ftf7:
REASON FOR
OPENING
W.OJPA
NO.
REOUESTED
BY
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O SUFFOLK
COUNTY
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FOREMAN
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DEPARTMENT
GAS CONSTR.
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APPROVED
SKETCH
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