HomeMy WebLinkAbout150 Main St
File No. / i V
I UWN Ut"" :;~:JU-l HULU
HIGHWAY DEPARTMENT
Peconic: Lane
Peconic,. New: York .t195a
(S.J6) 765"3140
P. O. /!boy- t7f.
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~-- Ref. n Tl00098124
".
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
"
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issuance of an ExcaY~,t1ori Permit pursuant" to ChapterB3 of the
Code of the 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, ordinia:~'~es, codes and regulations, and to permit
aut~orlzed Inspectors to m1ake; necessary:;/~spections of the job site.
\.
Print or Type
2)
175 E. Old.Country Rd.. Hicksvi11e. NY llll01
Add ress
150 Main St. - Greenport
Name of Owner of Premises Address
Bellhole wls paved area approx., 75' slo Wilmarth Ave., to directional drill a gas service.
Work Des,cription and Location (Str~~t. Number, Ham,let. Cross Street)
1) KEY SPAN ENERGY
Name of Applicant
3)
(al \. fs construction I05'ated wlthlnjS., feet of tidal wetlands? 'Yes No X
*If yes, other""""'Town permits ,:~ay be required. -
4) Builder's License No.
Plumber's License No.
,.;"
Electrician's' License No.
Other. Trade's License No.
S) a) Attach plot plan showing location ,of. proposed,'e'fcavation and relationship to
adjoining premises or public'stre,ets or areas, and giving a detailed descrlp-
~ ticn of l~yout of excavation. ::_':'
b) Attach all other necessary permh'sand licenses for this project.
u,,'-
c) Work covered by this 'applicati~n. may not commence before issuance of a
Highway Excavation Permit by ,.t~e Town Clerk.
6) Tax Map: Section
Black
, Lot'
~:.
7)
8)
, Completion Date
Starting Date:
Work Schedule:
:...-:
.:\
Excavation.................. :.~:~ .-;..................
...., \,
Facility Installation.. . ......., i...;.................
Backfill & Compaction....... ;.::.... ........... -......
Pavement Replacement........ <~,;" . . . . . . . . . . . . . . . . . . .
Completion Date
Phase
'.
9) . Under which authority is the application made:
10) Estimated Cost of Proposed Work: ".$.'
11)
. ....;~. .
Remarks:
\
'.: ~
....;.-
.-,
1)-1q
P"'C1l>: 1 of :\
"
Tl00098124
12) Insurance Coveral!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 $50,000 property damage,
13) Securitv:
a)
b)
Surety Bond
of$
Maintenance Bonded provided:
or Certified Check
provided in the total amount
2 years or
3 years
14) Fees foraoolications and oermits: Basic Aoolication Fee ................. $25.00
AI. ~/Service Connections excavations @ $20.00 = $ 20.00
No.
A2. ~I Additional Excavations same service @ $10.00 = $
No,
B. Excavations 18" in depth or less:
0-100 Lf. ~ $10.00
Lf. @ $0, 10 ~ $
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 Lf. ~ $30,00
Lf. @$0.30~$
Additional
D. Excavations 5' in depth and over:
0-100 Lf. ~ $50.00
Lf. @$0,50~$
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 $45,00
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.
iTENDENT OF HIGHWAYS
SOUTHOLD, NEW YORK
1(-- ,;Z~ - 0 }
Date
Permit Issued
/ '-I J-
II-~I,-IJ(
Date
Received by the Town Clerk
Permit No.
II-,zf, -al
:JI. / ,-/2-
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 of 3
REQUEST r:'OR STREET OPENING PERMIT
FO-B111.4
~ STATE
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NASSAU
COUNTY
r.- SUFFOLK
~ COUNTY
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PI'RMIT MIS JOB~ "" DAT
NO. NO. t/DOO 7/ /:2t/-- 1'1') :J. 7
LOCATION 'S,~, dZS i5~,t(tl"!q wkl1'tlt~~!tl ,.4/1h)(' 1.5.'.;10 ~/l/114 A..tf..1"H AvL-
R~~~~~~OR -r.'"";/.J I ~...:;?IlItZl fl )/~r~-;;"/"AI. ~~U " (i1l.l'.r~v.&c.
W.OJPA FOREMA DATE OF / I
NO, OPENING If. 5 3,0.1
REQUESTED ,r" IJ DEPARTMENT DIV ION-
BY /;.1 -Je-KU72. GASCONSTR. L..:z:.) c
DATE
APPROVED
SKETCH ~~~ r!.'-'.b c 10 7- rf1.
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H8~Vd NDIS30 SVD 08
LS81 (NOW)JO,6Z-'~80
Date: 11/26/01
Transaction(s):
1 Permits
Check#: 15226
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
15226
Subtotal
$45.00
$45.00
Internal 10: 42282