HomeMy WebLinkAbout2260 Peconic Bay Blvd
Date: 11/07/01
Transaction(s):
Name:
Clerk ID: L1NDAC
1 Permits
Check#:3754
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Town Of South old
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
~\~0
3754
Subtotal
$45.00
$45.00
Internal 10: 41779
~..
'~~.h{'::;
",,,.A
,~~.t'.~!J"
:.,
. ,'.: .
~tr\+.;'
.~. .'
,":.
".,-"
,L..::::......
,:f-{:
....,.;
~~::~~~~..{~
Ij
~~':'"':
:,j':'';'
..
. File NO'T3fi
Ref. # Tl00097326
~_!J
~p
HICHWAy'DEPARTMENT
Peconic : Cane
Peconlc;. New' York.n 958
(5-16) 76S~'31qO
Po. f2,oY- 176'
APPLICATION/PERMIT FOR HIGHw'~Y EXCAVATION AND REPAIR
..'~:.
APPLICATION IS HEREBY made to th.~ Superintendent of Highways of the Town
of Southold for the Issuance of an Exca"~.tlon Permit' pursuant to Chapter 83 of the
Code of the Town of Southold, Suffolk Ci>\Jnty, New York, and other applicable laws,
ordinimces or regulations for the excavatlon 'hereln deScrlbiod. .The applicant agrees
to comply with all applicable laws, ordiriap~es, codes and regulations, and to permit
. authorized Inspectors to make; necessarY~~rspectlons of the Job site.
.
Print or Type .;::,
1) KEY SPAN ENERGY . '.
Name. of Applicant
_ 175 ]!l, OlJ~coun,'trv Rd.. Hicksville r' em:
" ,.' . Address
llRO!
2)
..;f
. Name of Owner of Premises
Address
3) _2260 Peeonic 'Bav,B1v4:i. _ beUholesls naved area a~Drox...25' w/o ~cDonalds Rd_ in Laurel '_.
Work Des.crlptlon and LOCatlon (St~~~. .Number, Hamlet, Cross Street)
(a) \Is construction lopotEld withlh;,7S:.feet of tidal wetlandsl .Yes_No X
*If yes, othe0own permits ;.~~.y be required.
4) Builder's License No.
.,:;<
Plumber's License No.
Electrician's' License No.
Other. Trade's License No.
.:0-'
')"
5) a) Attach plot plan showing locatio.n :oI.proposed,"""cavatlon and relationship to
adjolnlng premises or publlc'stre.Elts or areas, and giving a detailed descrlp-
.. tlon of J~yout of excavation. ;".'."' .
b) Attach all other necessary pe~liojis' and licenses for this project.
..:-,t'
c) Work covered by this' appllcatlofo. may not commence before issuance of a
Highway Excavation Permit 'by :tl).eTown Clerk.
,
BI~fk
, Lot
6)
7)
8)
Tax Map: Section
,Completion Date
Starting Date:
Work Schedule: ~;' .
~,\ '. Completion Date
E~cavatlon.................. ~-_~:;..:.l~.................
, . " .
Facility 'Installation ~ '.' . . . . . . . : ;.'~. . , '. . . . . . . ; . . .. . . . ..
Backfill & Compaction..........,' >, " .. .., .. . .. .. .. . .. ..
Pavem~ht Replacement......... <~: ;... . . . '. . . . . . . . . . . . . . .
,
,
. .
9) . Under. which authority is the appllCi(Uon made:
10) Estimated Cost of Proposed Work: ."'$"
.;.,
11)
,;' ,~.,
Remarks:
\"
I. ~ .
....,
".
',!";::..\..'
~"'" ..'
n-~q
PRC"fP. 1 of 3
\.
,.
t\.~.:.',:::-,:
~ff~,;:
;:\.iii.'
.~:...:".:.:. ".
, '
:i;::,':'\;..,.
..,.....
.':r"; .
,....
. ,
.'.'.',
'::':"6:.:.:".'
...:..,....;.
:,",::''''
':~.;.\.::.: .
,;.:.:",".:.-.
.:.:::
;!l;,t,}
.......
t.;\~~~':/;
~;\~~;i
~~'
!i~; \
'-:':::"::,
:..::.......
,,',.',
',-,::;',:...
'.:,'.:"
"'.,
.....,
,;::.'.::":::.
....:,;....
:....,... :
III UUiur.nc.;e ....uver.Qe: "^-i.i.icn..1 L.Vl-')'i..'~; .
,1..'-
aJ
bJ
cJ
Insurance Company:
Poll cy .
State whether polley of ce~tiflcatlon on, file with
ment: : -,,~ .-'
the Highway Oapart-
l_'.:
Tl00097326
~
d)
-Id.-
Coverage required extende,d,to'the Town:
"I.
Bodily Injury ,and propil.ti.ydamage: $300,000/$500,000 Bodily InJury,
and $50,000 property d~,!,~ge.
13) Security: .-
>:,.,-
a) Surety Bond or<~ertlfl"d Check provldild In the
total amount of $ .,
bJ Maintenance Bond provided;! ' .2 years or 3 years
1~) Fees for applications and permits: ;";." Basic Application Fee........$25.00
ALl IServlce Connectlons'}excavatlons U $20.00 = $ 20.00
~ :1\.'
A2. IAddltlonal Excavatians same service U$10.00 = $
l'lO:""" '.; ,
B. EXcavations' 18" In depth ,~~'!ess:
0-1,00 I.f. = $10.00 (: '
/. I.f. U $0.10 ~';$"
Additional :C,:',
"C. Excavatlons--1ll" In depth' ti;i '5' In depth:
0-100 I.f. ~$30.00 , ,.,
I.f., U $0.30 "'?$
Additional
O. Excavations 5' in depth ai1~' over:
0-100 I.f. = $50.00 "",',
I.f. III $0.50 ;;;):$
Additional "i
E.
Utility
.,.,.
Repal;.";Excavatlons
;~~\-.;'. .
U$10.00, = $
No.
: 'i~:' .
Repairs same: service 'U $5.00..= $
'.'
.,.'
Additional
,---
F.
. ,'"
Notice to public . utilities pr<i<it'must be provided and
this 'appllClltlon prior to Is~:uance of permit,'
* ~/:;:...;. .
/
attact)ed ,to
\:."
,
TOTAL COST-' ~ 45.00
,;:<,
Authorization Is hereby granted to the Toy,,". Qerk of the Town of Southold to
Issue a Highway ExcavatlOli Permit 'to: ';", 't[E..~ Spt>#1
In accordance wlth,thls 'applicatlon. ,'."""', ( "
. ;:. ~.' ; '. .
#IPERIN' EN DENT OF HIGHWAYS
~*!!:N SOUTHOLD,. NEW YORK
"l',.
//'-.2 - 0 /
Date
'L;".
Received by the Town Clerk
I / - Jr.",,, (
Dat~;:"
;.,,:
/30
Permit Issued,.' /1- 7':'- 0 (
Date
,.(Perml t No.
~:
Permit expires one l1.J year fr.am Date of Issuance.
No work to start without ~8 hQl.\r notice .to the S..perlntendent of Highways.
Permit must be available for -h'ispectlon.
" _n
Page ,2 of 3
OCT. -29' IT: :MON) 07 33
Fe-6ll'.4
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W.O./PA
NO.
REQUESTED
BY
APPROVED
SKETCH
3~ GAS DESIGN PATCH
TEL 5:6 7585:36
P 004
KEYSPAN/6A.f
REQUEST FOR STREET OPENING PERMIT
o STATE
o
NASSAU
COUNTY
O SUFFOLK
COUNTY
I Xl SDu1HClb
DATE
lell. 7/2.col
MIS JOB~ a
NO, '//000 -,732."
~ DEPARTMEN,
v/;'; ..Jc-H'~7Z.. GAS CONSTR. L ,.2:,)
/III tJ /1.-D0I
-.s"/~
t5!-i. "D rt' o9!' - (,{) -2
N
PttOJ.Ht. AIliJ BL()h
t '1 25'~ ~I
4'14 ~ If
4")fL
-
I ,
I
,
I~
I~ ~
I, '"
'\I' t?'
,
"-
:to
61Jla6t.... l"-
eY
'"
~
- ;tt.
HSf
1. 'Z.. ,"0