HomeMy WebLinkAbout865 Peconic Bay Blvd
.'
Date: 10/24/00
Transaction(s):
1 Permits
Check#: 1028
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk ID: L1NDAC
Town Of South old
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1028
Subtotal
$45.00
$45.00
InternallD: 19259
"
Permit No. .1 ~ .
File No. -7 ~
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic . Lane
Peconic, New York 11958
(516) 765~31110
PO. !2>o'f.- /78>
APPLICATION/PERMIT FOR HIGHW'AY EXCAVATION AND REPAIR
, Ref. 11:2 7& yr,. 0 ~
APPLICATION IS HEREBY made to the Superintendent of Highways ef the Town
of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 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, ordiniinces, codes and regulations, and to permit
authorized inspectors to make: necessary ,inspections of the job site.
Print or Type
1) KEY SPAN ENERGY 441\ EAST MAIN STREET
Name of Applicant
PATCHOGUE, Nm, YORK
Address
11727
2)
Name of Owner of Premises
3)
Co....c
Description and
(a)
Is construction located within.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.
Other Trade's License No.
~~ ~~'
Signature of P . ant
" . I OJ 2-'1. 7 Q
Date
5) a) Attach plot plan showing location of proposed..ex'cavation and relationship to
adjoining premises or public streets or areas, and giving a detailed descrip-
tion 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 the Town Clerk.
Tax Map: Section
Block
, Lot
6)
7)
Starting Date:
Completion Date
8) Work Schedule:
Phase
,
, ,
Completion Date
Excavation............... ... .......... .............
Facility Installation...........,.....................
Backfi II & Compaction..............................
Pavement Replacement........ .... . . . . . . . . . . . . . . . . . . .
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11)
Remarks:
\'
0-39
Page 1 of 3
.
.
12) Insurance Coverage: (Attach copy)'
a) Insurance Company:
b) Policy #
c) State whethe~ policy of certification on file with the Highway Depart-
ment:
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) Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
2 years or
3 years
Al.
applications and permits:
I /Service Connections
~
Basic Application Fee........ $25. 00
excavations @ $20.00 = $ :10' u:>
14)
Fees for
A2. /Additional Excavations same service @ $10.00 = $
No.
B. Excavations lS" in depth 'o'r less:
0-100 I.f. ,= $10.00
I.f. @ $0.10-$
Additional
C. Excavations.,l'S" in depth to 5" in depth:
0-100 I.f. =-$30.00
, I. f. @ $0.30 = $
Additional
D. Excavations 5' in depth and over:
0-100 I.f. = $50.00
1.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.
* * '.k'
,
TOTAL CO:=;'f: S l.J5-~
Authorization is hereby granted to the Town Clerk of the Town of Southold to
issue a Highway Excavation Permit to:
in accordance with .this application.
SUPERINTENDENT OF HIGHWAYS
TOWN SOUTHOLD, NEW YORK
/t:J- 2-f/'~co
Date
Received by the Town Clerk
/0 Ie? ")6<;)
Date'
Permit Issued,' / () /01 '1/0U
Date
Permit No. /f r:;LJ
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice 'to the Sl:lperintendent of Highways.
Permit must be available for inspection.
Pa ge 2 of 3
D-39
-
KEYSPAN!6-,l/$
REQUEST FOR STREET OPENING PERMIT
.
FC-6111.4
PERMIT
NO.
o STATE
O NASSAU 0 SUFFOLK
COUNTY COUNTY
MIS JOB
NO. Z70~~()3()
b~ S l'ri Aj/€b IhtUl
J'cJ k u,,-~t -J; /')S/,t;-U
FOREMAN
o ':;uY'l!() LD
}/J"
REASON FOR J . I
OPENING wool> lA'hJl:.
W.O.lPA
NO.
REQUESTED
BY
lJ /';J .s::-JlI.A7z..
DEPARTMENT
GAS CONSTR. MAINT. & SERVICES
LOCATION
APPROVED
SKETCH
Grt./t:>tJ# (/15-/PD~3(,S2.(3 )
N
JJSf- tl 805 t
[8] ~
r:::.
~
1 Bu.ti1.,D ~
I ~
~()i/... C>
--rtnlJl.- ~
~
't...
\"
L.7 PeLDtJ/L fj{:l::j r1tJ;~ 3L\Jb
l
3.'~
-
. 2.SD'!
....
~~
,...,,,,,,..._.._-...,~.,.,-,,~,.
.." ""i"""''''''''''.''''''-''''''_'''''__'''