HomeMy WebLinkAbout500 Sunnyside Rd
Date: 10/10/01
Transaction(s):
1 Permits
Check#: 3721
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NOAC
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
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Receipt#:
Total Paid:
3721
Subtotal
$44.00
$44.00
Internal 10: 41034
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File NO'~
Ref. '. Tl 00090170
TOWN 01" Si>U,'HOLD
HIGHWAY DEPARTMENT
Peconic " Lane
Peconic;. New' York -11958
(~16) 76~c3140
P. D. 180,," Of:;
:..
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to th~ Superintendent of Highways of the Town
of Southold for the issuance of an ExcaY~,tjori 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 excavaJion herein described. The applicant agrees
to comply with all applicable laws, ordina);i'ces, codes and regulations, and to permit
aut~orJzed inspectors to make; necessary;:i,nspections of the job sIte.
Print or Type
1) KEY SPAN ENERGY'
Name of Applicant
175 E. ald..Countrv Rd.. H1cksv111e. NY 11801
Address
2)
Name of Owner of Premises
Add ress
3)
(500 Sunnvllide Rd ) - trench north in llI'a.Clll area WIll for annrox. 80' to dead end in Southald
Work Des,c!'iption and Location (Str~et,Number, Hamlet, Cross Stre~t)
(a)\f5 construction lo?ted withih \75:, feet of tidal wetlands? *Ves_No X
*If yesl othe......!own permits' .:n'Iay be required.
q)
Bullderls License No.
Plumber's License No.
-:'!'
Electrician's License No.
No.
~) a) Attach plot plan showing locatio.n ,of proposed.-.,rcavation and relationship to
adjoining premises or public' stre,ets or areasl and giving a detailed descrip-
J tion of layout of excavation. " -,'
b) Attach all other necessary per~~.t.s 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.
6)
7)
8)
,
Tax Map; Section
I Lot.
Block
~.'
_ Completion Date
UIOBL!ll
Starting Date: 1.lLQUJ)l
.-
Work Schedule:
:\..
'.
.:-,\
Excavation.................. .";... ..-~..................
. \,
Facility 'Installation.......... ~ ;'. ~ . ~'. .. .... ...... .. . .
Backfill & Compaction....... ..:;.:. .... .............
Pavement Replacement........ ~':"" ~ . . . . . . . . . . . . . . . . . . .
Completion Date
Phase
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: "$'
11)
Remarks:
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12) Insurance Coverage: (Attacn copy}",;,
.~, .
a) Insurance Company: ..'
b) Polley t
c) Slate whether policy of ce~trflcatlon on, file with the Highway Depart-
ment: . ,,'
d) Coverage requIred extende:c;:-~o- the Town:
.' i,.
Bodily Injury and prop~,t,tydamage: $300,000/$500,000 Bodily Injury,
a~d $50,000 properly d~,!,~ge.
13) Security:
a) Surety Bond or'.:"~erllfl~d Check provided ,in the
tota I amount of $"
b) Maintenance Bond provided,; ,2 years' or 3 years
14) Fees for appilcatlons and permits: ", Basic Application Fee........$25.00
A 1. 1 /Servlce Connection'/'excavatlons e $20.00 = $ 20.00
NO:- .','\.' "
A2. /Additional Excavations same service @$10.00 = $
"'FlQ.'"',;
B. Excavations 18" in depth .o~ '~Jess:
0-1,00 I.f. = $10.00 , .;~"
/ I.f. @$0.10~;$"
Additional
'C. EXCBvations-111" In depth .t9'S' In depth:
0-100 I.f. ~$30.00 ",'
SO ,l.f. @ $0.30 ;':::$ 24.00
Additional
D. Excavations 5' In depth and over:
0-100 I.f. = $50.00::'
I.f. @ $0.50 ~\$
Additional '. .i.
E.
~', :
Utility Repair',::Excavations @$10.00 = $
::.,:.:.
No.
'~~. '. .
Repairs same, service '@ $5.00..= $
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Additional
.----
F.
,', .
Notice to public 'utilities prQO( must be provided and atlacl)edto
this 'application prior to Iss'~ance of permit.
* .,,;:i~'i'
,
TOTAL CDS'!" ~ 44.00
....:.
Authorization is hereby gr~nted to the TO;"". CIJ'rk o,f Jhe Town of Southold to
Issue a Highway Excavation Permit to:.;.: 'H'f ~'q )
in accordance wlth'-thls application. ...'~~:';:'
S0PERINTENDENT OF HIGHWAYS
'tOWN 0 UTHOLD, NEW YORK
"~:~ '
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Received by the Town Clerk
/ 17-1;';. y
-ia~:r 01
;:Permlt No.
/.3~
Permit Issued,' / &-/!rrlt?1
Date
Note:
Permit expires one (1) year (r.bm Date of Issuance.
No work to start without 48 h"l.\r' notice .to the S~perintendent of Highways.
Permit must be available for ,Inspection.
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Page 2 of 3
Tl00090170
KEYSPAN/~AS
REQUEST FOR STREET OPENING PERMIT
FG-6111.4
PERMIT
NO.
LOCATION
D STATE
D
D
SUFFOLK
COUNTY
o .s; ..:1lklJ
;~ S"...i1l6l.))
FOREMAN
SO-l/,(1""L
DEPARTMENT
GAS CONSTR. "btl.lr. A t;tllJWL
DATE OF
OPENING If 'fI /2.001
"6JI-75E~5N-o
DATE
APPROVED
SKETCH
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