HomeMy WebLinkAbout1250 Laurelwood Dr
.
Date: 10/10/01
Transaction(s):
Name:
Clerk 10: L1NDAC
1 Permits
Check#: 3721
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Town Of Southold
P.O Box 1179
Southold. NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
r f (?J \
3721
Subtotal
$56.00
$56.00
IntemallD: 41033
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. File NO'~
Ref. # TI00093316
TOWN OF' S;1l.UHOLD
HIGHWAY DEPARTMENT
Peconic . Lane
Peconic;, New' Yark .11958
(5.16) 765"3140
P. O. /boY- 175
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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 Exca,!~.iiori 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, ordinap'ces, codes and regulations, and to permit
aut~orlzed inspectors to make; necessarY,inspections of the job site.
Print or Type
1) KEY SPAN ENERGY'
Name of Applicant
175 E. Old,Country Rd.. Hicksvi11e. NY 11801
Address
2)
(1250 Laurelwood Dr) T..aurelwood Ilr & Hea.therPl w bell hole wIg naved areaofI..aurelwood Dr.
missile to e/s 2I"aSS area then trench in Ill'a.'lS to Heather Pl then trench east in cmlSS n/s "fHeather PI.
for 120' in r .3l1rel.
Work Des.cription and Location (Stq~~t. Number, Hamlet, Cross Street)
(a)\fs construction los:ated within :]5:, feet of tidal wetlands? *Ves_No X
*If yes, other!own permits ,:may be required.
3)
4)
Bullder1s License No.
Plumber's License No.
:'j
Electrician1s License No.
Other. Trade1s License No.
, '/;--n .
czt-~~~h
....... . ". Sig. nat p ICijn
. . '. osepn &t?cz sk
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Date
5) a) Attach plot plan showing locatfoil,of proposed,.-elfcavatlon and relationship to
adjoining premises or public'stre.ets or areas, and giving a detailed descrip-
.. 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 byitle Town Clerk.
6)
7)
8)
Tax Map: Section
BloCk
, Lot
, t'ompletion Date
lli12LlU
Starting Date:_W22L2l
Work Schedule:
Completion Date
Phase
Excavation.................. ....,'. ."~"""""""""
", \.
Facility .Installation...........;... ~.................
Backfill & Compaction........:...... '. . . . . . . . . . . . . . .
Pavement Replacement........ .... . .... ...........
9) Under which authority is the appli~,tion made:
10) Estimated Cost of Proposed Work: ',"$'
11)
Remarks:
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~ 12)
Insurance Coveraqe: (A ttach copyf~"~
. .~ .
a)
b)
cJ
Insurance Company:
Po/i cy H
State whether policy
ment:
of cer;i"jfkation on, file with the Highway Depart-
d) Coverage required extende'~, ~o' the Town:
..1.
Bodily Injury and prope.t~y damage: $300,000/$500,000 Bodily Injury,
and $50,000 property darpage.
13) Security:
a) Surety Bond
total amount of $
bJ Maintenance Bond provided,:
or, Fertlfj~d Check
provided in the
3 years
2 years or
14) Fees for applications and permits: "/'" Basic Application Fee........$2S.00
AI. 1 /Service Connections:iexcavatlons @ $20.00 = $ 20.00
~ .
A2. /Additional Excavations same service @ $10.00 = $
~
B. Excavations 1811 in deptho'r::' ~Iess:
0-1,00 I.f. = $10.00 ",
, I.f. @$o.lo-A',
Additional
'C. Excavatlons..-1"811 in depth--tq :51 in depth:
0-100 I.f. =-$30.00 :
120 I.f. @ $0.30 ":"$ 36.00
Additional . ,
D. Excavations 5' In depth and over:
0-100 I.f. = $50.00'
I.f. @ $0.50 ~:$
Additional
E.
Utility Repair,,;I':Xcavations @$10.00, = $
Repairs same ;;~rvice'@ $5.00.= $
No.
Additional
-'
F.
Notice to public 'utilities prQof must be provided
this application prior to is~uance of permit.
,f",
* ""1':*.-,_;.
and attacned to
,
TOTAL COM-' S 56.00
Authorization is hereby granted to the
Issue a Highway Excavation Pennit 'to:
in accordance with ~this 'application.
T,'~.ow.,n ~ of the Town
;'.' ~)
,
of Southold to
..;:~
DENT OF HIGHWAYS
OUTHOLD, NEW YORK
. '
/tl- /cJ ~ t:r(
Date
Received by the Town Clerk
/ iio I
at .:.
Permit Issued,'
:Permit No.
/3/
Note:
/~,/ /4/
ate'
Permit expires one (1) year fr:~m, Date of Issuance.
No work to start without qa ho.~r notice 'to the S..perintendent of Highways.
Permit must be available for -Inspection.
" '"
Page 2 of 3
Tl00093316
PERMIT MIS JOB DATE
NO. NO. 7/0()eJ 933/t. I~
LOCATION LA uu.l.woo'b. 'bL ~ H.cA71Iu R. . ~~tLhU w/s AwE-b ~t"A.at- ~tdZlwDC1J~"
REASON FOR
OPENING Miss,'a 70 lIs' ~SS .A-Jt.1.A -t4--r..tLo.l'H i,.l 6u.ss -to Ht.lr7tl:t.i. ,-t(4\.
DATE OF
1"iUJlK e/J~-r;~ hJ.Aff ,1,'$ IJlllfI,1t/f.t Pi. /oL I ZO' iJ/ LAuliL OPENING /D .2.
REQUESTED DEPARTMENT /J "
BY bhAJ ~r/u1i. GASCONSTR. "b,s,1r. l'.41PtfiJ6&JL "6S/-75K-5I4o
DATE
KEYSPAN~S"
REQUEST FOR STREET OPENING PERMIT
FC-6111.4
D STATE
NASSAU
COUNTY
D SUFFOLK
COUNTY
D
APPROVED
SKETCH
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