HomeMy WebLinkAbout305 Old Shipyard Ln
Permit NO~~
File NO.~
Ref. II
TOWN OF S;JUi'HOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New' York 11958
d.3 "OIYSr-,,]t..J (516) 765-3140
fJO.a,c'f- ,7E!>
'.
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 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 excavat}on herein described. The applicant agrees
to comply with all applicable laws, ordinat'ces, codes and regulations, and to permit
authorized inspectors to make: necessary .}nspections of the job site.
Print or Type
1) KEY SPAN ENERGY 44R EAST MAIN STREET
Name of Applicant
PATCHOGUE, NEW YORK
Address
11727
2)
Address
Name of Owner
fJ
~
(Street
Hamlet,
_0--,;{
Cross Street)
L
Number,
3)
)0)" I
Work Description
(a)
(s 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 Trade1s License No.
~ ';,o/f""~"'
... j- s;- (/ J
Date
5) a} Attach plot plan showing location -of proposed- e)(cavation 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 permi.ts 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]
7l
Tax Map: Section
Block
, Lot
Completion Date
Starting Date:
8) Work Schedule:
Completion Date
Phase
Excavation.............. ..... ..... ',' ................ .
Facility Installation........... i.....................
Backfill & Compaction.........:....................
Pavement Replacement........ i'... .. . . .... .. . . .. . ....
9) Under which authority is the appliCation made:
10) Estimated Cost of Proposed Work: $
11)
Rema rks:
\
f)-1Q
P<'lflf' 1 of ~
12) Insurance Coveraqe: (A ttach copy),
a) Insurance Company:
b) Policy #
c) State whether policy of cer:tjfication on file with the Highway Depart-
ment:
d) Coverage required extende~ to the Town:
Bodily injury and prop~rty 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
3 years
2 years or
14)
Fees for a
lications and
Basic
Application Fee........ $25. 00
@$20.00=$~O 00
ermits:
A1.
IService Connections excavations
Nt. IAdditional Excavations same service @ $10.00 ;;: $ / lJ
~
cY
A2.
B. Excavations 1 a" in depth 'or less:
0-100 1.f. = $10.00
1.f. @$0.10-"$
Additional
'C. Excavations-.--1"a" 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
I.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.
* * *'
.~""'
TOTAL CO~T $~~ ,
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 F SOUTHOLD, NEW YORK
7-
Raymond Jacobs
/ - 1 - t:r/
Date
Received by the Town Clerk
Date
Permit Issued,'
/- /d- 0/
Date
i'o
Permit No.
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 4a hour notice .to the Sl:Jperintendent of Highways.
Permit must be available for inspection .
n_'UI
Page 2 of 3
FC-6111.4
KEYSPAN
REQUEST FOR STREET OPENING PERMIT
D ~~~N~~K @ --( 0 . s,ov+~o [J
D
NASSAU
COUNTY
MIS JOB
NO.
DATE
/1--- z.-g..- 00
D STATE
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W.O./PA
NO.
REQUESTED \
BY
APPROVED
~/3. (Jt..-h ~"MY(l. 3.00' &(,
SUVlC\:....- U G- V
FOREMAN
kiJ M~j{..IL<;
DEPARTMENT
GAS CONSTR. MAl NT. & SERVICES
A
s;: "A ~ , /J
DATE OF 01
OPENING - [<;;-01
DIVISION
GCtHj --z...V
DATE
SKETCH
Grzt~* /O'lr-n-t.ftf7b
N
'HOf'\!'\V
L- a
~
fU{].( S,flQ\I'n..-- ~
(l.'i(lL4C!...- (ltr;.U/"4-roL
~
Y''xl{1
OPw,,",,,
Date: 01/12/01
Transaction(s):
1 Permits
Cash#: 1103
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of Southold
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1103
Subtotal
$55.00
$55.00
InternallD: 24657
Permit NO.-I-I-D
File No.--/-l--7
F~\-\ Lf'ti .
Ref: /I 710 2-D
TOWN Or- S;JUiHOLD
H IGHWA Y DEPARTMENT
Pcconic Lane
Peconic, New. Yorl< ,11956
(5-16) 765c31110
PO. f2,cY- 175
;
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 Excavation Permit pursuant to Chapter 83 of the
Code of the Town of Southold. Suffoll< County, New York. and other applicable laws.
ordinances or regulations for the excavation herein described. The applicant agrees
to comply with all applicable laws, ordina.'i:l-c::es, codes and regulations, and to permit
authorized inspectors to make; necessary "inspections of the job site.
Print or Type
1) KF.Y SPAN ENERGY ooR EAST MAIN STRERT
Name of Applicant
PATCHOGUE , Nm~ YORK
Address
11727
2)
Name of Owner of Premises Address
3) 305" r) l~ sL,p v A,;J) LA- ~ (:~r),-< h A(
Work Description and Locat\on1(Street Number, Hamlet, Cross Strect)
(a) (s conslruction .Io~ated wit~in 75 feet of ti?al wetlands? 'YeS_NOe
*If yes, other~ -:rown permits may be required.
r
.J
II) Builder's License No.
Plumber1s License No.
Electrician's License No.
Other Trade's License No.
5) a) Attach plot plan showing locati"on .of proposed. c~:(cavation and relationship to
adjoining premises or public'strc.cts or areas, and giving a detailed descrip-
tion of layout of excavation. .
b) Attach all other necessary perml.ts and licenses for this project.
c) Work covered by this application may not commence before issuance of a
Highway Excavation Permit by ,the Town Cleric
6)
7)
Tax Map: Section
Blocl<
, Lot
Completion Date
Starting Date:
3) Worl< Schedule:
Pha se
Completion Date
Excavation....................... .\~........... ..... .
Facility Installation.............:....................
Backfill & Compaction.........:....................
Pavement Replacement........ ..:..~...................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Worl" $
11)
Remarks:
,-
n~ 10
Paqe 1 of 3
)2) Insurance Coveraqe: (Attach copyL.
a) Insurance Company:
b) Policy<<
c) State whether policy of cer;tification on. file with the Highway Depart-
ment:
d) Coverage required extende~. to the Town:
Bodily injury and property damage: $300.000/$500.000 Bodily Injury.
and $50.000 property damage.
13) Security:
aJ Surety Bond
tota I amoun t of $
b} Maintenance Bond provided:
or Certified Check
provided in the
3 years
2 years or
111)
Fees for
applications and permits:
-L-IScrvicc Connections
No.
Basic Application Fee........ $25. 00
excavations @ $20.00 = $ 2- c) if
A1.
'-<'
( IAdditional Excavations same service @ $10.00 ::;: $
""Nii:-
B. Excavations 1611 in depth o'r less:
0-100 I.f. = $10.00
I.f. @ $0.10 -:$
10
A2.
Additional
C. ExcaYations~.1'611 in depth to 5' in depth:
0-100 I.f. = $30.00
,1.f.@$0.30=A
Additional
D. Excavations 5' in depth and oYer:
0-100 I.f. = $50.00
I.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.
'" -II 'II'
f!!-
TOTAl. CO~T.' ~, c:; S
'Authorization is hereby granted to the Town Clerl< of the Town of Southold to
issue a Highway Excavation Permit to: '. Vp'-<( Sf)~
in accordance with~this application.
SUPERINTENDENT OF HIGHWAYS
T.....O...~F OUTHOLD., NEW YORK
"," ~
',' Raymond L. ~s
, tf~ 2..2-- dj
Date
Received by the Town Clerk
g-~:;'-Ol
Date
J /9
Permit Issued,' l? - .L ~ -0 (
Date
.Permit No.
~:
Permit expires one (1) year fr:om Date of Issuance.
No work to start without 116 hour notice .to the Superintendent of Highways.
Permit must be available for inspection.
Page 2 of 3
~ 00
}frr.~
,;;I'
,.~._.. .
"....'7<;. ~.
. ,:~,"k:, .:-
j
Date: 08/23/01
Transaction(s):
1 Permits
Check#: 1286
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of Southold
P.O Box 1179
South old, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1286
Subtotal
$55.00
$55.00
IntemallD: 39171
Date: 09/24/01
Transaction(s):
Name:
Clerk ID: L1NDAC
1 Permits
Check#: 1316
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\'}
1316
Subtotal
$15.00
$15.00
Internal 10: 40313
File No. ;~~
'VlIl1 v.- ~;.IV,I .........-
H ICHWA Y DEPARTMENT
Pcconic Lane
Peconic, New' Yorl< .11950
rt<\-t LI'-I7 (516) 765c31l10
7r.,dO Pe.0oY- ,7e,'
;,..
APPLlCAT.ION/PERMIT FOR HICHWAY EXCAVATION AND REPAIR
~Ii_~~ '
~~~
~c?.l + '}.'O~.
Ref. n
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issLlOlnce of <l:n Exc~vation Permit pursuant to Chapter 03 of the
Code of the Town of Southold, Suffoll< County, New Yorl<, and other applicable laws.
ordinances or regulations for the excllvation herein described. The applicant agrees
to comply with all applicable laws, ordina~'~es, codes and regulations, and to permit
authorized inspectors to niake: necessa.ry .,inspectlons of the job site.
Print or Type
1) KF.Y SPAN RNRRGY 1,1,R EAST MAIN STRRE~
Name of Applicant
P^TCHOGUE , NEll YORK
Address
11727
3)
Name of Owner of Premises Address
3 0 ~ 6 I ~.Pt S. 0 '-^ 0--_( :J
Work Description tion (Street. Number, Hamlet.. Cross Street
(a) rs constrllction lo,cated within ','75' feet of tidal wetlands? 'Yes_No ~
*If yes, other""#o:(own permits may be required. --r--
2)
II) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
t-:..':,':, "
:'{{:".'
.::;,'
.' ...
:....
5) a) Attach plot plan showing locat;'on .of proposed,"el<'cavation and relationship to
adjoining premises or public 's~re.ets or areas, and giving a detailed descrip-
tion of layout of excavation. .' .::.
b) Attach all other necessary pcrmi.,ts and licenses for this project.
c) Work covered by this applicnti~~. may not commence before issuance of a
Highway Excavation Permit by :the Town Cleric
G)
7)
Tax Map: Section
13 locI<
I Lot
Starting Datc:
Completion Dnte
0) Wor" Schedule:
~ "~.\ Completion Date
Exca va tion. . . . . . . . . . . . . . . . . . . '; . .. '\ . . ~ . . . . . . . . . . . . . .
Facility Installation...........~.:..~..................
Backfill t Compaction......... ~ . .. . . . . . . .. . .. . . . . . .
Pavement Replacement........ '..:..~...................
9) Under which authority is the appli~a.tion made:
10) Estimated Cost of Proposed Worl<: '$'
11) Remarl<s:
\.
,-!,.-.
'"
1)-1.
Paqc 1 of 3
12) Insurance CoveraC)e: (Attach copyL
a) Insurance Company:
b) Policy II
c) State whether policy of ccr;tification on, file with the Highway Depart-
ment:
d) Coverage required extende:~, to the Town:
Bodily injury and propch" damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13) Security:
.,..
a) Surety Bond or Certified C heel,
total amount of $
bJ Maintenance Bond provided: 2 years or
provided in the
3 years
111) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. /Service Connections ,'excavations @ $20.00 = $
NO:-
A2. IAdditional Excavations same service @ $10.00 = $
NO:-
B. Excavations 1811 in depth 'or. 'less:
0-100 I.f. = $10.00 ,',
I.f. @ $0.10 -;$
:.
Additional
, '
C. Excavations~"'8" in depth tQ '5' in depth:
0-100 I. f. = $30.00
,I.f. @ $0.30 =,)
D.
Additional
Excavations 5' in depth and over:
0-100 I.f. = $50.00 ,~,
I. f. @ $0. SO 7~$
Additional
lJ<7
E.
t
No.
t
Additional
Utility Repal~:,:,Excavallons @$10.00 = $ /0
Repairs same sl,rvlce@ $5.00 = $ .Jl7 S v'i
F.
Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
:(
* * i,
cJJ
/S:-
T01~^J. co~'r ~
"Authorization is hereby granted to the Town Clerlt of the Town of Southold to
issue a Highway Excavation Permit to:
in accordance with ~this application.
S0PERINTENDENT OF HICHWAYS
;~, ,F SOUTHOLD" NEW YORK
" /~~
. . Raymond Y acobs
f'-c?ly- 0/
Date
Received by the Town Cieri, 9- d i.;~ 0 (
Date
Permit Issued,' c; - d '-{'- C) / '. ,Permit No.
Date
J dk)
.
Note:
Permit expires one (1) year ft:om Date of Issuance.
No work to start wit,hout '10 hour notice .to the StJpcrintcndcnl of Highways.
Permit must be available for i~spection.
Page 2 of 3
~ on
~, R"eQiO,__n/COmpany !l.JGKU";
050LlJ SHIPYARD LN
", Int Street 1 I
Int Street 2
~-~-
_ I '
.wo~~~t: ~~~~~2349~
Direction ;
. From L---___
Belongs To I
Equipment L___
Contact Information
equestoL ..,
CustomeC-----
Phone I
~_]Rolel
Problem
P::I:: ~I:: L. , ,I
Leak Reading% c::~-~. --.J
Upgraded Date I I
Associated ProjecU
Work Order Detail
Oracle Project #
FWMS Project #
LMS# I
Ext Ref # I
Status 1703 I m~~~_
Work Type RS'PL
Status r:om"--l'
Status Due Date b
Date Rec;~:~ ~~~~O~~~~ll.bO.
location Priority i-- -~~
WO Priority - - g
___~~___J_~~
,:-J
I
J
J
I
Violation/Delay Notifications
Parking Reg c=
Svc Seq # L.....~ ,
Billing Unit L
Damages
I Location Detail
Circuit# I
Diary
I Map/Grid ~fT=-~ 1
Tax District nw---- ".
, -~~I
Responsibility
Owning Org.r62~RH , ]
Performing Org. r62~RH I Scheduler '--"- II
Project Manager IJ Crew Leader 1-- -,--- ---1 !
Designer __ .._ Contractor L~--__ __=J
Scheduling Infonnation Follow-up Work
Start __ Completion Originating L-
~--- , '1 Has Follow-up Work? f_T--
1__ , I
I
o:o~ Rem. Dur.L
Classification
Job Plan ~VGR~P ----.J
Program rKR~p-G I
Safety Plan
PM
Target
Scheduled
Actuai
Appt Date
Est Our. L_
Modified
By~---i
Date -~_~19-tj'~_~~9
.
FOOTAGE
/0
#t.
SIZE
1/.'"
" oL
r~-
MATERIAL
PX/
P /<;f-
,
.
.
ShIP'i{'J~d. LA
Pi
u Partial Stub
PRESSURE:
o Low (6" w.e.)
or
,lZ]High
PIPE
Main to PL
PL to Meter
FOREMAN/
,.. .JO
PRESSURE
TEST:
/~d
PSI
TIME: Hr.
. 4....
Mln L-"'"
'/ ,,&,-c../'~ d - 0 i
CATHODIC PROTECTION INFORMATION
A Is cathodic protection required? B Insulator device at meter: 0 YES
DYES' .$ NO Insulator device at main: 0 YES
If YES, complete "B" Anode Installed: 0 YES 0 NO Voltage
FG-,08361-SS.,,' :i,*,i.l~~~ SERVICE RECORD
o NO
o NO
.......... .
'N"
. ..
1
..r. ....
.............. .
........... .
. . . . . . . . . . . . . ... . .
.............. .
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. . . . . .. "k" . 0 . '- .4- . . . . . . . .. .. . . . . . . . . . .
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