HomeMy WebLinkAboutPeconic Ln
Date: 09/24/01
Transaction(s):
Name:
Clerk 10: L1NDAC
1 Permits
Check#: 1313
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:
* \do "J
1313
Subtotal
$55.00
$55.00
InternallD: 40304
File NO'~
Ref. Hr100083868
I UWN UI~. :':>;:JVI nVl...lJ
H IGHWA Y DEPARTMENT
Pcconic Lane
Peconic; New. York .11950
(5.]6) 765"31110
P. O. {2,o1. t7e;.
g~:,,-
Vl iI'ii
~. ~
~t1i .... '}.~~.
..
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 Excnvatlon 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 exctlvation herein described. The applicant agrees
to comply with all applicable laws, ordina:n.'c:es, codes and regulations, and to permit
authorized Inspectors to niake: necessary "inspections of the job site.
Print or Type
1) KIN ~P^N ENERGY 175 E. Old CQunt!:_ Rd.
Name 0 App ieant
Ricksvi11e NY 1180
Address
2)
Name of Owner of Premises
Address
3] Peconic La. (bellhole grass area w/s approx. 1.100' n/o M~in RiI.) - Peconic
Work Description and Location (Street- Number, Hamlet, Cross Street)
(a)
....
(s construction located within ""5' feet of tidal wetlands? .Ves
*If yes, othcr-'!own permits ,'may be required.
No X
II) Bullder1s License No.
Plumber's License No.
Electricianls License No.
Other Trade's License No.
(Signature .,f Applicant
Josepn J. Topczynski)
09/20/01
Date
5) a) Attach plot plan showing locatfon ,of proposed,'''c5tcavlltion and rclationship to
adjoining premises or public 'stre.ets or areas, and giving a detailed descrip-
lion of layout of excavation. ",'
b) Attllch 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:U:tc Town Cleric
G)
7)
Tax Map: Section
Blod,
, Lot
Completion Date
Starting Dtltc:
3) Work Schedule:
~
,'~" \
Completion Date
Excavation. .. . . . . . . . . . . . . . . . .". . .' .,~ . . . . .. . . . . . . . . . . .
r-acility Installation...........::....................
Backfill & Compaction..............................
Pavement Replacement........ ~:."....................
9) Under which authority is the application made:
10] Estimated Cost of Proposed Work: $
11) Remarks:
\
0-1f1
Po"e r or- :r-. -. ..
12) Insurance Coveraqe: (Attach copy).....
a) Insurance Company:
b) Policy It
c} State whether policy of ccr;tlflcation on, file with the Highway Depart-
ment:
d) Coverage required ex tend~~. to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13) Security:
a) Surety Bond or Certified Check
lata I amDun t of $
b) Maintenance Bond provided: 2 years or
providCd in the
3 years
111) Fees (or applications and permits: Basic Application Fee........ $25. 00
A 1. ~/Service Connection"~xcavatlons @ $20.00 = $ 20.00
No.
A2. 1 /Additional Excavations same service @ $10.00 = $ 10.00
~
B. Excavations 1811 in depth 'or less:
0-100 1.f. = $10.00 .'.
I.f. @ $0.10 -;$
.'
Additional
,
C. Excavations...,.81l in depth tQ '5' in depth:
0-100 I.f. = $30.00
1.f. @ $0.30 =.$
Additional' .'
D. Excavations 51 in depth and OVer:
0-100 1.f. = $50.00
I.f. @ $0.50 ,:,'$
Additional
Eo
Utility Repalr..:Excavations @$10.00 = $
No.
Repairs same ~~'rvicc'@ $5.00 = $
Additional
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
/.
. . .
1:0TA1. cowr' ~ 55.00
Authorization is hereby granted to the Town CierI< of tl1.l: Town of Southold to
issue II Highway Excavation Permit to: ". ~ y j rJr"'....
in accordance with ~this application. .
S8PERINTENDENT OF HIGHWAYS
TOWN SOUTHOLD, NEW YORK
~al
Received by the Town CierI< q /O(V. /Of
Permit Issued,' q Ie;; V J'f) I I Date. :ermit
I Datel
No.
Id..,~
Note:
Permit expires one (1) year fr:om Date of Issuance.
No work to start without 110 hou.r notice -to the Sl:Ipcrintendcnt of Highways.
Permit must be available for inspection.
Page 2 of 3
~ ,n
,
FC.6111.4
PERMIT
NO. .
LOCATION
REASON FOR
OPENING
W.OJPA
NO.
REQUESTED
BY
APPROVED
SKETCH
I~
~
~
"' ,
~
~
KEYSPAN#..45
REQUEST FOR STREET OPENING PERMIT
D STATE
D NASSAU
COUNTY
D SUFFOLK
COUNTY
~g: JOBA"JOOO 8'3 8~8
'E~,j;L &'. - Ifzfi#+lt bMS5 ~ tlI 'oS
If!. . JU iN il~d/c
FOREMAN
ev/JJ So-lu1"z_
DEPARTMENT
GAS CONSTR. "btl.!r. ~ ~Jf{)("'!..
~/-
/.
z
l()tJ ':"
2"Sfl- -
Pt.LOFJi~
LA1Ji.
L5U>.SS
MI.A
3LAc:f1/;! IMLtlJk ~7
tsb-<::<: AL~A
l.uu. !I.-1':P
fftZA
tSs !ltJ. ss
,.-.....
, .
.- .
. .. ~
"
IHliA
') ..
-1;.w"/ tJl Sc.u.-n/.O/.;b.
()~dEll1JoJ aJ'OI..
i
1"",....:.
.~
#I-;s~;LI:
,.
A-....
[E] <Wu1J/DaJ
DATE
9J; S/Z{) ()/
Affitv( . 10 '
DATE OF
OPENING
6lti>-t#- lOb -~/- I
q'x4 '
~
Ib"
I~
If'ro.
,,/'x"':"'" [:!J ~\
I
I
I
~
I~'
It..:
t'
n
I
I
I
/
------
-.
11
I~'
I~
I'"
I
I
I~
I'
.....
I~t
I~' ~
10' "
I~",
:;a
I
I
I
~
1<>
0-
Sl"-
t
l'
~
....'
,.
- ..
_"",,4
. ,.
,,'" ,-
.~tC:(
.
,.
'It
..~'
-<(-
~
~
~
r