HomeMy WebLinkAbout3015 Pequash Ave
Date: 09/24/01
Transaction(s):
.
1 Permits
Cash#: 1313
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
~
~ (r
1313
Subtotal
$45.00
$45.00
Internal 10: 40303
.File NO'~
Ref. U T100086190
I UYVI~ vr- ;:';JU.1 IIVl.......
HIGHWAY DEPARTMENT
Pcconic Lane
Peconic, New' Yor!< .11950
(5.JGJ 7G5c31110
P. O. (2,01- 175
g.~-
V> ffl
~ ~ ~
~~ ... ",.if,
"
APPLICATION/PERMIT FOR HIGI'/w'P,Y EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issunnce of an Excavation Permit pursuant to Chapter 83 of the
Code of the Town of Southold, Suffoll, County, New Yorl" and other applicable laws.
ordinances or regulations for the excavafion herein described. The applicant agrees
to comply with all applicable laws, ordina,,'~es, codes and regulations, and to permit
authorized inspectors to make: necessary \inspcctions of the job site.
Print or Type
1) KRY SPAN ENERGY 175 E. Old Country ]lit , HiokX1dr~~~' NY
Name of Applicant
11801
2]
Name of Owner of Premises
Address
3) 3015 Pe uash Ave. - Cut
Work Description and Location
treet Number, Hamlet, Cross Street)
(a)
1's construction located within -.is feet of tidal wetlands? -IIYcs_No
-IIlf yes, other--"'!own permits may be required.
x
II) Buildcr1s License No.
Plumber's 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'stre,cts or areas, and giving a detailed descrip-
lion of layout of excava lion. ..:.
b) Attach all other necessary pcrrili,ts nnd licenses for this project.
c) Work covered by this applic.:1tion, may not commence before issuance of a
Highway Excavation Permit by :the Town Clerl<.
G)
7)
0)
Tax Map: Section
Block
, Lot
C.ompletion Dnte
Starling Date:
Worl< Schedule:
Completion Date
~
"
" \
Excavation. . . . ., . . . . . . . . . . . . . '. ... .\~ .. . . . . . . . .. . . .. . .
r-acility Installation........... ~:....................
Backfill & Compaction.........:....................
Pavement Replacement........ ~':', '. . . . . .. . . . . . . .. . ....
9) Under which authority is the applica.tion made:
10) Estimated Cost of Proposed War": $
, 1) Remarks:
"
[)-1"
Paq~ r ot :1'" - iON
12) Insurance CoveraCJe: (Attach copyL
a)
b)
c)
Insurance Company:
Policy 1/
State whether policy of cer;t,iflcation on, file with the Highway Depart-
ment:
d} Coverage required extend~~. to the Town:
Bodily injury and propc,ity damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13) Security:
a) Surety Bond or Certified Check provided in the
total amount of $
b) Maintenance Bond provided: 2 years or 3 YCiJrs
, II) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. ~/Service Connections:~xcavatlons @ $20.00 ;: $20 00
No. \
A2. IAdditional Excavations same service @ $10.00 = $
""i'lO:-
B. Excavations 1011 in depth 'or. less:
0-100 I.f. ;: $10.00'"
I.r. @ $0.10 -;$
Addi tional
, '
Excavations...l81l in depth -t951 in depth:
0-100 I.r. ;: $30.00
I. f. @ $0.30 ;:.',$
Additional' .-
O. Excavations 51 in depth and over:
0--100 I.f. ;: $50.00 '
I.f. @ $0.50 ~\$
Additional
C.
E.
Utility Repai~:.:',Excavations @$10.00 ;: $
No.
Additional
;.-.
Repairs same service'@ $5.00 = $
F.
Notice to public 'utilities proof must be provided and attached to
this application prior to issuance of permit.
~ ~~', ,
* * :*"
TOTAL CO~1: ~45. 00,
'Authorization is hereby granted to the Town CIerI< of the Town of Southold to
issue it Highway Excavation Permit to: ~1 S n&a q
in accordance with ~this application. . .
. '
S\:lPERINTENDENT OF HIGHWAYS
tow SOUTHOLD, NEW YORK
, .
,
,
Raymond
9- Pl'- 0('
Date
Received by the Town Clerl<
q /~ cI/OI'
Date
Permit Issued,'
q I~~/n(
pate
Permi t No.
/ ~ ~j
Note:
Permit expires one (1) year fr:cim Date of Issuance.
No work to start wit,hout 110 hou,r notice .to the Stlpcrlntendent of Highways.
Permit must be available for inspection.
Page 2 of 3
~ 00
KEYSPAN/6'19S
REQUEST FOR STREET OPENING PERMIT
FC-6111:4
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W.O.lPA
NO.
REQUESTED
BY
APPROVED
D STATE
D
D SUFFOLK rJl ..-
COUNTY tK.J .J#..1J.f.U
v/;.J -'lIu7Z.
DEPARTMENT
GAS CONSTR. MAl NT. & SERVICES
SKETCH
, -..s/stc
~l-tb rt /~/- cf.2- 1-
N