HomeMy WebLinkAbout345 Bray Ave
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Date: 09/22/00
Transaction(s):
Name:
Clerk ID: L1NDAC
1 Permits
Cash#: 985
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:
985
Subtotal
$45.00
$45.00
Internal 10: 18188
, . perniit No. tP ~
'File.No.
RECEIVED
Ref. II d ~ ,~'1 o. O;}..
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT- 2000
PeconicLane 6tP 21
Peconic, New YOI"k 11958
(516) 765~31l10
Po. f2,c>'f- 17B Southold Town Clerk
APPLICATION/PERMIT FOR HIGHW'AY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Highways af 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 excavation herein described. The applicant agrees
to comply with all applicable laws, ordinances, codes and regulations, and to permit
authorized inspectors to mlake: necessary Jnspections of the job site.
Print or Type
1) KEY SPAN ENERGY 44R EAST MAIN STREET
Name of Applicant
T'ATCHOGUE, NEI>1 YORK
Address
11727
2)
Name of Owner of Premises
Address
3)
Location
Hamlet, Cross Street)
(a)
I-s construction located withih75. feet of tidal wetlands? *Yes No
*If yes, other-t~wn permits may be required.
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
~J, '~ A^C'-
. Signature 0 plicant
q. 2;..c;'- c5J
Date
5) a) Attach plot plan showing location of proposed.eltcavation and relationship to
adjoining premises or public' streets or areas, and giving a detailed descrip-
tion of layout of excavation.
b) Attach all other necessary permits and licenses for this project.
c) IVol"k covered by this application may not commence before issuance of a
Highway Excavation Permit by the Town Clerk.
Tax Map: Section
Block
, Lot
6)
7)
Starting Date:
Completion Date
8) Work Schedule:
Phase
,
" \,
Completion Date
Excavation............. ., .... .......................
.
Facility Installation...........;.....................
Backfill & Compaction......... ~ . . . . . . . . . . . . . . . . . . . .
Pavement Replacement..............................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11)
Remarks:
\'
D-39
Page 1 of 3
. ." ...
'12) Insurance Coverage: (Attach copy)
a) Insurance Company:
b) Policy #
c) State whether policy of certification on file with the Highway Depart-
ment:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
13)
Security:
a) Surety Bond
total amount of $
b) Maintenance Bond
or Certified Check
provided in the
provided:
2 years
or
3 years
14) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. IService Connections, excavations @ $20.00 = $ ~o" 'L>
No.
A2. 1 Additional Excavations same service @ $10.00 = $
No.
B. Excavations 18" in depth 'or less:
0-100 I.f. = $10.00
1.f. @ $0.10 -,$
Additional
C. Excavations...1'8" in depth to 5' in depth:
0-100 I.f. =.$30.00
, 1. f. @ $0. 30 :: $
Additional
D. Excavations 5' in depth and over:
0-1001.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.
* * 'ie'
,
TOTAL COfl-r- S
. .
4.5....03
Authorization is hereby granted,to the
issue a Highway Excavation Permit to:
in accordance with -this application.
Town Clerk of the Town of Southold to
WGY S~A-d
SUPERINTENDENT OF HIGHWAYS
TOWN 0 SOUTHOLD, NEW YORK
7- .~ 0</ -tf;?J
, Date
Received by the Town Clerk
cr/;u I T~
Date
Permit I ssued\ '
q !A ~/6d
/ Date'
Permit No.
to'~
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice 'to the Sl:Iperintendent of Highways.
Permit must be available for inspection.
Pa ge 2 of 3
0-39
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KEYSPAN/&-A S
REQUEST FOR STREET OPENING PERMIT
FC-6111.4
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NASSAU
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o STATE
co
PERMIT
NO,
LOCATION
REASON FOR
OPENING
W.OJPA
NO.
REQUESTED
BY
APPROVED
I2.fI~ AJL . At.
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DEPARTMENT
GAS CONSTR. MAINT. & SERVICES
SKETCH
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