HomeMy WebLinkAboutRailroad Ave
Date: 08/16/01
Transaction(s):
1 Permits
Check#: 1276
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of Southold
P.D Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
~
1276
Subtotal
$55.00
$55.00
Internal 10: 38796
Permit NO.t+f;;-
File NO.~
Ref. nf"~H4\jl 'l1..),0
TOWN OF S;,LUHOLO
H IGHWA Y DEPARTMENT
Pcconic Lane
Peconic, New' Yorl<11958
(516) 765c31110
P.o.00'l- 17&
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 excClvation herein described. The applicant agrees
to comply with all applicable laws, ordina:n'~es, codes and regulations. and to permit
authorized inspectors to make; necessary. inspections of the job site.
,
Print or Type
1) KEY SPAN ENERGY ~~R EAST MAIN STREET
Name of Applicant
PATCHOGUF., NEW YORK
Address
] 1727
2)
Nart:-tWj-;;: ~ses Ih- S~ L-<A~~S( j)
Work Description and Location (Street Number, Hamlet, Cross Street)
3)
(a)
(s construction located withih"75 feet of tidal wetlands? *Yes No
*If yes, other--Town permits may be required.
II) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
5) a) Attach plot plan showing location .of proposed. ex.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 perfil.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 CierI<.
6)
7)
Tax Map: Section
Block
, Lot
Completion Datc
Starting Date:
0) Work Schedule:
Phase
Completion Da te
Excavation. .. . .. . . . . . . . . . . . . . . . . '.' .. . . . . . .. . . .. . . . .
Facility Installation........... .......................
Backfill & Compaction......... ~ . . . .. .. .. .. . . .. . .. . .
Pavement Replacement........ '.. '. .. .. . ... .. . . . . . .. ..
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11)
Remarks:
\
YYI ~K( Y'/; /2~c5l~ (~
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Paqe 1 of ~.
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. 12) Insurance Coveraqe: (Attach copy):
a) Insurance Company:
b) Policy"
c) State whether policy of cer;tiflcation on, file with the Highway Depart-
ment:
d) Coverage required extende~. to the Town:
Bodily injury and properly damage: $300,000/$500,000 Bodily Injury,
and $50,000 properly damage.
13) Security:
a) Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
3 years
2 years or
lIt) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. LIScrvicC Connections excavations @ $20.00 :;: $ 2-0
No. '
A2. -L-/Addilionai Excavations same service @ $10. 00 ~ $ I 6
No.
B. Excavations lOll in depth 'of: less:
0-100 I.f. ~ $10.00
I.f. @ $0.10 -:$
Additional
C. Excavations..,lOIl in depth tc;> '51 in depth:
0-100 I.f. ~ $30.00
, I. f. @ $0. 30 ~', $
Additional
D. Excavations 51 in depth and over:
0-100 I.f. ~ $50.00
I.f. @ $0.50 ~;$
Additional
E.
Utility Repai~,..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.
,0',
U.
TOTAL COST'$ ~.~
. . .
Authorization is hereby granted to the Town
Issue a Highway Excavation Permit to:
in accordance with ~this application.
Clerk of the Town of Southold to
Sl:IPERINT -NDENT OF HIGHWAYS
TOWN OUTHOLD, NEW YORK
aymond L.
r- /L{-o/
'Date
Received by the Town Clerk cJ/;'I~(
~ ~ate
Permit Issued,' (., 101' Permit No.
atel
//t;
Note:
Permit expires one (1) year fr:om Date of Issuance.
No work to start without /10 hour notice .to the Stlperintendent of Highways.
Permit must be available for inspection.
Page 2 of 3
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