HomeMy WebLinkAboutBayview Ave
Date: 08/16/01
Transaction(s):
1 Permits
Cash#: 1276
Name:
Key, Span Energy
448 East Main Street
Patchogue. NY 11727
Clerk 10: L1NDAC
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
~
Receipt#:
Total Paid:
1276
Subtotal
$55.00
$55.00
InternallD: 38794
Permit ~o,r+(
File NO'y
TOWN OF S':JU "HOLD
H IGHWA Y DEPARTMENT
Pcconic -Lane
Peconic, New' Yorl< -11958
(5.16) 7G5c31110
P'O,0or- /76
Ref. II (rld'f'l1 J'-~O
,
APPLICATION/PERMIT FOR HIGHW'AY 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, ordinar'ces, codes and regulations, and to permit
authorized inspectors to make: necessary. inspections of the job site.
,
Print or Type
1) KF.Y SPAN ENERGY q4R EAST MAIN STREE1
Name of Applicant
PATCHOGUE, Nm~ YORK
Address
11727
2)
Address
~.,....... 1\..,,/ .:J
Number. Hamlet, Cross Street)
Name of Owner of Premises
~A-~()' ~w ~
ark 0 scription and Location
3)
(Street
?J
(a)
(s construction located within -75- feet of tidal wetlands? -RYes_No
*If yes, other''':r'own permits may be required.
II) Builder's License No.
Plumber's License No.
Electrician1s License No.
Other Trade's License No.
5) a) Attach plot plan showing locadon -of proposed- ex.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 pcrmi.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)
Tax Map: Section
Blocl<
, Lot
7)
Starting Date:
Completion Date
0) 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:
"
{Y\ ("-ILL u...7' ~ LL. (A- (c)~
(2 (' f I t4C .........r'V\ -e r-J
D-1CJ
P<lClC 1 of 3
li) Insurance Coveraqe: (Attach copy),
a) Insurance Company:
b) Policy n
c) State whether policy of cer:tification 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 property damage.
13) Security:
aJ Surety Bond or "'Certified Check
total amount of $
b) Maintenance Bond provided: 2 yea rs or
provided in the
3 years
111)
for applications and permits:
A ,. 1 IService Connections
~
(
Basic Application Fee........ $25. 00
excavations @ $20. 00 ~ $ .;20
Fees
,.
A2.
IAdditional Excavations same service @ $10.00 :;; $ /0
No.-
B. Excavations 1811 in depth or 'less:
0-100 I.f. ~ $10.00 ..
I.r. @ $0.10 -:$
Additional
'c. Excavations...1'8" in depth to '5' in depth:
0-100 I.f. ~ $30.00
.I.f. @ $0.30 ~..$
Additional
O. Excavations 5' in depth and over:
0-100 I.r. = $50.00
I.f. @ $0.50 ="$
Additional
E.
Utility Repair:Excavations @$10.00 = $
No.
Repairs same s'(:~rvice -@ $5.00 :;; $
Additional
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
~
* * *
c.r
TOTAL CO~T' $ 'od.-2
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.
S\;)PERINTENDENT OF HIGHWAYS
niWN 0 UTHOLD" NEW YORK
..e~
ymond L. Jacobs
y"'-/ C( --- 0/
Date
Received by the Town Clerk
Permit Issued, .Ff; '" It) (
Dat~
~/ C:!t)(
Da e.
liS-
Pcrmi t No.
Note;
Permit expires one (1) year ft:om Date of Issuance.
No work to start without 118 hour notice 'to the S1:.Iperintendent of Highways.
Permit must be available fori~spection.
Page 2 of 3
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