HomeMy WebLinkAbout870 Love Ln
Date: 08/16/01
Transaction(s):
Name:
Clerk ID: L1NDAC
1 Permits
Cash#: 1276
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Town Of South old
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
/IJ-
1276
Subtotal
$55.00
$55.00
Internal 10: 38797
Permit N,14-
,File NO'~
Ref. nClH Lf'f? 7~U.
TOWN Or- S;,(J ,'HOLD
H IGHWA Y DEPARTMENT
Pcconic Lane
Peconic. New Yorl< -11950
(5,1G) 7G5c31l10
P. O. 12>0'1- 17 e,
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, surrall< County, New York, and other applicable laws.
ordinances or regulations for the excClvafion herein described. The applicant agrees
to comply with all applicable laws, ordina):"ces, codes and regulations, and to permit
authorized inspectors to make; necessary\i"nspcctions of the job site.
Print or Type
1) KRY SPAN ENERGY ..R EAST MAIN STREE1
Name of Applicant
llATCHOr:UF.. NEW YORK
Address
11727
2)
Address
~
Number, Hamlet, Cross Street)
Name
3)
Work
(aJ
1's construction located within '75 feet of tidal wetlands? ""Ves_No ~
""If yes. other~'T~wn permits may be required.
II) Builder1s License No.
Plumber's License No.
Electrician's License No.
Other Trade1s License No.
ignature, "l. ~'ica
rt If'; /
Date
5) a) Attach plot plan showing locati"on .of proposed. cx'cavation and relationship to
adjoining premises or public'stre,cts or areas, and giving a detailed descrip-
tion of layout of excavation. .'
b) Attach all other necessary permits 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.
GJ
7)
Tax Map: Section
Block
. Lot
Completion Date
Starting Date:
0) Work Schedule:
~
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:
"
(Vl~(A-f !:c[:!r.4-T~r-
n- 11"1
P<1qc 1 or 3
f2) Insurance Coverage: (Attach copyL-.
a) Insurance Company:
b) Policy fl
c) State whether policy of cer:tification on. file with the Highway Depart-
ment:
d) Coverage required extende~. to the Town:
Bodily injury ond property domage: $300.000/$500.000 Bodily Injury.
ond $50.000 property damoge.
13) Security:
aJ Surety Bond
totol omount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
3 years
2 years or
111)
Fees for
Basic Application Fee........ $25. 00
excovotions @ $20.00 ; $ Z-a
A1.
applications and permits:
( IService Connections
~
r JAdditional Excavations same
~
service @ $10.00 ~ $
/0
A2.
B. Excavations 18" in depth 'o'r: 'Iess:
0-100 I.f. ; $10.00
I.f. @ $0.10 - ,$
Additional
C. Excavations....l811 in depth tQ51 in depth:
0-100 I.f. ; $30.00
.I.f. @ $0.30 ;$
Additional
D. Excavations 5' in depth and over:
0-100 I.f. ; $50.00
I.f. @ $0.50 ;"$
Additional
E.
Utility RepoirExcavotions @$10.00 ; $
No.
Repairs same s'ervice '@ $5. 00 ~ $
Addition,,1
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
.. .. it'
CP
~c-
TOTAL CO~T ~ '-J.>-
Authorizotion is hereby gronted to the Town Clerk of the Town of Southold to
Issue a Highway Excavation Permit to:
in accordance wi th ~this application.
. .
SQPERINT -NDENT OF HIGHWAYS
TOWN OUT HOLD. NEW YORK
. , ~
aymond L.
7'- / cr - cJ (
Date
Received by the Town Clerk
?JIl{jpr
Datc
Permit Issued,'
ej!~/I)(
Date
Permit No.
)/7
~:
Permit expires one (1) year ft:om Date of Issuance.
No work to start without 118 hour notice .to the S1:Jperintendcnt of Highways.
Permit must be available foririspection.
poge 2 of 3
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