HomeMy WebLinkAboutSkunk LnTown Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 08/24/00
Transaction(s):
Permits
Receipt#:
958
Subtotal
$294.00
Check#: 958
Total Paid: $294.00
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk ID: LINDAC internal ID: 17057
Permit No..
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic 'Lane
Peconic, New York 11958
(5.16) 765~31q0
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 Excav~i:tion 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, ordinahces, codes and regulations, and to permit
authorized inspectors to m]a.kelnecessary\inspections of the iob site.
Print or Type~
I} KEY SPAN ENERGY 44g EAST MAIN STREET
Name of Applicant
PATCHOGUE~ N~ YORK 11727
Address
2}
Name of Owner of Premises Address
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No
*If yes, other"~'F~)wn permits may be required.
4) Builder's License No. Plumber's License No.
Electrician's License No. Other Trade's License No.
s)
6}
7)
9)
10}
11)
Signature of A~p/,~/cant
Date
a}
b}
c}
Tax Map: Section
· Block
Attach plot plan showing location o.f proposed.-e~'cavation and relationship to
adjoining premises or public'streets or areas, and giving a detailed descrip-
tion of layout of excavation. .
Attach all other necessary permits and licenses for this project.
Work covered by this application may not commence before issuance of a
Highway Excavation Permit by the Town Clerk.
· Lot'
Starting Date:
Completion Date
Work Schedule:
Phase
Excavation .........................................
Facility Installation .................................
Backfill & Compaction ..............................
Pavement Replacement ..............................
Completion Date
Under which authority is the applibation made:
Estimated Cost of Proposed Work:
Remarks:
D-39 Page I of 3
1 3)
14)
Ins~Jrance Co~era~le: (Attach copy)t
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.
Security.:
a) Surety Bond or ~ertified Check
total amount of $ ·
b) Maintenance Bond providedi
Fees for applications and permits:
Al. / /Service Connections:excavations @ $20.00
NO.
provided in the
2 years or 3 years
Basic Application Fee ........ $25.00
A2. /Additional Excavati00s same service @ $10.00
B. Excavations 18" in depth 'oii less:
0-100 l.f. = $10.00
,,' l.f. @ $0.10 - $
Additional
C. Excavations--.-l'8" in depth t~ 5' in depth: 0-100 I.f. =-$30.00
-7 ~o ,~.r. @ $0.30 :.'$
Additional
D. Excavations 5~ in depth and over:
o-loo l.f. = Sso.oo
~.f. o $o.5o
Utility Repair Excavations 0510.00
Repairs same service @ $5.00= $
Additional
No.
Additional
Notice to public utilities p~0of must be provided .and attached to
this application prior to is§uance of permit.
Authorization is hereby granted' to the Town Clerk of the Town of Southold to
D-39
TENDENT OF HIGFIWAYS
SOUTHOLD,, NEW YORK
Ra?nd L. J 'obs
Date
issue a Highway Excavation Permit to:
in accordance with,this application.
Received by the Town Clerk
Permit Issued\'
Note:
Date
Permit No. ~_/-A~/
Permit expires one (1] year fromm Date of Issuance.
No work to start without 48 hour notice 'to the Superintendent of Highways.
Permit must be available for inspection.
Page 2 of 3
REQUEST FOR PERMIT
I Permit required to open!
TD /.~o ~ Type of Road
work Request ' Char.eaeeou.t
* [] Disbursement to Be made out of petty cash
[] Q.N. [] Cent. [] W,S. ~LE.S.
Gas Service for
iD To be billed ] [] No fee
Return Permit To: ~-New Business Department
[] Underground Lines Department
[] Oper, Plan. & Cont. Center
S 70'54'40" £
416.74'
~ LO~ 1
\.
L=35.37'
Town Of Southold
P.O Box 1179
Southold, NY 11971
Date: 11/26/07
* * * RECEIPT * * *
Receipt~: 1017
Transaction(s):
1 1
Permits
Reference Subtotal
531 $220.00
Check~:9563
Total Paid: $220.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old CountPJ Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 531
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
R~CEIV~D
Ref.#TI00816382 Sel~ho[~ Tc~.',-n Cfc, r~
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, 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 make necessary inspections oftbe
job site.
Print or Type
1) KEYSPAN ENERGY - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE~ NY 11801
Name of Applicant Address
2) Skunk Lane Cutchogue Name of Owner of Premises Address
4)
4) Builder's License No.
Electrician's License No.
5)
Skunk La. - bellholes and a 100' trench trench in the W/s grass area~ approx. 1,570' s/o Main
Rd. to install a Ras main and a Ras service for house #1490
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) is construction located within 75 feet of tidal wetlands? *Yes No X
*If yes, other Town permits may be required.
Plumber's License No.
Other Trade's License No.
11/19/07
Date
a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or
public streets or areas, and giving a detailed description of layout of excavation.
b) AHach all other necessary permits and licenses for this project.
¢) Work covered by this apptication may not commence before issuance of a Highway Excavation Permit
by the Town Clerk.
6) Tax Map: Section ,Block
7) Starting Date: Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
Lot
Completion Date
12) Insurance Coverage: (Attach Copy)
a) Insurance Company:
b) Policy #
c) State whether policy of certification on file with the Highway Department:
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 or Certified Check provided in the total amount
nfs
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for annlications and oermits:
Al. /Service Connections excavations ~ $20.00 =
A2.
/Additional Excavations same service ~ $10.00 =
No.
Excavations 18" in depth or less:
O-lO0 l.f. = $10.00 -
l.f. ~ $0.10 =
Additional
Basic Application Fee
2 bellholes ~.~
(plus $30.00 trench fee
And .30 ea. foot from 101 '..~-~
$99.00)
C. Excavations 18" in depth to 5' in depth:
0-100 l.f. =
Additional If~ .30 = 7461~ of trench ~ .30
D. Excavations 5' in depth and over:
0-100 l.f. = $50.00
l.f. ~ $0.50 = $
Additional
No.
Additional
Utility Repair Excavations ~ $10.00 = $
Repairs same service ~ $5.00 = $
Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST = $220.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Tom.Clerk
Permit lssued "/~ Permit No.
SUPE~ENDENT OF HIGHWAYS
Date
Note: Permit expires one (1) year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39 Page2 of 3
Cow Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
Findings (use code)
Applicant Notified
(To Permit Clerk)
REMARKS
CODE
IB - Improper barricades
IL - Improper lights
ST - Sunken trench or excavation
UTM Unable to measure (due to backfilling)
BUC - Building under Construction
WIP - Work in Progress
DB - Improper backfill (too high) (not sufficient)
HFS- Inspectorholdingforfinalsettlementofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
KEYSPP~N OAS CONSTR
KEYSPAN
REQUEST FOR STREET OPENING PERMIT
PERMIT
LOOATION
REASON FOR
OPENING
REQUESTED
BY
COUNTY []COUNTySUFFOLK
· MIS JOB
~S ~. MAI~. & ~R~GES .
TOTAL P. 05