HomeMy WebLinkAbout250 Condon Ct
. ~
, .
Permit NOr-f-f-
File. No. /--1--1-
TOWN OF S;J(j ,'HOLD
H IGHWA Y DEPARTMENT
Pcconic Lane
Peconic, New' Yorl< -11958
(51G) 7G5c31110
P.o.l2>o"- 17e,.
Ref. 11-tIOOtJ 7c?'/O:;J...
,
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, Suffolk County, New York, and other applicable laws,
ordinances or regulations for the eXCDvat~on herein described. The applicant agrees
to comply with all applicable laws, ordina),'ces, codes and regulations, and to permit
authorized inspectors to make; necessary.Jnspcctions of the job site.
Print or Type
1) KF.Y SPAN ENERGY ~~A EAST MAIN STREET
Name of Applicant
'PATCHOC:llR. NR1\1 YORK
Address
11727
2)
Name of Owner of Premises
Address
3) d S1J
Work
Co,..,) tJ",
Description and
c I UA-<-,.f <-f
Location (Street Number, Hamlet, Cross Street)
(a) '-s construction lo~ated withih 75 feet of tidal wetlands? *Yes_No ~
*If yes, othcr~-Town permits may be required.
II) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
nt
5) a) Attach plot plan showing locadon .of proposed..c,fcavation 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 pcrml.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.
G)
7l
Tax Map: Section
Block
, Lot
Completion Date
Starting Date:
8) Work Schedule:
~
Completion Date
Excavation...................... ...~.................
Facility Installation........... ..:....................
Backfill & Compaction.........:....................
Pavement Replacement........ "'. ~ . . . . .. . . . . .. .. . .. ..
9) Under which authority is the application made:
10) Estimated Cost of Proposed Worl" $
11)
Remarks:
"
0-,.
Paqc 1 or 3
'.
12) .. Insurance Coveraqe: (Attach copy)-
a) Insurance Company:
b) Policy II
c) State whether policy of cer:tification on, file with the I-lighway Depart-
ment:
d) Coverage required extende~. to the Town:
Bodily injury and property damage: $300.000/$500.000 Bodily Injury.
and $50.000 property damage.
13) Security:
aJ Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
3 years
2 years or
1ll) Fees for applications and permits: Basic Application Fee........$25.00
A 1. I IService Connections -excavations @ $20.00 :;: $ ~ 0 (.U
No:-
v
A2. I /Additionai Excavations same service @ $10.00 ~ $ 10
~
B. Excavations 1611 in depth 'o'r: "less:
0-100 I. f. ~ $10.00
I.f. @ $0.10 -:$
Additional
C. Excavations...ln" in depth -to -51 in depth:
0-100 I.f. ~ $30.00
, I. f. @ $0. 30 ~', $
Additional
O. Excavations 5' in depth and OVer:
0-100 I.f. ~ $50.00
I.f. @$0.50~\$
Additional
E.
Utility RepairExcavations @$10.00 ~ $
No.
Repairs SClme service '@ $5.00 ::: $
Additional
F.
Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
',0'.
'" '" ...'
iT
-r- ~
5::.
TOTAL CO~T. ~
Authorization is hereby granted to the Town CierI< of the Town of Southold to
issue a Highway Excavation Permit to:
in accordance with .this application.
SOPERINTENDENT OF HIGHWAYS
TOWN 0 OUTHOLD. NEW YORK
Raymond L. Jac
~~ ]'-c) f
Date
Received by the Town Clerk
Permit Issued, ,1 ~ /" (
DaAe
~ / % (
Date
Permit No. 1//
Note:
Permit expires one (1) year ft:om Date of Issuance.
No work to start without '16 hour notice -to the St:Jperintendent of Highways.
Permit must be available foririspection.
Page 2 of 3
~ on
KEYSPAN/&-~
REQUEST FOR STREET OPENING PERMIT
o ~~~N~~K 1;(1 S~1fkutJ
PERMIT. MIS JOB~ DATE / /
NO. NO. . /100& 7 Z. 40z. l? Z. l-DD I
LOCATION (}.ON'D ()l d, - ;.W[ P:S ~s:s Att~ -+ II Ttsl'r/Da 1'# 1Jf~ ~])
REASON FOR ".." L2. -IJ
OPENING ItilA fYJU- 1ltt: f-LuJ/.Ic r"lti>>.4.tY c m/JS/iL A 6frS An: u,.lJq( Tlfg ~~'IJ
bD1H Mfdc)( I o' e.-Io tJJJ-rit UuU u~ ,)) fAld.tL ~~~~I~~ !>(;Z1/6/
REQUESTED I ~ ;/ DEPARTMENT DIV ION
BY VJ/v' -.J?lfu72- GAS CONSTR. MAINT. & SERVICES C 'G&tLZ 7.;p -.s"/~
DATE
FC-6111.4
o STATE
O NASSAU
COUNTY
APPROVED
SKETCH
E
~
- .
M\
\'\\
~
~
R'
Date: 08/06/01
Transaction(s}:
,
1 Permits
Cash#: 1271
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of South old
P.O Box 1179
Southoid, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1271
Subtotal
$55.00
$55.00
InternallD: 38051