HomeMy WebLinkAbout1325 Marlene Ln
Date: 07/13/01
Transaction(s):
Town Of South old
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
1 Permits
Cash#: 1249
Total Paid:
if/oy
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
1249
Subtotal
$45.00
$45.00
Internal 10: 36691
Permit No. 'tJ1
. File No. /
Ref.
TOWN OF S;Jl.Ji'HOLO
H IGI-IWA Y OEPARTMENT
Pcconic L~nc
Peconic, New. York -11956
(51G) 7G5c31110
P. O. /2>0'1- Of:,.
'.
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
n"Tl DO- "31?Y
APPLICATION IS HEREBY mode to the Superintendent of Highways of the Town
of Southold for the isslIilncc of iln Excilvatiori. 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 excavafion herein described. The applicant agrees
to comply with all applicable laws, ordini(i:"ces, codes and regulations, and to permit
authorized inspectors to make; necessary\inspcctions of the job site.
Print or Type
1) KF.Y SPAN ENERGY 44R EAST MAIN STREET
Nome of Applicant
2) I ?,,,;1.s- rY1,4iC(~o/~ L;a
Name 0 Owner 0 Premises
11727
PATCllOGllE , Nm~ YORK
Address
..)dS< L C, A- c, <> 7/--
Address
3)
13~ 1/ It,) L. t:!J
Work Description and
S/..
Street)
fL... /'J1 ,</-f...J ,eQ
fl ~ rr.....c.4-
Location (Street Number.
I .;J..,Fv
Hamlet. Cross
(a)
1's construction located within '-75 feet of tidal wetlands? *Yes No
*If yes. other~.T'own permits "may be required.
II) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
"
s) a) Attach plot plan showing location .of proposed,el(covation .nd 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 perml,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)
7)
Tax Map: Section
Block
. Lot
Completion Dille
Starting Date:
8) Work Schedule:
Phase
Completion Date
Excavation. .. . .. . . . . . . . . . . . . . . . .. '.,: .. . . . . . .. .. .. . . . .
Facility Installation.................................
Backfill & Compaction.........:....................
Pavement Replacement........ ~:', '....................
9) Under which authority is the applic.tion mode:
10) Estimated Cost of Proposed Work: $
11) Remarks:
\
{)-1"
Paqo 1 0,( ~ .
'12) Insurance Coverage: (Attach copy).
a) Insurance Company:
b) Policy II
c) State whether policy of ce~tification on, file with the Highway Depart-
ment:
d) Coverage required extend~,~ to the Town:
Bodily injury and property 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 years or
provided in the
3 years
lIt) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. -L-IScrvicc Connections. excavations @ $20.00 ::: $ ao p:"
No.
A2. IAdditional Excavations same service @ $10.00 ::: $
"NO:-
B. Excavations 1811 in depth 'o'r: 'less:
0-100 I.f. ~ $10.00 ..
I.f. @ $0.10 -.$
Additional
'c. Excavations...la" in depth -to -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~.Excavalions @$10,00 ; $
No.
Repairs same service'@ $5.00 ::: $
Additional
F. Notice to public utilities proof must be provided and attached to
this applic<ltion prior to issuance of permit.
'"
. . .
TOTAL CO~T' ~ Y s::
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.
-NDENT OF HIGHWAYS
SOUTHOLD, NEW YORK
1/7
Raymond L. cobs
'7-s-0(
Date
Received by the Town Clerk
"7/1 ~ll)(
. Dat~
Permit Issued,. 7 1t.3 / (j (
J Date
. Pcrmi t No.
~:
Permit expires one (1) year fr:om Date of Issuance.
No work to start without 110 hour notice .to the Sl:Iperintendent of Highways.
Permit must be available for inspection.
Page 2 of 3
FC-6111.4
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W.O./PA
NO.
REQUESTED
BY
APPROVED
SKETCH
M 4/;.1
KEYSPAN/~~
REQUEST FOR STREET OPENING PERMIT
o STATE
o
NASSAU
COUNTY
O SUFFOLK
COUNTY
~
;N yV\A'"~ 7Ut.f(
FOREMAN
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7- ' -...S-;s4
, ~ 1/ __ DEPARTMENT
V//I ....J?/fUIZ- GAS CONSTR. MAl NT. & SERVICES
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