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Home My WebLink AboutIndian Neck Ln . Permit ~o.-iA-r . FiI c NO.--/..-.!d-L Ref. u-r/000300"~ TOWN Or- S;JlJ fHOLD H IGHWA Y DEPARTMENT pcconic Lane Peconic, New' Yorl< '11958 (51G) 7GSc31110 P'o.t2>o~ 17f> , APPLICATION/PERMIT FOR HiGHWAY EXCAVATION AND REPAIR APPLICATION is HEREBY mode to the Superintendent of Highwoys of the Town of Southold for the issutmce 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 excava,t,i~n herein described. The applicant agrees to comply with all applicable laws. ordina.~ces, codes and regulations, and to permit authorized inspectors to make; necessary __inspections of the job site. Print or Type 1) KRY SPAN ENERGY ~~E EAST MAIN STREET Name 0 Applicant PATCHOr.UF. Nm-1 YORK Address 11727 2) Address (Jp COt...J I C. Hamlet, Cross Street) 3) Name of Owner of Premises "J"Alci'AN NIUIc'. LI'rN~ Work Description and Location (Street Number, ~ , (0) 1's construction located within '-75 feet of tidal wetlands? *Yes No *If yes, other--"!own permits may be required. II) Builder's License No. Plumber's License No. Electrician1s License No. Other Tradcls License No. 5) a) Attach plot plan showing locati'on .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 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 Clerl<.. G) 71 Tax Map: Section Blocl< , 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) Estimoted Cost of Proposed Work: $ 11) Remarks: \ 0-11) Paqe 1 or ~ . . .'2) Insurance Coverage: (Attach copy). a) Insurance Company: b) Policy R c) State whether policy of cer:ti(jcation 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 or Certified Check total amount of $ b) Maintenance Bond provided: 2 yea rs or provided in the 3 years 111) Fees for applications and permits: -L-/Scrvicc Connections No. . Basic Application Fec........ $25. 00 excavations @ $20.00 = $ 02 o. (JV A1. 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 Excavations...l811 in depth .tQ '51 0-100 1. f. = $30.00 /I 3 0 . I. f. @ $0. 30 =. $ Addi tional D. Excavations 51 in depth and over: 0-100 I.f. = $50.00 I.f. @ $0.50 ='$ C. in depth: ,.i) 3 '37. Additional E. Utility Repai~.Excavations @$10.00 = $ No. Repairs same s'ervicc -@ $5.00 = $ Additional F. Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. ~ * * i. t.f/v TOTAL CO~T. ~ Authoriz~tion is hereby granted to the Town Clerk of the Town of Southold to Issue a Hi9hw~y Excavation Permit to: in ~ccordance wi th ~this application. s\:lPERINTENDENT OF HIGHWAYS TOWN OUT HOLD. NEW YORK aymond L. J~co q-C(-Oj Date Received by the Town Clerk '1- 'i - :M Date Permit Issued,' L/-S' ~O( Date /IJI Pcrmi t No. ~: Permit expires one (1) year fr:om Date of Issuance~ No work to start without 118 hour notice -to the St:.lpcrintendent of Highways. Permit must be available for inspection. Poge 2 of 3 - , , FC-6111.4 PERMIT NO. LOCATION REASON FOR OPENING W.O./PA NO. REQUESTED BY APPROVED SKETCH ~l ~ KEYSPAN/619> REQUEST FOR STREET OPENING PERMIT eSTATE D MIS JOB DATE NO. ~tJ()tJ 3006.2 3 213 .;Lool f;.JblA-1I J./&K "" - -1?1E..../oI.f,.d,G..&~.s' .,t"A: /2304~~/~6- r ftlJL.1/1 /"#I&~u~~ ~/.J11l.lJ&-41;1C ,;cI,4ttMI<:: FOREMAN DATE OF _ II /. OPENING -r1/O/<iI. O~I DEPARTMENT DIV ON GAS CONSTR. MAINT. & SERVICES ~(stlE 7 S8:9~ DATE t\ tY ..... :);:>" ~ ~ I" '" NASSAU COUNTY :s; lA THd1l.b D SUFFOLK COUNTY [RJ g~;))i /~tJ-~Z-/r' 3 N {tz- tA. WlA-;,J IJ.. 4'1& ~ ~M' .ti 25 - -t''.srL I i :z; cf" ""1:~"1iL I ~ I I I I I I I SJ/f.E.1" / ~I ~ su ,4 .., ~ U ..J/4a7' ~ I I It It I CN-1..t3 'J A(()ft1/{ ttJl.UrlJa. I 7/) i:t:.ilM(),J~ slkta I 2:dWlClNb LII, I 1\1 I ~ "" I l WO -li-1/0{)()JOM.Z LS-t;'Ua 1 /IJO-/'2" / + 3 I fJi3Cf) /.1/c. ~ Stla'/ Z /)/3 , I>'" - , 1;--\ :t> 1- ~ ~ ~~ g ~ l"- 'I 'l":::. I ~~~ 1 I ~~&A ~ ft\ ..... r..: I ;;-t:..rFtlI\ 1 ~ ~ ~~~~ I ~~, ~ I r- --. ~ ::::. I c::::. '~ ~ ~ b~ t ~ I ~l~ I I I ~ I V\ I j .set.. SHfer :P 3 :5 ~f2.iNIs- LAuE Date: 04/05/01 Transaction(s): Name: Clerk 10: L1NDAC 1 Permits Check#: 1180 Key, Span Energy 448 East Main Street Patchogue, NY 11727 Town Of Southold P.OBox1179 Southold, NY 11971 * * * RECEIPT * * * Receipt#: Total Paid: 1180 Subtotal $414.00 $414.00 Intem.IID: 29479 . Key, Span Energy 448 East Main Street Patchogue, NY 11727 Received $ 177 .00 ELIZABETH A. NEVILLE, TOWN CLERK Town of Southold Southold, New York 11971 Phone: 631-765-1800 RECEIPT #108 1 - Permits on 06/14/2001. Thank you. Permit ~o.~ 'File NO.LU.L TOWN OF S;)0. I'HOLO H IGHWA Y DEPARTMENT Pcconic Lane Peconic. New' Vorl< -11953 (51 G) 7G5c 31110 Po. /2>0,," /7E> Ref. U-rl 0005-511.:) 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 iln 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. ordina.n'ces, codes and regulations, and to permit authorized inspectors to niake; necessary "inspections of the job site. Print or Type 1) KRY SPAN RNRRGY ~~R RAST MAIN STRRRT Name 0 Applicant PATcnor:UR NF.\" YORK Address 11727 2) Name of Owner of Premises -rJ J- d . A-- 1J l' <- IC Work ascription and Location l-.+ (Street Address Pe L C)"J, c- Number, Hamlet, Cross Street) 3) (a) t"s construction located within ',75 feet of tidal wetlands? *Yes No P *If yes, other--Town permits may be required. II) Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No. 5) a) Attach plot plan showing location .of proposed. ex.cavation and relationship to adjoining premises or public .stre,ets or areas, and giving a detailed descrip- tion of layout of excava tion. b) Attach all other necessary pcrrili,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) 7l Tax Map: Section Block , Lot Completion Date Starting Date: 0) Work Schedule: Phase Completion Date Excavation...................... ..,~................. Facility Installation.............:.................... Backfill & Compaction......... ~. . .. . .. ... . . . ... .. .. Pavement Replacement........ ":'_ ~ . .. . .. . . . . .. .. . .. . . 9) Under which authority is the applica.lion made: 10) Estimated Cost of Proposed Work: $ 11) Remarks: \. 0-1f1 P.lC1C 1 of 3 12) Insurance Coveraqe: (Attach copy): a) Insurance Company: b) Policy<< c) State whether policy of ce-:tification on, file with the Highway 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: a) Surety Bond or Certi fi ed Check tot<ll amount of $ bl Maintenance Bond provided: 2 yea rs or provided in the 3 years 111) Basic Application Fee........ $25. 00 excavations @ $20.00 = $ Fees for applications and permits: A 1. /Service Connections Ne:- A2. /Additional Excavations same service @ $10.00 = $ Ne:- B. Excavations 1811 in depth 'o'r: less: 0-100 I. f. = $10.00 .. I.f. @ $0.10 -:$ Additional C. Excavations...1'a" in depth tQ51 in depth: 0-100 I.f. = $30.00 . I. f. @ $0. 30 ='. $ Additional D. Excavations 5' in depth an~ over: 0-100 I.f. = $50.00 1.f. @ $0.50 ='$ Additional E. Utility Repair -Excavations @$tO.OO = $ .' No. Repairs same service -@ $5.00 = $ Additional F. Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. (. (JJ * * *' TOTAL CO~T' $/ --"l7. 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. DENT OF HIGHWAYS UTHOLD. NEW YORK aymond L. Ja (; - ",4 -- 0/ te Received by the Town Clerk ~ INk; Daie /Q? Permit Issued,' ~ /N/I) ( . Date Pcrmi t No. ~: Permit expires one (1) year fr:om Date of Issuance. No work to start without ll8 hour notice .to the Sl:Iperintendent of Highways. Permit must be available for inspection. Page 2 of 3 n 0" L-" " ~ '~..... '~d "~ "- " FC.61 1 1.4 PERMIT NO. LOCATION REASON FOR OPENING REQUESTED BY APPROVED SKETCH E, ~~ ,... r~ C:t> ~E... j'Itl' r(' 1'f=. It\-- c. r.- l' J 11\ ff. ~ ::\ ~ ~ ~ !-'\ l;~' ~ ~~ ~ KEYSP AN/'?-I1S REQUEST FOR STREET OPENING PERMIT O NASSAU 0 SUFFOLK I.A r-r?} COUNTY COUNTY I2::l.JD <... ,pp{JJ MIS JOB DATE I' / NO. 1IoIJO 553 5 6 7/,).,001 .r 1J/~,J JEtt lA-.- --IE.' .52. u1li' .J,t. #bM.1IU ~, f~tf- /f/ 'f. NtU1ll iA/'/i,usj'"' ~I sAt;'/e-LA. 6vNrf ~..tl7l ~,.lLJsJ' 77-IE. ;Ji(./EC;: AA ~LE:OI 'Je ~ 1l!f&.AA' /;/ l:~~),L. ~~~~I~~ 6 /.:2S / ~ I ~lIip ~du1i ~;~AC~~S;NR~ MAINT. & SERVICES D~1J;;o6t/t: 7S"J>-.5/~ DATE o STATE GiJh.c /1)1) - ~2 - 3 N ~ t\ ~ ~ I -- ~ . ~ ~ I ~ 11L,'rJ1f I LAJi.. ,...... ~ I I I 1-;-\ ~ ~~,. ~~ '~ I I I I I I rcr~r ~ '" /c~ "- " '- -- - --. ~ ~1iLE-f t ~Eaa.'c ~ /'>1i..f1i1- If -r/<A1tt.'Z-. /f;