HomeMy WebLinkAbout1450 Horton Ln
Date: 06/13/01
Transaction(s):
1 Permits
Check#: 1240
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of South old
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1240
Subtotal
$45.00
$45.00
IntemallD: 34077
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".file No. I
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TOWN OF- S;'>U,,'HOLD
HIGHWAY DEPARTMENT
Pcconic LtlnC
Peconlc. New' YOI"'J< -11950
(SlG) ,7G5~31qO
P.o,lOo'!. /7&
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY ",.de to tlie Superintendent of Highways of the Town
of SouthoJd fer" the iSSUilnc.o of an Exc;avri~iort Permit pursuant to Chapter 03 of the
Code of the Town of Southafd. SufrolllO: County, New York, .-nd other applic:ablc la1N's,
ordinances or regulations (Of" the e;(~vi\fion herein de$crlbeda The. applicant agreos
to cornp.ly ".,ith an applicable laws, ordina~'~s, codes and regulations.. and lo p~rmit
author-bed inspectors to make.; nccessa~\inspcctlons of the jOb site.
Print or Type
1) ImY SPAN ENf.RGY 1,4R F.....~T HAm STltERT
Name of Applicant
PATcnnr.UF., Nr:W YORK
Address
11721
2)
Address
~o u 1\.." I :J
Hamlet, Cross StrOl!:t)
Name of Owner of Premises
/ 1.../ J:}b r-b t'C--/7) ,.J L /1+ :,'
work Description and Location (Street NUfI1bc:r,
e
3)
(oj
..'
1'5 construction located within :75 feet of. tid9l1 wetlands? *Vcs_No
*1 ryes, other"'""'!own permits may be requi red.
11) Builder's Liccr'ls~ No.
Plumber's License. No.
Electrician's LIcensc: No.
Other Trade's License No.
5)
a) Attach plot plan showing location .o.f proposed. i!X'CiI..r.JUon and relUionshlp to
adjoining premises or public "stre..cts or areas, and giving a deta.iled descrip-
tion of layoul of eXC":Jvalion. .' =."
b) JHrnch all other ne:cc5sary pcrrni~s :Jnd 1ic::~n5es ror this P,.ojcct.
c) Work covered by thi5 ~ppJic..lliDii m:JY not commenCe before issuance of ..
Highway E)(cnv~tion Permit by the Town CI~rk.
6)
lax Map: Saction
Blbcl<
. Lot.
7)
0)
COmpletion DElle
Starling Dllte:
Work Schedule;
Pha \. CompleUon Dute
~ ..'\ -
Excavation....................... ......................
,
Fat::ility Installation.... .~.. ... ..:..... ....~..... ..... I
..' .
Backfill & Compaction.........:......................
pnvement RepJill;cment....... .~..'.""'''..'''.'...'...
Under which ....thorily is the appliea,tion made:
Eslimated CoSl of Proposed Worlc: ' $
Remarks:
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P"flP. 1 or :i
mSSSL m:13l
H~LYd NDIS30 SYD OS
61>:60 (30L) 10 ,lI- 'NOr
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12) Insunncc Coveraqt!: (A un!;n copy).:..,
a) Insuranc:c Company;
b) poliey I ...
c) State whctht:r polic:y or ccr,tification on. fil~ with the Highway Depart-
ment:
d) Coverage: reqlJir-ed e)(.tcnd~~. to the Town;
Bodily injury .nd prope':t,! damage: $300.000/$SOO.OOO Bodily Injury,
and $50,000 property r;l.~age.
13) Security:
.) Surety Bond
toto1 amount of $
b) Maintenance Bond pn:n/ided.:
Dr "Certifieil Cheek
provided in the
3 ye3~5
2 YCilrs Dr
111) F~e5 for llppllciltions and oer-rnits: Bilsic ADPliciJtion Fee........$25,OO
N
A ,. IScrviC:,e. Connections. c.xc;aviltions (I $20.00 :;;; S 2- 0 -
~
Al.
IAdditional EXC3viltions same sCr"Vlce @ $10.00 =: $
~ "
E)(eavatians 1011 In depth 'o'r. .Iess:
0-100 I.r. ~ $10.00 ,-
I.f. 0 $0.10 -':$
Additional
Exc:ovations...1.O'1 in depth to S' In dc'pth:
0-100 I.r. ~ $30.00
,I.f. ~ $0.30 ~,)
Addi tio"al
Excavations 5' in depth and over:
1)-100 1. f. ~ $SO.OO '.'
I.r. Il $0.50 '7::$
Additional
B.
'C.
O.
1:.
Utilily Rop.ir.,:Excov.t1ons 0$10.00 ~ $
1'10.
.--
Rcpairs same. s"C!rvlcQ ,@ $5.00 = $
Additional
F.
Notice to public: 'utilities proOf must be provided and
this appllcation prior to is~uance of permit.
"
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attaehed to
<:!!-
~OT^L CO~'l' !
yr:
Authorization Is hereby granted to tllo Town Clerk or tho Town of Southold to
issue a Highway Excavation Permit to:
In accordance with ..this application.
TElolOENT OF HIGHWAYS
SOUTHOLD.. NEW YORI(
(p _ (;L -0 /
Date
RecelVed by the Town Clerk
tp/nJ/dj
Date.
/07
Permit Issued~'
(, //J /61
Date .
.Permit No.
~;
Permil expires Dna (1) year r~Om Date of Issu.nce.
No work to stort without 110 hour notica .to the Sl;Iperintendant of Hlghwoys.
Permit must be aVililabll for In5pocticn.
Page 2 Dr 3
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PERMIT
NO.
LOCATION
IEASON FOR
OPENING
W.O./PA
NO.
1EQUESTED
BY
APPROVED
SKETCH
'0-
KEYSPAN/.v-Af
REQUEST FOR STREET OPENING PERMIT
.
o STATE
o
NASSAU
COUNTY
MIS JOB
NO.
HoI.1i>,J LA. ~ ~a- E/s IkI~
.s;,..(?~a
FOREMAN
O SUFFOLK
COUNTY
C.4 iJfP6Jc ,
DEPARTMENT
GAS CONSTR. MAINT. & SERVICES
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