HomeMy WebLinkAbout425 Marratooka Ln
Date: 06/04/01
Transaction(s):
1 Permits
Check#: 1228
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk 10: L1NDAC
Town Of South old
P.O Box 1179
South old, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1228
Subtotal
$45.00
$45.00
Internal 10: 33322
i:;W:~;>;/ ...
Permit No. J...A.-/;.
File NO.1YE-
Ref.
TOWN OF S;)U ,'HOLD
H ICHWA Y DEPARTMENT
Pcconic Lane
Peconic, New'Vorl<: 11950
(516) 765c31l10
P.0.0o'l- ,76
APPLICATION/PERMIT FOR HICHWAY EXCAVATION AND REPAIR
oT!ooo5WIS-
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of $outhold for the issuance of an ExcnvaUori Permit pursuant to Chapter 83 of the
Code of the Town of Southold. Suffoll< County, New York, and other applicable laws.
ordinances or regulations for the excavan~n herein described. The applicant agrees
to comply with all applicable laws. ordina.nces, codes and regulations. and to permit
authorized inspectors to make: necessary \inspcctions of the job site.
Print or Type
1) KRY SPAN ENERGY 44R EAST MAIN STREET
Name of Applicant
PATCllOGUE, NIlW YORK
Address
11727
2)
Address
Name of Owner of Premises
'-/ 2~ fV1 A~(\-T rld (CA
Work cscription and Location (Street
t... A .-- vVI t+ ni Tt..(c ,~
Number. Hamlet. Cross Street) ~
3)
(a)
fs construction located within "75 feet of tidal wetlands? "'Yes_No ro
*If yes. other'!~wn permits may be required.
II) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
lieant
5) al Attach plot plan showing locati'on -of proposed- c){cavation 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.
6)
7)
Tax Map: Section
Block
, Lot
Completion Date
Starting Date:
8) Work Schedule:
Phase
'\
Completion Date
Excavation.... ... ............... '"~''''''''''''''' ..
Facility Installation........... ::....................
Backfill & Compaction.........:....................
Pavement Replacement........ '. ... ... . .. . . . . .. .. . .. . .
9) Under which authority is the application made:
10) Estimated Cost of Proposed Worle $
11)
Remarks:
,.
0-1'1
PClClC 1 of 3
12) Insurance Coverage: (Attach copy).
a) Insurance Company:
b) Policy"
c) State whether policy of cc-: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 dillnage.
13) Security:
a) Surety Bond or Certified Check
total amount of $
b) Maintenance Bond provided: 2 yea rs or
provided in the
3 years
11')
Basic Application Fee........ $25. 00
excavations @ $20.00 = $ dO. C.l
Fees for applications and permits:
A 1. -L-/Scrvicc Connections
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-..lD" in depth to -5' in depth:
0-100 I.f. = $30.00
I.f. @ $0.30 ~,$
Additional
D. Excavations SI in depth and over:
0-100 I.f. = $50.00
I. f. @ $0.50 ="$
Additional
Eo
Utility Repair,Excavations @$10.00 = $
No.
Repairs same service '@ $5.00 = $
Additional
F. Notice to public utilities proof must be provided and attached to
this appliciltion prior to issuance of permit.
* * *
,y~: (lJ
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 applictition.
Sl:lPERINTENDENT OF HICHWAYS
TOWN 0 SOUTHOLD, NEW YORK
/ '
s - 3~ - <' I
Date
Received by the Town CierI<
s /8 1/0 (
Dat~
10 &,
Permit I ssued\ .
~1<l1(J (
Date
Permi t No.
~:
Permit expires one (1) year fr:om Date of Issuance.
No work to start without Jill hour notice -to the St:Jpcrintendcnt 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
-
~
I . .;
KEYSPAN/~;1S
REQUEST FOR STREET OPENING PERMIT
D STATE
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DEPARTMENT
GAS CONSTR. MAl NT. & SERVICES
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