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HomeMy WebLinkAbout985 White Eagle DrTown Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 05/23/01 Transaction(s): 1 Permits Receipt~: 1223 Subtotal $55.OO Check#: 1223 Total Paid: $55.00 Name: Key, Span Energy 448 East Main Street Patchogue, NY 11727 Clerk ID: LINDAC Internal ID: 32575 Permit No.~ File No. J ~'~ Re. TOWN OF 5;JUi'HOLD H IGI4WAY DEPARTMENT Peconic Lane Peconic, New' York 11958 (516) .765; 31q0 ~o.~o~ ~7~' APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of tlne Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the Code of the Town of $outhold, Suffolk county, New York, and other applicable laws, ordinhnces or regulations for the excavation herein describ6d. The applicant agrees to comply with all applicable laws, ordinal'res, codes and regulations, and to permit authorized inspectors to mbke; necessary.,in~pectlons of the job site. Print or Type 1) KEY SPAN ENERGY' /,4~ EAST MAJ'N STREE'~ pATEUOCUE~ Nm/ YORK 11727 Name of Applicant Address 2) Name of Owner of Premises Address Work DescripLion and Locadon (Street Number, Hamlet, Cross Street) (a) Is construction located within ~ feet of tidal wetlands? *Yes No *If yes, other"Town permit~ may be required. ti) Builder's License No. Plumber's License No. Electrician's License No. Other Traders License No. 5) a) Attach plot plan showing Iocatioh .o.f proposed, e~cavation and relationship to adjoining premises or public's~?ts or areas, and giving a detaile~ descrip- tion of layout of excavation. ~:. b) At[ach all other necessary permits and licenses for this project. c) Work covered by this appli~tlo~ may not commence before issuance of a Highway Excavation Permit by.the Town Clerk. 6) Tax Map: Section" , BlOck , Lot' 7] Starting Date: Completion Date 8) Work Schedule: ~ ' Phase ~ ' 9) lO) 11) Facility Installation ................................. Backfill & Compaction .............................. Pavement Replacement ........ ;. ~ ................... Under which authority is the appM~ation made: Estimated Cost of Proposed Work: ' $ Remarks: ".' ' Completion Date t2) 1 3) 10) Insurance Covera.cje: (Attach copy).: a) Insurance Company: b) Policy ~ c) State whether policy of certification on file with the Highway Depart- d) Bodily injury and proper'ty damage: and $50,000 property dAr~age. Security: a) Surety Bond or'Certified Check provided in the total amount of $ b) Maintenance Bond provldedi 2 years or 3 years Basic Application Fee ........ $25.00 Fees ['or applications and permits: Al. /,/Service Connectlons.:excavations 0 $20.00 = A2. / /Additional Excavati~os same service No B. Excavations 18" in depth 'oF less: · I.f. @ $0.10 Additional ' 0-100 I.f, = $30.00 · l.f. ~ $o.3o Additional D, Excavations 5' in depth and over: o-10o I.f. = Sso.oo ,. [.f. e So.so Coverage required extende~ to the Town: $300,000/$500,000 Bodily Injury, Notice to public utilities p~of must be provided and attached to this application prior to issuance of permit. Additional E. Utility Repair.Excavations e$10,00 No. · Repairs salae Service 0 $5.00 Additional F, Authorization is hereby granted to the Town Clerk of the Town of Southold to Issue a Highway Excavatio~ Permit to: in accordance with-this appllc~tion. .." ~",PERIN~T~ENDENT OF HIGHWAYS ~'~, 2 ~' Raymond L.~fcobs Received by the Town Clerk Permit Issued\' Date Note: Date .,. Permit No. Permit expires one (1) year fK~m Date of Issuance. No work to start without q8 hour notice 'to the Superintendent of Highways. Permit must be available for ihspection. Page 2 of 3 KEYSPAN/~3 REQUEST FOR STREET OPENING PERMIT STATE ~'~ NASSAU SUFFOLK COUNTY ~] COUNTY PERMIT NO. LOCATION REASON FOR OPENING W.O./PA NO. REQUESTED BY APPROVED MIS JOB~-~- No. '/iZ::~ FOREMAN DEPARTMENT GAS CONSTR. MAINT.& SERVICES OPENING D,~)~,~./~SIO" DATE SKETCH N ~sTOWn Of Southold P.O Box 1179 outhold, NY 11971 Date: 09/14/06 * * * RECEIPT * * * Transaction(s): 1 1 Permits Reference 463 Subtotal $0,00 Cash Total Paid: $0.00 Name: Verizon, Communications 501 N. Ocean Ave Patchogue, NY 11772 Clerk ID: LINDAC Internal ID: 463 fl~/14/2006 TH[' 09:02 FAX 63144Z0416 VERIZON 501N.OCEAN SEP ~4 200~ 09:~ PRGE.02 r~P 1~ lq'C~ 00:46 6314470416 VERIZ©N 501 N OCEAN 4:35 09-20-2006 2/8 Notification of Request For Emergency Permit CellPhene: Eastern suffolk. ?dUST fax :ompiemd form to; Elizabeth Brady Fax ~ (631) 687-8512 'IT # or Job #: ,, Specify: ~].Town Road ~ Emergency 1. Nearest ctoea 8treat 3. ~pro~ a~ ~ extortion 4. ~ng on: (check ~e) ~ 31dewalK ~Road 5. Call~ fetTle & M~ ~ y~o C~e* __ 6. ~a~ Io~flon of s~lice pit ( Front of ~use ~ ) Central Office: ~ ~'~'~ , ¥o,,.:' .. Village: Out of Sm'vice [~Temp Service I ~' IGras~ Ral. # FOr '~vOrX being performed in the ;own of Srookhaven, please indicate customers property iine. SPEGIAL CONDITIONS ** TOTAL PAGE.~i ** 63144)'0416 VERIZON 501 N OCEAN 631.4470,416 VERIZON 501 N,OCEAN ~)003/005 3504 09-20-2006 4/8 ) ~4 0g-I 3-200§ 3 f5 A~.~e~ by the ToU~n Clerk.__.-----D~t-T~-- - SEP 14 2006 09:10 PRGE.O~ 6314470~16 · · VERIZON 50i NOC:N~.4~ 'p~v~mlt N'-..~-~~ ' pzg~. i c~ 3 PRG~. ~4 63~i 44r0.416 VERIZON 501...N OCEAN,~a~ 1/O3 '06.WED 13:$~ I,'A~ ed~. , .... ~ 1:34:54 09-13-2006 a) ineur~nc~ C~mpany:_ ,,. 3) 5uraW ~_ - ~1o8 I.f. = ~ddi~ 3/5 Autl~rlzt'tioh is hereby gmnt~ to the Town clerk of tho ToW~ ~ ~d m SUPERINTE"DENT OF HIGHWAYS TO~ ~.OL~" yORK pm-~lt IsSue~D/te -- . Page 2 of 3 p~&E.05 6314470416 VERIZO~N.5~01 N OCEAN,4Bb' 111:35:06 09-13-2006 4/5 Zrd__ IN se E CT O R'..~ RECOR ~. Date Flndlr~ I (use Applicant Not~fied _REd, ARKS_ CODE Paga 3 of 3 6314470.4~,6 , VERIZON 501 11:35:12 09-13--2~(~6 - 5/5 Office Phone: Cell Phone: Specify: ~---] Town Road ~] Emergency Notification of Request For Emergency Permit Eastern Suffolk. MUST fax comp/°ted form to: Elizabeth Brady ?ax '~ 1631) 681-8512 TT/; or Job #: Csn~'al Town: Village: ~ O~t Of ~e~l/Ice ~ Temp ~ervice Information R®qul ce.d.: 1. Nearest Cro~a o~t 2. OiMance to ~o~u~t cro~ etreet 3. ~pro~ ~ ~ ~c~on ~ ~v~ng on: (c~ck ~e) ~ Sidewalk ~Road 8. ~ ~aUon of apl/ce ~t ( Front of hou=e ~ ) NOTE"' RM. # For '//orX being performed in the ,'own of Sroo;~haven, A/ease/nd/cate customers proper~y ilne, i ** TOTAL PAGE.Bi