HomeMy WebLinkAboutOld Main Rd, Orient
f)- ~9
,"
-'
Permit No;
}Jrf
TOWN OF 5pU "HOLD
HIGHWAY DEPARTMENT
Pecon;c Lane
Peconic, New' York 119SB
(515) ,76S~31'10
PO, 12>0,!- 175
File No.
Ref. II ~ 3-0 1'f5f 'oJo
,
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 an Excavation Permit pursuant to Chapter Bl 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 ail applicable laws, ordinahces, codes and regulations, and to permit
authorized Inspectors to make; necessarY"i,nspectlMs of the jab site.
Print Or Type
1) KEY SPAN ENERGY 448 EAST MAIN STREET
Name 0 Applicant
2)
PATCHOGUE Nffi. YORK
Address
11727
l)
Name of Owner of Premises
Address
RJ-
c)f'l{~ ~(
No 7
(a) ,Is construction located within is feet of tidai wetlands? 'Yes'
*If yes, other-Town permits may be required.
lIJ Builderls License No.
Ptumberls License No.
Electrician's License No.
Other Trade's License No.
rJY\.:i,j J~~_~
Signature 0 Art
, 1-9-0/
Date
5) a) Attach plot plan Showing iocation of proposed, eXCovotion and relationship to
adjoining premises or pUblic streets or areas, and giving a detailed descrip-
tion of layout of excavation.
b) A ttach all other necessary permits and licenses for this project.
cJ \Vork covered by this application may not commence before issuance of a
Highway Excavation Permit by the Town Clerk.
6)
7)
B)
Tax Map; Section
Block
I Lot
Starting Date:
Work Schedule:
Completion Date
~
Completion Date
\,
Excavation, ". .. . .. . . .. , . .... . . . \... . . ... " . . '" . . ,
Facility Ins tal/ation. . , . . . " . . . ;'. . . . . . . . . . . . , . . . . . . . .
Backfill Eo Compaction.........:....................
Pavement Replacement........ ':,.. '" , .. .... " '" ....
9) Under which authority is the .pplic~tion made:
10) Estimated Cost of Proposed Work: '$
11) Remarks:
\'
12) Insurance Coverage: (Attach copy)..
a) Insurance Company:
b) Policy #
c} State whether policy of ce'~tjfication on file w
ment:
d) Coverage required extende~ to the Town:
Bodily injury and property damage: $300. 00/$500,000 Bodily Injury,
and $50,000 property damage.
:
13)
Security:
aJ Surety Bond
total amount of $
b) Maintenance Bond
provided:
or ~ertified Check
1 ~)
Fees for
Basic A
the Highway Depart-
rovided in the
2 Y
3 yea rs
s or
applications and permits:
I IService Connections e'xcavatlons @ $20 0 = $
~
-J,,-/Additional Excavations same service @ .10.00 = $
Ii tlon Fee........ $25. 00
~O. ().J
/ #/"
Al.
A2.
B. Excavations 1811 in depth 'o'r: less:
0-100 I.r. = $10.00
I.r. @ $0.10 -.$
Additional
C. Excavatlons","8" in depth to 5' in depth:
0-100 l.f. ~$30.00
I. f. @ $0, 30 = $
Additional
D. Excavations S' in depth and over:
0-100 I.f. ~ $50.00
I.f. @ $0.50 ~'$
Additional
E.
No.
Utility Repai:"ExcavBtions ~$10.. = $
Additional
Repairs same service '@ $5.00 =
F. Notice to pub/icutilities proof must be prov!
this application prior to issuance of permit.
* *: #C,"
Authorization is hereby granted to the Town Clerk of the
Issue a Highway Excavation Permit to:
in accordance with ~this application.
Received by the Town Clerk
Date
.' Permit No. ~ y
Permit Issued,/ -/~rO(
Date
and attached to
TAL CO~<r" S 5 S. aQ
n of Southold to
o
Dal
~:
Permit expires one (n year from Date of Issuan
No work to start without 48 hour notice 'to the erintendent of Highways.
Permit must be availab/e for Inspection.
Pfl~e ~ cf 3
KEYSPAN
REQUEST FOR STREET OPENING PERMIT
Fe-5111A
D STATE
D NASSAU
COUNTY
D SUFFOLK .-I ~ (;. .sacJ1'I1~l-11
COUNTY ~
PERMIT IIMIS JOB IDATE 1- 6 -0 I
NO. NO.
LOCATION ~!~ oj.. "';/5 O!..Q, 1--t9,.AI ~ ~ ~ lio I f..J/O rl4,;J ab 0;2 tr N'/
.
REASON FOR .s ~(I. vIet.- ,
OPENING vL " (;. /lA. b 'L--
W.O.lPA Z >-07l.{C)g-- 030 FOREMAN I ~ATE OF /).,SAf>
NO. OPENING
REQUESTED D~rv DEPARTMENT I DIVISION G ~
BY MA- R. ~ GAS CONSTR. MAINT. & SERVICES Ch~ - z-L/
APPROVED IDATE
~KETCH
~~I\)~ IIL/-SK- 0'1'17-
N
(l't>
MlwJ
t2~
Date: 01/16/01
Transaction(s):
Name:
Clerk 10: L1NDAC
1 Permits
Check#: 1108001108
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Town Of Southold
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
o
Subtotal
$55.00
$55.00
Internal 10: 24732
Permit No.
File No.
913
Ref.
TOWN Of' S;JlJ.,'HOLO
H IGI-IWA Y DEPARTMENT
Pcconic Lane
Peconic, New' Yorl(119S8
(516) 765c31l10
P'0.00'l- /7b
APPLICATION/PERMIT FOR HIGHW'AY EXCAVATION AND REPAIR
HI/()"{',JJ'i73
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issuance of an Excavation Permit pursuant to Chapter 83 of the
Code of the Town of Southold, Suffoll< County, New Yorl<, and other applicable laws,
ordinances or regulations for the excavation herein described. The applicant agrees
to comply with all applicable laws, ordinii,~ces, codes and regulations. and to permit
authorized inspectors to make; necessarY.Jnspcctions of the job site.
Print or Type
1) KRY SPAN ENERGY 44R EAST MAIN STREET
Name 0 Applicant
PATCHOGUF. NF.1\l YORK
Address
] 1727
2)
0\ .Q , ,-)
Work Description and Location (Street
,J\
Hamlet, Cross
j)J ~!~)
Address
Name of Owner of Premises
3)
(a)
1's construction located withih '75 feet of tidal wetlands? 'IIYes_No
*If yes, other--Town permits may be required.
II) Builder's License No.
Plumber1s License No.
Electrician's License No.
Other Trade's License No.
~.! \~
" ' Signature of Appl' t
: ~\~\DI
Date
5) a) Attach plot plan showing location ,of proposed, e,,:cavation and relationship to
adjoining premises or public'stre,cts or areas, and giving a detailed descrip-
tion of layout of excava lion.
b) Attach all other necessary permi,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)
71
Tax Map: Section
Blocl<
, Lot
Completion Drlte
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 Worl<: $'
11) Remarks:
\
n-1~
p(jqc 1 of 3
,,'..
.12) Insurance Coverage: (Attach copy)
a) Insurance Company:
b) Policy II
c) State whether policy of ce~tifjcation 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:
aJ Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
providecJ in the
3 years
2 years or
111) Fees for applications and permits: Basic Application Fee........ $25. 00
A 1. IService Connections excavations @ $20.00 :;; $ cJ" 0 ()
~
A2. IAdditional EXC<lvations same service @ $10.00 :;; $
--rro:-
B. Excavations 1811 in depth (ir. less:
0-100 I.~ . $10.00
I.~ @ $0.10 -:$
Additional
C.
Excavations...lS" in depth tQ51 in
0-100 I.~ .~ .
'-I 0 () I. ~ @ $0. 30 ..$
Additional
depth:
V"
I~O
D.
Excavations 51 in depth and over:
0-100 I.~ . $50.00
I.~ @ $0.50 .'$
Additional
E.
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 application prior to issuance of permit.
* * *'
E>
TOTAL con ~ I q ">. 0 0
Authorization is hereby granted to the Town Clerl< of the Town of Southold to
issue a Highway Excavation Permit to:
in accordance wi th ~this application.
SUPERINTENDENT OF HIGHWAYS
TOWN OUTHOLD. NEW YORK
cPr'
Raymond L. Ja s
:> -/2., Of
Date
Received by the
Town Clerk ....., /; 310 /'
! / Dafe.
3 i i/D I Permit
'Date
qf'
No.
Permit Issued\.
Note:
Permit expires one (1) year fr:om Date of Issuance.
No work to start without 118 hour notice -to the Superintendent of Highways.
Permit must be avait"able for inspection.
Page 2 of 3
~ ""
KEYSPAN!GAS
REQUEST FOR STREET OPENING PERMIT
o STATE
o
1;< I ~U;1fb~j)
FC-GI1IA
;~ 1ll1: s
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W.O./PA
NO.
REQUESTED
BY
DEPARTMENT
GAS CONSTR. MAINT. & SERVICES
APPROVED
SKETCH
r
6I.i1/"S I /rI- Sf) - Z-
/1 <I- ",SF:,. /
$
b .1 r. a:lrtf"
'.
~ RJ..
j. t
I~
;' T~ ~
~ t
It ~
!' R
N
~
~
~
~
"~ . ~
r- .,,1-
~
M::lS;U:
-35.-
f
J
, i'
I ~
I ~
~
~
C)
f'
D'
7/
/'
z
~I
.
Date: 03/14/01
Transaction(s):
Name:
Clerk 10: L1NDAC
1 Permits
Check#:3593
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
cp~ -if 98
Recelpt#:
Total Paid:
3593
Subtotal
$195.00
$195.00
Intem.IID: 28403