HomeMy WebLinkAbout1240 Latham Ln
ELIZABETH A. NEVILLE, TOWN CLERK
Town of Southold
Southold, New York 11971
Phone: 631-765-1800
RECEIPT #95
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Received $ 296.50 for 1 - Permits on 02/05/2001.
This receipt covers the following Permit/Sticker(s):
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~ is always our pleasure to serve you.
By:
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(time of day)
Date: 02/05/01
Transaction(s):
1 Permits
Check#: 1142
Name:
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Clerk ID: HELENEH
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1142
Subtotal
$296.50
$296.50
Internal 10: 26566
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Permit No. q J;'
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TOWN OF S;'U ,'HOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New'Vorkl1958
(516) 765c31110
PO. f2,c"!- /7E!>
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref. II T I OOb II d:5'::(
RE(;EIVm
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
FEB 5 ot~uthold for the issuance of an Excavation Permit pursuant to Chapter 83 of the
c~1 of the Town of Southoid, Suffoik 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,nces, codes and regulations, and to permit
,..,SOuthold ToiHt~reiied inspectors to make: necessary .,inspections of the job site.
Print or Type
1) KEY SPAN ENERGY 44R EAST MAIN STREET
Name of Applicant
PATCHOGUE. NEW YORK
Address
11727
2)
Name of Owner of Premises
Address
3)
/.:lYe) L,4fhA-- LA-
Work Description and Location (Street
t""
O!Z-le"";l
Number, Hamlet, Cross Street)
(a)
fs construction located within 75 feet of tidal wetlands? *Ves_No
*If yes, other--Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electricianl s License No.
Other Tradels License No.
~~\~
Signature of Applicant
.' ;)!t /0 J
Date
5) a) Attach plot plan showing 10cationoI proposed. excavation 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 permits 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:
B) 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 Work: $
11)
Remarks:
"
0-39
Page 1 of 3
12) Insurance Coveraqe: (Attach copy)
a) Insurance Company:
b) Policy #
c) State whether policy of cer;tification on, file with the Highway Depart-
ment:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300.000/$500.000 Bodily Injury.
and $50.000 property da",age.
/
13) Security:
a) Surety Bond
10tal amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
3 years
2 years or
14)
Fees for applications and permits:
A 1 . I IService Connections
~
Basic Application Fee........ $25. 00
it!
excavations @ $20.00 = $ 0)0
'"
A2.
I /Additional Excavations same service @ $10.00 = $ 10
~
Excavations 1 all in depth 'or less:
0-100 I.f. = $10.00
I.f. @ $0.10 -.$
B.
C.
Additional
Excavations-'--!~.Lc._.g~pth to S in depth:
0-100 I.f. =~
7cJ::r- .I.f. @$0.30 =$,;1/I.::0l
Additional
Excavations 5' in depth and over:
0-100 I.f. = $50.00
I.f. @ $0.50 =' $
D.
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.
* * it'
. T r-O
CO~T;$ b}9"-.:>-
TOTAL
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.
SUPERINTENDENT OF HIGHWAYS
TO'W~LD', NEW YORK
'. ~~
' - aymond L. J'ac -
~
0('- 5- 01
Date
Received by the Town Clerk
<2l?/tJ /
I Oa
Permit Issued, '
Permit No.
Date
~:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hc:>ur notice 'to the StJperintendent of Highways.
Permit must be available for inspection.
Page 2 of 3
I""'l.,'ll,
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Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INS P E C TOR' .S
RECORD
I nspection Date
Findings -(use code)
Applicant Notified
1st
2nd
3rd
4th
/
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0-39
(To Permit Clerk)
REMARKS
CODE
I B - Improper .barri<;:ades
IL - Improper lights\
ST - Sunken trench -or, excavation
UTM - Unable to measure (due to backfilling)
BUe - Building under: Construction
WI? - Work in' progress
DB - Improper backfill" (too high) (not sufficient)
HFS - Inspector holding for final settlement of excavation
RFR Ready to rep'air
Page 3 of 3
"
GENERAL NOTES
All Mains to be SDR 11 Medium Density Plastic and have an operating pressure of 60#'s
Mains to be trenched in grass area behind curbing
Test Holes to be dug when crossing other Underground Facilities to determine needed clearances
Install 850' of 2" Plst Main with 2-2" Valves
All Mains to be installed per CS's-11800, 11001, 11004, 11005, 11014 & 11016
All 2" Valves to be installed per CS's-lll 05 & 11111
Install Valve Location Markers For Valves in Grass areas per CS-lll 01
Any bellhole or test hole in paved areas to be filled with temporary patch
Squeeze off 2" main and install 2" electrofuse Cplg for Tie-in
Install Ball Markers to identify ends of mains
CREWS TO USE DISCRETION IN REGARDS TO MISSILlNG OR TRENCHING INDIVIDUAL DRIVEWAY CROSSINGS
(RECOMMENDED TO DRILL ANY DRIVEWAY WITH BELGIAN BLOCK BORDER)
MISSILE ALL ROAD CROSSINGS
,..11......_11_11_...11_11_11_11_11....11_11..........11.......11.....,
! U.G. ELECTRIC 8& TELEPHONE !
i IN COMMON TRENCH UNDER MACADAM i
'-II-"_II-'I_II_II_II_I'_II_II_II_II_I'-"_II_"_"_II_II_"_I'_"~
JOB NAME: Charles Brienza
STREET(S): 1240 Latham Lane
TOWN: Orient
GRIDS
50' 200'
120-08-4 120-4
DWG. 1
OF 2
KeySpan Energy Corp. d.b.o. KeySpon Energy Delivery
IGas Construction & Maintenance Services 'S
AREA 448 MAl N ST. CAlf
24 PATCHOGUE, NEW YORK None
DRAWN BY, OAT!: W.o. #
KEVIN SCHUTZ 1/31/2001
""'ITS, TAX DISTRICT TIOOOll255
Town 1300
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