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Home My WebLink About725 Lands End RdTown Of Southold P.O Box 1179 Southoid, NY 11971 * * * RECEIPT * * * Date: 04/26/00 Transaction(s): Permits Cash#: 832 Receipt#: Total Paid: 832 Subtotal $310.20 $310.20 Name: Clerk ID: Brooklyn, Union Gas Key Span Energy 444 East Main St Patchogue, N Y 11772 LINDAC Internal ID: 9554 REQUEST FOR PERMIT Request for .~) ~.,1 ,~lJ. ¢_) Permit J FEE* $ JDate Permit required to open! / Permit Requested By: ~t~'~l,/,,~/ ~-~/'f//4, ~ TD ~)~) Typeof Road Work Request# c~)~") ~ '~ -(~)..~ ~) Charge account ~ * [] Disbursement to be made out of petty cash Return Permit To: [~ew Business Department [] Q.N. [] Cent. [] W.S. ~J~ E.S. Gas Service for JJ--i To be billed J [] No fee [] Underground Lines Department [] Oper. Plan. & Cont. Center Permit No. 'File No. Ref. #~,~7 ~'~-0 ~ TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic ' La ne Peconic, New York 11958 (5.16) 765 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 83 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 all applicable laws, ordinances, codes and regulations, and to permit authorized inspectors to rnlakeI necessary~,inspections of the job site. Print or Type. 1) KEY SPAN ENERGY 448 EAST MAIN STREET Name of Applicant PATCHOGUE~ NE~ YORK 11727 Address 2) 3) Name of Owner of Premises Address Work-Description and Location [Street Number, Hamlet, Cross Street} (a) Is construction 10,cated within .75 feet of tidal wetlands? *Yes__ *If yes, other~Town permits may be required. 4) Builder's License No. s) 6) 7) 9) 10) 11) Plumber's License No. Electrician's License No. Other Trade's License No. Signature -o {~pl~Jica nt Date a) Attach plot plan showing location .of proposed-eR'cavation and relationship to adjoining premises or public 'streets 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. Tax Map: Section Block , Lot Starting Date: Completion Date Work Schedule: Phase Excavation .......................................... Facility Installation ............. Backfill & Compaction.. .......................... . . Pavement Replacement Under which authority is the appli~ation made: Completion Date Estimated Cost of Proposed Work: $ Remarks: D-39 Page 1 of 3 12) 13) Insurance Covetable: (Attach copy). a) Insurance Company: b) Policy # c) State whether policy of certification 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 $S0,000 property damage. Security.: a) Surety Bond or CertifieCt Check total amount of $ b) Maintenance Bond provided..i Fees for applications and permits: Al. provided in the 2 years or 3 years Basic Application Fee .... .~..$;5.00~ o~_./Service Connections excavations @ $20.00 = A2. /Additional Excavations same service 'No. B. Excavations 18" in depth 0W less: 0-100 l.f. : $10.00 {.f. @ $0.10 Additional C. Excavations,-.1'8" in depth to 5' in depth: 0-100 = $30.00 0.z0 =,. Additional D. Excavations 5' in depth and over: 0-100 l.f. = $50.00 I.f. ~ $0.50 Additional E. Utility RepairlExcavations @$10.00 = No. Repairs same s~rvice · Additional . F. Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. * * Authorization is hereby granted to the issue a Highway Excavation Permit to: in accordance with,this application. Town Clerk of the Town of Southold to StJ, PERINTENDENT OF HIGHWAYS TOWN//~OUTHOLD,. NEW YORK Date Received by the Town Clerk Permit Issued\ Date Note: D-39 Date Permit expires one (1) year from Date of Issuance. No work to start without 48 hour notice 'to the Superintendent of Highways. Permit must be available for inspection. Page 2 of 3 GENERAL NOTES All Mains to be SDR 11 Medium Density Plastic and have an operating pressure of 60#'s Install 870' of 2" Plst Main with 2-2" Valve on Lands End Road Install 30' of 2" Plst Main with 1-2" Plst Valves on Latham lane Install 2" H. V. Plst Tee and 2" Electrofusion Cplg for tie-in if 2" Plst main found or 2" M.T., a 17# Anode if 2" Steel main found when the bellhole is dug atop the existig gas main Mains to be trenched within 8' grass right of way behind curbing Directional drill State Highway crossing All 2" Valves to be installed per CS's-11105 & 11111 Install Valve Location Markers For Valves in Grass areas per CS-11101 Any trench, bellhole or test hole in paved areas to be filled with temporary patch All Mains to be installed per CS's-Il800, 11001, 11004, 11005, 11014 & 11016 Test Holes to be dug when crossing other Underground Facilities to determine needed clearances 2" Trans. Ftg., 2" Electrofuse Cplg. & MISSILE OR DIRECTIONAL BORE ALL ROAD CROSSINGS GAS SERVICE TO HOUSE #725 Install 1GO' of 1" HP MD Plst Svce Install 1" Plst Curb Valve with box Install 1" Anodeless Riser Missile Service I IN COMMON TRENCH UNDER MACADAM! JOB NAME: Kurt Werber STREET(S): 725 Lands End TOWN: Orient Point Road GRIDS .50' 200' 121-1-2 121-1 Install 900' of 2" HP MD Plst GM, 5-2" Valves & 1 Residential Service MEP #565 Keyspon Energy Corp. d.b.a. Brooklyn Union (;es ,-----~-~Oos Construction & Molntenance Services ,--- ~ ~ I PATCHOGUE, N~ YORK /mane I o~ ~: ~ W 0 ~ ~KEVIN SCHUTZ 4/21/2000 '' 25777-030 [~"~tate ~ Town '7~ B.,.~ 2330043 DWG. 1 OF2 LO.2,''e 25'7 7 7- Z'//'z-z 'X z ,~/z. GENERAL NOTES All Mains to be SDR 11 Medium Density Plastic and have an operating pressure of 60#'s Install 870' of 2" Plst Main with 2-2" Valve on Lands End Road Install 30' of 2" Plst Main with 1-2" Plst Valves on Latham lane Install 2" H. V. Plst Tee and 2" Electrofusion Cplg for tie-in if 2" Plst main found or 2" M.T., a 17# Anode if 2" Steel main found when the bellhole is dug atop the existig gas main Mains to be trenched within 8' grass right of way behind curbing Directional drill State Highway crossing All 2" Valves to be installed per CS's-Ill05 & 11111 Install Valve Location Markers For Valves in Grass areas per CS-11101 Any trench, bellhole or test hole in paved areas to be filled with temporary patch All Mains to be installed per CS's-11800, 11001, 11004, 11005, 11014 & 11016 Test Holes to be dug when crossing other Underground Facilities to determine needed clearances 2" Trans. Ftg., 2" Electrofuse Cplg. & MISSILE OR DIRECTIONAL BORE ALL ROAD CROSSINGS GAS SERVICE TO HOUSE #725 Install I~K)' of 1" HP MD Plst Svce Install 1" Plst Curb Valve with box Install 1" Anodeless Riser Missile Service !IN COMHON TRENCH UNDER MACADAHI JOB NAME: Kurt Werber STREET(S): 725 Lands End Road TOWN: Orient Point GRIDS Install 900' of 2" HP MD Plst GM, 50' 200' 3--2" Valves & 1 Residential Service 121-1-2 121-1 MEP #565 Keyspon Energy Corp. d.b.o. Brooklyn Union Gas ~ Gas Construction448 & MAINMa ntenoncesT. Servces ~ 24 PATCHOGUE1 NEW YORK I'~one D~W. a~: 4/21~T~000/2 W.O.# KEVIN SCHUTZ 25777-050 DWG. 1 OF 2 '~*""~' I ,,x o,~,oT B.L# State & Town! 1300 2330043 Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 08/13/09 Transaction(e): 1 1 Permits * * * RECEIPT * * * Receipt"8: 57363 Reference Subtotal 633 $150.00 Check#: 538 Total Paid: $150.00 Name: Verizon, Communications 501 N. Ocean Ave, 1st FI Patchogue, NY 11772 Clerk ID: LINDAC Internal ID: 633 RECEIVED TOWN OF SOUTHOLD HIGHWAY DEP~Ua'TMENT ' peconlc Lane PcCOrg¢: I~e~ York ,(s31) 7;5-'3~ ao A~PL[.CA~ION/PERM T FOR HIGHWAY· EXGAVA3~ION AND REPAIR AUG I 3 2009 ~PPLICT,¥1ON I$ HER£eY made ~.~e ~upednt~d~t of Hlgh~y= ~ ~e T~n of ~td for the is~mn~ et m ~tio~ P~;I 'pum~nt to Chair 8~ of o~l~nc~ ~ ~tlofis f~ ~e ~m~n ~reln d~b~. The ~ ~ g . Soufh0[d Tow~ C~r~p~ ~i~ all ,ppli~ble laws, or~s, ~ a~ ~aU~a, and m ~z~ In~p~ors ~ mkeJ n~ry ;nsp~ions of ~e job ~. Print or Type · 'N~m¢ of AppU~ Work De. scriptien and I.~caaon (street Number. Hamlet. Cress Street} -.z'7-I ) (a) ts ~st~cfion I~t~ w;t~'7S ¢~t of ~1 we~a~t ~ No~ ail y~, ot~ ~ewn ~1~ my ~ r~ulr~. El~ri~=~s ~c~se No. Other T~d~s Li~n~ No.~ ~lnln~ p~l~ ¢ publlc'~ or m~s, a~ gi~ng a de~ll~ ~e~Hr ~ of la--'of ~vatlon. b) A~ch all ot~ ~e~ permi~ and ll~ns~ for ~is'pmJ~t, ~ ' . ' c) ' ~'~e?~ by ~ appli=~ my ~t ~men~ before ~n~ of a , ,. Highway Ex~va~ofl Pe~ ~ ~e Town CI~. · 11] . 6) Tax Map: SectIo~ , Block . .., L~t 7) Startin~ Date: CoetpletiO~ ~te . . 8) Work p~ ~qon O~ ~v~nt R~la~t .............................. Und~ whi~ 8u~orlty Estimated Cost of Proposed D-39 MqR 24 20~6 15:Z~ Pag~ I of 3 PAGE. O4 1/03 '06 WED 13:56 F.4.Z 631 768 6145 SOU'fHULP 'IUWH ~LJ:.Y~ ~*~ ~zg=w=Z ~upu ~.v- ~2} Inaurarl== Coverage: (Attach a) ~nsurance Company: b) P~I~ l c) S~te whe~er ~l[=y of ca~i~.~tlon on fil~ with ~e Highway ~a~- d) ~ge r~uired ~t~d~ W the Town: B~lly InJu~ =nd p~pe~y and ~50,00~ pretty 13~ _Security: a) Surety Bond ,or Cu'tlfie~ Check pro~id~ In'the to~l amount of $ b) ~lnt~a~e ~nd provide: ~ '? y~ra or ~ y~n. A2. /Addifi~al Ex~vatlons ~e se~l~ a ~10.~0 * ~. B. Excavat;o,qs 0-100 l.f. = $10. aa ' I.f. o ~a40 - $__ ~clitional C. Excavations lr in de~th to Ss in depth; .I.f. e ~a.~o = ~L ,-- E. Utility Repair Excavations Repair~ -,amc service e ~5.~0 thls'appllc'Stlo~ prior to ~s.~anc~ of ~ib' Authorizati°n Is hereby grantL~d to the Town Clerk of the Town of S6uthdd to IsSue a Highway Exmvatie¢4 Permit 'to: in'accordance wll. h th%s'applicatJoh. SUpI:RINTENDENT OF ~IIGHWAY$ SOUT.O, 7 pew vo. Rece,Wed by the Town Clerk ~- 1'~ Date Date D-39 Permit expires one (1) year from Da~e of I.~suance, No work to star~ without ~ ~u~ ~otke to the ~uperlnt~d~t ~ Highways- Pe~*must be available for Ingp~fioh. Page 2 of 3 01/03 '06 .~ED 1~:57 FAX 631 765 6115 $OT;~EOL~ TO~TN CI~RK Highway Dep~ Copy DJctrlbu~loh: Highway Department Inspector Applicant Ta~n Clerk i N,S.,P E C T O R ',~ R E C O R D Inspactton Date Findings ruse code) Applicant Notified 2nd 3~d --(T6 permit Clerk) RF-~ARKS CODE lEI - hnpro~er barri~dc~ IL -.Improper lights ST - Sun~n ~ ~ ~vat/on UTM - Unable to m~su~ [due to ~c~lling) BUC - Bulld;n~ under ~n~ WlP - Work DB - 'lmp~ ~lll' (~ high) (mt HFS -' I~;p~r balding for final ;~t of ~vat~n RFR - R~ to repair Page 3 of 3 M~R 24 20C6 15:36 PRGE.06 abe~t Compitelle Alght*Of-Wey Manager Ou~da Plsnt Engineering · ~f~alk County. New York Ted.# vermzg n Notification of Request For 4~ Emergency Permit & New Service Installation Note; for Eastern Suffolk, MUST fax completed form W~lllam Temma Fax # (631) 727-~723 T-§Tfi P001/001 F-907 Note" in the V;llage of Southempton on~y, petmil~ ere needed fei' removing or repleei~l~ and rpz box, Foreman: ~ ~ Cel( Phone: Tech: ~ ~. ~.~..:,~ ~ EC #~ Srmcify: ~Tewn Road ~ IEmergency I[nf~matiofl Reauited; · Ap~ox. S~ ~ exception 4. ~.ing on: (check one) 6. ~aM ~=~on ~ splice p~ ( Indicate No~th SPECIAL CONDmON$: