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HomeMy WebLinkAboutNew Suffolk AveTown Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 04/24/00 Transaction(s): Permits Receipt#: 3211 Subtotal $45.00 Cash#: 3211 Total Paid: $45.00 Name: Brooklyn, Union Gas 444 East Main St Patchogue, N Y 11772 Clerk ID: LINDAC Internal ID: 9377 ,File i~o. ,~) TOWN OF SOU:THOLD HIGHWAY DEPARTMENT Peconic.' Lane Peconic; New York 11958 (S.~ 6] .7~S: 3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBy made to ~he 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 mlakej necessary,f'i"n~pections of the job site. Print or Type, 1} Brooklyn Union Gas East Name of Applicant ,-.:, 2) · Name of Owner of Premises 448':Eas~' Main St, Patch0~ue~ N,Y, 1'I772 - Address 4) Builder's License No. Electrician's License No. Address Worl~ OescriptioA and Location (Street Number, Hamlet, Cross Street) (a) l's construction Io~cated within '7.5~,feet of tidal wetlands? *If yes, other~'Town permits i~ay be required. ": Plumber's License No. Other Trade's License No. :.: Signature of A~.~c~nt '. Date ' 5) a) Attach. plot plan showing location.of proposed<e~;avation and relationship to adjoimng premises or public'str~eets or areas, ~nd 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 applicatioi~ :may not commence before issuance of a Highway Excavation Permit by t.be Town Clerk. 6) Tax Map: Section , BI0~I< '- , Lot 7) Starting Date: C~mpletion Date 8) Work Schedule: Phase, , Excavation · · -.. · '; ............. Facility lnstallat'on Backfill & Compaction. ........ ~ .................... Pavement Replacement ~ ·- 9) Under which authority is the applichltion made: 10) Estimated Cost of Proposed Work: 11) Remarks: Completion Date D-39 Page 1 of 3 12) · Insurance Coverage: (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 iniury and property damage:~ $300,00015500,000 Bodily Injury, and $50,000 property damage. 13) Security: v'l 4) b) Surety Bond or Certified Check total amount of $ Maintenance Bond provided,: 2 years provided in the or 3 years Fees for applications and permits: 'i Basic Application Fee .... $25.00~"~ Al. ~_~__/Service Connections.exCavations @ $20.00 A2. /Additional Excavations same service @ $10.00 = No. B. Excavations 18" in depth oK less: 0-100 I.f. = $10.00 l.f. @ S0.10 - $ Additional C. Excavations,-.1'8" in depth to 5' in depth: 0-100 l.f. ---$30.00 .l.f. @ $0.30 : $ Additional D. Excavations 5' in depth and over: 0-100 I.f. = $50.00 l.f. 0 $0.50 = $ Additional Eo No. Additional Utility Repair .Excavations @$10.00 Repairs same service @ $5.00 = $ Notice to public utilities proof must be provided and attached to this al~lication prior to issuance of permit. ***' 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. ' SIJ.PERINTENDENT OF HIGHWAYS TOWN OF..-~OUTHOLD,, NEW YORK ~,~ jRaymond L. J~obs Date Received by the Town Clerk Permit lssued~,~//-~g/-~ Date Date Permit No. ~ Permit expires one (1) year from Date of Issuance. No work to start without ~t8 hour notice to the Superintendent of Highways. Permit must be available for inspection. Page 2 of 3 Note: D-39 KEYSPAN REQUEST FOR STREET OPENING PERMIT ['~ STATE [---]NASSAUcouNTY ~COUNTySUFFOLK ~ PE,.R~MIT M S JOB DATE ,. REASON FOR I / OPENING W.OJPA FOREMAN NO. OPENING REQUESTED BY APPROVED DEPARTMENT GAS CONSTR. MAINT.& SERVICES DATE OF DIVISIOI~ j , / -- DATE SKETCH N Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 07/10/00 Transaction(s): Receipt~: 1 Permits --~ Check#: 889 Total Paid: 889 Subtotal $127.50 $127.50 Name: Key, Span Energy 448 East Main Street Patchogue, NY 11727 Clerk ID: LINDAC Internal ID: 14626 TOWN OF $OU. THOLD ~ Fil'e No. ~(~ HIGHWAY DEPARTMENT P econic Lane ~~~J Peconic, New York 11958 (5.16) 765'- 31'I0 ~~fff~ APPLICATION/PERMIT FOR HIGNW'~,Y 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 excava[ion herein described. The applicant agrees to comply with all applicable laws, ordin~hces, codes and regulations, and to permit authorized inspectors to mlake~ necessary.,inSpections of the job site. Print or Typ.e. 1) KEY SPAN ENERGY 448 EAST MAIN STREET Name of Applicant PATCHOGUE~ N~ YORK 11727 Address 2) Name of Owner Of Premises Address / / l, .8 - /k/__ ~ 0escript~on and Location (Street Number, Hamlet, 3) Street) Cross ~ork (a) Is construction Io~ated within .75 feet of tidal wetlands? *Yes~ *If yes, other~Town permits may be required. Plumber's License No. 4) Builder's License No. Electrician's License No. NoR Other Trade's License No. Date s) a) Attach plot plan showing location .of proposed~-e~kavation 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 applicatio~ may not commence before issuance of a Highway Excavation Permit by the Town Clerk. 6) Tax Map: Section 7) Starting Date: 8) Work Schedule: · Block , Lot' Completion Date Phase ', Excavation ....................... ~ ................. Facility Installation ................................. Backfill & Compaction .............................. Pavement Replacement .............................. Under which authority is the application made: Completion Date I0) Estimated Cost of Proposed Work: $ 11) Remarks: D-39 Page 1 of 3 Insurance CoveraBe: (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 E~odilY Injury, and $50,000 property damage. 1 3) Security.: a) Surety Bond or Certified Check total amount of $ b) Maintenance Bond provided: 14) Fees for applications and permits: Al. provided in the 2 years or 3 years Basic Application Fee ........ $25.00 /./Service Connections excavations @ $20.00 = $ c~O · Ca3 No. A2. /Additional Excavations same service @ $10.00 = $ No. B. Excavations 18" in depth 07 less: 0-100 l.f. = $10.00 ~ I.f. ~ $0.10.15 Additional C. Excavations-.1'8" in depth to 5' in depth: 0-100 I.f. :-$30.00 - / ?j . f. $o. 3o :, $ Additional D. Excavations 5' in depth and over: 0-100 I.f. = $50.00 l.f. t~ $0.50 = $ Additional No. Utility Repair Excavations ~$10.00 : $ Repairs same Service @ $5.00: $ Additional .... Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. TOTAL CO Authorization is hereby granted to the Town Clerk of the To.wn of Southold to issue a Highway Excavation Permit to: in accordance with~this application. SUPERINTENDENT OF HIGHWAYS TOW~,OF'~SOUTHOLD, NEW YORK ~ · / Raymond~-,f Jacobs Date Received by the Town Clerk Permit Issued\' ~"/e) ' Date Note: D-39 Date Permit No. ~ 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 REQUEST FOR PERMIT Re~luest f(~r '-~©~,~'~/0 ~*"~ I Date Permit I FEE* $ Permit required to open! TD /~30 / Type of Road Work Request # ~ ~-~OO(~- ~.~ Charge account Cf [] Q.N. [] Cent. Gas Service for * [] Disbursement to be made out of petty cash Return Permit To: ~ew Business Department I~ To be billed I [] No fee [] Underground Lines Department [] Oper. Plan. & Cont. Center P,e No.,__Z_- TOWN OF 5;)U,:HOLD HIGHWAy DEPARTMENT PeconJc Lane Peconic;. New' York 11958 (516) 765:3~10 ~. ~ AP--__P~JC~TION/PERM~T FOR H{GHWky EXCAVATION AND REPAIR 6) 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 apphcan~ agrees to comply with all applicable Jaws, ordinahces, codes and regulations, and to permit authorized inspectors to n~a,ke~necessarY inspections of the job site. Prin_~ ' " (a) Is construction lo,coted withln.~ feet of tidal wet ands? *Yes No *If yes, other-Town perm[ts may be required.~ Builder's License No. PIumber% License No. Electrician,s License No. - ~ ~ Other Trade's License No. al Attach plot plan showing location of proposed excavation and relationship to adjoining premises or public streets or areas, and giving a detailed descrip- tion of ~ayout of excavation. b) Att~ach all other necessary perrnils and licenses ~or this project. c) Work covered by this application may not commence before issuance of a Highway Ex~vatjo~ Permit by the Town C~erk. Tax Map: Section , Block~ _, Lot' Starting Date: - ,~ _ ~Comp;etJon Date Work Schedule: Phase E ' ~, ~Date xcavation ................... .... , .... . ......... Facili ~y installer;on ........... ;. .................... Bec ~ CompacUon ...... . ................. Pavement Replacement ........ :,:. ~ Under which authority Is the application made: Estimated Cost of Proposed Work: Remarks; . --NaAe ~t ~ ~I~ STREET PATCHOGUE N~ YO~ i 1727 ~ , Hamlet, Cross Street)~ D-39 13) 143 Insurance Covera.qe: (Attach copy) a) Insurance Company: bi Policy # c) State whether policy of certification on file with the Highway Depart- d) Coverage required extended to the Town: Bodily injury and property damage: $300.000/$S00,000 Bodily injury, and $50 000 property dar~age. Security,: a) Surety Bond .,°r Certified' Check provided in the total amount of $ b) Maintenance Bond providedi 2 years or 3 years Fees for appIications and permits'. ' Basic Application Fee ........ $25.00 Al, /' /Service Connections.excavations ~ $20.00 No. _/ /Additional Excavations same service ~ $10.00 = $ A2, B. Excavations 18" in depth b~ less: 0-100 l.f. = $10.00 " .' I.f. La $0.10 Additiona~ C, Bxcavatlons*,,l'8" in depth t~'S' in depth: 0-100 I,f, = $30.00 _l.f. 8 $0.30 .=., $. Additional D. Excavations 5' in depth and over: 0-100 l.f. = $50.00 l.f. La $0.50 Additional E. No. Additional F. UtiIity Repair Excavations Q$10.00 = $ Repairs same service L~ $5.00 = $ Notice to public utilities this application prior to pFoof must be provided and attached to issuance of permit. Authorization is hereby granted to the Issue a Highway Excavation Permit to: in accordance with-this application. ~:own Clerk of the Town of Southold to S~PERINITENDENT OF HIGHWAYS T:~WN/~F SOUTHOLD, NEW YORK / ~ Raymond L..r..~l~s Date Received by the Town Clerk Date Perm,, erm,t No. Date Note', Permit expires one (1) year from Date of Issuance. ~ No work to start without ~8 hour notice 'to the Buperintendent of Highways. Permit must be available for I~Spection. PacO 2 cf 3 PERMIT NO. LOCATION REASON FOR OPENING W.O./PA NO. REQUESTED BY APPROVED KEYSPAN REQUEST FOR STREET OPENING PERMIT ~ STATE ~ NASSAU COUNTY MIS JOB NO. COUNTY SUFFOLK DATE /-~'- O 1 ~// o ,~1~6~5c- ,4UE,) /'~'~-~'~l~ FOREMAN DATE OF OPEN NG DEPARTMENT DIVISION GAS CONSTR. MAINT. & SERVICES ~ DATE. r SKETCH N Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 01/16/01 Transaction(s): 1 Permits Receipt#: 1108 Subtotal $55.00 Check#: 1108 Total Paid: $55.00 Name: Key, Span Energy 448 East Main Street Patchogue, NY 11727 Clerk ID: LINDAC ~ntemal ID: 24737 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/24/01 Transaction(s): 1 Permits ReceiptS: 1316 Subtotal $15.00 Check#:1316 Total Paid: $15.00 Name: Key, Span Energy 448 East Main Street Patchogue, NY 11727 Clerk ID: LINDAC Internal ID: 40314 · File No. HIGHWAY DEPARTMENT Peconic Lane Peconic; New' York-Il958 APPLICA3~ION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to U:te Superintendent of Highways of tine Town of Seuthold for the issuance of an Excavatio6 Permit pursuant to Chapter 83 of the Code of the Town of Southold, Suffolk County, New York, and other applicable laws, ordinhnces or regulatiohs for the excava(ion herein described. The applicant agrees to comply wit~ all applicable laws, ordin~'~es, codes and r~gulations, and to permit authorized Inspectors to ~e~ necessary.,~specUons of the job site. Print or Typ~ ' '~" 1} K~ ~PAN ENERGY 41,~ F~T ~A~N STRER~ ~ATCItOCU~ N~ YORK 11727 Name of Applicant ,, Address Name of Owner of Premises · : Address .~c~ /dc: ~< '~ /'YIn, / ,T~c 3) /~)--(-J / '(Stree ~mber, Street) Hamlet, Cross Work Dosc~ipUon and Location t (a} )'s constrbction Iopated with)h '~75 feet of tidal wet)ends! *Yes · If yes, othe~'Town peKmlt~ may be Kequlr~d. ~l) Builder's License No. :. Plumber's License No. ElectKician's License No. .. Other Traders License No. s) a) 7) a) 9) 10) 11) b) c) Tax Map: Section Starting Date: Work Schedule: Phase ~.. Attach plot plan showing locafi'oh .o~' pro[bosed,.o~'cavation and relationship to adjoining premises or publ c'strepts or areas, and giving a detailed descrip- tion of layout of excavation. ;' ,. Attach all other necessary permits and licenses for this project· Work covered by this applicati0~i may not commence before issuance of a Highway Excavation Permit by .the Town Clerk. , Block , Lot' Completion Date · 'il;'x Completion Date Excavation ...................... ................... Facility Installation ................ ' ................. Backfill & Compaction .............................. Pavement Replacement ........ ~:..~ ................... Under which authority is the appli~a.tion made: Estimated Cost of Proposed Work: ' $ Remarks: Paqe 1 of 3. 12) 'Insurance Coverage: 10) {Attach copy).:.':, a) Insurance Company: b) Policy It_ c} State whether policy of' cer~i~icatlon on. file wlth the Highway Depart- ment: · · d} Coverage required extended,, to the Town: Bodily injury and prop~i"t~/ damage: $300,000/$500,000 Bodily Injury, and $50 000 property d~lage. Security.: :' a) Surety Bond or'~ertified Check ,provided in the total amount of $ t,.. b) Maintenance Bond providedi 2 years or 3 years Fees for applications and permlts: ,'i Basic Application Fee ........ $25.00 Al. /Service Connectlons.~xcavations 0 $20.00 = A2. /Additional Excavati~)ns same service B. Excavations 10" in depth 'ok less: Additional C. Excavations~.l'8" in depth to 5' in depth: 0-100 I.f. = $30.00 : '* Additional D. Excavations 5' in depth and over: 0-100 I.f. = $50.00 .,. Additional E. / Utility Repair:Excavations OS10. O0 = ~rvice'0 $$.00 = $ Repairs F. Notice to public utilities p~c~of must be provided and attached to this application prior to issuance of permit. 'Authorization is hereby granted to the 'l~0wn Cleric of the Town of Southold to issue a Highway Excavatiofl Permit to: in accordance with-this application. ,SI.~PERIN'TENDENT OF HIGHWAYS ~F SOUTHOLD; NEW YORK . .} / Raymond L...ltf~o s Date Permit Issued,' q' ~.C~-O(' . Permit No../~'~. Date Note: Permit expires one (1) year f'r~m Date of Issuance. · No work to start without ti0 hour notice 'to the Superintendent of Highways. Permit must be availhble for ih~pection. Page 2 of 3 G~.s 2083 HIGH PRESSURE GAS SERVICE RECORD Curb Cock .Size & Kind of Md~'~ Size of %p ~ver Location of Main .................... Ft ................ In .......of Line Location of Tap .............. Ft ....... In~ .... of. -- ~ouse Kind of Paving, ..~ize of Cut~ in Paving .... Length of Pipe Laid- M~ia to Prop. Line ............ ~ ....... 5i~ Length of Pip id- Prop L' to M~ter /~ ' ~i ~ ~" TOWN OF SOUTHO~ HIGHWAY DEPARTMENT Peconic Lane PeconJc, New York 11958 (631} 765-31~0 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the To~n of Southold for the issuance of an Excavatior~ Permit pursuant to Chapter 83 of the Cede 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 ali applicable laws, ordinances, codes and regulations, and to permR authorized inspectors to mlake~ necessary inspections of the job site. Print or Typ~ Name of Applicant Name of Owner of Premises Address Work Descript~n and Location (Street Number, Hamlet, Cross Street) (a) Is construction located within 75 feet of tidal wetlands/ *Yes No *If yes, other Town permits may be required. 4) Builder~s License No. Plumberas License No. Electriciaffs License No. Other TradWs License No. Signature of Applicant Date Address ' 5) a) Attach plot plan showing location o~ proposed ex,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. 6) Tax Map: Section , Block , Lot 7) Starting Date: C/_ o~-07 Completion Date 8) Work Schedule: Phase Completion Date Excavation ......................................... Facility Installation ........................... . .... . Backfill s Compaction .............................. Pavement Replacement .............................. 9} Under which authority is the application made: ~,q$ 10) Estimated Cost of Proposed Work: (J 12) Insurance Coverage: (Attach copy) a) Insurance Company: c) S~te whether~ljcy~°f ce~ifl~tion on file with the Highway Depa~- merit: d) Coverage required extended to the Town: Bodily Injury and property damage: $300,000/'$500,000 Bodily Injury, and $50,000 property damage. 13) lq) Security: a) Surety Bond or Certified Check provided in the total amount of $ b) Maintenance Bond provided: 2 years or 3 years Fees for applications and permits: Basic Application Fee ....... ~ Al. /Service Connections excavations 0 $20.00 = $ No. A2. /Additional Excavations same service e t~10.0O = $ No. tlons~8" in depth or lasts = _sro. oo / I.f. ~ $0.10- $ Additional Excavations 18" in depth to 51 in depth: 0-100 I.f. = $30.00 i.f. ~ $0.30 = $ Additional D. Excavations 5~ in depth and over: 0-100 I.f. = $50.00 I.f. @ $0.50 = $ Additional E. N~. /~) ,00 Additional Utility Repair Excavations ~$~0.00 = $ Repairs same service 0 $S.00 = $ Notice to public utilities proof must be provided and attached to this appliCation prior to issuance of permit. 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. SUPERIN~E~ENT OF HIGHWAYS TOW~//~F~THOLD; NEW Y.ORK I~eter W Harris Received by the Town Clerk Io ' "~-0~ Date Permit Issued JO- ~-0~ Permit No. q I O Date Note: Permit expires one (1) year from Date of Issuance, No work to start without &8 hour notice to the Superintendent of Highways. Permit must be available for inspection. Paae 2 of 3 Coov Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date 1~t 2nd 3rd Findings (use code) Applicant Notified (To PermitClerk) CODE IB - Improper barricades IL - Improper lights ST - Sunken trench or excavation UTM - Unable to measure (due to backfilling) BUC - Building under Construction WIP - Work in Progress DB - Improper backfill (too high) (not sufficient) HFS- Inspectorholdingforfinalset~lementofexcavation KFR- Ready to Repair D-39 Page 3 of 3 Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 10/03/05 * * * RECEIPT * * * Receipt~: 7449 Transaction(s): 1 1 Permits Reference 410 Subtotal $45.00 Check#: 7449 Total Paid: $45.00 Name: R & R, Construction 282 Line Rd Manorville, NY 11949 Clerk ID: LYNDAB Internal ID: 410