HomeMy WebLinkAboutWiggins Ln
.
Date: 04/24/00
/
Transaction(s): /
1 Permits
Check#: 3207
Name:
Brooklyn, Union Gas
444 East Main 5t
Patchogue, N Y 11772
Clerk ID: L1NDAC
Town Of 5outhold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
~ J;q
v/
3207
Subtotal
$45.00
$45.00
Internal 10: 9376
Permit No. if-?
'File No. '11
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
PeconicLane
Peconic, New York 11958
(516) 765'- 3140
Po. (2,0'1'- t7e>
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref. 1/ cf)57 ~1 6.)
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town
of Southold for the issuance of an Excava.tion 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 mlake: 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)
,...<; L4 ,oJ \\-...
and Location (Stre
It 1-' t2..J
Street)
/f7"(",-.JPO'C;
(a)
Is construction located within 75 feet of tidal wetlands? *Yes
*If yes, other-lawn permits may be required.
No
4) Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
~~~~tur~~; ,~
-.. Y!:NJ v
Date
5) a) Attach plot plan showing location of proposed.e5(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)
7)
Tax Map: Section
Block
, Lot
Starting Date:
Completion Date
8) Work Schedule:
Phase
Excavation. ..... . .,. ... . . . .. .. . ... .. . ... . ........ . .
,
Completion Date
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 Coverage: (Attach copy)
a) Insurance Company:
b) Policy II
c) State whether policy of certification 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:
a) Surety Bond
total amount of $
b) Maintenance Bond provided:
or Certified Check
provided in the
14)
Fees for applications and permits:
A 1. I /Service Connections
~
A2. /Additional Excavations same service @ $10.00 = $
2 years or 3 years
Basic Application Fee.......~
excavations @ $20.00 = $ d)o -6)
No.
B. Excavations 18" in depth 'or less:
0-100 I. f. = $10. 00
I.f. @ $0.10 -$
Additional
C. Excavations-,'l'8" in depth to 5' 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.
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.
* * *:
TOTAL COflT,",$ '15 ~
Authorization is hereby granted to the Town Clerk of the Town of Southold to :J
issue a Highway Excavation Permit to: '13/l~~ J /.//>,,';; /fCK} (Hy4,o~
in accordance with .this application. "
SUPERINTENDENT OF HIGHWAYS
TOWN 010 UTHOLD, NEW YORK
L( ~ 2..L) - cro
Date
Received by the Town Clerk "y-obI-tJ<f>
Date
Permit I ssued\' '1- 02 if - OC)
Date
Permit No. Lj 9
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice 'to the Sl:lperintendent of Highways.
Permit must be available for inspection.
0-39
Page 2 of 3
FC-6111.4
PERMIT
NO.
LOCATION
REASON FOR
OPENING
W.O./PA
NO.
REQUESTED
BY
APPROVED
SKETCH
KEYSPAN/U?i'S
REQUEST FOR STREET OPENING PERMIT
D STATE
D
D SUFFOLK
COUNTY
[E:l ::;; v.. ~ U)
-030
tis j uJ"&&I~ L/HJl /',j 1JI[ k;
1: IAi o-#S'.)i! a
'Z-i/,'N .r:,tIt., 'Ii
m/hl0
FOREMAN
DEPARTMENT
GAS CONSTR. MAINT. & SERVICES
11.
-1
~
,
~
~.
lI'\
......
i::)
M
~
VJ
E>"-
<:>
~
{"\
~
~~
0.0'"
N
N
~
I
I
~