HomeMy WebLinkAbout1900 Youngs Ave
Permit No.
~~
TOWN Of S,JU ,'HOLD
H IGHWA Y DEPARTMENT
Peconic -Lane
Peconic, New' York -11958
(516) 765c 31 qO
Po.t2>cY- ,7f>
,
File No.
Ref. II ;}J- o7'f~(/1(j
APPLICATION/PERMIT FOR HIGHW),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 excavat'ion herein described. The applicant agrees
to comply with all applicable laws, ordina,nces, codes and regulations, and to permit
authorized inspectors to make: necessary .}.nspections of the job site.
Print or Type
1) KEY SPAN ENERGY 448 EAST MAIN STREET
Name of Applicant
PATCHOGUE. NEW YORK
Address
11727
2)
Name of Owner of Premises
Address
~ '- 0-~0
Number, Hamlet, Cross
Street)
3)
L< ,.., t- S Av-<>
tion and Location (Street
(a)
1's construction located within 75 feet of tidal wetlands? *Yes No
*If yes, other-Town permits may be required.
4) Builder's License No.
Plumber's License No.
Electricianls License No.
Other Tradels License No.
~i9~#tpp)jcant
/- -\'- 0/
Date
5) a) Attach plot plan showing location .of proposed- ejircavation 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)
7l
Tax Map: Section
Block
, Lot
Completion Date
Starting Date:
8) Work Schedule:
Completion Date
Phase
Excavation.... ... ........... .-'.. .-.,\............ .....
Facility Installation. .......... ~'.....~.................
Backfill & Compaction.........:...... - ..... . ... ....
Pavement Replacement........~. ~.."""'."..""."
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11)
Remarks;
\
D- 39
Page 1 of 3
"
12) Insurance Coveraqe: (Attach copy)
a) Insurance Company:
b) Policy #
c) State whether policy of cer;tiflcation 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
3 years
2 years or
14)
Fees for applications and permits:
A 1. ~/Service Connections
No.
I
Basic Application Fee........ $25. 00
excavations @ $20.00 = $ ;hj ~
v
service @ $10.00 = $ I'L>
A2.
IAdditional Excavations same
~
B. Excavations 18" in depth a'r: less:
0-100 I.f. = $10.00
I.f. @ $0.10-$
Additional
C. Excavations...lSII in depth to 51 in depth:
0-100 I.f. =$30.00
.I.f. @ $0.30 =$
Additional
D. Excavations 51 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
thisapplicatiori prior to issuance of permit.
* . ."
~v
TOTAL CO~T'S .55,
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
TOWN SOUTHOLD, NEW YORK
(_ $'~ 0/
Date
Received by the Town Clerk
Date
Permit Issued, l-~ -0 (
Date
Permit No. g ~
Note:
Permit expires one (1) year from Date of Issuance.
No work to start without 48 hour notice "to the Sl:Iperintendent of Highways.
Permit must be available for inspection.
n ,n
Page 2 of 3
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KEYSPAN
REQUEST FOR STREET OPENING PERMIT
FC-6111.4
PERMIT
NO.
LOCATION f/s
REASON FOR
OPENING
W.O./PA
NO.
REQUESTED
BY
APPROVED
D STATE
NASSAU
COUNTY
MIS JOB
NO.
vE 1'-/0' tJ/o -I-fOMMLL-
V((I:.. u. P 6-VL4bt
FOREMAN
D
D
SUFFOLK
COUNTY
0'
-Ce. 30cJ-rH'l.-~
1"'2... - "l-Ir--oo
"A.. ko IJ
DEPARTMENT
GAS CONSTR. MAINT. & SERVICES
I-/S-OI
C-CM.~S 2.'/
DATE
SKETCH
~al~~ IDP;-01-So~tf
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Date: 01/12/01
Transaction(s):
Name:
Clerk ID: L1NDAC
.
1 Permits
Check#: 1103
Key, Span Energy
448 East Main Street
Patchogue, NY 11727
Town Of Southold
P.OBox1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#:
Total Paid:
1103
Subtotal
$55.00
$55.00
Internal 10: 24659