HomeMy WebLinkAbout11780 Sound AveTown of Southold
P.O Box 1179
Southold, NY 11971
Date: 11/12/09
* * * RECEIPT * * *
ReceiptS: 61304
Transaction(e):
1 1
Permits
Reference Subtotal
642 $170.00
Check#: 17982
Total Paid: $170.00
Name:
National, Grid - Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 642
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconie Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
W.O.# T1~I078646 ?'::'" '~?
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 make necessary inspections of the
job site.
Print or Type
1) NATIONAL GRID- GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE~ NY 11801
Name of Applicant Address
2) 11780 Sound Avenue Mattituck Owner of Premises Address
3) 1-4'x4' bellhole on the S/s of Sound Ave., approximately 175' e/o Lipco Rd., to install a
gas service
4)
5)
6)
7)
tidal wetlands? *Yes
No X
*lf yes, other Town permits may be required.
Builder's License No.
Electrician's License No.
Plumber's License No.
Other Trade's License No.
11-05-09
Date
5) a) Attachp~~tp~ansh~wing~~cati~n~fpr~p~sedexcavati~nandrelati~nshipt~adj~iningpremises~r
public streets or areas, and giving a detailed description 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:
Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
Completion Date
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
12) Insurance Coverage (Attach Copy)
a) Insurance Company:
b) Policy#
c) State whether policy of certification on file with the Highway Department:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury, and $50,000 property damage.
13) Security:
a)
Surety Bond or Certified Check provided in the total amount
of $
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee
Al. 1 /Service Connections excavations ~ $20.00 =
$150.00
$20.00
A2. /Additional Excavations same service ~ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 l.f. = $10.00 -
I.f. ~ $0.10
Additional
Excavations 18" in depth to 5' in depth:
0-100 l.f. =
Additional If. ~ .30 =
D. Excavations 5' in depth and over:
0-100 I.f. = $50.00
I.~ @ $0.50 = $
Additional
NO.
Additional
Utility Repair Excavations ~ $ l 0.00: $
Repairs same service @ $5.00 = $
Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST = $170.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SI~'~ENDENT OF HIGHWAYS
T~ SO?TH~L~ NEW YORK
~ -- ~lY~ter ¢~'. ~larris
Received by the Town Clerk ~t/- '/~7- dP ~'
Date
Permitlssued //'-/~)- ~ ~9 e.~ PermitNo.
Not~e: Permitexpiresone(I)yearfromDateoflssuance Noworktostar~without48hournoticetotheSuperintendentofHighways.
Permit must be available for inspection.
D-39 Page 2 of 3
PERMIT
NO.
LOCATION
REASON FoR
OPENING
W,OJPA
NO.
REQUESTED
BY
APPROVED
SKETCH
06:52 KEYSPRH GAS ¢OHSTE 631 ?58 5136 P.02
naTiORalgrlQ
REQUEST FOR STREET OPENING PERMIT
J---I'STATE ~ .AS$~U SU~O'.
· cou~ I-1 oou.~
~,: jo~/~.~/e?~,
I FOREMAN . ' DATE OF
i ~EPA"~ME"~ . D.v,L,Oo....,.G ~5~
GAS CONSTR. MAINT. & SERVICES
DATE
E)
N
TOTAL P.02
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
1st
2nd
4th
Findings (use code)
Applicant Notified
(To Permit Clerk)
REMARKS
CODE
lB 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 - lmproperbackfill (too high) (not sufficient)
HFS Inspector holding for final settlement of excavation
RFR Ready to Repair
D-39 Page 3 of 3
Town of Southold
P.O Box 1179
South01d, NY 11971
Date: 04/20/11
* * * RECEIPT * * *
Receipt~: 100945
Transaction(s):
1 1
Permits
Reference Subtotal
699 $230,00
Check~:20664
Total Paid: $230.00
Name:
National, Grid - Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 699
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peeonic Lane
Peconic, New York 11958
(631) 765-3140
£~CEIV~D
. r- ? ;;
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref#T101221944
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 make necessary inspections of the
job site.
Print or Tyne
1) NATIONAL GRID - GAS OPERATIONS DEPT.- 175 E. OLD COUNTRY RD. - HICKSVILLE~ NY
11801
Name of Applicant Address
2) 11780 Sound Avenue
Mattituck
Owner of Premises Address
3) 1-4'x6' bellhole & 35" trench on the e/s of North Cross Rd- 78' trench on the n/s Eastwood Dr,
missle road crossing to e/s of Holden Ave, 30' trench e/s of Holden Ave all in the grass area to
install a gas main and a missle shot across Holden Ave to 760 Holden Ave to install a gas service
4) Builder's License No.
Electrician's License No.
4) Work Description and Location (Street Number, Hamlet, Cross Street)
(a) Is construction located within 75 feet of tidal wetlands? *Yes No X
*If yes, other Town permits may be required.
Plumber's License No.
Other Trade's License No.
-Signature ~ f--A-ppli~n~"
4-18-11
Date
5) a) Attach plot plan showing location of proposed excavation and relationship to adjoining premises or
public streets or areas, and giving a detailed description 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.
~ Block , Lot
Completion Date:
6) Tax Map: Section
7) Starting Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
Il) Remarks:
Completion Date
D-39
12) Insurance Coverage: (Attach Copy)
a) Insurance Company:
b) Policy #
c) State whether policy of certification on file with the Highway Department:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury, and $50,000 property damage.
13) Security:
a)
Surety Bond _ or Certified Check provided in the total amount
of $
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee
Al. /Service Connections excavations ~ $20.00 =
100' trench fee
A2. /Additional Excavations same service ~ $10.00 =
No.
$150.00
+ 20.00 bellhole +30.00 for
And .30 ea. foot from 101'
$99.00)
B. Excavations 18" in depth or less:
0-100 I.f. - $10.00 -
I.£ ~ $0.10-
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 l.f. =
Additional If ~ .30 - of trench 130'
D. Excavations 5' in depth and over:
0-100 l.f. = $50.00
I.f. ~ $0.50 = $
Additional
No.
Additional
Utility Repair Excavations ~ $10.00 = $
Repairs same service @ $5.00 = $
Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST = $230.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
NATIONAL GRID in accordance with this application.
Received ~y t~¢ ~o~ Clerk
Permitlssued c/~.~ ~lf PermitNo. b ?7
SUPE~TENDENT OF HIGHWAYS
TO/WN ~F SOUTHOLD, NISW YORK
Peter W. Harris
q/n/i/
Not~e; Permit cxpires one (1) year from Dateoflssuance. Noworktostartwithout48hournoticetotheSuperintendento£Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
lst
Findings (use code)
Applicant Notified
(To Permit Clerk)
REMARKS
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- Inspector holding for final setfiement ofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
APR-14-2011 10:52 GAS SALES PATCHOGUE 6517585182 P.Og
nationalgrid
REQUEST FOR STREET OPENING PERMIT
'cC~' 11.4 J'~' STATE [~ NASSAU ~/
COUN~ ~ ~UFFOLK
NO. J ~ MIS JOB
_.: ~ .o. ~~ p'" ~/~
N
TOTAL P.09