HomeMy WebLinkAbout10016 Oregon RdTown of Southold
P.O Box 1179
Southold, NY 11971
Date: 02/10/11
* * * RECEIPT * * *
Receipt'8: 97574
Transaction(s):
1 1
Permits
Reference Subtotal
684 $177.00
Check~: 1206
Total Paid: $177.00
Name:
L, IPA
117 Doctor's Path
Riverhead, NY 11901
Clerk ID: LINDAC Internal ID: 684
Ref. Ti01199130
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
P.O. Box 178
P¢conic, New York 11958
(631)765-3140
RECEIVED
'-E ! 0 201/
APPLICATION / PERMIT FOR HIGHWAY EXCAVATION AND REPAIIt
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the iasuancc of an Excavation Permil
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 necessa,~y inspections of the job site.
Print or Type
I. LIPA - 117 Doctors Path, Riverhead, NY 11901
Name of Applicant Address of Applicant
Oregon Landing II 10016 Oregon Road, Cutchogue
Name of Owner of Premises Address of Owner
3. See permit application
Work Description and Location (Street Number, Hamlet, Cross Stteet)
(a) Is construction located within 75 feet of tidal wetlands? * Yes · If y~s, other Towa pemaits may be required.
4. Builder's License No.
Electrician's License No.
No
Plumber's License No.
Other Trade's License No.
· JS~'nstm'e of Applicant
Steven AT, ward _ LIPA 548-7062
Date
1/21/11
5. (a) Attached plot plan showing location of proposed excavation and relationship to adjoining premises or public street or areas, and
giving a detailed description of layout of excavation.
(b) Attach all other necessaxy permits and licenses for this project.
(c) Work covered by this application may not commence before issuance ora Highway Excavation Permit by the Town Clerk.
6. Tax Map No.: Section , Block , Lot
7. Starting Date:
8. Work Schedule:
Phase
Excavation
Facility Imtallation
Backfill & Completion
Pavement Replacement
Completion Date:
Under which authority is application being made:
10. Estimated Cost of Proposed Work: $
I 1. Remarks:
D-39 1 of 3
12. Insurance Coverage: (Attach Copy)
~) Ins.~ance Company:
('b) Pol/cy #:
(c) State whether policy of certification on file w/th thc 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 Bond provided: 2 years or 3 years.
14. Fees for Applications and permits:
Basic Application Fee $150.00
Al. /Service Connections excavations @ $20.00 $
No.
A2. / Additional Excavations same service ~ $10.00 $
No.
B. Excavations 18" in depth or less
0-100 i.f. = $10.00; Additional i.f. ~ $0.10 $
C. Excavations 18" in depth to 5' in depth
0_ 100 L f. = $30.00; Addifonal .t~ i.f. ~ $0.30 $ ~Zt~
D. Excavations 5' in depth and over
0-100 i.f. = $50.00; Additional i.f. ~ $0.50 $
E. Utility Repair Excavations ~ $10.00 $
No.
Repairs same service ~ $5.00 $
Additional
TOTALS /7/~ /~
' 'F. Notice to public utilities proof must be provided and at*ached to this application pr/or to issuance
of purmit.
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation p~rm/[ to:
Date Received by the Town Clerk
in accordance with this appl/cation.
oF momv^¥s
TOW'N/QE.S~UTHOLD, NEW ~
'~ - "~ 'l~eter W. Harris
Date Penmt Issued ( Permit No.
£ NOTE: Perm/t expires one (1) year from date of issuance.
No work to start without 48 hour notice to Superintendent of Highways.
Permit must be available for inspection.
D-39 2' of 3
Copy Distribution:
H~ghway Depata~ent
Engineer (with page 3)
Applicant
Town Clerk (Original)
1st
2nd
3~d
4th
Inspection Date
INSPECTOR'S RECORDS
Findings (use code
Applicant Notified
(To Permit Clerk)
CODE.
IB Improper Barricades
IL h~Lvp~, Li~ht~
ST
UTM
BUC
WI?
DB
HFS
RFR
Sunken Trench or Excavation
Unable to Measure (due to backfilling)
Building Under Construction
Work In Progress
Improper Ba _d~. 11 0too kigh, not sufficient)
Inspector Holding for Final Settlement of Excavation
Ready for Repair
D-39 : 3 of 3
:g SOUTHOLD TOWN PERMIT
LIPA WORK ORDER# T101199130
N
1) LIPA TO DIG A 2'X 60' TRENCH(IN GRASS) ON THE SOUTH SIDE OF OREGON RD.
STARTING +- 295' WEST OF ALVAH'S LA, THEN TRENCHING WEST FOR 60.
2) LIPA TO DIG A 2'X 30' TRENCH ACROSS OREGON RD.,+-335' WEST
OF ALVAH'S LA.
3) LIPA TO INSTALL A NEW POLE+- 355' WEST OF ALVAH'S LA.