HomeMy WebLinkAbout955 Soundview Ave ExtTown of Southold
P.O Box 1179
Southold, NY 11971
Date: 11/12/09
* * * RECEIPT * * *
Receipt#: 61303
Transaction(s):
1 1
Permits
Reference Subtotal
641 $17000
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: 641
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
RECEIVED
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
W.O.# T101077425
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. - HICKSV1LLE~ NY 11801
Name of Applicant Address
2) 955 Soundview Ave. Ext.
Southold Owner of Premises Address
3) 1-4'x4' bellhole on the N/s (grass area), approx. 700' e/o Lighthouse Rd., to re-install a
gas service
4)
$)
6)
7)
tidal wetlands? *Yes
No X
*If yes, other Town permits may be required.
Builder's License No.
Plumber's License No.
Electrician's License No.
Other Trade's License No.
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.
6) Tax Map: Section , Block
7) Starting Date: Completion Date:
8) Work Schedule:
Lot
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
Completion Date
9) Under which authority is the application made:
I0) 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:
13) Security:
a)
Bodily injury and property damage: $300,000/$500,000 Bodily Injury, and $50,000 property damage.
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: Basle Application Fee $150.00
Al. I /Service Connections excavations @ $20.00 = $20.00
A2. /Additional Excavations same service @ $10.00 =
No.
B. Excavations 18" in depth or less:
0-1001.f. = $10.00 -
I.f. @ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-100 1.f. =
Additional I£ ~ .30 =
Excavations 5' in depth and over:
0-100 1.~ = $50.00
l.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 -- $170.00
Received by the Town Clerk //~/d ~ o ~'
Date
Permit Issued //-/.~ ~ o '~ Permit No. ~_~ ~"~t/
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SU~ENDENT OF HIq~dWAYS
TO~N~SOU~'HOLD, I~E~N YORK
Date
Not~e: Pem~it expires one (I) year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39 Page2of3
nationalgrid
REQUEST FOR STREET OPENING PERMIT
FC-5111,4
PERMIT
NO.
LOCATION
REASON FOR
OPENING
~"-1 STATE ~1 NA$SAUcouNTY ~1COUNTySUFFOLK ~-~
~IS JOB
W.OJPA
NO.
REQUESTED
BY
APPROVED
FOREMAN
DEPARTMENT
GAS CONSTR. MAINT.& SERVICES
IDATE OF
OPENING
IDIVlSION
DATE
SKETCH
J
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
1st
2nd
3.4
Findings (use code)
Applicant Notified
(To Permit Clerk)
REMARKS
COD~
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 - Improper backfill (too high) (not sufficient)
HFS- lnspectorholding for final settlement ofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
Town of Southold
P.O Box 1179
Southold, NY 11971
Date: 12/17/10
* * * RECEIPT * * *
Receipt'8: 95029
Transaction(s):
1 I
Permits
Reference Subtotal
682 $170.00
Chec1~:20072
Total Paid: $170.00
Name:
National, Grid - Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 682
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
W.O.# T101192218
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 oftbe 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 CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSV1LLE~ NY 11801
Name of Applicant Address
2) 955 Soundview Ave. Ext., Southold
Owner of Premises Address
3) 1-4'x4' hellhole on the N/s grass area, approx. 700' e/o Lighthouse Rd., to install gas
service
4)
5)
6)
7)
tidal wetlands? *Yes
No X
*If yes, other Town permits may be required.
Builder's License No.
Electrician's License No.
Plumber's License No.
Other Trade's Licens.~Np.
Si~n~t~e~fAbplicant ~'/- /
12-10.10
Date
5) a) Atta~hp~tp~ansh~wing~cati~n~fpr~p~sedexcavati~nandre~ati~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
7) Starting Date:
8) Work Schedule:
Block , Lot
Completion Date:
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 Coverane (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 anolications and oermits: Basic Application Fee
Al. _l__/Service Connections excavations ~ $20.00 =
$150.00
$20.o0
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 I.f. =
Additional IE ~ .30 =
D. Excavations 5' in depth and over:
0-100 1.f. = $50.00
l.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 aRached 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.
Received by the Town Clerk /°t~ -/2'~/~)
/~ ,,,/~ ,,//g) Date
Permit Issued Pe~it No.
SUPERI'~:LT~DENT OF HIGHWAY~/
TOX3d~ OF~SO~'TH~}LO, NF,,W Y.~I~
~ter W. H~is
Date
Not~e: Permit expires one (l) year from Date oflssuanee. Noworktostartwithout48hournotieetotheSuperintendentofHighways.
Permit must be available for inspection.
D-39 Page2of3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
Findings(usecode)
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- Inspectorholdingforfinalsettlementofexcavation
RFR - Ready to Repair
D-39 Page 3 of 3
DEO-Og-"20~.0 ~.0:02 GAS SALES PATCHOC.:~JE ~1758518~ P.02
nationalgrid
~' REQUEST FOR STREET OPENING PERMIT
COUNTY F"] SUFEOLK COUN'FY
~o0 ~
TOTAL P.02