HomeMy WebLinkAboutHighland RdTown Of Southold
P.O Box 1179
Southold, NY 11971
Date: 04/24/09
* * * RECEIPT * * *
Receipt~:
46437
Transaction(s):
1 1 Permits
Check#: 2306
Reference
625
Total Paid:
Subtotal
$180:00
$180,00
Name:
R & R, Construction
282 Line Rd
Mano~ille, NY 11949
Clerk ID: LINDAC Internal ID: 625
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconlc Lane
Peconic: New York 11958:
(631) 765-31q0
A~PPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
RECEIVED
2 4 2009
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 permR
authorized Inspectors to mlak~ neceSSary inspections of the job site.
9)
10)
11)
Print or Type
Name of Applicant
Address
Name of Owner of Premises Address
Work Descri~tlon and Location {S[reet Number, mlet, C)~oss Street}
(a) Is construction located wlthih 75 feet of tidal wetlands? *Yes No ~,
*If yes, other Town permits may be requlrod. ~ ....
Zl} Builder's License No. Plumber's License No.
Electrician's ·License No. Other Traders License No.
$)
~,~ ~r!; t~eef App/icartt
a) Attach plot plan showing IocaUon o~Prol~x~sed ex.cavatlon 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 Excavatloh Permit by the Town Clerk.
6) Tax Map: Section
7) Starting Date: .~/:~O I O~
8) Work Schedule:
Phase
· Block , Lot
Completion Date
Co_~letlon Date
Excavation .........................................
FacUlty Installation .................................
Backfill ~, Cempectlon ..............................
Pavement Replacement .......... ~ ...................
Under which authority is the application made:
Estimated Cost of Proposed Work: ~ /,,~S'-OO'
D-39
Page 1 of 3
133
12)
Insurance Coverage: (^ttach copy)
a) Insurance Company: "TL~ ~c~ -
b) Policy #
c} S~te whether ~ltcy of ce~ifl~tlon on file with the Highway Depen-
d) Core,ge r~ulr~ ~tend~ to the Town:
B~lly ~nju~ and p~perty damage: ~300,000/$500,000 B~ily ~nju~,
and ~50,000 property damage.
Security:
a) Surety Bond or Certified Check
total amount of $
b) Maintenance Bond provided: 2 years or
~orovided in the
3 years
Fees for applications and permlt~: Basic Application Fee .....
Al. /Service Connections excavations e $20.00 = $ No.
A2. /Additional Excavations same service ~) $10.00 = $
N& _
B. Excavations 18" In depth or less;
0-100 hr. = $10,00
· ~ I.f. e $0.10- $ ~O,OO
A~lditional
C. Excavations 18" In depth to 5" In depth:
0-100 I.f. = $30.00
I.f. e $0.30 ~= $
Additional
D. Excavations 5' in depth and over:
0-100 I.f. =
i.f. e ~0. s0 = $
"~,ddltlonal
Fo
Additional
Utility Repair Excavations e$~0.00 = $
Repairs same service e ~5.00 = $
Notice to public 'utilities proof must be provided and attached to
this 'appllc~itlon prior to Issuance of Permit.
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.
Received by the Town Clerk ~7/-~/'d/ Date
Permit Issued c/-~y-O~/ Permit No.
Date
Note:
D-39
Permit expires one (1) year from Date of Issuance.
No work to start without ~8 hour' notice to the Superintendent of Highways.
Permit ·must be available for inspection.
Page 2 of 3
(~opy Dlstrlbutlo~:
Highway Department
Inspector
Applicant
Town Clerk
1st
2nd
3rd
~th
I N S P E C T O R ,.S R E C O R r~
Inspection Date
Findings (use code]
Applicant Notified
(To Permit Clerk)
REMARKS
,~,ODE
lB ~ Improper barricades
IL -Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
BUC - Building under Construction
WlP - Work in'progress
DB -'Improper backflll'(too high) (not sufficient)
HFS - Inspector holding for final settlement of excavation
RFR - Ready to repair ·
D-3g
Page 3 of 3
Town of Southold
P.O Box 1179
Southold, NY 11971
Date: 07/20/10
* * * RECEIPT * * *
ReceiptS: 88050
Transaction(s):
1 1
Permits
Reference Subtotal
658 $170.00
Check~: 19260
Total Paid: $170,00
Name:
National, Grid - Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 658
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
JUL 2 c 203
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Southold Town
W.O.# T101145496
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
t) NATIONAL GRID- GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE~ NY 11801
Name of Applicant Address
2) Highland Rd. Cutchogue
Owner of Premises Address
3) I-4'x4' bellhole on the W/s grass area, approx. 130' n/o Main Rd., to install a 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.
s)
Plumber's License No.
Other Trade's License ~'
7-14-10
Date
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) At~ach 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:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
, Lot
Completion Date
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: 2years 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.£ ~ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-100 I.f. =
Additional If. ~ .30 =
D. Excavations 5' in depth and over:
0-100 l.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 attached to this application prior to issuance of
permit.
TOTAL COST -- $170.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
Received by the Town Clerk 7 - a~ O-/~
Date
Permit Issued 7 - ~ ~/O Permit No.
SUPffdtffN~TEND_E~T OF HIGHWAYS
Note: Permit expires one (1) year from Date of issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
l~t
2nd
3rd
4th
Findings(usecode)
Applicant Notified
(To Permit Clerk
REMARKS
CODE
lB- Improper barricades
IL -lmproper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
BUC - Building under Construction
WIP - Work in Progress
DB - Improper backfill (too high) (not sufficient)
HFS- Inspector holding for final settlement ofexcavation
RFR Ready to Repair
D-39 Page 3 of 3
09:24
nationalgrid
REQUEST FOR STREET OPENING pERMIT
E~, STATE, [~ NASSAU SUFFOLK
COUNTY E~ COUNTY []
6317585182 P.05
PERMIT
NO.
LOCATION
RE.~80N FOR
OPENING
W.O~A
NO.
REQUEg'rED
BY
APPROVED
MI6 4OB ~
NO. '7/~'//'/'-¢*/' ~'~
FOREMAN DATE OF
/ DEPARTMENT DiViEi(ONPENINO
'/GAS ~ONSTR. MAINT. & SERV CE$
IDATE
N
TOT,qL P. 05
Town of Southold
P.O Box 1179
Southold, NY 11971
Date: 09/08/10
* * * RECEIPT * * *
Receipt~: 91652
Transaction(s):
1 1
Permits
Reference Subtotal
670 $185.00
Check#: 2964
Total Paid: $185.00
Name:
R & R, Construction
282 Line Rd
Manorville, NY 11949
Clerk ID: LINDAC Internal ID: 670
RECEIVED
8 2010
Permit No.
TOWN OF SOUTHOLD
::GHWAY DEPARTMENT.
=.~conic Lane
Peconlc. New York 11958
(631J 765-- 31q0
APPLICA3~ION/PERMIT FOR HIGHWAY~ EXCAVATION AND REPAIR
5)¸
e)
7)
8)
APPLICATION IS HEREBY made to.the Superintendent of Highways of the Town
of Southold for the issuance of an ExcavaUon Permit pursuant to Chapter 83 of the
Code of the Town of Southold, Suffolk County, New York, and other applicable laws,
ordln&nces 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
Name of Applicant
2)
Name of Ow,=r of Premises Address
WOrK Des~.i ;p;:i~lfn and Location (Stf'eet Number, I~amlet, Cross Street)
(a) Is construction located wlthih 75 feet of tidal wetlands? *Yes No
*If yes, other Town permit~ may be required.
4) Builder's License No. Plumber's License No.
Electrician's License No. Othq~ Traders License No.
a) Attach plot plan showing location o~., prol~sed ex.cavation and relationship to
adjoining prei~lses or public 'streets or areas, and giving a detailed descrll~
tion of layout of excavation.
b) Attach all other necessary permits and licenses for this project.
c) Wbrk covered by this application may not commence before issuance of a
Highway Excavation Permit 'by the Town Clerk.
Tax Map: Section , Block , Lot
Starting Date: Completion Date
Work Schedule:
Phase Completion Date
Excavation .........................................
Facility Installation .................................
Backfill ~. Compaction ..............................
Pavement Replacement ..............................
Under which authority is the application made:
Estimated Cost of Proposed Work: $
9)
11)
'Address
D-39
Page 1 of 3
12)
~3)
Al.
A2.
B.
Insurance Coverage: (Attach copy)
a) Insurance Company: ~
b) Policy #
c} State whether policy of certification on file with the Highway Depart-
ment:
d) Coverage required extended to the Town:
Bodily Injury and property damage: $300,000/$500,000 Bodily Injury,
and $50,000 property damage.
Security:
a) Surety Bond or Certified Check provided inthe
total amount of $
b) Maintenance Bond provided: 2 years or 3 years
Fees for applications and permitS: Basic Application Fee ........
o~ /Servic® Connections excavations e $20.00 = $ ~O. oo
N .
/Additional Excavations same service ~ $$0.00 = $
No.
Co
Excavations 18" in depth or Jess:
0-100 I.f. = $10.00
I~ i.f. e $o.~o - $
Additional
Excavations 18" In depth to 5~ in depth:
0-100 I.f. = $30.00
I.f. ~ $0.30 .= $
Additional
EXcevaUons 5' in'depth and over:
0-100 I.f. = $50.00
I.f. Q tO. SO = $
Additional
Eo
No,
Additional
Utility Repair Excavations e$~0. O0
Repairs same service 0 $5.00
F. Notice to public utilities proof must be provided and attached to
this application prior to issuance of permit.
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.
~eter W. [ltarris
D~te
Received by the Town Clerk
Permit Issued
Date
Note:
Date
Permit No. ~ 7~)
Permit expires one (1) year from Date of Issuance.
No work to start without q8 heu~ notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
IN SPECTOR~S RECORD
1st
2nd
3rd
qth
Inspection Date
Findings (use code}
Applicant Notified
{To Pemlt Clerk)
REMARKS
CODE
lB - Improper barricades
IL - Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure (due to backfilling)
BUC - Building under Constructioh
WlP - Work in'progress
DB - Improper backf'lll' (too high) (not sufficient)
HFS - Inspector holding for final settlement of ex~;avation
RFR - Ready to repair
D-39 Page 3 of 3