HomeMy WebLinkAbout2855 Westview DrTown of Southold
P.O Box 1179
Southold, NY 11971
Date: 08/09/10
* * * RECEIPT * * *
ReceiptS: 89818
Transaction(s):
1 1
Permits
Reference Subtotal
660 $170.00
Check#: 19376
Total Paid: $170.00
Name:
National, Grid - Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 660
Permit No.
File No.
TOWN OF SOUTHOLD RI:CF[VF~
HIGHWAY DEPARTMENT
Peconie Lane
Peconic, New York 11958 '~{'IC 9 ~010
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR $outho[d ~own ]1 ~C~er~
W.O.# T101156432
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) 2855 Westview Drive Mattituck
Owner of Premises Address
3) 1-4'x4' bellhole on the S/s of Westview Drive 173' w/o Grand Ave., to install a gas
service. J~:'. 2Eik/ED
4)
S)
6)
7) tidal wetlands? *Yes
Builder's License No.
' n 2010
*If yes, other Town permits may he reqnired.
Plumber's License No.
Electrician's LieenseNo.
Other Trade's License No. ~ · /
Signature of Ap~lican~ I ~'' !
7-30-10
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) l~stimated 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) SecuriW:
a)
Surety Bond or Certified Check provided in the total amount
ors
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee
Al. _l__/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 I.f. - $10.00 -
I.f. ~ $0.10
Additional
Excavations 18" in depth to 5' in depth:
0-100 1.f. =
Additional If. ~ .30 =
D. Excavations 5' in depth and over:
0-100 1.£ = $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 = $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 ~ - ~ - /
Permit Issued ~- ¢ ~Z'O Date Permit No.
SUPE~fl~iNDENT OF HIGHWAYS
TO UTHOLD, N ffORK
Not~e: 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
(C) National Grid 8/4/10 11:02 AM
09/08 '10 MON 15:07 FAX 631 765 6145 SOUTHOLD TOWN CLERK ~001
*** TX REPORT
TRANSMISSION OK
TX/RX NO
CONNECTION TEL
CONNECTION ID
ST, TI~E
USAGE T
PGS. SENT
RESULT
1247
15165454474
09/08 15:05
01'44
4
OK
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FAX TRANSMITTAL
To:
From:
Dated:
Re:
Linda Pierce
National Grid
Linda J. Cooper, Deputy Town Clerk
August 9, 2010
Highway Excavation Permit
Number of Pages (including cover): 4
If total transmittal is not received, please call 631-765-1800, Ext 210
COMMENTS:
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
FAX TRANSMITTAL
To-'
From:
Dated:
Re:
Linda Pierce
National Grid
Linda J. Cooper, Deputy Town Clerk
August 9, 2010
Highway Excavation Permit
Number of Pages (including cover): 4
If total transmittal is not received, please call 631-765-1800, Ext 210
COMMENTS:
Sorry I couldn't issue this without Pete's signature.
AUG-06-2010 00:57 KEYSPAN 46619 P.O01
Dept./Co.:, .,,. __
Fax No,'~-
Messages/Comments'
!'No. of l)ages
05/08 '10 TflU 11:50 FAX 631 765 6145 SOUTHOLD TOWN CLERK ~001
*** TX REPORT
TRANSMISSION OK
TX/RX NO
CONNECTION TEL
CONNECTION ID
ST. TIME
USAGE T
PGS. SENT
RESULT
1239
Hlghway Dept
05/08 11:48
02'17
5
OK
7651750
AU~-05-2010 00:67
KEYSPAN
4B619 P.001
AUG-06-2010 00:67
KEYSPAN
46619
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Pcconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGJ~WAY EXCAVATION AND REPAIR
W.O~T101156432
P.O02
APPLICATION IS HEREBY made to the Supcrintrndcnt of llighways of the Town of ~%uthold for the issuance of
Print or Type
1) ~/~TIONAI, GRID- GAS CONSTR. DEWf. - 175 ~, OLD COUNTRY RD. -HI~SVHJ~E. ~ I I~1
2) 2855 Westview Drive Mattituck
Owner of Premises Addre~
3) 1-4'x4' bcllhole on the SIs of Wcstview Drive 173' w/o Grand Av~, to install a gas
scrvicc.
a)
~)
No X
'ff yes, other Town ~ermi~ may be rcqulrcd.
Builder's License No.
Electrician's License
Plumber's License No.
Other Trade's License No.
7-30-10
Date
5) a) Attachp~t~ans~w~ngl~¢at~n~fpr~p~s~dexc~vati~n~ndre~tionshipt~adjoining~remises~r
public streets or areas, and giving a detailed description of layout of excavation.
b) Attach all other necessary permits and liceasez for this project.
c) Work cevered by thi~ application may not cam mcnce befare issuance of a Highway Excavation Permit
by the Town Clerk.
6) Tax Map: Section
7) 5~arting Date:
8) Work Schedule:
, Block ,, , Lot
Completion Date:
Phase
Facility tas mHation .....................................
Backffil & Compaction .........................................................
Pavement Replacement ............................. ,,, .........................
9) Under whicb authority iS the application made:
ComnletJon Date
AUG-06-2010 00:68 KEYSPAN 46G19 P.003
·" ' 10) Estimated Cost of Proposed Work: $
il) Remarlu:
12) ,~y~li~,,.C~ (Attach Copy)
a) In,~an-ance Company:
b) Policy #
c) Slate whether policy of certification on file with thc HighWay Department:
d) Coverage rexiuired extende4 to thc Towa:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury. and $$0.000 property damage_
13) S¢cndty:
a)
b)
Sur~'y Bond or Certified Chcck
ors
Ma/nlenance Bonded provided: 2 ye~u~ or
provided in thc toL~l tanount
3 years
14) Fec~ for aooli~i~ and .~:.it.~: Basic Application Fee
A.1. _l__/S~vicc Connections excavations (~ $20,00 =
^2. /Additional Excavations mu'n: scrvico ~ $10.00 =
'No.
$I 50.00
B. .Excavations 18" ia dcpth or l~s:
O-lO0 Lf. = $10,00 -
_ i,f. ® $030 =
Additional
C. Excavation~q 1 g" in depth to $' in d~pth:
0-100 l.t}=
Additional If. ~ .30:
D. Excavations 5' in depth and over:
O. lOO l.r. - $so.oo
13; (~ $0.50 = $
Addifiorml
No.
Additional
Utility Ropair Excavations ~ $10.00 = $
eepai~ same scrvicc ~ $5.00 = $
Noticc to public utilities proof must be provJdcd and attached to this application pfio¢ to issuan~ of
p~iL
TOTAl.COST = $170.~
Aulbe6zation is het~by gtanmd to'.he Town Clcrk of th~ Town of Southold to issuc a Highway 15xcavmlon Pcrmlt to;
'KEYSPAN ENERGY DELIVERY_in ~orda~c~ wlth this application.
SUPERIN~ OF I-.r[GI-IWAY$
TOWN' OF SOUTI-IOLD, NEW YORK
Pctcr W. Harris
Rcccivcd by thc Town Clcnk
Date
P~it Issued permit No.
Note.: Permit ~xpitcs ooc (1) ycar fix)m Date of ls.~uanc~. No work to start witlmut 48 hour nofic~ to thc Sul~rinkmd~t or:qi~ways.
pea'mit musl bc available for in~x~ection.
AUG-05-Z010 00:68 KEYSPAN 46Gi9 P.O04
Couv Di~bution:
H~h~ay Dcpaztmcnt
Inspector
Applicant
Town Clerk
IN~P EI~TOR',~ RECORD
Inspection Date
Findings (uS. code)
Applioant Notificd
(To Perm{: Clerk)
REMAR~
I]3 - Improper barricad~
IL - Improper light~
ST - gtmkcn trench ot cxcavatlon
[;TM - Unabl~ to moa~urc (duc to backfilling)
BUC - Buildkng und~ Construction
WIp - Work in Progress
DB - Improper backfill (too high) (not ~uIlici~nt)
HFS- Inspector holding forfinalse~emvmof*xcavation
RFR - P.:ady ~o Repair
Page 3 ar3
lierce~
Hot Center:
101 minor: 04265300 Scale: 1:72.02
(C) National Grid 8/5/10 11:39 AM