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Home My WebLink AboutTown Harbor LnTown Of Southold P.O Box 1179 Southold, NY 11971 Date: 02/25/09 * * * RECEIPT * * * Receipt~: 42284 Transaction(s): 1 1 Permits Reference Subtotal 609 $170,00 Check#:16722 Total Paid: $170.00 Name: National, Grid - Gas Constr. Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LYNDAR Internal ID: 609 Perm,t No. File No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (631) 765-3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR Re~#TI00991922 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. - H1CKSVILLE~ NY 11801 Name of Applicant 2) Town Harbor Lane Southold Address OwnerofPremises Address 3) 4) 6) I-4'x4' bellhole in Rrass area on W/s of Town Harbor La. s/o Main Rd. to relace a gas service 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~License N __ 2-23-09 Date s) 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: 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: 13) Security: a) h) 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 $ Maintenance Bonded provided: 2 years or 3 years 14) Fees for annlications and permits: Basic Application Fee Al. I _/Service Connections excavations ~ $20.00 = A2. /Additional Excavations same service ~ $10.00 = No. $150.00 $2o.oo B. Excavmions 18" in depth or less: 0-100 1.£ = $10.00- I.£650.10= Additional Excavations 18" in depth to 5' in depth: 0-100 1.£ = Additional Iff ~ .30 = D. Excavations 5' in depth and over: 0-100 l.f. = $50.00 kf. @ $0.50 = $ Additional No. Additional Utility Repair Excavations ~ $10.00 = $ Repairs same service ~ $5.00 = $ Notice to public utilities proof must be provided and atlached 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 or[ ! ~..~!(~ Permit No. SUPE/~L'[ENDENT OF HIGHWAYS TO¥(N OF~OUTHOLDA,~EW YORK -- ~l~e~r W."Harris ! Date 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 Page2of3 Copy Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date 1st 2r~ 3rd 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 WlP - 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 REQUEST FOR STREET OPENING PERMIT PERMIT NO. LOCATION REASON FOR OPENING W.OJPA NO. REQUESTED BY APPROVED ~'~ STATE E~ NASSAU COUNTY [] SUFFOLK COUNTY MIS JOB .o. P. 03 I FOREMAN DATE OF OPENING DEPARTMENT DIVISION GAS CONSTR. MAINT. & SERVICES ~g'~ ~'. DATE N SKETCH TOTAL P.03 Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 06/25/09 * * * RECEIPT * * * Receipt~: 52548 Transaction(s): 1 I Permits Reference Subtotal 629 $170.00 Check~: 17272 Total Paid: $170.00 Name: National, Grid - Gas Constr. Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC internal ID: 629 Permit No. File No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (631) 765-3140 RECEIVED JUN 2 5 ~009 $oothold Town Clerk APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR Re~ IRL385-7822 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 CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVH,!.E. NY 11801 Name of Applicant Address 2) Town Harbor Lane Southold Owner of Premises Address 3) I-4'x4' bellhole on the E/s of Town Harbor La., 15' n/o Daly Lane 4) 5) 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. 6-16-09 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 , 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 (Atiach 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) b) 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 $ Maintenance Bonded provided: 2 years or 3 years 14) Fees for anolications and permits: Basic Application Fee Al. I /Service Connections excavations ~ $20.00 = A2. /Additional Excavations same service @ $10.00 = No. $150.00 $20.0o B. Excavations 18" in depth or less: 0-100 I.f. = $10.00 - I.f. ~ $0.10: Additional C. Excavations 18" in depth to 5' in depth: 0-100 l.f. = Additional If. ~ .30 = D. Excavations 5' in depth and over: 0-100 l.f. = $50.00 1.£ $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 Pe~nit to: KEYSPAN ENERGY DELIVERY in accordance with this application. Received by the Town Clerk b - °~5~'~e6" Date ~o~ Permit Issued ~ ~ od'5~ tgi' Permit No. SU.p~E'q~II~NDENT OF HIG~IWAYS T~UT~t~N~ORK Peter W. Harris Note: Permit expires one (1) year from Date of Issuance. No work to strut without 48 hour notice to the Superintendent of Highways. Pennit must be available for inspection. D-39 Page2 of 3 Copy Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date 3rd 4tt, Findings (use code) Applicant Notified (To Permit Clerk) REMARKS CODE lB - Improper barricades IL - Improper lights ST - Sunken trench or excavation UTM -UnabIe 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 REQUEST FOR STREET OPENING PERMIT J-'~STATE J'~ NASSAU COUNTY SUFFOLK COUNTY P. O2 PERMIT NO. LOCATION REASON FOR OPENING W.O./PA NO. REQUESTED BY APPROVED IFOREMAN.~. /~/O~E~:://p...' DEPARTME.T GAS CONSTR. MAINT. & SERVICES DATE OF OPENING DIVISION DATE SKETCH -F 1~'-/7 lq '~/:)LY / ~),