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Home My WebLink About205 Private Rdo Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 08/11/05 * * * RECEIPT * * * Receipt~: 5362 Transaction(s): 1 1 Permits Reference Subtotal 401 $170.00 Check#: 5362 Total Paid: $170.00 Name: Keyspan, Energy - Gas Cont Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal iD: 401 Permit No. File No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peeonic Lane Peeonic, New York 11958 (631) 765-3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR ReL#T100532828 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 sit~ Print or Type 1) KEYSPAN ENERGY - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE, NY 11801 Name of Applicant Address 2) 2055 Bay Avenue, Mattituck Name of Owner of Premises Address 3) Bay Avenue - 4'X4' bellhole on w/s Bay Avenue, 650' n/o Bartle¥ Road~ for a gas service to #2055 4) Work Description and Location (Street Number, Hamlet, Cross Street) (a) Is construction located within 75 feet of tidal wetlands? *Yes No *If yes, other Town permits may be required. 4) Builder's License No. Electrician's License No. Plumber's License No. Other Trades It~'~nse No. Signature of Applicant 08-043-05 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: D-39 Page 1 of 3 T100532828 12) Insurance Coveranc: (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 lnjuty, 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 applications and permits: Basic Application Fee Al. _l__/Scrvicc Connections excavations ~ $20.00 = $20.00 $150.00 A2. /Additional Excavations same service @ $10.00 = No. B. Excav~ions 18"indepthorless: 0-I001.£ = $10.00- 1.£650.10 - Additional Excavations 18" in depth to 5' in depth: 0-1001.£ = Additional 1£ @ .30 = D. 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 Authorization is hereby granted to the Town Clerk of thc Town of Southold to issue a Highway Excavation Permit to: KEYSPAN ENERGY DELIVERY in accordance with t~is application. Received by the Town Clerk Date Permit Issued ~ . 11 ~ 0 ~ Permit No. SUPER~jJ~T~ENDENT OF HIGHWAYS TO~q OF2gOHTHOLD, N.~W YORK ¼ o_ - Peter W. Harris ' Dat~ 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 Cony Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date 3rd 4th Findings(usecode) Applicant Notified (To Permit Clerk) REMARKS CODE lB - Improper barricades 1L - 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- Inspector holding for finalsettlement ofexcavation RFR- Ready to Repair D-39 Page 3 of 3 I~'"-~ PF_AAMIT APPLICATION SKETCH DATE: LOCATION: TOWN: WORK ORDER: 8i4f200J 2:32:43 PM 2033 BAY AV MATFITUCK T100532828 VILLAGE O1; CROSS STREET: BARTLEY RD ~URFACE: ~ Here NO. 2055 4 x 4' BellHole BAY AY Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 03/24/09 * * * RECEIPT * * * Receipt#: 43928 Transaction(s): 1 1 Permits Reference Subtotal 615 $170.00 Check#: 16888 Total Paid: $170.00 Name: National, Grid - Gas Constr. Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal ID: 615 / Permit No. File No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT R~CEIV~D Peconic Lane Peconic, New York 11958 (631) 765-3140,~!~,.~.~: 2 4 20~ APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR 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. - H1CKSV1LLE~ NY 11801 Name of Applicant 2) 205 Private Road Southold Address Owner of Premises Address 3) 1-4'x4' bellhole on the S/s of Private Rd.~ 165' e/o Oaldawn Ave., to install a gas service 4) 5) 6) 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 Lic~e~se~llt Signatu ~-2o-o9 Date 5) a) Attachp~~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 ., 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 CostofProposedWork: $ 11) Remarks: 12) Insurance Coverage (AUach 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 orCertifiedCheck of $ b) Maintenance Bonded provided: 2 years or 3 years provided in the total amount 14) Fees for at~olications and permits: Basic Application Fee $150.00 Al. 1 /Service Connections excavations ~ $20.00 = $20.00 /Additional Excavations same service ~ $10.00 = No. B. Excavations 18" in depth or less: 0-100 l.f. = $10.00 - l.f. ~ $0.10 = Additional 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.fi - $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 hy the ~ow~ C~er~ Permit Issued 3 -a:~ q-O? Permit No. SUPE~N'T-~DENT OF HIGHWAYS TO UFL, F Peter W. Harris ~ Dat6t~ Not__e: Permit expires one (1) year from Date oflssuance. Noworktostartwithout48hournoticetotheSuperintendentofHighways. Permit must be available for inspection. D-39 Page2of3 Copy Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date 2nd yd 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- Inspector holding for finai settlement ofexcavation RFR- Ready to Repair D-39 Page 3 of 3 SUF~ACE: Macadam Rot: DATE: LOCATICiq: T OWN: WCRK ORDER: 3/20/2009 205 PRIVATE RD SOUTHOLD T101001763 PERMIT APPLICATION SKETCH Village Of C~OSS 5'[REET 2: OAKLAWN AVE 205 ~'-: 165' 4' x~4~Bell Hole PRIVATE RD LLI ¥ 0 ,I