HomeMy WebLinkAboutYoungs AveTOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
.ReL#T100482288
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) KEYSPAN ENERGY - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE, NY 11801
2)
3)
4)
Name of Applicant Address
Youngs Avenue, Southold
Name of Owner of Premises
Address
Youngs Avenue - 4'X4' bellhole in the grass on the w/s of Youngs Avenue, 120' n/o Main Road~
for a gas leak repair
Work Description and Location (Street Number, Hamlet, Cross Street)
(a) ls construction located within 75 feet of tidal wetlands? *Yes
*If yes, other Town permits may be required.
4) Builder's License No.
Electrician's License No.
No X
5)
Plumber's License No.
Other Tra~e~ License No.
' Signat~ of .~.p~ican~]
V 05-12-05
Date
a) Attach plot plan showing location of proposed excavation and relatioaship 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
7) Starting Date:
8) Work Schedule:
, Block ~ Lot
Completion Date:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
Comuletion Date
D-39 Pagelof3
T100482288
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 injary 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 applications and permits: Basic Application Fee
Al. _l~/Service Connections excavations ~ $20.00 = $20.00
$150.00
A2. /Additional Excavations same service @ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 1.f. = $10.00 -
l.f. ~ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-1001.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 Towr, 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 ~lJ~10~'~
Permit Issued S ! J ~"10~"" Date Permit No. qO~'~
SUPE ~I~TENDENT tOF HIGHWAYS
Peter W. Harris
Date
Note: Permitexpires one (1) year from Date oflssuance. Noworkto start without48 hournoticetothe Superintendent of Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
c) PERMIT
KEYSPAN
~EQUEST FOR STREET OPENING PERMIT
0
Date: 08/15/05
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt#: 5002
Transaction(s):
1 1
Permits
Reference Subtotal
402 $170.00
Check#:5002
Total Paid: $170.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LYNDAB Internal ID: 402
Town Of Southold
P.O Box 1179
Southold, NY 11971
Date: 05/22/08
* * * RECEIPT * * *
Receipt#: 19381
Transaction(s):
1 1
Permits
Reference Subtotal
552 $170.00
Check#:15087
Total Paid: $170.00
Name:
National, Grid - Gas Constr. Cept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 552
Permit No.
File No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
Rr:~
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
Ref.#T100860885
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
l) NATIONAL GRID- GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVII,I,E~ NY 11801
Name of Applicant Address
2) Youngs Avenue Southold
Owner of Premises Address
3) W/s Youngs Ave.- 1- 4'x4' bellhole~ on the W/s of Youngs Ave.~ 170' n/o Main St, to
repair a Ras leak
4) tidalwetlands? *Yes No X
*If yes, other Town permits may be required.
Builder's License No. ~ /'/ /)
Electrician's License No.
Plumber's License No. I~]//~
Other Trade's License No.
5-14-08
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) 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 , 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: $
il) Remarks:
12) Insurance Coverage (A~tach 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) Securitv:
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. 1 /Service Connections excavations @ $20.00 =
$150.00
$20.0o
A2. /Additional Excavations same service ~ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 I.f. = $10.00 -
1.£ ~ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-100 I.f. =
Additional Iff ~ .30 =
D. Excavations 5' in depth and over:
0-100 I.fi = $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 Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
5--a./-ak'
Received by the Town Clerk
Date
Permit Issued 0'~- ~,~. O~.'~ Permit No.
SUPERINTENDENT OF HIGHWAYS
TO~UTHOLD, NEy,' YORK
Peter ~. Harris
Not~e: Permit 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 Page 2 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
1~
2~d
3rd
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
WIP - Work in Progress
DB - Improper backfill (too high) (not sufficient)
HFS- Inspectorholdingforfinalsettlementofexcavation
RFR - Ready to Repair
D-39 Page 3 of 3
FILE No.60? 05/13 '08 09:35
ID: FAX: PAGE
PERMIT
NO.
LODATION
REASON FOR
OPENING
W.OJPA
NO.
REQUESTED
SY
APPROVED
KEYSPAN
REQUEST FOR STREET OPENING PERMIT
STATE [] NASSAU ~-~ ,SUFFOLK
COUNTY COUNTY ,
MIS JOB DATE
.o. ~/~ c~ ~./3'.,~'
FOREMAN
DEPARTMENT
GAS CONSTR. MAINT.& SERVICES
DATE OF
IOPENING
olvl$1o~ ~5'.
DATE
SKETCH
2/ 6
N
Avr_.
Town Of Southold
P.O Box 1179
Southold, NY 11971
Date: 10/21/08
Transaction(s):
1 1
Permits
* * * RECEIPT * * *
Receipt#: 29970
Reference Subtotal
590 $170.00
Check#: 16115
Total Paid: $170.00
Name:
National, Grid - Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 590
I HIGHWAY DEPARTMENT
File No. Peconie Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR ~ '
Ref.#T100938729.
APPLICATION IS HEREBY made to the Superintendent of Highways oftbe 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 oftbe
job site.
Print or Type
1) NATIONAL GRID - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD. - HICKSVILLE~ NY 11801
Name of Applicant Address
2) Youngs Avenue Southold
Owner of Premises Address
3) 3-3'x5' beliholes on the W/s sidewalk~ 3-3'x5' bellholes and 1-4'x8' hellhole on the E/s
grass median of Youngs Ave (Railroad Ave)~ to retire the gas main and transfer services
4)
5) tidalwetlands? *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.
10-15-08
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)
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
ors
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for aDolications and permits: Basic Application Fee $150.00
Al. I /Service Connections excavations ~ $20.00 = $20.00
A2. /Additional Excavations same sarvice ~ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 1.f. = $10.00 -
l.f. ~ $0.10 =
Additional
Excavations 18" in depth to 5' in depth:
0-100 l.fi =
Additional Iff ~ .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 ~" ~
Date
Permit lssued /d9 - ~/F O ~'~ Permit No.
SUPERINTENDENT OF HIGHWAYS
TOWN/~UTHOLD, N~E/W YORK
Peter W. Harris
Date
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
Page2of3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
2nd
3rd
4th
Findings (use code)
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 -lmpropcr backfill (too high) (not sufficient)
HFS- Inspector holding for final settlement ofexcavation
RFR Ready to Repair
D-39 Page 3 of 3
TOWN OF SOUTHOLD ROADWAY OPENING SKETCH
RAILROAD AVE (YOUNGS AVE), TRAVELER ST TO MAIN ST
SOUTHOLD
NATIONAL GRID PROJECT TI 00938729
NATIONAL GRID MAP 108096224
NATIONAL GRID ENGINEER: SCOTT HELD (5i6) 545-2576
RETIRE GAS MAIN AND TRANSFER SERVICE
PJ[ILROAD 4' x 8'
'
I-- S[DE~'ALK
$,1
II GRASS MEDIAN
AVE
·