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Home My WebLink AboutMill LnTown Of Southold P.O Box 1179 Southold, NY 11971 Date: 08/29/08 * * * RECEIPT * * * Receipt#: 28354 Transaction(s): 1 Permits Reference Subtotal 581 $754.70 Check#: 15751 Total Paid: $754.70 Name: Keyspan, Energy - Gas Cont Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal ID: 581 Permit 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£#TI00838826 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 I) KEYSPAN ENERGY - GAS CONSTR. DEPT. - 175 E. OLD COUNTRY RD.- HICKSV1LLE, NY 11801 Name of Applicant Address 2) Mill Lane MaHituck Name of Owner of Premises~ g:C EIV;' O 3) Install approx. 1~950' of gas main on Mill Lane. n/o Main Rd. (Rt. 25) ,~ J . 4) Work Description and Location (Street Number, Hamlet, Cross Street) (a) Is construction located within 75 feet of tidal wetlands? *Yes No__~fll~[tra]d TOWn *If yes, other Town permits may be required. 4) Builder's License No. Electrician's License No. Plumber's License No. s) Other Trade's License No. 08/22/~8 Date a) Attachpl~tplansh~wingl~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 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: $ Il) Remarks: , Lot Completion Date D-39 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 ors b) Maintenance Bonded provided: 2 years or 3 years 14) Fees for applications and permits: Basic Application Fee Al. /Service Connections excavations ~ $20.00 = 100' trench fee A2. /Additional Excavations same service @ $10.00 = No. $150.00 + 20.00 bellhole +30.00 for And .30 ea. foot from 101' $99.00) B. Excavations 18" in depth or less: 0-100 l.f. = $10.00 - I.f. ~ $0.10 = Additional C. Excavations 18" in depth to 5' in depth: 0-100 l.f. = Additional lf~ .30 = 1849ft of trench D. Excavations 5' in depth and over: 0-100 l.f. = $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 = $754.00 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 Issued ~6~' - ~ ~ ~ SUPERINTENDENT OF HIGHWAYS .x~SOUTHOLE?,oNEW YORK Peter W'7~arris ~ 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 Copy Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date l~t 3~ 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 SITE MAP LEGEND PROPOSED GAS MAIN - NEW INSTALLATION BY CONVENTIONAL TRENCHING PROPOSED PIPE JACKING OR DIRECTIONAL DRILL OF GAS MAIN EXISTING KEYSPAN GAS MAIN PROPOSED GASVALVE EXISTING WATER MAIN P-21 EXISTING UNDERGROUND TELEPHONE HAY BALES AND I OR SILT FENCING EXISTING POLE (LIPA / VERIZON) EXISTING RISER POLE WITH UNDERGROUND ELECTRIC PERMIT APPLICATION - TOWN OF SOUTHOLD ~= .- GAS CONSTRUCTION - LI POINT OF CONTACT: Thomas Buckleman 516-924-6861 PROJECT: Mattituckl Cutchogue Reinforcement PROGRAM: Gas Reinforcement Project I WORK ORDER: Tt00838826 DRAWING # TITLE PAGE DESCRIPTION: Install approximataly 1980 feet of 12" steel 124 psi gas main on Mill Lane in Mattituck. This project Is needed to Increase the KEYSPAN GRID: reliability of the gas supply to the eastern North Fork of Long 101-11, 12, 13, 18, 26, 35 Island. SCALE: NONE ....... ~ ~,~+,~ TEL. WATER <, BARN PROPERTY LINE TEL ................ PROPOSED '12" STEEL GAS MAIN - 424 PSi MAIN ROAD - NYS RT 25 TOWN OF SOUTHOLD - PERMIT APPLICATION nationalgrid GAS CONSTRUCTION - LI POINT OF CONTACT: Thomas Buckleman 516-924-6861 PROJECT: Mattituck/Cutchogue Reinforcement PROGRAM: Gas Reinforcement Project I WORK ORDER: T100838826 DESCRIPTION: Install approximately 1950 feet of 12" steel 124 psi gas main on DRAWING # 1 OF 3 Mill Lane in Mattituck. This project is needed to increase the KEYSPAN GRID: reliability of the gas supply to the eastern North Fork of Long 101-11, 12, 13, 18, 26, 35 Island. SCALE: NONE FARM PROPERTY BURIED SPRINKLER PIP <, II I 12" GAS UNDER I , FARM PROPERTY TOWN OF SOUTHOLD - PERMIT APPLICATION nationalgrid GAS CONSTRUCTION - LI POINT OF CONTACT: Thomas Buckleman 516-924-6861 PROJECT: Mattituck/Cutchogue Reinforcement PROGRAM: Gas Reinforcement Project I WORK ORDER: T100838826 DESCRIPTION: Install approximately 1950 feet of 12" steel 124 psi gas main on DRAWING # 2 OF 3 Mill Lane in Mattituck. This project is needed to increase the KEYSPAN GRID: reliability of the gas supply to the eastern North Fork of Long 101-11, 12, 13, 18, 26, 35 Island. SCALE: NONE ' Ci3UNTY ROAD 48 - MIDDLE ROAD INSTALL A 16" STEEL CASING SLEEVE UNDER THE LIRR ALONG MILL LANE IN MATTITUCK (EAST SIDE OF LIRR) UTILIZING PIPE JACKING/BORING TECHNOLOGY. CASING SLEEVE APPROX. 80 FEET IN LENGTH AND A MINIMUM DEPTH OF 7 FEET TO BE INSERTED WITH 12" STEEL GAS MAIN. ALL VENTING PER LIRR SPECIFICATIONS. LIRR PROPERTY LINE LONG ISLAND RAIL ROAD OFFSET 12" STEEL GAS MAIN INTO PIPE CASING RECEIVING PIT OUTSIDE LIRR PROPERTY 10' LX 10'WX 10'D LIRR PROPERTY LINE 15' OFFSET 12" STEEL GAS MAIN INTO PIPE CASING LU n,,' I PIPE JACKING PIT I OUTSIDE LIRR PROPERTY 40' LX 10'WX 10' D TOWN OF SOUTHOLD - PERMIT APPLICATION Nationalgrid GAS CONSTRUCTION - LI POINT OF CONTACT: Thomas Buckleman 516-924-6861 PROJECT: Mattituck/Cutchogue Reinforcement PROGRAM: Gas Reinforcement Project I WORK ORDER: T100838826 DESCRIPTION: Install approximately 1950 feet of 12" steel 124 psi gas main on DRAWING # 3 OF 3 Mill Lane in Mattituck. This project is needed to increase the KEYSPAN GRID: reliability of the gas supply to the eastern North Fork of Long 101-11, 12, 13, 18, 26, 36 Island. SCALE: NONE