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Home My WebLink AboutLeslie RdTown Of Southold P.O Box 1179 Southold, NY 11971 Date: 10/30/06 * * * RECEIPT * * * Receipt#: 1673 Transaction(s): 1 1 Permits Reference Subtotal 472 $193.00 Check#: 1673 Total Paid: $193.00 Name: R & R, Construction 282 Line Rd Manorville, NY 11949 Clerk ID: LINDAC Internal ID: 472 HIGHWAY DEPARTMENT PeconJc 'Lane Peconic: New York 11958: (631) 765-3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance or' an Excavation Permit pursuant to Chapter 83 of the Cede of the Town of Southold, Suffolk County, New York, and other applicable laws, ordinances or regulations for the excavation herein describ&d. The applicant agrees to comply with all applicable laws, ordinances, codes and regulatiOns, end to pemR' authorized Inspectors to' ntake~ tmceesary inspections of the Job site. Print or Type Name of Applicant 2) 'Name of Owner of Premises Address' Address Work Description and Location (Street Number, Hamlet, Cross Street) (a) Is construction located wlthih'75 feet of tidal wetlands? *Yes *If yes, other Town pemit$ may be required. Builder's License No. Plumber's License No. __No ~, s) Electric. Janes LiCense No. b) c) 6) Tax Map: Section 7) Starting Date: 8} Work Schedule: Phase Other Trade's License No. / ~7ata Attach plot plan showing location of:. pro,ed excavation and relationship to adjoining premises or public streets or areas, and giving a detailed descriP- tion of layout of excavation. Attach all other necessary permits and licenses for this project. Work covered by this application may not commence before issuance of a Highway ExcavaUon Permit by the Town Clerk. · Block , Lot Completion Date /0/4 / Completion Date Excavation ................................ · --- ---- · /o/~ Facility Installation ..................... · · .- -- --. --- Backfill & Compaction .............................. Pavement Replacement .............................. 9) Under which authority is the application made: 10) Estimated Cost of Proposed Work: $ 11) Remarks: 12) Insurance Coverage= 13) (Attach copy) a) Insurance Company: 7~ /-/~/~-~ ' c) S~te whether ~licY of ce~ifl~tion~n file with the Highway Depa~- d) Cove~ge r~ulr~ atend~ to the To~n: B~lly inju~ and p~pe~y ~mage: $3~0,000/$500,000 8~ily Inju~, and $50,000 p~pe~ damage. Security: a) Surety Bond or Certified Check provided in the total amount of $ b} Maintenance Bond provided: 2 years or 3 years Fees for ~ppIIcations and pemits: Basic Application Fee ........ .~:-'Z_~-O Al. /Service Connections excavations No. A2. /Additional Excavations same service ~ $10.00 = $ NO. ,)Excavations 18" In depth or less: 0-100 I.f. = ~0.00 ~ e $0.10 $ A~ditlonal I.f. - C. Excavations 18" In depth to 5' in depth: 0-100 l.f. = $30.00 I.f. Additional D. ExcavaUons 5' in depth and over: 0-100 I,f. = $50.00 I.f. e t~0.50 = $ Additional No. AdditiOnal" Utility Repair Excavations ~$~0.00 = $ Repairs same service e ~5.00 = $ F. Notice to public utilitieS proof must be provided and attached to this'application prior to issuance of Pemlt. Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation Permit to: in accordance with this application. SUPERINTENDENT OF HIGHWAYS I~eter W. Harris Bate Date Received by the Town Clerk Permit Issued /~,///DD~atOe~' Note: Permit NO. Pertalt m<pires one (1) year from Date of' Issuance. No work to start without q8 hou~ notice to the Superintendent of Highways. Permit must be available for inspection. CABLE T~ES ~ CATV ~METAL POLE X BR~ ~ COUU ~ UE~R LOC ~} ~ NODE ~ 8W TAP ............. .650" 0 ~LCO ~TRANSFORUER ~ JOINT USE ~ RES ~ EXISTING PED~1~ PO~R SUPP ~ 4W TAP .750" ~ O STRAND ROUTE: OROPS: %~ ~ PROP PED FIBER PR~OSED: BLUE ~ ~ MB / LE PROPOSED ,.BLUE EXIS~NG: RED EXISTING: RED ~ ~ PROP L~KBOX O SPLITTER ~ RISER Cop*/ Distribution: Highway Department Inspector Applicant Town Clerk IN SPECTOR~S RECORD Inspection Date Findings (use code) Applicant Notified 1st 2nd 3rd qth (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 backflll'(too high) [not sufficient} HFS - Inspector holding for final settlelaent of excavation RFR - Ready to repair l O¢T-,~[-06 ]I:STAM FROM-BRISOTTI & S,~ri~ORTH 63]2885486 T-g34 P.0Z/03 F-046 AC i. CERTIFICATEI F LIABILITY INSUI 53 THIS CERTIFICATE IS )SI AS A MATI'ER OF INFORMATION ONLY AND CONFERS RIGHTS UPON THE CERTIFICATE HOLDER. THIS DOES NOT AMEND. EXTEND QR ALTER THE iROED BY THE POLICIES ~ISLIRERS AFFORDING COVERAGE NAICg COVERAGE5 ~ ~ POLiCiES OF INSURANCE LISTED BELOW HAvE B~-I~N ISSUED TO THE iNSURED NAMEO ABOVE f:OR THE pC L~CY PERIOD INOICATEO. NOTWITHSTANDING IHiCH TfflS CERTIFICATE MAY BE ISSUED OR REQUIREMENT TER~ OR COND T ON OF ANY CONTRACT OR QTff~ DOCUMENT WITH ~[SPECT TO ~ ~S ExC~USIONS ~ND CONDITIONS QF SUCH Town o£ $ouchold Peco=lc, ,~' 11558 ACORD 25 [2001 ,o ACORD CORPORATION 1986 ~ qgT-~-06 ll:~?AM ~OM-B~ISOTTI & SILKWORTH T-g34 P. 03/03 F-04E IMPORTANT if the certificate holder is an ADDITIONAL INSURED, the policy(les) must b~ endorsed. on ~hls ceF[if;cute does no~ confer r~uh[s to trio certificate ~olcler in lieu of such end If SubROGATION IS WAIVED. subiee= to the zerm= one conditions of the po require an en¢lorsement. A s~a~emerl! on th;s certificate does no~ confer holder ~n heu of such endorsemcn~lsl. DISCLAIMER ACORD 2512001/081 cy. certain palic;es may igh[s ~o the certificate e policies I;stod 'thereon. Memo Number Daz Page 2006021434 10/25/.~006 1 Brisotzi & s~lkworzh. 8~00 Main Road p. O. Box ~4e8 Ma~i~uck, NY 11952 631-298-4747 voice To: Town Clerk 531-298-5496 FAX MEMO RE: Cer~ificase of Ins. Customer: R & R Cons~ruczion <R&RC00~ Enclosed you will find cer~ificaue of insurance req% insured, If you have any questions, please conuac~ us. From Lynn M. Sharar lsharar@lnsureli.com x16 [ebix,one Form 2019 (6/22/94)] ,es=ed for our Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 01/14/08 * * * RECEIPT * * * ReceiptS: 7820 Transaction(s): 1 1 Permits Reference Subtotal 539 $168.00 Check~: 1945 Total Paid: $168,00 Name: L, IPA 117 Doctor's Path Riverhead, NY 11901 Clerk ID: LINDAC Internal ID: 539 P'ermit No. LIPA Ref. #T100791009 3 Pillars Dev. Leslie Road, Cutchogue TOWN OF SOUTHOLD HIGHWAY DEPARTMENT P.O. Box 178 Peconic, New York 11958 (631)765-3140 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 au 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 al~l~licant 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. LIPA 117 Doctor's Path, Riverhead, NY 117~1 Name of Applicant Address of Applicant 2. 3 Pillars Development Leslie Rd, Cutchogue Name of Owner of Premises Address of Owner tm-da 160' in grass area S/S ro~llo ~ 729' W/O Irr~an ~ ~ for a ~ ro~irla't-lal service for V~or~ l~sffr~p~io~-a~j E~c~oh~StaSeet Nmnb~r, Hamlet, Cross Street) (a) Is conslruction located within 75 feet of tidal wetlands? * Yes No ·If yes, other Town permits may be required. 4. Builder's License No. Plumber's License No. Electrician's License No. Other Trade's License No. S. Aylward ~naYureofApplicant / Date 1 2/1 9/07 (a) Atrached plot plan showing location of proposed excavation and relationship to adjoining premises or public street 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 ora Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: Section , Block , Lot 7. Starting Date: Completion Date: 8. Work Schedule: Phase Completion Date Excavation Facility Installation Backfill & Completion Pavement Replacement 9. Under which authority is application being made: I 0. Estimated Cost of Proposed Work: $ I 1. Remarks: D-39 1 of 3 12.. Insur~ace Coverage: (Attach Copy) · la) Insurance Company: (b) Policy #: (c) State whether policy of certification on file ~vith 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 (b) Maintenance Bond provided: 2 years or 14. Fees for Applications and permits: ~Ba.sic Applic~ Al. /Service Connections excavations @ $20.00 No. A2. / Additional Excavations same service ~ $10.00 No. B. Excavations I8" in depth or less 0-100 i.f. = $10.00; Additional i.f. ~ $0.10 provided in the total Amount of $ 3 years. $150.00 $ Excavations 18" in depth to 5' in depth 0-100 i.f. -- $30.00; Additional i.£@$0.30 D. Excavations 5' in depth and over 0-100 i.£ = $50.00; Additional i.f. ~ $0.50 $ E. Utility Repair Excavations ~ $10.00 $ No. Repairs same service @ $5.00 $ Additional Notice to public utilities proof must be provided and attached to this application prior to issuance of permit. Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: in accordance with this application. Date Received by the Town Clerk Date Perofit Issued NOTE: SUPERINTENDENT OF HIGHWAYS F SOUTHOLD:..I~W YORK Pemfit No. 5--,~ ~' Permit expires one (1) year from date of issuance. No work to start without 48 hour notice to Superintendent of HigMvays. Permit must be available for inspection. D-39 2 of 3 : ~oP57'Distribution: Highway Department Engineer (with page 3) Applicant Town Clerk (Original) lst 3rd 4th Inspection Date INSPECTOR'S RECORDS Findings (use code) REMARKS Applicant Notified (To Permit Clerk) 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 Improper Backfill (too high, not sufficient) HFS Inspector Holding for Final Sei~Iement of Excavation RFR Ready for Repair D-39 3 of 3 W.O. OH W.O: UG NO. NO. T-791009 o~,m'"ssoc~'° S/OjlT_7glO12 BUDGET TYPE W,uGO.: LINE EXT NEW RES ITEM GRiD NO. 100-63 8B-gS2 PERMIT 'PIPE REO: T.O. SOUTHOLD PmMAm* VOLTS: 1-,~ KV TAX DIST. 1300 NUMBER SERVICE REO'D, BY - INFORMATION: CND: CCCD: FIELD DUE DATE: ~ASEMENT RED'D NO OUTRIGHT CONTR, $ % SALES TAX: TOTAL: SALES SUP NO. COMPLETION DATE TEL. CO. [NOIN£ER TEL. CO, C.O, lc.o, IS TREE TRIM REO'D : ATTACHMENT RECORD i OWNERSHIP RECORD INn'AL ATT LAST A. I E.L. TEL. TRANSFER MADE TO REM'O FROM REPLACED AS OWNERSHIP PROJECT/JOB DATA: 3 PILLARS DEV. ~OOeESS: LESLIE RD. tOWN: CUTCHOGUE CONTACT: J SQUARED-JOE PREPARED BY: O. DANEK ZIP: CONTACT TrL~ 445-1651 12-19-07 (DESIGNER SIGNATURE) (DATE) APPROVED BY: (DESIGN ENGINEER SIGMATUBE) (DATE) MARK OUT REQUIRED CAUTION UNDERGROUND ELECTRIC IN AREA AS PER FACILITIES MAPS THIS WORK IS REQUIRED TO EXTEND 160' OF SECONDERY CABLE TO A NEW RESIDENTLAL 300 AMP SERVICE &(AC 10' GRASS BGi~99171 I-3/C3/OAL CIC · ~50 EVA /" 160' LOT 6 LOTS LESLIE RD, 889' HSEJ2560 300 AMP LOT 7 I Town Of Southold P.O Box 1179 Southold, NY 11971 Date: 01/29/08 * * * RECEIPT * * * Receipt~: 10235 Transaction(s): 1 Permits Reference Subtotal 540 $198.00 Check#: 107 Total Paid: $19800 Name: Verizon, Communications 501 N. Ocean Ave, 1st FI Patchogue, NY 11772 Clerk ID: LINDAC Internal ID: 540 No. j~x' ~"~ TOWN OF SOUTHOLD HIGHWAY DEPARTMENT. Peconlo Lane pccon~cJ ,New York ~Apl~LICAi~iON/PEPJdJT DOR HIGHWAY. F.~CAVAT. ION AND REPAIR. APPLICATION I$ HEREBY made to.the Superlnte~de~t of Highways of the Town aC Southeld for the issuance of an Exca~aUofi Per~it 'pursuant to Chapter 83 of the Gode at' th~ Tow~! of Sa~thold, Suf~dk County, N~/ York~ and other appli~ble laws, ordiru~nce~ or recjulatlohs far the e.5:cavaUOfi herein descrlbL~. The applicant agrees to comply wlt~ all applicable laws, or~r~nces~ c, nde~ and reg~,la~ohs~ and to permR ' aut~oHzC~l Inspe~'tors t~ mlake~ nec~lry inspections of the job tote. Print .er Type /~. ~~(~ 2)--Name of Owner of premisez Address WOrk Descrlp~ie- and I_~c,tt~n (street *If y~, ot~ Town ~1~ ~Y ~ rNulr~' 7) s) Electric~=R*s [Jc~n~e No. . . Other Trade*s L;cens~ No.__ ' Signature ~/Appll~nt · / Date a) At.ch ~ot p~n ~1~ i~fi~ ~'p~ ~on and r~afi~lp'm fl~ of la--'of ~vatlon. b) A~ch all ot~r ~e~ per~i~ and ll~ns~ for ~is'pmJ~t. ' c) ' ~'~ee~ by ~ appli~h ~y ~t ~mmen~ before ~n~ of a High~ay Ex.vano6 Pe~lt ~ ~e Town Cl~k. Sta~ing Date: C~pletloh ~e Work Sch~ule: Und~ which eu~orlty ~o) E~tlmated Cost of Proposed 4Vor~:: ~ ~g~ 1 of 3 a) b) c) (Attach Insurance Company; State whether ~olley of cartif~catloR on file' with ~e Highway ment: ~ge r~uired ~t~d~ ~ the Town: B~I[y ~nJu~ and p~pe~y ~ge: $300~00J$~00,000 ~iiy lnJu~, and $5O,0a~ pretty damage. a) ~) Fees for Al. B. Surety Bond ..or Cectlfie~l Check provld~t Jn'+-he total amount of $ Maintenance B~nd provided: ~! years or 3 years. appIIcatlohs and permit~: /$et-vlc~ Connectiohs c.xc~vations ~1 $20.00 = $ /Additlb~al Excavations same service 0 $I0.~0 -'- $ /0o. O0 E. Utility Repair ExcaYat;ofl$ Repalr~ -~ame 5e~ice F. Net;~ to p~llc'~ilili~ ~ls'appli~tlo~ prior ~ Autharlzatlo~ Is hereby grant~:l to 'die Town Clerk of the ToW~ of 5~tho~d to Highway Ex~vat~ pemit 'to: In'a~a~ with ~is'appli~flo~, SUPERINTENDENT OF HIGHWAYS T~F ~UTHOLD,~W YORK ~etar W. Harri~ / Receded by the Town Clerk '-~ Date Date ' Note: P~it ~plres one (1} y~r from DaZe of No work to ~ wl~[ ~ ~ur no[Ice to the ~uperlnt~d~t ~ Highways- Pe~'mus~ be available for Pa~e 2 of 3 D-39 03/24/2006 FRI 16:28 FAX 01/'03' '06 W~li9 13:57 FAX 831 785 6145 SOLE3t0LD TO,TN CLIZRK Co~¥ DictribuUo~: Highway Depa~men~ inspector AppH¢=n~ To~n Clerk 2nd 3rd I N,s.,P E, C T O R'.e- InspecUon Date RECORD, FindingS: (use code) Applicant Notif~c~ (T~ p~mit ClerK] .R~L~RKS CODE lB - {mpro~er barri~,~d~, IL -.Improper l|ghts UTM - Unable to BUC - Bu{td{n~ under ~n~ WIP - Work DB - 'lmp~ ~c~lll' [~ high) (~t ~uffl~t) HFS -' I~p~r h~ding for final ~t of ~vat~n RFR - R~ to repair 0-39 Paga 3 of 3 flew York Telephone Ce. - Right el Way Diagram Reason For Work Name of Ouiider - Pr,op. Owner TT~ i.-..-~ .~ ~ ........ / Muoinipellly: Slate County Town V,/ Village Pvt. Prop. T~ench Opening (Lin. Ft.) for fllW Purpose Are poles Slaked? Yes No Name el Road or Street involved: mslance to & name of nearest Cross Street& Pole by No.: Oislance hem Curl) or Property Line lo work performed: Type Pavement & Width: ROUTINE