Loading...
HomeMy WebLinkAboutFactory AveTown Of Southold P.O Box 1179 Southold, NY 11971 Date: 01/08/07 * * * RECEIPT * * * Receipt'8: 7835 Transaction(s): 1 1 Permits Reference Subtotal 483 $170.00 Check~: 7835 Total Paid: $170.00 Name: Keyspan, Energy - Gas Cont Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal ID: 483 Permit No. File No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (631) 765-3140 R~CEt',, ~.D APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR Re£#TI00707744 $ouli,~id T~¥,a C;erk 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. - HICKSVII,I~E~ NY 11801 Name of Applicant 2) Factory Avenue, Mattituck 3) 4) Address Name of Owner of Premises Address Factory Avenue - bellhole on the N/s in the paved area~ approx. 645' n/w/o Main Road to install a gas main and service Work Description and Location (Street Number, Hamlet, Cross Stree0 (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. 5) No X Plumber's License No. Other Trade's License No. Signature of Applicant 01/04//07 Date 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: Phase Excavation ......................................................................... Facility installation ............................................................... Backfill & Compaction ......................................................... Pavement Replacement ......................................................... 9) Under which authority is the application made: 10) Estimated Cost of Proposed Work: $ ll) Remarks: ., Lot Completion Date D-39 12) Insurance Coveraee: (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 anolications and permits: Basic Application Fee Al. /Service Connections excavations ~ $20.00 = $150.00 $20.00 /Additional Excavations same service ~ $10.00 = No. 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.fi = Additional If ~ .30 = 746 fl of trench ~ .30 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 = $170.00 Authorization is hereby granted to the Town Clerk of the Town o£ Southold to issue a Highway Excavation Permit to: KEYSPAN ENERGY DELIVERY in accordance with this application. Received by the Town Clerk /'- ~-d7 '? Date Permit Issued / -a© -F9 -~ Permit No. Z"~O6'>-,~ SUPER~I~DENT OF HIGI~AYS TOWfiq O~UTJJ)OLD, N)~,V YORK - - ~eter W. fl~is 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 Page 2 of 3 Copy Distribution: Highway Department Inspector Applicant Town Clerk INSPECTOR'S RECORD Inspection Date 2nd 3ra 4th Findings(usecode) 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 - Improper backfill (too high) (not sufficient) HFS Inspector holding for final settlement of excavation RFR Ready to Repair D-39 Page 3 of 3 ' · NO. LOCATION REASON FOR OPENING W,OJPA NO.' BY KEYSPAN REQuEsT FOR STREET'OPENING PEIRI~ · ' COUNTY ] SUFFOLK co .TY [] ' M~S JOa ~ FOREMAN ' DATE OF ~ GAS CONsTR. MA}NT. & SERVICES TOTAL P.02 Town Of Southold P,O Box 1179 Southold, NY 11971 Date: 12/06/07 * * * RECEIPT * * * Receipt"8: 1314 Transaction(s): 1 1 Permits Reference Subtotal 534 $170.00 Check~: 9633 Total Paid: $170,00 Name: Keyspan, Energy - Gas Cont Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal ID: 534 Permit No. File No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peconic Lane Peconic, New York 11958 (631) 765-3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND ReL#TI00820415 APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for thc 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. - HICKSV1LLE, NY 11801 Name of Applicant Address 2) Factory Ave. Mattituck Owner of Premises Address 3) Rd. 4) tidal wetlands? *Yes Builder's License No. Electrician's License No. Factory Ave. W/s~ approx. 642' n/o Main Rd, to install a gas service to bldg. #10095 Main No X *If yes, other Town permits may be required. Plumber's License No. Other Trade's License No. 11-30-07 Date 5) 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 projecL 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 ......................................................... 9) Under which authority is the application made: 10) Estimated Cost of Proposed Work: $ 11) Remarks: Completion Date 12) Insurance Coverage (Attach Copy) a) Insurance Company: b) Policy # c) State whether policy o£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. 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: O-lOO 1.£ = $1o.oo - l.f. @ SO. lO = 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 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: KE¥SPAN ENERGY DELIVERY in accordance with this application. Received by the Town Clerk /':"2/~/°7 Permit Issued Permit No. SUPERI~.T-~DENT OF HIGHWAYS TO~/~Fff~~U OLD, N YORK .... Peter W~Harris~ 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 2~ 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 WIP - Work in Progress DB - Improper backfill (too high) (not sufficient) HFS- Inspector holding for final settlement ofexcavation RFR- Ready to Repair D-39 Page 3 of 3 OPENING. W.OJPA NO. REQUr.~cu BY ~, KEYSPAN REQUEST FOR STREET' OPENING PERMIT [] :STATE [] NASSAU COUITI'Y [] SUFFOLK FOREMAN , DEPARTMENT GA8 CONsTR. MAll*lT. & SERVICES d~'J~* / o l- 0 7....~.L,c.~ TOTRL P. 03