HomeMy WebLinkAboutSound AveTown Of Southold
P.O Box 1179
Southold, NY' 11971
* * * RECEIPT * * *
Date: 11/08/04
Transaction(s):
Permits
Receipt~:
4135
Subtotal
$295.50
Check#: 4135
Total Paid: $295.50
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 101650
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
ReL#T100438172
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. - HICKSVIIJ~. NY 1 lg01
Name of Applicant Address
2) Sound Avenue, Laurel
Name of Owner of Premises
Address
Sound Avenue - from the Riverhead town line, easterly for 835' in the n/s grass area in Laurel to
install a gas main for Harbes Greenhouses. See sketch for details. Note: Town of Riverhead
4)
4) Builder's License No.
permit to be obtained for Town of Riverhead portion of Sound Avenue.
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.
Plumber's License No.
X
Electrician's License No. Other Trad~lLicense No.,
/~ ] //Signature d~ App'l'ic:~nt
/ / 11-01-04
~/ 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) W~rkc~veredbythisapplicati~nmayn~tc~mmencebef~reissuance~faHighwayExcavati~nPermit
by the Town Clerk.
6) Tax Map: Section , Block , Lot
7) Starting Date: Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Baeldill & Compaction .........................................................
Pavement Replacement .........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
Completion Date
D-39 Page 1 of 3
T100438172
12) Insurance Coverage: (A~lach 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) Secuht¥:
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 ................. $25.00
Al. _l__/Service Connections excavations @ $20.00 = $20.00
A2. /Additional Excavations same service ~ $10.00 =
No.
B. Excavations 18" in depth or less:
0-100 l.f. = $10.00 -
1.£ ~ $0.10 -
Additional
Excavations 18" in depth to 5' in depth:
0-100 I.L = $30.00
735' I.L ~ .30 = $220.50
Additional
$ 30.00
220.50
D. Excavations 5' in depth and over:
0-100 1.£ = $50.00
Lf. ~ $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 = $295.50
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 w/th this application.
SUPE~t'iWE'N~DENT OF HIGHW/~YS
Peter W. Hairis
yth ,o
Permit Issued /t c/, Permit No.
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
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
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 - Improper backfill (too high) (not sufficient)
HFS- Inspector holding for final settlement ofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
9CT-2~2004 15:21
KEYSP~N G~S CBNSTR 631 ?58 51~6
P. 02
. qCT-~9~2004 15:21
KEYSPRN GRS CONSTR
631 ?58 5156
P. 03
KEYSPAN GAS CONSTR
?58 5136 P.04
TOTAL P. 04
Date: 05/17/07
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt'8: 449
Transaction(s):
1 1
Permits
Reference Subtotal
508 $210.20
Check~: 449
Total Paid: $210.20
Name:
Verizon, Communications
501 N Ocean Ave
Patchogue, NY 11772
Clerk ID: LINDAC Internal ID: 508
TOW~ OF SOUTHOLD
H]GH~/AY DEPARTMENT ·
Pe~ nj= Lane
p=conic: l~e~ York ~,19S~:
.(631) 765-~] ~0
~AppLICA'EION/PERM!T FOR HIGHWAY, ExCAVA'I'.ION ANO REPAIR_
I'/, A'? 7.7
of ~ld for the is~n~ of m ~tio~ P~tt 'pum~nt to Chair ua o~ -,
~ of ~' Tow~ of S~t~ld, Suf~k ~n~. H~ Yo~, and oth~ ap~e~aws. ,
o~;~nc~ or ~atlo~s f~ ~e ~h herein d~b~. The ~(l~nt a~tOl~ Tc~n Clerk
~d=~ Inspects ~ ~ke~ n~ry insp~ions of ~e lob -a,
Prin~ ~r Ty~
~ Addre~
. ~mc of Appti~ t ~ '
2)~Name of Own~ ~ P~is~ Addr~s[ / ~
(a} Is ~c~oh I~t~ ~;t~'TS ¢~t of fl~l ~eUa~t ~ Na~~
- ~onature ~ ~p)l~nt
U~ of la--'of ~vatlon. .
b) A~ch all at~r ~es~ per~i~ and ll~s~ for ~is'p~J~t, ; ' '
Highway ~va~o6 Pe~lt ~ ~e Town CI~K-
· ;)
7)
e}
11)
Tax Map: Section . I~loc~c , Lot
Starting Date: Coeepletio~ D~te
Work <checlule ~
Phase
E~cayatloh
Fadlity In;;llatlo~ ................................. ,,,
Parent RepI;c~m~t. 0 ............................
Under which authority Is the appIlc~do~ made:
Estimated Cost of Proposed
co_~mp, beUo~ D~.
D-39
Mq~ 24 2~ Z5:~5
Pag~ 1 of 3
~ge r~uircd ~t~d~ ~ the Town:
B~IIy In]u~ and p~pe~y ~gc: $300.000/$500,000
and ~S0,00¢ pretty damege,
12)
Coverage: (Attach
In~urence Company:
d)
_Security:
a) Surety Bond , or Ce~tlfie~ Check pro¥1d~ In'the
total amount of $
b} Malntezlam:e B~nd provided:
Fees for appllcatlohs and permj[~:
/~ ConsCioUs ~vatlon~
Ex~va~s lB" i~ d~.or less:
I.f. ~ $6.1o - $__
C.
~vatio~s
~lO0 I,f, = ~S~.~O
I.f. 8 ~,~0 = $, ,_
Add[tioh~ ~
E. __Utili~ Repair Ex~v~ons
Re~i~ ~me ~e~ice
F. Net;~ to p~llc ~ ~t,~ pr~f must
~is'appli~tlo6 prior ~ i~uen~
Autherlz~itlon Is hereby granted to the Town Clerk of the ToWn of S~utho~d to
Highway Ex~t~ pemit 'to:
In'ac~an~ wl[h ~%s'appli~oh.
SUPERINTENDENT OF HIGHWAYS
ReceNed by the Town Clerk ~'AYO-~
Date
Date
0-39
Permit expires one (1) yc~r fr~m Date of Issuance.
No work to s~r~ wlt-h~ut ~ ~ur no[Ice to the ~uperlnt~d~t ~ Highways-
Pe~'must be available for Ingp~fion,
03/24/2006 FRI 16:28 ?'AX
01/03 '06 ~D 13:57 FA,[ 83]. 78.5 61,~5
SOL. OLD TO~ CLI~RK
i N S p E C T O R ~.~, R E C O R D
Insp. ctJon Date
Findings (use code]
Applicant Notif~od
- ~~ 'Cler~)
RE;RARKS
GODE
lB - Improper barri~d¢~,
IL -.laprope~
UTM - Unable to me.~sure (due to
BUC - Building under ~n~
WIP - Work
DB - Imp~ ~c~ltl' [~ high) (~t
HFS -' I~p~r h~dlng for final s~z of ~vat~n
RF~ - R~ to repair
0-39
Page 3 of 3
VERIZON - RIGHT OF WAY DIAGRAM
b II
Reason For work
Name of Builder- Prop. Owner
Address
Reach numbm'
~ ~ S~? Y~
Name of Road ~x:Stmet Involvad:
Distance to & name of nearest Cross Street & Pole by No.:-
D~stance from Cu~ or Pro~ unaa to work Pertom~:
Type Pavement & Width:
ROUTINE
BLOCK NO:
q,
Reason For Work
~ame of Builder- Prop, Owner
~ddress
Reach number
trench Opening (Lin. Ft.) for ~ Purpose /~ !
Are poles Staked? Yes No BLOCK NO:
ENGINEERS CHECK LIST C,O. Diet.:
Name of Road or Street involved: Wire Center:
Distance to & name of nearest Cross Street & Pole by No.: Locality:
Distance from Curb or Property Linae to work Performed: Tax District:
Type Pavement & Width: Engineer:
Phone