HomeMy WebLinkAboutGull Pond LnDate: 12113106
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Receipt~: 1843
Transaction(s):
1 1
Permits
Reference Subtotal
479a $170.00
Check~: 1843
Total Paid: $170.00
Name:
L, IPA
117 Doctor's Path
Riverhead, NY 11901
Clerk ID: LINDAC Internal ID: 479a
Town Of Southold
P.O Box 1179
Southold, NY 11971
Date: 12/05/06
* * * RECEIPT * * *
Transaction(s):
1 1
Permits
Reference
479
Subtotal
$0.00
Cash
Total Paid:
$0.00
Name:
L, IPA
117 Doctor's Path
Riverhead, NY 11901
Clerk ID: LINDAC Internal ID: 479
· Permit No.
TOWN OF SOUTHOL~I~
HIGHWAY DEPARTMENT
P.O. Box 178
Peconic, New York 11958
(631)765-3140
$outhold Town
APPLICATION / PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the isanancc of an Excavation Permit
pursuant to Chapter 83 of thc Code of the Town of Southold, Suffolk County, New York, and other applicable laws, ord/nances 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
LIPA 117 Doctors Path, Riverhead, NY 11901
1.
Name of Applicant Address of Applicant
2. William Claudio
Name of Owner of Prerrfises
Gull Pond Lane, Greenport
Address.of Owner
open 4'x6' bellhole in the grass area on N/S Gui1 Pond Lane 1804' E/O Main
3. Road. Guide drill primary cable 190' to prop line & install a below grade
Work Desctiption and Location (Street Number Hamlet Cross Street% transformer fox ul~t~ svc to a new
(a) Is constmction'locatedwithin~Sfeeto~tidalwetlan~s?re*~edsenCe for willI~oam Claudio and
*If yes, other Town permits may be required, a f ut ute 1 ot.
4. Builder's License No. Plumber's License No.
Electrician's License No.
Other Trade's License No.
7. Starting Date:
8. Work Schedule:
Steve Aylward
Date 11/30/06
(a) A.tt~ched plot plan showing location of proposed excavation and relationship to adjoining premises or public stteet 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.
Tax Map No.: Section ., Block , Lot
Completion Date:
Phase
Excavation
Facility Installation
Backfill & Completion
Pav'e~lacement
Completion Date
Under which authority is application being made:
10. Estimated Cost of Proposed Work: $
11. Remarks:
D-39 1 of 3
12. ,Insurance Coverage: (Attach Copya~l~
(~) Insurance Company: W
(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)MaintenanceBond provided:
2 years or 3 years.
14. Fees for Applications and permits:
Basic Application Fee
Al. __/Service Connections excavations ~ $20.00
No.
A2. __/Additional Excavations same service ~ $10.00
No.
B. Excavations l 8" in depth or less
0-100 i.f. = $I0.00; Additional i.f. ~ $0.10
$150.00
$
$
$
$
Excavations 18" in depth to 5' in depth
0-100 i.f. = $30.00; Additional
i.f. ~ $0.30
Excavations 5' in depth and over
0-100 Lf. = $50.00; Additional
i.£ @
No.
Additional
Utility Repair Excavations ~ $10.00
Repairs same service @ $5.00
$
$
TOTALS
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 permi[ to:
in accordance with this application.
Date Received by the Town Clerk /o.2-/¥/o ~.
Date Permit Issued f$/o-'/D~' Permit No. t"/7 ¢
NOTE: Permit expires one (1) year from date of issuance.
SUPERINTENDENT OF HIGHWAYS
No work to start without 48 hour notice to Superintendent of Highways.
Permit must be available for inspection.
D-39 2' of 3
.Copy Distribution:
Highway Department~
Engineer (with page 3)
Applicant
Town Clerk (Original)
]st
2nd
3ra
4th
Inspection Date
INSPECTOR'S RECORDS
Findings (use code)
REMARKS
Applicant Notified
(To Permit Clerk)
IB
IL
ST
UTM
BUC
WIP
DB
HFS
RFR
CODE
Improper Barricades
Improper Lig~s
Sunken Trench or Excavation
Unable to Measure (due to backfilling)
Building Under Construction
Work In Progress
Improper Backfill (too high, not sufficient)
Impector Holding for Final Settlement of Excavation
Ready for Repair
D~39 3 of 3
OH S AREA W.O, UG
NO, NO,
T-880158 T-
PIC: PIG:
^ssoc~o S/0#T-§75479
ORDER~
BUDGET
ITEM
GRID 106-64
NO,
PERMIT
TYPE REQ: YES
TAX DrST. 1300
NUMBER
SERVICE
REQ'D. BY - INFORMATION:
CND:
CCCD:
FI~DUE
DATET
COMPLETION
DATE
TEL, CO.
INEER
TEL. CO.
JOB NO.
TRANSF.
LOAD
IS TREE TRIM REQ'D :
ATTACHMENT RECORD
S AREA
W.O.:OH LINE EXT NEW RES
UG LINE EXT NEW RES
CIR.
NO. 8J-08§
PRIMARY VOLTS:
EASEMENT REQ'D YES
OUTRIGHT
CONTR. $
~ SALES TAX:
SALES
SLIP NO.
TOTAL:
C.C. ILETTER
DIST.
SECD'Y
REG.
OWNERSHIP RECORD
E.L. TEL. TRANSFER
REPLACED AS OWNERSHIP
ZiP:
CONTACT TEL# 445-9760
I NtT.~ LAST ATT
MADE TO REM'D
E.L.
PR~/JOB DATA:
",lAM .E'~ WILLIAM CLAUDIO
ADDRESS: GULL POND LANE
TOWN: '~
GREENPORT
CONTACT:. FRED
PREPARED BY:
.D. DANEK
.(DESIGNER SIGNATURE)
11-6-06
(DATE)
APP,ROVED BY:
(DESIGN ENGINEER SIGNATURE)
(DATE)
P~/14
1-40'2
R-I 15 KVDE
R-I STR CLP
R-I llM 8'JAG DOWN
R-I RISER
~- IOOA CO
I-,~'LA
I-2/C~2AL PTHD
I-3" U-GUARD
TOP POLE
FS 8T
LBF
5/C#2
GULL POND LANE
18o4' .-t
MARK OUT REQUIRED
CAUTION UNDERGROUND ELECTRIC IN AREA AS PER FACILITIES MAPS
CAUTION GAS IN AREA AS PER FACILITIES MAPS
GUST TEMP
SVC POLE
0
190'
EDGE OF
MAC
FUTURE ~
400 AMP
15' ROw