HomeMy WebLinkAbout975 Shipyard LnTown Of Southold
P.O Box 1179
Southold, NY 11971
Date: 11/09/06
* * * RECEIPT * * *
Receipt~: 7505
Transaction(s):
1 I
Permits
Reference Subtotal
473 $170.00
Check~: 7505
Total Paid: $170.00
Name:
Keyspan, Energy - Gas Cont Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LINDAC Internal ID: 473
R~CEIV~D
Permit No. ~.~ ~ TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
File No. Peconic Lane ' ] ~
Peconic, New York 11958
(631) 765-3140
SoulI,~d_~¥,:n CJerk
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
ReL#T100691342
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. - HICKSVILLE. NY 11801
Name of Applicant
2) 975 Shipyard Lane, East Marion
Address
Name of Owner of Premises
Address
3) Shipyard Lane - bellhole on the E/s Shipyard Lane 940' s/o Main Street to install a cas
service
4) 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.
4)Builder's License No.
Electrician's License No.
5)
Plumber's License No.
Other Trade's License No.
Signature of Applicant
10-31-o6
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 , Lot
7) Starting 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:
Comnletion Date
W.O. #T100691342
12) Insurance Coverage (AUach Copy)
'FILE ~.164 11/06 '06 10:54 ID: FAX: P{qCm.~E 2/ 4
B. F,y~av~ou~ ]8"iudopthorle~s:
O-lO0 Lf.; $1o.o0 -
l.f. @ $o. lo =
C. F, xasvaZ{ans 18' in depth to S, in d~pth:
0-100 Lf. ~-
Addidou~J ltl @ .30 -
D, Excavatioos 5' in depth ~ ov~r:
O-I00 Lf. = $$0.00
ix, ~ so. so ~- $
646 Ft of Trench
NQ-
~ 1tMlily lVd~p~lr ~e.,wations @ ${0,00 = $
R~pai~ ma:no ~.rvi~ @ SS.O0 - $
Nolic~ m public umiliii~ proof must I~ provided and au~ached m this application prior lo issnan~ of
Au~ho~mi~an is ]~r, hy ~'mu~d to I~ Town ~ of tho Town of Southold ~u issue a Highway Ex~v~ion Pc:mit to:
SUPERINTENDENT OF HIGHWAYS
TO W¥'O-g'~UTH OLD, NEW~'ORK
Pete~ W, Harris
_ L(-
Distribution:
Highway Ocpmment
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- Inspectorholdingforfinalsettlementofexcavation
RFR- Ready to Repair
D-39 Page 3 of 3
PERMIT APPLICATION SKETCH
DATE:
LOCATION:
T OWN:
WORK Cl,,DER:
10~ 1 f'2006 11:43:39 AM
SHIPYARD LN
MA RION
T100~1~42
VILLAGE O~F
~O~ ~'~R~: MAIN ST
~
M~c~m Ro~d ~
Ho~ NO.
975
940'
4' x 4' Bell Hole
SHIPYARD LN