Loading...
HomeMy WebLinkAboutEast Mill RdDate: 05/30/06 Town Of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Receipt~: 1806 Transaction(s): 1 1 Permits Reference Subtotal 449 $174.00 Check~: 1806 Total Paid: $174.00 Name: L, IPA 117 Doctor's Path Riverhead, NY 11901 Clerk ID: LINDAC Internal ID: 449 Pel-mit No. ~'g 'q ~ LIPA Ref. #T100625540 TOWN OF SOUTHOLD HIGHWAY DEPARTMENT P.O. Box 178 P¢conic, 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 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 Tvpe LIPA 117 Doctor's Path, Riverhead, NY 11901 Name of Applicant James Neuman - E. Mill AddressofApplicant Road, Mattituck Name of Owner of Premises Missile 2 4" PVC sleeves on E. Mill Address of Owner Road, approx. 350' E/O Sebastians Cove Rd. Work Description and Location (Street Number, Hamlet, Cross Street) (a) Is construction located within 75 feet of tidal wetlands? *If yes, other Town permits may be required. 4. Builder's License No. * Yes No Plumber's License No. Electrician's License No. Other Trade's License No. Aylward Sig~r~ of Applic~-n~ Date May 1 7, 06 (a) Attached plot plan showing location of proposed excavation and relalionstfip 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 of a Highway Excavation Permit by the Town Clerk. Tax Map No.: Section , Block ., Lot Starting Date: Completion Date: Work Schedule: Phase Excavation Facility Installation Backfill & Completion Pavement Replacement Completion Date 9. Under which authority is application being made: I0. Estimated Cost of Proposed Work: $ 11. Renmrks: D-39 1 of 3 12. Insurance Coverage: (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) S~ety Bond or Certified Check provided in the total Amount of $ (b) Maintenance Bond provided: 2 years or 3 years. 14. Fees for Applications and permits: Basic Application Fee $150.00 Al. /Service Cmmections excavations ~ $20.00 $ No. A2. / Additional Excavations same service @ $10.00 $ No. B. Excavations 18" in depth or less 0-I00 i.f. -- $10.00; Additional i.f. @ $0.10 $ C. Excavations 18" in depth to 5' in depth 0-100 i.f. = $30.00; Additional 2~ ~(X~>~i.f. @ $0.30 $ ~¢- ~ D. Excavations 5' in depth and over 0-100 i.f. = $50.00; Additional i.f. ~ $0.50 $ E. Utility Repair Excavations @ $10.00 $ No. Repairs same service @ $5.00 $ Additional TOTALS #/Tq.av F. 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 perrrdt to: Date Received by the Town Clerk ~5-/,ffD/D~, Date Permit Issued ~-/~ ~" Permit No. NOTE: in accordance with this application. SUPERIN~2~xNDENT,4OF HIGHWAYS Permit expires one (1) year from date of issuance. No work to start without 48 hour notice to Superintendent of Highways. Permit must be available for inspection. D-39 2 of 3 C. opy Distribution: Highway Department Engineer (with page 3) Applicant Town Clerk (Original) 1st 2nd 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 Settlement of Excavation RFR Ready for Repair D-39 3 of 3 W.O. OH L S AREA W.O. UG NO. T-625540 54 NO. T-626064 PIC: Assoc~reo S/O/~T- 604199 ORDERS PIC: BUDGET TYPE W.O.:OH LINE EXT EXIST RES ITEM UG LINE EXT EXIST RES GRID NO. 094-59 CIR. NO. 8JA-625 PERMIT YES TYPE REQ: PRIMARY VOLTS: KV TAX DIST. 1300 EASEMENT REQ'D NO NUMBER SERVICE OUTRIGHT REQ'D. BY - INFORMATION: CONTR. $ CND: ~ SALES TAX: :D: D U E TOTAL: DATE: COMPLETION SALES DATE SLIP NO. TEL. CO. ENGINEER TEL. CO. C.G. IC.O. JOB NO. DIST. ILETTER TRANSF. SECD'Y LOAD REG. IS TREE TRIM REQ'D : ATTACHMENT RECORD OWNERSHIP RECORD INITAL ATT LAST ATT E.L TEL. MADE TO REM'D FROM REPLACED AS TRANSFER OWNERSHIP DATA: JAMES NEUMAN E. MILL RD. MATTITUCK CONTACT: PREPARED BY: D. DANEK (DESIGNER SIGNATURE) ZIP: CONTACT T£L# 5-1-06 (DATE) APPROVED BY: Ill! o. MARK OUT REQUIRED CAUTION UNDERGROUND ELECTRIC IN AREA AS PER FACILITIES MAPS l-P#89.5 1-40' 2 I-PTP/INS I-STR CLP I-IOOA CO I-2/C~2AL PTHD I-3- U-GUARD ES 8T LBF~12538 Pt83 r ~ '..lPVc © SWAMP © P~/2 © E. MILL RD. 350' LO. CUST TO TRENCH. LIPA TO PULL CABLE AND MISSILE TWO 4" SCH 40 PVC SLEEVES UNDER E. MILL RD. TO P~89.5 70' 0 5PVC ~--1-2 4"PVC SLEEVES GRADE 30' DROP THIS WORK IS REOUIRED TO REMOVE EXIST OH FACILITIES AT P~83 TO P]~83-3 IN MATTITUCK CREEK AND IS NOT ACCESSIBLE. CUST MS AGREED TO PROVIDE OPEN TRENCH AND INSTALL LIPA SUPPLIED SINGLE PHASE PRIMARY CABLE IN TRENCH. LIPA TO BUILD NEW RISER P#89.5 AND INSTALL A BG TRANSFORMER. CUST TO AGREE TO SIGN "HOLD HARMLESS" FOR P#83-1, 1.5, 2, 3 I-BG~98134 BUS~8672 37.5 KVA GRP 169 ETWO#542212 '(~ESIGN ENGINEER SIGNATURE) (DATE)