HomeMy WebLinkAbout535 McCann LnTown Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 08/16/04
Transaction(s):
1 Permits
Receipt~:
3463
Subtotal
$270.00
Check#:3463
Total Paid: $270.00
Name:
ClerklD:
Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
LINDAC
Internal ID: 99581
Town Of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT * * *
Date: 08/09/04
Transaction(s):
1 Permits
Receipt~:
3463
Subtotal
$270.00
Check#: 3463
Total Paid: $270.00
Name:
ClerklD:
Keyspan, Energy - Gas Cont Dept
175 E Old County Rd
Hicksville, NY 11801
LINDAC
Internal ID: 99324
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
Re£#T100402663
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 Yorl~ 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 Address
2) 535 McCann Lane, Greenport
Name of Owner of Premises
Address
3) McCann Lane - bellholes and a 725' trench in the e/s grass area~ missiling under the i/o Sutton
Place and a 25' trench in the s/s ~rass area of Sutton Place to install a gas main and service
4) Work Description and Location (Street Number, Hamlet, Cross Street)
(a) is construction located within 75 feet of tidal wetlands? *Yes No X__
*If yes, other Town permits may be required.
4) Builder's License No.
Plumber's License No.
5)
Electrician's License No. Other Trad~ License No~
~ignature of A~plica~t/
7-16-04
Date
a) Attach plot plan showing IocaBon of propased excavation and relationship to adjoining premises or
public slreais 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: Completion Date:
8) Work Schedule:
Phase
Excavation .........................................................................
Facility Installation ...............................................................
Backfill & Compaction .........................................................
Pavement Replacement .........................................................
Completion Date
9) Under which authority is the application made:
10) Estimated Cost ofProposedWork: $
11) Remarks:
· D-39
Pagelof3
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:
13) Security:
a)
b)
T100402663
Bodily injury and property damage: $300,000/$500,000 Bodily Injury, and $50,000 property damage.
Surety Bond or Certified Check provided in the total amount
of $
Maintenance Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee ................. $25.00
Al. I /Service Connections excavations ~ $20.00 = $20.00
A2. /Additional Excavations same service ~ $10.00 = $
B. Excavations 18" in depth or less:
0-100 l.f. = $10.00 ~
1.£ ~ $0.10
Additional
C. Excavations 18" in depth to 5' in depth:
0-100 1.f. = $30.00
650 l.f. ~ $0.30 = $195.00
Additional
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 = $270.00
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 with this application.
Received by the Town, Clerk
Permit Issued t~ ~-~/~7 ~ Permit No.
'f ' --
Note__: Permit ex' p' es 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 inspechon.
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JUNa30-~00~
14:06 KE~PAN GAS CONSTR
KEYSPAN
REQUEST FOR STREET OPENING pERMiT.
PERMIT
I
-'
P.02
JUN~30-2004
14:07
N
P. 0~
TOTAL P.O~
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date
1st
2~
3~
4,~
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
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