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HomeMy WebLinkAbout1600 Grathwohl RdTown Of Southold P,O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 06/30/04 Transaction(s): Permits Receipt: 3401 Subtotal $45.00 Check#: 3401 Total Paid: $45.00 Name: Keyspan, Energy- Gas Cont Dept 175 E Old County Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal ID: 96969 ELIZABETH A. NEVILLE TOWN CLERK I~EGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: From: Dated: Re: Janet Mitchell, Keyspan - 516-545-4941 Linda J. Cooper, Deputy Town Clerk June 30, 2004 Rush Excavation Permit Number of Pages (including cover): 5 If total transmittal is not received, please call 631-765-1800. COMMENTS: As you requested FILE No.470 O~,,'E8 '04 1~:40 Energy Delivery FAX: Date # of pages From Co. 1/ S Phone # Fax # NOT£S/COMMI~NTS FILE No.470 06~L::'8 '04 1~:41 FAX: Permit No. ~ File No. ~ TOWN OF SOtJTttOLD HIGHWAY DEPARTMF-NT Peeoni¢ Lane Peconic~ New York 119S8 (631) 76S-3140 Ap]~[.~CATION/I~RMIT FOR HIGHWAY EXC.A..yATION AND RF_,PAIR Ref,//T10Q402573 Print or Tyne !) KKYSP.4~N KNF..RGY- GAS CONSTR. DEPT. - ITS F-. OLD COf~qTi¥ RI~ - HICKSVILLE. NY II,MI Nmu~efA~ Address 2) 1 ~0 Grdhw~d R6~eL New h'uffolk Nmnc e~Ow~r erPremfses Addr~ ~wekl R~md - bdJhde e~ eross area. aMh"ox. 1 ?S' a/O ~ R0~d. New Suffolk. to Jnsttss a fas Work Dt~flMba sad Loca~ (Strt~ Number, Hamlek Cre~ Street) · If)es. mh~r Towa permits may b~ required. N~ X Pl#mber's Lk'euse NL Other ?tm .d~s License No. b) At~.h an ~he~ oeceem~ pe~____'~, aud Oceans f~ this pr~-~. c) Work coy(~-d by ~his oppllcaflo~ may not commeace bd'6re I~uanc~ of a mghway E~cavafiol Permit Tax Ma~. Secflm , Bio(k, S~artb~ l~tc: Comptctm Date: Wo~ Schedulc: FadflW Instdhtbn ............................................................. Bad~dl & Compm~ou ...................................................... Pavement Replaeemeat ......................................................... ~mnletion Date 9) Under which autbotiW is the applieafion made: 10) Es~'imated Cost of Pro~ Work: S 11) FILE No.470 06/28 '0.4 12:41 FAX: 3,' 5 13) seemi~ S~ Bo~l or Caftifi~l C~k provided in (he ~ ~mo~( of'& b) lv~da~e~ ~ provided: ,2 )mar~ or 3 ~ 14) * ' ~: ~ Al. ! /~:rvi~ ~om ~xmv~lians ~ $'20,00 = $. No. ,~.. 1'~. 0-100 I.f- - S10.00 tf.~ $0.10= S 0-100 I.f. == S30.O0 ~- .___. 1.£ 0 S0.30 = 0-100 I.f? $,S0.00 I.f. ~ $0.$0 = $ U~lit7 l~-pair Em~io~ ~ S ~ 0.00 = S F.. N~ ~o public u61i~s p~ofm~ be pmvi~l a~d ~ m ~!~ .pplicaiion ~ ~o i_~e~eoe of K~YSPAN' ENERGY DELIVE. RY TOWN OB' ~LD, ~OP.K --v P~r W. l~ds 0 Pen'nit No. ~ P~rdt ~x;pir~o~(1),yc~' .,fi~D~teaflssu~e. Nov~xkios~wttho~t4$bournodc~tol~Sup~int~t~fP.i~h~s. FILE No.470 06/28 '04 12:41 FO~(: P~qGE 4/ 5 Highway D~paml~m: Tow~ Clerk Fb~l~g~ (u~e ~.~) fro PJ:~ D-39 , Pig* 3 of 3 FILE No.470 06/2'8 '04 12:42 Ji~ FIqX: ,~2~.-;L:~ 1~:4!~RN GRS ~'r~ KEYSPAN REQUEb"r FOR STREET OPENING PERMIT ~ 5/ 5 ~ NA~tiAU OOUNTY ~'~ SUFFOLK · OOUNTY RUSH