HomeMy WebLinkAbout1275 Fanning Rd Permit No. `1 TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
File No. ��. 1r� Peconic Lane'
Peconic,New York 11958
(631)765-3140
APPLICATION/PERMIT_FOR HIGHWAY EX
C.AVATION AND REPAIR
W.O.T1016236_42
APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of
an Excavation Permit pursuant to Chapter 33 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 inspoetors to snake necessary inspections of the
job site.
Print�l
1) KEYSPAN CAS EAST CORPORATION d/b/a NATION T —GAS CONSTR. V . —1 5 F.OLD
CO RV RD.—HICKSVILL NV 11801
Name of Applicant Address
2) 1275 Fanning Rd. New Suffolk Premises Address
3)
4) Open a-4'x4'bellhole on the W/s of New Suffolk Rd,approx.75'N/o Fanning Rd.,to
install a gas service.
5)
6)
7) tidal wetlands? *Yes No_X
"1f yes,other Town permits may be required.
Builder's License No. N/A Plumber's License No. N/A
Electrician's License No. N/A Other Trade's LI e . N/A
G
::Z
Signature of Applicant .
Dau:07/07/14
5) 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.
e) 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 C:omvletion.Date
Exenvution.....
......................... .....................I................
Facility Installation..............................................................
Backfill&Compaction........ .................
Pavement Replacement.........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
12) lnst►rtncF . vrrare(Attach Cory)
Z00'd 6T99V ME) 1IV110I1)/11 63:TT tTOZ-LO-'IIID
a) Insurancc Company_
b) Policy#
c) Stutc whether policy of ratification on filo with the Highway Department:
d) Coverage required extended to the Town:
Bodily injury and property damage: $300,000/$500,000 Bodily Injury,and$50,000 property damages
13)
tt) Surety Bond or Certified Chcck provided in the total amount
of$
b) Maintenance Bonded provided: 2 years or 3 yom
la) Eg4.for mpplicationai and iit,: Basic Application Fee $150.00
A l_ _1 /Service Connections excavations @$20.00= $20.00
A2. /Additional Excuvatiomi samc service @$10.00=
No.
B. Excavations IS"in depth or loss:
0-100 it=$10.00-
1_E @,$0.10-
Addit tonal
C. Excavations 18"in depth to 5'in depth:
0-100 ti:
Additional If. Q.30=
D. Ex(myt ions 5'in depth and over-
0-100
ver:0-100 Lf.=$50.00
l.f.(q),$0,50=$
Additional
E. _ Utility Repair Excavations @$10.00=$
No.
-_---T RCp;ttrs WtirlC VCfVict ��$5.00
Additional
F. Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST—$170.00
Authorisation is herchy granted to the Town Clerk of the Town of Southold to issue a Highway Excavation P it to:
KFYSPAN ENERCY DELIVERY in accordance with this application.
SUPERINTEND OF IG
TOWN OF SO O
inc t Orlando
9
Received by the Town Clcrk _ t
Date
1, f ,
Permit Ixsucd 1 � 't Dale Permit
No. I"1
Nota: Permit expires one(1)year from DAtc of trsuanee_ No work to start without 48 hour notice to the Superintendent of Highways_
Permit must be avaitablo for inspection.
D%49 Page 2 of 3
Cupy Distribution_
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Highway Department
Inspcotor
Applicant
Town Clcrk
1NSPRCTOR°S_ _._RECORD
Inspection Date Findings(use code) Applicant Notified
2nd ..
3f°
(To Permit Clerk)
REMARKS
CODE
IB- Improperburricadec
IL — Improper lights
ST - Sunken trench or excavation
UTM - Unable to measure(due to backfilling)
BUC Building under Construction
W1P - Work in Progrw
D13 - Improperbackfill(too high) (notsufticient)
HFS - Inspector holding for final settlement of excavation
RFR- Ready to Rcpuir
D-39 Page 3 of 3
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W.OJPA AE MAN ' r -D-At E Or-
NO. OPENING
uautr-TEA f DEPARTMENT DIVISION
BY GAS CONSTR.MAINT. & S&VICES
APPROVED J.DATI
SKETCH �� 6777
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Phone No.: � � �� '�P�_ �� Phone No.: ��6 „ ��� ,
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Fax No.: 651 - 761- - j ?�-O Fax No.: 516-545-4941
Messages/Comments
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* * * RECEIPT * * *
Date: 07/01/14 Receipt#: 173574
Quantity Transactions Reference Subtotal
1 Excavation Permits 947 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK# $170.00 National, Grid -Gas Constr.
Dept
Name: National, Grid -Gas Constr. Dept
175 E Old Country Rd
Hicksville, NY 11801
Clerk ID: LYNDAR Internal ID:947
#--0.1
1 Permit No. x n TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
File No. Peconic Lane
Peconic,New York 11958
(631)765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
W.O.T101623642
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 GAS EAST CORPORATION d/b/a NATIONAL GRID—GAS CONSTR. DEPT. —175 E.OLD
COUNTRY RD.—HICKSVILLE,NY 11801
Name of Applicant Address
2) 1275 Fanning Rd. New Suffolk Premises Address
3)
4) Open a-4'x4'bellhole on the N/s of the road,approx.75'W/o New Suffolk Rd.,to install
a gas service.
5)
6)
7) tidal wetlands? *Yes No_X
*If yes,other Town permits may be required.
Builder's License No. N/A Plumber's License No. N/A
Electrician's License No. N/A Other Trade's License No. N/A
0����
Signature of Applicant
Date;06/24/14
5) 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. 1
6) Tax Map: Section Block ,Lot
7) Starting Date: Completion Date:
8) Work Schedule:
Phase Completion Date
Excavation.........................................................................
FacilityInstallation...............................................................
Backfill&Compaction.........................................................
PavementReplacement.........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
12) Insurance Insurance Coverag (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$50,000 property damage.
13) Securi :
a) Surety Bond or Certified Check provided in the total amount
of$
b) Maintenance Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee $150.00
Al. _1 /Service Connections excavations @$20.00= $20.00
A2. /Additional Excavations same service @$10.00=
No.
B. Excavations 18"in depth or less:
0-100 Lf=$10.00-
a @$0.10=
Additional
C. Excavations 18"in depth to 5' in depth:
0-1001.f=
Additional If. @.30=
D. Excavations 5'in depth and over:
0-100 l.f.=$50.00
I.f.@$0.50=$
Additional
E. Utility Repair Excavations @$10.00=$
No.
Repairs same service @$5.00=$
Additional
F. Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST=$170.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavati Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SUPER S w wr GGPCNtL cdwwl<d15 TOWN OF NTE OF YARK
Vincent M.Orlando
K-obi-/y
Date
Received by the Town Clerk L(a� �y
Date
Permit Issued qq7
Note: Permit expires one(l)year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Permit must be available for inspection.
D-39 Page 2 of 3
Copy Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date Findings(use code) Applicant Notified
I SI
2nd
3rd
4m
(To Permit Clerk)
REMARKS
CODE
113— 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 to Repair
D-39 Page 3 of 3
4-4
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a PERNM APPLICATION SKETCH
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Village Of
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DATE: 612412014
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LOCATION: 1275 FANNING RD CROSS STREET I: NEW SUFFOLK RD >"
T Ower: NEW SUFFOLK CROSS STREET z: FRED ST
WORK ORDER: 7101623642
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GENERAL CONDITIONS OF PERMIT
APPLICA"TION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
I . Permittee's Contractors to Comply with Permit Requirements: The Permittee is responsible for
informing its independent contractors, employees, agents and assigns of their responsibility to comply with
this permit, including all special/site specific and general conditions imposed by the I lighway
Superintendent while acting as the permittee's agent with respect to the permitted activities, and such
persons shall be required to comply with all permit requirements.
2. No Riaht to Trespass or Interfere with Private Property Rights: This permit does not convey to the
permittee any right to trespass upon the lands of adjacent property owners in order to perform the permitted
work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or
vested in a person not a party to the permit.
3. Protection of the Hip-hway and Future Hh!hway Maintenance: If future operations or highway
maintenance projects by the 'Town of Southold require an alteration in the position of the utility, structure
or work herein authorized,or if, in the opinion of the Highway Superintendent the work performed under
this permit shall cause unreasonable obstruction to required highway maintenance or endanger the health,
safety and/or welfare of vehicular or pedestrian traffic, this permit shall be revoked and the utility,
structure, till, excavation, or other modification of the highway hereby authorized shall not be completed.
Additionally, the permit may be revoked if the Highway Superintendent finds that the issuance of the
permit was illegal or unauthorized or that the applicant failed to comply with any of the terms and
conditions of the permit or Chapter 237 of the Town Code.
4. Revocation of the Permit by the Highway Superintendent: If the Highway Superintendent deems it
necessary to revoke this permit and the project hereby authorized has not been completed, the applicant
shall, without expense to the Town and to such extent and in such time and manner as the Superintendent
may require, remove all or any portion of the uncompleted utility, structure or till and restore the site to its
lormer condition.
5. Notice of Commencement: At least 24 hours prior to commencement of the project, the permittee and/or
contractor shall notify the Town Highway Department in writing that they are fully aware of and
understand all terms and project conditions of this permit. Upon completion of the work, the contractor
shall provide photographs of the completed work to the Town Highway Department and request a Final
inspection.
6. Storaae of Equipment & Materials: The storage of construction equipment and/or materials shall be
confined within the project work area and/or adjacent areas where permission / legal access has been
obtained in a manner that does not interfere with normal highway traffic.
7. L!tility Mark-Outs: The Applic^nt/ Contractor shall be responsible Ior verification of all rxisting utility
mark-outs and shall take all precautions to protect same. Damage to existing utilities shall be the
responsibility ofthe contractor and shall be repaired at the contractor's expense.
8. Road Closures: All scheduled road closures must first receive written permission from the Southold I"o"vn
Board prior to closing a road. Temporary lane closures may be permitted with the approval of the Highway
Superintendent. This item will included but not be limited to the installation ofappropriate signage and
flag men to stop and start traffic to allow for single lane traffic. Road Closures due to unforeseen
emergencies require immediate notification of the Highway Department and shall be limited to immediate
and/or expedited restoration of the Work "Lone.
9. No Construction Debris in Road Shoulder Area: All Construction Debris shall be removed from the job
site on a daily basis. All stockpiled soil as well as all other project materials that will be staged within the
Right-of Way must be delineated with reflective signage or other means to meet the minimum requirements
of the NYS DOT Construction Standards.
. . 4 .
GENERAL CONDITIONS OF PERMIT
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
(Continued)
10. Install, Maintain Erosion Controls: Required Erosion Control Measures (i.e. silt fencing) is to be placed
on the downslope edge of any disturbed area. '['his sediment barrier is to be put in place before any
disturbance of the ground occurs and is to be maintained in good functional condition until thick vegetative
cover is established.
11. Clean Fill Only: All project back-till shall consist of clean sand, gravel or soil (NOT asphalt, slag, flyash,
broken concrete or demolition debris). All unsuitable soils excavated at the site (i.e. Clay, Bog, etc.) are to
be removed from the site and not used to backfill any excavation within a Town I lighway.
12. All Areas of Soil Disturbance : All areas of soil disturbance resulting from the approved project shall be
stabilized to the satisfaction of the Highway Superintendent immediately following project completion. If
the project site remains inactive for more than 48 hours or planting is impractical due to the season, then
the area shall be stabilized with straw, hay mulch and/or jute matting until weather conditions favor
germination.
13. Backfill & Compaction of all Excavations: Back Fill shall consist of clean till or soils which exhibit a
well-defined moisture density relationship as determined to be in accordance with ASTMD 698. Fill shall
be placed in maximum lifts of twelve (12") inches thick and shall be mechanically compacted to a Ninety-
five(95%) percent maximum dry density. Suitable hydraulic compaction by waterjetting at three-foot
intervals will also be permitted subject to a project specific approval by the Highway Superintendent.
14. Restoration of the Road Shoulder Area: All man-made improvements located within existing road
shoulder areas must be protected to the greatest extent practical. Items would include but not be limited to
driveway & private road aprons, mail boxes, sprinkler systems, trees and ornamental plantings.
Excavations through driveways and private road pavements must be reconstructed to meet all requirements
of Southold Town Highway Specifications. All pre-existing road shoulder improvements that have been
disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the
Highway Superintendent.
15. Schematic Plans with all Technical information and Scope of Work: To reasonably and adequately
describe the proposed work, accurate schematic site plans must be provided to show or indicate all
proposed construction activity required under this permit. All Pavement surfaces scheduled for excavation
must be saw cut to the full depth of asphalt and/or concrete pavements. Accurate size of bell holes or width
oftrenching must be indicated by dimension or labeling. This schematic site plan must provide details on
all restoration required to meet the requirements of these General Conditions and requirements found in the
Southold Town Ilighway Specifications.
16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner:
i\ote: When Concrete Pavements are Present. Please review Restoration requirements with the Ihghway Superintendent)
a) Complete all back-till & soil compaction work as needed to provide a suitable sub-base:
b) Over-cut existing asphalt bell hole or trench by twelve (12") inches on all sides:
c) Install a compacted lift of 4"thick Stone Blend base (RCA Blend must meet NYS DOT Specification):
d) Install a two and one half(2.5") inch compacted lift of Asphalt Base Course:
e) Install a one and one half(1.5") inch of Asphalt(Type 6) Wearing Course. (Provide AC at all joints)
All work listed herein must meet the minimum requirements of the Southold Town I lighwa_y
Specifications.
17. "Trenching of Pavement Surfaces Exceeding One Hundred (100') Feet in Length: All trenching of
pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item
# 16 as noted above. Once all pavement reconstruction is completed to the satisfaction ofthe Highway
Superintendent, the entire road section and/or width of road over the entire length of trench shall be
repaved with a two (2") inch lift of Asphalt (Type 6) Wearing Course (Fvpical, shoulder to shoulder).