Loading...
HomeMy WebLinkAbout665 Laurelwood Dr * * * RECEIPT * * * Date: 09/24/13 Receipt#: 158708 Quantity Transactions Reference Subtotal 1 Excavation Permits 871 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#25843 $170.00 National, Grid - Gas Constr. Dept Name: National, Grid - Gas Constr. Dept 175 E Old Country Rd Hicksville, NY 11801 Clerk ID: LINDAC Internal ID: 871 own of South 6Tcr_ 7/25/13 Z y 6 Peribit Paym s : CLCC102/GC2427/652 Bank of New York ChecT101503599 *********170.00 NATIONAL GRID 25296 7/25/13 Town of Southold Permit Payments : CLCC102/GC2427/652 Bank of New York Chec T101503599 *********170.00 PRODUCT DLT104 USE WITH 91663 ENVELOPE A 19/09 '13 THU 13:06 FAX 631 765 6145 SOUTHOLD TOWN CLERK 4�002 09/14/2013 THU 10: 11 I'M -- — — -- (�642/ODo �9/'_�f2013 1C:50 51b545447A i iuRIb PACE; 0_9 e6 l�Cr2ril * �. Permit N 11 o. TOWN OF SOUTHOLD IRIGRWA,Y DEPARTMENT Bil *y RECEIVED e Peco No. nic Lane Pcconic.New S'ortc lI9>F �..�✓ iii (631)755-3140 SEP 1 J n 2WJ aPPLI ATION)pl IRMIT FOR H 'Y W Ea .AVATIQ�A1VD R�iPAI17 Southold Town Clerk W.0,TI(3150;1599 AFFUCATION 1S 114FREDY made to t11c Superintendent of HiFhwnys of ars Town of Southam for the tsguxnce of an ExcAvation Yerinit purnuant to Ehpptal-33 of the Code of the Town of Sout.hnK Soffoll(Colrnty.\eiv York,and other ApplicAble bws,erdinmces nr reRulada-for the exeavn(ion herein dnccribcd. The applICAnl Arrm to gnmply wlih nil applicable laws,ordinnncCF,codex and rcRulnfioag,and!n permit M11horized inspectors to make mmcssAry 419poct.ioni of the jab site, PrinL(ir TVpt 7.) ESATiORAL GR[D—GAS CONSTR. nEp1".__•�175 E.CLQ CQTUIN MY RU.—kIICKS\ILLF�N1�]]$O1 tiama ofAppliCnrtt Address 2) (165 Laurelivood Ar. Laurel Premises Addruss 3) 4) open a.-41x413 botlhole on the W/s of Laurelwood Dr,,631,SID Peconic Day Blvd,,to inxtal)a gas service. 5) 1) lidniwWands? *YesNo_X_ Tlfyev,nthrr Tawn Vrmils mn�'be required. Builder's License No. Plumber's I iccnse irn. Electrician's License Nn._ _ � _ Other Trade's License No. Signature o]Applicant b>itx:7rzsit a 5) a) Attach plot plan sholvirtg lOention of propose(i"CRVAtion and relationship to nrijoining premises or public streets or areas,An(l giving a(WAM'd(It:Scription Pf layout of axcaysilnn. 1)) All.ach o11 other ue[essgry permits lind 11concea for this prof et:t. (:) 'VYOrl(Covered by this application may not commence before issuance of n Highway Excavation Permit by the Tnwn(7lerk. 6) Tax Map; Section $IOek Lot 7) Starting Date: Completion)late: E1 Work Schedule: Phisc Com Ietion iJzte FACility 1nkfAllntinn.,,,,,,,,.. _ "'"""""" pnVenlcht R4QP1ACCtn Cnt......... ..,. ........ . ......... .. .......... 9) Under wlilcb nuthority is the applltation made: t0 l stimsted Cost of Proposed Work: 5 il) Remnrk�; 12) lnsuranoe C'ovcr c(Attach Copy) s) Insurimcc(,QrnpNny; 19-0�J '13 THU 13:06 FAX 631 765 6145 SOliTHOLD TOWN CLERK 09/7;9/2013 THU 10: 12 FAX _ X003 �fUO3/006 SKP-17-Zp!3 i1:1e 4ATIONAL GRID 4Fi61° P,G03 b) Policy;' C) S:aCC WI:CII1Cr policy of Cp21nCALtOt7E'Ilvhty;�y pelytt �cnt: d) Cove.ege rcyuircd cxti-nded to the Town: Bodily lnjury:mdprojx,t'tydamage : 8300,n00f11500,UUt7t3gdilylnlury,and S50,0oUr p operty damave. 13) $curi a) Surety Bond __or[citified Chcck of Ss _ prOvidcd in the toL'a3 Amount b) M:{intcn�ucc Handed prorided; 2 years or �_„•"1 Years 1 S) Rpec tbr applicatjQns and cJtCtiCF: Al_ _1^/Service CorneGiions excavations x,$20,00 sit App icatio, FCC 5150,00 1120"00 Al. /Addltional Excavations same service $10,00 a No. 13. L`xcavations 1 R"iu depth or leis; 0-JOOt,f=510,00- _�Lf w 80.10= Additional C- Excavations t$"ir:Uep i 10 5'in depth; 0-1001.r= AddihQnal lf- @-30 D. Excavations 5'in depth and over; 0.100 u,=x$0.00 I,F,C� Additional F o.,-, Utility Repair Excavations®$10.00—$ Iv --�.. Repairs same service Addir'anal P. Notice to publio utilities proof mus permit- t be provided and attoched to Ihis appliealion prior to iNsLimcr of TOTr1L��ST 5170 00 Apthori-46on is 1wmby granted to Dry 70 n 000 of thr:Ti,wn of Novtl,otd to issue a 1"figllway r{xcavation Fermlt w: ICKYSPAN RNERf Y U.=VERY in accordance with this application. SUPER'IN I' NDE,, TQF M;CWf VAYS TQVJV OF SF0TEl0L0 NEW yoRK Received by 6e 7bwn Clerk Date Llan Y.7/ Pcrrtait / Permit expire;Qj)o (i)yeainspeation.r t'rom ha s oI lssuonca No work to s4111wiU}eut 4s hour rotiee to the Superintendent or Ihghwyys, Permit must be avuitublblfer U•3� Page Z of 3 HLti<h a'ay'pepartmen t 19/0A '13 THU 13:07 FAX 631 765 6145 SOUTHOLD TOWN CLERK (j005 08/4 /2013 THU 10: 12 FAX —. 89179/2E�73 11J:5o 5165454474 �b04/006 NGRID PACE Inspector APFlicant Tv-a-n Clerk P1 jzT()B t]Rp lnspcetion bate Findings(use coele) Applicant Notified 1.� {7o hernrrit Clerk) RZr' KS car-) 113— improper hsrricede5 Ir — improperlighrc SIF ._ Sunken trench or excavation UTM — Unable to nic16urc(due to backfilling) ELIC — Building under Construction 'A7P — Work.in Progress 013 r fmprnper Backftll(tov high) (nal su(i'iciont) HFS — Inspector holding for final acttlCment of excavation Ready f.4.RCPAir A-39 vagu 3 at'i 09/19/2013 THU 10: 11 FAX ®001/006 ._ 09/19/2013 10:50 5165454474 NGRID PAGE 01/06 T • Date: 9 No. of Pages TO:. FROM: a6l�l - d Dept./Co.: DepL Co.. Phone No.: —IIAP Phone No.: • f S4 41 444 #At Pax No.: Fax leo.: S16-54,5'4- ,c,C 7 Messages/Comments 19/09 '13 THU 13:07 FAX 631 765 6145 SOUTHOLD TOWN CLERK 16001 �c TX REPORTxc TRANSMISSION OK TX/RX NO 2787 CONNECTION TEL 15165454474 CONNECTION ID ST. TIME 19/09 13:06 USAGE T 01'27 PGS. SENT 5 RESULT OK ELIZABETH A. NEVILLE - q :l Town Hall,53095 Main Road TOWN CLERK x P.U. Box ] 179 REGISTRAR OF VITAL.STATISTICS C� � .� Southold, Ncw York 11971 MARRIAGE OFFICER ;. " ��� �"",'• 1''aX (631) 765-6145 RF.CORDSMANAGEMENT OFFICER Tele1)t1011e (631) 765-1800 FRF;EDOM OF INFORMATION OFFICF;R OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD FAX TRANSMITTAL To: Linda Pierce, National Grid Loretta—Southold Hwy Dept From: Linda J. Cooper,Deputy Town Clerk Dated: September 19,2013 Re'. Excavation Permit No. 871 T101503599—665 Laurelwood Dr., Laurel Number of Pages (including cover): f If total transmittal is not received, please call 631-7651800,Ext 210 09/19/2013 THU 10: 11 FAX 09/19/2013 10:50 5165454474 NGRID PAGE 02/06 TORECEIVED 1>crrrtit No. ��T OF SOUTIIOI.n ED HIGkl.WAY D1rPARTMENT File No. Peconic Lane Peconic.New Voris 11958 SEP 1 9 2013 (631)765-3140 APPLICATION/PER . rORHT H—) ' YES` AVATIONAND +,PAIR Southold Town Clerk —" MLO. 03599 APPLICATION]C 1iF,RESY mode to rhe Cuperintcudcnt of HiFhwnys of.the Town of Soathold for the issuance of nn.F,xcavatinn Pcrm►t pursuant to Chapter 83 of the Code of the Town of Southold,Suffolk County.Ncw York,and other applicnUle laws,ordinAllcCS o�'regulations for the excavation herein described. The appllesnt agrees to cnnipiv with All applicable inivs,ordinaners,codes and repulAtions,and to permit Authorized inspectors to mske neccasoly inapect.i" of the .lob site. Pri I—mlYme ],) NATIONAL GR D— NST PT. —] 5 E. LA CC+I Address —Hi K MLLE N1' 8 l Name of Applicnnt Z) 665 Laurelivood Dr. Laurel Premises Address 3) 4) open a-41X413 bellhole on the W/s of Lsturelwood Dr.,681' s/o Peconic Bay Blv o install a gas service. 5) 6) 7) lidalwotlnnds7 *Ves No tlf yea.other Tawn permits mny be required. Builder's License No. Plumber's License No. Electrician's Licence Nn. Other Trade's],ieense No. Signature of Applicant DAtc;7/25/13 5) a) Attach plot plan showing location of proposed eXeRvalion and relationship to adjoining premises or public streets or vireos,antl giving a detailed description or layout of excavatlnn. b) Attach all other necessary permitA and licenses for this project. c) Worit covered by this application may'not commence before issuance of a Highway'Excavation Permit by the Town Clerk. 6) Tax Nylip: Section .Block ,Lot 7) Starting Date: Completion Date: 8) Work Schedule: Phase Comnletinn Date Excava(ion......................................................................... FacilityInatatlstinn............................................................ Aackfiil&ContpActinn............................. .. ...................... Pavement Replacement .M...-- 9) Under which Authority k the application m:sde: lo) Estimated Cost of Proposed Work: S 11) Remarks; tZ) Insurance Cover n>t (Attach CoPy) u) lnsura.nc.c t';ompany; w____.----- 09/19/2013 THU 10: 12 FAX 003/006 SEP-17-2013 11:18 NATIONAL GRID 46619 P.003 b) Policy$1 c) Statc whether policy of certification on filc with the Highway Dep:utr'— 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 Cheek provided in the total amount of S b) Maintcn.Anec Bondcd provided; 2 years or 3 years 14) Fees for applications andpertnitS; Bask ADDIicatioll FCC $150.00 Al_ -1—/Service Connections excavations @$20,00= 2� 0.00 A2. /Additional Excavations same service n S10.00= No. B. Excavations 18"in depth or less: 0-100 Lf=$10.00- Is,to S0,to= Additional C. Excavations 18"in depth 10 5' in depth: 0-1001.f= Additional If.. @.30= D. Excavations 5'in depth and over; 0.100 U.=S50.00 l.f. r@S0.50=$ Additional $, Utility Repair Excavations n$10.00-S No. Repairs same service @ SS-00=$ Additional F. Notice to public utilities proof must be provided and attached to this application prior to issuitr<ec of permit_ TOTAL COST=$170.00 Authorizadvn is thereby granted to tete Town Clcrk of the Town of Southold to issue a Highway Excavation Pcrmit to: KEYSPAN RNERCY DEIVRRY in accordance with this application. SUPERINTENDENT OF FI IGM WAYS TOW OF S430THOLD,NEW YORK Peter W.Marris /?//-31 Date Received by the Town Clerk I)atc �U( Pcrmit Issued , , 3 Pcr t-O No, . ...,......__....... ,.,._._..._._.. N=: Pcrmit cxpires one(I)year from Dnte of Issuanco. No work to still without 4t3 hour notice to the Superintendent or llighways. Permit must be uvailable for inspection. 0-39 P2ge 2 of 3 C91Dx Dieu cion: Highway Department 09/19/2013 THU 10: 12 FAX 2005/006 09/19/2013 10:50 5165454474 NGRID PAGE 05/06 SEP-1.7-2013 11: 111 GPS SRLES PPTCHOWE 6317585182 ='.02 -REQUEST FOR STREET OPENING P-pMIT NASSAU, SUFFOLK �^ Fc•ati�;q �:...i STATE C� COUNTY 'COUN' TY Q Df Jij PV/MIT MI$ JOB Qq DATE . . NO, IVP.. Q �} `r ' LOCATION. IEA60NFOR o , oPeNINa tb C A=o91G-_ZtyI��dj aFOR ANDATE OF, Q OPENIN'G 1 REQUREISTED DEPARTMENT D.IVIS ON ©AS CONSTR, MAINT, & $$PVICES APPROVED DATE i SKETCH 34AeK --QP 'DAA✓�w��r ,�%` � u -- OM C C.v TOTPL P,02 09/19/2013 THU 10: 12 FAX 2004/006 09/19/2013 10:50 5165454474 NGRTD PAGE 04/06 Inspector Applicant Town Cleric IN'SPE-QT OR`S RECORD Inspection Date Findings(use code) Applicant Notified I � "1 (To Permit Clerk) RE tARK,�i CODE li3— Improper barricades IT_ Improper lights ST Sunken trench or excavation UTM — Unable to measure(duc to backfilling) BLIC — Building under Construction WTP — Work.in Progress DB — Improper backfill(too high) (not sufficient) 14FS — Inspector holding for final settlement of excavation RFR— Ready to.Repair D-39 Pnge 3 of 3