HomeMy WebLinkAboutSound Rd Town of Southold
P.O Box 1179
Southold, NY 11971
* * * RECEIPT
Date: 11/21/11 Receipt#: 116565
Transaction(s): Reference Subtotal
1 1 Excavation Permits 739 $150.00
Check#: 1227 Total Paid: $150.00
Name: L, I PA
117 Doctor's Path
Riverhead, NY 11901
Clerk ID: LINDAC Internal ID:739
Permit No.
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT :' �,
P.O. Box 178 Z1 ZCl
Peconic, New York 11958
(631)765-3140
/ i3 ': y
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 Type
Name of Applicant Address of Applicant
2. /1/1���Lt_ lili� ti Cvfi
Name of Owner of Premises Address of Owner
3. ()A^) -Tr{�J(/Z�, i✓
ork Description and Location(Street Number,Hamlet,Cross Street) w T
(a) Is construction located within 75 feet of tidal wetlands? *Yes No
*If yes,other Town permits may be required.
4. Builder's License No. Plumber's License No.
Electrician's License No. Other Trade's License No.
Sign/ e of Applicant
Date
5. (a) Attached plot plan showing location of proposed excavation and relationship 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.
6. Tax Map No.: Section ,Block Lot
7. StartingDate: 1211 I /
�1 Completion Date:
8. Work Schedule: Phase _Completion Date
Excavation
Facility Installation
Backfill &Completion
Pavement ep acemen / n —
9. Under which authority is application being made: to.") AnJI� ��„�(,� l7i���pri�r
10_ Estimated Cost of Proposed Work: $
11. Remarks:
D-39 i 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$50,000 property damage.
13. Security:
(a) Surety Bond or Certified Check provided in the total Amount of$
(b)Maintenance Bond provided: 2 years or 3 years.
14. Fees for Applications and permits:
Basic Application Fee $150.00
Al. /Service Connections excavations @$20.00 $
No.
A2_ /Additional Excavations same service @$10.00 $
No.
B. Excavations 18" in depth or less
0-100 i.f._$10.00;Additional i.f. @$0.10 $
C. Excavations 18"in depth to 5' in depth
Ir
0-100 i.f._$30.00;Additional d i.f.@$0.30 $ G
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
TOTAL$ S ��
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 permit to:
in accordance with this application.
SUPERINTENDENT OF HIGHWAYS
TOWN OF S07D,NEW YORK
,`Peter W.Harris / `I
_-- — Date -
Date Received by the Town Clerk 11-o21-11
Date Permit Issued //—.L/— / Permit No. 7 3
NOTE: 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
Copy Distribution:
Highway Department
Engineer (with page 3)
Applicant
Town Clerk (Original)
INSPECTOR'S RECORDS
Inspection Date Findings (use code) Applicant Notified
1 St
2nd
3rd
4tr,
(To Permit Clerk)
REMARKS
CODE
IB Improper Barricades
--IU----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
NOTES: 7�T PROJECT NAME 7101285090
1. ALL PRIMARY CABLE TO BE 2/C#24LPE.
"MARK OUT REQUIRED" 1 V CONST' 24�� ,og'i "'0.0
E.D.kC.11.0. E.T.
2. ALL SECONDARY CABLE TO BE 3/C3/OAL CIC GAS IN AREA 130010
001 G.D.rEc.w.O.
3. GAS MAIN TO BE 2"-PLST. NO UG ELECTRIC IN AREA LOTS 3,4 & 5
4. INSTALL FAULT INDICATOR AT TRANSFORMER LOCATION. ORDERS OH. W.O. 10128860 s.D.AC.s.o.
5. LIPA TO CONNECT TEL BOND AT AT TRANSFORMER LOCATION. COMMUNMY GREENPORT GAS
5. REFER TO W.O.#T101288604 FOR OVERHEAD WORK im co xx)OOOOOx RE!
JOB/ xxxxxx BI/
JOB sQPT MIKE VERI PHONE/ MZCMC LOAD DATA GAS/UNIT
631-905-2920 OR 631-765-1802 LOAD CONDMON#2 SPC BTG
LL.1 GRID106-56 TAX DIST. 1300 UVING UNIT CODE—F 11TR HTG
LOT#4 EXISTING HOUSE cn Pa�aT BY Loco '�VNO 200 AEa ADD�LCDOK/DRx> t
C-3642 Ln CA BY Luno YES EASEMEM YES NO TOTAL
U Q PR,YI►RY VOLTAGE 132HV D.D. DOLL
CIRCUIT 8J-685 R REQ.
YES 0 NO 0
m 1
PREPARED KEN MUCCI 548-7234 11--12-11 IN CO 11HONI*
POLE 5-40 P G LAM FIsm 667-8568
PM#99794 1-2� #2AL POT HEAD a "PROM
STEVE AYLWARD DAN-
UPA LEAD 0 TEL LEAD 0
I-37.5KVA-GRP.171 1-3 -U-GUARD, pE° 50-7062 LSA ONLY CUST LEAD 0
GRID 106-56 PRIMARY RISER JOINT BURY LIPA LEAD
BUS 3649 7
LOT#5 ® I PRIMARY ONE-LINE 8J-685
C-3722 I—LARGE r N
SPLICE BOX I PM#99794 Pg##4292 ❑
40'-WIDE-COMMON DIRT DRIVEWAY Z
--295, COMMON DRIVEWAY I o
285 �X.�15
Z RUD DESIGN CURRENT REFERENCE (C.S.) DRAWINGS
I-SMALL W C.S.3504 BONDING THIRD PARTY CABLE TO SYSTEM NEUTRAL.
SPLICE BOX o C.S.3722 LOAD �Q4ELBOW.
w C.S.3947 ERO 2, ONTAINMENT FOR 10 FIBERGLASS PAD.
C.S.3950 GENE AL NOTES.
> o C.S.3960 PAD MOUNT TRANSFORMER.
EXISTING HOUSE o C.S.4027 SURGE PROTECTION 10 RUD OPEN POINT.
# o o� C.S.5370 TRANSFORMER LOCATIONS.
LOT 3 � C.S.5506 GENERAL SPEC. FOR U.G. SYSTEM.
C-3770 o C.S.6414 PLACEMENT KEEPING FOR CABLE IN CONDUIT.
C.S.6465 CABLE IN CONDUIT(C.I.C.) COMPONENTS.
C.S.6470 CABLE IN CONDUIT(C.I.C) GENERAL INSTALLATION.
C.S.6475 PADMOUNT TRANSFORMER WITH C.I.0 SECONDARY.
C.S.6628 SECONDARY SPLICE BOX.
NORTH RD. (ROUTE 25)