HomeMy WebLinkAbout745 East Rd * * * RECEIPT * * *
Date: 09/19/14 Receipt#: 177798
Quantity Transactions Reference Subtotal
1 Excavation Permits 976 $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: BONNIED Internal ID: 976
0-1
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Permit No. 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. T101655139
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 TVDe
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) 745 East Rd. Cutchogue Premises Address
3)
4) Open a-4'x4'bellhole on the S/s of the road,approx.50'W/o Fleetwood 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
Signature of Applicant
Date;09/16/14
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.
6) Tax Map: Section .Block ,Lot
7) Starting Date: Completion Date:
8) Work Schedule:
Phase Completion Date
Excavation.........................................................................
Facility Installation...............................................................
Backfill&Compaction.........................................................
PavementReplacement.........................................................
9) Under which authority is the application made:
10) Estimated Cost of Proposed Work: $
11) Remarks:
I2) Insurance Coveraize(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 Bonded provided: 2 years or 3 years
14) Fees for applications and permits: Basic Application Fee $150.00
Al. I /Service Connections excavations(c�$20.00= $20.00
A2. /Additional Excavations same service C$10.00=
No.
B. Excavations 18"in depth or less:
0-100 I.f._$10.00-
a @$0.10=
Additional
C. Excavations 18"in depth to 5' in depth:
0-100 I.f._
Additional If. (a.-).30=
D. Excavations 5' in depth and over:
0-100 I.f._$50.00
I.f.(w$0.50=$
Additional
E. Utility Repair Excavations @$10.00=$
No.
Repairs same service Cad$5.00=$
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 Excavation Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application.
SUPERINTEND NT F H AY
TOWN OF S YO
Vincent M.Orlando
Received by the Tow Cl e k Date�f\ "�1 "(
Date r_
Permit Issued l \ ` l� Permit No.
Note: Pen-nit expires one(I)year from Date of Issuance. No work to start without 48 hour notice to the Superintendent of Highways.
Pennit must be available for inspection.
D-39 Page 2 of 3
Coov Distribution:
Highway Department
Inspector
Applicant
Town Clerk
INSPECTOR'S RECORD
Inspection Date Findings(use code) Applicant Notified
15[
2nd
3 rd
4 t
(To Pen-nit 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
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Village Of
DATE: 9/16/2014
LOCATION: 745 EAST RD CROSS STREET 1: FLEETWOOD RD �
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C:ENERAL CONDITIONS OF PERMIT,
APPLICATION/PERNIIT FOR HIGHWAY EXCAVATION AND REPAIR
1 . Permittee's Contractors to Comoty with Permit Requirements: 'Fite Permittee is responsible for
inf'onning its independent contractors, employees, agents and assigns of their responsibility to comply till
this permit, including all special/site specific and general conditions irnpo,�ed by the I{ighway
Superintendent while acting as the perinittee's agent with respect tet the permitted actin ittcs, alld ;uch
persons shall be required to comply with all permit requirements.
2, No Right to Tresnass or Interfere with Private Property nights: 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 Highwav and Future Highway 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 Ilighway Superintendent the work performed under-
this pert-nit 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.
-f. Revocation of the Permit by the Highwav 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 fill and restore the tiitc to ills
loaner condition.
�. 'Notice est'Commencement: At least `'=t 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 terrns and project conditions of this permit. Upon completion of the work, the contractor
,hall provide photographs of the completed work to the Town I-lighway Department and request a f=inal
inspection.
6. Stora e 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 it) a manner that does not interfere with normal highway traffic.
Utility N1ark-Outs: The Applic,'nt / Contractor-,hall be responsible tc•r ceritication of all cxistn71 utility
rriark-outs and shall take all precautions to protect game. Damage to existing utilities shall he the
responsibility of the contractor and shall be repaired at the contractor's expense.
S. Road Closures: AH scheduled road closures must first receive written permission from the Southold fo% n
Board prior to closing a road. Temporary lane closures may be permitted with tite approval of the Ilighway
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
,end/or expedited restoration of the N/'ork lone.
9. No Construction Debris in Road Shoulder.area: A11 Construction Debris shall be removed from the.job
site on a daily basis. Ail 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 DO['Construction Standards.
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"Gown 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 NNhich 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-
tive(951'10) 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.
Fxcavations through driveways and private road pavements must be reconstructed to meet all requirements
Ot'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
I lighway Superintendent.
15. Schematic Plans with all Technical information and Scope of Work: Fo 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. I'his 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 I lighway Specifications.
16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner;
Acte. when Concrete PaNements are Present.Please rc�iew Restoration requirements\itth the I hghwua tiu4)erint�,ndeno
a) Complete all back-till & soil compaction work as needed to provide a suitable sub-base.
b) U\er-cut existing asphalt bell hole or trench by twelve ( 12") inches on all sides;
c) Install a compacted lift of-I" 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. (ProN ide AC at all joints)
111 work listed herein must meet tine minimum requirements of the Southold Town I lighway
Specifications.
17. Trenching of Pavement Surfaces Exceeding One Hundred (140') Feet in Length: All trenching of
Nu,ement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item
4 16 as noted above. Once all pavement reconstruction is completed to the satisfaction of the ffighway
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 (Typical, shoulder to shoulder).