Loading...
HomeMy WebLinkAboutLaurel Ave Town of Southold P.O Box 1179 Southold, NY 11971 (631) 765-1800 RECEIPT #975 09/19/2014 R & R, Construction 282 Line Rd Manorville, NY 11949 Received $ 170.00 for Excavation Permits, on 09/19/2014. Thank you for stopping by the Treasurer's Office. As always, it is our pleasure to serve you. Elizabeth A. Neville Southold Town Clerk Permit No. TO\V4OfSOLTH0LD D1011VVAYDEPARTMENT PcCooiCLuoe ycconic' New Ynck- | l958 ^ (631 )765-3140 APPLICATION /PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEKGBY mudemthe Superintendent o[Highways nfthe Town of Southold for the issuance of all Excavation pu`nit PUI�uant to Chapter 237 of the Code of the Town of Southold,Suffolk County,New York, and other applicable ivv,,ordinances ur o2u\mion,for tile excavation herein described. The applicant agrees to comply with all applicable laws, ordinances, codes and oilru|mions.tile attached'-Gcnem\Conditions ofPenni(`and"Special Condidoou'", i[un� and/opcnnitauthorized inspectors/omake necessary inspections ofthe johsitc- Prio(vrlvPe Name nfApplicant Phone Number Address n[Applicant Nof Ph�c�umb*, &dd�o,�Cn��xx Name ' ,> A� 3. ' ,o~p� JY /?J A,,r � Name^fP,oport�, Owner Requesting Service(if applicable) yN�dd, sof0vmo 4 Work Description and Location(Street Number, Hamlet, Cross Street) (o) Is construction located within 75 feet oftidal vvmu|unds? * Yes l�u *If yes. other Town permits may herequired. NOTE: All AUi"formuhvx requested by this xwriatUre ofApplicant Application/Permit Form is Required m,^ complete application! Date 5. (a) Attached plot plan mreasonably and adequately describe dhopmposcdon,k. Provide accurate schcmmiosite plan showing tile location of all proposed excavations and relationship to ad.joioinSpn,mioox public m,utu orareas, and give udetailed description of all site and pavement restoration work. UV Attach all other necessary permits and licenses for this prqjcu. (c) Work covered bythis application may not commence hel'ore issuance o[u Highway Excavation Permit by thoTown Clerk. 6. Tax Map Nv.: District_ll0D_, Section . Block _ , Lot 7SuuinaDo/e: � _ ` __-- C"mp|uion Da\c______ � hh� Date S. Work Schedule: Phase om o x e Excavation Work Schedule PncUit> /o,/nU^hou / Must be provided Backfill /u Completion for consideration as o Pavement Replacement _ _ _ Complete Application. 9. Under which authority isapplication beim, maJciAU Smc [o*nCode Chapter 2}7(E) PmvidcResolution by. cxumhooky6nn, the CdUt! being modified. N Estimated Cost o[Ympos,dWork: | | Rcmmts: yL � � Ti/ �^rc°7 �c`A~ (;,;ie c` " ` � ' — --------'''-- ��-��� n 1)-19 ~ ! Of 3 I'. Insurance Covera-c: (Attach Copy) 1-Ts ++ _ (a) Insurance COMpally- ! I p �L, $ (b) Policy : ] _ (c)State whether policy of certification on file with the highway Department: (d)Coverage required extended to the'I own: Any Loss including Bodily injury,property or commercial injury'caused by or attributable to the work performed: S 1.000,000 per Occurrence and S 2,000.000 general aggregate. 13. Securit) (a)Surety Bond of-Certified Check _ provided in the total Amount of$ (b) Maintenance Bond provided: �e�1o�lSlun- ?years or 3 years. 14. Fees for Applications and permits: Basic Application Fee (::5,150_00 ! A I. iService Connections excavations(& $20.00 $ , No. A2. Additional Excavations same service $10.00 S No. B. Excavations I S" in depth or less 0-100 I..E. =510.00: Additional L.F. (a)$0.10 S C. Excavations 1S" in depth to 5' in depth 0-100 1-.E. —$30.00; Additional L.F.Qt,$0.30 S D. Excavations 5' in depth and over 0-100 L.F. _$50.00; Additional L.F. 0a $0.50 E. Utility Repair Excavations t $10.00 $ No. Repairs same service n $5.00 S Additional 1�J TOTALS ' F. Notice to public utilities proof must be provided and Shall be attached to this application prior to issuance ol'permit. Authorization is hereby granted to the Tox-vn Clerk of the Town of SOLithold to issue a I lighway Excavation permit to: in accordance with this application and subject to the"General Conditions"and"Special Conditions"of permit(if any)attached hereto. SUPERIN 141-'NDEN" OF I IIGI IWAYS TOWN OF SO11TI VOrly, do Vince Date Date Received by the Town Clerk ` k-Al Date Permit IssuedPermit No. NOTE: Permit expires one(I)dear fi-ont date of issuance. No work to start without )4 hour notice to Superintendent of HIL,I V ys. Permit must be available at all times for inspection,on site. during construction. -I 9 — of' 3 r n� �7 L t t ` C)C\G - i 1 GENERAL CONDITIONS OF PERMIT APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR 1. 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 Highway 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 Rieht to Trespass or Interfere with Private Propertv Riuhts: 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 HiEhwav and Future Hi2hwav 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,fill, 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 Hiehwav 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 site to its former 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. Storage 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. Utilitv Mark-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility mark-outs and shall take all precautions to protect same. Damage to existing utilities shall be the responsibility of the 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 Town 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 of appropriate 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 Zone. 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. 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. This 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 Onlv: All project back-fill 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 Highway. 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 fill 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 water jetting 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 of trenching 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 Highway Specifications. 16. Pavement Reconstruction: All Pavement sections must be reconstructed in the following manner; (Note:When Concrete Pavements are Present,Please review Restoration requirements with the Highway Superintendent) a) Complete all back-fill & 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 Highway Specifications. 17. Trenching of Pavement Surfaces Exceedine One Hundred (100') Feet in Leneth: 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 of the 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(Typical, shoulder to shoulder).