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HomeMy WebLinkAbout3305 Peconic Ln �ggimx ' 1 ®fit Permit No. / / TOWN OF SOUTHOLD HIGHWAY DEPARTMENT File No. 1012—, Peconic Lane Peconic,New York 11958 (631)765-3140 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR W.O.T101683566 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) W` .. :�_. : Mn! Peconic Premises Address 3) — 4) Open a-41x4'bellhole on the W/s of the road,approx. 125'S/o Middle Rd.,to install a 5) gas service.op -J?W GPASS ARWA 1 1-07 6&) P4ML7 7)E(6oJIL ZA. _ 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 -9y�p/` Signature of Applicant Date;12/18/14 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 Hig'way Excavation Permit by the Town Clerk. 6) Tax Map: Section q. ,Block Lot l�� 7) Starting Date: Completion Date: 8) Work Schedule: Phase Completion Date Excavation......................................................................... FacilityInstallation............................................................... Backfill&Compaction.......................................................... Pavement Replacement......................................................... 9) Under which authority is the application made 10) Estimated Cost of Proposed Work: $ 11) Remarks: 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 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 l.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 Highw/aytion Permit to: KEYSPAN ENERGY DELIVERY in accordance with this application. ,C/- N&j LOCA%ON ��- '6W &tL SUPERNT F H HW S F–Z(L} oce TOWN W RK T Bg- 7Ae– Z '� 00 7f d 6;2RZ-�, Vincent M.Orlando Date Received by the Town Clerk � Date h ) Permit Issued / 11,5 Permit No. (J/ Note: Permit expires one(1)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 St 2nd 3`d 4 t (To Permit Clerk) REMARKS CODE IB— 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 wo '. oN ma�g a PERNffr APPLICATION SKETCH Tillage Of i}AT, 12118!20:! �3 M ;LOCATICM 3306 PECONIC`LN CROSS STREET 1: MIDDLE RD rower.' PECONIC CROSSSTREET2: CARROLL AVE oRK oROER: T1 Q16$3566 `r N M .M8c-adam. . 0 d; House N0 < \- �� 3305 w Q J� J O` ❑ o c: c 1 25' b cd 4' x 4' Bell`Hole U N PECONIC>LN 3 GENER.kL CONDITIONS OF PERMIT APPLICA'TIONMERtIMIT 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 iighway 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. No Right to Trespass or Interfere with Private Property Rights:_ "Chis 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 Highway and Future Hip-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 tinder 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 rinds 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"Gown Code. r. 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 anyportion of the uncompleted utility, structure or fill and restore the Site to its lormer condition. 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 ;hall provide photographs of the completed work to the Town Highway Department and request a Final inspection. 6. Stora?e of Equipment & Materials: Hie 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. Utility Mark-Outs: The Applicant/Contractor Shall be responsible fer verification ot•all rxistin,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. S. Road Closures: All scheduled road closures must First receive written permission from the Southold To"n Board prior to closing a road. Temporary lane closures may be permitted with the approval of the Ilighway Superintendent. This item will included but not be limited to the installation of appropriate sionage and Ilag 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 Ione. 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 Ititdmt-of Way must be delineated with reflective signage or other means to meet the minimum requirements ul'the NYS DOC Construction Standards. g" GENEILkL CONDITIONS OF PERMIT " APPLICATION/PERNUT FOR HIGHWAY EXCAVATION AND REPAIR '~ (Continued) 10, lastall, Maintain Erosion Controls: Required Erosion Control Measures (i.e. silt fencing) is to be placed on the downslope edge of any disturbed area. 'rhis 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 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. Backlill &r: 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 AS"FMD 698. Fill shall be placed in maximum lifts of twelve (12") inches thick and shall be mechanically compacted to a Ninety- tive(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 .houlder 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 ofSuuthold 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 Scone 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 ol'trenching must be indicated by dimension or labeling. "this schematic site plan must provide details on .ill 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; mute: When Concrete Pavements are Present. Please re%iew Restoration requirements%pith the I liuhwuy 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.j") 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 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 (Typical, shoulder to shoulder).