HomeMy WebLinkAbout915 Main StPermit No. /0 L s
File No. / 0 1 l
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane
Peconic, New York 11958
(631) 765-3140
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
W.O.T10.1718758
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) 915 Main St. Greenport Premises Address
3)
4) Open (2) 41x4' bellholes on the W/s of the road in the concrete sidewalk area, approx. 18'
S/o Wilmarth Ave., 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 Lic nse No. N/A
a
Signature of Applicant
Date; 06/10/15
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
7) Starting Date:
8) Work Schedule:
Block
Completion Date:
Lot
Phase Completion Date
Excavation.........................................................................
Facility Installation...............................................................
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) Securi
a) Surety Bond or Certified Check
of $
b) Maintenance Bonded provided: 2 years or
14) Fees for applications and permits: Basic Application Fee
Al. _1 /Service Connections excavations @ $20.00 =
A2. /Additional Excavations same service @ $10.00 = '
No.
B. Excavations 18" in depth or less:
0-100 l.f. _ $10.00 -
a @ $0.10 =
Additional
C. Excavations 18" in depth to 5' in depth:
0-1001.f. _
Additional lf. @.30=
D. Excavations 5' in depth and over:
0-1001.f. _ $50.00
l.f. @ $0.50 = $
Additional
E. Utility Repair Excavations @ $10.00 = $
No.
Repairs same service @ $5.00 = $
provided in the total amount
3 years
$150.00
$20.00
$10.00
F. Notice to public utilities proof must be provided and attached to this application prior to issuance of
permit.
TOTAL COST = $180.00
Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavat' n Permit to:
KEYSPAN ENERGY DELIVERY in accordance with this application. 7
TOWN OF
OF 141►CiHWAYS
Orlando
to
Received by the Town Clerk
I )) D e D
Permit Issued ( bJ Permit No.
— W,
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
IA
2nd
3rd
4 t
(To Permit 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
Town Of Southold
3
30 MPH Speed Limit
(2) 3' sidewalk
(2)4'shoulder
(2) 11' lane
W
Side Walk
Grass Area
Fog Line
Fog Line
Grass Area
Side Walk
Road Opening Permitequest
�/o1 718' 73�
915
4'x 4'x 4' conc bell hole 4'x 4'x 4' conc bell hole
72' n 18'
Curb Line
NYS 25 (Main St)
Curb Line
4" STL 60 PSI
W
ationalgrid
THE POWEF OF ACTION
n z
Date Submitted: 6/9/15 Not To Scale Revision: 1
C;ENF.IL\L CONDITIONS OF PERMIT
: APPLICA'nON/PERNUT FOR tIICHWAY EXCAVATION AND REPAIR
I . Permittee's Contractors to Comply with Permit Requirements: 'file Permittee is responsible fur
inl'ornaing 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 lighway
Superintendent while acting as the permittee's agent with respect to the permitted activities, and tiuch
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 tlip-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 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, 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 tailed to comply with any of the terms and
conditions of the permit or Chapter 237 of the `Gown Code.
-I. Revocation of the Permit by the Hip-hway Superintendent: If the Highway Superintendent deems it
necessary to revoke this permit and the project hereby authorized has not been completed, the applicant
;hall. 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
termer condition.
Notice of Commencement: At least 24 hours prior to commencement of the project, tile permittee andlor
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.
h. Storaue of Equipment & Materials: fhe storage ofconstruction 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 -huts: The Applic^nt / Contractor shall be responsible for verification ol'nll extitln- tttrlity
mark -outs and shall take all precautions to protect same. Damage to existing utilities shall he the
responsibility of the contractor and shall be repaired at the contractor's expense.
a. Road Closures: All scheduled road closures must first receive written permission from the Southold i'ovvin
Board prior to closing a road. Temporary lane closures may be permitted with the approval of the lhuhway
Superintendent. This item will included but not be limited to the installation of appropriate sh;na,e and
Ilav men to stop and start traffic to allow for single lane traffic. Road Closures due to unforeseen
_mergencies require immediate notification of the Highway Department and shall be limited to immediate
.tnd/or expedited restoration of the Work Zone.
1t. No Construction Debris in Road Shoulder :area: All Construction Debris ;hall be removed From the job
to on a daily basis. ,all stockpiled soil as well as all other project materials that will be'stav-ed within the
Right -of Way must be delineated with reflective signage or other means to meet the minimum requirements
ol'fhe NYS DOT Construction Standards.
GENEILkL CONDITIONS OF PERMIT
APPLIC'MON/PERrNUT FOR HIGHWAY EXCAVATION AND REPAIR
(Continued)
10. Install, i'Maintain F:ros'ion Controls: Required Erosion Control Meastu•es_(i.e. silt fencing) is to be placed
on the downslope edge of any disturbed area. `I`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 vcgetativc,
cover is established.
11. Clean Fill Only: All project back -till shall consist of clean sand, gravel or soil (NO'f asphalt, slag, flyash,
broken concrete or demolition debris), All unsuitable soils excavated at the site (i,e. Clay, Bog, ctc.) etre to
be removed from the, site and not used to backfill any excavation within a Town Highway,
12. ;111 .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
}vermination.
13, Backfill & 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'FNlD 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
,houlder areas must be protected to the greatest extent practical. Items would include but not be limited to
,Iriveway & 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. MI pre-existing road shoulder improvements that have been
disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the
Ilighway Superintendent.
15. Schematic Plans with all Technical information and Scope of Work: ro reasonably and adequately
,lescribe 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 schedulers forexcavatioi
must be saw cut to the full depth of asphalt and/or concrete pavements. :accurate size of bell holes or w idIth
ofirenching must be indicated by dimension or labeling. this schematic site plan must provide details on
.111 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 reconstntcted in the following manner:
iNoic: When l'oncrcte Pavetnentsauc 1'resent. Please rc%iew• Restoration requirements wth the Highway iuperinicn,lent)
a) Complete all back -till & 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:
o Install a compacted lift of -l" thick Stone Blend base (RCA Blend must meet NYS DO'r Specification):
d) Install a two and one halt (2.5") inch compacted lift of Asphalt Base Course:
el Install a one and one half (1.5••) inch of ;asphalt (-fppe 6) Wearing Course. (Provide :\C At all joints)
:111 work listed herein must meet the minimum requirements of the Southold Town I li,ghway
Specifications.
17. Trenching of Pavement Surfaces Exceeding One Hundred (100') Feet in Length:, ;\II trenching of
pavement ,urYaces exceeding 100' in length must first be reconstructed to meet the requirements of Item
1.6 as noted above. Once all pavement reconstruction is completed to the satisfaction ofthe Highway
�uperintcndent, the entire road section and/or width of road over the entire length of trench �ha1l be
repaved with a two (2'•) inch lift of Asphalt (Type 6) ``Nearing Course (fvpical, shoulder to shoulder).