HomeMy WebLinkAbout7940 Indian Neck Ln Permit No. ��� N 0* 700 0600 ZY / y '31
TOWN OF SOUTHOLD 4 5 F044.�,
HIGHWAY DEPARTMENT
Peconic Lane
�+A 2, Peconic,New York 11958 0 '�
�� �J � vl J (631)765-31400
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 237 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,the attached"General Conditions of Permit"and"Special Conditions",if any and to permit authorized inspectors to make
necessary inspections of the job site.
Print or Type,Long Island Lighting Company d/b/a
LI PA through its agent, Long Island
1. Electric Utility Servco LLC and PSEG
Name of 1 Long Island 117 Doctors Path Address of Applicant
2. Riverhead, NY 11901
Name of Contractor Phone Number Address of Contractor
3. ��eJ ll,%c�v�rjo.J 9 Vb -%/ 0iJ
Name of Property Owner Requesting Service(if applicable) Address of Owner
4. I�r'reG�i'n..,A / br 1 I 0,esr 7-v 64Sr Sy' Neck 4*
Work Description and Location(Street Number,Hamlet,Cross Street) e/
(a) Is construction located within 75 feet of tidal wetlands? *Yes No
*If yes,other Town permits may be required.
NOTE: All information requested by this Signature App ant
Application/Permit Form is
Required for a complete application! 5
Date
5. (a) Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan showing the
location of all proposed excavations and relationship to adjoining premises,public streets or areas,and give a detailed description of
all site and pavement restoration work.
(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.: District 1000 , Section Block Lot
7. Starting Date: Completion Date:
8. Work Schedule: Phase Completion Date
Excavation Work Schedule
Facility Installation Must be provided
Backfill&Completion for consideration as a
Pavement Replacement Complete Application.
9. Under which authority is application being made:
See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified.
10. Estimated Cost of Proposed Work: $
ll. Remarks:
D-39 1 of 3
•
5
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:
Any Loss including Bodily injury,property or commercial injury caused by or attributable to the work performed:
$1,000,000 per Occurrence and$2,000,000 general aggregate.
13. Security:
(a)Surety Bond or Certified Check provided in the total Amount of$
(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 L.F.=$10.00;Additional L.F.@$0.10 $
C. Excavations 18"in depth to 5' in depth
0-100 L.F.=$30.00;Additional_ I Q L.F.@$0.30 $ 3S.00
D. Excavations 5' in depth and over
0-100 L.F.=$50.00;Additional L.F.@$0.50 $
E. Utility Repair Excavations @$10.00 $
No.
Repairs same service @$5.00 $
Additional
TOTALS 0 J•CJS/
F. Notice to public utilities proof must be provided and
Shall be 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 and subject to the"General Conditions"and"Special Conditions"of pe it(if any)attached hereto
SUPE O IGH YS
TO ,NEW ORK
r - rVytic rlando
Date
Date Received by the Town Clerk 1136 I
Date Permit Issued W ( Permit No. l ��
NOTE: Permit expires one(1)year from date of issuance.
No work to start without 24 hour notice to Superintendent of Highways.
Permit must be available at all times for inspection,on site, during construction.
D-39 2 of 3
4
Copy Distribution:
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings (use code) Applicant Notified
IA
2nd
3rd
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 for Repair
D-39 3 of 3
REQUEST FOR TOWN OF SOUTHOLD FEE DATE S / 27 / 16
THIS PERMIT I S REQUIRED TD
DIRECTIDNA � DRI � � 50 SROM WEST TD
EAST UNDER INDIAN NECK LN , 2 , 700 '
ERST 0 � R � BINS � N � N
PERMIT REQUESTED BY: PSEG LONG ISLAND:] Q . N . C . N . W . $ . Z E.S.
TAX DISTRICT 1300 TYPE OF ROAD MACADAM SERVICE FOR
NOTIFICArIoN# 900000024164 CHARGE ACCoUNT#
DISBURSEMENT TO BE MADE OUT TO PETTY CASH � TO BE BILLED � NO FEE
RETURN PERMIT TO: DISTRIBUTION DESIGN DEPT .
JOB NAME/a=MER NAME A N I C OLS O
w STREET ADDRESS 7940 INDIAN NECK LN
-WvPECONIC UMC 1300 THIS WORK ORDER RELOCATES A PRIV PROP
GRID 10807 NO. 813-952 POLE 20' WEST FOR TWO PRI RISERS. ONE
uT1�N
PRIMARY OPERATING VOLTAGE: 13.2 KV
�,mr3I LONA T,B; »�ox nil OF WHICH FEEDS A PRIV PROP BG AND
4ilJ�
[SL" l ?�ii i THE OTHER RE-FEEDS OH PRIMARY UG AND
Ltr r,,n4 lnrra'rrrrA;a.w,uFJVERHRAD.
DISTRIBMN DESIGN PLANNETC JAMAHJE ANDERSON (631)28•-52RE-SURFACES O N A FAR SIDE H WY POLE. z
DESIGN ENGINEER PATCH0WV8RIDGEHAMPTON•CHRIS RkWKS(831)537-0217 ADDITIONALLY, ONE SECT OF OH PRI IS o
LEAD DESIGN ENGINEER RIVERHEAD: RICH INSERM (63 1)284-5288 cn
BLUE EXISTING RED INSTALL BEING INSTALLED TO MAINTAIN FEED TO OH z_
LEGEND GREEN REMOVE MAGENTA R I XFRMR. m
MMFm-RON+ 900000024164 ry
O
OVERHEAD UNDERGROUND
800000056601 X00000058091 I—LBF#15574 O P#29-40'P
GPA 800000056600 1,MG BUS#5367 } I—CUTOUT w/ 8T FUSE
OEO =80000005809 I 1—LA
PERMIT REOwnnYES/TOWN EAsEMEM REQD NO
CO1-#2AL POTHEAD
CHECKUST OWL= YES u .HT.ON= YES 6p I-3" PVC PRI RISER
NMFICAnON INLMTED YES NonFlm 5/2016 T ` \250 ` Z I I—GRND MATT
RAGGING REO'D NO TREE TRIM REO'D NO
I-\2/\C\#2ALPE
125' d
10' WIDE ELECTRIC EASEMENT U
P#26J � z �
I—LBF#15572
i
I—LBF#15573 s5'
BUS#5530 z 37.5KVA
R-1 -#3PVC - AO
11s' I 140' BUS#5492
P#26J R-3/C#
R-35'4/1-40'2 (INSTALL 20' WEST) —
R-PTP P#27 No Elm
R-SEC'DY STIRCLMP ® \ - P#26J —
I-PRI DE Rpoc 2G'WEST r — — — — —
I-ADDSL X-ARM BELOW DE ASSM3 C4OAU—BLY \ /
CUS INSTALLED P#28
I-(2) LA's I-BG#107676 P#27-35'P P#28-40'P
1-(2) CUTOUTS CUSTOMER TO R-PTP
DIP RISER: 12T BUS#5566 I—PRI DE
BG RISER: 8T FUSE 37.5 KVA SWING SVC CABLE R-STR CLAP I XFER XFRMR LOAD
GRP 234 TO SPLICE BOX R-SNGL SPL RK
1-(2) #2AL POTHEADS WHEN RISER IS TOP POLE R-PRI DE
1-(2) 3" PVC PRI RISER 1-(2) 2L ENCU
I- DE-ENERGIZED AND CATV/TEL PRESENT I R—SNGL SPL RK
I-GRND MAT'L SU E ERRE REMOVED FROM I-3" PVC SEC'DY RISER
I-11M DOWN GUY+ANCHOR 0SRGARRESTOR NORMAL OPEN STOR POLE
® P
KEEP ALL FACILITIES AS CLOSE TO W/PARKING 7940 8000
PROPERTY LINE AS POSSIBLE, WITHIN STAND
THE EASEMENT AREA. I-SML SBX
* * * RECEIPT * * *
Date: 06/14/16 Receipt#: 207379
Quantity Transactions Reference Subtotal
1 Excavation Permits 1136 $183.00
Total Paid: $183.00
Notes:
Payment Type Amount Paid By
CK#9000016269 $183.00 P S E G, Long Island
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: P S E G, Long Island
117 Doctors Path
Riverhead, NY 11901
Clerk ID: BONNIED Internal ID 1136