HomeMy WebLinkAbout9180 Sound Ave Permit No.��_ �
. TOWN OF SDUTHC)LD �4��u�FO��.�,o ,
HIGi�CJAY I)EPARTMENT ,y,e�:'.:- w G,�
- Peconic Lmne �i��, ' i�
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Peconic,Ne�vYork 11958 �e � t `��
T 101866831 � , (G31)765-3140 ��a.��;�� :�a`�.
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API'LICATIQN TS HEREBY mude to d�e Superin4endent ot Hi�ltwuys of the To�vrs of Sauthotd far►he issuaa�ce of an Excavokiori Permit
pursuant to Chapter 237�f the Cado of the To�vn aF Sauthold,Suffal�County,New York,and other upplicntile iaws,ordin�snccs or
rcgulntions far ench individunl cantiguous excnvation project lterein desoribed, The applicar�t agrees to comply�vith a11 appiiaable law,�,
ordinanccs,cades ond regulations,ihe nttnchcd°`General Conditians of Permit"nnd"Specinl Canditions",if Any and to permit authorized
inspeclors to make,necessary inspections af the job site. �
Print or'['vnc Keysp�n Gas Eas� Corp D/B/A Natianal Grid
T Gas Permits [}ept. �i{dg: 3 Ff: �
' � �, 516 545 4094 175 E. U{C� COU�iti')t Rd HIC�CSV{�tBi �Y 11��1
Name of Applicant , Phone NumUer Adclress af Applicani �
r
� 2,
Nnmc aT Contructor Ptionc Numbcr Address of Contructor
3. �
Name of Property Otivner Reqvesting Service(if npplicabPe) ,b►ddress of Owner
� 9180 SOUND AVE, MATTITUCK-S/S of road, 1074' W/O COTTAGE WAY
��4'ork Descriptiom m�d Locution(Strect N�smber,Hamlet,Cross Street)
(a) ls construction 9ocmt�d�vitl�in 75 feet of tidal�tietlands? �Yes No .
, *If yes,other To�vn permits may be required. �� lr��'
Margaret Paglia �
Nf3TE: All'anFormatDon requested hy t3s6s Si�nature.of Appiic t
, Ap�r�icAtion!�'crmit Carrn ts
Required for u cotnplete�ppl'sc�tion! 7/27/16 ___ _ _
� ' IDate
5. {a) Altaclied plat plan to reasonably nnd t+dequate{y describe the proposed rvork. t'rovida nccur�ce sohema[ic site plan sl�atiaing the
loc�tion oPnll praposed excavations und relntionship to�djaining premises,public streecs or nreas,and give n detnited description of
n19 site and pavemen4 restoration�vork.' , ,
(b) Attach ull fltller necessary permits and ticensas t'or dais project. '
(c) tirork covered by this npplicption may nal commence beCore issuance of n Highway Cxcc►vation Permit by ttte T'o�vn Clerk.
6. T�x Map No.: District 1000 , Section , i3lock . Lot
8/25%16 � 8/26/16
7. Stactin�Date: . __ .____ Cornpletion Dute:
8. 4Vark Scl�edulc: Plsnsc Comnlcticin []:i1c
Excavntian '4V�rk�rl�edutc
Facitity Ynstalfation 11]s�st be prnvideal
Bncktill S Completion fOC COI15�fS1'1'f1t�0II:15 A
f'�vement 6teplacement Compicte Appllcntinn.
a. Under�vhich authority is npplication being n�ade; Keyspan Gas East Corporation d/b/a National Grid
See Town Code Chnpter 237(E)-Pravide Resolution by,ar aulhority{'rom,ti�e Util'sty beiilg tnodified.
10. Estimated Cost oCPropased 1Vork: �_ � ��_ _,,��._ „�...,.,,.._.,�,._, ..�„..._
1 I. Remarks: install new�gas service
D-39 1 of 3
12, fnsurance Cpver��c;(AttAch Copy)
(u) Insurnnce Company:, .
� (b) Policy€�:
(c}State whether pot'scy of certificptian on tifc with the High�vuy Department:
(d}Cov�rage required extended to tlie Town:
Any Loss including Bodiiy injury,pruperty ar commercial injury caused by or nttributnble ta llte work performed:
�1,QOO,QQQ per Occurrence nnd�2,004,000 gcncral aggregate. �
l3. Sccurity:
(p)Surety Band or Ceriifsed Clieck providsd in the toinl Amount of$
{b}Maintennnce I3ond provided: 2 ycnrs or_ _ _ 3 years.
14. Fees for Applicatians and permiis:
Basic Application Fee for Each Project Location - $�54.Ofl
A ProJeet Loention would include each Bell Hole pndlor every road opening ar excavation within ariy
SO'Radius tivhethec or not#hey may be inter-connected by opan trcnch or directionnl borin�.
7'he totat numbec�F Project Locat9ons sha11 bc subject to the Approval of the Hi�hway Superintendent,
A1. � � 1Service Connections excavaiions Q�20,60 S 20.00
�4. �
A2, /AdditionAl Excavations same servicc Q S 10.00 S�_ ,, _
Na.
B. Excavatians 18"in deptU or less
0-100 i..F.=$14.OD;Additannal L.F. rQ�U.10 � _ _._
C.. �xcavations 18"in dcpth to 5' in depth
U-100 L.F.=$3Q.00;Additionai L.F.Q�0.30 S ___.._...__._
D. Excav�stions S'in depth and over �
0-100 L.F._�SU.00;Additiona3 L.F.Q�O,SD �
E. Utility Itepair Excavatians rQ$10.00 � •
No,
�Repai�s same service r{r�$S.OU $
ABdiciot��l ,
�,�T��� 170.00
F. Notice to public utilities proof rriust bc provided and
Shull be attached to this spplicAtian prior to issunnce of permit.
w+ � � m � � a r � � o � � ,� a
Authoriaation is hereby granted to the Tawn Clerk of the Town of Sauthold ta issue a Hig�titvay Excavntion pennit ta:
' accordance�vith
this application and subject to the"Gencrai Conditions'"und"Specint Conditions'°of pecrriit{if a )a4tached hereto
SLiPERINTEN T S
TOWN OP SO Yl0 ,N � K
incen �n^�����
Datc
i?ate Received by tlfe Totivn Cl�rk � �
Date Perrnit lssued � �� /t�._Permit No.� ,��
NOTE: Permit expires ane(1)year from date af issuance.
A10 work to sfart�vithout 24 hnur notice to Superintendenk of Highwuys.
Permit must be aevailable at aU times far inspection,on site,durins construction, �
L)-39 2 of 3 -
Copy Distribution:
' I'er�nxlt#
Highway Dep�rtment
' Enginaer(witti gage 3)
Applicant
Tawn Clerk(Original)
IN�PECT()R'S�CO��
Inspection Dute Findings(use cflde) Applicant Notified
151 �
and
' 3ra
�ch
� (To Permit Clerk)
REIYiAItICS
cou�
1B lmproper Baa�icades
IL lmproper Lights
ST Sundcen Trench ar Excavution ,
UTM Unuble to Me�sure(duc to bAck�liin�
sUC Building Under Conswction , �
WIP Work In Progress ,
I3B Impraper Backfitl(too t�i�,noi sufficient)
HFS Inspector Halding for Finul Serilement of Excavation
RFR Reatiy for R�pair
D-39 3 of 3
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'. GENFRAL COTVDITI�NS UF-PEItM.YT , � • , �
APPLFCATIUN/PETfMIT FfJR�IIGH��AY•��XCAVATIOr1 ANI9�ItEPAIR ,
' 1, 'Pcr�ilice's Cantr�ctors to Comnly�vith Pcr`m'it�Rairuiremer�ts: The Permittee is responsible far -
� � irifo�rning its i�depandent cor�tractors;employces,agat�ts und assigns af their responsibility to comply with .
� this p�rmit, includin�aII speciaUsiie specific'and general conditions imposed by�the Higiiwny
�Superintendent while acting ns thc permittee's�a�ent wiEh respcct to the pet�mitted activities,And such
'•pe'rsons shAll be requircd to comply virith a19 permit requireca�ents. , �
2, No Dti�lit la Tresn�ss a�Inlcrferc.�viif�Privste 1'roper#v Ri�l�ts; This permit does not convey io t�e
�pei�mittee'sny right to'trespass upon the'lands nf adjacent propeiiy owners in ordor to perfarm thc permitt,ed
� , tivark aor does it authorize the impairment�of any rights,title,or intcrest in real.or personfll propariy held or'
, • vested in a,person not a pArly to the psi�mit, � � '
�, Pa�otectian of t6c Uiel��vav and Tuturc ITieln4�av�Mnintenancc: If future bperatians ar highwuy '
' muintenunce projects by the Town of Southoid requirc an altcration in the positian af the utility,structure ,
or,wark Herein authorized,or if,in the opinion of the Highway Superiniendent tl�e work pe�'ormed undec
this permit shall cause unret�.sonabla ob�slrucEion to rcquired hi�hway r�iairitenance or endanger the heAlth, ,
safety and/ot welfare of vehicular or pedestrian traffic,this permit�shall be revoked and ihe utility,
str,ucture;fiil,cxcavation,or other modificatian of the high�vAy hereby autharized shall not be completed.
Additionally,the perm'st rnay 6e revoked if the HighwAy Superintendent finds that the issuance of the �
pei�mit was iliegal or anuuthorized�r that the applic�nt failcd te comply�vith any of the,terrns nnd ,
conditians of the permit or Ch�pter 237 of the Town Cadc. - ,
� A, Revocntson of�lic Permi't Uv dhe lC3ieh�vAv Sunerintco�dent: If the Highway Snperintetsdent deems it
� necessa 'ry to revoks this permit and the praject hereby uuthorized has not been cornplcted,the appticant
sh�lt,without expense to the Town and to such extent and iri s`uch time and manner us ihe Superintendent •
may rcquir�,remave all orany portion of the uncompieted utility,structure or�li,And reslore the site to its
� faimer condation. � '
� 5, N�tiea of Cam�enceinente At least 24 huurs prior to commcn�ement of ihe prajeet,the perrnittee and/or
co'ntractor shall dotify thc Town Highway Department in writing that thcy arc fully Awnre af and "
understand ail tcrtns arid project conditians of titis permit. Upon compietion of the work�the eontractor
' shAt!provide photogruphs of the completed work to tha Town Highwny Department and reques�n�inal .
� inspection. : � ' , ' .
� 6. Storssee of rpuipment S�Mntcrinls: The storfl$e vf coastivction equipment snd/or materinls s�all be
� con�ned within the project wark area and/or adjacc�t areas�vhere permission/legal access hAs been
oUtaincd in u mttnner'Ehat does nat interfere�vith normul highway,trnffic.
�, Utifitv Mnrlt-Otits: The Appiioant/Cansractor shal{be responsible for verification of all existing utitity �
m'wrk-outs and sh�ll tpke All precautions to proiect same. DAmage ta existing utiliEies sha11 bc the
respo�ssib':lity of the eontreetor and shall be repaired At the contractor's expense.
8, Ro�d Clasures: Alt schcduled roud clasures inust first rcceive tvritten permission from the Southaid Town. .
Baard prior to clasing a road, Temporary lunc closures rnay 6e permitted with the approval of the Highway , ,
' ' Superintendent. This item wi[I included but not be limited to the instnllation af approprinte signage and �
fl��men to stop and stari ttaffic�to allow for single tane traffic. Road Ctosures due to unforeseen
emergenciss require immediate notificution of the High�vny Department and shall be limited to immediate'
� � � and/or expedited restoration ofthe Wark Zone, �
� 9, N'a Consiruction Debris i��Roncl Shouldcr Arca: Ail Conskruction Debris shall be removcd frotn theJob
� siie on��daily bnsis, All'stockpiled soil t�.s well as all olher project materials that�vill be"staged within the
12ight-of Way must be dclincated with reflective signage or"oihcr means ta mcet tfie minimum requirements �
of the,NYS DOT Construciion Standacd5. , , -
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° �_��I�.�t�����. �
a PERMIT AP'PLI�iTI�N �K�T�H �
�fillage Of �
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DATE: �I27J2O'I� �
LOCATI�d'I: 9180 SOUND AVE CROSS Sl'REET 1: CGTTAGE 1NA`( �
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To�rr: MATTITUCK CROS"a SfREET 2: GQUNTY RD 48 ,�
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wa�c or.nE�z: T101$6�831 N
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. - ,GENE�.L CONDI'TIONS 4F P�RMTT .
APPLiCATION/PERMIT FOR I�IGHWAY EXCAVATION AND REPAIR
�(Continucd)
10. Jnstall,Mnintnin�rasion Cantrols: Required_Erosion Contral Meusures(i.e,silt fencing)is to be placed
. ori ilie doxmslope edge of nny disturbed Areu, This sediment batrier is.to be put in place before any
distt�rbancc of thc ground occurs and is to bc maintuined in good functionai conditian until thick vegetsitive
cover is established.
11. Clcan Till Onlv: A(1 project back-fill sl�ull consist of clean sf►nd,grAvel or soil(NOT uspltalt,slag,flyash,
, broken concrete o�'demdlition debris}, AII UIISUttAbIC 501�5 CXCBVStC(�a��1C SitC{l.e.Clny,Bo�,etc.)are to
be reinovcd from the sitc nnd nat u'sed to backfill'any exeavation witi�in u Town Highwuy. ' �
, 1 Z. �t[Areas af Soil Disturbance: Ali areas of soil disturbance resufdng from the approved project sizull be
stabilized to the satisfaction of the Highway Superintendent'immedintely follawir�g project completian', If
� the project site�emains inuctive for more than 48 haars ar planting is impractical due#o the season,tl�en
the area shall be stabilized with sRraw,hay muich andlor jute matting until weather conditions favor
germination. '
� - 13. l3ackfill&Comrihction of n11��ccs�v:etions: Bactc Fill s1taU consist of cican ftil or soils which exhibit�
we11-defined maisture density relfltionship as determined to be in uccordancc with ASTMD 698. Fill shnll
be placed in mrixittyutrt lifts of tweive(IZ'�inches thiek tutd shall be mechanictilly compacted to a Ninety-
• ' five(95%}percent maximum dry density. Suitabie hydraulio compkction by water jetting atthree-foot
intervals wili ulso be permif#ed subject to a project spec�c npprovel by the Highway Superintendent. �
14. Restors�tion of t9�c Road Slioulder Aren: Al)mat►-madc improvcments located within existing road '
, shoulder areas must be protected to the greatest extent practical. Items would include but not be limited to
, drivewuy&privAte road aprons,iiiait 6oxes,sprinkler systems,trees and ornnmental plantings.
Excavatians through driveways and private rond pavements must be ceconstrucEed to mect al1 reRuiremenis
of Southofd Town Highway Specificntions, All pre-existing road shoulder improvements thai have been
disturbed during construction must be rcplaced or repaired by the cantraetor to the satisfaction of the
Highway Superintendont.
15. Schemntic PlAns tivill�nI1 Tecl�nicsal inPormafion nnd Scone o1'VVorli: To reasonnbly und adequately
describe the propnsed work,accurate schematic site pinns must be pravided to show or indicate nll
praposed construction activity required under this pern�it. All Pavement surfaces schedulcd for excavAtion
must be saw cot to the fv{i depth of nsphult and/or eonerete pavements. 'Accurate size of bell holes or width
of trenehing must be indicated hy dimension or labe4in�. This schematic site plan must provide detaiis oa
all restoration required to meetthe requiremcnts of ihese Genern!Canditions snd reyuirements found in ihe
Southold To�vn Highway Speci�ications.
16. Puvement Reconstruction: All Pavement sections must be reconstructed in the follawin�martner;
'(Note:Whcn Concrete Pavements are Present,Picase rcview Rcstoration rcquircmenls with the Highwny Superintendcnt)
A} Complele nit back-fill&soi!compaction work�.s needed to provide A suitable sub-base; ,
b)�Over-cut existing asphalt bell bole or trench by rivclve'(12")inches on all'sides;
c) Install a compacted lift of 4"thick Stone Biend base(RCA Blend must mcet NYS DOT Specification);
d} lnstall n iwo aad one hnlf(2.5").inch compacted lift af Asphalt Dase Course; �
c) Install a one nnd one half(I,5")inch of Asphalt(Type 6)�Vearing Course. {Provide AC at all joints)
All work listed herein must mcet,the minimum requirements of the Southold Town Highwuy
� Specificutioi�: � '
I7. Trenebin�af Pnvcmen4 Seiri's�ccs Txcecdint Unc I1�unttretl(100'1Tcet in Len�tli: A!1 trenching of ,
'puvemeat surfaces exceeding 100' in length must first be recansweted to meet the requirements of Item
N 16 us noted above. Once All pavement rcconstntction is compleled to the satisfaction of the Highwny
, Superintendent,the entire road section andlor width af road aver the entire lengih of Vench shali be �
repaved with a two(2") inch Eift of Asphalt(Type 6}Wc.�ring Course(Typicul.shoulder to shoulder).
. . . . _ S�,y
* * �` RECEIPT �` * �
Date: 08/01/16 Receipt#: 211469
Quantity Transactions Reference Subtotal
1 Excavation Permits 1140 $170 00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#35495 $170.00 National, Gnd -Gas Permits.
Dept
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: National, Grid - Gas Permits Dept
175 E Old Country Rd
Bld 3 FI 1
Hicksville, NY 11801
Clerk ID: BONNIED Internal ID 1140