HomeMy WebLinkAbout1145 Fanning Rd Perntit No.
� TOWN OF SOUTHOLD � �gUFFO�,��
HIGH�IAY DEPARTNSENT ��,��;• �'°�y
Peconic Lane ��,� '� ,
I'cconic,New York 11958 ���,, �. 4�
T 101857788 (G3])765-3140 `��a�;� :�a°.
APPLICATi�N!Pt;RMlT st3R HIGTi�VAY TXCAVAT[O?V A1�II)RT:PA7R
APPLICATIQN IS H�RE$Y made to d�e Superintendent oi'HigEtwuys af the Town of Sautttold for the issuance of an Excavntion Pesmit
pursuant to Cliapter 237 of the Code of the To�m aF Southold,SufFalk County,Ncw York,and other applicuble in�vs,ordinAnccs or
re�ulntions for each individunl contiguons excnvntinn project lierein described. The applicaat agrees to con�ply�vith n11 appiicable lAtivs,
ordinanccs,eodes and regulntions,the nttnehed"General Conditians of Petznit"and"Specinl Canditions",if�ny ttnd to permit uuihorized
inspectors to maka necessary inspections of the jab site.
I�rintar'I'ync Keyspan Gas East Corp DJB/A fVational Grid
- Gas Permits Dept. Bldg; 3 F!: 1
�, 516 545 4094 175 E, Old Country Rd Hicksvilte, I1)Y �.18�1
Name of Applicttnt Phone Numbcr Address af Applicani
2.
Nnmc af Contrnctor Plionc Ruttiber Address of Contractor
3.
Name of Property.Otivner Requestiag Service(if npplicablej Address of Owner
� 1145 FANNING RD, NEW SUFFOLK, S/S of road, 196' W/O NEW SUFFOLK RD
�'�'ork Description and Location(Strect Nurnber,Nnmlet,Cross Streat)
(n) ls cvnstructlon locpted witl�in 75 feet of tidnl�tetlands4 *Yes No
ffi[E'ycs,othcr Tawn permits mny be rcquired. � r
Margaret Paglia
NOTE: All information requested by!l�is Si�natura of App{ic t
Appl6cution!1'crmit I'orm is
Required far a camplete�pplicntion: 7/27/16 _ __
Date
5. {a) Altached plot plan to reQsonably nnd Adequate{y describe the proposed�vork. 1'rovide nccur�te schematio site plan sl�owing the
loc�tion of afl propased excavatinns und relatinnship ta adjoining premiscs,public strccts or arcas,and give a detnilcci description of
all site and pavement restoration�vark,
(b) Attnch uil otf�er necessary permits und licenses E'ar this project.
(c) �Vork covered by tliis npplicntiom m�y not commence before issuancc ofn Highwuy Excnvntion Aermit by ttte Totvn Clerk.
6, TAx Mnp No.: District 1U00 , Section _ _, F3lock . Lot
8/25/16 8/26/16
7. Sta�cin�Date: ___ ____ _ ______ Camplelion Dute:
8. 1Vork Schedulc: Plsnsc Cornnlcfion [):tild
Bxcavntion 1Vork Scl,edule
I'ucility lnstflllation 111ust�e provided
Bnckfilt S.Completion Por conslciervttan:�s n
PAveritent Repincement Complete Ap�licntion.
a. Under�vhich uulhoriry is upplicntion being made; Keyspan Gas East Corporation d/b/a National Grid
See Town Code Chnpter 237(E}-Pravide Resolutian by,or nuthority t'rom,tl�e Utility being tnadified.
10. Estimated Cost of Prnpesed 1Vork: �, ,a._,.,�,_.,�„�„�._.�._..�. ...�.-�} .m__
1l. Remarks: install new gas service
_. . . _. .------, ---______ __.__._.. �_._...___..��
D_39 1 af 3
12. [nsurance Covc�gc:(Attneh Copy)
(o) Insurnnce Compuny: -
(6) Po[ioy t�: .
(c)Stnte whcthcr poticy of certificakion on filc with the High�vuy Department:
- (d)Coverage required axtended to tlie'I'own:
Any Loss including Bodily injury,property or commercial injury cuused by or attributable to ttte work peri'ormed:
�1,000,000 per Occurrence nnd�2,OOQ,000 general aggregate.
13. Sccurity:
(n)Surcty Bond or Ccrtificd Check provided in the totul Amaunt of$
{b)Maintenance Bond provided: 2 ycnrs or 3 years.
14. Fees for Applications and permiis;
Basic Appliaution Fee far Each Project LocAtion - $l 50.00
A Projeet Lacatlon wouid include each Bell Hole nnd/or every rond opening or excAvatlon within any
SU'Radius wl�ether or not they may be inter-connected by open trench or directionut boring.
7'he total number�f Project Locakions shnll be suhject to tl�e approval of the I�Ii�hway Superintendent,
A1. � /Scrvicc Connections excnvaiions Q�20,00 � S 20.00
No.
A2, /Additional Excnvations samc service Q S1Q.40 5 _ ___ �
No,
B, Excnvations 18"in deptl�or tess
0-100 L.F.=$10.06;Additional�L.P,Q 50.14 $ _
C. �xcavations 18"in depth tn 5' in depth
0-100 L.F._$30.04;Additionai L.F.Q�0.30 �
D. Excnvations 5'in depth and over
0-100 L.F.=$50,00;Additiona� L.F.Q�O.SD � _
E. Utility 6tepair Excavations rQ$10.00 �
No,
�,,,,,Repairs same secvice Q SS.OU $
Additional �
'!'OTALS 170.0�
F. Notice ta pulilic utilities pruof must be provided and
Shall be nYtached to this applieution prior to issuance of permit.
�p s # +N t a a 4 • a '� '� '� '�
Autharizution is hcreby grnnted to the Town Clerk of tlie To�vn oPSouthold to issue A Higt►tivay E cavption permit to:
en accordancc�vith
this application and subject to the"Genera{Gonditions"and"Special Coaditions"of permit{' n )ctttac reto
SUPERIN7'E T A S
TOWN Or T l L � Y
Vincent M.f�rf �// y�
I ` DAte,/' b
Date Received by ttie To�vn ler• �l � `1�
Datc Permit lssued ��l �I Permit No. I I
1�! �
NOTE: Pcrmit expires nne{1)year from date of issuance.
No work to stArt�vithout 24 hour notice to Superintendent oF High�vuys.
Permit musi be availaUte at all times far inspection,on site,during construction,
�-39 2 of 3
Copy Distributian:
Permit#
Highway Dep{urtment
Enginaer(with page 3)
Applicant
Town Clerk(Original)
IP+TSPECTOR'5 R�C0�5
Inspection Date Findings(use code) Applicant Natified
15l
2nd
3rd
, 4�n
(To Permit Clerk}
REM.�R�S
CODE
1B lmproper Barricades
IL lmproper Lights
ST Sunlcen Trench ar Excuvation
UTM Uaable to Measure(due to backFliing}
BUC Building Under Conswction
WIP Work In Progress
DB Impraper Backfilf(too high,not sufficient)
HFS Inspector Holding for Final Setticment of Excavation
RFR Ready for Repair ' �
D-39 3 of 3
¢ � ,
G�NERAL CONDITI(�NS UF PERMIT'� �
.d►I'PL'ICATTONIPERMIT FOR HIGHtiVAY�XCAVATION AND�I�EPAIR _
], .Pcrrniitec's Cantrnctors to Con� 1 '�viil�Pc'rmit Rc uirciuenis: The Permittee is responsible for -
, informing its indepondent contraetors,employees,agents und nssigns of their responsibitity to comply with
� � 'this peimit, ineludin�aII specieUsite specife and�eneral canditions imposed by the Highvsruy � _
' Superintendent while acting ns the permiKee's ageat with respcct to thc permitted netivities,pnd such ' -
` persons shull be required to comply with all permit requirements. �
2, No Rie9it la Tresnhss or Inicrfcrc,�vill�Privs�ic 1'roncrtv RieEits: This permit does not convey io the
1 permittee any right to trespnss upon the lands of'adjacent property owners in ardcr to perform thc germitted
� work nor does it authorizs the impairmant of uny rights,title,or interest,in real or personul p'roperty held or
� vested in a person not a pariy io the permit, � ' '
. 3, Protectian of tlia lJi�lititi�nv nnd Tuturc Il�l�r��nY 14fnintenAncc: Tf fuEura aperatians ar highway '
muintenance projects by the Town of Southoid rsquire an altcration in the position af the utility,structure
' or work hercin autharized,or if,in die opinion of the Hi�hway Superintendent thc work pert'ormed undcr
this}iermit shal{cause unrensonabte obstrucEi�n to rcquired highway maintenance or endanger the health,
' safety andJor tivelfarc of vehicular or pedestrian�truffic,this permit shalt be revoked and the utility,
structure,fill,cxcavation,or ather;nodification of the highway hereby authorized shal!not bc comple4ed.
' Additionally,the perrnit rnay be revokcd if the Highway Superintendent finds that the issuance of the , .
permit was illegal or vnauthorized or that the applicnnt failed to compiy with any of the terms nnd
conditians of ihe pe�init or Chapter 237 of the Town Code. � � ,
4. Revacntion of titic Pcrmit U li�c IIi hwA Su erontciidents if the Highway Superintendent deems it
necessary to revoke this perniit and the project 6ereby uathorized has not been cornpleted,the applicant
� shnll,without expense to the Town And to such extent and in such time and.manner as ihe Superintendent
may rcquire,removc all orany portion of the uncompleted utiliiy�structure or fll und resiore the site to its
farmer candition. • - �
5. Notice of Commencement: At lenst 24 hoars prior io commcncement of the project;the permittee and/or '
contractor shall notify the Town Highway Department in writing that they ure fuily aware of and
understand all terms und project conditians of tiiis permit. Upon compledon of the work�the contractor
shall�provide photographs of the campleted work to the Town Highwny Department and reques�n Finnl
inspection.
6. Storitiec mf I:quiameni&Mnicrirls: 7he stora�e ofcanstruction equipmcnt snd/or materials shall be
� confined within the projact wark area Andlor Adjacent areus where permission!lcgal access hAs been
obtained in u nior►ner that does not interfere with normul hlghWsy tPaff1C. � �
�, Utif;tv Mnrlc-Outs: The Appiicant/Contractor shali be responsiblc for verification of ul)existin�utility
mA.rk-outs and shnll take ull precautions to proiect same, DAmage to exi�ting utiliEies sha1S bc the
respansibility of the contractor und shall be repaired At the contractor's expense.
8. Ro1d Closures: All schcduled roud clasures rnust first receive written permission from the Southold Town
Board prior to closing a road. Temporary lnne closures may be permit#ed�vith the approval of the Highway, , '
Superincendent. lfiis item will included but not be li�nited to the instnllation of appropriate signage and -
flag men to stap and stact tr�ff c ta a11ow for single lane traffic. Road Clasvres due to unforeseen •
, emergeneies require imm�diate notifieatioo of tltie High�vuy Depnrtment and shall be limited to immediate
anci/or expedited restoration of the Work Zone.
9. No Consiruclion Debris ist Roted 5fiuuider'Area: A11 Constraction Debris shall be removcd from the job
siic on�daily bnsis, All stockpiled soil t�s wclt us all oiher project mAteriAls thut will be stagcd wi#hin the
' � Right-of Way must be delineated with reflective signage or other�rseans to meet tfie minimum requirements
' of the NYS DOT Construciion Stnndnrds. ; , ,
. ,
! }
G��RAL CONDI'I'IONS OF PERNIIT
APPLYCATION/I'ERM(S7C F�R I�IG�iWAY]EXCI�VATION AND YtEPAIR
(Contanucd)
10. Install,Maint:�in�r�sion Cantrals: Required Erosion Controi Measures(i.e.silt fencing}is to be placed
on ihc downslope edge of t�ny disturbed Areu. 7'his sediment barrier is to bc put in place before any
disturbanee of the ground occurs and is to be muintuined in good fuactional conditian until thick vegetsitive
cover is established.
11. CEcs�n�il!Onlv: All project back-fill sli�ll consist of cican sand,gravel or soil(NO'T usphnit,slag,flyash,
broken concrete or'demolition debris}. All unsuitable soi]s excavsttcci at the sitc(i.e.Clny,Bo�,etc.)nre ta
be removed from the site und nat used tv backfill any excavation witl�in a Town I-iighwny.
1 Z. �ti Areus of Soil]Disturbunce: AI(areas of soil disturbance resuiting from the approved project sliall be
stabilized to the satisfaction of the I�igh�vay Superintendent immedialely follawing praject completian, If
the project site remains inactive for more than 48 hours os planting is impractical due to lhe season,tl�cn
the�rea shall be stabilized with straw,hay mutch andlor jute matting until weather conditioas favor
germination.
13. l3acicfiill&Comnactiou af n1I�zcrv�tions: Back Fill shall consist of cicun fill oc soils which exhibit a
weli-defined moistwe density relationship as determined to be in aecorduncc with ASTMD 698. Fill shall
be placed im m�xitnutn lif�s of tweive(12'�inches thick nnd shall be mechanically campacted to a Ninety-
� five(95%)percent maximum dry density. Suit�ble hydr�ulie compAction by water jet#iag attliree-foot
intervals will nlso be peranitted subject to a praject specifio Qpproval by ihe Highw�y Super�ntendent,
lq, �tcstor�fion of 4lic Road Sf�ouldcrr A�'c�: Ail man-madc improvcments located within existing road
shoulder areas must be protected to the greatest ext$nt practicaf. Items would include but not be limited to
driveway&private road aprons,mail boxes,sprinklcr systems,#rees and ornamental plantings.
ExcAvatians through driveways and private road pavements must be reconstrucEed to mcet all requiremenis
nf SouthoEd Town Highway Specificntions, All pre-existing road shoulder improvements tha#have been
disturbed during canstxuction must be replaced or repuired by the con4ractvr to the satisfaction of the
Highway Superintendent,
15. Schenisftie PIAns rviih nID'Y'ee➢inic�l in!'or��e�ion nnd Scone oF��o�lc: To reasanably und adequat�ly
describe tha propased work,accurate sahematic site plans must be pravided to show or indicate ull
proposed canseruction activity r�quired under this permit. AI[Pavement surfaces schedulcd far excavation
must be sa�v cut to thc fvll depth of nsphult andJor concrete pavements, Accurat$size of bell holes or width
of trenchin�must be indicatcd hy dimcnsiun or labeling. This schematic site plan must provide deteiis on
all restoration required to meettha requirements ofihese Genera!Conciitions and requirements found in ihe
Southold To�vn Highway Specifications.
I 6. Puve�nent ReconstructiQn: Al)Pavement sections must be reconsttucted in the fotlowing manner;
(Tdote:When Concrete Pavaments ero Prescnt,Please review Rcsioration reyuircments with the Highway Superintcndcnt)
A} Complele all bnck-fill&s�i!compaction work us needed to provide A suitable sub-base;
b} Over-cui existiog ssphali bell hole or trench by rivclvc(12"}inches on all sides;
c) Install a compacted lift of 4"thiek Stone Hlend base(RCA Blend musi mcet NYS DOT Specification);
d) lnstafl a nvo and ane half(2.5")inch compacted lift of Asphalt Base Course;
e) Install a onc nnd one half(I.5")inch of AsphAlt(Typ�6)�Vearing Course, {Yrovide AC at all joints)
All worlc listed hcrein must meet the minimum requiranents of the Sauthold Town�[ighwAy
Specific�tions.
I7. TrencLine of Pnvemcnt SarSi�ces Txceedin�Onc Ilnntircd(l00'1 Tcet in Len�tli: A!1 trenching of
pAvcment surfaces exceedin� 100' in length mvst first be recanstructed io meet the requirements of Item
� t 6 us noted above. Once Afl pavement reconstruction is compleled to the sntisfnclion oS'the Highway
Superinlendent,the entire road section und/or width of road ovcr the entire langth of Vench shall Ue
repaved with n two(2") inch Eift of Asphalt(Type 6}Wcarin�Course(Typic�tl,shoulder to shoulder).
sJ�y
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a PERMIT APFLICATIUIIT �ICET�H _ �
Village Of �,
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DATE: -�I��I�O�� �
LocaTiarr: 114� FANNING RD CROSS SfREET 1: NEV1f SUFFQLK RD " �
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rowrr: NEV1f SUFFOLK CROSS SfREET Z: FRED RD ,�
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WOIiK ORDER: T1018���8� �
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* * * RECEIPT * * *
Date: 08/01/16 Receipt#: 211470
Quantity Transactions Reference Subtotal
1 Excavation Permits 1141 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#35496 $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 1141