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Home My WebLink About950 Wells Rd .. , , * * * RECEIPT * * * Date: 09/02/16 Receipt#: 213023 - Quantity Transactions Reference Subtotal 1 Excavation Permits 1151 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#35772 $170.00 National, Grid -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: LYNDAR Internal ID 1151 , , Permit No. � � � ' ' TOWN OF SOUTHOLD Sl1FF0�,�-, HIGHWAY DEPARTMENT �'��°�+ c°�s� Pecomc Lane �„� , � Peconic,New York 11958 �� (631)765-3140 ��'o� � �,�4� APPLICATION/PERMIT I+OR HIGHWAY�XCAVATiON AND RFPATR APPLICATION IS HEREBY�made to the Superintandent of Highways oP.the To�vn of Southold for the issuance af an�xcavation Permit pursuant to Chapter 237 of the Code of the To�vn of Southold,SufFo]k County,New York,arid other app]icaUle laws,ordinances�or regulations for each individual contiguous excavation project herein described. The applicant agrees to comply with all applicable laws, ordinances,codes and regulations,the nttaclted"General Conditions of Permit"and"Special Conditions", if any and to permit authorized inspectors to make necessary inspections of the job site. PrintorTv�e Keyspan Gas East Corp D/B/A National Grid Gas Permits Dept. Bidg: 3 FI: 1 � � 175 E, Old �GQuntry Rd Hick�viile, NY 11801 Name of Applicant Phone Number Address of Applicant 2. . �D� �� a� Name of Contractor Phone Number Address of Contractor 3. Name of,Property Owner Requestin�Service(if applicable) Address of Owner �. o ��.� ,�d-wls ��0 � �' � �� 2 Work Description and Location(Street, umber,Hamlet,Cross Street) (a) I's construction located within 75 feet of tidal wetlands? *Yes No *If yes,other To�vn permits may be required. • , NOTE: All information requested by this t i�tv�App�ic t Application�/Permit For'm is .� � � Required for a complete�pplicatton. Data 5. (a) Attached plot plan to reasonably and adequately describe the proposed�vork. Provide accurate sehematic site plan showing the location of all proposed excavations and relationship to adjoining premises,�pub]ic 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 1 Highwt�y Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 , Section " a � , Block � , Lot V 7. Starting Date: Completion Date: 8. Work Schedule: Phnse Comnlciion Dale Excavation Work Scl�edule Facility Installation Must be provided Bacicfill 8c Completion foi•consicteration�s 1 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: $ 11. Remarks: DI �'V �r, � r ��1 ' !��`�"� GN� �� / v' �V��il� ��C/�'� D-39 ' 1 of 3 12. Insurance Coverage;(Attach Copy) (a) Insurance Company: (b) PoIicy#: (c)State whether policy of certification ori file with the Higl�way 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 for Each Project Location - $150.00 A',Project Location would include each'Bell Hole and/or every road opening or excavation within any 50'Radius whether or not they may be inter-connected by open trench or directional boring. ` The total nurriber of P'roject Locations shall be subject to the approval of the Highway Superintendent. , A1. � /Service Connections excavations @$20.00 $ �� ` �U N o. A2, /Additional Excavations same service @$10.00 $ � No. � , B. Excavations 18"in depth or less 0-100 L.F._$1Q.00;Additional_ L.F.(a�$Q.10 $ � C. Excavations 18"in depth to 5' in depth 0-100 L.F._$30.00;Additional L.E.@$0.30 $ D. Excavations 5' in depth and over 0-100 L.F.='$50.00;Additional L.F.@$0.50 $ E. Utility Repair Excavations @$]0.00 $ No. Repairs same service @$5.00 $ Additional TOTAL$ I / 0� �v F. Notice to public utilities proof�must be provided and Shall be attached to this application prior to issuance of permit. * * * * * * * * * � * * * * Autl�orization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: i accordanca with this application and subject to the"General Conditions"and"Special Conditions"af parmit(if a )attached heret SUPERINTEND T G S TOWN OF SOU � R V ncer,`-^Q� do � ti � Date Date Received by the Town Cierk � � e�- �� Date Permit Issued l'•�� -t PermitNo. l ` J 1 NOTE: Permit expires one(1)year fi•om 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 Copy Distribution: 1 ` Permit# `� � ` Highway Department Engineer(with�page 3) Applicant Town Clerk(Original) , � INSPECTOR'S R�CORDS - Inspection Date Findings(use code) Applicant Notified lst . 2nd � 3rd 4cn (To Permit Clerk) �MA1tKS 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 r ' ' GEIVERAL CONDITIONS OF PERMIT APPLICATION/PERMIT FOR HIGHWAY ICXCAV�.TYON AND itEPAIR 1. Pcrmittce's Contr:ictars to Comnlv with�Pcrmii Requirements: The Permittee is responsible for , informing its independ'ent contractors,employees,agents and assigns of their responsibility�to comply with this permit, including all speciaUsite specific and general conditions imposed by the Highway Superintendent while acting as the permittee's agerit with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Ri�l�t to Tresn�ss or Interfcrc wiil�Priv�te Pronerty Ri�I�ts; This permit does not convey to the permittee any right to trespass upon the lands of adjacent properly owners in order to perform the permitted work nor does it authorize the iriipairment of any rights,title,or interest in real or personal property held or ' vested in a person not a party to the permit. 3. Pt•oteciian of tlic Iiiel��vav�nd Tuiut•e IIi�ln��av Maintenancc: 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 aufhorized,or if, in the opinion of the Highway Superintendent the work performed under this perniit sha(1 cause unreasonable obsiruction to requireil highway maintenance or endanger the health, safety,and/or welfare of vehicular or pedestrian traffic,this permit shall be revoked and the utility, structure,f 11, excavation,or other modification of the highway hereby authorized sha11 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 failed to comply with any of the terms and conditions of the permit or Chapter 237 of the Town Code. 4. Revocation of i6e Permit t�v the�Ii�hwa��Sanerintendent_: 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 any portion of the uncompleted utility,structure or fill and restore the site to its former condition. 5. Notice of Commenceinent: At least 24 hours prior to commencement of the project,the permittee and/or coniraator shall notify the Town Highway Department in writing that they are fully aware of and understand all terms and project conditions of this pennit. Upon completion of the work,the contractor shall proVide photographs of the completed work to the Town Highway Department and request a Final inspection. 6. Stora�c of•Fquin��ent&'M�atcrials: The storage of construction equipment and/or materials shall be confined within the project work area andlor adjacent areas where permission/legal access has been obtained in a manner that does not interfere with normal highway traffic. '7. Utilit�Marlc-0uts: The Applicant/Contractor shall be responsible for verification of all existing 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. 8. Road Closdires: All scheduled road closures must first receive written permission from the Southold Town Board prior to closing a road, Temporary lane closures may be permitted with the approval of the Highway Superintendent. This item will included but not be limited to the installation of appropriate signage and flag men to stop and start traffic to allow for single lane traffic.�Road Closures due to unforeseen emergencies require immediate notification of the Highway Departmerit and shall be limited to immediate and/or expedited restoration of the Work Zone. 9. Na Construction Debq•is in Ro:ed Sl��ulder Are�: 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 stageii within the Right-of Way must be delineated with reflective signage or other means to meet the minimum requirements of the NYS DOT�Construction Standards. i , } � . " �ENERAI� CONDITIONS OF PERMIT APPLICATION/P�RMIT FOR HIGHWAY EXCAVA.TYON AND REPAIR (Continued) 10. Instalt;Maintain�rasion Controls: Required Erosion Control Measures(i.e.silt fencing) is to be placed on the downslope edge�of any disturbed area, This sediment�barrier is to be put in place'before any disturbance of the ground occurs and is to be maintained in good functional condition untii thick vegetative � cover is established. , 11.,Clcan"Filt Oniv: All,project back-f 1]shall consist of ciean sand,gravel or soil(NOT asphalt,slag,flyash, � broken-concrete or"derriolition debris). All unsuitable soils excavated at the site(i.e. Clay,Bog,ete.)are to be removed from the site and not used to backfill any excavation within a Town Highway. I 2. AII Areas of Soil Disturbance: All areas of soil disturbance resulting from the approved project shall be stabilized to the satisfaction of the Highway Superintenderit 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 mat'ting unti]weather conditions favor germination. 13. I3aelcrll & Camnac'tion af'sill lCxea'vltions: Back-Fill shall consist of clean fill or soils which exhibit a well-defined moisture density relationship as determined to be in accordance with ASTMD 698. FiII shall be placed-in maximum lifts of twelve(12")inches thick and shall be meclianically compacted to a Ninety- � five(95%0)percent maximum dry density. Suitable hydraulic compaction'by�water jetting at three-foot inteivals'will also be perrriitted subject to a project specific approval by the Higliway Superintendent. 14. Restoriition�of tlic Road Sl�oixlder Area: All man-made improvements located within existing road shoulder,areas�must be protected to tha greatest extent{iractical. Items would include but not be limited to driyeway�&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. All pre-exi"stirig road shoulder imp'rovements that have,been disEurbed during construction must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15..Schenaatic Plaiis'�vitl� all Tecl�nicnl informn�ion and Sconc of Woric: ,To reasonably and adequately describe'tHe pioposed work,accurate schematic site plans rriust be provided to show or indicate all proposed construction activity required under tliis permit. All Pavement surfaces scheduled for` excavation must be saw cut to the full depth of asphalt and/or conerete pav,ements. Accurate size of bell holes or width � of trenching must be indicated by dimension or labeling. This schematic 'site plan must provide details on all restoration required to meetthe requirements ofthese General Conditions and requirements found in the Southold To�vn Highway Specifications. 16. Pavemaent Reconstruction: All Pavement sections must be reconstructed in the following manner; (TJote:When Concrete Pavements are Present,Please review Restoration requirements with the Highway 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(2.5") inch compacted lift of Asphalt Base Course; e) Tnstall 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. Ti�enchin�of Pnvement Surf.ices Txceedin�One T-Tundrecl'l100'-1 Teet in Lenath: All trenching of pavemerit 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'of the Highway Superintendent,the entire road section and/or width of road over the eniire length of trench shall be repaved with a two(2") inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). S��y � � � i �� ( - N � ��I:�,��I �� - �, a -PER1ViTI'��APl'i�I�ATI�N:SI�ET.CH, � 1�illage�Of ii � . . - � DATEe SI��I�O�� - � LdCATIO[�T: 9�01NELL� R� CROSS SfREET 1:� -ALBO DR" ','Md� - - - ^d 'TOI�T: 'LALIREL GR4SS,SfREET�2: _ � W�[tIC'ORDER: T10�878�70 `~ . � � � 0 . � M � . � � SIJRFAGE: '-' Macadam Ra d� - �°,��a � p 9�0 � •i� � A `-� o '� � � � �• � �: � . � bo . �%o-, � �� , �. .: - ��' � � - 4',�c 4' BeII�HaIe � U .� N . �r N UVELL� RD � � � . . 3 � � � � a� � . . � .�