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HomeMy WebLinkAbout1925 Youngs Ave Permit No. TOWN OF SOUTHOLD �yt1FF0c HIGHWAY DEPARTMENT Peconic Lime # Peconic,New York 11958 a� 7101888276 (631)765-3140 1 , ° LIPPLICATION/PEjMIT FOR HI[ii1WAY RXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance ofan Excavation Permit pursuant to Chapter 737 of the Code of the Town of Southold,Suffolk:County,New York,and other applicable 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 attached"Central Conditions of Permit"and"Special Conditions",If any and to permit authorized inspectors to make necessary inspections of the jab site. Printarl' Keyspan Gas East Cote D/B/A National Grid Gas Permits Dept. Bldg: 3 FI: 1 I 516 545 4094 175 E. Old Country Rd Hicksville, NY 11801 Name of Applicant Phone Number Address of Applicant z. Name or contractor Phone Number Address of Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner 4 1925 YOUNG AVE-E/S, 266' N/O HUMMEL AVE Work Description and Location(Street Number,Hamlet,Cross Street) (a) Is construction located within 75 feet of tidal wetlands? 'Yes No 'byes,other Town permits may be required. Margaret Paglia NOTE: All Information requested by this Signature of Applicant Application/Permit dorm Is 9/29/16 Required for a complete applicatlont -- Date S. (a) Attached plot plan to reasonably and adequately describe the proposed work. 'Provide accurate schematic site plan showing the locution 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) Anach all other necessary permits and licenses for this project (c) Work covered by this application may not commence before issuance ora Highway Excavation Permit by the Town Clerk. 6. Tax Map No- District„1000 . Section . Mock Lot 7. Starting Date: NOW Completion Date: S. Work Schedule: Plinio Completion Date Excavation Nark Schedulc Facility Installation ;dust be provided Backfill&-Completion for consideration as a Pavement Replacement Complete Application. 9. Under which authority is application being mad,: Keyspan Gas East Corporation d/b/a National Grid See Town Code Chapter 2.37(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: 5 - 11. Remarks:***EMERGENCY GAS LEAK*** 1 of 3 D-39 —-- - — - 12. Insurance Coverage:(Attach Copy) (a) Insurance Company: (b) Policy f;: (c)State whether policy of certification on file with the Hlghw-ay 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: S 1,000,000 per Occurrence and S 2,000,000 general aggregate. 13. Security: (a)Surety Bond or Certified Check provided in the total Amount ors (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 later-connected by open trench or directional boring. The total number of Project Locations shall be subject to the approval of the Highwny Superintendent. Al. /Service Connections excavations Q$20.00 S20.00 No. A2, 1 Additional Excavations same service @ S10.00 S No. B. Excavations 19"in depth or less 0-100 L.F.-S10.00;Additional,_IL.P.Q 50.10 $ C. Excavations iii"in depth to 5'in depth 0-100 L.F.=S30.00;Additional L.F.®S0.30 S D. Excavations 5'in depth and over 0-100 L.F.-$50,00;Additional LY.Q$0.50 S E. Utility Repair Excavations®S10.00 S No, Repairs same service Q$5.00 5 Additional TOTALS 170.00 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 theTown of Southold to issue a Highway Excavation,permit to: to accordance% this application and subject to the"General Conditions"and"Special Conditions"of permit(if 11Y ttac It o. SUPERINT AYS TOWN OF S D N V OR .,_.__. Vincent orl dP. ..�— dc Date Received by the Town Clerk LOW b _ D Date Permit Issued 1 1.q 1( 10 Permit No. l 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 Copy Distribution: Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S BE,C(MS Inspection Date Findings(use code) Applicant Notified 151 2"d 3"t 4t (To Permit Clerk) REIV'fAR S CODE 18 Improper Barricades 1L improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backfilling) BUC BulidingUnderConstruction WIP Work In Progress DB improper BackfilI(too high,not sufficient) HFS Inspector Holding for Final Settlement of Excavadon RFR Ready for Repair D-39 3 of 3 GM, AL rONDITIONS OF I'RRMTT APPLICATIOiVMERMIT FOR HIGHbVAY EXCAVATION AND REPAIR 1. Permittec's Contraclors to Comply with Pernill Renuircrnenis: The Permittee is responsible for informing its independent 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 agent with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Rieht to Tresn-iss or Interfere wish Privntq Property 11191119: This permitdoes 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 Mabivny rind Future Ili Irryn.Mnintenunce: If future operations or highway maintenance projects by the Town of Southold require an alteration in the position of the utility,structure or work heroin 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, safcty and/or welfare of vehicular or pedestrian traffic,this permit shall be revoked and the utility, structure,fill,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 afthe 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 ofthe Permit by the Hiebwav Suoerintendcut: 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 Commencement At least24 hours prior to commencement of the project,the permittee and/or contractor shall notify the Town Highway Department in writing that they are fully aware of and understand all terns and project conditions of this permit. 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. Stomize of Equipment&Maicrials: The storage of construction 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 trnffio: 7. Utility IVlnrit-Outs: The Applicant/Contractor shall be responsible for verification oral]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. S. Rgad C121ures: 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 theHighway 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 Department and shall be limited to immediate and/or expedited restoration of the Work Zone. g, No Construction Debris in Bond Shoulder Area: 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 staged 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. GEPIERAL CONDITIONS OF PERMIT APPLICATION/PERMIT FOR IiIGHWAY EXCAVATION AND REPAIR (Continued) 10. install-hinintain Erosion 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 until thick vegetative cover is established. 11. Clean Mill Only: All project back-rill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete or d emu]ition Jebris). All unsuitable soils excavated at the site(Le.Clay,Bog,etc)are to be removed from the site and not used to backfill any excavation within a Town Highway. 12, All Areas of soli Disturhance_: 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 germination. 13. Bncktill,&,Comnnctiait o!'nit Excnvntionst 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. Fill shall be placed in maximum lifts of twelve(12'1 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 or ilia Rond Shoulder Area: All man-made improvements located within existing road shoulder areas must be protected to the greatest extent practical. Items would include but not be limited to driveway&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-existing road shoulder improvements that have been disturbed during construction must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15. Schematic Plans with nil Technical information and Scotto orNVQrk: To reasonably and adequately describe 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 scheduled for excavation must be saw cut to the full depth of asphalt and/or concrete pavements. Accurate size of bell holes or width of trenching must be indicated by dimension or labeling. This schomatic site plan must provide details on all 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 reconstructed in the following manner, (Time:When Concrete Pavements arc present.Please review Restoration requirements with the Highway 5uperintmdent) 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(1211)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; C) Install a one and one half(1.5")inch of Asphalt(Type 6)Wearing Course. (Provide AC at all joints) All work listed heroin must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenchint or Pavement Surruees Excceding One Hundred(10011 Feet in Lenetltt All trenching of pavement surfaces exceeding 140' in length must first be reconstructed to meet the Pequirements of item 9 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 entire length of trench shall be repaved with a two(2") inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). s�ty 29/09/2016 02:39 (UTC/GMT) National Grid page 2 4ATIONAL 61klD REQUEST FOR STREET OPENING PERMIT 7--OwN ©� NASSAU SUFFOLK Jr0U7"IlOL2;) FC-s111.4 C� STATE CI COUNTY CI COUNTY PERMIT MIS JOBf 8 �� DATE NO. NO. A y! • LOCATION 1 g s O VL.. 1qrD tJl�i'1•� />'V O D REASON FOR Q r Pi%R 6:,#s LAX OPENING /` W.OJPA FOREMAN DATE OF NO OPENING fd REQUESTED �, DEPARTMENT --JDIVISION B l � GAS CONSTR.MAINT.&SERVICES ,f EGf' LJF 8L - APPROVED DATE SKETCH i qZS o �av� G�S Avr, Avt-. * * * RECEIPT * * * Date: 10/04/16 Receipt#: 213674 Quantity Transactions Reference Subtotal 1 Excavation Permits 1157 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#36077 $17000 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: BONNIED Internal ID- 1157