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Home My WebLink About2110 Cox Neck Rd f. * * * RECEIPT * * * Date: 10/21/16 Receipt#: 214024 Quantity Transactions Reference Subtotal 1 Excavation Permits 1165 $33200 Total Paid: $332.00 Notes: Payment Type Amount Paid By CK#36180 $332.00 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 Bid 3 FI 1 Hicksville, NY 11801 Clerk ID: LYNDAR Internal ID, 1165 Permit No.A f4j5tRECEIVED TOWN OF SOUTHOLD �psu�F111,t�, HIGHWAY DEPARTMENT Peconic Lane OCT 2 0 2016 Peconic,New York 11958 T101889735 (631)765-3140 Southold Town Clerk APPLICATION/PERMIT FOR HIGIIWAY 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 orthe 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 lawy, 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 or1 a Keyspan Gas East Corp D/B/A National Grid Gas Permits Dept. Bldg: 3 Fl: 1 1, 516 545 4094 175 E. Old Country Rd Hicksville, NY 11801 Name of Applicant Phone Number Address of Applicant 2. Name of Contractor Phone Number Address of Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner 4. 2110 Cox Neck Rd, Mattituck- E/S, 230' N/0 Westphalia Ave Work Description and Location(Street Number,Hamlet,Cross Street) (a) Is construction located within 75 feet of tidal wetlands? "Yes No *If yes,other Town permits may be required. Margaret Paglia NOTE: All information requested by this Signature of Appli ant Application/Permit Form Is Required for a complete application: 10/11/16 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. (e) Work covered by this application may not commence before issuance of n Highway Excavation Permit by the Town Clerk. 6. Tax Map No: District 1000 , Section Block , Lot 7. Starting Date: 11/09/16 Completion Date: 11/10/16 8. Work Schedule: Phase Completion Date Excavation Var i Schedule Facility Installation 119ust be provided Backfill S Completion for consideration as a Pavement Replacement Complete Application. 9. Under which authority is application being made: Keyspan Gas East Corporation d/b/a National Grid See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: S 11. Remarks: INSTALL GAS MAIN & SERVICE _ D-39 1 of 3 - 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: 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 of$ (b)Maintenance Bond provided: 2 years or 3 years. 14. Fees for Applications and permits: rD. 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 number of Project Locations shall be subject to the approval of the Highway Superintendent, Al. 1 /Service Connections excavations Q$20,00 S 20.00 No. A2. /Additional Excavations same service @ S 10.00 S No. B. Excavations 18"in depth or less 120.00 12.00 0-100 L.F.=$10.00;Additional L.F.Q 50.10 $ C. Excavations 18"in depth to 5' in depth 0-100 L.F.=$30.00;Additional L.F.®$0.30 $ D. Excavations 5'in depth and over 0-100 L.F.=$50.00;Additional L.F.Q$0.50 $ E. Utility Repair Excavations Q$10.00 $ No. Repairs same service Q$5.00 $ Additional TOTALS 332.00 F. Notice to public utilities proof must be provided and Shall be attached to this application prior to issuance ofpermiL F * 1 f t M 4 4 • K 9 M t i Authorization is hereby granted to the Town Clerk of the Town of Southold to Issue a Highway Excavation permit to: in accord cc ith this application and subject to the"General Conditions"and"Special Conditions"of permit fan atta ed to. SUPERINT ITG AYS TOWN OF ,N OR VincenOrlo 4� ® o�0_ I(V Date Date Received by the Town Clerk 1 I r - Date Permit Issued 0 ' �'j Permit No. ` (a5 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# G-5 Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings'(use code) Applicant Notified I Sl 2nd 3rd 4th (Tri Permit Clerk) R_EMARK 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 GENERAL CONDITIONS OF PERMIT' APPLICATIONMERMIT FOR HIGHWAY EXCAVATION AND REPAIR 1, Permittee's Contractors to Comply with'Permit Reauir6 ients: The Permittee is responsible for informing its imdepbndent contractors,cmployces,'agents and assigns of their responsibility to comply with this permit,including all special/site specific and gencral,condit" ns imposed by the Highway Superintendent while acting as the permittee's agent with respect to th'e permitted activities,and such persons shall be required to coinply with all permit requirements. 2. No Ri 'ht to Tres ass ar Interfere with Private Prover Ri his: This permit does 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,titie,or interest in real or personal property held or vested in a person not a,party to the permit., = 3. Protection at ilie Highwnv and Future Iliehwak Maintenance: If future,operations or highway maintenance projects by the Town of Southold require en alteration�in the position of the utility,structure of Work herein authorized;or if,in the opinion of the Highway Superintendent the work performed under this permitshall'cause unreasonable obstruction to required highway maintenance or endanger the health, safety and/or welfare of vehicular or pedestrian traffic;this'permit steall be revoked and the utility, structure,fill,excavation,or other modification of the highway hereby authorized shall not be completed. Additionally,ilia permit Wray be revoked if the Highway_Superintendent'fipds't, t the issuance of the permii,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 lheMiabwav Sunerintcndeut: 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 mayroquir'c,•remove all orany portion of the uncompleted utility,structure or fill and restore the site to its former condition: 5. Notice of Commencement: At least 24 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 terms 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. Storage of Equipment&Materials:-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 traffic.' '7, Milty Marl Outs: 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. S. Road Closures; All scheduled road closures must first receive written permission from the Southold Town Board prior to closinga road. Temporary lane closures may be permitted with the approval of the Highway, Superintendent. This_item wilt included but not be limited to the instillation 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, 9. No Construction Debris in Road Shoulder Arca: All Construction Debris shall be removed from the job site on a daily basis. All stockpiled soil as welt as all other project materials that will be stn' d 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: a GENERAL CONDITIONS OF PERMIT APPLICATION/PE_ RMIT FOR 1.11GHWAY EXCAVATION AND REPAIR (Continued) 10. Install,Maintain 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 in in good functional condition until thick vegetative cover is established. 11. Clean Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete or`°demolition debris). All unsuitable soils excavated at the site(i.e.Clay,Bog;etc,)are to be rentoveii from the site'and not used to backfill any excavation within aTown Highway. 12. All Areas bf Soil Disturbance s,All areas,of soil disturbance resulting from the approved project shall be stabilized to the satisfaction of the Highway Stapeiintendent i' mmediaicly 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. Bacictill&Co'ai -notion of all Excavation's: Back Fill shall consist of clean fill or'soils which exhibit a well4efined moisture deiislty'relationship as determined to be in accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve(ITT inches thick and shall,be mechanically compacted to,a Ninety- fve(95°/a)percent maximum dry density. Suitable hydraulic com pactionby water jetting at three-foot intervals will also be permitted subject to a project specifc approval by the Highway Superintendent, 14. Restoittion of the Road Shoulder Arca: 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,snail boxes,sprinkler systems,trees and,ornamental plantings. Excavations through driveways and private road pavements must be recnstructed to meet all requirements of southoid Town Highway Specif cations, All pre-existing road shoulder improvements,that have been disturbed during construction most be replaced or repaired by the contractor to the satisfaction ofthe Highway Superintendent. 15. Schematic Plans with nil Technical information rind Scone of Work: To reasonably and adequately describe the-propbsed work;accurate schematic site plans must be provided to show or indicate ull proposed construction activity required tinder this permit. AI!'Pitvementsurfaces 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 schematic 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. Puvemeiit Reconstructi n: All Pavement sections must be reconstructed in the following manner; (Note:When Concrete Pavements are Present,Please review Restoration requirements with theHighway 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; c) Install a one and one half(1.5")inch.of Asphalt(Type 6)\Vearing Course. (Provide AC at all joints) All work listed herein must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenching of Pavement Snrfaccs Exceeding One Hundred 1011' Tcct in Lcn tlr: All trenching of pavement 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 aver the entire length of trench shall be repaved with a two(2") inch lift of Asphalt(Type 6)Wearing Course(Typicalshoulder to shoulder). , sty g Road Opening Permit Request national g& T-M POWER or Acnol Municipality, Work Order. Location: WS014jda Grid: -fl�lyy-y ZIS Town: Requested By- Reason For Excavation: ,j—,jSj,_d_ ,f Description: qAA X 11 ly '5k J_ 0* < 1-ft 14 Vf Typical trench width is 12"wide Not To Scale Typical bell hole excavation is 4'x 4'x 4' Revision: Permit sketch may not include excavations required under 16 NYCRR Part 753 Date Submitted: