HomeMy WebLinkAbout1285 Marratooka Ln (2) * * * RECEIPT * * *
Date: 11/29/16 Receipt#: 214586
Quantity Transactions- Reference Subtotal
1 Excavation Permits 1180 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#36556 $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: LYNDAR Internal ID. 1180
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RECEIVIEED
Permit No.� _ NOV 2 8 2016
TOWN O
HIGHWAY DEPARTMENT NT
Peconie Lane Southold Torn C "?,
Peconic,New York l 1958 off,
T101887490 (631)765-3140
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 of the Town of Soutbold,Suffolk County,New York,and other applicable lbws,ordinances'or
regulations for each individual contiguous excavation project herein described. The applicant agrees to comply with'all applicable lawa,
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 od'Me Keyspan Gas East Corp 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
2.
Name of Contractor Phone Number Address of Contractor
3.
Name of Property Owner Requesting Service(if applicable) Address of Owner
4. 1285 MARRATOOKA LN, 415' N/O NEW SUFFOLK 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 Appii nt
Application/Permit Vorm Is
Required for a complete application! 11/22/16
' Date "
5. (a) Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan showing the
locnHon 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
r Excavation Permit by the Town Clerk.
6. Tax Map No.: District 1000 Section� _. Block `i , Lot � �•
7. Starting Date: 12/4/16 Completion Date: 12/5/16
8. Work Schedule: Phase Completion Date
Excavation NVorlc Schedule
Facility Installation Must be provided
Backfill&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 orProposed Work: S �.
11. Remarks: INSTALL GAS SERVICE
D-39 1 of 3
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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:
$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 5
(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 number-of Project Locations shall be subject to the approval of the Highway Superintendent,
A1. /Service Connections excavations Q 520.00 S 20.00
No.
A2. /Additional Excavations same service Q S 10.00 S
No.
B. Excavations 18"in depth or less
0-100 L.F.=$10.00;Additional L.F.Q$0.10 $
C. Excavations 18"in depth to 5' in depth
0-100 L.F.=$30,00;Additional L.F.®$0.30 S
D. Excavations 5'in depth and over
0-100 L.F.=$50.00;Additional L.F.Q$0.50 $
E. Utility Repair Excavations(Qa $10.00 5
No.
Repairs same service Q$5,00 $
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 the Town of Southold to issue a Highway Excavation permit to:
i accordance with
this application and subject to the"General Conditions"and"Special Conditions"of permit(if a )att ed hereto.
SUPERINTEND T
TOWN OF SO H W
Vi cent o
Date
Date Received by the Town Clerk
Date Permit Issued Permit No.
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 _
Towri Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use cbdp) Applicant Notified
2nd
3rd
.stn
(To Permit Clerk)
RE
CODE
IB lmp'roper Barricades
IL Improper Lights
ST -Sunken Trench or Excavation
UTM Unable to Measure(due to backfilling)
BUC Building Undei 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. Pi rmittcc's Contrsictar"s to Coinnlv'tivith Permit R640irciiients: -The Permittee is responsible for
informing its iadepondent"contractors;cmployces;`agents and assigns of,their iciponsibilityto'comply with
this permit, including all speclaUsite.specifc and general conditions imposed by the Highway
Superintendent while acting as the"permitlee's agent with'respect to the''permitted activities,and such
persons shall be required to'complp,with;all permit requirements,
2. No Richt to Tmc iris or Interfere Wi.Ili P nic fronerty RiA6--This permit,does not'conyey`to the
permittee any right to trespass upon the lands of adjacent propeity owners in order to perform the permitted
work nordocs`it authorize the impairment of ar y-rights,title,-or interest in real or personal property held or
vested in a person not a party to the'permit,
3. Protection of ilio Iliglrtivnv and Future Ili hwa y Maintenance: If future operations or highway
rnaintenance.projects;by the,Town�'of•Southoid require adalteration in the position of the utility,'structure
or,work herein authorized,or"ifjri the opinion of the Highway•Superintendent tlic work peribrmed under
this perinit2shall cause unreasanalile oli'struction to required highway maintenance or endanger,the health,
safety andlorwelfare of vehicular or pedestrian traffic,this'permit sh'ali be revoked and the utility,
Istructur"e;fill,excavation,;or other modification of the highway hereby authorized shall not be completed.
Additionally;'the permit may be4rcvoked if the Highway Superintendent figds that the issuance•of the
permit was illegal or unauthorized or that the applicant failed to comply"with ariy of the terms and
conditions of fhe permit or Chapter 237 of the Town Code.
4. Revocsrtion of the Permit by the Iligbivav Superintendent:„If the Highway Superintendent deems it
necessary` to;revoke this,peiinit and the project hereby authorized has not been completed,the applicant
,shrill,without expense to the Town and to such'extent'and in su'h ime and manner as the Superintendent
shay require,remove all orany'partion`of the uncompleted utility,structure or fill and cestare the site to its
farmer,condition.
5. Ndtice of Commencement: At least 24 hours prior to comrrtcncerrrent 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
shutl provide photographs of the completed work to the Town Highway Department and request a Final
inspection.
6." Storage of I:nuionsent&Materinis: The'storage of construction equipment and/or materials shall be
conf Tied within,the project work area and/or adjacent areas where permission!legal access hies been
obtained in a manner that does not interfere with`normal highway traffic.
7, Utility Mark-Outs: The Applicant/Contractor shall be-responsible for verification of all existing utility
mark=outs and shall_take,ull 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. ad_RoClosure's: All scheduled road closures must first receive written permission from the Southold Town
13oard'p'iior to closirig'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 in
of appropriate signage and
flagImenI to stop and start traffic to allow fo"r single lane traffic. Road Clasyres due to unforeseen
emergencies require iminedi_ate notification of the Highway Department and"shall be limited to immediate
aindlor expedited restoration of the Work Zone.
9, No Construction Debris in Road 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.
L 7
GENERAL CONDITIONS OF PERMIT
APPLICATIOINMERMIT FOR HIGHWAY EXCAVATION AND REPAIR•
_ (Continued[),
10. Install,Maintain Erosion Controls: Required Erosion Control Measures(i.e,silt fencing)is to be placed
on-the downslope doge of anydisturbed Brea. This sediment barrier is to be,put in place before any
disturbance of the ground occurs and is to b'e maintained-in good functional condition until thick-vegetative
cover'is established. ;
11. Clean Fill t)nly: All project back-fill shall consist of clean sand,gravei or soil(NOT'asphalt,slag,flyash;
broken'concrete-or'de'molition debris). All unsuitable soils excavated it the site-(i.-6.Clay,Bog,-etc.)are to
beremoved from the site and not used to backfill any excavation within a Town Highway.
12: A,II Area's KS.oil Dlstnrbance%'All areas of soil disturbance resulting from the approved project shall be
stabilized to th6,satisfaction-of the Highway Superintendent imtiiediately following project completion. If
-the project,site,remains inactive for more than.48 hours orplanting is impractical due to the season,then
the area'Wl be stabilizt:'d"with straw,hay mulch and/or'jtite matting until weather conditions favor
germination.
13. Baalcfrll'Sr-Compaction of all I'sxcavatio»s: Back Fill shall consist of clean fill or soils,which.exhibit a•
welPilefiaed inoisfure density relationship as determined to,be in accordance with ASTMD 698. Fill
bc'placed in mtiximusn lifts of twelve(I211 inches thick and shall be mechanically compacted to a Ninety=
five
(95%)percent maximum dry density., Suitable hydraulic coinpaa'tioit by water jetting at three=foot
inteivals'will also be permitted subject to a projectspeclfic.approval bythe Highway Superintendent.
14. Restorsrtion of the-Road'Shoulder Area. All man-trade improvements located within existing-road
shoulder areas must beprolected to the greatest extent practical. Items would include but not be-limited to
driveway&private'ioid aprons,mailboxes,sprinkler systems,#ryes and ornainentsl plantings.
Exca-vations 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-replaoed_ or repaired by the contractor to the satisfaction of the
Highway Superintendent.
15. Sclicmntic Plans with all Technical information and Scone of Work= ,,To reasonablyiritd adequately
describe"the proposed work;accurAte schematic site pians must be provided i6 thow or indicate all
proposed construction activity required 6der,this permit. All Pavement surface's,scheduled far excavation
must esaw cut'to the full depth of asphalt and/or concrete pavements. Accurate site of bell holes or width
of trenching must be indicated by dimension or labeling. This schertratie 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. Paverrrerit Reconstruction: All Pavement sections must be reconstructed in the following manner;
(Note:When Concrete Paveritcnts ere Present,Please review Restoration requiiemeats with the Highway Superintendent)
a} Complete all back-fill 8c 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;
d) Install 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 in requirements of the Southold Town Highway
Specifications.
17. Trenching of Pavement Surfaces Exceeding One fUntlred 1100'1 Teet in Length: All trenching'of
pavement surfaces exceeding 100' in length must first be reconstructed to meet the,requirements of Item
N 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 Asptialt-(Type 6)Wearing'Coutse(Typical,shoulder to shoulder).
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