HomeMy WebLinkAbout1600 Alvahs Ln , M
* * * RECEIPT * * *
Date: 11/29/16 Receipt#: 214585
Quantity Transactions Reference Subtotal
1 Excavation Permits 1179 $17000
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#36555 $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
Bid 3 FI 1
Hicksville, NY 11801
Clerk ID: LYNDAR Internal ID: 1179
RECEIVED
Permit No. A I NOV 2 8 2016
TOWN OF SOUTHOLD �gt1FF01�°
HIGHWAY DEPARTMENT
Peconic Lane Southold Town CI' r 'y
Peconic,New York 11958 v,f
T101903356 (631)765-31401'
APPLICATION/PERMIT FOR HIGIIWAY EXCAVATION AND REPAIR
APPLICATION IS HEREBY made to,thc Superintendent of Hlgltways of the Town of Southold for the issuance of an Excavation Permit
pursuant to Chapter 237 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 laiva,
ordinances,codes and regulations,the attached"General Conditions of Permlt"and`Special Conditions",'ff any and to permit authorized
inspectors to'make necessary inspections of the job site.
Print o I'Me Keyspan Gas East Corp D/B/A National Grid
Gas Permits Dept. Bldg: 3 FI: 1
L 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. 1600 ALVAHS LN-W/S, 2000' N/0 MAIN RD(NYS 25)
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 App cant
Application/Permit Form is
Required for a complete application! 11/22/16
Date
5. (a) Attached plot plan to reasonably and adequately describe the proposed wort:. 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.
(1
6. Tax Map No.: District 1000 . Section ®� , Block , Lot
7. Starting Date: 12/21/16 Completion Date: 12/22/16
8. Work Schedule: Pthnse Completion Dale
Excavation Work Schedule
Facility Installation Must 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: $ _ __ -.�
11. Remarks: INSTALL GAS SERVICE
D-39 1 of 3
12. Insurance Coverage:(Attach Copy)
(a)„Insurance Company:
(b) Policy#I _
(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:
$1,000,000 per Occurrence and S 2,000,000 general aggregate.
13. Security:
(a)Surety Bond' or Certified Check provided in the total Amount of$
(b)Maintenance Bond provided: 2 years or .3 years.
14. F_ees`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
-5W.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: /Service Connections excavations Q$20.00 $ 20.00
No.
Additional Excavatians,same service Q$10.00 S ,
Na. ,
13. Excavations'l8"'in depth or less
0-100 L,F._$10.00;Additional
C. Excavations 18"in depth to 5' in depth
0-100 L.F.1$30:00;Additional : - L.F.Q$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®$10.00
No.
Repairs some service Q$5.0.0 $
Additional
TOTALS 1 70.00
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 Ex avation permit to:
in actor n with
this application and subject to the"General Conditions"and"Special Conditions"of permit ' an alta ed ereto,
SUPER W YS
TOWN OF OUT 1 L ,N- V RK
VIW la
Date Received by the Town Clerk•
Date Permit Issued- q— I 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
' L
Copy Distribution:
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
1 St
2nd
3rd
4th
(To Permit Clerk)
REMARKS
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 OFTERMIT _
APPLICATION/PERMITTOR HIGHWAY EXCAVATION,AND REPAIR
1. Perrniiiee'a Contractors io Comply with Permit Rciiuiresucntso The Permittee is responsible for
informing its independent contractors,employees;.agents;and assigns of their responsibility to comply with
this "'—"" t,°:inolud" all special/site specific and'general conditions imposed by the Highway
Superintendent while acting as the permittee';agent with respect to the permitted activities,and such
persons shall 6e required to comply,with.all permit requirements;
2. No ftlit to Tresiiass or Inter"fere wilh'Private 1'ronerty Rial'i This permit docs not convey to the
permittee any rightto trespass'tipon the lands of adjacent property owners in order to perform the permitted
work nor does it authorize the impairment of Any iights,title,or interest in real or personal property,held or
vested in a person not a party to the permit,
3. P�rolection of the Liightivnv and ruturc Iiielnvn�`Maintensinec: If future operations or highway
maintenance piojects;by the Town of Southold require an alteration in the position of the utility,structure
or"'work herein authorized,`or itis the opinion of the Highway Superintendent the work performed under
this�permit shall cause unreasonable ob'sliuction to required highway nisinienaace or endanger,th_e health,
safety and/or welfare of vehicular or pedestrian traffic;this permit shall be;"revoked and the utility,
structure;,fill,excavation,,oi other modification of the highway,hereby;arborized shall '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 failcd_to comply with any of the terms and
conditionsofthe permit or Chaptcr237,of the Town Code.`
4. Revocation of the Permit,bv the Hiebwav Superintendent:-If the Highway Superintendent deems it
necessary to revoke this per nitand the project hereby authorized has hot,been completed,`the applicant
shill/,without expense to the Town and to suchixtent and,in such time and manner'' s the Superintendent
may require,remove all orany portionof the uncompleted utility,structure or fill and restore the site to its
former condition:
5. Notice-or Commencement: At least 24 hours prior to commcticerrient of the,project,the permittee and/or
contiaotor;fiat/aotify'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
shalt provide,photographs of the corripleted work to the Town Highway Department and request a Final
inspection.
6. Storage of Equipment'&Maleemis: The storage of construction equipment and/or materials shall be
confined within the'project,%fork area and/or adjacent areas where permission/legal access has s been
obtained in�a manner that docs not interfere with norma!highway traffic.
7. Utility Mn"rk-Oks: The Applicant/Contractor shall be responsible for verification of all existing utility
mtuk=outs and shall take all precautions to protect same. Damage to existing utilities shall be the
resp'orisibility of the contractor and shall be repaired at the contractor's expense.
8. Road Closures: All scheduled road closures must first receive written permissionfrom"the Southold Town
Board prior to'closing a road. 'Temporary lone closures may be permitted with the approval of the Highway
Superintendent. This item will included but not be limited to the instoliation of appropriate signage and
flag men to stop and start traff c to allow for single lane tiffic. Road Closures due to unforeseen
emergencies require immediate notification of the High-,vay 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 tis`Well as all other project materials that will be staged wi#hip the
Right-of Way must be delineated with reflective signage or other means to meet the minimum requirements
of the NYS DOT Construction Standards.
y
GENERAL CONDITIONS OFTE2MIT
APPLICA•TION/PERMIT FOR HIGHWAY,EXCAVATION AND REPAIR
(Continued)'
10. Iri'siall:•Maintain Erosion Can'trols: -RegWred Erosion Control Measures(Le,silt fencing)is to be placed
V on'thc downslope edge of any disturbed area, This sediment barrier is to bc'put in place before any
disturbanec'of the ground occurs and is to be maititui_ned in-good functions)condition until thick vegettitive
cover'is established.
l 1. Chan Till Only. •All project back-fill shall consist of clean sand,gravel or soil(NOT,asphal4 slag,flyash,
broken concrete'o'r demolition debris).-All unsuitable soils sxcavatcd at the site(Le.Clay,Bog,etc)are to
be removed from the site and nb't used to backf Il any excavation within a Town,Highway.'
12. All Areas of Soil Disturbance: All areas of soil disturbance`resulting'from,thc approved project shall be
stabilized to the satisfaction of the Highway Superintendent iniinediately followinng project completion. -If
tlic,project site remains inactive for more than 48 hours'or planting is impractical due to the season,then
the liras shall be stabilized,with straw;hay mulch and/or jute matting until weather conditions favor
germination.
13.;Bh:itnll S'Cotripactian of nil Excs vaiions: Back Fill shall consist of clean fill or soils which exhibit a
well4ofined moisture density`relationship as determinbd to be in-accordance with ASTMD 698. Fill shall
bc,placed in maximum lifts oftwelve(I2')'inches thick and shall be mechanically compacted to aNinety=
five(95%)percent maximum dry density. Saitable hydraulie compaction by water jetting at,three-foot
intervals will also be petmit#ed subject to a-project specifc approval by the Highway Superintendent,
14. Rcstoratioii of the Road Shoulder AreA- All man-made improvements located within existing road
shoulder a'rea's must be protected to the greatest extent practical.' Items would include but not be limited to
driveway,&private road'aprons,mailboxes,sprinkler systems,trees and ornamental plantings.
Excavations through driveways_and private-road pavements must be reconstructed to meet all requirements
ofouholdTown Highway Specifications. All pre-existing road shoulder'improvements that Have been -
dl'sturbed during construction must be replaced or repaired by the contractor to the satisfaction of the
Highway Superintendent.
15. Schbmn tic Plans with it11 Teelinical information and Scone of,Work:'To reasonably and adequately
describe the propos'e'd work,'aceurate schematic site`,plans must be provided to show or indicate all
proposed construction activity,repaired under this permit. All Pavement surfaces scheduled for excavation
must be saw crit to,thc full depth of asphalt and/or concrete pavements. -Accurate side`of bell holes or width
oftiehbli ng must be indicated by•dintension or labeling. This schematic site plaid must provide details on
all restoration required to meetthe requirements of these General Conditions and requirements found in,the
Southold Town Highway Specifications.
16. Pnvcmerit Reconstruction: All Pavement sections Most be reconstructed in the following manner,
(Note:When Concrete Pavements are Pmsent.Please tevlew Restoratton requirements with the Highway Superintendent)
a) Cotriplete`all'back-fill&soil compaction work as needed to provide a suitable sub-base;
b) Ove:cut existing asphalt bell hole or trench by hvelve(12")inches on all sides;
c) Installacompacted-lift of 4"thick Stone Blend bast:(RCA Blend must meet NYS DOT Specification);
d) Install a two'and one half(2.5")inch compacted lift of-Asphalt Base-Course;
e) Install a one and one half(1.5")inch.of Asphalt(Type 6)Nearing 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 Surraces Exceeding One hundred(1001Tcet Iin Leat=_tin 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 iscompleted to the satisfaction of the Highway
Superintendent,the entire road section and/or width of road over the entire length of trench shall be
repayed with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder).
sl ty
nat o n a[g,rid N
PEIMM AMq ICATION SKETCH
Village-Of
88
DATE: 11122120,16
LOCATION:, 16 ALVAHSIN CROSS STREET 1: MAIN R-D �
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TOWN: CUTCHO.OUE CROSS STREET 2:- COUNTYROAD 48:
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WORK ORDER: T1-01903'356, -d
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