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HomeMy WebLinkAbout390 Oyster Ponds Ln (2) RECEIVED Permit No. JAN > > zoM TOWN'OF HIGH HIGHWAY DEPARTMENT gofFac,��oG� Peconic Lane- Southold Town Cteta; ' Pecon'ic,'-New.York 11958 o� T101918119 '(63.1).765-3140 �rol, APPLICATION/PERMIT FOR HIGUWAY r..XCAVATI( ON AND REP 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 orsouthold;Suffolk County,New York,and other applicable laws;ordlnzinces 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"General Conditions of Permit"and"Special Conditions",if any and to permit authorized inspectors to'make necessaryinspections of the job site.- PrintorType .Keyspan Gas East Corp D/B/A National Grid Gas,Permits Dept. Bldg: 3,FI: 1 i, 5165454094 175-E.-Old Country Rd•Hicksyille; 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. 390 OYSTER PONDS LN-W/S, 350' S/O MAIN RD Work-Description and Location(Street Number,Hamlet,Cross Street) (a) is construction located within 75 feet of tidal wetlands-7 *Yes No 'If yes;other Town permits may be required. Margaret Paglia NOTE: All information requested by!Itis Signature of ApIficant Application/Permit Form Is Required for a complete applientlonl 1/ 6/17 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'projecL (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 i . Block . Lot 7. Starting,Date: 2/07/17 Completion Dater 2/08/17 8. Work Schedule: Phase Completion Dale " Excavation Woelc Schedule Cacility installation Must be provided' Backfill d: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' - I l.'Remarks: OPEN (1) 4'X4' MAC BELL HOLE D-39 - 1 of 3 12. Insurance Coverage:(Attach Copy) (a) ,Insurance Co_mpany: (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: $1,000,000 per Occurrence and S 2,000,000'general aggregate. 13: Securityi (a)Surety Bond or Certified Check provided in the total'Amount of$ (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 ony 50'Radius whether or nathey`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 520.00 S 20.00 No., A2, /Additional Excavations same service Q SI0.00 S No. B. Excavations 18"in depth or,less 0.100 LIT.—$10.00;Additional L.F.©$0.10 S C. Excavations 18"in depth to 5' in depth 0.100 L.F._$30,00;Additional LX.®$0.30 S D., Excavations 5'in depth and over 0-100 L.F.=$50,00;Additional L.F.Q$0.50 S E. Utility Repair Excavations Q$10.00 $ 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 ofpermit: Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: in accordance% 'th this application and subject to the"General Conditions".and:'Special Conditions"of permit f any)attach h to. SUPERINTE D T AY TOWN OF N YOR Vince r do DatC ,Date Received by the Town Clerk, -� Date Permit Issued 31(l 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 Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 1st 2nd 3rd nth (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•OFTEMM APPLICATION/PERMIT,FOR,HIGHWAY-,EXCAVATION AND REPAIR 1. Pcrntiilcc'S Contractors to Coinnly witliTerrnit Rcaiiirerrmnts:'Tlre Permittee is'responsible for, inform ing,its independent contractors,employees,agents and Assigns of their responsibility to,comply with this'peimit,4including all special/site specific and general conditions imposed by the Highway Superintend6nt,while acting'as the permittee's agent with_respect to-the permitted activities,and such persons-shill be required to-comply with all permit requirements. ,2, No-Riaht to-Trespass or Intcrfere.-MM Private Pronerty Rights: 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,title,or interest unreal or personal property held or vested in a person not a party'to,the permit. 3, Prbtcction of the llialiivav-nnd Future IlighwU,Mnintenancc: If.future operations or highway maintenance projects,by,thc.T_own of Southold require_an alteration in-the position af,the;utility,structure or woikherein authorized,or if,in'the opinion of the-Highway Superintendent the work performed under this°permit'sholl cause unreasonable obstruction to required highway maintenance or endanger,the`health, safety and/or.welfare of vehicular'ar 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.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, Ytcvocation of the Permit by lite Highway Superintendent _•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 least 24 hours prior to commencement'of the project,the permittee and/or contractor shall notify the Town Highway Department in writing that they arc 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 o Final inspection, 6. ,Stora' a of•r ui ment&Materials: The storage of construction equipment andlor 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, Utility MnAt-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 closing a,road. Temporarylane closures may be permitted-with the approval of the Highway Superintendent. This item will'included but not be limited to the installationlof 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; •q, •No'Construction'Debris in'Road Shoulder Area: ,All Construction D'ebris,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 dclirieated with reflective signage or other means to meet the minimum requirements of the NYS DOT Construction Standards. GENERAL CONDITIONS OF,PERM7T; APTLICATION/PERMIT-FORIIIGHWAY EXCAVATION AND REPAIR (Continued) "10. Install;MAintnin E,rosion'Contralm-Required Erosion Control Measures(i.e,silt fencing),is,to be placed on the downslope edge of any'disturbed'area..This sediment berrieris to be put in place before any disturbance of the ground occurs and is to be miintain6d in good,functions)condition until thick vegetative cover is established. I I.,,Clean Fill Only: Ailproject back-fill shall consist of clean sand,gravel or soil•(NOT asphalt,slag,.flyash, broken•concrete or`demolition debris)r_All unsuitable soils excavated at the site(i,&-Clay;Bog,etc)are to be iemoved,from the site and,not used to backfill any excavation within aTown Highway. 12. All'Arcas ofSoil : Ali areas=of soil,disturbance resulting from the'approved projectshall be - stabilized to the satisfaction'oftle Highway Supeiintendentimmediately following'project completion. If .the project site remains inactive for more.than 48 hours or-planting is,imprac6cal due,to the,season,,thcn the area shall be stabilized with straw,hay.mulch and/orjute matting-until weather,conditions favor germination. 13. Bacictill&Compaction of ill Excavations, 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 tweive'(17l'inches thick and'shall be mechanically compacted to a Ninety- five(95%)percent maximum dry density: -Suitable hydraulic compaction by,water jetting atthree-foot. intervals will Also be permitted subject to a project specific approval by the Highway Superintendent, 14.,Restoration of the'Road-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�constmctlon must be replaced or repaired by the contractor to the satisfaction of the Highway-'Superintendent. 15: Schen ntic Pians with nil Technical information kind Scone of Work: 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 oftrenching 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. Pavement Reconstruction: All Pavement sections must-be reconstructed in the following manner; (Note:When Concrete Pavements are Present,Please review Restoration requirements with the Highway Superintendent) a) Complete all back-fill A soil compaction work as needed to provide a suitable sub-base; b) Over-cut existing asphalt bell'hole or,trench by twelve(127)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-compaeted-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 liste0crein must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenching of Pavement Surfaces Exceeding One llundretl 100' Tcet 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 Asphalt(Type 6)Wcaring Course(Typical,shoulder to shoulder). s)iq rational rid a 1 IUM AP ICATION SKETCH Village Of DATE: 1/612017 U LOCATICK: 390 OYSTER PONDS &bss STREET 1: MAIN RD 0 0 TOWN: ORIENT CROSS STREET z: SKIPPERS LN WORK ORDER: 7101918119 an M 5 U N SURFACE: co" Macadam Roe dHN °"ea o 390 z LU n o CL a� cl• on 360' 4'x 4' Bell Hole U U _ N OYSTER PONDS LN 3 * * * RECEIPT * * * Date: 01/13/17 Receipt#: 215676 Quantity Transactions Reference Subtotal 1 Excavation Permits 1186 $170.00 Total Paid: $17000 Notes: Payment Type Amount Paid By CK#36876 $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: 1186