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HomeMy WebLinkAboutBetts St Permit No. RECEIVED TOWN OF SOUTHOLD �suFFOL4, HIGHWAY DEPARTMENT JAN 1 1 1010 Peeonie LaneLL 'Peconic,New York 11958 T101813974 (631)765-3140 Southold Town Clera1 APPLiCAT10N/PERMIT FOR HIGIIWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY"made to the Superintendent of Highways of the Toi4n 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 dcseribed, The applicant agrees to comply with alfappiicable laws, 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 jab site. Keyspan Gas East Corp D/B/A,National,,Grid Printor_Tsm Gas.Permits Dept. Bldg: 3 FI: 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. BETTS ST/EAST RD/FLEETWOOD RD/GLENWOOD RD/HAMILTON AVE/PEQUASH AVE/SOUTHERN CROSS RD Work Description and Location(Street Number,Hamlet,Cross Street) f - (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 ofAp cant Application/Permit Form Is Required for a complete application! 1/3/17 Date 1 S. (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'givc 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 ora Highway Excavation Permit1jjby the Town Clerk. 6, Tax Map No.: District 1000 Section , Mock Lot 7. Starting;Date: 1/14/17 Completion Date: 1/15/171 8. Work Schedule: Plinse Cmnnletilm D:itr k Sc Excavation tiVSchedule racility Installation Aust be provided Backfill&Completion for ponslderation as a Pavement Replacement Complete Application. 9. Under which authority is application tieing 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:,REINFORCE GAS MAIN - PLEASE SEE ATTACHED SKETCH Total of 87 openings= 32 in excess of 50' radius + 55 D-39 ` 1 of 3 12. Insurance Coverage:(Attach Copy) (a) insurance Company:, (b) Policy M (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,$2,000,000 general aggregate. 13. Security: (a)Surety Bond or Certified Check. provided in the total Amount of$ (b)Maintenance Bond provided: 2 years or- 3 years. 14. Fees for Applications and permits: ?01 , Basic Application Fee for Each Project Location - - $150.00 = , 7 �Bv 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 Locatiods shall be subject to the approval of the Highway Superintendent, Al. 87 /Service Connections excavations Q 520,00 g 1740.00 No. A2. l Additional Excavations same service Q S 10.00 S No. B. Excavations•IS"in depth or less 0-100 L.F._$10.00;Additional L.F.Q$0.10 S 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..©$0.50 $ _ E. Utility'RepairExcavations x@$10.00 S No. Repairs same service Q$5.00 $ Additional TOTALS 6540.00 F. Notice to public utilities proof must be provided and Shall be attached to this,applieation prior to issuance of permit. Authorization ishereby granted to the Town Clerk of the Town of Southold to issue,u,Highway Excavation permit to: _ in accorda ce with this application and subject to the"General Conditions and"Special Conditions"ohViteret SUPEAYS TOWN ORK Vift M.Orlando pI / tc Date Received by the Town Clerk t e 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 Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 1st 2nd 3rd 4th (To Permit Clerk) RE CODE 1B 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 RFP. , Ready for Repair D-39 3 of 3 GENERAL CONDITIONS,OF-PE RIYII'I'_ - APPLICATIONMERMIT FOR'HIGHWAY EXCAVATION AND REPAIR 1. Permittee'a Contmetor''s,to'ConinlvwiilrPermit Reauircinents: The Permittee is responsible'for informing its independent contractors,employees,agents and assigns of their responsibility to comply with this permit,including all special/site specific and general'condition§.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 Right to Tres nss or Interfere with Private Prone lU hts: This permit does not convey, the permittee any right to trespass upon the lands of adjacent property owners,in order to,performthe permitted work nondocs 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. Pr•otection'of the Ilighway nnd Future Ilighway'Maintenance: If future operations or,highway maintenance projects by the-Town of Southold require an alteration in the,position of the utility,structure or-work herein authorized;or if;in the opinion of the Highway Superintendent tiie work performed under this permit shell'cause unreasonable obstruction to required highway maintenance or endanger the health, safety 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 of the , permit was illegal or unauthorised 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 of tire Permit by the Highway Su erintendent: 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 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 docs not interfere with normal highway tmffre. 7., Utility Mark-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. '8. Road Closures: 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 the Highway 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. q. 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 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. GENERAL CONDITIONS OF PERMIT' APPLICATION/PERMIT FOR',I3IGHWAY"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 oceurs and is to be maintained 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•de'molition debris).:All unsuitable soils excavated at the site(i.e.Clay,Bog,etc.)-are to be removed from,the site and not used to backfill any excavatiori within aTown Highway.- 12. All Areas of Soil Disturbing: 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.m_ulch and/or jute matting until weather conditions favor germination.- 13. Backfill&Comnrictiatr of all Excavations: -Back Fill shall consistvf 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 arid-shall be mechanically compacted to a Ninety- five(95a/a)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 of tlrc Road Shoulder Aran: 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.'reconstr"ucted 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. Schenintie'Plans with all Technical information and Scope 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 of trenching must be indicated by dimension or labeling. This schematic site plan must provide details on all 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&soil compaction work as needed to provide a-suitable sub-base; b) Over-cut existing asphalt bell hole or trench by twclvc(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; e)-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 minimum requirements of the Southold Town Highway Specifications. 17. Trenching of Pnvement Surruces Exceeding One hundred 00017 ect in Length: All trenching of pavement surfaces exceeding-1001 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 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 F F ENING SKETCH COUNTY/TOWN OF SOUTHOLD/ HAMLET OF CUTCHOGUE / EAST RD/ FLEETWOOD RD/GLENWOOD RD/ HAMILTON AVE/ PEQUASH AVE -51-2295 WORK ORDER: T101813974 r ENGINEER: JAMES PERRY 4 's CONTACT: (347) 838-0354 OS 15 3'x5''r.lbr ♦♦ ♦♦ a x5 � O 000 'j 3'x5' QA FP 3'x5' ♦♦ ♦♦♦ ♦ �♦ �ti`A. oNo ♦, m 3'x5~♦ ♦�Ic 3'x5' 4 Ggsy 1y KEY: ♦ ♦ EXCAVATION PIT IN o5% PAVEMENT (N.T.S.): a°� EXCAVATION PIT 6 �0 ►-/�3�♦♦ti BEHIND CURB (N.T.S.): 2axes EDGE OF PAVEMENT: — EP— 8 . / 3'x5' TEST HOLE ( N.T.S.): DRILL LINE IN PAVEMENT --------- RO (N.T.S.): QTY (5) LIVI DRILL LINE BEHIND CURB --------- (28) T (N.T.S.): DRILL SUMMARY : TOTAL PROJECT JTHERN CROSS RD BETTS ST = 767' FLEETWOOD RD = 1,851' GLENWOOD RD = 735' HAMILTON AVE = 640' PEQUASH AVE = 909' 75 SOUTHERN CROSS RD = 312' foes 14S TOTAL = 5,214' ep las nationalgrid 2� 6 \ . 555 \ 555 y� % 3'x5'b yL 3'x5' F \ \It \ \ O ADO 8x5' 3'x5' ' S5 8x5 �O �"5S Fs OPENINGS: TOTAL PROJECT BEHIND THE CURB OPENINGS: TOTAL PROJECT SIZE = SUBTOTAL QTY DESC SIZE = SUBTOTAL T 8'X5' 200 SQ.FT. (13) DRILL OPENING 3'X5' 195 SQ.FT. .E 3'X3' 243 SQ.FT. (41) TEST HOLE 3'X3' TOTAL 452 SQ.FT. 369 SQ.FT. TOTAL 564 SQ.FT. * * * RECEIPT * * * Date: 01/13/17 Receipt#: 215677 Quantity Transactions Reference Subtotal 1 Excavation Permits 1187 $6,540.00 Total Paid: $6,540.00 Notes: Payment Type Amount Paid By CK#36855 $6,540.00 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 Bld 3 FI 1 Hicksville, NY 11801 Clerk ID: BONNIED Internal ID: 1187