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Home My WebLink About2800 Youngs Ave Permit No. -l TOWN OF SOUTHOLD �so�Fot,�c HIGHWAY DEPARTMENT �,�o• °°g Peeonic Lane Peconic,New York 11958v ' T101888269 (631)765-3140ol oo� APPLICATION/PERMIT FOR HICIIWAY 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 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 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 job site. Print or �Mc Keyspan Gas East Corp D/B/A National Grid 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. 2800 YOU NGS AVE-E/S, 685' S/0 CR 48, SOUTHOLD 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 r,arm Is Required for a complete application: 1/27/17 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 project. (e) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk. 6. Tax Map No: District 1000 . Section , block , Loi 7. Starting Date: 2/26/17 Completion Date: 2/27/17 8. Work Schedule: Phnse Completion Dale Excavation Work Schedule Facility Installation A1ust 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: OPEN 1 4'X4' MAC BELL HOLE TO REPAIR GAS LEAK 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: $1,000,000 per Occurrence and S 2,000,000 general aggregate. 13. Security: (a)Surety Bond or Certified Check provided in the total Amount of$ (b)Maintenance Bond provided: 2 years or 3 years. 14. Fees for Applications and permits: 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 numberbf Project Locations shall be subject to the approval of the Highway Superintendent, Al. 1 /Service Connections excavations Q$20.00 S20.00 No. A2. /Additional Excavations some service Q$10.00 S No. B. Excavations 18"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.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 Q$10.00 S 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(lie Town of Southold to issue a Highway Excavation permit to: I cc an wi this application and subject to the"General Conditions"and"Special Conditions"of permit(if a a ched h SUPERINTEND T A S TOWN OF SOU 17 RK v4wenfiUorland Date Date Received by the Town Clerk-—Ilk[�I f f f Date Permit Issued Permit No. I I 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 1s` 2nd 3rd -4� (To Permit Clerk) REMARKS CODE IB Improper Barricades IL Improper Lights ST Sunken Tr_eneh 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.ofExcavation RFR Ready for Repair D-39 3 of 3 GENERAL CONDITIONS OF PERIVIIT- APPLICATIONMERMIT FOR HIGHNVAY EXCAVATION AND REPAIR 1. Peemitiee,s Contrnctors to Comnlywith'Permit Reauiresnents: 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 conditions imposed by'the Highway Superintendent while acting as the perinittce's igent-with respect to the permitted activities,and such persons shall be required to comply with all permit requirements., 2. No Right to Tresnnss or Interfere with Private Pronerty Rights: This permit does not convey to the pe'rinittee 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 in real or personal property held or vested in a'person'nat a party to the permit 3. Protection of the Ilighivav end Tuture Iliglinvny,Mnintenances 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,oiif,in the opinion of the Highway Superintendent the work performed under this permit shall cause unreasonableobstruction to required highway maintenance or endanger the health, safety and/or welfare of vehicular or, pedestrian traffic,'this'permit shall he revoked and the utility, structure;fill,excavation,or other modification of the higfiwv iy 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 perrnit or Chapter 237 of the Town Code. 4, ReyocAtion of Qe Permit by tit Highway Sunerintendcnt: If the Highway Superintendent deems it necessary' to revoke this permit and the project hereby authorized has nbt 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 oi-any portion of the uncompleted utility,structure_or fill and restore the site to its fan ei r' condition. 5. Notice of Commencement: At least 24 hours prior to commencement of the project,the permittee and/or contractor shall notify"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 or E!guinment&Materinls: The storage of construction equipment and/or materials shall be eon,fined within the project work'amd and/or adjacent areas where permission/legal access has been obtained in a manner that docsnot interfere with normal highway traffic. 7, Utility Mnrlc-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility mark-outs slid shall-take all precautions to protect same. Damage to existing utilities shall be the resppnsibility of the eonireetor 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. Tempoiary 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, 9. No Construction Debris in Road Shoulder Area: All Construction Debris shall be removed from the job materials that will,be st site on a daily basis. All stockpiled soil as well as all other project mataged 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/mi R_ MIT FOR 1UGHWAY EXCAVATION AND REPAIR (Continued) 10. Instals Maintain Erosion Controls: Required Erosion Control Measures(i.e,silt fencing)is to be placed on-thc 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 maintained in good functional condition until thick vegetative cover is established. I 1:Clcan Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete 6Hemolition debris}. All unsuitable soils excavated at the site(i.e.Clay,Bog,etc)arc to be Tentoved from the site and not used to backfill'any excavation within a Town Highway. 12. All Areas of Soil Disturbancti: 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'rema'ins,iii ctive fo`r 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. Bncicfnll&Coinnnction of nlI Excavations: Back Fill shall consist of clean fill or soils which exhibit a ,well-defined moisture density relationship as•detemnined`to be in accordance with A971 m 698. Filfshall be placed in maximum lifts of twelve(12')inches thickiind 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 ShoAtI&Arca: Ail man-made improvements located within existing road shoulder areas must be'protected to the greatesf 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 construction must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent. 15. Schematic Plans with all Technical information rind Scone of Work: To reasonably and adequately describe the proposed work;accurate schematic site pians must be provided to`show or indicate all proposed construction activity required-under thispermit'. All Piivement 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-mustbe indicated by dimension or labeling. This schomatic'shd plan must piovide details on all restoration required to meetthe requirements of these General Condition's 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 Preserit,Pinse 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 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 luilf(2.5')inch compacted lift of Asphalt,Base Course; c). Install a one and one half(t.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 or Pavement Surfaces Exceeding One Hundred 000'1 Tect in Length: 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 over the entire length oftrench shall be repaved with n two(2") inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). sJ ty lea-i D14AL Gni-D — — — —---- —REQUE-ST—FOR—STREET-OPENING-°PERIMJIIT NASSAU ❑ SUFFOLK ® You.!Mo L-1Z) FC-61114 STATE COUNTY COUNTY PERMIT NMIIS JOB/ DATE ! to �8�26 q ! z�' `7 LOCATION zgo0 Logao Am. 8� e R. `!8. L0077100 REASON FOR OPENING W.OJPA FOREMAN DATE OF NO. OPENING REQUESTED DEPARTMENT DIVISION BY K C - fZ GAS CONSTR.MAINT.&SERVICES iEfJ S;cc P -v f-co I.,< APPROVED DATE SKETCH COUI�I�y �[7a Ll 9 N 6�5' loU1VGS AVE. x f X2800 Y s' GRASS * * * RECEIPT * * * Date: 01/31/17 Receipt#: 216095 Quantity Transactions Reference Subtotal 1 Excavation Permits 1195 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#37138 $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* 1195