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Home My WebLink About2595 Wells Ave L * * * RECEIPT * * * Date: 03/07/17 Receipt#: 216910 Quantity Transactions Reference Subtotal 1 Excavation Permits 1199 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#36567 $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 1199 RECEIVED Permit No. ` MAR - 1 2017 TOWN OF SOUTHOLD HIGHWAY DEPAN NT ��o�gOfFOt,�coG� Pecohic Lane STou7hold Town Clerk ' Peconic,New York 11958ati T101903798 (631)765-31401; - ao� APPLICATION/PrRMIT FOR 141GIIWAY rxCAVATION AND RRPAIR 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 appliepble 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. Keyspan Gas East Corp D/B/A National Grid Printor'1'�� Gas Permits Dept. Bldg: 3 FI: 1 l 516 545 4094 175 E. Ofd 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. 2595 WELLS AVE-S/S, 548' S/0 HILL RD W 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 ofAp 'cant Application/Permit Form Is Required for a complete applicationl 11/23/16 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 or all site and pavement restoration work. (b) Attach all other necessary permits and licenses for this project. (c) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk. 6, Tax Mnp No.: District 1000 . Section Block 4- . Lot 7. Starting Date: 12/22/16 Completion Date: 12/23/16 8. Work Schedule: Prase Catnnletion Date Excavation NVork Schedule Facility Installation A'lust 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.,lnsurance'Coverngci'(Attach Copy) ,- .. ..(a),Insuriuice Company: {b). POlicy`ti::. .'' N. (c)State whether policy of certification o,file with the HighwayDepartmentr (d)6verage required extended to the Town:', Any Loss including Bodily injury,`properiy 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 Arn*t of S (b)14aintenance413-ondprovided: _ 2_years-or 3 years. l4', Fees for Applications and permits: Basic-Application Fee for Each Project,Location - $150.00 A Project Lacutlowwould`includc'each Bell Hole and/or every road opening or,excavation wlthin any St)'Radios'Whether of not- may be inter-co_nnected by open trehch'or directional boring. The iotas nusribernf Project Locations'shull be subject to the approval of the Highway'Superintendent, Al., _ /Service Co_nnedtians excavations 0$20.00 ' - g 20.00', No. , •A2; R, I -�/Additional Excavations same service Q S 10.00 -S Na: _B. Excavations 18"in depth.oe less = 0-100 L,F.. $10.00;Additional L.F.Q$0.10 u 5 C. XExcavations 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.l±.=$50,00;Additional L.F.'Q$0.50 ' E: Utility Repair Excavations Q$10.00 $ No. Repairs same service A55.00 S Additional - TOTALs 1,70.00 P. NO'tice to public utilities'proof must be provided and Shali be attached to this'application prior to issuance ofpermit. Authorization is heieby granted to the Town Clerk-of the Town of Sauthold,to issue a Highway E a ation pc i ccord v' this,applicatian and subject to the"General Conditions"and"Special Conditions"of permit _ tin attac d o. SU PERINT TOF AYS' TOWN OF I OR _ Date Received by the Town Clerk Date Permit Issued 1- Permit No. NOTE:_ Permit expires one(1)year from date of issuance. " 4al 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: Q Permit# � 1 Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified 1 s< 2nd 3rd 4th (To Permit Clerk) R1E1Vli'ARKS 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-OF•PERMIT APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR 1. Pcrniitiec's Continiclots to C6n1P1jwit11'Pci•1111t Rcnuireinbtits: The'Permittee is responsible for infoimin'g its,itidepcndent contractoik'employees;`agerits and'assigns of their responsibility to comply with this permit, iricludirig`aIl speciaVsite specific and.gencral'conditions imposed by;th'c Highway Superintendent while acting as the-permittee's agent with respect to the permitted activities,and such persons sha116e required`to comply wWall permit�requtrements. _ 2. No Right to Tres"ass 6Inicrfei c wilh'14ivnte i'ronerty Rights:'This permit does riot convey,to the permiftec any right,to trespass pipon the lands of adjacent propctty►owners in aider to perform the permitted work nor does it authorize theimpairment'of any righis,,titleinterest in real or personal property;or field or -vested in a person nota part y.to the permit,= 3. Pi ol'ectian of tLc Iiighivny and ruiire IIiglnvay Maintenance:''If futiiie;operations or highway; maintenance projects by,the Town of,Southold require an''ulteration in the positidq df the utility,structure or'work herein authorized;or if;;in the;opinioe of the'Highmy„Superintendent the work performed under this permit shall ciius"e unicasonable olistivetion 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;f ll,excavation;or other modification of the highway.hereby,authgrized shall not lie conipteted. Additionally,tho permit niay 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`iuiy of the terms and conditions of thepermit or Chapter 23 7 of the Town Codc,' '4. Revocation ofitte Permit by the Higbwav SunerinteWddat: If the Highway Superintendent deems it necessuy to revoke this permit and the project hereby authorized has not been completed,the applicant shat I,without expense to the Town and to such'extent and in such'time anci riianner as the Superintendent, may require;reiriovc all orany portion of the uncompleted utility,structure or-fill and re ore site to its, farmer condition:= 5. N66ce 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 tiviiare of and understand all terms and project conditions df this permit. Upon corripletion of the work;the-co-ntractor shall provide photographs of the completed work to the Town-Highway Department and request.a Final inspection. ti. Stoi itee of F.guii meni Si Materials: The storage of construction equipment and/or materials shall-b c' confined within the project`work area andlor'adjacent areas where permission!legal access hits been obtained in a manner that does not interfere with normal highway traffic. 7. Utility Mnrtc-Outs: The Applicant/Contractor shall be responsible for verificatlon of all existing utility mark-outs Arid shall take all precautions to protect same. Damage to existing utilities shall be the responsibility of the contractor and shall be repdired 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 High�vay Superintendent.' This item will included but not be limited to the installation of appropriate signage and- flagmen to stop and start traffic to allow for single lane'traffic: Road CIoswes due to unforeseen emergencies require immediate notification of the'Highway Deportment and shall be limited to immediate and/or expedited restoration of the'Work Zone.' g. No Constriction Debris ill Road Shoulder Area: All Construction Debris shall be removed from the job site on a daily basis. All stockpiled soil"'well as all other project materials that will be staged within the Right-of Way must be`dclitticiifed'with`reflective signage or other means to meet the minimum requirements of the NYS DOT Construction Standards. GENERAL CONDITIONS OF,PERMIT -APPLICATION/PERMIT,'FOR-I-HGHWAY,EXCAVATION AND REPAIR (Continued) Iiktall'Maintain Erosion Controls: Required Erosion Control Measures(i.e.silt fencing)is to be placed, on the downslope edge 'f any disturbed area. This sediment barrieris to be put in placebefore any disturbance of 1:h6 ground occurs and is to be miiintained ingood functional condition until,thick vegetative cover is established. Clerin Fill Only:,Ail project back-Ertl shall consist of clean sand,gravel or soil(NOT asphalt,slag,tlyash,' site broken'concrete or'demblition debris}:,Ail unsuitable soils excaviitcd at the ,{i.e.Cldy;Bog,etc)ere to be-removed'fiom the,sitc Rind riot used to backfill any excavation within aTown`Highway. 12. All A>reas of Soil,Dlstueb6ice: Ali areas of soil disturbance resulting from the approved project shall be stabilized to the satiOd6tion'.of the Highway Sup`erintendet t immediately followingproject completion. �If the;project site remains inactive for,more than 48 hours'ar planting is ittipractic$1 due to the season;then _ the area shall be stabilized with'sitr'k•Bay mulch'anilo jute matting until weather conditions favor germination. 13. I3aetcfill&Cotriiiitctidit of nll ExcA Vi loris: Back"Fill shall consist of clean fill or soils which exhibit a well=defsned rtioisfwe'den"sity'ielationship as determined to;be in accordance with ASTIVID 698. Fillsholl be pieced in maximum.lifts of twelve(12')inches thick•and'shall be mechanically compacted to a Ninety- f hive(95°/a)percent maximum dry density.' Suitable hydrtiuliectiitipaction by,water jetting atthree-foot; intervals will also be'permitted subjectto a pro iectspeaific'approval,by the Highway Superintendent. 14..Rcstorsiiion of the'Road Shoulder Arca: All man=made'i.rnprovcments located within existing road shoulder areas must,be protected to the gtiatesi'extent practical.; Items would incldde but not 6e'limited to ,•. driveway&pnvate road aprons;mail boxes,sprinkler systems,trees and ornamental plantings. ; Excavations through driveways and private road payeinents'rtiust be;reaottsinicted to meet all requirements of Southold Town" High way;Specificatiotrs,"All pie-existing road shbolder improvements that have been disturbed during construction must be ieplaged or repaired by the contractor to the satisfactioitLof the Highway Superintendent.' ;15. Schematic Plans with 0Technical in rind Scone of Work: ,To reasonably and adequately describe ttie propo's"ed"work,acaur`atc'sch6rnatiesite plans must be provtded to show or indicate all ; proposed 6nstruc6n-activity required'under this permit. All Paveme'''nt surfaces scheduled for excavation must be saw cut to tho.full depth of asphalt and/or concrete pavements. Accurate sire of bell holes'or width oftrenching ritust be ind'icate'd by'-dimbnsion or labeling. ?his,schematic site plan must provide'details on all restoration required fo meet the requirements of these Gener,'a!Conditions and requirements found in the Southold Town Highway:Specifications, 16. Pitvement-Reconstruction: All Pavement sections most be reconstructed in the following manner; (Hots:When Coperete Pavements are Present.Please review Restoration requirements with the Highway Superintendent) p} Complete,all brick=f ll-&soil compaction work as needed to provide i suitable sub-base; ,b) Over-cut existing asphalt bell hole of trench by t%vclve(12")inches on all.sides; c) Install a compacted lift of 4"thick Stone Blend base(RCA Blend mustmeet NYS DOT Specification); d) Install a two and one half(2.5")inch compacted lift of Asphalt Base Course; c),,Install a one and onefialf(l:5")inch of Asphalt(Type 6)Nearing Course. (Provide at all joints) All work listed herein mustmeet the ininirmum requirements 0f the Southold Town Highway Specifications. 17. Trenchine of Pavement Surfaces Exceeding One ITundred(1061)Tect in Lcn tit: All trenching of emenf sui faces exceeding 100firs puv ' in length must t be,'ieconstruote'd to meet the requirements of Item #'16 its noted above. Once all pavement reconstruction is completed to the satisfaction of the Highway ,Superintendent,the entire road section,and/orwidth of road over the entire length oftiench shall be repaved with a two(2")inch lift of Asphalt Cr*6)Wearing Course(Typical,shoulder to shoulder). sJ ty C4-4 o e N ilonal, grid CQ N a MR= APPLICATION<SKETCH- Village-Of' DATE: 11123M% LOCATION: 2696 WELLS AVE CROSS-STREET I. HILL RDW' N TOWN: 'SOUTHOLD CROSS STREET 2e- 9 -WORtc DRDE,x: T1.01903798- .b b SURFACE: Macadam"Ro d- �Hou*NO. f � o rA a� CL- cq 0 an 4",x 4' Bell Hole U Sri _ _ N WELLS-AVE � a�