HomeMy WebLinkAbout11815 Sound Ave - 1
* * * RECEIPT * * *
Date: 03/20/17 Receipt#: 217244
Quantity Transactions Reference Subtotal
1 Excavation Permits 1200 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#37580 $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* 1200
RECEIVED
Permit No. 011u— ' 2 0 2017
'14 G14WA DE ARTNSt NT ' �o�guFFoc,1.�oG�
Peconic Lane , Southold Town Cler
Peconic,746v,York 11958 0
T101941792 (031)765=314001•;, ,
APPLICATION/PERMIT,FOR HiGI•IWAY-TXCAVATION AND REPAIR- ,
APPLICATION IS HEREBY made to the Superintendent of Highways of the to n' 61 Southold for the issuance of an Eatcavatioii Permit
pursuant to Cliapler`237 of the Code of the Town of Southold,Suffolk County,New York,and other applicable laws,ordinances or'
regulations far each,individual contiguous excavation project hereln described. The applicant agrees to comply with 411 applicable 1a1Y3,
ardinimces,codes andregiifations,the 4ttached"General_Conditions of Permit"and"Speelal Conditions",if any and to permit authorized
inspectors to make necessary inspections of the jobsite. ;
Print or'fvnc keyspan Gas East Corp 0/B/A National Grid
Gas'Permits Dept. Bldg: =3.FI c 1
I, 516 545 4094; 175 E. Old Country Rd Hicks;41e1 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. 11815 SOUND AVE - S/S, 185' W/0 LIPCO RD _
Work Description and Location(Street Number,,Hamlet;Cross_Street) `
(a) Is constivcton located ivithin,75 feet of tidal wetlands? *Yes No
'If yes,other Town permits moy be required,-
Margaret Paglia
NOTE: All information requested by this Signature of App i ant
Apphcation'/Permit form Is
Required for a complete appliention_t 3/13/17 .
Date
S.' (a) 'Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan showing the
locntion-of all proposed excavations and relationship to adjoining premises,public streets or,areas,and give a detailed,de_scrip
nll'site and pavement restoration work. tion,of
(b) Attach all othernecessary permits.and licenses for this project.
(e) Work covered by this application may not commence before issuance of a Highway,Exdavation Permit by the Town Clerk.
6. Tax Map No.: District-1000- ,Section , Block ; Lot
7. Starting Date:' 3/08/17 'Completion Date: 03/09/17 -
8. Work_ Schedule: Plhnse Comnletion`Dntc
Excavation Work Schedule
Facility Installation - Must be proyided
Backfill S Completion for consideratioa ns a
06ehnettt 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 INSTALL GAS SERVICE
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 number-of Project Locations shall be subject to the approval of the Highway Superintendent,
Al. /Service Connections excavations @$20,00 S 20.00
No.
A2, /Additional Excavations same service @$10.00 S
No.
B. Excavations 18"in depth or less
0-100 L.F._$10.00;Additional L.F.@$0.10 S
C. Excavations 18"in depth to 5' in depth
0-100 L.F.=$30.00;Additional L.F.@ S0.30 S
D. Excavations 5'in depth and over
0-100 L.F._$50,00;Additional L.F.@$0.50 $
E. Utility Repair Excavations @$10.00 $
No.
Repairs some service @$5.00 S
Additional
TOTAL$ 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 the Town of Southold to issue a Highway Exca ation permit to:
_ in accordance wi
this application and subject to the"General Conditions"and"Special Conditions"of permit(if ny) tache er
SUPERINT AYS
TOWN OF S D OR
Vincen 1 o
Da c
Date Received by tate Town Clerk - A'bv �
Date Permit Issued A aO 11 Permit No. ;L0
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# k900
Highway Depm1 nent
Engineer(with ptige 3)'
Town Clerk(Originai)
INSPECTOR'S RECORDS
Inspection Date Findings(use,code) Applicant Notified
1st
2nd
.3rd - ——
(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 OF PERMIT
'APPLICATION/PERIMT'FOR HIGHWAY EXCAVATION AND REPAIR
1, Pcrmitlec'c Cantrsectors to Comnlywitli-Permit Roauireiucnts: The Pennittee is_respotisible for
infai7ning its independent-contractors,employees,agents'and assigns"of their responsibility to comp{y with
th{s,permit;including al(special/site specific and general conditions imposed byth'e;Highway
Stiperintendent`whileacting as thg periiiittce's ageittwith respccfto the permitted activities,and such
persons'shali be required to`comply with'all permit requirements..
2; No Right to Trespas or Inierferc tiviu Pirwv tb l'ro er Ri hts: This permit does,not conveyto the
permittee any'right°to trespass`s upon the lands of ad jacent�"property'ownefs in order to perform the permitted
work nor does'it authorize the tinpairnteat of anyrights,title;or interest in real or personal property held''
vested"in a person not a,party to pepnit.
3. Protection of the Hi
,Is,v and Tu'ture Ilieliivny°Maintciiance: If future operations or highway,
maintenance projects by the Tewn'-of Southold require en altcratlon in the;position of the utility;structure
or work"herein authorized,or if,in the opinion of the Highway Superintendent the work periormed under
this-permii shah cause unreaso iabIo 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;f ll;'excavation;'or other modification of the"h{ghway hereby authorized slisilrnot lie completed.
Additionally,the permit may be revoked if tbe,Higbway Superintendent f ads that the issuance,of Ilie
permit was illegal.gr unauthorized or that the applicant failed to comply with nyof the tennis and
conditions of 6`;p rmit or Chapter 237 of the Town Code:
4, Reyociition elf the Permit by the 1•Iia6k Sunerintcii' a t: if the Highway Superintendent deems„it
necessary to revoke this'peimii and the project hereby authorizeen
ed has not bcompleted;the applicant
shall,without expense to the Town rind to such'extent and in such time and manner'as'ihe Superintendent ,
rnay,require,"remove all or any portion of the uncompleted utility, structure or fill and reslore'the site to its
former condition.
s. , Notice of Commencement: At least 24 hours prior to commencement of the project,the permittee and/or
contractor shall notify;the Town Highway Department{n writing that they"arc fully aware of and
understand=all tennis 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. Sterane of l:guininent&Materinls: The,storage of construction equipment"and/or materials shall'b
confined within the project work area And/or adjacent areas iv6ere permission/legal access hAs been, "
obtained in a manner that does not interfere with normal highway traffie.
7, Utility Mnrlt Outs: The Applicant/Contractor shall be responsible for verification of all existing utility'
mark outs acid shrill take ali'precautions to protect same. Damage to existing utilities-shall be the
responsibility of the contractor aad'shall be repaired at the contr`actor'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 se an
flag men to stop an star!traffic to a16v for single lane.traffic. Road Closures due to unforeseen
emergencies require immediate motif cation of the Highway Department and shall be limited to immediate
and/or expedited restoration of the Work Zone, '
g, No Construction Debris iu,Rond Shoulder-Area: All Construction Debris shall be removed from the job
site'-on a daily basis: All"stookpiled'soil as well as all other project materials that will be'staged'within the
-Right-of Way'imi t be delineated with reflective signage or other ineans to meet the minimum requirements
of the NYS DOT Construction Standards.
GENERAL CONDITIONS'OF PERMIT,
APPLICATIO•NMERNIIT FOR IiIGHWAY EXCAVATION'AND REPAIR
(Coritftiucd),
10. Install:Wint iiri Erosion Canirals: 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
disturbce ofanthe ground occurs and is to be maintained'iii-.66d furtctionai condition until thick vegetative
cover is established.
11. Cienn Till 006 All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,,_ h,
broken concrete oi'demolition debris).,All unsuitable soils cieuVated at the site(Le.Clay;Bog,etc)arc to
be removed from the site and not used to backfill any excavation within si Town Highway.
12. ,All Areas of Soii bisturb'ance: 'Ali areas of soil disturbance resulting from the approved project shrill be
stabilized to the satisfaction of the Highway Superintendent irtimedintely'followingprojcct completion. If
#tic project site remains inatitive for more than 48 hours or planting"is impractical due#o the season;then
the area•shall bestabillied with straw,,hay mulch and/ac j_ute matting until weather conditions favor
germination.
13. i3a`ekfill&'66ni ction orAl ExcAvations: Back Fill shall consist of clean fill or soils which exhibit a
well-'defined moisture density relationship as determined to be in_Accop .. pe with , , , - , 698. Fill shall
be ptaced-in maximum lifts of twelve(12')inches Blick olid shall be mechanically compacted to a Ninety-
fve,(95°!g}percent maximuiit dry density. .Suitable hydraulic compaction by wafer jetting at three=foot
intervals will also be`permitted subject to a project specific approval by the HightvgySuperintendent. ,
14.-Restoration of the Road Sliouhler Anew. All man-made`improV6ments located within existing road
shoulder'areas must be protected io the greatest extent practical.'_Items would include but not ba limited to
driveway&private road aprons,:mail oxes,sprinkler systems,trees and ornamental plantings.
Excavations through driveways and private road pavements,rnust be reconstructed to meet all requirements
of Sauthoid Town Highway Spe6ifi'cations, All pre-existing road-shoulder improvetnenfs that have been
disturbed during construction must be"replaced or repaired by the coniiactar to the'satislaction of the
Highway SuPeriatendent.
15. Schematic Plans with all Technical information and Scone of%Vrirk:,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 this permit. All Pavement surfaces scheduled for excavation -
must beIsaw cut to the full depth of asphalt and/or concrete paycmehts. At' ate size:'ofiiell holes or width
of trerioliing must be indicated by dimension or labeling. This schematic site plen,must provide details on
all restoration required#o rneetihe 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 arc Present.Please review Restoration requireincnts with the Highway Superintendent)
a) Coinplele all back=fill&soil compaction work as needed to provide a suitable sub-base;
b) Over-cut existing asphalt bell hole or trench by't%velve(12")inches on'ail sides; .
•c) install a compacted I ift,of 4"thick Stone,Blend base(RCA Blend must meet NYS DOT Specification);
d) Install a two and one half tzs, inch compacted lift of Asphalt Daae Course;
c) Install a one and one half(1:5"}inch:of Asphalt(Type 6)Weanng:Course. (Provide AC at,all joints)
All work listed herein must inset the minimum requirements of the Southold Town Highway
Specifications.
0. Trenching of Pavement Surraces Exceeding Oric Ilundred(100')Tcct in Length:.A!1 trenching'of
pavement surfaces exceeding'100' in length must first be�reconsftudd 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 aver the entire length of trench shall be
repaved with'a two(21)inch lift of Asphalt(Type 6)Wearing Course.(Typical,shoulder to shoulder).
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Vi Ilage Of
DATE: 311312117
DOCATICK; 11815 SOUND-AVE CROSS STREET 1: LIPCO RD N
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WmK ORDER: T10194179
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