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HomeMy WebLinkAbout4030 Stillwater Ave Permit No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peeonic Lane _` , Peconic,New York 11958 �`�. T101955352 (631)765-3140dl�, APPLICATION/PriiMIT FOR HIGIMAY-rxCAVATION AND RrI'A]R 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 To%vn 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 withall applicable laws, ordinances,codes and regulations,the attached"General Conditions of Permit"and"Speolnl Conditions",if any and to permit authorized inspectors to make necessary inspections of the jab site. PrintorT Keyspan-Gas East Corp D/B/A,National Grid Gas Permits Dept. Bldg: 3 FI: 1 l 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 4030 STILLWATER AVE; E/S OF TRACK AVE, 30' S/0 STILLWATER AVE, CUTCHOGUE 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 L-M- NOTE- All information requested by this Signature of Appi ant Application/Permit corm is Required for a complete application: 4/26/17 _ 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. (c) 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 , Lot 7. Starting;Date: 5/25/17 Completion Date: 05/26/17 8. Work Schedule: Phnse Completion[late Excavation W rk Schedule Facility Installation 1liiust be pf6vided 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: S _ y.. - --� - -• 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 fife 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©S20.00 S20.00 No. A2, I Additional Excavations same service()a S 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;Additiona6 L.F.Q 50.30 $ 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©$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 die Town of Southold to issue a Highway Exe vation permit to: in accordance with this application and subject to the"General Conditions"and"Special Conditions"of permit(if ny)attache ret . SLIPERINTEN A S TOWN OF S EW RK incent DAtC Date Received by the Town Clerk 6 l I "h_ Date Permit Issued I� I T Permit No. 1208 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 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 OF=PERMIT - APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR 1. ,Pcrrnitiec's Ctiiitractors to Coinrily with Permit Roauirentenis: -Tho Permittee is responsible for ' iciforinidg its itidepcndent'contractors,employees,agents'and"Assigns of their.responsibility'to comply with this;-,,*,,t, i ' i ding all spec!Wsite specific and general conditions imposed by the Highwisy Superintenifent'wbile acting°as the permittce's agent with respect to the permitted Activities',and such persons shill be required to comply with all permit requirements, 2. No Ri'ht io.Tres ii s or InlerPe`rc with Private Pro-de `Ri hts: This permit does not convey to the permittee any.right to trespass upon'the lands-of adjacent property owners in order to perfortn'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 not a party to the permit. ; -3. Protection of the Ilisinvly rind Tuture IIlelrnmy'Mnintenanee:. 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 the work performed under this permit shall cause unreasonable";ob`struciioa'to rcquired,liighway'rc ni'n'mance or endanger the health, safety and/or welfare of vehicular or pedestrian traffic,this permit shall be=revoked and the utility, strildWre,fill,czcavatioa,or other-modification of thc-higtiway 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, , Revocation oriiie,Permit by thel-ligbA&Stierintendent: If the Highway Superintendent deems'it necessary to revoke this permit and the project hereby authorized has not been completed,the applicant shrill,without eipense to'the'Town and to such extent and in such time and manner as the Superintendent may,require,remove all oreny portion of the uncompleted utility,structure or tilt and,reslore the site to its former`condition. = 5. Notice of Commencement: -At least 24 hours prior to commencement of the project,the permittee and/or coniiactor shall notify the Town Highway Department in writing that they'are fuily 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. Storitee of Eguinment&Materials: The storage of construction equipment and/or materials shall be confined within tha 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 Marls Ouls: The Appiicant/Contractor shall be responsible for verification of all existing utility mark=outs and shill take all precautions to protect sante. 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 front 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.tris installation of appropriate signage and flag mento 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 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. GENERA_L CONDITIONS OF-PERMIT.- - ` -APPLTCATION/PERMI_T.FOR` UGHWAY EXCAVATION AND REPAIR (Continued) 10. Install -Mnintnhl Erosion`Controls:` Required Erosion Control Measures(i.e,'silt fencing}is to be placed 6rt'tlie;downslope edge ofiuty 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 cstablisfied.' 14, Clenn'Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, bio_ken concrete oi'demolition debr`is)..All unsuitable soils excavated at the slit(i:e-Cluy;''Bog,'e`tc)are to be removed from the site and not used to backfill any excavation within a Town Highway. 12. All Areas of Soil Disturbance_: All areas of soil disturbance resulting from,the approved project shall be stal%ilizcd to the satisfaction of the Highway 3uperinteiident immediately following project coiripletioti. 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 mulch and/or jute matting until weather conditions favor germination. 13. B,.%'blctill&Compaction of n111Cacnvations: Back Fill shall consist of clean fill or soils which exhibit a well=definodmoisture density'"relationship as detemrined to he in accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve'(lTJ inches thick tutd shall be mecl:anicfilly compacted to a Ninety- ' five(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at three-foot intervals will also be permitted subject to a project specifto approval by the Highway.Superinteiident, 14, Restoration 6fthe 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 construction must be replaced or repaired by the contractor to the satisfaction"of the Highway,Superintendent. 15. Schematic Pians with ail-Technical information and Scope of Work: To reasonably and adequately de`scribe,tha._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 sow cut to the full depth of asphalt and/or coticiete pavements. Accurate size of bell holes or width of trenching must be indicated by dimension or labeling. This schematic site planmust provide details on all restoration required to meet the,requiremcnts of these General Conditions and requirements found in_ihe 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) Cotttplele 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 twoand one half(2.5' inch cornpacted lift of Asphalt Base Course; c) Install a one and one half(1.5")inch of Asphalt(Type 6)Wearing Course. (Provide At, at all joints) All work listed herein must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenebine ofPavement Surruces Exceeding One Hundred(Ion')Feet 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`satisfacdon of the Highway 'Superintendent,the entire road section and/or width ofroad 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). sJ ty 0 N a MR= M&CATION,SKE.T HI � Village ,Qf L -I}ATE'e 4/251201 7 kn °'LOCATICK-, 4030' TILLVVATER'AV(Ross srREET•r: STILLWATER AVE- ,.TOWN:, 'CUT TOWN., MOSSSTREET s;� w kn .W_mK oRbER: T-101955352, o U kn '• ui fvledm.Ro d ;HovMNOL c 4030 r� Q w o J � J co cC bq 30' cc -4 x 4' Ball Hale. a U Sri TRACK,AVE 3 * * * RECEIPT * * * Date: 05/02/17 Receipt#: 218889 Quantity Transactions Reference Subtotal 1 Excavation Permits 1208 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#38051 $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 Bid 3 FI 1 Hicksville, NY 11801 Clerk ID: BONNIED Internal ID. 1208