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HomeMy WebLinkAbout16 Sound Rd Permit No. - - - 7 , • Y • HIOL GHWAYD PARTNf NT- - ��o•,pgu>~FO,t,t�oG� ' Pecoriic Lane,;} . Peconic,-New Yoflc 11958 ' T1019,58323 (631)765-3140x1 APPLICATION t Pr,RM1T,r6R HIGinVAY TXCAVATION AND RT:PA7R• 'APPLICATION IS HEREBY made to the Superintendent of Highways of the Town�of Southold forthe issuance of an.l~xcavation Permit pursuant to Chapter 237 of the Code of the Town of Southold,Suffolk County,New York,k,otber applicable Iai ordinances or regulation's for'each individual contiguous excavation project herein described.•The.applicant agnea to comply with all applicable lbws, ordinances,codes and regulations;the attached"General Conditlons of permit"and"Spe'elal Conditions",if any and to ' rmitaulliorized inspectors to,make necessary inspections of the,job'site.' Print orTvnc Keyspan.Gas East Corp D/B/A,Na0onal•Grid• Gas; 12. Insurance Coverage:(Attach Copy) (a) `Insurance Company; (b) Policy#: t (c)State'whethcr policy of certification on fife with the Highway Department: (d)Coverage required extended,to the Town: ` Any Loss including Bodily injury;propeity,or commercial injury caused by or attributable to the work performed: S 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' 3years. 14. Fees for Applications and pe-rniiis: Basic'Application Fee.far Each Project Location -- S150.00 A Project Location would include each Bell Hole and/or every road opening or excavation within any 50'Radius whether br'not'they'may be'inter-connected by open trench or directional boring. . The total numbertf Project Locations shall be subject to the approval of the Highway Superintendent, Al. ' /Service Connections excavations Q 520.00 S 20.00 'No. A2, Additional Excavations same service Qa S10.00 S No. B. Excavations IS"in depth or less 0-100 L:F.'=$10.00;Additional L.F.©S0.10 $ C. Excavations 18"in depth to 5'in depth. 0-100 L.F.=$30.00;Additional L:F.®50.30 S D. Excavations 5'in depth and over 0-100 L.F._$50,00;Additional L.F.®'$0.50 $ E. Utility Repair Excavations Q$10.00 S NO., 11 Repairs same service Q$5.00 $ Additional TOTALS 1'70.00 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 Excav on permit to: I accordance this applicatiod'and subject to the"General Conditions"and"Special Conditions",of permit(if an att ed to. SUPERINTEND T.OF A S TOWN OF SO, H, E Y v' cent M. 1?t2 'Date ' Date Received by the Town lerk Date 1?ermitIssued Permit No. V 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 if Highway Department' Engirieer(with page 3) Applicant' Town Clerk(Original) = INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified lst 2nd (To Permit Clerk) ' REMARKS CODE ' IB improper,Barricades IL Improper Lights ST Sunken Trench,or'Excavation UTM Unable to Measure(due to backfilling l3UC Building Under Construction WIP Work In Progress DB Improper Backfill(too high;not sufficient) - HFS Inspector Holding for Final_Settlement of Excavation ItFit Ready for Repair D-39 3 of 3 GENERAIXONDITIONS OF PERMIT APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND`REPAIR 1. Permitiee's Contrnelars to Comwvwith Permit Recnsircinents: The Pesmittee,is responsible for informing its independent contractors,employees,agents and assigns of their cspon' ility to comply with th'is'permit,'including sill speciaUsite specific and general conditions imposed by the Highway ' Superintendent while acting as,the pesmittee's agent with respect to the permitted activities,and such persons shall lie required to comply with all permit requirements. 2. No!light to Tresn:iss or Inlcrrc"rc wilts]Mi i►te Property Riehts: This permit does not convey to the permittee any right to trespass upon the lands of adjacent property owners in order to perform the permitted work nor does it authorize ihe'impairmeni'ofany'rlgho,title,or iateiest in real,or personal property held or vested in a person not party to,the,permit. _ 3: Protection of the IIiahwny and Tuturc IIinliwny Maintenance: If future operations or highway, maintenance projects by the'Town of Southold require 'an alteration in the'position of the utility,structure --7„. or wank herein authorized,ar if,in the opinion,of the Hhg!►way Superintendent the work performed under' this permit shall'cause uiireasonable'obstruction to required highway;mairitenance or endanger hgatth, safety and/or welfare of vc_hlcuiar or pedestrian traffic;this permit shall be'"re'vok , and the,utility', structure,fill,excavation;or other modification of the highway heieby authorized shall not be completed. Additionally;the permit may be revoked if the Highway Ssiperintendentnds thatthe issuance of the ,permit was illegal or unauthorized ' that the applicant failed to comply with„any of the terms and conditions of the Permit or Chapter`2,7 of the.Town Code, 4. Revocntion orll a Persnht by the$Siehwa Superintendent: if the HighwAy Superintendent deems it ..necessary to`revoke this permit and the project hereby authorized has pat been'completed,the applicant shal 1,without expense to the Town and to such extent and Jn such time acid manner os the Superintendent may require,removalor any portion of the uncompleted.utility,structure or fill and restore the site to its former,condition. ' 5. -Ndticc'ar coM' meg&me'nt:,At least`24 hours prior to commencement of the project,tho perm ittee and/or contractor shall notify the Town Highway Department in writing that they ire fully aware of and understand ail terms and project conditions of this permit. Upon completion of the work;the contractor shall provide photographs ofthe completed,work to the Town Highway"Department and'request a Final inspection. = 6. 'Storaee of Equipment&Materials: The storage of construction equipment and/or materials shall be confined within the project ik6rk area,and/or Adjacent areas Where.petmission/legal acees&has been _ obtsi6 in a mariner that does notinterfere with norma!highway traffic: 7, Utility Mssric 'Is: The Applicant/Contractor shall be responsible for,verification of all existing utility mark- and shall take ail pre utions to protect same. Damage to existing utilities shall be the responsibiiitiof the coritiaator And shall be repaired sit the contractor's expense. . 8. Routh Closures: All scheduled road closures must first receive written permission from the Southold Town Board prhor to closing a road, Temporary-lane closures May be permitted with the approval or the Highway Superintendent. This item wilt included but not hie limited to the installation of appropriate signage and ' flag men to stop and start traffic to allow forsingie 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 dally basis:'All 'stockpiled soil as well as all other project materials that will be steed within the Right-of Way must be delineated with refleceNe signage or other means,to meet the,minimum'requirements of the NYS DOT Construction Standards.- GENERAL CONDITIONS OFTERMIT• APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR (Cantinucd) .10.-Install,Maintain Erosion Controls: "Required,Erosion Control Measures(i.e,silt fencing)is to be-placed op'the downslope edge of any disturbed area."This sedimehi 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 estabiislied. 11. C1enn:Fi11 Onlv:`,All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, . br'oken'coticrete or demolition debris): All unsuitable soils excavated at the site(Le.Clay,'Bog,etc)are to be rerrioved'from the sitcynnd not used to backfill,ahy excavation within aTowii'Highway: 12: All Areas of Soil Disturbance_: Allireas of spit,disturbance resulting from the approved project shall be stabilized to the satisfaetion'ofthe,Highway Superintcndeiit imniedinply,folioi+ving project completion. If tlie,project site rcritains inactive fol`more than 48 hours or planting is impracfical due to.the season,then the°area shall be stabilized with straw;hay mulch an .or`jute matting until weather'conditions favor germination. _ 13.-Backfill&Comprtclion of MI Ex6vations:'-Back Fill shall consist of clean fill or soils which exhibit a-, well=defined moisture density=relationship as deteiinined,to be in accordance with ASTfvID 698.`Fill shall bc'placed in maximum lifts twelve(1211 inches thick and shall be mechanic dty,coi ipacted`to a Ninety `five(95%)percent.maximum dry density., Suitable'hydratilic compaction by„water jetting at tluce-foot intervals wilt also be permitted,subject to a project specific,approve)by the Highway,Superintendent, 14. Restoration`or thc'Road Shoulder Area: All mat-made improvements located within existing road shoulder areas,riiust be protected to the greatest extent practical. Items would include but not be litriited to driveway&'$rivtite road aprons;mail bbxes-sprinkler systems,trees and o`rnamental,plantings. Exciivatidns through driveways and private road pavemerits'mustbe reconstructed to meet all requirements ; of Southold Town`Highway Specifications: All pre-existing road'shoulder improvements that have been disturbed.duriiig consiruetionmust be replaced or repaired by the contractor to the satisfaction•of the , Highway Superintendent. . , .-. ' 15. Selientatic Plan's with nil Teelinicatl information and Scone of Work:,.To reasonably and adequately describe the proposed"work,:accuratn:'schetnaticsite pians must be provided to show,or,indicate'ail proposed coiistrtiction activity required under this,permit:.Ali pavement_Lsurfaces scheduled far excavation 'must be saw cut to the full depth of asphalt,and/or concrete pavements. Accurate Size,of bel!holes or'width Of trenchuig must lie indicated by dimension'or'lalieling: This schematic site pian must provide details on. all restoration required to`meetthe re'uWremcnts,afthese`General Conditions and'requirements found in the Southold Town illjhway Specifications, 16, Pavement Reconstruction: All Pavement sectionsinustbe reconstructed in the following manner; (Mote;When concrete Pavements aro Present,Please review Restoration tequirements with the Higtiway 5nperinten�3rnt) a) Complete all back-f 114 soil.compaction work as needed to provide a suitable sub-base; P) Ovcr.cut existing asphalt bell hole or trench by twelve(12”)inches on all-sides; c) Install a compacted Iib 6`1`0 thick Stone Blend base(RCA Blend must meet NYS DOT-Specificafion); d) Install a two and anti half(2.5',)inch coinpaoted lift of Asphalt Base Course; c) Install a one and one half(1.5")inch of Asphalt(Type 6)Wearing,Cpurse. (Provide•AC at all joints) All,work listed herein m' ust'meet the minimum requirements of the Southold Town Highway Specifications. ' I7. Trenichine of pavenient Surfitces Exeeedine One llundred(1001)Tect in Length: A!1 trenching-of pavement surfaces exceeding 100' in length must first bie reconstructed to meet the requirements'of Item # 16 as noted'above. Once all pavement reconstruction is eompleted�to the satisfaction of the Highway trench shall be Superintendent,the entire road section and width of road over the entire length of repaved with a two(T)incfi'-lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). sl ty Boal . Wm M cd FE RAIT'-AFP%I ATI N SKETCH Vi.11ago,Of ' � u DATE: I1201, LOCATI e, 16 SOUND RD CROSS Sr REE T'I., NORTH RD 'k, T:ONM CREENPORT tRosssrREE-T,iv SUTTON_"PL o 'WGM',ORDERe T1_01958323, aD N 40, SMACE:- ft!Iacadaa dam, rtxo„�NOn i cq 0 40 V' 1--1 4'rx,4'�Bell-Hole- ° U N SOUND;RD - 3 * * * RECEIPT * * * Date: 05/16/17 Receipt#: 219751 Quantity Transactions Reference Subtotal 1 Excavation Permits 1210 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#38120 $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 Bld 3 FI 1 Hicksville, NY 11801 Clerk ID: BONNIED Internal ID 1210