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HomeMy WebLinkAbout1030 Westview Dr Permit No. TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Peeonic Lane Peconic,New York 11958a T101965517 (631)765-3140al. rA� APPLICATION PERMIT FORHIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold far 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 PermiP'and"Special Conditions",if any and to permit authorized inspectors to make necessary inspections of the job site. Print or'fvne Keyspan Gas East Corp D/B/A National Grid Gas Permits Dept. Bldg 3 Fl: 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 1030 WESTVIEW DR -E/S, 50' S/O BROWER RD, MATTITUCK 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 ant Application/Permit Form Is Required for a complete application! 05/30/17 _ 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 ]000 , Section Block Lot 06/27/17 06/28/17 7. Starting;Date: Completion Date: 8. Work Schedule: Plmse Comnlclinn Dale Excavation Work Schedule Facility Installation Must 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 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*Df Project Locations shall be subject to the approval of the Highway Superintendent. Al. /Service Connections excavations Q S20.00 S 20.00 No. A2. /Additional Excavations some service Q$10.00 S No. B. Excavations IS"in depth or less - 0-100 L.F.=$10.00;Additional L.F.©50.10 $ C. Excavations IS"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 $ 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 the Town of Southold to issue a Highway Exc ation permit to: in ac rdance with this application and subject to the"General Conditions"and"Special Conditions"of permit(if y) ched I t SUPERINTEN N TOWN OF SOT ,N W K V cen Orlan Date Received by the Town Date Clerk r Date Permit Issued Permit No.® � 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: I's;rntif# Highway Department Bngineer(with page 3) Applicant Town Clerk(Original) INSPECT'OR'S RE,CORIDS Inspection Date Findings(use code) Applicant Notified 1st 2nd 3rd 4th (To Permit Clerk) RlEL4ARKS CODE 113 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 GENERAI,'CONDITIONSOF;PI;RMIT„ APPLICATIOiNMERMITF,ORHIGHW4Y}EXCAVATION AND`REPAIR ` 1. Pehnittec's Caiitraciors:to'Comnly'tiyitliPermit Rcauireiirenim,the Permittee is responsib_le for inforriiing'its uid-.&hdent contractors;employees,iigeiits"and,assigns of their responsibility to comply with thi5'permit,"incl6dingall special/sitOoccifie,and'gencral conditions imposed by_the Highway Superintendent while acting as'tKe permittee's'ageiit with respect to thc permitted activities,and such persons,shall be re'quired'to complywith all permit requirements. 2, No Richt to Tresn;i's's or Iiiiertcre.wiih Privntc 1'ronerty Riellts: This permit docs'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 the impairment of any rights,title,or interest in real or personal property held or vested in a person not a paity to the permit: 3. Protection of'the Highway rind lrluture Ilighway`Maintenance: 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,-&if,in the opinion of the Highway Superintendent the work performed under this permit shall cause unreasonable obstruction to required highway maintenance or eiidanger.the health, safety and/or welfare of vehicular or pedestrian traffic,this permit shall be'revoked and the utility, structure"fill;excavation,or othermodificadon of the highway hereby authorized shall not be completed. Additionally,the perink may be revoked if the Highway Superintendent finds that the issuiuice of the permit was illegal or'un:iuthorized or that the applicant failed to comply with any of the terms And -conditions of the perm'it,or`Chapter'237 of the Town Code. 4, Revocation of the Permit by the Hiabwav Superintendent: If the Highway Superintendent deems it necessary' to,revoke this permit and the project hereby authorized has not 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 or any portion of the uncompleted utility,structure or fill and restore,the site to its forrmer condition. 5. Notice of Coinrn6cemeht: 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 are fully aware of and understand all terms grid 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 of Equipment&Materinis: The storage of construction equipment and/or materials shall be confined within the project work orea and/or adjacent areas where permission/legal access,has been obtained in a manner that does not interfere with normal highway traffic. 7. Utility Marli-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility mark-'buts and shall take all precautions to protect same. Damage to existing utilities shall be the responsibility of the contractor and shall be repaired at the contractor's expense. S. Road Closures: All scheduled road closures must first receive written permission from the Southold Town Board prior to closing a road. Temporary lane closures inay be permitted�yith 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 immeditite notification of the,Highway Department and shall be limited to immediate and/or expedited restoration of the Workzone. 9. No Construction Debris in Road Shoulder Area: All Construction Debris shall be removed from the job sitc'on a daily basis, All stockpiled soil'as welt 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. 1 , GENERAL CONDITIONS OF PERMIT APPLICATION/P+_RM_IT FOR I-iIGHWAY EXCAVATION AND REPAIR (Continued) _ 10. Iostall,•Maintain Erosion Controls: Required Erosion Control Measures(Le.,silt fencing)is to be placed ori the downslope edge of:""disiuilied area,,This sediment barrier=is to be put in place before any _ distuibancc of the ground occurs and is to be maintained in good functional condition until thick vegetative cover is established." 11. Clenn Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,'slag,flyash, broken concrete or'dentolition debris). All unsuitable soils excavated at the site(i.e.Clay,•Bog,etc.)are to be'remov'd from the site and not used to backfill any excavation within h7own Highway. 12. Ali Areas of Soil Disturbance_: Ali areas of soil disturbance resulting from the approved project shall be stabilized to the satisftetion'of the Highway Superintendent'immediate, ollowing proji:ct completion. 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,hny riiuich and/or jute matting until weather conditions favor - germination. 13-BickGll,&Compaction of nil Excavations: Back Fill shall consist of clean fill or sails which•exhibit-a well defined'moisitite density reliitionship as determined to be in accordance with ASTMD 698. Fill shrill be placed in maximum lifts of twelve(IT)inches thick and shall be mechanically compacted to-a Ninety- five(95%)percent maximum dry density. Suitnbie hydrnulie compaction by water jetting attlii', foot intervals will also be permitted subject to a project speciftc'approval by the Highway Superintendent. 14. Restorsstidn of the 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'roid aprons,.snail boxes,sprinkler systems,trees and ornamental plantings. Excavations_through driveways grid 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 canstruction•must be replaced or repaired by the contractor to the satisfaction of the Highway Superintendent, - _ 15. Schemntic Plans with all Technical info r ration and Scone of-Work: To reasonably and adequately describe tht%propased work,accurate schematic site plans must be provided to"show or indicate aii proposed construction activity required under this permit. All P&cment 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 of trenching must be indicated by dimension or labeling. This schematic site plan must provide details on all restoration required to meet the requirements of these General Conditions and requirements found in the Southold Town Highway Specifications. 16. Pavement Recon'st`ruction: 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) 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 9"thick Stone Blend base(RCA Blend must meet NYS DOT Specification); d) Install a two and one,half(2.5")'inch compacted lift of Asphalt Base Course; C) Install a one and one half(1.5")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 of Pavement Surfaces Exceeding One Hundred(1001)Feet in Length: All trenching of pavement surfaces exceeding 100' in lesigth'must first be reconstructed to meet the requirements of Item 0 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 of trench shall be repaved with a two(2") inch lift of Asphalt(Type 6)Wcaring Course(Typical,shoulder to shoulder). sI iy at o rid -FE-,R3, M- APPLICATION SKETCH' village'Of 512612017 dd in 'LOCATICK: 1030 WESTVIEW DR CROSS STREET 1: BROWER RD TO": MATFITUCK CROSS STREET 2-., 'WOVE,ORDER: T1,01965517 cd N .Macadam Roe d 1030 Lu- 0 ry m cd ai cd 50, rLA 4'x4"Bell'Hole cd WESTVIEW DR-, * * * RECEIPT * * * Date: 06/09/17 Receipt#: 221735 Quantity Transactions Reference Subtotal 1 Excavation Permits 1214 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#38329 $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: BONNIED Internal ID, 1214