HomeMy WebLinkAbout460 Fred St * * * RECEIPT * * *
Date: 07/07/17 Receipt#: 225073
Quantity Transactions Reference Subtotal
1 Excavation Permits 1218 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#38577 $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: LYNDAR Internal ID• 1218
RECEIVED
Permit No.
TOWN OF SOUTHOLD JUL - 5 2017
HIGHWAY DEPARTMENT
Peeonie Lane
Peconic,New York 11958 Southold Town Cie Q `
T101794690 (631)765-3140 -:3a°�:
AI!PLIC6T1ON/PERMIT FOR HIGIIWAY EXCAVATION AND REPAIR
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 applicable 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.
Print or 1 ,p 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. 460 FRED ST, NEW SUFFOLK-E/S, 359' S/0 GEORGE RD
Work Description and Location(Street Number,Hamlet,Cross Street)
(n) 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! 6/29/17
Date
5. (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 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 or n Highway Excavation Permit by the Town Clerk,.
6. Tax Map No: District 11300 , Section I\D Block -_� Lot
7. Starting Date: 7/28/17 Completion Date: 7/29/17
8. Work Schedule: Phase Completion Dale
Excavation Woric 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: $-
11. Remarks: OPEN (1) 4'X4'X3' MAC BELL HOLE E/S FRED ST TO INSTALL GAS SERVICE
D-39 1 of 3
12. Insurance Coverage:(Attach Copy)
(a) Insurance Company:
(b) Policy#:
(c)State whether policy of certification on file with the Highway Department:
(d)Coverage required extended to the Town:
Any Loss including Bodily injury,property or commercial injury caused by or attributable to the work performed:
51,000,000 per Occurrence and S 2,000,000 general aggregate.
13. Security:
(a)Surety Bond or Certified Check provided in the total Amount of$
(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 Q$20.00 S 20.00
No.
A2, /Additional Excavations same service Q S 10.00 S
No.
B. Excavations 18"in depth or less
0-100 L.F.=$10.00;Additional L.F.Q 50.10 S
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 510.00 $
No,
Repairs same service Q 55.00 $
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 Excavation permit to:
in accordance wi
this application and subject to the"General Conditions"and"Special Conditions"of permit f any attached re
SUPERIN DE YS
TOWN OF D, OR
Vincent
Date Received by,the Town ClDate
—le k I �� /] f�
Date Permit Issued _I i 1 '7 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 Distributions
Permit# ► a
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECT®R'S RE,C®RDS
Inspection Date Findings(use code) Applicant Notified
l st
2nd
3rd
nth
(To Permit Clerk)
REMARKS
CODE
18 Improper Barricades
IL Improper Lights
ST Sunken Trench or Excavation
UTM Unable to Measure(due to backfilling)
BUG Building Under Construction
WIP Work In Progress
DB Improper Backfill(too high,not sufficient)
HFS Inspector Holding for Final Settlement or Excavation
RFR Ready for Repair
D-39 3 of 3
GENERAL CONDITIONS OFIARMIT-
APPLICAMIN/PERMIT FORHTGH`VAY,EXCAVATION AND REPAIR
1. Pcrniitice'§Cositrsictors to Cam 1 with'1'crisiit Re'tsir`esnesiist,.The Perinittee is responsible for
informing-Its iisdeporident'coistiac"toi's;ciriployees,agenfs`and:sissggrss of their responsibility to comply with
this permit; including all speclsUsite'specific and general conditions imposcd,by the Highway
Superintendent while acting°as th`c persnittee's agent with"respect to'the permitted activities;and such
persons shall ' required to comply with-all permit requirements.'
2. No'Riehi to Trespass or Interfere wiih Private Pronerty'Rights: This permit docs not convey to the
permittee-any,right'to trespass upon the land's of adjacent property owners in order to perform the per=mitted
work riot does it authorize the imp pairment of any rights,title,or interest in real or persona)property held or
vested in a person not a party to the permit,
3. Protection of the Highway and IFuture IlieliwayMnintenance: If future operations or highway
maintenance pro}ects�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 permitshal_I cause-unreasonable 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, fill,excavationi or other modification of the highway 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'Cha 6f 237 of the Town Code,
4, Revocation of the Permit-[rythe Hiabwav Superintendent:.If the Highway-Superintendent deems it
necessary to revoke this permit and the project hereby authorized has'not been completed,the applicant
shill,,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
former condition.
5. Notice of Commencement: At least 24 hours prior to,commcneement 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 and project-conditions of this permit. Upon completion of the work,the contractor
shalt provide photographs of the completed work to the Town Highway Department and request a Final
inspection.
6. Storage of Equipment&Materials: The storage of construction equipment and/or materials shall be
confined within the 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 Mnrit-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility
murk-outs 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.
8. Road Closures: Ali 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 signage and
flag men to 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.
g, No Construction Debris-in Road Shoulder Arca: 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.
GENERAL-CONDITIONS OF PERMIT
APPLICATION/PERMIT FOIL lUGHWAY-EXCAVATION AND REPAIR
(Cnnfiniied)
10. Iristiill.Maintniri Erasion Ctinlrals: ,Required Erosion Control Measures(i.e,silt fencing)is to be placed
an the downslope edge of shy disturbed area,,•This sediment barner-is to`be put in place before any .
disfutiancc of the ground occurs and is to be maintained in good functional condition until thick vegetative
cover is established.
11. Clean Fill Only:.All project back-f ll shall consist of clean sand,gravel or soil_(NOT asphalt,slag,flyash,
broken concrete or'deinolitidii'debris). All unsuitable soils excavated at the sltd(Le,Clay;Bog,etc)are to
be.removed from the site and not used to backfill any excavation within a Town Highway.
12, Al]Areas of Soil Disturbance_: Ali areas of soil disturbance resulting from the approved project shall be
stabilized to 66 satlsfactiori'oftbe Highway Superintendent immediately following project completion. If
the project site remains mictiiye 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 ",lcfill r&'Compaction of fill Excavations: Back Fill shall consist of clean fill or soils which exhibit a LL
well-'&fined moisture density reliitionship,as determined to'be inaecocdunce with ASTMD 698: Fill shatl
be placed in maximum lifts of twelve(12")inches thick acid shall be rrieclianicully compacted to'a Ninety-
five(95%)percent-maximum drydensity. Suitable hydraulic compaction by water jetting at three-foot
intervals will also b- permitted subject to a project specific approval by the Highway Superifiteadent,.
14. Restoration of tlic Road Slrouldar' reii: Al]fhati-made improvements located within existing road
shoulder areas mustlid 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`theough-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 Plans with ail Technical information and Scone oMVrlc: To reasonably and adequately
describe the'proposed work,-accur ateIschematic site plans must be provided to show or indicate ail
proposed construction activity required under this permit. All Pavement sgrfices scheduled fo'r excavation
must be sa�v cut to the Poll 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. Pa'vemeirit Reconstruction: All Pavement sections must be reconstructed in the following manner;
(Note:When Concrete Pavements are Present,Please review Restoration requirements with the Highway superintcnitent)
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 02")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 two and one Half(2.5")inch compacted lift of Asphalt Base Course;
e)- Install a one and one half(1.5")ditch.of Asphalt(Type 6)Nearing Course. (Provide AC at all joints)
All work listed herein must meet-the minimum requirements of the Southold Town Highway
Specifications.
I7. Treticliia of Paventent Surfaces Exceedin One llundrecl 100' Tect in Len tli: All trenching of
pnverrient surfaces exceeding 100' in lengt1i'must first be reccnstfucted to meet the requirements of Item
9 16 as noted above. Once all pavement reconstruction is completed to the satisfaction ofthe Highway
Superintendent,the entire road section and/or width of road over 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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DATE. 6129/2017
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