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Home My WebLink About675 Hill Rd T * * * RECEIPT * * * Date: 07/25/17 Receipt#: 226429 Quantity Transactions Reference Subtotal 1 Excavation Permits 1219 $54730 Total Paid: $547.30 Notes: Payment Type Amount Paid By CK#38681 $39730 National, Grid - Gas Permits Dept CK#38764 $15000 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 1219 RECEIVED Permit No. �o��_ • TOWN OF SOUTHOLD �4�gUFFot,tco HIGHWAY DEPARTMENT JUL z 5 Zp) Pec nic Lane Peconic,New York 11958 T101966638 (631)765-3140 Southold Town C! APPLIC6TION/PERMIT FOR HIGIIWAY i-MCAVATIQN 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 tite jab site. Print orTtmc Keyspan Gas East Corp D/B/A National Grid Gas Permits Dept. Bldg: 3, FI: 1 1, 516 545 4094 175 E. Old Cduntry 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(irapplicable) ' Address of Owner 4 675 HILL RD, SOUTHOLD, N/S, 402' W/0 HARPER RD Work Description and Location(Street Number,Hamlet,Cross Street) (a) Is,constniction located within 75 feet of tidal wetlands? *Yes No *If ycs,other Town permits may be required. , r Margaret Paglia LGr NOTE: All information requested by this Signature of Appiic Application/Permit Form is Required for a complete aIpplicatlonl 7/12/17 Date S: (a) Attached plot pian 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. , (e) Work covered by this application may not commence before issuance ora Highway Excavation Permit by the ^Town Clerk. 6, Tax.MapNo.: District 1000 . Section_ �__, Block , Lot 7. Starting;Date: 8l Q/1 7 Completion Date: 8/11/17 8. Work Schedule: Phase Completion Mile Excavation Work Schedule Facility Installation Nlust'be provided Backfill&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 or Proposed Work: 11. Remarks: OPEN (2) 4'X6'X3 1/2' bell holes and (1)1'x191'x3 1/2' trench in the N/S.grass area, approx 402' W/0 Harper Rd to install gas,main and service. D-39 1 K`of 3 r � i i 12. insurance Coverage:(Attach Copy) (a) Insurance Company: (b) Policy{i: (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 3 c, ®® 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. 2 /Service Connections excavations Q 520,00 S40.001 No. A2. 1 Additional Excavations same service c(Qc 510.00 S No. B. Excavations 18"in depth or less 0-100 L.F.=$10.00;Additional L.F.@$0.10 S C. Excavations IS"in depth to 5' in depth 0-100 L.F.=$30.00;Additional 991 x.30 L.F.®S0.30 S 57.30 D. Excavations 5'in depth and overt 0-100 L.F.=$50.00;Additional L.F.Q$0.50 $ E. Utility Repair Excavations t@$10.00 5 No. Repairs same service Q$5,00 $ Additional --]] TOTALS rpp7,-'3 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 Excava' n permit to: accordance tiv'th this application and subject to the"General Conditions"and"Special Conditions"of permit(if a )n tacked h e SUPERINTEN F TOWN OF S •W inceni M o Date i Date Received by the Town Clerk Date Permit Issued a —1 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 r Copy Distribution: Permit# _ Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified l st 2nd 3rd 4th (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 APPLICATIONMERMIT FOR HIGHWAY EXCAVATION AND REPAIR I. Permittees Contractors-to Cont 1 witli Permit Re uireniciits: The Permittee is responsible for informing its,independent contractors,employees,agents and assigns of their responsibility to comply with this permit, including all speclaUsite specific and general conditions imposed by the Highway Superintendent while acting as the permittees agent with respect to the permitted activities,and such persons shall be required to comply with all permit requirements. 2. No Richt to Trespass or Interfere with Privnte Property Riahts: This permit docs not convey to the `permittee any right to trespass upon the lands of adjacent'property owner's in order to perform the permitted work nor does it authorize the impairment of any rights,title,or interest in Teal or`personal propertyheld or vested in a person riot a party to the permit. 3. Protection of the Ilighwnv and Tuture IIighway 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,'or if,in the opinion of the Highway Superintendent the work performed under this permit shall cause unreasonable obstructionto required highway maintenance or endanger the health; safety and/or welfare of vehicular or'pedestrian`traffic,this permit shall be revoked and the utility, structtire,'fill,excavation,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.Chapter 237 of the Town Code. 4. Revocation of the Permit by the Highway Superintendent:_If the Highway Superintendent deems it necessary yto 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 rraay-require,remove all orany portion of the unconipieted utility,structure or fill and restore the site to its former condition. 5.' Native of Commencement: 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 and project conditions of this permit. Upon completion of th6work,the contractor shall provide photographs of the completed work to the Town Highway Department and request a Final inspection. 6., Storaee df Equipment&Materials: The storage of construction equipment and/or materials shall be aonfned within the project work area and/or adjacent areas where permission/legal access has been obtained in a mariner that does not interfere with normal highway traffic. 7. Utility Mark-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility mark-outs and shall take all precautions to protect same. Damage'to existing utilities shall be'the responsibility of the contractor and shall be repaired afthe contractor'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 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. ,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 /tight-of Way must-be delineated with reflective signage or other means to meet the minimum requirements of the NYS DOT Construction Standards. r ti • GENERAL CONDITIONS OF PERMIT APPLICATIONMERNIIT FOR HIGHWAY EXCAVATION AND REPAIR (Continued) 10. Install.Maintain Erosion Controls: Required Erosion Control Measures(i.e.silt fencing)is to be placed an the downslope edge of any 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'established. 11. Clean Fill Only: All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete or`demolition debris). All unsuitable soils excavated at the site(i.e.Clay,Bog,etc)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 stabilized to the satisfaction of the Highway Superintendent immediately following project 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,hay mulch and/or jute matting until weather conditions favor germination. 13. nue'lcGll&Compaction of nil Excavation's Back Fill shall consist of clean fill or soils which exhibit a well-defined moisture density relationship as determined to be in accordance with ASTMD 698. Fill shall be placed in maximum lifts of twelve(12')inches thick and shall be mechanically compacted to a Ninety- five inety- f ve(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at three-foot intervals will also be permitted subject to a project specific approval by the Highway Superintendent. 14. Restoration of the Road Shoulder Ar6: All man-made improvcmenls 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 al]requirements ay of Southold Town HighwSpecifications, 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. Sctrentntic Plans with nil Technical information and Scene of Work: To reasonably and adequately describe the proposed•work,accurate schematic site plans must be provided to show or indicate all proposed construction activityrequired under this-permit. All Pavement 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 Reconstruction: All Pavement sections must be reconstructed in the following manner, (mote: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 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; 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. Trenchine of Pavement Surfaces Exceeding One Hundred(1001)Fcet in Length: All trenching of pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item #f 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 oftrench shall be repaved with a two(21) inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). sJ,y y Road Opening Permit Request nationalgrid Municipality ot✓�f df So Work Order1p� jl' Location: fo' 4;U Grid. /.0,S-/o- 3 Town: -ba&laa Requested By- A/,et&f r2- Reason For Excavation: i�i%l+tL ZA5 M;4 A'R -56eVi6L Description: a. �'��x 3Y��LL. oW AWdA ARCA APEX 40JL' IdA, gAA?ZA r fi 4W46 , Li s i M Gs'� z w ray I � �A �1