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Home My WebLink About1700 Peconic Ln * * * RECEIPT * * * Date: 07/28/17 Receipt#: 226641 Quantity Transactions Reference Subtotal 1 Excavation Permits 1220 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#38738 $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: LYNDAR Internal ID 1220 Permit No. TOWN OF SOUTHOLDO�gUFF9j'.Co HIGHWAY DEPARTMENT r� Peconic Lane Peconic,New York 11958 v 7101982215 (631 j765-3140 APPLICbTlOty/PERMIT FOR HIGHWAY EXCAVATION AND RE.PA1R APPLICATION IS HEREBY made to the Superintendent ormshways orthe Town orSouthold for the issuance of an Excavation Permit pursuant to Chapter 237 of the Code orthe Town or 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 f ermit"and"Special Conditions",if any and to permit authorized inspectors to make necessary inspections of the job site. r nt o T Keyspan Gas East Corp D/B/A National Grid Gas Permits Dept. Bldg: 3 FI: 1 1, 516 545 4094 175 E, Old Country Rd Hicksville, NY 11801 Name of Applicant Phone Number Address of Applicant 2. Name or contractor Phone Number Address of Contractor 3. Name orProperty Owner Requesting Service(Irapplicable) Address orowner 4 1700 PECONIC LN-WIS, 156' S/0 CARROLL AVE, PECONIC Work Description and Location(Street Number,Hamlet,Cross Street) (a) Is construction located within 75 feet of tidal wetlands? 'Yes No 'iryes,other Town permits may be required. Margaret Paglia &.49 NOTE: All information requested by this Signature ofAppiic Application l Permit Form is Required for a complete bpplicatioal 7/25/17 Date 5. (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 or 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 berore issuance of a Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District, 1000 Section , Block , Lot l 0 7. Starting Date: 8'/23/17 Completion Date: 8/24/17 S. Work Schedule: Phnse Completion Dale Excavation Wark Schedule Facility Installation Must be provided Backfill!C 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 Cade Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated costorProposed Work: S 11. Remarks: OVEN (1) 4'X4'X4' bell hole S/S Carroll Ave in the Grass Area, approx 60' E/O Peconic Ln to install new residential rias service. _ D-39 i 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 tate Town: Any Loss including Bodily injury,property or commercial injury caused by or attributable to the work performed: $1,000,000 pei Occurrence and S 2,000,000 general aggregate, 13. Security: (a)Surety Bond -or Certified Check provided in the total Amount of$ (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 Hale 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 Highwny Superintendent. Al. /Service Connections excavations Q 520.00 S20.00 ` No. A2, /Additional Excavations same service Q 510.00 S No. B. Excavations 18"in depth or less 0-100 L.P.=$10.00;Additional L.F.Q$0.10 $ �C. Excavations 18"in depth to 5',in depth 0-100 L.F.'=$30'.00;Additional L.F.®S0.30 S D. Excavations 5'in depth and over 0-100 L.F.a$50,00;Additional L.F.Q$0.50 $ E. Utility Repair Excavations Q$10.00 S Repairs same service Q$5.00 $ Additional TOTALS -170.00 P. 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 issuen Hight ny Excavation permit to: in accordance ti kh CIS application and subject to the"General Conditions"and"Special Conditions"of permi (if any)attach SUPERINT O G, S TOWN OF S EW RK Vi cent o Date _ Date Received by,the Town Clerk 1'r-)�a " __ 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: d Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings(use code) Applicant Notified ist 2nd 3rd 4th (To Permit Clerk) REMARKS i - CODE 1B 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 APPLICATIOMPERMIT FOR HIGHWAY EXCAVATION AND REPAIR 1. Permitie0s Contr actors to Comply with Permit Rectuiriments: The Permittee'is responsible for informing its independent contractors,employees,agents and assigns of their responsibility to comply with this permit, including all speciaWte specific and general conditions imposed by the Highway Superintendent while acting as the permittee s agbnt with respect to the permitted activities,and such persons shall be required to comply with'all permit requirements. 2. No Ri ht to Tres ass or Interfere with Private Prorierty Rights: 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 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 nighwny and Future Ilslnvay Mnintenanee; If future'aperations 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 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,excavation,or other modification of the highway hereby authorized shat!not 6e 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 orthe Permit 6 `the Hi bwav 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 orany portion of th-e uncompleted utility;structure or fill and restore the site Wits, former condition. 5. Notice or 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 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&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 rias been obtained in a manner that does not interfere with normal highway traffic. 7. Utility Mnrh-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility I ark-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: All scheduled road closures must first receive written permission from the Southold Town Board prior to closing a road. Temporary lane closuresmay 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 ofthe Highway.Department and shall be limited'to immediate and/or expedited restoration of the Work Zone. q, No Construction Debris in Road Shoulder Area: All Construction Debris shall be removed from the job site on a daily basis. All stockpiled'soii 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. a S - GENERAL CONDITIONS OF PERMIT AP_PLiCATION/PERMIT FOR RIGHWAY EXCAVATION AND REPAIR (Continued) 10. Install,Maintain Erosion Controls: Required Erosion Control Measures(i,e,silt fencing)is to be placed on 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 Onlv: 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,Hog,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: Ali 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. B-60ctill&Commetion of all Excrivations: 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(R5%)'ercent 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. Restoriii6ii of the Road Shoulder Arca: Ali 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. Seltentntic Plans with all Technical information and Scone of Work: To reasonably and adequately dt:serilie the proposed work,accurate schematic site pians must be provided to show or indicate all proposed construction activity required under this permit. All Pavement surfaces•scht:duled for excavation must be saw cut to the full depth of asphalt andlor 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, (Note:When Concrete Pavarients arc Present,Picric 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 trencWlby twelve(12")inches on all sides; c) Install a compacted lift of 4"thick Stone Blend base(RCA Blend roust 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)Nearing Course. (Provide AC at all joints) All work listed herein must meet the minimum requirements of the Southold Town Highway" Specifications. 17. Trenchin of Pavement Surfaces Lixeceding One Hundred 100' Tcet in Len tlt': All trenching of pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item /1 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)Wearing Course(Typical,shoulder to shoulder). sl ty Road Opening Permit Request national ro THE POWER OF ACTION Municipality:Town of Southold Work Order:T101982215 Location: 1700 Peconic Ln Grid: 100611012 Town: Peconic Requested By: Brian Romano Reason For Excavation: Install one new residential gas service Description: One 4'x 4'x 4' mac bell hole on the South side of Carroll Ave, approximately 60' East of Peconic Ln r v J Q) U_ J C 0 U 3 U Carroll Ave 60' Curb Line 4 0 0 Permit sketch may not include excavations required under 16 NYCRR Part 753 Revision:0 Typical trench width is 12"wide,Typical bell hole excavation is 4'x 4'x 4' Date Submitted:7/25/17 Not To Scale Number Of Permits Requested: 1