HomeMy WebLinkAbout65 Cardinal Dr * * * RECEIPT * * *
Date: 11/08/17 Receipt#: 229533
Quantity Transactions Reference Subtotal
1 Excavation Permits 1237 $223.30
Total Paid: $223.30
Notes:
Payment Type Amount Paid By
CK#39692 $22330 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. 1237
2 RECEIVED
Permit No. 3
TOWN OF SOUTHOLD , NOV' - 6' 2017 4�psuFFeI
HIGHWAY DEPARTMENT
Pecotiie Lane
Peconic,New York,11958 Southold Town Cie ,
T102011466 (631)765-31"40 ��^,
APPLiCATION/PERMIT FOR HIM)WAY EXCAVATION AND Ri:PA]R
APPLICATION IS HEREBY made to die Superintendent o f'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 eontiguotis 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 ofthe Job site. -
PrintorT�mc " Keyspan Gas East Cdrp D/B/A National Grid
Gas Permits Dept. Bldg:,'3 FI: 1
1, 516 545 4094 175 E. Old Cocltitry Rd Hicksville, NY 11801
Name of Applicant Phone Number Address of Applicant
2.'
'Name of Contractor Phone Number Address,of Contractor
3.
Name of Propeity Owner Requesting Service(if npplicable) Address of Owner
4. 65 CARDINAL DR-W/S, APPROX 111' S/O SR25 aka MAIN RD''MATTITUCK ,
Work Description and Location(Stiect Number,'Harnlet,Cross Street) '
(a) Is construction located within 75 feet of,tidal wetlands? *Yes No'
*If yes,other Town permits may be required. Ai
Margaret Paglia
NOTE: All information,requested by this Signature 6fApplic
Application/Permit Form is _ "
Requlre'd for a ctittiplete oppllcntlon! 11/2!17
Date
5. (a) Attached plot plan to reasonably ofid'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,find give a detailed description,of
all site and pavement restoration work.
(ti) Attach all oth6r necessary permits and licenses for this project.
(c) Work covered by this applicatiori may,notcommence beforeissuance of Highway,Cxcavation Permit by the Town Clerk.
6. Tax Map No.: District 1000 .. 'Section I Ls .�, Block 14, , Lot 2=�
7. Starting;Date: 11/3®/1 7 Completion Date: 12%1/17
8. Work Schedule: Phase Coinnlction Date
Excavation Work Schedule
Facility installation Must be provided
Backfill&Completion for consideration as a
Pavement Replacement Comp!cte Application.
9. Under which authority is application beim made: Keyspan Gas East COa poratiOn d/b/a National Grid
See Town Code Chapter 237(E}-Provide Resolution by,or authority from,the Utility beim modified.
10. Estimated Cost of Proposed Work:, - $
11. Remarks: Opert'& restore (1) VX1 I ° X4" GRASS TRENbH 1)4'X4'.GRASS BELL HOLE
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
t 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 S20.00
No.
A2. /Additional Excavations same service Q$10.00 S
No.
B. Excavations 18"in depth or less
0-100 L.F.=$10.00;Additional®L.F.@S0.10 S
C. Excavations 18"in depth to 5' in depth
0-100 L.F.=$30.00;Additional t t L.F.@$0.30 S 33.30
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 223.30
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 CIerk of the Town of Southold to issue a Highwa Excavation permit to:
inaccordan with
this application and subject to the"General Conditions"and"Special Conditions"of permi (if any)attache ereto.
SUPERINT D T WA S
TOWN OF 1 D V Y K
Vin nt M.Or
iN,
Date
Date Received by the Towd
Date Permit ss- _ �Mn Permit No. b
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
I
Copy Distribution: 1
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
151
2"d
3`d -
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
WAP 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 HIGHNVAY EXCAVATION AND REPAIR
1. Permittee's Contractors to COn1nlV with Peeinit Rcauiremcnis:'The Permittee is responsible for
informing its independent contractors,employees,agents Arid assigns of their responsibility to comply with
this permit,including all speciai/site specific and general conditions imposed by,the Highway
Superintendent while acting as the permittee'sagent with respect to the permitted activities,and such
persons shall be required to,compty;with all permit requirements.
2. No Riabt to Trespass or Interfere with Private PronerN Rifts: 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 partyY0 the permit.
3. Protection of the Ilighwav and Future 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,iii,the opinion of the Highway Superintendent the work performed under
this permit.shall cause unreasonable obstruction to required highwayinaintenance orendanger the'hea{th,
safety and/or welfare of vehicular or pedestrian traffic,this permit steall be revoked and the utility;
structure,fill,excaystion,or other modification of,the highway hereby authorized shall not be completed.
Additionally,the permit maybe revoked if the Highway Superintendent finds that'the issuance of the
permit was illegal or unauthorized or that ithe 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 Ilightivav 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,removc'all or any poition 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 commencement of the project,the permittee and/or
contractor shall notify the Town Highway Department in writing that they arc fully aware of and
understand all ierms 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&Materinls: 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 Mnrh-Outs: The Applicant/Contractor shall be responsible for verification of all existing utility- , -
mark-outs and shall take All precautions 6-protect same. Damage to existing utilities steal{'be the
responsibility of the contractor and shall be repaired at the contractor's expense.
8. Road Closurey: 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 or 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,
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 FOR HIGHWAY EXCAVATION AND REPAIR
(Continued)
10. Install,Maintain Erasion Controls: Required Erosion Control Measures(i.e.silt fencing)is to be placed
on the downslope edge of any disturbed area. This sediment barrieris.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 All Only: All project back-fill shall con' istofcleansand,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 usedtobackfill 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. Backfill&Compaction of Al Excavitions: Back Fill shall,consist of clean fill or soils which exhibit a
well-defined'moisture density' relkion'ship as determined to be in accordance with AS'1'MD 698. Fill'shall
be placed in maximum lifts of twelve(IT)inches thick and shall be mechanically compacted to a Ninety-
drydensity. 'Suitable hydraulic compaction by waterjclting at three-foot
five(95°a)percent maximum
intervals will also be permitted subject to a project specific approval by the High way'Superintendent.
14. Restomtion of tiie Road Shoulder Area: All man-made improvements located within existing road
shoulder area's must be protected to the greatest extent,practical. Item iwould includd but not be limited to
'driveway&private road aprons,mail boxes,sprinkler systems,trees and ornamental plantings. .
Excavations thiough'drive' and private road pavements must be reconstructed to meet all requirements
ofSouthold 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. Scltentntic Plans with sill Technical information and Scone of Worli: ,To reasonably and adequately
dekHbe'the proposed work,accurate'schematic site pians inust be provided to show or indicate all
proposed construction activity required under this permit. All Pavement surfaces scheduled far excavation
must be saw cut to the full depth of asphalt and/or concrete pavements. Accurate size of belt holes or width
of trenching must be indicated by dimension or labeling. 'This schematic site plan must provide details on
all restoration required to meetthe 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 mariner;
(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 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 ofAsphalt(Type 6)Wearing Course. (Provide AC at all joints)
All work listed herein most 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 length most first be reconstructed to meet the requirements of Item
# 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).
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