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HomeMy WebLinkAbout900 Youngs Rd C b * * * RECEIPT * * * Date: 11/08/17 Receipt#: 229535 Quantity Transactions Reference Subtotal 1 Excavation Permits 1238 $170.00 Total Paid: $170.00 Notes: Payment Type Amount Paid By CK#39691 $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 1238 RECEIVED Permit No. 93 NOV - 6 2011 TOWN OF SOUTHOLD �gOFFO,t,�c HIGHWAY DEPARTMENT Peconie Lane Southold Town Cl ,C Peconic,New York 11958 a T102018945 (631)765-3140oi APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPA1R APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance oran 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 fvne 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 of Contractor Phone Number Address of Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner 4 900 YOUNGS RD- W/S, 990' N/O MAIN RD, ORIENT 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. Alyssa Davan &04,DIZ4 j� NOTE: All information requested by this Signature of Applicant Application/Permit form is Required for a complete application! 11/02/17 _ Date S. (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 ora Highway Excavation Permit by the Town Clerk. 6. Tax Map No.: District 1000 , Section 1 , Block , Lot 1-2- 7. Starting Date: 11/30/17 Completion Date: 12/01/17 S. Work Schedule: Pince Comnlelion Date Excavation Work Schedule Facility installation Must be provided Backfitl 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 rrom,the Utility being modified. 10. Estimated Cost of Proposed Work: S _ — -- 11. Remarks: Open (1) 44 MAC bell hole on the W/S YOUNGS RD, 990' N/0 MAIN RD 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: $1,000,000,_per Occurrence and S 2,000,000 general aggregate. 13. Security: (a)Surety Bond- or Certified Check provided in the total Am'aunt-of$ (b)Maintenance Bond provided: 2 years or 3 years. 14. Fees for Applications and permits: BasicApplicaiion Fee for Each Prdject 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. T /Service Connections excavations©S20,00 S 20.00 No. ' A2, Additional Excavations some,service Q$16.60 S No: B, Excavations IS"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 S'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 S Additional - zoTALS 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: i accordance wi this application and subject to the"General-ConditioW'and"Special Conditions"of permit(if a )attached here .- SUPERINTEN F YS TOWN OF°SD ,N OR Vincent M. r Date Date Received-by the Town Clerk Date Permit Issued 1 Permit No. a3Z 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# - 23 Highway Department Engineer(with page 3) Applicant Town'Clerk(Originai) INSPECTOR'S RECORDS Inspection Date' Findings(use code), Applicant Notified ist 2nd 3rd - (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 sufcieni) HFS Inspector Holding for Final Settlement of Excavation RFR Ready for Repair D-39 3 of 3 , GENFRAL CONDITIONS OF PERMIT APPLICATION/P.ERMIT FOR HIGHWAY-EXCAVATION AND REPAIR 1. ParmittIcc's Contractors to Cons f with Pei•mlt Re uirc:nents: The Permittee is responsible for informing its independent contractors,employees,agents and assigns of their responsibility to comply with this permit,including all'spec'sal/site specific and general conditions imposed by the Highway , Superintendent while acting as the permittee's agent with respect to the permitted activities'and such persons shall be required to comply with all permit requirements Ri . 2. No ht to Tres ass'or Interfere witty Private Pro er ' 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 Piny rights,.fitle,'or interest in real or personal property held or vested in a person nota patty to the permit, 3. Protection of the Iliehway rind Tuturc Ilighivati Malntenanec: If futureeaperatlons or highway riiiintenance projectsby the Town of Southold require an alteration in the position of the utility,structure or work lieimin,authorized,or if,in the opinion of the Highway Superintendent the work performed under this permit shall cause unreasonable obst'r`uction to-rcquired highway m infenance or endanger the health,' safety andlorVelfare of vehicular or pedestrian traffic,this permit shall be,revoiced and the utility, structu' '"hill,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 ' pemtit was illegal or unauthorized,or that the'applicant failed to comply,with any of the terms and conditions•of the permit ar_liaptci 231 of the Town Code, 4, Revocation of the Parmit•bv the Ihift'sv Superintendent:_If the Highway Superintendent deems it .necessary to-revoke this permitand 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 forrner'cornditiori: 5.' Notiee of Cos"men"cifient: At least 24 hours prior to commencement of the project,the permittee and/or contractor shall notify�the Town Higbway Department in writing that they arc fully swore of and understand all terms and project conditions of this permit. Upon coinpietion of the work,the contractor, shall provide photographs of the completed work to the Town Highway Department and request a Final inspection. 6. Storaee ofEquipment&Materials: The storage ofconstruction equipment and/ materials shall be' confined within the project work area and/or adjacent areas where permission/legal access has been obtained in amanner that does not interfere with normal highway traffic. , 7, Utility Vinrh-0uts: The'Appiicant/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 at the contractor's expense. 8. Road Closures: All scheduled road closures must first receive written permission from the Soutl►old.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.stap 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 Arca: All'Construction Debris shall be removed from the job sitc'on a daily basis: All stockpiled soil as well as all other project diaterials 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/PERM.IT FOR HIGHWAY EXCAVATION AND REPAIR (Continued) 10. Jnstall,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. 1°1. 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: 111 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 g germination. 13.'I3:ickCll&Compaction of WI Excavations Back Fill shall consist of clean fill or soils which exhibit a , well-defined moisture density relationship as determined to he in accordance with ASTMD 698.,Fill shall be placed iri maximum lifts of twelve(IT)inches thick and shall be mechanically compacted to a Ninety- five(95%)percent makimum dry'deSuitable 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 Area: All maxi-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: Schematic Plans with nil Technical information and Scone of Worla To reasonably'and adequately describe the-proposed work,accurate schematic site plans must be provided to show or indicate,ail proposed construction activity required under this permit. All Pavement surfaces scbeduled•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,meetthe requiretncnts'ofthese General Conditions and rcquiremenis found in the Southold Town Highway.Specifications, 16: Pavement Reconstructions All Pavement sections must be reconstructed in the following manner; (Note-When Concrete Pavements are'Present,Please review Restoration requirements with the Highway 5dperintcndent) 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'twelvc(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(IX')inch of Asphalt(Type 6)Nearing Course. (Provide AC at all joints) All work listed here_in must meet the minimum requirements of the Southold Town Highway Specifications. 17. Trenching of Pavement Surfaces Exceeding Onc Ilundred(1001)Tect in Leni=th: All trenching'of pavement surfaces exceeding 100'in length must 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,shouider'to shoulder). V1 ty n'CaLtionalgrid PERMr APPLICATION SIETCH- V'illage Of DATE: 11/1/2017 LOCATION: 900 YOUNGS RD GROSS STREET 1: MAIN RD .y T OWN: ORIENT CROSS STREET 2: WORK ORDER: T102018045 0 N O U V7 Vn 4VRFA4~$: v Macadam Ra d� 1lougeNO. o 900 W) < Q 0 CL cq Q) to 990' 4' cd x 4' Bell Hale ,� U N U YOUNGS RD