HomeMy WebLinkAbout465 Town Harbor Ln * * * RECEIPT * * *
Date: 12/04/17 Receipt#: 229857
Quantity Transactions Reference Subtotal
1 Excavation Permits 1240 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#39905 $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: 1240
Permit Nd. IAC)
TOWN OF,souTHOLD
HIGHWAY�DEPARTMENT ti�4
Peconic Lane ;
Peconic,New York 119580 •
T102024510 (631)765-3140
APPILICATION/PF,RMIT,roR HIGIIWAY EXCAVATION AND Iti PAIR '
APPLICATION IS HEREBY made-to the Superintendent of Highways of t1id1own of Southold focthe issuance bran Excavation,Permit
pursuant to Chapter 237 of the Code of the Town of Southold,Suffolk County,New York,and other applicableaaws,ordinances or
regulations for each individual contiguous excavation project liere[n describdd.,Thi applicant-agrees to comply'ivith:all appiicable laws,
ordinances,codes'and regulations,the Attached,"General Conditions of Permit"and"Special Conditions",if any acid to permit authorized
inspectars'to make necessary ti 'of the job site.
Print or'1'vnc Keyspan Gas East Corp D/B/A_National Grid
Gas Permits Dept. Bldg: 3 FI:1
l 516 545,4094 175 E- Old Country:Rd Hicks, 0161 NY 11801
N& e'of Applicant; ,Phone Number `Addressof Applicant, '
2.
Name of Contractor ' Phone Number Address of Contractor
3. „
Name'ofProperty Owner Requesting Service(inapplicable)'; Address of Owner
4. 465 TOWN HARBOR LN- E/S, 375',S/O MAIN RD,-SOUTHOLD
`Work Description;and,Location(Street-Number,Hamlet;'Cross Street) ;
(a) is construction located within 75 feet of tidal wetlands? *Yes No
of yrs,other;Town perm its maybe required. ;
Alyssa Davan
NOTE: All information requested by this Signature' Applicant
Appikailon'/Permit Form Is.
Required for a eoiaplete application! 11/21117
Date'
5. (a) Attached-plot plan to-reasonably and adequately describe the proposedavork. Provide'accutate sohematic.site plan showing the'
location of ail proposed ekcavations and relationship to adjoining premises,public streets or arcus,and give a detailed description of
all site and pavement restoration work. "' , -
(bj Attach all other necessary` permitsand licenses for this project. -
(c) Work covered by this application may not commence before issuance of a Highway Excavation Permit,by the Town Clerk.
6. Tax Map No: District 1000 ;. Section_(Q , Block_ . Lot
7. ' Startinb Date: . 12/19/17 . Completion Date• 12/20/17 ,
8. %Vark Schedule- Phrise Comnlctinn DaN
Excavation Work Schedule
Facility installation ' , hlustbe provided
Backfill'&Completion- for`eonsiderstion as a
Pavement Replacement Complete Application.
9, Under'which authority is application being made: Keyspan Gas East Corporation d/ /a National Grid
See Town Code Chnpter 237(E)-Provide Resolution by,'or authority from,-the Utility being modified. "
i 0. Estimated'Cost of Proposed Work: S
11. Remarks: Open (1)4x4 MAC bell,hole on the E/S TOWN HARBOR LN, 375'S/0 MAIN RD to-install gas service,
D-39 I of 3
{
12. Insurance Coverage:(Attach Copy)
(a) Insurance Company:,
(b) Policy M
(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 nod$2,000,000 general aggregate.
13. Security:
(a)Surety Bond or Certified Check provided in the total Amount of$
(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 numbers f Project Locations shall be subject to the approval of the Highway Superintendent.
Al. /Service Connections excavations Q S20.00 S 20.00
No.
A2, /Additional Excavations same service @ S 10.00 S
No.
B. Excavations IS"in depth or less
0-100 LF.=$10.00;Additional L.F.Q$0.10 S
C. Excavations IS"in depth to 5'in depth
0-100 L.F.=$30.00;Additional L.F.®$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$10.00 $
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:
I accordant th
this application and subject to the"General Conditions"and"Special Conditions"of permit(i ny)at ched er to.
SLIPERINTE ENT H AY
TOWN OF �� YO
intent M.Ori
Date
Date Received by the Town Clerk
Date Permit issued 13 Permit No. `c240
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:
Permit#
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RE,CORDS
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
i
GENERAL,CONDITIONS OYPERMTL'
APPLICATION/PERMIT FOR`HIGHtiVAY EXCAVA'T'ION AND REPAIR
1. Permitice's Contractors to Comply iyith fcrmit Rcaiuircments: The Permittee is responsible for
informing its independent,contractors,employees,agents'and assigns of their responsibility to comply with
this permit,including all special/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 tequiremctits.
2. No Ri ht to Tres ass or Interfere wiIli Private llrorwrtv Ri his: -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,,tide or interest in real or-personal property held or
vested in a"person not a party to the permit.
3. Protection of the llighway and Future tlielnvny Mnintenaiice; If future'operations'or highway
maintenance projects by the'Town of Southold require an alteration in the position of the,utility,structure
, he opinion of the Highway Superintendent the'work performed under
or work herein authorized,or ifin t
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 shall not be completed.
Additionally,the permit maybe revoked if the Highway Superintendent finds'that the issuance,of the
permit was illegal or'un"' tharized or that the applicant failed to,'comply with ariy of the terms and'
conditions of the permit or Chapter 237 of the Town Code.-
4, Revocaition orihe Permit by the Iliebwav Sunerintenderit:,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'ti - and manner as the Superintendent
inay,regnire,remove all orany portion of the uncbmol6ted utility,structure or fill and restore the site to its
former condition.-
5. 14oiiee 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'condhions of this'permit.` Upon completion of the work,the contractor
shalt-provide'photogaphs of the completed work to the Town Highway Departrrient and request a Final
inspection..
6. Storaee of,I:auinment&Materinis: 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 docs not interfere with normal highway traffic.
7, Utility Mnrlc-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 at the contractor's expense.
8.1 Ro id 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 lancAmffic, 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,froin 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
APPLICATIONIPER_ NII_T FOR I•IIGHWAY 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 banier is to b$put in place before any
disturbance of theground 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 eoncrete'or demolition debris). All unsuitable soils excavatcd,at the site 0-6.Clay,Bog,etc.)are to
be removed from the site and not used to backflll any excavation-within a Town Highway.
12. All'Arias of Soil Disturbance: All areas of soil disturbance resulting from the approved project ilial]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&Comnnetion of all Exenvationse. 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(1'2')inches thick and shall be mechanically compacted to s Ninety-
S'(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at Wree-foot
intervals will also`be li r itted subject to a project specific approval by the Highway Superintendent,
14. Restoration of the Road Shoul6ir Arca: All 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.
Excavatibns through driveway's and-private road pavements must be reconstructed to meet all requirements
of Southold Town Highway Specifications, All pre-existing Toad shoulder improvements that have been
disturbed duping construction must be replaocd or repaired by the contractor to the satisfaction-ofthe
Highway Superintendent. '
15.-Scitenintic Plans with all Technical infornintion and Seobc of Worlc: To reasonably and adequately
cribe the proposed
deswork;accurate'schematic site pians'inust be provided to show or indicate all
proposed construction activity required under this permit. Ail Pavement surfaces scheduled for excavation
must be saw cut to the full depth of asphalt andlor`conerete pavements. Accurate zed bel!holes or width
of trenching must be indicated by dimension or labeling. This schematic-site plan must provide details-on
all restoration required to tneetthe 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 ConcrewPavquients aro Present.Please review Restoration requirements with the Highway Superintendent)
a) Complete ail back-fill&soil compaction work as needed to provide a suitable stib-base;
b) Over cut existing asphalt bell Ihole 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. Trenchinlr of Pavement Surfaces Execedint<One Hundred(I00')Tect in Length: 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�secdon and/or width of road over the entire length of trench shall be
repaved witha two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder).
s'J ty
N
a n --donalgrid-
ai
PERAM'"MICATION SKETCH-
Village,Of
' u
DATE: 11120/2017
,LOCATICK: 465 TOWN-HARBOR Ltioss sTREET is MAIN RD141
TOXVNa SOUTHOLD CROSS STREET 2: LHOMMEDIEU.LN
wmK oRDER: T102024510
N
C
V'1
RWACE:
_ U
Macadam Roe d0 Howe Na ,
465w Q
0 0
2
rA
C=7
C." J,
cd
37_5�
b
4'x 4,' Bell Hole o
a
U
N
Sir
N
TOWN HARBOR LN-
-� 3