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HomeMy WebLinkAbout2200 Pike St _s * * * RECEIPT * * * Date: 12/04/17 Receipt#: 229859 Quantity Transactions Reference Subtotal 1 Excavation Permits 1242 $373.00 Total Paid: $373.00 Notes: Payment Type Amount Paid By CK#39949 $37300 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: 1242 Ch 5 C r-X�a/7-F A16 I ^ Permit No. TOWN OF SOUTHOLD �g11FFitc H1GHWAY DBPARTNIENT Peconic Lane Pccohic,New York 11958 c • T102025396, (631)765-3140 1, I APL'L1C„ 6T1!QN/PF:BM13:FOR HIGIMAY EXCAVATION A A nF.l'A1R APPLICATION IS HEREBY made to die Superintendent of Highways of the Town of Southold for the issuance ofan'Excavation Permit pursuant to Chapter 237 orthe Code of the Town of Southold;Suffolk County,Now York,and other applicable lbws,ordinances or regulations for each individual contiguous excavation project herein described. The applicant egrees to comply with all'appl'icablti laws, ordinances,codes rand regulations,the attached"General Conditions of Permit"and"Special Conditions",it'any and to permit authorized inspectors to make necessary Inspections of the job site. r,�'� Keyspart Gas East Cole D/B/A National Grid Print Gas Permits Dept. Bldg: 3 Fl: 1 !, 5165454094 175 E. Old Country Rd Hicksville, W 11801 Name of Applicant Phone Number Address orApplicant 2. Noinc of Contractor Phone Number Address orContractor i 3. Name of Prop irty Owner Requesting Service(!f applicable) Address of Owner q 2200 PIKE ST-S/S, 180'W/O MAPLE AVE & PROCEEDING EAST-MATTITUCK Work Description and location(Street Number,Hamlet,Cross Street) (ti) is construction located within 75 feet of tidal wcd4nds? "Yes No a[f yrs,other Tawnparmits may be required. Margaret Paglia aq�gw--OL' NOTE., All information requested by this Signature orAliftant Application/Permit Corm is 11/28/17 Required for a complete application! I Date 5. (a) Attached plot plan 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 bdier necessary permits and licenses ror ibis project. (c) Work covered by this application may not commence be /fore Issuance of Highway Excavation Permit by the Town Clerk. 6. ToxMnpNo:l District 1000 •• Section 1 v A . Block J , Lot QCT 7. Starting Date: 11/29/17 Cornpletion Date: 12/6/17 S. Work Schedule Phaco Completion trate Excavation '1Vnrk Schedule Facility Installation Must 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 Chopter 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost ol'Proposed York: S 11. Remarks: Open&restore(2)4'x4'x4'mac hell holes&(1) 110'x1'x3'mac trench on the S/S of Pike St Extend G'as Main to install Gas Service to above address _ D-39 !�1 of 3 I r 12. Insurance Coverage:(Attach Copy) (a) Insurance Companyi (b) Policy N: (c)Stale 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 Wury caused by or attributable to the work performed: S 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 S (b)Maintenance Bond provided: 2 yours or 3 yours. 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 excovation within any 50'Radius whether or not they may be inter-cannesled by open bench or directional boring. The total number-of Project Locations shall be subject to the approval of the Highway Superintendent. A1. 2 /Service Connections excavations Q$20,00 S40.00 No. A2. /Additional Excavations same service{Qa S10.00 S No. B. Excavations 18"in depth or less 0.100 LF.=510.00;Additional_L.P.Q 50.10 S C. Excavations 18"in depth to 5'in depth 33.00 0-100 L.F.=530.00;Addittonnl " L.F.®S0.30 S D. Excavations 5'in depth and over 0-100 L.F.-$50,00;Additional L.P.Q$0.50 $ E. Utility Repair Excavations Q S10.00 S No, Repairs same service Q S5.00 5 Additional TOTALS 373.00 F. Notice to public utilities proormust be provided and Shall be attached to this application prior to issuance of permit. • • • • • 0 • • M • • r • • Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway E vation permit to: In accordance Itis application and subject to the"Qenerai Condltians"and"Speetal Conditions"of permit atto ed to. SUPE M VAY TOWN Or U i LD, YO Vincent M.Or an nn Date Date Received by the Town Clerk Date Permit Issued :LLAI 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 f GENERAL CONAITIONS OYPERMIT APPLICATION/PERMIT FOR IUGHWAY EXCAVATION AND REPAIR (Continued) i0, Instnll.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. l 1. Clenn Fill Only; All project back-fill shall consist of clean sand,gravel or soil(NOT asphalt,slag,flyash, broken concrete"ordemolition debris), All'unsultable soils cxcavatcd at the site(i.e.C4y;Bog,Etc)are to be removed from the site and not used to backfill any excavation within a Town Highway. 12. All Arens ofSoil Disturbance All areas of Boil disturbance resulting from�theapproved projct:tshnll be stabilized to the satisfaction of the Highway Superintendent immediately foiiowltig project comple6gn. If the project site remains inactive for more than 48 hours or planting is impractical due p the season;then the area shall be stabilized with straw;hay mulch and/or jute matting until weather conditions favor' germination. 13. ]iaekfill&Corn action of all Exc vationst Back Fill shall consist of clean fill or soils which,cihibit a well-defined moisture density relationship as doterrnined to be in accordanec with ASTMD 698. Fill shall be placed in maximum lifts of twelve(12")inches thick and shall be mechanically compacted to a Ninety- five(95°/a)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 Superintendt:nt. 14. Restorglio�n of the Road Shoulder Area: All man-made improvements located within oxIsting 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 pro-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. Seheronfic Plans with all Technical information and scone of Work: To reasonably and adequately describe 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 scheduled for for 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 those 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 Pavements are Present,Please review Rostomllon 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; e) Install a one and one half(I,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.Trenching orPnventcnt gurruces Exceeding One Hundred(10011 Tcet in Lengtltt All trenching of pavement surfaces exceeding 100' in length must first be reconstructed to meet the requirements of Item k 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 tronch shall be repaved with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). s)ty r Road Opening Permit Request nationalgrid a THE POWER OF ACTION Municipality:Town of Southold Work Order:7102025396,T202025397 Location:2200 Pike St Grid:101132819 Town:Mattituck Requested By:Brian Romano Reason For Excavation:Extend existing 2"gas main to install one new residential gas service Descrintian:Two 4'x 4'x 4'mac bell holes and one 110'x 1'x T mac trench on the South side of Pike St,starting approximately 180'West of Maple Ave and proceeding East o a� a � .fl U Pike St 110' <----- 70' ------- Curb Line 2200 w c q 3 y V � i 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 Subm-ned:ll/28/17 Not To Scale Number Of Permits Requested:) Copy Distribution: 1 �I Permit# a Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S U,CORDS Inspection Date Findings(use code) Applicant Notified lst 2nd 3`d 4'h (To Permit Clerk) MAdt CODE 113 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 orExcavation RFR Ready for Repair D_39 3 of 3 GENkRAL CONDITI NS,S7F PERMIT APPLICATION/PERMIT FOR HIGHN'VAY EXCAVATION AND REPAM 1, Pcrmiltee's Contractors in Comnlvwith Permit Renuirements: Ilia Pcmtittee 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 perdittee's agent with respect to the permitted acdvides;and such persons sliall be required to comply with all permit requirements, 2. No Right to Tresww or Interfere ivi Ili Pdvale Promarty Mahts: This permit docs net 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 Iliglrtivmv and Future Illehwnv Mmintenance: If Futuro operations or highway maintenance projects by the Town of Southold require an alteration in the positlan of the Utility,"Structure or work herein authorized,or if,in the opinion of the Highway Superintendent the work perlbrmed 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 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 the applicant failed to comply with any of the terries and conditions of the permit or Chapter 237 of the Town Code. 4. Revocation of the Permit by the}3iebway 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 acid manner as the Superintendent may require,remove all or any portion of the uncompleted utility,structure or till and restore the`site to its former condition. S. Notice of Commencement: At least 24 hours prior to commencement of the project,the,permitteo and/or contractor shall notify the Town Highway Department in writing that they arc 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 Eauinnient&Materials: The storage ofconstruction 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 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 at the contractor's expense- 8. Rgad 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 instaiiadvn 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 Bond Shoulder Aren: All Construction Debris shall be removed from the job situ 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.