HomeMy WebLinkAbout900 Albo Dr * * * RECEIPT * * *
Date: 01/18/18 Receipt#: 232929
Quantity Transactions Reference Subtotal
1 Excavation Permits 1249 $170.00
Total Paid: $170.00
Notes:
Payment Type Amount Paid By
CK#40349 $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: 1249
Permit No. d - '
TOWN'OF 30UTHOLD, gtifFO -
HIGHWAY DEPARTMENT
` Pecoriic,New York*1195 8
co • a
T102036326 " (G31)765-3140
- , ; `, . •- __' , . . Vit., . ,
" APPLiCAT10N/P<,12M1T rOR Hi(;1iWAY F.XCAVAT[ON APII)REPAIR
APPLICATION IS HEREBY mi►de to the Superintendent of Highways of the Toivn_of Southold for the issuance of an&cavation Pcrmit
pursuant to.Chaptcr 237'of the_Codo of the Town_of Southold,Suffolk County,Nciv York,and other applicable taws;or, rippes'or
regulations for°each individual contiguous cxcavatig'ti project hereindescribed,The applicant agrees to comply ivith all appl'ieitbl'e lasV3 -
= ordInunces,codes find regulations;the Attached"General Con_ditioniof Perimit"--,find"Special Conditions";if any and to perttiit'authorized,
inspectors to"make necessary Inspections of the job-site. ' : ,• _ . '.• 1
.PrintarTvne _ Keyspan Gas East Corp D/B/A Natiana_i Grid
- Gas PermitsLCi :Bldg: -3"FI: I ` -
1. 516 545 4094 _ 475 E.'Old:,COuntry Rd Hitkivillet NY'11801�-'-
Natite of Applicant ;- -Phone Number - Address of Applicant
Nninc,of Contractor _ ` , Photic'Number Address of Contractor =
Name ofProperty Owner_Requesting Service,(If applicable) Address ofOwner'
4: ,,900 ALBO;DR-,E/S,,525',S/O-WELLS-RD,,LAUREL -- _ ; - - ' � • ` " , __
'Work,Description'and Location(Street Number,`Hamlet,,Cross Sweet} ;-
(a) Is conitrtietion located within;75 feet of tidal4etiands? : _*Yes_ = No —
if yes,other Town perm'its may be required.°, -
c ' -Alyssa-Davan .
r NOTE:" All lnformatlon requcs'ted by tii'is $igttature of4j iicant
Applkiiilon/Permit Form Is, y
Required fora conipiete-noomation_:, - 1/0,9/1
-8'
Date _
5. '-(a) Attached plot plan-to reasonably and adequately describe the proposed work.-Piovide accurate schematic site plan showing the
locution of all proposed excavations-and •relationship to adjoining•preniises,public streets or areas,and give a detailed description of '
till site'and pztivcment""'i' ion work. ;
(b) Attach all other`necessary and.ticenses`I`or AhiS project"
(c) %Voikcov'ciW by this application"may not commence before issuance�dii 1-ligliw6 titivation Permit by tiie't'awn Clerk.,
6. Tax Map No. D1strictj000 , Section , Block
. ,-,completion Dater
Startint;Date: ', - -
S., Work Schedule:, Plisse .Comnietian Dale -
Excavation Work Schedule
., i z y_Installation -A]ust be provided-
.Backfill S Completion - for consldet tion`tts'a
Pavement Rcptacement Complete:Appllcation.
9. Under which authority is application being made: Ke' yspan Gas East Corporation d/b/a=Natiohi l Grid'
See Town Code Chapter 237(E);-Provide Reselntion by,or authority from,,the Utility being modified.
10.'Estimated Cost of Pr6posed Work-: S
11. Remarks"Open(1),4x4 MAC bell-hole on the-E/S ALSO DR, 525'S/O-WELLS RD.to install gas service
D-39 .1 of , 3
12.'Insurance Coverage;,(Attach Copy) :
(a);Insacarice Company:,
(b) Policy*:
(c)State whether policy of certification on fife_with the Highway Department: ;
(d)Coverage required extended Eo the Town:` =
Any_I:iiss including Bodily injury,property or-commercial injury caused by or attributable to the work perforined: -
$1,000,000 per Occurrence and S 2,000,000 genera[aggregate.-'
_ l3.'Security-`:
(a).Surcty Bond or Certified Check . _ provided in the total Amount of$
-(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 andlor,every road'op`ening or excavation within any'
=54'Raditis'whether or not ihey may be inier-connected lay open trench or directiohal boring.. _
Tb`e total nurnberbf Project Locations shall be'subjeet to the iippioval of the Nighway,Superintendent: -
Al. -- lScivice Connections excavaiioiu Q 520.00 ;, g 20.00 `
A2. = �/Additioni<l Excavations same,serAce Q 510:00 S _ -
B.. Excavations 18"in depth or-Iess '
0.100 U.=510.00;Additional .L.F.Q S0.10"- $
C. Excavations 181''in-depth to 3'in depth '
0=100 L.Y.=.530.06;Additidnai' LF;Q$0.30 5 _
D. Excavations 5'Jn depth and over _
0-100 L.F.=$50.00;Additional - L.F:_Q$O.SO _ -, $
E,' Utility Repair Excavations Q$10.00 , .5
No.
-Repairs same service Q$5.00
Additional
TOTALS 1-7a,.00 '-7O'.00
F." Notice,to public utilities proof.must be provided and
_ - Shall be attached to this application prior_to issuance oEpermit. _
Authorization is hereby granted to the Town Clerk of the Town of Southold to.iasuc ii iiightvriy Exca tion parinit to::
had rdance;with _
ihis-applicatiori and subject io tale"General Conditions"and"Special Conditions"of permit(if y) the etc -
SUPERINTE _
' TOWN Or'S Tl1 ,N V K. =
- incept )Qr ._
` Date
Date Received by the Town C erl:
Date Permit issued--1 � Permit No. ` a
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,Auring construction, _
D-39 2 of 3
v Y
Copy Distribution:
Permit# (C9.L4 9
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
INSPECTOR'S RECORDS
Inspection Date Findings(use code) Applicant Notified
1st
2nd
3rd
4tn -
(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
GENERAL CONDITIONS'OF.P>;ItNiIT`...
'APPLICATION/PERMIT FDR HIGHWAY E, O
XCAVATTN AND REPAIR f
1: 'Pcrrnittce'c Contractors to Coriinlywitli'Perinit Remiircroeiitse 'The Perirtittee is responsible for`
infoiining its independent contractors;employees,agents and assign's_of,their"responsiblity`to cotriply`.with;
this,periiiit;,�ncluding`a11 speciiiUsitespecific aiid;general conditions,impbs,, by the Highway
Supenntend6nt while.acting as the permittce's agent with respect to the permitted activities;and su_eh ;
, = -persons shall lie required td comply with'all permit requirements. ,- , .- .,' ; - • , ' , -
'J
2, No Ri ht to Tres :iss ar Inlcrferc'wilh Privnfe I'ro' cr `Ri 'fits:-This permit does not convey to the
_ perrriittec any right to ttespnss upon the lands'of adjacent propertyy owiners in order to;performrthc permitted '
- .
work not does it euthor:ze the ifnpairment of any rights,titie;'or interest in real or personal propertyheld or `
_.
vested in a pc`rsoi<'not a°pFuly to the permit,
Pi-bt`ecti6n of the Iliafitirriv n'jd Tutu're iIiehiti�nj-, nintenaiiew"If future operations of highway
p ty,
maintenance pro}eels by the,To'wri'of.Soutlioid requir`c an alteration tri the osition ofthc atilt structure ;
or wiirliherein au_thonzed;orifi in the opinion of the_Higiiway'Superintendent the work performed under
r -.,
= ' this permit shall cause urireasonabte ob5triicEion to iegiiired liighwuy niaiteruince or endanger:the'health; . .
safety and%r'welfare'of vehicular or pedestrian traffic,this'permit-shall be,revoked and the utthty,,
stnicture;fill,ckcavation,or,other modification of the hig}iway hereby,authorized shrill not lie coinp]eted. ;
Additionally;the permit may be`rcvoked if the,Highway Superintendent fiiids'that the issuance of rhe
_.
permit was illegal or anauthbr]ied__that the applicant failed to comply with"any of the;teriits and `
conditions of the perm it or Cha , 237 of the Town Code: " = .
q,` 'Reyocaition of the Permit by the YliehFvav Suoeriritcndi at:-if the,Highway Superinteni3ent deems if;
necessary to:'r'eV ke this peripit aad the,'piojedt hereby-authorized has.not 6een`co noleted,the applicant ,
shall,without expense to the Town grid to such extent and in suchtime acid manner as the Superintendent
may rcgiiire,.remove all ocany:p-onion of the uncompleted utility,structure or f 11 and cesto"re`the site to its
foiinercondition.
5; ,Notice of`Commencement: At least 24 hours prior to c'omincncemei i of the project,the permittee and/or
-contractor shall notify the Tewin Highwaybepakmehi in writing that they arc,fuily awArc of and
_ -understand all ii ii i and projectconditiops of this`pe,niiL' Upon completion of the work,the contractor _
shall provide pliotographs of the completed work io the Town Highway Department and request a Final
inspection. d '
ti. -"Storaec of hnuinmcnt&Materials: 'The storage of construction equipmetit"and/or materials shall be
confned within-the project work area and/or adjacent areas wheie permission/legal access has been '
obtained in ii manner that doe's not interfere with
nornial highway trtiff c.
�; Utility Mnrlc=Outs: -The Applicant 1 Contractor shall be'i6ponsible for verification of all existing'utility
- murk-out j fi`d shall take all precautions to protect same.�Damoge to existing utilities shill be the
responsibility of the'contraafor grid shall be repaired,at the contractor's expense. . .`
8. Road Closures: All scheduled road closures must first icebive written pei<ni'ssion from the Southold Town '
Board prior to-clositg a road.`Temporary an, closures may be permitted with the approval of the Highway = n
Superintendent. This item will included but not be limited to the installation of appropriate signage and
flag nieri'to stop and start traffic to alloW','for single lane traffic, Road Closures due to unforeseen
emergencies rmgu'6 itrift ediate.notificatioti ofthe Highway Department and shall be limited`to immediate,
and/or expedited restoration of the Work Zone;;
9, 'No ConstriiWonDe_hfls in Road Shoulder Arca: All Construction Debris shall be'removed from the job
site on i daily basis. All'sfockpiled sodas well as all other project materials that will be staged within the;
Right-of Way must be-delineated with'reflectivd signage or other means to'ineet the minimum,requirements
of the NYS,-PPT Construction Standards. ;
GENERAL CONDITIONS OF JPERMIT
APPLICATION/PERAUT FOR IiiGHWAY EXCAVATION AND,REPAIR_ ;
` - -` . ,. - _ . `- _ , . , - , ,=(Continued) _ ,. , ; • - _ - ,"
10. Install.Maintain Erosion Controls: Required li iiop Control Measures(i:e:silt fencing)is to be placed
mi the dovvnslope`edgc of any disturbed area.,This sediment harries isVto be put,in place before any
distui bantc of the ground tissues and is"to be tptiintained in"giiod functional condition until thick vegetative.
caves is established.
11.:C611'Fill`0'IV:;Ali project back-fill shrill consist of clean sand;gravel or soil,(NOT itsphalt;slag,flyash,
liroketi concreEe o�demolition debris). All unsuitable soils`cxcavated titthe site(i.e.Clay,Hog;etc)arc to
reiiiovcd from the its"anti not usedao backfill any excavation withina Town Highway.
12. Villi Areas of Soil Di9turliaiice Ali areas of soil disturbance resulting from the approved project ilial/be' - "
' stibilizcd to the sa`tisfaotion'of the Highway Superintendent immediately following project completion. If
;. .; ;
the projectstte remains mttctiye-for more ihan48_hours or planting is impractical due to the season;then
the area shall be stabilized`with straw;hay.mulch and/or jute muffing until weather conditions favor
germination: _.
13. I3ac1cfill&'Cohn- lion of n11"Excavations:'` Back-Fill,shail consist of clean fill or soils which exhibit
" . vi%eli�ilefined inoisture'densiry_ralationship tis determined to he in accordance with ASTMD 698: Fill shell '
be placed iti mnicimuin lifts of twelve(121)inches thick and shall be ifiechanically compacted to a Ninety-
dry density.
inety-
drydensity. Suitalile;hydraulic compaction by'water jetting attliree-foot
intervals will also be-permitted subject to a project specific approval by the Highway Superintendent: .-
`14:•Restorittinti of uie Road Sltoukler.Arca:"All inan=made improvements located within t3xistitig load ;
shoulder areas must be protected to the°greatest extent prataical:'bents would include but not be_limited,to
driveway&private road-sprons,'itimi boxes;sprinkler systt~ms,trees and ornamental plantings.
Excavations though drive�yays'and priyate'roitd"pavements must be reconstructed to meet alt requirements;
of Southold TownHighway Specifications:;All pie-existing road shoulder;imi ri v6inents that have been -
distu"rbed during construction must lie replaced or repaired by the contractor to the satisfaction'ofthe_ ,
. -" ' ', •' ' Highway Superintendent. _ ' .' - ' ' ; , ' .
15. ScTtemittic Pins witli nil Teelinicni infoi4 intion and Sconesof.Worlc:`•To retasonably and adequately
describe t}ia proposed'v+roi lc;accur>ite sotietnatig'Site pions must be provided to�show or indicate all _
proposed,construction activity required utide`r;this permit. ;Ail 1?6eitieirt sviftices scheduled far excavation
= must be saw cut to thc,full depth of asphalt and/or concrete pavements. Accu'rute-Mz6bf bel!holes or-width
of trenching must lie indicated by diinenston or labeling:'This schematic site plan must provide details oii
all restoration required to meet the requirements_'of theseGeperal co'ntiitions and requirements found in'the
5outhold,Town Highway Specifications.
- "i 6. 'Pa Reeonst'rtietij Ah Pavement sections must be reconstntctcd in the following matinee,
(Note:When Concrete Pavements"ate Present,Please review Restoration requirements with the Wi wiry Superintendent}
a) Coniplele all'b &soil compactioii'work its needed to provide a suitable sub-hese; ,
b) ,Over cut existing asphalt bell hole or'trench by t%velve(12"}inches on all-sides;
C) Install a compacted lift of 4"thick Stone Blend base(RCA Blend must inset NYS DOT Specification);
d} Insttall a tik'and one half(2.5')inch compacted lift of Asphalt Dase Course;
C) Instail,a tine and one half(I,5"}inch of Asphalt(Type"6j Nearing Course. -(Provide AC at alf joints)
All'work listed herein'rnusi meet the minimum'requirements of the Southold Town Highway
Specifications.
I7.. Trene,hint!of Pavemdut Stirfikes Eaceeaine One Mndred J1601)Tcct in-Length:"All trenching of
puvetneiit strfiices exceeding 100'in length must fist be tecottstirttcted to meet the requirements of Item
16 tis noted above. Once tt11 pavement rcaonstruction,is completed to the sfiiisfac66 i tithe Highway
Superintendent,the'entire`road section and/or width of road over the entire length of trench shall.be
repave d with a two(2")inch lift of Asphalt(Type 6)Wearing Course(Typical,shoulder to shoulder). '
. ,, . , .. � .. - . " • ', . ." , - ` Sty '
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