HomeMy WebLinkAboutPeconic Bay Blvd * * * RECEIPT * * *
Date: 01/24/18 Receipt#: 233583
Quantity Transactions Reference Subtotal
1 Excavation Permits 1250 $180.00
Total Paid: $180.00
Notes:
Payment Type Amount Paid By
CK#140568 $180.00 Bancker, Construction Corp
Southold Town Clerk's Office
53095 Main Road, PO Box 1179
Southold, NY 11971
Name: Bancker, Construction Corp
218 Blydenburgh Road
Po Box 970
Islandla, NY 11749
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Clerk ID: LYNDAR Internal ID 1250
- sPermit No. a
TOWN OF SOUTHOLD
HIGHWAY DEPARTMENT
Peconic Lane `
Peconic,New York 11958 0 ,�
(631)765-3140 ��d o
APPLICATION/PERMIT FOR HIGI•IWAY rXCAVATION ANIS REPAIR
APPLICATION IS HEREBY made to the Superinlendent•.of Highways,of the Town-or Southold for the.issuance dfan l xcevation-Permit
pursuant to Chapter 237,of-the Code of the Town of'Soulhold,,Suffolk County,New York,and',ather applicable laws,ordinances or
regulations,for the'excavatioa herein described. The applicant agrees to comply with all'-applicable laws,ordinances,codes and
rcgulations,the attached"General Conditions df Permit"and"S pecial'Conditions",if any and to permit authorized inspectors to make
necessary inspections of the job site.
j Print or Type h� (,/�C 11?` 218 Blydenburgh Road
1.
BANCKER CONSTRUCTION CORP TU (631) 582-8880 Islandla, NY 11749
Name of Applicant Phone Number Address of Applicant 218 Blydenburgh Road
2. BANCKER CONSTRUCTION CORP Islandia, NY 11749
Name of Contractor Phone Number Address of Contractor
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Name of Property Owner Requesting Service(if applicable) Address of'Own
i Open road to install an 8"bypass on a 12"water main on the Southold side of Peconic Bay Blvd.,about 600 ft.
4. from Laurel Lane.
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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.
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NOTE: All information requested by this 9 g a A cant
Application/Permit Form is
Required for a complete application!
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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 other necessary permits and licenses for this project.
y (c) Work covered by this application may not commence before issuance of a Highway Excavation Permit by the Town Clerk.
1 tt °z 5, Lot "I
6. Tax Map No.: District 1000 , Section E , Block_ ✓a(
` 7. Starting Date: � ' 4J� b Completion Date: Z l
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8. Work Schedule: Phase Com le'tion'I?ate
j Excavation f 15,1 1 C Work Schedule
Facility Installation I I I'� Must be provided
Backfill&Completion i11511% for consideration as a
{ Pavement ReplacementComplete Application.
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9. Under which authority is application being made:
See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility being modified.
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10. Esti mated Cost of Proposed Work: $ 0 U IIID
1 11. Re marks:
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12. Ins urance Coverage:(Attach Copy) i 1� /' n s t
(a) Insurance Company: {� '`Ll/� 1
(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$2,000,000 general aggregate.
13. Securit y:
(a)Surety Bond. or Certified Check provided in the total Amount of$ �5TVr 1
(b)Maintenance Bond provided: 2 years or 3 years.
14.Fees for Applications and permits:
Basic Application Fee $150.00
A l. /Service Connections excavations @$20.00 $ .
No.
a
A2. t`!�_ /Additional Excavations same service @$10.00 $ -
No.
B. "Excavations 18"in depth or less
0-100 L.F._$10.00;Additional L.F.@$0.10 $
C. Excavations 18"in depth to 5'in depth
0-100 L.F.=$30.00;Additional OD L.F.@$0.30 $ J�n
D. Excavations 5' in depth and over
0-100 L.F.=$50.00;Additional L.F.@$0.50 $
E. 0 Utility Repair Excavations @$10.00 $
No..
Repairs same service @$5.00 $
Additional
TOTALS ISO
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:
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in accordance with
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this application and subject to the"General Conditions"and"Special Conditions"of permit rf any)attach her o.
_ SUPERINT T O IG AYS
(CO49 ! TOWN O ORK
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Vinc t M./
Date
Date Received by the Town Clerk t
Date Permit Issued 4- Permit
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NOTE:. Permit expires one(1)year from date of issuance.
No work to start without 24 hour notice to Superintendent of,llighways.
Permit:must be available at all times for inspection;on site,during construction.
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Copy Distribution: ^
Permit# S-0
Highway Department
Engineer(with page 3)
Applicant
Town Clerk(Original)
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i INSPECTOWS RECORDS;
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Inspection Date Findings(use code) Applicant Notified
i 1st
2nd
3rd
4th - -
(To Permit Clerk)
REMARKS
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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
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GENERAL CONDITIONS OF PERMIT
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
I. P_ermittee's Contractors to Comply with Permit'Requirements: 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 requirements.
2. No Right to Trespass or Interfere.with-Private Proper-ty 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 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 Highway,and Future HigMyay'Maintehance: 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, in the opinion of the Highway Superintendent the work performed 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-may be revoked if the Highway Supttinte»dent'f nds'that Ute issuance of the
permit was illegal or unauthorized or that the applicant'failed-to comply with any of'the terms and
conditions of the permit or Chapter 237 of the Town Code.
4. R6vocatiowof the'Peemit by.the Righway Sunerintendenfi_.If the Highway,Supecintendent drentsA
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,remove all or any portion 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 are fully aware of and
f understand all terms and project conditions of this permit. Upon completion of tlie,work,the contractor
shall provide.photographs of the completed work to the Town Highway,Department and request a Final
inspection.
( 6. Storage of Eclnitiment c4-Materials: The storage of construction equipment and/or materials shall be
3 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. UtiliifMairk-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
i 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 Southold Town
Board prior to�closing a road. Temporary lane ciosures:may•be permitted with the approval of the Highway
I Supetintendent. This item will included but not be limitedfo,the installation of appropriate signage and
flag mento stop and start traffic to allow for single lane traff e, Road Closures due to unforeseen
I 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: ATCoostruction,Debris'shall be removed.from-the job
site on a daily'basis, All stockpiled,soit.as well as,all tither project'materialsaltat will be staged-within the
Right-of Way must be delineated with reflective signage-or.other means;to-meettlie minimum requirements
' of the NYS DOT Construction Standards.
GENERAL CONDITIONS OF PERMIT
APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR
(Continued)
10. Install,d 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.
11. Clear►Kill 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.
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j 12. All Areas of Soil Disturbance : All areas of soil disturbance resulting from the approved project shall be
stabilized to the satisfaction ofthe 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.
j '13. 13aekilll&'Compaction of all-Ti isvations: 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(12")inches thick and shall be mechanically compacted to a Ninety-
five'(95%)percent maximum dry density. Suitable hydraulic compaction by water jetting at-tluee-foot
i intervals will also be permitted subject to a project specific approval by the Highway, Superintendent.
14. Restoration of the Road Shoulder Area: 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 acid ornamental plantings.
Excavations through driveways and private road pavements must be reconstructed to meet all requirements
t 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. 5ehematic•Plans with Al Technical information and Scone of Work: To reasonably an'd it
describe the proposed work,ac_curafe•schematic site;plans,must. a provided to show or indicate,all'
proposed construction activity required under this-permit. All Paveindntsurfaces scheduled for,excavation
must be•saw,cut io.the full depth of asphalt and/or concrete pavements. Accurate'size of•bell Iioles�or width ,
of trenching,must'be indicated' dimension oi•'labeliiig. This schematic site plairmust provide details on
all,restoration required-to meet,the.requirements oftliese,General Conditions and requirementsfound`imthe
s Southold Town Highway Specifications.
16. PayementReconstruction: All Pavement sections must be reconstructed in the following manner;
ILW - (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;
i 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,10i of Asphalt Base Course;
# e Install a-tine and one half(1.5")-inch-df As halt(Type G WearingCourse. Provide AC at all joints)
All work Iisted herein-must meet the minimum requirements of the Southold Town Highway,
Specifications.
17. Trenching of Paveinenf Srirfaees EiEeccdiiier One Iltindred(1,001)=Feet•in Igen he,All trenching of
pavement surfaces exceedi'ngA 00'- 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
I Superintendent,the entire road section and/or width of road over the entire length of trench shall be
repaved with a two(21 inch lift of Asphalt(Type 6) Wearing Course(Typical,shoulder to shoulder).