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Home My WebLink AboutColony Rd ��a�EajK�P� TOWN, OF SOUTHOLD HiGt-tWAYDEPARTMENT Peconic Lane 4 j J �"o • �r b /r��1 o Peconic,Nevv York 11955 .J l�/ (631)765-3140 APPI.ICATIO`i/PF'ENUT FOR I31G1(tiV:\Y' L\C':1V:ITION AND RLP:![R helssuance Of Excavation r BY made to the Superintendent ofHighways of t`le TNe w Yorkwn of uand otherhold for tappl cable ordinances applicable laws, APPL[CAT'ION ,S HEREBY puisualit to Chapter 23 7 of the Code of the Town of Southold,Suffolk County, and to permit authorized Conditions of Permit"andlis '`Special Conditions",if any reoulal ations for each individual contiguous excavation project herein described. The applicant agrees to comply with a app le ttached er nldpectoi s,codes make necessary inspect ons of the jobis site. Pi int pr l�v c l l �U vLN Q� s _V&hal_ `®' a-0 • � Applicant I � Phone Number Address of Namc of Applicant tor Phone Number Address of Contrac Name of Contractor 3 nesting Service if applicable) Address of Owner gas/KewP �!line oCProperty Own�r R q Sof C�do� �� G , s Cl. if art°l � -r f der,Hamlet, ross Street) No cl i tion a d Location to e N"um wetlands? *Yes 9I'Vork Des p (a) Is construction located within 75 feet of tidalwetlands if yes,other Town permits may be req iigg�n'aat'uur'e of Applicant NOTE: All information requested by this q Application/Permit Form is Required for a complete application! Date remises,public streets or areas,and give a detailed description of Attached lot plan to reasonably and adequately describetheproposed work. Provide accurate schematic site plan showing the 5. la1 A P location of all proposed excavations and relationship to adjoining p all site and pavement restoration work. (b) Attach all other necessary permits and licenses for this project f a Highway Excavation Permit by the Town Clerk. Work covered by this application may not commence before issuance o (c) , Lot � Block I 12-1 I�� (, Tax Map No: District 1000 Section l!,Completion Date: Jo 7 Startutg Date. Phase Compietion Date Work Schedule g Work Schedule Must be provided Excavation n for consideration as a Facility Installatio Backfill &Completion Complete Application. Pavement Replacement 9, Under which authority is application being made: See Town Code Chapter 237(E)-Provide Resolution by,or authority from,the Utility beiing modified. 10. Estimated Cost of Proposed Work: 11. Remarks: --------- 1 of S D-39 12 Insurance Covet age-(Attach Copy) (a) lnsuiancc 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 attl ibutable to the work performed: - $1,000,000 per Occuirence and$2,000,000 general aggregate. 13. Security: or Certified Check provided in the total Amount of$ (a)Su (a}Surety Bond • ears. (b)Maintenance Bond provided:_ 2 years or 3 y 14. Fees for Applications and permits- Basic Basic Application Fee for Each Project Location - 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. I /Service Connections excavations @$50.00 $-!�o•00 No. $ A2 /Additional Excavations same service @$20.00 No. B. Trench Excavations 18"in depth or less $10.00 $ Total Lineal Footage of Excavation; L.F.@ h C. Trench Excavations 18"in depth to 5'in d th L.F.@$30.00 $ �'0 Oy Total Lineal Footage of Excavation; 1!5 JS D. Trench Excavations 5' in depth and over L.F. $50.00 $ Total Lineal Footage of Excavation; @ E. Utility Repair Excavations @$1,000.00/Each $ No. Additional Repairs of Same Service @$500.00/Each $ No: TOTAL$ 5)20 0 O F. Official 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 Ex avation permit to: in accordance wit this application and subject to the"General Conditions"and"Special Conditions"of permit(' any) ac re . SUPERINTE E 1 YS TOWN OF U W ORK intent M.O d Date Date Received by the To n(C�I rkp Date Permit issued ` 1`' o Permit No.to Q u s 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. 2 of S D-39 c..py Distribution- Perinit# 4 " Highway Department Engineer(with page 3) applicant Towr.Clerk(Original) INSPECTOR'S RECOItI3S code) Applicant Notified Inspection Date Findings use l St Tid �rd 0 — (To Permit Clerk) REl CODE IB Improper Barricades IL Improper Lights ST Sunken Trench or Excavation UTNI Unable to Measure(due to backfilling) BUC Building Under Construction Wlp work In progress DB Improper Backfill(too high,not sufficient) HFS Inspector Holding for Final Settlement of Excavation RFR Ready for Repair 3 of 5 D-39 ORNEI'A1L CONDITIONS OF PR1Z.i UT ,�gf'LICATION/PERiVJIT FOR III+GI3'� N' EXCAVATION ANIS REPAIR responsible for contractors,employees,agents and assigns of their responsibility to comply with 1 1'ermittee's Contractors toCoiv with Permit['e uirements: The Permittee n in its independent c general conditions imposed by the Highway this permit, including all special/site specific and 5 Su erinnit, int while acting i the pemittee's agent with respect to the permitted activities,and suc a p persons shall be required to comply with all permit requirements. prope owners in order to perforin the permitted o 2 No Ri ht to Tt es ass or interfere with Private Pro er p P ahts: This permit does not convey to the permittee any right to trespass upon the lands• vork nor does it authorize the impairment of any rights,title,or interest in teal or porsonal property vested in a person not a party to the permit. Southold require an alteration in the position of the utility,structure under 3. Protection of the[li hwav and Future Hi hwav N[aintcnance: if future operations of rk highway maintenance projects by the Town of Sou q of work herein authorized, or if, in tileopinio of on to requiredhiglway hway iimta1°�znanlce or end the health, this peri-nit shall cause unreasonable o permit shall'be revoked and the utility, safety and/or welfare of vehicular or pedestrian traffic, this p structure, fill,excavation,or other modification of t1ea i Superintendenttay hereby `filndsithat the zed l issuance of ht be ecompleted. Additionally,the perinit may be revoked if the H g Y permit was illegal or unauthorized o237that oflle he Tolwn icant C deed to comply with any of the terms an conditions of the Permit or Chapter . deems it applicant 4. ent !'evocation of the Permit by the Hiahwav Sul}C ebt authorized has nothbeen completedway , p licantnt necessary to revoke this pennit and the project Ytime and shall,without expense to the Town and tf such the uncompleted extentninsucutility,structure iorfill and the estorepthe site to its may require,remove all or any portion o former condition. encement of 5 Notice of Commencement: At least 24 hours ar for to n writing that they tare fully he aware of and or contractor shall notify the Town Highway 1GrDepartment and request a Final understand all terms and project conditionsted work to heiTown Highway Dep of the work,the contractor is Penn shall provide photographs of the completed inspection. uction equipment and/or materials 6. storage of E ui ment&iV[atk are: The storage adjacent areas twherre permission/legal access has been e confined within the project work arca and/or adjacent traffic. obtained in a manner that does not interfere with normal highway Utilit Ntari:-Outs: The Applicant/Contractor shall be responsble for ve existingutilities sl all bef all theexisting utility 7 Y — mark-outs and shall take all precautions to protect swine. Damage responsibility of the contractor and shall be repaired at the contractor's expense. royal of the Highway d Town 8. road Closures: All scheduled road closures closures maybepermitted with the appy n permission from tae of the Highway Board prioi•'to closing a road. Temporary Lane clo ro irate signage and Superintendent. This item will t luded but n allow for single lane traffic. Road 1Cloisures due to unforeseen flag men i stop and start traffic emergencies require immediate notification of the Highway Department and shall be limited to immediate and/or expedited restoration of the Work Zone ruction ebris l be removed rn the ll �. No Construction Debris in Road Shoulder Area: Aotl e�n rtoject materials tl atlwill be staged within the b site on a daily basis. All stockpiled soil as well as a r Right-of Way must be delineated with reflective signage or other means to meet the ininimuin requirements of the NYS DOT Construction Standards. �t of r GENERAL CONDITIONS OF PERMIT APPLICATION/PERMIT FOR ,HIGNVAY Continued) EXCAVATION AND REPAID 10 Install, hlair►t:►in Frosiun Controls. uibed a ealeTtEs sediment baon rrier as to be put in placesures(i.e.silt ibefore a ye placed on the downslope edge of any dist disturbance of the ground occurs and is to be maintained in good functional condition until thick vegetative cover is established. 1 l Clean Fill Only: All projectbac shall consist of clean sand,gravel or soil (NOT asphalt,sl tg,taiesto broken concrete or demolition or wiis). All unsuitable soils sed to backh sit fill any excavation n within t a Town(H gi Highway. Bog ) be removed from the site and n 12. All Areas of Soil Disturbanbe ce : All Highway Suoeriil�tendentcmmediesulately folng loweng pr jecdt project shall If stabilized to the satisfaction of the H b p -ie season, the project site remains inactive fore than 48 and/or urs r pe matlantintg until weather conditions favor then the area shall be stabilized with straw, Y germination. ll consist of clean fill or soils 13. Backtill&Com action ofall FnBerminledll st abe n accordance with ASTMDwhich exhibit 698. F Fill well-defined moisture density relationship as dbe be placed in maximum lifts Oftwelv e 2')inches Suitable'ick 1 ydratdil cl1colmpaction by wlat r jettngtaatl�e toot Ninety- Five Five(9s%) percent maximum dnsi y Y intervals will also be permitted subject to a project specific approval by the Highway Superintendent. vernents located ng 14. Restoration of the Road Shoulder ed to heei extent practical. Items would include ibut not ibe limited to shoulder areas must be protect greatest driveway&private road aprons,mail boxes,sprinkler systems, trees and ornamental plantings Excavations through driveways Specifications.sand trAllp evexisting road ements must be improvements em ntsto tthatall rhave been equiremnts of Southold Town Highway disturbed during construction must be replaced or repaired by the contractor to the satisfaction oft e Highway Superintendent. 15. Schematic Plans with all Technical information and Sco a of Worl;: To reasonably and adequately describe the proposed work,accurate riust be provied to show or i All Pavement surfaces scheduled for all proposed construction activity required under this permit holes or must be saw cut to the full depth obasphalt esion oa/or]abelingetTl�isyschemati Accurate ite size of pbovlide details on of trenching must be indicated by all restoration required to meet the requirements of these General Conditions and iequirements found in tile 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 Restoration 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(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. ct tin 17. Trenching of Pavement Sur IOU' E length muing Ost first►be reconstructed ndred LlowLAll trenching of cto meet the equirements of Item pavement surfaces exceedingin # 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 lengtshodh fttrench er to shshall ber). repaved with a two(2")inch lift of Asphalt(Type 6) Wearing Course(Typical, ,rc�5 (Fey, a118? POLE#5-40'P I-CUT-OUT F-8T) I-PHASE L A I-GROUND MATERIAL UG NOTES: 1-2/C#2AL POTHEAD POLE 6-35'P 1-3'-U-GUARD, PRIMARY RISER 655' - 3/C#4 � ® . . ® 6 . 1/OALPE GUIDE DRILL o I-C/O(F-8T) COLONY RD. 2/C#2ALPE 115' y� LBF XXXXX OPEN TRENCH 2/C#2ALPE z io N cef LiI— LOT#1 LOT#3 BG#107834 1-50KVA-GRP.234 I-SPLICE BOX GRID#107-29 I-SPLICE BOX BUS#6413 40' o OPEN TRENCH OPEN TRENCH o 3/C3/OAL CIC 3/C3/OAL CIC Ln LOT#2 z LOT#4 m I-SPLICE BOX LOT#5 TOWN: SOUTHOLD PSEGLI DESIGNER: KEN MUCCI GRID 107-29 NOTI ICATION #900000067510