The URL can be used to link to this page

Home My WebLink AboutGreton Ct Town of Southold P.O Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 08/21/26 Receipt#: 362555 Quantity Transactions Reference Subtotal 1 Excavation Permits 1877 $550.00 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#9000377782 $550.00 PSEG, LI Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: PSEG, LI 117 Doctors Path Riverhead, NY 11901 Clerk ID: JENNIFER Internal ID: 1877 Permit No. I 1 ( _ TOWN OF SOUTHOLD gU( - HIGHWAY DEPARTMENTS Email permit to:Gary.Dubovick@psegiiny.com Peconic Lane Job:9-240770 Peconic,New York 11958 (631)765-3140 ,1 APPLICATION/PERMIT FOR HIGHWAY EXCAVATION AND REPAIR APPLICATION IS HEREBY made to the Superintendent of Highways of the Town of Southold for the issuance of an Excavation Permit pursuant to Chapter 237 of the Code of the Town of Southold, Suffolk County,New York,and other applicable laws,ordinances or regulations for each individual contiguous excavation project herein described. The applicant agrees to comply with all applicable laws, ordinances,codes and regulations,the attached"General Conditions of Permit"and"Special Conditions",if any and to permit authorized inspectors to make necessary inspections of the job site. Print or Type 1. _PSEGLI- 117 DOCTORS PATH RIVERHEAD NY 119017 Name of Applicant Phone Number Address of Applicant 2. Name of Contractor Phone Number Address of Contractor 3. Name of Property Owner Requesting Service(if applicable) Address of Owner 4. THIS WORK ORDER CALLS FOR 1 ROAD OPENING AND ONE OPENING IN THE PUBLIC GRASS AREA. SEE SKETCH 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. NOTE: All information requested by this Signature of Applicadf Application/Permit Form is 7/22/2026 Required for a complete application! Date 5. (a) Attached plot plan to reasonably and adequately describe the proposed work. Provide accurate schematic site plan shoving 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 pro'lect. (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 Block Lot 7. Startim,Date: 9/1/2026 Completion Date: 11/1/2026 8. Work Schedule: Phase Completion Date Excavation Work Schedule Facility Installation Must be provided Backfill&Completion for consideration as a Pavement Replacement Complete Application. 9. Under which authority is application being made: See Town Code Chapter 2 37(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: S 11. Remarks: D-39 1 of 3 12. Insurance Coverage: (Attach Copy) (a) Insurance Company: (b) Policy n: (c) State whether policy of certification on file with the Highway Department: (d)Coverage required extended to the Town: Anv Loss including Bodily injury,property or commercial injury caused by or attributable to the work perfornied: 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 years or 3 years. 14. Fees for Road Opening Applications and permits: Basic Application Fee for Each Project Location - $500.00 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 number of Project Locations shall be subject to the approval of the Highway Superintendent. Al. 1 ;Service Connections excavations @ S50.00 $ 50.00 No. A2. /Additional Excavations same service(cr' S20.00 S No. B. Trench Excavations 18" in depth or less Total Lineal Footage of Excavation; L.F.(h),$10.00 S C. Trench Excavations 18"in depth to 5' in depth Total Lineal Footage of Excavation. L.F. (ri S30.00 S D. Trench Excavations 5'in depth and over Total Lineal Footage of Excavation: L.F. (ci $50.00 $ E. Utility Repair Excavations 65.-,S 1,000.00%Each $ No. Additional Repairs of Same Service @..S500.00/Each $ No. F. Official Notice to public utilities-proof must be provided and Shall be attached to this application prior to issuance of permit. 15. Fees for New or Alteration to Curb Cut: Basic Application Fee - $50.00 A Curb Cut would include any new or alteration of an existing driveway within the boundary of the right of way. The configuration of such is to the conditions set forth in Chapter 237 of town code. TOTAL$ 550.00 Authorization is hereby granted to the Town Clerk of the Town of Southold to issue a Highway Excavation permit to: in accordance with this application and subject to the"General Conditions"and"Special Conditions"of permit(if any)attached hereto. SUPER E DENT OF HIGHWAYS TO\ OF. t OLD,NEB YO cc Dat el.1 Goodwin l le ' Z /Date Received by the Town Clerk Date /- �O Date Permit Issued �(/ Z 1 l Z W Permit No. W7 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: 9 71 Permit# Highway Department Engineer (with page 3) Applicant Town Cleric(Original) INSPECTOR'S RECORDS hispection Date Findings(use code) Applicant Notified 1 S1 -)lid 3`I ,7 111 t (To Permit Clerk) REMARKS CODE IB Improper Barricades IL Improper Lights ST Sunken Trench or Excavation UTM Unable to Measure(due to backtilling) BUC Building Under Construction WIP work In Proaress DB Irnproper Backtill(too high,not sufficient) I-IFS Inspector Holding for Final Settlement of Excavation RFR Ready for Repair D-39 3 of 3 Request for: TOWN OF SOUTHOLD DATE: 7/22/2026 PERMIT REQUIRED TO OPEN: THIS WORK ORDER CALLS FOR .I. ROAD OPENING AND ONE OPENING IN THE PUBLIC GRASS AREA. ROAD OPENING IS A SPI..ICE PIT (4'XZI') TO EXTEND UNGROUND PRIMARY FACILITIES, PUBLIC, GRASS OPENING IS FOR A NEW BELOW GRADE TRANSFORMER WITHA 36"' COVER, THIS WORK IS REQUIRED FOR A NEW HOME AT THE END OF GRE FON CT IN MA FFITU K, LOCATION OF OPENING SHOWN ON ATATC HED SKETCH. Number of Road Openings: 1) In Grass Areas 1 2) In Roadway Areas 1 Approximate Start Date: 9/1/2026 Approximate Completion Date: 11/1/2026 PERMIT REQUESTED BY: G.DUBOVICK DIVISION: EASTERN NOTIFICATION # 900000240770 TD 1300 TYPE OF ROAD: PAVED WORK ORDER# 800000513327 RETURN PERMIT TO: GARY.DUBOVICK@PSEGLlNY.COM 900000240770 PERMIT SKETCH � I I 745 i 560 ------ \\ 4'x4' BELL HOLE TO EXTEND 750 \ \ UNDERGROUND PRIMARY AND INSTALL NEW BELOW GRADE \ \ TRANSFORMER WITH 36" ROUND \ \ COVER IN THE PUBLIC GRASS AREA. / s 1 FM#8009080 092010 00001234-001-001-TFISIP00081426181535-00-0-00001234 LONs -� PSEG. LAND 9000377782 PSEG Long Island Page 1 of 1 333 Earle Ovington Boulevard,Ste 403 Further Inquiry Call: Uniondale, NY 11553 973-430-6580 DATE 08/13/2026 Vendor No. 138173 TOWN OF SOUTHOLD HIGHWAY DEPARTMENT Gross Net Invoice Date Description Document No. PO Number Amount Discount Amount 07/22/2026 1300003964 550.00 .00 550.00 9240770 ti Total: 550.00 .00 550.0 ■ n.