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Home My WebLink AboutCalves Neck Rd Town of Southold P.0 Box 1179 Southold, NY 11971 * * * RECEIPT * * * Date: 09/01/26 Receipt#: 362850 Quantity Transactions Reference Subtotal 1 Excavation Permits 1880 $550.00 Total Paid: $550.00 Notes: Payment Type Amount Paid By CK#1494 $550.00 23 Montrose Corp., DBA AR Underground Southold Town Clerk's Office 53095 Main Road, PO Box 1179 Southold, NY 11971 Name: 23 Montrose Corp., DBA AR Underground 21 Greg Lane East Northport, NY 11731 Clerk ID: JENNIFER Internal ID: 1880 Permit No. U TOWN OF SOUTHOLD ` HIGHWAY DEPARTMENT ,boo Peconic Lane f Peconic,New York 11958 0 (631)765-3140 ►� 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 Tune Name of Applicant Phone Number Address of Applicant ,P3 rn a ►)-Fy-o�S C �✓Pi 2. Nb� - �h af�v�� 516 -31.E-6�J� Name of Contractor Phone Number Address of Contract 3. ; M , a a- 630 CG v N4c a/1 Name of Property Owner Requesting Service(if applicable) Address of Owner '�cs 4. oQ �d✓e6CI I U�.J ; /eG(� 36I - Work Description and Location(Street Number,Hamlet,Cross Street) (a) Is construction located within 75 feet of tidal wetlands? * No *If yes,other Town permits may be required. NOTE: All information requested by this Sigma re of Appli nt Application/Permit Form is Required for a complete application! 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 other necessary permits and licenses for this project. (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 b-S , Block , Lot 2 0 7., Starting Date: Completion Date: 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 237(E)-Provide Resolution by,or authority from,the Utility being modified. 10. Estimated Cost of Proposed Work: $ 11. Remarks: D-39 1 of 3 12. Insurance Coverage: (Attach Copy) C (a) Insurance Company: v (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$2,000,000 general aggregate. 13. Security: (a)Surety Bond or Certified Check provided in the total Amount of$ (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 Superinte dent. Al. C /Service Connections excavations @$50.00 $ No. A2. /Additional Excavations same service @$20.00 $ No. B. Trench Excavations 18"in depth or less Total Lineal Footage of Excavation; L.F. @$10.00 $ C. Trench Excavations 18"in depth to 5' in depth Total Lineal Footage of Excavation; L.F. @$30.00 $ D. Trench Excavations 5' in depth and over Total Lineal Footage of Excavation; L.F.@$50.00 $ E. Utility Repair Excavations @$1,000.00/Each $ No. Additional Repairs of Same Service @$500.00/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 - $50.00 A Curb Cut would include any new or alteration of an existing driveway within the boundary of the right of way. The configuration of such is to the conditions set forth in Chapter 237 of town code. TOTAL.$ 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. SUPERINTENDENT OF HIGHWAYS TOWN OF UTHOLD,NEW YORK .1yanie 1,12Goodwin Date Received by the Town Clerk -" 2-G Date Date Permit Issued L — Y 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 Copy Distribution: Permit# Highway Department Engineer(with page 3) Applicant Town Clerk(Original) INSPECTOR'S RECORDS Inspection Date Findings (use code) Applicant Notified 1st 2nd 3 rd 4th (To Permit Clerk) REMARKS r 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 iCorp-House-Reion Cust-Job#�— - 07839=424740-02-V 9 _ -------_ �Suffolk --_-- --------_--- -----__.�..__-.-- Market Type fi ,Appointment ID f,,0783942474002V0812 ;Job No . 4A , ob Type Trouble Call Technician Vendor sMastec North America Inc 'Customer First Name ?YEFIM —. - +.Customer Last Name IBRONFMAN _._-- tustomer Type iR iCustomer Address 630 C_A_LVES NECK RD,Southold,NY 11971-1218 ,Latitude �w _.� 41.061406 _. ;Longitude _ ;-72.423398 ?Customer Primary Phone Number �— Yfi312766341 __ - __�__ ;Customer Secondary Phone Number 0731161-194 Tech Number '2624 iTech Name ~W —Nicholas Coppolone ;Appointment Start Tome f08-13-2026 14:24:54 FAction Taken Time — .M.._..*~-......_- j08-13-2026 15:33:47 100 No Picture lAlorkTaskCode 102 ChnlMissing/NotAuth 41 106 Audio Problem 1107 Remote Problem Levels at House-Channel 4 ?Is Temporary drop in Place: ,No %FTTH Customer? Vo `— (Cable Type 'RG-11 iHave All Fittings& Equipment Been Changed ;Yes Sprinkler System Yes - Is a road bore involved __ _ 1'es 'Is This A Dangerous Situation i1 ____No iDoes the cable run in front of any other (No addresses 1s the customer WITHOUT service? No Levels at Bullet Vault-Channel 0 fl s �..,_._. .__-.... there an in-ground wired dog fence?: lNo Approx. Footage Required (feet) 55 . aLevels at Tap-Channel18 - tls a driveway bore involved 4lf so,what addresses - 'Detailed Comments iRun new drop from pole under road to right side of !house , i AN dmi fts MM Show ft didaa ncs b nsar®st 6®Pn®Po �®fig(h orb tench, i®ngth of bus OnI eke of beat hob. �34 c r r Poles 1 ,