Fillable STREET START DATE CROSS STREET END DATE DESCRIPTION (City of Kingston)

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STREET START DATE CROSS STREET END DATE DESCRIPTION (City of Kingston)

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Country of origin: US
File type: PDF

U.S.A. forms for City of Kingston

BROWSE CITY OF KINGSTON (NY) FORMS

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DATE OF APPLICATION:
STREET START DATE
CROSS STREET END DATE
DESCRIPTION DIG SAFE #
PROPERTY OWNER INFORMATION CONTRACTOR
Property Owner Name:
Address Owner
City/State/Zip Address
Phone/Cell Phone City/State/Zip
Email Address: 24 Hr. Phone:
Excavator (if different than Contractor)
By signing below I acknowledge I have read, understand & agree to abide by policies listed in the regulations,
procedures and instructions. The Superintendent or his designee has the right to revoke any permit and or
bonding from permit holder if all policies and regulations are not followed
CONTRACTOR/OWNER (PRINT)
CONTRACTOR/OWNER (SIGNATURE)
Sewer Repair/Replace Tap
Water Repair/Replace Tap
Gas Repair Replace Retire New
Services #
Trench Y/N Curb Cut Y/N
Placement of Cut Road Sidewalk
Size of Cut Width Length Depth
Description/Other
Street Excavation $300 Street Excavation & Tap $650
Sewer Tap $350 Curb Cut $100
Linear Trenches/Main Inst $2/Ft Street Excavation & Sidewk $350
Non Compliance $250 Emergency $100
FOR OFFICE USE ONLY: Approval
Amt Pd Check # Cash Receipt #
STREET/SEWER EXCAVATION - SEWER TAP - CURB CUTS
PERMIT #
LOCATION OF WORK
DESCRIPTION OF WORK (check all applicable)
FEE SCHEDULE
No
No
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STREET START DATE CROSS STREET END DATE DESCRIPTION (City of Kingston)

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Completed 23 January 2021

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