HomeMy WebLinkAbout44608-Z o��UFFot��DTOWN OF SOUTHOLD
BUILDING DEPARTMENT
s TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 44608 Date: 1/22/2020
Permission is hereby granted to:
Block, Carla
C/O Burner Law Group P.C.
12 Research Way
East Setauket, NY 11773
To: demolish existing dwelling as applied for.
At premises located at:
2875 Hyatt Rd, Southold
SCTM #473889
Sec/Block/Lot# 54.-1-12
Pursuant to application dated 12/24/2019 and approved by the Building Inspector.
To expire on 7/23/2021.
Fees:
DEMOLITION $786.70
Total: $786.70
Buil 'n ector
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 rt Survey
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E C.
Trustees
C.O.Application
Flood Permit
Examined 20� Single&Separate
Truss Identification Form
Storm-Water Assessment Form
r. Contact: CL��
Approved ,2046f� Mail to:
Disapproved a/c
Phone:
Expiration ,20
IDI t.,. .
Buildihd Inspector
DEC 2 0 2019 APPLICATION FOR BUILDING PERMIT
�.;.- Date Pezv,,bar 23 , 20
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale.Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy. -
f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months. Thereafter, a new permit shall be required.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordinances,building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature f applican or narVe if a corporation)
GC)6c1 235 lq,,dersojl A)-4. 5vu11,d4 A Il 71
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises I ova aQ ,rol l eeh
(As on the to roll or lates deed)
I applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
1 slumbers License No.
l lectricians License No.
Other Trade's License No.
1 Location of land on which proposed work will be done:
2875 Hdl, Road 115e7(
House Number treet Hamlet
County Tax Map No. 1000 Section 5L]
Block ' 01 Lot 12,
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy NIA — , )014*0 14 lawn C `,�
b'4evoAe4 (, �cta,,._l(
o✓i Pr'?- ('5eS i J
b. Intended use and occupancy_ A-
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Worlc
(Description)
4. Estimated Cost Fee
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars l
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear r_Depth.ry evio
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO Will excess fill be removed from premises?YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS.
COUNTY OF SJ61k )
DD '-Nck l-k P B I VAe""13, being duly sworn, deposes and says that(s)he is the applicant
(Name of individual si ning cont act) above named,
(S)He is the O wv.e r
(Contractor,Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applica ion;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me t&Ca
day of T_20_LGL
Cj Notary Publi(j— ` RACEY L. DV\IYER Signature o Appl cant
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2APAOI,
II' "SEG
131*.LA
9/30/2019
DONALD BLYDENBURGH Service To:
235 ANDERSON RD HORTONS PT EXT
SOUTHOLD,NY 11971 SOUTHOLD,NY 11971
Customer Project#:900000098247
Dear DONALD BLYDENBURGH:
This is to advise you that the PSEG-LI electric facilities at the above referenced location have
been disconnected and removed off the building structure that is located on the property.
Please note that there may still be PSEG LI facilities located within the property boundaries
and that NYS law(NYCRR Part 753) requires all contractors to call for a utility locate (NY
811)prior to performing any ground excavation or regrade activity. The call to the 811 Call
Center must be done at least 2 business days prior to the start of the work and confirmation of
utility marks having been identified must be received from all the facility owners prior to any
site work.
You must also contact National Grid at 631-348-6150 to procure a letter of demolition
associated with natural gas service, whether or not your home or business uses natural gas.
If you have any questions regarding the above,please contact Building&Renovation Services
at 1-844-341-6378 or via email at BRSLI@PSEG.com.
Very truly yours,
Carolyn Mackin—Manager
Building&Renovation Services
PSEG-LI
Evan T.Steffens NationaIgnod
Senior Supervisor
Gas Customer Connections,NY
October 17, 2019
Donald P. & Eileen Blydenburgh
235 Anderson Road
Southold, NY 11971
Email: EMTRILLICaGMAIL.COM.: DBLYDENBURGIHGMAIL.COM
National Grid WO#: T102254747
Service Address: 2875 Hyatt Road
Southold, NY 11971
To Whom It May Concern:
This letter is to advise you that National Grid investigated your request and confirmed that the
subject property does not have an active gas service line.
New York State law requires anyone planning underground excavation work to notify local
utilities by making one call to a toll-free number to get your underground lines identified
for you prior to doing any digging. This phone call needs to be made at least 2, days but
not more than 10 days prior to starting work, not including the date of the call. The
number to call is either the nationally sponsored-811", or the local number for NYC I LI
area, 1-800-272-4480.This confirmation letter of no active gas service line to the subject
property does not relieve the excavator of making this"811"call.
If you have any further questions, kindly contact me at 631-348-6150.
Respectfully,
Evan T. Steffens
Senior Supervisor
Gas Customer Connections NY
1650 Islip Ave,Brentwood NY 11717
T:631-348-6150 evan.steffensc>nation lidd.com ngridlirudarocessinit� nal rid.co
�natiom
A/PLUS ENVIRONMENTAL CORP
320 BEACH100T" STREET SUITE 41),
ROCKAWAY PARK, NY 11694
APLUSJRB a YAHOO.COM
T 516-395-3932 F 718-945-0374
Abattement Contractor ; License Number : 37262
A/Plus Environmental Corp. License Class : Full
320 Beach 100`" Street Suite 4d Date of Issue: 11/21/2019
Rockaway Park,NY 11694 Expiration Date: 12/31/2020
Abatement Date: 12/15/19 Invoice#00121519
Requested by Donald Blydenburgh
Attn: Donald Blydenburgh
Billing Address: 2875 Hyatt Road
Southold,NY 11971
Site of asbestos removal
2875 Hyatt Road,
Southold,NY 11971
Amount of asbestos Removed: 145 square feet of floor tile and 50sf of boiler insulation
material.
Work Area: Basement& First Floor
Completion Date: 12/15/19
Amount Paid; $2,500.00
Amount Owed: $00.00
Balance Due: $00.00
Received By
Junior Osaro P A 11'")
A/Plus Environmental Corp.
Thank you for your Business?
A/plus EnvironmentalCorp
310-Beach ioth-Street Suite-4D
Rockaway Park,NX i-1704
51��95-393slr8@y -3 o93 o}n
�� T 2
320 BEACH 100TH STREET SUITE 4D
ROCKAWAY PARK,NY 11694
APLUSJR8@YAHOO.COM
T 516-395-3932 F 718-945-0374
Proposal Estimate Submitted License Number: 37262
Attn: Donald Blydenburgh License Class: Full
Job Location: 2875 Hyatt Road Date of Issue: 11/21/2019
Work Area: First Floor& Basement Expiration Date: 12/31/2020
Southold,NY 11971
Subject: Asbestos Abatement Date: December 15, 2019
We hereby submit specification and estimate for the removal of 145 square feet of asbestos
contaminated floor tile and 50sf of boiler insulation material from 2875 Hyatt Road Southold,
NY 11971 A/Plus Environmental will plasticize work area and build critical barrier attach
negative air machine use wet method for the removal of floor tile material and use tent procedure
on boiler insulation ACM, double bag, bags out, HEPA vacuum work area and encapsulate in
accordance with local, state and federal regulations.
Please note that building owner is responsible for supplying electric and water. all our
Work shall be done in strict compliance with all applicable federal, state, and local regulations
guidelines governing the safe removal and proper disposal of asbestos containing materials.
A/Plus guarantee final air clearance of 0.01 fibers per cubic centimeters as determined by phase
contrast microscopy analytical techniques or background sample whichever is higher. A/plus
environmental will not be responsible for filing fees DEP, DOL & EPA Notification. A/Plus
Environmental will not be responsible for third party air monitoring in the building owner or
general contractor is responsible.
A/Plus will take waste to tri -state transfer associate, Inc. and A/Plus will be sending waste
manifest of legal disposal of waste and ACP 21 within two weeks of completion.
Note: area shall be inaccessible to anyone during abatement procedures until final air clearance.
We are fully insured and licensed by the State of New York and the City of New York. All items
must be moved from the work zone before abatement activity begins.
This proposal may not be changed. All necessary changes are to be in written form. We propose
hereby to furnish material, labor and disposal of ACM, complete in accordance with above
Specifications, for the sum of$2,500.00 including of tax. Check payment to be made as follows:
50%prior to commencement. Balance upon completion. Price shall remain in effect for 30 days
from date of propose.
Junior Osaro
Date of Acceptance: A/Pius F{nvirgnmental Corp A/Plus Environmental
320 Beach 16t4-Street$gite•4D
Rockaway Park,NY 11694
aplixs�'rS u�7yaht�o.co�n
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SCALE 1"=30'
�0 ea JUNE 19, 2019
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'RETAIN STORM WATER RUNOFF 2. ROUGH - FRAMIN z & PLUMBING
PURSUANT TO CHAPTER 3. INSULATION
PSTAN REPARED IFOR TITLE SURVEYS AS N ACCORDANCE WITH THE MINIMUM R 236 1�' 4. FINAL - CONSTRUCTION MUST
FBY OR E LIAL -0 APPROVED
NEW YORK 5T TEPTED OF THE TOWN CODE. 1I II
TITLE ASSOCIATION BE COMPLETE FOR C.O.
I ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
;gra YORK STATE. NOT RESPONSIBLE FOR
p DESIGN OR CONSTRUCTION ERRORS.
NYS LIG No SD467
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UNAUTHORRED ALTERATON OR ADDITION % 'I
Nathan Taft Corwin III TO THIS SURVEY IS A VIOLVIOLATION OF
SECTION 7209 OF E NEW YORK STATE
EDUCATION LAW
Land Surveyor COPIES OF THIS SURVEY MAP NOT BEARING
THE IAEO SURVEYORS INKED SEAL I v YYY
EMBOSSED SEAL SHALL NOT BE CONSIDERED
I TO RE A VALID TRUE COPY � L
Successor To Stanley J Isaksan,Jr LS CERTIFICATIONS INDICATED HEREON SHALL RUN Lr I
Joseph A In a n°LS ONLY TO THE PERSON FOR WHOM THE SURVEY
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TITLE COMPANY,GOVERNMENTAL AGENCY AND
Title Surveys—$Mbdrvisrons — Site Plans — ORSINCbOn Layout LENDING INSTITUTION LISTED HEREON,AND I I
PHONE (631)727-2090 FOK(631)727-1727 TUITIOTO N CERTIFICATIONS ARE NOT ASSIGNEES OF THE INTCrr�I TRANSFERABLE. I I,
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