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Home My WebLink About48390-Z �o�SU FF a TOWN OF SOUTHOLD a BUILDING DEPARTMENT TOWN CLERK'S OFFICE z 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#: 48390 Date: 10/12/2022 Permission is hereby granted to: Neighley, Raymond 245 Rachaels Rd Mattituck, NY 11952 To: Demolition of a single family dwelling as applied for. At premises located at: 245 Rachaels Rd, Mattituck SCTM #473889 Sec/Block/Lot# 108.4-7.43 Pursuant to application dated 8/29/2022 and approved by the Building Inspector. To expire on 4/12/2024. Fees: DEMOLITION $525.00 Total: $525.00 Building Inspector �4r9el- TOWN OF SOUTHOLD—BUILDING DEPARTMENT � ` Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 https://mlww.southoldtowiiny.gov Date Received APPLICATION FOR BUILDING PERMIT (� For Office Use Only PERMIT N0. 4(b3 { Building Inspector. JAz Applications and forrns:must beufilled:out-in.th-eir entirety.-Jncomplete`; << AUG 2 2022 applications will not be:accepted .Where the Applicant is not the owner,an., `Owner's Authorizatiorrform(Page,2)shall be-completed: TOVVN OF SoLlTF I_};;- Date: 2 Zai OWNER(S�OF.PR0 ERTY: Name: SCTM# 1000- Project Address: Phone#: - -.__ - -�- --- - -- -f - �--"G- - _�.� -- - - Email: � .�.(�'�-.rti/�JC'��'�/� �L.•Cv Mailing Address -CONTACT.-PERSON:,,-- Name: -►-V—�l - — ' Mailing Address: Phone..#_�. �.) " Email;----��-Oi DESIGN'-PROFE55IONAL.INFORMATION: - Name: --1------------ Mailing ____- _..----.Mailing Address_ (� - -�- - C7./�/ -. // Phone#: - � - - - . -(.' - - Email: K�J .( E It'��UD.0 :CONTRACTOR INFORMATION; Name: V I --scot -S-. v . /Oep Mailing Address: V C- J C S VY UC ,!� /(9O Phone#: 1 Email: ! x l-._. - DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair 04molition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? EKes ❑No f./� 1 I PROPERTY INF.ORIVIATOIV Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. ❑:Check.130X AfteY Reading The owner contractor/design professional is responsible for all drainage and storm wateeissuesas provided by Chapter 236 of the Towh Code. APPLICATION IS HEREBY MADE to-_the Building Department fai the issuance of a Building Permd pursuan#-to the Building Zone "Ordinance-of the Town of Southold,Su'ffolk;County,New York and other applicable Laws Ordinances orRegulations,fok the construct!on of-buildings, eddlitioi s,aiieratici sior for,7emoval or demolition asherein described The_apphcant agrees-to compiy wiih-all applicable laws,ordinances;building code, housing code and reguiations and to admit authorized inspectors on premises and in building(sl for necessary inspections.False statements rnadefier sin are- punisha6le as a lass-A misdemeanor pursuant to`Section210.45•of:the New York State genal Law Application Submitted By(print name): 1� �� (0 r ❑Authorized Agent M6wner Signature of Applicant: �/'_�G�✓ Date: STATE OF NEW YORK) S COUNTY OF ) 0 ) oc v 9.,�a N II� being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the 0r_,o V oA/, (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 application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this 12 day of �� , 20 Notary Public Monika Majewdd PROPERTY OWNER AUTHORIZATION I!IOTARYsWoallo.OI MBM OFN2WYORiC Registeatioa No.OIMA6392140 (Where the applicant is not the owner) Qualified in Suffolk County Commission Expires 05/26/2023 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 LONG. PSEG 8/25/2022 MONIKA MAJEWSKI Service To: 87 SANDY CT 245 RACBELS RD RIVERBEAD NY 11901 MATTITUCK NY 11952 Customer Project#:900000154801 Dear MONIKA MAJEWSKI, 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, Katherine GianCelli p/ Building&Renovation Services PSEG-LI RAY DONER,ARCHITECT ARCHITECTURAL DESIGN INTERIOR DESIGN PLANNING&DEVELOPMENT RESIDENTIAL-COMMERCIAL-INDUSTRIAL 95 RICHMOND AVENUE S.AMITYVILLE, NEW YORK 91704 Phone/Fax: (639)6914718 EMAIL:RDARCHITECT@YAHOO.COM September 19, 2022 Southold Building Department 54375 Rte. 25 Southold,New York 11971 RE: CERTIFICATION of No GAS 245 Rachels Road, Mattituck. To Whom it May Concern: This Letter is to Certify that there is no GAS SERVICE to this Residence. Sincerely, ARCh,�T Ray Doner, Architect. C2e ODI��O OF NE�� SEP 2 3 2022 BUILDING DEPT TOlf NOFSOU1di;- ,.�s ACQRD. CERTIFICATE OF LIABILITY INSURANCE D08/26/2022) 08/26/2022 PRODUCER 516-564-5656 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NORTH FRANKLIN BROKERAGE INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 13 N FRANKLIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HEMPSTEAD, NY 11550 INSURERS AFFORDING COVERAGE MAIC# INSURED INSURERA: American European Insurance Co. CUBIAS CONSTRUCTION CORP INSURER B: 76 GARDNER AVE INSURERC: HICKSVILLE, NY 11801 WSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLAIMS. INSR ADD'- POLICY NUMBER POLICYEFFEDATF(MMIDp VE POLICYEIP ITION VMS GENERALLIABILITY EACHOCCURRENCE $1,000,000 REMI A ✓ COMMERCIALGENERALLIABILIfY PETORENTED PREMISES Eaoccurence $100,000 CLAIMS MADE ✓❑OCCUR MEDEXP(Anyoneperson) $5,000 SKP200784210-12 10/21/21 10/21/22 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENLAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPADPAGG $2,000,000 RO- ✓ POLICY JECI LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILYINJURY $ SCHEDULEDAUTOS (Perperson) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (PeraccHderd) $ PROPERTYDAMAGE $ (Peracciderd) GE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTOONLY. AGG $ EXCESS(UMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONAND WCSTATU I OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ ' OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ It yes,describe under SPECIAL PROVISIONS below F-LDISEASE-POLICY LIMIT $ OTHER DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES/EXCIJMONSADDEDBYENDORSEMM/SPECIAL-PROVISIONS According to policy terms and conditions certificate issued for proof of coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION TOWN OF SOUTHOLD DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 53095 ROUTE 25 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO So SHALL PO BOX 1179 IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER,ITS AGENTS OR SOUTHOLD, NY 11971 REPRESENTATIVES, AUTHORIZED REPRESENTATNE ACORD 25(2001/08) ®ACORD CORPORATION 1980 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not conifer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the.terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or after the coverage afforded by the policies listed thereon. ACORD 25(2001/08) NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 461989045 NORTH FRANKLIN BROKERAGE r 13 NORTH FRANKLIN STREET HEMPSTEAD NY 11550 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER CUBIAS CONSTRUCTION CORP TOWN OF SOUTHOLD 76 GARDNER AVE 53095 ROUTE 25 HICKSVILLE NY 11801 PO BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2462 539-4 184917 01/24/2022 TO 01/24/2023 8/26/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2462 539-0, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT NOEMI LOPEZ TORRES CUBIAS CONSTRUCTION CORP ONE PERSON CORPORATION THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SURANCEFUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 128538110 U-26.3 Additional Instructions for Form D13-120.1 By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2: The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this-Certificate. (These notices may be sent by regular mail)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent;,or until the policy expiration date listed in Box 3c,whichever is earlier. This Certificate is issued as a matter of information only and confers no rights upon the certificate holder.This Certificate does not amend,extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note:Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form;if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID'FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department, board,commission or office to pay any disability benefits.to any such employee if so employed. (b)The head of a state or municipal department, board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and atter January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB420.1 (12-21)Reverse SURVEY OF PROPERTY NM ��' SITUATE � '' MATTITUCK ryryO�p �� TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000- 108-04-7.43 s �� SCALE 1 "=40' �� APPROVED AS NOTED JULY 22, 2022 , DATE B.P. # �139—Q ' FEE: 5a5.0o BY A NOTES. 44 o 1. THIS PROPERTY IS SHOWN AS LOT 1 ON k. '� � NOTIFY BUILDING DEPARTMENT AT SUBDIVISION MAP OF NORTH FORK HOUSING ALLIANCE APPROVED BY THE TOWN OF SOUTHOLD PLANNING 765-1802 8 AM TO 4 PM FOR THE BOARD ON AUGUST 25, 1989 FOLLOWING INSPECTIONS: 2. MAP MADE FROM OFFICE RECORDS. C1, 1. FOUNDATION-TWO REQUIRED r � FOR POURED CONCRETE 2. ROUGH-FRAMING,PLUMBING, COMPLY WITH ALL CODES OF STRAPPING, ELECTRICAL&CAULKING 3. INSULATION NEW YORK STATE & TOWN CODES 4. .FINAL-CONSTRUCTION & ELECTRICAL AS REQUIRED AND CONDITIONS Of MUST BE COMPLETE FOR C.O. �• ' ALL CONSTRUCTION SHALL MEET THE SOUTHOLD REQUIREMENTS OF THE CODES OF NEW YORK STATE: NOT RESPONSIBLE FOR�. SOUTHOLDtIMRA�8� DESIGN OR CONSTRUCTION ERRORS. EXISTING HOUSE TO S SOUTHOLD TOWNTRUSEEg FOUNDATION TO REMAIN � , , :. . ...___. N.Y.S.DEC g u� X95 .I �� 11 �G PREPARED IN ACCORDANCE WITH THE MINIMUM r STANDARDS FOR TITLE SURVEYS.AS ESIABUSHED ' t1, - BY THE LIJL _ D-N RRRRQQVVEEEDDRAANND ADOPTED FO FTORESUC E BY NEW g Sf LAND 4�+c¢y Q7,7�YYii 0 �, 4�Q✓�p Jit+ ! 0� 4r o�J� NrY.S. Lic. No. 50467 "A 4p$ 70 THIS SURVEY ALTERATION TI ADDITION Nath ft- Orwin III lO THIS SURVEY IS A VIOLATION OF EDUCATIONSECTION ZLAW THE NEW YORK STATE a " COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. CER FICATIONS INDICATED HEREON'SHALL RUN Successor To: Stanley J. Isaksen, Jr. LS. ONLY 70 THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno LS. IS PREPARED,AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND Tithe Surveys —Subdivisions — Site Plans — Construction Layout I LENDING INSTITUTION USE HEREON,AND TO THE ASSIGNEES OF THE LENDING INSTI— PHONE (631)727-2090 Fax (631)727-1727 TUTION.CERTIFICATIONS ARE NOT TRANSFERABLE THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O._ Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947