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HomeMy WebLinkAbout48580-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT " TOWN CLERK'S OFFICE 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 #: 48580 Date: 12/12/2022 Permission is hereby granted to: Cubells Stephen 950-7 Old Medford Ave Medford, NY 11763 To Demolish existing cottage and construct new accessory garage at existing single family dwelling as applied for., At premises located at: 2475 Bay Ave, Mattituck SCTM #473889 Sec/Block/Lot# 144.-4-5 Pursuant to application dated 11/28/2022 and approved by the Building Inspector. To expire on 6/12/2024. Fees: DEMOLITION $202.00 ACCESSORY $615.60 CO-ACCESSORY BUILDING $50.00 Total: $867.60 , Y Buildi g Inspector `""e��'ft�d f•� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 41 Telephone (631) 765-1802 Fax (631) 765-9502 hl :lLwwu.stt'atlaldtownn + v Date Received APPLICATION FOR BUILDING PERMIT I- R NOV 2 8 2022 For office use only PERMIT N0.� �c�"� Building Inspector. WILDING DEPT' OF &art' Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 11/22/2022 OWNER(S)OF PROPERTY: Name: Stephen Cubells SCTM# 1000-144-4-5 Project address: 2475 Bay Avenue, Mattitcuk NY 11952 Phone#: (631)767-0294 Email: stephen@allislandcleaning.com Mailing address: 950-7 Old Medford Avenue, Medford NY 11763 CONTACT PERSON: Name: Henry Alia Mailing Address: 950-7 Old Medford Avenue, Medford NY 11763 Phone#: (631) 678-2667 Email: teamalia65@gmail.com DESIGN PROFESSIONAL INFORMATION: I C Name:Thomas D. Blore Architect, P.C.. Mailing address: 60 Carlton Avenue, Suite 202, Islip Terrace, NY 11752 Phone#:( ) Emall: p� arch com tblore tdb.._ 631.........277-2022 CONTRACTOR INFORMATION: Name:All Island Cleaning Corp. Mailing address: 950-7 Old Medford Avenue, Medford NY 11763 Phone#:(631) 695-6250 Email:stephen@allislandcleaning.com DESCRIPTION OF PROPOSED CONSTRUCTION ddition I�I A +ern+inn Estimated Cost of Project: New Structure ❑r♦uui�iv�� «�..�,.... ❑Rapair ®Demolition 1 D Other Garage with 2nd Floor storage $40,000.00 Will the lot be re-graded? RYes El No Will excess fill be removed from premises? ❑Yes IRNo 1 PROPERTY INFORMATION Existing use of property: Residence Intended use of property: Garage Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 this property? ❑Yes ®No IF YES, PROVIDE A COPY. 5R Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(pri erne,«Ste hen CUbells ❑ �� y+ ` Author- edA ent ROwner Signature of Applicant: � Date: �` STATE OF NEW YORK) SS: COUNTY OF Suffolk Stephen Cu bel IS being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)heisthe Property Owner (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 Zz dayof 20 ..: :„ tart'Public -'1,( P ' PROPERTY OWNER AUTHORIZATIONI^!o009DY65279 (Where the applicant is not the owner) Inti O�Iii 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 Btdiding De2artment Application AUTHORIZATION (Where the Applicant is not the Owner) �- mm idi Ae residing at 00 � `"► .. q ._ (Print property owner's name) (Mailing Address) ( " 11-167 do hereby authorize (Agent) to apply on my behalf to the Southold Building Department. Z w i rage 's Signature) ate) Print Owner m....... ( 's Name) vb err�WAW �w �r A " d6pox t a BOARD OF"SOUTHOLD TOWN TRUSTEES e SOUTHOLD,NEW YORK g PERMIT NO.2M DATE: AUGUST 18,2021 � , w ISSUED TO: STEPHEN &KAREN CUBELLS PROPERTY ADDRESS: 2475 SAY AVENUE.,MAT"1ITUC SCTM#1000-1444-5 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on Aggust 18,202 11, and in consideration of application fee in the sum of ULO.00 paid by Ste_hen Karen,Cubells and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits I r r the following: Wetland Permit to demolish existing,one-story dwelling and construct a.new two-story,single- family dwelling in.its place; renovate and expand-a one-story cottage from 34.5'x1.0.5'to 34.5'x22.11; construct a 161x36' in-ground swimming pool with 48'x59.8'patio; and adjustments to grades using approximately 431 cubic yards of clean fill over an 11,653.7sq.ft. area;and to revegetate approximately 1,314sq.fL,of cleared area adjacent,to tidal wetland areas; establish and perpetually maintain a 15'non-turf buffer landward of the flagged p wetland line; and as depicted on the site plan prepared by Nelson,Pope&Voorhis,LLC, received on August 17,2021,and stamped approved on-,August 18;2021: IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these 4 presents to be subscribed by a majority of the said Board as of the 18th day of August ,202 1. r If d' .. i ,r r I .r r v"., ,ru„ r ,✓ „:�.Msx�. rr,�»,yw'•••rn rn +cf..m. +i. ��,,ftbpry rtw' ,swrwr exwdw�xcs„-+a+� ,,� eh5 ,r,t.;x u .r.,xrr �.um r�.:r ,w no's v$ ry�,rv„y' '4,iAM " ��” ; ,�� w �aF�«r w;� "' w, "'""tea ✓"' '"""'' ''" ' 1 Glenn Goldsmith,President so Town Mall Annex A.Nicholas Krupski,Vice President r, 54375 Route 25 JAL P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams � � Fax(631) 765-6641 cou BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 23, 2021 Brant Reiner Nelson Pope Voorhis 70 Maxess Road Melville, NY 11747 RE: STEPHEN & KAREN CUBELLS 2745 BAY AVENUE, MATTITUCK SCTM# 1.000444-4-5 Dear Mf. Reiner The Board of Town Trustees took the following action during-its regular meeting held on Wednesday, August 18, 2021 regarding the above matter: WHEREAS, Nelson Pope Voorhis, on behalf of STEPHEN & KAREN CUBELLS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated May 27, 2021, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to;the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator recommended,that the proposed application be found Consistent with the LWRP, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 18, 2021, at which time all interested persons were given an opportunity to be heard; and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent,with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code; and, RESOLVED, that the Board of Trustees approve the application of STEPHEN & KAREN CUBELLS to demolish existing one-story dwelling and construct a new two- story, single-family dwelling in its place; renovate and expand a one-story cottage from 34.5'x10.5' to 34.5'x22.1'; construct.a 16'x36' in-ground swimming pool.with 48'x59.8' patio; and adjustments to grades using approximately 431 cubic yards of clean fill over an 11,653.7sq.ft. :area; and to revegetate approximately 1,314sq.ft. of cleared area adjacent to tidal wetland areas; establish and perpetually maintain a 15' non-turf buffer landward of the flagged wetland line; and as depicted on the site plan prepared by Nelson, Pope &Voorhis, LLC, received on August 17, 2021, and stamped approved on August 18, 2021. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, 4L Glenn Go dsmith President, Board of Trustees GG:dd IWO" - cg mom 0 a IIT Z CN '; 00 LAA OW r- II ss JU I u 1 ILLLJJ LU 0 • mom=f adz 0 �� 0 TERMS AND CONDITIONS The Permittee,,Steen Daren Cubells residing at 24'7 _l ay Avenue,Mattituck, blew 4`�ar as part of the consideration for the issuance of the Permit does understated and prescribe to the following: I That the said Board of Trustees and the ,Town of Southold are released from any and all damages,or claims for dainages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit,And the said Permittee will,,at his or her own expense,defend any and all such suits initiated by third parties;and the said Permittee assumes full liability with respect thereto, to the complete,exclusion of the Board of Trustees of the Town of Southold. 21 That this Permit is valid for a period of-24 months,which is'considered to'be the estimated time required to complete the, work involved,,but should circumstances warrant, request,for an extension may be Heade to the Board at a 1afar.date. :ia That this Permit should be retained indefinitely,or as long as the said Per'rnittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Hoard or Its agents, and non-compliance with the provisions of the,originating application maybe cause for revocation of this Permit by resolution of th'e said)Ioard. , g 5w. That there will be no unreasonable riterfcrence wrth:riavi anon as a result of the work herein :authorized. 6- That there shall be,no interference withthe right of the public to pass and repass:along the •beach'between'high,and low water.marks. �. That if future operations of the Town of Southold require the removal and/or alteration 'in the location of the work herein authorized, or if,in the opinion of the Board of"Trustees, the work ;shall cause unreasonable obstruction to free navigation,the said Pee-mittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. The Permittee is required to provide evidenee.that a copy of this Trustee,permit has been ,recorded with the Suffolk County Clerk's.Offrce''as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar days of issuance of this permit. 9. That the said Board will be notified by the Permtitee of the completion of the work authorized. 10. That the Permittee will obtain all other permits and consents that may be required supplemental to this.permit, which may be subject:to revoke upon failure to obtain same. 11. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the-riparian,rights of others in order to perform the permitted work nor does it authorize the impairment of any rights,title, or interest in real or personal property held or vested in a person not a party to the permit. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY 4 Stony Brook,50 Circle Road,Stony Brook,NY 11790 P:(631)444-03651 F:(631)444-0360 www,dec.ny.gov July 1, 2021 CUBELLS, STEPHEN 950-7 OLD MEDFORD AVE MEDFORD, NY 11763 Re; CUBELLS PROPERTY 2475 BAY AVE SCTM� 1000-144-04-05 MATTITUCK, NY 11952 DEC IDS: 1-4738-00917100004 Dear Permittee:, In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you;are unable to comply with any conditions please contact us at the above address. Also enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. Sincerely, Laura F. Star Deputy Permit Administrator Enc. Cc: NPV DEC-BMHP File goer pepartment of ro E. i�rrrcrezaiMx, Envirorrrnenti i.N Conservation. Am NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC 1D 1-4738-00917 PERMIT __....... EC Under the Environmental ConservationLaw�. -Permittee and Facility Information Permit Issued To: Facility: STEPHEN CUBELLS CUBELLS PROPERTY 950-7 OLD MEDFORD AVE 2475 BAY AVEISCTM# 1000-144-04-05 MEDFORD,NY 11763 MATTITUCK,NY 11952 Facility Application Contact: NELSON POPE&VOORHIS LLC 572 WALT WHITMAN RD MELVILLE,NY 1;1747 (631) 427-5665 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: Mattituck Facility Principal Reference Point: NYTM-E: 707.619 NYTM-N: 4539.579 Latitude: 40°58'51.5" Longitude: 72°31'55.7" Project Location: i2475 Bay Ave. Watercourse: James Creek Authorized Activity: Demolish the existing primary dwelling and construct a new single-family dwelling. Renovate and expand the existing',cottage. Install a new pool and patio. Place fill to level. Install a new Innovative/Alternative Onsite Wastewater Treatment System and stormwater drywells. Revegetate a 1,314 sf area with native vegetation. All activities authorized by this permit must be in strict conformance with the attached plans stamped approved by NYSDEC on July 1, 2021. Permit Authorizations.. ..-µmm _..._._. _Wmm ......- .. Tidal Wetlands- Under Article 25 Permit ID 1-4738-00917/00004 New Permit Effective Date: 7/1/2021 Expiration Date: 6130/2026 Page 1 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION " Facility DEC 1D 1-4738-00917 .. NYSDEC .. NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator:LAURA F STAR, Deputy Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook,NY 11790 -3.409 Authorized Signature: _ Date Xtion List . ......_ .._...._ ...m._...__----------- _ Distribution..—___�.�,....-._..._ ...��_ NELSON POPE & VOORHIS LLC Marine Habitat Protection LAURA F STAR Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS 1. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 2. Notice of Commencement At least 48 hours prior to commencement of the project,the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project,the bottom portion of the form must also be signed and returned, along with photographs of the completed work. Page 2 of 7 Am KEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-00917 3. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Nelson &Pope, dated Nov. 25,2020 and by Nelson, Pope, & Voorhis, LLC, last revised May 10, 2021, both stamped approved by NYSEDC on July 1, 2021. 4. Concrete Leachate During construction,no wet or fresh concrete or leachate shall be allowed to escape into any wetlands or waters of New York State, nor shall washings from ready-mixed concrete trucks,mixers, or other devices be allowed to enter any wetland or waters. Only watertight or waterproof forms shall be used. Wet concrete shall not be poured to displace water within the forms. 5. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this,project shall be completely removed from the adjacent area(upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 6. Materials Disposed at Upland Site Any demolition debris, excess construction materials, and/or excess excavated in shall be immediately and completely disposed of in an authorized solid waste management facility. These materials shall be suitably stabilized as not to re-enter any water body, wetland or wetlandadjacent area. 7. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 8. Storage of Equipment,Materials The storage of construction equipment and materials shall be confined within the,project work area and/or upland areas greater than 75 linear feet from the tidal wetland boundary. 9. Clean Fill Only, All fill shall consist of clean sand, gravel, or soil (not asphalt, slag,flyash,broken concrete or demoliton debris). 10. Department Jurisdiction The department retains jurisdiction of all regulated lands where fill has been permitted. Placement of fill shall not be used to alter the department's Tidal Wetland jurisdictional area at the project site. The area remains a regulated area subject to Tidal Wetland Land Use restrictions of 6 NYCRR Part 661. 11. Long-term Plant Survival The 1,314 sq ft restoration area shall be planted as shown on plans by Nelson, Pope, &Voorhis, LLC, last revised May 10, 2021 and the permittee shall ensure a minimum of 85% survival of plantings by the end of five growing seasons. If this goal is not met,the permit holder shall re-evaluate the restoration project in order to determine how to meet the mitigation goal and submit plans to be approved by the office of Marine Habitat Protection NYSDEC Region 1 Headquarters SUNY @ Stony Brook150 Circle Rd Stony Brook,NY 11790 -3409 Page 3 of 7 Am NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION '" ► Facility DEC ID 1-4738-00917 12. Straw Bales or Other at Tidal Wetland A row of staked straw bales or approvable erosion control devices shall be placed at the landward edge of the buffer area or 75 linear feet from the tidal wetland boundary, or as per the NYSDEC-approved plan,prior to commencement of any regulated activities and remain in place and in good, functional condition until the project is completed and all disturbed areas are stabilized with vegetation. 13. No Drywells in or near Wetland Dry wells for pool filter backwash shall be located a minimum of 100 linear feet landward,of the tidal wetland boundary. 14. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 15. Driveway/Parking Area of Pervious Material Driveway and parking areas shall be constructed of NYSDEC-approved pervious materials. 16. Authorized Innovative/Alternative Onsite Wastewater Treatment Systems (I/A OWTS) Septic Systems This permit authorizes the installation of any models of I/A OWTS septic system which have received the approval of the Suffolk County Department of Health Services (SCDHS). If SCDHS rescinds its approval of one or more of these models during the term of this permit, DEC will no longer approve new installations of that model. The list of I/A OWTS systems which have received approval by SCDHS are found on the Suffolk County Website under the Reclaim Our Water-Homeowner section at: Overview of Provisionally Approved Technologies. 17. Maintenance of Installed Innovative/Alternative Onsite Wastewater Treatment Systems (I/A OWTS) The permittee must maintain, service and repair the installed I/A OWTS in accordance with the maintenance schedule set forth in the Suffolk County Department of Health Services (SCDHS) permit issued for the system. 18. Contain Exposed, Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales/silt curtains (or other NYSDEC approved devices)placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 19. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other environmentally deleterious materials associated with the project. 20. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Page 4 of 7 Aft Mow NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC 1D 1-4738-00917 21. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if, in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions, or hazards caused thereby without expense to the State, and if,upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed,the owners, shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the,State of New York on account of any such removal or alteration. 22. State May Require Site Restoration If upon the expiration or revocation of this permit,the project hereby authorized has not been completed,the applicant shall,without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. GENERAL CONDITIONS - Apply to ALL Authorized Permits: _�w.�w .w....._.... .. 1. Facility Inspection by The Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation (the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71- 0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms, conditions or requirements contained in such order or determination. Page 5 of 7 Aft NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-00917 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal,modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal, modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC Region 1 Headquarters SUNY @ Stony BrookJ50 Circle Rd Stony Brook, NY11790-3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; { d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner, any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 6 of 7 Aft 4okwo NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-00917 _..� . .. ._. _. HER PERMITTEE OBLIGATIONS NOTIFICATION OFF OT Item A: Permittee Accepts Legal Responsibility and Agrees to Indemnification The permittee, excepting state or federal agencies, expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the State of New York, its representatives, employees, and agents ("DEC")for all claims, suits, actions, and damages,to the extent attributable to the permittee's acts or omissions in connection with the permittee's undertaking of activities in connection with, or operation and maintenance of, the facility or facilities authorized by the permit whether in compliance or not in compliance with the terms and conditions of the permit. This indemnification does not extend to any claims, suits, actions, or damages to the extent attributable to DEC's own negligent or intentional acts or omissions, or to any claims, suits, or actions naming the DEC and arising under Article 78 of the New York Civil Practice Laws and Rules or any citizen suit or civil rights provision under federal or state laws. Item B: Permittee's Contractors to Comply with Permit The permittee is responsible for informing its independent contractors, employees, agents and assigns of their responsibility to comply with this permit,including all special conditions while acting as the permittee's agent with respect to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental Conservation Law as those prescribed for the permittee. Item C: Permittee Responsible for Obtaining Other Required Permits The permittee is responsible for obtaining any other permits, approvals,lands, easements and rights-of- way that may be required to carry out the activities that are authorized by this permit. Item D: No Right to Trespass or Interfere with Riparian Rights This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. 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J a a J C a DECLARATION OF' COVENANTS THIS DECLARATION made this 4 day of November 2021 by Stephen Cubells and Kaden Cubells residing at. 2475@ay `hpk0d.n.aft6r. referred to as "DECLARANT(S) ": W I T N E S :8 8 t 14 WqE'R E�S, DECLARANT (S) is/are the owner(s) Of :c,,ertain real Property located �on 2475 Bai Avenue Matfitudk Town of Southold, ------------------- County of �uffolk, State Of New York, des Orbed in, the ;Suffolk 'County Tax Map as J)iatrict 7,i00'0.,. Section 144Block 4 Lot 5 which is more partto.ularly bounded and described as set. 'forth :'n Schedule " Vannexed hereto, ,he,rp,.Ln4f te� referred to as the Property,, WHERE�S? the Property is -situated on lands within the jurisdiction of the 80afd of. T�U'steos of the Town of Southold (here:inafter the "'Trustees" pursuant to 'Chapter'! 275 of the Town code of the !rows Of Southold or its successor,, and various activities conducted upon the PXQP1q:,rty may thus be subject to the ;jppgulation jand approval of the Trustees prior to bei coriductedp WNERE,kS, the DECLARANT(S) therefore made; application to the Trustees for ,4 permit. pur$Uant to the Wetlands Law ,of the 'Town of Southold to undertake certain ,regulated activities; and as a condition of the granting of a Wetlands Permit, to undertake such regulated activities. the Trustees requi.toa that a 15 f6ot "non-turf buffer" ,adjacent: to and landward of the flagged wetland]ines as depicted on the.site plan and WHEREAS, the DECLARANT has considered the foregoing and has determined that the same will be for the best interests of the DECLARANT and subsequent owners of the Pronprijw -1 1 NOW, THEREFORE, the DECLARANT(S) do/does hereby covenant and agree as follows: 1} Upon the substantial completion of the aforementioned permitted aictivities there shall be established and perpetually maintained 'd"a ent to tidal wetland areas, a 15 foot "non-turf buffer;, as 4efined by Chapter '275 of the flown Code, to wit: "A designated area were turf grass:, pe'stic-14es and :fertilizers. are not permitted, and as depicted on the lte kan re aged fel on, leo e "�"oC�rlli LLC, reoieved on u u t , 2021 aid stamped approved on i t u t l8, 2021' r ,see Exhibit rel°;t.ached; ,and 2) "These covenants shall run with the, land and shall be binding on the D CLARA-NT(S) , his/her/their heirs., assigns, purchasers, or successors ,in i�te:rest and may only be M001, :6.ed after a public ;hearing and upon .rbsol tion of the Trustees.. IN TYNE S� WHEREOF® the owner(s) has/have duly executed this. instrument 'this !� day of , 20-. I G E of $-TGNATUR.Fr w—— G , 's .SISNA "URE TATE OF N]{W YORK ) COUNTY OF 2L) ss: On theda..y of � , i.n the year 2 before me the dersignea Wot4' Public in and for said State, personally appeared personally known to me or proved to me on the basis of sat sfatory evidence to be the individual (s) whose name(s) is/are subscribed to the within instrument and, acknowledged to me that he/she/they executed the same in his/her/their capacity, and that by his/her/their signature(s) on the instrument, the individual or the persons on behalf of which the individual(s) acted, executed the instrument. 1l y 1"C leu li.c o..001 DY5 5a 7 EX y di EX M $ , �K C 2 OF N �= CERTIFICATE OF LIABILITY INSURANCE °ATE`M`�°°(YY"' l " 01/14/2022 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER;AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. 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). PRODUCER CONTACT Camille Wadsworth NAME:. E A Funk&Associates,Inc. PHONEINo, (631)467-4747 FAX No): (631)467-5160 1919 Middle Country Road E-MAIL S& cwadsworlh ericfunkagency:com ADDRE Suite 300A INSURER($)AFFORDING COVERAGE NAIC# Centereach NY 11720 INSURER A: Lloyd's of London 112200 INSURED '..INSURER B: Merchants Mutual Insurance Company 23329 All Island Cleaning Corp. INSURER C: 950 Old Medford Ave INSURER D INSURER E: Medford NY 11763-2659 INSURER F: COVERAGES CERTIFICATE NUMBER: OL214104380 REVISION NUMBER. THIS IS TO CERTIFY THATTHE 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR.. ADDIL WEIR POLICY EFF @CYE P S TYPE OF INSURANCE POLICY NUMBER MM/DC)AY7 MWODIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 157MA6E TO RENTED CLAIMS-MADE ©OCCUR F ' S occu e,te $ 100,000 " Contractual Liability MED EXP(Any one person) $ 5,000 A Y MPL4053698.21 04/02/2021 04/02/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN"LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 JEa FILOC PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY N OTHER: Per Project Agg Limit $ 5,000,000 AUTOMOBILE LIABILITY O® BItEeD SINGLE d'k'M'&T $ 1,000,000 X ANYAUTO BODILY INJURY(Per person) $ H IRESONLY AUTOSONLY: O DAMAGE $ A� AAAAA B AUTOS ONLY ANUOTNOOs FD CAPI073167 04/02/2021 04/02/2022 BODILY INJURY(Per accident) $ AUTO $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY Y)N A T ER ANY PROPRIETOR/PARTNER/EXECUTIVE 'N(A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Li (Mandatory In NH) E,L,DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is included as additional insured under general liability when required by written contract or agreement under form#E6838.1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Route 25 AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD nationalgrid December 16, 2021 Stephen Cubells 950-07 Old Medford Ave Medford, NY 11763 Email: stepahen allislandcleanincp.clam National Grid WO#T102440887—2475 Bay Ave, Mattituck To Whom It May Concern: This letter is to advise'you that the natural gas service line to the above location was physically disconnected on December 14, 2021. Please advise your contractor that care should be taken not to damage or remove the existing gas valve curb box. This curb box will be used in the future by National Grid to reconnect the gas service line to this property. New York State law requires anyone planning underground excavation work to notify local utilities by making one call to a to number to get your underground lines identified for you prior to doing any digging: This phone call needs to be made at least 2, but not more than 10 working days in advance of starting work, not including the day the caps was made, The number to call is either the nationally sponsored'111", or the local number for NYC/ LI area, 1-800-272-4480,This confirmation letter of a gars cut-off does not relieve the excavator of making this "811".call. If,you have any further questions, kindly contact me at 833-359-0645. Respectfully, Christina M. Bonelli Sr. Supervisor, Central Processing Gas Customer Connections 0 PSE(J"' I INN't) 12/2/2021 STEPHEN CU ELLS Service To: 950-07 Old MedfordAve, 2475 BAY AV Medford,NY, , Y 11763 MATTITUCK, NY 11952 i i I Customer Project :900000140402 Dear STEPHEN CU ELLS: 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 haying been identified must be received from all the facility owners prior to any site work. j 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. i. 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 Gianelll"ii t/011,54 XX�ee' Building & Renovation Seryices PSEG-LI � 1 UTI-1 4060 Sunrise Highway,Oakdale, New York 11769-0901 December 14Deecinber 14,2021 steL:)henCya]lislandclewibig corn RE: 2475 BAY AVE,MATI'ITUCK To Whom It May Concern: On December 9, 2021, our representative confirmed that the water services were physically disconnected at the above referenced location. Please advise your contractor that care should be taken not to damage the existing vault and /or curb box, as the"cost of any repairs would be billed to the premise and no service initiated until the balance is paid. Sincerely, Lisa Cetta New Construction Manager LC/db YIIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 6 N04" ^^^^:^^ 113405062 ALL ISLAND CLEANING CORP 950=7 OLD MEDFORD AVENUE' MEDFORD NY 11763 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER- CERTIFICATE HOLDER ALL ISLAND CLEANING CORP TOWN OF SOUTHOLD BUILDING DEPT 950-7 OLD MEDFORD AVENUE 54375 ROUTE 25 MEDFORD NY 117631 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE. 12354 646-8 343968 02/28/2021 TO 02/28/2022 1/13/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2354 646-8, 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, WE'TH 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 HT'TPS:I"W.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 STEPHEN CUBELLS ALL ISLAND CLEANING CORP (ONE PERSON CORP) THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS 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 STATE SUR NCE FUND 4 �/ DIRECTOR,INSU RANCE FUND UNDERWRITING VALIDATION NUMBER: 723726786 U-26.3 i O R workers' CERTIFICATE OF INSURANCE COVERAGE s7ATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW i PART 1.To be completed b Disability and Paid Family .......0 .�....._. I __.._.._ p y y ily Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured use street address only) 1( Business Tele ___ .. g ( y) phone Number of Insured ALL ISLAND CLEANING CORP 631 608-6250 950 OLD MEDFORD AVE UNIT 7 MEDFORD,NY 11763 1 c.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 113405062 .......2:Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Insurance Fund(NYSIF) TOWN OF SOUTHOLD,BUILDING DEPT 54375 ROUTE 25 3b.Policy Number of Entity Listed in Box"1 a" SOUTHOLD.NY 11971 DBL 6015 10-2 3c.Policy effective period 12/01/2021 to 12/01/2022 icy ro._........ ,�� 4.Pol y p vides the followingbenefits: ® A.Both disability and paid family leave benefits Q B.Disability benefits only Q C.Paid family leave benefits only 5.Policy covers: ® A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the'insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 1/13/2022 By (Signature of insurance carrier's authorized representative or NYS Licensed_. of that p sed Insurance Agent of that insenraiace carrier) p ) 332 Name and Title Kristin Markwica,Head of Disability Insurance Unit Telephone Number (866 697-4 ............. IMPORTANT: If Box 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. i If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of.Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200 PART 2.To be completed by the NYS Workers Compensation Board only if Box 4C or 5B of Part .._.... _. ' p ( 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. DateSigned by - (,rgnature oI Auihor§iod NYS wo'rkcrs'Cootn.;pensation Board r-�npi ...........--..- .._� .. ..... Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licens .......... .............._.-. ed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) Certificate Number 672394 Suffolk County Dept of Labor Licensing&ConsurnerAf it HOME IMPROVEMENT UCENSE FA Name STEPHEN.ACLSELLS Susiness Name This cerbTies that the ALL 18—LANG DCORP bearer is duly licensed by the County of Suffolk Ucen" K-45129- Rosalie Drago Gommim0ner ,.«>.,X,;t : D8/01/2022 T