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Home My WebLink About33439-Z FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33439 Z Date OCTOBER 2, 2007 permission is hereby granted to: CUTCHOGUE FIRE DISTRICT 260 NEW SUFFOLK RDVE CUTCHOGUE,NY 11935 for : DEMOLITION OF FIVE (5) BUILDINGS AS APPLIED FOR at premises located at 22600 CR 48 CUTCHOGUE County Tax Map No. 473889 Section 084 Block 0004 Lot No. 001 Fee $ 691.80 approved pursuant to application dated SEPTEMBER Building Inspector to ORIGINAL Rev. 5/8/02 09,/25/2007 16;55 f~U 631 734 7079 Cutchogue fire Dlst ItJ 0002/0003 LIPA ~---- 1 ~ T [}oCWIS Pam Ri;erhOfld. NY 1190 1 m~-. !.I :. c -. ,'!":I ;:, :-- ! i 1,"___ " r II"~ fBl28 L.'--- T .July 6, 2007 Cutchogue Fire District 260 New Suffolk Road Cutchogue, NY 11935 RE; 5000 Cox Lane (Rear) Cutchogue LIPA Ref # T10C767521, Meter #94555024 Dear Mr. Martin: This letter is to advise you that the electric service to the above referenced premises was removed on July 5, 2007. If you have any questions, please contact Fred Perez at (631) 548-7037. Very truly yours, s~r Design Supervisor Electric Design & Construction SA/am 09/25/2007 16;56 ~\X 631 734 7079 CutchOBU~ Fire Dlst 1410003/0003 LIPA Lonv"""" - AulhorlIy n :r:! r..... r; j ',' 7 Doctors Patn nive,~head, N't' 11901 0" i' SEP2R ! I I I J"olly 16, 2007 Cutchogue Fire District 260 New Suffolk Road Cutchogue, NY 11935 Attn: Mr. Martin RE; North Road, Cutchogue - LIPA Ref #T100771197 5000 Cox Lane, Cutchogue - LIPA Ref #T100771198 Meter #'s 021792655 ~ 093512063 Gentlemen: This letter is to advise you that the electric service co the above referenced premises was removed on July 12, 2007. If you have any questions, please contact Fred Perez at (631) 548-7037. Very truly yours, Sceve Aylward Design Engineer Elect.ric Design & Const!."uction ~ SA/am <, . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOym HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Approved Disapproved ale ~rr-'~; ,20_I: . I! ,20 : --.--, BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic F ann N.Y.S.D.E.C. Trustees Stann-Water Assessment Fonn_ PERMIT NO. 3~Lt~/ Examined -..--- r.-__ Contact: Mail to: Phone: Expiration ,20 1.-. B' .. st.? 7. :) Date Sept. I ~ l----\ . '.' : _~ INSTRUCTIONS ,20.!l2- ~~ST 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 oflot 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 ofthe 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 Tow" ofSout.'lold, Suffolk County, New York, and other applicablt 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. \ 'APPLICATION FOR BUILDING PERMIT e. . ~'G-S t- rn D(Jt/t.es address of applicant) tJ '{ 1/91{0 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises LA.. {! '1 )(~ 0, <C'..)'tIic t- ofdul Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. o corporate officer) 5c-. jfin"r\G -rmp(o{E'vrlet1+ GC-ef'tS c :#=- J<{ '-/ 71 1-1 House Number one: S-15'b Cf) ~ , LL 'h L c; t.-L-E- Hamlet vft1VI 8./1U'j . ( I. Location of land on which (Name) ()~i-f...~ _ ,Of; ~ 8!.1I.,.d un" Lot 001 Lot County Tax Map No, 1000 Section Subdivision 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: a. Existing use and occupancy Or! 11ft tJ / ,'+7,)'1 (I r h.-( l lc-t I "':> ) . b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Repair Removal Demolition~OtherWork 4. Estimated Cost $ I fJ I 000. UO Fee Alteration (Description) 5. If dwelling, number of dwelling units If garage, number of cars 6 (To be paid on filing this application) Number of dwelling units on each floor 0 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth -9. Size oflot: Front Rear Depth 10. Date of Purchase Name of Former Owner II. 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 L NO_Will excess fill be removed from premises? YES_NO L 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. IS a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO V * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY ~E JEQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_NO---LL- * 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 OFSuffOLKl l7~o{1ilAC, ("12 EU No being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (-S)He is the CORP.OFF(cr;:e POE<"j)FI\J. (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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. lIIa.A1ON .. ..." Publlo.... II -.__ No. Ot4T__ 0ulIIIfled In IuIaIIc CounlIt _ . ..,... ExplNe NcMlmIltr 30, ~ Sworn to before me this 2./ day of S/?'PT ~/r~ Notary Pub!' c 20 (J'1 _New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ TKF EXCA VA TION & DEMOLITION L TO 4 PEPPERIDGE LANE EAST MORICHES NY 11940 POLICYHOLDER TKF EXCAVATION & DEMOLITION LTO 4 PEPPERIDGE LANE EAST MORICHES NY 11940 CERTIFICATE HOLDER CUTCHOGUE FIRE DISTRICT 260 NEW SUFFOLK RD CUTCHOGUE NY 11935 POLICY NUMBER 11300832-1 CERTIFICATE NUMBER 925866 PERIOD COVERED BY THIS CERTIFICATE 07/03/2007 TO 07/03/2009 DATE 9/20/2007 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1300832-1 UNTIL 07/03/2009, 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. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 07/03/2009 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION, 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 INSURANCE FUND I~:JM~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https:/Iwww.nysif.com/cerUcertval.asp or by cailing (888) 875-5790 U-26.3 VALIDATION NUMBER: 162272041 ?/lS/2007 12:07 PM FROM: Cavalli no TRM Group, Inc. TO: 16316537430 PAGE: 002 OF 007 ACORD~ CERTIFICATE OF LIABILITY INSURANCE I OATt:[M1IIODIY'I'YT} il/1812007 !'RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CAVALUNO RISK MGT, INC. 831.385-5980 ONt Y AND CONFE"S NO "'GHTS UPON THE CEI'TIFICATE 315 Walt VVhllman Rd Suite 309 HOLDER. THIS CERTIFICATE DOES NOT AMEND, exTEND OR At TEl' THE COVERAGE AFFORDED BY THE POLICIES BELOW. Huntington Station, NY 11146 INSURERS AFFORDING COVERAGE HAle .. -- -- - INSUR!:O I~RE:RALINCOLN GENERAL 404 T.K.F. EXCAVATING & DEMOLITION - 4 PEPPERIDGE LANE '.SURER ..EVEREST INDEMNITY INSURANCE CO EAST MORICHES, NY 11940 INSUREFlC: --------. INSURER D. _.----- , INSURER.E: COVERAGES THE POLICIES OF INSURANCE lISTED BElOW HAVE BEEN ISSUED TO THE INSURED NA~O ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REaUIRE~NT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXClUSIONS AKI CONOmONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO ClAIMS. W'R ""'- -. POLI~ NUMBER P~..~";f:FFf:C1IVE POlley EXPIRATION LIMITS B X ~NEIU.l L1ABIUty 40000008530-071 3113/2007 3/13/2008 EACH OCCURRENCE I 1 000 000 - :=JIIolERCIAL GENF'RAl LIABILITY ~~S'i'Ea~~~l I 50,000 - CLAIMS W,OE [KJ OCCUR ~DEXF'(A~ronepeISO!lJ . 5000 ~ PERSON.-.L & Ami INJURY , 1000000 - GENERAL AGG~GATf: I 2,000,000 ~~ AGGREF-i LIMIT AFJPn~ER PROOUCTS .COMf'IOP AGG . X POLICY PRo.. LOC A X ~lOM06lLE; UABIUTT LBA 10275 3113/2007 3113/2008 COIleINE.DSII'lGLELIIIIIT . 1,000,000 - AWf AUTO (ElOacOOenlJ X ALL OWNED AUTOS BOOIl Y INJURY [~~n;onJ . - SCHE;:OULEO AUTOS - I-I1R5D AUTOS BOOllYINJURY [Per8Cl;:idn11 . .- OON.oWNEO AUTOS -~._. -_.-..~.- .-- - PROPERTY DAMAGE I , (Peracc;ldeflll =iAGE ,....., AU fO ONl. Y . EA ACCIDENT I ANY AUTO OTHER THAN EAA~C I AUTO ONLY: ,",,0 I ~E(SSlUM8RELlA UABLrrt I EACH OCCURRENCE . OCCUR D CLAIMS MAOf I AGGREGAT5 . ---- I , . ~ DEDUCTIBlE . RETENTION , . WORKERS COMPENSATIOl\l AMJ 1 WCSTATIJ-, I IO!~- EMPlOY'!:AS'llABllIT'l' E.L. EACHACCIOENT ANY ~PRIEI0R/PARTN:R/EllEClIfIVE , OfFlCEMlEMBER EXCUDED1 E L DlSEJlSE.UENPLoYEE I ---- ~J:.,..~~V~bIll<lw -- E.L. DISEASE.POLICYLMT . OiHE.R DE$CRFTIOf\I OF OPERATJONSJ LOCATIONS I VEHICLES I EXCLUSIONS ADDED H'(ENOORSE!W:NT j SPECIAL PAOVISIOHS CERTIFICATE HOLDER IS HEREBY NAMED ADDITIONAL INSURED. CERTIFICATE HOLDER CUTCHOGUE FIRE DISTRICT 260 NEW SUFFOLK RD CUTCHOGUE, NY 11935 631-653.7430 CANCELLATION SHOULD ANY Of TME ABOVE OescAEEO POUCIE& BE CANCELLED '8UORE mE EXPIRATION VA'E THEREOf. THE ISSUING lMSURER WLL ENDEAVOR TO M...... ~ DAY$ WRlnEN NOTICE TO THE CERflflCATE HO~A tuNED TO THE l.eFT. BUT fM.URE TO 00 50 $HALL IMPOS~ NO OBLIGATION OR LIABlLm 0 RI"PRl!~ AUTHORIZED }- @ACO"OCORPORATION1988 -- ACORD 25 (2001/08) 09/25/2007 16:54 FA); ();)l i,'~4 707~1 Cutchogue Fj re Dist Gli 000li0003 CUTCHOGUE FIRE DISTRICT Board of Fire Commissioners f':,~--.' , ' , i I I i SEP ? R , 260 New Suflolk Road. Cutchogue.I'.'Y 11935 Telephone (6311734~69(J7. Fa.x(6S1) 734~70'T9 E-maJl: cutfd@optonliI1e.net September 26, 2007 l'KF Inc. Atten: secretary . Per your phone message the tollowing are two letters fr~. LIPA disconnecting the two oerv~ceG to the buildings. . As for the phone connections, I don't the guy who lived there used his cell believe there phone. ore =y ".=~ questions on t-11i" you may <:a:~l my cell phone at 766-2666 and I will get back to YO'J. Best regards, Matt Martin D~et Secretary . .