HomeMy WebLinkAbout33893-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33166
Date: 07/22/08
THIS CERTIFIES that the building SERVICE OR GAS STATION
Location Of Property: 28975 MAZN RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Nap No. 473889 Section 102 Block 5 Lot 26
Subdivision
Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated MAY 6, 2008 pursuant to which
Building Permit No. 33893-Z dated MAY 13, 2008
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is issued
is REPLACEMENT OF EXISTING TANKS TO AN EXISTING GAS STATION AS APPLIED FOR.
The certificate is issued to REALTY CORP 808
(OWNER)
of the aforesaid building.
SIIFPOLR COONTY DEPARTMENT OF HEAI,TA APPROVAL 13668
ELECTRICAL CERTIFICATE NO.
07/21/08
8315 07/18/08
PLDMIDSRS CERTIFICATION DATBD
V~ ~~/l ~
Authorized Signature
Rev. 1/81
87-tB-i?~9 09: q5 50.1THDLD 6UILDLNG CEPT 16317659582 PHGE3
fmm No.6
TOWN 06 SOVTHOLI~
Ili'R.DI.Kf; 11RPARTMEN'1
ranr HALL.
7es-lenx
APTI,ICA'1'InN YnR ('Rlt'1'llrl<'AI'1': Qf M'f.liTn'VCY
'I'bis ;gtltltcation nxrsr i,e tilled in ny tyltewriler ar ink and nrbmrttrd In tale futild ma !•)c•p.rnrnr m with the fo; lrlving
For urw bnitdLrg or nrw usr:
! final survey M property with accurate lceation of :dl huildtnus prerpctt~~ Imes, su rety, and a x,~unl neutral nr
Ilr(u,t;r;rphia•. (i:nlurv5.
2. Final Apsrovel from Hctrph 1>uln of w~tcrsupply and stsvmnFC•dis)rnsxl (~ 9 Bain).
? Ahpn,valofelectricalinstnllationfrwnHoxrdofFin+ll»du,+'nicrs
q. Sworn state:mtrlt from phml6er crltitying th»t the e,dJ,~r n.crl in <ysl r:» cnntnins less tha» 2/10 ul' Ny(, trod
5. l'Olmnetx:i»1 buildinc, inJu.e,Hl F„uldin@ nxthiplt Itsldencr. nlnl .Nmilar hrd4Gnga xml incutllahons. a cnTifitate
of Code t'nmplianct fmm :nrhitcct or ct:giltl:e.r rs}u,nJ611: Gri ILu A~,iA!i ug.
1. Subnut 1'IaTatinc Hu:ml npprovsl ~d con:plred site )>1nn rrqutrcmcnts
Q. Tor ecisting buildings (prior u. April 9, 1957) uno-confmtmiug ascs. o. bnddinL;+ n,rJ °prt-rt,irtraX • InndoseJ:
{ Accurate surrey o(prlnc~rlp::hrro-iut;:ill properly I»Irs, snteu, hud,liu:uxl unu..unl nnnrnd nr Iopugraphic
Half llrl.;t
2. :\ pr nlxrlr congaeled application :Ind cuttsl:nl to in.pat ann-I hi~ tfu nlgilirnut II x Crttilitatc of Axup.utcy i::
Aanaxl, thr Ruddmg. Inspectr~r shall slate. ti;c masau, rh.:-::fur in l,'rtnnp u, the applicant
C. Fcrs
). tS:rl rticni., nl'<lavpaney Ncl,~d+ve'I~.ni ~i2S 011, AAdit ions t„dt, cllinc 5?$.OO. :~Iternuum: la: dlvJlhp; x~i.pn,
Strinunin~)ti+cl Y25,00 ,\vcu~..nrylruillliu;! A1S tltl. AcfJiri:,w: u.alcc!s,ny irlclJinfc 55,nu, Husi+xs.esSSU.UU.
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S ~~lgnpuru'v ('~lrtdiealy Oft )cellpa!Ia„ ~ I(r5lrll'7111u1 XI S.l)p. ('Clnlltlltfi'1:11 Xl S.fl(i
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[,ocatio» of Pr„pe,ty. ~ -! 7`~_ /('~~ /K) /~-~ .tJepcs~.. ~ ~ ?"C \ ~U rz-,~_ o C r ( ~' -
1-lot.'.c No ~/y~ ~itilla:cr T~ Ilundct
(hvncr nr (hrners of Proprrt)': 6:'~r~ _ ~L\ ~ L~_ ~~ r
---~
yufGdk t`•xntlg'1'ax Map Nr, ItNl/l, Surnon _LOL Hlock J LnI Y~
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Pcnnit NO. ~ ~ 8 ~ 3 ? C)~rtc al^n n~.ily-I I ~~ Iv~._ :11,I:~iCdllr I~~17 ~- 1"I \._~
Hc:Jgr L)r;pt Approval'. _~~~_ / -,1~ ~~1 htderwritac Approval- _~ /~ OId' /, ~ ~(/
Platvrin@ Board Approval: - .
Re(µtest tot ferrryx~rnry('eltiti.::~lc Fnl;tt l'endicare' (check u,tt)
Fee Subntiurcf' S _ ~~ ~ ~i/F/
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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. 33893 Z
Date MAY 13, 2008
Permission is hereby granted to:
REALTY CORP 808
PO BOX 1006
WESTHAMPTON,NY 11978
for
ALTERATIONS TO AN EXISTING GAS STATION AS APPLIED FOR
at premises located at 28975 MAIN RD
CUTCHOGUE
County Tax Map No. 473889 Section 102 Block 0005 Lot No. 026
pursuant to application dated MAY 6, 2008 and approved by the
Building Inspector to expire on NOVEMBER 13, 2009.
Fee $ 250.00
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD
BUII.DING DEPARTMENT
TOWN~B:ALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoatholdTown.NorthFork.net
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or Deed dre following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
PERMIT NO. / ~ l T ~_ Ch~
Septic Focm
N.Y.SDB.C.
Examined ,20_
Approved 20~
Disapproved a/c
Expiration , 20_
Flood Permit
Storm-Water Assessment Fomr
Contact:
Mail to: Lahti Engineering
k Rd Suite 212, Stony Brook NY 11790
wv,ne~ 751-6433
Building Ifispector~~_
;APPLICATION FOR BUILDING PERMTT
~1FY 6 _ I Dated oL , 20 a8
INSTRUCTIONS 0
~ a. '[~ja atigt%T~mPletely filled in by typewriter a• in ink and submitted to the Building Inspector with 4
sets•o~pTans,-accurnte 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 wmmenced 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 throughorrt 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 wmpleted within 18 months from such date. If no zoning amendments or other regulations affecting the
property have been enacted in the iruerim, 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 Courrty, New York, and other applicable Laws, Ordinances or
Regulations, for the constrtaKion of buildings, additions, or attentions or for removal or demolition as herein described. Tbe
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.
(Sigrr~ure of appl' t or name, if a corporation)
Lahti Engineering 207 Hallock Rd Suite 212 Stony Brook,NY 11790
(Mailing address of applicaot)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Engineer
Name of owner of premises
808 Realty Corp.
If applicant is a corporation, signature of
(Name and title of corporate officer)
Builders License No._
Plumbers License No. _
Electricians License No._
Other Trade's License No.
1. Location of land on which proposed work will be done:
~ag75 Route 25A Cutchogue
House Number Street
Hamlet
County Tax Map No. 1000 Section 102 Block 5 Lot.
Subdivision Filed Map No.
(As on the tax roll or latest deed)
ized officer
26
Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Service station; S-1
b. Intended use and occupancy Service station; S-1
3. Nature of work (check which applicable): New Building Ai
Repair Removal Demolition Other
(Description)
4. Estimated Cost $35 , 000 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
anks
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Service station 100%
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 Heigh Number of Stories
8. Dimensions of entire new construction: Front Reaz Depth
Heght Number of Stories
9. Size of lot: From 176' Rear 173' Depth
10. Date of Purchase Nov 1989 Name of Former Owner
11. Zone or use district in which premises are situated
100'
Robert Kull
12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO X
13. Will lot be re-graded? YES_ NO X Will excess fill be removed from premises? YES X NO_
POB 1006
14. Names of Owner of premises 808 Realty CorpAddre~Westhampton Beachph~No_ 288-0281
Name of Architect William Lahti Address Stony Brook NY phone No 751-6433
Name ofConttactor Island Pump & Tank Corp Address 40 Dovle Ct Phone No. 462-2226
I S a. Is this property within 100 feet of a tidal wetland or a freshwater wetland?'YES NO X
• 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 X
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 X
' IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
CO[JNTYOF Suffol
W i 11 i am J . Lahti being duly sworn, deposes and says that (s)he is the applicazd
(Name of individual signing contract) above named,
(S)Heisthe agent/engineer
(Corrcractor, Agent, Corporate Officer, etc.)
of said owner m owners, and is duly authorized to perform or have performed the said work acrd to make and file this applicatice;
that all statemecns 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.
Swom,~p before me this
,-~ ~ / day of ~+ ~ 20 °
Notary lic
JDHN V. SODEriBEt70
Ntaery Pudb, Slma of NwY YoAc
No. ~9355T/
DuaAfled In SuMdk r71,~ ~
Danmissbn Ebbw Jury
~~~
Signature o Applicant
~OF SOUTy / r
• .~O
~'~OOUNiV N~
'TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
;,,
'~ 1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE 8~ CHIMNEY [~ FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
REMARKS:
.w.-Gm'~I ~k•r~'~° 5~ ~'.~:> ~..a w ~ ~~ "tom:.-~l
DATE ~ ~` ! ~ ._ t?d' .~~ -~ -~~
INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
ro
FOUNDATION 1ST) ~
x
---------------------------------- ~
C
~1 ~
FOUNDATION (2ND)
z
0. 0
~.
~ ~
ROUGH FRAMING &
PLUMBING ~ y
--- -
x
----_-- - -----
--- ~~.,
"3
INSULATION PER N. Y.
STATE ENERGY CODE v
''~
O
l~
FINAL
ADDITIONAL COMMENTS
O _
(o -'`'~ -O ~ 7-r~ s , ~ ~ o~ ~~t,~7Ci ~c vv~o /i v L,q-n~S D o~ ~ilf. ~~
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,
Nassau Suffolk Electrical Inspections,Inc.
P.O. Box 549, Aquebogue, New York ~ 11931
Te1:631-591-3097 Fax:631-591-3098
Application: 8315
Issued to: Sob Realty Corp.
Address: 28975 Main Rd
Village: Cutchogue
Residential
Date: 7/18/08
Introduced By: Major Electric
License #: 2579-E ,
Commercial ~
The following was examined and approved up to the above date and found to
be in compliance with the NEC:
Attic 1" Floor ^D 2"° Floor 3rd Floor Garage Conversion
Basement Hot Tub Addition Detached Carage Pool
Switches Receptacle Fixtures G.F.I. Range HOOd Smoke Detectors
5 8 14 1
Fans Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Carbon Monoxide
Pomace Oil Gas Heat Zones Whirlpool Bell Transformers
Final Insp. Meter Amps Phase Motors
7/18/08
Other Equipment:
1 I-'ire Supression System
3-2Hp Submerged Pumps
3-Multi-Hose Gas Dispensers
Tank Monitorin¢ System
I-Hot Box For Water
8-LBD Fixtures
2-2>0 Watt Pole Fixtures
~~
Permit#: 33893
This certificate must not be altered in any manner
07/21/2000 15:43 6318542505
Interii;».:Permit to 4pe'rate
Su£~'olk Countp ,Department of Health Services
Humsyun J. ii" 1laudhry, DU,1N5 Commissioner
Article Xl [Hazardous Mater1a1 Storage
FACILITY REFERENCE 13668 Date of Issuance:.TITLY 21, 2008
SCHDS REGISTRATION #10-0040 Permit expires one year frnm
SCDHS PLAN # IiM07-221R2 the Aate of Issuance"
FACILITY NAME & ADDRESS:
OWNER NAME & ADDRE8.9:
METRO SERVICE STATION PETItOI.EUM 888 REALTY CORD
RTR 25 MA1N'RD RTE 25 MAIN RD
CUTCHOCUE NY 1I935 CUTCHOGUE NY 11935
TANKS
TANIC# VOLUME CONTENTS
13 20th GALLONS GASOLTNP.
la 8000 GALLONS GASOLINE
15 12000 GALLONS OTRSEL
PAGE 01
The above listed tank(s) have beon aF?ntved, inspcoted end built according to the requirements of Article
Xll of the Suffolk County Sanitary Cc•Ic. This permh romaine valid as long as it is operated in accordanoo
with its design controls and has iu enr;uel fee paid. The Department roaervos Uto right to revoke this permit
if these candi6ons aro not met. In ad ilition, the operator of the facility gives the Department the right to
inspect this inemllation nt any time tc vivify its operation in compliance with int permit design. Renewal
permits will be received in the form o I' an annual bill. A copy of this perndt must be kept on display et the
facility.
The above fink(s) may be placed imn service provided that all necessary permitting, lnspectbn, and
other regulatory requfremeabt of tor~,lt, village and ell other munkipalltke have been satietied. This
inclutles, but is not limited to, meeting all local building cotle, zoning, and iIrc safety raquiremeeh.
ISS SY:
.r~J
ward W. Olson
Associate Public Health Sanitarian
Otlicc of Pollution CAnttni
Permit Administrator
87-21-2008 15:42 SDUTHOLD BUILDING DEPT 16317659502 PAGE1
May. 20, 2008 4:02PM ISLAND PUMP & TANK CORP.
No, 0007 P. 1
~;~ ~ r ~~ ~ i„ .~,,
'~ - - - ~`
.~;
ISLANT7 PUMP & TANK CORP ~ 20 '-.~
40 DOXLE COURT ~ _
,.,
EAST NORTHPORT, NEW YORK 11731
PHONE (631) 462-2226 RAX (631) 462-6434
PACSrMiLH TRANSMITTAL SHHHT
TO: FRUM:
Creorge (irlleri Jenlufer
COMPANY: DATB;
Town of Southold 05!20/08
FAX NUMBHR: TOTAL. NO. OF PA064 INCLUDTNO COVfilL
765-9502 2
PHONa NUMDBR; SENOr:AS A&PBRBNCB NUMRRR:
Rri YOUR RBPaAaNCC
Metm Service Station
Main Road and Depot Road
Cutchogue
Permit # 33893z
^ rJACL+N'r ^ POA RBVlHW ^ Pr.IrASR COMMLNI' ^ PLEASE REPLY I7 PLEASIr RnCYCrn
NOTnS/COMMftN'f5:
Inspector Crillen,
Please accept this as a formal notification that Island Pump & Tank Corp has began work today at
the above referenced location, please note that we are only installing perimeter fence, saw-cutting
the tank mat and installing shoring, we will schedule all appropriate inspections for the tank
replacement.
Should you have any questions plcasc contact me at 631-462-2226.
Thank you,
Jennifer Caccioppoli
631-462-2226
OS-20-2008 16:01 SOLJTHDLD BUILDING DEPT 16317659502 PAGE1
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
John Tsunis
Tsunis & Gasparas
801 Motor Parkway
Happaugue, NY 11788
Re: Valero -Cutchogue
Dear Mr. Tsunis:
~o~~pF SO(/r~o~
# #
~`~UIY 1 ~ i~~
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
Fax (631)765-9502
Telephone (631) 765-1802
Based on our conversation, the Southold Town Building Department will lifr the stop
work order issued against the Valero property in Cutchogue, NY (SCTM# 1000-102-5-
26), effective immediately.
However, only work permitted under building permit #338932 is permitted to continue.
Upon completion of construction, allowed under building permit #338932, your client
will be permitted to operate a gasoline station and automotive uses only. Any additional
proposed uses must first be approved by this office.
If you have any questions please feel free to contact this office at (631) 765-1802,
between the hours of 8:00 a.m. and 4:00 p.m.
Respectfully Yours,
/ _
Michael Verity, Chief Buil~ing Inspector
i3~dd ZOS6S`JLL£9T id3u .,rilanma a~aHinos 6b~0i a00z-£0-LO
TSIJNIS &GASPARIS LLP
' JOHN C. TSUNIS
MARIA GASPARIS
Client:
Matter:
+++xx+++x+++++++rx+++++w+xw+++t++xxx++x+xxx++++++x+++xx+xx++xx++xx+x+++x++xx+*++xx++++x+++++++x+++:r+t
To: ~"t i C~~.~~1 U
FACSIMILE fit: ~~o ~ - q ~h ~
DATE: -71i3 ~b~
FROM: '_~`("t~..,, C . ~sy~.S
TIME: ~ l7 5~ (~~
TRANSMITTED BY: ~ q
NUMBER OF PAGES (INCLUDING THIS COVER PAGE):
If you do not receive all pages indicated above, please call (631) 582-4000 as soon as possible and
ask for the person who transmitted this facsimile.
THE INFORMATION CONTAINED IN THIS FACSIMILE MESSAGE IS ATTORNEY PRIVILEGED AND
CONFIDENTIAL, INTENDED ONLY FOR THE USE OF THE INDIVIDUAL OR ENTITY NAMED
ABOVE. IF THE READER OF THIS MESSAGE IS NOT THE INTENDED RECIPIENT, YOU ARE
HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPY OF THIS
COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION
IN ERROR, PLEASE IMMEDIATELY NOTIFY US BY TELEPHONE AND RETURN THE ORIGINAL
MESSAGE TO US AT THE ADDRE33 BELOW VIA 7'HE U.S. POSTAL SERVICE. THANK YOU.
COMMENTS:
-_ _ .801 MOTOR PARKNINV, HAUPPAUCIE, LONG l9lAND. NY 11798 • T&: 691a92d000.54X: 631 fi82-4091 • e-maA:hunk.po~parkCproglpy.net
I'd TB04-Z88-TE9 dl~ SIMHdSa9 'i SIIJf1S1 NaL4~OT 8002 EO IBC
83~Jtid 20S6S9LT£9T 1430 ~JNIO~IIlB O~OH1f10S 6b:0T 8002-£0-L0
TSUNIS & GASPARIS LLP
JOHN C. TSUNIS
MARIA GASPARIS
B FAX 631-765-9502
Michael J. Verity
Chief Building Inspector
Southold Town Hall
53095 Main Road
Southold, New York 11971
Re: Valero - Cutchogue
Dear Mr. Verity:
Thank you for taking the time to see me this rnorning without as appointment. Pwsuant
to ow conversation, this is to confirm that the Town of Southold is releasing the stop
work order on the above referenced property as it relates to the replacement of gasoline
tanks and what is otherwise alkrwable in the permit.
This is W further confirm that upon completioq the client will be permitted to proceed
with the sale of gasoline and accessory automotive uses customarily found in filling
skatans, including cigarettes, candy and soda.
Notwithstanding the above, my client shall not proceed with any additional construction
or renovation until all site plan and building permit applications are in place.
Please confirm yow agreement with the contents of this letter by fax at yow earliest
convenience. Should you wish to speak with me, my call phone number is 63t-793-6192.
Again, thank you for your courtesies aL~ please enjoy a safe July 4'" weekend.
very a„ly yours,
TSUNIS & GASPARI3 LLP
r yam' . _
--~ 1 ~r~ ~c/5)
JOHN C. TSUNIS
JCT/ds
CC: Nick Bartolomeo
Gene Buccellato
901 MOTOR FN~RI(WAl', MAUPPAUGE, LONG BAND. NY 11788 • ?EL: 631-5824000 • FAX: 631582-4081 • e+rwA:lswcCaapaflcOprooigy.nel
Z'd iB04-Z8S-TE9 del SI21HdSH'J 9 SIWf1Sl WHLi~Oi BOOZ EO TIC
r~xrr~N~Rr~~~v~ ~1vvrRo~lvr~ coNSa~rrz~~ pc.
207 Hallock Road, Suite 212
Stony Brook, NY 11790
Tel (631) 75t-6433
Fax (631) 751-6434
May 6, 2008
William J. Lahti, P.E.
New York Vvginia
Connecticut New Jersey
North Carolina Massachusetts
Via overnight mail
Mr. Michael Verity
Town of Southold Building Department
54375 Route 25, P.O. Box 1179
Southold, NY 11971
Re: Metro Service Station @ Main Rd & Depot Ln, Cutchogue
SCTM# 1000-102-5-26
Deaz Mr. Verity:
Enclosed please find the following items associated with our proposed installation of a
new dispenser island and associated piping at the above referenced site:
1. Building Permit application
2. (4) copies of proposed plans (already approved by the SCDHS)
3. Filing fee check in the amount of $250
It is my understanding from Mr. Damon Rallis that the tank replacement portion of the
project does not require a permit from the Town. Upon completion of your plan review,
please direct your comments or approval to my office. Thank you.
Sincerely,
William J. L P.E.
w~""~ ~~
ao~: o~osaot towa Pan 5~c.aoc
THIS PERMIT IS VALID FOR THE FOLLOWING
.STORAGE FACILITIES ONLY
SCDHS# LOCATION VOLUME CONTENTS NOTE
13 Under /Out 20,000 gal. Gasoline
14 Under/.Out 12,000 gal. Diesel .Compartment 1 oft
15 Under /Out 8,000 gal. Gasoline Compartment 2 of 2
For. up to 90 days afrer [he. PemuC to Constmcf expires; the permit is renewable. The job filewill remain
open for that period. If the Office of Pollution. ContioLdoes not ieceive a renewal application with the
appropriatefees within the90 days, the file will be closed and anew application for a Permitto Constmct
wilLhave to be filed if the job is to be re-opened.. All applicable filing fees will once again become due and
payable.
Issuance of this permit does not supersede any existing agreements with, or mandates by,
the bf5ce of Pollution Control orany other government. agency.: The construction period
does not supersede any existing compliance dates agreed to, or mandated by, the Office of
Pollution Control or any other government agency. Issuance of this permit does not
authorize the use of the storage facility(s) that are in violation of the Suffolk County
'Sanitary Code or any other government code.
Special Conditions:
None
PERMIT TO CONSTRUCT
Toxic and/or Hazardous Material Storage Facility
Suffolk County Department of Health Services
Humayun J. Chaudhry, DO, MS Commissioner
SCHDS REFERENCE # 13668
SCHDS REGISTRATION # 10-0040 Date of Issuance: May 2, 2008
SCHDS PLAN # Permit expires one year from
HM07-22182 the Date of Issuance'
"FACILITY NAME & ADDRESS:
Metro Service Station
Main Rd. &, 'Depot Ln.
Cutchogue,Nl' U93y
..Your Application for Permit to Cohstmct a Toxic or Hazazdous Material Storage Facilities Tor the above
referenced site has beenreviewedforcomplffance with Articles.? & 12 of the Suffolk County Sanitary-Code.
The applicaCion has been approved. The items listed below and on the back of this Perrrpt are'conditions of this
Pernut and.h`ave to be observed during constmction:. ,
1. A copy~of~the approved plan must be kept~at the constmcfion site. A copy of Phis peinut must be kept
..on display at the facihry duffing Fonstrr3ehan:. „
2 Safe' constmction practices must be followed during the installation of the storage facility(s).
3: The storage facility(s) must be constructed m accordance with theapproved plan. Any changes in
design, materials or use requrres pnor zvntten~ consent of both the design professional and~the.Office
of Pol~ution.ControLThe changes liA'y~[o ba subzwtted m al~'a`rmthatis acceptableto the;Office of
Pollution Control. The contractor and/or design professional iS requiredto inform the owner that the -
changes are being made..
4. The Office of Pollution Control has the`right to inspect this installation at any time to verify its being
cons4ucted in compliance with this permit..
The Office of Pollution Control mustbe contacted at 85¢-2523 at least 2 business days prior to commencement
of any wor14 tojairange for the required construction inspections. -
Contact~th~e local building. department andfor fire safety enforcement office for any additional requirements that
may apply'to your project
The storage facility cannot be placed into service until the Office of Pollution Control performs all
required installation inspections and issues an interimpermit tp operate.
The Office of Pollution Control reserves the right to revoke this pemut as allowable bylaw.
-- - ~ --- -
ISSUED BY:
C~tP
e~Clunie
Bureau of Environmental Engineering
Office of Pollution Control
Division of Environmental Quality
* See the back for exceptions
DEPARTMENT OF HEALTH SERVICES
HuMAYImr J. CHAUDHRY, DO, MS
Commissioner
BUREAU OF ENVIRONMENTAL ENGINEERING
APPROVAL NOTICE
Lahti Engineering May 2, 2008
207 Hallock Rd: Suite 217
Stony Brook, NY 11790
Attn.: William Lahti
Re: SCDHS Job No. : HM07-221R2
SCDHS Fac. ID. No.: 10-0040
SCDHS File Ref. No.: 13668
Dear Sir/Madam
Your application for a permit to construct a_project at Metro Service Station, Main Rd. &
Depot Ln., Cutchogue, NY 11935 has been reviewed for compliance with Article 12 of the
Suffolk County Sanitary Code. The application hasbeen approved.
Enclosed you will find the Permit to Construct. This permit has to be hosted at the construction
site during the construction. - _
If you have any questions regarding the review process or need assistance, feel free to contact
this office at (631) 854-2528.
Very truly yours,
~x ti
Kenneth A. Clume
Assistant Public Health Engineer
$ureau ofEliyironmental Engineering
Pi7bliCHealth Division of Environmental Quality ~ Office of Pollufion Confrol - 15 Horseblock Place - Farmingville, Ny 11738-1220
Phone (631) 854-2528
Fax (631) 854-2505
COUNTY OF SUFFOLK
~~
STEVE LEVY
SOFFOLK COUNTY EXECQTIVE
_ ~ 2_ ..
SUFFOLK COUNTY DEPARTMENTOF HEALTH SERVICE OFFICIAL USE ONLY
TOXIC LIQUID STORAGE REGISTRATION FORM Fac. Ref. No.
nnapa roperty
Tax Code District 1 0 0 0 Section 1 0 2 Block ~ ~
Lot
Facility Name No. Street Communlty State Zip
Metro. Service Station Main Rd & De of Lane Cutchogue NY 11935
Tank Owner No. Street Communlty State Zi
808 Realty Corp. P.0. Box 1006 Westhampton Beac NY 11978
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Change
Add ~
Phone No.
Phone No,
288-0280
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I certify that Information on this application and all attachments have been reviewed and that, based on my Inquiry of those Receipt No. ~
persons Immediately responsible for obtaining the information contained In this application, I believe that the Information
is true, accurate, and complete. I understand that false statements made herein are punishable as a Class A misdemeanor ,i
pursuant to Section 270.45 of the Penal Law. Amt. of Fe$
Date Print Name Si na
__.--
O1 ~Y ~ Eugene Buccellato Vlilce Presideri~
nirviwo nev zraa
_ 18-262-..3/88
L--
~.dfi~ Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
-PROPERTY IOCAnoN: 8.C.7.M. R: _... 7NE FOLLOWING ACYYDNS MqV REGVIRE THE SUBMISSION OF A
~OV O ~Oi3~ ~a~p STORILWATER, CRABING, DR4INAGE AND ERq$ION CgNiRpL ALAN
orawd scd;n,. eioek rat CERTIFIED BY A DESIGN PROFESSKINAL IN THE STATE OF NEW YORK
item Number. (NOTE: A Check Mark (~) for each Question Is Requhed for a Complete Apprioatfon ~ -.
Yes No
~ WIh this Project Relaht All Slnrm-Water Ru~Ufl Germrated try a Two (T) htch Rainfall on SIte7 ~ ^
(This item wih include aq rttn-off cre?atetl by ~ilr, Bearing and/or COnstruGlon aglvltias as w911 as all She
Improvements and Ne permanent creation of impervious surfaces.)
Z E1oes tha Sire Planandlor Survay Show AIt Proposod Drainage Shuclures Indicating Size 8 location? / ^
This hem shall inctutle all proposed Crede Changes and Slopes COttVOlling Stufarn. WaterFlOwt
3
Wltl this Prpjert Require. any Land Filling, Gradlrg or Exravahon whore there is a change to the Natural 1~-~~
Existing Grade Involving more than ZOD Cut>ir, Yards of Material withk+ any Parcel?
4 Will this Application Requirr. Lora} bitiuxtwrg Adivifias Emxxnpassktg an Area N F-xcass of ^
/
Five Thousand {5,000) Syuare Feet of GraurW Surface? -
fs there a Natural Water Course Rurxtin0 through the Sile? ~ /
Is this Project within iha Trustees jurisdiction a vrilhin Ono Hundred (100') feet o1 a Wetland or Beach? -
Will there be Srte preparation nn Exlshng Grade Slopes whlrh Exceed PlReen (15) Teet rN Vertical Rise to
' ^ /
One Hundred (100
} M Horizontal Plstance7 - -
] Wirl brier-ways, Parking Areas or otlx:r Impervious Surfaces he Sloped to Dkect Storm-Water Run-Off ^ /
into and/or in the direction of a Town right-of-way'! -
WIII dri5 Prt>jed Requlra the Placdment of Notarial, Rereroval df Vegetation andlar the Conshuction oT 1I1--~--~~~11r
any Item Within the Town RigM•oi-Way or Road Sltotrlder Area?
(This item wilt NO7 include the Insbhation vl DrWeway Aprorta.)
g Will this Project keyu"vc She Preparation within the Cns Hundred (100j Vear Floodplain of any Watercourse? ^
NOTE: tF Any Answer to Quastions One through Nine is Mt:wered with a Check Mark In tha Box, aStorm-Water, Grading,
Drainage 8 Ero6lon Control PWn Fs Roqulred and Must do SuhmltMd for Review Priw to Issuance of MY Buikfing Permitl
__-_-___-~~~-_.-_---_---_---_ Ves •.. No_
EXEMPTION: , .
Oces this project meet the minimum standards fur rAassifica00n as art AgfiCURtrral Project?
Note= tf You Axcwarad res to this queauon, aStorm-Water, Grotlhtg, Drainage & Erosion Control Plan is NOT Retjrriredl - -J
~~_~~-------------------------------~-.. _. .~J..--. ~...~___-_~-
srn~: or Ivrw raltx,
coulvrror-.....:..S~f~~i~......--- -~
1'lul 1 . ............~~ / ~ L~L^.:!.,.--. J.:._~Yt.~ -
I - .-..._---- Lr.ing duly swum, rlclx>scs and says f1Rd he/she is dtc appGcun for Ycrmit,
tName of Indlwdual signing Dowmcnp
Hurl t}ctt he/she is Iltt: ~.1.:~'17.~~-,~!~ ' a' 4~ ~- l h ~C'{r ....................
............. ......... y-.. ............................................-.........
(Urner, Conaactor, Agent Corporals Orf~wr, ck.J
(hvuer :mrl/or mpreseutalire of dte (honer Of (.Twrters, and is duly authorized fn (x:rfonn or 1 ~ ~ stud work atul In
make :md file this applicatiun; tlttl all statements conrutted in this dPPliration arc tmc to t~)q ~d hclief; :md
that dui work will he prrfnrntcd in the m:untCr set lurdt iu dtr application tiled hertwidt- No. 4935577
Sworn to Ixfore e. this; 0.~-'°.:: in Sutioik Cotrnly ~
2~ Canmr:,wn frxpiros Juno 6,~. Dl
- a,~ ...............................day t>~r.fY.f..f..lL./.......................... z~ ~8 / • I /] // ~-
NOmry 1>trhlir.: ---' ~ .. ~:... ~yt' ......................................... --..Gll/r..,...1.~ L ..
tsy,mt~re a r7
FORM - 06/07
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