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Home My WebLink About36127-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 36127 Z Date JANUARY 7, 2011 Permission is hereby granted to: G~-MA PROPERTIES OF DEER PARK MATTITUCK,NY for : DEMOLITION & REMOVAL OF UNDERGROUND STOP, AGE TANKS, PIPING, PUMP ISLANDS, CANOPYS & KIOSK AS APPLIED FOR at premises located at County Tax Map No. 473889 Section 142 pursuant to application dated DECEMBER Building Inspector to expire on JULY 9945 MAIN RD MATTITUCK Block 0001 Lot No. 027 30, 2010 and approved by the 7, 2012. Fee $ 100.00 ORIGINAL Rev. 5/8/02 ¥OWN OF SOl BUILDING DE] TOWN HALL SOUTHOLD, N TEL: (631) 765- FAX: (631) 765- SouthoidTown. N, Ex ined Approved Expiration 7 ~-- ~7 , 20 ! ~ BUILDING PERMIT APPLICATION CHEEKLIST Do you have or need the following, before applying? Board of Health NA 4 sets of Building Plans_ ,/ Planning Board approval.N^ Sarvey_ ~/ Check $100.oo Septic Form N^ N.Y.S.D.E.C. nA Trustees N^ Flood Permit N^ Storm-Water Assessment Form N^ Contact: Mail to: High Point Engineering 410 Jericho Tpke, Suite 105, Jericho, NY 11753 Buildi[g Inspector Phone: 516-433-4320 APPLICATION FOR BUILDING PERMIT Date December 29 ,20 10 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. High Point Engineering (Signature of applicant or name, ifa corporation) 410 Jericho Turnpike, Suite 105, Jericho, NY 11787 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Engineer Name of owner of premises Gama Properties of Deer Park, inc. (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer Chris Tartaglia, Principal (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: 9945 Main Road (Route 25) Mattituck, NY 11952 House Number Street County Tax Map No. 1000 Section 142 Subdivision --- Hamlet Block 1 Lot 27 Filed Map No.--- Lot --- 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Gasoline Service Station b. Intended use and occupancy_N^ 3. Nature of work (check which applicable): New Building. Addition Alteration Repair Removal ,/ Demolition Other Work Removal of existing canopy, underground storage tanks, piping, pump islands and kiosk. 4. Estimated CostS40,0O0 Fee 15100.00 (To be paid on filing this application) 5. If dwelling, number of dwelling units N/^ Number of dwelling units on each floor N/^ If garage, number of cam N/A 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. N^ 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories N/A - Existing canopy, UST'$, piping, pump islands and kiosk will be removed. Dimensions of same structure with alterations or additions: Front Rear Depth Height. Number of Stories N/A - Existing canopy, UST'$, piping, pump islands and kioak will be removed. 8. Dimensions of entire new construction: Front N/A Rear N/A .Depth N/A Height N/A Number of Stories N/A N/A - Existing canopy, UST's, piping, pump islands and kiosk will be removed. See attached plans for details of proposed work. 9. Size of lot: Front ~ga' Rear146, .Depth t6o' 10. Date ofPurchase NA Name of Former Owner NA 1 I. Zone or use district in which premises are situated s. General Bussiness 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO '/ 13. Will lot be re-graded? YES__ NO '/ Will excess fill be removed from premises? YES__ NO__ 14. Names of Owner of premises ~a,,a Properiies of Deer Park. Inc. Address ' 410 Jericho Turnpike, Suite 105 Name of ArchitectHigh Point Engineering AddressJericho, NY 11753 Name of ContractorAventura Construction Corp. Address 1101WavelfyAvenue Phone No. 516-5134)155 (ext. 333) Phone No 516-433.4320 Phone No. 631-654-0660 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of^ tidal wetland? * YES NO v * IF YES, D.E.C. PERMITS MAY BE REQUIRED. NO / 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 ~r · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF Nassau ) Chris Tartaglia being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Engineer (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 tree 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. ~ ' (~--Notar~ublfc ~f~pplicant 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy Gasoline Sopzi¢o Station b. Intended use and occupancy N^ 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal ¥ Demolition Other Work Removal of existing canopy, underground storage tanks, piping, pump islands and kiosk. 4. Estimated Cost$40,0o0 Fee $100.oo (To be paid on filing this application) 5. If dwelling, number of dwelling units N/^ Number of dwelling units on each floor N/A If garage, number of cars N/A 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. N^ 7. Dimensions of existing structures, if any: Front Rear Depth Height_ Number of Stories N/A - Existing canopy, UST'$, piping, pump islands and kiosk will be removed. Dimensions of same structure with alterations or additions: Front Rear Depth. Height_ Number of Stories N/A - Existing canopy, UST's, piping, pump islands and kiosk will be removed. 8. Dimensions of entire new construction: Front U/A Rear N/^ _Depth N/A Height N/A Number of Stories N/A N/A - Existing canopy, UST's, piping, pump islands and kiosk will be removed. See attached plans for details of proposed work. 9. Size of lot: Front ~98' Rear146' .Depth is0' 1 0. Date of Purchase UA Name of Former Owner NA 1 1. Zone or use district in which premises are situated B- General Bussiness 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO '/ 13. Will lot be re-graded? YES NO '/ Will excess fill be removed from premises? YES NO__ 320 Frost Pond Road 14. Names o f Owner of premises Gama Properlies of Deer Park. Inc Address o,, ,rook,,,,. NY 11545 Phone No. 516-513-0155 (ext. 333) 410 Jericho Turn[:lke, Suite 105 Name of Architect High Point Engineering Address Jericho, NY11753 Phone N0516'433-4320 1101 Waverly Avenue Name of ContractorAventura C°nstructi°n Corp. Address .~,..i,. r~v~17a9 Phone No. 631-654-0660 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES__NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES__ NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES__ NO */ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF Nassau ) Chris Tartaglia being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the Engineer (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. ore me th.is N 0";'t'" Q~' ~:" ~,?,¥ 9_7, of.'~pplicant High Point Engineering 410 Jericho Turnpike Suite 105, Jericho, NY 11753 Website: www. Hi ghPointEngineerin g.com Phone: (516) 433-4320 Fax: (516) 433-4364 email: info(~highpointengineerin g. com TRANSMITTAL Via: To: Attn: Hand Delivery [] U.S. Mail [] Suffolk County Dept. of Health 15 Horseblock Place Farmingville, NY 11738 Walter Linley Enclosures: Quantity Date No~ 1 12/29/10 --- 1 12/29/10 3806 FedEx Standard Overnight [] Date: December 29, 2010 Pick Up [] Re-' Citgo Service Station 9945 Main Road (Route 25) Mattituck, NY 11952 Project # AVEN10-04 Description SCDHS Application for Closure of UST's Check in the amount of $400.00 Comments: Enclosed please find the above referenced items for your Department's use in processing the closure of the existing underground storage tanks at this facility. Chris Taffagha, P.~ cc: Joe Pepe, Aventura Construction Corp. - w/enclosures (via email) P:\!PROJECT DIRECTORY\Aventura\AVEN 10-04 Mattituck\Letters, faxes~ etc\Transmitlal-SCDHS-12.29 10.doc SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPLICATION FOR CLOSURE OF UNDERGROUND STORAGE TANKS Name Distdct Section Gama Properties of Deer Park, Inc. Block Physical Address 9945 Main Road (Route 25) Property Owner's Name I Gama Properties of Deer Park, Inc. Phone Number 516-513-0155 Community [ State Zip Mattituck I NY 11952 Fax Number Mailing Address 320 Frost Pond Road Community I State Zip Old Brookville I NY 11545 Contact Person George Abizeid ConsultantJAgent (if applicable) High Point Engineering Mailing Address 410 Jericho Turnpike, Suite 105 Phone Number 516-433-4320 E-mail Address Fax Number 516-433-4364 Community I State Zip Jericho I NY 11753 Contact Person : E-mail Address Chris Tartaglia ctartaglia @ highpointengineering.com For Abandonment Requests, describe why that the tank(s) cannot be removed and provide supporting documentation (List all tanks to be removed and abandoned on the back of this form) Chris Tartaglia, P.E. 12,29.10 Applicant Signatu~' Pdnt Name Date See reverse side for required additional information. Page I of 2 Tank Information Enter Information for all tank(s) to be removed or abandoned, below*: SCDHS Disposition Tank # Volume Contents (circle one) 6 10,000 Diesel ~-Rem~Abd 7 10,000 Gasoline ~"Re rr~/Abd 8 10,000 Gasoline .~. n~ / Abd 11 280 Fuel Oil .(,Re~Q:~ Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd Rem / Abd *if additional space is needed, attach addendum. Instructions For All Requests, submit the followinq: 1. A site plan showing the location of the tank(s) as well as utilities and other structures that may interfere with removal. A sketch is acceptable with the initial application but a more detailed site plan may be required by the Department. 2. A check, per SCHDS Fee Schedule. 3. Return the application to the address listed below. You will be contacted to schedule an appointment For Abandonment Requests, in addition to the above, provide a submittal that includes the followinR: 1. For requests based upon Utility Infringement, provide diagram and photographs of the mark outs. Photos must indicate tank location. 2. For requests based upon Building Infringement, provide: (a) Burial depth of tank. Measure from grade to top of tank. (b) Distance of tank center line to any adjacent structure. (c) Diameter of tank. (d) Depth below grade of footings supporting the adjacent structure(s) 3. Diagrams and Photographic evidence of any other item(s) that are claimed to prevent removal of any tank. If you have questions, call 854-2536 Submit all Information to: Suffolk County Department of Health Services 15 Horseblock PI. Farmingville, NY 11738 .3 BUILDING PERMIT EXAMINER CHECKLIST Applicant: ~ '~'-~ ~CTM# 1000- /~- I ~'~ Subdivision: *Date Submitted:/~-']0-/C7 Date Reviewed: /- 7- Estimated Cost: ~ Zone: Conforming? City: /~~ PreCOs? Building Permits (Open/Expired): BP __-Z / C/0 Z- , Info: tP__-Z / C/0 Z-__., Info: BP -Z / C/0 Z- tingle & Separate Search Required? Y o~Determination: BP __ -Z / C/0 7_,- , Info: , Info: BP __-Z / C/0 Z-__, Info: __ I.EQ. Lot Size: ACT. Lot Size: REQ. Lot Coy. ACT: Lot Coy. IBQ. Front ACT. Front REQ Side ACT. Side REQ. Rear PROP: Rear ll~Q. Height ACT. Height I~ ~ a~ , ~o:t~_ Sl b~5 /t c T ?roje,ctDescription:..~ c,L ~ ~ ~ · ~/ . v~---~.~--~ - ~ ,c..-~~ ~raterfront?Yo~2/ /( / ~' ,~r~- "~'~- - z ~ lyes, water body: ~"-/~t~'Panel# ~ Flood Zone: Bulkhead/Bluff Distance: |outhold Trustees: Y 0~)- Date: __ __ louthold ZBA: Y oG ~ Date: /__/ louthold Planning: Y Oq~- Date: / ?own Landmark C of A: Y o~DTE: __ __ LDDITIONAL APPI~OVALS REQUIRED lth~.' Y ' lk Count/Hen or N- If yes, *Bed#: *Date: . / *Permit#'.' ~ ~ ~--/~', - If no, certification required. Y or N Received: Y or N By: ~IYS DEC: eR~-o~c ~n~Ts Y otQ~l/- Date: / / Permit #: / Permit #: Permit#: / Permit #: - Notes: Compliance (page 2): Y o~ / / *NYS CODE Town Septic: Y or N or NJ Letter - Notes: or NJ Letter - Notes: - Notes: ~ee Structure: Calculation: :oundation: SF SF X $ =$ :fist Floor: SF + Initial Fee: $ ~ ~9 o ,. 6'~ ',econd Floor: SF + Addition.al Fee ( ): $ )ther: SF SF X $ =$ ?otal: SF + Initial Fee: $ + Additional Fee ( ~/,$ NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC D~SIGN CRITERIA: · (~ro~d Snow Load: ~.0. , Wind Speed~ I20MPH Seismic Design Category." B Weathering: Severe__ .Frost Depth: 36"__ Termite: M-H' Decay: S-M .. Design Temp: 11 · Ice Shield Underlay: YI~ . Flood Hazards: USE/OCCUPANCY CLASSIFICATION: · HEIGI:IT/FIP,~ AREA: TYPE OF CONSTKUCTION: DESIGN CRITERIA: ENGINEERED/pREscRIPTIVE FULL FRIkMING DESIGN ELEMENTS: y/N IlEAl)ERS: Y/N WALL STUDs: Y/N CEILING JOISTS: Y/N FLOOR JOISTS: Y/N LUIYIBER SPECIES AND GRADE: Y/N GLRDERS~ ROOF RAFTERS: W][NDOW AND DOOR SCHEDULE} NIISSLE TEST REQUIREMENTS: Y/N EGRESS 5.7 S.F.: Y/N LIGHT 8% :Y/N ~rENT 4%: Y/N NAILING/CONSTRUCTION SCHEDULE: Y/lq ME~S OF EGRESS: Y/N PLUMBING RISER DIAGRAM: Y/N LOCATION OF FIILE PROTECTION EQUIPMENT: YfN 'TRUSS DESIGN: Y/N CERTIFICATION: YfN ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) COI'~!PL f v,/rTH NEW YORK STA-;E AS REQUIRED ;ODES OF 'N CODES TOWN ZBs BOARD , ":b EXIST. KIOSK TO BE REMOVED EXIST. OVERHEAD CANOPY TO BE REMOVED EXIST. 280 ABOVEGROUND STORAGE TANK TO BE REMOVED EXISL I STONY MASONRY BUILDING TO REMAIN EXIST. {...3) 10,000 GAL/ON UNDERGROUND STORAGE TANKS/ PIPING TO BE REMOVED PER SCOHS REQUIREMENTS -- EXIST. DISPENSERS/ CONCRETE ISLANDS TO BE REMOVED 2O KEY MAP APPROVED AS NOTED / NOTIFY BUILDING D~P~ 765-1802 8~ TQ& ~ F~THE FOLLOWING ~ FO UNDATIO~~D FOR POUR~C~ S RAPPING, ELEC~C~ 3 ~SU~T~ ~ F~AL- coHsm~ ~mlc~ MUST BE C~P~TE ~ ~. ALL CONSTR~ REQUIREMENTS ~ YORK STA~. ~T DESIGN OR C~~ GRAPHIC SCALE 0 2o 4o ( IN FEET ) 1 inch = 20 ff. HIGH .[~ POINT ENGINEERING CHRIS M TARTAGLIA 9945 ROUTE 25 (MAIN ROAD) MATrrrucK, TOWN SUFFOLK COUNIY, NY ~S~RICT: 1000 SECRON: 142 BLOCK: 1 LOT: 27 REMOVALS PLAN