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HomeMy WebLinkAbout38907-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 'D 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#: 38907 Date: 5/27/2014 Permission is hereby granted to: Habitat for Hum of Suff Hous 643 Middle Country Rd Middle Island, NY 11953 To: Demolish an existing dwelling as applied for At premises located at: 550 E Greenway, Orient SCTM # 473889 Sec/Block/Lot# 15.-2-14 Pursuant to application dated 5/12/2014 and approved by the Building Inspector. To expire on 11/26/2015. Fees: Total: $0.00 Building Inspector ~ TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 �+ Survey SoutholdTown.NorthFork.net PERMIT NO. �J%fl Z Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined 7,20A StorypWater t m�Fgpn Contact: C �/Vll/ Approved 20jEC ,' `\,� Mail to: V Disapproved a/c C J PhoX13 Expiration 20 204 Buil r DG.DEPT. APONOb ERMIT T L4 Date '20 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 cod housing code,and regu ions,and to admit authorized inspectors on premises and in building for necessary inspections. Jok4w (Signature of applicant or name,if a corporation) G`!3 In,ddk- Ctu, n& M/dd YS lfi /� (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder D Name of owner of premises I U Y u n (As on the tax roll or latest eed) applicant is a oration,signatur f duly auth riled offi�r,, I� 2Ile �A,I ��t�c Y" (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Locatlpi of lan which proposed work will done: O ' House Number Street Hamlet County Tax Map No. 1000 Section Block 01N Lot / Subdivision Filed Map No. Lot r w � 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable)- ilding Addition Alteration Repair Removal emolition Other Work (Description) 4. Estimated Cost 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 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 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 Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front Rear Depth 10.Date of Purchase Name of Former Owner 11.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_NO Will excess fill be removed from premises?YES_NO 14.Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 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'�kcdK ) �/ ASIC 5kAY-K'e, being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, 3 c N (S)He is the CED 0._t(1� E _C-,ok�V� �\Y 2 Gib Z h o N (Contractor,Agent,Corporate Officer,etc.) in 0 NY 10 O v to c of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; W yN that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be p tn performed in the manner set forth in the application filed therewith. ` oN� a o w Sworn to before me this J :3 o-%ro: day of 20j Z � -- p N Try Public Signature of Applicant Z U Paul Snationalgrid Senior Supervisor Customer Fulfillment Department March 29, 2014 Habitat for Humanity of Suffolk 643 Middle Country Rd Middle Island, NY 11953 Email: habitatsuffolk@habitatsuffolk.org RE: National Grid WO T101591928 Service Address: 550 Greenway E Orient Point, NY 11957 To Whom It May Concern: This letter is to advise you that National Grid investigated your request and confirmed that the subject property does not have an active gas service line. New York State law requires anyone planning underground excavation work to notify local utilities by making one call to a toll-free number to get your underground lines identified for you prior to doing any digging. This phone call needs to be made at least 2, days but not more than 10 days prior to starting work, not including the date of the call. The number to call is either the nationally sponsored"811",or the local number for NYC/LI area, 1-800-272-4480.This confirmation letter of a gas cut-off does not relieve the excavator of making this"811"call. If you have any further questions, kindly contact me at 631-348-6218. Respectfully, ., A . clam, Paul A. Cama Senior Supervisor Customer Fulfillment Gas NY 1850 Islip Ave,Brentwood,NY 11795 T:831-3488218 F:516545-2333 paul.camaQnatlonatgrid.00m www.nationalgrld.com PSEG Long Island 175 R.Old Country Road Hicksville,NY 11801 MEGI..,ON(;I;SI.AND We male things uwh for you. April 17, 2014 Habitat For Humanity 643 Middle Country Rd Middle Island,NY 11953 ATTN: Carol Jean D'Aquila Re: Ref. No.T101688571 550 Greenway Rd Orient, NY 11957 Dear Sir/Madam: This is to advise you that the PSEG-LI electric facilities at the above referenced location have been removed. You must also contact National Grid at 516-545-4973 to procure a letter of demolition associated with natural gas service, whether or not your home or business uses natural gas. In accordance with the New York State General Business law - Chapter 818, Industrial Code Rules 53, please inform the demolition contractor to notify the Utility Control Center at 811 or 1-800-272-4480, 48 hours prior to starting work to request a mark out of the utility services in the area. If you have any questions regarding the above, please contact Customer Order Fulfillment at 516-545-2242. Very truly yours, II a6 Manager Customer Order Fulfillment PSEG-LI :x New York State In_sura_nce 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 ^^^^^^ 112840553 HABITAT FOR HUMANITY OF SUFFOLK INC 643 MIDDLE COUNTRY ROAD MIDDLE ISLAND NY 11953 POLICYHOLDER CERTIFICATE HOLDER HABITAT FOR HUMANITY OF SUFFOLK INC TOWN OF SOUTHOLD 643 MIDDLE COUNTRY ROAD BUILDING DEPT MIDDLE ISLAND NY 11953 TOWN HALL SOUTHOLD NY 11971 POI 120N3MB3 R CERTI 1 28 6 NUMBER PERIOD COVERED TO 03/22/2015CERTIFICATE 5/7DATE 2014 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1201 379-3 UNTIL 03/22/2015, 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 03/22/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 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. 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 DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certva1.asp or by calling(888)875-5790 VALIDATION NUMBER:249502437 U-26.3 STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE CO'V'ERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 19. Legal Name and Address of Insured(Use street address roily) lb.Business Telephone Ni anber of Insatred HABITAT FOR HUMANITY OF SUFFOLK INC (631) 924-4966 643 MIDDLE COUNTRY RD tc.NYS Uneutploymerit Insurance Employer Registration MIDDLE ISLAND, NY 11953 Number of Insured 0457445 1d.Federal Employer Identification Number of Insured or Social Sectuity Number 112-84-0553 2. Name and Address of the Entity Requesting Proof of 3a.Name oflms Trance Carrier Coverage(Entity Being Listed as the Certificate Holder) NEW YORK STATE INSURANCE FUND Town Of Southold Building Department 3b.Policy Number of entity listed in box"ter": Town Hall DBL 3173 57 - 3 Southold, NY 11971 3c,Policy effective period: 07/01/2013 to 07/01/2014 4. Icy covers: a.® All of the employees employees eligible under the New York Disability Benefits Law b. Only the following class or classes of the"loyees employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurmlca carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Sigtted 05/1/2014 By '5;? Joseph J. Masi (Sigrat um of irsura me d niers a utho dad represartet We of RM,uGe reed I reum mo Apra of that irsura noe o.mer) TetephoneNumber (866) 697-4332 Tarte Director of Disability Benefits Insurance IMPORTANT: tf boat"4a"is arcked,and ibis form is signal by dee insunwrce curkes auitwiind reptestamlive or NYS Licatstd ha nwe Apeat of that carrier.this certiScafe is COMPLETE. Mail it dimity to die certificate holder. Ifbox"4b"is checked,this certificate is NOT COMPLETE for purposes ofSection 220,SUbd.I of the DisabitU,it Benefits Law. It trtust be retailed for completions to the workers•Conveosadon Board,DB Picot Aoeeptswe Unit.20 put Street,Albury.New Yost 12207. PART 2. o be compilated by NYS WorkeWornpensat on Board(Onlyx'14b"of Part 1 has Won chocked) State Of New York Workers'Compensation Board According to informaticu maintained by the NYS WodWe Con4nnaation Board.the above-nursed employer has complied with the NYS DiuWlity Benefits Low with respect to all ofhisAw employees. Date Sigmed By (Sipastme of NYS workers"Compensation Hoard Employee) Telephone Number Title Please Note:Only insurance carters licensed to write NYS disability benefits inumoce policies and NYS licensed insurance agents of those insutamce carriers are audwfized to issue Fomu D&120.1. Insurance brokers are NOT authorized to issue this form. 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DISTRICT: 1000 SECTION: 75 BLOCK_ 2 LOT(S).14 LOT 5 U.P.O N83'1 1'50"E 150.00' -^--------------- 0 O n PRINCIPLE BLDG.0 F- O o 40' ENVELOPE. 50' tC) CORC,DR-1 - G6R6GC I I [17 O I � BlCO 66.0' z 8 o LAND NSF LOT a n..caw a c aip scDn OF 'Dwbuwc c� JssD LATHAM I 16.0' I W CANTILEVER I' W I u I I I � � I 39.8" m-� I O W N CTI w rh io O o 1,6 M Q Q Q L _________________ J a z �- PIPE o U P" FE 4" STOCKADE FENCE 6' STOCKADE FENCE EC PIPE o0 ' :aE S83"11'50"W 150.00' 00.7 LOT 3 MAIN ROAD N Y.S. RT. 25 ZONED R-40 NON—CONFORMING LOT MAX LOT COVERAGE 209, FRONT SET BACK 40' REAR SET BACK 50' SIDE SETBACKS 15'MIN (35' TOTAL) THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 20,250.00 SQ.FT. or 0.46 ACRES ELEVATION DATUM- _ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUI;TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 4 CERTIFIED TO: HABITAT FOR HUMANITY OF SUFFOLK; MAP OF GREEN ACRES AT ORIENT FIDELITY NATIONAL TITLE INSURANCE COMPANY; FILED:APRIL 73, 7962 No.3540 SITUATED AT:ORIENT TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC ..SUFFOLK COUNTY, NEW YORK ,/ Professional Land Surveying and Design P.O. -Box- 153.Aquebogue, New York 11931 FILE # 73-726 SCALE 1"=30' DATE: JULY 22, 2013 PHONE (631)298-1586 FAX (631) 298-1588 N.Y.S. LISC. NO. 050882 ,int,ining the record,of Robert J.111--y 8 Kenneth N.Moychuk