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HomeMy WebLinkAbout39762-Zgv�rn�K. TOWN OF SOUTHOLD S��coL 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 #: 39762 Date: 5/12/2015 Permission is hereby granted to: Universalist Church I To: PO BOX 221 Southold. NY 11971 Demolition of an existing church structure damaged by fire as applied for. At premises located at: 51970 Route 25. Southold SCTM # 473889 Sec/Block/Lot # 63.-6-6.1 Pursuant to application dated 5/11/2015 and approved by the Building Inspector. To expire on 11/10/2016. Fees:. DEMOLITION $100.00 Total: $100.00 SUFFnt4- TOWN OF SOUTHOLD ���, BUILDING DEPARTMENT g 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 #: 39762 Date: 5/12/2015 Permission is hereby granted to: Universalist Church PO BOX 221 Southold. NY 11971 To: Demolition of an existing church structure damaged by fire as applied for. At premises located at: 51970 Route 25, Southold SCTM # 473889 Sec/Block/Lot # 63.-6-6.1 Pursuant to application dated 5/11/2015 and approved by the Building Inspector. To expire on 11/10/2016. Fees: DEMOLITION $100.00 Total: $100.00 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL BUILDING PERMIT APPLICATION CHECKLIST SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 3 9 �ck_ov� SoutholdTown.NorthFork.net PERMIT NO. Examined , 20 Approved , 20 Disapproved Expiration , 20 APPLICATION FOR BUILDING INSTRUCTIONS Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees C.O. Application Flood Permit Single & Separate Storm -Water Assessment Form Contact: Mail to: S P 2 7 Phone: Date 20 l5 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. (Signat re of applicant me, if a corporation) " 1om Fadc waq (Mailing address of applicant) eri -r l r5Y l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ( -(ef2�- C ofvtr d -6t^ Name of owner of premises✓l/L�✓li�i1-���Q (As on the tax roll cK4atest deed) If applicant -is a corporation, signature of duly authgrizeo fficer CN\(arc cvah ,I() r (erre gcl;arr (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: House Number Street l3 Hamlet County Tax Map No. 1000 Section ted —Block ---6---5 Lot W LPj2 1 Subdivision 2. State existing use and occupancy of premises a. Existing use and occupancy, C b. Intended use and occupancy. Filed Map No. intended,►se and occupancy of 17-, Lot construction: Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost If dwelling, number of dwelling units If garage, number of cars Fee (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Height Number of Stories Rear Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories Depth 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 RIO / 1 - 20 o r 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO " Rear 13. Will lot be re -graded? YES NOt 7�Will excess fill in removed from premises? YES NO job V%YLv2r6 a_ Ohw[—W-W df �ac-Wow eatR,C�t6( , 14. Names of Owner of premises Addresses(7O Phone No.6631) 4-77 2-(_73 Name of Architect Address Phone No Name of Contractor G6M. CC(Q.GLw Fe_9fDrILOM, Address I OM (20dlaw Phone No. tO S25 8250 fic . A✓vn,cC.e 'Va Weaw j 6-ty 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 t/ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan ad dist ces tQ pro ert lipes._ thou LcL C w does Kof have- -wmzt ac, it wa4, to;v cw 17. If elevation at an point on property is at 10 feet or below, must provide topographical data on survey.j�Qv2 Y P P P Y � P 50��t� 18. Are there any covenants and restrictions with respect to this property? * YES NO ✓ bw �"l e * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF61a%au,) CU-G aftGff __ being duly sworn, deposes and says that (s)he is the applicant aae of individual signing contract), abboyve named, (S)He is the co',"�' "'"C-�Dr (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 theork will be performed in the manner set forth in the application filed therewith. ®' Sworn tR before me th's Jai✓ day of _� 20 t5 Notal`Y/69MABEL C. MARTINEZ NOTARY PUBLIC, STATE OF NEW YORK NO. 01MA6061140 QUALIFIED IN NASSAU COUNTY COMMISSION EXPIRES JULY 9,206 - Signature of A Sarah From: PSEG Long Island -Customer Service <CustomerServiceLl@pseg.com> Sent: Tuesday, April 14, 2015 9:20 AM To: SARAHMMARIN@AOL.COM Subject: SERVICE CLOSED AND FINALED AS OF 3/18/15 Ud" 0 LONG PSU%J ISLAND UNIVERSALIST CHURCH 09-963-39-2860-05 MAIN RD SOUTHOLD MAIL: P 0 BOX 221 SOUTHOLD DEPOSIT AMT DUE CURRENT 30 DAY 00 .00 .00 .00 #BUDGETS BILLED BB/BAL NY 11971 BOX 221 NY 11971 60 DAY 90 DAY TOT ARREARS .00 .00 .00 CASH -DTE TE CASH -AMT * BB/AMT BILL -TOTAL BILL -DTE 04-07-15 11 553.41- * 2539.43 03-18-15 03-30-15 65 2270.99- * 290 .00 MARCH 03-16-15 85 5.03- * 290 608.92 02-16-15 02-26-15'11 290.00- * 290 .00 JANUARY 01-28-15 11 290.00- * 224 356.84 12-13-14 01-05-15 11 224.00- * 224 .00 NOVEMBER 12-03-14 11 224.00- * 224 580.41 10-17-14 10-31-14 11 224.00- * 224 .00 SEPTEMBE 10-06-14 11 224.00- * 224 659.06 08-15-14 0.9-03-14 11 224.00- * 224 .00 JULY 07-18-14 11 224.00- * 280 416.44 06-12-14 07-01-14 11 280.00- * 280 .00 MAY 06-03-14 11 280.00- * 280 427.30 04-14-14 04-30-14 11 280.00- * 252 .00 MARCH MOR SCNS ELEC-AMT-RD GAS -AMT -RD 2539.43 F .00 608.92 E .00 356.84 A .00 580.41 A .00 659.06 A .00 416.44 A .00 427.30 A .00 The information contained in this e-mail, including any attachment(s), is intended solely for use by the named addressee(s). If you are not the intended recipient, or a person designated as responsible for delivering such messages to the intended recipient, you are not authorized to disclose, copy, distribute or retain this message, in whole or in part, without written authorization from PSEG. This e-mail may contain proprietary, confidential or privileged information. If you have received this message in error, please notify the sender immediately. This notice is included in all e-mail messages leaving PSEG. Thank you for your cooperation. 0 PSEGISLANTD VW, make things tuork far}aet. CUSTOMER ORDER FULFILLMENT DEPARTMENT 175 E. Old Country Road, Hicksville, NY 11801 April 29, 2015 Sarah Jumena 1089 Rockaway Avenue Valley Steam, NY 11581 Re: Reference 900000007110 51970 Main Road Southold, NY 11971 Acct: 9633928600 Dear Sarah Jumena: 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 516-545-4982 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 516-545-3137. Very truly yours, o Carolyn ackin Manager Customer Order Fulfillment PSEG-LI CM/kt 5/7/2015 Suffolk County Contractors License Search This page will enable you to search for businesses with active licenses in Suffolk County, Do not assume that the party you are researching Is not licensed if no results are returned, For further verification, please call the Office of Consumer Affairs at (631) 853-4600 Monday through Friday, from gam to 4 pen, —searcn data License and Phone License Number (Numeric portion only) Owner FlrstName Marc Business Name City There were 1 records found, Telephone Number 631 Last Name Madnoff Street Address State Search LJWIld Card Business Name j ClearScreen1 Zip Licensee / Salesperson Name Companv Phone License 9 Type Issue, pate Expire Dal:e License Category Address MARC MARINOFF M MARIN RESTORATIONS INC (516) 825-8850 22145 H 01 -Dec -93 01 -Dec -15 H1 - GC 1089 ROCKAWAY AVE VALLEY! Version 1,30 03/19/2013 3;OOPM Copyright Suffolk County Information Technology Services. All rights reserved, Consumer Affairs Home Page Suffolk County Home Paoe Caw CA, http://apps.suffolkcountww.q oVConsunw%20Affa1 rs/ContractorSearc;h/default.asox 1/1 AC" E® CERTIFICATE OF LIABILITY INSURANCE D /DD/YYYY) 4//14/14/ 2015 THIS CERTIFICATE IS ISSUED AS A 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(ies) must 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 Dinegar-Schneider-Reaccuglia, Inc 2577 Francis Lewis Blvd Flushing NY 11358 CONTACT Lorena Amoroso NAME: PHONE (718)423-1300 FAC No: (718)423-3175 E-MAIL ADDRESS: enc lorena@dsrag y' com INSURERS AFFORDING COVERAGE NAIC # INSURERA:Tudor INSURED M.marin Restoration Inc 1089 Rockaway Avenue Valley Stream NY 11581 INSURER B: INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL1541415505 REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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 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 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMLDD EFF MMIDDY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR 54375 RTE 25 SOUTHOLD, NY 11971 RPP8252589 /24/2015 /24/2016 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 PREMISES Ea occurrence $ r MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per.Rdent UMBRELLA LIAB EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y / N PROPRIETOR/PARTNER/EXECUTIVE❑ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A STATU- OTH- TR JM TANY E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) INS025 rgmnnst m ©1988-2010 ACORD CORPORATION. All rights reserved. Tha Arr1Rr1 nama anti Innn ara ranicfararl mnrka of Ar npin SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF SOUTHOLD BUILDING DEPARTMENT AUTHORIZED REPRESENTATIVE 54375 RTE 25 SOUTHOLD, NY 11971 Andrew Reaccuglia/LOR , ACORD 25 (2010/05) INS025 rgmnnst m ©1988-2010 ACORD CORPORATION. All rights reserved. Tha Arr1Rr1 nama anti Innn ara ranicfararl mnrka of Ar npin 0 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 2ND FLR, MELVILLE, NEW YORK 11747-3166 Phone: (631) 756-4000 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^ " ^ ^ ^ ^ 113380021 M. MARIN RESTORATION, INC 1089 ROCKAWAY AVENUE VALLEY STREAM NY 11581 POLICYHOLDER M. MARIN RESTORATION, INC 1089 ROCKAWAY AVENUE VALLEY STREAM NY 11581 CERTIFICATE HOLDER TOWN OF SOUTHOLD BUILDING DEPARTMENT 54375 RTE 25 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER I PERIOD COVERED BY THIS CERTIFICATE DATE 1 H1274 343-1 769716 04/08/2015 TO 04/08/2016 5/7/2015 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1274 343-1 UNTIL 04/08/2016, 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, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOL'DER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/08/2016 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 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 J, DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysitcom/cerUcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 416744574 U-26.3 STATE OF NEAT YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier Ia. Legal Name and Address of Insured (Use street address only) lb. Busitress Teleplione Ntunber of vtsured M. MARIN RESTORATION INC. (516) 825-8850 1089 ROC KAWAY AVEN U E lc. NYS Unemployment Irlstuatrce Employer Registration VALLEY STREAM, NY 11581 Number oflastired Id- Federal Employer Identification Nunnber of Insztred or Social Sectuity Number 113-38-0021 2. Nance and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed asthe Certificate Holder) NEW YORK STATE INSURANCE FUND Town of Southold 54375 Rte 25 3b. Policy Nttutber of entity listed in box "la": Southold, NY 11971 DBL 5030 01 -1 3c. Policy, effective period: 04/08/2015 04/08/2016 to 4. Policy covers: a. [@ All of the employer's employees eligible itader the New York- Disability Benefits Laiv b. ❑ Only the folko%yiug class or classes of the employees employees: Linder penalty ofpmjuq, I certify that I aux an authorized representative or licensed agent of the irlsitiance carrier referenced above, and that the named insured has NYS Disability Benefits insurance coverage as described abo,.v- Date Signed 05/7/2015 By -�;7- Joseph J. Masi (§igreture of insurance carrier's a utho rived represe rtat ide of NYS Line reed i rsura Yce Agent of .that icsura noe carrier) Telephone Ntimber (866) 697-4332 Title Director of Disability Benefits Insurance AMPORTANr: Elbow "4a" is rbeeked. and this form is signed by the insurance ca rites awhorized represenlalive or NYS Licensed Iusntunce Agent of prat carrier. this certificate is COMPLETE. N141 it directly to rhe certificate bolder. rfbax "4b" is checked, this cenifsata is NOT COMPLETE for purposes of Section 220. Stabd. 6 of rke Disability Benefits Law. It tm i be tmrited for contpteaion w the Ulorkers' Compeasatiom Board. DR Plans Accept=e Unit. 20 Pari Street. Albany. New York 12207. PART Z. To be completed by NY$ Workers' Compensation Board (Only If box "4bt' of Part 1 has been checked) State Of New York Workers' Compensation Board Aecordimg to information umintained by the NYS N'lrorkers' Compensalion Board, the alcove -named elmployer has complied with the NYS Disability Benefits Law with respect to all of hiAiier employees. Date Sighed By (Sigaattrrc of NYS workers' Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance Policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Fonu DB -124.1. Insurance brokers are NOT authorized to issue this form. DB -124.1 (5.06) Certificate Number 321365 t4tF V. STAVE TE 32 40 .44- j L. C -v NE ku A z : , I ci to / 4; Faj,1AE I , i C:�4tlm$A BLDG. w 0 IL it -bo co ol wm—.Yl—WW*.o 0-/201 C, 5.� r .l rNwYohsdi SCAM'5').%. 4c 39 6M­d."wMWWtoft Q9 0. y C.3I 'V. 1000 63 6- 6.1 4 6 -2