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HomeMy WebLinkAbout42122-Z �s�Fent�c TOWN OF SOUTHOLD moo pay 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#: 42122 Date: 11/6/2017 Permission is hereby granted to: Slavonik Frank & NormsTrust 315 Boisseau Ave PO BOX 143 Southold, NY 11971 To: demolish two accessory buildings and a single family dwelling as applied for. At premises located at: 315 Boisseau Ave, Southold SCTM #473889 Sec/Block/Lot# 62.-1-19 Pursuant to application dated 10/31/2017 and approved by the Building Inspector. To expire on 5/8/2019. Fees: DEMOLITION $785.50 tal: $785.50 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 Southoldtownny.gov PERMIT NO. �� Z� ! Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single&Separate Truss Identification Form Storm-Water Assessment Form d Contact: Approved 120 Mail to: Disapproved a/c Phone: Expiration __ 7M D m Zrn4ect OCT 3 1 2017 APPLICATION FOR BUILDING PERMIT ,'RJj `' i' f��� ® Date a L)AA , 20 l7 T r T07,FN OF SOUTHOLD 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. pp `'L_ a- (Signature of applicant o me,if a corporation) i3 iJl�klN SilZr 0 a SO'-MiOL ,NY 119-7I (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder 0 VIJ ER- Name of owner of premises SCS LI5 1"lU 1�1Si12a.e� (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. 0139 mer Plumbers License No. T Electricians License No. -- Other Trade's License No. 1. Location of land on which proposed work will be done: I i S 130 IS CAU AVEN JE SoUT14-ab House Number Street ,W �{�t}Hgl(anet County Tax Map No. 1000 Section2 Blo„s � ck Lot yZY , C nil �"? x,a� �'� ';a�j „ ,1� •.•hi Subdivision 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 iZl7S1DAJ i IAtr PVJkLLI tJ,/ b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition '/4 Other Work (Description) 4. Estimated Cost -37,`sl& Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units 9 Number of dwelling units on each floor 1 If garage, number of cars 414t 3 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front3 Rear 23° Depth T2.7' Height %.'= ',25 ` Number of Stories 7 Dimensions of same structure with alterations or additions: Front Rear Depth _ Height r Number of Stories 8. Dimensions of entire new construction: Front Rear — Depth Height Number of Stories 9. Size of lot: Front Rear 4?/, F2-e Depth 10. Date of Purchase Name of Former Owner WOKMA !I-A V UJIV 11. Zone or use district in which premises are situated 14� (14AHLP- SUIS S5) 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NOV 13. Will lot be re-graded? YES NOWill excess fill be removed from premises?YES NOS 14.Names of Owner of premises Ftm pisT. Address 5S13-5 K4%vJ S'% Phone No. 6:3 765- 3V5 Name of Architect M/ -► SAND e �l.i,A. Address 215 Re4w A. Phone No 63h --7"-1;35L Name of Contractor CNA-ihL06 *, i0c , Address law N,<AVff Phone No. 631- 74(1- 017-7 Pu fty, 1(\-7 5pJMr) NZk&WFjr 10 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wMand? *YES NO . * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. lso5 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-X— * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OFSU F6600 CSL A-, Oq being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, C O (S)He is the �` - (Contractor,Agent, Corporate Offi er,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. Sworn to before me this /a/ ` 2(14 day of 20 CARUSLE E.COCHRAN,JR. NotarNotary Public Of ®WYo Signature of Appli nt No.01C05015101,Suffolk County Commission Expires July 12;20j PSEG Long Island Building&Renovation Services 15 Park Drive Melville,NY 11747 LONG . 4 PSE j ISLAND 11n ra(tkrlhingv worh fr)wrr. 11/14/17 Southold Fire District PO Box 908 Southold, NY 11971 Re: __ Electric Demolition Request 315 Boisseau Av Southold, NY 11971 Ref#:900000060540 Dear Southold Fire District, This is to advise you that the PSEG-LI electric facilities at the above referenced location have been disconnected and removed off the building structure that is located on the property. Please note that there may still be PSEG LI facilities located within the property boundaries and that NYS law (NYCRR Part 753) requires all contractors to call for a utility locate (NY 811) prior to performing any ground excavation or regrade activity. The call to the 811 Call Center must be done at least 2 business days prior to the start of the work and confirmation of utility marks having been identified must be received from all the facility owners prior to any site work. 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. If you have any questions regarding the above, please contact Building & Renovation Services at 1-844-341-6378 or via email at BRSLI@PSEG.com. Very truly yours, Carolyn Mackin Manager Building &s Renovation Services PSEG-LI MARTIN F. SENDLEWSKI, A.I.A. VIIIARCHITECT - PLANNER October 31, 2017 Town of Southold Building Department 54375 Route 25 Southold,NY 11971 Attn: Mr. Michael Verity Re: Demo Permit Application Southold Fire District 315 Boisseau Avenue, Southold, TM# 1000-62-01-19 Attached please find the following as required to obtain a demolition permit for the existing structures at the above noted location. • Completed Building Permit Application • (4) Sets of Plans • Contractor's Workers' Compensation • Contractor's Liability Insurance • Contractor's NYS Disability Insurance Should you require any additional information please feel free to contact me. Very truly yours, Arthur Rast Cc: Owner D � lr Q OCT 3 1 2017 TO IARq OF SOUTHOLD 215 ROANOKE AVENUE RIVERHEAD, N.Y. 119010 (631) 727-5352 FAX (631)727-5335 _ c CARTINC-01 PATI CERTIFICATE OF LIABILITY INSURANCE FDATE Y) 9/26/2017 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 631 472-8400 CONTACT ( ) NAME. Jeff RadOVICh Edwards and Company PHOWC,NE (631)472-8403 �a/c,No) (631)472-8486 140 Greene Avenue E-MAIL o Ext _ P.O.Box 428 ADDRESS jradovich@edwardsandco.net Sayville,NY 11782-0428 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A.Allied World Assurance Company 19489 INSURED Carter-Melence,Inc. INSURER B:Hartford Casualty Insurance Co 29424 P.O.Box 907 INSURERC-ACE American Insurance Company 22667 Sound Beach,NY 11789 INSURER State Insurance Fund Safety Group 458/LEVI 36102 INSURER E: i INSURER F. COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE AULIL BR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE T OCCUR Y N 5050016217 3/5/2017 3/5/2018 PAMAGE TO RENTE[5 REM SES Ea occurrence $ 100,00 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY T PRO- LOC 2,000,000 CTPRODUCTS-COMIO OTHER $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO N I N 12UECBJ1913 3/5/2017 3/5/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 C EXCESS LIAB CLAIMS-MADE N N N06571542004 3/5/2017 3/512018 AGGREGATE $ 3,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE OER YIN N D ANY PROPRIETOR/PARTNERIEXECUTIVE N 6359152 6/29/2017 6/29/2018 EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ® N/A (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re:Main Firehouse:55135 Main Rd.,Southold,NY 11971,Substation: 650 BaywaterAve.,Southold,NY 11971. As respects to General Liability if required by written contract the following are included as additional insured per the policy form CG2010. Southold Fire District.,Martin F.Sendlewski,AIA Should any of the above described policies be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold Fire District THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O.BOX 908 ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971- AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD , New York State Insurance Fund Workers Compensation &Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y 10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A .--Y1 - 112996299 LEVITT-FUIRST ASSOCIATES LTD �ti� '� ••�, 520 WHITE PLAINS ROAD, 2ND FL • TARRYTOWN NY 10591 "S��•�`- Scan to Validate POLICYHOLDER CERTIFICATE HOLDER CARTER-MELENCE INC SOUTHOLD FIRE DISTRICT PO BOX 907 P.O. BOX 908 SOUND BEACH NY 11789 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 635 915-2 850608 06/29/2017 TO 06/29/2018 9/28/2017 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 635 915-2, 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 YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS//WWW.NYSIF.COM/CERT/CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 FUNC a DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER 782593558 1 I-9F 1 Yd�x Workers' CERTIFICATE OF INSURANCE COVERAGE STATE CoC11}1�ar1tSa1it3tt UNDER THE NYS DISABILITY BENEFITS LAW Beard PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured CARTER-MELENCE, INC. 631-744-0127 1c.NYS Unemployment Insurance Employer Registration Number of Insured P O BOX 907 SOUND BEACH,NY 11789 1d.Federal Employer Identification Number of Insured or Social Security Number 112996299 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being listed as the Certificate Holder) ShelterPoint Life Insurance Company Southold Fire District 3b.Policy Number of Entity listed in box 1a": P.O. Box 908 DBL391009 Southold, NY 11971 3c.Policy effective period: 01/01/2017 to 12/31/2018 4.Policy covers: a. ❑✓ All of the employer's employees eligible under the New York Disability Benefits Law b. R Only the following class or classes of the employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 9/26/2017 BylJ/ (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Title Chief Executive Officer IMPORTANT:If box"4a"is checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If box"4b"is checked,this certificate is NOT COMPLETE for the purposes of Section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board,DB Plans Acceptance Unit,328 State Street,Schenectady,NY 12305. PART 2.To be completed by NYS Worker's Compensation Board (Only if box"4b"of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Worker's 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 Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (9-15) SURVEY OF PROPERTY SITUATE SOUTHOLD ' •• EXISTING 2—STORY H❑ TOWN OF SOUTHOLDUSE T❑ '.': •�� SUFFOLK COUNTY, NEW YORK BE DEMOLISHED ' - ALL FOUNDATI❑NS TO BE :'•d • S.C. TAX No. 1000-62-01 - 19 REMOVED PRE VIDE O SCALE 1 "=20' - ALL EXISTING U/G UTILITIES TO CONST RU TI❑N BE CAPPED AND REMOVED. PENCE JULY 119 2017 - ANY ABOVE GROUND UTILITIES .;', TO BE REMOVED AND CAPPED AT PROERTY LINE • ' - CLEAN FILL TO BE ADDED TO 3 y AREA = 15.685 sq. ft. EXISTING GARAGE p n�C• AREA OF DEMOLITION 239 '•f' o.3so ac. T❑ BE DEMOLISHED N/o pT s°�oy ALL FOUNDATIONS TO BEW REMOVED C01,000i•�' ;� tom . • CER TINED T0: - ALL EXISTING U/G UTILITIES TO �'� , O "0"„ SOUTHOLD FIRE DISTRICT BE CAPPED AND REMOVED: �, i► ` �� SAFE HARBOR TITLE AGENCY CLEAN FILL TO BE ADDED TO �• 2 o� • y ,� AREA OF DEMOLITION 00,�� PROVI k �7i '•' d. '• '� 26.5 C❑NSTR cTz�N 7A•� G _�,,�;( . .� •. �;,,,,,v �. FENCE N awM' 1 , a dam""••. _j ! •4 . 46.7 �•. :. •� •. .��. ,-.- �� ' ` .N' •�' ` - ALL ASPHALT PAVING.ON �• ' ,�' ••�v' + A, W SITE TO BE REMOVED Z > :a ' • ' '•' a, 1C�•�a 2 - ALL ASSOC, EXISITNG C*'r"P' SANITARY STRUCTURES TO 00• BE REMOVED N ••' F - PATI❑ AND LAMP POST TO w• '' ' ••'R° 1 b BE REMOVED 0 W PROVIDE - ENCLOSED PORCH TO BE 0 , CONSTRUCTION FENCE c EXISTING SHED T❑ �„ ALONG THESE AREAS REMOVED BE DEMOLISHED 1 0.0 o - ALL EXISTING U/G !„.. UTILITIES TO BE CAPPED rn •.o AND REMOVED. 1 r // • �•q- � - CLEAN FILL T❑ BE ADDED ..�_. " �Yo TO AREA OF DEMOLITION P SNFA �► FOLLO. 6� 7�t { 8,p0 T 2. ROUJ3. p4SULAT ION o L _ TI._.�! 4. FINS; ���! ` MUST ca N„ f 000'P • + ALL CONMEET THE �1rl�'sil :� .�« 5 p4 N��� Y P,CC�I�IFI 13LE FOR 75 �, d0 y DAy YORK STATE. P"DT %'t=.SI ,�Ee` pFc t l l OR COP; Tr�l1C I lO[d LRROR . PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. 2 5� ` N.Y.S. Lic. No. 50467 y '� UNAUTHORIZED ALTERATION OR ADDITION OTO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE Nil, EDUCATION LAW. N a t i h I an Taft Corwin 1�\y COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR Land S u r v e y o r EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE Successor To: Stanley J. isaksen, Jr. L.S. TITLE COMPANY, GOVERNMENTAL AGENCY AND Joseph A. In a no L.S. LENDING INSTITUTION LISTED HEREON, AND p 9 9 TO THE ASSIGNEES OF THE LENDING Title Surveys - Subdivisions - Site Plans - Construction Layout INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. Y Y PHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947