Loading...
HomeMy WebLinkAbout43398-Z O Q c Town of Southold 1/24/2019 P.O.Box 1179 y 53095 Main Rd �4A Its Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40185 Date: 1/24/2019 TMS CERTIFIES that the building WINDOWS Location of Property: 17130 Main St.,New Suffolk SCTM#: 473889 See/Block/Lot: 117.-9-28.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/17/2019 pursuant to which Building Permit No. 43398 dated 1/17/2019 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 WINDOWS IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Simon,Michael&Shannon of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 0 ' ed Signature o�SUFfock o TOWN OF SOUTHOLD oy BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • �� 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) f Permit#: 43398 Date: 1/17/2019 Permission is hereby granted to: Simon, Michael PO BOX 303 New Suffolk, NY 11956 To: Replace existing windows "in kind" as applied for. Replaces BP # 39557 At premises located at: 17130 Main St., New Suffolk SCTM #473889 Sec/Block/Lot# 117.-9-28.1 Pursuant to application dated 1/17/2019 and approved by the Building Inspector. To expire on 7/18/2020. Fees: PERMIT RENEWAL $100.00 Total: $100.00 Building Inspector g�FEoc TOWN OF SOUTHOLD BUILDING DEPARTMENT c z 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#: 39557 Date: 2/25/2015 Permission is hereby granted to: Simon, Michael & Simon, Shannon PO BOX 303 New Suffolk, NY 11956 To: Replace existing windows "in kind" as applied for At premises located at: 17130 Main St, New Suffolk SCTM #473889 Sec/Block/Lot# 117.-9-28.1 Pursuant to application dated 2/20/2015 and approved by the Building Inspector. To expire on 8/26/2016. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO -ALTERATION TO DWELLING $50.00 Total: $250.00 r Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. 02/13/2015 New Construction: Old or Pre-existing Building: X (check one) Location of Property: 17130 Main St New Suffolk House No. Street Hamlet Owner or Owners of Property: Shannon and Michael Simon P Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Power HRG Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: X (check one) Fee Submitted: $ 50.00 A cant Si e �J 1 _- �aDE SO(/lho # TOWN OF SOUTHOLD BUILDING DEPT. u765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ VgSULATION ( ] FRAMING /STRAPPING [V] FINALA)"VO" [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: Ux DATE / ., INSPECTOR FIELD INSPE 6N DATE COMMEl!ITS IFFOUNDATION(1ST) FOUNDATION(2ND) ROUGH FRAMING& y PLUMBING IN$ULATZON PEP,N.Y. H STATE ENERGY CODE Ate" > FINAL , 00, 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 13 O 4 sets of Building Plans TEL:(631)765-1802 I / Planning Board approval FAX:(631)765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.D E C Trustees C.O Application Flood Permit Examined 20 Single&Separate Storm-Water Assessment Form Contact: Approved #420 �!J Mail to. Shane Laird Disapproved a/c 2501 Seaport Dr,1st Flr,Chester,PA 19013 Phone —" 888-736-6335 ext.2391 IC—Ex i tto" I � 20 I � Building Inspector F E B 19 2015 APPLICATION FOR BUILDING PERMIT Date February 13 120 15 BLDG DEPT. INSTRUCTIONS TOM]OF SOUTHOLD 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. Power HRG (Signature of applicant or name,if a corporation) �7p � 2501r gap'orX DI"?;lsi Flr,,Chesfel•;PA'i19,0'�j 3 (Mailing add ess ofapplicant) State whether applicant is owner,lessee,agent,architect,engineer,general��i tTr�e an,�l�imbev�o-�8r general contractor FEE ® BY _�._.. U I BUILDING Dc Ai i ib1ENT Name of owner of premises Shannon and Michael Simon 765-1802 8 AM TO 4 PM FOR TI- 001", F r ;f,., (A#ion the tax roll or lEtest deedy"I'�_= .„ ,PEC 1!1J N S If applicant is a corporatio ,signature of dulyiauthorized officer 1 FOUNDATION-TWO REQUIRED FOR POURED CONCRETE ' 2 ROUGH FRAMING,PLUMBING, (Name and title ofc9rporate officer);,z o =L �,w Builders License No. A _ STRAPPING, ELECTRICAL&CAULKING Plumbers License No. 4- ; ' i ( / ' /` ' ' 3 INSULATION Electricians License No. 4 FINAL-CONSTRUCTION &ELECTRICAL Other Trade's License No MUST BE COMPLETE FOR C 0. 1. Location of land on which proposed work will be done: ALL CONSTRUCTION SHALL MEET THE 17130 Main St t4 I ff�NTS OF THE CODS OF NEW OTFUFT­ House Number Street H e K I SIbLEt -c I N OR CONSTRUC_�? RgORS County Tax Map No. 1000 Section Block Lot Scott A. Russell ST(�>> AAWAX]E]R, SUPERVISOR co ZL� (� IM[A\ISA\G]EM[]EN r IE' SOUTHOLD TOWN HALL-P.O.Box 1179 Q � ! 53095 Main Road-SOLITHOLD,NL•lN YORK 11971 'f• ) �- Town of Southold ~�Q( 11(1 yt< CHAPTER 236 - STOR1YJlWATER IV ANAGEMENT WORK SHEET (TO BE COMPLETED BY THE APPLICANT) DOES THIS FROJECr INVOLVE ANY OF THE FOLLOWING Yes No KIIECK ALL THAT APPLY t ❑ , A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑ B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. -C__ShLpM lobs which e,ceed 10 feet vertical rise to 100 feet of horizontal distance. El 19] D. Site preparation within 100 feet of wetlands, beach, bluff or coastal 1 erosion hazard area. I; El IN E. Site preparation within the one-hundred-year floodplain as depicted t on FIRM Map of any watercourse. ❑0 F. Installation of new or resurfaced impervious surfaces of 1,000 square i feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement.of impervious surfaces. If you answered NO to all of the questions above,STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number!, Chapter 236 does not apply to your project. If you answered YES to one or more of the above,please submit Two copies of a Stormwaler Management Control Plan and a completed Check List Form to the Building Papartment with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. -1: 1000 Date- / n !n7 / ptstriet NAME: PoLd6f4drte eu6d,,II;'t, Gfu�� CSh rd) 2 •3 j^ Section Bloc Lot Mfi LL11LD1.NG DEPAAA�14 RT AIL-NT USE ONLY Contact InformationSN;gUE,G�L(ZLJ2(,,Jer/Ityco.,t T:s:psr vw:hn. — Reviewed By: �f -- - -- - - - - - — - - - — - -• — Date- Property Address /Location of Construction Work: — — •-- — — — — — —_ — — — — -- pproved for processing Bu:iding Permit. I 12j /// ✓1 Storrnwater Management Control Plan Not Required, Stormwater Nlanagement Control Plan i�,Rectnrea. /U "l/ I /v l ❑ Forward to£ng;necrjng Department for Revtetl; F014I"fi `N1CP-";QS;'1yY20t4 Southold Town Building Department �o�gUFfot�coGy P.O.Box 1179 Permit#: 39557 53095 Main Rd o _ Southold,New York 11971 Permit Date: 2/25/2015 4,, �ao� (631) 765-1802 Expiration Date: 8/26/2016 Parcel ID: 117.-9-28.1 BUILDING PERMIT RENEWAL LETTER Dated: 1/3/2019 Applicant: Power Home Remodeling Group Location: 17130 Main St,New Suffolk Work Description: WINDOWS Replace existing windows "in kind"as applied for A FEE OF $100.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: Simon,Michael& Simon, Shannon ,Mvo Address: PO BOX 303 New Suffolk,NY 11956 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department, P.O. Box 1179, Southold, New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. II 0 o BONN, 0 f8ar,� MGIA M-1-5 =r- z: � �f � c,C u ty l e t t LaborY�ento ­7 su m. - er..,A,ffI*4i! .­ ' S NE -1788 NEWYORKI VETE -MOPJAL MGHWAY - 4 No. 48568-H S,9TJE DATE IS�SLJED.. ,'4/7,/2'0 01 M -sttvb c V LK, 0 _NTY N 4" A -e se !e 91 -t- _Cb.h.,tir RAR This MNG,. :- `�G,,GRo.u-p-__LLc doing bii§ine- -,b'- an' -rules AJIn­f'q"d'c A ce,ml faR tq�T,4� ( ?-I hA-,,-bNf4 h;�vy .,s pi and 'ea46 c -,of 6-pqt -80 Nj rek6latibIfts. Ahe& ew, or p1grepy, jqensi b6i�ffi t busine=ss, a HOW 7%of IwP,0VEWN-TP.-00xTR,A GT ;In,. e`c f SIM JA00�Cate gqry NOT VALID nesses Nt DEPARTEPALSEAL. T ANDAC i4,T Com6m*SsIon,er > �18PrI y'�f AIR., fill 44"""Nof I I. r:s= NORM`., 11V M, It� 96th oil, 't U% mc S'P A �%,M 60_>Tj c 1993 GOES 3461 UTHO IN U SA All R,qhts Rosmed SUFFOLK COUNTY DEPT OF LABOR, ! LICENSING&CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR " •mN BiR. NWE . F:YLE E BARRING +_?Y BUSINES5NA1.ff This certifies that the POWER HOME REMODELING GROUP LLC bearer is duly licensed by the uon+.eumu,r o.eauwe County of Suffolk 04/0712011 I 48568-H 04/01/2015 coAM.donu L. �1 POWER-1 OP ID: EL ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) kk.� 1 09/11/2014 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(les) 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 CONTACT NAME: Lacher&Associates Ins AgencyPHONE 215-723-4378 Nc No):215-723-8604 Lacher Insurance Group Arc No Ext 632 E Broad St P O Box 64398 ADDRL ADDRESS: Souderton,PA 18964 Chad Lacher INSURERS AFFORDING COVERAGE NAIC# INSURER A:Harleysville Preferred Ins.Co 35696 INSURED Power Home Remodeling Group, INSURER B:Harleysville Worcester Ins Co 26182 LLC INSURER c:Nationwide Mutual Ins Company 23787 2501 Seaport Drive,Suite 8110 Chester,PA 19013 INSURER D:Pennsylvania Manufacturers 12262 INSURER E 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 ADD B POLICY NUMBER MWDDIYYYY MMIDD�YY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE FKOCCUR MPA00000089793N 10/01/2014 10/01/2015 PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 15,000 PERSONAL BADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC PRODUCTS-COMPIOPAGG $ 2,000,000 JECT OTHER $ AUTOMOBILE LIABILITY JE accidentSINGLE LIMIT $ 1,000,000 B X ANY AUTO BA 00000089796N 10/01/2014 10/01/2015 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA UA13 X OCCUR EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB CLAIMS-MADE CMB00000089794N 10/01/2014 10101/2015 AGGREGATE $ 10,000,000 DED I I RETENTIONS $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER YIN D ANY PROPRIETORIPARTNEREXECUTIVE / 201400 6620967 10/01/2014 10/01/2015 E L EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) ELDISEASE-EA EMPLOYEE $ 1,000,000 If un es,descnbe der 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ B Mass Auto BA 00000018227P 10/01/2014 10/01/2015 Auto Liab 1,000,000 B NY Auto BA 00000074849R 10/01/2014 10/01/2015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SUFFOLK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Suffolk County Dept of Consumer Affairs AUTHORIZED REPRESENTATIVE Box 610 Ha Hauppauge,,NY 11788 � ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD _._,4!7A.1v1,:5- .00vAv,4Z --- TOWN OF �pUT,t,/pLp , SUFFOLK COUNTY N.Y. i �'eOpE.eT'Y i CO. CLK. NO. FILED bc- V //.7 •'. y n s►�.s cove_ • ,v�cc: u . • ,� j m x, q oti ��• .a.wc .�IL(p Q � a n iv.t �, �� yo.e.eAr '• � r q6. �+ a� 'V j rn 14Z s a` 0 U ,cA-iv Al'C Mlm4EL ` .4NN.4 V4•vG/ SURVEYED SEpJ:Bi 19c55BY WILLIAM R. SIMMONS JR. P/O BOX 377 . _ JAMESPORT, L.I., N.Y. 11947 FELE NO. ��9�� PAGE 2¢ GRID,-,39 ;. Ir, dp •1 rr,�• .t.. 410IP a.::•. 9fdeflllNne;il . €PTIFIEW u Fa�tor(u.S,11 F1 ,;'rr PAlor,H@at Ga n. Qn cieri�;; :!lisipla Tran$ml4tan>=8% •FQnden$alin�,,f���lacanG�;t:{ rt� flll ry�11.;C 4 YW7'(TY,")•t>t t„rir 'l.l.r 11 J`tgv 111 n,.r1l 5 I(_4 ) F�(I p�J(- t I 1L I Ir7i-sl 1�1—'E 4°fy t.a11�s 1 t �gtp.,f{LI�d I�l��riSala` `1t�i�iv I`5 i IF; fr' ih 1 ny tl 1 L I It>� C N ,�l 1 r9Vr`( L, I S r}�'If�SI`�litl��.�•x_j����i:ft I ,�1�1 crT-•�+-'f 4i i 5 i^ "ii r I}'7 G4�rl'�'jllrr���sll , ��y/jayri� 11( frl F Ir4t 7J {r 4,1 1 Ir7�1 I�^7uI Ir�_'i)It ❑�t�� � 1,:!r11,1J 1� m � I.' 1151 ` �i v`�r�1 I�tl �,r '-+��tt.)tif I�I}�7•]j�il:�', r1 tt.� nl�I t t.fi � ft �-`y I,�t,, 1r�M11� ��r.l '{ �i r - r)147r1ja rJ; LI � t Ip� It t {,i 7r (,rt 'r, t I Iil, j � rt5<t I It Ji I i�t`I, C�I�) cj.i lrCu,?tl�lrfr Jl41'',sllfja „u(,,.�{ I{i Fli t,! Y`'�i II_•I - ci,y{(. ./lr , Y 1J, t (,r„t:i.�l1 "+IF'Y!l 3/ I e]r �f 5—I J T�L (c1'1 I{,)itf-c I S hj+ { Ik I ,an Iiii I SI I`II 1�1�111t t a ifj�tr)I ). I rT � ,1 �r +}i )I)j}Sjflj..yg�)(71r( y 1 .t i i I � •S � ��