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HomeMy WebLinkAbout46644-Z TOWN OF SOUTHOLD 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#: 46644 Date: 8/2/2021 Permission is hereby granted to: Menta, Drew BO mPO X 1466 Southold, NY 11971 To: Install generator at existing single family dwelling as applied for. At premises located at: 900 Gin Ln., Southold SCTM #..._47388.9..................... _...,........................_.__ __........_...�........_._ ..........w_..................... a _...,...........�.. _... Sec/Block/Lot# 88.-3-11 Pursuant to alication dated 7/2 pp 3/2021 and approved by the Building Inspector, . To expire on 2/1/2023,uu_.._ Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-ADDITION TO DWELLING $50.00 ... Total: $235.00 00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT 4111, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htthw://www soutlioldtownnv Dov ........ ..... Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only .�� ; PERMIT NO Building Inspectom°_„,n Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an F, 1 „��,.r�lt Owner's Authorization form(Page 2)shall be completed. t p y Date:July 22,_2021 OWN..ER(S)�OF PROPERTY:_................eeeee.....M...�_.........�_ _M....... ........�....�...�.........._u.._�...�. .......,_ . Name:Drew Menta SCTM# 1000-088.00-03.00-011 .000 ......._ Project Address:900 Gin Lane Southold NY 11971 Phone#:631-407-5326 Email:unciel02l@gmail.com Mailing Address:900 Gin Lane Southold NY 11971 _......_.............�_..... ......... .�... _._... .........._�.�.�.. _a ......._..........a.-... ._m. ..........................—..........w.._._.. . ........................._ .._......_...__ . .......� CONTACT PERSON: Name:SearlONeill ...w.-._w www ..�....._ ....��..�__..�._�.-..._._ . _ w. ._._.� Mailing Address:PO Box 64 Jamesport NY 11947 Phone##631-722-3595 ~ 11111- Email:oneilloutdoorpower@hotmail.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Laurel Lighting Inc. & Frank Fenoy Mailing Address:1977 Main Road Laurel NY 11948 ...... 31 6: ._-..__....... Email kfcelectric@aol.com ##:631-457-3363 ............_...W�.._ ..................�._._._..M._._...� r ....@.._...... .�_�_..._w_�_.._.,,..mm_......................�..._.d�_ ..... DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOther Generator $16,000.00 Will the lot be re-graded? ❑Yes iii No Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property:Residential ......_�..______.......�. Intended use pro ertxy�..��.�..___.........���,.�...._ Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes *No IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name):Sean ONeill Authorized Agent ❑Owner Signature of Applicant: Date: �— a CONNIE D. BUNCH STATE OF NEW YORK) Notary Public,State of New York No. 01 BU6185050 SS: Qualified in Suffolk County COUNTY OF Suffolk ) Commission Expires April 14, 2r .,µ Sean ONeill being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) ab!�,ye named, .- (S)he is the Agent Contractor A ed"� ( g .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/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of � . °�& 20 a,, j-`�n,,p /-?�M d� L Notary Public PR0Pl:::R"ry OWNER AU r I °11`1 (Where the applicant is not the owner) I Drew Menta _.M.__. residing at 900 Gin Lane __. ..........................._ Southold 11971 Sean ONeill do hereby authorize„NNNNw mmm_N_N_ to apply on my behalf to the Town of Southold Building Department for approval as described herein, 07/22/2021 Owner's Signature's Date Drew Menta Print Owner's Name 2 CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) 03/23/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 Piave ADDITIONAL INSURED provisions or 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 oodorsement(s). PRooucERA Lori McBride IMAM'CONE� _ Roy H Reeve Agency,Inc. PON E a (631)298-4700 k (631)298-3850 PO Box 54 _ _ _... .. Al Nle m__.... ADDRESS: Ilne,btdde ycDytaeve r-cs1T 13400 Main Road .._....... m_.... .......� _.._.... _ DING COVERAGE NAIC# NY 11952 INSURERA: General Casualty Cc of AFFOR Mattituck Wisconsin(0310761) 24414 INSURED INSURER B Laurel Lighting Inc&Frank Fancy INSURERC_........... ...___,.........._.....�_�__,__.._,,,,,._,.,....-_____-......_.,._�. ....,.......... m..,_..... 1977 Main Rd �M .M....�.w_...........�.M_...... .w. _m_......_w.......... INSURER D��, INSURER E t ..m_.,,....,.,. Laurel NY 11948 _.. ._ INSURER F COVERAGES CERTIFICATE NUMBER: CL2112513854 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 CONTRACTOR 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. Wff'-__-_-_______''No .. TYPE OF INSURANCE DLYC. .-._..,.. W FdV"Rr "P dY ----._. .._......_-_ _ mmm„ IN C- POLICY NUMBER Ml�fnbdYYYY) �MlpolfCyD9YYY'K LIMITS XCOMMERCIAL GENERAL LIABILITY _ EACH tJ...... PIIkEN?,E�_ $ 1,000,000 (,f..� ._........,.._....»�____...__........ ... ..„�CLAIMS-MADE OCCUR ( rrrarrrE.lr, $ 100,000 Contractual Liability MF pT L P CAa„ one I cw uy $ 5,000 A BBP0017497-00 01/30/2021 01/30/2022 ..PER ONAL&ADYINJURY � 1,000,00( GEN'L AGGREGATE REGATE LIMIT APPLIES PER: _ 2,000,000 G°bEIff.,6�dhq.AGGREGATE $ POLICY E JEPRO Loc - 2,00 PRODUCTS COMPIOPAGGv $ ...,.,,0,000,.-..,._____.�....� $ AUTOMOBILE LIABILITY... ............�, . „"”. w—____.... ..._ __..,... --.•.,,,—...... "._,,.,.. C'Mfiv4UIIMf:.17,IM9CL.E;:R.IM1'1` $_ '., . Fau ca.,;�wden-9.'E� ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) '...$ HIRED NON-OWNED RFr RP dkAIJA,.C"P= .......,... AUTOS ONLY AUTOS ONLY $xrr,ddrnP M M Y ry m „ WW OCCURUMBRELLA LIAS EACH OCCURRENCE ._.�. $ CLA S-MADE AGGREGATEA $mm_ _.. AND EMPLOYERS'N ABIL�rICT�d $ LECE.. RMTrN r LIABILITY _.,,........� ._........... ...� ,.,,,...___,._ ........-_._____.._.,,._....._ ....,.,...�.._,., .�. . .. WOR4CERS COMPENSATION C t)tt &,"171 I YI_N a ATUTE FF# ANY PROPRIETOR/PARTNER/EXECUTIVE OF"HCEWMEfAICER EXCLUDED? NIA EL LAIwIPo,�.tl'C,I�bW-INN $ (Mandatory in NH) E L IC31 Ct'A F EA EMPLOYEE $ If psrrm,describe under mmm_... .. fopriopi OF F9tad P.A'R"Id7MtC PadrNaawro d C38s9"'A E POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 >, t ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New Mork State Vnsurar"e Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 202207186102 mir ROY H REEVE AGENCY INC 13400 MAIN RD PO BOX 54 MATTITUCK NY 11952 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LAUREL LIGHTING INC TOWN OF SOUTHOLD 1977 MAIN ROAD PO BOX 1179 LAUREL NY 11948 53095 MAIN ROAD SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11282068-4 578811 09/21/2020 TO 09/21/2021 9/23/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1282068-4, 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 POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY„INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE„VISIT OUR WEB SITE AT HTTPS.I6 .NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. FRANK FENOY(PRES) OF ONE PERSON CORP LAUREL LIGHTING INC 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 VALIDATION NUMBER: 173203216 U-26.3 CERTIFICATE OF LIABILITY INSURANCE °ATE 091/2323//22020020 ' 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conddons 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 COMAy; NAMF Carol Lcasquartro Roy H Reeve Agency,Inc. PNONE (631)2984700----. 98+3700 _ . -FA (631)298-3850 PO Box 54 ��kl — ABC,No ADDRESS. closquadro@royreeve.com 13400 Main Road — -- INSURER(SLA F"F012OING COVERAGE NAIC 8 Mattituck NY 11952 MaXurrl Ind Co .._ .. w., tNsl&REr1 a: 2tz?4.3 INSURED ".".""...... INSURER B Eastern LI Gas Services LLC ..INSURER C: PO Box 1134 .. ............... INSURER D INSURER E ._._.�� _...... Mattituck NY 11952 INSURER F COVERAGES CERT'IF'ICATE NUMBER: CL2092313140 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. R. TYPE OF INSURANCE WV'O POLICY NUMBER MMIDO MdM 1tdDrd/M MYY' LIMITS JXCOMMERCIAL GENERAL LIABILI Y EACH OCCdJRr&E"Nf E $ 1«000"000 CLAIMS-MADE 1 OCCUR ' $ 50,000 MED F.A';P WR one ta�aasowrnl $ 5,000 A � BDG0082594-07 09/18/2020 09/18/2021 PERSONAL&ADVWJU'RY $ 1,000,000 GEN"LAr;QRE(1A'rE LIMIT APPLIES PER: 2,000,000 POLICY El OE`NER,ALAGGREGATE LE JECOT- ❑Loc PRODUCTS-COMPCOPAGG $ 1,000,000 OTHER AUTOMOBILE LIABILITYRMriIOYd„';U S1NC;L E LIMfT '$ ANY AUTO Ee rmfiadwak�h BODILY INJURY(Per person) $ OWNED SCHEDULED ---------- ........ AUTOS ONLY '..AUTOS BODILY INJURY(Per accident) m.,'...HIRED NON-0WNED AUTOS ONLY AUTOS ONLY Pee rMu:eddcetnl $ UMBRELLA LIAR OCCUR _ EACH 41C'L„bdStRENCE $ EXCESS LIAR I CLAIMS MAL1E. AGGREGATE ... DE_D _ RE"I"'E'N"GI'QN�.._..,.. ...,._.�....... YI ORKERS COMPENSATION.. w W : AND EMPLOYERS'LIABILnY Y/N 'Tdrh UT:C;' F ANY PROPMETORIPARFTNEMXECLMVE ❑ N/A E.L.EACI”ACCIDENT $ ..w OFHCEWMEM'eER EXCLUDED? (Mandatory in under E.L.DISEASE-EA E'MP."O'YEE $ It yes,describe an�u OEi.S4wRIPTION 2E C'APEFRAT'IONS below ._........._..............._..... _............. III 1...01 eI:`!AL"b'EI_POLICY I.IMI'T $ ......_._._.....,.. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main RD PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD J. NYSIF New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "^^^^^ 463076153 EASTERN LI GAS SERVICES LLC PO BOX 1134 MATTITUCK NY 11952 " SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SMITH DRIVE NORTH EASTERN LI GAS SERVICES LLC TOWN OF SOUTHOLD PO BOX 1134 53095 RT 25 MATTITUCK NY 11952 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12344 620-6 622886 09/24/2020 TO 09/24/2021 9/25/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO, 2344 620-6, 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 POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY,. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY„INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS/ W.NYSIF.COMICERT/CERTV'AL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH ;NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 10 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:863999430 U-26.3 J.