The URL can be used to link to this page

Home My WebLink About48322-Z 00 ,�, TOWN OF SOUTHOLD "� rz BUILDING DEPARTMENT U� TOWN CLERK'S OFFICE N" SOUTHOLD NY "IIW 411, 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 #: 48322 Date: 9/22/2022 Permission is hereby granted to: Andrews, Jonathan 1365 Donna Dr Mattituck, NY 11952 To: legalize "as built" alterations to existing single-family dwelling as applied for. Additional certification may be required. At premises located at: 1365 Donna Dr, Mattituck SCTM #473889 Sec/Block/Lot# 115.-16-13 Pursuant to application dated 9/22/2022 and approved by the Building Inspector. To expire on 3/23/2024. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $438.40 CO-ALTERATION TO DWELLING $50.00 Total: $488.40 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT tl Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 ,r Telephone (631) 765-1802 Fax(631) 765-9502 litI) :/Pwww.soLjtlioldtow t r,off Date Received PPI ICA I 1011M FOR IAEAPERMIT �r C For Office Use Only AUG 0 �1 2022 � PERMIT N0. Building Inspector;, �Uit uslwa�?!i r P. TOVoi of SOUTHO i'r. Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: 111/'D 4^"" s' SCTM#1000-j]S, o0-/6,00 -Dl "'j Om0 Project Address: Phone#: G- I—T -7 `f _ri 0 K 3 Email: Mailing Address: PC) /� , S---9 7 CONTACT PERSON: Name: 4v._ Mailing Address; �{ (G Phone ®O Email: �, a DESIGN PROFESSIONAL INFORMATION: Name: 01.l^t-�, �f f Mailing Address: #�- � e M �rQ- ,j S , r a :,�� f I 71 ®`�' 16, 0hone#: 7 Email: � G A",4L-tq e- Co CONTRACTOR INFORMATION: - Name:_Te10b� SIe C,L Mailing Address: 8cr_, �,,. , � G14vYL/'k J AJ 11 3 Phone#: I � �3 L� Email: CA4 e C` ,, f Cm,,y DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ 'OA=) Will the lot be re-graded? ❑Yes ZNo Will excess fill be removed from premises? ❑Yes ZrNo 1 PROPERTY INFORMATION Existing use of property: — Intended use of property, ' Zone or use district in whichreml es is sit WW p situated: _ Are any covenants and restrict' ns with respect to ? PROVIDE A COPY. w. . ....._ ..._ ...�._._._. _ �� -' -r� this property. Dyes .. o IF YES,_._..._..�_.e._..._._..��..._...�.�..... 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): r �� -'l ❑Authorized Agentcaner Signature of Applicant: N, Date: STATE OF NEW YORK) SS: COUNTY OF 1 I being duly sworn, deposes and says that(s)he is the applicant (Name of individual sign i ontract) above named, (S)he is the (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/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 dayof 20 Notary Public r:° �P iR,.,)I a 1 0,� 1 ,J I R � VICTO=County d 1 �w Notary Publiw York 60 (Where the applicant is not the owner) N0.0nQualifiedntyMy Commission14, 2026 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 BUILDING PERMIT SUMMARY APPLICATION SUBMISSION DATE:08/08/22 SCTM#1000-115.00-16.00-013.000 PROPERTY ADDRESS: 1365 Donna Drive, Mattituck, NY 11952 HOME OWNERS: David Mangiameli and Higer Abdallah The general project categories are as follows: 1-Exchange of a bearing wall for placement of a low steel girder, per architectural drawing provided The exchange of the first floor bearing wall for a steel girder, relies on a 26' 3%2" low steel I-beam girder, mounted on two steel posts that seat on foundational concrete footings. 2-Expansion of a downstairs bathroom, per architectural drawing provided The preexisting first floor bathroom will expand northerly for 3'to accommodate a new shower utility 3-Replacement and expansion of a mounted deck, per architectural drawing provided 4- Upgrading electrical service and removal of noncompliant exposed wires by a licensed/insured compliant electrician, who is still to be determined,followed by and in accordance with Southold Town Electrical Inspection J (o-3 S7 3 ro S- 7 ' °'4$ cn n M S bba �7 eZ Q O Er wt�cQ rn aiN � � U] w � 1V ,98-k"6 m x,06,06.00 E 9� J,o7 ce � /s 107 Li h X't co h p o r�a �"�i J✓ ��K,�,�,, 9q � 7 .I a-ad o ° n2 v1 o) arvo � O o I--,6'4£.._x°- 'gee h s p � M 'h rrH M � � Cc QD CQ �y ti,d�vOOZ'- 00'266 v .,06,06.u70 N r LYAIUQ b'NNO r� = ti r � � 3 �p, DATE(MM/DD/YYYY) C<>RL ' CERTIFICATE OF LIABILITY INSURANCE �_ 08/06/22 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 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 m�AM)_: Dale BonocoPe&Michael Bonocore A.J.BONOCORE AGENCY,INC. PHONE 6:11 234.6696 �F(Arc Nod 223 Wall St#148 r�AIL mattheWbonocore a bonoc re,com .......... Huntington,NY 11743 INSURERS AFFORDING COVERAGE NAIC# WWW_ INSURER A: American Southern Home Insurance Company 41998 INSURED INSURERB:: American Family Home Insurance Company 23460_ Tebbens Steel,LLC INSURER C: Ace American Insurance Company 22667 INSURER D: Crum&Forster/The North River Insurance Co. 21106 800 Buman Blvd. INSURER E: Calverton NY 11933 INSURER w:: COVERAGE$ 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. _ TN-SR'- _ iV L SUBR_ POLICY EFF POLICY EXP LIMITS L TYPE OF INSURANCE POLICY NUMBER Y X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000 000 DAMAGE TO RENTED CLAIMS�v1ADE7XI OCCUR _I?REMASES Ea occur,nr $ 100,000 X Contractual l..B_abllity MED EXP(Anv one person) _ $ 6,000 A X Primary&Non-Contributory Y Y 88AGGL0000187 02/09/22 02/09/23 PERSONAL a ADV INJURY $ 1,000,000_ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000 000 PR'O'' PRODUCTS-COMP/OP AGG $ 2 000,000 POLICY❑X JEC' 7] LOC OTI°IIrR: p roducts1completed operatio $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea aecld�nll $ v 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ SCHEDULED B OWNED AUTOS ONLY _m..._.. AUTOS Y Y 88A6CA0000278 02/09/22 02/09/23 BODILY INJURY(Per accident), $ HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY Peraccrdent -- $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 41000,000 C EXCESS LIAB CLAIMS-MADE, Y Y N10996723 006 02/09/22 02/09/23 AGGREGATE $ 4 000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 11000,000 D OFFICER/MEMBER EXCLUDED? � N/A Y 408-743443-8 07/01/22 07/01/23 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 N yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:220722s#1366 Donna Drive,Mattituck,NY 11962. The Certificate Holder is Additional Insured as their interest may appear,. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE David Mangiameli THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 687 Medford,NY 11763 AUTHORIZED REPRESENTATIVE ©1988-2016 ACOFkb CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW Board PART 1. To be com leted by NYS Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carder 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Tebbens Steel LLC 631-208-8330 800 Burman Blvd. Calverton, NY 11933 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured (Only required if coverage is specificay 80-0021926 limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Metropolitan Life Insurance Company 3b.Policy Number of Entity Listed in Box 1a David Mangiameli 234439 3c.Policy Effective Period: October 1,2021to September 30,2022 4.Policy providesthe following benefits:. ® A. Both disability and Paid Family Leave benefits. ❑ B. Disability benefits only. ❑ C. Paid Family Leave benefits only. 5.Policy covers: ® A. All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B. Only the following class or classes of 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 and/or Paid Family Leave benefits insurance coverage as described above. Date Signed: A_ugk4st 22 Si nature of insurance carriers authorized representative or NYS licensed insurance ( carrier's p agent of that named insurance carrier) Email: a ca tr t Name and Title: el-an Consultant IMPORTANT: If Boxes 4A and 5A are 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,4C or 5B is checked,this certificate is NOT COM PLETE for purposes of Section 220,Subd.8 of the NYS Disabil"Ry and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.eov or it can be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit, PO Box 5200„Binghamton, NY 13902-5200. PART 2. To be completed by NYS Workers'Corn ensadon Board(Only if Box 4B,4C or SB have been checked State of New York Workers'Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to al I of their employees. Date Signed: By: (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number,_ Name and Title: Please Note:Only insurance carriers licensed to write NYS disability and Paid Family Lea ve benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOTauthorized io issue this form. D13-120.1 (12-21)