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HomeMy WebLinkAbout48342-Z ..� .. TOWN OF SOUTHOLD BUILDING DEPARTMENT iag TOWN CLERK'S OFFICE ^v 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#: 48342 Date: 9/28/2022 Permission is hereby granted to Walters Jr, William 305 Hill St Mattituck, NY 11952 To: construct accessory in-ground swimming pool as applied for. At premises located at: 1260 Nokomis Rd, Southold SCTM #473889 Sec/Block/Lot# 78.-3-14 Pursuant to application dated 8/15/2022 and approved by the Building Inspector. To expire on 3/29/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-95021 : � mm rr .sootl e d�owng , qN, Date Received APPLICATION FOR SII IT For Office Use Only PERMIT NO. Building inspector.. AUG 12022 Applications and forms must be filled out in their entirety.Incomplete BUILDING]), EpT. applications will not be accepted. Where the Applicant is not the owner,an TOWN OF SOJJn-r01,D Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: � y 7G�s SCTM#1000- Project Address: Phone#: �SS3 -C�S33 Email: .A.5Iwcj ie (S.Je-,6ori Mailing Address: 5,Q>Y,5- CONTACT PERSON: Name: Mailing Address: r iJV /1936— Phone#: 631 yS Email: gG ,;4-cX cD cp�on 1 rte DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: 014 k-rUV c' [)UL,S Lam= Mailing Address:•gyp •-eju c�� Cv����c v&, -,0" /193�r Phone#: &3) _�yo-y-$1041 DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other Will the lot be re-graded? Kyes El No Will excess fill be removed from premises? Xes ❑No 1 PROPERTY INFORMATION Existinguse ofproperty._ Intended use S> � �/wE JU p r ,� w.•yM.,�y -7�oz,L. Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes Ao IF YES, PROVIDE A COPY. heck Boi(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(Fin t name): 506760E i!244" e A(Authorized Agent 0Owner Signature of Applicant: Date: &117-'1ZZ STATE OF NEW YORK) SS: COUNTY OF J. U b(.E- being duly sworn,deposes and says that(s he is the applicant (Name of individual signing contract)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 14^y of04 20! ry ublic Yak PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I, l residing at do hereby authorizetea apply on M I hal to the own f Sou Id Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 YO workers' CERTIFICATE OF INSURANCE COVERAGE STATE: Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured CHITUK POOLS LTD 631-484-4245 PO BOX 9 CUTCHOGUE, NY 11935 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 113306347 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold PO Box 1179 3b.Policy Number of Entity Listed in Box"1 a" DBL614067 Southold, NY 11971 3c.Policy effective period 05/01/2022 to 04/30/2023 4. Policy provides the 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: agentUnder pnsed the nsu ed hasINYS Disability and/or Paid Fam ly Leave Benefits nsut atnce coverag asdescribed abovence carrier referenced above and that the named Date Signed 8/4/2022 By ()Wdd 4f (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number 516-820'-8100 Name and Title RlChard White, Chief Executive Officer 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 COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov 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 the NYS Workers' Compensation Board (only if sox 413,4C or 56 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 all 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 leave 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 (12-21) 11 JillIIIIIIIIIIIIIIIINIIIIIIIIIINIIIIIIIIIIIIIIIIIIIII /1-11 CERTIFICATE OF NEW Workers' NYS WORKERS' COMPENSATION INSURANCE COVERAGE YORK STATE Compensation Boa,rd' Insured Detail Is.Legal Name and address of Insured(Use street address only) 1b.Business Telephone Number of Insured Chituk Pools Ltd 631-734-7665 PO Box 9 Cutchogue,NY 11935 1c.NYS Unemployment Insurance Employer Registration Number of Insured Id.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to 113306347 certain location in New York State,i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Company Town of Southold PO Box 1179 3b.Policy Number of entity listed in box'Ila Southold,NY 11971 WWC3563869 3c.Policy effective period: 111/2022 to 1/1/2023 3d.The Proprietor,Partners or Executive Officers are: included(Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"Y insures the business referenced above in box'Ila"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c';whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. 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 the coverage as depicted on this form. Approved By: Matt Zender (Print name of authorized representative or licensed agent of insurance carrier) Approved By: 2/3/2022 (Signature) (Date) Title: SVP,Workers Comp Production Management A� DATE(MMI() CERTIFICATE OF LIABILITY INSURANCE 08/15/2022/2022 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 C'ONT'ACT Lauren Murphy NAME: Roy H Reeve Agency,Inc. PHOO N (631)2984700 FAX No: (631)298-3850 PO Box 54 fE-MAIL Imurphy@royreeve.com DRESS: 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 URERA: Valley Forge Insurance Company 20508 INSURED URER B: Chltuk Pools Ltd. INSURERC: PO Box 9 INSURER D: INSURER E: Cutchogue NY 11935 INSURER F: COVERAGES CERTIFICATE NUMBER: CL228417514 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 MAYBE 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. IW ADDLSUBR POLICYEXP LTR TYPE OF INSURANCE IN . POLICY NUMBER MMI DIYYY MMMO VYYl LIMITS X, COMMERCIAL GENERAL LIABILITY 'EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑ AMA ;E' 100,001 X OCCUR PREMISES0 $ accurrrrc X,,, Contractual Liability MED EXP(Any one person) $ 15,000 A 6018146726 03/15/2022 03/15/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0 ECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBIN'EDSINGLF LIMIT $ Exp gr,I dec8 ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS ONLY AUTOS -- HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY YIN STATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L..EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E...L..DISEASE-EA EMPLOYEE $ If DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) William Walters, 1260 Nokomis Rd,Southold,NY 11971 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. PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 3ry ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD S.C.T.M. NO. DISTRICT: 1000 SECTION 78 BLOCK 3 LOTS) 14 #R-21-0024 t ' Ir' .S ..{ -^^� 3L�F1L`iGARg LAND N/F CF y CENDY RtWAW :ED- W/pueuc aA fegERUCigx U.P.P NDN. N84°2)'00°E 180` 8' EL 1 KAON. Z E 13.0 my OR M-, EL 12.3 n Y. w w PROPOSED OFNEW AY •dyf I� � 38.0'x®EpgMRo; y`X4 pY.m"FL TEPR. DM WdL tis'Lara eOMxYDEFA; 11U1 SIFFICIL" WUL,) 6 a N I p SEDIMENT'OTl ars (rt.$) .Nn , $ HAY 8El AND/OR .XSd4T FENCING •I z..", 8 0 .tr+mt'cyinp�.,,•. GF( ) ttito4w ST EL fo. /2£0 Gni.B.A. Jr (T 1.S Ix0 �ROPD 18)RDUrJ'DKE'P' / �, (a BEDRraDws) JO —0N ENTRANCE-FOUNDATION OF COMPACTL9 y 'J,+''4'S70NE DAEND aR N.Y.STATE D.O.T:APPRWED RCA --35.0' flLL it)18"(Min.)AW4 IXMND GRADE FOR ORNNWE SOL 7i7a1t smnc C(t00} PEPDSED UWT ao " OF CLEMRO N i�+18'dAW'DEEP ' 27.4' Dr�xweu+cE �M°;{ rrPxxi Dmwtu CRMsEcnoN 1ZW Sr.i (GONG.PRECAST COMPONENTS) 1 " SILT FENCE I r eAe Fan xa-RLyEa ewxM Y xae 19e tNRx Mxxx ' '1;Z+PYSCT?/i X YRRPAD YYa lib p81 ABX/NYE ND IPFaWiG EL 9.0 S$4°2)'00"LV L 7.1 EL B.d NDR EL 10.3 Yx�•xa a7.ar TP aNUE N /4�"wa..rEj Rn ...121.34' warn 10E UP. ®O CI Cl I LAND N/F OF qq JOAN COLAVTFO TYPICAL CLEAN OUT \\'� SLATE OR STOPPER END I SUITABLE COVE OR PLUG DRAINAGE'CALCULATIONS: A)OR'aLM FDDTPRNN61,721 SD:Fr 7 WA I��.,8' 1,721 x D,id¢�2880BK 20EeE I DUIR® 00" 30' ELBOW (2I 8'aA, 4%DEEP D NEO+301aF PRDVm D MDR FEL aYATERw ro R)DRh1 wY.178D sore sz saa N D ORA EL 60' WYE 1=94W.281H (1) x 7'DEEP DRYWEU,-3TDY7 PRDADW FLam 10.0 OW-n- OR BROWN FPLt13.81 OLWNW LfN1i 1.2' MLOCOVER TD GRADE-^may EL 11.8 BROWN 11 I yy FINISH GRADE SM SILTY 2.8' SAND I'SRN-2'MAR $ /8..._._-FT. ' d, SW MEDIUM BROWN SAW 107T✓ I B y e (8.4) 8:SOME 5.1' WATER EL 1 •• HIGHEST E%PECTED WATER EL;4 CRAVE). FOUNDATION FLOW 810 Y COLLARWATER IN WALL BAFFLE MI . POOL CLEAN BROWN COARSE M 2"-B" 3'C2SW �D � v"sl SOME t GRAVEL USE 4'Dot ARPRi)VED SEINER PIPE 5 'I JWI�� .�,y :EBCiWGAL. PRECAST"S.T, F„2�rt1 15.i' 6.4) ZONED R-40 DEC. 12,2020 .. - �Z , i r L�,ps NON-CONFORMING LOT Lilq'f K,WOYCHUK LS FRONT YARD: 35'MIN 104ES'Y'.,10SCTED.OMNI)WATER 35 THE WATER SUPPLY, WELWELLS, ORYWEtLS AND CESSPOOL RIDE YARD: MIN, 25' TOTAL ¢X1'4 LOCA71ONS SHOWN ARE FROM FIELD OBSERVA77ONS REAR YARD; 35' MIN AND OR DATA OBTAINED FROM OTHERS AREA:13,532.86 SQ.FT, or 0.31 ACRES REVISED 01-29-21 ELEVATION DATUM: NAVD88 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE"EDUCATION LAW. COPIES OF 7HIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY.. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF To me RILE COMPANY GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON,.AND TO THE ASSIGNEES OF THE LENDING INS77TUTTON, GUARANTEES ARE NOT TRANSFERABLE: THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED 70 MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD117ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS ANDIOR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEYOR DESCRIBED PROPERTY CERTIFIED TO: WILLIAM WALTERS MAP OF: FILED: 51TUATED AT: SOUTHOLD _ SOUTH OLD KENNETH id WOYCHUK LAND SURVEYING, PUCSUFLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 168 Aquebogue, New York 13931 FILE 220-204 SCALE:1�=20' DATE:DEC. 20. 20120 PHONE(091)81N1-1688 PAX(881)808-1588 E N.Y:S. LISC, NO. 0508B -WVA6bAA1 the ft=,a°t Babext 1.RM-"WT k X*ft-R U.W.Y h k ,