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HomeMy WebLinkAbout48369-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#: 48369 Date: 10/4/2022 Permission is hereby granted to: Dorado-Waldkirch, Chris 105 N 9th St Brooklyn, NY 11249 To: Legalize an "as built" accessory in ground swimming pool to an existing single family dwelling as applied for. Must maintain a minimum setback of 5 feet. At premises located at: 2900 Pe uash Ave, Cutcho ue SCTM # 473889 Sec/Block/Lot# 103.-13-23 Pursuant to application dated 8/19/2022 and approved by the Building Inspector. To expire on 4/4/2024. Fees: CO- SWIMMING POOL $50.00 AS BUILT- SWIMMING POOL $500.00 Total: $550.00 ° Building Inspector l+dw P'k 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) 765-9502 htln s:// ww.,sootholdto w°nn .go'v Date Received APPLICATIONL PERMIT For Office Use Only PERMIT NO. L�Q Building Inspector: m A 1 V Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an I Owners Authorization form(Page 2)shall be completed. Date:06/07/2022 OWNER(S)OF PROPERTY: Name:Chris Dorado-Waldkirch SCTM#1000-103-13-23 Project Address:2900 Pequash Avenue, Cutchogue, NY 11935 Phone#:1-917-748-4366 1Email:chris.doradoalvarado@gmail.com Mailing Address:2900 Pequash Avenue, Cutchogue, NY 11935 CONTACT PERSON: Name Jonathan De Leon Mailing Address: PO Box 490, ,Speonk, NY 11972 e Phone#.631-831=0452 Email:jdeleon @ ppas.com DESIGN PROFESSIONAL INFORMATION: I Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Jonathan De Leon Mailing Address:PO BOX 490, Speonk, NY 11972 Phone#:631-831-0452 jdeleon @ ppas.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated CostofProject: Otherin round Fiberglass Swimming Pool $70,000 . Will:the lot be re.'-graded? Byes❑No Will excess fill be removed from'p remises? @01Yes ❑No 1 PROPERTY INFORMATION Existing use of property:Residence Intended use of property:Residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 this property? ❑Yes *No IF YES, PROVIDE A COPY. ® Check..Box fter'i eadin : 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):Jonathan De Leon RAuthorized Agent ❑Owner Signature of Applicant: Date: Nlqzz STATE OF NEW YORK) SS: COUNTY OF Suffolk Jonathan De Leon being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Agent (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—hl J' daffy of " 4 f No ublic Garrin C Lanning f m ( ( Notary Public State of New York "" "" No.01 LA6382861 (Where the applicant is not the owner) Qualified in Suffolk County Commission Expires November , Chris Dorado-Waldkirch residing at 2900 Pequash Avenue Cutchogue, NY 11935 Jonathan De Leon do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. 06/07/2022 Owner's Signature Date Chris Dorado-Waldkirch Print Owner's Name Suffolk County Dept of ' Labor,Licensing 3 Consumer Affair. HOME IMPROVEMENT LICENSE Name, got, "I�9 CARLOS R DELEON Business Name I his Certifies that the bearer is duly iltcensort Home Management Solutions Inc by ow County of sultok Ucense Number:HI-64965 Rosalie Drago Issued: 04/12/2021 Commissioner Expires: 04/01/2023 c, w , ro workers'ation CERTIFICATE OF INSURANCE COVERAGE ATE Compens 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) ib.Business Telephone Number of Insured Premier Pools and Spas of the Hampton Inc 631-919-9017 5 Windmere Court Speonk, NY 11972 Work Location of Insured(on(yrequired#;coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-up Policy) or Social Security Number 27-2929120 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Guardian Life Insurance Co. Town of Southold 54375 Route 25 3b.Policy Number of Entity Listed in Box 1a Southold, NY 11971 939314-0000 3c.Policy Effective Period 06/01/2020 to 12/31/2022 4. Policy provides the following benefits: X A.Both disability and Paid Family Leave benefits. F1 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' sed agent of the insurance carrier referenced above and that the named insured has NYS disability and/or Paid Family Leave benefits insurae ve ge a escribed above. Date Signed August 15, 2022 By ts8oatura in, rbc Carrier'sautiararlrbidr pre cwt arNYSItcensedinsuranceagentofthatinsurancecarrier) Telephone Number (212)964-2150 Name and Title President 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 Box 4B,4C or 511 have been checked) State of New York Worker' Compensation Board According to information maintained by the NYS Workers'Compensation Beard„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-1120.11 (12-21) 111111 111111111111 IDB-120.1 (12-21) PREMP02 CERTIFICATE OF LIABILITY INSURANCE DATE 512 0 221 08115�2t122 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 ri hts to the certificate holder in lieu of such endorsement(s). PRODUCER 301-9164805 � ' Kimberly A Costanxo,CISI . ...................................._.. �(-....... .......... Mood yy 8 Associates,Inc. >d 1(AJC Nc:301-417-0040 P.O.Box 1857 (AJC.PHONE.E v m tl 301 916-4805 Frederick,MD 21702 lac. costan moo y nsurance com Laura Bianchini Pritchett - - �..._...__ „..INSURER(§J AFFORDING COVERAG9. .NA•IC*•,W,,• .............. INSURER A:Peleus Insurance Compan 34118 1NSUR�D INSURERS AmGUARD Insurance Company f2390 Premier Pools and Spas of the --- --W---- — Ham ons Inc INSURER c,New York State Ins. Fund P 0 ROx 490 _... ........ _W Speonk,NY 11972 INSURER D INSURER E Wvvv INSURER F: COVERAGES CERTIFICAT UMBER: EVISION N E : 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. TYPE OF INSURANCE __ POLICY NUMBER PO _ LIMIT..�.v__v INSR ODL UBR POLICY EFF POLICY EXPIML S COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE [ OCCUR D MAGE TO RENTED 100,000' 600 GL 0204344-00 09/02/2021 09/0212022 .(�a el:cc,�rau� a ........ _MED EXP(Any one person)_ _. ........ 5,000, _.___.. 1,000,000 PERSONAL 8 ADV INJURY„ w, GREGATE LIMIT GEN°POLLIICY PRO APPL❑IE JECTLOC PR CaSGC0.7hpi fOi� C 2,000,000 B AUTOMOBILE LIABILITY COMBINE Q SbNq/mE LIMIT 1,000,000 ANY AUTO PRAU299254 05/07/2022 05/07/2023 gQQILY brarRr � yaiL OWNED SCHEDULED _......... AUTOS ONLY X AUTOS BODILY INJURY Per accident X AUTOS ONLY X AUTN 'Y Iec�d' tA•bdAl°sE $ �..w.... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LU\B CLAIMS-MADE AGGREGATE $ ....."-" .. .......�.... ..._�...... ..........��...._............... ... DED RETENTION$ COMPENSATION X PER 0TH- ANY PROPRIYERS'LUIBILITY STATW1E_ „•,-,,,, AND ROPRIETOR/PARTNER/EXECUTIVE YN 2556871-8 10/05/2021 10/05/2022 500,000 C �WORKERSE (MPand8rM�Nn NH)EXCLUDED? N/A ELEACH A, (DENT.... ........ L DISEASE EA EnnPLOYrE„ 500,000 If yes,describe under �� - ••�•• DESCRIPTI N OF.OPERATI NS b I w 500,000 . ..DISEASE-P LI. Y LIMI DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HQLOER CANCfLLATION TOWNS01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE d ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD S.C.T.M. NO. DISTRICT: 1000 SECTION:103 BLOCK: 13 LOT(S):23 `J s`r 0 4l MON. ' 00, P LAND N/F OF ¢ n1 VINCENT LAROCCA h� 'Cb W.V. W.M. Sn U.P. A 0 c0� 00, Xs C PROPOSED 4' POOL FENCE "�, �O ✓� MON. ,9 r, FRAMEX2900MON. ' �+ s. o 9` S 5p q r pno, r, ,may O- rFa pw PROP.,—/ —_ __ DRY WELL POOL WASTE WATER LAND N/F OF WILMA C DOROSKI IRREVOCABLE TRUST 0.4'W rn, tya a LAND N/F OF DAVID G WALSH PROPOSEDy,�. $0�'^'� ""' 4' POOL FENCE ( e MON. / REVISED 10-03-22 REVISED 06-29-22 LAND N/F OF THEODORE 0 BEEBE FAMILY TRUST THE WATER SUPPLY, WELLS DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 14,318.75 SQ.FT. or 0.33 ACRES ELEVA77ON DA TUM.' UNAUTHORIZED ALTERATION OR ADD177ON TO THIS SURVEY IS A WOLA770M OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS7771070N, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD1770MAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO:RONNY WALDKIRCH• MAP OF: CHRIS DORADO—WALDKIRCH' FILED: FIDELITY NATION TITLE INSURANCE, LLC; JP MORGAN CHASE BANK, NA; SITUATED AT:CUTCHOGUE TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PUC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Bog 153 Aquebogue, New York 11931 0 PHONE (691)298-1568 FAX(631) 298-1568 FILE # 19-92 SCALE: 1".20'DATE:JULY 16th, 2019 N Y.s USC. NO. 050882 Matelnl.S the ee..ede&$.beet J.Henneeey a Kenneth H.A.ychuk