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HomeMy WebLinkAbout48465-Z � F TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE t 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 #: 48465 Date: 11/9/2022 Permission is hereby granted to: AW Frame LLC 1299 Ocean Ave Ste 333 Santa Monica CA 90401 To: construct accessory pool house as applied for. At premises located at: 640 Ski ers Ln, Orient SCTM #473889 Sec/Block/Lot# 24.-1-10 Pursuant to application dated 7/18/2022 and approved by the Building Inspector. To expire on 11/9/2023. Fees: ACCESSORY $388.00 CO-ACCESSORY BUILDING $50.00 Total: $438.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT �i 1/ Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 ��Iemt . a / uuilt �� a, e Date Received For office Use Only PERMIT N0. � Building Inspector.—A:�--- `' t Applications and forms must be filled out in their entirety. Incomplete JUL applications will not be accepted. Where the Applicant is not the owner,an (m Owner's Authorization form(Page 2)shall be completed. JI"DIN, �,) Date:09/28/2021 OWNER(S)OF PROPERTY: Name:A.W. Frame L.L.C. IS-CTM# 1000-24-01-10 Project Address:640 Skippers Lane, Orient, NY 11957 Phone#:310-451-0744 Email:jjacobs@goodfriendjacobs.com Mailing Address:_._. 640 Skippers Lane, Orient NY 11957 _._.......� �._ _ ....._......_ _ . _.. .. .�.� CONTACT PERSON: to ..' Name:Daniel Schillberg Mailing Address:2 Sky Drive, Cornwall, NY 12518 Phone#:646-645-3687 Email: Daniel@dado-architecture.com .._._.W....�.�.._ ... .. .�--w- � ._i.... �.�.�. DESIGN PROFESSIONAL INFORMATION: Name: DADO Architecture PLLC Mailing Address:2 Sky Drive, Cornwall, NY 12518 Phone#:646-645-3687 Emall' Daniel@dado-amhitecture.com CONTRACTOR INFORMATION: Name: C -Q- YNCOMS v O M Otil 1 L Mailing Address: I ct � USIC..4 012.IVC% 1c\O1 Phone#: Email: r�,31 335 2a 3 4 T .-t o C-&k6-3 � �1Cc�-- Uf L(Cwt DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition []Alteration ❑Repair ❑Demolition Estimated Cost of Project: []Other Will the lot be re-graded? ❑Yes W No Will excess fill be removed from premises? WYes []No 1 PROPERTY INFORMATION Existing p p ert use of ro Intended use of property: Residential property: Residential 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. 0 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. I Application Submitted By(print name): 6j)'Jim ';5 ����b Authorized Agent� ❑Owner te Signature of Applicant: Date: R - o�� . 712002 . STATE OF NEW YORK) SS: COUNTY OF )' Suffolk ` r being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor (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 application4thereth. Sworn before me this day of .— 207-2 tary Public Qais Azizi 71NOTARY PUBLIC,STATE OF NEW YORK , Registration No.OIAZ6432635 Qualified in Suffolk County Commission Expires 05102/2026 (Where the applicant is not the owner) A.W.FRAME L.L.C. residing at 640 Skippers Lane, Orient, NY 11957 do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. 09/28/2021 Owner's Signature Date Jeffrey Jacobs,CFO Print Owner's Name 2 � a Generated by REScheck-Web Software Compliance Certificate Project New Accessory Building , 0T. Energy Code: 2018 IECC Location: Suffolk County, New York «� Construction Type: Single-family Project Type: New Construction Orientation: Bldg. faces 123 deg. from North 041371 Conditioned Floor Area: 347 ft2 Glazing Area 27% Climate Zone: 4 (5999 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 640 Skippers Lane A. W. Frame LLC Dominique Haggerty Orient, NY 11957 640 Skippers Lane DADO Architecture, PLLC Orient, NY 11957 2 Sky Drive Cornwall, NY 12518 845-534-0321 info@DADO-architecture.com Compliance: 3.2%Better Than Code Maximum UA: 158 Your UA: 153 Maximum SHGC: 0.40 Your SHGC: 0.26 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Sllalb-on-grade tray:doffs are Imo Ilei ngeir considered in the UA or peirforirnance cornphai ce p:.math lin RIEScheclk. Il:::aclhm slab-oin••grade asseirrnblly in the sper.:'ptied c:ii-nate zoime iMUSt inrneet time irvmpnimurn einergy code irnsupat1on R-vakse and depth requirements. En lue Prop.Gross Area Cavity Cont. Prop. Perimeter Ceiling 2: Flat Ceiling or Scissor Truss 142 49.0 0.0 0.026 0.026 4 4 Ceiling 1: Cathedral Ceiling 240 30.0 0.0 0.034 0.026 8 6 East Wall: Wood Frame, 16" o.c. 283 15.0 3.6 0.058 0.060 10 10 Orientation: Front UBFLD12070: Glass SHGC: 0.26 86 0.300 0.320 26 28 Orientation: Front UDGDRTR2812:Wood Frame:Double Pane with Low- E SHGC: 0.26 12 0.300 0.320 4 4 Orientation: Front UWDGRT5150: Wood Frame:Double Pane with Low-E SHGC: 0.26 15 0.300 0.320 5 5 Orientation: Front North Wall: Wood Frame, 16" o.c. 280 15.0 3.6 0.058 0.060 14 15 Orientation: Right side Project Title: New Accessory Building Report date: 11/08/22 Data filename: Page 1 of 10 Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter UIFDG22670: Glass SHGC: 0.26 18 0.300 0.320 5 6 Orientation: Right side UWDGRT5150:Wood Frame:Double Pane with Low-E SHGC: 0.26 15 0.300 0.320 5 5 Orientation: Right side West Wall: Wood Frame, 16"o.c. 283 15.0 3.6 0.058 0.060 10 10 Orientation: Back UBFLD12070: Glass SHGC: 0.26 86 0.300 0.320 26 28 Orientation: Back DGDRTR2812:Wood Frame:Double Pane with Low-E SHGC: 0.26 12 0.300 0.320 4 4 Orientation: Back UWDGRT5150: Wood Frame:Double Pane with Low-E SHGC: 0.26 15 0.300 0.320 5 5 Orientation: Back UWDGRT2750: Wood Frame:Double Pane with Low-E SHGC: 0.26 3 0.300 0.320 1 1 Orientation: Back South Wall: Wood Frame, 16" o.c. 280 15.0 3.6 0.058 0.060 14 14 Orientation: Left side Arched Door F: Glass SHGC: 0.26 24 0.300 0.320 7 8 Orientation: Left side UWDGRT2424: Wood Frame:Double Pane with Low-E SHGC: 0.26 15 0.300 0.320 5 5 Orientation: Left side Slab: Slab-On-Grade:Unheated : Fully Insulated (uniform R-value across perimeter and under slab) 75 20.0 0.261 0.360 0 0 Insulation depth: 2.0' Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and Cather calculations submitted with the permit application.The proposedbuild g has been designed to me he 2018 IECC requirements in REScheck Version : REScheck-Web and to comply with the mandatary equirements listod in t Scheck Inspection Checklist. DOMINIQUE HAGGERTY 11/0812Q22 Name-Title S�ignkge Date Project Title: New Accessory Building Report date: 11/08/22 Data filename: Page 2 of 10 ­ AC"Re CERTIFICATE OF LIABILITY INSURANCE DD/YYYY) DATE(MM/ 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 endorsements . CONTAC PRODUCER NAME`. On Your Team Insurance Agency PMINO MN ' 631"828-193 - N a31-938-0220 AJL 1733 North Ocean Ave ADDRESS° Medford, NY 11763 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Insurance INSURED INSURER B: CNK Construction Inc. INSURER C: C/O Ginna Pardo INSURER D. 19 Josica Drive INSURER E: Riverhead, NY 11901 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 I LTR TYPE OF INSURANCE D USR POLICY NUMBER POLICY FF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE 7 OCCUR PREMISES fEa 2ggaLemp�— $ MED EXP(Any one erson) $ A X RNYG306235-01 8/27/202 8/27/2022 PERSONAL&ADV INJURY GEN"L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY F]JECTPRO ❑ LOC PRODUCTS-COMP/OP AGG $ PRO- OTHER:. $ AUTOMOBILE LIABILITY I $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY t UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION �NIA EACH AT TE ETH ANYD ROPRIIETOR/P R LNIER EXECUTIVE E L PE Y/N ❑ CH ACCIDENT $ OFFICER/MEMBER EX (Mandatoryin NH) E,L.DISEASE-EA EMPLOYEE $ If yes,describe under 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) CNK Construction Inc, is a home improvement company/contractor working on Residential Homes in Suffolk County. CERTIFICATE HOLDER CANCELLATION Southold Tow Clerk Office SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORO CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD ACORDs provided by Forms Boss.www.FormsBoss.com; (c)Impressive Publishing 800-208-1977 NYSIF New York state Insulrance Fund PO Box 66699 AlbanY,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "^A^^^ 371930678 CNK CONSTRUCTION INC. 19 JOSICA DRIVEme RIVERHEAD NY 11901 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER CNK CONSTRUCTION INC. SOUTHOLD TOWN CLERK OFFICE 19 JOSICA DRIVE 53095 MAIN RD RIVERHEAD NY 11901 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12522102-9 92596 09/0112021 TO 09/01/2022 7/18/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2522102-9, 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://WWW.NYSIF.COM/CERT/CERTVAL.A$P.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. PRESIDENT GINNA PARDO CNK CONSTRUCTION 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 STAT SURN+ E FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 126142823 U-26.3 mmYOR workers' CERTIFICATE OF INSURANCE COVERAGE .- 51'Xrc .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 carrie 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured CNK CONSTRUCTION INC. 631-664-8502 ATTN: GINNA PARDO 19 JOSICA DRIVE RIVERHEAD,NY 11901 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) 371930678 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 Southold Town Clerk Office 53095 Main Rd. 3b.Policy Number of Entity Listed in Box"1 a" Southold, NY 11971 DBL621209 3c.Policy effective period 09/01/2021 to 08/31/2023 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. E] B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I alp 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 7/18/2022 9 By (Signature of!nsurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard 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 Box 46,4C 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) 111111111 111111 . STSOR workers' CERTIFICATE OF INSURANCE COVERAGE 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 1 a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured CNK CONSTRUCTION INC. 631-664-8502 ATTN: GINNA PARDO 19 JOSICA DRIVE RIVERHEAD,NY 11901 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) 371930678 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 Southold Town Clerk Office 53095 Main Rd. 3b. Policy Number of Entity Listed in Box"1 a" Southold, NY 11971 DBL621209 3c.Policy effective period 09/01/2021 to 08/31/2023 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: Under penalty of perjury,1 certify that 1 am an authonzea representative or Ilcensed 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 7/18/2022 By cv/w (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number 516-829-8100 Name and Title Richard 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 513 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 46,4C or 5B 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. 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