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HomeMy WebLinkAbout48510-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 #: 48510 Date: 11/18/2022 Permission is hereby granted to: Corcoran, David PO BOX 1106 C utchog ue, NY 11935 To: install generator as applied for with flood permit. At premises located at: 405 Fleetwood Rd, Cutcho ue SCTM # 473889 Sec/Block/Lot# 137.4-15 Pursuant to application dated 9/21/2022 and approved by the Building Inspector. To expire on 5/19/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-ACCESSORY BUILDING $50.00 Flood Permit $100.00 Total: $335.00 Building Inspector v 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 littl)s-//www.sotitliol,dto,wtiii,.. ..,-- Date Received APPLICATION For Office Use Only V PERMIT NO. Building Inspector.__Iz n - P p" 1 2022 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an BUILDING DEPT. Owner's Authorization form(Page 2)shall be completed. TOWN OF SOU+HOLD Date:August 31, 2022 OWNER(S)OF PROPERTY: Name:David Corcoran SCTM#100137-04 -5' Project Address:405 Fleetwood Cove, Cutchogue NY 11935 Phone#:631-727-6550 1 Email:Constructiveframing@gmail.com Mailing Address:405 Fleetwood Cove, Cutchogue NY 11935 CONTACT PERSON: Name:Nick D'Amico @ Shore Power Electric Mailing Address:108 Frowein Road - Unit 2, Center Moriches NY 11934 Phone#:631-766-7423 Email:Nick@ShorePowerElectric.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Shore Power Electric, Inc Mailing Address:108 Frowein Road - Unit 2, Center Moriches NY 11934 Phone#:631-766-7423 FEm-;i�l:Nick@ShorePowerElectric.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: F10therStand-by Generac Generator $20,216.52 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes I@No 1 PROPERTY INFORMATION Existing use of property:Residential Intended use of property: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 15 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 210AS of the New York State Penal Law. Application Submitted By(print name):Louis DeSantis WAuthorized Agent ❑Owner Signature of Applicant: Date: August 31, 2022 STATE OF NEW YORK) .SS: COUNTY OF .._„) Louis DeSantis 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 day of 20 ZZ Notary Public PROPERTY 0W1'4..1 UT11 l IIRIZ '"ION (Where the applicant is not the owner) I, V � 1 �t9 _ ,AN residingat +� � *� O� e ` �do hereby authorize apply on my behalf to the Town of Southold Building Department for approval as described herein. Aj 141� f/ 3� v2 Z Owner's Signature ANDREA AM) 10—i AqY PU::LIC,STATE OF N ZVJ � �< Layij " No.Oib11609654-1 Print Owner's Name QUALIF-M IN SLMLK COUNW,"Y 2 g�FFOEk -� BUILDING DEPARTMENT- Electrical Inspector .v TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 r; Telephone (631) 765-1802 - FAX (631) 765-9502 ro err southoldtownny.gov— seand@southoldtgWony.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: . 1-ate Company Name: a c �ZkC. Name: DAIca License No.: ie email. Address: ZQ& 690 &P1- Sta—a t" 'r Phone No.: 3!— o R,' JOB SITE INFORMATION (All Information Required) Name: L2,6cvid Co'qCOAAP4, Address: O; "' r a COV 119',3s'' Cross Street: 510 Phone No.: 6 3 7A, 7- S:SO Bldg.Permit#: email:9 q ;vEc Tax Map District: 1000 Section: Block: C) y- Lot: 3 7. 3 BRIEF DESCRIPTION OF WORK (Please Print Clearly)0 Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Sf- 2 1 P-0 22BUILDING ® Request for Inspection Form.As ° "E Workers' CERTIFICATE OF INSURANCE COVERAGE sTATIE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name i£Address of Insured(use street address only) 1 b.Business Telephone Number of Insured SHORE POWER ELECTRICAL CONTRACTING, INC 108 FROWEIN RD-#2 6313954029 CENTER MORICHES, NY 11934 Work Location of Insured(Only required if coverage Is specifically limited to I 1c.Federal Employer Identification Number of Insured certain locations in New York Siete,i.e.,Wrap-Up Policy) or Social Security Number 20-4999885 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Standard Secure Life Insurance Company of New York Town of S�otathold Security P Y 54375 Route 25. 3b.Policy Number of Entity Listed in Box"1a" Southold, NY 11971 79516-00 3c.Policy effective period 1/1/2018 to 8/30/2023 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: 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 des above. Date Signed 8/31/2022 By (Signature of insurance carrier's authoriz d representafGive or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBUPOLICY SERVICES 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 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 4C or 56 of Part 1 has 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 with respect to all of his/her 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 dorm. DB-120.1 (10.17) � ��'B� � i0�l (� i �17)�� AC4C>RL>> CERTIFICATE OF LIABILITY INSURANCE DATE'MNUDD/YYYY) llla. "T 8/31/2022 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(les)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 oartifloate holder In lieu of such endorsemen s. PRODUCER OCNITACT Hometown Insurance Agency of L.I., Inc. PHONE 5 Orville dr 631-589-0100 F N 631-589-0164 Ste 400 -ADDEr�I11 R certs0hometowninsurance.corn Bohemia, NY 11716 INSURER(Sl AFFORDING COVERAGE NAIL0 INSURER A:Ohio Casualty Insurance Co INSURED S14ORPOW-01 INSURER B:Hartford Pro a and Casualt 34690 Shore Power Electrical Contracting, Inc. INSURER C: 108 F`rowein Road,Suite#2 Center Moriches,NY 11934 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1617539848 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 ADD POLICY EF LI'CY EXP LTR TYPE OF INSURANCE POLICY NUMBER LIMITS A X COMMERCIALOENERALuABILrrY Y BKO(23)57918685 7/1712022 7117!2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE O OCCUR � � IS 22p $300,000 MED EXP one $15,000 PERSONAL&ADV INJURY $1,000,000 GEN"LAGGREGATE LIMIT APPLIES PER- GENERALAGGREGATE $2,000,000 POLICY JEC LOC PRODUCTS-CAMPIOPAGG $2,000,000 'OTHER: $ AUTOMOBILE LIABILITY CEO I D S M e A909-901) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ 'AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTYAMAG ; $ AUTOS ONLY AUTOS ONLY P $ UMBRELLAL;7-±$ OCCUR EACH OCCURRENCE $ EXCESS LIACLAIMS MADE AGGREGATE $ DEQ ION $ B 'AND MPLOYERSS''LIABILITY YIN 12WECAB5PSI 7/20/2022 7/20/2023 ')C 7A ER ANYPROPRIETORIPARTNERIEXECUTIVEE.L EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? ❑ NIA (Mandabory in NH) EL DISEASE-EA EMPLOYEE $1,000,000^ yy DESG IPTION OFOPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Adddional Remarks Schedule,may be aUached if more space is required) The Town of Southold is hereby listed as an additional insured,as required by written contract.Subject to policy terms and conditions. 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. 54375 Route 25. AUTHORIZED REPRESENTATIVE Southold, NY 11971 /f ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD I(T)A VUWorkers' CERTIFICATE OF Ti Compensation p NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only 1b.Business Telephone Number of Insured 631-396-4029 Shore Power Electrical Contracting,Inc. 108 Frowein Road,#2 1c.NYS Unemployment Insurance Employer Registration Number of Insured Center Moriches,NY 11934 Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up 1d.Federal Employer Identification Number of Insured or Social Security Policy) Number 20-4999886 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Hartford Casualty Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"l a" 64376 Route 26. 12WECAB6PSI Southold,NY 11971 3c.Policy effective period 07/20/2022 to 07/20/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/offioers included) X all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"S'insures the business referenced above in box"1 a"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"2". 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: Michael DiPalma (Print name or authorized representative or licensed agent of insurance carrier) Approved by: LLA"/p4;0aAm-al 8/31/2022 (Signature) (Date) Title: Certificate Coordinator Telephone Number of authorized representative or licensed agent of insurance carrier: 631-567-1011 Ext 317 Please Note:Only Insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C406.2(9-17) www.wcb.ny.gov Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name NICHOLAS UAMICO Ousiness'lame This certifies that the bearer is duly licensed SHORE POWER ELECTRICAL by the County of suffolk CONTRACTING INC License Number:H-48269 Rosalie Drago Issued: 01/06/2011 Commissioner Expires: 01/01/2023 r+ Hal -jui HN ���q& as o a bMR 14 1Fm �o tit yN ° m gnu �^ Sip $ $ RuNSl � z 1 �x 141 � log m; a` PHI> � a p 92 a o $_ �nwm oiww vWmuni>mw Tin TO }1 v w 01 �d� � r � � ��W:nW:. .,.� ,s � � .` .,,.,a�W�u ; � z� ✓a!„��t � �� �3 � � � cmRs g E £ '.'bMC 9Z@ .nr,..,•'"v` lae N 7 d a:` �}' > ' o E USA W i E w=10SIN 1 pop ssus's m 5 ° o q @ tip o o ga¢ �So Ngo �" kV gq 9Go � s Z n r� 7V P n "3 q � a Ciotti 66 1.v j2'ygm aim. (^^w, gS $"s ^n uuU ® ter' uUU