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HomeMy WebLinkAbout48549-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 #: 48549 Date: 12/1/2022 Permission is hereby granted to: Johnson, Jean 165 Duane St Apt 4C New York, NY 10013 To. construct an outdoor shower and make alterations to an existing accessory deck surrounding swimming pool as applied for. Two CO's required. At premises located at:. 1015 Sound Dr, Greenport SCTM # 473889 Sec/Block/Lot# 33.-3-20 Pursuant to application dated 9/28/2022 and approved by the Building Inspector, To expire on 6/1/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ADDITION TO DWELLING $50.00 ACCESSORY $306.80 CERTIFICATE OF OCCUPANCY $50.00 Total: $606.80 uil ing Inspector " F � ', TOWN OF SOUTHOLD —BUILDING DEPARTMENT f °t Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone 631 765-1802 Fax 631 765-9502 _tt : Www v so tlaa ldta °nn . Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only f PERMIT NO. Building Inspector: Applications and forms must be filled out in their entirety. Incomplete tea, 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: „, e6UfJ JMIJ S61.J SCTM # 1000- Project Address: 4D ` � 56010 �Vl6"1 N F', tI— Phone#: 7t b -7 4.4 f& 1� Email: kyd v ` K rv5dn c► yki4, &J4 Mailing Address: J O IC; s 6 4-7 ��, GriR,R I CONTACT PERSON: Name: Mailing Address: p I e, A Phone#: (0�5 1 33s (40 ZTO Email ` ' C AOL , 66M DESIGN PROFESSIONAL INFORMATION: Name: ,"M 6tRl Mailing Address: 'I) Vi 1.S j7�N Phone#: 69; 1 -7'4G x 3 ej Email: ,t 1 10 qq4 'CONTRACTOR INFORMATION: Name: Mailing Address: 92 b H,&1A1PV/'J Email Phone#: 51 ( 27 (0( JOE Di1�1'' �� DESCRIPTION OF PROPOSED CONSTR ' ION ❑New Structure ❑Addition b1Alteration ❑Repair ]Demolition Esti ed Cost of Project: ❑Other DOlTLfW-N S $ - Will the lot be re-graded? ❑Yes 540 Will excess fill be removed from premises? ❑Yes �0 -4 &A/fDO+ SiqdwF� 4kc& 1 PROPERTY INFORMATION Existing use of property: (LC S I() Intended use of property: S➢i �s ' Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes 5fNo 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 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(p „ant name): uthorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF SIrCc,rLL ) being duly sworn, deposes and says.that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the AL (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 ofd 20 Z Notary Public LEO P DAVIS NOTARY PUBLIC,Swe of New'York N ,Suffolk o city No. Expires:/ (Where the applicant is not the owner) i, apinw JCH �O�J. residing at i®1< do hereby authorizeto 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 New York State Insurance)Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) L . 'PTwl I•" ^^^^^^ 471846079 MALONEY&MALONEY INC 108 WEST MONTAUK HIGHWAY PO BOX 1024 HAMPTON BAYS NY 11946 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DUNN DEVELOPMENT& TOWN OF SOUTHOLD CONSTRUCTION CORP PO BOX 1179 39 HAMPTON BAYS DRIVE 53095 ROUTE 25 HAMPTON BAYS NY 11946 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBERPOLICY PERIOD DATE 12398335-6 352478 09/05/2022 TO 09/05/2023 9/27/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2398 335-6, 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.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 SU VCE FUND 4 4v DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:671994422 U-26.3 DATE(MMIDD/YYYY) CC>R" CERTIFICATE OF LIABILITY INSURANCE �. 09/27/2022 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 CONTAM Jennifer McGroarty NAME's Maloney and Maloney Inc. ?Hc No ext: (631)728-0400 Ai (631)728-0695 o No: 108 West Montauk Highway F-MAII ss: jennifer@maloney-maloney.com P.O.BOX 1024 INSURER(S)AFFORDING COVERAGE NAIC# Hampton Bays NY 11946 INSURERA: Southwest Marine&General INSURED INSURERS: Merchants Preferred Insurance Company 12901 Dunn Development&Construction Corp. INSURER C: NY State Insurance Fund 39 Hampton Bays Dr INSURER D INSURER E: Hampton Bays NY 11946 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21122212401 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 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. IL R TYPE OF INSURANCE "N. POLICY NUMBER MM/D EFF MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO KENT CLAIMS-MADE �OCCUR PREMISES Ea occurrence $50,000 MED EXP(Any one erson) $ 5,000 A GL2021LHB00462 11/24/2021 11/24/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN"LAW2REOATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT ww OTHER.: $ AUTOMOBILE LIABILITY MBINE5§10LE.00T $ 1,000,000 (Ea a :ideal) 'y ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED CAP1065566 09/18/2021 09/18/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per madden" Medical payments $ ..... _ — UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION v UTE E0 ANY PROPRIEEOR/ARAND BTINER/EXECUTIVE LITY YIN XEACHACCIDENT ER $ 100,000 C OFFICER/MEMBER EXCLUDED? N I A 12398335-6 09/05/2022 09/05/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BROWN JOHNSON ACCORDANCE WITH THE POLICY PROVISIONS. 1015 SOUND DRIVE '..AUTHORIZED REPRESENTATIVE GREENPORT NY 11944 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD " 1 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/27/2022 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 taAM Jennifer McGroaRy Maloney and Maloney Inc. PHONE E (631)728-0400 ? (631)728-0695 108 West Montauk Highway E-MAIE5?r: jennifer@maloney-maloney.com P.O.BOX 1024 INSURE S)AFFORDING COVERAGE NAIC# Hampton Bays NY 11946 INSURERA: Southwest Marine&General INSURED INSURER B: Merchants Preferred Insurance Company 12901 Dunn Development&Construction Corp. INSURER C: NY State Insurance Fund 39 Hampton Bays Dr INSURER D., INSURER E: Hampton Bays NY 11946 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21122212401 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. iLT TYPE OF INSURANCE It D yrVD POLICY NUMBER MMita MNtPD d111YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 50,000 CLAIMS-MADE FX OCCUR I�REMVSES Eh esrre+m + $ MED EXP'Ara orae pesaon) $ 5,000 A GL2021LHB00462 11/24/2021 11/24/2022 PERSONAL&ADV INJURY $ 1,000,000 GE,ITLAGGREGATELIMITAPPLIESPER: GENERALAGGRE'GATE $ 2,000,000 ,"✓ 2,000,000 POLICY El JJECOT LOC PRODUCTS-COMPIOPAtaG S OTHER: COMBINED INGLEIJM$T $ 1,000,000 AUTOMOBILE LIABILITY (E,a=W!!'rt X''ANY AUTO BODILY INJURY(Per person) h$ B OWNED SCHEDULED CAP1065566 09/18/2021 09/18/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PR�7PERTY DAMAt HIRED NON-OWNED P'9ra ideart $ AUTOS ONLY AUTOS ONLY Medical payments $ UMBRELLA LIAR OCCUR FAGFI OCYCUIRRENGE $ EXCESS LIAB —CLAIMS-MADE AGGREI.�ATE " $ ITEC} RETENTION'$ WORKERS COMPENSATION STE ERS TATU AND EMPLOYERS'LIABILITY C ANY PROPRIETORIPARTNER/EXECUTIVYE' Y� N 1A 1 2398 335 09/05/2022 09/05/2023 E L EACH ACCIDENT_ $ 100,000 OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EAEMP'LOYEE $ 1001000 (Mandatory in NN), ifyyos„describe under E1.DISEASE-POLICY LIMIT $ 500,000 DESGRIKION DF'OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF SOUTHOLD 53095 ROUTE 25 AUTHORIZED REPRESENTATIVE PO BOX 1179 SOUTHOLD NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Suffolk County Dept.of Labor, Licensing & Consumer Affairs HOME IMPROVEMENT LICENSE G� Name JOSEPH DUNN S t Mness Marne s certifieshat irer is ul licensed DUIN DEVELOPMENT CONSTRUCTION COBE the County of suffolk Ucense Number: Ht-,6,3347 Rosalie Drago Iss l: 01A5/20 Commissioner Expires: 01/4 / 02 S.C.T.M. NO. DISTRICT: 1000 SECTION:33 BLOCK:3 LOT(S):20 SOUND SRI . EDGE OF PAVEMENT o.3'E N74-04'10"E 145.96' o V a o �z cn GRAVEL DRIVEWAY o DRAIN 44.0' 3.3'W ® N U SpG� O lwZi. 7{'yt{ rm 2ND FLR. Y CANTI 4' WOOD FENCE z J CONC STONE PATIO �x 40.9' ;q 561 50 4' ` 3.2'W GATE r. 1'.8'W 6' STOCKADE FENCE ^ 2 STY FRAME 1.0 6,.,., 44.0' rt '' DWELLING #1019 Ye"" S,r LLw�x ®: 50.3' ci.'t0.5". GATE OLO ��N 4VERL�T04P ��''M0 Zaw z a a X WOOD 48.4' g=U DECK h� w IMS CK EL a !N ROUND POOL 0 � O m CL LL w WOOD DECK I.8'W 0 CJ b O 0 m � � m m z o 2 47.1' � LOT 16 2.9'E 9'9 E 6' STOCKADE FENCE 0.5'N 19 9 HYD 0.5'E DEER 0.7'S ¢ °'SN i FENCE S 74°04'10"W 151.65' LOT 15 THE WATER SUPPLY, WELLS DRYWELLS AND CESSPOOL LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS AREA:22,319.05 SQ.FT. or 0.51 ACRES ELEVA77ON DATUM: -----—----—_—_________ UNAUTHORIZED AL TERA 770M OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SECT70N 7209 OF THE NEW YORK STATE£DUCA 77ON LAW COPIES OF 77-IIS 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 INS777UTTON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, 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 ERECT70N OF FENCES, ADD177ONAL S71?UC7URES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF:LOT 16 CERTIFIED TO: JEAN BROWN JOHNSON; MAP OF: EASTERN SHORES AT GREENPORT FIDELITY NATIONAL TITLE INSURANCE SERVICES, LLC; FILED:APR. 27, 1964 No.4021 SITUATED AT:GREENPORT TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 PHONE (681)298-1588 FAX(631) 298-1588 FILE #220-113 SCALE:1"=20' DATE:AUG. 20, 2020 N.YS LI,'C. N0. 050882 maintaintna the records of Robert J.Henneasy&Keemeth M.Raychuh