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HomeMy WebLinkAbout48573-Z .'m TOWN OF SOUTHOLD Ott 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 #: 48573 Date: 12/8/2022 Permission is hereby granted to: ivinetto. Ralph .. ................... 821 BowlingwnGreen Dr _..__..__.......................... __ ..... Westbury/ NY 11590 _._... .� _ _m ........ �6 d To: Construct additions and alterations to an existing single family dwelling as applied for. At premises located at: 2595 Wells Ave, Southold SCTM # 473889.................................................................... ............... .....------ ....--- ................................................................. ._...__..._�_�_ Sec/Block/Lot# 70.-4-17 Pursuant to application dated 10/5/2022 and approved by the Building Inspector.. To expire on _ ._6./8/2024,ww m Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $228.00 CO-RESIDENTIAL $50.00 .........--.....----.._..-_.-$278 Total: .00 .... .,� Building Inspector sQC a r 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 littla ://WNNIW,SOLttIloidtow vi t . ',(,rv,. u hR Date Received BUILDINGAPPLICATION FOR For Office Use Only " PERMIT NO, 3 gInspector:—J& V..��,u� 0d ,' 0 Building Applications and forms must be filled out in their entirety. Incomplete E`,9G.Or- applications will not be accepted. Where the Applicant is not the owner,an TOS' Owner's Authorization form(Page 2)shall be completed. Date: j $ OWNER(S)6FPROPERTY: Name: -1000- 070 ` C3.4 - 017 0-0 6 ) e. Project Address: 'L5a)5 welly venue,nye, � tJtbo)� �-7 Y 1 Phone#: / L� l o� - 1 EmaI,v e7To �� V Fr29Zvni ; iV e�' Mailing Address: 'ZrMS Wells Avenue Sou-t-WJ l toll CONTACT PERSON: r Name: J, A f ( V t q + �J e 2 Mailing Address:- ?glam' 1' oaf -S �+ e f O ° q Phone# "! G) a 7 2-1 `� Email: —T V 0V IfV e- TTS --�' "� l' Zoe"' N DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: , 21 MVI-1-774cl Phone#: 16 : Email: a . @ zJf1 CONTRA OR INFORMATION: Name: C LJ SC� (ke- i�E� �o � �L1" Ii0e" N Mailing Address: II N .� �- ��� JN b R 4 !m a Phone#: q � �� Email: �p2i(; SGI c1� G(1 X31 µ.. DESCRIPTION OF PROPOSED CONSTRUCTION CIO ❑New Structure w A � ddition ltes'ation ❑ Estimated Cost Repair ❑Demolition f Project: ❑Other Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? Dyes Rflo 1 PROPERTY INFORMATION Existing use of property: Res I��Ace Intended use of property: r"&5i clerGp Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to 12'_ 40 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 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, M Application Submitted BY qnt name): ❑Authorized Agent W,61wner name Signature of Applicant Date: STATE OF NEW YORK) SS: COUNTY OF being duly sworn, deposes and says that(s)he is the applicant (Name of indi dual signing contract) above named, (S)he is the e 6J AlC2 (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 a?- Notary Public Kathleen Bruno PROPERTY OWNER 4lotary Public, State of New York No. 0I BR6343362 (Where the applicant is not the owner) Qualified in Nassau County !/ Commision Expires 06/06/20 T i, residing at do hereby authorize to apply on MY- a the Town of Southold Building Department for approval as described herein.. "ner"sture Date Print Owner's Name 2 0 Generated by REScheck-Web Software N/* Compliance Certificate Project Addition/Alteration @ 2595 Wells Avenue, Southold, NY Energy Code: 2018 IECC Location: Southold, New York Construction Type: Single-family Project Type: Addition Climate Zone: 4 (5572 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 2595 Wells Avenue Ralph Vivinetto james elberfeld Southold, New York 11971 2595 Wells Avenue James Elberfeld RA AIA Southold, NY 11971 21 arielle court islandia,New York 11749 6318063488 arkij@optonline.net Coral hao cep O,O%lBe tier Than Corfu: Maxtlr iuirvn dib. 24 YoudrUA4 MaX&Mrn SBfGa';°, 0.40 Your SIhNGCn 0.30 The l Better or worse Than Code Index reflects how those to co mupnOpzvuce the house rs based on code trade-off roes, kt DOES Nor prove de an estirnate of energy use or cost re adve to a cv Wrruaruror-cocde honne. SUraUf-trn... rade tradeoffs,airera I uc longer coin sudered �I a the UA or performance cezm phance path in RCESch eck, Each sO alb-tan grade as ern Ny in the specified t.:gorrruate zone must, meet the ra*6rnurn energy code aero.=..,Oata olra R-vah.ae and depth uerpu4o erroen s. Ceiling: Flat Ceiling or Scissor Truss 549 38.0 0.0 0.030 0.026 16 14 Wall: Wood Frame, 16" o.c. 56 19.0 0.0 0.060 0.060 3 3 Window:Vinyl Frame 11 0.250 0.320 3 4 SHGC: 0.30 Floor:All-Wood Joist/Truss 54 30.0 0.0 0.033 0.047 2 3 Compliance Statement. The proposed building design described here is consistent with the building plans, specifications,and other' calculations submitted with the permit application.The proposed building has been designed to meet,the 2,018 IECC requirements in REScheck Version : REScheck-Web and to comply with the mandatory re uirerrnents listed in the REST° .cis Inspection Checklist. gWeTI?,t e Sunatu C1ate Project Title: Addition/Alteration @ 2595 Wells Avenue, Southold, NY _..- ..mm Report04/13/22- m �. a ort date: Data filename: Pagel of 1 Workers' Y0111 'Compensation CERTIFICATE OF INSURANCE COVERAGE 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 EW SCii llM"FFI!'�CONTRACIMNG 631 .495-.5039 3,BAY1E1,ERRY1'-AINE SWTHTOWN,NY 1178_7 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 113200312 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carder (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company T1C.,)WN OF SOUTI-101 D 54375 MAP14 RD 3b.Policy Number of Entity Listed in Box"l a" PO �BOX 1179 DBL406410 S S UJTHOLD, NY 11971 3c.Policy effective period 04/2.3/2022 to 04122/2023 4. Policy provides the following benefits: X A.Both disability and paid family leave benefits. F.] B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: A.All of the employees employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employees 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 described above. Date Signed 10/4/2022 By (Udd, ht (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-4,000 Name and Title Rchard WNte, CNef Exemiti've Offie(air 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 carder,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 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-12a 1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 11bIINii—iwrii�i1iiiiii1 �wiiil1 �. a DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 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 rl hts to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lisa Mare ..__.... ................ . .................... Aspen Agency Inc PHONE 631-4711-7575 q,No),(q l)389.243°9 191 Ronkonkoma AveORE lispoaspe ny.co _,.n. Ronkonkoma, NY 11779INSURE,,,,,,,IR S,IT)AFFORDING COVERAGE NAIC# _ www---- ...... ........ .... ...._. INSURER A: ..�. ...,. �a�. �. I .,.e._..................... INSURED EW Schaefer Contracting Inc INSURERS: ................ ... ..-. -_ ..�... ,,. Eric Schaefer INSURERC` 3 Bayberry Lane INSURERD: Smithtown,NY 11787 ""S" E E INSURER F;. COVERAGE'S C'ERTIFI'CATE NUMBER: 00001671-441980 REVISION NUMBER. 36 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. . 0 F INSURANCE ....W.. 6... .......�. iNBR TYPE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MIMMO A X COMMERCIAL GENERAL LIABILITY Y ART3000257420 05/16/2022 05/16/2023 EACH OCCURRENCE $ 1 000 000 �AM9GE_rTiEN't�- . _....... ..,,ms.. _a ..,�CLAIMS-MADE OCCUR PREMISES,,�Ea_yr�rurrgQ q),......�,,,-„_„ 1wl4ll0 MED EXP(An one Qerson)ww_ $... .... _ 5000 .^ _..�.-.......--_.......�.._.. PERSONAL&ADV INJURY 8 ...... 1¢000,000 GEN'L AGGREGATE LIMIT IMI�..._ GE ..a. X POLICY _._ DMITAPPLIESPER: GENERAL AGGREGATE $ 2000,000 ,. PRO- LOC _.. P AGG $ 2 000 OOO LOC PRODUCTS-COMPIO m,m,�mm„ „�n OTHER. $ AUTOMOBILE LIABILITY J �0SING'Lk LtMfT $ OfuGE3VNECY ........ .. _..._...,..-._... . ANY AUTO BODILY INJURY(Per person) $ OWNED -..., SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY UTOS AUTOS ONLY ,....,,; AUTOS ONLY IIDOGE $ HIRED NON-OWNED PROPERTY $ UMBRELLA LIAR OCCUR .EACH OCCURRENCE $ ............. m_ EXCESS L1AB CLAIMS-MADE AGGREGATE $ 'DED RETENTION$................,_.,.... ... ,_..,,,,..,, ...,.�—.. . .....w..-....... ..... $ WORKERS COMPENSATION AND EMPLOYERS'LIABWTY YIN 7AT. „EfiH.. ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? N/A ''........(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ .......................��___ Ifes,describe under DESCRIPf 1ON OF OPERATIONS below E.L DISEASE-POUCY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED FOR GENERAL LIABILITY UNDER BLANKET ADDITIONAL INSURED ENDORSEMENT,AS REQUIRED BY WRITTEN CONTRACT CERTIFICATE HOLDER CANCELLATION _ _ _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF SOU I HOLD THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 54375 ROUTE 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1179 Southold, NY 11971 'AUTHORI�RESENTAxI us ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by LIS on 10/04/2022 at 10:54AM S I F PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) d AAAAAA 113200312 E W SCHAEFER CONTRACTING INC 3 BAYBERRY LANE ■i SMITHTOWN NY 11787 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER E W SCHAEFER CONTRACTING INC TOWN OF SOUTHOLD 3 BAYBERRY LANE 54375 MAIN ROAD SMITHTOWN NY 11787 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11107 353-3 369034 02/18/2022 TO 02/18/2023 10/3/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1107 353-3, 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 13 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. ERIC SCHAEFER,PRES. E W SCHAEFER CONTRACTING,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. NF1A/Y(1PK RTAT SU NCE FUND ry DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER:247062405 U-26.3