Loading...
HomeMy WebLinkAbout48765-Z TOWN OF SOUTHOLD � BUILDING DEPARTMENT a 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#: 48765 Date: 1/19/2023 Permission is hereby granted to:. TG3 Holdings LLC 4 Monroe Ave Larchmont NY 10538 To: Construct outdoor shower at existing single family dwelling as applied for. At premises located at: 1 Mulford Ct, Cutcho ue SCTM # 473889 Sec/Block/Lot# 14.-2-1.6 Pursuant to application dated 1/6/2023 and approved by the Building Inspector.. To expire on 7/20/2024. Fees: ACCESSORY $133.60 CO-RESIDENTIAL $50.00 Total: $183.60 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT aTown Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 40 =" Telephone(631) 765-1802 Fax(631) 765-9502 )iit s.r//'vy� w. otit ojdlownli .gowe, Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. N Building Inspector: Applications and forms must be filled out in their entirety. Incomplete R JAN 0 C) 2023 applications will not be accepted. Where the Applicant is not the owner,an BUILDING DEPT. Owner's Authorization form(Page 2)shall be completed. 'MWN 0FS0lITNn1 D Date:10/11/2022 OWNER(S)OF PROPERTY: Name:Timothy Quinn TS-CTM#1000-14-2-1.6 Project Address: 1 Mulford Court, Orient Point, NY 11957 Phone#:717-575-8118 Email:tcquinn@gmail.com Mailing Address: 1 Mulford Court, Orient Point, NY 11957 CONTACT PERSON: Name:Brant Reiner Mailing Address:70 Maxess Road, Melville, NY 11747 Phone#:631-427-5665 Email:breiner@nelsnpope.com DESIGN PROFESSIONAL INFORMATION: Name:Ricardo Romo-Leroux Mailing Address:155 Jermain Avenue, Sag Harbor, NY 11963 Phone#:917-957-2036 Email:ricky_romo@yahoo.com CONTRACTOR INFORMATION: Name:TWO STORIES WOODWORKING, LLC Mailing Address: 2235 South Harbor Road Southold, NY 11971 Phone#:(631) 335-9363 Email:. DESCRIPTION OF PROPOSED CONSTRUCTION ®New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? Dyes IgNo Will excess fill be removed from premises? Dyes *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 R_80 this property? ❑Yes 0 N IF YES, PROVIDE A COPY. IN 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(print name): Brant Reiner (NPV) @Authorized Agent ❑Owner Signature of Applicant: �� Date: 10/17/2022 Ashley L C Marcls yn STATE OF NEW YORK) Notary Public,At 1 w York 0007 SS: Qualified in Suffolk County COUNTY OF Suffolk ) Term Expires August 18,20 Z�,- Brant Reiner (NPV) 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 6e -74�1 �j �q 1 '1/0( Notary Public PROPERTY OWNERTH RIS 'ION (Where the applicant is not the owner) Timothy Quinn residing at 4 Monroe Ave.,Larchmont, NY 10538 I, do hereby authorize Nelson Pope Voorhis to apply on my behalf to the Town of Southold Bl4ilding Department for approval as described herein. 10/14/2022 Owner's Signature Date Timothy Quinn Print Owner's Name 2 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY o Stony Brook,50 Cirde Road,Stony Brook.NY 11790 P:(631)4440365 1 F:(G31)L144-0360 :;.vcdre Ilygnv LETTER OF NO JURISDICTION 12/20/2022 Timothy Quinn 1 Mulford Court Orient, NY 11957 Re: Application#1-4738-04722/00003 Quinn Property 1 Mulford Ct, Orient, NY 11957 SCTM#1000-14-2-1.6 Dear Applicant: Based on the information you submitted, the Department of Environmental Conservation (DEC) has determined that the referenced parcel is more than 100 feet from DEC regulated freshwater wetlands as shown on the survey prepared by Kenneth M. Woychuk, Licensed Land Surveyor, last revised 12/1/2022. Therefore, no permit is required pursuant to the Freshwater Wetlands Act (Article 24) and its' implementing regulations (6NYCRR Part 663). Additionally, the portion of the property located landward of the contour labeled "Top of Bluff', which exceeds ten feet above mean sea level in elevation, as shown on the survey prepared by Kenneth M. Woychuk, Licensed Land Surveyor, last revised 12/1/2022 is beyond the jurisdiction of the Article 25 Tidal Wetlands Act. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661), no permit is required to conduct regulated activities landward of that contour. Be advised, no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all precautions are taken to prevent any sedimentation or disturbance within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the jurisdictional boundary and your project (i.e. a 15' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. This letter shall remain valid unless site conditions change. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. Si cerely„ gran Ackerman. Regional Permit Administrator cc: Nelson Pope Voorhis BOH BMHP File ra I tJE YORK Department o€ nv wnnrn'ra__ u+n riunr Eironmental Conservation YORK Workers' CERTIFICATE OF INSURANCE COVERAGE srA E 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 1a.Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured TWO STORIES WOODWORKING LLC (631) 335-9363 2235 SOUTH HARBOR ROAD SOUTHOLD,NY 11971 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) 47-4075958 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 CONFIRMATION OF COVREAGE 3b.Policy Number of Entity Listed in Box"I a" Z22638-000 3c.Policy effective period 11/21/2022 to 12/31/2023 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,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. s. h , Date Signed 11/21/2022 By (Signature of insurance 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 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 5B 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 form. D13-120.1 (10-17) I Illi�B�a �2ii � �iii1111111 M �dill AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNM) 11/18/2022 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 L 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 ri hts to the certificate holder in lieu of such endorsement(s). '.....PRODUCER CONTACT5:....... TomNAM JSM Brokerage Inc. PHONE 9 �1)765 2777 A taa: 631)765 m2776 15400 Main Road a"MAIL tmurr srnl)rokera e,com INSURER(SI AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: PENNSYLVANIA LUMBERMENS MUT INS 14974 INSURED INSURER B: TRAVELERS INSURANCE CO.OF AMERICA Two Stories Woodworking LLC INSURER C: 2235 South Harbor Road INSURER D: INSURER E: SOUTHOLD NY 11971 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 _Abbtguaft POLICY EFF POLICY EXP LT TYPE OF INSURANCE INSD VdVn POLICY NUMBER JNWP2=J AMMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 191 OCCUR PREMISES(Ea occurrence $ 100,000 MED EXP(Anyone erson) $ 5,000 A 31-T294-01-22 06/03/2022 06/03/2023 PERSONAL&ADVINJURY $ 1,000,000 G✓EN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PRO- LOC $ 2'000'000 GENERAL AGGREGATE JECT PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEOSING.ELIMIT $ �C�Idan4 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY l $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE 7s5,000,000 A X EXCESS LIAR HCLAIMS-MADEJ 31-T294-02-22 06/03/2022 06/03/2023 AGGREGATE $ 5,000,000 DED I RETENTION$ $ WORKERS COMPENSATION PER 0TH_ AND EMPLOYERS'LIABILITY YIN r 3UTE R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? NIA 000W233045 09/28/2022 09/28/2023 •— (Mandatory inNH) '...E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CONFIRMATION OF COVERAGE CERTIFICATE NOG-DEFT CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONFIRMATION OF COVERAGE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured (718)767-9226 Two Stories Woodworking LLC 2235 South Harbor Road Ic.NYS Unemployment Insurance Employer Southold, NY 11971 Registration Number of Insured Work Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured limited to certain locations in New York State, i.e., a Wrap-Up Policy) 47-4075958 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Travelers Insurance Company of America CONFIRMATION OF COVERAGE 3b.Policy Number of entity listed in box"la" 000W233045 3c. Policy effective period 09/28/2022 to 09/28/2023 3d. The Proprietor,Partners or Executive Officers are included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" 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"T'. The Insurance Carrier will also notes the above certificate holder within 10 days IFa policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insuredfrom 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 it earlier. Please Note: Upon the 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: Thomas Murra (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 09/28/2022 (Signature) (Date) Title: Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier: (718)-767-9226 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. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the -entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall riot issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee il'so employed, 2, The head of as(ate or municipal department,board,c<>rnmission oroffice authorized or required bylaw to enter into any contract for or in connection with any work involving the employment<:)f employees in a hamrdous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof dUly subscribed by an insurance carrier is produced in a forni satisfac(my to the chair,that compensation for all employees his been secured as provided by this chapter, C-105.2(9-07)Reverse Scott A. fill � FRZ 5TO�][�l��MAT]E][L RrILDING DEPT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of So u th o l d CHAPTER 236 - STOR WATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) - - - - - — - — - - - - - - - - - - - — - - -- - - — — — - - — — — - - i APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME. . _ � A Date: 1-2- I I I^awr�ilbal wNk�P � {q Contact Information: Ne-Is-74,\ C O r'- ��S LrGi,. e r e net So o,N p 4 i (G-Mail&Telephone Number) / i` 617;( I Property Address / Location of Construction Site: F I �, i-� .� r o e�. S.C.T.M. #: 1000 it q District "( 'r /. I � Slc+on Block Lo f .. I TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Re uired f ;h 0 a Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Re uired I r i l Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly ❑ to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit. ® - Area of Disturbance is Greater than I Acre & Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN 4 „ a S.P.D.E.S. Permit through the Southold Town En ineerin De artment Prior to Issuance of a Buildine Permit. �i �f Reviewed B �.:._.te F(1R MCM('P-T(1C Ortnh tr� CC WR