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HomeMy WebLinkAbout48794-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#: 48794 Date: 1/25/2023 Permission is hereby granted to: Lentini, David 111 Prospect Park SW Apt 4 Brooklyn, NY 11218 To: Construct accessory garage at existing single family dwelling as applied for. At premises located at: 580 Kouros Rd, New Suffolk SCTM # 473889 Sec/Block/Lot# 117.-6-19.1 Pursuant to application dated 12/22/2022 and approved by the Building Inspector. To expire on 7/26/2024. Fees: ACCESSORY $279.20 CO-ACCESSORY BUILDING $50.00 Total: $329.20 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT 4� ill Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 htt� ://%yW o ffiook ov�:�l . o� Date Received ,APPI.ICA71171014 FOR BU11 I)ING P1.1:11111NAIT For Office Use Only PERMIT NO. � Building lnspector: DEC 2 2 2n22 Lo Applications and forms must be filled out in their entirety.Incomplete sNo999 G DE 'l,; applications will not be accepted. Where the Applicant is not the owner,an WN0FS0D SJR r) Owner's Authorization form(Page 2)shall be completed. Date: December 20, 2022 OWNER(S)OF PROPERTY: Name:David & Leonida Lentini TSCTM# 1000-117-6-19.1 Project Address:580 KOuros Rd, New Suffolk, NY 11956 Phone#:917-386-4628Email:dblentini@verizon.net MailingAddress:PO Box 227, New Suffolk, NY 11956 CONTACT PERSON: Name:David Lentini MailingAddress:PO Box 227, New Suffolk, NY 11956 Phone#:917-386-4628 Email: dblentini@verizon.net wawa..... DESIGN PROFESSIONAL INFORMATION: Name:James A Koppenhaver, P.E. MailingAddress:575 Van Reed Rd, Wyomissing, PA 19610 Phone#:484-794-9949 Email:koppenhaverpe@gmail.com CONTRACTOR INFORMATION: Name: Sheds Unlimited LLC Mailing Address: 2025 Valley Rd, Morgantown, PA 19543 Phone#:717-442-3281 1 Email:office@shedsunlimited.net DESCRIPTION OF PROPOSED CONSTRUCTION RNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $37,000 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? RYes ONO 1 PROPERTY INFORMATION Existing use of property: Yard Intended use of property: Detached garage Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 1 fam residential this property? ❑Yes JRNo IF YES, PROVIDE COPY. Check I,II x After r It 'adi I'i : The owner/contractor/design professlonal 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 bulding(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): David Lentini ❑Authorized Agent NOwner Signature of Applicant: - Date: 12/20/2022 STATE OF NEW YORK) SSS: COUNTY OF S Uu L h ) 1. being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (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 � C � C� 20da of "-411-14-�,&, a Notary Public REBF-CCA A i..UCAK tary Public,-Stare Of New York w mm mm .. F ) A ) brio,01I_U6,186882 tlP �m� " 1 (Where the applicant i5 not the owner) uaaiifi d In Suffolk county y Coinrrni, s�rw :��miry --b,04,2023 I,. residing at do hereby authorize to apply on my behalf to the I own of Southold Building Department for approval as described 'herein. Owner's Signature Date Print Owner's Name 2 0 DATE(MMIDD/YYYY) AC491R" CERTIFICATE OF LIABILITY INSURANCE 12/21/2022 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 NcAQWCT Janice Rleker Lechner&Stauffer, Inc. Pt�NE FAX P.O. Box 26 215-679-9568 A No EMAIL Pennsburg PA 18073 rieke[j'@Iechnerstauffer.com DD INSURERS AFFORDING COVERAGE MAIC# License#:0727475 INSURER A:Atlantic States Insurance Co. 22586 INSURED SHEDUNL-01 INSURER6:Done al Mutual Insurance Co 13692 Sheds Unlimited LLC 2025 Valley Road INSUF! R Morgantown PA 19543 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:247595212 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 L S POLICY EFF... POLICY`EXP IJMITS '''. LTR TYPE OF INSURANCE POLICY NUMBER MIDD Y' M A X COMMERCIAL GENERAL LIABILITY CPA 9480709 1/1/2022 1/1/2023 EACH OCCURRENCE $1,000,_000 r-71 DAMAGE TO CLAIMS-MADE X OCCUR PR ,MNS I RENa o•TtEtx'olro $100,000 MED EXP(/any one person) $5000125000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000 000 POLICY E JE T Fx]LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ m A AUTOMOBILE LIABILITY CAA 9480709 1/1/2022 1/1/2023 COMBINED INGL LNMI $1,000,000 AERAaddlol JX ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED ) AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY'IIAMAGE $ AUTOS ONLY AUTOS ONLY r $ B X UMBRELLALIABI X OCCUR CXL9480709 1/1/2022 1/1/2023 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 OEO RETENTION $ ORKERSGOMPENSATION....... 111 PER OT1=1- AND EMPLOYERS'LIABILITY YIN STATUTE R OF CER/MEMWREXC EXCLUDED'EC'U"rIVE F1 N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If vs,doscribe tondrir - DESGRIPTiON 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of SOuthhold NY ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 PO BOX 1179 AUTHORIZED REPRESENTATIVE Southhold NY 11971 i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD /PkN NYSIF New York Skate Onsurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �I AAAAAA 472659516 SHEDS UNLIMITED LLC 2025 VALLEY RD MORGANTOWN PA 19543 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SHEDS UNLIMITED LLC TOWN OF SOUTHHOLD 2025 VALLEY RD 53095 ROUTE 25, P.O. BOX 1179 MORGANTOWN PA 19543 SOUTHHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE A2080 871-3 637821 07/27/2022 TO 07/27/2023 1.2/21/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2080 871-3, 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:IIWWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STATE 'SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:551060269 U-26.3 NORIK I Workers' CERTIFICATE OF INSURANCE COVERAGE r Compensation YOT 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&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured SHEDS UNLIMITED LLC (717)442-3281 2025 VALLEY RD MORGANTOWN,PA 19543-9649 1c.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 472659516 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Insurance Fund(NYSIF) TOWN OF SOUTHHOLD,NY 53095 ROUTE 25,P.O.BOX 1179 3b.Policy Number of Entity Listed in Box"1 a" SOUTHHOLD,NY 11971 DBL 5826 54-1 3c. Policy effective period 07/27/2022 to 07/27/2023 4.Policy provides the following benefits: N A.Both disability and paid family leave benefits F1 B, Disability benefits only n C. Paid family leave benefits only 5.Policy covers: N A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law F] 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. Date Signed 12/21/2022 By I�'4ld 4 (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number (866)697-4332 Name and Title Kristin Markwica,Head of Disability Insurance Unit IMPORTANT: If Box 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, DB 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. 13113-120.1 (10-17) Certificate Number 715414 S,C,T.M„ NO, DISTRICT: 1000 SECTION:117 BLOCK: 6 LOT(S):19-1 IKpUROS ROAD 0 — _ . sal , I 1s9 .4r bG 4FuWB4NlC _ 4 GXWf N ` mm l Edi �"an4�d LAND N/F OF VIRGINIA V06KINARIAN FAMILY ?D 1.T IRRFVfI(:.4P.IF A LAND N/F OF r b* m""•.• ,. RICHARD FAHEY — 7 vb ,I"♦ Y d � m.imrb rl it �m�r'rm ... LAND N/F OF VICTORIA GERMAISE 5Yq •�� ry LOT 4 AT SUBDIVISION KOUROS ACRES I I LAND N/F OF THOMAS ARENA THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCAIIONS SHOWN ANL hMOM IILLU O89LRVAIIONS AND OR DATA OBTAINED FROM OTHERS. AREA:24,922.46 SO-FT. or 0,57 ACRES ELEVATION DATUM: __..........._.._........ .__.___________. UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS 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 TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF 774E LENDING INS77TU770N, 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 IN7ENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF-,DESCRIBED PROPERTYWe, CERTIFIED TO:DAVID LENTINI, .. MAP OF: d.���A ndr yLpyp J{?,�, FILED: m.w........ .._..�... .�., .... .�... SITUATED AT:$OU TI-OLD � �. TOWN K THOLDKEN� Tjpgr,SNTH M _S ILC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and DesignP.O- Boxe, New w PHONE (881)20N-16813 FAX (681) 'LBB-1668 FILE N222-62 scALE:1"=30' DATE:APRIL 20, 2022 N.Y.S. LISC. NO. 050882 W ti>,�lne Beards of Robert J.11--my k Ke—tn H.xoyeb„><