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HomeMy WebLinkAbout48886-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT r „f 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#: 48886 Date: 2/9/2023 Permission is hereby granted to. Forbes, Susan 1075 Narrow River Rd PO BOX 428 Orient NY 11957 To: install generator as applied for. Generator must maintain minimum 5' setbacks from rear and side yard lot lines. At premises located at: 1075 Narrow River Rd Orient SCTM #473889 Sec/Block/Lot# 27.-3-6.2 Pursuant to application dated 1/25/2023 and approved by the Building Inspector. To expire on 8/10/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 Building Inspector u S11 TOWN OF SOUTHOLD—BUILDING DEPARTMENT it Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 Mips:/"www.soLil:holdtt)wniiy.go v Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only 'D�ive m PERMIT N0. Building Inspector: J0 2 5 2023 Applications and forms must be filled out in their entirety. Incomplete 7 I�@LlFs PT. nnTPnLD applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:January 19, 2023 OWNER(S)OF PROPERTY: Name:Susan Forbes =CTM i000-27-3 & 5 Project Address:1075 Narrow River Road Orient NY 11957 Phone#:917-653-5331 1Email:susanaforbes638@gmail.com Mailing Address:1075 Narrow River Road Orient NY 11957 CONTACT,PERSON; Name:Sean O'Neill Mailing Address:PO Box 64 Jamesport NY 11947 Phone#:631-722-3595 Email:oneilloutdoorpower@hotmail.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone# Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: Email: DESCRIPTION,OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: EOtherGenerator $16,000 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes 5RNo 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 witl, 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 Cade. 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,buliding 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 pass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print nam Sean O'Neill Authorized Agent ❑Owner Signature of Applicant: Date: January 20, 2023 CONNIE D.BUNCH STATE OF NEW YORK) Notary Public,State of New York SS: No. 01 BU6185050 COUNTY OF Suffolk ) Qualified in Suffolk County Commission Expires April 14, 2�a L Sean O'Neill 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 aµ day of , 202 0 Notary Public PROPERTYT I I N (Where the applicant is not the owner) I, Susan Forbes residing at 1075 NarrowRiver Road Orient NY Sean O'Neill do herebyauthorize .o apply on my be to the Town of S thoid Building Department for approval as described herein,. j� I January 20, 2023 Owner's Signature Date Susan Forbes Print Owner's Name 2 � tf°fit BUILDING DEPARTMENT-Electrical Inspector " . TOWN OF SOUTHOLD �r Town Hall Annex - 54375 Main Road - PO Box 1179 ° Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 dP, put gldtownny.gov' APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INF MATION (All Information Required) Date: - Company Name: , Name: i ,- License No.: - email: Q, d 7 3 45; ,," Address: / ,' / V`�. r" "' Phone No.: JOB SITE INFORMATION (All Information Required) Name: Address: O Cross Street: Phone No.:_ I — 3" Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: ? — BRIEF DESCRIPTION OF WORK Peas Clearly)(Please Print !/ Circle All That Apply: Is job ready for inspection?: YES / P Rough In Final Do you need a Temp Certificate?: YES / 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 Request for Inspection FormAs - ► = CERTIFICATE OF LIABILITY INSURANCE -AT�Dl T 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 be endorsed. If SUBROGATIONIS 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 CONTACT USAA INSURANCE AGENCY INC/PHS 65812845 PHONE (888)242-1430 FAx (A/C,No,Ext): (A/C,No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio,TX 78251 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Hartford Insurance Company of the 37478 TRYAD PLUMBING&HEATING INC INSURER A: Midwest 1350 COX NECK RD Property and Casualty Insurance Company 34690 MATTITUCK NY 11952-1450 INSURER B of Hartford INSURER C: Hartford Underwriters Insurance Company 30104 INSURER D S INSURER E; INSURER F: ` COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ww_ww_ww_� � ww THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI Z POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEI,T 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000'.. CLA IAS-MADEOCCUR DAMAGE TO RENTED $300,000 PR l , o c .nre X General Liability MED EXP(Any one person) $10,000 A 65 SBA NE7099 07/19/2022 07/19/2023 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,0 POLICY II X II JECT PRC- LOC PRODUCTS-COMP/OP AGG $2,000,000 L ....9 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 r ANY AUTO BODILY INJURY(Per person) C ALL OWNED r SCHEDULED AUTOS AUTOS 65 UEC UW5400 07/19/2022 07/19/2023 BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) JUMBRELLA LIAB OCCUR EACH OCCURRENCE CESS LIAB CLAIMS- AGGREGATE MADE O RETENTION$ WORKERS COMPENSATION PEf OTH- AND EMPLOYERS'LIABILITY X S'TATU"I E'. R ANY YIN E.L.EACH ACCIDENT $500,000 B PROPRIETOR/PARTNER/EXECUTIVE rI'� N/A 65 WEC GA6886 07/19/2022 07/19/2023 v OFFICER/MEMBER EXCLUDED? L E.L.DISEASE-EA EMPLOYE $500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONSbelow DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Those usual to the Insured's Operations. CERTIFfCATE HOLDER CANCELLATION__ The Town Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 53095 MAIN RD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED SOUTHOLD NY 11971-4642 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7 ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD N' YS I F New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) CJ. m- •0 ^^^A^A 471592478 UNIVERSAL ELECTRICAL SERVICES,LLC 151 FIRST AVENUE rm�nnl ' MASSAPEQUA PARK NY 11762 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER UNIVERSAL ELECTRICAL SERVICES, LLC SOUTHOLD BUILDING DEPARTMENT 151 FIRST AVENUE 54375 MAIN ROAD MASSAPEQUA PARK NY 11762 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2449 563-2 291109 07/16/2022 TO 07/16/2023 9/20/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2449 563-2, 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://IMWW.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 CEF?rIFICATE 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 S7�v NCE FUND . DIRECTOR,MSURANCF FUND UNDERWRITING VALIDATION NUMBER:823317445 U-26.3 2 UNIVELE-02 BEGEI1 1 DATE(MMIDDIYYYY) CERTIFICATE OF- LIABILITY INSURANCE 9/20/2022 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 ® _ ,QCT Ellen Goldman(egoldman a@butwin.com) twin any,Inc. I 4213 t 1024l fNo).(516)466 _-4200 ANathan NY ss ino@butwin.com _ INSIJR k(,Sy AL p u IV!N,VDVING COVERAGE _ _ NAIC# INSURERA:Utica First Insurance Co. 15326 INSURED .. - INSURER B: -._. ..... ._ .... ....... ..._ Universal Electrical Services LLC INSURERC: 151 First Avenue INSURER D Massapequa Park,NY 11762 ; INSURER E: 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. PE OF INSURANCE 111 P( ` ,E._ __ ......_.. ....._- A&WDLfSUBRi POLICY " POLICY NUMBER ACOMMERCIAL PO P ,LLIMBS GENERAL LIABILITY S ' ,1 000 000 EACH OURRENOE,_- _ ..., OCCUR I ART3000425430 8/2012022 8/20/2023 }DAMAGE TO RENTED 50,000 CLAIM&MADE X..f PREMISES,.(Easarcurno )_11$11 .-.. ._....-. ME�roEXP.IAnygncrPPJ $._ 1,000 PERSON4,s ADS a alaY„ 1,000,000 GEM'LAGGREGATE LIMIT APPLIES PER;. 2,000,000 P CaEhWEFiAL,AGRE_OAGE ,,,. .!$,. X 1 POLICY J T [ LOG „&?RC7C1h.,W T$ ,CC7�aGPJI„P,AI„Ghw2,000,000 ...... OTHER: ... ..-- ? 1 (g AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO OWNED .,,.,SCHEDULED : aQ ILYINJURY(Pe¢,per n)__�:._ _.... _ .. AUTOS ONLY IAUTOS,,.. so IL INJl��BY(_P�radenRp„5..... HIRED 'Nail- N PROPfTM �AMACE AUTOS ONLY :AUT00Perc arc rc7 mt_._ .._ S -- I UMBRELLA LIAB OCCUR LACH OlC,1.lRdLNCE. ,wS EXCESS LIABN 1 CLAIMS-MADEI AGGREGATE_ _4 DED L....... l RETENTION$ S .._... WORKERS COMPENSATION PER 07H- AND EMPLOYERS'LIABILITY Y/N STATUTE '...ER .. ANY PROPRIETORIPARTNER/EXECUTIVE I—_I EL.EAC'HACCBOENT;,,,,,, ,5.,_,,, (Mandatory n NHR EXCLUDED? N/A - EX,DISEASE•EA EMPLOYEE$ If yyam.describe under ... ,® .e, ..�. OE:SCRtl_jON OF OPERATIONS below ' F E.L DISEASE-POLICY LIMIT i S i i DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) ,RTlFI!;ATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) Y. ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Aa EW' �y ,< workers'uensati°n CERTIFICATE OF INSURANCE COVERAGE +Oorrt BD,,T. 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 carrie .................. ....._ _... 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured UNIVERSAL ELECTRICAL SERVICES LLC 516-850-7776 151 1ST AVENUE MASSAPEQUA PARK,NY 11762 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 471592478 ...._._�_ 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 Southold Building Department 3b.Policy Number of Entity Listed in Box"1 a" 54375 Main Road DBL537882 Southold, NY 11971 3c.Policy effective period 07/09/2022 to 07/08/2023 4. Policy provides the following benefits: Pfl' A.Both disability and paid family leave benefits. r 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. Date Signed 7/12/2022 By (Via ge (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 ExecutiveOfficer 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 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-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 111111111�!°°1°°11°°1°1°11°°1°°°111°111111 Additional Instructions for Form D13-120.1 By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage (Certificate)to the entity listed 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 cancelled 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 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 NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits 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 Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) 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 employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first,two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. 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 disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and 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 form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (12-21)Reverse S.C.T.M. NO. DISTRICT: 1000 SECTION:27 BLOCK: 3 LOT(S):6.2 Q AREA o N$ a PROPOSED PROPERTY LINE TO BE CONVEYED. o� 19, 4,730 SQ.FT. Lu L 7' p PROPOSED LAND N/F OF o WELL O POOL EQP. COHEN EXISTING LOT COVERAGE OE IN EXIST. SHED LOT AREA: 16,447 S.F. DWELLING W10ECKS: 2729 S.F. 1V EXISTING PROPERTY LINE SHED: 140 S.F. EXIST. TOTAL: 2869 S.F. or 18.057 PROPOSED POOL: 420 S.F. LP GAS Aj 28'4,--,-TT �' � EXISTING PROP. TOTAL: 3289 or 20.0% 'j x x x Q SHED, SEPTIC LOC, PROP. POOL a N 67°18'10"E _ Y. x RA1X x _ a - >157.62' LAND N/F OF N x X x n �`Y•, X X x m _ �- �T LP D W. ELIZABETH HOLTZMAN o * # x x -GRAVEL PROP D .; 0 8.3' 213� GENERATOR� 52.9 z PROP. °' POOL WASTE WATER D '© ' DWELLINGDRYWELL ti 1025 _:_ 23 3' 50'MIN FROM WELL o 20'MIN FROM L,P. 12.5'° CONC. m H g 8.3 308' _a DECK - LAND N/F OF "3 0 -. -. - SUTTER 237.70' ROOF OVER GRAItEL WALK m N GRAVER m (� DRIVEWAY O REVISED 01-25-23 - S 71-46'40,,W _ THE WATER SUPPLY, PELLS DRYI/EZLS AND CESSPOOL HEDGE - - LOCA71pVS SHOIW ARE FROM FX70 CBMRVA77ONS om AND OR DATA OBTAINED FROW OTHERS 148.72, AREA:16,447 S.F. or 0.38 ACRES flEVAnaN DATUM: - LWAUTTI06I7ED ALTERAnON OR AO "0W M INS SURVEY IS A YIDLARON Of SECnLN 7209 DF IN'NEW mgrs SLATE EDUCATION LAW CWWS OF RR5 smVTEr NAP NOT REARING THE LAND S/RvirmRS ENDOSSED SERI.SNALI NOT DE 2mUwERED TO ar A VALID TRUE"yGUARANTEES TNDLCATEO NEREQV SHALE RUN CNLY>o ,,PERS FOR NI/OLI ITN'SURVEY IS PREPARED AND DN NIS BEHALF M INE"TIE COMPANY,DYIVERNNENTAL AGENCY AND LENONG NSDTUITOVT NARROW RIVER ROA.O USIED NEREOV.AND M THE AS9GNEE5 DF n/E LENLVA'G INSnIUnON,GUARANTEES ARE NOT TRAxsIEwAB(e. THE OVTSM OR OWENSIOVS"M NE GN IRON n PROPERTY LINES M THE 57RUCIURES ARE FOR A SPEORC PURPOSE AND USE TNEADT THEY ARE NOT WTEND TO NONLWENT INE PROPERTY UNES OR M GUIDE THE ERECTM OF nNG'S ADOTTTCNAL SIRUCnJRES OR AND O HER WPROVENENTS EASEAIENiS AND/OR SITBSURFACE SMUG LINES RE004I1:3 OR UNRECORDED ARE NOT GUARANTEETI MR.ESS tvimcALLY rminr DN ME PRE SES AT THE WE OF SURVEY SURVEY a: DESCRIBED PROPERTY CERTIFIED TO: SUSAN FORBES; MM OF: -..----.. FILED: - STUAND AT: ORIENT TOW OF: SOUTHOLD ggNN=Td ItOYC831E LAND SURV6YB30,PLLC SUFFOLK COUNTY, NEW YORK proleadond Land Surveying and Design SUP. --- !� ✓ P.O.Dar IDS Aquebogee,Naw York 11891 FILE j 222-120 SCARE:1 =20'DATE SEPT. 1, 2022 N.Y..a USC.NO.050m Poo"(0.1t1P9a-leas PAI(0.11)Aga-.—