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Home My WebLink About48857-Z x " 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#: 48857 Date: 2/3/2023 Permission is hereby granted to: Griffin, Carter 11925 Soundview Ave Southold, NY 11971 To: Demolish existing dwelling and construct a new single family modular dwelling with HVAC system as applied for per SCHD approvals. Additional certification may be required. At premises located at: 11925 Soundview Ave, Southold SCTM # 473889 -____ _ ...._....... ...._......................._....._._...._....-.m.� mm.. __ __ Sec/Block/Lot# 54.-5-45.5 Pursuant to application dated 12/6/2022 w and approved by the Building Inspector. To expire on 8/4/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $2,731.60 CO-NEW DWELLING $50.00 DEMOLITION $305.70 Total: $3,087.30 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT r Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 w' Telephone(631) 765-1802 Fax (631) 765-9502 ttl v v srltllo wt rutty m Date Received APPLICA-rm FOR BUILDING REIRIM11" For Office Use Only e PERMIT NO. Building Inspector. '° 210 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 11.17,2022 OWNER(S)OF PROPERTY: Name: Carter and Sara Griffin SCTM# 1000-54-5 -45.5 Project Address: 11925 Soundview Ave, Southold Phone#: (646)263-2118 Email: cartergriffin02@gmail.com Mailing Address: 25 Joralemon st#3, Brooklyn, NY 11201 CONTACT PERSON: Name: Krzysztof Zebrowski Mailing Address: 121 C Main Street,Westhampton Beach, NY 11978 Phone M 631 830 5059 Email: peconicbaybuilders@gmail.com DESIGN PROFESSIONAL INFORMATION: Name: Jeffrey I Butler Mailing Address:PO Box 634, Shoreham , NY 11786 Phone M 631208 8850 Email: jell@butler-ae.com CONTRACTOR INFORMATION: Name: Flanders Renovations Inc BDA Peconic Bay Builders Mailing Address: 121 C Main Street,Westhampton Beach, NY 11978 Phone#: 631287 7010 Email: peconicbaybuilders@gmail.com DESCRIPTION OF PROPOSED CONSTRUCTION ®New Structure ❑Addition ❑Alteration ❑Repair ®Demolition Estimated Cost of Project: ❑Other $ l.2QQIQQQ.QQ --- Will the lot be re-graded? ®Yes ONO Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property: Residential dwelling Intended use of property: Residential 2 story dwelling Zone or use district in which premises is situated:R120 Are there any covenants and restrictions with respect to this property? ❑Yes ®No IF YES, PROVIDE A COPY. ® f��l''iecic IIIIPI ox Afteir Readlftig,'w' 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): Krzysztof Zebrowski ®Authorized Agent ❑Owner Signature of Applicant: Date: // 17. 2Z STATE OF NEW YORK) SS: COUNTY OF Krzysztof Zebrowski being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the contractor (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 ffaT177 6 tr 20 Notary Public AGNIESZKA RENES SOPOLINSKI NOTARY PUBLIC-STATE OF NEW YORK No.01RE6334035 IPI Ii) Illi°t 1l"V` QW�114ER AUIlliH O RIZ tt � Qualified in Suffolk County (Where the applicant�pp Is not the owner) My Commission Expires 12-07-2023 I I� Carter Griffin residing at 25 Joralemon st#3, Brooklyn, NY 11201 do hereby authorize Krzysztof Zebrowski to apply on my behalf to the Town of Southold Building Department for approval as described herein,. Owner's Signa ure Date ��%� �t Vii/✓ Print Owner's Name 2 Scott A. Russell � � Wu SUPERVISOR ,- NI A\N A\�G►]EA\I I E N IF SOUTHOLD TOWN HALL-P.O.Box 1179 " u 53095 Main Road-SOUTHOLD,NEW YORK 11971 /h,1'11---- ° Town of Southold t Q1 . CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: _ .t `y ate: 1Z Ci7-) Contact Iznformr�aef,Qo �satiotz: tE-Aflail&"I elephom Number) Pro ert Address / Location of Construction Site: V S.C.T.M. 1000 District _ Section Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT Area of Disturbance is less than I Acre. No S.P.D.E.S. Permit is Required ed I - Project does Not Discharge to Waters of the State. No SY.D.E.S. Permit is Ra;nnired 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 Buildin Permit, - Area of Disturbance is Cxreater than I Acre & Storm-`,.vater Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of Neuv York. THE APPLICANT MUST OBTAIN _ � _ a S.P.D.E.S. Permit through the Southold Tawn E ;tneernn De _artment Prior Io Issuance of a Building Permit Reviewed By. . '* ` ..... ._ .....�..... w.._........ _ _ ..F'fnRM.�' CMC'r+-T°f 1C (nr-tnhpr 7()1<l Town Half Annex Telephone(631)765-1802 75 Main Rued °7 � �� ,' Fax(631)765-9502 P.d.Box 1179 Southold, NY 11971-0959 o ' BUILDING DEPARTMENT TICSUTILIZATION TRU q® S W A Agygm C4 d C I AMB AwfM prygM y N AEW Y�IM�& Aw CONSON AND TRUCT A"A�' I C �1 ® C li �rmww�m..rmn __....._ ...'.7 wm........_.._._.. ..Y___. Owner: V mm PleaseLocation of Property: _ I 10 . notice (check lic l line): New commercial or residential structure Addition to existing commercial or residential structure ._ Rehabilitation to an existing commercial or residential structure to be constructedr t the subject propertyf ill utilize (check li I line): T (TT) ._,..m_ ...�.... _.mPre-engineered wood constru (PW) _�. .._..... Timber construction (TC) in the following location(s) (check applicable line)- Floor ine):I r framing, including gi rs and beamsO ._ Roof framing (R) ... � Floor and roof framing (FR) Signature: r Name (person submitting this form): ? 2 applicable line): __......_ .� .. ��._._. Owner .. .� Owner representative TrussReql 5.doax EffeMve 1/1/2615 9/7/2022 CARTER GRIFFEN Service To: 11925 SOUNDVIEW AV 11925 SOUNDVIEW AV SOUTHOLD,NY 11971 SOUTHOLD,NY 11971 Customer Project-4:900000155914 Dear CARTER GRIFFEN: This is to advise you that the PSEG-LI electric facilities at the above referenced location have been disconnected and removed off the building structure that is located on the property. Please note that there may still be PSEG LI facilities located within the property boundaries and that NYS law(NYCRR Part 753)requires all contractors to call for a utility locate(NY 811)prior to performing any ground excavation or regrade activity. The call to the 811 Call Center must be done at least 2 business days prior to the start of the work and confirmation of utility marks having been identified must be received from all the facility owners prior to any site work. You must also contact National Grid at 631-348-6150 to procure a letter of demolition associated with natural gas service, whether or not your home or business uses natural gas. If you have any questions regarding the above, please contact Building&Renovation Services at 1-844-341-6378 or via email at BRSLI@PSEG.com. Very truly yours, Katherine Gianelli Building&Renovation Services PSEG LI Evan T. Steffens Nationalgrid Senior Supervisor Gas Customer Connections,NY September 7, 2022 Carter Griffin 25 Joralemon Street, Apt 3 Brooklyn,NY 11201 E-Mail; 102' �� National Grid WO#: T 102499515 Service Address: 11925 Soundview Avenue Southold,NY 11201 To Whom it may concern, This Letter is to advise you that National Grid investigated your request and confirmed that the subject property does not have an active gas service line. By Law, excavators and contractors working in New York City and Nassau and Suffolk Counties must contact New York"811"at least 2 full business days, not including the day of contact, prior to digging by calling "811" or by using the websitehttps:/1Uftwyork- 81 1.com/. This confirmation letter of no active gas service line to the subject property does not relieve the excavator of contacting NY"811". If you have any further questions, kindly contact me at 833-359-0645. Respectfully, 4 rom=o/ r# Evan T. Steffens Senior Supervisor Gas Customer Connections NY 1650 Islip Ave,Brentwood NY 11717 T:833-359-0645 eyan� [(qns is a fte,ra c� , �rr�14 r i;i is a aim a a a as a�� r j /Ok\ NYSIF New York State hisuairance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) A A A A A A 203592246 PROACTIVE BROKERAGE INC 926 SUNRISE HIGHWAY180%%. WEST BABYLON NY 11704 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER FLANDERS RENOVATIONS INC DBA TOWN OF SOUTHOLD PECONIC BAY BUILDER 54375 NY-25 121 C MAIN ST SOUTHOLD NY 11971 WEST HAMPTON BEACH NY 11978 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12172 435-6 574087 11/25/2022 TO 11/25/2023 12/5/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2172435-6, 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:IANWW.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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. KRZYSZTOF ZEBROWSKI, PRESIDENT OF FLANDERS RENOVATIONS INC ONE PERSON CORP 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. NEWYORK STAT S4 71*1 NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 248282167 U-26.3 A CERTIFICATE OF LIABILITY INSURANCE °ATE`MM,°°`Y,"Y, " 12/05/2022 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. : If the ce 1fNca e holder is an ADDITIONAL R e po cy ies must be endorsed. If SU13ROGIT16M 19 WAIVED,subect 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 COWAUT NAME: Walter Gesla Gesla Insurance Agency,Inc AIC,No EAI 631-840-0027 Ext 211 (Arc Ni 2410 North Ocean Ave,#304 ACDR� cowesia net _ " INSURER(S)AFFORDING COVERAGE NAIC# Farmin vllle _......._.. _.._.. m ._. . _ _r NY 11738 INSUR ... ERA: OBSIDIAN SPECIALTY INSURANCE COMPANY 16871 INSURED INSURER B: FLANDERS RENOVATION INC INsuR. .��,... �_.......�_�.mw. _ ......-...............-- _,__�w...._......m...m.�_____ ERC: 121 Main St INSURER D .. _._ . .... ..._ .......... W .. .e...... Apt C INSURER E _-- Westhampton Beach NY 11978-2670 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. q� . ... 'INSD WVD POLICY NUMBE nOCTCYEFF TR TYPE OF INSURANCE """ _.��,_,.,.,..�� _•m R MMIDWYYYY MWDDIYYYYJ LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ..... CLAIMS-MADE El occuRs rn $ 50000 MED EXP(Any one person) $ 5,000 A _ SCB-GL-000020568 12/21/2022 12/21/2023 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,000 POLICYEl LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: ❑ PR4?- AUTOMOBILE LIABILITY ��accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident)" $ AUTOS AUTOS PR3�I MTCYAP1ft „� „ NON-OWNED (Peraccldeml) HIRED AUTOS .AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE .$ ..” _... DED RETENTION$ $ WORKERS COMPENSATIONOTH AND EMPLOYERS'LIABILITY STATUTE ER Y/N mm ANY EACH IDENT OFFICE IME BE PROPRIETOR/PARTNER/EXECUTIVE lEXECUTIVE E.L.DISEASE EMPLOY $ OFFICERIMEMBER EXCLUDED? El N I A (Mandatory ) E $ If yes,descre under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT ,$ ..... DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Rd AUTHORIZED REPRESENTATIVE Southold NY 11971 fa?' � 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r µgat Workers' YORK Compensation CERTIFICATE OF INSURANCE COVERAGE sTArEBoard 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) 1 b. Business Telephone Number of Insured FLANDERS RENOVATIONS INC. D8 A:PECONIC BAY FLANDERS BLVD BUILDER 6318305059 FLANDERS,NY 11901 Work Location of Insured(only required if coverage is specllicallyllmited to 1 c.Federal Employer Identification Number of Insured certain locations In New York State,Le., Wrap-Up Policy) or Social Security Number 20-3592246 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier T6ntV1�N eOF SOUTHOLD ing Listed as the to Holder) Standard Security Life Insurance Company of New York 54375 NY-25 3b. Policy Number of Entity Listed in Box"1 a" Southold, NY 11971 R89142-000 3c.Policy effective period 3/22/2017 to 12/5/2023 4. Policy provides the following benefits: Q A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. ❑ C. Paid family leave benefits only. 5. Policy covers: 0 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 des c` d above Date Signed 12/V/LOLL By of insurance carrier's authoriz re,resentatIve or NYS Licensed I (Signature p nsuranceAgent ofthat insurancecar•vier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES 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. 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