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HomeMy WebLinkAbout48910-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 #: 48910 Date: 2/14/2023 Permission is hereby granted to: Ender, Katherine 11235 Soundview Ave Southold NY 11971 To: Construct in ground swimming pool at existing single family dwelling as applied for. Must maintain a minimum setback of 10 feet to pool and equipment from property lines. At premises located at: 11235 Soundview Ave, Southold SCTM # 473889 Sec/Block/Lot# 54.-5-40 Pursuant to application dated 1/31/2023 and approved by the Building Inspector. To expire on 8/15/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL. $50.00 Total: $300.00 Building Inspector TOWN OF SO OLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax (631)765-9502 r��tti� �a�� o,wutholdtnwonv.�uV I p Date Received 'h Ali,���1")��,,,��'�. A" ����°�I 1 ��m.,��R B j J ��.,'II��N� �,�I ���Em1 R11����1��IF For Office Use only nD F, 6" IF PERMIT NO. Building 0,tspext ag.,„..._ JAN 1 12023 Applications and forms must be filled out in their entirety.Incomplete WIWI%mpr applications will not be accepted. Where the Applicant Is not the owner,an TOWN OFV Owners Authorization form(Page 2)shall be completed. Date:1/27/23 OWNER(5)OF PROPERTY: ...._.._.. �... .. .. Name Katherine Ender and Shoshanah BrowM#1000-54-5-40 Project 000 54 5-40 Project Address:11235 Soudview Ave, southold, NY 11971 Phone#:917-575-7757 Email katherine.ender@gmaii.com Mailing Address:22 Kelly Road, Cambridge, MA 02139 CONTACT PE Name:Jennifer Del Vaglio / East End Pool King Mallin g Address:p,O.box 369 Peconic, NY 11935 ..w.,-.. .,,.,M....... ------ Phone ._.,.� Phone#:631-7634-7600......... Email c�@eastendp.......oolking eom ............. ........... DESIGN PROF SIO INFORMATION: Naone� N/ . Mailing Address: Phone II I mnai CONTRACTOR INFORMATION: Name:East_End Pool King, LLC Mailing Address:p,O.box 369 Peconic, NY 11935 _.... Phone#:6_31 _734-7600 Email:cj@eastendpoolking.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair—❑Demolition _ Estimated Cost of Project:- DOthergunite swimming pool 15x30 ,$,135.000 I be removed from premises? ®Yes ❑No Will the lot be re graded [ Yes LINO Will excess tli .. .. _.....,, . ._ .. .. ............� ., ..., 1 �. ...... ....... ..m.� PROPERTY INFORMAnm Exusdnlg use of property. single familly intended use of property: iau ml ,,, ........... Zone or use district fin wfnic.h prerni.ses k situate& ire there any covenarrit and restdctio ns with r sped to this property �NoW YES, PROVIDE 11 lr COPY, El .._������......._...._,.��.�...»�....� e d.4 rafm i nal is r bane for and .ge and Mim water Issues as hided by Ompter 236 of the'rown Code.APPUGATION M HERBY MADE to dw Rufkft Deparftmmt for Ow Iswance of a rraaddr pwsuanl to the Irares Zone r a"c a of ft Town of SauthoW,Suffok County,New Yot and v9 w appbcabWUw,% anwym. l cw IRwrtaww,n9aareaea for tM cuu1stmCdon of b adigtkws,aftwxUons or fm rwaval or demcWwa as awwdn dnathed.The ngmm:4greez to campapolcabk LuM ordb%anm,buNdft code, houskv code vW vevAhMens and to admit authoitmd inn cm on pnmnbn and Imre W s )for owr2mry IuupocVom FAm sraWwwots made heTMn uuwe rRawwishulhde as sa(3was pwsuant to Sec&m WAS of th#Nm Twk ree ftnef Low. I Application 5rrbr nicked 8 runt narr�ie �ll ""' urtfiari ed IpIGn y�p ��" ir Agent0-Owner Signature of Appfi�°�ant Brown � Axa u�>�re 4 S by a��a�� Date. J nNmr'y 2023 hStn1 �r 19• py r 11141 P Y I • � d �`' STATE OF NEW YORK) ..,.....a f ..� ,, �m•S. CON SN I t- _. _ r Notary Public,Mate of New York ,: CUPy"lyCli No.01BU6185050 C)(,ialified in Suffolk County 1! Comm rssion Expires April 14, 2� � n 1 Brown._ ... . �..... .._. �.._ being dully sworn,dam.wose�s and says that(s)lie is tim appMic�ant and � �r 'fiU"1 i"�1im (Name of indMidual signing colrntraL:)above named, Jennifer III lig IIS ? IEri in L (5)he is the � ,,,,m (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have pen°forlrned the saW work and to make and fife this apfrH ation„that all staterrnernts contained urn this s aplp4c.ation are true to the(nest of his/Ener knowledge and Relief;and that the work wHII be performed in the Irnann•elr set.forth lin the alippiiitatlon file therewith. Sworrn before me this ��..._ day of 20 Notary Public (Where tlrne alpplicant is riot tfie owner) IKatherine Ender, and Shoshanah1125'5 Sou�ndnriew Ave Sou�tl'nold, Y' 119 '1 residingat,,���,��._�..�_.�. ,�..�u.� .�•,,�..�.��� ___.____.�.�.m_._._�,._ ._..do hereby authorize Jennufelr Dee Va Ho(East Ei nd Pool (King 1.i....C�._.�._�'trr reply on my hehaff to the'rown of Southold Bujiding Deplartrnerut:for approval as described her6n. N.WIgMaThlbraB 117 rwnarh�kvau''. Shoshanah BrownData?02301,VJ18,S1,5� 01AW)" "January 30, 2023 wa f� lhel GIr1�R3 End arid S�no�,•ro n�arsah Brown Owner's Sigruature s inat sf Print.Ommerss Name 2 'C CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDnYYv) 116� 11 1111812021 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. It the certl#icate 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 CONNOMI,C'' Barbara Dammers Roy H Reeve Agency,Inc. PHONE (631)298-4700 (631 298.3850 Atc N,e. ) PO Box 54 E-MAIL SS:. bdammers@royreeve.com ADDRE 13400 Main Road WSURER(Sl AFFORDING COVERAGE NAIC q Mattituck NY 11952 INSURER A: CNA Insurance Companies INSURED INSURER B: ContinentalInsuranceCo. 35289 Eastern End Pools LLC,DBA:East End Pool King INSURER c:, Transportation Insurance Co 20494 P O Box 369 INSURER D INSURER E: Peconic NY 11958 INSURER F: COVERAGES CERTIFICATE NUMBER: CL21111815751 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 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. R AVOL SUBIR POLICY EFF Po TYPE OF INSURANCE LTR N POLICY NUMBER MM1DD : MM1DD LIMITS COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 1,000„000' CLAIMS-MADE ®OCCUR PRE141SES IEZ9wo rr rroc. S 100,000 IX Contractual Liability MED EXP An one person) 15,000 A I Y Y 6080837145 11/15/2021 11/15/2022 PERSONAL&ADV INJURY S 1,000„000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY �JE 7 LOC PRODUCTS-COMP/OP AGG 2+000„000 OTHER: AUTOMOBILE LIABILITYI I D S NG”E.LIMIT S 1,,000,000 zu sIntl ANY AUTO BODILY INJURY(Per person) S B OWNED SCHEDULED 6080837159 11/15/2021 11/15/2022 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED PRO PER1YDAMAGE AUTOS ONLY AUTOS ONLY Pagr ar, cit S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ S. WORKERSCOMPENSATIONP R TH AND EMPLOYERS'LIABILITY TATUT ER C OFFICER/MEANY IM EREXCLU ED?ECUTIVE YYN 'N/A 6080837162 11115/2021 11/15/2022 E.L.EACH ACCIDENT $ 11000+000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L,DISEASE-POLICY LIMIT s 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is included as additional insured under General Liability as per the terms and conditions of form#CNA75079XX-Blanket Additional Insured with Products-Completed Operations Coverage Endorsement, Form CNA74705NY-Contractors GL Extension Endorsement,NY includes waiver of subrogation&primary&non-contributory coverages as required by written contract or agreement. Additional insured under the business auto is included under Form#CNA63359XX-Auto Contractors Extended Coverage Endorsement-Business Auto Plus. 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. PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 —­;-gw7L�ZL= ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I uf[I, CONBOY ! 8.61 ACRES Al R-j :GHT OF WAYS, o TS OF RECORD LAND N/F ,h p0 GUARANTEED. MARIA o 4p' PILE ^ , 0s SD EN , _ PORCH SHED LAND N/F 2.s•/s _ CORA G STOLL 3 0>. ` cam 4 , S SHED �. 2.T/W POLE t LAND N/F oyer PIPE EDWIN L o THIRLBY /EYING ,•� .4 POLE � O p, co A A VIOLATION FORS INKED IPS JD TRUE COPY. y , YY IUN ONLY TO BEHALF TO o d ISTITUTION G f iTITUTION. O 1 ADDITIONAL I a __ ✓� 'ANCE COMPANY a - , 13UILUINU DEPT ,.�