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HomeMy WebLinkAbout48920-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT i T 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 #: 48920 Date: 2/15/2023 Permission is hereby granted to: Hei I Fc� amity Trust PO BOX 32 Peconic NY 11958 To: Install wall mount mini split units at existing single family dwelling as applied for.. At premises located at: 3651 Soundview Ave Peconic SCTM #473889 Sec/Block/Lot# 68.-1-14.2 Pursuant to application dated 2/3/2023 and approved by the Building Inspector. To expire on 8/16/2024. Fees: ACCESSORY $200.00 CO-RESIDENTIAL $50.00 Total: _ $250.00 Building Inspector saz, V 11P " o TOWN OF SOUTHOLD—BUILDING DEPARTMENT q, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 as Telephone (631) 765-1802 Fax (631) 765-9502 littos,://www.souttioldtowiltiy.go,v Al Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only u... PERMIT NO. Building Inspector. I(� 0 3 '423 D=r, i Applications and forms must be filled out in their entirety.Incomplete ,WN!l3� p' fi WN fly S0I1TH0LV applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date:2/3/23 OWNER(S)OF PROPERTY: Name:Constantine & Sofia ZachariadisscTM# 1000-68 - 01 - 14.2 Project Address:3651 Soundview Avenue, Peconic, NY 11958 Phone#:973-725-8501 Email: GZachariadis@gmaii.com gmail.com Mailing Address:66 Woodland Rd., Glen Head, NY 11545 CONTACT PERSON: Name:Constantine G. Zachariadis Mailing Address:66 Woodland Rd. Glen Head, NY 11545 Phone#:973-725-8501 Email:CGZachariadis@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:N/A Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Traditional Air Conditioning Systems & Service Mailing Address:32 E. Carl St., Hicksville, NY 11801 Phone#:516-932-2020 Email:ray@traditionalac.com DESCRIPTION OF PROPOSED CONSTRUCTION ,D rnolition Esti- -- = Project: ❑New Structure ❑Addition LJAlteratlon ❑Kepalr IJuern�ii�wi, FctimatPd Cost Of PrOI ❑' Other Installation of Ductless Air Conditioning System 20,000 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes ANo 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? Dyes BNo 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 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 210AS of the New York State Penal Law. Application Submitted By(print ame):Constantine G. Zacharladis ❑Authorized Agent ®Owner Signature of Applicant: Date: 2/3/23 STATE OF NEW YORK) 1 SS: COUNTY OF 141M YtRk ) 771rJt G. being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the Pi . nJcIm owm (Contractor,Agen(, 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 � J day of 20�� , Notary Rublic Alexander B.Breton AUTHORIZATIONPROPERTY OWNER Notary Public-State of New York (Where the applicant is not the owner) No.OMR63ss312 Commission Expires 12/31/2026 residing at do hereby authorize to apply on r �_ f Southold Building P1..pairt....ent for I de.�atrlbed herein my behalf t0 the IUV1%fl UI JUUIIIVIU DUIIUIIIb' LJC L/Ol 11116111 IVB approval o.i Owner's Signature Date Print Owner's Name 2 Suffolk County Dept.of mer Affairs ' This license is the property of Suffolk County Labor,Licensing .51 Department of Labor,Licensing&Consumer Affairs. Possession of this license does not guarantee its validity. HOME IMPROVEMENT LICENSE Additional Business Name Name License Category RAYMOND MCDEVITT H12-Duct Work 0oww"arr" Business Name his certifies that the earer is duly licensed TRADITIONAL AIR CONDITIONING INC y the County of suffolk License Number:H-42053 Rosalie Drago Issued: 05/17/2007 Commissioner Expires: 05/01/2023 %r Suffolk County Dept.of This license is the property of Suffolk County Labor,Licensing&Consumer Affairs / Department of Labor,Licensing&Consumer Affairs. Possession of this license does not guarantee its validity, RESTRICTED PLUMBING Additional Business Name Name License Category RAYMOND MCDEVITT RP1—HVAC Business Name its certifies that the parer is duly licensed TRADITIONAL AIR CONDITIONING INC the County of suffolk License Number: RP-42817 Rosalie Drago Issued: 05/17/2007 Commissioner Expires: 05/01/2023 Suffolk County Dept.ofThis license is the property of Suffolk County Labor,Licensing&Consumer Affairsi 4l Department of Labor,Licensing&Consumer Affairs. Possession of this license does not guarantee its validity. , ; Additional Business Name RESTRICTED ELECTRICAL LICENSE Name License Category RAYMOND MCDEVITT RE1—HVAC Business Name s certifies that the arer is duly licensed TRADITIONAL AIR CONDITIONING INC the County of suffolk License Number:RE-42768 Rosalie Drago Issued: 05/17/2007 Commissioner Expires: 05/01/2023 /700-NIIN� NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 113387560 HAMOND SAFETY MANAGEMENT LLC 6800 JERICHO TURNPIKE lRol -*A0,h., SUITE 105W SYOSSET NY 11791 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TRADITIONAL AIR CONDITIONING INC CONSTANTINE& 32 EAST CARL STREET SOFIA ZACHARIADIS HICKSVILLE NY 11801 3651 SOUNDVIEW AVENUE PECONIC NY 11958-0959 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 1227 095-5 1 757213 01/01/2023 TO 01/01/2024 1/31/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1227 095-5, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE DOES NOT APPLY TO THOSE JOB SITES WHICH ARE COVERED BY OTHER INSURANCE AND ARE SPECIFICALLY EXCLUDED BY ENDORSEMENT. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 STAT S7,*,NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 198165038 u-96.3 N I T New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 113387560 HAMOND SAFETY MANAGEMENT LLC 6800 JERICHO TURNPIKE SUITE 105W SYOSSET NY 11791 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TRADITIONAL AIR CONDITIONING INC TOWN OF SOUTHOLD 32 EAST CARL STREET 54375 MAIN ROAD HICKSVILLE NY 11801 P. O. BOX 1179 SOUTHOLD NY 11971-0959 POLICY NUMBERCERTIFICATE NUMBER POLICY PERIOD DATE G1227 095-5 T 757197 01/01/2023 TO 01/01/2024 1/31/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1227 095-5, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE DOES NOT APPLY TO THOSE JOB SITES WHICH ARE COVERED BY OTHER INSURANCE AND ARE SPECIFICALLY EXCLUDED BY ENDORSEMENT. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 STAT SU NCE FUND DIRECTOR,INSU RANCE FUND UNDERWRITING VALIDATION NUMBER: 808999748 11-963 A ,�..... CERTIFICATE OF LIABILITY INSURANCE =DATEYYM G 3 THIS CERTIFICATE IS ISSUED AS A IIAATTER OF INFORIwIATiON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMIEND,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 SU IMPORTANT- If the OertlIVED,holder is an+4DDITIONAL INSURED,the palicy(Ie3)must have ADDITIONAL INSURE'CI 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 ettprssmerlt( ),, PRODUCER Cotgreave Insurance Agency,Inc. NAME; Diana Maddox (631)981-5400 558 Portion Rd. PHONE No).. (631)981-5448 A IDRESS, dmaddDx@get-insured.com Ronkonkoma INSURER(S)AFFORDING COVERAGE NY 11779 NAIL# INSURED INSURER A: Ohio Security Ins CO 24082 Traditional Air Conditioning Inc. INSURER B: The OhiD Casualty Ins Co 24074 32 E Carl St INSURER C: AXIS Specialty U INSURER D a Hicksville INSURER E: NY 11801 COVERAGES INSURER F, CERTIFICATE NUMBER: 22-23 Master ND((CAT DCNCITTWITHSTANp N AN IES OE INSURANCE LISTEt7 BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDAtR VI SION IIE OBER» REQtJIREMEdVT,TERM OR CONOITIOIN OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TOW CH 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. LTR TYPE OF INSURANCE IN COMMERCIAL GENERAL LIABILITY POLICY NUMBER MMMO M1M XP LIMITS CLAIMS-MADE FX_1 OCCUR EACH OCCURRENCE $ 1,000,000 PREMISES:Ea occurran $ 300,000 BKS59564347 MED EXP(An.eme pureen) 5 15,000 03/01/2022 03/01/2023 $ 1,000,000 POLICY ATELIMITAPPLIESPER: PERSONAL BADVIN„p!URY GEN'LAGGREN P COT- Loc vENERAfl AGGREGATE S 2,000,000 OTHER, PRODUCTS-COMP/OPAGG $ 2,000,000 AUTOMOBILE LIABILITY Owners or Lessees $ X,ANYAUTO E acINEDSINGL .. VIanItT $ 1,000,000 A OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS BAS59564347 HIRED 03/01/2022 03/01/2023 BODILY INJURY(Peraccdent) AUTOS ONLY NON-OWNED AUTOS ONLY PR PIE:DAM E Per aecldant $ " UMBRELLA LIAB OCCUR PRVF $ B EXCESS LIAB 0 CLAIMS-MADE-MADEUS059564347 3/01/2022 03/01/2023 EACH OCCURRENCE S 5,000,000 DED X RETENTION$ 10,000 AGGREGATE 5,000,000 WORKERS COMPENSATIONAND EMPLOYERS'LIABILITY Y/N S ANY PROPRIETORy''P,ARTNERIEXECUTWE 'STAT E ERH- OFFICER?MEMSER.EXCLUDED? N/A (Mandatory In NH) E.L.EACHACCIDENT $... XI Yes dascribe under OESORIPTION OF OPERATIONS below EeN,DISEASE-EA EIuIPLOYEE $ C . Professional Liability E.L.DISEASE'. POLICY LIMIT S Cyber Liability P-002-00003070 08/01/2022 09/01/2022 $3,000,000 each claim $10,000 Retention DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 107,Additional Remarks Schedule,maybe attached If more space Is required) RE:Constantine&Sofia Zachariadis,3651 Soundview Ave.,Peconic,NY 11958.Certificate Holder is listed as additional insured as per written contract, subject to the terms and conditions of the policy. 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-Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Annex 54375 Main Rd. P.O.BOX 1179 .AUTHORIZED REPRESENTATIVE Southold NY 11971 �. Kew. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD;"1988-2015ACORD Cf iRPC1RATION. All rights reserved. <N01, l workers' CERTIFICATE OF INSURANCE rt Compensation COVERAGE Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1,To be completed„��by NYg disability and Paid�FamilyITLeave benefits tarn� _ �� _WW�`-"WW- -`"�""`�"" —�----- m �c agent of that carne 1a. Legal Name&Address of Insured(use street address onl � �"' Y) 1 b. Business Telepho a umbe oe insu edranc TRADITIONAL AIR CONDITIONING INC 516-932-2020 III32 EAST CARL STREET HICKSVILLE, NY 11801 1c. Federal Employer Identification Number of Insured Work Location of Insured (Only required it coverage is specifically limited to or Social Security Number certain locations in New York.,tate,i.e., Wrtsp_Up policy) 113387560 2. Name and--- ��. ...._� _ �� ,.,. ....�_. M�.-.....�.. e (Entity Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier ( y Bei ng Listed as the Certificate Holder) Town Of Southhold-Building Department ShelterPoint Life Insurance Company Town Hall Annex 54375 Main Road 3b. Policy Number of Entity Listed in Box"1a° P.O. Box 1179 DBL178063 Southold, NY 11971 3c. Policy effective period 4. Policy provides the following benefits: 02/01/2022 to 01/31/2024 © A.Both disabifity and paid family leave benefits. F1 B.Disab'iiity benefits only, nC.Paid family leave benefits only. 5. Policy covers: a 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: Und ty of rjury, I Certify at I am an zed nsuured haslNYS Disability and/ortPaid Fam ly Leave Benefiits nsu atn a ive oo=overage as des licensed agentGibed above ac carrier referenced above and that the—named Date Signed 1/31/2023 ` BY �^ (Signature i.rf irisur'anr e carrier s:atatl'rurizi d in�:rresrtnl:atirre or NYS Licrnrr d lirtaraarr At„e,s7C of Chat insurance carrier) Telephone Number 516-829-5100 Name and Title 9itrlary White ”. Executive fir �.. �. Licensed insurance s IMPORTANT: If Boxes 4A and 5A,are checked, and this form is signed b the insurs tensed Insurance Agent of that carrier, this certificate is COMPLETE, Mail it directly to the certi tate holder.representative NYS 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 e Workers'Compensation Board, Plans Acceptance n the b the NYS Workers" Compensation p Unit, PO Box 5200 Binghamton, NY 13902-5200. PART 2 To be completed y .� Board (Only if Box 46 4C or 56 have been checked) State of New York Workers' Compensation Board to information maintainedby the NYS Workers"Compe on Board, the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article g of the Workers'Compensation Law)with respect to all of their employees. Date Signed B (Signature of Authorized NYS Workers'compensation Board Employee) Telephone Number Name and Title agents of those nis i. _.an,.... carriers to ._._ �._ . .. Pease Note Only i carriersancenare l authored oriissue Form DB- 120.d aid famil te NYS disability an p leave benefits insurance Policies and NYS licensed insurance 7. Insurance brokers are NOT authorized to issue this form. 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