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HomeMy WebLinkAbout48957-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#: 48957 Date: 2/24/2023 Permission is hereby granted to: Hale, Scott PO BOX 635 Southold, NY 11971 To: Install accessory standby generator to existing single family dwelling as applied for. Must maintain minimim 3 foot setback from property lines. At premises located at: 595 Ro ers Rd, Southold SCTM # 473889 Sec/Block/Lot# 66.-2-43 Pursuant to application dated 2/17/2023 and approved by the Building Inspector. To expire on 8/25/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO-RESIDENTIAL $50.00 Total: $235.00 Building Inspector TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-95021ittp ://xvww.southoIdtokvnn . Date Received APPLICATION FOR BUILDING PERMIT � �� ILINt�tI For Office Use Only PERMIT NO. Building Inspector. � ��B 17 '� � Mr SUILDING DEPT Applications and forms must be filled out in their entirety.Incomplete 'TOWN OFSODTHOLD applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: oZ / 17 ( cT 3 OWNER(S)OF PROPERTY: Name: -�Go4 ��za� SCTM# 1000- (Q `� 43 Project Address: 5 o S A'*t d I(61 1 Phone#- � �a Ic�c�— -- 6�� , Email: 1MGv� �e cnr� Mailing Address: J s- 1Z CONTACT PERSON: Name: iK66,2(� S t",ku r, Mailing Address: EQ &3 < S-111)— Phone 1 )— Phone#: IS-16- '911- ~l r c( ( Email: �n=j c DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: I Name: Mailing Address: pD i3o .-i L�4�no Phone#: 3 i✓1_ 5fj a Email: C DESCRIPTION OF PROPOSED CONSTRUCTION pEp�IN k. n_i_ilio ... r1 n ice_-_tee__ —In_p_:_ EE]LD.... olitio . Estimvt-4 .!'n ct n-F Drniart: LJpv� StNmucti°re LJHUUILIUII LJHILCIdLIUII LJRC�.ldll LJUCIIIVIILIVII �-������u�...0 / ^ Cher6o (J Will the lot be re-graded? ❑Yes 9160 Will excess fill be removed from premises? ❑Yes F4146- 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Eyes El No IF YES, PROVIDE A COPY. ❑ Check llikox After Readling: 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 ao'd`�' 4,3 le, ❑Authorized Agent/-(Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF 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 2day of 20�r Notary Pubi CHFtYSAASQlI1LONIE-FtILL1l NOTARY PUBLIC,STATE OF NEW Y Registration No.0 F"A 07' 'RI OWNER TH )� �( Qualified In Suffolk County ( here the applicant is not the owner) Commission ExplresAuguat S,20 q, residing at do hereby authorize to apply on my behalf to the Town of Southold Building rlonnrtmont fnr nnnrn\/al aG flPGrribPd hPCP__In. Owner's Signature Date Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD ' Town Hall Annex- 54375 Main Road - PO Box 1179 {"' Southold, New York 11971-0959 Telephone 631 765-1802 - FAX 631 765-9502 ll, ro err southoldtownn . 1ov - seand@southoldtowniny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/17/23 Company Name: Peconic Power Systems Electrician'' Name: Robert Stanevich License No.: ME-45056 Elec. email: Peconicpowersys@gmail.com Elec. Phone No: 516-819-7191 ❑I request an email copy of Certificate of Compliance Elec. Address.: PO box 512 Cutchogue NY 11935 JOB SITE INFORMATION (All Information Required) Name: Scott Hale Address: 595 Rogers Rd, Southold, NY 11971 Cross Street: Hippodrome drive Phone No.: 310-422-6681 Bldg.Permit#: S 7 email: Scott@eplmanagement.com Tax Map District: 1000 Section: Block: r Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): New 26KW Generac Generator with 200 amp Transfer switch Square Footage: Circle All That Apply: Is job ready for inspection?: YES Z NO Rough In Final Do you need a Temp Certificate?: r-1 YES Z NO Issued On Temp Information: (All information required) Service Size1 Ph 3 Ph Size: A # Meters Old Meter# ❑New Service[]Fire Reconnect[]Flood Reconnect[]Service Reconnect❑Underground❑Overhead # UrrU rground' Laterals I n Frame Crow vvUrK done UII JCIvice? T N Additional Information: PAYMENT DUE WITH APPLICATION N -SURVEY OF PROPERTY l_ AT SOUTHOLD Vol TOWN OF SOUTHOLD 9 1\1150SUFFOLK COUNTY, N.Y. 1000--66-02-43 k1A vk 6, SCALE. 1'-20' 1 � s MARCH 20, 2018 OF01) vol r scS I ' 00. G 'OP ` aaE ��yr' p Vol '£ o. 7EST HOLE DATA McDCNAm GE0.4MWE 210712018 EL 702 DARK MW LOAM OL MMUN SWDY CLAY CE C EL»' ♦♦ T' w r0 00 l PAF BROWN JUNE TO ,,.q BRICK APRON MEINUM SAND SP �IK -#•+ �� *�, .tea`��� � '� 26 9 _ WME4/N PALE BROW n� 0 G RAE SAND SP O N07E• WA7FR DWOUMMED 99•BELOW SURFACE \ BRiCC APRON `'AO LOT NUMBERS REFER TO "MAP OF BEIXEDON ESTATES BLOCK 7' FILED IN THE SUFFOLK COUNTY CLERKS OFFICE AREA-8,250 80. FT. ON MARCH 16,1946 AS FILE NO. 1472. ELEVATIONS ARE REFERENCED TO NAVD.88 I am familiar with the STANDARDS FOR APPROVAL !N ,_ys AND CONSTRUCTION OF SUBSURFACE SEWAGE / LIC. NO. 4_9618' ANY ALTERATION OR ADD1770M TO 7HIS SURVEY IS A WOLA71ON DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES PECONIC SURVEYORS, P.C. OF SEC77ON 7209OF THE NEW YORK ST47E EDUCA77ON LAW. and will abide by the conditions set forth therein and on the 6311 765-5020 FAX 631 765-1797 EXCEPT AS PER SEC770M 7209-SUBDIWS10N 2. ALL CER77RCA710NS permit to construct. HEREON ARE VALID FOR 7HlS MAP AND COPIES THEREOF ONLY IF P.O. 80X .709 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR The location of wells and cesspools shown hereon are 1230 TRAVELER STREET WHOSE SIGNATURE APPEARS HEREON. from field observations and or from data obtained from others. 0jj1 N Y 11971 18-110 DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01 18 0 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,IEXTEND 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rl hts to the certificate holder in lieu of such endorsements. PRODUCER Mitchell FAX Freedom Coverage Corp PHONE L E•MAN 80 Orville Dr Suite 100 E-MAIL m e ,rr� reraa pY com Bohemia, NY 11716 INSURER(8)_AFFORDINO COVERAGE _!!AIC p .'. m ...._._m..a.,...... ......_,n... .......... ....,_._.� .....�._... ._,. ..__..___,........,.w_.��_�..,.,_._,.,,_._ INSURERA.. e � ., _��.. �F .�.O, tpan INSURED 1NS URER Peconic Power Systems LLC INSURER C: .�._..... .�.. .._.. ._... _. _� a. 315 Commerce Rd INSURER D Cutchogue, NY 11935 INSURERS INSURER F: COVERAGES CERTIFICATE NUMBER: 00000108.0 REVISION NUMBER: 7 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. .._. __.._. ._n _ POLICY NUMBER POLI O P LTR TYPE OF INSURANCE /NSR AizL$UY�R POL(CY EF6'' LIMITS COMMERCIAL GENERAL LIABILITY GLP1092481 05/28/2022 05/28/2023 EACH OCCURRENCE $ 1 000yOOO A .. Aal BTr CdED CLAIMS-MADE OCCUR P - a m m zraas z.s �l� rr� ).. 100 000 MED EXP(Ani one pereon) $ 5 OOOm w PERSONAL„B,ADVINJURY w r5 w����.()Q(,��(a(�.Q.._ N L AGGREGAT CY JLIIMIIT APPLIES POECR: RAL AGGREGATE _ S 1�OOO„r000 �” GENE PRODUCTS COMPIOPAGG $ 2,l)OO,000 OTHER $ AUTOMOBILE LIABILITY COMBNL�a�.raectlED $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED ( �) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGEaccdent AUTOS ONLY AUTOS ONLY JL4 $ I $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ ESSLIAB D AGGREGATE — .. .W EXCESS CLAIMS-�.�-. e rr MA E RETENTION$ $ WORKERS COMPENSATION R OTH- B AND EMPLOYERS LIABILITY 12WECAT7UBP o9l0212022 09102/2023 X sTATUTEAEgm _. . L. ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N _,,,E CH ACCIDENT $ 1 000000_ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ _1,000,000 DESCRIPTION OF OPERATIONS below -E.L.DISEASE”' POLICY LIMIT $ _1,000,0 O If as,describe under 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,AddlUonal Remarks Schedule,may be attadwd If more space 1s required) As pertains to insureds operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall Annex 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1179 Southold, NY 11971 AU REPRESENTATIVE p r 51 JCM ©1988-2015 ACORD CORPORATION. All rights reserved.