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HomeMy WebLinkAbout49119-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT E" 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#: 49119 Date: 4/13/2023 Permission is hereby granted to: Golisz, Catherine 1300 Stars Rd East Marion, NY 11939 To: construct accessory in-ground swimming pool as applied for. At premises located at: 1300 Stars Rd, East Marion SCTM # 473889 Sec/Block/Lot# 31.-4-1 Pursuant to application dated 3/15/2023 and approved by the Building Inspector. To expire on 10/12/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector t' TOWN OF SOUTHOLD—BUILDING 0EP Town SCR gat 541751'ail n Road' °0.Bo 117 Southold, 1197159 T" 1 hw( j)765.13h12 Fax(i31)765.9302 h.!M ? 0M ReceW APPLICATION FOR BUILDING PERMIT For ORlce Use only PERMfTNO. Bulldingf Applications and forms must be filled out in their entirety.IncompleteI applications vnll not be accepted.Where the Applicant Isnot the owner,an MAR Owners Authorization form(Page 2)shall be completed i Date:3/13!23 OWNERS)OF PROPERTY: �/ Name:Myers, Noreen SUM a 1000-_31.-0-1 Project Address:1300 Stars Road, East Marion NY 11939 �16J_Phone#:516-459-1721 EmaiI:noreenmyers , -------------- Mailing Address: CONTACT PERSON: ',, „ ;,/�77�7/%%%%%% Name:Jennifer DelVaglio :> = MailingAddress:PO Box 369 PeconiC NY 11958 Phonefi: Email: DESIGN PROFESSIONAL INFORMATION: Name: Maillng Address: Phone p: Email CONTRACTOR INFORMATION Name: Jennifer DeIVa lio Mailing Address a tf PO Box 369 Peconic.NY-11958 631-734-7600 DESCRIPTION C1F PROPOSED CON �UCTI,or i�i��% ���/���(Jli � BtJewStructure ❑Addition ❑Alteratidrl ❑Reppir"ODemgfitwn�°'�'� j"�%//✓�" /��"' n , »rt , , ❑Othef of 'V a+d�N awilnrlr�ing Pool ��' %/���������1/ � Will the lot be re-graded? Byes❑fVo � � � , , 'PROPERTY INFORMATION „ Existinguse of roe Intended use of roe ' P P 'fi`�r@Sldefltlal P P nY�re$Identlal Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Roo this property? ❑Yes WNo IF YES,PROVIDE A COPY. 11 Check Box After Reading: ThP owns/oonascoor/dela,�oresso m rail" for ON d .nd morn`.gar kwes c aro+rld d bl► Chapter 236 of the Town Code.APPuCAmoN is HEREBY MADE to the Butlding Department for the issuance of a Su"Permit pursuant to the Building zone Ordinance of the Town of Southold,Suffolk,County,New York and other opplloble laws,ordinances or Rtpdatlons,'for the construction xf bufldIIW6 " addltiom,alterations or for removal or demolition as herein described.The applicant to comply with all applikable laws,ordinances, axis, housing oWe aid regulations and to admit authorized 4gpectors on premises and In buiidina(s)for necessary InspeetioriL False statements made herein are punlshebk as a Class A mbde meanor pursuant to Section 210AS of the New York State Penal law. . . Application on Submitted BY(print name e � _�lo rizedABent ❑Owns r Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF Suffolk ), Jennifer del Vaglio being duly Sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, I (S)he is the Contractor/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/h&knowledge and belief,and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this / I �� Of Pl N"9���I't ��) l fi NOTARY PUBLIC,STATE OF NEW YORK � Notary Registration No..01 C00001701 Qualified in Suffolk County Comm;,,srnr Fx irS16 2117 F „ O PERTTOW ( Where the applicant is not the owner) Noreen .Myers : 1300 1, residing at, East Marion % do hereby authorize_enn�fer D,,__.,,,,,,,, i1fi� �r%% f t mbehalf ! • ,l/ /f i y .to the Town of Southold Building or-approval as descri�ied�i�reln���/!///1 � � � ; Owners Sigghatu d , r � Print Owners Na Now iii,,/O/��'cif/% DATEDIY CERTIFICATE OF LIABILITY INSURANCE 11118/2/18120211 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 POLIGIES 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 pol cy0e )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 NANytE, Barbara Dammers Roy H Reeve Agency,Inc. P oNE (631)298-4700 N, (631)298-3850 111N 0.Etll PO Box 54 E-MAIL bdammersl royreave.com 13400 Main Road MSUREtB S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: CNA Insurance Companies INSURED INSURER B: Continental Insurance Co. 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; CL2111181 751 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. LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER MM/DDIYYYY MIIMdODrrYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ®OCCUR PREMISES IF qc re pcol S 100"000 X Contractual Liability MED EXP(Any oneperson) S 15,000 A Y Y 6080837145 11/15/2021 11/15/2022 PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S 2,000,000 PDLVCY 0 P • „000,000 JROT LOC PRODUCTS-COMP/OPAGG S ROTHER; S AUTOMOBILE LIABILITY O 91 E1 I 15 L LIMIT $ 1,000,000 (EDANY AUTO BODILY INJURY(Per person) �S B OWNED SCHEDULED 6080837159 11/15/2021 11/1512022 BODILY INJURY(Per accident) 5 AUTOS ONLY AUTOS HIRED NON-OWNED PR5PERTT DA AGE ,.. AUTOS ONLY AUTOS ONLY ar archd n S S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSHLIAB CLAIMS-MADE AGGREGATE S DED '..RETENTION $ S WORKERS COMPENSATION P EOTH ER. - AND EMPLOYERS'LIABILITY STAT 7E � r C ANY PROPRIETOR/PARTNER/EXECUTIVE YINE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? �Y ,NIA 6080837162 11/15/2021 11/15/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,00'0 If yes,describe under 1 4'00,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I 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 ,,- ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD a � 4; Awl Etc AD {, INt a w % TM ASIP W. 10 JUMP i 3 too AS 9.QxRYt11Z�+k111-a-9'#�l.C'Ff t9$i`L`4111 - ue qtr aw �w".000031", .�.0 - csrfl� aofo ' 4 w � t t�€ e h ourt�*�