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HomeMy WebLinkAbout49163-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 #: 49163 Date: 4/26/2023 Permission is hereby granted to: Neske, Jacob 83 Montaomery St Apt M Jerse Ci , NJ 07302 To: construct accessory in-ground swimming pool as applied for. Pool and pool equipment must have minimum setbacks of 20' from lot lines. At premises located at: 460 Lighthouse Rd, Southold SCTM # 473889 Sec/Block/Lot# 51.-2-2.3 Pursuant to application dated 3/23/2023 and approved by the Building Inspector. To expire on 10/25/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector kap TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 a< Telephone (631) 765-1802 Fax (631) 765-9502 lett S://)'Vww,Southo1dtowqny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only " ��ti� 4 ii V6 l ! . PERMIT N0. Building Inspector: % IncompleteMAR 2 3 2623 Am Applications and forms must be filled out- their entirety. y applications will not be accepted Where the Applicant is not the owner,an g ) x6 4i " 3�. 01. "0i._D Owrer's Authorization form(Pa e 2 shall be completed. Date: OWNER(S)OF PROPERTY: Name: SCTM # 1000- 'J " ., w "' Project Address: ® L� , Phone#: ��a X71 C� Email: Mailing Address:. CONTACT PERSON: Name: 'saa A k Mailing Address: Phone#: ��1 ���" a Email: DESIGN PROFESSIONAL INFORMATION: Name: el r m Mailing Address: Phone#: �� �l�' (� Email: CONTRACTOR INFORMATION: Name: 14 ; , , Com „ L Mailing Address: �1,� �an as .1 s ► ��- c Phone#a l (�31 �q�, ��q Email: f1FGf QIDTI�IN AC PROPOSEDNCTQI irTiniu ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: fr-Li Other t %or ,� 1311 SO , 0'1) Will the lot be re-graded? Ves [--]No Will excess fill be removed from premises? ❑Yes 190 1 A %/fji/air/i/// J �," %Jr/7"/�% J "r J P�pPER'�1f 111(FORMA'C`f©N / G f _. J1/ti,�; .e. 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? ❑Yes ®No IF YES, PROVIDE A COPY. Check Box After Reading: ;The owner/contr�ctorJdesign professional is responsible for all drainage and starm:water Is;ues as proyufed by Chapter 236 of the Town Code. APPLICATION:15 HEREBY ADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County NewXork and other applicable Laws,Ordinances or Regulations,for the construction of uflih' additions,alterations or for removal or demoiitlon as he ""'in described.Tire applicant agrees to compiytvith�all applicable laws drJ nances,bullding code g" �" p g( l necessary P erh i, housingc"ode and regulations and to af�mit autliorued In'Vectors on remises and'In buildin s for necessa Inspections.False statemenEs made herein are punishable as a Class A misdemeanor pursuant to Seckion 210.45 of the Newyork State Penal,Law. Application S uti itt v Dr•/�L� `� v tflf 1 .� P . s...rt�,�.ed B, ( rit name): �� uthr�ri2ea Agent ❑Clwner o Signature of Applicant: . s ?,� Date: 3` 3 CIE D. BUNCH Notary Public,State of New York STATE OF NEW YORK) No. 01BU618.5n5n SS: Qualified in Suffolk County COUNTY OF Commission F_xl,ire ; 1-ts April 14, mm) 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 perTorm 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 mow— ;. j ay of ... . " .. -411 Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) residing at _....._ do hereby authorize mmIT to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date e _.__..........._....._. ....... Print Owner's Name 2 �._ ,;,rs,ua. ago, rJa<�rr�i�r rr�t3�' .tcri;er, �o uive7cw, Ga'rGs) an S. 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"d4"",1.iF:lPa",I ' LII ` 7fl.AAC00 INF KX..Ag!!"�4�.�w�l4�d��r .. P 9 � 111.x" 0 r 'KENNETH. 341M 01-ASU PLLC .. 153 ry.r, ga�rlionufwew.o.n�alLand obSurveying urvae �y9n..Qar ned.mDesign P.O. Box ague. New York 11931 7eowsoa)2ae—Psaoa �) Ego—loon ao n o�a M4 05 2 ■��enw 8-7 A. R 11 ° �F� �]F 0�]E�.I��][WA1F]E1K Scott usse SUPERVISOR I��1[A1�A�tG�]EI��[]EI�'7C' LEa (3 1� -1'.O.sox 1179-� 1),NEWYORK 11971 Town Of Southold MAR 2 7 2(123 �^ " ` * 236 - STORMWATER MANAGEMENT REFERRAL FORM �:�_ ..._:mom .:.: .�..�:. .... -=-_ _.�._ ���____•� T_ ( 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: . Date: G w, y,a -;� - 3 � 3 Contact Info>oration , `� : � �3 i �� —�� j �'. (E-Mail a Telephone Numher) ..e..�. — ...,. l .......�� X11 Property Address / Location of Construction Site: L� S.C.T.M. : 1000 District C�c 1 '-Sect-ion Block Lot ... .. m-. •. �.-... _.. _. ._ m_ . ,� �a.�.. __ TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT 0- Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Required ! Project does Not Discharge to Waters of the State. No S.P.D.E.S, Permit Is Required ° I - Area of Disturbance is Greater than l 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 h� DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a BuildinE Permit, - Area of Disturbance is Greater than I Acre & Storm-water Runoff' Flows Through Southold Towns MS4 Systems to Waters of the State of New York, THE APPLICANT MUST OBTAIN a S-P.D.E.S_Permit through the Southold Town Encrinecring Department Prior to Issuance of a Building Perrnil. a p ' Reviewed By: �° '� Date: � �r —CMM -C'P -T.(1C__.Clrr-tnhha... F•!1R r`A � r Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name MYKHAYLO ABRAMCHUK Business Name This certifies that the bearer is duly licensed AQUA COASTAL INC by the County of suffoiK License Number.H-43470 Rosalie Drago Issued: 09/19/2007 Commissioner Expires: 0910112023 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) AAAAAA 202506176 PROACTIVE BROKERAGE INC 926 SUNRISE HIGHWAY WEST BABYLON NY 11704 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER AQUA COASTAL INC TOWN OF SOUTHOLD P O BOX 226 54375 MAIN RD ISLIP TERRACE NY 11752 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11415789-5 946692 04/01/2023 TO 04/01/2024 3/7/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1415 789-5, 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, 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://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 POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. MYKHAYLO ABRAMCHUK(PRES) OF ONE PERSON CORP AQUA COASTAL INC 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 SUP NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING x--ov—`� Lor—K I Irlll.A I C Ur LIADILl I T IMPUKAINI.0 31612023 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: 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 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 CONTACT PROACTIVE BROKERAGE INC PHONE_ AX g. (631)482-1860 ._ ,.[ Net. 08B B59„6455 . 926 Sunrise Highway � 1 �T._ roactivebro.corn West Babylon,NY 11704 .. INSURER(S)AFFORDING COVERAGE. ..... ___ ,,,NAIC1_ INSURERA: Atlantic Casualty .. .... 42846 INSURED INSURERS P,ro9.reSSIVe Insurance 24260,,, Aqua Coastal Inc. INsuRERc 38 CARLETON AVENUE _INsuREI!p INSURER E. East Islip NY 11730 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 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, NSR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I.. ....__... ._. .� ..._.. OL SUER _ ... POLICY EFF”._ POLICY E9(P"�.. .. ..... ... LTR . _.---_.-------- TYPE OF INSURANCE POLICY NUMBER MMID LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,,000 CLAIMS-MADE X OCCUR „PREMISES Ea WOP@ ,, ,$___. 1,,,..-----0�0,.,.,. MED EXP�Any one Person)uu $... 00 A Y L035013818-5 7/30/2022 7/30/2023 PERSONAL$ADV INJURY $ 1.000.000 GEN'L AGGREGATE LIMIT APPLIESmm PER: GENERAL AGGREGATE.. $ �2,000,000 PRO- $ 1.000.000 N_/1 POLICY X JECT LOC PRODUCTS-COMPI AGG OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) ....$ 100.000 WW --. OWNED X SCHEDULED (Per $ B AUTOS ONLY AUTOS 03861607-4 7/2212022 7/22/2023 'BODILY INJURY(Pe 300 000 HIRED _-. NON-OOWNED PROPERTY 5VMA!r's,'E m g—mum- AUTOS O OO�L.. AUTOS ONLY AUTOS ONLY mLdt} �- $ UMBRELLA L OCCUR EACH OCCURRENCE $ EXCESS LIABCLAIMS-MADE AGGREGATE �....- $ .........__ DED RETENTION$ $ WORKERS COMPENSATION R OTH AND EMPLOYERS'LIABILITY YIN +TI1J 1-1.ER..._, ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT .. $ �OFFICER/MEMBEREXCLUDED? F-1 N/A' ""'"""-"' """""""""' (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes.describe 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 mon:space is required) The following are included as additional insured required by written contract subject to the terms and conditions of stated polices:TOWN OF SOUTHOLD CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF SOUTHOLD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 MAIN RD ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD NY 11971 AUTHORIZED REPRESENTATIVE 985-Z61 5 AG RD CO r�0 WICA I rights reserved. i 2-2-3 SSeSS�'s LM`&J Q ALL PIPING TO BE 2"PVC 6"TILE BAND -► G7f § �' I I I (WATER)` � IE I i MARBLE DUST l — O � 1 SKIMMER SKIMMER ^ #4 STEEL REBAR r:rxrrr.:: i hF.:::iTc=__; I ^ - - DEEP END I H (VERTICAL) 12"OC ° D — __; 0 I #4 STEEL REBAR (HORIZONTAL) 12"OC — — ' cn SHALLOW END 12"TO 36"RADIUS a D -= I NIPAGT S{t7 1 == 8'dia.,4'deep (VARIES) ° ! W� I I:iir= . : •I I_,!EIi-= =-' \\ DRYWELL / uJ I- — — -� 3500psi `II'~W_Y_ I _ — FILTER&PUMP i MAIN DRAIN D I O r"1 CONCRETE _ I —_ ( (MIN.3'APART) L RETURN RETURN ^ 8" MIN. ( _.__.- 1 ( ) D a D P D I I I ( i I I I a a I ' 3 i — — — — __ �_ _-_, c� w = NOTES: \ _ _ _ _ _ALL PIPING TO BE SWIMING POOLTO BE EXCAVATED ONE FOOT OVER DESIGN SPECIFICATIONS AND 2"PVC SOILTO BE LEFTON PROPERTY.SOILTO BE STOCKPILED OR RUFF GRADED(AS PER OWNER)ON THE DAY OF EXCAVATION ONLY UNLESS SOIL IS TO BE CARTED tt. V ^ AWAY. SWIMING POOL STRUCTURE TO INCLUDE A MATT OF 3/8"STEEL REBAR TIED, 20 foot x 40 foot 12"ON CENTER FOR WALLS AND FLOOR,6"ON CENTER FOR ALLTRANSITION BREAKS AND BOND BEAM. LlCEt1 THE POOL SHELLTO BE MADE OF 1-4 DRY GROUT GUNITE MIX SHOT INTO THE STEEL CAGE AT A THICKNESS OF NO LESS THAN 12"ON THE TOP EDGE OF THE POOL(BOND BEAM)AND NO LESS THAN 12"ON THE WALLS AND FLOOR. INTERIOR FINISH OF POOL TO BE"PEBBLE TECH"DURABLE FINISH.COLORS AS PER OWNER. x a Q w !�— �, w w 0 —� W —1—� W 12" 12" 12" 12" 12" 12" z z ° zLo Wx � N (4)#4 REBAR(TYP.) Z O 0 co O00I— b D D _E A n. a 4 d ° a 7-1/2" o 4'0 +/ frrn^^ /� = cM 61 1�1 a a v ° W IL 1 a D .1P D .fib D ° 4 ° 0 CONNECTTO _._- — Q' ° Q ^^ n a e Q ° Q ° 8'X4'DRYWELL ' © �RENFORCA6UMTE16'A �.4 BACKFLOW (T/Yp4L) D .�b D .'b - Q a Q a Q e Q a o a a a FLOOR REINFORCED WITH FILTER VJ Q r n 4 e Q ° d e Q ° 4 ° 4 #4 REBAR AT 12"OC EACH WAY(TYR) HAIR&LINT D 1 A . 4'0 . Q'A �'� A D D . b D P D P. D PUMP CATCHER O -TE_— b D .1P D .�b D .'P D .�P D .lb D b D . b D a D P ... Q Q 47 a 11 a 19. a a Q a a a a a p a WATER LINE -- ... j1=�' ' { DRAWN BY: JF r 1/17/2023 COMPLIES WITH: 2"RETURN MAIN SECTION R326 OF THE 2020 NYS RESIDENTIAL CODE TO INLET DRAIN SCALE: SEE PLAN SECTION N1103.12 (R403.12) RESIDENTIAL POOLS AND 2"PIPE PERMANENT RESIDENTIAL SPAS SECTION R326.4 BARRIERS SHEET NO: SECTION R326.5- R326.6.5 ENTRAPMENT AVOIDENCE