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HomeMy WebLinkAbout49337-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 #: 49337 Date: 6/2/2023 Permission is hereby granted to: Leis _'David_... . �.... ._....... ......... 760 W End Ave #15-A _._._.................... .._............ ............. New York, NY 10025 To: Construct deck addition and window alterations to an existing single family dwelling as applied for per DEC and Trustees approvals. At premises located at: 990 Grand.....Ave...Mattit u....ck mm ........ SCTM # 473889 Sec/Block/Lot# 107.-8-44.1 Pursuant to application dated 5/1/2023 _ and approved by the Building Inspector,. To expire on 12/1/2024. Fees: CO-ADDITION TO DWELLING $50.00 SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $249.20 Total: _... $299.20 w......................................... ...._..............................._....................................................................................................._........._........... .............. 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) 765-9502 httla //www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. � � Building Inspector. a 023 Applications and forms must be filled out in their entirety. Incomplete111i...Y'My'(s )LI 11 - applications will not be accepted. Where the Applicant is not the owner,an x'� 1 1 1m rTr'0',`;"r Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name:David & Helen Leis SCTM # 1000-107-8-44.1 Project Address: 1150 Grand Ave - Mattituck, NY 11952 qqa 6-K*Q ID Ayg. m4k, Phone#:917.678.9327 Email: david.leis@yahoo.com Mailing Address:1150 Grand Ave - Mattituck, NY 11952 CONTACT PERSON: Name: Gerardo Ixcotoyac Mailing Address: 50 Tuthill In, Cutchogue NY, 11935 Phone#: 631-384-6957 TFm gixcotoyac56@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:Zackery E. Nicholson, RA Mailing Address:1250 Evergreen Drive - Cutchogue, NY 11935 Phone#:631.513.6589 Email:ZENicholson.Arch@gmaii.com CONTRACTOR INFORMATION: Name: Gerardo Ixcotoyac, Gic finished carpentry LLC Mailing Address: 50 Tuthill In, Cutchogue NY, 11935 Phone#: 631-384-6957 Email: gixcotoyac56@gmail.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: E Other Deck Addition&Replacing Windows $ $20,000 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes *No 1 TOWN OF SOUTHOLD-BUILDING DEPARTMENT w Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 littps: ,/www.sou:tligldtowiin-y-.6,o—v Date Received APPLICA"I"10N FOR BUILDING ISII,.: IF For Office Use Only PERMIT N0. I� I Building Inspector:___ ....... _ , MAY 1 h.� .' Applications and forms must be filled out in their entirety. Incomplete ._ applications will not be accepted. Where the Applicant is not the owner,an " ` � ""�' Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: David & Helen Leis SCTM # 1000-107-8-44.1 Project Address:1150 Grand Ave - Mattituck, NY 11952 gL30 6-K**,JV Arg- Phone#:917.678.9327 Email: lavid.leis@yahoo.com Mailing Address:1150 Grand Ave - Mattituck, NY 11952 CONTACT PERSON: Name: Gerardo Ixcotoyac Mailing Address: 50 Tuthill In, Cutchogue NY, 11935 Phone#: 631-384-6957 Email: gixcotoyac56@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:Zackery E. Nicholson, RA Mailing Address:1250 Evergreen Drive - Cutchogue, NY 11935 Phone#:631.513.6589 Email:ZENicholson.Arch@gmail.com CONTRACTOR INFORMATION: Name: Gerardo Ixcotoyac, Gic finished carpentry LLC Mailing Address: 50 Tuthill In, Cutchogue NY, 11935 Phone#: 631-384-6957 Email: gixcotoyac56@gmail.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: •❑Clther Deck Addition&Replacing Windows $ $20,000 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes 9 No 1 r' p � x �i �xnra w mew vr.x�ww x ws«wwxnewxv waurw , ronArwawu ___. ...___ wa�famyw,aw�lwrv�a�rmrvxna^�rtl��'irV^%a �ffl�w4xAaaiWaorv�i rtaX� w,u� mn� «y BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.10218 DATE: SEPTEMDER 14 2022, �! ISSUED TO: DAA&HELEN LES PROPERTY ADDRESS: 1150 GRAND AVENUE MATTITUCK SCTM#1000-107-5-44.1 AUTHORIZATION ' Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on Septtmber 14„2422, and in consideration of application fee in the sum of$250,U paid by David&Helen Leis and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit for the as-built(per Emergency Permit#9584E)removal and replacement of existing sanitary system with a new UA type in a further landward location than existing;and to install a proposed second story 9'3"x13'4"deck with step to ground;and as depicted on the site plan prepared by Jeffrey Patanjo,dated July 3,2022,and stamped approved on September , 14,2022. p M IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these presents to be subscribed by a majority of the said Board as of the day and year first above written. M 01 � E '' �... .glwM'+VkWamwwNirr�rawrBewvarhsaYr�.Www^Marvlwaw6rnG:arw�,uuW''w+,+www,✓aaudwawwRdvaY�FM'Um4wMMrN�lwrl 'urmw4NrewnnwuwwHcei usratdmwaWp mamba'Wrwtid�r 4ewwut'N%'%'u'�rao!CYU�d'1wmw?iGrA'Aaw1w a�,WMa�wiuol'imru�urrWvb�wu�cv �w > a i W _"a " xWd a F Po _e Glenn Goldsmith,President � " , Town Hall Annex A.Nicholas Krupski,Vice President t' 54375 Route 25 Eric Sepenoski P.O.Box 1179 Liz GilloolySouthold,New York 11971 Elizabeth Peeples - Telephone(631) 765-1892 G" Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 16, 2022 Jeffrey Patanjo P.C. Box 582 Bohemia, NY 11716 RE: DAVID & HELEN LEIS 1150 GRAND AVENUE, MATTITUCK SCTM# 1000-107-8-44,1 Dear Mr. Patanjo: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, September 14, 2022 regarding the above matter: WHEREAS, Jeffrey Patanjo on behalf of DAVID & HELEN LEIS applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated July 14, 2022, and, WHEREAS, said application was referred to the Southold Town Conservation.Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and,. WHEREAS, the LWRP Coordinator recommended that the proposed application be found Consistent with the LWRP, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on September 14, 2022, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, x 2 WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the Local Waterfront Revitalization Program pursuant to Chapter 268-5 of the Southold Town Code, and, RESOLVED, that the Board of Trustees approve the application of DAVID & HELEN LEIS for the as-built (per Emergency Permit#9584E) removal and replacement of existing sanitary system with a new I/A type in a further landward location than existing; and to install a proposed second story 9'3"x13'4" deck with step to ground; and as depicted on the site plan prepared by Jeffrey Patanjo, dated July 3, 2022, and stamped approved on September 14, 2022. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, JL4" Glenn Goldsm President, Board of Trustees GG:dd NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY @ Stony Brook,50 Circle Road,Stony Brook,NY 11790 P:(631)44403651 F:(631)444-0360 www.dec.ny.gov April 10th, 2023 David & Helen Leis 1150 Grand Ave Mattituck, NY 11952 Re: Permit No. 1-4738-04905/00001 Leis Property - 1150 Grand Ave, Mattituck, NY 11952 SCTM # 1000-107-8-44.1 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. Enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. :an:ielle EStango-Torre Environmental Analyst r EtY011K Department of Environmental Conservation NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04905 �._.. __..... ........ NYSDEC Approval By acceptance of this permit,the permittee agrees that the permit is contingent upon strict compliance with the ECL, all applicable regulations, and all conditions included as part of this permit. Permit Administrator: SHERRI L AICHER, Deputy Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony Brook150 Circle Rd Stony B ok,NY 11790 -3 9 Authorized Signature: �• Date l 10 /2-bZ3 Distribution List JEFFREY PATANJO Bureau of Marine Habitat Protection DANIELLE A STANGO-TORRE WWWWWWW�._W L......Pe.rmiltComponents NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS,APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS -Apply to the Following Permits: TIDAL WETLANDS 1. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by Jeffrey Patanjo,last dated 1/30/23, and stamped NYSDEC Approved on 4/10/23. 2. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation,or for other purposes, and no claim or right to compensation shall accrue from any such damage. 3. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. Page 2 of 5 GRAND AVENUE N11'17'20'V 245.98' 12500 z. k' 142.0*45'20'V TIDAL WETLANDS TIDAL WETLAND BOUNDARY AS IDENTIFIED BY J. PATANJO ON 11-15-2022 PROPOSED 9'3" X 13'4 COND STORY DECK ADDITITION W/ S TO BELOW 0, so5.18�1�`�e � �'�� TIDAL WETLAND BOUNDARY AS IDENTIFIED BY J. PATANJO ON 11-15-2022 s. PROPERTY OWNER DAVID & HELEN LEIS 1150 GRAND AVENUE MATTITUCK, NY 11952 PREPARED BY: TOTAL ADJACENT AREY 39,941,98 SF — 100% JEFFREY PATANJO P.O. BOX 582 EXISTING IMPERVIOUS: BOHEMIA, NY 11716 HOUSE/POOL HOUSE/GARAGE = 4315 SF — 10,8% 631-487-5290 DR-lWVAY/WALKW,AYS/—OUNTX-N = 3447 SF — 8,6% JJPotanjo@gmaii.com TOTAL EXISTING IMPEFVIOUS = 19.4% PROPOSED IMPERVIOUS: N Y S D E C CAU: DECK 130 SF — 0.= APPROVED AS PER TERMS PROPOSED PERMIT PLAINS'S 1S"=30' TOTAL IMPERVIOUS ADJACENT AREA — 19.72% AND CONDITIONS OF PROPOSED PLAN DLA--f- PERMIT NO. I-Ll-131�1-C5,lq IN 7-3-2z DATE. L4 Joja�l fj50 GRAND AVENUE MATTITUCI(, TOWN OF SOUTHOLD SUFFOLK COUNTY, NY TAX MAP jV0. f000—t07-8_44.1 1 OF 1 YORK Workers' CERTIFICATE OF STAT Compensation Board NIBS WORKERS' COMPENSATION INSURANCE COVERAGE B 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured GIC FINISHED CARPENTRY LLC 631-384-6957 50 TUTHILL LA 1c.NYS Unemployment Insurance Employer Registration Number of Insured Cutchogue,NY 11935 N/A Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 87-3866515 _____....... 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Halder) National Liability &Fire Insurance Company DAVE AND HELEN LEIS 3b.Policy Number of Entity Listed in Bax"1 a" 1150 GRAND AVE N9WC742233 Mattituck, NY 11952 3c.Policy effective period 08/19/2022 to 08/19/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) X❑ all excluded or certain partners/officers excluded. s This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"l a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". 4` The insurance carrier must notify the above certlflcate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. �! This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law, Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. I I Approved by: Rakesh Gupta (Print name of authorized representative or licensed agent of insurance carder) Approved by: 05/01/2023 (Date) Title: Chief Operations Officer p Telephone Number of authorized representative or licensed agent of insurance carrier: 844-472-0967 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov f " DATE(MMwOrYYYYy CERTIFICATE OF LIABILITY INSURANCE 5/0112023 THIS CERTIFICATE IS ISSUED AS A MATTER OFINFORMATIONONLY 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(ies)must have ADDITIONAL INSURED provisions or he 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). CONTACT PRODUCER HONE � 63 ....090 FAX �.. 92M1d Ill (AIC. two: D— .. 57AEAST MAIN ST,UNIT INS.AGY EMAIL GIACi OINC ^GCdPiACdPi NI- 4J41d 6 RIVERHEAD, NY 11901 AooRss: 'm CONTACT:JEANINE GIACALONE ATLANTIC CASUALTYDING INSINS CO GE 42846 INSURER q: � � ..ww...W..... INSURED ......._............. INSURER 8: ------------------- GIC FINISHED CARPENTRY LLC INSURERC: _. 50 TUTHILL LA '''.. .__ INSURER 0 CUTCHOGUE, NY 11935 INSURER E: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE a.. i _. .._..... I ' F INSURANCE INSD SIJB'R W Pr1LCCY EFF POLICY EXP , POLICY NUMBER MMI AtirDO LIMITS COMMERCIAL GENERAL LIABILITY L068027375-1 EACH OCCURRENCE $ 1,000 000 A Y Y 8/23/2022 8/23/2023 CLAIMS-MAGE ®OCCUR � m PRMIEs We q4 CidPrk9 ,L, $ _ ._. 100,000 MED EXPAnymonem mmersan $ 5000 PRO- ...........�. .. PERSONAL&ADV INJURY $ 1,000 000 OEN'LAGGRFOATELIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ,)ECTLOC PRODUCTS-COMPIOP AGO $ ZO,O LOTHER $ AUTOMOBILE LIABILITY UOMEVNeD Sl'NGL E LIMIT $ .JEa q4ggdank ... .. ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (per,: c rot UMBRELLA LAB h ,,,,,,,,,,,,,,„, OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ ANUDED RETENTION$ $ ! WORKERS COMPENSATION R OTH r EMPLOYERS'LIABILITY YIN '- T ANY PROPRiETOR/PARTNERIEXECUTIVE ❑ _EJ- ACCIDENT $ i OFFICERIMEMBER EXCLUDED? NIA _EJ'L E”EA {Mandatoryin NH} E DISEASE-EA EMPLOYEE'$ If yes,describe under _ k DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S f" DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltlonal Remarks Schedule,may be attached 11 more space is required) CI" Ik CAPRENTRY-INTERIOR/EXTERIOR/REMODELING U CERTIFICATE HOLDER IS ALSO ADDITIONAL INSURED i ;k i CERTIFICATE HOLDER CANCELLATION DAVE&HELEN LEIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1150 GRAND AVE THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. MATTITUCK, NY 11952 AUTHORI Eq,f&FP ESENTA74VEq ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Sufflolk Coun,4-r Dept . of Ll t L,abor,. L,ic,,e- nisi. ii�g & C :O - - ,,,,S 1-- , N 'T L U Name - Ak, ILL N a XF, a. Ir ,osolie DI.f-, go kA� MENEM I Th "s 1 the property of Suffolk County iceinse Is Department of Labor. Ucens 'ng & Consumer Affairl Us fic Pr -kssiorl of th- ense does no* guaraf)tee its vaiid,tv, Additional Business Name Ljocense Category Kftchens and Bath- 0 t s-P F* 19 - Oieckls