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HomeMy WebLinkAbout49581-Z "drat 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#: 49581 Date: 8/15/2023 Permission is hereby granted to: Powers Kristen M 2013 Trust C/O Kelley Drye & Warren LLP 175 Greenwich St FI 67 New York, NY 10007 To-, Replace windows at existing single family dwelling as applied for, with flood permit. At premises located at: 220 Park Ave Ext, Mattituck SCTM #473889 Sec/Block/Lot# 123.-8-26.1 Pursuant to application dated 7/7/2023 and approved by the Building Inspector. To expire on 2/13/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Flood Perini/ $100.00 Total: $350.00 Building Inspector TOWN ON SOUI'HOLD—BUILDING DEPARTMENTr� Town Hall Annex 54375 Main Road P, O. Box 1179 Southold, NY 1 1971-0959 ! i ,.� �'tO!% I� Telephone (631) 765-1802 Fax (631) 765-9502 hII_���. I) , .... .. w.._. . Date Received For Office Use Only l PERMIT NO. � !.. _..�.�—. Building InspcCor: —.-. _—_..._.. ......__ 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: 07/05/2023 OWNER(S)OF PROPERTY: Name: Kristen and Steven Powers _ SCTM# 1000- Project Address: 220 Park Avenue Extension Mattituck, NY 11952 Phone#: (631) 298-0090 Email: steve.powers37@gmail.com Mailing Address: 220 Park Avenue Extension Mattituck,NY 11952 CONTACT PERSON: Name: Alison Shumway Mailing Address: 121 Express St Plainview,NY 11803 Phone#; (631)742-4955 Email: alison.shumway@powerhrg.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email; CONTRACTOR INFORMATION: Name: Power Home Remodeling Mailing Address: 2501 Seaport Drive Chester, PA 19013 Phone#: (888)736-6335 Email: alison.shumway@powerhrg.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure [--]Addition ❑Alteration ❑Repair []Demolition Estimated Cost of Project: ®Other Remove and replace 7 windows(same size/location).U-factor 0.27;No structural changes . $ 16,1m13.16 Will the lot be re-graded? ❑Yes ONO Will excess fill be removed from premises? ❑Yes END 1 PROPERTY INFORMATION Existing use of property: Private (one family) Intended use of property: Private (one family) 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. O i,@': 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. M..». w Application Submitted By(print name): Robert Ciskanik ®Authorized Agent ❑Owner Signature of Applicant: rtw Date: 07/05/2023 STATE OF NEW YORK) SS: C0 U NTY O F Robert Ciskanik ._ mmmmmm -..._being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the Contractor (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 -day of L420 _ Notary Public MARIA HERNANDEZ NOTARY PUBLIC-STATE OF NEW YORK No. 01 HE6076686 i Qualified in Nassau Count! Commission Expires December 28,2026(Where the applicant is not the owner) 1, .,,,,_Steven/Kristen Powers residing at 220 Park Avenue Extension Mattituck' Y 11952 do hereby authorize Robert Ciskanik _. .„- _._mmmm to apply on my behalf t he Town of o old Building Department for approval as described herein. O per's Signature Date Print O ner's Name 2 �" R" AC DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 3/29/20.23 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON T HE 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 endorsements , PRODUCER CONTACT Lacher&Associates Insurance Agency NAME . 9 Y PalomaErAz Lacher Insurance Group (A/C,N0i,Exi:. 1 5-723-43'78 , _ (Air„No);215-723-5757 EMAIL 632 East Broad Street ADDRESS; car ificate@lach,erinsurance corn Souderton PA 18964 INSUREIR(S)APFORDING COVERAGE NAIL# INSURER A 1.enn,ylvaniaManlafactE.irers'Ass(.)ciatlorIInsurance 12262 INSURED POWFRCL-01 INSURER B: Harleysville Insurance Co of New York 10674 Power Home Remodeling Group, LLC I - 2501 Seaport Drive,4th Floor INSURER C Markel Arnericarl Ins Co 28932 Chester PA 19013 ONSUREyR D: INSURER E: bNSuar--.N,F COVERAGES CERTIFICATE NUMBER:555221946 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 INSR ADDL'SBF# ,. .v., ,, .,, ._ f POLICY EFF POLICY EXP ,,,_TYPE OF INSURANCE c, y jrD POLICY NUMBER (MM1DpM/YY1,(MMIDD LIMITS A ' X COMMERCIAL GENERAL LIA80ITV 302375-66-20-96-7 4/1/2023 41112024 rpA{:II 04 C4}ffP1d NCL? $2,IJRI(1 0000 AWnAfiP tO RUNTO) y;1,041 TOO CL AINNIS-MADE X I OCCUR pRI r'"81',f,ip occu<ra,NRtCO ) S 1Gi,+„b00 M1Ib r Axx ,��^iyin vt�©i"� nxs _ 4I M ASG'REGAtlu?:l.lIMII AP'INI I r'V.PR: C41RFR I,AGGRRI GAH ,4A,(1W,4100 ,}L':CT 11.00 PRODUCTS.Cr)f�Ar'fJfa d,a, 1a4,P,1ClGl, Cl%,1 owl f1411:i6R A AUTOMOBILE LIABILITY 152375-66-20-96-7C MA and NY 111 2023 1/1/ � X ANY AUTO . SCHEDULED BODILY INJURY INCE k-LIMIT $2,000 000 2024 ^��MBIIWLU S 1/1/2024 (E i ac id-t . A I I RY(Per person) $ AUTOS ONLY AUTOS f i BODILY INJURY(Pa acr.,idr.nt) $ " a HIRED ED f FiRDdC°6tTY E}AMAGr: AUTOS ONLY AUTOS ON $ B X UMBRELLA LIAB X OCCUR CRA0000027 4(1(2.023 4/1/2024 m�EACI I OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGA”["F $9,v(00 000 _ .�,a- Y t a Gdkit _... _.._b° .. _- k d r ra rurs ""99}r9Burzu..__ �1(k6 J tiro P"ME1T PRN"'%"U1N0tlON,�."° ........... .._ ...,._.._. 4 .__ _._. _.. °.-...-,,._.. ..�.. ...- ..., ....... A WORKERS COMPENSATION 20237566-20-96-7 111/2023 1/1/24724 ,X IAIh�6lfl 4�P@Ii- AND EMPLOYERS'LIABILITY -- - - ANYPROPRIETOR/PARTNER/EXECUTIVE Y P N E L EACH ACCIDENT $'1,000,000 OFFICER/MEMBER EXCLUDED? Y NIA (Mandatory In NH) E L DI S IASkI'',i F A EMPL`kYL I„ $1,000,060 If describe under �� A W --- --- - __.... .... DESCSC RIPTION OF OPERATIONS!?slow F I DISEASE�ASE L POLICY LIMIT 6100(},000 „mmmIT ITITmm��„ C EXCESS LIABILITY '.... MKLM7EUE101009 4/112023 4/1/2024 'EACH OCCURRENCE 5,000„000 AGGREGATE 5,000,000 Excess oP 3,000„000 _ _ _ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) 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. 53095 Route 25 P.O. Box 1179 Southold NY 11971 AUTHORIZED REPRESENTATIVE USA S, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Ile National Headquarters -" 2501 Seaport Drive,Chester, PA 19013 888-736-6335 WWW.POWERHRG.COM PRODUCT SPECIFICATIONS Buyer(s)' Information and Description of the Property: Project Number: 36-73233 July 05,2023 Steven Powers Date of Agreement (631)298-0090(Home) Kristen Powers (703)994-5265(Steven's Cell) steve.powers37C�gmail.com E Mail Address 1 220 Park Avenue Extension (631)298-0090(Home) Mattituck, NY, 11952 ninthhole@ E-Mad AdailAd com Address 2 County:Suffolk Township: r Buyer(s) listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification sheets, in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively, this"Agreement"). Pre Installation Inspection Date: Your pre installation inspection is tentatively scheduled for Fri 7/7 between 9.00a and 10 00a. . Windows- Power Symphony Inclusions: Includes welded corners, steel reinforced meeting rails, nighttime safety locks on double hung windows orily, foam enhanced frames, Heatshield, Zen Glass, Leak Guard Technology, Lift Assist, Exterior custom capping, installation, clean up and haul away of all job related debris.. It is agreed and understood by and between the parties that the Product Specifications, along with the Custom Remodeling and Improvement Agreement, constitutes the entire understanding between the parties, and replace any and all prior negotiations, representations, or agreements, either written or oral. The Product Specifications may not be changed, modified, or varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s) hereby acknowledge that Buyer(s) has read the Product Specifications. I have read and received each page of this 3 page agreement. Zer H Raod g Group Buyer(s) Buyer(s)/07105/23 _______/07/05/23 Signature of Remodeling Consultant Signature Signature Robert Riedel Steven Powers Kristen Powers YOU,THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. July 05, 2023 12:05 IIIII�IIIIIIIIIIIII�III�I�II IIIII��IIII�IIIIIII�I r- National Headquarters 1 2501 Seaport Drive,Chester, PA 19013 888-736-6335 WWW.POWERHRG.COM Project Specifications Windows: Back den 1 71.0"x58.0" WINDOWS: Model Power Symphony Style Slider Type 2-Lite Config Manual Lock OPTIONS: Color White/White I Removal Aluminum/Vinyl/Glass Strength Non-Tempered 1 Hardware i Finish Color Match Interior I Grid Pattern None I Glass Options Low-E I Additional Details None t Windows Back den 1 71.0"x58.0" WINDOWS: Model Power Symphony Style Slider Type 2-Lite Config Manual Lock -- — -- - -- OPTIONS: Color White/White/Removal Aluminum/Vinyl/Glass Strength Non-Tempered I Hardware Finish Color Match Interior I Grid Pattern None I Glass Options Low-E I Additional Details None Windows Master bedroom 1 47 0"x58.0" WINDOWS: Model Power Symphony Style Slider Type 2-Lite Config Manual Lock OPTIONS: Color White/White/Removal Aluminum/Vinyl/Glass Strength Non-Tempered 1 Hardware Finish Color Match Interior 1 Grid Pattern None I Glass Options Low-E I Additional Details None Windows. Master bedroom 1 47.0"x58 0" WINDOWS: Model Power Symphony Style Slider Type 2-Lite Config Manual Lock - - - - - OPTIONS: Color White/White/Removal Aluminum/Vinyl/Glass Strength-Non-Tempered 1 Hardware Finish Color Match Interior I Grid Pattern None I Glass Options Low-E I Additional Details None Windows Back den i 72 0'x80 0' WINDOWS. Model Power Symphony Style Sliding Glass Door II 7ype None Config None OPTIONS: Split 2 Panel : Custom Width and/or Height I Color White I White 1 Hardware Finish Color Match Interior I Grid Pattern None I Glass Options Low-E.I Additional Details None Windows. Master bedroom 1 24.0"x50 0" WINDOWS: Model Power Symphony Style Double Hung type None Config Manual Lock OPTIONS: Color White/White/Removal Aluminum/Vinyl I Opening Control Device Manual/Glass Strength Non-Tempered I Hardware Finish Color Match Interior I Grid Pattern None I Glass Options Low-E I Screen Type Half I Additional Details Special Options(ie. Full Screen, Obscure Glass,etc) Different Color Capping No I Trim Options Yes New Inside Casing No I New Outside Brickmold No I New Sill No I New Stool No I New Apron No I Frame Options Yes Frame In for vent or A/C unit No I Build Up No I Build Down No I Pack-In No I.Buck Frame/Stops/Casing No 1 Remove and Reinstall Yes :A/C units July 05. 2023 12:05 II�IIIIIII IIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIII National Headquarters 2501 Seaport Drive, Chester, PA 19013 888-736-6335 WWW.POWERHRG.COM — Project Specifications Windows: Master bedroom 1 72.0"x81.0" WINDOWS: Model Power Symphony Style Sliding Glass Door II Type None Config None OPTIONS: Split 2 Panel : Custom Width and/or Height I Color White/White I Hardware Finish Color Match Interior I Grid Pattern None I Glass Options Low-E I Additional Details None July 05. 2023 12:05 IIII II III HN 11111111111111 11IIIIIN