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HomeMy WebLinkAbout49590-Z a. = TOWN OF SOUTHOLD �tBUILDING DEPARTMENT r TOWN CLERK'S OFFICE k, 9vu 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 #: 49590 Date: 8/16/2023 Permission is hereby granted to; Creighton, Ellen PO BOX 1217 Southold, NY 11971 To: construct an accessory in-ground swimming pool in the rear yard as applied for. Swimming pool and pool equipment must have a minimum setback of 15' from lot lines and the on-grade patio must be a minimum of 4' from side yard lot line. At premises located at: 1775 H att Rd, Southold SCTM #473889 Sec/Block/Lot# 50.-1-18.6 Pursuant to application dated 7/19/2023 and approved by the Building Inspector. To expire on 2/14/2025. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector tx or �� .. 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 htt s:/I w.w.sootholdtowtirt .zo ,m Date Received APPLICATION FOR BUILDING PERMIT LD CCS[ Odd For Office Use Only PERMIT N0. 1 Building Inspector: BUHDLNG DEPT. Applications and forms must be filled out in their entirety. Incomplete ___ E. ' `c`-11 applications will not be accepted. Where the Applicant is not the owner,an . ` Owners Authorization form(Page 2)shall be completed. Date:06/28/2023 OWNER(S)OF PROPERTY: Name: SCTM#1000- Ellen Creighton Project Address:1775 Hyatt Road, Southold 11971 Phone#:(631 ) 765-1115 Email:emcreighton@optonline.net Mailing Address:PO Box 1217 CONTACT PERSON: Name:Jennifer Del Vaglio Mailing Address:PB Box 369 Peconic NY 11958 Phone#:631-734-7600 Email:cj@eastendpoolking.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address.. Phone#: Email: CONTRACTOR INFORMATION: Name:Eastern End Pools, LLC DBA East End Pool King Mailing Address:PO Box 369 Peconic NY 11958 I Phone#:631-734-7600 T—Em ai 1 1:I'll cj@eastendpoolking.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Rother 14x26 Vinyl Pool $65,937 Will the lot be re-graded? RYes ❑No Will excess fill be removed from premises? ®Yes ❑No 1 PROPERTY INFORMATION Existing use of property , Intended use of property: Zone or use district in whichre` �ises i' p si situated: Are there any covenants and rest ation :'with respect to this property? ❑Yes Eallo IF YES, PROVIDE A COPY. ❑ i-h�e c k 411,ji x Af 14'P Reading: 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 name): °i i4 ,' C� *Uthorized Agent ❑Owner t, Signature of Applicarlt�'�7 Date: CONNIE D.BUNCH STATE OF NEW YORK) Notary Public,State of New York SS: No.01BU6185050 COUNTY OF ) Qualified in Suffolk County ` Commission Explres April 14,2 6 being duly sworn,deposes and says that(s)he is the applicant (Name of indiviclIdal signing contra t)above named, (S)he is the (Contra r,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 Q�dayof J �r`� 20 �� C�son ,�•� C� Notary Public .....,.. „ ............. (Where the applicant Is not the owner) I, �. ...� residing at 1441111 do hereby authorize ( 110 o apply on my behalf to the Town of Southold Building Department for approval as described herein, • � � Owner's.Sig attire Date M Print Owner' Tame 2 PROPERTY INFORMATION Existing use of property: Intended use of property: , Zone or use district in which pre ises Is situated: Are there any covenants and reAdioNKith respect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. ❑ Clieck Box After Reading- The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by I Chapter 236 of the Town Code. APPUCATION 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 name): �`i uthorized Agent ❑Owner Signature of Applican Date: ('o�a� �1 s CONNIE D.BUNCH O� STATE OF NEW YORK) Notary Public,State of New York SS: No.01 BU6185050 COUNTY OF ) Qualified in Suffolk County Commission Expires April 14, 20�, being duly sworn, deposes and says that(s)he is the applicant (Name of indivi I signing contract)above named, (S)he is thek&;c w) egg�-- \(-"A ocz, (Cont r,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 11 . T L , C 1� qday of . . tA 20 o, � Notary Public 1'"'IIU" ° IIUz :MW' "'ry CMIYEFI AtJ°°Illi ION (Where the applicant is not the owner) I, residing at do hereby authorize C " &o to apply on my behalf to the Town of Southold Building Department for approval as described herein, Owner's Signature Date kj e Print Owner'` ame 2 ACCIRO CERTIFICATE OF LIABILITY INSURANCE DATEtMM1D�lYYYY) 1111812021 ; THIS CERTIFICATE 15 ISSUED ASA MATTER OF INFORMATION ONLYAND 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 cerli ficate holds;is an ADDIT10 AL INSUR'IED,the policy(les)must have ADDITIONAL INSURED provisions or be endoarsed. 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 endorsemenALS1 PRODUCER NAME. Barbera Dammers Roy H Reeve Agency,Inc. PHONE (631)296-4700 Atli No (631)298-3850 PO Box 54 bdammers@roy-reev-e.com ADDRESS! @ Yreeve.com 13400 Main Road WSURCR S AFFORDING COVERAGE NAIC dl Mattituck NY 11952 INSURER A: CNA Insurance Companies INSURED INSURER a. Continentat Insurance Co. 35289 Eastern End Pools LLC,DBA:East End Pool King INSURER C: Transpodation Insurance Co 20.494. P O Box 369 INSURER O: INSURER E Peconic NY 11958 INSURER F COVERAGES CERTIFICATE NUMBER: CL21111815751 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 INSURANCEPOLICY NUMBER.... ''. kIMPf9t1.. MIMrrJ LIMITS COMMERCIAL GENERAL LIABILITY EAC•HOCCURRENCEHENTE1, S 1,000,000 3 Z CLAIMS MADE 19 OCCUR PR ee J,re � S 100,000 Contractual Liability MED EXP(Any oneperso n) B 15,000 A Y Y 6080837145 11/15/2021 11/15/2022 PERSONAL BADV INJURY S 1,000,000 RGEN'LAGGRIGArE LIMITAPPLIES PER, GENERALAGGREGATE S 2.000,000 POLICY JECT F__1 LOC PRODUCTS-COMPlOPAGG S 2.000,000 OTHER: S AUTOMOBILE LIABILITY =L610=1 Lima S 1 w0(l'0,0�00 ANY AUTO BODILY INJURY(Per person) B OWNED SCHEDULED 6080837159 11/15/2021 11/15/2022 BODILY INJURY(Per accident) $ - AUTOS ONLY AUTOS 25 HIRED NON-OWNEDMME AUTOS ONLY AUTOS ONLY per s nt S S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESSLIAB CLAIMS-MADE AGGREGATE S OED RETENTION'S' S WORKERS COMPENSATIONO AND EMPLOYERS'LIABILITY Y/N TA TE R ANY PROPRIETOR/PARTNER/EXECUTIVE11000,000 C OFFICER/MEMBEREXCLUDED? N/A 6080837162 11/15/2021 1 11/15/2022 E.L.EACH ACCIDENT �- $ (Mandatory in NH)describe under E„L.DISEASE-EA EMPLOYEE S 1 a000,000W -W111 w DESIf CRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1.000',000 I; DESCRIPTION OF OPERATIONS I 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(2016/03) The ACORD name and logo are registered marks of ACORD Scott A. Russell STO�][�I�IMA\T]E]C. SUPERVIS®R MANAGEMENT 6 ,.JAS, $ir SOUTHOLD TOWN HALL-P.O.Box 1179 , 53095 Main Road-SOUTHOLD,NEWYORK 11971 '�* ;�� �` .Y;a� Town of Southold CHAPTER 236 - , . " ER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT (Property t Owner D sj,n Rrofes onal, Agent, Contractor, Other) NAME: ' .. I L_ Date. Contact Irt��rca�atitsn, C�.- , b Etk.. i1,ma,i&Telt mvvv`nrmc,, } .,_ ..� " Property Address / Location of Construction Site: t- 1 _ '"� ., 't-1- " C S.C.T.M. 1000 I( "A 11"A 4- -_a� ff District Section Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - Area of Disturbance is less than 1 Acre, No S.P.D.E.S. Permit is Re uired t Project does Not Discharge to Waters of the State. No S P D E.S Perriilt isl(e uived 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.a, Pet-IIIit DIRECTLY From N.Y.S, D.E.C_ Prior to Issuance of a Building Permit. Area of Disturbance is Greater than 1 Acre&Storm-teeter Pel io f Flews Through Southold Town's MS4 Systems to Waters of the urate of Nett York. 1 HIE APPLIC'AN'T MUST OBTAIN a S,P,D E.S, Permit throu h the Southoki Town Ermneeri t t;i�ei�t ino De.ta,. l:�t toa° is I suance of a.Sudd_in Pumit, Piet:e-wed By: Gate: r:-t`1R�lf ' fw:0lif'F-"I'i";C flr�nh= Jf}w.. .. _._..._........._..,...e...�.., ...,..........,......�.Y........_..., ._..._.,...