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HomeMy WebLinkAbout49594-Z TOWN OF SOUTHOLD rr 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#: 49594 Date: 8/17/2023 Permission is hereby granted to: Sand Castle No Fork LLC 13110 New Suffolk Ave Cutchogue, NY 11935 To: Construct alterations and repairs to an existing single-family dwelling as applied for per SCHD approvals. At premises located at: 8985 Route 25. East Marion SCTM # 473889 Sec/Block/Lot# 31.-3-17 Pursuant to application dated 5/24/2023 and approved by the Building Inspector. To expire on 2/15/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $1,056.80 CO-ALTERATION TO DWELLING $50.00 Total: $1,106.80 Building Inspector TOWN OF SO OLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Sox 1179 Southold, NY 11971-0959 Telephone(631) 7654802 Fax(631) 765=9502 tt :// . outho1 townn! o ..W ......... Date Received APPLICATION OR BUILDING PERMIT For office Use Only N B PERMIT NO. Building Inspector: ------------- MAY2 k 2023 LD Applications and forms must be tilled out in their entirety. Incomplete applications will not be accepted. Where the Applicant Is not the owner,an IUIIIUE oiO O_D Owner's Autherizatvn form(Page 2)shall be completed. (date=April 12,2023 OWNER(S)OF PROPERTY: Name-.Sandcastle North_ Fork LLC, SCTM#1000=31=-3-17 Project Address $985 Main Road East Marion NY, 11939 Phone#:516-2$6-2643 �mail: illtldllmitr.com Mailing Address:13110 Now Suffolk Ave Cutchoguoy, NY 11935 CONTACT PERSONS Name Allison Mlnuccl-Noli�.n Mailing Address:13110 New Suffolk Ave CutchOgue, NY 11935 Phone#:516-236=2643 :IKM�ll:willandall@mac.com DESIGN PROFESSIONAL INFORMATION Name Avila Design Worshop Mailing Address 5$53 Selfridge St Forest Hills NY 11375 Phone#:917=519=5134 email: CONTRACTOR INFORMATION: Name&Northfork Property Care LLC Mailing Address:13110 New Suffolk Ave Cutchogue, NY 11935 Phone#:516=995=$361 thforkpc@gmall.ccm DESCRIPTION OF PROPOSED CONSTRUCTION [INew structure DAddition RAlteration Wkepalr []Demolition Estimated Cost of Project: D other $500,900 Will the lot be re=graded? E]Yes WNo Will excess fill be removed from premises? EJYes M No PROPERTY INFORMATION Existing use of property:Residential Intended use of property-Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Hamlet Business this property? ©Yea F-0 No IF YES, PROVIDE A COPY. Check Box After Reading: The owner%contralto%design professional is responsible for all draimp and stone water Issues as provided by Chapter 236 of the Town Cede: APPUCAPON is HEREV 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 Reguiatl=6 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 authorwo inspectors on premises and in bupding,(s)for necemry inspections.Eaise statements made herein are piiniehetile as a class/I rrliBdertleanor piiri:iiant tO Section X10.44 of the New York State penal Latif. Application SubiTi y(p int moire): I I Ison M I n m-I v o I an pALithorized Agent ROwner r, Signature of Applicant: date. ZO 23 STATE OF NEW YORK) : COUNTY OF .�1i �. 1 - ," • , ) T��--L1 -:!50N , ► ITN U _ ' being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named (S)he is the Owner (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 1 C� 'i �� ., NotarPublic DARLENE K BRUSH Notary Public-State of New York NO.01BR6318051 PR OPEOWNER myQmissioniE pireslJano20t 207 (Where the applicant is not the owner I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 NYSIF NOW'York Matt)Itustikindo Purid PO Bax 66099,Albany,NY 12200 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A„ti 852707301 a COVERAGE CONCEPTS INC 4953 NESCONSET HIGHWAY PORT JEFFERSON STA NY 11770 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE=HOLDER NORTH FORK PROPERTY CARE LLC TOWN OF SOUTHOLD 13110 NEW SUFFOLK AVENUE [BUILDING DEPARTMENT CUTGHOGUE NY 11935 54375 NY 25 SOUTHOLD NY 11071 PCL-ICY NUM81=R CERTIFICATE NUMBER POLICY PERIOD DATE 125119 6440 2x 7640 05/02/2023 TO 05/02/2024 5/8/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO, 2580644-0, CovERING THE ENTIRE 0131.IGATION 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 CANCELLATt+ONS, OR TO VAL11DATE THIS CERTIFICATE,VISIT OUR WESSI'TE AT HTTPS,-/ 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 AFFORDS COVERAGE TO THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY: WILLIAM NOLAN OWNER NORTH FORK PROPERTY CARE LLC 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: NEW YORKTA " SU N:I FUND 4 *1 DIR€0TOR,IN8URAN0E FUND UNDERWRITING VALIDATION NUMBER:203357050 NORTH03 •. CERTIFICATE OF LIABILITY INSURANCE DATE 001X8/2i) 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 V REPRESENTATIE OR PRODUCER,AND THE CERTIFICATE HOLDER. .. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONAL INSURED'provisions or I!e endorsed. If SUBROGATION! IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement, A statement on this 2-4ftificartLw.d"s not confer rights to the certificate holder in lieu of such endomement s. _ PRooucER 631.331-7700 Coverage Concepts Inc Covera4953 N sconset IIlghwway- IEA p;531 331 '?00 Ax ia31 331 7790 Port,Jefferson Sta,NY 11778 PIION cci covera +�cf�rlCpt. om Insuranee Co. 18326 ... .. .. . .....mWs...,,...m . _... . u:Nsu tZMAE Pork Pro rty Care LLC 13110 NeW S olk AveIf PRERC: Cutcfi- ue,NY 1'1936 � RQ: I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMES ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. fN;R ._.... - ACI L�LI'eR ._.__.��...Lis POL EF �PCq..1YE�ip TYPE OF INSURANCE POLICY NUMBER LIMITS LU161L-RY �FO.�IENTE � ..m�X 1,OOO�t100 CLAIMS-MADE OCCUR ART3000878980 03/15/2033 03/15/2024 A Gommili=AL GENERAL "o 0-CTO RENTED IMOD HIED€ inner p �aal!I_. t 5,000 _ 00 F9R iA1�!kA–DK99Rv_ :,A 1,000�0— �X__._ TE LIMIT APPLIES PER. GEN,ERA�AGGREGATE Z 000,000 L AGGRF X POLICY A..� FILOC ,p00 ._ AUTOMOBILE LIABILITY COMI3CNED IGNOLE,LIMIT ANY AUTO AUTO NrOONLY A,gUIUS Hrm FIS 9�#DILYINIIJRY,LPeraccldenll • „m, „� _, II S ONLY U Tl7��Y P A94iAGiE UMBRELLA LIA9 OCCUR A EXCESS LIAe CLAIMS-MADE DED RETENTION$ A MSRIAM YIN ANY PROPRIS W PARTNEFI/E IECUTIVE E L ACLA 1 pGIDENT . N=ICI RlI S M A E GCLUDI D" F N I A arrdalam�' ru ff E d� rbba under PEEFATlOIt -I ` DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CANCELJAT ........ 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. Building Department 54375 NY 25 AUTHOR"O REPRESEMYNOVE Southold,NY 11971 ACORD 25(2018/03) IJ 1988=2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of AGORD l ...'S tt SQr Compensation workers' CERTIFICATE OF INSURANCE COVERAGE Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed b NYS disability and Paid Family Leave benefits carrier or linens P y ty y ed insurance agent of that carrier. 1a.Legal Name&Address of insured(use street address only) 1b.Business Telephone Number of Insured NORTH FORK PROPERTY CARE LLC 516-996=8861 13110 NEW SUFFOLK AVENUE CUTCHOOU€,NY 11935 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of I nsu red(Only required it coverage is specifically limited to certain locations in New York state,i.e.,Wrap=up Policy) 852767361 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of insurance Garner (Entity Being Listed as the Certificate Holder) BhelterPelnt Life Insurance company THE TOWN OF SOUTHOL-D BUILDING DEPARTMENT 54375 NY 25 3b:Policy Number of Entity Listed in Box"1a' .. SOUTHOLD; NEW YORK 11971 DB1_690262 3c:Policy effective period 04/13/2023 to 04/12/2024 4: Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disability benefits only. © G.Paid family leave benefits only. 5. Policy covers: ® A:All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. © B.Only the following class or classes of employer's employees: Under p nalty df peryidr}l,I certify that i atri an aiiChorized representt tivtr or licensed ar aril df kite instirarice carrier fel renceri tibdve and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. i[late Signed 5/10/2023 By 4140, 4t Si--ature of insurance carrier's authoRzed representative or NYS Licensed Insurance Agent of that insurence carrier) Telephone Number ,516-829-8100 Name and Title Richardlte Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is Signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier;this certificate is COMPLETE: Mail it directly to the certificate holder. If Box 413,4C or 56 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. it must be emailed to PAU@wcb:ny_gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 1-3002=5201 . PART 2i To be completed bre the NYS Workers'Compensation Board(Only if Box 48,4C or 50 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Bayard,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation'Law)with respect to all of their employees. Date Signed gy (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title v. Please Note-Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS-licensed insurance agents of those insurance carriers are authorized to issue Form DB-120:1 :insurance brokers are NOT authorized to issue��pp this form. Da.120.1(12-21) IIIII�AI�® IIIIII��I�I�I II I�II013-120-1. (12-21) RESIDENCE 4d. � rywmmunxvvxl qIX 1 .�m , rdxu w r. COMMERCIAL a+•w wswww ue wxws,n Nlw ♦nrvn�aA nm'ra�x*wn P �� A E, f ' ,bT.M ! �e� Vfalf'WX T 1 ` 1 .� xsrrr� xIR tl+w..+.. .•^••! .,, NIX1�'SfA'IIONtl �.y' A;.: RESIDENCE i' L![Y uxxNOxxl E. ocxxnac HEW.zar«r. q o , l Styr yya.. �..,.� um C) 7 � x� SP ..r'� +..a �",.„w. � '4r / ASPHALT 0� .. 9 u! ... - -- W� y..: M„ DRIVEWAY wNP�wa.Vl p NaKaMYwwrG-w"'"aryx x .��.�.�... ^ AY I A�^+' omva [wmxxua ;,,.: O MglA+acG « wN "loll" l.0 :w r wwwmxAnnuww rorwa � � a�w� u�Ht. ,^ �.. "wJFw �� , a+us�unwam +nKm[w.TmurN.T«n! SAN;" ,L�� rm�p rery;ax�xw«w« wP: ll ""Ea"Rm Dwr4wsw ua�w>E„.� xxsAn w.[x<• �r,xxH uw.,uNMANN ` d ..^ r„•.•�' »:;,"w"S':rLt” mf .. - rw��.0 wxo- ro� N [ w � a w..-�Wncsu w N� wry wmw wa4M � ���� Nxrt�urIDENCE �PAn..a,[ex[cro .++,axwx x[xoxxl .u.we.an,nxwwn.e. > ww awawsMcun ry W [w.a„v.rvxu 'ui r twzNm LL---- N 17 xlr� r RESIDENCE TYPICAL OUT AIL V1 Kz•x+om[Hary sOmsat�x[rn W41 � [�] aa�x[„Ha.�AaxP�B.[ SITE PLAN scA�E:i"=30,_0„ 4 "cm n , uma� �I! 1 �nl�w �, C/1 PO4 z xrce'+, t cAwxx,ca ,w.wrr .. r ''' k, Ilm.�� c � „Fk W F� O In x � V w - ,wxxxrv" _ __ . ._ _ a. x *,: a OQ'IfM#Il�3Il�Il9 Ltd °° � 41 � --------------------------------------------w� � 0 �} �--"-� �n,awxn,. ! r'a "'",, �� DESCRIPTION: AREA LOT COVERAGE: V1 � xwmlPO H [ 1 PROPERTY. 32.61026 SF 0.]5 x W Egg xN n. xrr ^ �' 1 N ( tl A y$ wxYWpxwwx MaxxNNwflYwHpRww° baxWA,ux ixOX,,x �• HOVSE: 300>SF f X x' 1 !NfI�I X 4fx�I.w'Y.xtlMMHGV. 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