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Home My WebLink About49831-Z �r TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY 49-ft ?? 1 w 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#: 49831 Date: 10/4/2023 Permission is hereby granted to: Gibbons, John 220 Water St A t 334 Brook/ n, NY 11201 To: Construct in ground swimming pool with spa at existing single family dwelling as applied for. At premises located at: 1380 Orchard St, Orient SCTM # 473889 Sec/Block/Lot# 25.4-11.1 Pursuant to application dated 6/27/2023 and approved by the Building Inspector, To expire on 4/4/2025. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 1111y� 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 httos://www.sotitlioldtownny.gQAPPLICATION FOR BUILDING PERMITv w, For Office Use Only PERMIT NO. Building Inspector. _ 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: ZU23 OWNER(S)OF PROPERTY: Name:John Casey Gibbons& Marissa Gibbons scTM# )o-025-04-11.1 Project Address: 1380 Orchard Street, Orient NY Phone#:(60) 435-8225 Email:casey@f riendsfamily.co Mailing Address: 220 Water Street, Apt. 334, Brooklyn NY 11201 CONTACT PERSON: Name: Melissa Butler Mailing Address: 206 Lincoln Street, Riverhead NY 11901 Phone#: (631) 338-8449 Email: mbut1er75@mac.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: e Name: Mailing Address: '?S Phone#:C4130 `592--jI y10 Email DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: [n]Other Proposed in-ground pool POOL, Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes 9i No 1 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 R-80 this property? ❑Yes iiNo IF YES, PROVIDE A COPY. Check( tax Aft.elir Read fing: 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. Melissa Butler Application Submitted By(print nam @Authorized Agent ❑Owner Signature of Applicant: � ^ Date: 6-1242-0z-:5 STATE OF NEW YORK) SS: COUNTY OF 5LINOUC, ) Melissa Butler being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, Agent (S)he is the (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 ! da of l/ ,20 Y Notary Public MA RIA" 'lMARD p UBUIC.,STATE OF NF-WYOR PROPERTY R -i'- (Zistrabon No.01'� I4 1 20 a�. ..- Where the applicant isnot the owner ualBFedfitr B�LkC�RY" g mis ion Expire$CdObOr 1%2V 220 Water Street, Apt. 334, I� John Casey Gibbons residing at Brooklyn NY 11201 Melissa Butler do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. 5/25/23 0 ner's Signature Date John Casey Gibbons Print Owner's Name 2 rum so g zx UR "R 'A IN, o'\Ng" 3" Q�K n ,Rs I'A e': p" ","Jffi a- Np IN gg a MEN\\ Wl� 01, -34"JO A M, "'P Allb \M ,k Al A A bm �i Al� N m W A R ik g�, OW, Wl�lot a t j&4 fil'+-lCF i-ij"All 14) i "pq �Q 3, TOWN OF SOUTHOLD BUILDING DEPARTMENT SOUTHOLD,N.Y. NOTICE OF DISAPPROVAL DATE: August 22, 2023 TO: Melissa Butler(Gibbons) 206 Lincoln Street Riverhead,NY 11901 Please take notice that your application dated June 27, 2023: For permit: to construct an, access��.pool (inclusive of fence cool equipment and heater), and to construct a deck addition to an existing sin 7Ie-fa�nil dwelling at: Location of property: 1380 Orchard. Street Orient NY County Tax Map No. 1000—Section 25 Block 4 Lot 11.1 Is returned herewith and disapproved on the following grounds: The construction is not )ermitted pursuant to Chapter 170 of the Southold Town Code and is subject to Historic Preservation Corprnission approval. Authorized Signature Note to Applicant: Any change or deviation to the above referenced application may require further review by the Southold Town Building Department. CC: file,Landmarks DATE(MM/DD/YYYY) C R" CERTIFICATE OF LIABILITY INSURANCE 05/30/2023 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(ies)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 Barbara Dammers NAME: Roy H Reeve Agency,Inc. PHONE (631)2 98 4700X (631)298-3850 = No Ext); ... 'APC,Mo I: PO Box 54 ADDRESS bdammers@royreeve.com 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: Twin City Fire Ins Co Co 29459 ._..... INSURED INSURER 8: ...... ........ _..._ ..... Ricciardi&Sons Pools&Spas Inc. INSURER C 63 Bedell St.,ApL 1 INSURER D: INSURER E: Lindenhurst NY 11757 INSURER F COVERAGES CERTIFICATE NUMBER: CL235519083 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. ADDL'SIIBR „ P LI EFF POLI Y EX-0 .:... . LTR TYPE OF INSURANCE IN D.WVD POLICY NUMBER .MM/DO. MMIDD LIMITS * COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 770TAn,—110-REN I ED CLAIMS-MADE X OCCUR -PREMISES Earaccuatence $ 300,000 MED EXP(Any one person) $ 5,000 A Y Y 12UENOJ2200 05/18/2023 05/18/2024 PERSONAL&ADV INJURY $ 1,000,000 .... GEN'L:AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE is 2,000,000 POLICY . PRO- 0 LOC 2,000,000 JECT �I PRODUCTS-COMP/OP AGG $ Is %HEIR;: _ AUTOMOBILE LIABILITY COMffNEDSINGLE LIMIT $ _kE ra acoltte:nt 9 ... ... ANYAUTO BODILY INJURY(Per person) $ .. ... .............. OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED MOPE RTY DAMAR.E:. $ AUTOS ONLY AUTOS ONLY (Per acdd'enl UMBRELLA LIAB OCCUR EACH OCCURRENCE ... $ .�..:„.-. ... EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN „......••, STATUTE ER. ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E..LEACH ACCIDENT OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) E L.DISEASE EA EMPLOYEE $ 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 more space is required) Certificate holder is listed as additional insured as per the terms and conditions of form#HG0001(06/05)-Commercial General Liability Coverage Form,as required by written contract or agreement.Coverage under general liability is primary&non-contributory and a waiver of subrogation applies. 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. P O Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 i @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD l 7 6 5 4 3 ---- 2 �, b'-8" 3'-3" 4'-0" 4'-0a 4'_a' 4'-0" 14.-0" 4'-C+ 4'-Y" 2'-1" " �/ f I 4'-7" ' 1 F 1 MOM r - I 7 E E;e '� �f�l� •/—Q" , 1 i ' (1 ____. . _.,__._ .,`mac 1V lir {+J 1 O f 1 D 1, Ic go r = j Go i 1 t M e 1 I = cIc- 2'-3" a ._ iV A r-I00Ll B in LO PLo is N ^ W-r-- { 28'-C"' ,o f _ Leisure Paoks and Spas Manufacturing North America Irc. � Area: 616.7 Sq ff 2901 leisure[stand WaY•KnowMe.Tennessee 37914 Ultimate 40 Volume: 17,690 gal A rlaaC*At ca"taE LEISURE POOLS a.w;XE POW M, 1•:•++!H. +c..n..c y;rS k'£F�C�YSC�CIiM►llY.f'. JISA Perimeter: 110' 10" lin ft ' a 40'LONG X 15'S' WIDE a/06 rn�lc� I 87 6 I 5 4 ( 3 2 1