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Home My WebLink About50046-Z TOWN OF SOUTHOLD dpW BUILDING DEPARTMENT TOWN CLERK'S OFFICE 60 C SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLAN'S AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 50046 Date: 11/20/2023 Permission is hereby granted to: Melly BJ Irry Trt 2555 Youngs Ave 14A Southold NY 11971 To: construct alterations to existing single-family dwelling as applied for. At premises located at: 2555 Youngs Ave Unit 14A Southold SCTM # 473889 Sec/Block/Lot# 63.2-1-43 Pursuant to application dated 11/3/2023 and approved by the Building Inspector, To expire on 5/21/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $250.00 CO-ALTERATION TO DWELLING $100.00 Total: $350.00 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 Date Received APPLICATIONF::0R BUILDING PERMIT For Office Use Only p �1d PERMIT N0. Building5664_ Ices ector't 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: f J 2a OWNER(S)OF PROPERTY: Name: SCTM# 1000 3; 2. . Project Address: ZS 5Yb v i k i AVC 8I/1 L-0/'V (IoV 7 4 J O 17JV t�q Phone#: S,6 — Fr�Z Email: Sf-C / .s y � 9Z � Mailing Address: 1,) 1-/e. igcq�-/ 33` 813 CONTACT PERSON: Name: AN WCSL� Mailing Address: PO 130( 6Sq S/. 1-L4 -T 5L l 'JO' Phone#:(6 51) 3 -77 r 2-606 Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: /11/t 12-1-/AJ C LAW-eL A/ C G C . 1�I le-1 37-9 Mailing Address: 99 C0 uliVk f WOOD D2 S44 N 63 Phone#: G31 160-1 -sJ23� Email: /11 �-Cif//I&C t- ?6 DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Add itionlxAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ J16 (V . "0 Will the lot be re-;graded? ❑Yes o Will excess fill be removed from premises? ❑Yes/N�o ZJ Ago 11,11(CA y-±r1J -41y 1 PROPERTY INFORMATION Existing use of property: SvAgtjA Lyl plug' Intended use of property: s vM M.--C MU!4E- 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. ❑ Check Box After Reed!U"IR: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by 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): DU" f�� Authorized Agent ❑Owner Signature of Applicant: Date: /I /3/z STATE OF NEW YORK) SS: COUNTY O WeSr being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the t7`' (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 I day of 202--3 Notary 13661ke, ROBERTA MAZZAFERRO NOTARY PUBLIC-STATE OF NEW YORII NO. 01 MA6207376 PROPER C kIIIImf C w �� QUALIFIED IN SUFFOLK COUNTY Where the applicant is not the owner) ( coMMlssloN EXPIRES JUNE 15,20--,;-& I, JhL, �� residing at 255-5 Vovwt,s Ave OVlt'01"" IT/4 'c U) fflbo I P do hereby authorize �' '°" Wes ilviz— to apply on my alf o t e Tow Sout aid' Buildin Department for approval as described er in. q Owner's Signature to Prin Owner's Name i 2 apt BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err so utholdtownn ov — seand southoldtownn ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: 1113Z2-3� Company Name: 14W j"Nc Electrician's Name: N,11-t i.i H�--r License No.: 5 q Elec. email: � �,✓2,,�rx IG N Ccin Au(-If 60r Elec. Phone No: 631 1 request an email copy of Certificate of Compliance Elec. Address.: I ,1 1A, Sd JOB SITE INFORMATION (All Information Required) Name: I 5 L � Ll� Address: Z5n,5 N(is LTC �U r,r,a L Cross Street: Phone No.: L3L 3'IT 2606 Bldg.Permit#: C)q, email: I I ( Pr�L • Cn��l Tax Map District: 1000 Section: Block: Lot: - ' BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage. � Circle All That Apply: Is job ready for inspection?: YES [] NO Rough In Final y p NO Issued On Do you need a Tem Certificate?-. YES Temp Information: (All information required) ❑ Service SizeEll Ph 3 Ph Size: A # Meters Old Meter# ❑New service[:]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 0 1 FJ2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION CERTIFICATE OF LIABILITY INSURANCE DATE 11/01/2023Y' 11/01/2023 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 pollcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 /RGT NAIrU Michael McCrain PRONE 631-998-4101by Ax N 531-982-54;33 PO Box 936 ADDRESS, mccraininsuranGe _' bll. aranlw East Quogue,NY 11942 INSURERS AFFORDING COVERAGE NAILS INSURERA.FARM FAMILY INSURANCE COMPANY 13803 INSURED tNsURERB: UNITED FARM FAMILY INSURANCE COMP MJC CARPENTRY INC INSURERC: 98 Collingswood Dr INSURER D. INSURER E, Sag Harbor NY 11963 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. LTR RTYPE OF INSURANCE POLICY NUMBER ADDLISUBR POLICY 9" POLICY EXP LIMITS A X COMMERCIAL GENERAL UABanY 3101X6504 7/10/23 7/10/24 EACH OCCURRENCE $ 1,000,000 FZ71 TO RENTED CLAIMS-MADE L,%J OCCUR =S E $ 100,000 X Contractual Liability MED EXP(Any one n $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 www GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE $as e - ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident)', $ AUTOS ONLY AUTOS HIRED NON-OWNED PROi"ERTYDAg4W E $ AUTOS ONLY AUTOS ONLY S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERSCOMPENBATION 3102W7417 7/10/23 7/10/24 AND EMPLOYERS'LIABILITY ANYPRIEF� m ROPrOR/PARTNER/ CUTIVE �Y!NE-L EACH ACCIDENT $ 100,000 OFFICERIMEMBEREXCLUDED9 l� NIA'... (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE j$ 100,000 DEse SCRIPTION.OF eOPEIi kTIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached lanae space in required) CERTIFICATE HOLDER CANCELLATION Town Of Southold Building Department PO BOX 1179 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold, NY 11971 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE e y 0 10882015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ' c Workers' CERTIFICATE OF sTJA , Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured MJC Carpentry Inc. 98 Collingswood Dr 1c.NYS Unemployment Insurance Employer Registration Number of Sag Harbor, NY 11963 Insured 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,Le.,a Wrap-Up Policy) Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) United Farm Family Insurance Co. Town of Southold Building Department 3b.Policy Number of Entity Listed In Box"1a" PO Box 1179 31021M417 Southold, NY 11971 3c.Policy effective period 7/10/23 to 7/10/24 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box If all partnerstafflcers Included) all excluded or certain partnerslofficers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 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". The insurance carrier must notify the above certificate 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 indicatedon 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 authorised representative or licensed agent of the insurance carrier referenced above and that the named Insured has the coverage as depicted'on this form. Approved by: Michael McCrain (Print name of authorized representative or licensed agent of insurance canler) Approved by: ��Q,�az 11/1/23 (Signature) (Date) Tide: Agent Telephone Number of authorized representative or licensed agent of insurance carrier. 631-998-4101 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 � •off• 50�/� t�I w O�Tk 6AT PATIO of CX IBAT ATH LIVRNG. ROOM Ns rAu, F � �a BEDRAOm S-ED ROOM t' �2 U��' KITCHEN W 10-4/11-4 ' tvw� tj� 12-0/11-4 � .0.0 c9 DIMING j X10-0/� 1—IS FLOOR PLAN MODEL A FOUNDERSVILAGE TOWNHOUSES 80lDYHUI:D, abEw YORK �jv �'� !"� �� f2 F��I�� ►' 1