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HomeMy WebLinkAbout50207-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT �,. TOWN CLERK'S OFFICE �' SOUTHOLD, NY '91 a 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 #: 50207 Date: 1/11/2024 Permission is hereby granted to. Ortiz, Joseph 650 EaIg a Nest Ct Laurel NY 11948 _..........e.. _ ...... ____ To. Install an accessory inground pool / spa combination to an existing single-family dwelling as applied for. Pool and pool equipment must maintain minimum setbacks of 15 feet. At premises located at: 650 Ea le Nest Ct, Laurel .........., .................--- ----...................................................................................w........... .._�m..m,,, 5CTM # 473889 .m ....................... --------— Sec/Block/Lot# 127.-9-6 Pursuant to application dated 12/8/20m a and approved by the Building Inspector, p p 23 . To expire on 7/12/2025. Fees: SWIMMING POOLS- IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: $400.00 ...................J. - � ____.m__-__ Building Inspector �" o /111 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 tDs://www.southoldtownq Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only I PERMIT N0. C) � � Building Inspector: Applications and forms must lae filled out in their entirety.Incomplete " applications will not be accepted.`Where the Applicant ls'not'the owner,an � Owner's Authorization form(Page 2)shall be completed, Date: OWNERS)OF PROPERTY: Name: The- l tvre( YiousL S SCTM #1000- )Z-7- - C)9— J(' t� Project Address: S eVI es { Gf (&.Urel Aly ( I qg' Sl l Phone#: - Email:�l6 - L( 58'— C��ItB' S;Mrnet Slb1 �•�d�'`1 Mailing Address: (9 S7 e-a-se- rles� C- /VV I t Cl G1 CONTACT PERSON: Name: S e-q-K m 0 rr%,-3o n I`1( ]POIJ, IrlNr 1 i qo Mailing Address: be roh nKr11 GorISI✓rve+14n m &- m`111 ,cOwl Phone#: S�l 6 _ C�d 6 - Q'4 Email. DESIGN PROFESSIONAL INFORMATION: Name: The- (bol MCA n Mailing Address: 116 0h;n Gr�nHlr /11C7r1Cc hrS /J/r 1 `(3 c( Phone#: ��- Email: �vw [CONTRACTOR INFORMATION: Name: Mailing Address 3 I`ll �G ►7� L n eM S�— y0d-rflotCS Vii q t(o Phone#: S lL - Yo 6 _ :, Email: bBn�h rr1�,rl S C0,1Ikilo+.it DESCRIPTION OF PROPOSED CONSTRUCTION []NewStructure ❑Addition [--]Alteration ❑Repair ❑Demolition Estimated Cost of Project: Ll6ther POOP 1 $ (90 10 Will the lot be re-graded? es ❑No Will excess fill be removed from premises? ❑Yes Pf\10 1 PROPERTY INFORMATION Existing use of property: GS Intended use of property: Zone or use district in which premises is situated: Are there any covenants as d restrictions with respect to 8'o this property? ❑Yes I(�'No IF YES, PROVIDE A COPY. @fiheck Box After 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 15 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): Se,,,.,? P,/p/`,k0"n uthorized Agent ❑Owner Signature of Applicant: Date: �1'2 STATE OF NEW YORK) SS. COUNTY OF being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the reit 0 (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� r .20� Notary Public Joshua L. Whalley Notary Public, State of New York Reg. No. 01 WH6440404 PROPERTY OWNER AUTHORIZATION Qualified in New York County, (Where the applicant is not the owner) Commission Expires Ates 1, f- 65"m"l2 residing at h s�0 I� ✓►�s e�f' r; a Mor'/'�Yon do hereby authorize S e, to apply on my behalf to the Town of Southold Building Department for approval as described herein. w �Z 4 A Owner's Signature ate �I ZF PJ-� Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD " Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 r Telephone (631) 765-1802 - FAX (631) 765-9502 Mtl w rc err southold'townn . 'o - seand southoldtownn . o APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date Company Name: 14 I e1jus i-rees L- t) Electrician's Name: r ,n License No.: q1 S3 lVig Elec. email: Elec. Phone No: N ❑I request an email copy of Certificate of Compliance Elec. Address.: 0 1,3 hLVU ,qte- ba 11 l JOB SITE INFORMATION (All Information Required) Name: S,r 6,n1' dY ` wh Address: 5-t7 Ie �t Cross Street: IZ_h I , etjle, �i Phone No.: S 16 o &r Bldg.Permit#: Q a(59 email: "be mv,;(I� crm:l A--hin ✓►, `I•Gu.� Tax Mae District: 1000 Section: 121' Block: c7l Lot: a G BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): LI S1 X. Ipool w�` 1'1 i , X S PC�— Square Footage. 07q Circle All That Apply: Is job ready for inspection?: ❑ YES ENO Rough In Final Do you need a Temp Certificate?: 11 YES ENO Issued On Temp Information: (All information required) Service SizeEl1 Ph[]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y EIN Additional Information: PAYMENT DUE WITH APPLICATION Scott A. Russell 1�SUFFQIr S' F 01KIM[WA'7C']EIK SUPERVISOR MA\,NA�G1EM1EN1F W SOUTHOLD TOWN HALL-P.O.Box 1179 O� Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 1 C TER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) - - - - - - - - — - - - - - - - - - - - - - - - - - - - - - - - - - - APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) d NAME: I 4­ Date: ign 4.t Contact Information: JU i O Co— (E-Mail o(E-Mail 8 Telephone Number) Property Address / Location of Construction Site: O C14-& �" s .. �� S.C.T.M. #: 1000 District 9 ' 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 Required ! Project does Not Discharge to Waters of the State. No'S.P.D,E.S. Pet`mrt is Rei+iiu'� Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. TI IE APPLICANT MUST OBTAIN a S,P,D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Bt;oaldrn Permst. - Area of Disturbance is Greater than I Acre & Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S_ Permit through the Southold Town En inee ing Dwartment Prior to Issuance of a Building Permit.. r rr Y Date Reviewed By. : �� F(lR M # CMf P-T(1C(lrtnhPr 7n 14 c e I YP 3 NYSIF New York state Insurance Fund PO Box 66699,Albany.NY 12206 I nysif.com CERTIFICATE OF WORKERS` COMPENSATION INSURANCE k NAAAAA 833988362 GIACIZZO INC T/A ir GIACALONE INSURANCE AGENCY 57 EAST MAIN ST SCAN TO VALIDATE RIVERHEAD NY 11901 AND SUBSCRIBE r. POLICYHOLDER CERTIFICATE HOLDER MILL POND PAINTING LLC TOWN OF SOUTHOLD 38 MILL POND LANE 53095 RT 25 ' EAST MORICHES NY 11940 PO BOX 1179 SOUTHOLD NY 11971 : :. POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12403 342-5 12485 11/08/2023 TO 11/08/2024 11/30/2023 C THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO, 2403 342-5, COVERING THE ENTIRE. OBLIGATION OF THIS POLICYHOLDER FOR WORKERS" COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATIONS LAW "sIIdITH RESPECT TO ALL �Ir 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. °y IF YOU WISH TO RECEWE NOTIFICATIONS REGARDING SAID POI, CY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTP'S:/ .NYSIF.COIIMI/CERTICERTVAL.A SIP.TIME NEIN YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED, AS A MATTER. OF INFORMATION ONLY AND CONFERS NA RIGH EXTEND INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE OR ALTER THE COVERAGE AFFORDED BY THE POLICY. t k; fc ?i !I I ii �l NEW YORK TT 7NGE FUND DIRECTOR,INSURANCE FUND UNDERWRITING 4, I VALIDATION NUMBER:286957092 Suffolk County Dept,of Labor,Licensing&Consumer Affairs :,. HOME IMPROVEMENT LICENSE Name SEAN A MORRISCN Business Name �hs Cg'"Wk%rtrai,he Mill Pond Painting LLC ar�c is 0 y P Cer5ed License Number HI-64781 I�w loaf"oPk Issued: 04102J2021 I"��' Vrag . Expires: 04/01/2025 CERTIFICATE OF LIABILITY INSURANCE [:!12J (MM/DDIYYYI�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 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). PR11 ODUCER CT Eric Kirk _.",."..:..., ....._.. Kirk Associates LTD 631-727-7767 Nis 631-727-1941 tlat: _... L... t E-MAIL lCirtc",assDsVc BmDr1C3n^relatiDnal.com 18 First Street ADDRE . YNSURERS AFFORDINGCoVCRAGE _....._. NALCO Riverhead _•.•......" """ . NY 11901 IN 'ty Casulaturance Company _ 13803 .........__... suRERA Farm Faml INSURED INSURERB: United Farm Familyy InsInsurance Company 29963 Mill Pond Painting LLC INSURER : ...._ •••••..._. .......... ........._ 38 Mill Pond Lane INSURER 0: ... ......... INSU..RER E: ..... .........�_ ..._ East Moriches NY 11940 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. .. ......... •.. __ .... ... _._....._.... ADD BA ....... . .... POLICY EI^F Pt�t.ICY E10'� INr X A TYPE LIMITS COMMERCIAL X � 3102L9402LICYNUMBER 02/22EACH OCCURRENCE $ 10000001023 82/2212024 CLAIMS-MADE Fx_]OCCUR ._. .$ 100,000 _. ..... RF CONTRACTUAL LIABILITY Mtq P(AluyontLX1rsrrrt) $ ............. 5,000 PERSONAL&ADV INJURY $ 1,000,0'00 _ _ .._ _. GEN'L.AGGREGATE LIMITAPPLIES PER. ..... GENERAL AGGREGATE $ ...... IT.2,000,000 PRO- PRODUCTS ,S•__ 2,000+000' POLICY JECTPRO- LOC $ OTHER. COQ_MBINEDSINGLE LIMIT person) $ 1„000,00'0 B AUTOMOBILE LIABILITY 3101 C6�a82.. 11/24/2.022 11/24/2023 $ DILY INJURY 11/24/2023 11/24/2024 ” ANY AUTO AUTOS ONLY AUTOS PROP .RT;7 MA0AG $ OWNED SCHEDULED BODILYI (Per accident) HIRED NON-OWNED E $ AUTOS ONLY AUTOS ONLY Pei °pJ """""""" '- - .. B X UMBRELLA LIAB OCCUR 3101E4404 02/22./2023 02/22/2024EACH OCCURRENCE $ 1„000'0()o EXCESS LIAB CLAIIMS-MADE AGGREGATE $ . ......_: DED .+^.�terr s RETENTION$ 10x,000 WORKERS COMPENSATION PER OT41- MPLOYERS'LIABILITY STATUTE E _ ANDE YIN ANYPROPRIETOR/PARTNERIEXECUTIVE NIA _E_L EACH ACCIDENT $ FFICERIM in SE EXCLUDE OI E (MandataryI E L DISEASE EA EMPLOYEE $ dP++��sw.destrite Israaler I ... ............�.�. D.SCRIPTION OF OPERATIONS below E.1."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 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE Kirk Associates Ltd ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Survey for: q THE LAUREL HOUSE 650, LL C ,-, `� Lot 6, "Golden View Estates" ►� '� At � I v7 Laurel o M.W Town of 37, Southold n N c . 1 o43 ` 3 Suffolk County, New York ,► , CL m N ��� 1 7 .�s �" 1 11 `� 0 S.C.T.M.: 1000-127.00-09.00-008.000 O11 _z ��,rcr IT/OF OLARIPIO^IRO A 11\1 1 � ,, ,... �LI�/ 0�'� 2p j 1 1\ ��\ 0- 40 0 40 'F A EL a NI \\ �j ,1 i W✓ '� of „ t 1 aS+ SCALE .1"=40' 0 NOTES: * � IIto 15` 1 `° ` ° r \I1 ��•`' ' 0 1. AREA = 47,816 S.F. 2. • = MONUMENT FOUND, e = STAKE FOUND. 3. SUBDIVISION MAP "GOLDEN VIEW ESTATES" FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON AUG. 30, 1984 AS FILE NO. 7770. «.` 4. ELEVATIONS REFERENCED TO N.A.V.D. (1988). 9 DEC. 06, 2023 AMENDED PROP. CABANA DATE: OCT. 21, 2023 JOB N0:2023-463 "� �` ' • : ---''--"" — � ���� ��� �i CERTIFIED TO: s FR�a " � � THE LAUREL HOUSE 650, LLC s��' e 6miry JEFFREYIMME & CONNIE KIMMEL 11 x r TEST HOLE DATA ti° e�$' ~ 00� � 4 MCDONALD GEOSCIENCE OCT 02 2023 EL=17.7 DARK 0.0 - BROWN LOAM �L0 STP I) BROWN ,} Q m CLAYEY SAND SIC A ih 3.0 � IV- DAVID H. FOX, l.S„ P.C. N.Y.S.L.S. #50234 PALE BROWN SP DRAINAGE CALCULATION: o 'a t0 FOX LAND SURVEYING FINE SAND REQUIRED: 64 SUNSET AVENUE G.W. __ w 15.7 CABANA = 340 S.F. �� WESTHAMPTON BEACH, N.Y. 11978 EL=2.0 340 x 1.00 x 0.17 = 57.8 C.F. X_ lu (631) 288-0022 57.8/42.24 = 1.4 V.F. / �0 WATER IN PROVIDE: UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY PALE BROWN i E AVD ATI,'A ¢wr COPIES EOa AN� 7THt OF VE NEW NOT STATE FINE SAND SP (1) s'� x 2' DEEP POOL = 2 V.F. ' ED CA'TY QPk 1.N W. 'CO S k 4.1E TH1.n L O JK MAP O BEARING / THE LAND S'dUR'�!(i:'e"CYG�x INi0.ED .�LFd. CXBT Crwkk3 U:i S,K�J 'WEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY,.. CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY ANDLENDING INSTITUTION LISTED HEREON I AND TO THE 17.0 ASSIGNEES OF THE LENDING INSTITUTION CKpd TWIr;'ATIONS TM j ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONSM OR SUBSEQUENT OWNERS.. .. DWG: 2023-463 .. .. _ ... ..... ...... .. .. _ _ m _,....._ . 50,9-Or7 t YO 90 ry Aq A1 )k -. 1 lz Afft .0ok DFC ' l ^,J23