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HomeMy WebLinkAbout50370-Z TOWN OF SOUTHOLD �y 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#: 50370 Date: 2/26/2024 Permission is hereby granted to:. Sucic Alba h... ..................................................._� ... ....m..........______ ._.... _ ._.—_ 1505 Custer Ave . POBOX 22 .............................................e.. _ ------------ ........— --- ..................................................................................................................�.................___ So.u.t�h.o.Ld��.....NY.......1................. ...........�m...._.._......._.._..-_..------......................------........................................... .... ��1�............................... 1971,.....�.. ._.....-..-................--.....--................................ ...��...... _._. To: Legalize "as built" deck to an existing single-family dwelling as applied for. At premises located at: 1505 Custer Ave, Southo.l�.d ... ...�� ..._...- .._w_.........................................................._���_.._ SCTM # 473889 Sec/Block/Lot# 70.-9-14 Pursuant to application dated 1/17/2024 and approved by the Building Inspector. To expire on lease 8/27/2025. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $848.00 CO -ADDITION TO DWELLING $100.00 Total: $948.00 Building Inspector sr r 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 oy Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only r, a , 503-70 7 f� PERMIT NO. Building ""��� 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:01/09/2024 OWNER(S)OF PROPERTY: Name: Cheryl Trimboli SCTM# l000-70.9.14 Project Address:1505 Custer Avenue, Southold, NY 11971 Phone#: 516-647-9971 Email. cheryltrimboli@danielgale.com Mailing Address: 8 Wilson Street, Garden City, NY 11530 CONTACT PERSON: Name: Cheryl Trimboli Mailing Address: 8 Wilson Street, Garden City, NY 11530 Phone#: 516-647-9971 JEmail: cheryltrimboli@danielgale.com DESIGN PROFESSIONAL INFORMATION: Name: Tim Klesse Mailing Address:35 Chatham Road, Short Hills, NJ 07078 Phone#:973-379-6602 Emailaim@klesse.com CONTRACTOR INFORMATION: Name: Andy Cacciatore Mailing Address: 2290 Bellmore Avenue Bellmore NY 11710 Phone#: 516-316-2002 Email: andy_cacciatore@yahoo.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ■Repair ❑Demolition Estimated Cost of Project: ❑Other $ 3 500.00 Will the lot be re-graded? ❑Yes ■No Will excess fill be removed from premises? ❑Yes ENO 1 PROPERTY INFORMATION Existing use of property: Owner occupied Intended use of property: Owner occupied Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Southold this property? ❑Yes ■No IF YES, PROVIDE A COPY. Il Check 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 IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town oCSouthold,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 bulldingis)for necessary inspections.False statements madeberein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name):Cheryl Trimboli ❑Authorized Agent ■Owner Signature of Applicant: Date: /d b Z J STATE OF NEW YORK) SS: COUNTY OF kQ ' �r 1�h ��) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, ( ) She is the �wFAer (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 21 day of ebcr 202? No ary Public GEORGE PATRICK FORMONT Notary Public-State of New York NO.01F06339228 PROPERTY OWNER AUTHORIZATION Qualified in Nassau County (Where the applicant is not the owner) My commission Expires Jun 27,2024 residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Ow r s Signature Date —1C114- �0 . Prin Owner's Name 2 �- YWorkers' CERTIFICATE OF INSURANCE COVERAGE STATi'Compensatioil°t Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW W PART 1.To be completed by NYS disability and Paid Family WLeave benefits carrier or licensed insurance agent of that carrier .rie ........ ......... ......... 1a. Legal Name&Address of Insured(use street address only) 1b. Business Telephone Number of Insured A&J BUILDING&CONSTRUCTION CORP DBA HUNTER CABINETS 516-221-6525 ATTN:ANDREW CACCIATORE 2290 BELLMORE AVENUE BELLMORE,NY 11710 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 200197705 _._......._ i .�............. .............. .._ 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold-Building Department Town Hall Annex 3b.Policy Number of Entity Listed in Box"1 a" 54375 Main Road DBL435907 PO Box 1179 3c.Policy effective period Southold, NY 11971-0959 01/01/2023 to 12/31/2024 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.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 penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. 12/19/2023 1,d"(,� Date Signed By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, 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 4B,4C or 5B 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 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (only if Box 4B,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,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 By (Signature of Authorized NYS Workers Compensation Board Employee) Telephone Number Name and Title _ ..... _. 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 this form. DB-120.1 (12-21) II II I�I III IIIIIIIIIIIIIIII I III I 1�1 DB 120.1 (12-21) YORKW " orke S' CERTIFICATE OF STATE CO ' l"M 0 �iiO Boarld NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&IAddress of Insured(use street address only) lb.Business Telephone Number of Insured A&J Building&Construction Corp 516-221-6525 2290 Bellmore Ave Ic,NYS Unemployment Insurance Employer Registration Number of Bellmore,NY11710 Insured Work Location of Insured(Only required if coverage is specifically limited I d.Federal Employer Identification Number of Insured or Social to certain locations in New York State,i.e., a Wrap-Up Policy) Security Number 200197705 2.Name and Address of Entity Requesting Proof of 3a Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Merchants Mutual Insurance Company Town of Southold-Building Department 3b Policy Number of Entity Listed in Box"I a" Town Hall Annex WCA9102446 54375 Main Road 3c Policy effective period PO Box 1179 09/23/2023 to 09/23/2024 Southold,NY 11971-0959 3d The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) all excluded or certain partners/officers 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 PACE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent wilt 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 indicated on 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 authorized 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: Anthony D'Elia (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 4;L_ (Signature) (Date) Title: President 12/19/2023 Telephone Number of authorized representative or licensed agent of insurance carrier: 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) wwva wcb,Dy oov =12il I 0 CERTIFICATE OF LIABILITY INSURANCE --- 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 poticy(les)must 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 endorsament(s). PRODUCER.... NAME Anthony,D'Ell Acumen Solutions Group PHONErTr Lfiw 55 i AIc Nok 35 Pinelawn Road E1AIL ,A R elfa*=r4a ..__ Melville,NY 11747 Its IrRDDUCE � $NSIfflENS AFFORDING 00VVEla.ca� _®............ NAIC0 INSURED ..r. INSURERAtMerchants Mutual Insurance Compag �u-��332 A&J Building&Construction Corp INSURER_x 2290 Bellmore Avenue INSURFR C Bellmore,NY 11710 INSURER D INS1IRER_ �....www__._. ..�.W_.._._._.. _..... uNSIIRGRF r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES'OF INSURANCE LISTED BELOW kl1WVI-BEEN ISSUED TO TIME INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAND&NG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT"VV17H RESPECT TO WHICH THIS SUBJECTOERTIFICATE MAY BE ISSUED OR MAY PERTAiN, THE INSURANCE TO ALL THE TERMS, EXCLUSIONS AND CON.l7IONS'OF SUCH POUMES.LIMITS SHOWN MAY THAVE BEEN R50FORDED BY THE UGEDL DESCRIBEDICIES HEREIN IS BY PAID CLAIMS ��� dNTSNR U woLICYEFF POLIGYExP TYPE OF INSURANCE.... POLICYNUMBER MMICOIYYYY iomf AOrI'Y"YY C,Ii OCCURR'CI`vCE. LIMITS 1.00(I ..... GENERAL LIABILITY 0912312CI23 09/23/2024 EACH A BOP1105233 tTITE r4T s 1 x COMMERCIAL GENERAL LIABILITY Y �""" ER�MI� (d Vie!,+�'rr TM0 -�1�, CLAIMS-MADE L.',::I OCCUR MED EXP(Any one assan) 0 PERSONAL?.AOV INJURY GENERALAGGREGATE $ 2,00 ,000, GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOPA G 6 .I1tI� 8 POLICY PRO. LOC TOMOBILE LIABILITY COMBINED SINGLE LIMIT" $ AU. (Eaa�denl) ... ANY AUTO ' BODILY INJURY(Perpersan) S 11 .�..e........ ......... - ALL OWNED AUTOS BODILY INJURY(Per accident) S SCHEDULEDAUTOS PROPERTY DAMAGE $ (per accident) HIRED AUTOS S NON-OWNED AUTOS -$ UMBRELLA LIAR =cLoA',umRs,.Ac _ H OCCURRENCE 3 7 EXCESS LIAR AGGREGATE S S DEDUCTIBLE RETENTION S ...... `f1m�TT�TI.F- C)"fH^ WORKERS COMPENSATION t4 .LIMM61 AND EMPLOYERS'LIABILITY E.L.EW H AC'CIDEW �S ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA m -I•EA- OFFICERIMEMBER EXCLUDED? E.L.015E.A51„-EA EMPLOYE S IWMandMory In N14) Ef yes,desuibe under BJL.DISEAwE-POLICY LIMIT S ......... DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,IFm0M space Is required) CERTIFICATE HOLDER CANCELLATION VE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Southold-Building Department I Town Hall Annex EXPIRA nON DATE THEREOULD ANY OF THE F,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold,NY 11971-0959 7988-2009 ACO 0 CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD � Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name JOHN R CACCIATORE Business Name This certifies that the nearer is duly licensed A&J BUILDING&CONSTRUCTION CORP :)y the County of suffoik DBA License Number:H-44872 Rosalie Drago Issued: 06/03/2008 Coear'rratss'ic°ler Expires: 06/01/2024 jr This license its the property of Suffolk County r Department of Labor,Licensing&Consumer Affairs. ,r Poss,ession cuf this licvlse dries nw guarantee mY.5 vAdity. Additional Business Name HUNTER CABINETS License Category H1-GC #0 ; . ,.. N/F KOKOT NIF ALEXANDER N/F DULIS LOT 4.1 LOT 5.0 LOT 6 S84047'00"E 100.00, ea FENCE FENCE aroI Ia ,L. -S O.P' N 0.3' W2.0' W0.2` 40141 $ 4-V .....,_... SHED pT.FdCE p' 'ry PUMP FENCE W 10 t... ]ENCLOSURE FENCE �F'Fl�ICE 5Yd17.9'� �;i 0,3" E 0„2" 5 3.d' GARDEN Ju 5 5.4' .p f CaNNNG cof"p METAL SHED h� W D.0' V u LOT 14 NIF RUTKOWSKI N7F DUFFY LOT 4 2 LOT 13 WOOD DECK V 160,..r.,.....� STORY .G FRAME FTNEE ` Jp a 4, - ", .,, ,.a� GrAGEy, 77II SAY lV FENCE, j ., ...., E.... ONO" W 09' k '� k'N'd14>•: 5r. '� (V sy Irv~mm LL 9 BRICK 0 1 STEPS p 0C"i Lo C7 ,J_ L "ONLY COPIES FROM THE ORIGINAL OF a L 0 F� THIS SURVEY E LAD WITHSURVEYOR'S AN L/ }E°i� ORIGINAL OF THE LAND SURVEYOR'S INKED OR EMBOSSED SEAL SHALL BE CONSIDEREE TO BE TO DE A TRUE VALID COPY. UNAUTHORIZED ALTERATIONS OR ADDITIONS TU A LAND SURVEYING CERTIFIED TO: DRAWING BEARING A LICENSED PRO FESSIDNAL LAND SURJEYOWS OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY SECT IS A HOUTIoN OF ARRCLE luOF , SECTION 7209, PARAGRAPH 2 TRINITY ABSTRACT,L.L.C. THE NEW YORK STATE E DdCATIDN M.ARGARETE VAN ANTWERPEN and CHERYL ANN TRIM60LI u`W- DIST 1000 SECT. 70 BLOCK 9 LOT 14 LAW OFFICE OFJAMESj-MCGUIRE,P.C. NOTES. TITLE SURVEY I. PROPERTY INFORMARON SHOWN IS OF : , 1 o Ot EKISTING CONDITIONS AS OF 9/14/23. ',« , ANDRE K. 1505 CUSTER AVENUE 2. THIS IS TO CERTIFY THAT THERE ARE NO SITTEAMS OR NATURAL WATERCOURSES IN IG� A ' SOUTHOLD THE PROPERTY AS SHOWN ON MIS Y y MILLER, P L TOWN OF SOUTHOLD SURVEY, 26 VILtAajE ATAZA a d COUNTY OF SUFFOLK 3. RHODE ARE NO UNDERGROUND OR C V RONK NKOTW,A'NY a I a. STATE OF NEW YORK 1197 OVETtHEAD UTILITIES swDWN DN TNIs unP. TEL:65 Y 6172. 40 W 4.THE DIMEHSIGNS SHOWN HEREON ARE FOR FX°d�'i3 G !tl 8"a.*'T7EI A SPECIFIC PURPOSE AND BUY NOT BE C+' F)(; l{p!51,7 L6,�"GURIAT'YUBG1�IGS➢dA USED TO GUIDE IN THE ERECTION OF .,. ..., ... STRUCTURES OR FENCES. ANDRE K.Ml!!LI-E' NEW YORK LIC I"1TLE TA t�D2.30.1d7E,,,„a,,,,,, ,, DATE: 9--15-2023 SCALE: 1'=20' NO SD921 `lo-ot- i 6 70 0 SIMPSON HURRICANE ANCHOR MODEL H2.5 (DIRECTION AS REQUIRED) AT EVERY JOISTS / GIRDER INTERSECTION. 2X8 DECK JOIST 3/8" GALV. NUT, BOLT & WASHER ASSEMBLY STAGGERED EVERY 24", 2" FROM EACH EDGE. (2) 2" x 8" P.T. GIRDER DROPPED y SIMPSON BCS2-2/4 POST CAP 4" x 4" P.T. POST. SIMPSON PB44 POST BASE GRADE a . . NEED i a e • ' a 8" SONOTUBE FILLED W/ 3500 PSI CONCRETE j To ° 1'=0" X 1'-O" X 1'-O" EARTH FORMED 3500 PSI COCCRETE \ 0 ° a FOOTING I P CHITE t ti as : � d; Z UNDISTURBED EARTH oLu e� ~ t%, Y .J�VJ��,•,� t1. DECK DETAIL sT 1 SCALE: 3/4" = 1'-0" INTERIORS ARCffiTECTURE PLANNING �/ �� DRAIUNG NUNHR MXM ARMTHECPS SHORrc pia N I 0 o a HLBSSS� .,COY