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HomeMy WebLinkAbout50436-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 8" 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 #: 50436 Date: 3/14/2024 Permission is hereby granted to: mid ............................... Barbera — �... .._._ ... ........_ ...... 738 Ascon Rd Franklin Saumare, NY 11010 To: Legalize "as built" windows in-kind to an existing-single family dwelling as applied for. At premises located at: 56815 Route 25, Southold SCTM.._# 473889 .m... ... �................. __ . .W.._.............__ ...........e.................. ..............................................................m. Sec/Block/Lot# 63.-3-17.2 Pursuant to application dated 2/9/202 4 and approved by the Building Inspector. To expire p . ...._....................... on ,,,,9/13 2025m Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00 CO-ALTERATION TO DWELLING $100.00 Total: $600.00 Building Inspector w TOWN OF SOUTHOLD—BUILDING DEPARTMENT `ry Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 litt :1 www outhol tnwrii ov Date Received APPLICATION FOR BUILDING PERMIT W y&. Far Office Use Only &�, PERMIT NO, lL______ Building Inspec rr: l I y 20 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an 1`� Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: ?-) C—j(ff�CA SCTM# 1000- U 3 Project Address: UQ`v Phone#: _(OUA Email: (i � Mailing Address: 1 CONTACT PERSON: Name: Mailing Address: Phone#: \77&& (,c>L4�2 Email: ben o 0-0 1. (-pyvL DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR,INFORMATION: Name: i Mailing Address: 61 k- P e7P6F 'P Phone#: I _ s�C Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑AlterationRepair ❑Demo)it'ian Estimated Cost of Project: ❑Other VVL If Will the lot b re-graded? ❑yes i h Will excess fill be removed from premises? Dyes yNo 1 PROPERTY INFORMATION Existing use of property: 4m I ��rOP��-� Intended use of property: -PQ Vo l i l' �- ague 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 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 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): Una ` owrow4c;_- CKAuthorized Agent ❑Owner Signature of Applicant: (�->?Qjn e*1 0"a Date: a\XIL A STATE OF NEW YORK) SS: COUNTY OF Su V:4:0NK ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (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 day of ha -/ t ,20 Notary 'ubllc COLLEEN E. DILAVORE NOTARY PUBLIC-STATE OF NEW YORK PROPERTY ER AUTHORIZATION No. OID14853844 (Where the applicant is not the owner) Qualified in Suffolk County '77 My Commission Expires February 24. to V'c.." Gk residing at U OV�/� � �os�— tj `(4 Biro cAlt_++� ere�by authorize� IQ 1 � y� e'MC g " t to apply on my lie alf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector " u;4 TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 �ww► Telephone (631) 765-1802 - FAX (631) 765-9502 amesh@southoldtownny.gov seand southoldtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑I request an email copy of Certificate of Compliance Elec. Address.: -1 f Required) Liz- JOB SITE INFORMATION (All Information q fired ) Name: ro c Address: Cross Street: Phone No.: Bldg.Permit#: "Sw email: Tax Map, District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): �" `�,{ti i G� O(�-� f �i J�L✓ �tJ��Y1 lbw� Square Footage: Circle All That Apply: Is job ready for inspection?: F] YES NO Rough In Final Do you need a Temp Certificate?: YES[-� NO Issued On Temp Information: (All information required) Service Size 1 Ph[]3 Ph Size: ©® A # Meters. Old Meter# [ New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals L 11 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION N F New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �M `C ^^^^^^ 113413895 HAMOND SAFETY MANAGEMENT LLC 6800 JERICHO TURNPIKE . SUITE 105W SCAN TO VALIDATE SYOSSET NY 11791 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER IANNACCONE HOME IMPROVEMENT CORP DOROTHEA GERACI 1105 MONTAUK HIGHWAY,SUITE C 3 DUBON CT EAST PATCHOGUE NY 11772 FARMINGDALE NY 11735 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 1219 319-9 857378 01/01/2023 TO 01/01/2024 11/2/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1219 319-9, COVERING THE ENTIRE OBLIGATION 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS//WWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. ROBERT IANNACCONE PRESIDENT OF IANNACCONE HOME IMPROVEMENT CORP THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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 YORK S E S7�VN!CE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:262642014 U-26.3 AC 11/02/ 02 CERTIFICATE OF LIABILITY INSURANCE DATE`MM/2023 Y) 3 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 poliic'y(les)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). coNTACT Mary Lou McLoughlin PRODUCER VRP Insurance Agency PHONE (631)738-7300 (631)738-7382 �No„ E- AIL mmcloughlin@vrpinsurance.com 955 Main Street ADDRESsa Suite 2 INSURER S)AFFORDING COVERAGE. NAIC# Holbrook NY 11741 INsuRERA: Mesa Underwriters Specialty Ins.Co 36838 INSURED INSURER B: Merchants Mutual Insurance Company 23329 lannaccone Home Improvement Corp. INSURER C 1105 Montauk Highway INSURER D Suite C INSURER E: East Patchogue NY 11772 INSURER F. COVERAGES CERTIFICATE NUMBED,: CL2372511395 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. SUOR L'9 TYPE OF INSURANCE POLICY NUMBER MMUDDY EFF MMI'DDdYYYY LIMITS COMMERCIAL GENERAL LIABILITY �/#CH oCCURRENCE S 1,000,000 tS� 100,000 CLAIMS-MADE �OCCUR PREIwhIS Ea orrcu re,ra: $, j CONTRACTUAL LIABILITY MEO EXP(A one peraenl $, 5,0000 A MPOO82001006483 07/23/2023 07/23/2024 PERSONALSADVINJURY S 1,000,000 GwEN'L AGGREGATE LIMIT APPLIES PER: (wwI NERALAGC.,REft�rAY�E. 2,000,000 POLICY [X PR'O- 0 LOC P%20DU'C'YS-COMPIOPAGG S 2,000,000 JE 'T OTHER: COMBINED AUTOMOBILE LIABILITY 9a wxJdenffl $ 500,000 LE'.LIMIT ANY AUTO BODILY INJURY(Per person) $ B OWNED ��r SCHEDULED CAP1063064 06/01/2023 06/01/2024 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS PROPERTY DAMAGE HIRED NON-OWNED $ AUTOS ONLY �" AUTOS ONLY Per PIP-Additional $ 50,000 UMBRELLA LEAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIM&MADE 29REGAT°E DED RETENTION$ $ 'WORKER.SCOMPENSATION PER OTIH• .AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE O NIA E L.EACHACH ACCIDENT S •• OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.OtlSEASE-EA EMPLOYEE w If ves,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ jI DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Job Site 56815 Main Rd.,Southold,NY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Dorothea Geraci ACCORDANCE WITH THE POLICY PROVISIONS. 3 Dubon Ct AUTHORIZED REPRESENTATIVE Farmingdale NY 11735 a m. @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD BENNY GERAGI%// ,.. NAME: ET � � "V'RET ODE MA/ ADDRESS: 56815 IN o/% sOUTHOLQ/ NY, r PHONE. (631) PROJECT: / / ,///%///'/fl/ /�j; CUSTOMERdp/� / / THIS IS NOT A RECEIPT ///��/ail �,, PRICE EXTENDED , P.O�S.# QTY DE%RIPTION ** OEL VERED 1„ 88404 1440 1/2X6 BEVELE��CE{)AR PRIMED 2.2p.30 3312.00 00 3,, 29000 1� FUEL SU„RCH0 ,/, 4, 88451 1 Iln13032 VHT/UNPIN W/SCREEN 550.00 '550.00 5,. 88451 SUBTOTAL $6,282.04 TAX g541.83 $6,823.87 � 0 C) pffiFC0.1'�0.PG � b D AT REDIk r } i�trii � y�I O'� / a` 1/ /r , /r, ,1 1' MU$Tr a MLV'ME NIX oR.., FOLLOWING DATE 0 FESTIMATE» rr �� WITNOT L T'QNLY UNTIL THE D� , END OF THE AERT�3 �,�� E"PE€IUUD of//o OFFS FROM DRAWINGS OR BLUEPRINTS OR THAT ODUCTS RE[EW ALLSQUANTITIESTED WILL E AMOUNT 'OF ESTIMAT TAKE TE , ED TOTAL PRICE WILL RENDER UNIT PRICES FIRM FOR 30 DAYS FROM, DATE OF DEPOSIT, THE �i RESPOMSI6ILITY FOR ACCURACY OF CUSTOMERS SHOULD HAVE QUALIFIED ENGINEER OR ARCHI �fiQMER?5 INTENDED PROJECT, BJECT R CONTENTS OF PACKAGE CHANGE,,. � NSTIYUTE A CONTRACT OF SAL TO CHANGE IF TOTAL PACKAGE NOT PURCHASED O OR AVAILABiLITV OF ANY PRODUCT LISTED. ��%�°/ 3�fTAl PACKAGE PRICE AND r a uote on Builders! fcmt EEC dba 84 Insurance for a 1 Ext 1" 5 or visit 84i nsurance.com. from producer and is a separate entity rl �p � insurance not Sell insurance, d to and does tensed COMPLY WITHALL CODES O CONDITIONSNEW YORK STATE&TOWN CODES SOMOLDTOWNIBA SOUTH T/ OUJ OWN PLANNING BOARD UTHOLDTOWN TRUSTEES 1S,DE SOUTHOLD HP CPU D E'j'1'1i�sx i rr--rr— •�—� n — 01/24/24 12:20 PM � 5 V �� ^� ^�J � 1� -- NAME: BENNY GERACI STORE: 0620 - RIVERHEAD CODE: .•11 ADDRESS: 1751 WEST MAIN STREET ADDRESS: 56815 MAIN RD PHONE: (631) 369-0084 SOUTHOLD. NY 11971 ASSOCIATE: MATTHEW RAGIMIERSKI PHONE: (631) 714-9395 FAX: EST DATE: 01/23/24 START: / PROJECT: • < THIS IS NOT A RECEIPT > #761 CUSTOMER COPY ___ ___ _ ---------- ---------------------- - P.0 S'.# QTY DESCRIPTION PRICE EXTENDED ------------------------------------------------ ** DELIVERED 1. 88404 1440 1/2X6 BEVELED CEDAR PRIMED 22,30 3312.00 3. 29000 1 FUEL SURCHARGE 5. 88451 1 TW3032 WHT/UNFIN W/SCREEN 550.00 2400.04 550.00 • =z=���--- =sue same=�- SUBTOTAL $6,2B2.04 TAX $541,83 TOTAL $6,823.87 84 LUMBER CO. ESTIMATE.AND PRICING POLICY �. �,�„ •, UNIT PRICES ARE SUBJECT TOICHm�EEN OF THEUERTISEDMSALE PERIOD. FOLLOWING DATE OF ESTIMATE. ARE IN EFFECT ONLY UNTILDAYS FROM DATE OF T OF FULL AMOUNT OF ESTIMATED TOTAL PRICE TkAIKELOFFSRENDER FROMUNIT DRAWiNGSSORFIRM B BLUEPRINTS OR THAT THE PRODUCTS PLISTED WILL ASSES NO RESPONSIBILITY FOR ACCURACY OF 1. S NOT ETE CUSTOMERS INTENDED PROJECT. CUSTOMERS SHOULD HAVE QUALIFIED YEPRIODUCR �STEDHITECT REVIEW ALL QUANTITI S NOT CONSTITUTE A CONTRACT OF SALE OR GUARANTEE GE IF TOTAL :BpcEp ON TOTAL PACKAGE PRICE AND SUBJECT TO CHANGE IF TOTAL PACKAGE NOT PURGED OR CONTENTS OF PACKAGE CHI fall Maggie's Mgt LLC or Insurance 84�nsuran�eecom on,Builders -::877-866-1384 Opt. 1 Ext is a licensed insurance producer and is a separate entity from Co. is not licensed to and does not sell insurance. 4. y.. tag,