The URL can be used to link to this page

Home My WebLink About50461-Z t � TOWN OF SOUTHOLD BUILDING DEPARTMENT �n TOWN CLERK'S OFFICE �.y SOUTHOLD, NY aro- r 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 #: 50461 Date: 3/20/2024 Permission is hereby granted to: Forbes Susan 1075 Narrow River Rd PO BOX 428 Orient, NY 11957 To: Construct an accessory inground swimming pool to an existing single-family dwelling as applied for. Pool and pool equipment must maintain a minimum setback of 5 feet. At premises located at: 1075 Narrow....River R rient „ ..-_ ... .....__........................................ ................................................._... SCTM #473889 Sec/Block/Lot# 27.-3-6.4 Pursuant to application dated —2/9/2024 and approved by the Building Inspector. To expire on 9/19/2025. Fees: SWIMMING POOLS -1N-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 _._......... Total: .... $400.00 _........_ _...........__� .. ........................ —..........._..__................�..... Building Inspector " t 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 lift : Jwww,southpldtowpn gpv Date Received BUILDINGAPPLICATION FOR For Office Use Only 4 W I ..PERMIT NO. O 1 I Building Inspector. 024 I� `� d, 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. i Date: �OaLA OWNER(S)OF PROPERTY: Name: Susan Forbes SCTM#1000-27-3-6.4 Project Address: 1075 Narrow River Road, Orient, NY 11957 Phone#:631-734-7923 (Agent) I Email:creativeenvdesign@yahoo.com MailingAddress:P,O. Box 160, Peconic, NY 11958 CONTACT PERSON: Name: David Cichanowicz Mailing Address: P.O. Box 160, Peconic, NY 11958 Phone#: 631-734-7923 Email: creativeenvdesign@yahoo.com DESIGN PROFESSIONAL INFORMATION: Name:Agent/Contact Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Creative Environmental Design Mailing Address: P.O. Box 160, Peconic, NY 11958 Phone#:631-734-7923 Email:creativeenvdesign@yahoo.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: lil0ther inground gunite pool $ 150,000.00 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes El No 1 ,I PROPERTY INFORMATION Existing use of property: residential Intended use of property:same 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. N Check Box A' 'er 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 hereln 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): David I i.chanowicz igAuthorized Agent ❑Owner Signature of Applicant: Date: I FFF STATE OF NEW YORK) SS: COUNTY OF Suffolk David Cichanowicz being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Agent (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 CJ� day of 20 1 1 � r Apt' Notary Public q 1/� lih ta-Q--� PENNY Lt JISF M 'FFET NE NOTARY PUBLIC,STATE OF NEW YORK Registration No. 0 1 MA6402379 RROPERTY OWNER 11THO IZA, I ed in Suffolk CommiissolnExpi es DecemberUntY 3M,2M7 (Where the applicant is not the owner),.. I, residing at Susan Forbes 1075 Narrow River Rd Orient, NY 11957 do hereby authorize David Clchanowicz to apply on my behalf to the Town of Southold Building Department for approval as described herein. (,Z , jq Owner's Signature Date A — Print Owner's Name 2 ------------- r,y� Suffolk County Dept,of Labor,Licensing 4-Ccinsunrdt Affairs HOME IMPROVEMENT LICENSE Name DAVID J CICHANOWICZ Business Name This certifies that the INDIAN NECK CORP DBA bearer is duly licensed License Number H-29895 by the County of suffolk Issued: 1 211 3/20 0 1 Jenuu fer Cabre,r L, Expires: 12/01/2025 Commissioner 6 r' f ' CERTIFICATE OF LIABILITY INSURANCE =DATE(MM/DD/yyYY) THIS CERTIFICATE IS I S ED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES N AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS GERTIFI� TE OF INSURANGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR P a DUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the cert I ate holder is an ADDITIONAL INSURED,the policy(les) must have ADDITIONAL INSURED provisions or be endorsers'. If SUBROGATION IS WA D, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not a fer rights to the certificate holder in lieu of such endorsement(s PRODUCER CONTACT Matt Daley Farm Family Insurance PRONE 631-744-3350 AL N Miller �ODREs mati.t:laley@Ofat „631-744-3383� Echo Ave-Suite 2 'in-famiiy.com Miller Place, NY 11764 INSURER S AFFORDING COVERAOF NAIL ...... - �._ _ INSURER A., Farm' elnlll aowUalt 13803 INSURED INSURER B Indian Neck Corp. DBA Gmative Environmental Design INSURER . PO Box 160 .. INSURER D. . : ..Peconic NY 11958 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT TAE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIT'I-ISTA 1NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE"D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIO NS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IWS TYPE OFINSURA E H .. PO CY fffF POLICY E;XP LTR D POLICYN'UMSER MM22Lt YY MM)DO YYY11 LIMITS , A COMMERCIAL GENERAL LIABILITY 3152X2360 06/01/23 06/01/24 EACH OCCURRENCE S 1,000 000 CLAIMS-MADE 11�,OCCUR n , 1H� mm 1 OO `�E„�wccinramr $ ,OOO x Select Business 0,1O ICED EXP Anr ono araeia $ 5,000 PERSONAL&ADV INJURY $ 1,00'0,000 GEN L AGGREGATE LIMITAP .ES PERT GENERAL AGGREGATE $ ,000,000 X POLICY❑PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHESs $ AUTOMOBILE LIABILITY COMBINED INGLELINT $ :.q mdcld of ANY AUTO BODILY INJURY Per ) erson $ person) OWNED DULEO BODILY INJURY(Per $ AUTOS ONLY S I ) - HIRED )fOS OO'WAMEO PROPERTYOAIdAOE _ $ AUTOS ONLY ONLY Per aes dent) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED I i RETENTION $ WORKERS COMPENSATION O - AND EMPLOYERS'LIABILITY STATUTE E.R1" Y 1 N E.L.EACH AGCIOENT $ AhIY'PkTOP6iq'E'¢ORPPARTC+kER/,E IJTYVE. ❑ NIA A. OF F'ICERIMEMBEREXCLUDED? gMandatory In NH) E.L.DISEASE-EA EMPLOYEE $ IP' es,describe a rtdor O SCR1PTI0N0r0PtRAtE0N ONOW E.L.DISEASE-POLIC'YLIMIT $ DESCRIPTION OF OPERATIONS 1 LOU ITIONSfVEHICLES (AVORD 101,Additional Remarks Schedulo,may bo attachod if more space Is required) MASONRY/LANDSCAPI /CARPENTRY CERTIFICATE HOLDER CANCELLATION Town of Soutl Id PO BOX 1179 T SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold, NY 1 971 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ..W,y 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 412i Na NYSI New York State InSW lr CO Fund PO BOX 66699,Albany,NY 12206 1 nysif.com CE TIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) AAAAAA 112294493 AMWINS INSUF NCE BROKERAGE LLC 200 ELWOOD VIS ROAD m SUITE 200 Rol LIVERPOOL NY 1 3088 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLD CERTIFICATE HOLDER INDIAN NEC' CORP. TOWN OF SOUTHOLD T/A CREATI v E ENVIRONMENTAL DESIGN PO BOX 1179 PO BOX 160 SOUTHOLD NY 11971 PECONIC N 11958 POLICY NU BER CERTIFICATE NUMBER � POLICYPERI OD DATE Z1318 0 -8 966723 05/01/2023 TO 05/01/2024 11/20/2023 THIS IS TO CE I TIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1318 046-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' CC PENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS I THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW„ IF YOU WISH T RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDA THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP,THE NEW YORK STATE 1 URANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFIC TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE U ON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE SUR NCE FUND I DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION N J BER:541632407 U-26.3 Work ' CERTIFICATE OF INSURANCE COVERAGE r.,.. S,ATE Compe Isation Beard NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be coml feted by NYS Disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Add`agss of Insured(use street address only) 1b.Business Telephone Number of Insured INDIAN NECK CORN DBA CREATIVE LAND-SCAPE DESIGN. 39160,ROUTE 25 PECONIC,NY 1195 1c.Federal Employer Identification Number of Insured or Social Security Work Location of 1115 ed(Only required if coverage is specifically Number limited to certain locati s in New York State,i.e., Wrap-Up Policy) 112294493 2.Name and Address o'Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as he Certificate Holder) HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY 3b.Policy Number of Entity Listed in Box 1a LNY323682 3c.Policy effective period 01/01/2024 to 12/31/2024 iEl provides the f flowing benefits: A.Both disc iltty and Paid Family Leave benefits. B.Disability benefits only. C.Paid Fam ly Leave benefits only. 5.Policy covers: ❑X A.All of the nlployer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the Dilowing class or classes of employer's employees: Under penalty of perjui f,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the name insured has NYS Disab I Ity and/or Paid Family Leave benefits insurance coverage as described above. Date Signed 01-24 024 By 7� (signature of Insurance carrier's authorized reprosonl,allvo or NYS licensed insurance agent of that insurance care er'i Tel Number t2 553-S074 Name and Title: GLIZABETH TELLO—ASSISTANT WRECTOR,STATUTORY SE'R ACES IMPORTANT: If So s 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licei 1 11 ed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. if Bog 4B,4C or SS is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 o the NYS Disa lity and Paid Family Leave Benefits Law.It must be emailed to PAU@wcb.11y.gov or it can be mailed for comlilotion to the Workers'Compensation Boards Plans Acceptance Unit,PO Brix 5200,Binghamton,NY 13902-5200� PART 2.To be Tled NYS Workers' Compensation Board(Only if Box 413,4C or 5B have been checked) State of New York Workers' Compensation Board According to itained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and aid 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'Compensallon Board Employee) Telephone Number Name and Title Please Note.,Only insura ii e carriers licensed to write NYS disability and Paid Family Leave benefits insurance policies and NYS ficensed insurance agents of those insurance carriers rt authorized to Issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. D6.120.1 (12.21) 15 __:� :co,.1 (12 21) ky6sms X\ DW-- - -- -AL -T I F J /-- POOL EQUIP 14x32 �� GUN(TE POOL. ' T75 5HEE) - J -A L —T-1 --F1 10 al -T-H 12 T-i F r EL --F-1 F 156 5F BRICK 5F LUE5TONE BORDER 5F r OUTDOOR SHOWER 1240 5F 5ET WfTH CONCRETE [3A5E 672 5F 5ET DRY W CONLRETE EDGE RE51DE N.. CE _- __ _ _-- ---------- ------ ----------- I J I OWNER: 5U5AN FORGES NARROW RIVER ROAD, ORIENT, NY 5c-rm# 1000-27-3-6.2 Revision #: Scale : Landscap e Pl an : 9-23-23 Landscape Design by : Davi d Cichanowicz VV V D ate : 1 0/18/2023 1 /4 Fuo% rbes 'mevisio "i '"i Creative invi roio�l mental Ic" n i i PROVIDED CONTI N UOU5 PROVIDE PAVING TO MATCH TERRACE PROVIDE PRE-FAB POOL POURED GUNITE BOND OVER AUTOMATIC POOL COVER BOX WITH COPING 24" W. WITH BEAM AND HAUNCH WITH REQUIRED 5.5. SUPPORTS FOR PAVING BULLN05E EDGE AT REQUIRED REBAR AS ANCHORED INTO POOL STRUCTURE. POOL (TYP.) SHOWN " STONE COPING 2'-711 AUTOMATIC POOL COVER. ---- ------- - - - -- ----- - - - ---- - - - _ _ GRADE 5EE MANUFACTURER'S of SPECIFICATIONS FOR 51ZE ................................................................................................................................ WATER LINE _ AND REQUIREMENT5 GUNITE POOL STRUCTURE TO 3" CL - -^ PROVIDE POURED STEPS INTO POOL WITH #3 @ 121, O.C. VERT. PROVIDE CONTINUOUS POUR BE CONSTRUCTED AS A 5 EQUAL RISERS, TO BE POURED WITH BOND BEAM AND HAUNCH WITH CONTINUOUS SINGLE POOL 5TRUCTURE WITH NO COLD JOINTS. #3 @ G O.C. HORIZ. REQUIRED REBAT IN POOL STRUCTURE WITH NO COLD MARBLE DUST FI N ISH � STRUCTURE BELOW FOR JOINTS. PROVIDE REBAR AS PAVING AS REQUIRED AT SHOWN. SLOPE ill PER FT. MARBLE DU5T FINISH RADIUS 1211STONE TERRACE TO BE CONSTRUCTED A5 A MONOLITHIC STRUCTURE WITH COMPACTED GRANULAR SAND POOL STRUCTURE WITH NO FILL. COMPACT IN 1 2 LIFTS TYPICAL FLOOR - G" TH . DRAIN LINE FROM AUTOMATIC POOL COLD JOINTS - TYPICAL GUNITE WITH #3 REBAR5 AT G" COVER BOX TO DRYWELL SURROUND FOR POOL. SIDES OF WALL EVENLY (TYP.) TO 95% DENSITY. FILL BOTH OC EACHWAY MIN. (TYP.) UNDISTURBED SUBGRADE (TYP.) - POOL SECTION A - � I- -] 8' DIA. x 4' D DRYWELL FOR POOL I BAC KWA5 H I F -- � I I I POOL SKIMMER POOL SKIMMER ago I I I I I 321 I I I I I , PROVIDE DRAIN WITH DRAIN I UNDERWATER POOL COVER CONNECTED TO LIGHT SWITCHED AT SHALLOW END I I SUBSURFACE DRAINAGE= RA NAGS I KE51 DENCE WATER LEVEL: 5' DEEP Z DRYWELL (TYP.) I w I I STEPS INTO POOL I 5 RISERS D � i II � ct� I AUTOMATIC POOL COVER. LOCATION A I II 3' I I - I I m POOL RETURN POOL RETURN I I POOL COPING (TYP.) P 0 0 L P L A N NOTE: SEE SITE PLAN FOR LOCATION OF CODE COMPLIANT FENCE AND GATE, AND POOL EQUIPMENT. ISSUES/REVISIONS CLIENT/OWNER PROJECT DRAWING No. FORBES cpy� CREATIVE ENVIRONMENTAL 1075 Narrow River Road, DESIGN Robert 1. Brown Orient, NY ` ° { Architect, P.C. SCTM No. 1000-27-3-6.5 NEW 239160 RTE 25 Zo Bay Ave. Green NY SWIMMING S PECONIC, NY info(W brownarchrtect.com DRAWING TITLE 631-734-7923 631-477-9752 POOL D ETAI LS POOL ��------Y creativeenvdesign@yahoo.com DATE IT IS A VIOLATION OF THE LAW FOR ANY PERSON,UNLESS SCALE ACTING UNDER THE DIRECTION OF A LICENSED ARCHITECT. Aug 31 20Z3 „ TO ALTER ANY ITEM ON THIS DRAWING IN ANY WAY.ANY > , , AUTHORIZED ALTERATIN MUST BE NOTED,SEALED AND = O DESCRIBED IN ACCORDANCE WITH THE LAW. POOL POOL C E FENCE WELL P FENCE N 20) 899 POOL COD F " 145 ONOW 32 14x d � 5HED I PN P POOL C 3PE FENCE 5ELF CL051NG POOL FENCE WALK GATE i jcp� I I - I � I I I I ` I �- LOT COVERAGE CALCULATION5 RE51PENCE I - - - DECK _- _ 169447 5F TOTAL LOT COVERAGE _ I - - Z729 5F- 1)WELL1W,;;r/[)ECK I _ 4 I _ 140 5F 5HED I - 420 5F MOP05ED POOL i GRAVEL WALK 3 239 5F TOTAL PROP05ED LOT COVERAGE i I GRAVEL 19.99% LOT COVERAGE � I 3 DRIVE i 1.1Ar 2 0 20 NARRow VER RO,4D 1075 NARF�'OW RIV. F--R ROAD, GRIENT, NY 5CTN# 1000-27-3-ros2 ' Scale: Landscape Plan : 6-20-23 Landscape Design by: David Cichanowicz Rev�s�on # ' _ 10' o No virUl 11 1 lel&*%Ital Desigi 1Date. 3/20/�_0241