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HomeMy WebLinkAbout50537-Z �� TOWN OF SOUTHOLD f Fat �y �" � vn BUILDING DEPARTMENT d 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 #: 50537 Date: 4/10/2024 Permission is hereby granted to: Koener, Roseline PO BOX 274 Westhampton, NY 11977 To construct accessory pool house as applied for per SCHD approval. At premises located at: 435 Maple Ln, Green port SCTM # 473889 Sec/Block/Lot# 35.-8-1.3 Pursuant to application dated 3/5/2024 and approved by the Building Inspector. To expire on 4/10/2025. Fees: ACCESSORY $371.00 CO-ACCESSORY BUILDING $100.00 Total: $471.00 (k——"�—I 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 https://ww.sotholdtow ny ors Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ' �v// E PERMIT NO. Building Inspector. - Applications and forms midst be filled cut in their entirety.Incomplete, � MA R III 2024 a p a ationsFill'botieaccepted, heratheA 0�011b s Ado PsSe + ola�wrplewd'. � west a erg stir s fn Date: ¢ OWN OF PROPERTY-. Name: A0Qt J-kim#1000- a Project Address: 3 S'" LP 0 Phone#: 61 26 Email: �' Mailing Address: CO ACt 09 Name: 4" L. 2ve,' f Mailing Address: t/ f !1 �s C2 �r Phone#: ,� :� Email: d e. OESIGN"P "ION" I FO A+ 1I'1ON Name: A3 r Mailing Address: V0 4 . Phone#: ( Email: fV�Q.y 'wi ICONMCMR INFORMATION: S So 02-A w j + Mailing Address: i I Phone#: "?- Finall: 0000"ION OFPROPOSED CONSTRUCrION XN-ew Structure Add" iqn ❑ lteratican Cl repair ElDemol"Itlon Estimated Cast of Project: Llother Will the lot be re-graded? ❑Yes a Will excess fill be removed from premises? [:]Yes0 1 PROPERTY INFORMATION Existing use of property: W .l Intended use of property: [ { Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Ye - o 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(pri me): ❑Authorized Agent wner Signature of Applicant: Date: STATE OF NEW YORK) S : COUNTY OF �. being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)a ove named (S)he is the 1 (Contract r,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 efolre me this —5day of � -' A ,2024' � ... NOf bl' ' ffD`i .afA6 14ct3ry public,"State of ME"'Y l c, )ST%7i 79 ' PROPERTY OWNER AUTHORIZATION IliP �o an 6 drrirlll591ork -i Fxp (Where the applicant is not the owner) I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 a Oak Scott A. Russell SUFFCX� ,;F01KMWAX]EIK SUPERVISOR I��l[Al�A��G�]El�ul[]EI�IC' o SOUTHOLD TOWN HALL-P.O.Box 1179 Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 CHAPTER 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) NAME: .- Date: Contact Information: iEhail&Telephone Numbed 1 Pro erty Address / Location of Construction Site: District Section Block Lot YYY ~n^TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT Area of Disturbance is less than I Acre. No 5,1 .D•E S• Permit is RecLutred r Project does Not Disc'harge"to Waters of the State`. N S P D•E.S, Pern11 ss ile titr I j 0 •- Area of Disturbance is Greater than I Acre & Storm water Runoff Discharges Directly to Waters of the State of New York. THE APPLICA,NT MUST OBTAIN a SP.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit., 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 hold Town En ineerrn I e artrnent { Prior to issuanceof.S_ Permit ap Building ePermit, p 3 .7 Reviewed Bye Date: FL FnR M x CM(-P-TnQ mmnh- 7n 14 I ve4 3 b L. Suffolk County Executive's Office of Consumer Affairs o VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 , DATE ISSUED: 8/22/2001 No. 29373-H SUFFOLK COUNTY a Home Improvement Contractor License This is to certify that PAUL J DAVEY doing business as SLIGO CONSTRUCTIION CORP ( having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules and regulations,of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. Additional Businesses � f NOT VALID WITHOUT DEPARTMENTAL SEAL AND A CURRENT CONSUMER AFFAIRS ID CARD Director i i _, r Suffolk County Dept of , Labor,Licensing&Consumer Affairs , Ff HOME IMPROVEMENT LICENSE Name PAULJDAVEY Business Name SLIGO CONSTRUCTION CORP This certifies that the bearer is duly licensed License Number H-29373 by the County of suffolk Issued: 08/22/2001 ROSOAZe,P"a- Expires: 08/01/2025 Commissioner NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) A A A A A^ 582445685 SLIGO CONSTRUCTION CORP 1365 WATERSEDGE WAY �md,* * SOUTHOLD NY 11971 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SLIGO CONSTRUCTION CORP TOWN OF SOUTHOLD 1365 WATERSEDGE WAY 54375 ROUTE 25 SOUTHOLD NY 11971 PO BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11353 733-7 205572 04/15/2023 TO 04/15/2024 3/4/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1353 733-7, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. 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/CERT/CERTVAL.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. PAUL DAVEY PRESIDENT AND LISA DAVEY VICE PRESIDENT OF SLIGO CONSTRUCTION CORP (A TWO PERSON CORP) 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK ST T U NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:387350156 U-26.3 DATE(MM/DD/YYYY) C '"! V, CERTIFICATE OF LIABILITY INSURANCE 0212612024 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 endorsements. PRODUCER CONTACT CO N Lisa Marie Aspen Agency Inc PHONE 631 71-7575t (6a)39 2439 191 Ronkonkoma Ave EMAIL en-r1 cc Ronkonkoma, NY 11779 INSURER(§)AFFORDING COVERAGE NAIC# _ INSURERµA:__Southwest Marine General Insurance Co _ ........ .. ........ INSURED INSURER B Sligo Construction Corp INSURERC: 1365 Watersedge Way INSURERD: Southold, NY 11971 INSURERE; IN U.RER F: COVERAGES CERTIFICATE NUMBER: 00019981-1047792 REVISION NUMBER: 39 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. _.. tMilk ,z ADD'.SUBR' POLICYEFF pOLICYEXP LIMBS TR TYPE OF INSURANCE POLICY NUMBER 1 A X( COMMERCIAL GENERAL LIABILITY GL2023RLH00420 10/15/2023 10/15/2024 EACH OCCURRENCE $ 1 000 000 CLAIMS-MADE a OCCUR PR ES(a 100,000 ED EXP(Any one person) $ 5 000 ................... ..... [PERSONA _...,.._,.� ... L 8 ADV INJURY $ 1,000,000 ... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 RxPOLICY PR,O LOC PRODUCTS-COMPIOPAGG $ 2.000 000 JEC"4"' OTHER. $ AUTOMOBILE LIABILITY COMBINED..JEi ISINGLE t,.NMIT $ ANY AUTO BODILY INJURY(Per person)mm mm$ ...... OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED W�ROpEAT'TY DAMAGE AUTOS ONLY AUTOS ONLY Par aoctiderrt' $ UMBRELLA LIAB OCCUR EACH_OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE Is DED RETENTION$ _ $ WORKERS COMPENSATION R 0::AND EMPLOYERS'LIABILITY -STAT ITE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L. H ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A """""'""""""""""EAC��-- (Mandatory In NH) E.L.DISEASE-EA EMPLOYE"I'$ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 54375 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold, NY 11971 AUTYIORI sPRESENTATIVE l .'- , LIS ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by LIS on 02/26/2024 at 05:32PM 7� R -p 4" SDR 35 N H, A L;-,i,'r N Pi CH 1/8"/FT IA/OV%fTS 7) GRADE 5% MAX EL(14.5) INV13.16/ DIST INV12.96 EL1 3.13 BOX I INV12.8 ---rIN 3j 6/ :3p) INv12-96 V1 1 IST 12.8 2) E V or BOX 77 8 OX� IN 3 (2) EACH 8'OX6DEEP 4" SDR 35 LEACHING PITCH 1/8"/FT P� POOL E 7 Lf7.1 EL7.1 45 HIGHEST EXPECT. GROUND WATER EL 0.9 NITARY INVERTS Mkma �P 10W S F--U7 - -hnan 'n (- 'a GEOMMLE FABRIC SUPPORT POSTS E gr WOOD OR METAL :TS j- FLOW DIRECTION j BACKFILLED TRENCH NO EXCAVATED AND RES1 -:�NE� X I- :-PTS: Pool House(0 Bedrooms) VIER#3009C EXISTING GROUND )VER#3017-C20 R-24-021 8 212612024 KS, 3017-G20 SER#3009 RISER#3009 t -R12 t 4 )CAP TYPE cvF - vE�.Rc 'ELING DEVICE BOX SEAL, POLYLOK SEAL NORTH ROAD #3001 TYP.40PLCSTYP- MIN.12"COMPACTED SAND OR PEA GRAVEL LEVELING PAD LAND N/F OF ANTHOULA KATSIMATIDES M®FAtENA KER 2l`g 5 DWELLING WIPUBLIC WATER 150' 171.17' 11 N 55'25'20" E I I I 1 D D Vc�j5N?-FN55-2520- E LING ELECTRICAL PANEL Uj 0 LIJ 4- CIRCUIT BREAKERbo 30AMP Exp-- I 8'0x4'DEEP ICATED 1 OVERSIZED FOR I LAND NIF OF tEURXAI,SEPIA CE TO 8 PROPOSED DRIVEWAY POOL WASTE WATER I SUMMIT ESTATES HYDROACTiON CONTROL PANEL f,—1% MIN 1000 GAL. /—IN HOMEOWNERS ASSOCIATION INC ELEC.SERVICE TO CONTROL PANEL k D.W.) 3 I A D.w VACANT 150' ELECTRIC AND AIR SUPPLY HOSE TO 0 L.P. 8' CONTROL PANEL AND AIR PqMP &ax4DEEP C.0, 2'SCH40 PVC VENT PIPE 15.0) — 41x4� PPOPQSEf )NTROL B'0x6'DEEP 7- 'ANEL WIHAL IFBATH-1 LP GF(15.5) FR(145 36.6' o zi GO 0. 533 , 0 D 36 7' 7—*- LP 00 IN co N CEN5 STY F;;�.-j &OxVDEEP MI DWELLING BE 30' 2-YA EXP .0 PROP.U.G.LrriLrrIE5 w w w PRCIPOSED WATER LINE LAND NIF OF 999 LONG ISLAND AVE REALTY LLC D.W./ DWELLING WtPUBUC WATER 150- LP FINISHED GRADE GAS 14 ELEV, 15.7 SM LOAMY SAND 1.7' /If SM SANDY LOAM 3.6' COARSE SIP SAND Es M E!N WtGRAVEL 10.6' v--q pc9 — MIXED SP SAND lo, W/GRAVEL UNDWATER -0 WATER IN HIGHEST EXF r"3 MIXED WATER EL I 11Z SP SAND lo, WIGRAVEL 45' POOL I SHAWN M.13ARRON M,S. jULY 19,2022 IAL) lo,