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HomeMy WebLinkAbout50722-Z TOWN OF SOUTHOLD �� ttt 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#: 50722 Date: 5/22/2024 w..w Permission is hereby granted to: Wipf M Trust 940 W Creek Ave Cutchogue, 11935 _..._._. �._. _. To: Install replacement windows to existing single-family dwelling as applied for. At premises located at: . . .......... . 940.W Creek_Ave, Cutchogue..... � ............. . ... _......ry.... .........._..._...... ....... .......�. ..._.........�.._....._ .. .. SCTM # 473889 Sec/Block/Lot# 103.-13-7 Pursuant to application dated 4/12/2024 and approved by the Building Inspector. To expire on 11/21/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $250.00 CERTIFICATE OF OCCUPANCY $100.00 . ...... .. ._... Total: $350.00 Building Inspector PROPERTY INFORMATION Existing use of property: residential Intended use of property: residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes jkNo 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 bulldingis)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.4S of the New York State Penal Law. Application Submitted By(print name): Marion Wipf ❑Authorized Agent WOWner v Signature of Applicant: x A6tx— Date: STATE OF NEW YORK) SS: COUNTY OF ) PA/5,)�,,�L'Odjvip--E-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 April 24 20_ Notary Public SETH G BANK PROPERTY" OWNER AUTHORIZATION Notary Public-State zif e`"York (Where the applicant is not the owner) Qualified in Suffolk County My Commission Expires Jan 3,2026 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. 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Hd %. � �n " Wh r G Client#: 1721414 LONGICUS ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATEIYYYY) 6/29/20212023 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 endor sed. 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NA E TACT D J Hardist USI Insurance Services LLC IPrHkO NED J9.1H4a 4 59 6200 J IAcA N ) 610 537-4220tirx) 333 Westchester Ave,Suite 102 E-MAIL )��DrtEsss ....._....rdisty�usl com White Plains, NY 10604 INSURERS)AFFORDING COVERAGE NAIC# 914 459-6200 INSURER a Selective Insurance Company of New York 13730 INSURED INSURER B ........_.._. .......... ........._.„....__w� Long Island Custom Windows '.INSURER C 2029 New Highway INSURER D. Farmingdale, NY 11735 E. ''.....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 CONTRACTOR 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. INSR AOOL S 11 Uf382 1111-POLICY Eri ... Y TYPE lff .. LIM._IT S7L OAL 12YNUMBER A X COMMERCIAL S20016211 6/2012023 05/01/202 EACHoccuRRENCE $_1_rC00 n q00 jft `eENTan $5I01017t1 ..",�CLAIMS-MADE � X�OCCUR MED EXP CAS one versos) $1,5tf100 ........ PERSONAL&ADV INJURY $,1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 OTHER OC PRODUCTS COMP/OPAGG $3,000,000 ".... $..._.. .._PRO........ ...... .................. '....... .. ... .. ... ..,,, ... ..... .w�w..- ... ..,, ...w..,,. ._,......_" ..... POLICY JECT I L """" " " 1 A AUTOMOBILE LIABILITY S200162112 6/20/2023 05/01/202 I. a)I¢aG1 u.IMI. .._.... 1,000,000„ ,X� ANY AUTO ... person) $ BODILY INJURY(Per pe AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ . OWNED .X..,.. SCHEDULED ..,f<„hPERI'Yt'SAMAGE PB $ HIRED NON-OWNEDQ"erawaratuaa,pt,)....."..., ..,..... _.. ...... ........ .,,_ X AUTOS ONLY AUTOS ONLY X EXCESS LIAB X OCCUR _ S200162112 � 612012023 0 /',1 A UMBRELLA LIAB 01/202 EACH OCCURRENCE A.. ......,.,"... . ......... .. CLAIMS-MADE i., ,,,.. ,. I'pEd2.. .w C"bTF ,,...... AGGREGATE m ._..__,.. 6dEfLNT4tJN51�I01J1� WORKERS COMPENSATION OFFICER/MEMBER EXCLUDED? ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A AND EMPLOYERS'LIABILITY Y I N LEACH ACCIDENT $ (Mandatory in NH) � EMPLOYEE $ E�:.. SEASE EA LfiwiPL.. ..... ........ .. ......... . ....W._...... If s,describe s�R'tea' PJ RIP feON OF OPERA1'N �belowE.L.I11SLA mE� POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The General Liability policy includes an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder only when there is a written contract that requires such status, and only with regard to work performed by or on behalf of the named insured. CERTIFICATE HOLDER CANCELLATION Town Of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Rd PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold, NY 11971 � rg,� C�©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S40622619/M40595713 SACT "* YWorkers' ORCERTIFICATE OF INSURANCE COVERAGE F_ . , e .. TIE Compensation oarfi NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To becompleted by NYSDisability and Paid Family Leavebenefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured LONG ISLAND CUSTOM WINDOWS,LLC DBA RENEWAL BY ANDERSEN OF L DBA RENEWAL BY ANDERSEN OF LONG ISLAND 2029 NEW 1c.Federal Employer Identification Number of Insured or Social Security HIGHWAY Number FARMINGDALE,NY 11735 Work Location of Insured(Only required if coverage is specifically 364619760 limited to certain locations in New York State,i.e., Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY TOWN OF SOUTHOLD BUILDING DEPT 54375 MAIN RD PO BOX 1179 3b.Policy Number of Entity Listed in Box 1a SOUTHOLD, NY 11971 LNY623001001 3c.Policy effective period 04-01-2024 to 03-31-2025 4.Policy provides the following benefits: x❑ A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. ❑ C.Paid Family Leave benefits only. 5.Policy covers: ❑X 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: W Under penalty of perjury,I certify that Iam an authorized representative or licensed agent of the insurance carrier referenced above and that the name insured has NYS Disability and/or Paid Family Leave benefits insurance coverage as described above. Date Si ned 04-04-2024 #j.�.......__.__ . (Signature of insurance carrier's authorized representative or NYS licensed insurance agent of that insurance carrier) Tel hone fit mbtrr 2� a3-8074 gName and Title, ELIZABETH TELLO—ASSISTANT LREq_TOR,STAT'UTORY SERVICES 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) w.__...��.......�..ww_....._ �.._w_. � State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-natned 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 ....... �w�w w_......aa.-....._.,.._.. ,w_.� (Signature of Authorized NYS Workers'compensation Board Employee) Telephone Number Name and Title Please�Notei Only insurance carriers licensed to write NY disability a rid "aid F�arridy Leave benefits insurance policies and NYS tic n$ed/rRsiarance 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) /7--0rN*N41 NYSIF New York state Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 11^A A^^ 364619760 � N USI INSURANCE SERVICES LLC 333 WESTCHESTER AVE SUITE 102 WHITE PLAINS NY 10604 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND CUSTOM WINDOWS LLC DBA TOWN OF SOUTHHOLD BUILDING RENEWAL BY ANDERSEN OF LONG ISLAND DEPT 54375 MAIN RD 2029 NEW HIGHWAY PO BOX 1179 FARMINGDALE NY 11735 SOUTHHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE H2403 991-9 671822 12/01/2023 TO 12/01/2024 4/9/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2403 991-9, 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, 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:I/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 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 STAT SUR NE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 739997371 I C)3 ' 0722 /A5_5C550R Order Summary dba:RENEWAL BYANDERSEN OF LONG ISLAND Marion Wipf Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H 1 940 W Creek Ave R EVNE WA L Nassau Lic#H0810150000 1 NYC Lic#.1307704 Cutchogue,NY 11935 bYAN_DERSEK 2029 New Highway I Farmingdale,NY 11735 H:(631)745-3896 IWYTtRpBI0PNE8p;I1W1(Md Phone:631-843-1713 1 Fax:631-843-1717 1 techs@rbalongisland.com Measure Tech:Eligio Hix, .• ROOM JOB 101 Dining 70" 56" Window: Acclaim'Y' Gliding Double, 1:1, Passive / Active. EJ Frame, Exterior .71-1/4" 59-1/4" White, Interior Pine Performance Calculator: PG Rating: 30 1 DP Rating: + 30 / -30 Glass: All Sash: High Performance SrnartSun Glass, No Pattern Hardware: Stone, Standard Color Extra Lock, Standard Color Hand Pull Screen: Fiberglass, Full Screen Grille Style: No Grille Misc: None Construction: Replace Rotted Wood (1), Pad Opening (1), No Bars (1), Aluminum Removal (1) Material: None 0" 0" Misc: Misc, Window Unit Installation, 2 Unit Window installation, Quantity 1 Construction: None Material: None 102 Dining 70" 56° Window: Acclaim'"' Gliding Double. 1:1, Active/ Passive, E1 Frarne, Exterior 71-1/4" 59-1/4" White, Interior Pine Performance Calculator: PG Rating: 30 1 DP Rating: + 30/ - 30 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: Stone, Standard Color Extra Lock, Standard Color Hand Pull Screen: Fiberglass, Full Screen Grille Style: No Grille Misc: None Construction: Replace Rotted Wood (1), Pad Opening (1), No Bars (1), Aluminum Removal (1) Material: None PRODUCTS: 3 WINDOWS: 2 PATIO DOORS: 0 ENTRY DOORS: 0 SPECIALTY: 0 MISC: 1 Updated 3127124 Job#03752853 101/102/dining/double glider rip measured full frame finish with 1x6 clear cut to size with backband clear Estimated Duration:1/2 days 03/27/24 Page 2 / 9 101 ' dba:RENEWAL BYANDERSEN OF LONG ISLAND Marion Wipf Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H 1 940 W Creek Ave RENEWAL Nassau Lic#H0810150000I NYC Lic#1307704 Cutchogue,NY 11935 bYAN-D-ERSEN 2029 New Highway I Farmingdale,NY 11735 H:(631)745-3896 Phone:631-843-1713 1 Fax:631-843-1717 1 techs®rbalongisland.com Measure Tech:Eligio Hix, Dining 0 71-1/4" W 59-1/4" H Window, Gliding - Double Window: AcclaiMMI Gliding Double, 1:1, Passive/ Active, EJ Frame, Exterior White, Interior Pine Performance Calculator: PG Rating: 30 1 DP Rating: + 30/ - 30 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: Stone, Standard Color Extra Lock, Standard Color Hand Pull Screen: Fiberglass, Full Screen Grille Style: No Grille Misc: None Construction: Replace Rotted Wood (1), Pad Opening (1), No Bars (1), Aluminum Removal (1) Material: None CONSTRUCTIONUNIT NOTES UNIT Replace Rotted Wood 7 Pad Opening No Bars Aluminum Removal 7 UNIT MATERIALS UNIT PHOTOS Image 1 Image 2 03/27/24 Page 3 / 9 : . `r. 102 dba:RENEWAL BYANDERSEN OF LONG ISLAND Marion Wipf Legal Name:Long Island Custom Windows I License#Suffolk Lic#43991-H 1 940 W Creek Ave RENEWAL Nassau Lic#H0810150000 I NYC Lic#1307704 Cutchogue,NY 11935 bYANDERSEN" 2029 New Highway I Farmingdale,NY 11735 H:(631)745-3896 iuue+aersimxvaoaeu�.uvurr Phone:631-843-1713 1 Fax:631-843-1717 1 techs®rbalongisland.com Measure Tech:Eligio Hix, 102Dining 71-1/4" W 59-1/4" H l Window, Gliding - Double Window: AcclaimT"' Gliding Double, 1:1, Active / Passive, EJ Frame, Exterior White, Interior Pine Performance Calculator: PG Rating: 30 1 DP Rating: + 30/ - 30 Glass: All Sash: High Performance SmartSun Glass, No Pattern Hardware: Stone, Standard Color Extra Lock, Standard Color Hand Pull Screen: Fiberglass, Full Screen Grille Style: No Grille Misc: None Construction: Replace Rotted Wood (1), Pad Opening (1), No Bars (1), Aluminum Removal (1) Material: None UNIT NOTES UNIT CONSTRUCTION Replace Rotted Wood 1 Pad Opening 1 No Bars 1 Aluminum Removal 1 UNIT MATERIALS A Image 1 Image 2 _....._.....�-----—--_ - - - — 03/27/24 Page 5 / 9 e p 102 Room Window-71.00W x 61.00H ».�,µa.,.,,a,.�....p',�s"��»w°"�"�'g='W.,K_,<,,...�.,.,r,�'���...---.......... ....5 -;q"';`:;rv.."`" jg�,•""r,._ m S;•r H :.{'• «���>d'. ;_� �,' e;,V..:,A,;�` w'tee �"«�°..;�`,•�,. _• :A '�. ��:' ,�� ,.mow- i'