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HomeMy WebLinkAbout50671-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT �= TOWN CLERK'S OFFICE 1-4 0 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#: 50671 Date: 5/14/2024 Permission is hereby granted to: Klei, Laurie Ave NY 11768 Northport, . . _.. .... .. To. Construct an in ground swimming pool accessory to an existing single-family dwelling as applied for. Pool and pool equipment must maintain a minimum side and rear yard setback of 10 feet. At premises located at: 540 The Greenwa , East Marion ... �_. SCTM #473889......... ..-..........____ .... , ..... — ... .. ....,...-..._ _ _.... .. Sec/Block/Lot# 30.-243 Pursuant to application dated 4/2/2024 and approved by the Building Inspector. _ To expire on 11/13/2025.a Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: ....... .. .... $4,...�.� 00.00 . ,. _._... ........__ _.�._. _.� ..... Building Inspector rr�+' TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959 Y Telephone (631) 765-1802 Fax (631) 765-9502 t ://w w.southoldtownn". 'o' Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only D E C E 0 W E C I PERMIT NO. 5 Q l Building Inspector:-J&&-- APR Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,anelFae Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: - SCTM#1000- oo — 0.2 O c7 0 13, Project Address; lC) r 3 Phone#: l�' " ACC, Email:g1/6 44✓Z._ Mailing Address: CONTACT PERSON: Name: m l Mailing Address: I00 Phone#: f k - -2 - 13 Email:QAll r . DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: /7UN — `/JE GJA�✓1 i✓v L/G l�35�f l Mailing Address: Phone#: 6 1440 Email: M.4 11—. DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: 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): Ae L 6/eLA `O v ❑Authorized Agent f f owner Signature of Applicant:... Date: 0q(cz- Z� STATE OF NEW YORK) COUNTY OFlz�)LA&L (C;tQ Pe �rL AllIdO being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the ux— (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 aday of , 20 �' ' Notary Public Notary Public . State of New York PROPERTY d T No. 0l01.0019E99 Qualified in Suffolk Ceunl�y (Where the applicant is not the owner) M Comm. Expires.fan. 10, 210 8 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 Suffolk County Dept.of Labor,Licensing&Consumer Affairs HONE INPROVENENT LICENSE Name JOSEPH P DONIANO JR Business Name rNs certifies:hal the DOMIAIO POOLS INC DBA 3earer is ddy licensed )y the County of suffolk License Number: H-16355 Rosalie Drago Issued: 03101i1989 Comn•;ssiorer Expires; 03/01,2025 a 74/112024 (MMIDDIYYYY) ACCORa 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 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 JOSEPH C.TIN+ INS.COM GO FAx � (631 THE TINGO INSURANCE AGENCY INC PHONE 619�289 xt 631 61 55 AIc.Ndl; ..4 3771 NESCONSET HIGHWAY, SUITE 210 Et D IL ss JTI dGGo TIN SOUTH SETAUKET, NY 11720 INSURERGS)AFFORDING cravERn NAIC# INSURER A: TRANSPORTATION INSURANCE COMPANY 20494 INSURED INSURER B: ............... _...._.... .......... ._.............m.-..�.. DOMIANO POOLS INC INSURER C: _ .......... DBA POOLFECTION INSURER D 531 RTE 111 INSURER E: ........ ........ . .. HAUPPAUGE NY 11788 INSURERF: 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 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. ......._. .. _ .... m... 1NSR ADaL$U'SR -- POLICY EFF POLICY EXP LIMITS LT � TYPE OF INSURANCE ZOaPOLICY NUMBER MMIDD IDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000�y000 bA ,�a d N 5�... CLAIMS-MADE N-1 OCCUR PR MB F ( .c rr net $ 300,000 X CONTRACTUAL LIABILITY _ME D EXP(An y oe p nerson) $ 1„0 000 A _ Y 16019985774 3/30/2024 3/30/2025 PERSONAL&ADV INJUR Y $ 1,000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 O00 000 PRO- POLICY 1-1 JECT F LOC PRODUCTS COMP/OP AGG $ 2000000 OTHER; AUTOMOBILE LIABILITY LgA.pSINEGb StlNLaLE LIMIT $ �arTaoqrdenRl .�...- ... ... ANY AUTO BODILY INJURY(Per person)mmm $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS µW- HIRED NON-OWNED 9�ROi'ER'TY DAMAGE $ AUTOS ONLY - AUTOS ONLY 4Pe° ° rNC •. -•• -• UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY ,V„„„ STATUTE _ ERITITITIT _.-.,..., ANY PROPRIETOR/PARTNER/EXECUTIVE YIN p E L EACH ACCIDENT $ ITITITITmmm OFFICER/MEMBER EXCLUDED' N/A mmm (Mandatory in NH) DISEA SE-EA EMPLOYE $E.L. eO1 „_�. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project: 540 The Greenway, East Marion NY 11939 Rush Builders Inc. is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Rush Builders Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11 Livingston St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Bay Shore, NY 11706 AUTHORIZED REPRESENTATIVE I © 88.2015 ACORD CORPORATIO'NI: All rights reserved, ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYI F New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 4AAAAA 113234713 "t-Lo TINGO INSURANCE AGENCY INC3771 NESCONSET HWY STE 210 SOUTH SETAUKET NY 11720 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOMIANO POOLS, INC. DBA RUSH BUILDERS INC POOL FECTION 11 LIVINGSTON ST 531 RTE 111 BAY SHORE NY 11706 HAUPPAUGE NY 11788 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12357 753-9 299524 04/14/2023 TO 04/14/2024 4/1/2024 �] THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2357 753-9, 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://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. PRESIDENT JOSEPH DOMIANO OF DOMIANO POOLS,INC. DBA POOL FECTION(ONE 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. NEW YORK STAT SU NCE FUND DIRECTOR,INSURANCE..FUND UNDERWRITING VALIDATION NUMBER: 366462555 1 LOA 2 It R-91\,N� NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^^^^^^ 113234713 TINGO INSURANCE AGENCY INC " 3771 NESCONSET HWY STE 210 .. m SOUTH SETAUKET NY 11720 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOMIANO POOLS, INC. DBA RUSH BUILDERS INC POOL FECTION 11 LIVINGSTON ST 531 RTE 111 BAY SHORE NY 11706 HAUPPAUGE NY 11788 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12357 753-9 1 346423 04/14/2024 TO 04/14/2025 4/1/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2357 753-9, 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:/ANM.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. PRESIDENT JOSEPH DOMIANO OF DOMIANO POOLS, INC. DBA POOL FECTION(ONE 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. NEW YORK STAT SU NCE FUND DIRECTOR,I NSU RANCE FUND UNDERWRITING VALIDATION NUMBER: 903090612 1 i_Wa 14 r] FOU N DATION STAKEOUT LOT 105- MAP OF PEBBLE BEACH FARMS, SHEET 2 FILED: JUNE 11, 1975-MAP NO.6266 N� oN SITUATE � o . EAST MARION TOWN OF SOUTHOLD SUFFOLK C , N.Y. U TAX M N 0.: 1000-030.00-02.00-043.000 a LOT EA:22,396.80 S.F. (0.514 ACRES DATE URVEYED: JUNE 16, 20 IS 0 PROPER 11,2023 Q a rn o 0 0) �s a -ELEVATIONS REFER TO NAVD88 o 0 -ZONING: R40 m --NO WETLANDS OR SURFACE WATERS WITHIN 300' --NO WELLS WITHIN 150'OF SUBJECT PROPERTY m 4 r LAND N/F CHERYL & ROBERT SCHEIDET Z RESIDENCE - PUBLIC WATER to N z O r L T1 z o J In r I m N66D28'1O E / 290.88 r 'O,1s rn o 0.9'N 4'METAL FENCE 0.3'N r / I � Lil m I Stake Set O / / / qp MON.FND. r s�9 c I- r v �g37q C I)j / O) / 1 N I O7 `21 C o POOL u 32.0 // ® / r4E /// I DnN)r I z Z EQUIPMENT o EL41.0 0 fn INGROUND / 4�gp/ m g Ex POOL =q D a G) 32.0 /I Prop�oosed _ ��p 1 I " Ln r -2 Story 80:L T1 5 1 6 Bedroom o 8-0.8'�g?� I-Py / < Q -- 1.�, Single Family `( m ' zI Z i a I Dwelling ``.P.� '� `� 'q� m v In I) I 111111111111 Ld I w I 1111111111I F.FL:46.00 OLE ,Q '�` ! 40.0 1 K d zZCI JI .54 "❑ Y\ / -s8 ,(' -i — / 9 = iCf) IV I EL.44.0 1 _ _ 4CCi.OD _ _ ______________________ -__�-_-o Ot� --�i / 1 9� �2 D o rn m I = c GARAGE co / EL41.50 EL-4I�O 55' i I 3S 9+0) Q / 63 9' q 29.0 DRIVEWAY o 1201 .00' I C) \ a ®v Hie I qp K O E 1 T � �@„za. m ® MON.FND. 290 86 *42 Stake Sel *q MON.FND. " �, Z B' ?9q S66°28'10HVV �� s9 T a M s n rn I M C [ LOT 1 04 = Z RESIDENCE - PUBLIC WATER M LAND N/F WELSH620LLC 60'wide C) public 2 right of way t� ®�®go® E E LAM U Y� C it x T l0 LEGAL NOTES' pOTOS I.COPYRIGHT 2022—LAND SURVEYING ILL.,ALL RIGXTS RESRIED (/) 2.UNAUTHORaEDALTERATION OR ADDITION TO THIS SURVEY MAP SEARING A LICENSED LAND SURVEYOR'S SEAL GAVIOLATION OF SECTION T1 09, ,= 15•i'J SU&UMSION 2.OF NEW YORK 9TATE EDUCATION LAW V 3 ONLY THE SURVEYOR'S ,JialL d�SurveyingNp�.�:C=�;;% <,CERTIF�CATOANSOxTXS BOUNDARY SURVEY h1APSGNIFYTHATE S OF THE SURVEYORS ORIGINAL THEMAPWPREPAREDNgCCORDANCEWTHSEAL ARE GENUINE TRUE AND CORRECTIES 7HECURRENTFJ(5TN O RK CCEOFPRACTCE J • � AND OFINK)N. FOR LAND SURVEYS ADOPTED BY THE NEWYORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.INC THE CERTIFICATION G LIMITED TO PERSONS �' •'j_L:a•n:d='S.urve, in�t & IR.I:an•n,rn ` -W ) 1 •.y FOR WHO M THE BOUNDARY SURVEY MAP IS PREPARED.TO THE TITLE COMPANY TO THE GOVERNMENTAL AGENCY,AND TO THE LENDING INSTITUTION LISTED ON Q - - lye ` 1 THI9 BOUNDARY SURVEY MAP 5 THE CERTIFICATIONS HEREIN ARE NOT�•- - - -"J •" •.-a./ �f�• `^9- --� _�l f •''•-J =* SFERABLE o THE LC CATION OF UNDERGROUNDI IMPROVEMENTS R ENCROACHMENTS ARE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED IFANY N -- 153'VVacJi%g:River-LMarior Rci., nofVille 1-19491 ,�.,, :::.•�-_,.� UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN.THE IMPROVEMENTS OR ENCROACHMENTSARE NOTOVERED BYTHIS SURVEY D 30 60 U _ i THE OFFSETS LOB DIMENSIONS)SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE p Y f ✓-w S'-., _ ,�i,:- `•�""—^ ARE NOT INTENDED TO GUIDE THE ERECTION OFFENCES RETAINING WALLS,POOLS PATIOS PLANTING AREAS.ADOITX)NS TO BUILDINGS.AND ANYOTHER TYPE �P-hone: :3�1484&9973 — - OF CONSTRUCTION Feet -.--'�� ✓J -tj.�'I'•'~'W--3 -�/'�•'-f -'�- -:� •Ci`✓" /;�: V�-1'- S.ONLY SURVEYS BEARING THE MAKERS EMBOSSED SEAL SHOULD BE RELIED UPON SINCE OTHER THAN EMBOSSED-SEAL OPIESMAYCONTAIN m -.Small: info@AjcLandSurveying.com UNAUTHORIZED AND MONUMENTS WERE NOT SET ASDPARTIOF THIS SURVEY UNLESS OTHERWISE NOTED SCALE: 1 inch= 30 feet •� —� 10 ALL MEASUREMENTS REFER TO U S.SURVEYFOT U 1 • wooer gTEPS �111.tY�.."LtU�Q � � 'TYPICAL V�.�LL IMP 7 s'3. 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