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HomeMy WebLinkAbout50763-Z u TOWN OF SOUTHOLD f BUILDING DEPARTMENT TOWN CLERK'S OFFICE -°Y 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 #: 50763 Data: 5/30/2024 Permission is hereby granted to: McDowell. Kathleen 51540 Route 25 Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. At premises located at: 51540 Route 26, Southold SCTM It 473889 Sec/Block/Lot It 70.-2-1 Pursuant to application dated 3/15/2024 and approved by the Building Inspector_ To expire on 11/29/2025. Fees: SWIMMING POOLS - IN-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 1 179 Southold, NY 1 1971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 hats /mrvrw outholdtcrwn€ c Dat--- APPLICATION FOR BUILDING PERMIT - c For Office Use Only _ v. u : Y- ut a PERMIT NO_ � i Building Iris ecbD \ \\ Date 23- r/ Zq fp� \\ - ti _ -��_ , _ 77 v Name: �Ol 1 r L �OInJ�I I SCTM # 1000- O - Z Project Address: k (L,,A Phone #: t31,- 4(o3- 143 1 C) Email: L��l 3 s \ " 1 Mailing Address: y Narne: Mailing Address: ��, ---- �y Email• - EI�E��1,Gk���R �F�S'St€�O!,��1.,11tiI��>�lEt�fi�p►T4�]�kV Name: `- p-4QS 17 duel f I -7 p Mailing Address: " AA ! t /4 7 Phone # 3� 2-4 s-740 Email: 116-00-4- > + \ - - -- - Name: r t Mailing Address: (7- Phone # ?)� �L�� Email- offlceCa)aepools com EJNew Structure ClAddition (]Alteration =Rep,air [--]Demolition Estimated Cost of Project: Will the lot be re-graded? RlYes ONo Will excess fill be removed from premises? 'ties ONo (5)1 ti � A Yl ��JJ ,� 11 m rP , Suffol"' LourDepartmentLabor, icensing & Consumer Affairs a VETERANS MEMORIAL HIGHWAY HAUPPAUGE NEW YORK 11788, 1`1 DATE ISSUED; 07/01/1978 No, H-4436 1 e yl SUFFOLK COUNTY „Y .�� r0�een� C��� rctOr, �ceseHome J This is to certify that ARTHUR J EDWARDS doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA 1 SUPP �J F ,l g ( ) having r � g furnished the requirements set forth in accordance with and subject to the provisions of applicable e laws rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct 1 business as a HOME IMPROVEMENT CONTRACTOR,in the County of Suffolk, NOT VALID WITHOUT Restrictions Additional Businesses f ` DEPARTMENTAL SEAL AND A CURRENT HI-GC; ARTHUR J EDWARDS POOL&SPA CENTRE ry H26-Pools and Spas/Certified; ` CONSUMER AfTA1RS ....... ....... H3-Po olslSpas � 'r ID CARDSuffolk Coue�r Dept of U 1 Labor,Licensing&Consumer Affairs J U HOME IMPROVEMENT LICENSEk Name ,J � rhlp ° ARTHUR J EDWARDS �, 1Y �r 12)Yy N ' Business Name o' rhws 004ires that the r ` RosalR aeareris,dtlyl6oensed ARTHUR J EDWARDS MASON ie �rag� DBA INCIN CONTRACTING CO C 1 SUPP i��the County 0 I{�rlk - � � Commissioner Rosalie D License Number H 4436 j I Issued. 07101/1978 i Commissioner E*res: 07/01/2024 t. r f 1 (i �I llw I (lli bd"i('(i J `pQ N 1 T DATE(MM/DD/YWY) CERTIFICATE CIF LIABILITY INSURANCE may_ �2i18�2(�2 THIS CERTIFICATE 1S 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(ias) 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). PRODUCER CONTACT Matthew Rupert NAME: _.............. Liberty Risk Management, Inc. PHONE (s��)�€�s�s� � �1�): {��1)56s 636 2333 Route 112 " OORESs matthe 11bertyriSk-or,2 Medford, NY 11763 IAISUREF€S AFEOII<O[N s COV(€=:ITACsE NAIC# INSURER A: Careenwlch Insurance INSURED INSURER.B: Arthur J_ Edwards Mason Contracting Company Inc. € DBA Arthur J. Edwards Pool 81 Spa Centre INsuRER c 929 Route 25A INSURER 0: Miller Place, NY 11764 INSURER E: INSURER F: COVERAGES CER'rIFICA` I NUMnER: 00000005-1766199 REVISION NUMBER- 4 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. INSFx ---_ A LSLggSUe Rol-icyEFF POLICY¢7GP ---- ----. LIMITS LTr TYPE OF INSURANCE S POLICY NUMBER IMmm _... _ A X COMMERCIAL GENERAL LIABILITY NPC-1004300-03 01/01/2024 01/01/2025 1 EACH OCCURRENCE S 1 000 000 CLAIMS-MADE F_x] OCCUR _ PREMISES Ee occu ence I $ 300,000 MED EXP(Any one person) S. 10 000 PERSONAL&ADV INJURY $ 1.000 OOO _ GEN'L AGGREGATE LIMIT APPLIES PER: : GENERAL AGGREGATE $ 2,000,000 POLICY� PECT li�] LOC F PRODUCTS-COMP/OP AGG $ 2 000 O00 AUTOMOBILE LIABILITY EDI �'LE'-IMIT $ ANY AUTO BODILY INJURY(Per person) is OWNED -- SCHEDULED _ BODILY INJURY(Per accident) $ AUTOS ONLY _. ' AUTOS HIRED NON-OWNED PR AMASE_ is AUTOS ONLY �I AUTOS ONLY UMBRELLA LIAR 1 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE $ DED RETENTION$ i I i $ (WORKERS COMPENSATION - 'STA TE iR- AND EMPLOYERS'LIABILITY - YIN ANY PROPRIETOR/PARTNERIFXECUTIVE N A E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) _ E.L..DISEASE-EA EMPLOYE S 1 s,describe under [ -ya DESCRIPTION OF OPERATIONS below I I E_L.DISEASE-POLICY LIMIT $ e 6 ; E I DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (^CORD 101.Addltlanal Remarlks Schedule,may be attached If more spaca In required) Town of Southold is included as an Additional Insured, ATIMA, as requried by written contract, subject to policy terms, conditions, and exclusions. CERTIFICATE KULDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall ACCOROANCE WITH THE POLICY PROVISIONS_ P_O_ Box 728 Southold, NY 11971 AUTHORIZED REPRESENTATNE 1 MJR ©1988-2015^CORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by MJR on 12/18/2023 at 02:07PM lil_M► worlcer:ii* CERTIFICATE OF INSUF2ANCE COVERAGE C, r DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1. To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a. Legal Name &Address of Insured (use street address only) 1 b. Business Telephone Number of Insured ARTHUR J E13WARDS MASON CONTFtAOT tNO.COMPANY INC DBA: ARTHUR J. EDWARDS POOL AND Sf-^OENTER 631 74401 74 97-9 ROUTE 25A MILLER PLACE.NY 11764 Work Location of Insured (Only required If cvaraga is specifically limited to 1 c. Federal Employer Identification Number of insured o certain locations in New York State,i.e., Wrap-Up Policy) Or Social Security Number 1 1-2377925 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (EntityTW N eOT Listed SOUTHOLD Certificate Holder) Standard Security Life Insurance Company of New York PO BOX 728 3b. Policy Number of Entity Listed in Box-1 a' SOUTHOLD, NY 11971 Z06874-000 3c_ Policy effective period 7/1/2020 to 6/3/2024 4. Policy provides the following benefits: Q A. Both disability and paid family leave benefits. © B. Disability benefits only. (] C. Paid family leave benefits only. 5. Policy covers: 0 A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. 0 B. Only the following class or classes of employers employees: Under penalty of perjury. I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits Insurance coverage as desc~above- Date Signed 6/5/2023 By _ (S7gnatum of irs urance carrier's atahori. reprwmen or NYS Licensed Insurance 4gorit€st that in urance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY 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 58 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 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 4C or 5B of Part 1 has been checked) State of New York Workers' Copiertaation Board According to information maintained by the NYS Workers' Compensation Board, the-above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed BY (Signature of Authorized NYS Workers'GompensatlonBoard Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form OB-120.1. Insurance brokers are NOT authorized to issue this form. oB-120.1 (,0 �11I ]Do�» uH� uiiini mir PO Box 66699,Albany, NY 12206 New York State Insurance Fund 111]/8If.CO1T1 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 112377925 LEVITT-FUIRST ASSOCIATES LTD ' ■ 520 WHITE PLAINS ROAD, 2ND FL TARRY-TOWN NY 10591 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARTHUR J. EDWARDS POOL & SPA CENTRE TOWN OF SOUTHOLD ARTHUR J. EDWARDS P.O. BOX 728 929 RTE 25A SOUTHOLD NY 11971 MILLER PLACE NY 11764 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 2438 491-9 394600 06/29/2023 TO 06/29/2024 07/17/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2438 491-9, 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 WESSITE AT HTTPS://WWW.NVSIF-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 STATE INSURANCE FUND DIRECTOR, 1. SURANCE FUND UNDERWRITING VALIDATION NUMBER: 763749953 IMININW00000000001173515371 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Po1icy-24384919] U-26.3 41 [OOOODO�0 000 1 173 5153]][0001-0000243&9919][�f3GG]Clfi19o-02][CeYLNOP{ERT_3][Ol-0DOOl] Nunemaker, Amanda From Fuentes, Kim Sent: Wednesday, May 29, 2024 12:38 PM To: Nunemaker, Amanda; Verity, Mike Subject: RE: McDowell, 51 540 Route 25, SCTM No. 1000-70-2-1 Hi Amanda and Mike, During the May 23, 2024 meeting of the I-IPC, it was determined that the proposed "fence surrounding the swimming pool" is not within the I-IPC's jurisdiction (according to the Town Attorney), and therefore not subject to an PIPC application. Accordingly, a building permit may issue for the swimming pool. Kim E. Fuentes BOCRrd Assistant Zoning Board gfAppeals Coordinator, Historic Preservation Commission 63I-765-I809 dim uth�l,�t Location: 54375 Main Road Mail- P_0. Box II79 Southold, NY II97I From: Fuentes, Kim Sent: Monday, April 29, 2024 3:24 PM To: Nunemaker, Amanda ¢Amanda.Nunemaker@town.southold.ny.us� Subject: McDowell, 51540 Route 25, SCTM No. 1000-70-2-1 Hi Amanda, During the IBC meeting of April 25, 2024, the members requested a completed I-IPC application to include the pool and fence plotted (with sizes and distances) by a design professional, signed and sealed. i Please ask the applicant to contact me so I can instruct her on the application. Thank you. Kim E Fuentes Board Assistant Zoning Board of Appeals Coordinator, Sistoric Preservation Commission 63I-765-I809 imsoholdt V.go v Location: 54375 Main Road Maif. P.O. Box I Z 79 Southold, NY II97Z z OF New y� M,4P OF DESCRIBED PROPERTY TOW11/ OF SOUTfHOL 0 � - r _ ` .,�; SAND " SUFFOL K CO.,N.Y. 90 p-r� ��a p p f�- ►T �, o N F -.-- - 4 do w O WIRE MI " C �i IZ ' FF IARjV 4 Z 00 SP4 ° 1 . .. 40.0 " �, �� tk".w " .y u�� , Kv 4.o ' 5ry fol?. 7p O tai 405 FR N t RI " ti Z T INpN" 350. M ACr(JL `V1 329. gid0 �6" 5 Eye$0 S FR O CERTIFIFO rn: donack associates Q). FNo W E L.I. USL/FE N AF INS CO. e 313 west main street F HQ CL/FFORO M?CHELL AREA= 36,595 a ' �5°I2 KATHRMF MIMIEu r�verhead , new York 11901 N. (516)369 1717 (212) 746 3020 0840 ACRES CREFK Sept 3 , 1983 Job NE 83-331 - J0CKFY DR 'V E 1000-070-02- 01 Scale: 1"= 40 ' W. ', . . .. I--'. . . .. . . U): : " ' : : : : : : : : ' : : . . . : : . : :' . : ' :g: v roman'sw �,m: . :m . °. . . . . . . . . . . O00 ,. E F'. . . Fes, - - -To Fftw Mae. Pump . . . . . . . . . . . . . . . . . . . . To To Ribum . . ,: , 'Rolled wog,f°c. Q . . . . . . . . . A. . . Plan. . :. . • :. 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