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HomeMy WebLinkAbout50817-Z - � TOWN OF SOUTHOLD � 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#: 50817 Date: 6/13/2024 Permission is hereby granted to: Martin, Liam PO BOX 165 ............. .......................... Orient, NY 11957 To: Construct an 8 foot deer fence with required pool barrier protection to an existing single-family dwelling as applied for. At premises located at: 1640 Calves Neck Rd, Southold SCTM # 473889 Sec/Block/Lot# 70.4-39.1 pp ............4 and approved by the Building Inspector. Pursuant to application dated 5/2/202 _w_ To expire on d. 6/13/2025.mmmmmm Fees: DEER FENCE $100.00 Total: $100.00 _.........................Js Building Inspector xta�sn ry rsaM I tw TOWN OF SOUTHOLD—BUILDING DEPARTMENT A Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 (141"s i� Telephone (631) 765-1802 Fax (631) 765-9502 jitt s,//www.southol(Itownjiy.gov Date Received" APPLICATION FOR BUILDING PERMIT iI C r For Office Use Only PERMIT NO. ✓o�/ Building Inspector:A�1& MAY 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. Date: OWNER(S)OF PROPERTY: Name: Liam Martin SCTM # 1000-70-4-39.1 Project Address: 1640 Calves Neck Road, Southold, NY 11971 Phone#:631-734-7923 (Agent) Email: Creativeenvdesign@yahoo.com Mailing Address: CONTACT PERSON: Name:David Cichanowicz/ Creative Environmental Design Mailing Address: P.O. Box 160, Peconic, NY 11958 Phone#: 631-734-7923 Email: creativeenvdesign@yahoo.com DESIGN PROFESSIONAL INFORMATION: Name: 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: ❑Other Deer Fence $ Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes ❑No 1 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 *No IF YES, PROVIDE A COPY. H 0heck Box After Re:dh1g. 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, David Cichanowicz/Creative Environmental Design Application Submitted B (print name): Authorized Agent ❑Owner Signature of Applicant: Date: 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 S day of , 2021- Notary Pubficf PENNY LOUI E MAIFFETONE NOTARY PUBLIC,STATE OF NEW YORK ry ,.._.. d_.ww N Registation No.01MA8402379 (Where the applicant is not the owner) Qualtfled In `*County CommlBelon residing at do hereby authorize David Cichanowicz/Creative Environmental Design to apply on my behalf to the Town of Southold Building Department for approval as described herein, Owner's Signature Date Liam Martin Print Owner's Name 2 PROPERTY INFORMATION m 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®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 220.45 of the New York State Penal Law. David Cichanowicz/Creative Environmental Design Application Submitted'R (print name): BAuthorized Agent ❑Owner Signature of Applicant: Date: 51) J e o�L l 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 Sd 10 ' � dayof 20 �/ ... Notary Pubficf PENNY LOUkSE MAFFETONE ,STATE OF NEWYORK PROPERTY OWNER WJ°�1HORI T11 IN Nr�T gfta C to No.OIMA6402M (Where the applicant is not the owner) old In Suftk County '20V I, Liam Martin residing at 640 Diedricks Road Orient NY David Cichanowicz/Creative Environmental Design do hereby authorize to apply on my b6h If to the T,Ow o Vaut�ho,Id~ Ilding Department for approval as described herein. 1 May 1 2024 Owner's Signature Date Liam Martin Print Owner's Name 2 Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name DAVID J CICHANOWICZ Business Name INDIAN NECK CORP DBA This certifies that the bearer is duly licensed License Number H-29895 by the County of suffolk Issued: 12/13/2001 Jerulifer Cabrera, Expires: 12/0112025 Commissioner �t Y' t 1"�1t1pW •rs' �.� '�ori3r(t CERTIFICATE OF INSURANCE COVERAGE Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART I.To be cam leted by NYS Disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Add�ess of Insured(use street address only) 1b.Business Telephone Number of Insured INDIAN NECK CORP DBA CREATIVE LAND-SCAPE DESIGN, 39160,ROUTE 25 PECONIC,NY 1195 1 c.Federal Employer Identification Number of Insured or Social Security Work Location of Ins red(Only required if coverage is specificaliy Number limited to certain I'Facaii sin New York State,i.e.,VlPrzip Up fTrnlacy)i 112294493 .Name m Bei g L Address as he Cty Requesting Proof of Coverage 3a.Name of Insurance Carrier ( ty, ertificate 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 12/3112024 4.Policy provides the f Wwing benefits: ❑x A.Both disa llity and Paid Family Leave benefits. ❑ B.Disability benefits only. ❑ C,Paid Farn y Leave benefits only. 5.Policy covers: ❑X A.All of the mployer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the f Mowing,class or classes of employer's employees: Under penalty of per)u „I certify that l am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disabi i'ty and/or Paid Family Leave benefits insurance coverage as described above. Date Signed 01-24--024 B (Slglnatcrra of lr.suranco cerr7or"s at„ahar'Gxad representative or a�YS'fl8conarnd knatrrenoa agent o4 tlreal ansuranca caGrl,e i Tele lvne Nurnbar 21 �553.8074 Narnta and TitleC @-IA4.i3ETI•t T'l..LLt�--AiTANT Dlf2E.CTCYft 'STATUTd,�ftY' Eftwi� s IMPORTANT: If Box s 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licen ed Insurance Agent of that carrier„,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 4B,4C or 56 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Diab lity and Paid Family Leave Benefits Law.It must be emailed to PAU@wcb.ny.gov or it can be mailed for compl tion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be comple ed by the NYS Workers'Compensation Board(Only if Box 4B,4C or 5B have been checked) State of New York Workers' Compensation Board According to Informs ion maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and P id 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'compensation Board Employee) Telephone Number Name and Title Please Note:Only'insuran e carriers licensed to write NYS disabday and I-OW Family Leave benefats insurance poltcies and NYS Wensed insurance agents of those insurance carriers at authorized to issue Form DS-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) IIllIIIIIII/IIIIMIMIIIIII T 0 DATE(MM/DD/YYYY) ACCORV CERTIFICATE OF LIABILITY INSURANCE �., 05/01/2024 WIS 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 endorsoment(s). PRODUCER NAME. � Matt Daley Farm Family Insurance 631-744-3350 FAAM No: 631-744-3383 PHONE EMAIL matt.dale farlT►-lamil' .00ni 85 Echo Ave-Suite 2 ApDREss: � Miller Place, NY 11764 INSURER S AFFOROINGcovERAGE NAI+CI- «wawa INSURERA: Farm Famil Casualt 13803 INSURED INSURER B: Indian Neck Corp. DBA Creative Environmental Design INSURERC: PO Box 160 INSURER D INSURER E: Peconic NY 11958 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. INS'R ADDLMER POLICY EFIF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER /O MMOIYYYY' IO MMO A COMMERCIAL GENERAL LIABILITY 3152X2360 06/01/23 06/01/24 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE DOCCUR 06/01/24 06/01/25 PRE-MISES EaoccurrrpnEf _ 100,000 x Select Business PKG MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECT FLOC 2,000,000 JF, ,I. PRODUCTS-COMPlOP AGG $ OTHER; CO AUTOMOBILE LIABILITY ffama6INED tlTlfal uT �ro aacd ent ANY AUTO BODILY INJURY(Per person) OWNED 'ASCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY UTOS HIRED i NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accldenY I $ UMBRELLA LIAB EACH OCCURRENCE $ EXCESS LIAB �,J:OCCUR LMS-MADE AGGREGATE $ DED RETENTIONS $' WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A` - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) MASONRY/LANDSCAPING CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD 54375 MAIN ROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O. BOX 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved.. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD a � NYSIF New York state Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 112294493 AMWINS INSURANCE BROKERAGE LLC 200 ELWOOD DAVIS ROAD SUITE 200 LIVERPOOL NY 13088 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER INDIAN NECK CORP. TOWN OF SOUTHOLD T/A CREATIVE ENVIRONMENTAL DESIGN PO BOX 1179 PO BOX 160 SOUTHOLD NY 11971 PECONIC NY 11958 POLICY NUMBER CERTIFICATE NUMBERT POLICY PERIOD DATE Z1318 146-8 738667 05/01/2024 TO 05/01/2025 5/1/2024 THIS IS TO CERTIFY 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' 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 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 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 UR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:412189446 U-26.3 435' FENCE I I_•�I'I I II - - - - - - • - -- - _y C COOP,PE �. - - - - - . - - - ' E , RE,E � T T.R (QNNd��O�jN' ••- cu rdn 15x3O Co POOL O cu E c: >,POOLIDEED FENCE 5TRETT EE5 .0 U) LJJ DECK U cu RE510ENCE BILOO 5TREET TREE5o0 x �, FRONT All ll� PROP05E0 FOOL PEER FENCE LOCATION GARAGELIAMRTIN : OWNER 5CTN# 1000-70-4-39.1CL c FLOWERING FLO IN TREE '426STEL EDGING U) _ - _ _ - _ - - - - . _ _ . _ - - - T TRE5 STREET TREES PROP05EDSCREN PLANTING1, 7 T IC- I S- N O . . N N O c . . CAL.-VE!F? NECK FZOAX�) •> � � o