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Home My WebLink About50851-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#: 50851 Date: 6/21/2024 Permission is hereby granted to: Wirstrom M Liv Trust PO BOX 156 Mattituck, NY 11952 To: construct accessory outdoor shower as applied for. At premises located at: 4630 Nassau Point Rd, Cutcho ue SCTM # 473889 Sec/Block/Lot# 111.-8-10 Pursuant to application dated 4/25/2024 and approved by the Building Inspector. To expire on 12/21/2025. Fees: ACCESSORY $125.00 CO-ACCESSORY BUILDING $100.00 Total: $225.00 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) 765-950211tt s-/hvw-\v.5 gtthholdto nn Date Received APPLICATION FOR BUILDING PERMIT u a t �� d ��,f ,r ✓ u,m� -.... For Office Use Only i PERMIT NO. Building lnspecton f A P 2 6Nor- 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:04/24/2024 OWNER(S)OF PROPERTY: Name:Marc Wirstrom SCTM# 1000-111-8-10 Project Address:4630 Nassau Point Rd, Cutchogue NY 11935 Phone#: Email:marc@wirstrom.me Mailing Address:11 Hoyt Street, Apt 18, Brooklyn NY 11210 CONTACT PERSON: Name:Brad Hooks (Oza Sabbeth Architects) Mailing Address:PO Box 2007, Bridgehampton NY, 11932 Phone#:631-808-3036 Email:brad @ozasabbeth.com DESIGN PROFESSIONAL INFORMATION: Name:Brad Hooks (Oza Sabbeth Architects) Mailing Address:PO Box 2007, Bridgehampton NY, 11932 Phone#:631-808-3036 Email:brad@ozasabbeth.com CONTRACTOR INFORMATION: Name:Andrew Pennacchia MailingAddress:PO Box 2007, Bridgehampton NY, 11932 Phone#:631-899-4225 Email:andrew@moderngreenhome.com DESCRIPTION OF PROPOSED CONSTRUCTION ®New Structure ❑Addition ❑Alteration ❑Repair []Demolition Estimated Cost of Project: ❑Other $ ,000 Will the lot be re-graded? IiYes []No Will excess fill be removed from premises? iiYes [:]No 1 PROPERTY INFORMATION Existing use of property: D y d Intended use of property:�nuSe J Zone or use district in which premises is situated: Are there any covenants and restrictions'wA respect to this property? ❑Yes OdNo IF YES, PROVIDE A COPY. eS t eel. e- _ D I"iet k 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): BAuthorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) COUNTY OF o 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 Z LA _day of , 20 2 N libert DeStefano N�oRv' Notary Public,State of New York a �.• w N0,01DE6321944 PUBLIC, Qualified In Suffolk County PROPERTY OWNER AUTI lGIRIZATION commission Expires March 301h,2Q7-7 (Where the applicant is not the owner) Marc Wirstrom residing at 11 Hoyt Street, Apt 18 Brooklyn NY 11201 I Brad Hooks (Oza Sabbeth Architects) do hereby authorize to apply on my behal o the f Southold Building Department for approval as described herein. February 14, 2024 Owners Signature Date Marc Wirstrom Print Owner's Name 2 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 261840723 BALDON GROUP INC r 1 S OCEAN AVE SUITE 206 Q . PATCHOGUE NY 11772 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MODERN GREEN HOME LLC TOWN OF SOUTHOLD PO BOX 2007 53095 ROUTE 25 BRIDGEHAMPTON NY 11932 PO BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12234 366-9 1 711699 09/23/2023 TO 09/20/2024 4/23/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2234 366-9, 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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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' SUIT NCE FUND It 14kk 4*1 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:462965099 U-26.3 vegT-963 089) x7a gggTrgez(T6g) amoHd em90 'ON 'osn SA'N LZOZ '9 'NVr :31va :37v0s •b0-LZZ A 31w cZ-LO-LO 31b'Odn TS6TT aI=oA —X 'ouloganbd ggT aoH '0'd SZ-OZ-LO 03SLA3a TTB!eaQ pus BmSaems pus? 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Box 153 P.O. Box 974 j I ---------- ----------- --i (631 298 1588 I I ( � ----------- ----------- -------- -- ) 931 ( 3 ) 288 8158 Aquebogue� NY 11 Westhampton Beach NY 11978 61 - — - _ Architect's Notes cfl 00 - - - -- f - - ----------- ---- - ---- ----------- ao I I ~ I 1 - I I I I I i I L —————————— ——————————— ----------J I i I li I - - - - ---------- ————————————————I � -- - _ ----------- ---------- I - - ---------- ----------- ---------- � I I � � I 1-— j a - ---------- ----------- ---------- - - - - II 1IIIIIIIIIII1I1IIIIIIIIII II11III11IIIIIIIIIIIIIIII 11II1111I1I1IIII ——————————— — — j� i - No Issue Date e PERMIT SET 06.12.20246 -10 1/4 Simpson Post Connector Simpson Post Connector Patio Flush to Grade I 1 I L------------------------------------------ 6 _SO_,IIiU_T__I_H I I ELEVATION LEVATION ' � 1 1 j I IIII 1II,IIIIIII,,IIIIIIIIIIIIIIIIIIIII1I I IIIIIIIIIIIII1I 1I11 I I SOUTH OUTH II1I1I11IIIIIII III ELIIIIIIIIII1IIIII1I1IIIIIIIIIIIIIIIII EVAIIIIIIIIII1IIII TIONI;I I I I IiI I II11III1IIIIIII IIII I I I_ III1IIIIIIIIII11IIIIIIIIIIIIIII1IIII ----- IIIII1111IIIIII - - I A801EnlI1 argI-II e-/ d'IIiI� r _F__-- ou--n- dI----a ti—o n P--AAl 88a00 11 n SCALE: 3/4" V-0" SCALE: 3/4" V-0" SCALE: 3/4" V-0" 5 rOrr 6 17 3 -- ---- I- � II1I1IIIIIIIIII ---_ -6 ------—--- - — - - P' Y V R 1 2'-7 112" 3 81' Simpson Post Connector Simpson Post Connector ____J_-__ , ________________________________ ____ �_____ ___________-___-_---_-____ Outdoor Shower D /z� e/t a i l s AJ% 801 2 Scale: 3/4 1 _ 0 Date: April23, 2024 Drawn By: CIZA SABBETH ARCHITECTS Oza WEST ELEVATION SOUTH ELEVATION ENLARGED PLAN Sabbeth 3 SCALE: 3/4" V-0" 2 SCALE: 3/4" V-0" SCALE: 3/4" V-0" Architects 2408 MONTAUK HIGHWAY#2A BRIDGEHAMPTONNY11932 These plans are copyrighted and are subject to copyright protection as an"architectural work"under Sec.102 of the Copyright Act,17 U.S.O.as amended December 1990 and known as Architectural Works Copyright Protection Act of1990.The protection includes but is not limited to the overall form as well as the arrangement and composition of spaces and elements of design.Under such protection,unauthorized use of these plans, work or home represented,can legally result in the cessation of construction or buildings being seized and/or monetary-- I ( '1 compensation to OZA/SABBETH ARCHITECTURE. ONE 6/12/24 2:13 PM