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HomeMy WebLinkAbout50901-Z � TOWN OF SOUTHOLD BUILDING DEPARTMENT �a 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#: 50901 Date: 7/3/2024 Permission is hereby granted to: S atn , Denise 4045 Narrow River Rd Orient, NY 11957 To: construct deck addition to existing single-family dwelling as applied for. At premises located at: 4045 Narrow River Rd, Orient SCTM #473889 Sec/Block/Lot# 27.-2-2.4 Pursuant to application dated 5/13/2024 and approved by the Building Inspector.. To expire on 112/2026. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $308.00 CO-ADDITION TO DWELLING $100.00 Total: $408.00 Building Inspector TOWN OF SOUTHOLD-BUILDING DEPARTMENT o Y, Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownnov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector--k I 1194' 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: sl t 3 1 2L- OWNER(S)OF PROPERTY: Name: p 6,/J e S C s�,�-�� SCTM # 1000- 2-Z, Z Z. L. Project Address: p4 5 �c7 c„) IR:V ,(� 1p tJ c7R-1 t,,AT 1,3 y t t ck 5-I. Phone#: &3 Email: d�'><IisfE"5PAg4'tc96- L, C07 � Mailing Address: 4404 5 /U,— V W KWCa- fko 0(2-( ,+u.0 i-i,f I t0tr)7 CONTACT PERSON: Name: i2v o3 g 4L-t 5�>tT�7. Mailing Address: sit kf— /'S ,3eV ir- Phone#: 5sb,`,��. ;qr� Irw Email: e-1,,�i �S r�">o�c�V� DESIGN PROFESSIONAL INFORMATION: Name: ✓-lZ2 41�"F `1,f--p {J G I L Mailing Address: PO C—Z C��20 d--J ltt ` 4 Phone#: _ % Email: �J� SDI b 11,e j, rt'yZrt�z�c�p��/S a i2�.v, ni rc T CONTRACTOR INFORMATION Name: SJ/s g('1kc,OM4,L5 epic:- �r� t Mailing Address: Phone#: t7 3 j -—�?j — Z t�l Email: -<+0Vy �. DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure VAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project. ❑Other 71�0QGIL $ 5'c�oL?' 00 Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes o 1 YSIF New York state Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) AAAAAA 112994098 HAMOND SAFETY MANAGEMENT LLC %12 6800 JERICHO TURNPIKE SUITE 105W SYOSSET NY 11791 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SID BEEBE&SONS BUILDERS INC TOWN OF SOUTHOLD P 0 BOX 979 PO BOX 1179 CUTCHOGUE NY 11935 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G2096 932-5 1 35675 01/01/2024 TO 01/01/2025 12/7/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2096 932-5, 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:/11NWW.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. SIDNEY D BEEBE PRESIDENT THOMAS E BEEBE VICE PRESIDENT SID BEEBE&SONS BUILDERS INC THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STAB" SCAR MNCE FUND 4 �V DIRECTOR„VNSURANCE FUND UNDERWRITING VALIDATION NUMBER: 145326815 U-26.3 Rio � tl CERTIFICATE OF LIABILITY INSURANCE DATEIMWDD/YYYY) 05/08/2024 THIS CERTIFICATE 13 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 MUREO,tho pollcy(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 Ilieu of such endorsement(s), PRODUCER VOINITAUT Debra SirnTfth NAME! Roy H Reeve Agency,Inc. PHONE (631)298-4700 (631)298.3850 PO Box 54 Ne` ADDRESS,, 13400 Main Road INSURER S)AFFORDINO COVERAGE NAIC e Mattituck NY 11952 INSURERA: Mesa Underwriters Specialty Iris Co. INSURED INSURER B: Merchants Mut Ins Co 23329 Sid Beebe&Sons Builders Inc INSURER c PO Box 979 MSIIRETI D INSURER E: Cutchogue NY 11935 SURER F COVERAGES CERTIFICATE NUMBER: C'L244520837 REVISION Nt1MBERT 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. LTR - TYPE OF INSURANCE VOR POLICY NUMBER ..�......... MMmwY'YFYY MAllnwyYYy LIMIT! ..._...-.-..-._.�.... 1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ©OCCUR DAMAGE TO 0 PRET41SE5 E.nocrrutvonoe� S 100,000 A MPOO82001007774 04/03/2024 04/03/2025 PER ON L arse INJURY t 1,000.000 ----..�.... PERSONALBADV INJURY i GENt.AIDGREGATEUMrTAPPUESPER: GENERAL AGGREGATE : 2,000,000 POLICY JJEC LOC PRODUCTS-COMPIOPAGG 3 2,000,000 OTHER, ..�..._ $ AUTOMOBILE LLARU TY IN d .. E 4cedde5 1,000,000 ANY AUTO BODILY INJURY(Per person)... i OWNED SCHEDULED B AUTOS ONLY ,,,, '..AUTOS CAP1068395 04/03/2024 04/03/2025 'BODILY INJURY(Per acrJdem) ; HIRED AUTOS ON PR1r�Xf�TIMfAGE..,- ... _ AUTOS ONLY '......AUTOS ONLYLY ^Wei acrdanl),,,.� ._ ..5.... Underinsured motorist t 1,000,000 UMBRELLA LIAR occuR EACH OCCURRENCE f -"'- EXCESS LIA6 CLAIMS-MADE AGGREGATE S DEC) RETENTION S � WORKERS COMPENSATION I PER T ."� AND EMPLOYERS'LUIBIJTY Y/N T TLITE t E. .,.. ANY PiWIPR'I',,67OPWARTNERIEXECUTIVE ❑ NIA A E.L EACH ACCIDENT S -- OFFICER/MEMBER EXCLUDED? (Mandn"In N♦♦) E.L.DIBEABE-EA EMPLOYEE $ Ir yes,descMm under 6. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddIdonal Remake Schedule,may be allsched If more spats Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 AUTHORIZED REPItESENTAnVE Southold NY 11971 O 1988-20115 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NOTE: WELL AND SEPTIC SYSTEM LOCATION BY OTHERS. B.O.H. REF. No. SEPTIC LOCATION _A. -B- _C_ `D` S.T, 31' 55` L.P.1 41` 44' L.P.2 55.5 57' THE NYS REGULATED FRESHWATER L.P.3 44• 56.5' WETLAND BOUNDARY WELL �6' B3' AS DELINEATED BY D. LEWIS ON S 73°56'30"E 1/17/17 12.08' POND RAD = 1800.00' 2.0 EL NAIL LEN = 197.92' WETLAND GRAVEL FND LINE DRIVEWAY - - 50 RIGHT OF WAY 5 FOR POSSIBLE FUTURE HIGHWAY 3 DEDICA 0TION RAD = 550.00' LEN = 12 8.5 5' COMMERCIAL LAN /p 50.00' "BOAT YARD" s.0 D.W. 00, PROPOSE DECK ' , E O. (SEE DETAILI MQ S 08058'00"W At`� 2 STY FRAME 2 5.0 0 ' ' y>- RESIDENCE (SEE DETAIL) WELTEST L ' / /ZONE HOLE �5 AE 6.0 ZONE ` ` + Oc. 06, 0, POND 2.3 E�L LOT 5 I RESIDENCE WITH WELL SEPTIC SLATE OR OTHER STOPPER OR END PLUG SUITABLE COVER POLE e PIPING SEPTIC TANK PIPING L.P.L PI GRADING 69 1 6.3 FF. EL. � POLE 205 LOCKING CASTING ++ Y TO GRADE POLE �g 1/ I/q• CLEAN-OUT � ��' EXISTING Fi y� PROP. GROUND GRADE PITCH ^ WER PIPE 1 MIN I` MIN AREA OF PROPOSED lu„_ 4 DIA 2' MAX 2` MAX} FILL O E MIN. 4' DIA 1 DPI D 1 SEPTIC TANK 0a o 0 0 0 VACANT W m o o C=l o _ C3 �y COL AIR '' COL AIR a xys� a B.B. a. BACKFILL WITH HIGHEST CLEAN SAND AND EXPECT GRAVEL MATERIAL GROUND WATER GRO. WATER SANITARY SYSTEM DETAIL ........ ..: : . ....:.:..:.. .:.:.::... ..::... : ..::... ..... ..:.. ... .:... .....:. r na4s+Mw+e.wrw,a+wa^s' r- '�, 1: P ;... io 7�K &+. Cd 77 . : At .; y I . jj - -x g DATE N.J. MAZZAFERRO, P.E. DRAWN'BY:NJM PROFESSIONAL ENGINEER DATE; O ao 05? h pi A. P.O_BOX 57,GREENPORT NY,11944 51;6.457.5596 EMAIL nickmamferro@verizon.net SCALE:&qk M Z ill OW SHEET NO: