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HomeMy WebLinkAbout50984-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE CNN yp SOUTHOLD, NY 4 ^ryr cl, 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#: 50984 Date: 7/25/2024 Permission is hereby granted to: Snyder, Marjorie PO BOX 558 Green ort, NY 11944 To: install roof-mounted solar panels to existing single-family dwelling as applied for. At premises located at: 1245 Inlet Pond Rd, Green port SCTM #473889 Sec/Block/Lot# 33.-2-29 Pursuant to application dated 6/6/2024 and approved by the Building Inspector, To expire on 1/24/2026. Fees: SOLAR PANELS $100.00 ELECTRIC $125.00 CO-ALTERATION TO DWELLING $100.00 Total: $325.00 Building Inspector � r r � TOWN OF SOUTHO L1<D -BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 1 1 97 1-0959 Telephone (631) 765-1802 Fax (631) 765-9502 1itt s: Date Received APPLICATION FOR BUILDING PERK r rg LL For Office Use OnlylgL, I I PERMIT NO. �� Building Inspector: �_0 I Applications and forms must be filled out in their entirety.Incomplete pep t e"t applications will not be accepted. Where the Applicant asnot the ow ner,an guiidin of S00101d Ownees Authorization form(Page 2)shall be,completed. '(own Date: 6 ,,, " c� OP4 NE, ( )OF(PROPERTY, Name: a l.- n, nudorSCTM# 1000- Project Address: oZ 4 n 4 0 nk u c o(4 /\ . 1 1 9 4 F i Phone#: �� �_ Email: Mailing Address: r M . I NL/v CONTACT PERSON.- Name: Lo r-rA e n< t�� Mailing Address: -7 4-7® S ouAd avoKOL141 dam , Y. )[1q,5 P1--- Phone#: (-V 3 1-3192 �-7 0 q 9 DESIGN PROFESSIONAL IIYIE ATION. Name: Mailing Address: Phone#: Email: CONTRACTORINFORAIIIIAnOW. Name: eIe,1'ne-n vi f-rl tAL- Mailing Address: 141 ® ? ��C Phone#: �� v ,M s .-I a 4 ) Email: ��� b �y►'t (DESCRIPTION OF PROPOSED CONSTRUCTION a p t of Project:. *then t)�'s5*►..a 7 Sb 1 � P V 3 KW ructure ❑Addition ❑Alterat on f❑Re r�❑Demofitiorl Estimated Cos Will the lot be re-graded? ❑YesXNO Will excess fill be removed from premises? ❑Yes o I PROPERTY INFORMATION Existing use of property: Z�i Intended use of property: .. Zone or use district in which nremises is situated: Are there any coven Wtd restrictions with respect to- this property? ❑Ye IF YES, PROVIDE A COPY. eck Bost After Read!ng`: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by apter,z36 of the Towne Code. APPLICATION is HEREBY MADE to the Building Departmennt 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 WAS of the New York State Penal Law. Application Submitted By(pro ame):Lorraine DiPenta @Authorized Agent ❑Owner Signature of Applicant: dA Date: sly-7 STATE OF NEW YORK) SS: COUNTY OF Suffolk ) Lorraine DiPenta being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor (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 ..,. day of NO, 20� �✓ Not9y Public LOUI S J ROMEO PROPERTY OWNER i iGIRIZATIGIN Notary Public,State of New York No.01 RO6314813 (Where the applicant is not the owner) Oualifed in Suffolk County Commission ExPires November 17,204 � .. / I I, + t�� l`� s✓I er residing at gil J,/ do hereby authorize 0AU k1i to apply on my behalf to the Town of Southold Building Department for approval as described herein, 5 17 z 04er's Signatur Date nA LOUIS J ROMEO l l`I Q r f-1 e— Syl e—(— Notary Public,State of New York No.01 R06314813 Print Owner's Name Qualified in Suffolk County Commission Expires November 17,20 Z G 2 m 1651 IF f1,rBUILDING DEPARTMENT- cIspe tort n 0 � TOWN OF SOUTH " Ze Town Hall Annex - 54375 Main Ro O Box " Southold, New York 11971-095� o � 10 0 Telephone (631) 765-1802 - FAX (631) 76 1502 rogerr@southoldtownny.gov seand(cD_southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: (o 5 Company Name. GIMCA4rl L.L- Electrician's Name:Jo mt1 M I nni License No .� a, (n� _ ��( t Elec. email: Perm i- , Ca S yS, e_&#1 Elec. Phone No: -1 1q3 (91 request an email copy of Certificate of Compliance Elec. Address.: 7 `t 7 o cSo v v)6L aVe, JOB SITE INFORMATION (All Information Required) Name: �� ar o✓l- sYY) l Address: P61,2AJ , I ✓� '. r /. ( clLl Cross Street: , Li 4 Phone No.: (n 6 1 .511 - '7 0 Lt � Bldg.Permit #: email:: PZr-M i eat Tax Map District: 1000 Section: 3 Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): n s-t,�-1,l F L�S►� �-o rnk3x+f_h . S co 10.,r- P N/ S4f_e-% I rj, 1C Square Footage:: Circle All That Apply: Is job ready for inspection?: El YES NO F—] Rough In El Final Do you need a Temp Certificate?: E, YES NO Issued On Temp Information: (All information required) Service Size1 Ph[]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 E71 H Frame Pole Work done on Service? Y N Additional Information:. PAYMENT DUE WITH APPLICATION 'wo ip ' Com enensation CERTIFICATE OF INSURANCE COVERAGE zrArc Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.W y an Family To be completed by NYS disability Paid Fly Leave benefits carrier or licensed insurance agent of that Carrie 1a.Legal Name 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ELEMENT ENERGY LLC 7470 SOUND AVE MATTiTUCK,NY 11952 1 c.Federal Employer Identification Nurri Insured Wont iocatior Of Insured j0nlyrsquired ifcoverage is specrilcallylimded to or Social Security Number certain tocadons in New Yorh stare,i.e.,Wrap-up Policy) 823336604 2.Name and Address of Entity Requesting Proof of Coverage ¢3a_Name of Insurance Carrier (Entity Being Lister as the Certificate]inkier) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 54375 MAIN ROAD 3b.Policy Number of Entity Listed in Box"la" SOUTHOLD,NY 11971 DBL567527 3c.Policy effective period 01/01/2023 to 12131,r2024 4. Policy provides the following benefits_ ® A Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. S. Policy covers: ® A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. C] B.Only the following class or classes of employer's employees: Under penally of perjury,I certify that I am an authorized representative or ficernwo anent of the insurance carrier referenced above and Umt Ow named insured has NYS Disability and/or Paid Farnily Leave Benefits insurance coverage as described above. Date Signed 7/10/2023 B 4J)Jd y (Signature of insurance carriees authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White Chief Executive Officer 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 513 is decked,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 emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit,PO Box 6200,Binghamton,NY 13902-5200. .................. ........ .._._.................. PART 2.To he completed by the NYS Workers'Compensation Board(only if Box 48,4C or 5e have been checked) State of New York Workers' Compensation 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(Articfe 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authariwd NYS workers'Compensation Board Employee) j umber Name and Title 1 Telephone N _�m...� ............... _..... ° _....... 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 Fcrm AB-120.I-Insurance brokers are NOT authorized to issue this form. i 08.120.1 (12-21) A41104OR CERTIFICATE OF LIABILITY INSURANCE DATE IMM7/1l r 3 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT, If the certificate holder is an ADDITIONAL INSURED,Me policy(les)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 tc%MNV�„....M ROBERTS FEDE INSURANCE AGENCY PHONE 6317-WT7W...._ 23 GREEN STREET,SUITE 102 ........�... HUNTINGTON,NY 11743 AOpRSS:, -....... �. ....... ....... ROBERTS FEDE INSURANCE ATLANTIC CASUALTY - - A ....AFFORDING COVERAGECOVERAGENAI IISURFLRA: ANTIC rUALTY INS.CO. 524210 INSURED INSURER Element Energy LLC INSURER C., DBA ELEMENT ENERGY SYSTEMS � RAI-' TICO.. ...... . 7470 SOUND AVENUE "ARE. MATTITUCK, NY 11952 INSURFJt F 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. I R TYPE OF IN3URAN C6 POLICY NUMBER_."."a.._.-�r f �._,�•..,����.....,.�. LIMr9 COMMERCIAL GENERAL LIABILITY L1460036873 EACH OCCURRENCE $ 3,000,000 u 7/1412024,4 -�- X X 711 412 0 2 3 � . cLAiras-MADE accuR � PREMISES�.A�r�!*rrnuxaL,W ; 100,000 _ EXP fArt cm perwnl $ 5000 X �Contfactual Lia IMA3882�3B 7/19/2022 7/1912024 PERSONAL NLADV 1JLI71 3 3000000 POLICY JECT PLIES PER a� PPLAGGREGATELIMITAP LI ,000,0 PRO- PRODUCTS COWPI .. '� TE i 3��,() LOC � OP AGG $ r�T�: a MrOMOBILELMJWTY 1 rMBIN sIN ANY AUTO BODILY INJURY(Per person) $ OWNED ....a SCHEDULED ..a.W ......-.-..._.._._._._. AUTOS ONLY AUTOS BODILY INJURY Per�_ M) $ HIRED OPEe""r DAAt3F .. .... AUTOS ONLY AUTOS a _ ......... wwww............... s __- UMBRELLALIAB OCCUR.. EACH OCCURRENCE $ EXCESS UAB CLAIAAS-MADE AGGREGATE $ ❑ED RETErmcNS $ wORISERs c0lIPENSATh7N 124494445 PER ANY RIFTOMPARTN�cECUTIVE Y f N 7/132023 7/1312024 T OFFICERAAEMBER EXCLUDED? � N I AtMan EL EACH ACCIDENT ; 1 In NH) EL DISEASE-FA EMPLOYE ; '.QQt}�(�QQ R yeaa�4*9*ft u+ider DESCRIPTION OF OPERATIONS below EL DISEASE-POLCY LIRMT,; NY State DBL DOL567527 1/01/2023 12/31/2024 Statutory DESCRIPTION OF OPERATIONS I LOCATIONS I VE MLE5{ACORD 101,Addfdonal Remarks Schedule,maybe asfaesed I elore*Pace Is relOffid) CERTIFICATE HOLDER IS ADDITIONAL INSURED Certtificate holder and Property Owners are hereby named as additional insured(Using CG 2010 and CG 2037)(Blanket)on a non contributory basis including completeted operations on GL Waiver of subrogation is applicable to General Liability. 30 day notice of cancellation applies. CERTIFICATE HOLDER' CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Main Road THE EXPIRATION DATE THEREOF, NOTICE PALL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Raber s. Fedz ©1988-2015 ACORD CORPORATION. All rights reserved. ar-non rk-APnDn ,,a I ,,. _ .:a. _ .,—�--9 Arr%Mn