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HomeMy WebLinkAbout51109-Z TOWN OF SOUTHOLD � BUILDING DEPARTMENT 4 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#: 51109 Date: 8/21/2024 Permission is hereby granted to: Celano, Serafino 371 Titus Way East Williston, NY 11596 To: construct accessory in-ground swimming pool as applied for. At premises located at: 13305 New Suffolk Ave, Cutcho ue SCTM # 473889 Sec/Block/Lot# 116.-2-22.2 Pursuant to application dated 7/8/2024 and approved by the Building Inspector. To expire on 2/20/2026. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: $400.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. ®. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 b :/Pwww.s�autholdtownn o . +. IN 139 Recei APPLICATIONI IPERMITw For Office Use Only ° ' 7 PERMIT NO. Building Inspector: g'. 010 A r li a l n aNr + s rnb t o l� � 't an their e r � ln49mplete �` j � .' `�x�, ;;�����, � �; ' �" +�� 1Ehe Appt� "wt �r�ot,tl�efawn�r,an;,;° 0rw�+ �' �?�lw�r �� n Date: )4 OWNERS)OF PROPERTY: � "� SCTM# 1000- 1 2.- 2-2.2- Name: lFFir►0 �V1n�1�1Q21fi (;Y.lQYl1'J Project Address: i 3305 Nee 6 j7-6Xkve- Phone#: Email: -Fn, +1?0000141 k enrr\ Mailing Address: 3,7 1 1 � /S E&s�- CONTACT,PER$ON: Name: ' hfjQ�G/J S Mailing Address: Email: Co Phone#: � � � �� DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Wko 0-b1i1\6L 0c, X.,nkl�tawr� - 12�� Phone#: QZ Email: CONTRACTOR INFORMATION: o r Narne: Mailing Address: �,�- 2� Il�i� �I(,t('e (70 V Phone#: �1 Email: ? ., DESCRIPTION OFPROPOSED CONSTRUCTION ❑New Structure ❑ ❑ ❑ Estimated Cost of Project: Addition Alteration Repair ❑Demolition Estimated, I;Other NO5(IIIA L Will the lot be re-graded? fYes ❑No t / za (Mt�/Will excess fill be removed from premises? 'es ❑No 1 � 5 � Suffolk CouDepartment of Labor, Licensn ,1 101 j vConsumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 Akk DATE ISSUED: 07/01/1978 No. H-4436 _4 i SLTPPOLK COIL,NTY �- .dome Improvement Contractor Licenseng �k This is to certify that ARTHUR J EDWARDS �- doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA (1 SUPP) al- having furnished the requirements set forth in accordance with and subject to the provisions of applicable 21 laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. NOT VALID WITHOUT Restrictions Additional Businesses Mal DEPARTMENTAL SEAL N AND A CURRENT H1 -GC; ARTHUR J EDWARDS POOL&SPA CENTRE t H26-Pools and Spas/Certified; CONSUMER AFFAIRS H3-Pools/Spas ( ' ED CARD Suffolk County Dept.of � pL Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE to Name � �� - ARTHUR J EDWARDS A €, Business Name ARTHUR J EDWARDS MASON i This certifies that the Rosalie DragO CONTRACTING CO INC DBA(1 SUPP) bearer is duly licensed \ by the County of Suffolk License Number H-4436 ` � Commissioner Issbed: 07/01/1978 (� ( WayrGT Royery Expires: 07/01/2026 r `,. Commissioner VOL a - /;P--a,rll\�N NYSIFPO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE I� AAA AAA �L �"".. ',,. 112377925 LEVITT-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FL " TARRYTOWN NY 10591 � U SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARTHUR J.EDWARDS POOL&SPA CENTRE TOWN OF SOUTHOLD ARTHUR J.EDWARDS TOWN HALL 929 RTE 25A P.O. BO 1179 MILLER PLACE NY 11764 SOUTHOLD NY 11971-0959 POLICY NUMBER PERTIFICATE NUMBER POLICY PERIOD DATE G 2438 491-9 881298 06/29/2024 TO 06/29/2025 F06/26/2024 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 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 STATE INSURANCE FUND 4 DIRECTOR,I(SURANCe FUND UNDERWRITING VALIDATION NUMBER: 633467799 1II1IIvOi 0 0 0012 Form WC-CERT-NOPRrNT Version 3(08/29/2019)[WC Policy-243849191 U-26.3 7 [00000000000129018175][0001.000024384919][##G][16418-05][CerL-NDP-CERT 1][01-00001] Workers' CERTIFICATE OF INSURANCE COVERAGE sT�,Tf Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS 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 EDWARDS MASON CONTRACTING COMPANY INC DBA: ARTHUR J.EDWARDS POOL AND SPA CENTER 6317440174 929 ROUTE 25A MILLER PLACE,NY 11764 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York Stale,i.e.,Wrap-Up Policy) 11-2377925 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TOnWN eO LSOUTHOLD to Holder) Standard Security Life Insurance Company of New York PO BOX 728 3b.Policy Number of Entity Listed in Box 1a SOUTHOLD, NY 11971 Z06874-000 3c.Policy Effective Period 7/1/2020 to 6/4/2025 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: Q A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. 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 des d above. Date Signed 6/5/2024 By (Signature of insurance carrier's authors tv ptesentat4ve or NYS licensed insurance agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANTAf Boxes 4A and 5A are checked,and this form is signed by the insurance carriers 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 5B 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 emailed to PAU@wcb.ny.gov or it can 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 413,4C or 5B of Part 1 has 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(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 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 DB-120.1. Insurance brokers are NOT authorized to Issue this form. DB-120.1 (12-21) �IIl�iaii� uuiiiii(iw -iii )i�� -� DATE(MM/DD/YYYY) A bra CERTIFICATE OF LIABILITY INSURANCE 12/1812023 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 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 endorsements' PRODUCER NA CONTACT Matthew Ru rto ...... Liberty Risk Management, Inc. PHa" 631 569-5633 FAX31 669s 2333 Route 112 AIL DDR.9S:.. MA erg gibe risk o _.. .. �. . 8 Medford, NY 11763 INSURERS)AFFORDING COVERAGE NAIC# _ !!SI IFMA: Greenwl�ch Insurance.......... mmmmmmmmmmmArthur J.Edwards Mason INSURED ............_............� INSURER.B on Contracting Company Inc. ...._.--- _ -""'��°� - DBA Arthur J. Edwards Pool 8r Spa Centre INSURER _ITIT, _ ____.......... 929 Route 25A INSURER D:_,,,,_ Miller Place, NY 11764 INSURERS _.. INSURER F COVERAGES CERTIFICATE NUMBER: 0000000 -1766199 REVISION NUMBER: 48 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. ....... .... _ �....... _ _.. INSR TYPE OF INSURANCE _-- ADDL£UBR POLICY NUMBER MMLICY EFF MPQLICOY E tP LIMITS LTR ..... EACH OCCURRENCE $ _1000,000 _._. COMMERCIAL GENERAL LIABILITY NPC-1004300-03 01/01/2o2a o1/o1no25 A ,?� oAMA 'Y6_fk�rrtt _ CLAIMS-MADE FX1 OCCUR PREMISES IEa oGG mn. $ 300 000 MED EXP(Any one person) $ 10,000 _PERSONAL&ADV INJURY $ 1 O0O O00 GENT.N AGfxRE�GATE......... �...-....... _ - .. LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 000 000 PDLICY . JEF ❑ Loc 000 -PRODUCTS-COMP/OP AGG $ 2 OOO OTHER: AUTOMOBILE LIABILITY COPBINEmmD SINGLE LI+ICr $ ANY AUTO BODILY INJURY(Per person) $ OWNED 1 SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY „ AUTOS AUTOS ONLY �_. AUTOS ONLY DAMAGE $ HIRED NON-OWNED (R�1PET'n $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR J CLAIMS-MADE AGGREGATE $ _._.. -._...... -- _. ,,, ...-.-.. DED RETENTION$ $ WORKERS COMPENSATION PER O1H AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A EACH A T $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE EA E E.L.EACH CCIDE (Mandatory In NH) PLOYS $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached H more space Is required) Town of Southold is included as an Additional Insured,ATIMA,as requried by written contract,subject to policy terms, conditions,and exclusions. CERTIFICATE HOLDER 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 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 728 Southold, NY 11971 AUTHORIZED REPRESENTATIVE MJR ©1988-2015 ACORD 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 AREA = 16,875 SOFT. SCDHS REF# R10 16-0028 SURVEY OF PROPERTY T CUTCHOWE TOWN OF SOUTHOLD r SUFFOLK COUNTY, MY 1 116-02 44 SCALE.' 1'=300 MARCH 21, 2012 " ~ OCTOSER 14 2017 (PROP. HOUSE) IL ZO 6� OCTOBER 12 2017 NDAR S ST NOtOWBER 07, 2017 (FOVAIDATIONS LOCATED) MARCH 9. 2018 (RN P "` a. Pot " r �+ TEST HOLE DATA sly MCDONALD GEOSCIENCE S 02/20/2012 rL R . EL 7.s DARK BROWN LOAM OL OMA BROWN SILTY SAM Ski 4, l GREY CLAY CL OwO 6 PALE BROWN RNE SAND SP i. EL_ Go IL r WATO zap X WATER IN PALE BROWN F*X SAND SP CZRTWM 1: SERAFM AL CELANO 'Iy� (� t,$ . FMZL ff NATIONAL TMX LLC. o� lox o /i'8T se W TCI G N TO y 0EPA :y'OF HEAt T#4 SEW C;ES LJF23r A St r '" -- , T01t A j (ptl�c A 7E7p p� >wuntx Pvzlr Qs r ELEVATIONS ARE REFERENCED TO Al.A V.D. r I am familiar with the STANDARDS FOR APPROVAL r AND COIVSTRUC710N OF SUBSURFACE"ACE SEWAGE ZONE X ZONE AE �e0F NEW DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDEIVCES 1 (Q 67 a.' and will abide by the conditions set forth therein and on the permit to construct. j o The location of wells and cesspools shown hereon are from field obsermtIons and or from data obtofned from others. Lia NO. 49618 L 07 0 oR AM 9 d AQ�V R7 115 AYOR/C STA7r L� R P.-5f120 FAX (631) 765-1797 SEC110W — NST01N 2 ALL C�7RTN"TCiI 9'OX 909 Y FLOOD ZONE FROM RRM RATE MAP NO. 36103CO501H7230 TRAVELER STREETM APPEARS M� ay. -EPTEMBER 25, 2009 wFn OS SOUTHOLD, N.Y. 11971 1,2-122 r" . . . . . . .. . . . . . . Murni :. . . jB I . . . .. . . E F : : ' : : . : . F W�,Fu . : :. . . . . To Woat� ' -To FmLirtr . .(Dry WAN�oOQ. 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