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HomeMy WebLinkAbout51130-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#: 51130 Date: 08/28/2024 Permission is hereby granted to: Pt Pleasant Prop Mngmt LLC 1300 Veterans Memorial Hwy Ste 130 Hauppauge, NY To: Construct a new single-family dwellingto include HVAC systems as applied for per Trustees non-jurisdiction, DEC non-jurisdiction and SCHD approvals. Premises Located at: 1995 Pt Pleasant Rd, Mattituck Section\Block\Lot # 114.4-7.1 Pursuant to application dated 06/21/2024 and approved by the Building Inspector, To expire on 08/29/2026. Contractors: Required Inspections: DRAINAGE, FOOTING/REBAR, FOUNDATION 1ST, FOUNDATION 2ND, FRAMING/STRAPPING , PLUMBING , ELECTRICAL- ROUGH, FIRE RESISTANT PENETRATION , ELECTRICAL- FINAL, INSULATION , FIRE SAFETY INSPECTION , FIRE RESISTANT CONSTRUCTION , FINAL, Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $2,748.50 CO-NEW DWELLING $100.00 Total $2,848.50 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) 765-9502 )ittml)s.,/`WWW Sotitt!olOIOAN"IllI oy Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only L5 PERMIT NO.. I "O Building Inspector. A- JUN . 1 2024 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an 11 DING DE PT- Owner's Authorization form(Page 2)shall be completed. TO x solo I f 3, Date:6-20-2024 OWNER(S)OF PROPERTY: Name:John Black SCTM #1000-114-01-7.1 Project Address: 1995 Point Pleasant Road, Mattituck NY 11952 Phone#:631-360-4394 Email:j.black@itsequity.com Mailing Address: 1300 Veterans Memorial Highway, Suite 130 Hauppauge NY 11788 CONTACT PERSON: Name: Steven Kaplan Mailing Address: 90 Bridle Court Cutchogue NY 11935 Phone#:347-258-8642 Email:sckaplan@hotmail.com DESIGN PROFESSIONAL INFORMATION: Name: David Turner Mailing Address: 366 West 30th street, New York NY 10001 Phone#:917-916-9451 Email:davidturner@verizon.net CONTRACTOR INFORMATION: I Name: Joe Sallan0 Mailing Address: 306 Main St B, Northport NY 11768 Phone#:631-358-1799 Email; DESCRIPTION OF PROPOSED CONSTRUCTION RNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $750,000,00 Will the lot be re-graded? RYes ❑No Will excess fill be removed from premises? RYes ❑No 1 'n +t PROPERTY INFORMATION Existing use of property:Vacant Intended use of property: Single Family Home Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes F*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 bullding(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). John T. Black ❑Authorized Agent BOwner Signature of Applicant: Date: 1 a 6 f STATE OF NEW YOR SS� COUNTY OF [ _ bhp being duly sworn, deposes and says that(she is the applicant (Name of individual signing contract) above named, LNotary ANCINE CIESL:New blic-State ofork O e is the yO 01C1506575(Contractor,Agent,Corporate Officer, etc.) sion Expires S026 Shof said owner or owners, and is duly authorized to perform or have performed the said wor arr om a I 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 — 0 - z- -sp day of 20 Notary Public PROPERTYOWNER AUTHORIZATION (Where the applicant is not the owner) I, .WW_...._ residing at ............. do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date ........ Print Owner's Name 2 ACC?RD1 CERTIFICATE OF LIABILITY INSURANCE DATE(MMlOD/YYY1) 8/24/2023 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(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). PRODUBorg ER �Miner _ .. - 1, C Ne Huntington NY 11743 1 f Borg 9Borg Inc, AHo'N ES -nr 148 East Main Street fAtl 78t10 — " 1 831 351 17D0 NAME U IMSURER(S�AFO���POROING COVERAGE �, NAIC N anmd General w 12294 ._... .._._ ...� _.. ....��........... .. �u_�Lt�sO�e/E�PC f489��: INSUR,ERA„Southwest (NSURED Gold Hill Builders LLC GOLDHIL-01 INSURERS 302 Main St,Lower Level Northport NY 11768 INSURER o; .... ............. INSURER F: COVERAGES CERTIFICATE NUMBER:1816164758 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/'1t'R'".__�........_.TYPE OF INSURANCE 1'�St:.,S.0, ...e„_____.�.....-POLICY NUM BER.m,m.,.mw LTR LIMITS A ° X COMMERCIALGENERALLIABILRY GL2023LHB00019 1/17/2023 1/17/2024 EACHOCCURRENCE $1,000,000 _ __. CLAIMS-MADE �OCCUR f werl „( „� 1„ st00.000 � __ PERSONAL 8 ADV IWURY $1,000„000 GENL AGGREGATE LINT APPLIESPER .. ,GENERALAGGREGATE S 2,0 w..,._ ...,��.� ........ ......... .00,000 POLICY PRO _.._.,JECT LOCI PRODUCTS COMPIOP AGG S 1 000.000 w_......m. ,., -_ .._.__—_- - OTHER, $ '.. AUT0111100"LIABILITY CONFINED GL INE LIMIT S '' ' .tT acr?d�rrll. m ANY AUTO ! BODILY INJURY(Per person) 5.. ....�,.,..,,.�. ....., . BODILY INJURY(Per accident W.. „m..........~ OWNED SCHEDULED 0 S AUTOS ONLY AUTOS mm HIRED NON-OWNED PRO Rwbx w F- $ AUTOS ONLY AUTOS ONLY ?L +) ,,,,,,„„.— ...�... .. .. � j S UNISRE r A LIORAVG ,EACH OCCURRENCE S OCCUR EXCESS IIAB I AGGREGATE ...... ._ $._ .,. _......_ DIED RETENTIONS I S AM BMLOYSM LIABILITY — ,_:S?ATUTIs-.. „ „ .R. g�AR ErpgECUTIVE Y� NIA EL.EACH ACCIDENT SOFFICERAAEN - (HModa�bNN) EL DISEASE-EA EMPLOunder YEEr yp, ... ..A. ,.... DESCIiIPT10N OF OPERATIONS below+ EL DISEASE-POLICY LIMIT<$ pA DESCARTION OF 04ERATM7NS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached M more spice Is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WTTH THE POLICY PROVISIONS. Proof of Insurance AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YIF Now York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ 472086863 BORG&BORG INC " 148 E MAIN ST RIM, ". HUNTINGTON NY 11743 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GOLD HILL BUILDERS LLC GOLD HILL BUILDERS LLC 302 MAIN ST.LOWER LEVEL 302 MAIN ST. LOWER LEVEL NORTHPORT NY 11768 NORTHPORT NY 11768 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12436 146-1 602271 01/26/2023 TO 01/26/2024 8124/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO, 2436146-1, 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.COMICERT/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 NS4�R N E FUND 4/ DIRECTOR,INSUf3'ANCE FUND UNDERWRITING VALIDATION NUMBER:535495929 U-26 3 Glenn Goldsmith, President ' Town Hall Annex °A. Nicholas Krttpski,Vice President 59:375 Route 25P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly w Elizabeth Peeples � Telephone(631) 765-1892 Fax (631) 765-6641 BOARD OF WN 0 S OUT HOLD � �:• rb June 14, 2024 HUHdDING DE PT. Cole Environmental Consulting 425 Montauk Highway East Quogue, NY 11942 RE; JOHN BLACK 1995 POINT PLEASANT ROAD, MATTITUCK SCTM# 1000-114-1-7.1 Dear Ms. Rummel: The Southold Town Board of Trustees reviewed the site plans prepared by Ward Brooks Land Surveyor, last dated March 5, 2024 as well as performing a site inspection of the proposed staked out project, and determined that the proposed construction of a single-family dwelling with seaward side patio and an I/A OWTS system is out of the 100-foot Wetland jurisdictional area under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary, or within 100 feet landward from the edge of vegetated wetlands, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and/or Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. Sincerely, h �- Pt Glenn Gu�l s ith, President GG:ec ,' Scott A. Russell PTO [WA\T]E]k SUPERVISOR 2MIANA.GIENHENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 "e l ;, pwn of So u th o l d CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) Pro ert Owner Design Professional Agent, Contractor Other) i - - - - - - - — - - - - — - - - — - - - — - - - - - - - - - - — - - - APPLICANT: (Property Y g g � A 1 Date: NAME. L, lR"imouAu ; 1 G Contact act Information: � i Property Address / Location of Construction Site: c k . + S.C.T.M. #: 1000 District I ; A Section Block Lot si �.._ mmmm _.. III TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - - - - - - - — -- - - - - - - — — — - - — - - - - - - - - - - - - - - - w - Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Required ! i Project does Not Discharge to Waters of the State, No S.P.D.E.S. Permit is Required,,!, . J g 1 " 1 ❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit f" DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit. �, ❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Flows Through Southoldi Towns MS4 Systems to a ngin D Waters of the State of New York. THE APPLICANT MUST OBTAIN f a S.P.D.E.S. Permit through the Southold Town Engineering Department rtment I, y� Prior to Issuance of a Building Permit. � Reviewed By: Dat _ e nc nrrnhar 90 i d'irc[`can about:blank NEW 1fC:DRK STATIC:,DEPARTNIIENT OF ENVIRONMENTAL O NMEN1CAL CONSERVATION r.DOVl.olupu W ELtl�Y 10106fl G'U1 P+lid i'"�liEtl hrCu r$L tj ld:dll f94.➢NY Di.uk,50 C6,ek R,,a➢,SNIIIY r:—111,NY 1990 r':(633)444-03G'.5 V r:(63$i AIM-J360 r.E l e" fat No.16.gCtIS10d[ g I rlILA AST-Lr NDS A l &N0T1FIl L fl(I N f31:.. c dr lm m l tg a Patrice Stewart May 9,2024 1300 Veterans Memorial Iiwy, Suite 130 Hauppauge,,NY 11788 i° 1DEC;ID#1-4736-04602/00002 STl WART Property—1995 Point Pleasant Fed, SC I M#: 1000-114-1.7,1 I.Dear Applicant: ba%c,o our the infa nnalkni H otr wnlaniittecd true Depa(tmelit of t rwirofirnerillal G oli ervAburl 11,35 (iotiarmiined that the porii0lu or tier property Itic ted landward of the 10 Contour,as;Shown oil the Wirvi iy tirelarnan d by Va wd Monks it wensed Land Surveyor),d a st revised 03)05(2024,is beyond lhr lour alrr�,liraan aaI tYner ArCra de.'2r I acta[ e hands Acl rherefore uen occorcl mane wrdh[tie currerut I1r.l",id w"tiy� iPs3racl�l_,arard t ¢ dwefgkiNratrrrrua QdaIV1"C:"Ifdr~t 1°aat 41di't�,Tara fiexanrh is regiadra�¢d iaa antiradeae'r�d regulated activities landward of that contour pIoriscw he aariwised the DEC has documented the summer cocimenrx of the Northern Long k a:arcd Hat iNLE131 JMyoojs,aegrteralr°rorn.�nlr l„sa spci;des liistwl as"endangered"by holh New w Yolk Staat(.,r grad the US Fish&'Wadlife Srarv'ice,witiairr 3 miles of the project location, 1 ieae cullfnll al this,loc"atiori betwoult Match f and Novernbor'Ji)of any cple.ndar year in ay rc null iuu the lake of the)ec nraclrarnfgererdPttira ate ana rt species or,their li ahat at within the rune ranancg tat CE.livironniental Conservation I'm(LC[.) 1 1-53S T tie li ruau Vik is defined in par( as the direct kiNlin,g or irngury Of rrrdivicluanl tier rrrl:ier,of a prolaactcd species,interference with c;r^rlrorrd breeding„foraging,nnifll aBoi V r)r ollher essential behaviors,of the adverse modification of tlnc >pociers"hahidaaL The take'"of as species tasted as endangered or ltareatenecd is prolaahaled if) td're absence of a pernud dror°ra lhix Denp)aartaaieral tssuaad pursuwarai Ira EC t 11-535 To avoid an Endangered Species t,akc,' nea tree rnttirng acrivitios can be conducted at the project site he tween vino dates of M n ch 1 and November 30 of any calendar year. id you home cote slions about the presence of pcate(t ie(l species on or ne it your propa r ty,tln0 pule»nlarrd ealffecis of actrvalaeas on these e specicu s or your iesfaenrn ib'idi e as a landowner err projeu',l Sponsor uanafi,r dike Fn daangwrr.,d p,nna;da s Rerguintrnaaes"iale as.colilocf tln r Ike giomil n [ldlife Manager at 631-444-0310,or wildlife i 1 -rlqw. Rrr ftli oa advi,r.,d,rues fir ifisturtasni.e of aany ke rid rnai,y lake,pad ire, sa uwnoI rsf tlic,hr.4-l well arads 6turisdictimml tioarandory,as above.without a perri'arl It is your re aponsihudity to en Fire that all pa"eacauliolns are trikeen to prevent any 'iedinientaation or distuurbanGe within Article 25 jurisdiction which may resaadl faon`a any future pfujeol. Such pia e .auirtm nr ay inctrade nwiuit airiraicN adequate work area belwet-Iri the juarisdia tionaal boundary saivrl yoni,pr(lject(d.r,„s air 15'wirge construction area]ou a,aechng a temporary fencer,barrier,or hay hale burn Huts letter shall remain valid unless site conditions change. rig r grarvmi�irll aF y rna� rrexrravrai"iatrntal 4onferu,errnn I ot`4 6/6/2024, 10:40 AM Firefox about:blank Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities Sincerely, Laura F.Star Deputy Permit Administrator GG Cole Environmental Services, Inc. BHP Wildlife File 2 of 4 6/6/2024, 10:40 AM Firefox about:blank ua� I Yar I� I[ • )IN l;nv ,�,��; ,, j ar a� Ir r rt f t ..f Q K)ME RKEE �h MASM 1II OAD7 63 1 a 90 E ar r tv 600. f r t tk l d V h r ?•� � S °+ ?�f I ( 9 _._..._ —..... „ TJAJ,J , ., "_ w 00 C� I W�U e 67 49061, kP 'fit '" 52,89' PAR AR� �.�4: M1..,` F 19 Fes' IL�9'� 20 ON 7 d. 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