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HomeMy WebLinkAbout51356-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#: 51356 Date: 11/04/2024 Permission is hereby granted to: Marco Sacchi 19 Greenview Ave Princeton, NJ 08542 To: Construct accessory pool cabana as applied for,with SCHD approval. *Construction of dwelling and pool must commence priorto construction of cabana. Premises Located at: 100 Arrowhead Ln, Peconic, NY 11958 SCTM# 98.-2-2.1 Pursuant to application dated 05/16/2024 and approved by the Building Inspector. To expire on 11/04/2026. Contractors: Required Inspections: Fees: CO Accessory Structure $100.00 Accessory-New Structure $366.50 Total 466.50 � �� Building Inspector 0 f"4'N 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 iLttp.,s,�/wWW,.,southoldtowiLny ,ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only % PERMIT NO. �� Building lnspector:_.- A P/Ppmp 0! M AY 2 2 4 a6�1,forms mu st I '-apolkitl6ns Will not acceptedApplicant is� *t' %imeri an z'atil 6-6'forMi (Page 2)ihaii/Itt 1 6d, e comp et Date: qwNfR(S)OF PROPERTY., Name: 00- 'A4AR sk(cWS01i Project Address: to() )4RqUW k:swb F- COIJ lis Phone#: 609 SS2 Email: N 0, C,0 S 0_GC - o Mailing Address: �ttJc2 CONTACT PERSON: Name: 9 J�" S Mailing Address: l[J ORSLP Phone#: 601 SSA 3?-�?- Email:- DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: i0-0 Vou-T� ?>WOAZ,`CI} SUITF- « U)'ArLL Phone#: '??j2- '+6 1 919 2- Email: WWUI' L6&A L CONTRACTOR INFORMATION: Name: Kb H r Mailing Address: -W Pori 4,-,, k Pj !l klva /4 ALK Iq Phone#: 'i Email� (6 3 1 - 4,66- cvi i ' 76 //o,- DESCRIPTION OF PROPOSED CONSTRUCTION XNew Structure ElAddition ElAlteration DRepair DDernolition Est'T JJC sitofProject: E1Other Will the lot be re-graded? OYes XINo Will excess fill be removed from premises? DYes ONO 7, PROPERTY INFORMATION Existing use of property: intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to 4 ® this property? ❑YesXNo 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 i;Ib,of the Town Cope.-APPLICATIQN IS HER EBY`MA,DE to the`Building Department for this lssuan�e of a Building Permlt pursuant to the Building tone Ordinance of the Town;of Southold,Suf#olk,County;New York and other applicable Laws,ordinances or Regulations,for the cgnstruction:of buildings, additions,alterations odor removal dr demoiition as herein described.The applicant agrees to comply with all applicable laws;ordinances;building code, housing code and regulations and,to admlf authorized inspectors on premises and trr boilding(s�for necessary lnspittions.False stafernents rtaade herelnare punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law, Application Submitted By(print name): CC,(k( ❑Authorized Agent A�wner Signature of Applicant: Date: 5- ►(o—,29 STATE OF NEW YORK) SS: COUNTY OF f- Q YC-0 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 day of a _ , 201)LL tart'Public TRACEY L. DWYER PROPERTY OWNER AUTHORIZATION NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 (Where the applicant is not the owner) QUALIFIED IN SUFFOLK COUNI- COMMISSION EXPIRES JUNE 30,20ik I, 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 0. TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 0 Telephone (631) 765-1802 Fax (631) 765-9502 t1ps:// yw. outhoidto)ynn oy BUILDING PERMIT APPLICATION INSTRUCTIONS&CHECKLIST • Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. • The work covered by this application, including land clearing/site work, may not be commenced before issuance of a building permit. • No building shall be occupied or used in whole or in part for any purpose whatsoever until the Building Inspector issues a Certificate of Occupancy. • Every building permit shall expire if the work authorized has not commenced within twelve (12) months after the date of issuance or has not been completed within eighteen (18) months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an additional 6 months. Thereafter, a new permit shall be required. ALL APPLICATIONS MUST BE SUBMITTED WITH THE FOLLOWING MATERIALS: ❑ Building Permit Application: Complete, signed and notarized. ❑A survey/site plan, drawn to scale at original size, showing the location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas and waterways. ❑Four (4) sets of plans bearing the signature and original seal of a NYS licensed professional engineer or architect illustrating compliance with the Building Codes of New York State. ❑Contractor's proof of insurance and Suffolk County license: • Certificate of Workers' Compensation Insurance (C105.2 or U26.3) AND a Certificate of Disability Benefits Compensation Insurance (DB120.1) • Certificate of Liability Insurance "Note: Final Fees will be calculated by the Building Department using the fee schedule. Fees will be collected after the permit is written" ADDITIONAL DOCUMENTATION MAY BE REQUIRED AS IDENTIFIED BELOW: ❑Suffolk County Department of Health Services Approval (original copy) ❑Approval of the Zoning Board of Appeals, Planning Board, and/or Historic Preservation Commission (if applicable) DElectrical Permit Application (FILED SEPERATELY): Electrician must have an active license with Suffolk County El Flood Plain Development Permit Application (if applicable) ❑Southold Town Trustees Permits may be required: If any work will be done within 100' of a tidal or fresh water wetland. ❑NYS D.E.C. Permits may be required: If any work will be done within 300' of a tidal wetland or 100' of a fresh water wetland ❑1 copy of ComCheck/ ResCheck (if applicable) ❑1 copy of Manual J, Manual D and Manual S (if applicable) ❑Utilization of truss re-en ineered wood timber construction form (if applicable) ❑Single and separate title search (if applicable) ❑Curb cut permit (NYS or Suffolk County form 23F) (if applicable) ❑Original signed Owners Authorization: if applicant is other than owner. 3 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 htt ash ,//wr Kw.sotithpidtowji.�ily. ov A�4v INSPECTION &CERTIFICATE OF OCCUPANCY INFORMATION It is the responsibility of the applicant, owner, or contractor to request inspections from the Building Department. Construction must be completed and certificate of occupancy must be obtained within eighteen (18) months, or the permit may need to be renewed. Building permits shall be visibly displayed at the work site and shall remain visible until the authorized work has been completed. Work shall remain accessible and exposed until inspected and accepted by the Building Inspector. The permit holder shall notify the Building Inspector when any element of work described below is ready for inspection. The following elements of the construction process shall be inspected, where applicable: • Footing reinforcement or pier excavation prior to pour; • Footing keyway with foundation wall reinforcement; • Foundation before backfill; • Foundation damp proofing; • Framing, tie down/strapping and plumbing; • Underground plumbing; • Perimeter insulation; • Rough electric; • Insulation and caulking; • Solid fuel-burning heating appliances, chimneys, flues or gas vents; • Energy Code compliance; and • A final inspection after all work authorized by the building permit has been completed. After all necessary inspections are completed additional documents, including but not limited to the following, may be required: • Suffolk County Health Department Approval —original copy • Plumbers Affidavit • Miscellaneous Certifications as requested by Plans Examiners or Inspectors The Certificate of Occupancy will be issued after all of the required documents are submitted to this office. No building may be used or occupied in whole or in part, until a Certificate of Occupancy shall have been issued by the Building Inspector. The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. The person responsible for this site must call in for all inspections listed above. Contact the Town of Southold Building Department at (631) 765-1802 to schedule your inspections. Please have your building permit number ready. 4 i„ - RK Workers' CERTIFICATE OF INSURANCE COVERAGE ._...... STATE 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 carde 1a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured KDMAX CONSTRUCTION INC 631-953-9336 338 MONTAUK HIGHWAY EASTPORT, NY 11941 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to 844188515 certain locations in New York State,i.e., Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 3b. Policy Number of Entity Listed in Box"I a" BUILDING DEPARTMENT DBL623010 PO BOX 1179 SOUTHOLD, NY 11971 3c, Policy effective period 09/18/2023 to 09/17/2025 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: ❑X 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 employer's employees: Under penatty of per)ury,I certify that I am Wan authorized representabi (i or licensed agent of the'insurance carries referenced above anti that thi named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above,. 5/8/2024 ° Date Signed __. ...._ By (Signature of insurance carrier's authorized rep resentative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 ___--. Name and Title Richard White Chief Executive Officer _w 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 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 sox 4B,4C or 58 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(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) 111111111D°°°1°°°°111° °!1°�!�°°°1°°IIIIIII DATE(MM/DD/YYYY) AC"R ► CERTIFICATE OF LIABILITY INSURANCE 05/08/2024 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 Jo NA 6 n Micena f JOHN MICENA PHtrNE 31-268�454 _.w.ww FAX ti31 288-8039 .. MAIL John PO BOX 777 ��p MPO BOX 777 :. EAST QUOGUE NY 11942 INsr�a;w FARM FAMILY CASUALTY INSURANCE CO 13803 INSURED._..... ...__. _._..., w_....., __. .....,,.,www._.... .............._.,,,..,.. v .... ...._ .._„ ,,.,.,,......L_.........._,,.. IN.URE KDMAXCONSTRUCTION INC 'YI ua�tt�c.,:�._..... ...._.......�.....__......_.�..�....wm.m...��..m..w� ,..��_.....�.._.�....._ _..�_.w_-..._.µ.�....._,w_ 338 MONTAUK HWY iNSUR rtD _...-.........._........ „__w ww. _..__. ... _. ..MSI,IRER�:.?...._..m_,.�._._....._ww�.�.�..........................w�w�.�...-.�._.....�.........._..._��_....._.._............,... ....._.- I EASTP`ORT NY 11941 INSURER F; �._.ww _.. ......._. _.. 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„ SIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS EX _ ...._v.....w._�..�. ...,..,,,..��w__ .�............. -....... � .,........ POLICY NUMBER, P9M�I4:" � M������ &.RCY�EX�" �._� rA TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY 3101 L7802 7/31/23 7/31/24 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR F?R wGdkl . . rtr�- _._,,,.w _„ 100,000..- MED EXPAtr rsraem amtan) $ 5,000 PERSONAL B.ADV INJURY $ 2 000 GENT „w....w .w ........� . N`t.AGGREGATE LIMIT APfUES PER: � PRNERALAC�4aRE0ATF $ 4 0(JO 0CI0 _...�_ POLICY JECT _.,.,_J G $ 4,000,000 PRO- LOC ODUgrs wCOMP/OP A da' .. OTHER: 1 IE _ $ AUTOMOBILE LIABILITY (t$,, k�J0 $ MSINED 6pwiULLL G IMkT nt w..ww ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE Is AUTOS ONLY AUTOS ONLY C I LO.01....... .,.., ,,,,,..._ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE...... ....� .....w�.....,,,...w.w..._.......,,.... -- ­­­­­­­­-I ­ LIAB CLAIMS MADE EXCESS AG�TRE WORKERS COW Wm DLD RETENTION $ MPENSATION i � .,--_- g ........ AND EMPLOYERS'LIABILITY Y/N N/A ANYPROP'METORdPARTNERIEXECUT'IVE E,L.L)dSEASE_DEN $EACH ACCIDENT OFFICER1MFM8F'REXCLL&DED ._. .. A E L EA (Mandstoty In NH) mEA MPI ClYEE $ ...... IP yyam,daacriba'O'no't DESCRIPT&ON OF OPERATIONS ItaQorn! E.L.DISEASE-POLICY LIMIT '$ ( d DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1179 SOUTHOLD, NY 11971-0959 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A^AAA^ 844188515 JOHN MICENA 1 543 MONTAUK HIGHWAY RI �t PO BOX 777 SCAN TO VALIDATE EAST QUOGUE NY 11942 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KDMAX CONSTRUCTION INC TOWN OF SOUTHOLD 338 MONTAUK HIGHWAY BUILDING DEPT EASTPORT NY 11941 PO BOX 1179 SOUTHOLD NY 11971-0959 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12523 837-9 754971 09/18/2023 TO 09/18/2024 5/8/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2523 837-9, 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:/iWWW.NYSIF.COM/CERTICERTVAL.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. PRESIDENT RAFAL KRUPA VICE-PRESIDENT VIOLETTA KRUPA KDMAX CONSTRUCTION INC 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 SUR NCE FUND 4 �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 250042308 U-26.3 Town Hall Annex 5475 Alain Road w, P. 0• Box 1179 Telephone(631)765-1802 ,° Southold, NY 11971-0959 Fax(631) 765-9502 BUILDING DEPARTMENT NT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE- WOOD CONSTRUCTION AND/OR TIIIIISE�R CONSTRUCTION ENGIIV EREIJ Date: �� I Owner: ►�J�C� S —�Z—�—I Location of P roperty: tCd kpow t+� Please take . otice that the (check applicable line): New commercial or residential structure --� Addition to existing commercial or residential structure --�_ Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above (check applicable line): ve will utilize Truss type construction (TT) Pre-engineered wood cons truction (PW) Timber construction (TC) in the following location(s) (check applicable line): ,._ Floor framing, including girders and beams (F) Roof framing (R) - - __ Floor and roof fra . 9 (F Signature: Name (person submitting nW �-.-_..._._....._,w_...�.�.�...�_� g this fo ): .�,. . .�.��'��C_c3 Sd�l� Capacity(check applicable line): --- _._.. Owner Owner representative TrussReg15.docx Effective 1/1/2015