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HomeMy WebLinkAbout51415-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#: 51415 Date: 11/25/2024 Permission is hereby granted to: Jan W Benzel 625 Uhl Ln Orient, NY 11957 To: construct additions and alterations to existing single-family dwelling as applied for per SCHD approval. Premises Located at: 625 Uhl Ln, Orient, NY 11957 SCTM# 15.-5-24.9 Pursuant to application dated 10/07/2024 and approved by the Building Inspector. To expire on 11/25/2026. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition&Alteration $610.00 CO-RESIDENTIAL $100.00 Total $710.00 B�ww ding Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT � Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 k Telephone (631) 765-1802 Fax(631) 765-9502 hgL)s://www.sotitlioldtonIM)�..6j(.)v Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. BuildingInspector: u° Applications and forms must be filled out in their entirety.Incomplete -px k�.1' d applications will not be accepted. Where the Applicant is not the owner,an NJ N Owner's Authorization form(Page 2)shall be completed. Date:9/27/24 OWNER(S)OF PROPERTY: Name:Jan Benzel & Bruce Weber scTM# 1000-15-5-24.9 Project Address:625 Uhl Lane Orient NY Phone#: Email: Mailing Address: CONTACT PERSON: Name:James P Olinkiewicz IIIIIIIII Mailing Address:PO Box 591 Shelter Island Hts NY 11965 Phone#:631-902-4402 Email:hilyamused@gmail.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Olinkiewicz Contracting Mailing Address:PO Box 591 Shelter Island Hts NY 11965 Phone#:631-902-4402 Email:hilyamused@gmail.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition IORAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes RNo 1 PROPERTY INFORMATION Existing use of property:Residence Intended use of property:Residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R40 I this property? ❑Yes RNo IF YES, PROVIDE A COPY. 0 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 building(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):James P Olinkiewicz @Auth riled Agent ❑Owner Signature of Applicant: date: STATE OF NEW YOR SS: COUNTY OF +' S K e r c,.�<<Z being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (f"'.''-� — (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 u *'J�cz day of OG �� 1( ,20 2 - N ary Public BRITTANY'A CONRAD Notary Pub ie,Slate of New York Reg. PROPE Where the 'N OWNER AL1"nj0R1ZA''ri0N Qualified in Suffolk County Commission Expires July 18, © .7 ( applicant Is not the owner) L vwz I, _ residing at pp do hereby authorize �/ G-� to apply on :W—y6-my be Try I7w f Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 .._INKIE 0 P ;_J CoERTIFICATE OF LIABILITY INSURANCE D09/20/2024 J -HIS CERTIFICATE IS ISSUED AS A MATTER OF IN _ - FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS Y :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES V 3ELOW. THIS (S) AUTHORIZED CERTIFICATE HOLDER. .� .. ISSUING INSUR REPRESENTATIVE ORFPROD""" AND T_.C RT FS NOT CONSTITUTE olic CesNmust haBe ADDITIONAL INSURED IMPORTANT. If the certificate holder is an ADDITIONA L INSURED,of such policy, a certain policies may require an en provisions A statement endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the olic , endorsement A statement on ''iis certificate does not confer rights to the certificate holder in lieu a PRODUCER 631-67 -0500 C4 O CTE Cliff ?IB rady 05_00 FAX P.Brad/Agency,Inc. PHONE6316�3 - A No l 631�23 0956 487 Now York venue --. Huntington,NY 11743 AI Clifford T.Brady INSURERS)AFFQRDING COVERAGE NAIC M A Evanston Insurance Company Inc INSURED Olinkiewicz Contracting,Inc., INsiiRlrR B State Insurance Fund 36102 Shelter Island Heights, NY 11965 _ tY s Co PO Box 591 g RINS ia§k�0� Standard Security Life In IrsuRER E: _ m — . .... .._... ..... INSURER F: _- m RAGES _....... I ��,A E NIJIURBEfI _. __W.. F E' Sl N NI,1'1 S .. _ ........_. 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, ED BY PAID CLAIMS INSR TYPE OF INSURANCE AD� R _.. NUMBER POLgi YT P MAY HAVE BEEN REDUCED w ....... EXCLUSIONS DeNDRALON CONDITIONS POLICIES._ LIMITS SHOWN MAY thl k�(m, YI 1MWIPP YYY) m__ -- LIMITS 1,000,000 _ ,.COMMERCIALLACH.P(CURR9,K9 _,,,_ DAMAGE TO RENTED 100,000 X m CLAIMS-MADE X OCCUR X 3AA724419 10/30/2023 10/30/2024 p8 �� may_ __.. ...... 10/30/2024 10130/2025 MED kP AAruyOcle arsan)__ d — 6, BlanketAI Inc--I u 1,000,000 0 -- ____ � __X ,004 GENERA ...._ _GEN'L AGGREGATE LIMIT PER: R t 00,000 000 . IXPOIC [_ PECOT LOC . ., . .. _.7 .. COMBINED SINGLE kku1T _.._ '.. AUTOMOBILE LIABILITY Ma'aV6 0M ........ _....,..._._.._-... ANY AUTO _ OWNED SCHEDULED 4AAUUTOS ONLY AU�TOS �i�S ONLY ,. Nhik O�ON Y OP1RTY AMAGE radep�¢. S ._ UMBRELLACUR EACH 0)PPgRRPN9L S A EXCESS B CLAIMS MADE A�aRTS_ „„,.... ,� � �.. ..... LIAB OCCUR _ .- DED V RETENTION$ S _ .....O � ��� N 11325 7so_s osns/zo2a osrls��n..__ m _ �.... .. ---ppp B WORKERS COMPENSATION X iT1�T H , AND EMPLOYERS'LIABILITY 500,000 OFFkCER41fM9FREX kT.i,IDED?ECUTIVE I N/A EL E/CikAC IOENT I Y/ I /2025 5 0 (Maradafoi kn I E L OtSEASE•I„A EMPi t3YEE $ C under .wr 00,f0.0 L DIP� EIt ns, ._ Drsabill R08247-000 01101/204011 5 Limits Pe.r.,ry ........ ......_ ... .,.... ..,.. ...... ... .. .._. .. ......... New York ..........�s_ E. .__ __ Stat.. .._. a Law DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CEIT iCATB HOLDER CANL'EI , T�71,tw1' _ __ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Suffolk County Department of ACCORDANCE WITH THE POLICY PROVISIONS. Labor,Licensing,&Consumer Affairs AUTHORIZED REPRESENTATIVE PO Box 6100 Clifford T.Brady Hauppauge,NY 11788 ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �n� r Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name JAMES P OLINKIEWICZ Business Name This certifies that the OLINKIEWICZ CONTRACTING INC bearer is duty licensed License Number H-52130 by the County of suffolk Issued: 08/14/2013 Rosalie,prago- Expires: 08/01/2025 Commissioner PROPERTY OF BENZEL AND WEBER I 625 UHL LANE ORIENT, NY SCTM # 1000-015.00-05.00-024.009 TOTAL LOT AREA = 40,233sf (0.92ac) GROUNDWATER MANAGEMENT ZONE IV; TOTAL ALLOWABLE SANITARY FLOW = 300 GPD HD PERMIT 93—SO-76 Q J UG UTILITIES AS SHOWN Z O TOWN ZONING USE DISTRICT R40 P: NO STORM WATER CONTROL PROPOSED Q U ALL PROPERTIES WITHIN 150' VACANT OR SERVICED BY PRIVATE w ON SITE SANITARY DISPOSAL FACILITIES AND WATER SUPPLY WELLS. THERE IS NO PUBLIC WATER OR SEWER � DISTRICTS THAT SERVE THIS AREA. Z PROJECT IS 1 BEDROOM ADDITION TO EXISTING 3 BEDROOM HOUSE EXISTING WELL & WATER LINE TO REMAIN ABANDON EXISTING SEPTIC TANK AND LEACHING POOL O X INSTALL NEW IA OWTS AND LEACHING o f N SANITARY DESIGN; U g : 4 BEDROOM DESIGN: 440gpd DESIGN FLOW � PROVIDE (1 ) FUJI CLEAN CEN5 500gpd I/A OWTS 300sf SIDEWALL REQUIRED 0 O LOAT PROVIDE (2) 8'Ox6' LEACHING POOLS Z O_ SANITARY SITE PLAN BASED ON SITE SURVEY KENNETH M. WOYCHUK LAND SURVEYING, PLLC DATED 5.6.2024 LOT 159 ORIENT BY THE SEA SEC 3 01 FILED 9.24.93 MAP No. 6160 > ELEVATIONS BASED ON NAVD'88 DATUM BASED ON ADJACENT SURVEYS U) NO WETLANDS OR SURFACE WATERS WITHIN 300' OF PROPERTY U) 1— NO EXISTING OR PROPOSED STORMWATER STRUCTURES z LU 0 Q w EIICAT Design Professional's Certification Required. uJ W MAC80R Submit P.E. or R.A. Certification For FLOW 18 CF t iz ALPRESSURE 2. PSI The Installation and Construction of the Sewage Disposal System z :f+ I Q 4ER 120WI/ i OA/6O LETrooNNECT[ N 14lNCH Use Form WWM-073 CNT 11 LBO VE—CONSUMPTION r 66 W z [Nation/Operation&Maintenance Notes; Q ata bower on appropriate base. sue adequate ventilation � W protect against sunlight. }— m aintenance requires a trained technician. I� W it maximum efficiency, inspect and clean internal air filter LU i I every months. Q W aplace diaphragm/valve assembly once every 12 months. and wire blower to IA control panel. < — z � � Q z U) Z 1= z z 6j„ - - Lw w SUFFOLK COUNTY DEPARTMENT OF HEALTH 4U�, F I SERVICES o 0 � N 7 " PERMIT FOR APPROVAL OF CONSTRUCTIONFOR A < o W N SINGLEFAMILY RESIDENCEONLYZ � Z 6j„ _o W ~ m Uj _ DATE 10/3/24 R-24-1250 MAXIMUMAPPROVED Ld - 4 FOR w 0 m - o N ~o EXPIRES THREE YEARS FROM DATE OF APPROVAL 0 N - (n Z F=— O r Q Z LLJ Q m Q U o Z o 0 —P-1 103'+ 125± 'vj L _R U V�R I 1V- A I , 246-33 '1 I u 0 80o,2015011 E V-1 C) �o ---)A Le A 0 00 0 v 9 n't AA I U C:l c) L P r,',j G P R co CEP; 0 x V, ESL ik A. C) I g p�- VE, . jo r f Obo c .A BLOWER & ------------- 14,5' 1 0-- 'S E P o FN 0 VE R QUIP 0 VLER I _01 SE WEL. Fo SITE PLAN SCALE 1:40 ExCAVATION INSPECTIONREQUIRED FOR SANITARY SYSTEM 4" INLET Pi 4 AL By HEALTHDEPARTMENT INLET