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Home My WebLink About51437-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#: 51437 Date: 12/04/2024 Permission is hereby granted to: 150 Deer Run LLC 337 Merrick Rd Lynbrook, NY 11563 To: construct accessory in-ground swimming pool as applied for. Lot clearing shall be limited to one acre. Premises Located at: 150 Deer Run, Southold, NY 11971 SCTM#79.-4-17.19 Pursuant to application dated 10/11/2024 and approved by the Building Inspector. To expire on 12/04/2026. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Accessory $100.00 Total S400.00 ilding 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) 765-95021itt as://w^ d.southoldtowi ll .gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Onlym PERMIT NO. /411 Building Inspector: Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owners Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: � + G � ° SCTM#1000- + — ._ 7 Physical Address: - Phone#: , ✓,� Email: �""" ' '�, �.��, , � Mailing Address: ". OJ'/ry 1 YIZI Il CONTACT PERSON: . Name: o 2938 99M- atcad TU Mpike Mailing Address: Sires 212 Phone#:' Email: DESIGN PROFESSIONAL INFORMATION: `j Name: t Mailing Address: q n '31 S3 Email: Phone#: bmtdo'& hmesuaaiaa c,, CONTRACTOR INFORMATION: � Name: Loon )� , pct� 4.. - Mailing Addre Phone#: Email: . g DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated.Cost of Project: Cher $ � . Will the lot be re-graded? ❑Yes MO Will excess fill be removed from premises? k0es ONO 1 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 this property?`�69es ❑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 Lode. 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 buildingls)for necessary Inspections.False statements made herein are punishable as a Gass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print n e): I - EfAuthorized Agent ❑Owner Signature of Applicant: Date: 10 r02� I 1 STATE OF NEW YORK) SS: COUNTY OF c.�'1-r-OL- ) „" � being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Wit (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 ram- 3 µ dayof 0 Notary Public CAROLINE M MACARTHUR Notary Public.State of New York PROPERTY OWNER ,AUTHORIZATION NOa 01MA6384635 Qualified in Suffolk County (Where the applicant is not the owner) My Commission Expires Dec 17,2026 Ill. 0 1 re iding at 2 3 0 ��47� LA/ Zy �/41,/A JrA/ r o hereby authorize I10to apply on my behalf e T wn of Southold Building Department for approval as described herein. 's Signature 6ate el/-'q Print Owners Name 2 t � f01 BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err southoldtownn . ov- seand@so,utholdtownn_y.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Req uired) Date: Company Name: Electrician's Name: License No.:l'Yl,E-S1(Q 1.% - Elec. email: 6,1 vil, i M tA Ed qyu,upC ' M Elec. Phone No: U31-13L:5a0LJ 01 request an emailcopy of Certificate oaf Vmplia ce Elec. Address.: al n . ,DOE SITE INFORMATION (All Information Required) Name: III Address: 1,5L , Cross Street: ti Phone No.: BIdg.Permit#: email: "le& Coni Tax Map District: 1000 Section: Block: rot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly).. Square Foota e: Circle All That Apply: Is job ready for inspection?: YES�NO ❑Rough In ElFinal Do you need a Temp Certificate?: 0 YES E]NO Issued On Temp Information: (All information required) Service SizeEl1 PhD Ph Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead #Underground Laterals 0 1 M2 H Frame Pole Work done on Service? Y N Additional Information.. PAYMENT DICE WITH APPLICATION --- Suffolk County Dept*of Labor,Licensing&Consumer Affairs k ,� HOME IMPROVEMENT LICENSE Name MICHAEL J DOMINICI Business Name This certifies that the nearer is duly licensed LONG ISLAND POOL&PATIO INC 3y the County of Suffolk License Number:H-45707 Rosalie Drago Issued: 01/22/2009 Commissioner Expires: 01/01/2025 DATE�fiAItUD THIS: l t FPl "'i l AS Y O Nl G RtINN�k, ". THE dEk UPOwr k Y EX 0 ANTEND,D ALTER " COVERM AFFORDED �H� Q&t.l�l LOW TAIS CERTIFICATE IIF INIt IR NCB,,D+O S"NCO". till Tl"Ii M""0 , ONTRA T l E TWES14 THE ISSUING II tIRI�R� �� AU"IHCOI PRESMATI'VE`+41R FRODUC�AND.Tti.E� ' RTIP' JET FOUR, IMpqIf SILI4t*IBRT If t ei IIII��G) ldor nttw tDp��INSURED, �swe AWN 3hITIyNAL�INSURED PrarnAs11 1*�w or be endorsed. Is thllw pollcyr�ias)most rmB Bind Conditions of the policy,Certain oPoss ma require an endorsament, A statement on GIs ��w des not Corr, �c6r�ate holder lri-llsu`art soah andomenvi nt s PRooUCER 1 �k n pan°P.R n Rs d ,Inc. "a 4�DrAv+r 610� 4 �F � 03 Babytoh,NY I1702 Regan Agency;Irks I. ar!qqn Casua � an �2..0491 Stq�ts Iniuran�Fund hs�nq�, and PtI R Pal3o,Inc. � � , a �10 S 3 SiII .0 n ry,11d. Cam,f+Y1i7" 7 oINSURER D: -OGUMR a . e USEs ND16Altb. NOTWITHSTANDING + IY� 1JFI Ew�I` � tip I �A 0�'COhJ7R� CIn OCIIi�C 150 �NIwI O F FOR THE POLICY PEIt1 TtIIE Is TO CERTIFY THAT THE,PO EMR ISI agTR TO OR IIV3klIi D NAIL NT WITH I1EEitC1'TO WHICH PEO.I I IiES,LIMI HINSURANCE Y HAVE BSE N REDUCED,B�ID CLAIMS. FIEF�II+1 IS SY10IECI TC ALI WNICIi C7� CERTIFICATE MAy 0E ISSUED OR MAY E7tOLNJ9ILdN3AIdI3 CONDITIONS�GYI= LNCI�I TYPE OF INSURANCE O POUCY � � UNM A X weal RCIAL�IrAL t 1A61L1LY " CH OCCURRE bE , r CLAW&MAbE- X OCCUR E'cu E soe�2�es4o " 12I21Uz023 72110/2034 10o,ll00 1E IIIEIO -ffR' a ADV 1,000 060 I'CA, SPEA6 t3 EaA�" ,000,000 LOB. _� PO�Y . I PRgRU P S UFMA00 FA AUTOMOBILE LU►BIl iTY U OVY AUTO ANY AHMNED SCHEDULEb SONLY" AUTOS BO ILY Y AUTOS ONLY de nt MAC�� UMBRELLA LIAB OCCUR EXCESS LIAR (iLAIMB-MADE REGAT Drm RETENTION$ AO, GP 13 OOP` 2430 7914 04110/202 Or2024 E t R. " 100,0 r Nl.A 3 04l1 � 00� °II M Z pa ly fL 00,0k1I AProporly3woon 99 0 3 I2J2012,024 IBM 0 C+drtl l'Oalca Holder i IACORo 1S�Ii a If more apseata DESCRIPTION OP bPEkA710N8 L LOCATIDNBl.VEItICCEB rVal Remarks t3cheduhr,may tie attached s'ad.ditionat Insured. " iOU HOE raULD'ANY rrF THP ABOVE DESCRIBED POLICIES BE CANCELM BEFORE ?N DATE"THEREOF, NO1fiCE VaLL. 9E °DEL IV RRD AN ofllouthold'-, ACCORDANCE ltlT . yN1"THE 1L0Y PROVISIONS. Southold,NY 11971' anrrRO�r,�ss�rr�t ACORTy 2II010103) Th name and logo are.l'egistered marks,ofACORDCORD CORPORATION: AIIArlphte ceserwed. e ACORD NYSI NOW York State ImurSke FAn d PO Box 66699,Albany,NY 122p6 . nysif..com CERTIFICATE OF WORKERS' COMPENSATION INSURANdE (RENEWED) n n n n n n 112590890 REGAN AGENCY INC 463 DEER PARKAVENUE , BABYLON NY 11702 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POOL&PATIO INC TOWN OF SOUTHOLD so MIDDLE COUNTRY RD' 53095 ROUTE 25 CORAM NY 11727 SOUTHOLD NY 11971 POLICY-NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 1243I 791»1 3I77 7 . 04/10/2024 TO 04110/2025 2123/2024 THIS.IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY 'NO. 2439 791-1, 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.I OF NEW YOLK, TO THE POLICYHOLDERS 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 WESSsITE AT HTTP;S,IAWWI ,NYSIF.CO CERTICER VAL 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 COR,PORA'T'ION, PRESIDENT MIC 1 OOMI'NICI LONG ISLAND POOL IIK PATIO INC (ONE PERSON'CORPS 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 DI'RECTOI ,INS, NC'E'FUND UNDERWRITING VALIDATION NUMBER:,51 072 U,26.3 M . l � CERTIFICATE OF INSURANCE CO VERAOE NYS DISABILITY AND.PAID FAMILY LEAVE BENEFITS LAW PART I.To be completed by NYS disability and Pald Family leave benefits carrier or licensed Insurance agent of that Carrie 1a.Legal Name&Address of Insured('use street address only) 1 b.Business Telephone Number of Insured LONG ISLAND POOL&PATIO INC 543 MIDDLE COUNTRY ROAD CORAM,NY 11727 1 C.Federal Employer Identification Number of Insured 'Work Location of Insured fob requtrasd If coverage is spedYl rMlyiimlted to or Social Security Number certarin locaftas to NOW York Mate,).e.,.P<w*-Up jor,Ilcy) 11259089.0 2.Name and Address of Entlty Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certlflcate Holder) ShelterPolnt Life Insurance Company Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed In Box"1 e" Southold, NY 11971 DBL575672 so.Policy effective period 01/01/2023 to 12/31/2024 4, Policy provides the following benefits: A.Both disability and pald family leave benefits* B.Disabillty benefits only. C.Paid family leave benefits only. 5. Policy covers: ® A.All of the employer's employees ellgible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class:or classes of employer's employees: Under insured of perjury, rt that I am an authorized representative or license 'agent of the Insurance Carrier referenced above and at a named U has NYS Dlsability and/or Paid Family Leave Benefits Insurance coverage as described above. Date Signed 12/20/2023 By t (Signature of insurance Carrlar's puthortteai representative or NYS licensed Insurance Agent of that Insurance carrlerl Telephone Number 51 - 2 Name and Title Richard White Chief Exe ubve Officer IMPORTANT: If Boxes 4A and SA 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 Box48,4C or 5B Is checked,this certificate Is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Laid Family Leave Benefits Law,It must be emall'ed to PAV@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 49,4C or 5B have been checked) State of New York Workers' CIDfxlprensatiort Board According to Information maintained by the NYS 1 /orkerW Compensation Board,the above-named employer has compiled with the NYS Disability and Paid Family Leave Benefits Law(Articl'e 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (51ghsaturr+ar of Authorlied NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note.Only,insurance carriers licensed to write NYS"disability and paid farnily leave benefits Insurance pallvies and NYS licensed Insurance agents of those Insurance carriers are authorized to Issue Form DB-120.1.Insurance brokers are NOT authors zed to issue this form. DB-120.1 (12-21) �INII�DB-120.1 '(12-21) �II S.C.T.M. NO. DISTRICT. 1000 SECTION: 79 BLOCK: 4 LOT(S): IZ19 DRAINAGE CALCULATIONS: A) DWELLING W/COVERED PORCHES=3,362 SQ.FT. 3,362 x 0.166= 558cf REQUIRED (3) 8'DIA x 5' DEEP DRYWELL=663cf PROVIDED B) DRIVEWAY=2100 SQ.FT. 2100 x 0.166= 349cf (1) 8'DIA x 8' DEEP DRYWELL=354cf PROVIDED LOT 7 O OPEN SPACE V v MON. TYPICAL SILT SCREEN SECTION � � • GE07EXfILE FABRIC SUPPORT POSTS LOT 3 ,� ~ LOT 59 WOOD OR METAL. OF - O FLOW DIRECTION - - E,,. COWN&'REM d0MM EXCAVATED AND BACKFIUFD TRENCH I LOT 2 O EXISTING GROUND 7-X: " , O LOT 60 OF MY WELL B'DL%NDEEP JAM&KATKTM NEM Dwaymm W WATER �` r 'U FOUNDATION LOCATION Z N FEB. 21, 2023 O J J DRY WELL A TE L.P. MON. '. I`VDIW'DEEP m U- eP O " •• 00 ¢ .I� cc t A UNE STUB ,i,, t y=' �'N , ` LOT61 LAND N I i DRY f - "mw "e`&s°"R W OF a'DlAxi'DEEP Wmz ° Z 00EM ¢ , UNDERGROUND MDN. TEST HOLE #1 UTILITIES (LOT 1) 4Q / LOT 62 TOP SOIL VACANTK4119 OF M X FIVAM FINCH ND Qy LOT 7 ,11, 6.0' N PIPE COARSE Z / t?i RED 00 A 6� Tar tint SAND AS SHOWN ON FILED µYp TYPICAL CLEAN OUT Qp 12.0' 11 ? SLATE OR STOPPER END SUITABLE CO1�ER OR PLUG LIGHT COARSE SAND NORTH BAYVIEW ROAD 30' ELBOW NO WATER 17' _ 60' WYE AS SHOWN ON FILED MAP FLOW-;-- OCT. 1, 2004 FOUNDATION LOCATED 02-21-23 LOT CLEARING IS LIMITED TO 1 ACRE. REVISED 03-25-22 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL UPDATED 10-17-14 LOCA71ONS SHOWN ARE FROM FIELD OBSERVATIONS REVISED 09-08-14 AND OR DATA OBTAINED FROM OTHERS AREA: 86,235 SQ.FT. or 1 .98 ACRES ELEVA77ON DATUM. NAVD8 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT 7HE PROPERTY LINES OR TO GUIDE 7HE EREC71ON OF FENCES, ADDIT70NAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 7HE PREMISES AT 7HE 77ME OF SURVEY SURVEY OF: LOT 2 � CERTIFIED TO: RACHAEL C. DAVEY; F MAP OF: ZOUMAS CONTRACTING CORP. M. FILED: OCTOBER 1, 2004 No.11166 SITUATED AT. BAYVIEW r � � a TOWN OF-. SOUTHOLD KENNETH M WOYCHUK 1AND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK ._ OsOsS2 Professional Land Surveying and Design I< P.O. Bog 153 Aquebogue, New York 11931 FILE # 14-129 SCALE: 1 "=50' DATE: AUG. 26, 2014 PHONE (631)298-1588 PAX (631) 298-1588 N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk