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HomeMy WebLinkAbout51442-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#: 51442 Date: 12/05/2024 Permission is hereby granted to: SogolofF HK Revoc Trt 1 Gracie Square Apt 4 New York, NY 10028 To: install generator as applied for. Generator shall be located more than 100'from edge of wetland boundary. Premises Located at: 1305 Soundview Ave Ext, Southold, NY 11971 SCTM# 50.-2-18.1 Pursuant to application dated 10/11/2024 and approved by the Building Inspector, To expire on 12/05/2026. Contractors: Required Inspections: Fees: GENERATOR $125.00 ELECTRIC -Residential $100.00 CO-RESIDENTIAL $100.00 y Total $325.00 Uilding Inspector µsag 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 lift c axil .ejl n o Date Received APPLICATION FOR BUILDING PERMIT g For Office Use Only PERMIT NO..5t_�� Building inspection.,.....— Applications and forms must be filled out in their entirety.Incomplete _w - applications will not be accepted. where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: q OWNER(S)OF PROPERTY: SCTM# 1000- Name: Project Address: �'� O SO tt A�v l .._ e* , m Phone#: Lt Z — ( Email: t(,.( -A �� t r'4 . Mailing Address: t L>✓ r�- � (QG 1 CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: -, Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: p�C � ,�„ ,d� �� Phone#: � — Email. . t e- , ,-,4 � DESCRIPTION OF PROPOSED CONSTRUCTION ❑New 5'tructure OAddition L7Alteration ❑Repair ❑Demolition Estimated Cost of Project: '0- Cither �� '"a '"44 —,0 � �a� Will the lot be re-graded? ❑Yes 0No Will excess fill be removed from premises? ❑Yes ONO PROPERTY INFORMATION Existing use of property: .- I A_L,_ Intended use of property: Zone or use district in which premises is situated. Are there any covenants and restrictions with respect to this property ❑Yes No IF YES,PROVIDE A COPY. d]Check Box After Reading: The owner/contractor/design professional is responsiblefor 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 oonstrur3ion of buildings, additions,alterations or for removal or demolition as herein desvibed.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 buildings)for necessary Inspections.False statements made herein are punishable as a Gass A misdemeanor pursuant to Section 21CAS of the New York State Penal Law. Application Submitted By(print name): ZMuthorized Agent ❑Owner Signature of Applicant: Date: 1610 Lt STATE OF NEW YORK) SS: COUNTY OF/eb,/ ) � J-Z �.nc, �-•� ling duty 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 perf rmed.the said work and to make and file this application;that all statements contained in this application are true to he 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 I L4P/ 20 Nola. Public LO ETTA LAMB York PROPERTY OWNER AUT O 1 ATInpi Pubfic,State Of RM (Where the applicant is not the owner) 01 LA ti7 8 ' ()uatifled in SfiO(NCO%-lam "� a"rn ireS E)epeltlber 10 2I " I, residing at o ( � A-i t '�- t,� f- , ( o hereby authorize �` � •�- t tag apply on � my behalf to the Town of Southold Building Department for approval as described herein. , 't-eA Ci (q I vi wner*s Signa ure Date g — 0 ! -- Print Owners Name AT SOU HOLD t , To WN OF SOUTHOLD ` SUFFOLK COUNTY, NEVYOf 100 -- 02 .1 SCALE."err- w r ^ star wu. .,, .•� r rx sfAe-. d&sjs0IIAMARP ArtsA IA 'MEW a' t" by the 'C i s het 'fdrti *mar#9'tw and purrdt,to construct. Y. 4 t r ry: 4Ad4 w.*sopools, so*iift �lroer�. '<A 765wawr 7 oi- dd . a A C8 BOX 909 " 1230 TRAVELER STREET r navel„4�& ,: SBUTHE", N.Y.. ,1t97'3 astld. datum. Vtla� `re reF.e Fo s ^ l t 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 . amesh southoldtownn . ov seand@,soUthoIdtownnv,qov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 9/30/24 Company Name: Peconic Power Systems Electrician's Name: Robert Stanevich License No.: ME-45056 Elec. email:Peconlcpowersys@gmaii.com Elec. Phone No: 516-819-7191 ❑1 request an email copy of Certificate of Compliance Elec. Address.: PO Box 512 Cutchogue NY 11935 JOB SITE INFORMATION (All Information Required) Name: Helen Sogoloff Address: 1305 Soundview Ave Ext. Southold, NY 11971 Cross Street: Phone No.: 646-26§-4334 Bldg.Permit#: -c-�— email:Khilkin@gmail.com Tax MaE District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): New 26kw Generac generator with 200 amp service rated transfer switch Square Footage: Circle All That Apply: Is job ready for inspection?: �I YES NO Rough In Final Do you need a Temp Certificate?: ❑ YES❑ NO Issued On Temp Information: (All information required) Service Size❑1 Ph3 Ph Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead #Underground Laterals 1 2 M H Frame 0 Pole Work done on Service? Y N Additional Information: PAYMENT" DUE WITH APPLICATION' DATE(MMIDDIYYYY) .4CC►RV CERTIFICATE OF LIABILITY INSURANCE 0911120 4 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 endorsements. aRooucER Rik Freedom Coverage CorpPHONE CONTACT JOsh Mitchell g ) m_,� � 80 Orville Dr Suite 100 E-MAILp Ja r edomcovera eNY.com� 631 709 2777 _..S_m _�....� �.�..— . � �.. �...� Bohemia, NY 11716 1NSURER B AfE DING COVERAGE_—_ Narc�r� _..m_�.._....... IIiSURI RA; rival dim rnp y .__ 113�. INSURED !tiSURER B. to .._.,...�.... 517 Peconic Power Systems LLC IN U 1 C. BerlL hlr l� r v C9lre tla ut n AMv 315 Commerce Rd INSURER 0 "I II �rftr Nns irlpliv _. 424 Cutchogue, NY 11935 INSURREa .... . INSURER F: COVERAGES CERTIFICATE NUMBER. 00000166-206682 REVISION NUMBER: 55 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. 'fNA TYPE OF INSURANCE oL Buda GLP109248WVD POLICY NUMBER 05/28/2024 05/28/2025 . eR .... LIIMIITS COMMERCIAL GENERAL LIABILITY EACH UAWMOCCURRENCE $ 1,P00 0(10 __... CLAIMS MADE OCCUR .EBE,gISE_4 E&A ;u st $ 100(D 0 MED�,Any q ne p>TRM $ 5 OUO0 PERSONAL&ADV INJURY $ 1 1000,000 _WW............. GEWL AGGREGATE LIMIT APPLIES PER: _--_•_ATE-_ 2 000 0�N�1 GENERAL AGGREG $ POLICY�PRO—JECT LOC PRODUCTS-COMPIOP AGG $ 2 000 0100 $ 'OTHER: B AUTOMOBILE LIABILITY 32-2324-04 05128/2024 05/28/2025 cDM I INGt LI ' $ 0 t) L�4.. .�cCdonll �.�,�.._�. ANY AUTO ( BODILY INJURY Per person) $ AOWNED X SCHEDULED BODILY INJURY(Per accident) $ OS ONLY AUTOS PROP fM DKM_9dE HIRED � NON-OWNED $ AUTOS ONLY +�,_, AUTOS ONLY (firwnC) _._ _...... _..._ $ `` " UMBRELLA LIAR OCCUR N9CX577151 05/28/2024 05/28/2025 EACH OCCURRENCE $ 3 ggO,000 EXCESS LIAB CI AIM MADE AGGREGATE _ $ 3, �C10',0'00 NTION S 10000 OTW D WORD sCOMPENSATION 12 WEC AT7UBP 09/02/2024 09/02/2025 X sT ER A rAND EMPLOYS'LIABILITY YIN ANY PROPRIETORIPARFNEWEXECUTIVE Y NIA E.L.EACH ACCIDENT $ 1 000,00I)'..•. OFFI CE'RIMEMBER EXCLUDED? El (Mandatory in NMI EMPLOYE 1,00ti3O llM' E.L.(DISEASE EA if yyea,describe udder E.L.D9SEASE-POLICY LIMIT $ 1 00,000 OESORIPTION OF OPERATIONS be4ow9w DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks schedule,maybe attached if more space Is required) As pertains to insureds operations CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold Building Department THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall Annex 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. P.O. BOX 1179 AUTHORIZED REPRESENTATIVE Southold, NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by JCM on 09/11/2024 at 09:07AM