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HomeMy WebLinkAbout51448-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#: 51448 Date: 12/06/2024 Permission is hereby granted to: Brendan J Mckeon 985 Track Ave Cutchogue, NY 11935 To: Construct an unconditioned detached garage accessoryto an existing single-family dwelling as applied for. Must maintain minimum rear and side yard setback of 5 feet. Premises Located at: 985 Track Ave, Cutchogue, NY 11935 SCTM# 137.4-25 Pursuant to application dated 10/01/2024 and approved by the Building Inspector. To expire on 12/06/2026. Contractors: Required Inspections: Fees: Accessory-New Structure $287.50 CO Accessory Structure $100.00 Total $387.50 Building Inspector TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 1 1971-0959 ,. Telephone (63 t) 765-1 g02 Fax (631) 765-9502 flit I�) r/W%VW. aiB1 ash V! tr ca,+ w Date Received APPLICATION FOR. BUILDING PERMIT k For Office Use Onlyfiw4 � PERMIT NO._ Building Inspector;_, ... !-J pp Y p Applications and forms must be filled out in their entirety. Incomplete lxa applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form (Page 2)shall be completed. Date: VA41PLI OWNER(S) OF PROPERTY: Name: �OSE P,21Q sCTM#10 10 134 - 1 -25 Project Address: 393 RACIC AVIE CuTcNpbuf • tN •11g S5 Phone#: ... C31 - 300 - 5 50 Email: y 36sE . P14112 a Noo.cam Mailing Address: 9213 M ID DLE Coum iq RD * CAtvE2Iam •NY •1)433 CONTACT PERSON: Name: :S� P1Ral2 Mailing Address: 9213 ID COU10 1Ry RD • CAcuE2J10,M OtQ •J)g33 Phone#: IQ 31 — 30G - 5y50 Email: 34% , P12i(2 o@ YANoo.COM DESIGN PROFESSIONAL INFORMATION: Name: AV1p 2-rAAnnls AaCA1)*C___. ..-. �..._� 1S rnAp Mailing Address: Ca +NX • 115) ...� Phone#: g31 - 33? - 3p2/ Email: d M @. A2GN iTEGTS MAO.Cooli CONTRACTOR INFORMATION: Name: ir�r Cyr. �aJC.�,0.+, C� Mailing Address: 1 Phone#: ) 0C.) Email: \� DESCRIPTION OF PROPOSED CONSTRUCTION ®New Structure ❑Addition ®Alteration ❑Re emolitioq Estimated Cost of Project: XOther �+ 6 $ 15 10 .Old Will the lot be re-graded�OYes�MNo excess �b, moved from premises? ❑Yes MNo 1 rPROPERTY INFORMATION x operty: -51" E_ FlAMtLy OteaiN6 Intended use of property: sir&ce- Fgrn��y (),,,kcz�,V6 ct in which premises is situated. Are there any covenants and restrictions with respect to this property? ❑Yes) No IF YES, PROVIDE A COPY. er Re���,hlg; The owner/contractor/design profession al'is responsible for all drainage and storm water issues as provided by apter6 o te 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 ofthe New York State Penal Law. Application Submitted By(print name): _3�f_ P ❑Authorized Agent DOWner Signature of Applicant: Zos-g ?(;,y Date: 09 . 3 0 —_ZL4 STATE OF NEW YORK) SS: COUNTY OF .._.. _ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the tL (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 20 Notary Public ENotary E A ANSMAN State of New YorkPROPERTY I E IION AN6392329 �1/Ilere thew Ilcant IS not the OWrle SuffolkCounry( pp r xpires May 22, 2027 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 Town Hall Annex Telephone 631 765-1802 54375 Main Road Fax(631)765-9502 P. O. Box 1179 "Southold, NY 11971-0959 "y j� f`u ' BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPECONSTRU9TIONPRE-90GINEiREQ WOOD CONSTRUCTION ANVOR TIMBER CONSTRUCTION Date, . Location of Property: _q85 -rgACK __AUK_ _ -Cu TC.No6uE A,, " Please take notice that the (check applicable line): New commercial or residential structure Addition to existing commercial or residential structure X Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) Pre-engineered wood construction (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 framing (FR) Signature: Name (person submitting this form): DAvi_D. IAQTlNs.___-- Capacity (check applicable line): Owner . _ Owneir representatt:ive TrussReg15.docx Effective 1/1/2015 A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/°°/YYYY) 09130/2024 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 endorsement(s). PRODUCER CONTACT NAME Lisa Marie _. mm ON Aspen Agency Inc (Adler Jt . ..631, 71-7575 191 Ronkonkoma Avenue EMAIL lira as en n com A0D9 .. ..._ .. -- ._. M .__...r....__ Ronkonkoma, NY 11779 I ., , NSURERS) FF AORDING yCOVERAGE NAIC# INSURERA Utica First Insurance Co 15326 INSURED INSURER B. CorpINSUR...e... .......,._. w.._.,m .., .......,._n. ,..m„ .,...__.. ................ _....... ,,,,,,, �,_ ,n........._... Pirir Construction ER c: INSURE... . em. _ ... .....__., _.__ 4213 Middle CountryRd RD: Calverton, NY 11933 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 00020547-610877 REVISION NUMBER: 30 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. ILTR TYPE INSURANCE .... AODd.Stl7lt .POLICY POLICY EFF d POLICY EXP [ .._.... , NUMBER w(MM/DD/YYYY],P MMIDD/1'riY LIMITS COMMERCIAL GENERAL LIABILITY H OCCURRENCE $ 1,000,000 A X _ Y ART3001273960 07/11/2oz4 07/11/2025 EACH -- ._ .�CLAIMS-MADE �I OCCUR PREW5g' (Earyrrurreup�) ,�. .. 100 000 _, MED EXP(Any one person) $ 5,000 m .... .... ,000 ,PERSONAL&ADV INJURY $ 1 00, OO_ PRODUCTAGGREGATE ( 2,000,000 POLICY LOC S COMP/OPAGG �)I Z�OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: —GENERAL F ry OTHER:rul 1 $ _.. AUTOMOBILE LIABILITY 4,OMBCNr(.]'S1h�IC.I.I-.LIM07 $ ANY AUTO BODILY INJURY(Per person) $ - OWNED SCHEDULED BODILY IN . ..---- ----- - ,..__.. ..... ....., ._..... AUTOS ONLY AUTOS JURY(Per accident) $ HIRED AUTOS ONLY AUTOS ONLY 1$IG M DAIAI�CaL ..- _ _.. ' Mpg) .........,,, ,.....$....., �.­.. UMBRELLA LIAB CLAIMS MADE $ OCCUR EACH OCC URRENCE EXCESS LIAR — TE $ DED RETENTION-$ $ WORKERS COMPENSATION _ PER IITF ER. AND EMPLOYERS'LIABILITY YIN �,SAT .....,.-, FCERIMEn E EXCLUDED? E N/A _E.L.EACH ACCIDENT $ ANY PROPRIET PARTNE EXE (Mandatory' ) E.L.DISEASE EA-EMPLOYEE $ If yes,describe under .. , .. .,._, _. DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT $ _._._ ._. ........ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT FOR GENERAL LIABILITY UNDER BLANKET ADDITIONAL INSURED ENDORSEMENT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Southampton ACCORDANCE WITH THE POLICY PROVISIONS. 116 Hampton Road Southampton, NY 11968 AUTHORIZ- FPRESENTATIVE LIS ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by LIS on 09/30/2024 at 10:42AM NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Cl: IV A A A A A A 473963558 ASPEN AGENCY INC 191 RONKONKOMA AVE RONKONKOMA NY 11779 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PIRIR CONSTRUCTION CORP TOWN OF SOUTHAMPTON 4213 MIDDLE COUNTRY RD 116 HAMPTON RD CALVERTON NY 119333905 SOUTHAMPTON NY 11968 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 124053 801849 12/13/2023 TO 12/13/2024 5/20/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2405 340-7, 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.COM/CERT/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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JOSE P PIRIR COTZOJAY PIRIR CONSTRUCTION CORP (ONE PERSON CORP) 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 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 414309069 U-26.3 l' sir. Workers' CERTIFICATE OF INSURANCE COVERAGE �°r�e-r°� 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 carrier _. _ ..... ....._...... 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured PIRIR CONSTRUCTION CORP 631-300-5450 4213 MIDDLE COUNTRYROAD CALVERTON, NY 11933 1c. Federal Employer Identification Number of Insured Work Location of Insured (Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e., Wrap-Up Policy) 473963558 . ...._. __..... _......_..-.. .... �..... 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 SOUTHAMPTON 1 1 16 HAMPTON RD 3b. Policy Number of Entity Listed in Box"Ila" SOUTHAMPTON, NY 11968 DBL666790 3c. Policy effective period 05/26/2024 to 05/25/2025 4. Policy provides the following benefits: ❑X A.Both disability and paid family leave benefits. B.Disability benefit's only. C.Paid family leave benefits only. 5. Policy covers: 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 penally of perjury,P certify that t am an aulhorized representative or Ifcensed agent of the insurance carrier referenced above and'that:the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 9/30/2024 By /1;t� (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number ,516-829-8100 Name and Title Leston Welsh,Chlet Executive Officer 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 b the NYS ... _.._..........__�... ....... ......... ........ _. .......................... p y Workers' Compensation Board (only if Box 413,4C or 56 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 writ y benefits � ._...... ....olio .....__-mmmmm .......e ..... y write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Fonn DB-120.1. Insurance brokers are NOT authorized to issue this form. D113-120.1 (12-21) II Jill P111°°1°1°°°1°°1°11°11°°°11°�IIIIIII THE EXISTENCE OF RIGHTS OF WAY UNAUTHORIZED ALTERATION OR ADDITION DRAWN MM I CHECKED W DATE AUGUST 2024 DRAWING k JOB NO. 24-768 AND/OR EASEMENTS OF RECORD IF TO THIS SURVEY IS A VIOLATION OF ANY, NOT SHOWN ARE NOT GUARANTEED. SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. ELEVATIONS REFER TO NAVD 1988. COPIES OF THIS SURVEY MAP NOT BEARING Area- 17,900.5 s.f. Premises known as: THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED # 985 Track Avenue, Cutchogue 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 10.1 TO THE ASSIGNEES OF THE LENDING INSTI- /0 lr� TUTION. GUARANTEES ARE NOT TRANSFERABLE. ! \ q, Sp !p 00 / o E %4 6 Ile sp /r. 4 °o T !p l '. 1119 p 40�f1b* Aqe '�, ,�; `,�` � �� sue• ° _ S3r, { _ `=6 g 1z3 Ale ON Survey of Lots 50% and 60 MAP OF SECTION 2, PROPERTY OF M.S. HAND ir FILED MAY 12, 1939 AS FILE NO. 1280 situate at Cutchoue Town of Southold Suffolk County, New York Michael W. Min t o,_ L.S.P. C. District 1000 Section 137 Block 1 Lot 25 LICENSED PROFESSIONAL LAND SURVEYOR NEW YORK STATE LICENSE NUMBER 050871 Scale 1 "= 30' Surveyed August 15, 2024 87 Woodview Lane GRAPHIC SCALE Centereach, N.Y. 117,?o 30 a is 30 60 rep PHONE/FAX: (631) 580-1202 CELLULAR: (631) 766-9714 -IN FEET EMAIL: mikemintolspc®gmail.com ( ) 1 inch = 30 ft.