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HomeMy WebLinkAbout51449-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#: 51449 Date: 12/06/2024 Permission is hereby granted to: Brendan J Mckeon 985 Track Ave Cutchogue, NY 11935 To: Construct an inground swimming pool accessory to an existing single-family dwelling as applied for. Pool and pool equipment must maintain minimum side and rear yard setbacks of 5 feet. Premises Located at: 985 Track Ave, Cutchogue, NY 11935 SCTM# 137.4-25 Pursuant to application dated 09/30/2024 and approved by the Building Inspector, To expire on 12/06/2026. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector "Ol TOWN OF SOUTHOLD—BUILD[NG DEPARTMENT % Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 ,. . Teleplione (631) 765-1802 Fax (631) 765-9502 httd2 �� ^_ rgj!!L[l Ij W n 7 Y.. ( r Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only i 1 v .o 5 '� - 1 Building Ins ector. PERMIT N O.�_....._.�._ g p " "" .M Applications and forms must be filled out in their entirety.Incomplete .,, applications will not be accepted. Where the Applicant is not the owner,an IX Owner's Authorization form(Page 2)shall be completed. , ""� ��� Date: OWNER(S) OF PROPERTY: Name: 112 �� A SCTM# 1000 134 _ 1 -,2S Project Address: 9$5 RACK AVE - CUTCli0bof • N •llgg5 Phone #: C31 300 - 5g50 Email: 54� , P'442 yA1400.COM Mailing Address: 9213 rn ID DLE Cauou W-y RD " Vjwe2'1OP4 *MY •))q33 CONTACT PERSON: Name: 75� P,24Q Mailing Address: 9a13 F410" COUk)liy RD " CAa F-"O" 'ICY PD933 Phone#: Q31 - 300 - 5g5O Email: 56M . P►2iR °@ yAHoo.CoM DESIGN PROFESSIONAL INFORMATION: Name: DAvID fY1A2-nN-5 — AQCA4)*C.1S MAv Mailing Address: )b 11111D1DW,,+ . ° CAC-- .NY • 11 SH Phone#: 631 — 332 �21 Email: CIM@— AaN ITEV5l11AD.COM CONTRACTOR INFORMATION: Name: _ ��t�Y y^-• C Mailing Address: °Z C�+l � �� f �,,, ( ��--� N. y �c3 Phone#: �-l�� Email: a 1 ��Y li �� C4-1 DESCRIPTION OF PROPOSED CONSTRUCTION ®New Structure ❑Addition i ❑Repair ❑Demolition Estimated Cost of Project: ®Other Will the lot be re-graded? ❑Yes MNo Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property: siN6�_ �gmtey fl cuu6 Intended use of property: s1W.Ree- CAmity OWIEcci�u6 Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to p^ 40 this property? ❑Yes)ENO IF YES, PROVIDE A COPY. ChefkllCCBox 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): -3OSf— P ❑Authorized Agent ®Owner Signature of Applicant: ?i y Date: 09 --3 0 -ZL4 STATE OF NEW YORK) cc SS: COUNTYOF -?o ITmm P being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the / f f"D./'�Z— ........... (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 c7 20�day of �"� ....__......... ....._ Notary Public » LORRAINE A ANSMAN Notary Public-State of New York PROPERTY OWNER 11 R I NO.OIAN6392329 Qualified iffolk Co unty (Where the applicant is not the owner) My C¢ is w s May 28, 2027 I, ........_...... residing at Ao hereby authorize „_„w,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 DATE(MMMWIYYY) . `cR, CERTIFICATE OF LIABILITY INSURANCE �-� 09130/ 24 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 Lisa Marie NAME - As A Inc PHONE - Aspen Agency g y 631471.7575 TAX �� )aa 191 Ronkonkoma Avenue E MA°L � lies as en n com FtP-PRESS r ._ ...�.....P._ __ ................. _ ...,......._. _.._.... Ronkonkoma, NY 11779 NAIcn ._�....... .................. INSURERJSI AFFORDING COVERAGE. .... ...,.. _.... ...._,,..,,,®„,.. . .._ INSURERA. m.Utica First Insurance Co .,.,.,,. _.... 1632fi.. ..,.,_. INSURED INSURER B Pirir Construction CorpER C .... _ 4213 Middle Country Rd INSURERD: 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. �LTRTYPE OF INSURANCE .... POLICY NUMBER .., MMID--„ ..._ .. .............. .._ .w...,.,,, .. ...,..._.....�..,.. ...._ .m �....... L OLiDYAYYYY MM RD YYY NSR l x mX 4 mm mmwm-mm Y LIMITS �� PRFM SFS a occurrence)..,,,. ,.$,. CLAIMS-MADE OCCUR 100 A COMMERCIAL GENERAL LIABILITY Y ART3001273960 07/11/2024 07/11/2025 EACH OCCURRENCE $ __1r 000i000 ,.000 ny one person) $-.._ _ 5,000 u. PERSONALA&ADv INJURY $ 1,000,000 .. .0 A. POLICY �E�rc d Loc - G - 2,000,000 a� _2,000.000 L] I RO ES PER: pRODRAL AGGREGATE AGG GEN'L AGGREGATE LIMIT APPLI UCTS COM OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE I%Ml f $ 2rdpnt.) ..._,........... ,. ....,,.. ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS P HIRED NON-OWNED PRFyPEfxTY DAMAGE $ AUTOS ONLY AUTOS ONLY (r'�r�(c,,iet) _ ._....... UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS CLAIMS-MADE AGGREGATE $ ......EXCESS L. ........... ��.-_...... DED RETENTION PER WORKERS COMPENSATION ............. ............. � O'tH AND EMPLOYERS'LIABILITY .I N I STATUTE.] ,,,,,,,.ER,_,. _ ANY PROPRIETORIPARTNER/EXECUTIVE E L EACH ACCIDENT _ $ OFFICERIMEMBER EXCLUDED? NIA E L DISEASE-EA(Mandatory in NH) "" EMPLDTE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT .� �$ I DESCRIPTION OF OPERATIONS I LOCATIONS I 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 D EPRESENTATIVE X 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 RD .`A ` ^^""^^ 473963558 N ASPEN AGENCY INC I 191 RONKONKOMAAVE 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 12405 340-7 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:/M/WW.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 �/4 !/Ii DIRECTOR,,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:414309069 U-26.3 MPH( workers' CERTIFICATE OF INSURANCE COVERAGE NE x rn.fr Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability a d Paid Family n _ 'y Leave benefits carrier or licensed insurance agent of that Carrie 1 a. 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 1 c. 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 EntityProof _ ..i....M.......... _ _........ Requesting g_ of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHAMPTON 116 HAMPTON RD 3b. Policy Number of Entity Listed in Box"I a" SOUTHAMPTON, NY 11968 DBL666790 3c.Policy effective period 05/26/2024 to 05/25/2025 4. Policy provides the following benefits: WJ A. Both disability and paid family leave benefits. F] B. Disability benefits 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 penalty of perjury,I certify that I am an authorized representative or licensed 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 .... _ . . (Sign atureof insurance carriers authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title LeSton Welsh Chief 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 by the NYS Workers' Compensation Board (only if Box 413,4c or 513 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 disabilityand paid - ........._... ........_insu_...n _�....... p 'd 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) 11111111°1°°1°°°°°1°1°°°°1°°°°°�IIIIII THE EXISTENCE OF RIGHTS OF WAY UNAUTHORIZED ALTERATION OR ADDITION DRAWN MM CHECKED MM DATE AUGUST 2024 DRAWING do JOB N0. 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 ELEVATIONS REFER TO NAVD 1988. EDUCATION LAW. 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 !or TO THE ASSIGNEES OF THE LENDING INSTI— zo TUTION. GUARANTEES ARE NOT TRANSFERABLE. -.Nv"� 0' � v ;F2 0 !off r � 4el. o 61 !r 0 19 Nil M1 101,r } / 0 110 °l !oT 1+ to 24 o _ 4, _ .0 , = 151 a 1 _ A �� Survey of Lots e#w and 60 _ MAP OF SECTION 2, PROPERTY OF M.S. HAND FILED MAY 12, 1939 AS FILE NO. 1280 z situate at 081 Cutch ue 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 Y ry NEW Y RK STATE OOdPi LICENSE NUMBER 050871 87 Scale 1 "= 30' Surveyed August 15, 2024 ew Lane GRAPHIC SCALE Centereach, N.Y. 117ZO 30 0 1s 30 60 120 PHONE/FAX: (631) 580-1202 CELLULAR: (631) 766-9714 EMAIL: mikemintolspc®g mail.com ( IN FEET ) 1 inch = 30 ft.