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HomeMy WebLinkAbout51480-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#: 51480 Date: 12/16/2024 Permission is hereby granted to: Elizabeth Davis Clark 180 Terry Ct Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. Premises Located at: 180 Terry Ct, Southold, NY 11971 SCTM#59.-11-10 Pursuant to application dated 10/11/2024 and approved by the Building Inspector. To expire on 12/16/2026. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building 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) 765-9502 lxtt ://www.sotith2ldtowiixiy._kov org ats APPLICATION FOR BUILDING PERMIT � For Office Use Only . o PERMIT NO, Building Inspector: -k-- T 'Eir' Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: 10 l/1 1 Z OWNER(S)OF PROPERTY: Nameff � : e z— SCTM#1000- � Project Address: 1 -rerrq O l-� Email:Phone#: �(- 52 - C,(A r K C±.,.'ho-Nd-d Mailing Address: I�-Df"'" CA—, t/9'2 / CONTACT PERSON: Name: Z Mailing Address: 7 r r 0-I 6460!m Phone#:I,31 _-523 _ 2-0 q w I Email: DESIGN',PROFESSIONAL INFORMATION: Name: A Mailing Address.04 Email: Lre 4 , CONTRACTOR INFORMATION: Name: �kr S , y Mailing Address. ,6 S— f/ t Phone#: Emai ` DESCRIPTION OF PROPOSED CONSTRUCTION t of Project: ther p DNewStructure ❑Addle ion ❑Alterat n ❑Re air ❑Demolltlon EstimatedCos Will the lot be re-graded? ❑Yes QKO Will excess fill be removed from premises? Ves ❑No 1 TM' PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated; Are there any covenantsnd restrictions with respect to A _�0 this property? ❑Yes IF YES, PROVIDE A COPY. Check Box A t rReading: 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): TDIe--�e r Speck uthor zed Agent ❑Owner Signature of Applicant: �" Date: o l STATE OF NEW YORK) SS: COUNTY OF -U-(-CQ1K ) "+ 0 4 being duly sworn, deposes and says that(s)he is the applicant (Name of ind 'idual signing contract)above named, (S)he is the Contractor,Agent 'orporate 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 L 4" g J�day of Ol +o i K ,20� - ck) Notary Public TRA EY L DWY R NOTARY PUBLIC„;STATE OF NE%i/V"YOw PROPERTY III;;, T1 10RIZATION NO.01DW63o6goo OILIALIFIED IN SUFFOLK COUNTY (Where the applicant is not the owner) CCIIVMiSSItON E PIRESjuNr-ti0, residing at to apply on do hereby authorize I � my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature D,I file �� Print Owner's Name JOHN A. MAKI Notary Public-State of New York 2 No.01 MA6164838 My COMMIN151on Gxp: 04/30/202-77 YSI New York State Insurance Fund PO BOX 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 5� A A A A A A 010648957 INNOVATIVE RISK CONCEPTS,INC. 179 SOUTH MAPLE AVENUE RIDGEWOOD NJ 07450 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SPECHT-TACULAR POOLS INC TOWN OF SOUTHOLD BUILDING 265 BROOKFIELD AVENUE DEPARTMENT MAIN ST CENTER MORI;CHES NY 11934 TOWN HALL, SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2557 589=5 157094 02/28/2024 TO 02/28/2025 7/29/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2557 589-5, 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 WE1331 "E AT HTTPS:/ .t4YSI .COINII/ICERTICE'RT'VAL.ASP.THE NEW YORK STATE INSURANCE FUND I'S NOT LL49LE IN TIME 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 DIETER SPECHT SPECHT-TACULAR POOLS INC 1 OF 1 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,INSL tCEU 4 ND UNDERWRITING VALIDATION NUMBER:764788639 U-26.3 -4CZ>RDr CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 011OL2024 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 pollcy((es)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 cesrtifivate does not Confer rights to the certificate holder in lieu of such endorsem! s). PRODUCER L I ebacca An elinas iberty-Risk Management, Inc. PH"11 (631)569.5633 F 831 569-tLfI38 2333 Route 112 L rebec Ibe sk.o Medford, NY 1 763 INSURERS AFFORDING COVERAGE NAIC A INSURERa: ce 'o INSURED MDanV INSURER B: MarShants Insurance QmpAn-y233 Specht-tacular Pools Inc MuRm c I HagMr Insurance- 265 Brookfield Avenue wsuiu R D Center Moriches, NY 11934-1001 INSURF.Re. DISU4R F: COVERAGE$ CERTIFICATE NUMBER, 00000072-I1 REVISION NUMBER: 100 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. I1@SII TYPE OF INSURANCE ADDL WOR POLICY Y 12 UUN OZ8606 9/18/2024 POLICY NUMBER ATCOMMERhAL GENERAL d;. eIILITY 9/18/2025 EACH OCCURRENCE $ 1,000,000 S-MADE IR OCCUR ;zafl1 $ ._. . ., MED EXP Aff ons elaon'9 S 5 000 PERSONAL&ADV INJURY $_ 1090 000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $� 2I')(IIb 000 L'.-+" Lj� :POLICY _.J JECT LOC PRODUCTS-COMPIOP AG4 $ IOI) �0() OTI IER $ g auTnMoen.e LIABILITY ANY AUTO CAPI068516 3/27/2024 3/27/2025 LNG $ 000+000' BODILY INJURY(Per parson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per aoddenll $ -� HIRED NON-OWNED AUTOS ONLY AUTOS ONLY NYO $ UMBRELLALUIB OCCUR EACH,OCCURRENCE $ EXCESS LUU3 CLAJ E AGGRI GATE DED I RETENTION$ S WOICNERS COMPENSATION AND EMPLOYERS"UASILITY ANY PR'OPRIEI ORIPARTNMEXECUTIVE .-N OFFICERIMFJMBER EXCLUDED? ED N I A E.L.EACH ACCIDENT $ (Indalcry in NH) Il under E.L.DISEASE-EA EMPLOYEE $ Di 1 MMON OF ERATIONS E.L.DISEASE-POLICY LIMrf $ C Inland Marine HIS J6223'i30 9/18l2024 9/18/2025 Any One Occur 507,436 C Inland Marine HIS J822380 9/18/2024 9/18/2025 Newly Acq Equip 100,000 DESCRIPTION OFO OP Town Of SOPgRATIONS I LOCATIONSI VEHICLES(ACORD 101,AddlHonal Remarks Schedule,maybe'arAChed lI more$Poe la raqula Southold Is included as additional insured,ATIMA,as required by written contract,subject to policy terms,conditions, and exclusions. CI RTbiFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Main Street,Town Hall Southold, NY 11971 O p REPRESENTATIVE RPA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by RPA on 09/18/2024 at 01 A0PM vORK Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensat ion 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 carrie 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured sPECHT-TAcuLAR POOLS INC. 631-696-3900 265 BROOKFIELD AVENUE CENTER MORICHES,NY 119M 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) 010648957 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 Southold Building Department 3b.Policy Number of Entity Listed in Box"1 a" Main Street Town Hall DBL152822 Southold, NY 11971 3c.Policy effective period 09/26/2023 to 09/25/2025 4. Policy provides the following benefits: of A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: m A.All of the employers employees eligible under the NYS Disability and paid Family Leave Benefits Law. B.Only the following class or classes of employers employees: Under penalty perjury,I certify that am an authorized representative or IF—ensed agent ofthe insurance carrier referenced above and Tat the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. w =4 Date Signed 9/25/2024 By /44-- (Signature of insurance carriers attdtoriza t representative or NYS UCensed 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 413,4C 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 4B,4C or sB 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 disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1,Insurance brokers are NOT authorized to Issue this form. DB-120.1 (12-21) DB-120.1. (12-21) 15's 00 E 7 02.0' 13.0' EX. SHED Au t J%0- O Nv TI 41 29,5' . ' STOOP 3. _ 40.E1 Q M n 2 STORY `„ o�>c FRAMED HOUSE J Q Z x n W o.0' STOOP t rn rn ,�- 0 N N v� C 1 STRUCT I N Ell l NCE U 64° 2 3 0 '! 1T D V D T 102.0