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HomeMy WebLinkAbout51498-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#: 51498 Date: 12/19/2024 Permission is hereby granted to: Bozena Skuriat-Krolik PO BOX 455 Cutchogue, NY 11935 To: install roof-mounted solar panels on existing single-family dwelling as applied for. Premises Located at: 310 Duck Pond Rd, Cutchogue, NY 11935 SCTM#83.-2-19.11 Pursuant to application dated 10/29/2024 and approved by the Building Inspector. To expire on 12/19/2026. Contractors: Required Inspections: Fees: SOLAR PANELS $100.00 ELECTRIC -Residential $125.00 C:q-RESIDENTIAL $100.00 Total S325.00 Building Inspector F'f 4 e r a TOWN OF SOUTHOLD—BUILDING DEPARTMENT 3 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax (631) 765-9502 htt-) :/mow% tMwt�j7loldto vi�n .'o:y Date Received APPLICA rII Ip' I DIII NG PERMI . v° rt .. E C E 0 W L For Office Use Only MY PERMIT NO. S 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 't•r vJi" m' ' " ' "'r' irk Owner's Authorization form(Page 2)shall be completed. Date:10/23/2024 OWNER(S)OF PROPERTY: Name:Bozena Skuriat-Krolik ]±ML# 000-083.00-0200-019.110 Project Address:310 Duck Pond Road, Cutchogue NY 11935 Phone#:646-752-9455 Email:bosku@aol.com Mailing Address:310 Duck Pond Road, Cutchogue NY 11935 CONTACT PERSON: Name:Krzysztof Kaminski /Amanda Pabon Mailing Address:117 Bay 8th Street, Brooklyn NY 11228 Phone#:(718)490-0208 Email:apabon@kamtechsolar.com DESIGN PROFESSIONAL INFORMATION: Name:Chun Feng, RA Mailing Address:409 Jackson Avenue, Township of Washington NJ 07676 Phone#:(201)638-5851 Email:cfeng3000@gmaii.com CONTRACTOR INFORMATION: Name:Krzysztof Kaminski (Kamtech Restoration Corp.) Mailing Address:117 Bay 8th Street, Brooklyn NY 11228 Phone#:(718)490-0208 Email:apabon@kamtechsolar.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: E Other Installation of solar PV panels flush mount to roof $8,300 Will the lot be re-graded? ❑Yes DNo Will excess fill be removed from premises? ❑Yes li]No 1 PROPERTY INFORMATION Existing use of propertv:Residential (1 Family) Intended use of property:Residential (1 Family)- No cha Zone or use district in which premises is situated; Are there any covenants and restrictions with respect to AC this property? ❑Yes 0 No IF YES, PROVIDE A COPY. Q Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by Chapter296 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(prin ame):K sztof Kami y pAuthorized Agent El Owner Signature of Applicant: Date: 10/23/2024 STATE OF NEW YOR SS: COUNTY OF Kings ) Krzysztof Kaminski being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, Contractor (S)he is the (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 23 day of October 20 24 N Y k�ACOLON YTATF AL IKG 86763 S COUNTY L I SI N EXPIRES 01-28-2027 PROPERTY OWNER AUTHORIZATION �....._h'Vhere the applicant is n�_�..._�.�..�.�. ( pp of the owner) Bozena Skuriat-Krolik 310 Duck Pond Road utcho ue NY 1 C 1935 I, residing at 9 Krzysztof Kaminski / Kamtech Restoration Corl o hereby authorize, to apply on my behalf to the Town of Southold Building Department for approval as described herein. Lx� r° 10/23/2024 Owner's Signature Date Bozena Skuriat-Krolik Print Owner's Name 2 ,♦ AUG 16 198A S C DWT.OF �A KCH OWES 00 40 . w 60 i y^ 4i % 04 " of SUFFOLKCOUNTY AILTIbIEF,A MENT SINGLE FAMILY Jft ON 00 H.D.REF.NO.. 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YOUNG & YOUNG o"�YE�HEAE>,LI VORK AM, a* Atw4w#r a-STAA%r ALM W.YCOJNO PNOFESSAONAL ENGINEER AND LAND SURVEYOR M V-t LICENSE NO.NE6115 HOWARD W^YOUN61 LAND SURVEYOR 141 Axla�AwavAlAad+ThxlWTrcTwNAItiMiA 1MYITNNrIpAtpN N.Y.S.LICENSE N0.46995 IYXiA•lNcNN 1TNpuA IpMTL11!MAxMIpAA NIA CITI"IS,001AN D Few OT19 o A nlwxw I= Holm Suffolk County Dept. of � Labor,or, Licensing Consumer Affairs HOME IMPROVEMENT UCENSE Name, K ZYSZTOF KAMI SKI- Bu,siness,-Name, , d Karntech Restora'ion Corp License Nufootv HL-6618 . e issue 3 2C?22 � Expires: Q3Q�l2Q w 9 DATE(MM/DDIYYYY) AC<__>R" CERTIFICATE OF LIABILITY INSURANCE � 10/23/2024 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(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 endorsoment(sl. PRODUCER CON' RlChie$zarkowicz SZARKOWICZ BROKERAGE LLC 1 718)389.0646 7 NAM: PHONE ( ) C N ( 18)389-0670 PO BOX 140736 E-MAIL . richie@szarkowiczgroup.com /+l�.G.. s ..-----....-_ _ _.- ......... ,_. — ...._ _. INSURER§)AFFORDING COVERAGE,. STATEN ISLAND NY 10314 INSURER A; Mesa Underwriters Specialty Ins Co 36838 ............................ .......... _ _ _ -_.,,,.. .......... m ...........- _ INSURED INSURER B; Palomar Excess and Surplus Ins Co 16754 KAMTECH RESTORATION CORP INSur;Ert c.. 203 SHERIDAN BLVD INSURER D _...-...... _. . INSURER E. INWOOD NY 11096 INSURERF COVERAGES CERTIFICATE NUMBER:: REVISION NUMBER: 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. . TYPE OF INSURANCE III POLICYNUMBER MMIDDOL1IIY YY MMIDO/EXP LIMITS mmmITmmmmmIT X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �. .0 RSHb......... _mmmm CLAIMS-MADE X1 OCCUR PR ISE EM , 6u EaoncrrenrreJ) ,$ 100,000, MED EXP(Any one person,) S 5,000 A X X MP0082001008805 10/21/2024 10/21/2025 __............. _ ... � PERSONAL&ADV INJURY $ 1,000,000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE m.. S 2,000,000 _ PRODUCTS-COMP/OP AGG $ 000,000 POLICY JET LOC 2',-._�.�.�........ OTHER: $ AUTOMOBILE LIABILITY COMBINED SIN V.I EMITAN $ ANY AUTO BODILY INJURY(Per person) $ _. OWNED SCHEDULED BOD _.. AUTOS ONLY AUTOS ILY INJURY(Per accident) .. HIRED NON-OWNED PROPERTYOAMAGE AUTOS ONLY AUTOS ONLY IderaY)--•- $,. -• _..W.__..... 2,000,000 UXCESS LIAR X OCCUR EACH OCCURRENCE $.... ... --- B X EXCESS LIAB CLAIMS MADE PES-XS-01-3097 10/21/2024 10/21/2025 AGGREGATE $ 2,000,000 DIED RETENTIONm$ $ WORKERS COMPENSATION STARTU7E ORH AND EMPLOYERS'LIABILITY YIN mm ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? NIA """"""""""""'""" (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S If yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AdditionalRemarks Schedule,may be attached If more space Is required) Certificate holder Is Included as additional insured with respect to CGL policy.Waiver of Subrogation included in the policy.Primary&Non-contributory wording included. CERTIFICATE HOLDER CANCELLATION Town of Southold Town Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold NY 11971 �IED RR ESE TATIh�'E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) A A A A A A 465203149 SZARKOWICZ BROKERAGE LLC PO BOX 140736 mov,* STATEN ISLAND NY 10314 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KAMTECH RESTORATION CORP. D/B/A TOWN.'OF SOUTHOLD TOWN HALL KAMTECH SOLAR SOLUTIONS 53095 ROUTE 25 203 SHERIDAN BLVD SOUTHOLD NY 11971 INWOOD NY 11096 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE K2348 857-0 321533 11/22/2024 TO 11/22/2025 10/24/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NE W YORK STATE INSURANCE FUND UNDER POLICY NO. 2348 857-0, 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 WESSITE AT HTTPS./ .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(1 OF 1 ) KRZYSZTOF KAMINSKI OF KAMTECH RESTORATION 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 STAT SU NCE FUND DI RECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 396211666 U-26.3 1-11 RH Workers'sTAT Compensation CERTIFICATE OF INSURANCE COVERAGE A... 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 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured KAMTECH RESTORATION CORP. 203 SHERIDAN BLVD 7189158360 INWOOD, NY 11096 Work Location of Insured(only required if coverage isspecifcallylimited to 1c. Federal Employer Identification Number of Insured certain locations in New York state,i.e.,Wrap-Up Policy) or Social Security Number 46-5203149 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Town Hall Standard Security Life Insurance Company of New York 53095 Route 25 3b. Policy Number of Entity Listed in Box 1 a Southold, NY 11971 1 L78513-000 3c. Policy Effective Period 12/1/2014 to 10/23/2025 4. Policy provides the following benefits: Q A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. ❑ C.Paid Family Leave benefits only. 5. Policy covers: ❑K 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 de scr d above. Date Signed 10/24/2024 By of Insurance carrier's puthori d ire resentative'or NYS licensed insurance (Signature p rance agent of that Insurance carrier) Telephone Number 212 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT:lf 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 5B of Part 1 has 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) 111111111°°1°�! !°1°111°!�p� 1 �111111