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Home My WebLink About51567-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#: 51567 Date: 01/16/2025 Permission is hereby granted to: Elizabeth Swift 725 Park Ave Hoboken, NJ 07030 To: Construct additions and alterations to an accessory garage as applied for to include second story storage and an outdoor sauna. Premises Located at: 1690 N Bayview Rd, Southold, NY 11971 SCTM#70.-12-37 Pursuant to application dated 11/07/2024 and approved by the Building Inspector. To expire on 01/16/2027. Contractors: Required Inspections: Fees: Accessory-Addition/Alteration $375.00 CO Accessory $100.00 Total $475.00 21 Building Inspector� � tlbW"pC 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 littpsHwww.southoldtowiinv.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT N0. � Building Inspector., NOV 7 2024 � ,. 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: — L4 -a c a s OWNERS)OF PROPERTY: Name: T>,Ay�� SW 1000- ProjectAddress: ` GC\0 R. Phone#: —1 l � —_�� S—aLIa3 Emai1: X SWI1i;+T K\K\ Mailing Address: CONTACT:PERSON: Name: A<og Mailing Address; Phone#: —�(.!�s—�as`1 Email: DESIGN'PROFESSIONAL INFORMATION: Name: Mailing Address„ Phone#: Email:. CONTRACTOR INFORMATION:' Name: , Mailing Address: Phone#: G3 !— 14 Email: K,C N�lam. P� DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition VAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ " Will the lot be re-graded? ❑Yes 190 Will excess fill be removed from premises? ❑Yes k,0 1 PROPERTY INFORMATION Existing use of property: 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 END IF YES, PROVIDE A COPY. ❑ i 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 building; addRions,alteratbro or for removal or demolition as herein described The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations aid to admit authorized Inspectors on premises and In building(s)for necessary inspections.False statements made herein are punishable as a Cass A misdemeanor pursuant to Section 210AS of the Now York State Penal Law. ,t Application Submitted By(print name • v Authorized Agent Signature of Applicant: Date: CONNIE D.BUNCH STATE OF NEW YORK) Notary Public,State of New York No.01BU6185050 SS: Qualified In Suffolk County COUNTY OF! CV) 04 ) Commission ExplreSApr11 14,2 k It duly sworn,depos s' a tthat s)he is the app ica t (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 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 �— t` day of Nov OR 6ec- 20 4 Notary Public MARC S.WASSER Notary PUblic,State of New York Qualilicd in Nassau County I No.01 WA6340938 ` .:_ a My Commission Expires April 25,20 (Where the applicant is not the owner) I, Ryl� 1 residing at bQ� !"° • LAO1EIP1 (ZD . Ny do hereby authorize I Q a P41116� to apply on my alf to the Tow Southold Building Department for approval as described her Owner's Sig Date 1Zf Print Owner's Name 2 TITAN-2 ID:El �,. . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)11107'12024 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 endorsements. PRODUCER 631-669-3434 Brennan P.Regan R6e an A envy nc. 1.669»3434 631-669.3035 4Deerr ark A ,1E1 El :63 faw Babylon,NY 11702 Regan Agency,Inc. INSURERS AFFORDING COYEWE. C INSURERA:Hudson Excess Insurance Co 14484 U INSU B:State Insurance Fund 36102 nToction Management Services Inc. URE CMerchants Mutual Insurance Co. 23329 14 Mill Street Hartford Underwriters Ins.Co. 10466 Port Jefferson Station,NY 11776-3210 INSURER D: INSURER E: INSURER F COVERAGES C BER; 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. INSR LTRTYPE OF INSURANCE OL Brd POLICY NUMBER POLICY EFF O' LIMITS A X COMMERCIAL GENERAL LIABILITY EACH gC_CWMNGE 1,000,000_ CLAIMS-MADE OCCUR X HXMP105130 10/26/2024 10/26/2025 GE TO REfaTED 100,000� 001 MED EXP ift pry person) 5,000 PERSQN&&ADVINJURY S 1,000,000 GEN"L,RAGGRE LIMIT APPLIES PER: GENERAL AGG TE 2,000,000 POLICY jECT LOC PRODUCT - MP/OPAGG 2'000,000 r+ AUTOMOBILE LIABILITY OOM'BIMD SINGLE:LIMIT 1,000,000 X ANY AUTO X CAP1057897 03/3012024 03/30/2025 80DILYINJURY Per ptrson OWNED SCHEDULED AUTOS ONLY AUTOS yy p DI Y INJURI� Per accident S AUT0.S ONLY AUTOS ONY E�MAGE A X UMBRELLA LIAR X OCCUR EAO C U NCE 2,000,000 EXCESS LIAB CLAIMS-MADE X HXMX203642 10/26/2024 10/26/2025 AGGREGATE 2,000,000 DED X RETENTIONS 10,0010 B WORKERS COMPENSATION X 'PER OTH- ANY OR/PARAND EMPLOYERS' BT ERIF_XECUTNE ❑ EA L YILITY ►N 199 290-4 03/27/2024 03/27/2025 T 100,000 rFFI n BER EXCLUDED? N/A 9(rl NH) Ej. OY $ 100,000 If yes,describe under 500,000 DESCRIPTION OFO_PERATIONS belaur rz.L DISEASE-PO CY D Property Section 12SBAAMON9J 06/0712024 06107/2025 BP P 6,300 it DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Town of Southold New York-is Additional Insured. CER11FICATE PER CANCELLATION E SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold New York ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 54375 Route 25 AUTHORIZED REPRESENTATIVE Southold,NY 11971 ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MYSIF New York State Insurance Fug PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE �I �, 11 A A A A A 261530470 REGAN AGENCY INC 'w . 463 DEER PARK AVENUE ' BABYLON NY 11702 ' SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TITAN CONSTRUCTION MANAGEMENT TOWN OF SOUTHOLD NEW YORK SERVICES INC PO BOX 11791 14 MILL STREET 54375 ROUTE 25 PORT JEFFERSON STATION NY 11776 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12199 290-4 355087 03/27/2024 TO 03/27/2025 11/7/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2199 290-4, 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:NWWW.NYSIF.COM/CERTICERTVAL.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 RONALD PONELLA VICE PRESIDENT KELLY SMITH TITAN BUILDING CO INC TWO PERSONS 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 AT i SU NOE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:753644943 Suffolk County Dept of Labor,Licensing&Consumer.Affairs' -I HOME IMPROVEMENT LICENSE Name � RONALD PONELLA Business Name � TITAN CONSTRUCTION MANAGEMENT { This cart11es'thatttra SERVICES INC bearer Is dryly licensed by the County of Suffolk License Number HI-63813 Wagftz,T. "w' Issued: 06/19/2020 Commissioner Expires: 06/01/2026 i Suffolk County Dept.of Labor,Lieeneirig&Consumer Affairs HOME IMPROVEMENT LICENSE Name RONALD PONELLA Business Name TITAN CONSTRUCTION MANAGEMENT This certifies that the SERVICES INC bearer is duly licensed a by the County of suffolk License Number HI-63613 Issued: 06/19/2020 W "�T Expires: 06/01/2026 Commissioner NYS F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE :A 11^^^^^ 261530470 REGAN AGENCY INC "^ 463 DEER PARK AVENUE BABYLON NY 11702 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TITAN CONSTRUCTION MANAGEMENT TOWN OF SOUTHOLD NEW YORK SERVICES INC PO BOX 11791 14 MILL STREET 54375 ROUTE 25 PORT JEFFERSON STATION NY 11776 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12199 290-4 355087 03/27/2024 TO 03/27/2025 11/7/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2199 290-4, 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:/IWWW.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 RONALD PONELLA VICE PRESIDENT KELLY SMITH TITAN BUILDING CO INC TWO PERSONS 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 STILT SUR N+ E FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 753644943 TITAN-2 O ACORU" DX (MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 1TE 1107/2024 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 631-669.3434 NC2AJACT Brennan P.Megan Regan Agency',Inc. P►los 631-669-3434 FAX 63"I-66t1-301s 463 Deer, ark Ave lA/C,No,Ext: 'AC,No): Babylon,NY 11702 Regan Agency,Inc. INSURERS AF'FOR'DING COVERAGE NAIL INSURERA„Hudson Excess Insurance Co 14484 Psu D INSURERB:State Insurance Fund 36102 itanonstruction Management Services Inc. INSURERC:Merchants Mutual Insurance Co. 123329 14 Mill Street Hartford Underwriters Ins. Co. 10456 Port Jefferson Station,NY 11776-3210 INSURER0. INSURER E: INSURERF: CQV_EP,AGE$ ggaTIFICA E NUMBER: REVISION NU 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. iINSR TYPE OF INSURANCE DDL USR POLICY NUMBER POLICY EFF POLICY EXP LIMITS 11& WWIA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 19000,000 CLAIMS-MADE l - V OCCUR X DA Go.T REIITI 100,000 HXMP105130 10/26/2024 10/26/2025 $ MED EXP(Any one person $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[X]JEC LOC PRODUCTS-COMPIOPAGO $ 2,000,000 OTHER C AUTOMOBILE LIABILITY COIuIBI/+6k=D SINGLE LIMIT 1,000,000 i X ANY AUTO X CAP1057897 03/30/2024 03/30/2025 BODILY INJURY(Per pprson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY AUUTOQ ONLY PROPERTY DAMAGE Per acc dent $ A X UMBRELLA LIAB X OCCUR 2,000,000 EACH OCCURRENCE $ ., EXCESS LIAB CLAIMS-MADE X HXMX203642 10/26/2024 10/26/2025 AGGREGATE S 2,000,000''' DED X RETENTION$ 10,000 B WORKERS COMPENSATION X PTR T OTH- AND EMPLOYERS'LIABILITY 2199 290-4 03/27/2024 03/27/2025 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? '.N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DE§CRIPTION OE OPERATIONS below E.L.DISEASE-POLICY LIMIT D Property Section 12SBAAMON9J 06/0712024'06/07/2025 BPP 6,300 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101 Additional Remarks Schedule,may be attached if more space is required) Town of Southold New York is Additional Insured. CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold New York ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 54375 Route 25 AUTHORIZED REPRESENTATIVE Southold,NY 11971 ACORD 25(2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD