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HomeMy WebLinkAbout51568-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#: 51568 Date: 01/17/2025 Permission is hereby granted to: Cassano R&L Irry Liv Trt 3225 Nassau Point Rd Cutchogue, NY 11935 To: construct accessory in-ground swimming pool as applied for. Premises Located at: 3225 Nassau Point Rd, Cutchogue, NY 11935 SCTM# 111.-9-1 Pursuant to application dated 11/06/2024 and approved by the Building Inspector.. To expire on 01/17/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 d ing Inspector �mxPs TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main.Road P. 0. Box 1 179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 litt s: /%N,,ww.sotitholcltoNkiiii ()v Date Received APPLICATION FOR BUILDING PERMIT y 4 � For Office Use Only ° d PERMIT NO.-5 nt Building Inspector: NOV _ '` 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 �4 �� ri° g. Owner's Authorization form(Page 2)shalbbe completed. "'i � ) Date:10/3124 OWNER(S)OF PROPERTY: Name:Lee Cassano scrM#1000-111-9-1 ProjectAddress:3225 Nassau Point Rd Cutchogue NY assano@gmail.com#:6312358202 @' gmail.com Mailing Address:3225 Nassau Point Rd Cutchogue NY CONTACT PERSON: Name:Andrew S Braum Mailing Address: 1924 Bellmore Ave Bellmore NY Phone#:5167854200 Email:office@asbengineering.com DESIGN PROFESSIONAL INFORMATION: Name:Andrew S Braum Mailing Address: 1924 Bellmore Ave Bellmore NY Phone#:5167854200 Email:office@asbengineering.com CONTRACTOR INFORMATION: Name:Anthony Pagano Mailing Address: 163-03 87th St Howard Beach NY Phone#: 5 (® q0 Email:anthonycpaganol@gmail.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure nAdditilgn DAlteration ❑Repair ❑Demolition Estimated Cost of Project: OOther swimming pool r 30000 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes ONo 1 PROPERTY INFORMATION Existing use of property:Singie Family Intended use of ropeFamily�Sin ie Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ENo IF YES, PROVIDE A COPY. 9 Check Box 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.APPUCATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Soutlrold,Suffo66 County,New York and other applicable laws,Ordinances or Regulations,for the construction of buRdings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with aR 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):An`n re B ra u m OAuthorized Agent ❑Owner Signature of Applicant: Date: 10/3/2024 STATE OF NEW YORK) SS: COUNTY OF Nassau Andrew S B ra u rn being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (5)heisthe Agent and Engineer ,ContiaUor,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-WiMcf ,. 211 Notary Public CRIS TINA A MARINELLI Notary Public-State of New York PROPER_ Y OWNER No.01MA6439812 (Where the applicant is not tine owne Qualified in Nassau County ._ r) My Commission Expires 08/29/2026 ,, Lee Cassano residing at 3225 Nassau Point Rd C utch og u e do hereby authorize Andrew S B ra u rn to apply on m beha"thewn "outhold Building Department for approval as described herein. 10/3/2024 Owner's Signature Date Lee Cassano Print Owner's Name 2 Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) I, L� C(m ®�residing at _ Cr.... fiINCj (Print property owner's name) (Mailing Address) W�th V do hereby authorize fq"W S, (Agent) ............. to apply on my behalf to the Southold Building Department. 10131 Zy 41wiier's Si tu.r ) (Date) L�� ASS an 0 ............................... (Print Owner's Name) Suffolk unDept. of Labor, Licensing' Consumer Affairs t,l l; HOME IMPROVEMENT LICENSE ,O j/1" Name 'y° ANTHONY PAGANO Business Pagano & Son Installation & Restoration fl This certifies that the Inc bearer is duly licensed by the County of suffolk License Number HI-63023 Issued. 11/07/2019 Commissioner Expires: 11/01/2025 ,4�RE)i CERTIFICATE OF LIABILITY INSURANCE 10122IDD/YY12024Y) e D' OI224 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 ri hts to the certificate holder in lieu of such endorsements. Joseph J. Bologna 8�Co., Inc. PH cx 16)437-2150ITm (AX ) PRODUCER John V Santoro p 9 1324 Hempstead Tpke EMAIL 2150 Np (516 437 2 11 .__ E-MAIL Johinl JboI�D na com ... Elmont, NY 11003 - SIT.... License#: BR-641011 _ oilwsuLERIsf AFFarcrla COVERAGE .......... atA+�# ...................I INSURERA: _U iCa.,.FlrSt ..........-.--------- ..__ INSURED INSURER B: _ ... .. --------- .._.._...._ Pagano&Son Installation and Restoration Inc I INuR sERC: _ ...„_,_IT,,,, .......... „_. 3510 Centerview Ave INS RER D Wantagh, NY 11793 INSURERmE: _ �......._. INSURER F: COVERAGES CERTIFICATE NUMBER: 00004186-0 REVISION NUMBER: 1 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 INS ._.._....-_ __._.. -..._ __.............._... _..._-----.. ".INSR ADOL SUBR PO1�IC'M EFF POLICY EXP T INSURANCE POLICY NUMBER FO YYYY YY LIMITS A X COMMERCIAL GENERAL LIABILITY ART3000557860 10/17/2024 10/17/2026 EACH OCC�LORRENCE $ 1000000 CLAIMS-MADE -- ❑X occuR P.Itl I - � +.s� $ ..._100_.m._,A00�0 MED EXP(Any one t ecsnmr $ 6000' PERSONAL.&ADV INJURY $,... ...1 00,, O00 GEN'L AGGREGATE LIMI T APPLIES PER: GENERAL AGGREGATE $ 2000000 x. POLICY❑ PLOJECT_ D LOC PRODUCT COMP/OPAGG $ t 9—O'OO OTHEF't: AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ t ? ..........._._ ANY AUTO BODILY INJURY(Per person) $ . . ......... OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS -° HIRED NON-OWNED P OPERTY OAUX6ffmm IT $ AUTOS ONLY AUTOS ONLY $ UMBRELLA ._. B t�cB 4 0CCU THE EXCESS ABIA_IT J�JOCCU'R L MADE. AGGREGATmEmmmmmITITITIT ..........,mm.. DEO RIFTENTION$ $ WORKERS COMPENSATION PER OTH, AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A $ E L.EACH ACCIDENT wDFFVCER/M.E'MBER EXCLUDED? (Mandatory in NH) E L DISEASE EA EMPLOYE $ VI yes,describe under _.. ........ 0,SORI•FTION OF OPERATtlONS.bel 9 w E.L.DISEASE POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Route 25 Southold, NY 11971 AUTHORIZED REPRESFINTATIVE I k JVS ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by JVS on 10/22/2024 at 10:56AM YYp Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Pagano &Son Installation and Restoration 516-987-3040 3510 Centerview Ave • 1c.NYS Unemployment Insurance Employer Registration Number of Insured Wantagh, NY 11793-2710 N/A Work Location of Insured(Only required if coverage is specifically limited to 1 d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) NorGUARD Insurance Company Town of Southold 54375 NY 25 3b.Policy Number of Entity Listed in Box"l a" Southold, NY 11971 PAWC576083 3c.Policy effective period 11/25/2024 to 11/25/2025 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) X❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1 a"for workers' compensation under the New York State Workers'Compensation Law,('To use this form, New York(NY)must be lusted under Item 3A. on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. 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 the coverage as depicted on this form. Approved by: Adam Edelstein (Print name of authorized representative or licensed agent of insurance carrier) 140 Approved by: 01/15/2025 (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 800-673-2465 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov vo K workers' CERTIFICATE OF INSURANCE COVERAGE STATE 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 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured PAGANO FOODS INC.DBA PAGANO&SONS INSTALLATION AND RESTORATION 516-987-3040 3510 CENTERVIEW AVE WANTANGH,NY 11793 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e., Wrap-Up Policy) 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 THE TOWN OF SOUTHOLD 54375 ROUTE 25 3b.Policy Number of Entity Listed in Box 1 a" SOUTHOLD, NY 11971 DBL627607 3c.Policy effective period 11/25/2023 to 11/24/2025 4. Policy provides the following benefits: © A. Both disability and paid family leave benefits. 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. 11/5/2024 Aip� Date Signed By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat 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 46,4C 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 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 pp this form. 'I 'I DB-120.1 (12-21) 111111iiiulli1111iuioiiiiiiiiuiiiiumiiiJill 1 SURVEY OF LOT 15 AMENDED mAP A" oF NASSAU POINT CLUB PROPERTIES FILE N.. 156 FILED AUGUST 16, 1922 SITUATED AT NASSAU POINT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-111-09-01 SCALE I"=20' OCTOBER 22, 1999 11 AUGUST 8,2005 ADDED DROP SED GARAGE ADDITION OCTOBER 30,2006 FROVON 1)GARAGE ADDTIUN ,A.NVA9Y 15,2007 AD0FD SPOT LLEVAIII)Nb r Ul CS AREA = 35.651.83 TIE N�­)O.888 1� A VOTES 4 1, ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM t M EXISTING EI EVATIONS ARE SHOWN THUS:,� (R t I 7�L m R08ERT CASSANO LEE CASSANO ;w C) 6 U, 50 75-56 %M a > 'OT @ � .57.5. �A t % 0 DOT I- ELEVATIONS ARE REFERENCED TO H.G.V,D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS;- W"AND(�CR WIB�Kn. 11 A. a,9II ,NDT Joseph A. Ingegno Land Surveyor 1'D 0 K. "-N PHONE(551)727-2090 F.z CE31)727-1727 2 PFOCES LOCA AT 322 ROM.mKE AVENK FA.eor Ml 1891 RkarRevtl,Nvw Yeeq 11.1-85