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Home My WebLink About51569-Z p 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#: 51569 Date: 01/17/2025 Permission is hereby granted to: Cassano R&L Irry Liv Trt 3225 Nassau Point Rd Cutchogue, NY 11935 To: install hot tub as applied for. Premises Located at: 3225 Nassau Point Rd, Cutchogue, NY 11935 SCTM# 111.-9-1 Pursuant to application dated 01/16/2025 and approved by the Building Inspector„ To expire on 01/17/2027. Contractors: Required Inspections: FOOTING/REBAR, ELECTRICAL- ROUGH, ELECTRICAL- FINAL, DRAINAGE, FINAL, Fees: SWIMMING POOLS-ABOVE-GROUND WITH REQUIRED FENCING $300.00 CO Swimming Pool $100.00 Total S400.00 Building Inspector y 11 '$0 r0A" TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main.Road P. O.Box 1 179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 Litt)s. vwNy'. outholdtownny go'v Date Received APPLICATION FOR BUILDING PERMIT 3 For Office Use Only PERMIT NO. Building lnspectar: y OV - S 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 s f .<` _ Owners Authorization form(Page 2)shall:be completed. Date:10/3124 OWNER(S)OF PROPERTY: Sam#Z000-111-9-1 Name:Lee Cassano Project Address:3225 Nassau Point Rd Cutchogue NY Phone#:6312358202 Email:leecassano@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#: 13 K® Email:anthonycpagano1@gmail.com 5t DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alter tion ❑Repair ❑Demolition Estimated Cost of Project: 30000 9 oth t"- 1 Will the lot be re-graded? ❑Yes 51No Will excess fill be removed from premises? ❑Yes l]No 1 PROPERTY INFORMATION'� Sin •• Existing use of property: �'• le Family Intended use of property: �• g Y Single Family Zone or use district in which remises is situate ___m ., .. p d: Are there any covenants and restrictions with respect to this property? ❑Yes gNo IF YES,PROVIDE A COPY. 2 Check Box After Reading: The owner/contracter/dasign professional is responobte for all drainage and storm waterissues as provided by Chapter 23 w of the town Coach. Apf"tt t"rtffN is HERE11V MAOF to the 9ulld'in Department for the issuance of a Building perrnit pursuant to the Building'Zone Ordinance of the Town of Southold,Suffolk,tOunty,Ne"w York and other applicable taws,ordinances or Regulations,for the construction of buildings,. additions,afternoons or for removal or demolition as herein described.The applicant agrees to comply with all ap-pocablo haws,ordinances,builcfinig code, housing code and regulations and to admit authorized Inspectors on premises and in building(s)for necessary Inspections.False statements made herein are purtislisbie as a mass A. lsdemannar pursuant to 5e+ct;6n 210,45 of the Now York Ste to Penal Law. Application Submitted By(print name):An re Braum pAuthorized Agent ❑Owner Signature of Applicant: Date: 10/3/2024 STATE OF NEW YORK) SS: COUNTY OF Nassau Andrew S Braum being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is theAgent and Engineer of said owner or owners,and is dui authorized to�perform Noy aie officer, etc.j Y p 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 3 rRay of 20 2-1 a*�Mowwa llotary Public CRISTINA A MARINELLI Notary Public-State of New York PROPERTY OWNER AUTHORIZATION No.01 MAS439812 (Where the applicant is not the owner) Qualified in Nassau County My Commission Expires 08/29/2026 Lee Cassano residing at3225 Nassau Point Rd Cutchogue Andrew S Braum —do hereby authorize _to apply on m I ehalf t,'o the Town ou'thold Building Department for approval as described herein. 10/3/2024 Owner's Signature Date Lee Cassano Print Owner's Name 2 PORK 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 • 1 c.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 82-1828355 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"1 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) XQ 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 listed 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) .41 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