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HomeMy WebLinkAbout51595-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#: 51595 Date: 01/29/2025 Permission is hereby granted to: Edward J Scroxton 695 Peters Way#3 Fishers Island, NY 06390 To: Convert heating and cooling source from oil to electric by installing a HVAC system to an existing single-family dwelling as applied for. Premises Located at: 695 Peters Way, Fishers Island, NY 06390 SCTM# 6.-2-3.9 Pursuant to application dated 12/04/2024 and approved by the Building Inspector. To expire on 01/29/2027. Contractors: Required Inspections: Fees: HVAC $250.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $350.00 Building Inspector � r .F 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 litti)s://www.southoldtowniiy.&vonv Date Received PERMITAPPLICATION FOR BUILDING WC For Office Use Only r„F 2) PERMIT NO. 1515q6 Building Inspector.. DEC ,r _ 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: OWNER(S)OF PROPERTY: Name:Edward Scroxton SCTM #1000- Project Address:695 Peters Way #3, Fishers Island, NY 06390 Phone#:631-788-7726 Email:scroxtonedward62penn@gmail.com Mailing Address:695 Peters Way#3, Fishers Island, NY 06390 CONTACT PERSON: Name:Julie Liu, President, Centsible House, INc Mailing Address: 1265 Dean St, Brooklyn, NY 11216 Phone#:917-615-4392 TT-MT1 :Julie@centsiblehouse.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Linli HVAC Inc Mailing Address:4228 College Point Blvd, Flushing, NEW YORK 11355 Phone#:7174613057 Email:service@linlihvac.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition IgAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $22500 Will the lot be re-graded? ❑Yes W No Will excess fill be removed from premises? ❑Yes INo 40 1 PROPEF TY INFORMATION Existing use of property: 1 family Intended use of property: 1 family Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes ONO IF YES, PROVIDE A COPY. Chapter ❑ha to eck Box After Read ing: The owner/contractor/design ofessional Is responsible for all drainage and storm water Issues as provided by p 236 of the Town Code. APPUCATION IS HEREBY MADE to the Bi liding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and othe applicable laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described. he applicant agrees to comply with all applicable laws,ordinances,building,code, housing code and regulations and to admit authorized Inspectors on We nises and in buikling(s)for necessary Inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the lew York State Penal Law. Application Submitted By(print name):Julie Liu, Centsible House, Inc ! Authorized Agent ❑Owner Signature of Applicant: Date: 0101210Wy STATE OF NEW YORK) SS: COUNTY OF _�� ) k he- Li U t eing duly sworn,deposes and says that(s)he is the applicant (Name of individual sig ing con race)above named, (S)he is the i (Contractor,Age it,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 applic ion 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 Htaridon M Rivera llobly Public State ofMw York a"d ,A_��' M.41R:16a15P38 day of e c 20� /�1 �J"'! 1"I CommisionExpuesO3/29=5 Notary Public PROI)ERTYw wQVY NERHOmm L II !y (Where the apF ilicant is not the owner) I Edward Scroxton residing at 695 Peters Way#3 Fishers Island, NY 06390 Julie Liu, President Centsible House, Inc do hereby authorize to apply on i1il behalf t the Town of Southold Building Departm Sri for approval as described herein. Raj It" 'Q1"jI;K�q Owne r's Signature n e g Date Ed Scroxton Print Owner's Name 2 Buildine De Dartment Application AUT ION (Where the A)plicant is not the Owner) Edward Scroxton residing at 695 Peters Way#3 Fishers Island, NY 06390 (Print property owner's name) (Mailing Address) do her by authorize Centsible House, Inc t (Agent) to apply on my behalf to the Southold Building Department. QNR(Owner's Signature) (Date) Edward Scroxton (Print Owner's Name) { 10 MS. MON OTIM ..._AM— ft v= .._ „��. ?�.��\ A. Z.. �._� �� _ -__ ` - .Mom, e ., ..o s �i If Suffolk County Department of Labor, Licensing Consumer Affairs �� , VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 ' .... DATE ISSUED: 11/15/2022 No. RP-67151 cS : --- ----. --- ----. F \ SUFFOLK COUNTY. s Restricted Plumbing License z This is to certify that Qu Guo r it Am doing business as LINLI HVAC INC having given satisfactory evidence of competency, is hereby licensed to perform plumbing work necessary and solely related to the operation, installation, maintenance and repair of the equipment specified below in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. NOT VALID WITHOUT Restrictions Additional businesses DEPARTMENTAL SEAL RPI RVA AND A CURRENT CONSUMER AFFAIRS ID CARD . { . Rosalie DragoAe- Commissioner VON -� f0 AW - .,tis� - ...` ....:. -� ., � - __ � _ -tom_• - _- 'MON ..................................... �a Atk ID 1M- �- in=ti' ,. ' ;; 1 __a —:. �' _ .�-.� Wit.RM - t� �.-. .< -. - , `� �. ..1- No. RP-67151 � Certificate of Competenc , Ail -M ISSUED BY { ��o k o nty a artment o Labor, Licensing & ' .. Consumer Affairs This is to certify that Qu Guo Has duly qualified by examination and is therefore entitled to receive a Restricted Plumbing ' license from the Suffolk County Department of Labor, Licensing & Consumer Affairs in accordance with the . provisions of the Suffolk County Occupational Licensing Law. � � Dated: 11/15/2022 Restrictions "1—HVAc NOT VALID - WITHOUT DEP TNMNTAL 3 SEAL Rosalie Drago 60 Commissioner 3 70 t - �� �`z 4 Suffolk County Dept.of Labor,Licensing&Consumer Affairs RESTRICTED PLUMBING LICENSE Name QU GUo Business Name LINLI HVAC INC This certifies that the bearer is duly licensed License Number RP-67151 by:he County of suffolk Issued: 11/15/2022 Wa.yrwT "e-rs- Expires: 1 1/0112 02 6 Commissioner �- - _ -- -- i ��f. �. -=.3_: - .f, f -E` - _ .. .ram Ni_ tea `- - �,�` ter`— -__ _ - 4 , y • + � Sl a��ok Coat epmn ofLb artetaor, ices E Consumer Affairs VETERANS MEMORIAL HIGHWAY HAUPPAUGE NEW YORK 11788 vvw M. � ; DATE ISSUED: 11/15/2022 No. RP-67151 SUFFOLK COUNTY � estre � � aicese sLn 'gj ' �{ This is to certify that Qu Guo = Ak LINLI HVAC INC doing business as g g satisfactory competency, Y p plumbing necessary � Navin given satisfacto evidence of com etenc , is hereby licensed to perform lumbin work m and solely related to the operation, installation, maintenance and repair of the equipment specified below in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. NOT VALID WITHOUTtestclicns Adiditional Businesses , yANDEPARTMENTAL SEAL IMP g HVA AND A CURRENT CONSUMER AFFAIRS ID CARD VIM Rosalie Drago �. Commissioner rk - --- `- `�' Mrs- e F = - _ Nr AMM UP ;£ 3-am-- i €i _ - No. RP-67151 � EJ Cerfiricate- of Competenc�'' s ISSUED BYif A � . fi I tle Suffolk County De art ent o Labor, Licensing MA Consumer Affairs 61 This is to certify that Qu Guo . AV Has duly qualified by examination and is,therefore, entitled to receive a Restricted Plumbing license from the Suffolk County Department of Labor, Licensing& Consumer Affairs in accordance with the provisions of the Suffolk County Occupational Licensing Law. Sj Dated: 11/15/2022 Restrictions RP 1-HVAC NOT VALID - WITHOUT . DEPARTMENTAL s. SEAL 1, Rosalie Drago Commissioner A r' AM �a ► CERTIFICATE OF LIABILITY INSURANCE DATE{MMIODIYYYY] 1zro4r2o24 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 olicy(ies)must be indorsed. If S�IBROGAT�ION I a'WAtIP�D,St1laJect 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 enrlorsernent(s). cN PRODUCER NAM UR GLOBAL INC PHONE 2s5II Nu11 212-994 0986 118-122 BARTER ST#602 E-MA URG URELIANCE.NEf KE 10013 NEW YORK,NY INSURER s.AiFORtIIN aCDv'sRACE NA 4 1NSURERA.WESTERN WORLD INSURANOE GO. 13196 .INSURED 1NSURERB'r. 'AI LI LINLI HVAC INC INSURERC: 42-28 COLLEGE POINT BLVD,1FL iNSURER0. -..-._. FLUSHING, NY 11355 INSURRE: INSIIRU=R p'; COVERAGE'S CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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. )� EPF POLI.Y LIMITS.... TR TYPE OF INSURANCE POLICY NUMBER, M' Y M GENERAL LIABILITY NPP6097657 6106/2024 6106l202fi RPM OCCURRENCE 1,000,000 X EACH 000 COMMERCIAL GENERII�ALU,ABILUTY ` ts 10i�" A C�LAIMA&MADS �OCCUR MED FXP Aru one person S 5,a0 3 E"ERSONAL A ADV INJURY IS 1 tl'[I0 IrICI0 GENERAL AGGREGATE 5 2,000,000 LIMIT APPL3FSPER: PR'I�'DUCTS�-C'OMPIOPAGG LA . '$ x POLICY' PRO,.e, LOC $ AUTOMOBILE LIABILnY as ICI S ANY AUTO BODILY INJURY(per person) $ AALL UTOS NED I SCHEDULED BODILY INJURY(Par w6deral $AUTOS .... NON OWNED ROPERTYOA w $ r1I HIREO AUTOS � ;AUTOS $ I 9 UMBRELLA LIAB 'OCCUR EACH OCCURRENCE 5 EXCESSLIAB C.�py�ll,pS., AOE....,. AGGREGATE 5 ,mow Dso 71 RETENTIONS $ TMoTA WORKERS COMPENSATION � � i TIC AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORMAR3"MMUEaCUTIVE� N f A E.l EACI1 AC'CIDEN"f 5 I dERIM N,IA..�C^HI)EXCLUDED? E,I..DI'SEASE..EA EMPLOYE' 5 at"IIy�de%dbar ul6dal' I;L,DISEASE-POLICY LIMIT 5 DESCRIPTION OF PERAT9ON5 NYS DISABILITY Z11828-000 1/01/2024 12/31/2024 STATUTORY LIMITS DESCRIPTION OF OPERATIONS f LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) JOB LOCATION:695 PETERS WAY#3,FISHERS ISLAND NY 06390. CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD-BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRJBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX 54375 MAIN ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, P. O.BOX 1179 SOUTHOLD, NY 11971 AUTHORIZEDREPRESENTATIVE ©188 RD CORPORATION. All rights reserved. ACORD 25(2010/05` The ACORD name and logo are registered marks of ACORD 4 A workers' CERTIFICATE OF INSURANCE COVERAGE ArF. 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 LINLI HVAC INC 42-28 COLLEGE POINT BLVD., 1FL 7188881655 FLUSHING, NY 11355 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 695 PETERS WAY#3 20-5455840 FISHERS ISLAND NY 06390 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York TOWN OF SOUTHOLD - BUILDING DEPARTMENT 3b.Policy Number of Entity Listed in Box 1a TOWN HALL ANNEX 54375 MAIN RD Z11828-000 P. O. BOX 1179 3c.Policy Effective Period SOUTHOLD, NY 11971 4/7/2021 to 12/31/2024 4. Policy provides the following benefits: ❑K A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. C.Paid Family Leave benefits only. 5. Policy covers: ❑X 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 desbr'' d above. Date Signed 12/4/2024 By (Signature of insurance carrier's auCwi cf representative or NYS licensed insurance 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) III 11iuiuiiiuiiuiiiiiiiiiiiiiiiiiiiuiiiiii111111 NF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 205455840 GOLDEN CENTURY INSURANCE AGENCYINC 69-27 164TH ST STE 2 SCAN TO VALIDATE FRESH MEADOWS NY 11365 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LINLI HVAC, INC. TOWN OF SOUTHOLD BUILDING DEPT 42-28 COLLEGE POINT BLVD, 1 FL TOWN HALL ANNEX 54375 MAIN RD FLUSHING NY 11355 PO BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 02330 243-3 521686 04/01/2024 TO 04/01/2025 12/4/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2330 243-3, 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://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 SUR NCE FUND 4k �/ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1055951920 U-26.3