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HomeMy WebLinkAbout51631-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#: 51631 Date: 02/12/2025 Permission is hereby granted to: Janet E Staples 29 Middleton Rd Greenport, NY 11944 To: Demolish an existing accessory inground swimming pool as applied for. Premises Located at: 1270 Middleton Rd, Greenport, NY 11944 SCTM#41.-2-1 Pursuant to application dated 02/12/2025 and approved by the Building Inspector. To expire on 02/12/2027. Contractors: Required Inspections: Fees: Demo- Pool $125.00 Total $125.00 Building Inspector �� t TOWN OF SOUTHOLD—BUILDING DEPARTMENT f' Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownnv. o I Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only 5 PERMIT NO. l Building Inspector: B, f 4 :a r 1i Applications and forms must be filled out in their entirety.Incomplete F E B 1 2 202 applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. .r Date: 3 � OWNER(S)OF PROPERTY: Name: f 3 �n SCTM # 1000- Project Address: 1A Phone#: Email: Mailing Address: CONTACT PERSON: Name: Mailing Address:?c� 1 ...Phone#: � 477 Email: , .. Lc Gn DESIGN PROFESSIONAL INFORMATION: Name: C� ,- Mailing Address: ly Phone#: Email: CONTRACTOR INFORMATION: Name: L LA�'n 6:�-eu, 2A ,' (- cl-\ Mailing Address: Phone#: �?)' 77 7 Email: DESCRIPTION OF PROPOSED CONSTRUCTION [--]New Structure ❑Addition ❑Altera4n epair emolition Estimated Cost of Project: ELL- ��. $ Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes o 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? Dyes ❑No IF YES, PROVIDE A COPY. ❑ 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. 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. � ffAuthorized Agent ❑Owner on Signature of Apo i �Date: STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Contractor gent, Corporate Officer, etc.) of said owner or owners, and is duly authonz l.1a 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 � 1��rhVo ay of6Lbruau , 20 Z5 , tiatary Public Tr e^CY L. EDW'YE R NC,?9Y r UL-L!C,STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION , rNO.010W63M9CQ 1,! IE,IN ^Ii FCXKCO�11,,--y (Where the applicant is not the owner) C0MMV"ScAra E*-PT CES J U N E 30,2002�P 1, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein, Owner's Signature Date Print Owner's Name 2 z3uffolf;'� County o L on Pirs Labor, icensir ".-I" Sur, FIR-W, NO W� VEN//1 'E: NT LIDS &— *4 ........... ,���� � � Name COS D TSIE Business Namc RATSEY CONSTRUCTION This certifies that the bearer is duly licensed License Number H-20428 by the County of suffolk Issued: 01 /01 /1992 -r. P'qge"ry Expires: 01 /01 /2026 Commissioner t�} DATE(MMIDD/YYYY) ACOPIR CERTIFICATE OF LIABILITY INSURANCE 02I05/2025 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. IMPORTANM If the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 endorsement(s). CONTACT PRODUCER NAMEw Alexandria Whitney McMann Price Agency,Inc. PHONE E (631)477-1680 Wit» N�; (631)477-8930 828 Front Street ADD RES& alex.andria( mcrnannpHce,com INSURER(S)AFFORDING COVERAGE NAIC# Greenport NY 11944-1542 MSURERA: Atlantic Casualty Ins Cc INSURED INSURER B: Ratsey Construction&Ratso,LLC Atima;Colin D Ratsey INSURER C PO Box 398 INSURER D: INSURER E: Greenport NY 11944 INSURER F a COVERAGES CERTIFICATE NUMBER: C'L252504'384 REVISION NUMBER: THIS IS TO CERTIFY'THATTHE 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. LTR TYPE OF INSURANCE WVD POLICY NUMBER MMIOD MMMDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE /� OCCUR PRf EXP( En.11,111,11, $ 100,000 ❑ An one person) $ 10,000 A M068002388-3 05/09/2024 05/09/2025 PERSONAL&ADVINJURY $ 2,000,000 GEN'LAGG'.R GATELIMITAPPLIESPER: GENERAL AGGREGATE $ 4,000,000 PRO POLICY JECT LOC PRODUCTS-COMP/OP AGG '...$ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBNE51 INGLE LIMIT $ Ea accident , ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAd6NA ''E' $ AUTOS ONLY AUTOS ONLY Pair acoldavtt' UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE NIA E.L,EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 Village of Greenport ACCORDANCE WITH THE POLICY PROVISIONS. 236 Third Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 Ailu—( ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD /7-%*\N1111 NYSIF New York State finsuairance Fund PO Box 66699 Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � r AAAAAA 133376596 COLIN RATSEY D/B/A RATSEY CONSTRUCTION uu PO BOX 398 GREENPORT NY 11944 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER COLIN RATSEY D/B/A VILLAGE OF GREENPORT RATSEY CONSTRUCTION 236 THIRD STREET PO BOX 398 GREENPORT NY 11944 GREENPORT NY 11944 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11103 816-3 695123 01/09/2025 TO 01/09/2026 2/1/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1103 816-3, 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:/11MWW.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 THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STA S, 7NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:684737938 U-26.3