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Home My WebLink About51634-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#: 51634 Date: 02/12/2025 Permission is hereby granted to: Andrew Ceresney 160 Stratford Rd Brooklyn, NY 11218 To: reconstructand enlarge existingdeck addition (to include an outdoor shower and hot tub)to existing single-family dwelling as applied for. Premises Located at: 3415 Laurel Trail, Laurel, NY 11948 SCTM# 126.-12-4 Pursuant to application dated 12/16/2024 and approved by the Building Inspector. To expire on 02/12/2027. Contractors: Required Inspections: FOOTING/REBAR, FRAMING/STRAPPING , DRAINAGE, FINAL, Fees: Single Family Dwelling- Addition&Alteration $685.00 SWIMMING POOLS-ABOVE-GROUND WITH REQUIRED FENCING $300.00 CO-RESIDENTIAL $100.00 r Total $1,085.00 Building Inspector � r 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 li'ttL)S,'//www,sotitho,ldtovvnny.gov Da=e Received APPLICATION FOR BUILDING PERMIT � I For Office Use Only 1 PERMIT NO. Building Inspector: 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: 1190 l 'r-- SCTM#1000- Project Address: ( � L . Phone#: Mailing Address: 3 4 1 5 L Au,g,sk. CONTACT PERSON: Name: �IaN G L°M A N Mailing Address: 2p 9 L Phone#: (fl 3 1 (o a — 3 8 6 Email: DESIGN PROFESSIONAL INFORMATION: Name: �.� . N, � Mailing Address:C) ° N Ps V11115: S^ 0 F 7 Phone#: eo3i ^3Ch1�3 ^ z. :?� E3 Email 51 �" � - � fZ. GQM CONTRACTOR INFORMATION: Name: G. Mailing Address: v IN T ) V M Phone#: 3(0.5 s 2 v Email DESCRIPTION OF PROPOSED CONSTRUCTIONo to-TL.ootri s C OAA []New Structure ❑Addition ❑Alteration epair ❑Demolition Estimated Cost of Project: �jLC)ther G 1J y O O I' �i�G $ � t7 � Will the lot be re-graded? ❑Yes''-Vo Will excess fill be removed from F remises? ❑Yes'560 1 + PROPERTY INFORMATION Existing use of property: Ie �O i G Intended use of property: I 'F AV-n I 1 m 11. e tl.9 M L.L,I r-j Zone or use district in which premises is situated: Are there any covenants and restr ctions with respect to this property? ❑Yes';KNo IF YES. PROVIDE A COPY. C'hec ftx f er Reading' The ownor/contractor/design professional Is responsible for all drainage and storm truer 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 law.,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 nann Ivputhorized Agent ❑Owner Signature of Applican Date: STATE OF NEW YORK) SS: COUNTY OF S y fEO L �) N c- L 110 A.N being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the �v (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work anc'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 .20 Notary Publi PATRICIA A,WAL, PI �� IIIV mr OWNER . 11w ll10RIZ, 1'IIII m 1, °°°'° „ Notary No.WWA °2ew y�rx " ChmPikgid:in Suffolk OUnt (Where the applicant is not the owner) mrnissiar,EWres November , residing at l3 FP— do hereby authorize r*J to apply on my behalf to the T n of Southold Building Department for approval as described herein. Owner's Signature ate CL& L 1 Print Owner's Name 2 4 � Town Hall Annex �' � Telephone(631)765-1802 54375 Main Road Fax Fax(631)765-9502 P.O. Box 1179 � Southold, NY 11971-0959 dry BUILDING DEPARTI.'ENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRF-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: 2,L Owner: V 4 N IF— Location of Property: . -- ._.� �. Please take notice that the (check applicable line): New commercial or residential structure Addition to existing commercial or residential structure Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including girders and beams (F) Roof framing (R) Floor and roof framing (FIR) Signature: Name (person submitting this form): ''� ? _ G Capacity(check applicable line): Owner Owner representative TrussRegl5.docx Effective 1/1/2015 ft(') BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD � Town Hall Annex - 54375 Main Road - PO Box 1179 o� Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ., am�esh so�atholdtowrut .g ov �- sea nd�� southoldto nn y . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail information Required) Date: ll - 1s -2 Company Name: S A1. r - l p%alT1 l" . Electrician's Name: b A 16 S License No.: 3 07 !a Elec. email: a ps, S , Al L Elec. Phone No: 5,I 6- 1 request an email copy of Certificate of Compliance Elec. Address.: 19 3 4 14 Pr I N p,V IS/ =IF—AI&N Ck I I I I (0 (o JOB SITE INFORMATION (All Information Required) Name: , Address: 1. 1 l9 Cross Street: Phone No.: -. - O:3 a io Bldg.Permit #: email: Lv-)p1 ivc- Aac,l4 v;_rL Aloe 40n4 Tax Ma District: 100 Se ton: /2,G Block: 2.,,, Lot: ,BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): o v -r-L rc'T S V-o 4 ^E.)c r faN ho >_10 bE 4-V- w I -T J+ R-o'T'" -V V +B I'SI-rGIAEN Al� EP S care Foota e: Circle All That Apply: Is job ready for inspection?: YESZ NO [:] Rough In El Final Do you need a Temp Certificate?: YES® NO Issued On Temp Information: (All information required) Service SizeEll Ph 03 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 H Frame Pole Work done on Service? Y FIN Additional Information: PAYMENT DUE WITH APPLICATION A p--00-1 k\ NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 1 A A A A 300209402 C.P.GALLAGHER CONSTRUCTION CORP 154 EAST 17TH STREET HUNTINGTON STATION NY 11746 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER C. P. GALLAGHER CONSTRUCTION CORP TOWN OF SOUTHOLD-BUI LID ING,DEPT 154 EAST 17TH STREET TOWN HALL ANNEX,54375 MAIN HUNTINGTON STATION NY 11746 ROAD; PO BOX 1179 SOUTHHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11318 895-8 333895 04/22/2024 TO 04/22/2025 10/29/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1318 895-8, 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. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:IPAWW.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. CHRISTOPHER P GALLAGHER, PRESIDENT OF ONE PERSON CORPORATION C.P. GALLAGHER CONSTRUCTION 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 STATE INSURANCE FUND DIRECTOR,INSU(ANCE FUND UNDERWRITING VALIDATION NUMBER:43543405 CERTIFICATE OF LIABILITY INSURANCE D10/29/2024 ) � �0�"2 /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 BYTHE 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). ... CONTACT PRODUCER g Property Casualty 8�45 790 5092 312 E,r�ALn rxr orinneJ Lombard) Hotali'n Pro ert &Casual LLC r? tl ( A C Nn)(845)471 7494 8 Fletcher Place _ 2 Melville,NY 11747 A° � c�Nb� ln net INSURERS AFFORD „ AIC# _..... .. .-...........�..._�.L...�.....IwNG_COVERAG E N�..--...._ INSURER A:Southwest Marine & General InsuranceCo 12294 INSURED ..INSURER B C.P. Gallagher Construction Corp. INSURE?o ....... _... _. m.�. .••- m• —.-- ••- — 154 East 17th Street INSURER D:. _ ....... _ Huntington Sta.,NY 11746 „INSUR.ER.E ----- .. .._ ... -..-.. ... _.......,,, w.... INSURER F .._.. _ ..... COVERAGES CERTIFICATE NUMBER. REVISION NUMB' _.......... 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 SUBJECTTO ALL THE TERMS, TEXCLUSIONS AND CONDITIONS OF SUCH POLICIES.wv LIMITS HOW MAY HAVE BEEN POLICY�_ PAID CLAIMS. _ ... ..._m _ - POLI BER TYPE OF INSURANCE (SU R LIMITS S RED D YF POLICY EXP LIMITS 1,000,000 _ M .$,. A X COMMERCIAL GENERAL LIABILITY ADDL � � EACH OCCURRENCE,,,, yr. ED EXPTnyoneperson CLAIMS-MADE X OCCUR GL2024RLH00336 8/30/2024 8/30/2025 1t100 0 mm PERSONAL,B ADV INJURY S, 5,000 0 000,000 GFN'LA ...... ..... .._ � ,00 2,000,000 GGREG'ATELIMIT APPLIES PER: AGGREGATE 2,000,000 R COMP/OPAGG . POLICY X PECT LOC PRODUCTS-,w•, IT_mmmm mm ..._�..m._—w.m _. OT'W R. _ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY w Fa.,r,pC#Ignl,„m„�w, $ ANY AUTO BODILY INJURY Per erson),.,. .,........ .................-,.... OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Peracclderrt) S A�RE� �yyyy�y qq� P GPERiY AMAGE UTOS ONLY AI�OS CNI / IerIt — _W UMBRELLA LIAB OCCUR EACH OCCURRENCE, $ — EXCESS LIAR CLAIMS-MADE AGGREGATE AND KERS COMPENSATION MPE.... ENTION$_ -..YlN DED RET EMPL LIABILITY .... OTH- ANY tlPEROPRIE OR/EARTNEEOEXECUTIVE N/A B LEACHACCIDFNr S� Pr C /ME E� ar�datory In r�tJ) E.L.DISEASE EA EMPLOYEE w If yes,describe under ....-..- mm. E DESCRIPTION OF OPERATIONS below L.DISEASE.:.POLICY LIMIT ............. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AC 0RD 101,Additional Remarks Schedule,may be attached if more space is required) General Contractor/Remodeler Town of Southhold is included as additional insured when required by written contract _C'ERTIEICATE HOLDER ..................._ CANCELLATION .............. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southhold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southhold, NY 11971 AUTHORIZED REPRESENTATIVE I _....... ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD rw Workers' CERTIFICATE OF INSURANCE COVERAGE Yorfr svAYE 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 carrie 1a.Legal Name&Address of insured(use street address only) 1b.Business Telephone Number of Insured C.P.GALLAGHER CONSTRUCTION CORP. 631-425-1327 154 EAST 17TH STREET HUNTINGTON STATION,NY 11746 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Onlyrequired if coverage is specificellylimited to certain locations in New York State,i.e.,wrap-up Policy) 300209402 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShetterPolnt Life Insurance Company Town of Southold PO Box 1179 3b.Policy Number of Entity Listed in Box"1 a" DBL353785 Southhold, NY 11971 3c.Policy effective period 04/01/2024 to 03/31/2026 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disability benefits only. 0 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 employers employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the Insurance carrier refeirencod above and that the roamed insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date signed 10/29/2024 By llr$� (Signature of Insurance carrier's authorized representative or NYS Licensed Insurance Agent of that 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 camel'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 SB 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 beneffls insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DS-120.1.Insurance brokers are NOT authorized to issue this form. D13-120.1 (12-21) 11111111IBIIIIIINIIUIIUIIII�I�NIIIIIIIIIIII1111 Suffolk County Dept. of Labor, Licensing & Consumer Affairs HOME � �IPPOVEMENT LICENSE Name C F= E � R P GALLAGHER i nss Name CP GAI_ I AGHE- R CONSTRUCTION This cert' fes thCat the CORP nearer is duly licensed by :he County cf scffolk License Number H-29486 W"kAz, T. Rog ery Issue : 09/20/2000 �Cornrnissioner Expires : 09G01 r2a26