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HomeMy WebLinkAbout51650-Z 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 l it � ww c t tl c l ltowxtt �O P ) ) 1 S� . Date Received BUILDINGAPPLICATION FOR w ti For Office Use Only PERMIT NO. Building I nspecton 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: =CTM #1000- I� Project Address: guo 'In L4 G)t -YV Ns �SqLA�A Phone#: 15 SO Email: k M Mailing Address: nvma' k . �„ CONTACT PERSON: Name: Mailing Address: . 11 Phone#: Email: ES i( YYi DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: ]Hai:- CONTRACTOR INFORMATION: Name: 1 S 17h C. Mailing Address: �y� Y�►�l I I Cj�-{� Phone#: (�d - Email: o6r)1sm(Imal, LCO DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure [--]Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ther N� CCe�" i n $ l Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? , es ❑No 1 PROPERTY INFORMATION .................. Existing use of property: I intended use of property: Lk) Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? []Yes�lcl IF YES, PROVIDE A COPY. L- - - .......... Pheck Box After Read ing- 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 tacomply 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 210AS of the New York State Penal Law. Application Submitted By print name): thorized Agent []Owner Signature of Applicant Date.- CONNIE 0,BUNCH STATE OF NEW YORK) Notary Public,State of New York SS'. No.016U618so5o COUNTY OF Cluallfled In Suffolk County COMMISSIM F-xPlres April 14,2 o-C-ly being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (Contractor,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 3 day of 20-- Notary Public PROPERTY OWNER Au rHORIZATIWW.ON (Where the applicant is not the owner) 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 LuildinL, Dej)_artment A Ali anon A UTH ORRI I ZZA III ON (Where the Applicant is iiot the owner) I 0?� S, (I ac residing at (Print property,owner's unic) (Mailing Address) V do hereby authorize (Agent) to apply on my behalf to the Southold Building Department. (Owner's'Sit a rct ate N, (Print Owner , Name) 3 ll � " �a a W pp gga`Q¢¢ u o gg y 11 i5 g ® � m a it op UJ �g OZ OOZ N ; ` .� 0...�. �oz 9z.lzs • o 2" o _ $ x o 0� ® raa�aa'' 5 "YA"4'"4rv4b"7QP5ffi'°'�! uv iwn� �u� �w�. gnu xua� xiwr ��a. .. wim. ED p 1 M 4 N �J C\2 E- 6 * ` I QW ° O N �¢ p ®" nW O _ AWE C4 ¢ lit �> E— �W l z b� 6 � m ED � n 0 NY o ® 0�8 z U' ozg w _ 1-7 .x r p F � _I1JJIM ww W°-Y��^ s 00'OOZ M„O-V,8S.CZN >a.wzoo; C.0 ¢w�zwj uS aa' -WLW83 Zn cn P t NEW Workers' Compensation CERTIFICATE OF INSURANCE COVERAGE `,go, 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 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured PATRICK'S POOLS INC 631-941-4113 PO BOX 3024 EAST OUOGUE,NY 11942 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) 262929943 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShetterPoint Life Insurance Company Town of Southold 54375 Main Rd 3b. Policy Number of Entity Listed in Box"I a" PO Box 1179 DBL318565 Southold, NY 11971 3c.Policy effective period 05/13/2024 to 05/12/2025 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 employers 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. Date Signed 6/20/2024 By 14ZZL� (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 515-39-9100 Name and Title LeSton WeISh,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 413,4C 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 sox 4B,4C or 5B 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 this form. DB-120.1 (12-21) 11111111111uiiiiiiiiiiiuiiiiiiiiu111111110111111111 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) A� 08A23d2024 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 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 endorsements). PRODUCER CONTACT NIChOIas ZUlkofske _, PHONE 831 941 Brookhaven Agency,Inc. tit 941t113 0I AX 100 Oakland Ave,Ste 1 MAIL certificates iarookllveta anc com _� Port Jefferson,NY 117775(i SPY I Philadel hie Indemni Insurance Company INSURED Merchants Mutual Insurance ComPan� � Patrick's Pools,Inc. j r�_Wesco Insurance Compares ww PO Box 3024 East Quogue NY 11942 COVERAGES CERTIFICATE NUMBER.* REVISION NUMBER: 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 CONTRACTOR 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. 1NSR _ AODL SUB POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY _EWH QggIQRRF 1 O00 O00 DAMAGE TO RENTED A Q CLAIMS-MADE [j]OCCUR 1 OO OOO GE IS� X Contractual Liability PHPK2658571 02/28/2024 02/28/2026 �n XPaAn onep9rson 5 00„0 P RSQ„NAL&ADV INJURY 1.000 000 1611 AGGRE TE LIMIT APPLIES PER: .9 N , QGRE9AT_ 2 000,000 � m_ POLICY POTHEW E LOC PRQDUCTS-COMP/OP AGG $2 OOO O00 AUTOMOBILE LIABILITY COMBINED VNGLE LIMIT AUTOMOBILE 500 OOO B X BODILY INJURY(Per person) $ ANY AUTO ...... ALL OWNED SCHEDULED X X CAP9267113 07/12/2024 07/12/2025 BODILY INJURY(Per accident) $ AUTOS AUTNON OWNED PROPERTY DAMAGE $ X HIRED AUTOS ' AUTOS dra3lD UMBRELLA LIAB OCCUR EACH%_Q RR_ENCE J_ . EXCESS LIAB I I.AIIM, ;MAOE A�F�E�+RTI WORKERS COMPENSATION X PERUT OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE / E;,(x;,,Aft C�H A ,D IENT. C OFFICERIMEMBER EXCLUDED? � N/A WWC3714386 05/13/2024 05/13/2025 _L1 OO OOP (Mandatory In NH) E L lal�n �FA Mw?!c 100 000 If yes,describe under E.L.DISEASE-POLICY LIMIT 1,2 500,000 DESCRIP'MON OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Town of Southold is included as additional insured per written contract CERTIFICATE HOLDER CANCELLATION Town of Southold,Town Hall Annex SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE <NSZ> ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD RK Workers' CERTIFICATE OF ATIt ari sensation Bo NYS WOR RS' COwjojojjMPENSATION INSURANCE COVERAGE �lo�lr�l 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 631-996-4687 Patrick's Pools,Inc. PO Box 3024 ic.NYS Unemployment Insurance Employer Registration Number of East Quogue NY 11942 Insured Work Location of Insured(Only required ff coverage is specifically!lmfted to 1d.federal Employer Identification Number of Insured or Social Security certain locations in New York State,I.e.,a Wrap-Up Policy). Number 262929%3 2.Name and Address of Entity Requesting Proof of ge 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Company Town of Southold 3b.Policy Number of Entity Listed In Box"1 a" Town Hall Annex WWC3714386 54375 Main Road Southold,NY 11971 3c.Policy effective period nni1Aian9a to nstj�Mn95 3d.The Proprietor,Partners or Executive Officers are 0 Included.(Only check box If all partners/officers Included) 0 all excluded or certain partnersloffioers excluded. This certifies that the insurance carrier indicated above in box"3"Insures the business referenced above in box 01 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under IWM.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 02" 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 0,there are reasons other than nonpayment of premiums that canool the policy or eliminate the insured from the coverage Indicated on;this Certificate.(Those notices may be sent by regular mail.)Otherwise,this Certificate Is valid for+aroma 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 cortificate holder.This certificate does not amend, Wend 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 Cear0ficate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New Yottt State W rs'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the Insurance caller referenced above and that the named Insured has the covaraga as depicted on this form. Approved by: Mchoias Zulkofske�' (Print name of d,represen or kennssed agent of insurance r11) Approved by: (sins (Date) Title: Authorized Agent Telephone Number of authorized representative or licensed agent of Insurance carrier. 631-941-4113 Please Note:Only Insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are No authorized to issue It. C-105.2(947) www.wcb.ny.gov f a Bargain and Sale Deed with Covenants against Grantor's Acts as THIS INDENTURE, delivered the I � day of November 2024 STEVEN MASSEY and MARGO MYERS-MASSEY 3900 Route 25 Greenport,New York 11944 party of the first part, AND BRIAN JASPERS and SUSAN JASPERS aS. klskand 90 Turkey Lane Cold Spring Harbor,New York 11724 party of the second part, WITNESSETH,that the party of the first part, in consideration of TEN DOLLARS ($10.00) and other valuable consideration paid by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or successors and assigns of the party of the second part forever, all that certain plot, piece or parcel of land, situate, lying and being SEE SCHEDULE A ATTACHED HERETO AND MADE A PART HEREOF. DIST: 1000 SECTION: 035.00 BLOCK: 05.00 LOT: 001.000 SAID PREMISES KNOWN AS: 3900 ROUTE 25,GREENPORT,NEW YORK BEING AND INTENDED TO BE the same premises described in a deed dated October 29,2009 and recorded November 24, 2009 in Liber 12607 Page 433 in the Office of the Clerk of the County of Suffolk,New York. TOGETHER with all right,title and interest, if any,of the party of the first part of, in and to any streets and roads abutting the above-described premises to the center lines thereof,TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to said premises,TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or successors and assigns of the party of the second part forever. AND the party ofthe first part covenants that the party of the first pail has not done or suffered anything whereby the said premises have been incumbered in any way whatever, except as aforesaid AND the party of the first part,in compliance with Section 13 of the Lien Law,covenants that the party of the first part will receive the consideration for the conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word "party"shall be constructed as if it read"parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above written. IN PRESENCE OF: Steven as M VAI argo Myers-Ma stay STATE OF NEW YORK } } ss.: COUNTY OF SUFFOLK } On the 24th day of October 2024,before me,the undersigned,personally appeared STEVEN MASSEY personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument,the individual,or the person on behalf of which the individual acted, executed the instrument. A K [t5gsinn PUBLIC,STATE OF NEW YORK istratk)n No. PR497753 uaiitiod in Suffolk County 2td27 Notary Public _ E Februa STATE OF NEW YORK } } ss.. COUNTY OF SUFFOLK } On the 24st day of October 2024, before me,the undersigned, personally appeared MARGO MYERS- MASSEY,personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by her signature on the instrument, the individual,or the person on behalf of which the individual acted, executed the instrument. —Wiffl.PROKOP NOTARY Pi BUC,STATE OF NEW YORK Registration No,02PR4 77533 Ouaiified In Suffolk County Notary Public Oommissinn Exp4res February 4 027 Appellate Land services LTD. . 6851 Jericho Turnpike,Suite 110, Syosset, NY 11791 • Phone No. 516-801-6366- Fax No. 516-801-6364 Title No.: APS25072S Client: Jared Kaplan,Esq. Applicant: Brian Jaspers and Susan Jaspers Closing Date: 11/15/2024 at 11:00 AM Reference: Jaspers and,etal.from Massey and,eta]. Premises: 3900 Route 25,Greenport,NY 11944 Dist. 1000 Sec.035.00 Block 05.00 Lot 001,000 Owners: Steven Massey and Margo Myers-Massey Buyers: Brian Jaspers and Susan Jaspers CHARGE DESCRIPTION BEJYER{S) SELLER(S) LENDER(S) TITLE POLICIES AND INFORMATION Pciltt r Premiums * ALL CASH Policy for$1,090,000.00 .Owners Policy Premium _ $4.594,0 � (Premium $4,594.0 ) 0 _.. .........�......., �.w.__. .w...._._..�...�......_...._....��.�.....w.._._,.,,..._ ....- -._......M.......... . _�._�_�_ Underwriter Compensation .__. -- ---.... . --- $689.10, Title Agent Compensation E1do::...._._�e�...-�...�...........�_.._ _- ...m .... $3,904.90 * Property Type is Residential One R rdln�Tex .. _.0 ..__... �...ro.......... _..�_._.....-............ Family Dwelling Transfer Tax New York State(TP584) $4,360.00 **As per the annulled regulations, �Transfer Tax Peconic Bay Region _ $22,2�50.00'' Appellate Land Services,LTD. r Tax Additional Transfer_ ....._. . __ __... ._• _.. _. ansion) authorizes title closers to accept Trans fe (M Tax $10,900.00 gratuities. • Underwriter:Stewart Title Insurance ..�_..__..,a � �.�..,.. ......_.. __.....,R Company rdln Fees f~.._ __ • +items are subject to NYS Sales Deed $200.00 Tax _5......._ _. w .m. ..µ.,..._ .., -__.. ..._,. ......... . ...__,,.. __.. _ __. m..,.. uffolk County Tax Map Verification(x1) $200,00 __� ......._...._.._._.��_ Recording Service Fee($40 x 1) $40.00 Satisfaction of Mortgage $55,50 S......�_........'6._ ni, yT—Veri..�.............i......___. . uffolk ounty'Tax Map ficat'on(x1) $200.O0 Recording Service Fee($40 x 1) �_..._. .-�...�..............�M.._. -$ 0,00 Estimated 24/25 1H T/C/S Tax due 12/1 $7,310.23 No Open Water as of 9/16 eCe e8 r' h NewSurvey/Inspection(Client paid) � - urvey Service Fee $50.00 9ankruptcy Search + $200.00 Patriot 5 arch + _�.�.�.�...... $200,00 Overnight/Courier Fee _ $50,00 Escrow Service Fee..�.�.�.�__._,��_..........�...�.......ww....,_........._..�._�_._._....._._._. ._. ..,..._..,_...m,...._vw .........�_...._��.........�... $50.00 -Filing/Technology Fee ...ww.__ •�____.......................�$5.,. .. �.�.. .�._.�.�. E 5.00 Municipal Search + $450.00, Sales...Tax Suffolk ..g_.6.,.2_....5% ._........_...._........_..�'_,.._ �� _.�..... .._...._�... - $73.31 _...... 2 54 S FiS 50 .�.w...... _w._. GRAND TOTAL-$51,275'. TOTALTOmAprtl Lend Services LTD. �48,t'� . DISCLOSURE INFORMATION _ _ NOTICE:Title costs for this transaction may include charges for certain services not specified in the state approved Rate Manual and are provided by this Company at the request of your lender or attorney. Printed on 11/05/2024 1:21:29 PM (Continued on next page). Page 1 of 2