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HomeMy WebLinkAbout51673-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#: 51673 Date: 02/24/2025 Permission is hereby granted to: William Hallock 1230 Clearview Ave Southold, NY 11971 To: Construct an inground swimming pool accessoryto a single-family dwelling as applied for per DEC and Trustees approvals. Pool and pool equipment require minimum side and rear yard setbacks of 10 feet. Premises Located at: 1230 Clearview Ave, Southold, NY 11971 SCTM#70.-9-56 Pursuant to application dated 11/21/2024 and approved by the Building Inspector. To expire on 02/24/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 ' Total $400.00 Building Inspector 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 ht s:llwww.sotitholdtoy�vain .gv Date Received APPLICATION FOR BUILDING PERMIT �J r For Office Use OnlyI U LL LE C PERMIT NO. Building Insp ctor ��; , E Applications and forms must be filled out in their entirety.Incomplete r NMIr 4 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: MNOAA6 V-4 j&y1am1 =SCTM#1000-10. Project Address: ti'ZJ� VIA ...Phone#: �� y v Email: (:�i k t Mailing Address: u 3o G( �.V lie�, /4-� d'"'ft,a CONTACT PERSON: Name: bwIV-A/ Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: F �m Mailing Address: 6 Phone#: � � ' ,Ctl CONTRACTOR INFORMATION: Name: X+ I^" Mailing Address: `3�o wC v e'6 0r1 Y1114 l q Email• Phone#: 7 - �c�3 r � ( DESCRIPTION OF PROPOSED CONSTRUCTION []New Structure ❑Addition rIAlteration ❑Repair ❑Demolition Estim I/10ther Will the lot be re-graded? IvAyes ON Will excess fill be removed from premises? ❑Yes KNO I 1 PROPERTY INFORMATION Existing use of property: Ucgl &( Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to � _�o this property? ❑Yes ❑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 Impactors 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(pr%n ): Uvl I�(0,M 1 �NQl1llQ6w1-t1Gtf, CL_ ❑Authorized Agent VOwner Signature of Applicant: '� �( . Date: STATE OF NEW YORK) S '` l rf COUNTY OF Wrll llam �&nja— ,t, foa-6 I P dl eA I being duly sworn, deposes and says that(s)he Is the applicant (We o 'ndividul si agning 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 day of 20 X3 ,41 ff CFTTER, N- AIRY INT,9OF NEW YORK Registration No.OISC5039767 Oluallfied In Suffolk County PROPERTY OWNER AUTFBORIZ lti Expires February 27,20 L (Where the applicant is not the owner) I, 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 Glenn Goldsmith, President Zf so Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President P.O. Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly = Telephone (631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 Cou BOARD OF TOWN TRUSTEES TOWN OF SOUTHO C E E February 13, 2025 I � P025 William & Mariam Hallock 1230 Clearview Avenue Southold, NY 11971 13011ding ga it Town Of S I1'1 1d RE: 1230 CLEARVIEW AVENUE, SOUTHOLD SCTM#: 1000-70-9-56 Dear Mr. & Mrs. Hallock: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, February 12, 2025: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit #10574, as issued May 15, 2024, to reduce the size of approved in-ground swimming pool to 16' x 28' with 1' coping and perimeter trench drain; remove approved 660 sq.ft. pool patio surround; swimming pool drains to be a minimum of 100' from wetlands; and as depicted on the site plan prepared by John Gallacher Land Surveyor, received on January 23, 2025, and stamped approved on February 12, 2025. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Glenn Goldsmith, President Board of Trustees m January 23,2025 William Hallock m i 1230 Clearview Ave Southold NY 11971 E , 1 JAN 2 3 2025 a SOOM Town C Board of Southold town Trustees I pq N Information for Administrative amendment. i Wetlands permit#10574 Changes made to trustees approved wetland permit plan by request of NYS DEC: ® 16'x32' in-ground swimming pool with I'wide coping surround changed to smaller 16'x 28'in-ground swimming pool 1'coping and perimeter trench drain. ®approved 660sq.ft. pool patio surround changed to no patio surround. " ®swimming pool distance from wetland increased from 79' w changed to 86'from wetland. ®swimming pool drains moved to be minimum 100 ft from wetland B d I I G w p d t r V B Board of Trustees 6 May 15, 2024 3. Jeffrey Patanjo on behalf of NEOFITOS STEFANIDES requests a Wetland Permit and a Coastal Erosion Permit to construct a set of bluff stairs consisting of a 10'x10' top G platform flush with surrounding grade to a 4'x4' upper walk to 4'xl6' steps to a 4'x4' �C., platform to 4'x4' steps to a 4'x4' platform to 4'x16' steps to a 4'x4' platform to 4'x4' steps to a 4'x4' platform to 4'xl6' steps to a 4'x6' platform and 4'x8' retractable aluminum stairs to beach. Located: 1070 The Strand, East Marion. SCTM# 1000-30-2-77 GJz, e��&AeA T�I r bIOW- res4v r,-�-vi IPA, ,e-c L Aye 4. Taplow Consulting, LTD on behalf of WATERVIEW REVOCABLE TRUST requests a d� be Wetland Permit and a Coastal Erosion Permit to install 120 linear feet of rock revetment consisting of boulders at a maximum of 2.5 tons per lineal foot along existing bottom of C' bluff; importing 40 cubic yards of clean sand fill from upland sources and re-vegetating disturbed bluff areas with Cape American beach grass plugs at 12" on center for entire disturbed area; install non-treated 2"xl2" terrace boards every 10' along bluff face in un- stabilized areas only; and install and perpetually maintain a 10' wide non-turf buffer along the landward edge of the top of the bluff. Located: 905 Aquaview Avenue, East Marion. SCTM# 1000-21-2-11 LL 614`1 LI z TG�ol� Qt� a�r lc'�nvS /��� / -[1 h-y es 5. PER REVISED PROJECT DESCRIPTION & PLANS RECEIVED 5/10/2024. Costello Marine Construction Corp. on behalf of FTKS HOLDINGS, LLC requests a Wetland Permit and a Coastal Erosion Permit to reconstruct 530 linear feet of existing bulkhead within the existing basin. Located: 2835 Shipyard Lane, East Marion. SCTM# 1000-38-7-7.1 POSTPONED 6. Jeffrey Patanjo on behalf of STERLING BRENT REAL ESTATE LTD, c/o BRENT NEMETZ requests a Wetland Permit and a Coastal Erosion Permit to construct a set of bluff stairs consisting of a 10'x10' deck (flush with surrounding grade) at top of bluff to a 4'x4' top platform to 4'x8' steps down to a 4'x4' middle platform to 4'x7' steps to a 4'x4' lower platform with 3'x6' retractable aluminum steps to beach; all decking to be un- treated timber. Located: 38255 Route 25, Orient. SCTM# 1000-15-2-17.6 - POSTPONED WETLAND PERMITS: 1. AS PER REVISED SURVEY RECEIVED 4/17/2024 ,) WILLIAM & MARIAM HALLOCK request a Wetland Permit to install a proposed 16'x32' � in-ground swimming pool with a I' wide coping surround; a 660sq..ft. pool patio surround-, C 4' high pool enclosure fencing; a pool drywell for backwash; pool equipment area; and the area seaward of the pool fencing to be established and perpetually maintained as a non-disturbance buffer area. Located 1%' � � slry Avonwe" out�hold'.SCTM# 1000-70-9-56 G��,n r✓l i��ed-Gt� dcl 5F e__ 9J1� y J °,! atiPsq 0t'/'h., " Il,,.r '' ",�F�,�w n w rm v ++t ww�n�,9 �M�'„�,N'nnaw; '�r d�„r''P q � tl.�:�^f � �'�'+� r��°� w„°"'I ...r„ �°�'4�'n �� ,J tH�, ,(k,�•2 ��° ��dosr;;r" ,py",..r � J -w��,"� yr J'J I„"N;r,:�',.z ,m., wi,^ d, � r, i r � ,kt bow Iv f� ,Ivy Wll r �,, �,r� »� nd� � ^ l;p, - ..?✓ _;., e I p rIY gvrr,fr ,,, dw y�fi� � „�r;„h G3y,��"` iX �,», r3 >q V 4 ro dg fi^f✓,� 'r r wua ,u gi�na.., dY ,« y" r w'x^n"" I,CvGu r �b ,.�_m. �,Ir qd ruJr,„, e62r I ,n' ,"x rf .+�. J�i / a r , I BOARD OF SOUTHOLD TOWN TRUSTEES nw SOUTHOLD,NEW YORK r° ry at F �✓� N �t"o yi ty � PERMIT NO. 10574 DATE: MAY IS,, ISSUED TO: WILLIAM & MARI.AM HALLOCK �rlh rM�yl f, f;Y / � PROPERTY ADDRESS: 1230 C"LEARVIEW AVENUE SOU'I"HOLD y 1 SCTM# 1000 70 56 r AUTHORIZATION ' Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with theResolutionof the Board of Trustees adopted at the meeting held on &��la_y; .Zt- 4,and in w, ,t consideration of"application fee in the scum,of l 50.,�tLQ paid by�U!W &Mariam �'lallock and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board ofTrustces authorizes and perm its i � r k the following: i Wetland Permit to install a proposed 16 2 in-ground swimming pool with a 1 wide J ��n iN7yUr�4 9• P p g pool copingsurround; a 660s ft. pool patio surround; 4 high ool enclosure fencing; a pool �4 drywel:l for backwash; pool equipment area; and the area seaward of the pool fencing i a to be established and perpetually maintained as a non-disturbance buffer area; with the ����r� �N N� r r condition of a two-to-one tree replacement; all as depicted on the revised site plan � i "� � �. d prepared b John Gallacher� Land Surveyor, received on April 17 2024 and stam e nr r ,. approved on April 17, 2024. I 91 a �, IY AW IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, ; i r and these presents to be subscribed by a majority of the said Board as of the day and year written above. �� �. �..... .. .. .._ ------- - v'w�l w '4V S", � AS � a r � l AW I ri" tj r ; /i f � a ,,,., R u"!� ,E 1, If t w~w ,,;°nh, °��..,o. °4 rW," ,�, ,b.:,ft1W'�� '.f'� ,d r ^," > ,;�qw I ✓y+ ;, rq�' ay,;���'q� ,/�i�i I 6,�°,. „i Cm y� o if �a°i �°�r "' ryi, a,,, ly�:, rr ;+k, ,;�,q �1 � r�,�„, ,�i J �„ IV��IG �' ,� C ,✓�Ild,�udl -:r^gm~44°�i ,✓",,.,,^,,, ru-„ ,,, , M„ P i, aw W,�Wfi�4u��,�'f"°N // �:� roah',����a r 1 �a✓"� �r� ����rR:, e� J ���"� '.fr ,..,, � '��� ,�f�y,• NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY @ Stony Brook,50 Circle Road,Stony Brook,NY 11790 P:(631)444-03651 F:(631)444-0360 www.dec.ny.gov November 13, 2024 William Hallock 1230 Clearview Avenue Southold, NY 11971 Re: Application #1-4738-04787/00002 Hallock Property: 1230 Clearview Avenue. Southold, NY 11971 SCTM# 1000-70-9-56 Dear Permittee: In conformance with the requirements of the State Uniform Procedures Act (Article 70, ECL) and its implementing regulations (6NYCRR, Part 621) we are enclosing your permit for the referenced activity. Please carefully read all permit conditions and special permit conditions contained in the permit to ensure compliance during the term of the permit. If you are unable to comply with any conditions, please contact us at the above address. Enclosed is a permit sign which is to be conspicuously posted at the project site and protected from the weather and a Notice of Commencement/Completion of Construction. Sincerely, A.f-i� Heather Leonard Environmental Analyst Cc: BMHP File 4NOi� artrn nt ,r AT Environmental Conservation NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Am Facility DEC ID 1-4738-04787 PERMIT Under the Environmental Conservation Law ECE ermtttee and Facility Information Permit Issued To: Facility: WILLIAM HALLOCK HALLOCK PROPERTY 1230 CLEARVIEW AVE 1230 CLEARVIEW AVE1Sctm# 1000-70-9-56 SOUTHOLD,NY 11971 Southold,NY 11971 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Facility Principal Reference Point: NYTM-E: 716.15 NYTM-N: 4547.554 Latitude: 41°03'01.9" Longitude: 72°25'41.0" Project Location: Water- Goose Creek Canal Authorized Activity: Install in-ground swimming pool, patio, fencing, drywell,and pool equipment area. All work shall be done in accordance with plans prepared by John Gallacher, last revised 10/24/24 and stamped'NYSDEC Approved'on 11/13/2024. HWL Permit Authorizations Tidal Wetlands- Under Article 25 Permit ID 1-4738-04787/00002 New Permit Effective Date: 11/13/2024 Expiration Date: 11/12/2029 NYSDEC Approval By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the ECL,all applicable regulations, and all conditions included as part of this permit. Permit Administrator:SHERRI L AICHER,Regional Permit Administrator Address: NYSDEC Region 1 Headquarters SUNY @ Stony Brook150 Circle Rd Stony rook,NY 11790 - 4 9 Authorized Signature: 4A, Date Distribution List Bureau of Marine Habitat Protection Heather Leonard File Page 1 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-04787 Permit Components NATURAL RESOURCE PERMIT CONDITIONS GENERAL CONDITIONS, APPLY TO ALL AUTHORIZED PERMITS NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS NATURAL RESOURCE PERMIT CONDITIONS - Apply to the Following Permits: TIDAL WETLANDS 1. Post Permit Sign The permit sign enclosed with this permit shall be posted in a conspicuous location on the worksite and adequately protected from the weather. 2. Conformance With Plans All activities authorized by this permit must be in strict conformance with the approved plans submitted by the applicant or applicant's agent as part of the permit application. Such approved plans were prepared by John Gallacher, last revised 10/24/24 and stamped 'NYSDEC Approved' on 11/13/2024. 3. Notice of Commencement At least 48 hours prior to commencement of the project, the permittee and contractor shall sign and return the top portion of the enclosed notification form certifying that they are fully aware of and understand all terms and conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be signed and returned, along with photographs of the completed work. 4. Precautions Against Contamination of Waters All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended solids, sediments, fuels,solvents, lubricants,epoxy coatings, paints,concrete, leachate or any other environmentally deleterious materials associated with the project. 5. No Construction Debris in Wetland or Adjacent Area Any debris or excess material from construction of this project shall be completely removed from the adjacent area(upland) and removed to an approved upland area for disposal. No debris is permitted in wetlands and/or protected buffer areas. 6. Storage of Equipment, Materials The storage of construction equipment and materials shall be confined within the project work area and/or upland areas greater than 75 linear feet from the tidal wetland boundary. 7. Clean Fill Only All fill shall consist of clean sand, gravel, or soil (not asphalt, slag, flyash, broken concrete or demolition debris). 8. Materials Disposed at Upland Site Any demolition debris, excess construction materials, and/or excess excavated materials shall be immediately and completely disposed of in an authorized solid waste management facility. These materials shall be suitably stabilized as not to re-enter any water body, wetland or wetland adjacent area. Page 2 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION da Facility DEC ID 1-4738-04787 9. Wood Preservatives a. Pressure treated wood used for construction of in-water structures must have undergone a treatment process approved (stamped or otherwise marked as certified)by the American Wood Preservative Association. b. Wood treated with Pentachlorophenol (PCP) must not be used in marine or brackish waters. Wood treated with PCP must be aged in the open air for at least three months prior to in-water use. c. The use of creosote treated wood is prohibited both in the water and upland areas. d. Chromated Copper Arsenate (CCA)pressure treated wood must be clean and free of CCA surface deposits. Wood with surface deposits must be washed for at least 5 minutes under running water prior to use. The washing must occur greater than 100 feet landward of any regulated wetland and/or water body. (Note "E," below for handling wash water.) e. Any wood debris such as sawdust or wash water must not enter any water body, including wetlands or protected buffer areas. 10. Install, Maintain Erosion Controls Necessary erosion control measures, i.e., straw bales, silt fencing, etc., are to be placed on the downslope edge of any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to be maintained in good and functional condition until thick vegetative cover is established. I I. Area of Disturbance for Structures Disturbance to the natural vegetation or topography greater than 25 feet seaward of the approved structure is prohibited. 12. No Drywells in or near Wetland Dry wells for pool filter backwash shall be located a minimum of 100 linear feet landward of the tidal wetland boundary. 13. No Pool Discharges to Wetland There shall be no draining of swimming pool water directly or indirectly into wetlands or protected buffer areas. 14. Direct Runoff Away from Tidal Wetland and Buffer Roads, driveways, and parking areas shall be graded to direct runoff away from tidal wetlands and protected buffer areas. 15. No Disturbance to Vegetated Tidal Wetlands There shall be no disturbance to vegetated tidal wetlands or protected buffer areas as a result of the permitted activities. 16. Seeding Disturbed Areas All areas of soil disturbance resulting from the approved project shall be stabilized with appropriate vegetation (grasses, etc.) immediately following project completion or prior to permit expiration, whichever comes first. If the project site remains inactive for more than 48 hours or planting is impractical due to the season, then the area shall be stabilized with straw or hay mulch or jute matting until weather conditions favor germination. 17. Incidental Disturbance to Vegetation It is the responsibility of the applicant to remedy any incidental disturbances resulting in damage or removal of wetland vegetation. Upon completion of construction activities,any disturbed areas shall be planted with the appropriate marsh vegetation. Please contact the Bureau of Marine Habitat at(631)444-0295 for more information. Page 3 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION a Facility DEC ID 1-4738-04787 18. Establish Vegetated Buffer To protect the values of the tidal wetlands, a permanent vegetated buffer zone shall be established. There shall be no disturbance to the natural vegetation or topography within an area extending 20 linear feet landward of the tidal wetland boundary. 19. Long Term Plant Survival The permittee shall ensure a minimum of 85%survival of plantings by the end of 5 growing seasons. If this goal is not met, the permit holder shall re-evaluate the restoration project to determine how to meet the mitigation goal. The permittee must submit these re-evaluation plans to the department for review along with the annual report for that respective calendar year. The report must be submitted by January 15th of each calendar year and sent to: NYS DEC -Region 1 Bureau of Marine Habitat Protection,Attention Compliance 50 Circle Road Stony Brook,NY 11790 20. Contain Exposed, Stockpiled Soils All disturbed areas where soil will be temporarily exposed or stockpiled for longer than 48 hours shall be contained by a continuous line of staked haybales/ silt curtains (or other NYSDEC approved devices) placed on the seaward side between the fill and the wetland or protected buffer area. Tarps are authorized to supplement these approved methods. 21. State May Require Site Restoration If upon the expiration or revocation of this permit, the project hereby authorized has not been completed, the applicant shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may lawfully require, remove all or any portion of the uncompleted structure or fill and restore the site to its former condition. No claim shall be made against the State of New York on account of any such removal or alteration. 22. State May Order Removal or Alteration of Work If future operations by the State of New York require an alteration in the position of the structure or work herein authorized, or if,in the opinion of the Department of Environmental Conservation it shall cause unreasonable obstruction to the free navigation of said waters or flood flows or endanger the health, safety or welfare of the people of the State, or cause loss or destruction of the natural resources of the State, the owner may be ordered by the Department to remove or alter the structural work, obstructions,or hazards caused thereby without expense to the State, and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other modification of the watercourse hereby authorized shall not be completed,the owners, shall, without expense to the State, and to such extent and in such time and manner as the Department of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and restore to its former condition the navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on account of any such removal or alteration. 23. State Not Liable for Damage The State of New York shall in no case be liable for any damage or injury to the structure or work herein authorized which may be caused by or result from future operations undertaken by the State for the conservation or improvement of navigation, or for other purposes, and no claim or right to compensation shall accrue from any such damage. Page 4 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION da Facility DEC ID 1-4738-04787 GENERAL CONDITIONS - Apply to ALL Authorized Permits: 1. Facility Inspection by The Department The permitted site or facility, including relevant records, is subject to inspection at reasonable hours and intervals by an authorized representative of the Department of Environmental Conservation(the Department) to determine whether the permittee is complying with this permit and the ECL. Such representative may order the work suspended pursuant to ECL 71-0301 and SAPA 401(3). The permittee shall provide a person to accompany the Department's representative during an inspection to the permit area when requested by the Department. A copy of this permit, including all referenced maps, drawings and special conditions, must be available for inspection by the Department at all times at the project site or facility. Failure to produce a copy of the permit upon request by a Department representative is a violation of this permit. 2. Relationship of this Permit to Other Department Orders and Determinations Unless expressly provided for by the Department, issuance of this permit does not modify, supersede or rescind any order or determination previously issued by the Department or any of the terms,conditions or requirements contained in such order or determination. 3. Applications For Permit Renewals,Modifications or Transfers The permittee must submit a separate written application to the Department for permit renewal, modification or transfer of this permit. Such application must include any forms or supplemental information the Department requires. Any renewal, modification or transfer granted by the Department must be in writing. Submission of applications for permit renewal, modification or transfer are to be submitted to: Regional Permit Administrator NYSDEC Region 1 Headquarters SLTNY @ Stony BrookJ50 Circle Rd Stony Brook,NY11790 -3409 4. Submission of Renewal Application The permittee must submit a renewal application at least 30 days before permit expiration for the following permit authorizations: Tidal Wetlands. Page 5 of 7 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION As Facility DEC ID 1-4738-04787 5. Permit Modifications, Suspensions and Revocations by the Department The Department reserves the right to exercise all available authority to modify, suspend or revoke this permit. The grounds for modification, suspension or revocation include: a. materially false or inaccurate statements in the permit application or supporting papers; b. failure by the permittee to comply with any terms or conditions of the permit; c. exceeding the scope of the project as described in the permit application; d. newly discovered material information or a material change in environmental conditions, relevant technology or applicable law or regulations since the issuance of the existing permit; e. noncompliance with previously issued permit conditions, orders of the commissioner,any provisions of the Environmental Conservation Law or regulations of the Department related to the permitted activity. 6. Permit Transfer Permits are transferrable unless specifically prohibited by statute,regulation or another permit condition. Applications for permit transfer should be submitted prior to actual transfer of ownership. Page 6 of 7 CERTIFICATE OF LIABILITY INSURANCE [2!!4Mn3 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,tits policy(tes,)mast have ADDITIONAL INSURED,proYlsions 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 endorseme s,. PRODUCER SPECIALIZED INSURANCE 8,SERVICES DIVE - - 204 RTE. 112 EMAIL °� ASHLEY SPECIALIZEDINSLI NCE.COM Ama�sr PATCHOGUE,NY 11772 Auto-Home-Business -etc. Ir�sulaE s AFrxolaosnr��cov�sRAeE �c INSURER A,ATLANTIC CASUALTY"INSURANCE CO 42846 INSURED INSURER B EXTRAORDINARY DESIGN INC INSURERC r 360 MONTAUK HWY INSURER 0 EASTPORT. NY 11941 INSURERS INSURER F: 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 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. INSR LTR TYPE OF INSURANCE POL7CYNUMBER I FXI� LIMITS Y Y DCLIRRENCE s 1,000,000 COMwAAIMS MAGDEE OCCUR L266000839 1 2/02/2023 2102/2024 =�I s s 100 00 NdED EXP oae 5,000 PERSONAL&ADV INJURY s 1 000 000 CAN L AGGR9GATE LIMIT APPLIES PER: 4ENERAI ADCREGATE 3 2 000 O'er PRO- PRODUcTS,COMPIOPAGO $ POLICY JECT ❑LOC i OTHER. BIpIEI3 L MI' AUTOMOBILE LIABILITY S ANY AUTO BODILYINJURY(Perparoon) W$ OWNED SCti1EDUI.0 BODILY INJURY(Per acatdent) $ AUTOS ONLY AUTOS OPE WNFD AL ITOOS ONLY AUTOSIRED ONLY $ $ UMBRELLALIAB H OCCUR EACHOCCLIRRENC'E $ EXCESS LUIB CLAIMtI @JIAOE AGGREGATE S DIED RETENnON& rIGIFtItERS COAfPTSNSATION A CERlMEMBER LIABILITY YIN ANYPROPRJEIORIPAD EMPLOYERS' R CU1MWE E.L.EACH ACCIDENT S NIA E.L.DISEASE-EA EMPLOYEES Joey ) IF ds$06bo under N 4elo E.L.DISEASE»POLICY LIMIT S RjPTIO_N OF DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K more space In"Ved) SWIMMING POOL-INSTALLATION OR REPIAR-ABOVE GROUND AND BELOW GROUND BELOW ARE LISTED AS ADDITIONAL INSURED AS PER WRITTEN AGREEEMENT INCLUDING WAIVER OF SUBROGATION: CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 ROUTE 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1179 SOUTHOLD.NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2016 ACO q CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD /7-100\*N4, NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12M I nysitcom CERTIFICATE OF WORKERS' COMPENSATION INSURANCE U00. N A A A A A 824379601 RICHARD ROSSI INSURANCE AGENCY INC 204 MEDFORD AVE PATCHOGUE NY 11772 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER EXTRAORDINARY DESIGN INC TOWN OF SOUTHOLD 360 MONTAUK HIGHWAY 53095 ROUTE 25 EASTPORT NY 11941 PO BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12438 153-5 788375 02/24/2023 TO 02/24/2024 1 Q/5J2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2438153-5, 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 POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JARED SCHAEFER EXTRAORDINARY DESIGN INC 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 ZCE FUND 4 DIRECTORINSURANCE FUND UNDERWRITING VALIDATION NUMBER:848832108 U-26.3