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HomeMy WebLinkAbout51688-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#: 51688 Date: 02/26/2025 Permission is hereby granted to: Domingo L Rodrigues 14 Titus Ave Carle Place, NY 11514 To: construct accessory structure as applied for. Premises Located at: 2350 Elijahs Ln, Mattituck, NY 11952 SCTM# 108.-3-5.16 Pursuant to application dated 01/14/2025 and approved by the Building Inspector.. To expire on 02/26/2027. Contractors: Required Inspections: Fees: Accessory-New Structure $530.00 CO Accessory $100.00 Total S630.00 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 littps,://www.soutliolcitownny.gov Date Received AP PLICATION FOR BUILDING I G PERMIT IEFor Office Use Only 2 PERMIT NO. � Building Inspector: r Applications and forms must be filled out in their entirety. Incompleteu11d11A Ou�olcly applications will not be accepted. Where the Applicant Is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: la/l/o24 Name: SCTM#1000- Mpg _ 3 D3rr1 i tl (ZOdlt c)25 0 Project Address: a_,50 fc.I=Al1's LANE MA".rV4 • My 11R52 Phone#: 5I G 3Jr i _ -� Email: QXfi b, 1 , cal Mailing Address: jL4 -Ti+cis ke Cane (Mace by I 1 i.q CORTWPERSOW" Name: Codonoes Mailing Address: i L4 -T&x5,J Aye (Irle P Iup- ICY 1 I 4,5-1 Phone M Email; �l 351 -0313 DESIGN PROFESSIONAL INFORMATION: Name: DAvic MA211INS (ARWIV" MAD Mailing Address: i8 M10TOWN l20 •e!at& PL&,F- • NV 11 514 Phone#: 631- 332 -3621 Email: dmQ AQx*IrEc-r,5 mADcam "CON,' , TO I,FQR A JONtr Name: QE�IN FAEt,co F[.AwI.Es3 ffA60n► INC. Mailing Address: p(),aov 1,09 Sm m+rouJN Ny • II184 Phone#: (03)_ 446 _ 9411 Email: pEU1N @ F�W�55 mAsoN �m DESCRIPTION OF PROPOSED CONSTRUCTION ©New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: []Other $ '20,000.00 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property: SIAI6LE FAmwy Owe"" Intended use of property: 61,E F'AMuy owlswAML Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-w D this property? ❑Yes R]No IF YES, PROVIDE A COPY. l9 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 buliding{s)for necessary Inspections.False statements made herein are punishable as a Gass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print n " �Uf`f�tfl(r S �oclric�c�e� ❑Authorized Agent RfOwner Signature of Applicant: 7 •1 Date: 1'21 1® Izq STATE OF NEW YORK) SS: COUNTY OF a"CAl ) 0 kO L 0 being duly sworn, deposes and says that(s)he is the applicant (Name of in idual signing c tract) above named, (S)he is the O LAI N E(L (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 Notary Pub iZBEL X r 1M.MARQUES Notary Public,State of New York PROPERTY OWNER AUTHORIZATION A!/A No.01MA6009473 (Where the applicant is not the owner) Qualified in Nassau County Commission Expires on June 29,20, 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 Town Nall Annex �„ °lug Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O. Box 1179 Southold, NY 1 1 971-0959 BUILDING III=PARTMNENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: l� i....� ��..,.,.. ,.�.... ._.__........�._�..�... Owner: Location of Property . r o ' . L rary . --Mk , ,.M . _.. ..........� Please take notice that the (check applicable line): v _ New commercial or residential structure (A"65or1.b ,5W xR*6J 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): WIT Truss type construction (TT) „ esr 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 (FR) Signature Name (person submitting this form): . _ Capacity (check applicable line): Owner �C Owner representative (AWu Iroci) TrussReg15.docx Effective 1/1/2015 s :'I /i///°r//iH! /i fr,�lriia,lr JY�rlfdrrgji4rr(r�(l f�d�J {./P,iWd� �i�"�r/.��/f-rjf��. it it ��w'•sl �� }... �I,.. W r/ / {r r""'�WIvrY"IGI�I`A1rAU/ �Fln lr I r A!✓0r�,+, "l I�r�l/r l�s��(dl�� � ! r/.� �J ��f J �Jf, ul✓{i�r/�/���i>"in�f�pryy�rkriA�J,'+/iev(�(,�f����Ti uulf� rYifr7d'�', ` ".,!!ri i� i, �!�r lIY I�Y�/� d (,. / r" ri/r �..afb/,(rr////I�rir✓�jf/���titf%/lrY��li`�ii'�r��1I r�i�r?'d7 I Ir ��n/' �( l.. r � /irr / / ✓rW,r'���,a�r ��/�ll (t�in✓✓�f r � �� r I f r i / � , ,e r�rlM,/FF,(�rr�rrr��xv'`�'✓r?���t',�i�� r f���I� ��, � ,r;<��i �ll � /�� r /r /> rfd/;✓/l /i!l /fr r� �I �/f'➢Yh �i ✓ Y!�✓�'I °,/'I°j�//ry//W� rl r,�� ( I r/n rl �`rr r�2'/�;ri%/r ern YiM�/�� ;, dr � l�✓¢;l G� ��/ r /ti r /u �rr1/rl7//✓lr%�,!�'�'�/>�/�r����r�1 f� r 17 ��/ �/� // � rr v/lrrrt/ r� nr/1�rf���y/dw✓%�Ilr i,� �(rw 1 �'>' r �l���/���r/w i r'/J ��/virn/rnrrnlp�I Y oFlr rl� I Jvr, ��I �/f(r,�A� e I / w ti ✓ r llY to�r✓1"il� �Yrl� / �17 ///�Mr r, �� I H`r/ �i / ( YfyN�r���/�Ar��/�yf%Y''Y�✓ �� { I DI rr ��/rt��" ��i� i /i// � nr �r����✓��y p�l,� 1 � I �yaY r/ ������ r/", r rrl ✓���%f��/i "�`hJI �I✓w�yrfjy(lor I r I r (�/ / r 1 r r r r /ri/ eF l r✓w'�ri l r /Irvr�// r // r rid.�J✓//i�� lr crii ir/,' ��lf�ry��/���/�/���%//� I / ' , Wy./%r Jry r/p ri�/r/H✓/� I���jl Wi�rr%�/i%�����/n W��li�� 1� r✓ry r GGi r� rr'%%lJl/ 1� 1 r r/r0''/i / /v` /��% a / /l; a�✓ryr�i //l / � / r/o //i�rr /rr /�r� ��/ , - -- / fir/ / r r/� ✓Jf //% � /����/���✓ lJ/. r/rm//rli /D/� f � �%/ �r i r/Mid✓�lr�r/i p �, �'� fii t/Yi"j jri ai/i�✓iJ1��rl/ rJ/ r// J I �'✓. l9% /� Jr " This certifl® barer *s day by the ��✓gill//1� /��r„ 1 w „�;-r; rri,/l% /i%j����///j/�A���r������;1 J✓J�'' � m �yY uuu ia� ✓ al I q ri rMror r rri�f Il / rl ? /I r I/n ✓H Mr Jr rr rulrG// /! ,r/ lrrr✓i /✓r �r �r/rlli/i�/ � , t CERTIFICATE OF LIABILITY INSURANCE DATE / 01/04l04/2024 Y' 024 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 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 endorsements. PRODUCER James Winter/ITKathryn Pere t eFar James J Winter State Farm Agency PHONE 631.981 1000 FAX 63 CONTACT NAME ____ AA, s ' i Il im 1.648.9511 312 Lake Avenue Kathryn@JamesJWmter.Com A pP Saint James,New York 11780 INSURERS AFFORDING COVERAGE """," """"" ,.,, ._ NAIL#"„ ,,,, _ INSURER A: State Farm Mutual Automobile Insurance Company 25178 INSURED ........... .... ..."" "" ." .. """" .. .... ...... ..�"""""......a- INsuRER B; State Farm Fire and Casualty Company 25143 Flawless Masonry Inc. INSURER9 POBOX 1284 INSURER.D..w...........................................� .........................."""........."""""""""""""....� Smithtown, New York 11787 INSURER E r 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. _"Ask aI� ......,...........___......_._....._.. ,. , O CY'EF� POLICY EXP LTq TYP.E OF INSURANCE POLICY NUMBER POLICY Myy ....._.."LIMITS .."._ ....�,. COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 E8M� '"RFC 100,000 CLAIMS-MADE ®OCCUR PREMMSE ,(.V p.,g��an„;q; _ �.....5�.�� ...".�. ED EXP(AnX one person) $ B 92-C8-Z633-1 02/2212024 02/22/2025 ERSONAL&ADV INJURY $ 1,000,000 NERALAGGRE GEN'L AGGREGATE LIMIT APPLIES PER: GE """."....."..... gREGATE $ 2,000,000 POLICY u PRO LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTIHER' $ AUTOMOBILE LIABILITY 279 2072-618-32 02/18/2024 02/18/2025 COMBINED INGLE LIMIT g 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A OWNED INJURYBODILY (Per accident) $ -.-_, HIREDROS ONLY AUTOS NON-OWNED (WNED RfdPtRT DAMAGE,,..� SCHEDULED AUTOS ONLY AUTOS ONLY -I� $ H OC UMBRELLA LIAB C OCCUR EA_ CURRENCE $EXCESS LIAB CLAIMS-MADE AGGREGATE $ D E D ,RETENTION$ WORKERS COMPENSATION PER OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE D? E"L FJaCH AE�EA EMPLOYE $ -AND EMPLOYERS'LIABILITY YIN STATUTE ER OFFICER/MEMBER EXCLUDE N I A -^ (Mandatory in NH) E.L.DISEASE- $ . yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY " " LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) "masonry" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Suffolk County Department OF Labor, ACCORDANCE WITH THE POLICY PROVISIONS. Licensing&Consumer Affairs AUTHORIZED REPRESENTATIVE PO BOX 6100 Hauppauge,New York 11788 I ©1988-2015 ACORD CORPOYZATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 Iry Workers' Air Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of Insured(use street address only) lb.Business Telephone Number of Insured Flawless Masonry,Inc. (631)366-3512 dba Flawless Masonry,Inc. PO Box 1284 lc.NYS Unemployment Insurance Employer Registration Number of Insured Smithtown,NY 11787-0895 Work Location of Insured(Only required if coverage is specifically Id.Federal Employer Identification Number of Insured or limited to certain locations in New York State, i.e.a Wrap-Up Policy) Social Security Number 743101133 2.Name and Address of Entity Requesting Proof of Coverage(Entity 3a.Name of Insurance Carrier Being Listed as the Certificate Holder) Continental Indemnity Co. Town of Southhold 3b.Policy Number of Entity Listed in Box"la" Building Department 54375 Route 25 46-491671-01-09 Southhold,NY 11971 3c.Policy effective period Attn:Project Manager 09/30/24 to 09/30/25 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box "la"for workers' compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Item 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"2'. 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 IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured ftom the coverage indicated on this Certificate.(These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one 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 certificate holder. This certificate does not amend,extend 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 Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. 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 the coverage as depicted on this form Approved by: Todd Brown (Print name of° Iaori:red representative or licenced agent of inf;tnn annn:e carrier) Approved by: ..... 12/12`2024 (Signature) (Date) Title: Authorized Representative _...... Telephone Number of authorized representative or licensed agent of insurance carrier (877)234-4424 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov Area= ,W�f IX t t FP N/ fD 1 ,h. "'I" VkN 40,892 sq.ft. � ' bAll f Y tl C 0 I 0.94 acres .'d. � tl f PN .'i P r"f .A n1r 6 Y RR1'G9 G ❑F.RV.Tk ,"� s a r rd� rrn r war r r ,r,Pru„P „Opau�W qdb vl.f 4,"n,,�.PV,xrnYf�:mflP. P.ffA pY.r';:Yi ....ArtEO! ',muk^'}µ �l'' P pry Prt,,,M1 i a a � w.r„m. � ✓3 ff1 r AF P".i AONF �--a. 11 , "wa IVA . 1 I No a Cto, owl 0 k �4a b a NVO '-'464,0 i °a,au'P:err rrx N)i l VC �'C,t CYYC'R!' Ch V$ Hr 9r�ei�rnn s;°'r ��m�eT GPIr. �,;oim e�a,,," Survey of Lot 12 r ory, a!„701e;4c�.;". I PrI,Y�s Y'�illrAfk.�r Mattituck Town of Southold r�,otr �ervr�r�d, ��r Suffolk County, New York Tax Map #1000-108-03-5.16 n p� Scale 1'= 30' Jan. 19, 2024 GRAPHIC F ,. y I Ma,GB. &knbtt P�4MJFS °Sm;ffiPown, OdeP,. 'f fl787 r e� r<