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HomeMy WebLinkAbout51691-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#: 51691 Date: 02/27/2025 Permission is hereby granted to: Hufflepuff LLC 544 Broadway Dobbs Ferry, NY 10522 To: legalize "as built" hot tub as applied for per Trustees approval. Premises Located at: 1580 N Bayview Rd, Southold, NY 11971 SCTM#70.-12-34 Pursuant to application dated 01/15/2025 and approved by the Building Inspector. To expire on 02/27/2027. Contractors: Required Inspections: Fees: As Built Pool/Hot Tub $600.00 CO mming Pool $100.00 Total S700.00 Building Inspector U6Vol ` « '� 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 httas://www.southoldtoE .gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only {E PERMIT NO, 51Building Inspector., Applications and forms must be filled out in their entirety.Incomplete 02- applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. p °m t,i w O'�P rt,m e' t m a i^ outhold Date:12/23/24 OWNER(S)OF PROPERTY: Name: SCTM #1000- HufflePuff LLC Project Address:1580 N Bayview ave southold NY Phone#: _ 767 32'/e�- Email: Mailing Address: `, ' 91 * Je acre - CONTACT PERSON: 11 Name: �Y`fl ,�� `"Iecr Mailing Address: Phone#: — 767-3 Email: � Ct<� DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:James Bissett Mailing Address:32 enterprise zone dr unit D Riverhead NY 11901 Phone#:6317673915 Email:Absolutepropertycareli@gmai.com DESCRIPTION OF PROPOSED CONSTRUCTION []New Structure ❑Addition ❑ ❑ ❑Alteration Repair Demolition Estimated Cost of Project: $ l�M Will the lot be re-graded? ❑Yes Flo Will excess fill be removed from premises? ❑Yes gNo 1 d Building Department Application AUTHORIZATION (Where the Applicant is not the Owner, I L I, CCuo��e� 'JcJJ' ?11 residing at SL'N (Print property owner's name) (Mailing Address) a� do hereby authorize * + (Agent) to apply on my behalf to the Southold Building Department. ( wner's Slrntitre (Date) (Print Owner's Namel Workers' CERTIFICATE OF INSURANCE COVERAGE qyN,TQE,WJ,TX, t"ompansation 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 ABSOLUTE PROPERTY CARE LLC 631-767-3915 36 BLACKBERRY LANE CENTER MORICHES,NY 11934 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations In New York State,Le.,Wrap-Up Policy) 661421258 WWW...W 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 54375 MAIN ROAD 3b.Policy Number of Entity Listed in Box"I a" SOUTHOLD, NY 11971 DRL723237 3c.Policy effective period 06/1212024 to 06/11/2025 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 7/12/2024 By (Signature offnsurance carriers authorized representatNe or NM Licensed insurance Agent ofthat fnsurance 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 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 4B,4C or 5B is checked,UVa cettiftcate.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 4B,4C or 513 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 benelifs 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) �IVII�IIIII�iIIIIIIIIIIIIIIIII1IIIIIIIIIIIIIIIIIIIII <E.W ICWorkers' CERTIFICATE OF T Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b,Business Telephone Number of Insured ABSOLUTE PROPERTY CARE LLC 631-767-3915 36 BLACKBERRY LANE 1c.NYS Unemployment Insurance Employer Registration Number of CENTER MORICHES, NY 11934 Insured Work Location of Insured(Only required lfcoverage Is specifically limited to 1d.Federal E oyppTn l � lon Number of Insured or Social Security certain focatlorrs In New Yorks afa,i.e.,a Wap-60 Pbftl Number II II iiff Enlll 'Bain Listed as the Certificate Holder Oder 2.Name and Address of EntityRequesting Proof of Coverage 3a.Name of I e C r ( y 9 ) TOWN OF SOUTHOLD 54375 MAIN ROAD 3b•Policy Number of Entit Listed In Box"la" SOUTHOLD, NY 11971 WWC37025 3c.Policy effective period 3/10/2024 _ to 3/10/2025 3d.The Proprietor,Partners or Executive Offkers are I] Included.(Only check box If all partners/officers Included) ® all excluded or certain partnerslofficers excluded. This certlfles that the insurance carrier Indicated above in box"3"Insures the business referenced above in box"1 a"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"21. The Insurance carrier must notify the above certificate holder and the Workers'Compensatlon 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 from the coverage indicated on this Certificate.(These notices may be sent by regular mall)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"3e,whlchever is earlier. This certlflcate 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: ERIC NOELDECHEN (P name of authorized representative or licensed agent of Insurance carrier) OW 10;000 LA Approved by: 5lgnature) (Dale) Title: PRESIDENT Telephone Number of authorized representative or licensed agent of Insurance carrier: 631-758-6780 Please Note;Only Insurance carriers and their licensed agents are authorized to issue Form G-105.2,Insurance brokers are NOT authorized to issue It. C-105.2(9-17) www.wcb.ny.gov � DATE(M"" & AC CERTIFICATE OF LIABILITY INSURANCE 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 pol)cy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the pokey,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). PRODUCER CONTACT NAME. SPECIALIZED INSURANCE&SERVICES PiIDNE FAX 31 204 RTE, 112 E»141AIL i .tL�l: ADiYREsy: ASHLEY@SPECIALIZEDINSURANCE COM PATCHOGUE,NY 11772 AIC N Auto-Home-Business-Cycle-etc. INSURERS AFFORDING COVERAGE N sNsuRER n:RT+ rrc cas�,az7r rnrsuRar�cF co 42s46 INSURED INSURER B: _ ABSOLUTE PROPERTY CARE LLC .INSURER c: _.�.._._. .� 36 BLACKBERRY LANE INSURER0: CENTER MORICHES, NY 11934 .. INSURERE: ..._............ 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. IN R AADDL SUGII POLICY EFF POLICY EXP T LIMITS TYPE OF INSURANCE POLICY NUMBER IDD M D COMMERCIAL GENERAL LIAB2fTY L266000581-3 3/10/2024 3/10/2025 EACH OCCURRENCE A Y N �ai5REtEiS CLAIMS-MADE ®OCCUR N�.S.. _ urmncr� $ 50�000 MEO EXP(Any one arson $ cJ 000 PERSONAL&ADV INJURY $ 1,000,000. _...... ......_...... .... GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000 000 _....... r POLICY a JECT LOC PRODUCTS-COMPIOPAGG $ NCIMED OTHER. $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ E ace ANY AUTO BODILY INJURY(Per person) $ OWNED PAUTOS SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLYHIRED NON-OWNED PROPERTYOAMAGI AUTOS ONLYAUTOS ONLY Per accldenl $ $ UMBRELLA UAB OCCUR EACH OCCURRENCEITITm $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ''..DEC RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY Y ANY PROPRIETOR/PARTNERIEXECUTNE ( N( p I A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? u (Mandatory In NH) EL DISEASE-EA EMPLOYE $ If yes,describe under _.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD teT,AddWonaf Remarks ScIvedufs,may ba aHactwd Irmore space Is negMredJ REAL ESTATE PROPERTY MANAGEMENT CERTICATE HOLDER AND BELOW ARE ADDITIONAL INSURED AS PER WRITTEN CONTRACT OR AGREEMENT CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 MAIN ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACO9b CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Glenn Goldsmith,President Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 P.O. Box 1179 Eric Sepenoski j§8 Southold,New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples ` Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 13, 2024 James Bissett Absolute Property Care -32 E-rderprise Zone D-five _ ..M.e _...,..m ., ... _..,.... _. Riverhead, NY 11901 RE: HUFFLEPUFF, LLC 1580 NORH BAYVIEW ROAD, SOUTHOLD VU SCTM#: 1000-70-12-34 +" Dear Mr. Bissett: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, June 12, 2024: RESOLVED, that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Wetland Permit#9808 to modify the pool layout to have a.25'x20' raised deck with a 7'x13' above ground precast pool attached to the existing deck; and a proposed free-standing 6.5'x7' hot tub on concrete slab 27' from bulkhead; and as depicted on the site plan prepared by Young Associates, received on May 15, 2024, and stamped approved on June 12, 2024. ny oth_er activit+.;-ith„n •Irn' Jf+ke wetland nni.r%r1_ n; n � ;r--. pa i+frown thi- eff!�n. .J - _. r,- .. JL - •�...•ua..:.0 ✓v.i: �.k.-�a...�- ..1 a Gi ti ii l�l lei :va:f - :vv. This is not a determination from any other agency.: If you have any questions, please call our office at (631) 765-1892. Sincerely, 411- 4" Glenn Goldsmith, President Board of Trustees 4O0 O.br-dar Aven P,v-h—1 Naw Yank IW01 _g®81 Gal.651.7272303 fax.551.727OfA4 88dd PF�I a�"� crRF Fes.f adnll®younyar ylnaarltg.eom ®a CfM1P R - Y\"CAS LaF£sYYEr I I 14 SITE DATA AREA=28,337 SQ.FT, 4 $ {`{ � "VERTICAL DATUM NAND(1938) APPROVED BY BOARD OF'I RUSTEES TOWN OF SOUTHOLD ate_ 4 z DATE e°4E7nGyyg N0, T - � :�3 SURVEYOR'S CERTIFICATION I gr WA#P9i£PAREo]1tA `R+€ W:It;r,EE 4F Ia14GfItT FOR LAI4 VSV5;ADu 3-r zST-1PF.A35&.Unomt _, c tali £ i€ •g 3 3 HOWARD W.s -.'it' SNOt 1 .' 3 O DANIELA.WEAVER,MYS LS NO.50771 '` r Cn SURVEY FOR CAROLINE BURTON at Southold,Town of Southold Suffolk County,New York sS cS;- PROPOSED !'1� I—PROPOSED 5 DE § EQUIPMENT y3 BUILDING PERMIT SURVEY LEGEND POOL 1000 70 12 33.1 x _•- `:f2p IDW 70 P2 33.2 �+ BBC =BELGIAN BLOCK CURB l ;; _ C..my Tax M¢p pno-Ft IO00 9e- 70 8mcb I2 Rey 34 ` BSW =BRICK SIDEWALK _ -6— 157 FIELD SURVEY COMPLETED MAR.06,2024 CUP =CHAIN LINK FENCE o CMF a CONCRETE MONUMENT FOUND _ MAP PREPARED A1AR 42.2029 CM5 =CONCRETE MONUMENT SET - ) .£ i DI =dtAINAGE11dLEP `� --- , Record of Revisions EOP =EDGE OF PAVEMENTll REVi5I0N DATE IPF =IRON PIPE FOUND �} MLF =METAL FENCE - .c_Is �L!! 1.1AY 1 S W OL =ON PROPERTY LINE °<* £ PAP =POST&RAIL FENCE 1 RO =ROOF OVER WIF =WIRE FENCE WSF =WOOD STAKE FOUND -46 4 1V 5 MISS =WOOD STAKE SET =UTILITY POLE =LIGHTPOLE 30 -_ -----0 IS 30 60 90 • =END OF bIRECTIONIDISTANCE Scale:1"= 30' 70B NO.202A-0023 DWG.202A-0023bp I OF I