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Home My WebLink About51697-Z 0to � 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#: 51697 Date: 02/28/2025 Permission is hereby granted to: Long GM 2017 Irry Trt PO BOX 1016 Cutchogue, NY 11935 To: Construct an unheated sunroom addition with basement foundation to an existing single-family dwelling as applied for. Premises Located at: 620 Ihar Ln, Cutchogue, NY 11935 SCTIVI#83.4-14 Pursuant to application dated 01/21/2025 and approved by the Building Inspector. To expire on 02/28/2027. Contractors: Required Inspections. Fees: Single Family Dwelling- Addition&Alteration $394.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $494.00 Building Inspector Act 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 https �-so thoidti r� o Date Received APPLICATION FOR BUILDING PERMIT ,`d 17 For Office Use Only '� '� 5I69 I PERMIT NO. Building inspector: A "020 f. , 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: i �a i k'L f - OWNER(S)OF PROPERTY: Name: Cr L,, ^y SCTM#1000- t3 I Project Address: k-�c 1ni� Li! J•L : , �l3 Phone#: l 7 G? 6 o Email: 41 Mailing Address: AVL er-, CONTACT PERSON: Name: Mailing Address: 11 -1_ 7 2— Phone#: 7 7 o Email: ws 4-w is- Q A4 4A . G6-� DESIGN PROFESSIONAL INFORMATION: Name: / t e LAWd Mailing Address: Sfi �cr�► ( � '� Z Phone#: G 3 ( ��n � I. Email /� (i� r�C CONTRACTOR INFORMATION: Name: Mailing Address: k- ric,I,— °k c✓l RL - - Phone#: 6 .-- ya Email: SU�ISc in DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ®'Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ ..2sCi LPv-:1 Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes I�No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ❑No IF YES,PROVIDE A COPY. ❑ Check Box Abe,Readi= 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 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 name): a,2vjc 6 Vc5e,,A6`r uthorized Agent ❑Owner Signature of Applicant: Date: 1 i t`Zq 1 STATE OF NEW YORK) SS: COUNTY OF ) C U being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above na , - (S)he is the (Con-ir-a-c—to-ri Agent,Corporate Officer,etc.) of said owner or owners,and is duly author zed to perform or have performed the said work and to ma a and file this #PkIftion;that all statements contained it this application are true to the best of his/her knowledge and belief;and that th&work will be performed in the manner set forth in the application file therewith. ,qMbefore me this _ ayof �� 20 �P Notary Public l NotW Public,Mete ofl Yak o.0ll?RiFIi21fr9E, 0=11 i tv�gxpir April l8,2028OWNER sere the applicant is not the owner) residing at Z� l�e.r t—,✓ (J�c�o tf do hereby authorize c� s Yew 6 to apply on my behalf to the Town of Southold Building';Department for approval as described herein. Owne s Signatur Date PrGt Owner's e 2 Albert J. Krupski, Jr. ? , < STORMWATER, SUPERVISOR 3 �VJ[A�N A\�Gr]El��/1[]EN�C SOUTHOLD TOWN HALL-P.O.Box 1179 ]� ] 53095 Main Road-SOUTHOLD,NEW YORK 11971 T Southold � = l oW n of CHAPTER236 - STORMWATER MANAGEMENT REFERILAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design Professional, Agent ontr Other) I ° t NAME: ;z,; o z >n.�,- Date: IPrmt- _ R S1 t ur Contact Information: , ,, ti T-Mail 9 Telephone:Number, �' I �-Z L I Property Address / Location of Construction Site: ao S.C.T.M. #, 1000 District Section Block Lot To BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ❑ n�leu o" n;�turl-an�e ;s Ic�s t' an ia cre. No a.P D E.c�. Permit is Required I t �iv L it - Project does Nnt Discharge to Waters of the State. No S.P.D.E.S. Permit is Required I ❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly tn Waters the State of Ne,.v York. THE APPLICANT MUST OBTAIN! a C F C Permit ., W�t,..., of ..... ...u.., .,. ..,,.. ,.N ,. ,,.P.A....,. DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Buildin Permit. ❑ - Area of Disturbance is Greater than I Acre & Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York, THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit through the Southold Town-Engineei-Mg Department Prior to Issuance of a Building Permit. Reviewed Bv: ,�� Date: FORM ' SMCP-TOS December 2024 /. Q"EW Workers' CERTIFICATE OF INSURANCE COVERAGE TATE 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 earlier 1a.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured BJR CORPORATION DBA SUNSCAPE PATIO ROOMS 631-265-2902 888 LINCOLN AVENUE BOHEMIA,NY 11716 1c.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) 810600075 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 BUILDING DEPARTMENT 3b.Policy Number of Entity Listed in Box"I a" 54375 MAIN ROAD DBL196971 SOUTHOLD, NY 11971 3c.Policy effective period 04/01/2024 to 03131/2025 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: m 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 employer's employees: Under penalty of per)'ury.I certify that I ant an authorized representative or licensed agent of the insurance carrier referenced above and that tfle named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 91 412024 By (Signature of Insurance carrier's authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number 51"2 81t 0 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 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 Box 4B,4C or Ss 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. oB-120.1 (12-21) INII�! i� ii�iiwiiii(i1ai- ��1� DATE(MMIDDIYYYY) A CERTIFICATE OF LIABILITY INSU CE 109/24/2024 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 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 pollcyl les)must be endorsed. if SUBROGATION MWAIVED,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. - CT 1010 t3lkOfske PRODUCER Brookhaven Agency,Inc. PHONE E,4.Lq11 941-411 6 ` 941 5 100 Oakland Ave,Ste 1 ism Certifioat9!gl3rookhavenMncy.com Port Jefferson,NY 11777 _ Arm s€ I INsuBW • Utica First Insurance Coln 1532 INSURED BJR Corporation dba Sunscape Patio Rooms 888 Lincoln Avenue Bohemia NY 117% 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. TYPE OF INSURANCE SUBR C2=NUMBER POLICY EFF DO EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1 000 000 A CLAIMS-MADE E OCCUR DAMAGETO 50,000_ AR73000795790 02N5/2024 02N512025 QED Fop A L ny 2m amon) 5,000 P �$ADV INJURY 5 1,000,000 EhrLAC RE TE _LIMIT APPLIES PER: ENERALAGG 2 000 000 POLICY LU JECOT- 1:1 LOC PRO _ TS-COMPIOP AGG 2 OOO,OOO AUTOMOBILE LIABILITYCOMA ED S�NN�aCE LIMIT $ ANY AUTO _ BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED $ PROPERTY DAMAGE HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB ES4iApE 62rzRg9ATg -- WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE NIA E L-EACH ACCIDENT OFFICERIMEMBER EXCLUDED? (Mandatory In NH) EL.DISEASE-EA EWL gYEE If e gEgW DNS below s,describe under EL.SJISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached IT more space Is required) 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 Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Rd Southold,NY 11971 AUTHORIZED REPRESENTATIVE <P 12014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /70%'N NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 810600075 BJR CORPORATION T/A SUNSCAPE PATIO ROOMS 218 CEDAR AVE SCAN TO VALIDATE PATCHOGUE NY 11772 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER BJR CORPORATION T/A TOWN OF SOUTHOLD SUNSCAPE PATIO ROOMS BUILDING DEPARTMENT 888 LINCOLN AVENUE 54375 MAIN ROAD BOHEMIA NY 11716 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11350 592-0 218868 04/01/2024 TO 04/01/2025 9/24/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1350 592-0, 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/CERlrVAL.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 BRUCE ROSENBERG SECRETARY STACEY ROSENBERG OF BJR CORPORATION T/A SUNSCAPE PATIO ROOMS 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 4 */ DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:24784861 U-26.3 LOT AREA =419�850 SO. FT. 99-169 99-132 a o IHAR LANE (47.7) ' N.51°00'00'"E. 8 3.98' sg 24 r.t 0` S.39oWOO-E. % % 25.00' et 1A ' r seff N,51°00'OO' 82:53 s 00_ O 3 % p tk 0 w a o 00 0 0 ems" aD p o �l.s; 0 z d ° Ul r tn Y j O 56.4' P-W GAR, 2-STY. 5 COVERED PORCH FR. O DWELL. J "Y 0 J 0 2 D O 0 to li 0 l0 z wel l 00 O z � 3 w OO N 8 0 p1 O z vi set set stk S.51°00'00"W. 173.50 stk 5-27-1999 STAKED PROPERTY CORNERS LOT NO. 17 TOWN OF SOU T H O L D 4-22-99 FINAL SURVEY 2-10-1999 LOCATE FOUNDATION CESSPOOL 8 SEPTIC TANK 8 WELL LOCATIONS L2_15-98 REVISED ROOSE BY OTHERS 3-3D-9B RE115FD F+ovsE JOB NO. 97— 269 FILE NO. WOODBINE MANOR SURVEYED FOR LOT NO. 14 MAP OF WOODBINE MANOR SITUATED AT C U TC H O G U E TOWN OF SOUTHOLD -SUFFOLK COUNTY NY SCALE 1" = 50' DATE 7 — 23 — 199 7 FILED MAP NO. 8239 DATE.12 — 15 — 198°6 GUARANTEED ONLY TO TAX MAP NO. 1000 -83 —4 - 14 (REF. ONLY) DISK 17E GARY M.8 LINDA M.LONG RIDGEWOOD SAVINGS BANK HAROLD F. TRAMCHON JR. P.C. COMMONWEALTH LAND TITLE INS.CO. LAND SURVEYOR 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 N.Y. LIC. NO. 048992 516-929-4695 HAROLD F. TRANCHON JR. PENN. LIC. NO. 21115-E