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HomeMy WebLinkAbout51712-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#: 51712 Date: 03/06/2025 Permission is hereby granted to: Tabibzadeh M Trt 3 Aldgate Dr W Manhasset, NY 11030 To: Construct an inground swimming pool accessory to an existing single-family dwelling as applied for. Pool and pool equipment must maintain minimum rear and side yard setbacks of 10feet. Premises Located at: 490 Willow Dr, Greenport, NY 11944 SCTM#33.-6-4 Pursuant to application dated 01/28/2025 and approved by the Building Inspector. To expire on 03/06/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $1.00.00 Total $400.00 ��� Building Inspector TOWN OF S®UTHOLD—DIJILDING DEPARTMENT Town Hall Annex 54375 Main Road P. ®. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 htt. ;�/ " ".southojdtownn . o Date Received APPLICATION FOR BUILDING PERMIT Qa For Office Use OnlyC PERMIT NO. 519 2 Building Inspector, i Town of So uthold ApPlitjn ,and forms �be fblld rrr they �° I ncomplete e �� , Ii tlbhs i ll f at be ff l;(( Iti g the A0,00 not the owner,an Owner,,s Aawil ut(atlon r�( 4g It ill be cblih l t � Date: /-15-26- OWNER(S)OF PROPERTY: SCTM# 1000- 33 _ Name: Mak-m A M i �A Project Address: /po W:llow Uzlve' R&n Phone#: v�b-1�5�-QS � Email: Mailing Address: 3 ��� lvC t ( � CONTACT PERSON: Name: Mailing Address: �' ( ���1 Jaiee P �17� Email: 6)F�Fk ce- . PjD/5, eD,-, Phone#: DESIGN PROFESSIONAL INFORMATION: �. . Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: : o Mailing Address: q?a P,}- 2S-A J41 1 l 1cp 117( Phone#: 6)-7q(�--7��S I Email: }t-ftL' d) DESCRIPTION OF PROPOSED CONSTRUCTION p molition Estimated Cost of Project: ❑Neva Structure ❑Addition ❑Alteration ❑Re air ❑De $ Other It"l t. a i s [--]No C dC�q �l1 �p q Will excess fill be removed from premises? ,Yes El No Will the lot be re-graded? gYe . 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)KNo IF YES, PROVIDE A COPY. The design fessional is aePtar b of theV. t ON IS H CLOY MADE to the Su� i tleflolt Department for the ISIUM0 water ssuanre Of Outlrtin Permit pu uarmt to the zone ap 4iijarte oftherown of Southold,Suffolkdcoupty,New York and other applicable LAWS,Ctrdtnartcax or f aflons,for than construttion of hult4i�, additl ns,aalterarttor sr r,for removal of otmiollhon as herein described.The applicant aptrees tO corn y with all p lloble lam,ordinances,buftdin die, housing tode and r uwfat M and to a�wt authorized Inspectors on premises and buildindtsf for westarY intp�ons.False�stat rents made herein are Punishable as a class A rnlsder�iuean" ant to Section 110AS of the New York state penal IAA, Application Submitted Ry(print name): M al-,) )0-6�074J-41 ❑Authorized Agent ,Owner Signature of Applicant: Date: �—Aa 2S STATE OF NEW YORK) SS: COUNTY OF ) Qn �G��b ��1 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 / /day of r1lU _ _ >20 Zak ota Public MAR GARE F A. KIDNEY Notary Public—State of New York No. 01 K1602I I I I Qualified i.n Suffolk County RI ) AUTHORIZATION My Commission Expires March 8,2027 (Where the applicant is not the owner) 1 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 DATE(MMIDDNYYY) A►C+0R" CERTIFICATE OF LIABILITY INSURANCE 12 12t2024 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(les)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. WNIAVI PRODUCER NAME: Rebecca A�IInaS Liberty Risk Management, Inc. F4_MNq.Us _. ww .,J, ) 69 s36 .. ... . 2333 Route 112 ILs$ rklccalibert+rltlk orb B _ ....... Medford, NY 11763 INSURERJS)AFFORDING COVERAGE , INSURER A: _ „P m -y Si"" .............----............. .....�..aa..�...__........,.,.,.,.,,,,,,.........�.�.._w_................--���........._..._..._.._....._....._._._. __ww_.w._._.....,.m_�l���w..V_ fsurance Com. Man � ........._ ._............_._,..._.................. . INED INSURER ArthurJ. Edwards Mason Contracting Company Inc. �......B_............_�w�__��.__.........................­_._.,,,,,—„__.w.__-----------------,,.-ww______...........,_.._ � ..__...w,_�.. DBA:Arthur J.Edwards Pool &Spa Centre „iNsuRERc _. ....ww..__ _........................._.. _www._._......._.........w 929 Route 25A IlrsuR t D: __.............. w,....__w_............................,.. __w ._........_._.......... ... w..... Miller Place, NY 11764 INSURERE -„ .-w-w-, INSURER F COVERAGES CERTIFICATE NUMBER 00000005-0 REVISION NUMBER. 63 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. Fi iQ ..........._..TYPE OF INSURANCE_ww..........._...,-._,. 61 .,,..__.......POLICY NUMBER ..... "Mp"Ql.1C'�ETFKK Lt�'1C 1�'-w.ww. ,,,-,......._..................M..,,,,.,.._.LIMITS ,�...w.._...,..._,...,.,.,,,.w..._.. LTR A X COMMERCIAL GENERAL LIABILITY Y NPC-1004300-04 111/2025 1/1/2026 EACH OCCURRENCE $ 1.000.000 CLAIMS-MADE FRI OCCUR PRF�M( w(y�?gnrcE) w $ 100000 MED EXP(And one person) ...$ W S,OOOm_ .-www ......_.,,-,,.__...wwww_...._,,._mmm-w---w-w_._�,�,• PERSONAL&ADV INJURY $ 1 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2p000,O00 POLICY PRO PRODUCTS COMPlOP AGG $ 2 OOO OOO .- ❑X JECT LOC ..,m.ww-ww ..,,,-..w...-.._.... a,.-.......wwsw_........— OTHER: AUTOMOBILE LIABILITY COMBINED SINGL BIN ;l..Iw_N............ $ ..__..,,..,..w.,.»......._................ ANY AUTO BODILY INJURY(Per person) $ _................. w . _............. ..... OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ----------„ ^.,..•------^__---...-.,.,,,,,,,,, HIRED NON-OWNED ' OFER&YL>AMtAGE. AUTOS ONLY AUTOS ONLY Pfkt a d $............ ..m...w _.m UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ..... ................ EXCESS LIAB .......�..............CLAIMS-MADE AG,GREGATE�.�w-www,.__...., $ w_.............. .....,_,,m,.w..,..._._...,.. ..,_w�.DED...�.F.,....RETENTION..$ __..,.-.-.... $ WORKERS COMPENSATION H _._.. UTE„ . R ....................... AND EMPLOYERS'LIABILITY ....................... ANY PROPRIETOR/PARTNER/EXECUTIVE Y N/A E.L.EACH ACCIDENT $ w ... ...H,._....w OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Ifyes,describe under ._.........,..�...__._.................w_..,........ .... w_....................,,..:,.....-......,. ..DESCRIPTION OF OPERATIONS below E„L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Town of Southold is included as an Additional Insured,ATIMA,as requried by written contract and subject to policy terms, conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 8 B P.O. x 728 11971 AUTHOW11 RESENTATIVE SouRPA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by RPA on 12/12/2024 at 0B:15AM workers'Compensation CERTIFICATE OF INSURANCE COVERAGE �T ATg 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 carrier 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ARTHUR J EDWARDS MASON CONTRACTING COMPANY INC DBA: ARTHUR J.EDWARDS POOL AND SPA CENTER 6317440174 929 ROUTE 25A MILLER PLACE,NY 11764 Work Location of Insured(Onlyrequired if coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 11-2377925 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TO yy N ein O Listed as the SOUTHOLiD to Holder) Standard Security Life Insurance Company of New York PO BOX 728 3b.Policy Number of Entity Listed in Box 1a SOUTHOLD, NY 11971 Z06874-000 3c.Policy Effective Period 7/1/2020 to 6/4/2025 4. Policy provides the following benefits: ❑)f A.Both disability and Paid Family Leave benefits. Fj B.Disability benefits only. ❑ C.Paid Family Leave benefits only. 5. Policy covers: ❑X 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 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 d d above. 11 Date Signed 6/5/2024 By - I. , (Signature of insurance carrier's autitori representative or NYS licensed insurance agent of that insurance carrier) Telephone Number (212) 355-4141 NameandTitle SUPERVISOR-DBL/POLICY SERVICES 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 46,4C 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 413,4c or 5B of Part i has 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) III«� �wr� � �� NYSIFPO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ... 112377925 LEVITT-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FL TARRYTOWN NY 10591 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARTHUR J.EDWARDS POOL&SPA CENTRE TOWN OF SOUTHOLD ARTHUR J.EDWARDS TOWN HALL 929 RTE 25A P.O.BO 1179 MILLER PLACE NY 11764 SOUTHOLD NY 11971-0959 POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE G 2438 491-9 881298 06/29/2024 TO 06/29/2025 06/26/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2438 491-9, 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. 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 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,((SURANCE FUND UNDERWRITING VALIDATION NUMBER: 633467799 I IIr� III Ilrs Ill�rr m o w I 00000000001.2901 w.8'1llr 70 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-243849191 U-263 7 [00000000000129018175][0001-M24384919][##G][16418-05][Cet—NoP-CERT 1][01-00001] z_ MY __\ .<.- \ � - .�� zi Suffolk bounty Denartment of Labor, Licensing Consumer er Affal*rs p VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 �; � � = DATE ISSUED: 07/01/1978 No. H-4436 �. SL.TFF01X COU,NTY i Home Im rove ent Contractor .l icense This is to certify that ARTHUR J EDWARDS VW doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DB_A I SUPP t �o 14 having furnished the requirements set forth in accordance with and subject to the provisions of applicable S AN laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct 0 business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. y NOT VALID WITHOUT Restrictions Additional Businesses ° v DEPARTMENTAL SEAL E �-Ilbu NI HI -GC; ARTHUR J EDWARDS POOL&SPA CENTRE AND A CURRENT H26-Pools and Spas/Certified; v CONSUMER AFFAIRS H3-Pools/Spas ` ID CARD Suffolk County Dept.of � Labor,Licensing&Consumer Affairs IM HOME IMPROVEMENT LICENSE t Name ARTHUR J EDWARDS Business Name gg z ARTHUR J EDWARDS MASON This certifies that the CONTRACTING CO INC DBA(1 SUPP) Rosalie Drago bearer is duly licensed � I - by the County of Suffolk License Number H-4436 ` Commissioner IssLe 07101/1976 t � WDC_ommissioner Expires: 07/01/2026 \ s -�, mg � - ti. `\tip �_ - APPROVED AS NOTED TE.3 ~ -B.P 5 1 c COMPLY WITH ALL CODES OF D, " �� NEW"YORK STATE&TOWN CODES REC I ED AND CONDITIONS OF NOTIFY BUILDING DEPARTMENT AT Salflt(IU}TOMIN 631-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: FOUNDATION-TWO REQUIRED FOR POURED.CONCRETE Hm ROUGH-FRAMING&PLUMBING INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET 714E ELECTRICAL PEOUIREMENTS,OF THE CODES OF NEW INSPECTION REQUIRED YORK FATE. NOT RESPONSIBLE FOR DESIGN OR CONSMUCTION ERRORS 'I ENCLOSE POOL TO CODE UPON Comm.EMN BEFORE"WATER" RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE r- I New York State Law You Must Call 811 Before You Dig A OAkwkium T.Mir F. Pwnp To _ _ T.P.M ftgoOPU* PlowNk! _ Plan Piping . Arrangement WON Sedlon 42" 1 Bn1- NEW Section B— r P LU s Section A—A Typical Wall Section E- -11 SIZE A B C D E F G H AREA CAP - c I abibzadeh FEET FT FT FT FT FT FT FT FT SQ. FT GAL. MA�cn 15 X 30 11J5 30 10 12 5 3 3 9 450 15,000 &SPA CEN18B o V1�11�Q�J ��1u`e 16 X 36 16 36 12 PERMACRETEPOOL 14 6 4 4 8 576 21,600 WALL S M Greet)�Q� sic. 18 X 36 18 36 12 14 6 4 5 8 648 24,30Py 0 929 Route 25A Miller Place NY 117649ft 20 X 50 20 50 24 14 8 4 5 10 1000 34,000 (631) 744-7185 FAX (631) 744-0174 ) 4J 9"otram* 5�5 1 l 9qy z1ft emu 24 X 44 24 44 18 14118 4 8 10 798 35,000 Suffolk License #4436—HI 24 X 48 24 48 20 16 8 4 6 10 900 38,500 Nassau License #HI74450000 M 1, Irl I f j VM j e, I r�o FA n I "I B I',1� )all -11 AXA,;S 1 �`T f f) C'L,,'N1 r-�F,' ,(,'2, 7 1 IN" n M15i VVI-1110� 111, U N M/ Vh 'j, KA"/ 04 lu" A 473889 33.-6-4 239 17 3963 490 Willow Dr 0.57 W, M INK 349,275,904 2,912,706 210 1 1 Family Res 12/5/2023 900 5,800 n vk au'.","","R 235.....—AUI(Y-5-DIG IT 11030 Tabibzadeh M Trt 3 MdgiAe L)r W Nowaski, Joann mcqqjasse,t,NY 11030-3940 T�........................... r T CW First Half: 3965 2,983.25 1/3/2023 5/17/2023 5,800 �0.57% OF�'M' 1,017,5,14 Second Half: 3965 2,983.25 5353%' 5,800 1,118,866 6.50% 6,489A2 Greenport School 1.76% 5,800 36,719 2.00% 212:97 Greenport Library F ;1 ... ........ 55.29% Z� /.....I'..llpf"'11"."A 1.33% 5,800 27.901 Mo% 161.83 Suffolk County Tax SC Community College 0.09% 5,800 1,959 0.00% 11.36 RM, Mly, 17 3,19 & "A g /f 1.42% V D, �7 2029.63 16,74% 5,800 349.937 3.40%% Southold Town Tax Mg,11;1/1y1111X,01&1' IJ a 2,02�1 63 16.74 5,8010 0675 560% 192 M rA Payroll I ax 031% 5,800 0701 -16,E0% 4,07 Out of Cl. sccc 03% 5,800 1,5111 -76,10% 8.76 NYS Real Prop raxl-aw 001% 5,800 87�546 1.20% 507,77 I 19,yo 0.00% 2,606,31 E-W Protection FD 21 50% 0 14.928 -24A0% W58 Pro-Rata Assessment 5,800 0,71 Solid Wasie District 26.53% 3217.41 o"Aaw", /a jo 12,1,!2.62 6,061.31 6,06-11 31 VVI iW I M1 IIIINAL I V(I'I(.)MA,I,�1 fl�Aii 0�q��,()p �Wo 111,JSIAI N �Wl MUILE ANO Uffll',�N GOINAP R01 I EIR,�; '11,1 I-OR PEN"11- . ................