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Home My WebLink About51713-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#: 51713 Date: 03/06/2025 Permission is hereby granted to: George T Brunn 69 Accabonac Rd East Hampton, NY 11937 To: Construct an inground swimming pool accessory to an existing single-family dwelling. Pool and pool equipment must maintain a minimum rear and side yard setbacks of 25 feet. Floodplain permit is required. Premises Located at: 1710 Gull Pond Ln, Greenport, NY 11944 SCTM#35.-3-12.1 Pursuant to application dated 01/29/2025 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 $100.00 Flood Permit $150.00 Total $550.00 Building Inspector �� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main load P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 ht s:// ' w. o tholdto'w na '• o Date Received PERMITAPPLICATION FOR BUILDING , For Office Use Only " y CC95 5 I P PERMIT N rl Building Inspector 91 vo Applications and forms must be filled out in their entirety.Incomplete i0 applica4ions will not be:'accepted Where the Applicant'ls riot the owner,an, Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: # 1000-a Neen 99-1nnTSCTM p Project Address: Phone#: m, Email: 6T6RU rill� ma , eo m Mailing Address �D� O � I J"� 1137 CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name- jh -Ew/t eQS Mailing Address: L4 A— . i�� P g 176 Y . Phone#: �1 / i"��Jr X SA Email: QFFIe e CC'✓ ��L5 . e�7 03 DESCRIPTION ION OF PROPOSED CONSTRUCTION ❑Ne w Structure ❑❑Addition ❑❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: 260ther C Lil ! Will the lot be re-graded? CYes ❑No Q�� Will excess fill be removed from premises? ' Yes ❑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? j4Yes ❑No IF YES, PROVIDE A COPY. k hec9 Aef eja01ri 'rimeaawner/co r r/d igrn Professional respon�le4orail drainage and storm r�wa r ues, provided by Chapter 236 of the Town� P�u T N.�g HEREBY MADE to the Building Depa�ent for the issuance of a Building permit pu uant to the ftilading Tone Ordinance of the Town of ut-16ld folk,6 unty,New fork and other applicable taws,Ordinances or Regulations,for the consouttionol bu din , additions,alterations or for removal or tdemollbon as herein descrlbed4 The applicant agrees to comply with all Applicable laws,ordiawances,building code, housing-code and regulations and to admit Authrorked inspectors on premises and innbuilding(;s(for wear rye inspections.False.statements made herein are punishable as a Class A misdemeanor plarsdant to Section 210.45 of the New York State Penal taw.. Application Submitted By(print name): � �1 ' ❑Authorized Agent XOwner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF 63 /1 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract)above named, (S)he is theL (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 Y da of la 1 2 Notary Public MARGARE F A. KIDNEY Notary Public—State of New York No. 01 1<_1603 1 1 1 1 Qualified in Suffolk County PROPERTY OWNERAUTHORIZATION My Commission,Expires march s,20ZZZ ' (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 -o maw ,+Fs/M9l1Al 1//IIYM%),... Yll ,.YILI... /.iYNIAYGY JiYv iY mor„i.,.,...... ....-... ^MAM2. JIY»A'9YIRN`1(lin mi»mw G.... i2l�I.f." HH vnYY/,,, rorr rriv,...,. rr,nm. ynr ri r .. .i ma.m.v.ir v, w -�F . " S�C'�0�][�1�� WATIEIK Scott A. Russell ° a f SUPERVISOR I��S[A\,NAG�]El��l[]EI�T SOUTHOLD TOWN HALL-P.O.Box 1179 Town �fSouthold (1JtiO u ],�O]� 53095 Main Road-SOUTHOLD,NEW YORK 11971 rt� p � a j 1 b b (7 C _..._ FORM ��ER 236 - STORMWATEIt MANAGEMENT REFERRAL�.... . . ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design. P i .. �� P �y � .... rofessional, Agent, Contractor, Other) «,x "" &inn Date: NAME: � _ P mail.eGm i1 COILt�C&i�ep1�(7Nnl�tl011: t"l.i't'll�(c �.. ....._ �._ ,...rv�...-....... ii inne )r i Prop Address / Location of Construction Site: aly Construction. S.C.T.M. #: 1000 District .......... .-.n __... _-... Section Block -- e r TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - Area of Disturbance is less than I Acre. No .P.D.0 �$ �iuired! Project does Not Discharge to Waters of the State, No S.P.D.E.S. Permit is ReqLukred ! c" - Area of Disturbance is Greater than I Acre&Storm-water Runoff Discharges Directly ....P.D.E.S. Permit to Waters of the State of New York. THE APPLICANT MUST OBTAIN_a S. DIRECTLY From N.Y.SD.E.C.Prior-to Issunce of a Bu�ildir�P �� p _ Area of Disturbance is Greater than 1 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 E q ne rurirn De� rtment Prior to Issuance of a Buildine Permit„ _ t Reviewed By rye Date Fr1RM P-TC1C(1rFntwr 7nl�r j �io OFFICE.I3t Ufci &"I �"� ��'� �TROLD �� MOlV' 5:10 rL�H?YJ 4 00 x w. Cb.BOX 14f19CON �Wy� 631-765 1$03 F1�X:'63Y176 a,,,' "�'`,1.•049'J ' 1. " *� rr` "� " °".'! " ��' +4r �,4�M f � r'd"„ ' '- � BILL NUMBEF �%��/ • . IF TIiEWORD"ARREARS"IS PRINTED HERE SEEACCOUNT /, �' °� NOTICE OF ARREARS ON REVERSE SIDE, ` a835; 17 4148 9 / / 1714 Gull Pond Ln 3,$8 '/ "966,953 2,551,977 19222 I. 1 Family Res WARRANT DATE LAND ASSESSMENT TO NSSESSFIENT . 40� 504' i �ii %// ��r% ` Ak L Ft}R AARC 1 t 7 /�� i / / /i o/ai Bruhn T /% y 69 Amabonac Rd fUn#1 G Or B East Hampton,NY 11937-2609 N� a ,.0/� :, ,,,..,, r,,,,, ,rr /......../ ,r.�, ,::./O/ ,ii✓i,,,i////%,'" /% ;. ,/,/..: � ,�/�Oj rid- t 8/1 r ri r, ✓ c,� H,/ ��, w ✓ rw r x �� + / / r /w„ r f/ r r' r iro 69,$6% . 1rlf r / , / / //;/, / r of /��j/ �%//� /,o, ,,,..,,r rr�ci y�,,/i.,r /.., ,rr / / ✓�/ � ,✓/�. � ,rrr� ,,, ,r ,ri ,,,,,,//i / ,%/r. �.r,/f..r // - ri. r, ��,// / 711 ��i f� u.... ➢Y ➢UIl„Il I,`,;QI�'l��( �I� �'�Id�W %i� i!n!/ , + 1 y 1 v ,/Fr11, vht � J _, rr / ,,, � r /r �/i / r i Ili i III IIIII iiI / Jr rf I% f " 6 r / ,;w! � /I r,Ir,�,a,r riii//✓/r//rir%,r,/a/..,,, „, c�,r,// ,�,!;,,,q i s/,;,� ��/, r / Shawn M. Barron M.S. 124 Pleasure Drive,Riverhead,NY 11901 631.786.6672 shawn@baffonenvironmental.com October 7, 2024 Mr. George T. Brunn 1710 Gull Pond Road Greenport,NY 11971 Re: Wetland Delineation Situate: 1710 Gull Pond Road, Greenport SCTM#: 1000-35-3-12.1 Dear Mr. Brunn On October 4, 2024, I personally inspected the above referenced property, and delinated the wetland boundaries by marking with orange surveyors tape. Three separate areas were delineated,numbered 1-8, 1-9, and 1-15 (see sketch). If you wish, you may now contact your surveyor so that the lines may be located and depicted on a revised survey. If you have any questions,please do not hesitate to contact me. Thank you for your attention in this matter. Sincerely, Shawn M.Barron,M.S. Wetlands flagged in orange,#1-7 Wetlands flagged in orange,#1-9 i Wetlands flagged in orange,#1-15 ,l „w G DATE(MM/DD/YYYY) '"�-`'�'"RV CERTIFICATE OF LIABILITY INSURANCEF1211212024 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. PRODUCERCONTACT Rebecca An ellnas FN -w. .__.w.. Al Libe Risk Mana ement, Inc. 631 569 5633 Fax 61 56963rtY 9sta _ te )2333 Route 112 reb!c __ lbertyrisk orbMedford, NY 11763 INSURER AFFORDING COVERAGE NAIC#..........www A: � II1WICfi.... hranCe CO,,RI ateINSURED Arthur J.EdWa gINSURER INSURERB�.:......._.Mw-.._...-.........,,,µ,.._..._.............._.m,.. ._._ ..................,,..--..rds Mason Contractin Company Inc. _ DBA:Arthur J.Edwards Pool 8r Spa Centre ._.w_._C _._. ........w._.........................._.,_..,. .................,.ww.� 929 Route 25A NsuR� .....w...w,..........W......_......................._._,._...._..... _,..... �.., _........ Miller Place, NY 11764 INSURERE; _._..___,,..,_.w.w�w........................"...___.w_""_w_._........ ......... . ...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. ----------- _.. _._....._ _.m._ _.,. ...LI w_"..."...... fNift - ICt11. NJ �R�. .."OF .� LICY �� LIMITS LTR TYPE OF INSURANCE POLICY NUMBER O A ' COMMERCIAL GENERAL LIABILITY Y NPC-1004300-04 111/2025 1/1/2026 EACH OCCURRENCE $ 1 000 000 6/tv9 R � 1TD _w.. ...........�.....w L z........... ..._._ CLAIMS-MADE i OCCUR ..PR k.A1�;a�')C'cpwaap%I;prae�,.,,,..,,u...$ .............._.m.�w�O._.a. ,0..�..w MED EXP(Any one person) $�W """"" w S�OO,,,O ....... ..... " L 8 ADV PERSONA INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGR"E"GATE _ ''$ _ 2000 00_0 ._.. POLICY PRO PRODUCTS-COMP/OP AGG $ 2 OOO OOO w JECT LOC ...._"-.,.....w.-.�.,. .........� a...wwww_.a........._,.ww. OTHER: AUTOMOBILE LIABILITY L M 1 l d'I•f f N $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY ... AUTOS .-,....� HIRED NON-OWNED 000-R7YDAMAGE $ .. AUTOS ONLY AUTOS ONLY r a1cr„�4ran ............ ..,......._....w . $ UMBRELLALIAB OCCUR EACH_OCCURRENCE $ .......W. EXCESS LIAB .,.,......DED .._ "µRETENTION$ WORKERS COMPENSATION PER O AND EMPLOYERS'LIABILITY YIN N ",S�T""/jITF " E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EX ECUTIVE ""'� N/A ..„,..........._. .......,._,,,,ww-..__,..",.-w......,_.-.--.. (MandatoryOFFICER/M In H)EXCLUDED? E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) w._._.. ,,,.,..,.w-. w........... .�_...._...-..._.....,.--- Ifyes,describe under DESCRIPTION OF OPERATIONS below _L —--------- E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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. P.O. Box 728 Southold, NY 11971 Al6THOR4 D REPRESENTATIVE RPA O 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 08:15AM eiE workers'nsation CERTIFICATE OF INSURANCE COVERAGE !compe 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) 1b.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 yyand Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier E TO n i O�LSed as the OUTHOLD to Holder) Standard Security Life Insurance Company of New York PO BOX 728 3b.Policy Number of Entity Listed in Box 1 a SOUTHOLD, NY 11971 Z06874-000 3c.Policy Effective Period 7/1/2020 to 6/4/2025 4. Policy provides the following benefits: Q A.Both disability and Paid Family Leave benefits. 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 de �dabove. (21 Pit Date Signed 6/5/2024 By (Signature of insurance carrier's authod d reprassenfatir a or NYS licensed insurance agent of that insurance carrier) Telephone Number 22112) 355-4141 NameandTitle SUPERVISOR-DBL/POLICY SERVICES IMPORTANT:lf Boxes 4A and 5A are checked,and this form is signed by the insurance carriers 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,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 5B of Part 1 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) II � � , i� �1;� edo (pfm NYSIFPO Box 66699,Albany,NY 12206 Now York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 112377925 4vtw- SCANLEVITT-FUIRSTASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FL TARRYTOWN NY 10591 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 �I2 DIRECTOR,I(SURANCE FUND UNDERWRITING VALIDATION NUMBER: 633467799 II[dMIMNI 0000000000012901.81. Form WC-CERT-NOPRINf Version 3(08/29/2019)[WC Policy-24384919) U-26.3 7 [00000000000129018175][DDOI- 0243849191[*OGI[16918-05][CRrUOP-CERT_11[01-00001) _,_ate; 5 � - a �t ti _ Suffolknty Department of Labor, Licensing \ \ Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 'M DATE ISSUED: 07/01/1978 No. H-4436 ; ITPFC"I,R �"0T�.�NTY o e I Provement (L"O atractor license IA This is to certify that ARTHUR J EDWARDS 3 doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA (I SUPP) having furnished the requirements set forth in accordance with and subject to the provisions of applicableJi laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. 1 NOT VALID WITHOUT Restra t Additional Businesses DEPARTMENTAL SEAL f H1-GC; AND A CURRENT ARTHUR J EDWARDS POOL&SPA CENTRE H26-Pools and Spas/Certified; CONSUMER AFFAIRS H3-Pools/Spas ID CARTS Suffolk County Dept.of � � � ; Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE i E Name ARTHUR J EDWARDS Business Name - ARTHUR J EDWARDS MASON This certifies that the CONTRACTING CO INC DBA 1 SUPP 1 =�, fl ! Rosalie Drago bearer is duly licensed - by the county of suffoik License Number H-4436 Commissioner R W"nt,T " lss a 07101/1978Rai, 1 � � Expires: 07/01/2026 - Commissioner ` W. F. .:c ' '�. __ -� - c .-= -.Ede- - - _ �ll,1 _�, ��..._..,_ a r o / / f , r r� rr r , r/ r r r / / r / / / r / / � I / / // / f / r / / / r r poi////i��%/`ii�///// / // ✓�� / / / � / / �/,' / r / J / / r / / r/ r / r / / / 1 r / / / r l rrrr r r r r r /r / /r / 7. I fl- ' uillll i ,I r NII r f f