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Home My WebLink About51740-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#: 51740 Date: 03/14/2025 Permission is hereby granted to: Gabriel Kochmer 13 Peacock Path East Quogue, NY 11942 To: Construct alterations to an existing accessory garage to create a cabana/pool house (no bathroom) as applied for. New construction must maintain a minimum rear yard setback of 5 feet. Premises Located at: 780 Legion Ave, Mattituck, NY 11952 SCTM# 142.-2-13.1 Pursuant to application dated 12/17/2024 and approved by the Building Inspector. To expire on 03/14/2027. Contractors: Required Inspections: Fees: Accessory-Alteration $370.00 CO Accessory $100.00 Total $470.00 Building Inspector �� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone 631 765-1802 Fax 631 765-95021 tt y��wwr o �thg1dto i1n . o P ) ) � _ —M Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ° e - PERMIT NO. 51 114 1) Building Inspector:._1118 _.. r�y� Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. �7, Date: (( + OWNER(S)OF PROPERTY: Name: iw ku,tVV'&'%q SCTM#1000- ProjectAddress: 'ZS� ( - /GN AVC-I-VC= N-t Phone#: 512— 21 — s$ Email: C1 kc�C tI V'X f-2 ` • CC, Mailing Address: p S 0+�bcn.` CONTACT PERSON: Name; Cw S /L2,NUL,-oq o Mailing Address: —Sij� wt%Aiv-� Qa&4N-- Qk,-) -�2t+*�t�,r) N� ft'� Phone#: 63/- 27G -333 4- Email: n7 (M G4/L • Ct �^ DESIGN PROFESSIONAL INFORMATION: Name: OC-r Mailing Address: o'Q i-,tt-r QovNS� Co b0 6 ( G Sam-I0LfS Phone#: G3 Z9 5 JEmail: 1;,, k,w w(g OPTati'L iAfS: , AACT CONTRACTOR INFORMATION: Name: AVAS U cn-jG v G ty-s Mailing Address: 1.54-ct Phone#: 6 333 4— Email: Cp7-5 7-UP— 44t e-- DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition teration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ A` Will the lot be re-graded? ❑Yes Cho` Will excess fill be removed from premises? ❑Yes 1 ............. PROPERTY INFORMATION Existing use of property: Intended use of property: 2G��. .._.._... Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? E]Yes DNV-TF-YES, PROVIDE A COPY. 11 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 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 24u�thorized Agent 00wner Signature of Applicant: ....... Date: IZIOC7 STATE OF NEW YORK) COUNTY OF S U I 84 rl,, (1, being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the A &4 (ContrWor,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 jay of UULV)�Lw 20_4 Notary&Ij y,*icWlo Nlotor�,--P,!060 State of York count',)0T�;Uffo�lk PROPERTY OWNER AUTI-10RIZATION REG#01 t0LJ6090387 1 A. (Where the applicant is not the owner) Expires April 20 1, residing at KO L tt3 V do hereby authorize to apply on my be to th Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 ""' E" CERTIFICATE OF LIABILITY INSURANCE DATE(M111D/18/ 4 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 pollcy(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 endorsement s PRODUCER SPECIALIZED INSURANCE&SERVICES NAME' 204 RTE.112 PRDNE ) S3T=7S071iI E_I AO 31 77 MAIL. ASHLEY@SPECIALIZEDINSURANCE.COM PATCHOGUE,NY 11772 ... Auto-Home-Business-cycle-etc. (s)AFFORDING COVE _� NAIC# INS046RA:ATLANTIC CASUALTY INSURANCE CO 42846 INSURED AMS HOME IMPROVEMENT LLC INSURERS -- 1549 MAIN RD tKSU c t _- --�-- — RIVERHEAD, NY 11901 INSURMD: ..LMLA RiL........� INSURER P a 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. INSR -_� TYPE OF INSURANCE ' POLICY NUMBER POLICY FF Wt?L&C1f FJIP UMrrs COMMERCIAL GENERAL LIABILITY L14B000921 A Y N 11/08/2024 11/08/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR $ 100 000 MECk EXPEXP�I�n1,;�atraon s 5 4�iWNl� PERSONAL S ADV INJURY $ 1 000'000 GENLOLICYEI'3ATEJRO-IMIT APPLIESPOER GENERAL RE13ATE $ 2000000 OTHER: PRODUCT'S-COMPIOPAGO S _... OTHER: -.. �.D $ AUTOMOBILE LIABILITY C D SlNGU5 LIMA $ ANY AUTO --- BODILY INJURY(Per person) $ OWNED W DULED AUTOS ONLYS BODILY INJURY(Per accident) $ HIRED OWNED PROPERTY DA AUTOS ONLYS ONLY $ $ UMBRELLA LIARCCUREACH OCf U CEEXCESS UASLAIMS-MADE AGGREGATE $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN AN'Y PROPRIFTORIPARTNERMXXECUTIVE OFFICERIMEMSER EXCLUDED? NIA EL EACH ACCIDENT $ (Mandatdty in NH) pl d a unda�r E L.DISEASE-EA EMPLOYE! �C Y N$ R E TIO A dsk,ar EL OISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addillonal Remarks Schedule,may be attached N more space Is required) DRY WALL OR WALLBOARD INSTALLATION,PAINTING-INTERIOR BUILDINGS OR STRUCTURES CERTIFICATE HOLDER IS ADDITIONAL INSURED AS PER WRITTEN CONTRACT OR AGREEMENT CERTIFICATE HOLDER CANCELLATION SOUTHOLD TOWN BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 NY 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTHOLD,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RET+RES E �"IIIIf+"�,Iwur� 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD IST RK Workers' Certificate of Attestation of Exemption ►rl Compensation from New York State Workers' Compensation and/or Board Disability and Paid Family Leave Benefits Insurance Coverage 'This form cannot be used to waive the workers'compensation rights or obligations of any party." The applicant may use this Certificate of Attestation of Exemption ONLY to show a government entity that New York State specific workers' compensation and/or disability and paid family leave benefits insurance is not required. The applicant may NOT use this form to show another business or that business's insurance carrier that such insurance is not required. Please provide this form to the government entity from which you are requesting a permit,license or contract. This Certificate will not be accepted by government officials one year after the date printed on the form. In the Application of Business Applying For: (Legal Entity Name and Address): Building Permit Ams Home Improvements LLC From: Southold building dept 54375 main road PO Box 1179 Southold NY 11971 1549 Main Rd Riverhead,NY 11901-6006 PHONE:631-779-3727 FEIN:XXXxx1541 The location of where work will be verformed is 780 legion Avenue,Mattituck,NY 11935. Estimated dates necessary to complete work associated with the building permit are from January 1,2025 to April 16,2025. The estimated dollar amount of project is $25,001 -$50,000 Workers'Compensation Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE SPECIFIC WORKERS'COMPENSATION INSURANCE COVERAGE for the following reason: The business is a LLC,LLP,PLLP or a RLLP;OR is a partnership under the laws of New York State and is not a corporation. Other than the partners or members,there are no employees,day labor,leased employees,borrowed employees,part-time employees,unpaid volunteers(including family members)or subcontractors. Partners/Members: stuart daccus Disability and Paid Family Leave Benefits Exemption Statement: The above named business is certifying that it is NOT REQUIRED TO OBTAIN NEW YORK STATE STATUTORY DISABILITY AND PAID FAMILY LEAVE BENEFITS INSURANCE COVERAGE for the following reason: The business MUST be either: 1) owned by one individual; OR 2) is a partnership(including LLC,LLP,PLLP,RLLP,or LP)under the laws of New York State and is not a corporation; OR 3) is a one or two person owned corporation,with those individuals owning all of the stock and holding all offices of the corporation(in a two person owned corporation each individual must be an officer and own at least one share of stock); OR 4) is a business with no NYS location. In addition,the business does not require disability and paid family leave benefits coverage at this time since it has not employed one or more individuals on at least 30 days in any calendar year in New York State. (Independent contractors are not considered to be employees under the Disability and Paid Family Leave Benefits Law.) I,stuart daccus,am the Member with the above-named legal entity. I affirm that due to my position with the above-named business I have the knowledge,information and authority to make this Certificate of Attestation of Exemption. I hereby affirm that the statements made herein are true,that I have not made any materially false statements and I make this Certificate of Attestation of Exemption under the penalties of perjury. I further affirm that I understand that any false statement,representation or concealment will subject me to felony criminal prosecution,including jail and civil liability in accordance with the Workers'Compensation Law and all other New York State laws. By submitting this Certificate of Attestation of Exemption to the government entity listed above I also hereby affirm that if circumstances change so that workers'compensation insurance and/or disability and paid family leave benefits coverage is required,the above-named legal entity will immediately acquire appropriate New York State specific workers' compensation insurance and/or disability and paid family leave benefits coverage and also immediately furnish proof of that coverage on forms approved by the Chair of the Workers'Cotnpcnsatio 3oard to the government entity listed above. SIGN HERE Signatllre: Z .-_ Date: Exemption Certificate Number Received 2024-08$486 November . . NYS orke 'C mp n atio rat CE-200 01/2018 Joseph Fischem.FIE pafessiwatE _ __ axe w 11sre s n 7 hY ligr ai§-�5"«S85 1 �s TC-T 1.FOR GARAGE AND POOL HOUSE_9M SF Md m ow �.sihzP� 21801 :5 s1 Jos-pf Eisehetti,RE - _ "`"�f4� ;Frafessianai En�irre�er s j�� 6 631.:F=°S54 — r ; _ �� c - 631-%SSi'ti}TI 6 E K-bW 7 7 �z V z t m az _ s Ff _ m AO Joseph Fischetti,PE APPROVED AS NOTED Professional Engineer 5 HRoad NY 11 DATELI 1—K B,R 4 5 1 14 0 WJG�N. FA V6�Ob BY dhi) NOTIFY BUILDING DEPARTMENT AT 631-765-1802 aAM TO 4PM FOR THE FOLLOWING INSPECTIONS: FOUNDATION-TWO REQUIRED FOR POURED CONCRETE ROUGH-FRAMING&PLUMBING INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR A DESIGN OR CONSTRUCTION ERRORS COMPLY VATH ALL CODES OF NEW YORK STATE&TO IN CODES RE IFIED AND CONDITIONS OF SCRIUM 1`10LD TOON ZBA 011m MI'PLAINN11ru Fakrtl I.Y.S.Dm SWIMMG -11.'T TOTAL FOR GARAGE AND POOL HOUSE:988 SF Prolde Wind me debris protection for new exterior glazing on buildings as per NYS Code. E z RETAIN STORM WATER RUNOFF o - z o PURSUANTTO CHAPTER 236 OF THE TOWN CODE Con_,ilTuchm mu,5+ provide, chma;k f h,COA cic6a'An cri OL �r 2 02D Site Plan 1—D- 1-4 the C1 Joseph Fischetti,PE Professional Engineer U—X 6N011,Ic 2 1 Fl— VW-1 Q` tD Y N21II 1-T 6 z a- Plan,Elev.Section 2— AO SURVEY OF PROPERTY N SITUATE: MA-MTUCK w E TOWN: SOUTHOi_p SUffOLK COUNTY, NY s SURVEYED 14,20a020 5uFF=co"W TA)(a I(00•IW2=2-MI (timplEDTN; nnre}t0.TV.WAxiPow Th4MYi1MIJdNMM1 ��bXONi.WY MAYq}UA.YM1YI`RAUbMH"UpR61'ICA'R W F q ff/ i AV , 'w et L t a b�ui��• ,MMN C"EHLERS LAND SURVEYORI ` MN<I Mxx G t �RIVCa".1tEl+D,W.Y. ... "v:.eru Ne n'�"I •4 WT W 45MET 4�.��3 � nooi