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Home My WebLink About51751-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#: 51751 Date: 03/18/2025 Permission is hereby granted to: Ronald B Shelton 222 E 80th St Apt 2 New York, NY 10021 To: construct accessory in-ground swimming pool as applied for. Premises Located at: 1050 S Harbor Rd, Southold, NY 11971 SCTM#75.-3-14 Pursuant to application dated 02/10/2025 and approved by the Building Inspector. To expire on 03/18/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total S400.00 ` uilding Inspector � TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://wwwsouttioldtownny.aoy Date Received APPLICATION I IPERMIT For Office Use Only PERMIT NO. 1 Building Inspector; . APpllcat�gns and fgrrrrs must be filled out in ttfei�enre �rtcomPl, te a s��ca i►�� 1r � p,red Where#lie SAP i n#, of the uWrier,;en OePRrtment OwnQr's Aithoriz #ipn form(Pagi'2r shall 6e completed;, B�u11d1n Ton of Southold Date: OWNER(S�C1F PR�E►ERT�f Name: �� L- SCTM #1000- r75_ 3 _ I Project Address: )050 &J'-ry �Ubo,c R0 c Phone#: �0��-5�1- 3��a Email: yn R— . 'i o 5�2 �t1 �Ma� •['�tirn Mailing Address: 222 �_ 20-l" 6keef 2E Ne f YOLK, QVy ��QZI v CCN'�A 'I PARSON; Name: Mailing Address: Phone#: Email: DESI,,GN'PROFESSIONAL INFORMATION: Name: 7777?f A Mailing Address: ,� i-*tjv,8 _ _Adilq V1fi1OV,, Phone#: Email: R ai l"el 1 y ' y CONTRACTOR INFORMATION: -. w ` 's't 1 Name: jr✓q,GOs Mailing Address: z�,� (�{?� �01Aco 176V Phone#: W5— Email: 0FFlC2 A-e (,$ , e3m DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition DAlteration ❑Repair ❑Demolition Estimated Cost of Project: lZ Other VinV, ,,J,rrim rry Ax Will the lot be re-graded? XYes ❑No VoXA ea dnj Will excess fill be removed from premises? XYes El No 1 Pa a ry 1NOIDRnrla`n Existing use of property„ � �=Intendecl use of property: / Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? [:]Yes,[ o IF YES, PROVIDE A COPY. h— e ed boxAfter Readi , n►t t 1« f t11 : +a tn, n. t r t a o� a aY AbE t�t e a r r i �w rt eawt t I+ � s rt t r �w t+ 4 1 r«x C rd It 0* f� ',' d pl quo � ��a �s'r 0 1�� ( rst1 �f , f ' �'1t tdr�r1' �fic1 � r�kifdifw uirTcP scant,, Application Submitted By(print name): []Authorized Agent `Owner Signature of Applicant: Date: .2-5-2-5- STATE OF NEW YORK) SS: COUNTY OFFf%U� Ro�►Q`o � � � being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the 0 WNep_ (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 20 2S— Q MARGARE'T A. KIDNEY Notary Public Notary Public-State of New York No. 01 K16021 111 Oualified in Suffolk County PROPERTY OWNER AUTHORIZATION My Commission Expires March 8,20&'L (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 !!? rre�r 18�r NY'S I F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nySIf.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 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 HTTP$://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 (S,UiRAN� 4DIRECTOR,IE FUND UNDERWRITING VALIDATION NUMBER: 633467799 ISIN 111r00000 O000 0 129 18 1 511111 Form WC-CERT-NOPAINr Version 3(08/29/2019)[WC Policy-24384919] U-263 7 [00000UD0000129018175][0001-M24384919][A#G][1641MS][CerL-ND'{0RT 1][01-00001] „,” a DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 t2 2 24 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 poticy(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 dights to the certificate holder in lieu of such endorsemenl e. ACTPRODUCERONT R@b@CC8 Attu@IinaES' NAME; .�.-.., „„„.. ...... Fes......... LibertyRisk Management, Inc. PHONE 631 5ss-5s33 c ),"" 1ss3s 9 .mot);"� 2333 Route 112 NIAIL rebec NI'b@ risk»or Medford, NY 11763 INSURER S�A1FFORDING COVERAGE _µNAIC ft w».,--_._._.w... "_Wm..._.......�..-,......w..-.w.___...ww..____�w......__._._.........................__-w-w........w...»..#NSURERA: ,,7i� .[1., „.,.�r. 11. '....1"l•�" �ny.....-www_wwwwwww..w. INSURED INSURER B: Arthur J. Edwards Mason Contracting Company Inc. .__. _ . -------- .""""'M' DBA:Arthur J.Edwards Pool &Spa Centre INSURERC` ------"" ............_ 929 Route 25A INSURER D: ..... .................... �. Miller Place, NY 11764 I-"--suREE' ---•- INSURER F; COVERAGES CERTIFICATE NUMBER: 00000005.0 REVISION NUMBER: 6 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. _wwwwwwww I"SR' TYPE OF INSURANCE wwwwwwwwwwPOLtCX"UMBER '�' POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY Y NPC-1004300-04 1/1/2025 1/1/2026 EACH OCCURRENCE $ 1y000000 qCLAIMS-MADE FX1 OCCUR PFt t1n; $ 100 000 MED EXP(A.y one person) $ 5 000 PERSONAL 8 ADV INJURY $ 1 000,,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 Ek PRO- POLICY LOC PRODUCTS.COMPIOP AGG $ 2000000 OTHER, $ AUTOMOBILE LIABILITY COMONCO SNUCELIMIT $ ANY AUTO BODILY INJURY(Per person) $ _... �.w wwww.......-.......... OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY OAPvGd" AUTOS ONLY .. AUTOS ONLY M �'..nt ..... w$ �'XEDRETENTION B OCCUR EACH OCCURRENCE $ EXCESS CLAIMS-MADE AGGREGATE $ $ $ WORKERS COMPENSATION PER H- T .!?w AND EMPLOYERS'LIABILITY Y/N 1 _www ....... ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E"L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? '""'""'""'" (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 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. P.O. BOX 728 Southold, NY 11971 AU'THO O REPRESENTATIVE nc "" RPA 01988-2015 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 Workers' CERTIFICATE OF INSURANCE COVERAGE 8oardensation 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 9ss ROUTE R J. EDWARDS POOL AND SPA CENTER 6317440174 MILLER PLACE,NY 11764 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TO yy N eO�LSOUTHOLD as the to Holder) Standard Security Life Insurance Company of New York PO BOX 728 3b.Policy Number of Entity Listed in Box la SOUTHOLD, NY 11971 Z06874-000 3c.Policy Effective Period 7/1/2020 to 6/4/2025 4. Policy provides the following benefits: ❑X A.Both disability and Paid Family Leave benefits. ❑ B.Disability benefits only. C.Paid Family Leave benefits only. 5. Policy covers: Q A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following Gass or classes of employers 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 above. Date Signed 6/5/2024 By . 1 4�4 fSignatuute of insurance carrier's authodw representative or NYS licensed insurance agent of that insurance carrier) Telepho"Number (2112) 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 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 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. \ �\ �" - zgggpqt \ \ v\ \ gag- • may ` Suffo � � e ��t eat �� twr, eensng ti Consumer Affairs -_ vy a VETERANS MEMORIAL HIGHWAY * HAUPPAUOE, NEW YORK 11788 DATE ISSUED: 07/01/1978 No. H-4436 vy SUFF01r,K COL,NTY �, e Improvement Contractor License \ AD \ R'�`\ This is to certify that ARTHUR J EDWARDS o doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA (1 SUPP) having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, axles 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. s \\�' NOT VALID WITHOUT Restrictions Additional Businesses 1 DEPARTMENTAL SEAL HI-GC; ARTHUR J EDWARDS POOL&SPA CENTRE v � AND A CURRENT �\ H26-Pools and Spas/Certified; CONSUMER AFFAIRS H3-Pools/Spas tE ID CARD Suffolk County Dept.of v mayv - labor,Licensing 8,Consumer Affairs I; \ HOME IMPROVEMENT LICENSE Name ARTHUR J EDWARDS v Business Name v ARTHUR J EDWARDS MASON c v� This certifies that the CONTRACTING CO INC DBA(1 SUPP) ` v Rosalie Dragon v bearer is duly licensed v v by the County of suffolk License Number H-4436 t Commissioner Issued: 07/01/1978 Wa y T Expires: 07/01/2026 Commissioner x SURVEY OF: PROPERTY LOCATED AT SOUTHOLD TOWN OF SOUTHOLD ROAD SUFFOLK COUNTY. NEW YORK �A � 25) S.C.T.M. n 1000-75-3-14 AREA = 1 SCALE: 1'=30' NOTE: THE EXISTENCE OF RIGHT OF WAYS. LAND N/F o WETLANDS AND/OR EASEMENTS OF RECORD IF ANY. NOT SHOWN ARE NOT GUARANTEED. DORA RODRIGUEZ SECAIDA 9 OSCAR R SECAIDA ELEVATIONS REFER TO 1988 NAVO L/l ELEVATIONS SHOWN THUS *++ PENCN 79.3 '30.E H 209.40, VBK 3zis I FENCE FENCE - L7'/S VEL pµNENAY N B.R- 0 SMEO - AT't. ON/R.R.TIE.o O CON., y MON. 1y �'L ��. i O W FM (P W O rn A O UP ACOP UNIT Ln u: -o IDOL LAND N/F f CAROL SMITH _ }; FENCE 1 &4'/S 26,50"W h Rµl FENCE S 72p9.38. SURVEYED BY: FENCE at/s LAND N/F PAUL BARYLSKI LAND SURVEYING ONMnSMS)ALTERATMN OR MHEN VALE "TSN ET 6"' L"Tm" DAVID MGTAGGART 9 CRFFSCOF INS MWEt NAAPP MR BATMS TIDE LAND Sl Ef=MW JOCELYN BELL MCTAGGART PATCHOGUE NY 11772 M OROSSM BEW WALL NW M IM®EDTO E A VALAME CITY. PHONE 631-294-6985 oNRANIUM O CEUVICATMS SATES MFIE=WU RIM OaT TO THE FENENFWIM THE SLIM IS"NR"RmN CHHSBDV&F'° FAX 631-627-3186 THE TRIE COVANF.GDW ME fAL AGENCY AM IF70O RSTRunEN LEM WOW ANDTO THE AOROEM O'THE Looms Diffnur II PAULBARYLSKIa YAHOO.COM MIA WREFS OI C0"*'=IMS ARE OR TRANSFOW IE M Am TMW.L e6nTums OR SUMMM RIREIB. JANUARY 20. 2025 6065 r. ! A 'P VED AS NOTED DjA •� B.P . B � NOTIFY BUILDING DEPA MENT AT `RETAIN STORM WATER RUNOFF 631 765-1802 8AM TO 4PM FOR THE PURSUANT TO CHAPTER 236 FOLLOWING INSPECTIONS: OF THE TOWN CODE. 1. FOUNDATION-TWO NF`')''?��n FOR POURED r 0lNJ ;P_ 2. ROUGH- FRAMING& 3. INSULATION 4 FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTON ERRORS COMPLY WITH ALL CODE'S OF NEW YORK STATE &TOWN CODES AS REQUIRED AND COEMI " S OF INSPEC71014 REQUIRED PLANNINGSOUTHOLD OWN BOARD OWX , HPC SCH7 OSE `,"'00L TO CODE. SE ORE VAT USE IS l. WITHOUT CERTIFICA7 .. .. ............ _._... " " -. BENCH __...w...... ., „s w c� 0 46 DEEP '6' DEEPw v e e 16 w z m ... V'I'I 4 _ ,.._2 _4 _ _ em u ll_u'_ . w v n A r 4A' a _... �a ,Q"b` .... _�nnvr ra,�mrwiianr .....,._ ..w_ 4 O ap �nrr, jptl y Plan " Piping Arrangement uV«aa c M... kF Section B—B K Section A—A Typical ball Sectt � „„ _.......�., _5 . _ 2E 8 w.,,...,.,,_.,.___ .._m.� ................._...„,.,.,,,.,.___�_,..,_.._.._.._.,_....,., as :: .m.,,....v....,..,..,..... .x :.„-m:.:„_,:.:. .^. FEET 'WFT FT FT FT FT FT FT FT 54 Fi GAL^ 16 X 32 S6 32 B 14 6 4 4 � Q r}/ Ronald&Mary Shelton „„, 8 512 23100 us x 21. na s a �� rERMACRM OL Sr,SPA CePPM 1. a s a s 8 648 26.7as WALL SYSTEM 1050 South Harbor Rd 18 x 36 18 s 1z 1 w .�_. _w_w—.,g2g Route 25A Miller Place NY 11764 20 x 40 20 „40 16�14 6 4 S N30 800 33,000. (631) 744-7185 FAX (031) 744-0174 Southold, NY 11971 z4x44 za 44 18 14 8 a 8 10 79e 35,000 Suffolk License F443e—M 2a X 48 24 48 20 16 8 4 6 10 900 .....,._..,�,w_,_.,_..__..0 Liacase �FHI74460000 _ ..w _ 98,500 aBB9.m____..W_...,�,.._._,.�.,�..,�..