Loading...
HomeMy WebLinkAbout51786-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#: 51786 Date: 03/26/2025 Permission is hereby granted to: NF Community Club LLC PO BOX 1672 Mattituck, NY 11952 To: construct accessory in-ground swimming pool as applied for. Pool equipment must be located in the rearyard with minimum side and rearyard setbacks of 25 feet. Premises Located at: 2050 Depot Ln, Cutchogue, NY 11935 SCTIVI# 102.-2-5 Pursuant to application dated 03/07/2025 and approved by the Building Inspector. To expire on 03/26/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 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 ]ttt)�s://www.soutlaoldtowjln . god° Date Received APPLICATION m t:3 Y For Office Use Only I v a R PERMIT NO, � Building Inspectors ., 2025 5 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an ems, Owner's Authorization form(Page 2)shall be completed. V I Date: S OWNER(S)OF PROPERTY: Name: AJ F Om loll.(.n t ISCTM# 1000- Project Address: Phone#: Email: Mailing Address.: CONTACT PERSON: Name:&? YY10(Z(.9 � Mailing Address: PO 13 nZ kLMQNLA GAW l Phone#: ?J cj s 0 O Email: �O )y-)eL YY)m O�7 C . cry DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: M t-YYl PO 0�S Mailing Address: ?0 Qo.,,! \30' , 1�1 a^mow ( '� I) qc4 (D Phone#r �01� 6 Email: OFj�' Cvw^a t C C o m DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addltlon ❑Alters Ion ❑Re I ❑D I Project: Estimated Cost of Proj t par emollt on ❑Other 5Pvj,`►,�i m 1'wt o, rat+ I 00 O Will the lot be re-graded? ❑Yes TeNo Will excess fill be removed from premises? ❑Yes 'KNo 1 PROPERTY INFORMATION Existing use of property: � C> 'fia Intended use of property: � � �.1 Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes L2'No IF YES, PROVIDE A COPY. ❑ 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 nam ): J�h� P. (� L7Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OFIv ww 30�n Y1 Q. � o '(2 (� �� being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the C- nkr�GTU a l (Contractor,49ent, 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 , Notary Pbblic ELIZABETH A KOEHNE PROPERTY 0 1'JE( AUTHORIZATIONl Notary Public,state of New York _._.__..�.._._._._.... ��. ... No.01 K06334345 -ant is not the owner) Qualified in Suffolk County Commission Expires 01-I9- r A do hereby authorize 6 1 r'n 0(L G �'J/f rn t to apply on my alf to the Town of Southold Building Department for approval as described herein. Owner's Signature r Date Print Owner's Name 2 Albert J. Krupski, Jr. � , S /r 51F O RIMMAT]ER SUPERVISOR �" l\\][ANA�G1ElwJ[]ENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 .. w, ` Town of Southold CRAFTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: ev o IQ C56 6 i) _ Date: IA 4 r �� ._. ....... .. ._...�............................ _.�. __. ..... .........._. Contact Inform. ioti: ��u L D t i �� �`� �- L Z� `�J t - 6, �5 2a .................. .�...........�..�.. ....... __ ....- ............. .................................. _....... ........................... ...... (E`Aad&Telephone Nu ime Property Address / Location of Construction Site: 7' e , c, Z. p,v S.C.T.M. #: 1000 Di strict 2 Sectirn Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ❑ - Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Required !Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Required ! ❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a BuildipS Permit. ❑ - 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 EngineeringDe artment Prior to Issuance of a Building Permit. Reviewed B} _.. ..._...—..... ............. .. Date: ...._ / FORM " SMCP-TOS December 2024 keCe ('v (,,J 114" Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) 1, Nyd) residing at s— �,Imllv A� ............... .......... (Print property owner's name) (Mailing Address) do hereby authorize ................. I P (Agent) d — to apply on my behalf to the Southold Building Department. ,111.......................................................................................................................... ............. ----;(7&;ner's Signature) (Date) (Print Owner's Name) DATE MIMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 11/04/2024 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(SJ AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate hoiden is an ADDITIONAL INSURED,the j0 y(les)must have ADDITIONAL INSURED p ovlslons or be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorseme s). PRODUCER WNTACT Kate Maloney Cell FAX VRP Insurance Agency PHONE (631)738-7300 AfCNo: (631)738-7382 955 Main Street ADdRE55 maksarey mdlaney.Coln Suite 2 INGUREnAFFOR0010 COVERAGE, "Co Holbrook NY 11741 INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B:. Merchants Mutual insurance Company 23329 M&M Pools LLC INSURER C Shelterpoint Insurance PO Box 1302 p1SURER D INSURER E: Hampton Bays NY 11946-0300 INSURER 1: COVERAGES CERTIFICATE NUMBER: CL2472312788 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADUIr LTR' TYPE OF INSURANCE ) POLICY NUMBERX1 POLICY LIMITS 1,000,000 COMMERCIAL GENERAL LIABILITY EACH OCCUR $ CLAIMS-MADE ©OCCUR ISEB EaaawaRenen $ i00IURENTED 000AAA MEoEXP :Ualapelaari $ 5,000 A Y PHPK2580404-003 07/23/2024 07/23/2D25PERSONAL SADVINJURY $ 1,000,000 GEMLAGGRESATE LIMITAPPLIES PER GENERALA GRE TE $ 2,000,000 POLICY JERCT LOC PRODUCTS-COMPIOPAGO 2,000,000 OTHER AUTOMOBILE LIABILITY " S 1,000,000 ANYAUTO BODILY IW IURY(Per person) $ B OWNED SCHEDULED CAP1076370 07/23/2024 07/23/2025 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS HIRED NON-OWNED ® $ AUTOS ONLY AUTOS ONLY Petaafd $ UMBRELLALIAB OCCUR EACH OCCURRENCE S EXCESS LIAB k1MB'•t'NAD'E AGGREGATE $ CEO I I RETENTION s $ WORD COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY NERVEXECUTIVE MIA E..PACIIACCIOEIXT - OFFIOERIMBEREXCLUDEDf 040ndatoryInNHi £L DtS FJ4SE t°AEMPLOMEE It YD RVTIONund U'F OPCRA11ON$WOW E L.D Ef St Pot Y L9fArr $ C NYS DISABILITYIPAID FAMILY LEAVE DBL433241 01/01/2014 01/01/9999 STATUTORY DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) certificate holder is listed as an additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT. AUTHORIZED REPRESENTATIVE 54375 ROUTE 25 SOUTHOLD NY 11971 ✓ 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks ofACORD Y workers' CERTIFICATE OF INSURANCE COVERAGE srYr 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 carrier la.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured M&M POOLS LLC PO BOX 1302 HAMPTON BAYS,NY 11946 1c.Federal Employer Identification Number of Insured 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 DEPT 3b.Policy Number of Entity Listed in Box"I a" 54375 ROUTE 25 DBL433241 SOUTHOLD, NY 11971 3c.Policy effective period 01/01/2025 to 12/31/2025 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: © 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 employers employees: Under penalty of perjury„I certify that I am an authorized representative or licensed agent of the insurance carper re erenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 2/6/2025 BY (Signature nature of insurance carrier's authorized representative or NYS Licensed Insurance Agentof that insurance carrier) Telephone Number 516- 29-8100 Name and Title Leston Welsh/ Chief Executive Officer IMPORTANT: If 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 58 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 DS-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) III IIIP1°°°1°20°°1iiii!i1i2iii2i1oiillll� DISTRICT: 1000 SECTION: 102 BLOCK: 2 LOT: 5 94 Dwalm DWELLING 1000-102-2-4 2 W/WELL WATER LAND N/F OF I 0 OVER 150' SINGLEKEE FAMILY RHES DENCE DIR1f T - LE" S 45 049'16" W R-80 456.091 MON " 22 IF .-- HEDGE MAN / N REMAINS DRIVEWAY C,a r CS !`on i0 BE RIOVEQ (JJ I o 2 4 STORAGE �+ r7 EXISTING CONTAINER ( ) 00 W PORTION f0 r�C W 107.1' BE REMWED v 1 / I �'""^^p/` TI tXIS11NG EL 24.6 EL 24. POR ON . @4#,,.H., f0 Q M.H. i IY`+. �WREMOVED z w� CROP 'ELEC.S R+JIC1:<TO CONTROL PANEL � F'RAME�✓EIRICK �SWi14I«1N0 P tls � CONkTR t PANEL AND AIR PUMP ''E1LLaG rx 1II'x3Li"� x / ELECTRICANDAIRS PLYHOSETOOWTS '2050 �F� J Y SCO14 PVC VENT PPOE .T 6 R as '^�.I FFL 213 S U O I E—E—E—E— E—E E -- PROF* 4 BEDROOMS CONC. _U I OP' I ^•a i.°'" ar". L.P. RAIL FENCE 4[�ps -iti?- PROP, F PROMOS11 2 ,O PATIO V TOVERCI N OOL P44IL10 N IV O ex cbn se tiu Tank to &022.45" y P Jay1„66' o be removetl1 INLET, M.H. EL 2AA 7 OUTLETS 5 '� C�ONC.F a.. ENTRY PROPOSED ,• PROP0SEl1 n 1 1�020.66" I y RAIL � � I I IE REMOVED PARKING LOT �WOAw"R P 'T I � 'v LEI BOX ACCEPTS: F �� FEAFCE `7 EXN LP ADDITION 1 LI �aE Q C ( M.H. O LIGHT COVER#3009C � I O (p TOP VIEW HEAVY COVER#3017-C20 M.H.O GRATE #3017-G20 ' BRICK RE—USE OM.H. 6"TALL RISER#3009 I �' 5o PILLAR II'. P2 E 12"'TALL RISER#3009-R12 p� ® O I EP FLAG T.H. NDCAP TYPE I '"' POLE N LEVELING DEVICE f U / L.P.�O- \ HYD I Lp0 ENT, PµT, BOX SEAL, 26 POLYLOK SEAL I U.P. P MON O 1 11 CCJJ / p �7 1 MON MIN. "COMPACTED 458. /5 MIN.12"COMPACTED SAND OR ��j PEA GRAVEL LEVELING PAD \ I � S 45 51 13 Y V / FRONT/SIDE VIEW \ f )X I' IyI1k DETAILS I A W/WELLLLWATER DSO. \ I cq OVER 150' / C) N MAIN ROAD / SANITARY NOTES / 1. THE OWES INSTALLER SHALL HOLD AN ENE / 2.AN EXECUTED OPERATION AND MAINTENANI 4" SDR 35 SHALL BE PROVIDED TO THE SCDHS ITCH 1/8"/FT / 3. PROVIDE A 2'VENT PIPE FROM THE OWT: THE VENT PIPE SHALL BE PITCHED TOWAR AIDE 25.0 GRADE (25.0) GRADE 5% MAX 4. AN EFFLUENT FILTER SHALL BE INSTALLED • EL(�5.5) ./o TO oRAe�E, .�.�.. _ IN B OX INV23.52 PROPOSED SEPTIC SYSTEM UP TO 4 BEDRC INV23.92 NV23.82 EL23.73 ( ) CLEAN ( ) ''4""SDR 35 "SDR 3 INV23.4 (1) EACH (1) LEACHING POOLS B'0x12DEEP 4 PITCH 1/4"/FT 5 8'0x12'DEEP =1 (1) EXPANSION LEACHING POOLS PITCH 1/8"/FT LEACHING 0 POOL 0 EL19.52 OOOOOO FUJI CEN5 EL11.73 HIGHEST EXPECT. GROHNTI WATFR T=1 9 n