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Home My WebLink About51810-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#: 51810 Date: 04/07/2025 Permission is hereby granted to: Andrew Samaan 1210 Alberta Dr Winter Park, FL 32789 To: construct accessory in-ground swimming pool as applied for. Premises Located at: 600 Praity Ln, Cutchogue, NY 11935 SCTM# 109.-5-27.2 Pursuant to application dated 02/27/2025 and approved by the Building Inspector. To expire on 04/07/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total S400.00 1A - , - uilding Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 �s1 -emu Telephone(631) 765-1802 Fax (631) 765-9502 htt s:byly soulholdtow�r . ow Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector. a FEB .... 2 p Applications and forms must be filled out in their entirety.Incomplete Applicant not the owner ,an applications will not be accepted. 'Where the w Owners Authorization foam(Page 2)shall be completed. Date: OWNERS)OF PROPERTY: Name: ,/ SCTM#1000- � _ S �7 UU Project Address: 6� � c .� � - .5'-6d-- S Phone#: / Mailing Address: &00 w I��.itc., c a,c9 / //.g- CONTACT PERSON: Name: �u Cali T Mailing Address: ` ?,eD' ► X 9 Phone#: 266 S' Email•ckC, re. DESIIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: 0-"XVU 4-1 1 's II,, Mailing Address:, Phone#: Co 3)- � /�7CoC�5 Email: �Gh i � � hyv o /1,J DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: P Other * Will the lot be re-graded? Mes El No Will excess fill be removed from premises? Mes ❑No i 1 PROPERTY INFORMATION Existing use of property:_/ cry r, Intended use of ropert I Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? DYeSAAo IF YES, PROVIDE A COPY. i,`�Io?,,Aing: 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 taws,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): 7 Authorized Agent ElOwner Signature of Applicant: Date: 71Z STATE OF NEWYORK) CONNIE D.BUNCH Notary Public,State of New York SS: No.0 1 BU6185050 COUNTY OF aualified In Suffolk County Commission Expires April 14,2 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 aIL6day of 20 �7- Notary Public 11'11111�1 F (Where the applicant is not the owner) 6W *_t j Z4 iS;q*wa vi-residing at f,e ol do hereby authorize &04' IdA;f!A� M)to apply on my behalf to the Town of Southold Building Department for approval as described herein. 'Es Owner's Signature Date Print Owner's Name Sc ott A. Russell SUPERVISOR I�WANAA,Gr]EI� 1ENIF SOUTHOLD TOWN HALL-P.O.Box 1179 b \' Town o f So u th o l d 53095 Main Road-SOUTHOLD,NEW YORK 11971 k `- CHAPTER 236 - STORN' WATER MANAGEMENT REFERRAL FORM �r INFORMATION TO� - � ( APPLICANT...... E COMPLETED BY THE APPLICANT 4' ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner-, Design Professional, Agent, Contractor, Other) NAME: Dater � Contact Inf orrnat ton:. 3 ��r �.��.,�_�-.:.--� -�-.-� lYi-�+6u1`C ICI+:prino!e!Uu.ribkul I Property Address / Location of Construction Site:. ,... _...... ._. .. .m__ S-C.T.M. : 1000 5 1 ss t G I C—t sectloil Block TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ® Area of Disturbance is less than I Acre. No S.P.D.E.S, Permit is ReQuirr ed!„ SP.D.E S. Permit is Required ! ® - Project does Not Discharge to Waters of the State.. No w��._... ..q........- - Area of Disturbance is Greater than I. Acre & Storm-\,cater Runoff Discharges Directly Prior to of a $uildinQ Permit. D.E.S. Permit DIRECTLY From N.Y.S._ D.E.C. OBTAIN a ,S P to Waters of the State of New Yoi k. TI IE APPLICANT MUST OBT ,vca of Disturbance is Greater than I Acre & Str,i-m-`,`ater Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of Nev\ York. THE APPLICANT MUST OBTAIN a S.P D E.S_ Permit throouRh the Southold Town Engineer irr epaqment Prior to Issuance of a Building Permwit� a Date: R FY1R ..-�.ww (`1C rlrrnhar '7nIQ 0 DATE(MWDDNYYY) "R" CERTIFICATE OF LIABILITY INSURANCE 02/25/2025 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 endorsement(s). PRODUCER �. LBUren Murphy Roy H Reeve Agency,Inc. PHONE E 7 -3850298r1 PO Box 54 ADDRESS: Imurphy@royreeve.com 13400 Main Road INSURERIS)AFFORMNGCOVERAGE NAIL# Mattituck NY 11952 INSURERA: Continental Casualty Company 20443 INSURED INSURE'RB Chituk Pools Ltd. wsURERC: PO Box 9 INSURER D INSURER E Cutchogue NY 11935 INSURER Fa COVERAGES CERTIFICATE NUMBER: CL252622643 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PDLICY U Ti) TYPE OF INSURANCE IN SO POLICY NUMBER MMM MMVIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENGIE S 1,000,000 CLAIMS MADE © ENI OCCUR PRISEs Ea a _n0a) S, 100,000 Contractual Liability MEO EXP(Any one p riaan S 15,000 A 6018146726 03/15/2025 03/15/2026 PERSONALSADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGA)E $ 2.000,000 POLICY PE 4 LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERW EAMKGE $ AUTOS ONLY AUTOS ONLY Per a 5DEDFRET;ENTIONI OCCUR EACH OCCURRENCE $ Ct.AIMS^MA'DE' AGGREGATE '$�_,, I] $ S I !ER WORKERS COMPENSATIONSTA TUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNEWEXECUTIVE ❑ N/A EL EACHACCIDENT' $ OFFICE,RINMMSER EXCLUDED? (MandalorylnNH) E.L.DISEASE-EAEMPLOYEE $ If describe yore,;dibe under OES escrON OF OPERATIONS Irultiva 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) Re: Andrew Samaan,600 Praity Lane,Cutchogue,NY 11935 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. PO Box 1179 '.AUTHORIZED REPRESENTATIVE Southold NY 11971 " O 1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1/1 CERTIFICATE OF "'Ew 'Workers' NYS WORKERS' COMPENSATION INSURANCE COVERAGE YORK -1-11","'STAFT Compenisation Board Insured Detail Ia.Legal Name and address of Insured(Use street address only) 1b.Business Telephone Number of Insured Chituk Pools Ltd 631-734-7665 PO Box 9 Cutchogue,NY 11935 le.NYS Unemployment Insurance Employer Registration Number of Insured 1d.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain location in New York Stale,i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Company Town of Southold PO Box 1179 3b.Policy Number of entity listed in box"la": Southold,NY 11971 WWC3754584 3e.Policy effective period: 1/1/2025 to 1/1/2026 3d.The Proprietor,Partners or Executive Officers are: 0 included(Only check box if all partners/officers included) fV all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"Y insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'.T -anceled due to he insuranc c e arrier inut.n sotif y life above certificate holder and the Board within 10 dal,s IF it polity A c nonpayment qf premiumv or within 30 days IF there are reasons other than nonp(xyinent qfprentiums that cancel ille policy or eliminate the hisared fi-oni Cite coverage indicated on this Certificate. (77idese notices may be sent Al,regular snail) this(,'el-dficate 1v valid for one year after thiS form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon,the certificate holder:This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. 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 the coverage as depicted on this form. Approved By; Matt Zender (Print name of authorized representative or licensed agent of insurance carrier) Approved By: 2/25/2025 (Signature) (Date) 'ladle: Senior Vice,President Now workers'Compensation s CERTIFICATE OF INSURANCE COVERAGE TArF " Beard NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PA 11 RT 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carriel 1 a. Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured CHITUK POOLS LTD 631-484-4245 PO BOX 9 CUTCHOGUE, NY 11935 1 c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i,e.,Wrap-Up Policy) 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 PO BOX 1179 3b.Policy Number of Entity Listed in Box 1a" DBL614067 Southold, NY 11971 3c.Policy effective period 05/01/2024 to 04/30/2025 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 emp!oyer'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 described above. Date Signed 5/10/2024 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number 516-829-8100_ Name and Title L2Ston WelSll Chief Executive Officer 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 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 �ww 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 sox 4B,4C or ss 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 DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 111RDB-120.1 (12-41)1 F�CP� Q ' F N \ cr) UP 2XIE ` 3 � � 3 LSD ' + UJ N Lu w I z LL. ` ` W i z I TEE LANE GKN BLS{CUpaS FENCE cats 1.0`W \ a 0.8'S ASPHALT C3 \ EE.C1.7'e DRIVEWAY 1 J`'� v'. 1 \ C pfLpT�nSC� Z +l IFD 34-4' CO I GAR �— r � s t co I N Y a .` 4.0 GAS I 8 3.W TANK 1 �� 1 its IS` a 1z STY a.m 43 ` go FR RES I . #600 N LL er 1 , o r F fi i p I 7 O' I = 0 ' O.D. BR.WALK ors W IL I &STOOP Q U. I FR � 4.1' Z DECK 24.8 m X 0 79.51' AC W CE C - � Cm V N cm K. I I FD - - FD ; Z Z 0 5S METAL FENCE OA'E z 0 N 75016'50"W N/F BARTLETT 205.00' DESCRIBED PROPERTY SITUATE AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK CERTIFIED TO:ANDREW SAMAAN AND MOLLIE MARCOUX SAMAAN FIRST AMERICAN TITLE INSURANCE COMPANY WELLS FARGO BANK, N.A. OCOPYPJGW 2024 WARD BROOKS.ALL RIGHTS RESERVED,DUPLICATION OF THIS DOCUMENT LSA VIOLATION OF FEDERAL COPYRIGHT LAW. THIS SURVEY HAS BEEN PREPARED IN ACCORDANCE WITH THE CODE OF PRACTICE ADOPTED BY THE NEW YORKSTATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS. CERTIFICATION SHALL RUN ONLY TO THE PERSON,THEIR INTEREST ANWR ASSIGNS. CERTIFICATIONS ARE NOTTRANSFERABLE THE EXISTENCE OF RIG-ITS OF WAY,ANDIOR EASEMENTS OF RECORD.IF ANY NOT SHOWN ARE NOT GUARANTEED. SCALE 1"=40' ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7208.2 OF THE NEW YOM STATE EDUCATION LAW. SCTM 1 OQO-109.0O-OJ.00 027.002 DO NOT SCALE FENCES.OFFSETS SUPERCEDE. SURVEYED:MAY 2,2024 LAND SURVEY LONG ISLAND.COM WARD BROOKS LAND SURVEYOR u 11 OCEAN AVENUE BLUE POINT, NY. 11715 (631 ) 576-7794 (631 ) 363-3179 zz s WARDBROOKSOOGMAIL.COM FILE#11526