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HomeMy WebLinkAbout51823-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#: 51823 Date: 04/11/2025 Permission is hereby granted to: Benjamin Bennett 160 Ainslie St Apt 1 Brooklyn, NY 11211 To: Construct accessory outdoor shower,at a single-family dwelling, as applied for. Premises Located at: 1220 Ninth St, Greenport, NY 11944 SCTM#45.-6-9.2 Pursuant to application dated 08/15/2024 and approved by the Building Inspector. To expire on 04/11/2027. Contractors: Required Inspections: FOOTING/REBAR, FOUNDATION 1ST, FRAMING/STRAPPING, PLUMBING , ELECTRICAL- ROUGH, ELECTRICAL- FINAL, DRAINAGE, FINAL, Fees: Accessory-New Structure $125.00 CO Accessory Structure $100.00 1ata 225.00 Building Inspector . ' � TOWN OF SOUTHOLD—BUILDING DEPARTMENT ' Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 us �. V Telephone (631) 765-1802 Fax (631) 765-9502 Lt)s://www.southoldtowtiii ov Date Received IF APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO., � Building Inspector: AUG 02 Applications and forms must be filled out in their entirety.Incomplete ert applications will not be accepted. Where the Applicant is not the owner,an Bttllding Clop'a Owner's Authorization form(Page 2)shall be completed. Town of SOUthoid Date:08/16/2024 OWNER(S)OF PROPERTY: Name:Ben and Carolyn Bennett SCTIVI#1000-045.00-0600-009.002 Project Address: 1220 Ninth St, Greenport, NY 11944 Phone#:917-442-9487 Email:benneb@gmail.com Mailing Address: 160 Ainslie St, APT 1, Brooklyn, NY 11211 CONTACT PERSON: Name:Peter DePasquale (architect) Mailing Address:370 Lexington Avenue, Suite 407, NY, NY 10017 Phone#:516-383-5341 :EEmKaill:pete@gdp.work DESIGN PROFESSIONAL INFORMATION: Name:peter DePasquale (architect) Mailing Address:370 Lexington Avenue, Suite 407, NY, NY 10017 Phone#:516-383-5341 Email:pete@gdp.work CONTRACTOR INFORMATION: Name:North Fork Woodworks, attn: Scott Edgett Mailing Address:810 Traveler St, Southold, NY Phone#:631-298-7900 Email:scott@nfwoodworks.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑ ❑ Estimated Cost of Project:Repair Demolition s.000 D othe r Outdoor Shower Will the lot be re-graded? ❑Yes �@No Will excess fill be removed from premises? ❑Yes ®No 1 Docusign Envelope ID:1993D390-6A1F-47A5-A283-ACF9D69A5161 PROPERTY INFORMATION Existinguse ofproperty: Intended use of property:Single Family Residence Single Family Residence 9 Y Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R40 this property? RYes ❑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 name Peter DePasquale 19,Authorized Agent Downer Signature of Applicant: Peter J ePagWe Date: 07/18/2024 STATE OFM)W*6IK) Florida L NI V SS: COUNTY OF)" Broward) Lip Peter DePasquale being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, Agent (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 ,,;1 PAMPA 18 July 24 d� day of 20 Notary Public Luis Davila y �„� z�tIillPr P ��� LUIS DAVILA tn� Notary Public-State of Florida G Commission HH519 '.. O' "NER. AUTHORIZATION Expires on April 21,20228�(Wh re the applicant Is not the own a� OF 4'ire uiplul�a Notarized remotely online using communication technology via Proof. Benjamin Bennett residing at 160 Ainslie St, Apt 1, Brooklyn, NY 11211 I, , do hereby authorize Peter DePasquale to apply on my behalf to the Town of Southold Building Department for approval as described herein. 07/17/2024 Owner's Signature Date Benjamin Bennett Print Owner's Name 2 DATE(MMIDi AC M CERTIFICATE OF LIABILITY INSURANCE 07/17/2, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TI, CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE, 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(le's) must have ADDITIONAL INSURED provisions or be endorsed. if SUBROGATION IS WAIVED,„subject to the terms ,and conditp'bns of t e policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of s ch endorsement s 1. CO CT PRODUCER �q .E.,. CommercialSty vcsrt _ ... Edgewood Partners Insurance O'14er HONE (63) 390w-9700w. ,, FAX p AOXJ§3pp390�9790 40 Marcus Drive E.-MAIL 3rd Floor �n D� MSMCertxCM@picbrcNkers cote Melville NY 11747 NAIL �.� 6::1 INSURE �uFF" NGCOVERA(3E ,, _. 294.... INsI,IRERA SOtJ11AESS" MAtItIE AND O�EBAT I 12 _ ..� North Fork Woodworks Inc.....,�.�.. UNSURER PO Box 1407 INSURER D ,.... _ �.. .. ...... .._ _.... ..m— Southold NY 11971 Ilt .." INSURER W. COVE IS TO CERTIFY THAT THE POLICIES ESTOF INSURANCATE CE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDENAIMII D NUMBER: THISES NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE TERMS, BE ISSUED POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. HEREIN IS SUBJECT TOALL IN EXCLUSIONS ONS ANDYCONDIT CONDITIONS OF SUCH ADDL rrB THE POLNCYmN6.PMBE N — 6'b LIMITS CERTIFICATE MAY PERTAIN, I:.R TYPE OF INSURANCE COMMERCIAL 2024 Ol/Ol/2025 EM 000,000 A X EAChIOCCURRENCE $ 1� COA CLAIMS-MADE mX OCCUR Y GL2024LHB00012 01/01/ i?. S EaS c�+rrelca ,,_ _ 1000000„ 5E7UU �.. $ 1 000 000 PERSUNAL&ADV INJURY .. $ 21.00)0,,000 GENTAGGRE ATE LIMIT APPLIES PER: PRODUCTS COMPIOPA GENERAL AGGREGATE GG 5 2,000,000 �. .. POLICY r jECOT LOC $ O7 IER COaMak$ SINGLE L IT ) $ AUTOMOBILE LIABILITY BODILY INJURY(Per arson .....�u ANY AUTO Per accident) OWNED SCHEDULED BODILY INJURY( V $ AUTOS ONLY _,. AUTOS PROPERTY DAMAGE $ HIRED NON-OWNED II"earden() AUTOS ONLY AUTOS ONLY $ A UMBRELLALIAB X 'OCCUR EX2024LHB00004 O1/01/2024 01/01/2025' NCCU RENC _,2r0091000 .,e,... AGGk(EGATE ...�_ $ 2 000„ 0Q X EXCESS LW9 CLAIMS-MADE DIED RETENTION$ PER OTH- WORKERSCOMPENSATION T."T.g,1F _ ... AND EMPLOYERS'LIABILITY Y/NEACH E L D DENT $ ANYPROPRIE GORIPARTNERPEXECUTIVE ❑ NIA _E L DISEASE LEA EMPLOYEE:OFFMRIMEMBEREXCLUDED? E $ (Mandatory In NH) �.-.....�... UP ,describe under DISEASE-POLICY LIMIT $ DESC E.L.RIPTION OF OPERATIONS below 5 Schedule,may be ttached if e space is Benjamin &F Carolyn sBennett, is(included as additionalS (ACORD 101,Additional ksinsured for generalrliabilityrc I LOCATIONS liability coverage as J required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Benjamin & Carolyn Bennett 1220 9th Street AUTHORIZED REPRESENTATIVE Greenport NY 11944 0�`U"�" ©1988-2015 ACORD CORPORATION.,. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Workers'RK CERTIFICATE OF INSURANCE COVERAGE TATp Compensation under the NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW Board ART'/,To be completed by Ctisability and Paid Family Ltaave Benefits Oarrier or f-icensed Insurance Agent of that Cartier 1a,Legal Name S Address of Insured 1^sestt�taadreeeomrl 1b.Business Telephone Number of Insured NORTH FORK WOOD WORKS INC 631-298-7900 810 TRAVELER STREET c.Federal Employer Identification Number of Insured or Social Security SOUTHOLD NY 11971 timber Work Location of Insured (only required it coverage Is specifically limited to certain locations In New York Stale,l.e„Wrap-Up Policy) T nd Adtfress of Errlity Ret)uestln,g Proof of Name of Insurance Carrierge(Entity Being Listed as the Certificate Holder) HARTFORD LIFE AND ACCIDENT INSURANCECOMPANY IN AND CAROLYN BENNETT H STREET b Policy Number of Entity Listed in Box"1 a" PORT NY 11944 LNY-628416 c Policy effective period 04/01/2024 to 0 313 1/2 02 5 4.Policy provides the following benefits: O A.Both disability and paid family leave benefits. ❑B.Disability benefits only. ❑C.Paid family leave benefits only. 5.Policy covers: O 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: 7namedinsured 7hasNYS ,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the Disability and/or Paid Family Leave Benefits insurance coverage as described above. /2024 £ r IStgnattrre of insurance carrilles au'hamea represemattYa or NYS Lreaneed Irtsuranea Agantef that Ir"Urahca canter) Telephone Number (212)553-8074 Name and Title:Elizabeth Tello—Assistant Director,Statutory Services 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 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 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 4C or 5B of Part 1 has been checked) - State of New York Workers' Compensation Board According to Information maintained by the l'~I"Y"S Workers"Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave'Benefits Law with respect to all of his/her employees. Date SI nad B (Signature of Authorized NYS Workers'Compensation Board Employee) Tale /torte Number Name and Title Please ents of Note:Only insurance carriers insurance licensed are authorized toite sI Issue disability DS-2d11.family Ins rance benefits bro brokers a e insurance p�lor authorized and d t licensed insurance policies 9 to issue this form. DB-120.1(9-17) II B— I20��1 09-17' � IH Additional Instructions for Form D13-120.1 By signing this form, the insurance Carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"l a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity fisted as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate, (These notices my be sent by regular mail.) Otherwise,this Certificate is 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 Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits policy Indicated on this form,if the business continues to be named on a permit,license or contract issuedi by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a,state or municipal department, board, commission or office authorized or required by law to issue any permit for or in;connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carder is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first, two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or In connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an Insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.11(9-17)Reverse NYSIF NY 12206 New York State Insurance Fund PO Box 66699,Albany, � nysif.comcom CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) NA A A A A 272628352 AMWINS INSURANCE BROKERAGE LLC 200 ELWOOD DAVIS ROAD *40 SUITE 200 SCAN TO VALIDATE LIVERPOOL NY 13088 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER NORTH FORK WOOD WORKS INC BENJAMIN AND CAROLYN BENNETT P O BOX 1407 1220 NINTH STREET SOUTHOLD NY 11971 GREENPORT NY 11944-0158 FPOLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2280 317-5 685667 05/01/2024 TO 05/01/2025 4/15/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2260 317-5, 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 WESSITE AT HTT'PS-/IWWW.NYSIF.COMiICERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT SCOTT EDGETT NORTH FORK WOOD WORKS INC 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 STAT UR. NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 325615146 Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name KYLE JSCHADT Business Name This certifies that the 3earer is duly licensed NORTH FORK WOOD WORKS INC. iy the County of suffolk License Number:H-45819 Rosalie Drago Issued: 02/19/2009 Commissioner Expires: 02/01/2025