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HomeMy WebLinkAbout51867-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#: 51867 Date: 04/24/2025 Permission is hereby granted to: Joshua Molgano 17 Newmarket Rd Garden City, NY 11530 To: construct accessory in-ground swimming pool as applied for. Premises Located at: 2300 Pine Neck Rd, Southold, NY 11971 SCTM#70.-9-7 Pursuant to application dated 03/18/2025 and approved by the Building Inspector. To expire on 04/24/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector „, TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 7, Telephone (631) 765-1802 Fax (631) 765-9502 , Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only SNb]- Y , PERMIT NO g K Building Ins ector;—l- � °' 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. Date: . OWNER(S)O PROPER :. Name: Ali SCTM#1000- Project Addressoc tsle� .. Phone#: Email: - Mailing Address: CONTACT PERSON: Name: Mailing Address: ” Ao Phone#: , Email; DESIGN PRqfESSIONAL INFORMATION: Name Mailing Address: Phone#: f„ Email; CONTRACTOR MIFOR;;ATION: Name'. ^ ' Mailing Address: Phone DESCRIPTION OF PROPOSED CONSTRUCTION El New Structure ❑P8 ,ont ❑ ipAlteration ❑Re ar ❑Demolition Estima d Ca t of Project: ❑Other Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covena is and restrictions with respect to this property? ❑Yes IF YES, PROVIDE A COPY. r Reading: The owner/contractor/design rofessional is responsible for all dra age and storm water issues as provided by eck Box After p g a r 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 rdnance 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 : uthoriz d Agent ❑Owner Signature of Applicant: Cate: ' P STATE OF NEW YORK) SS: COUNTY OF ping duly sworn, deposes and says that (s)he is the applicant Kame of indiv' i 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 day of ItIT � yU. JVIQ X�✓ lary Public 2t0 W Ufiw"Oy y C,O PN FIR)PERTY OWNER AUTHORIZATION ? -za. here the applicant is not the owner) 9l �NNIS\w !I 25X A II i Aresiding at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. U-, LA &,VV Z Owner's Signat a 6ate I Print Owner's ame 2 Yoll Workers' CERTIFICATE OF INSURANCE COVERAGE TA 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 carrie 1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured FENCE KING OF ROCKY POINT INC.DBA SWIM KING POOLS &PATIOS 471 ROUTE 25A ROCKY POINT, NY 11778 1c.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 53095 Rt. 25 3b. Policy Number of Entity Listed in Box"1a" DBL37154 PO BOX 1179 Southold, NY 11971 3c.Policy effective period 02/01/2024 to 01/31/2026 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 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 1/22/2025 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Leston 'WelSh Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance 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 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 513 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) p Tele hone 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) 1111110111111111111111� llllll�)��1111 Yyo Workers' CERTIFICATE OF sTATF Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 631-744-8100 Fence King of Rocky Point,Inc.,DBA:Swim Kings Pools Randy T Rodecker Inc DBA:Swim Kings Pools 1 c.NYS Unemployment Insurance Employer Registration Number of Fence King of Rocky Point,Inc dba Swim King Pools&Patios Insured 471 Route 25A Rocky Point,NY 11778 Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 11-3092960 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Co Town of Southold 3b.Policy Number of Entity Listed in Box 1 a" 53095 Rt.25 WWC3748015 Southold, NY 11971 3c.Policy effective period 11/05/2024 to 11/05/2025 3d.The Proprietor,Partners or Executive Officers are �X Included.(only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box 1 a"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"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled 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 the coverage indicated on this Certificate.(These notices may 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 dues 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: Philip Colletta (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 9A— 10/25/2024 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 631-465-4000 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov SYMBOL LEGEND El MONUMENT FIJD (0 MANHOLE IQ TEST HOLE BEARINGS SHOWN HEREON ARE 0 I.P. / I.B. FND M2 "A"-INLET �;; TREE BASED ON LIBER 13166 PAGE 873 I.P. / I.B. SET r] "B"-INLET SHRUB �%0'5 SPOT ELEVATIONS YARD INLET BOLLARD CC-) UTILITY POLE YARD INLET WETLAND FLAG l-- GUY WIRE LF] ELECTRIC METER. CANT. CANTILEVER UTILITY POLE WAIGHT ❑G GAS METER FE. FENCE LIGHT POLE ® WATER METER. MAS. MASONRY Gy - SIGN M GAS VALVE PLAT. PLATFORM �r PVC FENCE (PVC) W, W,W. WIIJDOW WELL STOCKADE FEIJCE (STK) M WATER VALVE B/W BAY VJINDOW —'X— CHAIN LINK FENCE (CLF)O/H OVERHANG C/E CELLAR ENTPANCE —— WIRE FENCE R/O ROOF OVER 71 FIRE HYDRANT D.C. DEPRESSED CURB A/C UNIT CROSS CUT G.QL. GENERALLY ON LINE A STAKE O/L ON LINE R.O.W. RIGHT OF WAY PINE NECK .ROAD (50' WIDE) EDGE OF PAVEMEIJT EDGE OF PAVEMEIJT CLF T €� 100 00� .s' 4 0*1 LINK FEN. a � ( _ 117.05' Az; i kA .. TS.t TAX LOT 8 au .. 4 TAX LOT 6 SFIO RO.t' 6'_ TOCX a FEP§, - i err`' s i S'(}F FEN TAX LOT 9 CV (?9 Flap 0 80-r�3#ry' MOAN 49.es 6'STDC1 ADE FEN, 100.00 -�- 8 * ` 10"W S WEREFEN, ' FEN 2.a' TAX LOT 12 TAX LOT 11 LOT AREA 19,502.77 S.F. 0.45 AC. GRAPHIC SCALE 30 0 15 30 GUARANTEED TO: - TITLE NUMBER: PARA-54696 JOSEPH ARDITO, ESQ. ARDITO & ARDITO, LLP ( IN FEET ) FIDELITY TITLE INSURANCE COMPANY REM 1 inch 30 ft. SURVEY OF PROPERTY O NEwSCALICE land surveying 2300 PINE NECK ROAD, SO SITUATE NEW YORK 11971 mjslandsurvey:com P:631 —957-2400 souTHOLD, TOWN OF SOUTHOLD 01 ` South , p NY 11751 011 1 S th Bay Avenue, SUFFOLK COUNTY, NEW YORK LAND DR.:MC CREW.:JM SCALE: 1" = 30' TAX MAP N0. DATE SURVEYED:09/24/2024 JOB No,S24-5278 1000-070.00-09.00-007.000 €a}UEiNtttiCds3dO AT6fA€tiO[I OF,A 1N 4 To Do wlw&f Nw A 1�wrm_m i X8 Imo#B..A K_ SEC, TA%' -�Y, &ON 5L�'e EQUATION l W i2P OILY 6 UIIDAP.Y ILAPS wM �'S T�§� tXn cm x e 14r €I i OMNE�T EtA3� '.i?E I# 5'i f�IGu�I WCAK)Q-HFaG t TO} tntlaCA i6 Ylp Ttm -_ `5.hwe A} T�av INAT UK .p i (�RFPdhSTF m AG 4wd--C MIN TEA culum- T r w..s C or PAA ME( UMA) AN-"W THE Nft M%S ASMCIFNN Of PROP -RIAL L.4 Ulm! 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