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HomeMy WebLinkAbout51886-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#: 51886 Date: 04/30/2025 Permission is hereby granted to Castelforte LLC 259 Barton Ave Patchogue, NY 11772 To: construct accessory in-ground swimming pool as applied for. Pool equipment shall be located a minimum of 10'from the side yard lot line. Premises Located at: 750 Kerwin Blvd, Greenport, NY 11944 SCTM# 53.-4-44.46 Pursuant to application dated 03/25/2025 and approved by the Building Inspector. To expire on 04/30/2027. 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 r; Telephone(631) 765-1802 Fax(631) 765-9502 lit(ps://www.southoldtowiiny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only s — PERMIT NO.. 15 Building Inspector:_ Applications and forms must be filled out in their entirety.Incomplete M A R 2 52025 applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. a'ulld'l'ng Opp Date: Town of Southold OWNER(S)OF PROPERTY: Name: Z C SCTM#1000- S 5- `A Physical Address: 1 n fV Phone#: 3rr �� Email: Mailing Address: CONTACT PERSON: Name: Mailing Address: Phone#: �1 .. Mail: D, DESIGN PROFESSIONAL INFORMATION: Name: _ r Malling Address: To 15 ox COLA eat, n RA 0�3 Email" Phone#: -1 BMIX11 CONTRACTOR INFORMATION: Name: b Mailing Address: 5!h- midaw Phone#:� _ _ �/f(�� Email• DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: _K: Will the lot be re-graded? ❑Yes Will excess fill be removed from premises?�Mosed es ❑No i n � debul Luqf x 0 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes XNo IF YES, PROVIDE A COPY. C eck 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): ❑Authorized Agent awner Signature of Applicant: Date: �(//Z5 STATE OF NEW YORK) SS: .kke-34�OrJ COUNTYOF SU F- - \V- ) (� GL In L� being duly sworn, deposes and says that(s)he is the applicant (N,ame of Yndividual Aigning co tract)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 "d. 202� w`Notary Public RYAN HAVEL Notary Public,-State of New York PROPERTY OWNER AUTHORIZATION NO.OiHA0032384 Qualified in Suffolk County (Where the applicant is not the Owner) My Commission Expires Dec 27, 2028 /11 residing at , do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Sign ure Date �a Writ Owner's 4ame 2 MA Rome &1k V`rCE:40 L„ I, i.'- :0I'l i7 $ _•�, 1,,, f` +1R�;, 1 i I d Name , i�r�li i I 8 r � j LIPOO-1 "el CERTIFICATE OF LIABILITY INSURANCE DATE 1 . 12N31/202024 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 cartificate holder is an ADDITIONAL INSURED,the pollcy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If'„SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,,certain policles may require an endorsement. A statement on this certificate doss not co ter rigift to the cedifidats holder in lieu of such endoaa^aemont s �M1M Ave IAMC1IN411, G 63l rannaan F'"IP UCER Re n A ny,Inc. CI 46 Deer Babylon,NY 11702 Regan Agency,Inc: I.ssR Ne RAaE NAIL IMMRA.Hartf�rd Fire Insurance Co. 19682 I � 1Trurnt►ull InsuMnCO Co. 27120 �o�n IP LL Patia Ins Dartford-Casualty Insa n Co � 14397 I AM edal� oluchaelRDdomllllcl INSUITIBI o: Karam,NY1172T� y UfiER'P s_ C RAGES I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE;INSURED QED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO W HrH THIS CERTIFICATE MAY BE.ISSUED OR MAY,PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DE'SCRIeEO HEREIN IS SUEUECT TO ALl!,..THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. L USR POLICY'aw' LIMITS tl Sk { TYPE OF 1NIIRANCE POLICY ICYYEFF' A X COMMERCIAL GENERAL LIABILITY E 11000,000 CLAIMS-MADE X OCCUR 12UUNOOCTA 12120/2024 10/17/2025 RENTI o 100,000 X 15,000 P ' S Lone-209 12 + 000 MED N GATE 2,110"'000 GEN'L AGGREGA LIMIT APPLIES PER: 2,Illlll,tl00 X POLICY JpECT F]LOC PRODUCT -, P ACr • AUTOMOBILE LIABILITY III I7 LIMIT 100,0iItI'., v V,Y AUTO 2UEN009CUO �1212012024 10/17/2025 INJURY NED SCHEDULED AUTOS ONLY AUTOS INJURY YIN URY e I X AUTOS ONLY X AUTOS ONLYRI AtE r- X UMBRELLALIAB OCCUR CURRENCE 1'" ,TRIO EXCESS UAB CLAIMS-MADE 142HHUQD9CU1 121201202410/1712025 T's DED I X I RETENTIDNs . 10,000 WORORS SATIOMI PEAR O7II JMN1>F.MP'�.OYERS LlAII1LTTY ., Y I IN PROPRIETORIPPAA YE N...1 A E.;L,EACH A ENAL I., Fia F-L DISEASE'-EA E: $ IDI os i Lm un 2E er 2 TI NS E..P YLNMT A Props 12UIUNQDSCTA 12/20/224 1011712025 BP 1I17,-000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space.is required) ' Certificate Holder Is Additional Insured. CERTIFICATE HgLPER . SCMt9" I^ffOL 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. 53095 Route 25 Southold,NY 11971 AUTHA7RIZENAREPRESNENTATPYE ACORD 25(201"3) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYS" F New York state Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS',COMPENSATION INSURANCE (RENEWED) A A A A A A 112590890 REGAN AGENCY INC 463 DEER PARK AVENUE BABYLON NY 11702 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POOL&PATIO INC TOWN OF SOUTHOLD 54.3 MIDDLE COUNTRY RD 53095 ROUTE 25 CORAM NY 11727 SOUTHOLD NY 11971 POLICY•NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE I 12439 791-1 317737 04110/2024 TO 04/10/2025 2/23/2024 THIS IS TO.CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2439791-1, 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, AND, WITH.RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE. POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSiF.COWCERTICERTVAL.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 MICHAEL DOMINICI LONG ISLAND POOL&PATIO INC (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 DIRECTOR,INS : tCEUND UNDERWRITING VALIDATION NUMBER:51022972 U-26.3 CERTIFICATE OHNSURANCE COVERAGE 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 LONG ISLAND POOL&PATIO INC 543 MIDDLE COUNTRY ROAD CORAM,NY 11727 1a Federal Employer Identification Number of Insured Work Location of Insured(Only required If coverage Is specifically limited to or Social Security Number certain locations In New York Slate,Le.,wrap-up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3s.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPolnt Life Insurance Company Town of Southold 53095 Route 25 3b.IPolicy Number of Entity Listed In Box"la" Southold,NY 11971 DBL575672 i 3c.Policy effective period 01/01/2024 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 employer's employees: ` Under ponalty of perjury,I.ceirtify that I am an authorized representative or licensed agent of the Insurance carrier referenced above and that tha named Insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage:as described above. Date signed 12/23/2024 By - (Signature of insurance cmrrier autl9ordted representative or NYS Uwnwd Insurance Agent of that insurance carrier) Telephone Number 10 Name and TIUe Le tort Weish.Chief Executive Officer IMPORTANT: If Boxes 4A and 5A ar6 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 6B Is checked,this certificate Is NOT-COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Pamffy Leave Benefits Law.It midst be amailed to PAU,@wcb.ny.gov or it can be mailed for completion to the WVorkers'Compensation Board,Plans Acceptance'Unit,P'O,Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only If Box 4B,4C or 5B have been checked) Stater of Now York Workers' Compain ation 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 Warkers'Compensation Board Employee) Telephone Number Name and Title Please Note.Only insurance carriers Ifcensed'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) �I�N a � io2iiMi1iiiiii�ui- ruilNl l SURVEY OF LOT 3 1 MAP OF CONKLING POINT ESTATES SIT UA TE ARSHAMOMAQUE 0� TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK <1* S.C. TAX No. 1000-53-04-44.46 SCALE 1 "=40' JANUARY 15, 2014 AREA = 29,869 sq. ft. 0.686 ac. o 0- a O m 11 CERTIFIED T0: MKM ABSTRACT TITLE No. 30711 N SUNNY'S KIDS LLC CYRIL SPARAGNA <, MAGGIE SPARAGNA cX EO GiV9EStN IN PREPAREDNxelMl uwaED AND ADOM K STATE C. �7• � . �o9 owmma:. *� dvp 10 001 wM'Vol N,Y".S. LID. '�Ga. '50467" SEPTIC SYSTEM TIE MEASUREMENTS F�OQ HOUSE HOUSE ION OR ADDITION TO THIS�UKWTIMIZED��VORK STATE ,�0 •O"` CORNER QA CORNER 08 EDLICATIOcorers of THIS slmvrY ww NOT a�raNG N thm Tf Corwin 1 1 O GJ� SEPTIC TANK THE LAND SURMOR'SSAL INKED EC OR Land Surveyor �""� 30' 38' O J EMBDSm LID RUE C NOT BE COl61DETim COVER ro BE A VALID TRUE COPY. 29 48 Trrlr:� wrnm HIW�suRver LEACHING POOL ONLYMTHE 1EF HEREON� oN�r ro THE�N FOR wNDN TIR: COVER'1 Isti .A1�GH HIS ELF TOW AND Title Surveys —Subdivisions — Site Plana — Construction Layout LEACHING POOL , �°" t 1' 1 AND COVER 2 42 53 ulloN iwH AM Nor LENDING E PHONE (631)727-2090 Fax (631)727-1727 LEACHING POOL , THE EYISTENCE OF RIGHT OF WAYS OFFICES LOGI7m AT MAILING ADDRESS COVER 43, 42 ANO/Q1t EASEMRNTS OF RECORD, IF 1566 Main Road P.O. Sox 16 ANY,. NOT S,MII A1TE NOT GUARANTEED. "part,, New York 11947 Jamesport, New York 11947