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HomeMy WebLinkAbout51903-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#: 51903 Date: 05/07/2025 Permission is hereby granted to: Gerard Dennis 98 MacGregor Ave Roslyn Heights, NY 11577 To: demolish an existing above-ground swimming pool and construct an in-ground swimming pool as applied for. Premises Located at: 2755 Westphalia Rd, Mattituck, NY 11952 SCTM# 114.-10-20 Pursuant to application dated 03/31/2025 and approved by the Building Inspector. To expire on 05/07/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Ukjlkding Inspector * FFRL TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Mairi Road P. O. Box 1179 Southold,NY 11971-0959 u ' Telephone 631 765-1802 Fax 631 765-9502 https-,//www.southoldtommnxgo Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. 5jqg Building Inspector. ' M , 2 Applications and forms must be filled out in their entirety.Incomplete applications will'not be accepted. Where the Applicant is not the owner,an Building Department Owner's Authorization form(Page 2)'shall be completed. Town of Southold Date: OWNER(5)OF PROPERTY: Name: Gerard Dennis SCTM#Z000- 114-10-20- Project Address: 2755 Westphalia Rd., Mattituck Phone#: Email: -B" Contra CH(1 e rf)0_ a ,(.ZM Mailing Address: 2755 Westphalia Rd., Mattituck CONTACT PERSON: Name: Heather Sanderson Mailing Address: 180 Gloria Blvd., Hauppauge, NY 11788 Phone#: 516-359-0873 Email: Expeditehls@gmaii.com DESIGN PROFESSIONAL INFORMATION: Name: Lhri S`� 1 Ie LGt-h a vt Mailing Address: 400 ++CLw l�LlnS AV6• . (Z0n1C0Y11C0)1y0 . 1 Igqq Phone#: 1931 . (0}(0_ 4551 Email: La.bcrew 0 opfooUrn2•n6t CONTRACTOR INFORMATION: Name: Gransasso, Inc. Mailing Address: 10 Walter Court, Commack, NY 11725 Phone#: 631-804-6334 Email: info@gransassoinc.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: lil Other 16 x 32 inground pool Will the lot be re-graded? ❑Yes TNO Will excess fill be removed from premises? 0'es ❑No 1 PROPERTY INFORMATION Existing use of property: Residential Intended use of property: Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Dyes BNo IF YES, PROVIDE A COPY. 4-check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as pronrlded by Chapter 236 of the Town Code,APPUCATION IS HEREBY MADE to the 8ullding Department for the Issuance of a Building Permit pursuant to the Ilfuilding torte 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 210.41 of the New York State Penal Law. Heather Sanderson Application Submitted BY(' rint BAuthorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ) Heather Sanderson being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, Agent(S)he is the A 9 (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 thi s day of ch Zp o�� ota Public MARY CAPOSIANCO Notary Public,State of New York No.01 CA6327242 PROPERTY AUTHORIMION Clue4r,ad In Nassau county . ,�. .. Ctornm"s4lon Expires July 26.20 (Where the applicant is not the owner) Gerard Dennis 2755 Westphalia Rd. I, residing at, Mattituck Heather Sanderson do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. holz Owner's Signature Date Gerard Dennis Print Owner's Name 2 Suffolk County Dept. of Labor, Licensing Consumer Affairs \` HOME IMPROVEMENT LICENSE Name\� FRANK A GRANSA SO ,\ Business Name `\\ G NSSS I NC Tl-is certifies thcat the bearer is duly licensed License Number H-5491 by the county cf suffolk Issued : 03/26 2015 W o-4j T. Rag erk Expires: 03/01 /2027 Commissioner This license Is the roe of Suffolk Count property Y : . : . Department of Labor, Licensing & Consumer Affairs. .•, - . . � Possession C this license does rot guarar ,Ce ins val City. • Additional Business Name License Category H3 - PoolsiS as; H8 - Masorry; H26 - Pools and Spas;Cei-:i ied r • • ,q w, Confers upon Frank Gransass The designation CBP Certified Pool & Spa Buildingprofessional" for meeting the education requirements, successfully passing an objective examination and pledging to uphold the PHTA Code of Ethics. 12/31/2027 Expiration Date Sabeena Hickman • President&CEO, Pool&Hot Tub Alliance N Y I New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AA^^^^ 263797151 COMP MATTERS INC 12 OAK ST BAYPORT NY 11705 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GRANSASSO INC SOUTHOLD TOWN HALL 10 WALTER CT 54375 ROUTE 25 COMMACK NY 11725 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12409191-0 146745 02/11/2025 TO 02/11/2026 3/18/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2409191-0, 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:/NIIWW.NYSIF.COM/CERT/CERTVAL.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 FRANK GRANSASSO GRANSASSOINC A ONE-PERSON CORP 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 SUR NCE FUND DIRECTOR,IfiSURANCE FUND UNDERWRITING VALIDATION NUMBER: 577073264 Workers' CERTIFICATE OF INSURANCE COVERAGE 4YTOAfTE 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) 1 b.Business Telephone Number of Insured GRANSASSO INC. 631-804-6334 10 WALTER COURT COMMACK, NY 11725 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) 263797151 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 Southold Town Hall 54375 Route 25 3b.Policy Number of Entity Listed in Box"I a" Southold, NY 11971 DBL687349 3c.Policy effective period 03/31/2024 to 03/30/2026 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. �,� 4r" Date Signed 3/18/2025 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 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 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) 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) 11111111D°°°1°°11°°1°1°°11°1°11°°°�IIIIIII 0 DATE(MM/DD/YYYY) A R " CERTIFICATE OF LIABILITY INSURANCE 03/18/2025 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(ies) 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 endorsements). PRODUCER CONT,h Tricia Baratta PHONE 631 248 2500 A/ No 631 278 9842 Comp Matters Inc. (�t.IL. td: ( ) .............A.m. _� ..., ............. m ... � mattersinc com ...... _... 12 Oak St. E-MAIL cafttDe com AIJCIq$�? p.... .. INSURgM)AFFORDING COVERAGE NAIC# mm. Xp �. ..1 _ _. _CONTINENTAL CAS CO 20443 Ba ort ... � ...� ... ._.. NY 11705 INSURER A: CONTI .....� �_........ .. ..... INSURED ,,INSUR,ER B -....,-,,....._-....--.... �...�-...-... .......... -...... ......................A -, ........ Gransasso Inc. INSURER C:!.._.n. ��..._............ ,..._.........._.�.._� �.............. .�.. .�........._..m 10 Walter Court INSURER D: ................._..._., ...........__..._ ...... I suRER E Commack NY 11725 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. LIMITS. ....^ .... IiRR ........-TYPE OF INSURANCE POLtCY NUMBER.....,,.,. POG I MM/EtO E'%.P]v...�„ x COMMERCIAL GENERAL LIABILITY EACH OccURRE NCF. $ 1"00U00 bAWAIUJ rC rz Ed $ 1,000,000 CO CLAIMS-MADE OCCUR PREv(05(WS(E"a atcurrgN110,)_... ,m, MED EX,, one erswwn) $ 10"000 � __ A B 7013566212 02/12/2025 02/12/2026 PERSONAL&ADV INJURY $ 1,000,000 ..N 2,000,000 PRODUCTS-COMP/OP AGG `✓ POLICY JECT LOC .�- $ 2"t��C).C)0( AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ PRO- j OTHER, ... ..,,. AUTOMOBILE LIABILITY COMBINED Si N'GLE LIMfr ANY AUTO BODILY INJURY(Per accident) $ BODILY INJURY(Per person) OWNED SCHEDULED $ AUTOS ONLY , AUTOSH RED NON-OWNED •m AUTOS ONLY __. AUTOS ONLY AP �� IJAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE CLANMS MADE` _ m WAGGREGATE EXCESS LIAB .. .._ ... DEO RE T°EC�NT'iONsN$ $ WORKERS COMPENSATION OTNi, AND EMPLOYERS'LIABILITY Y/N STATWITE R ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E L EACH ACCIDENT (Mandatory in NH) SE-EA EMPI-OYEE $ VT yes,describe ender DESCRIPTION OF OPERATONS Wo E.L.DISEASE-PPJI.GCY LVMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Southold Town Hall SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2�015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD COL i i OEt on al! 1 *low VKX III p MMJME IT FNO 0 LP, /10. F11D I.P. /IN. TET .0-0 SPOI ELEVAran CCU miTY POLE �-- GUY WARE a.�T ulJTT PULE wUai 1 IA ROAD "L LIGHT POLE WE Sm FIRE NTURANT (50- WIDE TIME -�— PVC FENCE (PVC) (49.�J6- WIDE—b-- STOCKADE FENCE (S1K) — -- CHAN LOW FTNCE F EDGE OF PAVTMINT r1E FENCE -------------------- �------- .,..�� Q MANHOLE _ 10 'A'-RILET 2 RT * 0*1 'B'-INIEI !`w T ALK YARD RRIEi �O.OD• III I 75.00 s 0 YARD INLET -4�0-r ) m A/C UNIT /0.!• Ia m ELECTOK METER w 1 bt M CAS METER m WATER METER pQ OAS VALVE �I M WATER VALVE 1 �Q 4b TEST HOLE N 1 IR[E • tol ® SHRUB t U j 1 F IF BOLLARD WEILAND FLAO D.C. DEPRESSLD CURB 1 i FE. FENCE ti L MAS. MASONRY _ 1 PLAT, PLATFORM In 7 R/O OPEN W.W. WOO"HELL B/W BAY WINDOW C/E CELLAR ENTRANCE T im VM I �- I R 0 ROOF OVER kpie I ' I CANT. 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