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Home My WebLink About51913-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#: 51913 Date: 05/12/2025 Permission is hereby granted to: William Rich III 165 Morris Ave Rockville Centre, NY 11570 To: legalize "as built" mini split HVAC system to existing single-family dwelling as applied for. Premises Located at: 500 Meadow Ln, Cutchogue, NY 11935 SCTM# 116.-2-26 Pursuant to application dated 04/02/2025 and approved by the Building Inspector. To expire on 05/12/2027. Contractors: Required Inspections: ELECTRICAL- ROUGH, PLUMBING , ELECTRICAL- FINAL, FINAL, Fees: As Built HVAC $500.00 ELECTRIC -Residential $200.00 CO-R IDENTIAL $100.00 Total S800.00 16 W Inspector Mg6�FFPl� TOWN OF SOUTHOLD—BUILDING DEPARTMENT ^ Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 .. Telephone (631) 765-1802 Fax(631) 765-9502 https://www.soLitlioldtownaysov Date Received APPLICATION FOR BUILDING PERMIT C E 0 d E i For Office Use Only PERMIT NO. ::� Building Inspector. AP11 2 2025 Applications and forms must be filled out in their entirety.Incomplete BulldIng Department applications will not be accepted. Where the,Applicant is not the owner,an ToWn of Southold Owner's Authorization form(Page 2)shall be completed. Date: OWNERS)OF PROPERTY: 2. Name: " , SCTM#1000- Project Address:. �m Phone#: `" Email: . . Mailing Address: M CONTACT PERSON: Name: • _ . Mailing Address: Phone#: 4? 0(0" JE DESIGN PROFESSIONAL INFORMATION: Name Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: ( 6 C) Phone#: 607 maiV: DESCRIPTION OF PROPOSED,CONSTRUCTION .� pEstimated �Project: Other � ��- �� ❑Alteration ❑Re air ❑Demolition $stimated�Cost of Pr� � ❑New Structure ❑Additio Will the lot be re-graded? Dyes �KNo Will excess fill be removed from premises? ❑Yes IVo 1 PROPERTY INFORMATION Existing use of property- Y - Intended use of property: r—Ilm1 Zone or use district in which premises Is situated: L Are there any covenants and restrictions with respect to this property? ❑Yes 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 210AS of the New York State Penal Law. Application Submitted By(print name): 1 j JCb.eV�n 'V6,0Uy-t)e ❑Authorized Agent U&ner Signature of Applicant: - Date: STATE OF NEW YORK) SS: COUNTY OF 5S�� 1 ) t being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, r) (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 � 20_ otary Public PROPERTY OWNER AUTHORIAT! �� v (Where the applicant is not the owner) I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 f� 0 BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 iames,h@southoldtownnv.gov - seand CcDsoutholdtownn . ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: j YYl � Electrician's Name: " " License No.: � Elec. email: '�.� a C�-M Elec. Phone No: �2 ( - L� 4f 5- ❑I request an email copy of Certificate of Compliance Elec. Address.: +0 1 JOB SITE INFORMATION (All Information Required) Name: /2"t, F Address: w , Cross Street: r Phone No. f-- 0 " Bldg.Permit#: email: Tax Map District: 1000 Section: Block: 6, Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: KYES [] NO Rough In Final Do you need a Temp Certificate?: a YES E' NO Issued On Temp Information: (All information required) Service Size01 Ph 3 Ph Size: A # Meters Old Meter# El New service[—]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 M2 H Frame 0 Pole Work done on Service? Y N ,additional Information: PAYMENT DUE WITH APPLICATION NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 113527190 ROY H REEVE AGENCY INC 13400 MAIN RDEll 16 PO BOX 54 SCAN TO VALIDATE MATTITUCK NY 11952 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DONALD STARZEE D/B/A WILLIAM RICH STAR MECHANICAL 500 MEADOW LANE 150 MOOSE TRAIL CUTCHOGUE NY 11935 CUTCHOGUE NY 11935 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11470 138-7 266550 01/25/2025 TO 01/25/2026 4/1/2025 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1470138-7, 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.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 THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 SU NCI= FUND 4 DIRECTOR„INSURANCE FUND UNDERWRITING VALIDATION NUMBER:515168388 U-26.3 AC 0 4/01 CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) i w /0112025 /2 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', It the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 rl hts to the certificate holder In lieu of such endorsement(s). PRODUCER „CT Debra Simicich Roy H Reeve Agency,Inc. PHONE r (631)2984700 FAx w a: (631)298-3850 PO Box 54 E•MAIL dsimidch@rcyreeve.com ADDRESS: 13400 Main Road INSURE S AFFORDING COVERAGE; NAICu Mattituck NY 11952 INsuRERA: Merchants Preferred Ins Co 12901 INSURED INSURER B: Donald Starzee DBA Star Mechanical INSURER c 150 Moose Trail INSURER D: INSURER E: Cutchogue NY 11935 MSURERF: COVERAGES CERTIFICATE NUMBER_ CL24122322321 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE 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. iINBR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMDrYYYY LIMITS LTR I,000,000 COMMERCULL GENERAL LIABILITY EA,C;'.H OCCR,NR,RENCE $ CLAIMS-MADE ®OCCUR ®r $ 5,0,000 MED .ExP(An one arson) $ 5000 A CTRI010129 01/25/2025 01/25/2026 PERSONALBADVINJURY $ 1,000,000 GEN1.AGr.REGAr'E.LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000.000 POLICY PRO 7 LOC PRODUCTS-GOMPIOPAGG S 2,000,000 JE OTHER:. AUTOMOBILE LIABILITY COM'OWED SINGLE LIMIT $ deal ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PFtOPEIiTY OAIa1�AGE $ AUTOS ONLY AUTOS ONLY Per acckdgm I UMBRELLALIAB OCCUR EACH OCCURRENCE $ .. EXCESS LIAB CLAMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY YIN S7 lE ER ,,, ANY PROPRIMB R/PARTNER/EXECUTNE ❑ NIA E.I....EACH ACCIDENT $OFFICER/ME ..,,, (Mandatory in NH) EXCLUDED? (Mandatory in NH) EL DISEASE-EA.EMPLOYEE $. If yes,describe under DESCRIPTION OF OPERATIONS below 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN William Rich ACCORDANCE WITH THE POLICY PROVISIONS. 500 Meadow Lane AUTHORIZED REPRESENTATIVE Cutchogue NY 11935 1 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ............. ...... .,...-... ....ry ( SURVEY OF PROPERTY SITUATED AT CUTCHOGUE µ ��I TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 11 I. S.C. TAX No. 1 Q00-1 16-02-26 SCALE 1"=30' I � Ow D 1 z37fis JANUARY 10 1997 MARCH 6. 1997RREVISED P ROPOSED LAN SEPTIC LOCATION i� MAY 7, 1997 REVISED PROPOSED SEPTIC AS PER S C.D.H.S_ E MAY 4, 1999 REVISED _0' PLAN c 1 DECEMBER 17. 1999 UNDER CONSTRUCTION SURVEY _ P -�• ��„ M 3 JULY 17, 2002 FINAL SURVEY SEPTEMBER 20. 2002 SHOW WELL OFFSET 6.51 40' D AREA = 43,853.94 sq. ft.. (TO TIE LINE) 1.007 ac. M p N U UQ 44 LS .q„ 4 * N N In y "L Z A I, T, '1L 2v, ...__ 1 Y Iji A 41 F i I � E9.Y'CpRoC EMITS "l ru L � 5 89'S6'40" Wgu w265.97' d I� »._..... ... M I N/®OF a4 DAVJD TERRY CASE p TO THIS SURREY F A VID I Y RF 3AUE MATH LAW THE N'£V YlWN STATE .�1 ( EDucAnDN aw /`S �//'r c1�°-'C� COPES OF THIS SURVEY MAP NOT t f > THI I.d&57 NJWWk:A'!GN'"9 INKED SEAL OR 04905M�'.PY SM SHAU NOT BE CONSIDERED TO BE A VALID TRUE COPY y CERflF CAnDNS INOCATED HEREON SNALL RUN ONLY TO THE PERSON FOR=THE SURREY 6 M`4'uAAEI AH41.MAD DEbwu.M"tlD THE a%f "A," dx.wF7rrA'AtEwaAL AOENFI'Alto TO h6 ASSIONUEE9 OF THE LEND G". - y�� TORDN.asinFICATIONS AFC NOT 7RANEFERABLE h THE EXISTENCE OF RIGHTS OF WAY AHD�OR EASCUOTTS OF RECORD,IF ANY.NOT SNOWMr.ARE NOT GUARANTEED. C NEW SUFFOLK AVENUE PREPARED MW WZMANCA MAH 411 1Mwt#fVUIV yO#IA NYwFy AFO^Hti`GA0 M1 Np AACLYD AS TFAARIT FNT VNN Joseph A. I1e gtC M'OR P M!"nC Hv M Y Cw 5' SrAPS JfMG1 IRI.6 55Ow.AA":N mIT NOTES,• � Land Su rveyor 1 ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM "ar; ........... . . —.,r 2. THIS PROPERTY' IS IN FLOOD ZONE AE (EL 8) AS SHOWN ON FLOOD INSURANCE RATE MAP COMMUNITY—PANEL No. 36103CO501 G ��r � a � 141c SI!n.AA 5""d 4Y" %moo mo N' ua Mr+aauN 8.�ua ZONE AE (EL 6) AREAS OF 100—YEAR FLOOD. BASE FLOOD ELEVATIONS AND Y H'H4'PIL(63T)7!T' 2090 Fo, (6I )'127—Y'T;k7 FLOOD HAZARD FACTORS DETERMINED. A ° "� 4 �` 4.r><1X.ka tOF.�71 AT MAtE.lkC JkEERCSS C(1\..• k .J N Y ._Lwe t„,s a '. rC#TM'2 Ooc"k*A m%. RA go, 1931' N4*Yvk 11W $Ngwhwd Now VOA m4m-0965