HomeMy WebLinkAbout51929-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#: 51929 Date: 05/19/2025
Permission is hereby granted to:
Gomb Beach LLC
58-25 229th St
Oakland Gardens, NY 11364
To:
Construct a new single-family dwelling as applied for to include pool/spa addition and roof top hot
tub as per Trustees, DEC Non-Jurisdiction letter, and SCHD approvals. Project was begun in 2021 and
is exempt from present code changes.
Premises Located at:
54205 CR 48, Greenport, NY 11944
SCTM# 52.4-3
Pursuant to application dated 03/21/2025 and approved by the Building Inspector.
To expire on 05/19/2027.
Contractors:
Required Inspections:
Fees-
Single Family Dwelling-NEW $3,054.50
rr��
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
,HOTrtUMWIMMING POOLS-ABOVE-GROUND WITH REQUIRED FENCING $300.00
CO Single Family Dwelling-New $100.00
Total $3,754.50
Building Inspector
„� r m 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 htt s://www.sou.tLhol It Nylillill r. ov
Date Received
For Office Ust
PERMIT N0. Buh Ln
Applications and forms must be filled out in their entirety. incomplete Building 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: March 21 st , 2025
OWNER(S)OF PROPERTY:
Name:GOMB BEACH, LLC SCTM# 1000-52-01-3
Project Address:54205 County Road 48, Southold, NY 11971
Phone#:917 335-5262 1Email:mike@AirGuardWindows.com
Mailing Address:58-25 229th street, Bayside, NY 11364
CONTACT PERSON:
Name:Michael Holevas
Mailing Address:58-25 229th street, Bayside, NY 11364
Phone#:917 335-5262 Email:mike@AirGuardWindows.com
DESIGN PROFESSIONAL INFORMATION:
Name:TOC Architects
Mailing Address:1200 NY-45 Hauppauge, NY 11788
Phone#:631 650-6666 Emaii:Todd@tocarchitects.com
CONTRACTOR INFORMATION:
Name:Finne Contracting
Mailing Address:120 Center Street, Greenport NY 11944
Phone#:631 484-2596 Email:finnecontracting@gmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
IONew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $685,000-750,000
Will the lot be re-graded? MYes ❑No Will excess fill be removed from premises? Wes ❑No
1
PROPERTY INFORMATION
Existing use of property:Vacant Lot Intended use of property:Single Family Res.
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 Residential Vacant Land this property? BYes ONO IF YES, PROVIDE A COPY.
N 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):M.0 a Ho �� s ❑Authorized Agent ®Owner
Signature of Applica t: OLOA HOLE Date: March 21 st, 2025
NOTARY PUBLIC,STATE OF NEW YORK
Registration No. 01 H06233414
STATE OF NEW YORK) Qualified in Queens County
SS: I Commission Expires December 27,2026
COUNTY OF )
Michael Holevas being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Corporate Officer
(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
21 st 25
day of March ,20
Notary Public
PROPERTY OWNER AUTIJORIZATION
(Where the applicant is not the owner) a
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
1 ,
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BOARD OF SOUTHOLD TOWN TRUSTEES
b SOUTHOLD, NEW YORK p
P
1
PERMIT NO. 10047 DATE: DECEMBER 15,2021
ISSUED TO: COMB BEACH,LLC
f
PROPERTY ADDRESS: 54205 C.R.48,GREENPORT
a
SCTM#: 1000-52-1-3
AUTHORIZATION
i
Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in
i
accordance with the Resolution of the Board of Trustees adopted at the meeting held on Decemis r 1 2021, C
and in consideration of application fee in the sum of$250.00 paid by Gomb Beach, LLC and subject to the h
Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits I
the following:
Wetland Permit to construct a new 2-story frame house and garage(1,532sq.ft.footprint),front
porch(51sq.ft.),rear deck(105sq.ft.) and elevated pool/spa(231sq.ft.),stone driveway }
(2,001sq.ft.), public water service connection,nevv sanitary system,i.e. one(1)700 gallon
wastewater treatment unit and two(2)8' dia. by 8' effect.depth sanitary leaching pools
(UOWTS),and new storm water control structures for roof runoff and driveway runoff,i.e.
DW#1—(1) 81dia by8' effect.depth drainage leaching pool and DW#2—(1)8'dia by 7'effect.
depth drainage leaching pool; establish and perpetually maintain a 10'wide non-disturbance
buffer landward of top of bluff; and as depicted on the survey prepared by Howard M.Young,
Land Surveyor last dated November 29,2021,and stamped approved on December 15,2021.
�I
1 IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these
presents to be subscribed by a majority of the said Board as of the 15th day of December,2021.
Greg Williams A sent
TERMS AND CONDITIONS
The Permittee.,_:6 omh B 4p ,_G C.,resiCR!1_gA.542L0L5
__)LgLrk as part of the
consideration for the issuance of the Permit does understand and prescribe to the following:
1. That the said Board of Trustees and the Town of Southold are released from any and all
damages, or claims for damages, of suits arising directly or indirectly as a result of any
operation performed pursuant to this permit,and the said Permittee will,at his or her own
expense, defend any and all such suits initiated by third parties, and thf,said Permittee
assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees
of the Town of Southold:
2. That this Permit is valid for a period of 24 months,which is considered to be the estimated
time required to complete the work involved,but should circumstances warrant,request for
an extension may be made to the Board at a later date.
3. That this Permit should be retained indefinitely,or as long as the said Permittee wishes to
maintain the structure or project involved,to provide evidence to anyone concerned that
authorization was originally obtained.
4. That the work involved will be subject to the inspection-and approval of the Board or its
agents,and non-compliance with the provisions of the originating application may be cause
for revocation of this Permit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the work herein
authorized.
6. That there shall be no interference with the right of the public to pass and repass along the
beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations in the
location of the work herein authorized,or if,in the opinion of the Board of Trustees,the work
shall cause unreasonable obstruction to free navigation,the said Permittee will be required,
upon due notice,to remove or alter this work project herein stated without expenses to the
Town of Southold.
S. The Permittee is required to provide evidence that a copy of this Trustee permit has been
recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to
the deed of the subject parcel. Such evidence shall be provided within ninety(90)calendar
days of issuance of this permit.
9. That the said Board will be notified by the Permittee of the completion of the work
authorized.
10. That the Permittee will obtain all other permits and consents that may be required
supplemental to this permit,which may be subject to revoke upon failure to obtain same.
11. No right to trespass or interfere with riparian rights. This permit does,not convey to the
permittee any right to trespass upon the lands or interfere with the riparian rights of others in
order to perform the permitted work nor does it authorize the impairment of any rights,title,
or interest in real or personal property held or vested in a person not a party to the permit.
COUNTY OF SUFFOLK
EDWARD P. ROMAINE
SUFFOLK COUNTY EXECUTIVE
DEPARTMENT OF HEALTH SERVICES GREGSON H. PIGOTT, MD, MPH
Commissioner
PERMIT CONDITIONS
Project Name:54205 North Road (C.R. 27)
Health Services Reference#: R-20-1350
SCTM#: 1000052000100003000
Revision#: 0
The attached plan, when duly signed by a representative of the department, in conjunction with these conditions,
constitutes a permit to construct a water supply, sewage disposal, and/or collection system for the property as depicted.
The applicant should take note of any conditions of approval, which may be indicated on the plan or enclosed herein.
Construction must conform with approved plans as well as all applicable standards including Standards for Approval of
Plans and Construction for Sewage Disposal Systems for Single Family Residences. Omissions, inconsistencies or
lack of detail on the plan do not release the applicant from the responsibility of having the construction done in
conformance with applicable standards. Issuance of this permit shall in no way relieve the design professional of
responsibility for the adequacy of the complete design.
The permit(plan) expires three (3) years after the approval date. Any modification to the approved design requires the
submission of a revised plan and additional fees (if applicable)for approval prior to construction. No inspections will be
performed by the department if a copy of the approved site plan/survey is not on site during construction or if
the permit has expired.
Permits may be renewed, transferred, or revised in accordance with the procedures described in Instructions to Renew,
Extend, or Transfer an Existing Permit for Single Family Residences(Form WWM-104).
It is the applicant's responsibility to schedule an inspection of the sewage disposal and/or water supply facilities prior to
backfilling. This includes inspections of the sewage collection and disposal systems, water supply system components
and piping, and final grading as shown on the approved plans. This can be done by calling the department at (631) 852-
5754, or through the ACA Portal at bnaaSAaa- I K In certain cases, inspections of the soil
excavation may be required to determine the acceptability of the soils for sewage disposal systems. Excavation
inspections must be confirmed by calling (631)852-5700 between 8:30a.m. and 9:30 a.m., the morning of the
inspection.Article VII of the Code, "Septic Industry Businesses," requires that all installers of septic systems within
shall possess a valid license from the Office of Consumer Affairs. This office will not perform inspections for or grant final
approval for construction of projects that are installed by an unlicensed individual. It is, therefore, in your best interest to
utilize a cesspool contractor with a valid license to avoid substantial delays in your project
Final approval issued by the Department is necessary prior to the occupancy of new buildings, additions to
existing buildings, or for the use of sewage disposal or water supply systems.
WWM-016 Page 1 of 2
INEW Workers' CERTIFICATE OF INSURANCE COVERAGE
ATE Compensation
Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier
1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured
FINNE CONTRACTING INC (631)477-1430
120 CENTER ST
GREENPORT,NY 11944
1 c.Federal Employer Identification Number of Insured or Social Security
Work Location of Insured(Only required if coverage is specifically limited to Number
certain locations in New York State,i.e.,a Wrap-Up Policy)
043644409
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) New York State Insurance Fund(NYSIF)
TOWN OF SOUTHOLD
PO BOX 1179 3b.Policy Number of Entity Listed in Box"1 a"
SOUTHOLD,NY 11971 DBL 5822 08-6
3c.Policy effective period
07/07/2024 to 07/07/2025
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 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
/ass�described above.
Date Signed 3/21/2025 By e��
(Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier)
Telephone Number (866)697-4332 Name and Title Kristin Markwica,Head of Disability Insurance Unit
IMPORTANT: If Box 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 mailed for completion to the Workers'Compensation Board,
DB 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 NYS 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 Signed By
(Signature of Authorized NYS Workers'Compensation Board Emp ogee)
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 (10-17) Certificate Number 830598
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"la"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 listed as
the certificate holder in box"2".
The insurance carrier must notify the above certificate holder and the Worker's 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 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
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 issued 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 carrier 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-120.1 (10-17)Reverse
Am�
NYSF
New York State Insurance Fund PO Box 66699,Albany,NY 12206
1 nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
AAAAAA 043644409
CRANDLE AGENCY INC
44655 COUNTY ROAD 48
PO BOX 1345
SCAN TO VALIDATE
SOUTHOLD NY 11971
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
FINNE CONTRACTING INC TOWN OF SOUTHOLD
120 CENTER STREET PO BOX 1179
GREENPORT NY 11944 SOUTHOLD NY 11971
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
12079 611-6 234150 07/07/2024 TO 07/07/2025 3121/2025
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2079 611-6, 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:UWWW.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.
DANIEL FINNE JR,PRES OF
FINNE CONTRACTING INC
(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 SU NCE FUND
�/-
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 135810135
U-26.3
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Wslon of Environmental Permits,Region 1
SUNY 0 Stony Brook.50 Circle Road,Stony Brook,NY 11790
P:(631)444-03651 F:(631)444-0360
www.dec.ny.gov
LETTER OF NO JURISDICTION
TIDAL'i/M/ T NDS ACT
Gomb Beach LLC February 19, 2021
58-25 2290' Street
Bayside, NY 11364
Re: Application#1-4738-04781/00001
Gomb Beach LLC Property— 54205 North Road (County Road 27)
SCTM# 1000-52-01-3
Dear Applicant:
Based on the information you submitted the Department of Environmental Conservation has
determined that:
The referenced property, landward of the functional bulkhead greater than 100 feet in length (as
shown on the plans by Howard W. Young last revised 12/18/2020) and was constructed before
August 20, 1977 (as shown on the Tidal Wetland Map#716-550) is beyond Tidal Wetlands Act
(Article 25)jurisdiction and no permit is required for work landward of this structure.
Be advised, no construction, sedimentation, or disturbance of any kind may take place seaward
of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your
responsibility to ensure that all precautions are taken to prevent any sedimentation or
disturbance within Article 25 jurisdiction which may result from your project. Such precautions
may include maintaining adequate work area between the jurisdictional boundary and your
project (i.e. a 15'wide construction area) or erecting a temporary fence, barrier, or hale bay
berm.
This letter shall remain valid unless site conditions change.
Please note that this letter does not relieve you of the responsibility of obtaining any necessary
permits or approvals from other agencies or local municipalities.
Sincerely,
(4,4 . V--
Laura F. Star
Permit Administrator
cc: Thomas Wolpert; Young & Young
BMHP
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