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HomeMy WebLinkAbout51934-Z TOWN OF SOUTHOLD 10 ON 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#: 51934 Date: 05/20/2025 Permission is hereby granted to: 265 Arshamomaque LLC 3 Sandie Ln Manorville, NY 11949 To: construct accessory in-ground swimming pool as applied for per DEC Non-Jurisdiction letter and Trustees approval. Premises Located at: 265 Arshamomaque Ave, Southold, NY 11971 SCTM# 56.-2-14 Pursuant to application dated 04/09/2025 and approved by the Building Inspector. To expire on 05/20/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 ding Inspector ^�� . r wv 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 https: /www.southpidtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only E C E E W i PERMIT NO, Building Inspector: ,R— A P 9 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Bupd;r p Depati.went Owner's Authorization form(Page 2)shall be completed. Town Oi<SM11thold Date: 31 2- OWNER(S)OF PROPERTY: Name: ° SCTM#1000�� 02 —� Project Address: AVe, ) o 1J 8��! Phone#: Email: Mailing Address: l2, I C I 1 Ct`O CONTACT PERSON: Name:. lc-ke r no r Mailing Address: — (� Phone : t " —�5-�� Emaip: I ' _ RPfE 1ONAL,INFORMATION: Name: i. nlolol , Mailing Address: �`-- A ve oE)ftL(D R&I.L3 10-79 Phone#: ." E CONTRACTOR INFORMATION: Name: 0 ardlor Vool S Mailing Addre s: 1 Phone#: q� b0 Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Ad 'ition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: "' $ SOdD ['Other l �• "' Will the lot be re-graded? ❑Yes lNo Will excess fill be removed from premises? Edyes ONO 1 PROPERTY INFORMATION Existing use of KOM. � ,e perty Intended use of pro : Zone or use district in which prem'ses is situated: Are there any covenants and restrictions with r spect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. „, 6:ck 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 HER MADE to the Building Department for the issuance of a Building Permit pursuantto 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 descfibgd.,The applicant agrees to comply with all applicable laws,ordinances,building,c�tle, housing code and regulations and to admit authorized inspectors on premises and in buildings)for necessary inspections.False stateme"is 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): 1e-42( Sp-eChT uthorized Agent ❑Owner Signature of Applicant: Date: 3 © J z�`L� STATE OF NEW YORK) S COUNTY OF being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the � (Contract r,Ag a 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 tday of M Crime(- h 20 / Notary Public CHRISTINA DIANNE PARISE NOTARY PUBLIC,STATE.OF NEW YORK p E,mFIT OWNER AUTHORIZATION Registration No.01PA641557R .. Quaiifietl in Sult k ount Z cant Is not the owner (Where the apple ) MyCtrmmtsston Expires residing at a�Y i:� C do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. e/dwner's Signature Date Print Owner's Name 2 .�` r �u�i��hml"�r, �aa,��snPwi�rus�,�aarnwr�rArerot �� 7sv�� awe i BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD, NEW YORK ' PERMIT NO. 10723 DATE: ......R1.1AlLY 1.2 2025 E � ISSUED TO: 265 ARSHAMOMA UE LLC PROPERTY ADDRESS: 265 ARSHANIOMAfWE AVENUE. SOUTHOLD { I SCTM# 1000-56-2-1 4 AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the:Resolution of the Bayard of Trustees adopted at the meeting held oar I� b�?aar 12� � 5„and pp p rooma ue, I,,LC and subject to the G in consideration of application.fee�n the suns of l„25�.174I paid by"��...�Arsha�n l'errns and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorises and permits j the following: Wetland Permit to construct a 16'x32' inground swimming pool with 12"wide coping; install 4' high pool enclosure fencing with gates; install a drywell for pool backwash and install a pool equipment area; with the condition to establish and perpetually maintain a 25' vegetated non-turf buffer landward from the top of bank; and establish and perpetually maintain a non-disturbance buffer seaward of the top of bank; all as depicted on the site plan prepared by Peconis Surveyors, P.C. received on March 13,� � 2025, and stamped approved on March 21, 2025. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, 4 and these presents to be subscribed by a majority of the said Board as of the day and year written above. 9 4 � � x.v w, � ..::��� a �."�tt"[a�'t��i+ �"44%�',�"r,�,+•�FM.,,�'�T3,7s�� � f� n v. 9;nr"'�. �'� �.. F 3 � e - SURVEY OF PROPERTY o Fbnc AT SOUTHOLD a TOWN OF SOUTHOLD N ELEVAnON SUFFOLK COUNTY, N.Y. _ mFl„ 1000-56-02-14 aoA SCALE. 1'=30' FEBRUARY 8, 2024 _wLe MARCH 13, 2024 (REVISIONS) r APRIL 1, 2024 (PROPOSED SEPTIC SYSTEM ADDED) �51 MAY 23, 2024 (CONTOUR LINES ADDED) SEPTEMBER 28, 2024 (REVISIONS) 9 �5g SLT Fa1I DETw OCTOBER 7, 2024 (revisions) NOVEMBER 18, 2024 (BUFFER &PROPOSED POOL ADDED) MARCH 10, 2025 (25' Buffer Added) TEST HOLE DATA �P1 WDONALD CEOSCIENCE ,7,7zDz, APPROVED BY &"11'e F W BROWN LOAM OL BOARD OF'i RUSTEES O s° TOWN OF SOUTHOLD BROW SILT AIL DATE Mr�L.V. J1 �-0.5 PAS Ism D al< VACANT LOT 'g, Ir ., 71 $ NON',NO WATER ENCOUNTERED - �t]L � 'fit r In 4 N8O si)E 4 a o SLY u72 IT €m ce. fir,: d ' LOT 5 ct1 * � ice" � 9 +' _ a b a Tf. KEYS S Q =REBAR L 3, 3 LOT 6 1U ' sEre.,cK w�c �K PUBLIC WATER 3 i 3 s -TEST HOLE g m DVIELLING WITB Certified To: a 265 Arshamomaque, LLC • =PIPE American Dream Abstract, Inc. e =MONUMENT First American Title Insurance Company r =WETLAND FLAG UTILITY POLE =WETLANDS AREA=26,361 SO. Fr.. N.Y.S. LIC. NO. 49618 CONTOUR LINES AND ELEVATIONS REFERENCED TO NAYD✓!B - N.Y.S. LIC. NO. 051132-01 N07E..PROPOSED SEP7,C SYSTEM DESIGNED BY OTHERS ANY ALTERATION OR ADD1710AI TO THIS SURVEY IS A 140LA7ION PEC .IC FLOOD CERTIFICATE SOLUTIONS OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW (631) 765-5020,(631)989-9174 LOT NUMBERS REFER TO "MAP OF BEIXEDON ESTATES" EXCEPT AS PER SECTION 7209—SUBDIWSION 2. ALL CERTIFICAPONS Email: BLOCK 2 FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF sttcfift'ad e SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR P.O. BOX 909 09-202 MARCH 16, 1946 AS FILE NO. 1472. WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD. N Y. 11971 NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY @ 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 June 20, 2024 265 Arshamomaque LLC 3 Sandie Lane Manorville, NY 11949 Re: Application ID 1-4738-05010/00001 265 Arshamomaque Avenue Southold SCTM# 1000-56-2-14 Dear Applicant: Based on the application your agent submitted and additional New York State Department of Environmental Conservation (DEC) information, DEC has made the following determinations. The proposed project, as shown on the survey of the properly by Peconic Surveyors„ P.C. last revised May 23, 2024, is more than 100 feet from NYS regulated freshwater wetlands and beyond the jurisdiction of Article 24 Freshwater Wetlands. Please be advised,the wetland located on the east end of the referenced property and shown on the survey, is not currently designated a NYS regulated freshwater wetland.As a result, all activities proposed by this project are located outside of DEC freshwater wetland jurisdiction (100 feet). On January 1, 2025, changes to the NYS Freshwater Wetlands Act, Article 24 of the Environmental Conservation ILaw will go into effect. These changes will establish a new definition of a NYS regulated freshwater wetland, and the wetland on this lot may become a jurisdictional wetland. At that time, if it is determined to be a jurisdictional wetland, any regulated activities proposed in or within 100 feet of the wetland would require a DEC Freshwater Wetlands Permit. a The portion of the referenced property upland (rarest) of the "Top of Bank', as shown on the aforementioned survey, is beyond the jurisdiction of Article 25 Tidal Wetlands and an Article 25 permit is not required. Please be advised, however, that no construction, disturbance, clearing, discharge, or sedimentation of any kind may take place within 100 feet of NYS regulated freshwater wetlands or below the Top of Bank' without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Freshwater Wetland and Tidal Wetland jurisdiction which may result from your project. Such precautions may include maintaining an adequate work area between your project (i.e., a 15' to 20' wide construction area) and the 100 foot freshwater wetlands adjacent area or erecting a temporary fence, barrier, or hay bale berm. Be advised, any additional work or modificaation to the project as described above within 100 feet of the freshwater wetland or below the "Top of Bank", may require DEC authorization. Please contact this office if such activities are contemplated. HRx �0 of w ErwarorNmental conservatJon M M DEC has documented the summer occurrence of the Northern Long Eared Bat (NLEB) (Myofis septentrionawiis), a species listed as"endangered" by both Now"York State and the US Fish &Wildlife Service, within 3 miles of the project location. We have determined that tree cutting at this location between March 1 and November 30 of any calendar year may result in the"take"of these endangered species within the meaning of Environmental Conservation Law (ECL) §11-535. The term "take" is defined in part as the direct killing or injury of individual members of a protected species, interference with critical breeding, foraging, migratory or other essential behaviors, or the adverse modification of the species' habitat. The "take" of a species listed as endangered or threatened is prohibited in the absence of a permit from this Department issued pursuant to ECL§11-535. To avoid an Endangered Species "take" or the need for an incidental take permit, no tree cutting activities can be conducted at the project site between the dates of March 1 and November 30 of any calendar year. If you have questions about the presence of protected species on or near your property,the potential effects of activities on these species or your responsibilities as a landowner or project sponsor under the Endangered' Species Regulations, please contact the Regional Wildlife Manager at (631)444-0310. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from local municipalities or other agencies. ;Ve truly yours, herri L. you' Regional Permit Administrator SLA/mrp C: David Roberts BEH BMHP Wildlife File _ $e VNELLM ORDPR-CORSTROC110R Qp PLPWC WAYM MAW L R 0 ND%FUm'RR1 13W OF PROPERLY Ig N n� S O g rn m0M >x of M.7' o v z o 9� ' lulliNp J a D t . 1 a„ r A� a Co --k o ' x � 0 , " .. K Kid } K K/ CIO to +R 5r ROB 4,SSOCIAres cptn o 2�0cp + � No�y4 4 6 it �0 (n VIE �CIO Q r rn z � � a V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) I F9/1812 24 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(les),must have ADDITIONAL INSURED provlslons 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 ri hts to the certificate holder in lieu of such endorsemen;d). PRODUCER Rebecca Angelinas Liberty Risk Management, Inc. P 631'S69�33 a 631 6636 2333 Route 112 rbecca Ibe riak.o Medford, NY 11763 INSURER s AFPORDNIaeu CovERAiaE NANc NNauRErzA: H ti I'i C n ..INSURED INSI➢RER e: M n M CIDm 3 Specht-tacular Pools Inc INI3URERI�: Ver s Nv o'rrI 265 Brookfield Avenue INSUItERD: Center Moriches, NY 11934-1001 INSURER E: INSU F: - 00 COVERAGES IS ISSUED TO THE INSURED NAMED ABI��lE FOR HE POLICY CERTIFICATE NUMBER: 0000007 REVISION NUMBER: THIS 1S TO CERTIFY THAT THE'.POLICIES OF INSURANCE LISTED BELOW Hl�'4"l=BEEN THE I�ON.ICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR 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, NSR TYPE OF INSURANCE Y N PO F FRe POLICY NUMBER LIMITS A COMMERCIAL GENERAL LIABILITY' Y 12 UUN OZ8606 9118/2024 9/18/2025 EACH OCCURRENCE $ 11000.000 CLAIMS-MADE ®OCCUR To RERTE0— 's $ 300,000 MED EXP one arson 5 000 PERSONAL&ADV INJURY S 000 000 GIxNPOAGGREGATE LIMIT APPLIES PER: 2ENERJ LAGGREGATE $ 2.000.000 POLICY JECT LOC PRODUCTS-COMPAOP AGO $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY CAP1068516 3/27/2024 3/27/2025 t Pal I $ (l ANY AUTO O OWNED r-1 CH A BODILY INJURY(Per person) $ AUTOS ONLY UT OS AUTOS ONLY SEDULED BODILY INJURY(Per accident) $ HIRED NON-OWNED AUTOS ONLY PPkIO® DAMAGE $ $ UMBRELLA LIAB OCCUR EACHOC CURRE CE EXCESS LIAR CLAIMS MADE AGGREGATE $ DED RI:TEENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPI rOR1PARTISIF E7dECUT6VIx' Y 1 N kOFFNCEr�1MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT' (Mandatory In NN) Pr ea,d cinder E.L.DISEASE-E4EMPLOYEE O ESORNPTION OF O ERAT ONS E.L,�9'ISF­E.,POLICY'UMrr $ C inland Marine HIS J822380 9118/202-4 9/18/2025 Any one occur 667,436 C Inland Marine HIS J822380 9/18/2024 9/18/2025 Newly Acq Equip 100,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Town of Southold is included as additional insured,ATIMA,as required by written contract,subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS, Main Street,Town Hall Southold, NY 11971 AUORI D REPRESENTATIVE RPA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by RPA on 09/18/2024 at 01:40PM Z�ZEW YORKST ATIE Workers' CERTIFICATE OF INSURANCE COVERAGE 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 clrrie 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured SPECHT-TACULAR POOLS INC. 631-696-390U 265 BROOKFIELD AVENUE CENTER MORICHES,NY 11934 1c.Federal Employer Identification Number of Insured Work Location Of Insured(Only requited if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 010648957 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 Building Department 3b.Policy Number of Entity Listed in Box 1 a" Main Street Town Hall DBL152822 Southold, NY 11971 3c.Policy effective period 09/26/2023 to 09/25/2025 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 employees employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employees employees: Under penally;T­pa­d_ur_y_,1 certify that I am an authorize representative or licensed agent of the insurance carrier Fef—erenced above EiR that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 9/25/2024 By i (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 513 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 5B 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) IIIII1111111111111111 DB-120.1 (12- 1) �i I OL "'L �17 ox!-C" r -,�7 Flag#4 � AND SP N FOR POOL BACKWASH VACANT LO �`� I, 1 `� \� \PROPOSED 8'0 DRYWELL T ���� .r EL16.9 I� Fla 3 r t 4 9 � p PROPOSED 8'0 Z. � � _ _��. r� � W DRYWELL TrP. OF 2 +� , 6V VLU w: pr Wt48 0 10POOL P 1.. EQPMNT. rnW 1 t % a06 0 � . � oI GATE E_21.7' VAC L2L GATTEE 0 Li 6* rc ���cw ✓ may° a o m e C U, (� O ZD PERVIOUS v a ace' 5 } - Flog#2 ` Q r7ccs LOT 5ry. w .�` - , ' a Q 20 OR , �,I��Nr gin �' C) m. J 3 7 N 1 , „w r 4q ,, I tL _j w � iEL17.4.. �. .w e ` EDGE OF LAWN _ - ,,,,,,,,�, 347.,Ep a 1 22 1 TT<iw�AIR uE 0 2' ; l x * ��� EL2 l r ti ti `� tL O C ELECTRIC SERVICE LINE Landward edge of Fresh Water Wetlands as delineated • , by Peconic Surveyors March 6, Z 'TM. as 3 et¢G ITp,p .20 1 iGG' TOP OF BANK 6 _� OF LAWN S83 SETBACK LINE LOT ATER 1, TEST HOLE C W Z EL22.1' `` 2__ CL.= 1.9 --_�z C WITH PUBLI pWELLIN Certified To: 265 Arsham,.cn.aque, LLC American Dream Abstract, Inc. First American Title Insurance Company "s ,�. c' . z A 4i L ' AREA=;e0,3"k61 u. . TO N 4 VD 88 " AN Y AL TERA TION OR ADDI TION TO THIS SUR VEY IS A VIOLA TION _PE`coTvlc VED BY OTHI RS. OF SECTION 72090F THE NEW YORK STA TE EDUCA TION LA W. (631) i " MAP OF BEIXEDON EST4 TES" EXCEPT AS PER SECTION 7209=SUBDIVISION 2. ALL CERTIFICATIONS Email: f HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF peconicfc )UFFOLK COUNTY CLERK'S OFFICE ON SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR P.O. BC ,r-, 4 ,, -7r, I,vuncc cI11_AIn 7711?C APPP_dQC E-IPRF'nti .SOUTROLL