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Home My WebLink About39121-Z Town of Southold Annex 9/16/2014 P.O.Box 1179 54375 Main Road Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37153 Date: 9/16/2014 THIS CERTIFIES that the building WINDOWS Location of Property: 900 Yennecott Dr, Southold, SCTM#: 473889 Sec/Block/Lot: 55.-6-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 8/18/2014 pursuant to which Building Permit No. 39121 dated 8/18/2014 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: WINDOW REPLACEMENT (15 WINDOWS)TO A SINGLE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Quinones,Karen (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED r t rized gnatu e TOWN OF SOUTHOLD BUILDING DEPARTMENT ' TOWN CLERK'S OFFICE SOUTHOLD, NY iTlS�X 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#: 39121 Date: 8/18/2014 Permission is hereby granted to: Quinones, Karen 900 Yennecott Dr PO BOX 211 Southold, NY 11971 To: window replacement for a one family dwelling as applied for(15 windows). At premises located at: 900 Yennecott Dr, Southold SCTM #473889 Sec/Block/Lot# 55.-6-7 Pursuant to application dated 8/18/2014 and approved by the Building Inspector. To expire on 2/17/2016. Fees: PERMIT RENEWAL $100.00 Total: $100.00 Building Inspector 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#: 36631 Date: 8/16/2011 Permission is hereby granted to: Quinones, Karen 900 Yennecott Dr PO BOX 211 Southold, NY 11971 To: window replacement for a one family dwelling as applied for (15 windows). At premises located at: 900 Yennecott Dr, Southold SCTM # 473889 Sec/Block/Lot# 55.-6-7 Pursuant to application dated 8/5/2011 and approved by the Building Inspector. To expire on 2/14/2013. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector Form No.6 TOWN OF SOUTHOLD, BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2110 of I% lead. . 5. Commercial building,industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance`from architect or engineer responsible for the building. .6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957) non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool $50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-.existing Building- $100.00 3. Copy of Certificate of Occupancy-$:25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy -Residential $15.00, Commercial $15.00 Date. New Construction: y Old or Pre-existing Building: (check one) Location of Property: 9,00. 0()-?j'- ��l VC .--)0L1Ti�/(� L /� House No. / Street Hamlet Owner or Owners of Property: �'1 d�� Q 1) 1 /D A/'G5 Suffolk County Tax Map No 1000, Section Block fo Lot 7 Subdivision Filed Map. Lot: Permit No. '/-o Date of Permit. 1 - // Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �(� •�j�)o _ P Applicant Signa"r 2 I OF SOUL N ip TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] 1 LATION [ ] FRAMING / STRAPPING [=L [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: l DATE D `� INSPECTOR i c� 1 ' ho��,uF su�Tyolo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROU H PLUMBING [ ] FOUNDATION 2ND [ ] !,NISOLATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE l INSPECTOR u� FIELD INSPEMON REPORT DATE COMMENTS i . FOUNDATION(ISTD wM� MMM�wMM 14 FOUNDATION(2ND) (y M C O ROUGH FRAMING& H PLUMBING =l Cz INSULATION PER N.Y. H STATE ENERGY CODE ' Y f '! FINAL ADDITIONAL COMMENTS LA 0 ,fix TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. J {y�o 3� Check Septic Form N.Y.S.D.E.C. Trustees Examined 01(" ,206 Contact: Approved 20__a_ Mail to: Pow tlo1nt Q-Q,rY oAdtq 6foq- Disapproved a/c 2,50k se sem ��l' � n0 Phone: 8s �13Cv.. (p'3J X2 3Z Ca Expiration 11p,201 X 31 7� 5 -8Sg3 Building Inspector b31 2Y,, - PS 20 pC� C� c � �IC� PPLICATION FOR BUILDING PERMIT AUG " 5 2011 Date $ l ! r , 20 I/ INSTRUCTIONS a. This B DG.REPT. T6WRQajggp�NJ1ST be cr ipletely filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets accurate plot pan t5—scale. .-ee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. 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, or 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 for necessary inspections. (Signature of apl cant or name,if a corporation&'oup ,Z-so rc 0n re. C Vstex, P l\ iao 13 (Mailing address of applicant) State whether applicant is owner, lessee,U=t, architect, engineer, general contra t a umber or builder c, horiZe oI t cn-�radtaY . Name of owner of premises are n oU i non e C FEE• 5=�J'D_ RV (As on the tax roll or lJWirtMtc$UILDING DEPARTMENT AT If applicant is c oration, signature of�iuly authorized officer 765-1802 8 AM TO 4 PM FOR THE 2� _ �� FOLLOWING INSPECTIONS: (Name and title of corporat officer) 1• FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 2 ROUGH-FRAMING,PLUMBING, Builders License No. C_ECTRICAL 8 CAULKING Plumbers License No. 3. 1N,,uLAF10N Electricians License No. 4 F'NAL -Ct-KIFT01)710N ,� r•7�-�'C4L Other Trade's License No. A C:: .vc TI( )HAI :^F- RC ?i ilh dTi 1. Location of land on which proposed work will be done: YOP.K ;T. ` '- qoO �enne�a ' Drive Sl. �F ;�:,Nsr1 K .T{�ik�b-ridfrt-c��l House Number Street Hamlet R County Tax Map No. 1000 Section 5S Block of P Subdivision Filed Map No. ( tt (Name) CERTIFICATE ' , Cj&JPANCY 2. State existing use and occupancy of premises and intended use and occupancy ofroposed construction: a. Existing use and occupancy 5t t')a✓ t - -Pa V�1�VL,i S l d�QOO b. Intended use and occupancy tJl R ndt Chrba n a 3. Nature of work(check which applicable): New Building Addition Alteration Repair A Removal Demolition Other Work [)`FQ C,)Of 1 S -2`7 15 0,nAl C�C�z rr� w t W S (Description) 4. Estimated dost Od Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner j n kno(,o n 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO?O 13. Will lot be re-graded?YES__NO–XWill excess fill be removed from premises?YES NO 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NOX_ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: !�C�OUNTYt OF ) co ��C�`�p� C � (�/ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the <'ocrkad" 1Q&&10Qyi'Xj awt (Contractor,Agent, Corporate Offic ,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 knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Swin YOefore me this day of. �' 2071'1—X' � Phi* Notary Public Sign atu e o Applicant NOTARIAL SEAL JAMIE LEE CARDEN Notary Public BROOKHAVEN BOROUGH, DELAWARE COUNTY My Commission Expires Nov 23,20;4 OP ID: EL ARS' CERTIFICATE OF LIABILITY INSURANCE r DATE (MM/DD/YYYY) 03/29111 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(iss)must 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 endorsemen s PRODUCER 215-7234378 CONTACT Chad Lacher Lacher&Associates Ins Agency 215-723-8604 P k ,215-723-4578 No 215-723-8604 Lacher Insurance Group MINL2. 632 E Broad St P O Box 64398 ADDREss: Souderton,PA 18964 CUSTOMER Ip y POWER-1 INSURER(S) AFFORDING COVERAGE NAIL/ INSURED Power Home Remodeling INSURER A:Pennsylvania Manufacturers 141424 Group,Inc. INSURER B:Pennsylvania Manufacturers 12262 2501 Seaport Drive Suite B110 INSURER C: Chester,PA 19013 INSURER,D: INSURER E: 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 MIRK 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 F POLICY EXP TR POLICY NUMBER MMDD/YYYY MMDD/YYYY LIMnS GENERAL LIABILITY EACH OCCURRENCE ; 1,000,000 EU- A X COMMERCIAL GENERAL LIABILITY 21000-66-20-96-7 091122/10 09/22111 PREMISES Ee occurrence i 3W,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) PERSONAL&ADV INJURY GENERAL AGGREGATE ; 2,000, GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMP/OPAGG ; 2,000, X POLICY JECT F-1 PRO- LOC ; AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT : 1,000, WC ANY AUTO 151005-66-20-96-7 09/22/10 09/22111 (Es accident) BODILY N.URY(Perperson) ; ALL OWNED AUTOS A X SCHEDULED AUTOS BODILY INJURY(Per accident) ; A X HREDAUTOS PROPERTYDAMAGE ; (Per accident) A X NON-OWNEDAUTOS = ; UMBRELLA WB X OCCUR EACH OCCURRENCE ; 5,000,0 EXCESS ; B ciAwtis�nADE AGGREGATE 51000,DEDUCTIBLE 51000-66-20-96-7 09/22(10 09/22N 1 ; X RETENTION 10,000 = WORKERS COMPENSATION WCSTATLL OTH- APD EMPLOYERS'LIABILITY XTORY LIMITS ER A AW PRROPRIIETOER E)CLU CUn�YIN 01000-665-20-96-7 N/A 01000-66-20-96-7 09/22110 09/22/11 E.L.EACH ACCIDENT ; 100, OFF(Mandatory In NH) Mdescribe under E.L.DISEASE-EA EMPLOYEE ; 100, PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT ; 500, DESCRIPTION OF OPERATIONS/LOCATIONS/VEHCLES(Attach ACORD 101,Additional.Remarks Schedule,it mon spats is required) CERTIFICATE HOLDER CANCELLATION SOUTNY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOMCE WILL BE DELIVERED IN ACCORDANCE WITH 7HE POLICY PROVISIONS. 53095 Route 25 P.O.Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ®1988-2009 ACORD CORPORATION. All rights reserved. STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PhRT 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name and Address of Insured(Use street address only) 1 b.Business Telephone Number of Insured POWER HOME REMODELING GROUP INC 610-874-5000 ATTN:DANIEL SCHAEFFER I c.NYS Unemployment Insurance Employer 290 BROADHOLLOW ROAD,SUITE 220 E Registration Number of Insured MELVILLE,NY 11747 1 d.Federal Employer Identification Number of Insured or Social Security Number 233030708 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Zurich American Insurance Company Town of Southold 58 South Service Road,Melville,NY 11747 53095 Route 25 P.O.Box 1179 3b.Policy Number of entity listed in box"1 a": Southold,NY 11971 4859716-001 3c.Policy effective period: 3/15/2011 To 3/15/2012 4.Polic covers: a. hX All of the employer's employees eligible under the New York Disability Benefits Law b. ❑ Only the following class or classes of the employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carver referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 3129/2011 By 401-VA4)_ (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (631)845-2200 Title Operations Manager IMPORTANT: if box"4a"is 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"is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,New York 12207. PART 2. To be completed by NYS Workers'Compensation Board(Only if box"4b"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 Benefits Law with respect to all of his/her employees. Date Signed By. (Signature of NYS Workers'Compensation Board Employee) Telephone Number Title Please Note.Only insurance carriers licensed to write NYS disability 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. ............. ............. P- ------------------- iv J, er Affairs Suffolk County D%erpartment of Consum VETERANS MEMORIAL FUGHWAY HAuppAUGE, NEW YORK 11788 No. 48568-H DATE ISSUED: 4/7/2011 SUFFOLK COUNTY t Contractor License Home Improvemen KYLE E BAPJUNG This is to cerfifv that doing business as POWER HOME REMODELING GROUP INC Ji IT hig fuihifh iwnhedeeqmondih nd ubjt tthp •viif pplicbllwl State of New York is hereby licensed to conduct business as a HOME and regulations of the County of Suffolk IMPROVEMENT CONTRACTOR,in the County of Suffolk. License Category GC NOT VALID WITHOUT Additigndjgain� DEPARTMENTAL SEAL AND A CURRENT CONSUMER AFFAIRS ID CARD _J Director ............................. ...... ----—---------- ............ ............. ..... ... AJ 1XI IF