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HomeMy WebLinkAbout37250-ZFOL e 9 " Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 631-765-1981 CERTIFICATE OF OCCUPANCY No: 37418 Date: THIS CERTIFIES that the building RESIDENTIAL ALTERATION Location of Property: 1527 Carroll Ave, Peconic, SCTM #: 473889 Subdivision: Sec/Block/Lot: 74.-3-21 Filed Map No. 2/5/2015 2/5/2015 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/18/2012 pursuant to which Building Permit No. 37250 dated 5/24/2012 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 TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Hubbard, James & Hubbard, Ruth (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED AV A e ign re s TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE q 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 #: 37250 Date: 5/24/2012 Permission is hereby granted to: Hubbard, James & Hubbard, Ruth 1527 Carroll Ave PO BOX 266 Peconic. NY 11958 To: replace 12 windows as applied for At premises located at: 1527 Carroll Ave. Peconic SCTM # 473889 Sec/Block/Lot # 74.-3-21 Pursuant to application dated To expire on Fees: 11/2312013. 5/18/2012 and approved by the Building Inspector. SINGLE FAMILY DWELLING - ADDITION OR ALTERATION $200.00 CO - ALTERATION TO DWELLING $50.00 Total: $250.00 f� 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 2/10 of 1 % 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 $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, 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 New Construction: Location of Property: 1 5a7 JDate. Old or Pre-existing Building: t- l A \Pe (check one) OW It House No. �— Street JFHamlet Owner or Owners of Property: JJ 1V%r_'�- S d- L p Suffolk County Tax Map No 1000, Section Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Block Filed Map. Date of Permit. Applicant: Request for: Temporary Certificate Fee Submitted: $ 50 Pa.. L'o jW Underwriters Approval: Lot Lot: Final Certificate: (check one) Al�icant Signature 72— q s cou TOWN OF SOUTHOLD BUILDING DEPT. 76S.1802 INSPECTIO FOUNDATION I ST FOUNDATION 2ND FRAMING/ STRAPPING FIREPLACE & CHIMNEY FIRE RESISTMT CONSTRUCTION ELECTRICAL (ROUGH) CODE VIOLATION M le RM A M Be Oft. ROU PLUMBING OU I I ULATION U F L INAL FIRE SAFETY INSPECTION FIRE RESISTANT PENETRATION ELECTRICAL (FINAL) CAULKING DATE INSPECTOR FIELD 'WPECT 3tEPORT FOUNDATION (1ST) DATE CONDOMS t9-� ro Sv � FOUNDATION (2ND) ROUGH FRAATING & PLUMING o INSrULATION PER N. Y. STATE ENERGY CODE W f FINAL ADDITIONAL COMMENTS �o z rn ti Jj —o v� z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined 20� Approved Disapproved a/c Expiration ly 20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey PERMIT NO. ,'37�i,�� Check Septic Form N.Y.S.D.E.C. FRnnFMAY E o V I r Assessment Form Contact18 2012 MLZ BLDG. DEPT. N 0E SOUTHOLD Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date 20 a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee 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. 6 (Signature of applicant or name, if a corporaOr tion) ,AIM I T C E RT I F I ��(Myaii mg a dr s01applicant) �y State whether applicant is own r "` sFe; ap nt i n eer, general cont 4a of, elkct cl0t,Tum�1 u e Go ✓%+r0—C plolnBY AT Name of owner of premises1�-A ' O 4 Pry1 FOR THE (As on the tax roll or lat a %° Ifpp�qplicant is corporation, signature of duly authorized officer 010 C1",T1'"1N TWO R: OUIRED �d.�eor — L0LkP P,; 2. State existing use and occupancy of premises; a. Existing use and occupancy 5.11 b. Intended use and occupancy intended use and occupancy of pr posed const ction: � }c c*.i i— . ` V .S i CJ�2rn 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost C 6 � b 5. If dwelling, number of dwelling units If garage, number of cars Fee 4—% (Description) (To be paid on filing this application) Number of dwelling units on each floor 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 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_ NO—L/ 13. Will lot be re -graded? YES_ NO--ZWill excess fillge removed from premises? YES_ NO 14. Names of Owner of premises �BS� F"` Address J/�% CtiiRsU R� 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 NO * 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO _ NOTARIAL SEAL STEPHANIE CLIFFORD * IF YES, PROVIDE A COPY. Notary Public BROOKHAVEN BORO, DELAWARE COUNTY STATE OF NEW YORK) My Commission Expires Nov 18, 2012 SS: COUNTY OF ) P, 1, — 6Q,nllo� being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor—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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. AO sand. uoiss0 6 Swo to before me this (� day of 20 .Z ublic Signature of it0i Bt N . 3 . !uui 0 W AIN= 3klyMy130 'OWOB N3AVH)IOOUO 0114nd ARoN OtlOdd110 31NVHd31S 1V3S 1VIUVlON TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET VILLAGE DIST. SUB. LOT J10,E iie, rL 6 ve Co 7 D e C, FORMER OWNER NE ACR. 1317? S W TYPE OF BUILDING RES SEAS. VL. FARM comm. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 100 11--) IA -<11'1170 ConS,'�, decJk- addip'on - 4 6-00, 3 AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Acre Value Tillable FRONTAGE ON WATER Woodland FR0NTAGE ON ROAD Meadowland DEPTH House Plot BULKHEAD Tata,l DOCK --1 POWER -1 OP ID: EL ACRD DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/21/11 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 pollcy(les) 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 endorsement(s). PRODUCER Lacher Insurance Group Agency 632 E Broad St P 0 Box 64398 Souderton, PA 18964 Chad Lacher 215-723-4378 215-723-8604 WNwAMNE ` Chad Lacher AVOL PHONE E,d :215-723-4378 A/c No): 215-723-8604 ADDRESS: MM/DD INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Pennsylvania Manufacturers 41424 INSURED Power Home Remodeling Group, Inc. 2501 Seaport Drive Ste 8110 Chester, PA 19013 821100-66-20-96-7 INSURER B: Pennsylvania Manufacturers 12262 INSURER C: Ironshore Specialty Ins. Co. 25445 INSURER D: PERSONAL & ADV INJURY $ 1,000,00 INSURER E: GENE RAL AGGREGATE $ 2,000,00 INSURER F: PRODUCTS - COMP/OP AGG $ 2,000,00 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. INS LTR TYPE OF INSURANCE AVOL SU15H POLICY NUMBER PO YE MM/DD/YYYY MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FKOCCUR 821100-66-20-96-7 09/22/11 09/22/12 EACH OCCURRENCE $ 1,000,0001 PREMISES RFNTFO IF a,� $ 300,00 MED EXP Any one person) $ 10,00 PERSONAL & ADV INJURY $ 1,000,00 GENE RAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS 151100.66-20-96-7A 09/22/11 09/22/12 COMBINED SINGLE LIMIT 1 accident ,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ X X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE 001158200 09/22/11 09/22112 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 6,000,00 DED I X I RETENTION $ 10000 $ A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITYI ANY PROPRIETOR/PARTNEWEXECUTIVE YIN (Mds �EMBHR EXCLUDED? ❑Y a In If under describe under DESG�RIPTION OF OPERATIONS below N/A 201100-66-20-96-7 201107-66-20-96-7B(MASS) ( ) 09122/11 09122111 09/22/12 09122/12 X WC $TATO- OTH R LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 A MASS AUTO 151107-66-20-96-7B 09122111 09/22/12 LIABILITY 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) SOUTNY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 P.O. Box 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE �11-epoZ� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE In. Legal Name & Address of Insured (Use street address only) POWER HOME REMODELING GROUP, INC. 2501 SEAPORT DRIVE 1ST FLR, SUITE 8110 CHESTER PA 19013 0 Work Location of Insured (Only required ifcoverage is specifically limitedto certain locations in New York State, i.e,. a,Wrap-Vp Policy) i 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Southold 53095 Route 25 P.O. Box 1179 Southold NY 11971 f+ Ib. Business Telephone Number of Insured 215-874-5000 lc. NYS Unemployment Insurance Employer Registration Number of Insured Id. Federal Employer Identification Number of Insured or Social Security Number 23-3030708 3a. Name of Insurance Carrier Pennsylvania Manufacturers' Association Insurance Co 3b. Policy Number of entity listed in box '`la" 201100 6620967A 3c. Policy effective period 09/22/2011 to 09/22/2012 3d. The Proprietor, Partners or Executive Officers are included. (Only check box if all partners/officers included) all excluded or certain partners/officers excluded. —'o wuuws uiat 111c insurance carrier maicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe sent by regular mail.) Otherwise, this Certificate is valid for one year af?er 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. Please Note: Upon the cancellation of the workers' compensation 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 Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. 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 the coverage as depicted on this form. Approved by: ,Mary Mason Smith, C.ISR, CPIA (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (Date) Title: Associate Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier: 484-530-8241 Please Note. Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) www.wcb.state.ny.us Suffolk County Department of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 4/7/2011 No. 48568-H SUFFOLK COUNTY Horne Improvement Contractor License This is to certify that KYLE E BARRING doing business as POWER HOME REMODELING GROUP INC having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. License Category NOT VALID WITHOUT Additional Businesses GC DEPARTMENTAL SEAL AND A CURRENT CONSUMER AFFAIRS ID CARD Director NATIONAL HEADQUARTERS 2501 Seaport Drive, Chester, PA 19013 888 -REMODEL 917"" 'IMW6" 0 Project Specifications Windows: living room 1 104.0"x57.0" Windows: living room 1 104.0"x57.0" WINDOWS: Models SL 2700 Styles Bow Types 4 -Lite Configs End Casements OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None Windows: kitchen 2 35.0"x37.0" Windows: kitchen 2 35.0"x37.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Contigs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None Windows: dining room 2 31.0"x37.0" Windows: dining room 2 31.0"x37.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details Special Options (ie. Full Screen, Obscure Glass, etc) Full Screen No I Obscure Glass No I Specialty Color No I Different Color Capping No I Trim Options Yes New Inside Casing No I New Outside Brickmold No I New Sill No I New Stool No I New Apron Pine I Upgrade Head, Seat and Jambs No I Frame Options No I Remove and Reinstall No Windows: master bedroom 2 31.0"x37.0" Windows: master bedroom 2 31.0"x37.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl Additional Details None Windows: guest room 2 31.0"x37.0' Windows: guest room 2 31.0"x37.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None Windows: guest room 2 31.0"x37.0" Windows: guest room 2 31.0"x37.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White : Grid Pattern : None I Removal Aluminum / Vinyl I Additional Details None James and Ruth Hubbard 30-43684 April 10, 2012 48568 April 10, 2012 19:46 Page 2 of 3 NATIONAL HEADQUARTERS '^+ 2501 Seaport Drive, Chester, PA 19013 j�G?1XlER OM1. Fbme Henwdegnq Group - 888 -REMODEL Project Specifications Windows: bathroom 1 22.0"x37.0" Windows: bathroom 1 22.0"x37.0" WINDOWS: Models SL 2700 Styles Double Hung Types None Configs None OPTIONS: Color White / White: Grid Pattern : None I Removal Aluminum / Vinyl 1 Additional Details Special Options (ie. Full Screen, Obscure Glass, etc) Full Screen No 1 Obscure Glass Double Hung : Both Sashes I Specialty Color No 1 Different Color Capping No 1 Trim Options No I Frame Options No 1 Remove and Reinstall No James and Ruth Hubbard 30-43684 April 10, 2012 48568 April 10, 2012 19:46 Page 3 of 3