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HomeMy WebLinkAbout42787-Z ����gFOt,�coGy Town of Southold 7/23/2018 0 P.O.Box 1179 co ,� 53095 Main Rd D�,1ra� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39788 Date: 7/23/2018 THIS CERTIFIES that the building GENERATOR Location of Property: 30235 Route 25, Cutchogue SCTM#: 473889 Sec/Block/Lot: 102.-2-17 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/5/2018 pursuant to which Building Permit No. 42787 dated 6/13/2018 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: ACCESSORY GENERATOR AS APPLIED FOR The certificate-is issued to Vanname,Allen&Jeanne of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42787 07-18-2018 PLUMBERS CERTIFICATION DATED Authorized Signature ���gUFFnt,r�, TOWN OF SOUTHOLD �G BUILDING DEPARTMENT y s TOWN CLERK'S OFFICE oy • o� 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#: 42787 Date: 6/13/2018 Permission is hereby granted to: Vanname, Allen & Jeanne PO BOX 11 Cutchogue, NY 11935 To: install generator as applied for. At premises located at: 30235 Route 25, Cutchogue SCTM # 473889 Sec/Block/Lot# 102.-2-17 Pursuant to application dated 6/5/2018 and approved by the Building Inspector. To expire on 12/13/2019. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CO -RESIDENTIAL $50.00 Total: $235.00 Bui ' g ector 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$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 t ' Date. JL., -y, of New Construction: Old or Pre-existing Building: V'O" (check one) Location of Property: 13wasC House No. Street jHamlet Owner or Owners of Property: A top/� -� �P Gt�n t� � n K)"t— Suffolk County Tax Map No 1000, Section Block 6 ;1- Lot 6 - Subdivision Filed Map. I Lot: Permit No. a Date of Permit. Applicant: �1 1 ZQI� L_4 00' Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 6 plicant Signature SO Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 , ® roger.richert(a)-town.southold.ny.us Southold,NY 11971-0959 Q lyc®UN�9� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Vanname Address: 30235 Route 25 city,Cutchogue st: New York zip: 11935 Building Permit#: 42787 Section: 102 Block: 2 Lot: 17 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Shore Power Electric License No: 42536-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches' Twist Lock Exit Fixtures TVSS Other Equipment: 11 KW Standby Generator with Automatic Transfer Switch Notes: Inspector Signature: Date: July 18, 2018 0-Cert Electrical Compliance Form.xls FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) CP.Iy ------------------------------------ 'FOUNDATION (2ND) O ROUGH FRAMING& PLUMBINGy a J 1 INSULATION PER N.Y. y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS 00 W d H TOWN OF ST4THOLD - 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 SoutholdTown.NorthFork.net PERMIT NO. 7i Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined �. 20� Single&Separate Storm-Water Assessment Form Contact: Approved 20A Mail to: V_a�,JIo( Disapproved a/c Phone: 3�-39 5-LA b) Expiration 13 207' Shore Power - 1.08 Frowein Ad V_*ta ® NnUVR Bu n ctor Center Mori�e C-NY`lM4 • D • JUN o 5 2018 APPLICATION FOR BUILDING PERMIT Date WK.� L;s , 20 BxJL" '1G DE, INSTRUCTIONS TOWN OF SOUTHOLD 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 enacts-d 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. ignat a of applicant or name,if a corporation) Shore Power 108 Frowein'Rd Unita Cel'MO taPMOM State whether applicant is owner, lessee agent, rchitect, engineer, general contractor, electrician,plumber or builder Gi(tn ctc) Lem dor - 1,Z*iCn Name of owner of premises Tfa h nc, E. van palx e�, (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. 4Q,5 3(QMC Other Trade's License No. 1. Location of land on which proposed work will be done: House Number Street Ha et County Tax Map No. 1000 Section 'ICA Block C2;L -Lot"-- / -7 Subdivisior,4 Filed Map No. Lot 2. State existing use and occupancy of premises and intended.use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work 5+ 'o (Description 4. Estimated Cost 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 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded?YES NO Will 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 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 * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY Ok=I K ') ��1 ZCI�� Laws r being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the (Contracto ,Agent, Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said wo &Te�I �' ,VAVWc tion; that all statements contained in this application are true to the best of his knowledge and b 11 '; h+t]t:tl tNtbrk performed in the manner set forth in the application filed therewith. Registration$01WAGNION4 Cusiified In Suffolk Cerunty Sworn to before me this 6vmoilsslon Expires April 11.2620 5+h —day of 20 (�j�om otary Public Signature of Applicant 113.15' - --�f ® N.39°50'00S ° o 00 O o o C o OCL ' r, 4g•2' cN -- - ----- 16.x' c� U Z.1 O Pram � yaray? o ® �, 49.2__,___ dyPvopay shed 2.0' /.7' a vJ o 0 le IC 4• Q r _--_—_ 2 "tory � ` s OL PTc,—''> ® ee �A 1 � to l.or. 1 � 113•x® 25) 01 S2 AW R OADSUR VE Y FOR REA ® .31712 sq ft ALLEN P &I JEA NNE VAN NAME A T CUTCH GIDE oven P. van Nose TOWN OF SOUTHOLD eanne E Van Name SUFFOLK COUNTY, . Y. CROS Mortgage, Inc. 1000 ® 102 m 02 - 17 'tate of New York Mortgage Agency 'econic Abstract Inc. Scale: 1®® o 30 v � N � 35v� . s �l-Fos z- f V4f L%/Z- fall //-(c,w C` j (s-A-4or d� �50FOI, �O BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD .y. .�' Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 'roger:richertg1own:southold.ny us APPLICATION FOR ELECTRICAL INSPECTION- REQUESTED BY: L aw ` ,- Date: lu -w_%1Z Company Name: Name: License No.: 4 5 3(Ph E _ email: Address: 10 -OWleA Q- c� dOCIL&S Phone No:: &31-ZI 5- 4ua JOB SITE INFORMATION: (All Information Required) Name: r �ICt Llca _ Address: 119.x' Cross Street: Phone No.: 1_ — Li p 161 Bldg.Permit#: �� email: V ,n a juna.GcM Tax Map 0 S District: 100ection: 0,PL_ Block: ��. Lot:: BRIEF DESCRIPTION OF WORK(Please Print Clearly) -_.01rsNtKtV CI Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: . _ A #Meters _ __ Old Meter# New Service- Fire Reconnect- Flood Reconnect-Service Reconnected - Underground - Overhead #-Underground Laterals 1 2 H Frame Pole Work done on Service? _ Y N -Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection FormAs Rr �. g New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 0 A^AAAA 204999885 HOMETOWN INSURANCE AGENCY 5 ORVILLE DR SUITE 400 BOHEMIA NY 11716 ❑ Scan to Validate POLICYHOLDER CERTIFICATE HOLDER SHORE POWER ELECTRICAL CONTRACTING TOWN OF SOUTHOLD INC TOWN HALL ANNEX 4 BRUCE DRIVE SOUTHOLD NY 11971 MANORVILLE NY 11949 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11329705-6 716302 07/20/2017 TO 07/20/2018 8/25/2017 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1329705-6, 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:/MIWW.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. NICHOLAS D'AMICO, PRES,OF SHORE POWER ELECTRICAL 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 STATE INSURANCE FUND J, DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:218385201 U-26.3 SHORE-4 OP ID: KL CERTIFICATE OF LIABILITY INSURANCE DATE08/24DDm7Y) 08/24/2017 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(ies) 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 CONTACT Hometown Insurance of LI,Inc NAME: Weber Agency a/co Ne E.11:631-567-1011 FAX No):631-589-4207 5 Orville Drive,Suite 400 E-MAIL Bohemia,NY 11716 ADDRESS: James Small INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:The Ohio Casualty Insurance Co INSURED Shore Power Electrical INSURER B: Contracting,Inc. INSURERC: 108 Frowein Road,#2 Center Moriches,NY 11934 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 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 INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR NS WVD POLICY NUMBER MM/DD MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 1XI OCCUR BKO(18)57918685 07/1712017 07/17/2018 -DAMAGE RENTED 800 000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY Al JECOT- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOSAUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ Is WORKERS COMPENSATION I SEROTH- AND EMPLOYERS'LIABILITY Y/N TATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE L EACH ACCIDENT Is OFFICERIMEMBER EXCLUDED9 r N/A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION TOWN014 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Haff Annex ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE Wout-�L' V'-4� I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD