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Home My WebLink About46780-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#: 46780 Date: 9/7/2021 Permission is hereby granted to: Stocker, Christopher 3375 Depot Ln Cutchogue, NY 11935 To: Construct enclosed accessory carport at existing single family dwelling as applied for. At premises located at: 3375 Depot Ln., Cutchogue SCTM # 473889 Sec/Block/Lot# 102.-1-6.1 Pursuant to application dated 8/23/2021 and approved by the Building Inspector. To expire on 3/9/2023. Fees: ACCESSORY $580.00 CO-ACCESSORY BUILDING $50.00 Total: $630.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Y` Telephone(631)765-1802 Fax (631) 765-9502 h , wov,sot _ ' nny,gov AII)PLICATION FOR BUILDING INS ER I - Forteonly PERMIT NO. nspecton Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: SCTM#1000- 10 2 o J b. Project Address: Phone#: 1 � f Email: Mailing Address: C 1j po CONTACT PERSON: Name: - J �brrS � � - k r Mailin Address: - Phone#: 0 2— � 0 Email: L DESIGN PROFESSIONAL INFORMATION: Name: -k _ Mailing Address: a 3 Phone#: Email CONTRACTOR INFORMATION: Name _ Mailing Address: _, It Phone#: 73 Email: - Com- DESCRIPTION OF PROPOSED CONSTRUCTION likNew Structure ❑Addition ❑Alteration ❑Repair ❑Oemol tin Estimated Cost of Project: ❑Other P�'?G� dLY r L � ce ,- - $ Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes O No 1 PROPERTY INFORMATION Existing use of property: rc�iIntended use of prope • - - Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to — Y`e-,� , J zvi c, this property? ®Yes RNo IF YES, PROVIDE COPY. Checkx After Reading: The owner/contractor/design prof ional Is responsible for all drainage and storm ter Issues as provided b 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 applible Laws,OrdinancesRegulations, r the construction of buildings, additions,alterations or for removal or demolition as herein described. applicant agrees h all applicable law,ordinances,buildin e, 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 210.4S of the New York State Penal Law. Application i (print : ;,' �0C�e V- OAuthorized Agent Nowner Signature lig t: y Date: STATE OF NEW YORK) S - J COU OF a 1 ' r t Q. y- being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the O W V),Y— (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 tree this 3 $ P day of 2 1 Notary Public DARLENE K RRU5f1 Tia,v Public-State of New York > `}ze t1R631S051 N _ _... _ — N0.01Qualffle in Suffolk County (Where the applicant is not the own My Commission Expires Jan 20, 2023 1, residing at do hereby authorize to apply on tray behalf tot e Town of Southold Building Department for approval as described herein. Owner's Signature Date PrintOwner's Name 2 DATE(MMIDWYYYYI CERTIFICATE OF LIABILITY INSURANCE 8/1212020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFCRIIflATICN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE T AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTERCOVERAGE FF C BY THE POLICIES BELOW. THIS TIF! T F INSURANCE T CONS71TUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE R CERTIFICATE HOL . IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statementon this certificate does not confer rights to the certificate holder In lieu of such endor ent s). PRODUCER NAME. Meagan Chilton Sa a y Carney Insurance Ext!: 7048728740 Wil: 333 l3roo e 17r gleyul ee,e Suite A IN RER(S)A RD! COVERAGEMAIC Statesville NC 28677 INSURER A: SCO INS CO 25011 INSURED INSURER 8: I New Tea rt LLC INSURER C: a 130 Cone In INSURER D: INSURER E: Mount Airy NC 27030 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 AVE 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. — — LTR TYPEOFINSURANCE IINSO WvD POUCYNUMBER 8 {_ T LIMITS COMMERCIAL GENERAL UAH TY EACH OCCURRENCE � 1,000,000� CLAIMS-MADE FRIOCCUR PREMISES(Ea occurrences) $ 100,000 QED EXP(Any one person) i$ 5,000 A WPPI877086 00 0810612020 0810612021 PERSONAL&ADV INJURY i$ 1,000,000 GEN1_AGGREGATE LINT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 LICY PRO- PO LOC PRODUCTS-CO !OP Am Is 2,000,00{) OTHER: is AUTOMOBILE LIABILITY €. ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accidentdt $ AUTOS ONLY AUTOS ( } HlREQ NON-OWNED i .- I$ AUTOS ONLY AUTOS ONLY .ro $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAR GLAlMS.MADE I AGGREGATE is DED i RETENTION$ is ORRIKERS COMP =SATIi O NI mm E _ ER m _ NUE PLOY 'UABIL NY PRO IETO ARTNE CUnVE YJN E.L.EACH ACCIDENT $ 1,000,000 A FFICERIMEMBER EXCLUDED? N 1 A WWC3479059 06105/2020 0610512021 andatary In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Md -under RF-TION-OF OPERATIONS bel ow E.L.DISEASE-POLICY LIMIT $ 1,000,000 D CR! N OF oPE -no i LOCATio /VEHIC (ACORD 101,Additional Rernarks Schedule,maybe attached I mrs space is Ld CERTIFICATE HULLER CANC ILA C� SHOULD ANY OF THE ABOVE DESCRIBED LID! S BE CANCELLED THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVEREDI New Team Carport LLC ACCORDANCE WITH THE POLICY PROVISIONS. 130 Cone Ln AUTHORIZED REPRESENTATIVE M Mount Airy TIC 27030 @ 1988-2015 ACORD CORPORATION. Allrights re e ACORD 25(2016/03) The ACORDname and logo are registered ark f ACORD 3/10/2021 Certificate of NV Workers'Compensation insurance CWeragG CIEE RT IT Z-C AT E 0 N M ' Worker-' p4jS WORKERS' COMIDENSATION INSURAINCE COVERAGE E 0 YORK STX_ i. Oen tion Board M-sured Detail a,Legal Name and address of Insured(Use street address only) 1b.BasinessVelephone Number a3 Insured _36-55-9195 New Team QurpoILLC =a, 0c2e Name Mount AiTJ-,NC 27030 lcN-VS 1'een p-loyment Insurance Employer Rvgmradort Nurn of Insured 11d Federal Employer Idendfle-atioll Number of-n-sared o=r Social Secarit- y Numner "'VoKk-o-calion e� j�spec4fica14,Ratited to 8-Alo . _S8,) cefw,n 1"catum M New 1ork State.;e,a Aiap-L-0-Mo-ficv) 2.Name and Address of the Entity Requestiqg Proof olf Coverage 13a,Name oflasurance Carrier ut (Enfity Bdng Ll sted as the Cercirlicate Holder) 'Vesco insurance;Com;Comp=oy Town of Southold 53095 Route 25 3b.Pori2ey Number of en-tiq li=sted in box"la".- Southold,NY 119'l WWC3-479059 '3-.1rolicy effective period- 6!5;2020 to 615/2021 13d. Abe Proprietor,Partners or Executive Officers are: included(Only check box if all panne 'officers included) all excluded or certain partners/officers excluded ti es that the insu i r i a"for workers'compensation This cer kle i -rance cars indicated above in box"Y'insm res the business referenCed above in box" under the New York State%Vw-kers'Conioensation Law.(To use this form,New York(a3' must be listed under Item 3A on the i Certificate of INFORMATION PAGE of the workers'compensation insurance potiCVY.The Insurance Carrier or its licensed agent vvisend this l Insurance to the entity r listed above as the certificate holder in box"2". The insurance carrier truist notify the above certificate holder and the War kers'Coffprensation Board within 10 dxvs I apolim r iscaneelendire to M poilpayntenr Dj1premiums 01"virldr,30 dap!T there are reivions other thats niinpaynient oji'pretriums that cancel therxdicy or ellioditate lite imvzw � - re.Mh se no ices ne e_e, i liar inail. V F a d-C na fire his rn the cove.r,,�te ijj,&_are_4 ot�jhj5 Cerr:flcm ems- 1 q'r q&Certificate is V Ito f1r One Y r It r t fra. isted in boc 'Ve whichever is earlier. or lintil tile_polio;expiration date It fo,t.,j is gApproved he the insurance e currier or&r ficepsed agn,te This;ecrtifficute is issued as a matter ofinfornriatiop onty and confers no rights upon the cerfificate holder.-j.-his certificatt does not atnwnd�extend d enced or alter the coverage afforded by the pour'.listed.nor does it confer an� rights or rcsponsibijitics bevond those containein the refer policy. This certificate may be used as evidence ofa%Vorkers'CompiensatiOn c0ilit-lact 0-finsurance only While the underlYmig poficy'is in C&CL b Please Note:Upon cance ation ofthe workerst compe.n.sation policy indicated on this form,if the business co Minues toe named on a permW z license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of XVoakers' Compensation Coverage or other ailiffiffized proof that the business is conipit ing with the mandatory coverage requirements or the New Vork State VNIorkers'Compensation Under penalty of penury,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. App-OvUli BV- Henry C.Siblev (Nint n irnc ofauthorind rcrrc,eniafivc or :zad age of`ura-ce-iz:I Approved Ry- (Date) Title: undemrivng Mamwer TelephaneNumbezr ofainheAlLcd repre-3entativear ticcmvA agent air ul"r-raLee carrier,Cara ierPhani Please Mate:01113 hisura"Ce carriers and their HeensedagenEy are authorized to ifsae rise(7405.2jomni,hisurarce brokers rare A70rauthorized to issue h. 1 - - 112 https://,,mc.am'rustgroup.com/AN-A',NC/Po-�cvNYCe-fifice-teOVIcins.aspx?-Index-.d=330509&lnstancp-ldi292-45d Ao DEPOT LANE yt e ov RDwuAr ` 21 Ot}' 1 � si DF PN&UErr �g jDF PA S alp E S 38'13'3 9 ._ O O l ` N u-) CV � a-oOQ 2D,2� 32.6' 1_1/2 STORY FRAME Oy"SE sea' --- ENE 20.r � a E =� w �n o � A 935-------- d26' F FRAME BARN F 2$.d. 1 Q M 34 d' W �� e Q � N 71 M RDw o '" MDN. z FOUND 6 21 4•V0' OONO. N '30" W N1IF THE BID}yELL FAMILY LI�ZZTED PARTNERSHIP jI JJI I jjfJf t