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HomeMy WebLinkAbout47762-Z r IUwN Ut- sUUiNULU BUILDING DEPARTMENT r 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 #: 47762 Date: 4/29/2022 Permission is hereby granted to: Nadel, Joshua 13115 Main Ba viers Rd Southold, NY 11971 To: Conversion of garage into living space (under construction) and construct deck addition to existing single family dwelling as applied for. Additional certification may be required. At premises located at: 13115 Main Bayview Rd., Southold SCTM #473889 Sec/Block/Lot# 88.-2-14 Pursuant to application dated 3/14/2022 and approved by the Building Inspector. To expire on 10/29/2023. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $522.00 CO -ADDITION TO DWELLING $50.00 AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $596.00 Total: $1,168.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ; Telephone(631) 765-1802 Fax(631) 765-9502 lit�t�s://wm� � �v. o tlioldlo Ain It Date Received APPLICATION BUILDING PERMIT P For Office Use Only PERMIT NO. / 6 Building Inspector: R MM 14 2022 BUILDING DEPT. TOWN OF SOUTHOLD 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:Josh Nadel & Joanne D'Agostino SCTM#1000-88,-2-14 Project Address: 13115 Main Bayview Road, Southold, NY 11971 Phone#: 917-843-2920 Email: joshuanadel@gmail.com /jomamadag@gmail.com Mailing Address: same as project address CONTACT PERSON: Name: Karen Szczotka, Agent Mailing Address:Robert I. Brown Architect PC, 205 Bay Ave., Greenport, NY 11944 Phone#: 631-477-9752 Email: karen@ribrownarchitect.com DESIGN PROFESSIONAL INFORMATION: i Name: Robert I. Brown Architect, PC Mailing Address:205 Bay Ave., Greenport, NY 11944 Phone#:631-477-9752 Email: rob@ribrownarchitect.com CONTRACTOR INFORMATION: Name: Torkelsen Construction, Peter Torkelsen Mailing Address:800 Summer Lane, Southold, NY 11971 Phone#:(516) 807-2265 Email:peter.torkelsen@gmail.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure iOAddition RIAlteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other D&=C4, $ 150,000 Will the lot be re-graded? ❑Yes 9 N Will excess fill be removed from premises? ❑Yes WNo 1 PROPERTY INFORMATION Existing use of property: _ icC�e ' Intended use of property: Li Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑YesVNo IF YES, PROVIDE A COPY. ❑ CJW.vk ftx After If 'Ott cd p 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 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,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(s)for necessary Inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print ame : �/ ) Authorized Agent ❑Owner Signature of Applicant: Date: 31tiq I�� STATE OF NEW YORK) SS: COUNTY 0F4e,(�[ ) I ZIS being duly sworn, deposes and says that(s)he is the applicant (Na de of individual signing contract)above named, (S)he is the (Contra Agent, or orate Officer, etc.) of said owner or owners,and is duly authorized to p 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 f arCh � day of 20 oC Nota DWYER NO'T=Y I�uBLIC, ' TIS OF NEW YORK' IV{ ,till]W6306900 QUALIFIED IN SUFFOLK COUNTY p( '�'� '"�I NER At,, HORI '"II .. ErMMI EION E PIE JUNE 30 jp (Where the applicant Is not the owner) ry I I, 2 &siding at dd -114 � do hereby authorize to apply on my 7btVhT f Southold Building Department for approvalescriTdh rein. ✓ `� I Q Owne Signature Date Print Owners Na ' me 2 " DATE(MMIDDIYYYY) CCOR CERTIFICATE OF LIABILITY INSURANCE 106/09/2021 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 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 statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C1"fTACT Sarah Arebalo NAOME;: Roy H Reeve Agency,Inc, PHONEfAIC.No,Ext. (631)298-4700 C NW. (631)298-3850 PO Box 54 E' AIL sarebalo@royreeve.com ADORESS: 13400 Main Road INSURERS)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: Southwest Marine and General Insurance Compa INSURED INSURER B: Peter Torkelsen&Company LLC INSURER C: 800 Summer Lane INSURER D: INSURER E: Southold NY 11971 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2012113549 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 ADOLSUBR PULICYEFF POLICY EXP LIMITS LTR TYPE OF INSURANCE yWVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 A. .,,.,,.., CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A GL202ORLH00314 06/13/2020 06/13/2021 PERSONAL&ADV INJURY $ 1,000,000 MXI 'LAGGREwE.LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO"' LOC PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY �n JEC'�' OTHER: Employee Benefits $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SqN LE LIMIT $ Daaccd,ent� m ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per ac6dwA UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION$ -1-15H WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNEWEXECUTIVE NIA E L EACH ACCIDENT $ OFFICiERRAEMBER EXCLUDED? IMandatory in NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Nadel ACCORDANCE WITH THE POLICY PROVISIONS. Josh and Joanne AUTHORIZED REPRESENTATIVE 13115 Main Bayview Road Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD