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HomeMy WebLinkAbout48584-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT `un 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#: 48584 Date: 12/13/2022 _.....�. Permission is hereby granted to: Stack.,.John _ — ........... .. .... �vv..._.... 7825RNassau Point ._.. _ d OX 1296 Cutchogu. ... �.... _��._... ......t .. , .... ... �.___... �m. .. _ ... . ._ ...... ..m_.m e NY w 11936mmmmm To. Construct an accessory detached garage to an existing single family dwelling as applied for. At premises located at: 7650 _Nassau mPoint Rd, Cutchogue _.. ..._ _.......� .... SCTM # 473889 Sec/Block/Lot# 118.-3-4.1 �....._�..... ............. ....�......... _.... ........... �_... �.._..��.......�. 102 Pursuant to application dated 10/7/2022 and approved by the Building Inspector... To expire on _.__6/13/2024, m Fees: .._m. . ... _ .n..� ��.. ACCESSORY $599.60 CO-ACCESSORY BUILDING $50.00 Total: ... �$6 mm......._ _.. 49.60 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT �d Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502��1a : �� xr . atl�toiciowr,n . o Date Received APPLICATION FOR BUILDING PERMIT CDC For Office Use Only ' D PERMIT NO. Building Inspectors �. 14 i�1�22 Applications and forms must be filled out in their entirety.Incomplete BUILDINGD� applications will not be accepted. Where the Applicant is not the owner,an � OWN OF SOUrHOLD Owner's Authorization form(Page 2)shall be completed. w Date:3/20/22 OWNER(S) OF PROPERTY: Name:John Stack & Patricia McCaffrey scTM#1000-118-3-4.001 Project Address:7650 Nassau Point Road, Cutchogue, NY 11935 Phone#:(646) 519-1093 Email:jackstacknyc@gmail.com Mailing Address: 1160 Park Avenue, Unit 9B, New York, NY 10128-1212 CONTACT PERSON: Name:William Barba Mailing Address:PO BOX 90, Blue Point, NY 11715 Phone#:(631) 560-7908 Email:wbarba@bardarch.com DESIGN PROFESSIONAL INFORMATION: Name:William Barba - Barba Architectural Design, PLLC Mailing Address:PO BOX 90, Blue Point, NY 11715 Phone#:(631) 560-7908 Email:wbarba@bardarch.com CONTRACTOR INFORMATION: Name:Thomas Downing - Coastal Management LLC Mailing Address:26 Old Riverhead Road, Westhampton Beach, NY 11978 Phone#:(631) 288-1226 Email:tom@buildcoastal.com DESCRIPTION OF PROPOSED CONSTRUCTION LJNewStructure ®Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project: El Other $500,000 Will the lot be re-graded? ®Yes []No Will excess fill be removed from premises? ®Yes ❑No 1 PROPERTY INFORMATION Existing use of property:Single Family Residential Intended use of property:Single Family Residential Zone or use district in which premises is situated:. Are there any covenants and restrictions with respect to R-40 this property? ❑Yes �No IF YES, PROVIDE A COPY. I Check Box After Reading: 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 orfor 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 210.45 of the New York State Penal Law. Application Submitted By Willi m Barba BAuthoriaed Agent ❑Owner Signature of Applicant: mate: »31 , 12 - STATE OF NEW YORK) COUNTY OF !S:T William Barba being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the Architect/Agent (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 me this d, y of r 20 � blic- State of New tart PUbIIC JUSTIN E HILLMAN York Notar, Pu No.01W6178965 �g ty Qualified in suf-05 De u 7, PROPERTY -'I O@ N Y C om mission Expires Dec i,p 2023 (Where the applicant is not the owner) olnat 7650 Nassau Point ®ad Cutchogue, Nle 11935 do hereby authorize 1/ iIIiam Barba to apply on ma Ito the Town of Southold Building Department for approval as described herein. Owner's Signature Date r Print Owner's Name i 2 Town Hail Annex ° aw a Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P. O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: 9/16/22 Owner: John J. Stack and Patricia M. Stack Location of Property: „7650 Nassau Point Road, Cutchogue, NY 11935 Please t ke notice that the (check applicable line): New commercial or residential structure ...��. Addition to existing commercial or residential structure Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) Pre-engineered wood construction (PW) „w w Timber construction (TC) in the following location(s)(check applicable line): Floor framing, including girders and beams (F) Roof framing (R) > Floor and roof firamux (FR) f Signature: IUame lncrcnn cnihmiffinn Chic fnrml- William Barba. AIA Capacity(check applicable line): Owner Owner representative TrussReg15.docx Effective 1/1/2015 701 workers' CERTIFICATE OF INSURANCE COVERAGE TATECompensation - Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured COASTAL MANAGEMENT LLC OLD COUNTRY RD. 631-288-1226 WESTHAMPTON, NY 11977 Work Location of Insured(only required ifcoverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e., Wrap-Up Policy) or Social Security Number 20-2648957 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York Town of Southold 54375 Route 25 3b.Policy Number of Entity Listed in Box"l a" P.O. Box 1179 R94933-000 Southold, NY 11971 3c.Policy effective period 1/1/2014 to 9/21/2023 4. Policy provides the following benefits: ❑X A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: ❑X A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. n B.Only the following class or classes of employer's employees: 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 NYS Disability and/or Paid Family Leave Benefits insurance coverage as desc d above. Date Signed 9/22/2022 By (Signature of insurance carrier's aulhorla d representAlve or NY5 q.icensed Insurance Agent ofthat insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT: If Boxes 4A and 5A are 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,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4C or 5B 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 and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave 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. D13-120.1 (10-17) 111111111 °1°1°1°1°°1°1°1111°°1111°1°1111111 Client#:9990 COASMAN DATE(MM/DD/YYYY) ACOPU, CERTIFICATE OF LIABILITY INSURANCE 9/16/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFI(3ATE 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:mmITITITITIT � the _.. _..............__... m ..__....._m .....__ er is If the certificate holdan ADDITIONAL... INSURED,the olic lyl es 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER N E;CT Commercial Support _ Ed ewood Partners Ins.Center H NE Ext r 9 631 90 9700 O lA/Ca Na a 631-390-9790 40 Marcus Drive EMAIL AOmRA :certificates@cookmaran com 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Melville, NY 11747 ........._ XXXRA Southwest MarineWB General Ins Co � 12294 INSURER A INSURED INSURER B:General Casualty Company of WI 24414 Coastal Management, LLC . .................. ._ 26 Old Riverhead Rd. INSURER c ... ...., �.... __— Westhampton Beach, NY 11978 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 CONTRACTOR 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. LNTSRR D L SUV R _... F O.EX POLICY EFF' POLI LIMITS TYPE OF INSURANCE POLICY NUMBER MINI/OD9YYY MMfD „„„„„„_,,,„„ IT.. A I GL2021 LHB00393 1 COMMERCIAL GENERAL LIABILITY � RRENCE $1,000 OOO 0/13/2021 10/13/202 'EACHOCCURRENCE CLAIMS-MADE II X1 OCCUR PIPFfuIW.^. 'S(rza4000�OUO T IN + ME EXP(An one person) $5, 000 BI/PD Ded:2,500 ...y... "W...r PERSONAL$ADV INJURY $1 17 =1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000,000 .n... �... — ...DU 7 LOTIIIER: CY�ECOT LOC GG $2,000,000 PRODUCTS-COMP/OP A $ ...._.. ................ .... ..— ..............._........ . .......�........................... ....... . .. AUTOMOBILE LIABILITY BCA000551100 10/13/2021 10/13/202 COMBINED 5INt71.E LiA,tlT 1,000,000 B Era idrt Ertl).. .....-.._. $ ANYAUTO BODILY INJURY(Per person) $ OWNED AUTOS LED RODOIPLYRITNJYUDRY GerEaccident _. .... SCHED AUTOS ONLY ) $ X AUTOS HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY .. bderad7 ”"""" -• Pea'a .._�_.�.-.. A.." UMBRELLA UAB X OCCUR � EX2021 LHBOO119 10/13/2021 10/13/2022 EACH OC ., CURRENCE,,,,,,,,,,,,,,,�m$4,�Op0�000 X. EXCESS LIAB CLAIMS MADE AGGREGATE $4,000000 mm DED: RETENTION$ ....._..".. WORKERS COMPENSATION 1 AND EMPLOYERS'LIABILITY Y/N .�LPER _..T./?U?�." $"""'"' ""'""""""""'""" ANY PROPRBETORJPAIRTN'ER/EXECUTIVE E.L.EACH ACCIDENT $ OfHCERFMEMSER EXCLUDED? N/A _... ......... (Mandatory in NH) 'EwL DISEASE EA EMPLOYEE $ ..... If yes,describe under DESCPTION OF OPERATIONS below E.L.DISEASE POLICY LIMIT $ RI DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION The Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S4285563/M3261846 RH002 /70N*N41 New York state Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 51 A^"^^^ 202648957 COASTAL MANAGEMENT LLC 26 OLD RIVERHEAD ROAD WESTHAMPTON BEACH NY 11978 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER COASTAL MANAGEMENT LLC TOWN OF SOUTHOLD 26 OLD RIVERHEAD ROAD 54375 ROUTE 25 WESTHAMPTON BEACH NY 11978 P.O. BOX 1179 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2120 126-4 254493 04/01/2022 TO 04/01/2023 9/16/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2120126-4, 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://WWW.NYSIF.COM/CERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STAT i iSUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:639826224 U-26.3 m = � = oo imp Q8 ZB — rq soawtz! m �w< v O z (n o pQz2o OWN z +� �a4 Rig G G U3 ig! awn 11 ilia 51 M H a ss i ri w�aao a 11 lid, its 5 Y W �w f� M 4�— ow - 61 I p N3 I 3 i 3 SS I i -•m 1 @Mq4� � .:, `y�,z_"'�'"�!-C.4�"�- �' � ,n g o N 4 0`1 R �'•".` g 0.w � � ,gyp h i/�w �i. p w r N - W 11c,o J w i Q i 1 r ao4ti 4 J 8 t3�0 IH Yar'� �i U \ e J 6rspuo�d a1�5 pasodo���s6ui,xo�p a�oikuo�\6mp�ini.��pooy�uiod n.soN 059E 000'88ttZ�-d u�d5n-�n —�in� Fi tlac