HomeMy WebLinkAbout48825-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
<d 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 #: 48825 Date: 1/31/2023
Permission is hereby granted to:
Levine, Noah
360 Central Park W Apt 12E
New York, NY 10025
To: convert the existing single-family dwelling to an accessory garage/storage building and
pool house as applied for per SCHD approval.
At premises located at:
4790 Blue Horizon Bluffs
SCTM # 473889
Sec/Block/Lot# 74.-1-35.56
Pursuant to application dated _ 8/25/2022 and approved by the Building Inspector.
To expire on 8/1/2024.
Fees:
ACCESSORY $443.20
CO-ACCESSORY BUILDING $50.00
Total: $493.20
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11 -0959
'Y P ) ) L P � 22
Telephone 631 765-1802 Fax 631 765-9502 1 ttarwr . otlz�al t V. ��/��
Date Rec i I``u^ ";uU 111,4 )
APPLICATION FOR BUILDING PERMIT
q,p,,-c`r Office Use Only W r`
PERMIT N0. Building Inspector: MAY22 1 22
MA
Applications and forms must be filled out in their entirety.Incomplete R
PP UVLDI 0 DEPT
applications will not be accepted. Where the Applicant is not the owner,an TODUN SUTOL
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name:Jonathan Rebell/Noah Levine scTM#Zo00-71-01-35.56
Project Address:4790 Blue Horizon Bluffs, Peconic, NY
Phone#: Email:tom@hfswanson.com
MailingAddress:3tp CI NVLkL'�OR�w New York, NY 100'2-b-
CONTACT PERSON:
Name:John David Rose Architect P.0 AIA Of
Mailing Address:596 Hampton Road Unit 1, Southampton, NY 11968
Phone#:(631)283-2051 Email:admin@jdrarchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:John David Rose Architect P.C. AIA
Mailing Address:596 Hampton Road Unit 1, Southampton, NY 11968
Phone#:(631)283-2051 Email:admin@jdrarchitect.com
CONTRACTOR INFORMATION:
Name:HF Swanson Construction & Associates LLC
Mailing Address:P.O. Box 1897 East Hampton, NY 11937
Phone#:(631)324-6905 Email:,
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition QlAlteration ❑Repair ❑Demolition Estimated Cost of Project:
$ �C> C��J
❑Other w ' '" �-C)
Will the lot be re-graded? DYes El No Will excess fill be removed from premises? ❑Yes BNo
1
PROPERTY INFORMATION ,,1
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated; Are there any covenants and restrictions with respect to
RR/R-40 this property? ❑Yes iRNo IF YES, PROVIDE A COPY.
❑ 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 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 210.45 of the New York State Penal Law.
John David Rose Architect P.C.AIA
Application Slabrn� BAuthorized Agent ❑Owner
Signature of Applica s �r ° Date: /fig /2�j2
STATE OF NEW YORK)
COUNTY OFt_ � 4.. )
John David Rose Architect P.C. AIA
,being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the 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
day of ,20 �
Notary Public
SUSAN PIERRE
Notary Public,State of Now York
No.01141
PROPERTY OWNER AUTHORIZATIONOW11fledIn SuffolkCoi"tty
Corr"NrWw Expims 01/28/20
(Where the applicant Is not the owner)
Noah Levine/Jonathan Rebell residing at 133 W 22nd Street Apt 89, New York, NY
do hereby authorize John David Rose Architect P.C. AIA to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
Glenn Goldsmith,President ��' � �� ��" �p��°�'�� Town Hall Annex
5
� 4375 Fbaute s
A.hiiehola; Krupski,trice President � �� � �� � w
Uric P.O.Box 1179
`�epenoski 'r I f w
Liz Czillooly �aut.hc�ld,New York 11971
�D; r
Elizabeth Peepl,s
1 1p ww Telephone(631) 766-1392
�r °ip il1 � d, Fax(631) 7605-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 10193A
Date of Receipt of Application: July 11, 2022
Applicant: Jonathan Rebell & Noah Levine
SCTM#: 1000-74-1-35.56
Project Location: 4790 Blue Horizon Bluffs, Peconic
Date of Resolution/Issuance: August 17, 2022
Date of Expiration: August 17, 2024
Reviewed by: Elizabeth Peeples, Trustee
Project Description: Conduct construction activity within 1 00'from the landward edge
of wetlands for the construction of a new 1,786sq.ft. two-story frame dwelling with a
241sq.ft. screen porch, a 497sq.ft. deck with trellis and 69sq.ft. stairs to ground, a
255sq.ft. side porch with 121sq.ft. stairs to ground, an 800sq.ft. swimming pool; one (1)
8' dia. by 10' effect. Depth discharge drywell for the pool, new I/A sanitary system and
removal of existing conventional sewage disposal system.
Findings: The project meets all the requirements for issuance of an Administrative
Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an
Administrative Permit allows for the operations as indicated on the survey prepared by
Howard W. Young, NYSLS, last dated May 16, 2022, and stamped approved on August
17, 2022.
Special Conditions: Installation of gutters to leaders to drywells to contain roof run-off
to be installed more than 100 feet from the top of the bluff.
Inspections: Final Inspection.
If the proposed activities do not meet the requirements for issuance of an Administrative
Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be
required.
This i nota deter ination.frn ny other agency.
Glenn Goldsmith, President
Board of Trustees
Glenn Goldsrnith, President �, ����� � �����"�" , Town Half AnneN.
A Nicholas Knkpski,Vie President 5437a RaUte 25
/ %l °/iii R 0. Box 11 9
Eric,'Se 7erao ki i ��/�o�
Southold; New York, 1197.1.
Liz Gilloolq; kdl
Elizabeth Peeples .�� r�� ✓��1�"r a � w�`` Telephone (631) 765-1$92
Fax(63-1.) 665 6641
yip yg�'q{ Mp � kd
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SOUTHOLD TOWN BOARD OF TRUSTEES
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF
BELOW
INSPECTION SCHEDULE
Pre-construction, hay bale line/silt boom/silt curtain
1't day of construction
'/z constructed
When project complete, call for compliance inspection;
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�� Town Hall Anne
Glenn Goldsmith,President �,+ 1 �1 x.
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54375 Route 25
A.Nicholas Krupski,Vice President , } P.O_Box 1179
Eric Seppta(,)ski Southold,New York 11971
Liz Gillooty y Telephone(631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
BOARD OF.TOWN TRUSTEES
TOWN OF SOUTHOLD .,
Storm Water Runoff
With recent heavy rainfalls, we are reminded once again of the problems Southold Tovai has
with storm water runoff. With over 100 road ends terminating at creeks, bays, inlets,or Long
Island Sound, as well as all of the lawns and homes lining our miles of shoreline, 100's of
thousands of gallons of storm water runoff enters our Wetlands-every year.
Carrying sediment that prevents sunlight from reaching aquatic plants,nutrients from animal
waste and lawn fertilizers that promote algae blooms detrimental to shellfish;and bacteria and
other biologicals that in high doses can be harmful to swimmers,storm water runoff is one of the
Trustees main public safety concerns. So important, in fact,that Southold has a Stonn Water
Management Code.
Southold Town's Chapter 236 provides an outline for how people need to deal with storm water
runoff from their properties. For example,new construction or renovation is required to contain
any potential runoff to the wetlands from the construction by installing hay bales and silt fencing.
This acts as a barrier and keeps our wetlands clean. Another example in Chapter 236 is that
every building mint have provisions to collect and disperse;ON-SITE;at least a 2 inch.rainfall.
This is usually handled by installing gutters, leaders and drywells to the home. The Trustees also
have a standing policy of requiring pervious non-turf buffers along bulkheads and at tops of
bluffs that help keep run off from entering the wetlands and prevents erosion to bluffs. These are
important measures to keep our wetlands safe and clean!
Before deciding to renovate or build, the Town Trustees urge you to check our website and the
other department's websites to make sure what you are planning to do meet the Town's Code.
These codes have been developed for the good of all citizens. And the wildlife all around us too!
New York State Department of Environmental Conservation
Division of Environmental Permits, Region 1
SUNY @ Stony Brook
dshod
50 Circle Road, Stony Brook, NY 11790-3409
Phone: (631)444-0365 • Fax: (631)444-0360
Website:
LETTER OF NO JURISDICTION
TIDAL WETLANDS ACT
July 19, 2018
Jonathan Rebell
Noah Levine
360 Central Park West
Apt 12E
New York, NY 10025
Re: NYSDEC ID#1-4738-04611/00001
Rebell Property
4790 Blue Horizon Bluffs
Peconic, NY 11958
Dear Mr. Rebell:
Based on the information you submitted, the Department of Environmental Conservation has
determined that the portion of the above referenced property shown landward of the 'Crest of Bluff'as
evidenced on the survey prepared by Howard W.Young, last revised July 09,2018 is beyond Tidal
Wetlands Act(Article 25)jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land
Use Regulations(6NYCRR Part 661) no permit is required for project activity proposed landward
of the `Crest of Bluff.
Be advised, no construction, sedimentation,'or disturbance of any kind may take place seaward"
of the tidal wetlands jurisdictional boundary, as indicated above,without a permit. It is your responsibility
to ensure that all precautions are taken to prevent any sedimentation or disturbance within Article 25
jurisdiction which may result from your project. Such precautions may include maintaining adequate work
area between the jurisdictional boundary and your project(i.e. a 15'wide construction area)or erecting a
temporary fence, barrier, or hale bay berm.
This letter shall remain valid unless site conditions change.
Please note that this letter does not relieve yo of the res sibaiily of obi in,g any necessary
permits or approvals from other agencies or local m icipa,litie
S' cerel
i
arad ��.-..'.,---..�
epu as Admin trator
cc: Thomas Wolpert
NYSDEC-TW
File
Board of Trustees Application
AUTHORIZATION
(Where the applicant is not the owner)
owners of the property identified as SCTM# 1 00- in the town of
New York,hereby authorizes oy\ 00 V t a C),5 �
A- to act as my agent and handle all
necessary work involved with the application process for permits)from the Southold Town
Board of Trustees for this property.
Property Owner's Signature I' operty Owner's Signature
SWORN TO BEFORE ME THIS DAY OF 2
Notary Public SUSAN G VONSFw Et.
Notary Pubfi ,State of New York
No.01VO6366 47
Ouaiified In uffolikounty,
Commission Empires ttkJa l o
Board of Trustees Application
AFFIDAVIT
00 k �c EING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN
ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT
ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE
BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES
AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF
GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE
TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE
CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO
INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION,
INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF
TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE
COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL
EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM
OF THE PERMIT.
Signature of Property Owner S;' ature of Property Owner
SWORN TO BEFORE ME THIS DAY OF _._ .- 20 1 0
SAN 0 VONBARTHEW
ry PUNIC,Sate of New Yc*
Notary Public `
� " in r cu
w
APPLICANTlAGENUREPRESENTATNE
TRANSACTIONAL DISCLOSURE FORM
+ ipi.—s!.. �..g o �.s.�_ t of intc st no t7te iLa t �wrr o ccrs an ployees.The t)unx)c of
utls n d s cle of Ft1G" x !ibsts coa�t1ic
this f rN�:�.fsr„��vld�:in..��sataon tv ai is ca[�rtl tt�c coeur t�f �ilsle c &ct^� � 'i er�arodatl rv't to tars°�rlr�ta:�u'r r�rRio is; ,
YOUR NAME: L�V1 f1 Cjooca iA + p
°� '�t'����D�Vt�
(hast name,fiilt name,griddle Initial,unless you are.applyingid the name of
someone else or other entity,such as a company.If so,indica ,the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply.)
Tax grievance Building
Variance Trustee
Change ofZone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map PlanWng
Other
(If"Other",name the activity-)
Do you personally(or through your company,spouse,sibllq&parent,or cltW)have a relationshrpwrith any offib.-r,or employee
of ClicTown of SOuthoIdl '"fie"ladonshTp? includes by blond,. " g or business interest".Fusims intereW t4paps a b�usir css,
inelu4 tg n"pdrtncrship,in Which the town offiocr or cmployee has even a partial oWne tlp pf(ort ft ploymot by)a corporation
in which tho,towwrn olficer,or employee owns moxe#ion 5%of.thc sba s..
YES _._.. NO
Ifyou answered"YES",complete the balance of this form and date and sign where:indicated.
Name of pemsan•employed by the Town of Southold
Title or position of that person,
bcscribc,thc telationship wwten yourself(th; and the town officer or employee.Either check
the appropri$e,linc A)through.D)and/or describe int the space provided.
The town o ffic.r or employee or his or her spouse,sibling,parent or child is(check all that apply):
A)tho,owner ofgreater than %of the shares of the corporate stock of the applicant
(ew'nanthepplicancisa corporationy,
B)the legal or'!rencticialor'! owner'of any interest:in a non-corporate entity(whets,the
applir nt is not a e6rrpo tion); <
C)an officer,director,partner•,or employee of the applicant;.or "
D)the actual applicant:
DESCRIPTION OF RELATIONSHIP
Submitted this day of fit, tl
print Namc 4,
Form TS 1
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NYSIF
New York State insurance Fund PO Box 66699,Albany,NY 12206
nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
^^^^^ 113791393
H F SWANSON CONSTRUCTION ASSOCIATES
LLC ■
PO BOX 1897
EAST HAMPTON NY 11937 SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
H F SWANSON CONSTRUCTION ASSOCIATES JONATHAN REBELL&NOAH LEVINE
LLC 4790 BLUE HORIZON BLUFFS
PO BOX 1897 PECONIC NY 11958
EAST HAMPTON NY 11937
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
11464751-5 781453 09/08/2021 TO 09/08/2022 4/5/2022
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 1464 751-5, 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 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 SUR NCE FUND
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 145892933
DATE(MM IDD/YYYY)
CCORL" CERTIFICATE OF LIABILITY INSURANCE
�.. 04/05/2022
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).
cONTA
PRODUCER MAMIwq.cr Barbara Dammers
Roy H Reeve Agency, Inc, P NF ,, (631)298-4700 A! Nor (631)298-3850
IAICNo.ExPO Box 54 A�DDESSs MAIL bdammers@royreeve.com
13400 Main Road INSURE (S)AFFORDING COVERAGE NAIC#
Mattituck NY 11952 INSURERA: Southwest Marine and General Insurance Compa
INSURED INSURER B: Merchants Preferred Ins Cc 12901
HF Swanson Construction Assoc.LLC INSURER C
PO Box 1897 INSURER D:
INSURER E:
East Hampton NY 11937 INSURER F.
COVERAGES CERTIFICATE NUMBER: CL2110715460 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDINGANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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,
ADDL SUER,N TYPE OF INSURANCE MM
POLICY NUMBER 20-1YYYY MMIDDIYYYY LIMITS
LICY EXP
LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
ice" 1001000
CLAIMS-MADE F OCCUR PREMISES Era urence S
X Contractual Liability MED EXP(AnX one person) $ 5,000
A GL202OLHB00450 10/12/2021 10/12/2022 PERSONAL&ADV INJURY S 1,000,000
GEN'LAGGREG'ATE LIMITAPPLIES PER: GENERAL AGGREGATE. $ 2,000,000
+v PRODUCTS-COMP/OPAr.,G S 2,000,000
POLICY ,r^�« JECT E LOC
$
OTHER
SINGLE:LIMI
AUTOMOBILE LIABILITY aeMsCS $ 1,000,000
III
ANYAUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED CAP1067708 11/16/2021 11/16/2022 BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
«w,,,r HIRED NON-OWNED
Pe' I accident). DAMAGE $
�""�x. AUTOS ONLYIX AUTOS
X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000
A EXCESS LIAB HCLAIMS,MADE EX202OLHB00123 10/12/2021 10/12/2022 AGGREGATE s 5,000,000
DEO �.RETENTION$ 0 S'
WORKERS COMPENSATION
STATUTE. SER
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE r NIA E.L..EACH ACCIDENT $®...�.„-..
OFFICE'RIMErMIB-ER'EXCLUDED?
(Mandatory in NH) E.L..DISEASE-EAE,MPIOYEE S..
If MOs,describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/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
Jonathan Rebell&Noah Levine ACCORDANCE WITH THE POLICY PROVISIONS.
4790 Blue Horizon Bluffs
AUTHORIZED REPRESENTATIVE
Peconic NY 11958
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