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Home My WebLink About48858-Z " fat 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 #: 48858 Date: 2/6/2023 Permission is hereby granted to: Stulsk , Christine PO BOX 114 New Suffolk, NY 11956 To: construct repairs and alterations to existing single-family dwelling as applied for. At premises located at: 515 Orchard St New Suffolk SCTM # 473889 Sec/Block/Lot# 117.-5-35 Pursuant to application dated 1/17/2023 and approved by the Building Inspector. To expire on 8/7/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00 CO-ALTERATION TO DWELLING $50.00 Total: $250.00 Building Inspector 7 Y+r 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 htt s://www.,southoldtowiiiiy.gov Date Received APPLICATION For Office Use Only E E � W PERMIT NO. � Building Inspector: R JAN 17 1023 Applications and forms must be filled out in their entirety.Incomplete BUIll3ll' GDEP,. applications will not be accepted. Where the Applicant is not the owner,an 7OWNOFSODMOLD Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: Clk_ SCTM#1000- Project Address: f � ,G j�C.�i �✓-e�-✓ �(,c��OTk Phone#: Mailing Address: �� CONTACT PERSON: Name: we Mailing Address: �� ' �� %70e Phone#: ( Email; ��,. 'S DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address- Phone =mail- CONTRACTOR INFORMATION: Name: Mailing Address: .7 Phone#: _ g� Email,Loll - �•— DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition 4p!AIteration>4epair ❑Demolition Estimated Cost of Project: ❑Other f90 Willthe lot be re-graded? ❑Ye o Will excess fill be removed from premises? Dyes P<o 1 FFZonPROPERTY INFORMATION �� Intended use of property: Z " e use of property: l'�>1/� use district in which premises is situated: this property?Are there any c❑PesWo IF YI S, PROVIDE A COpy respect to ❑ C.1veck Box After I emfgr : 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 ction of buildings, ordinance of the Town of Southold,Suffolk,County,New York and other applicable taws,Ordinances orRegulations,all applicable flaws,ordinancebuilding code, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply PP In building(s)s for necessary Inspections.False statements made herein are actors on re mises andl g 1 hor4ed Ins P housing code and regulations and to admit aut P punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. uthorized Agent ❑Owner Application Submitted By(print name): /'/��"v�— r Date: Signature of Applicants �— STATE OF NEW YORK) COUNTY OF ) ' being duly sworn,deposes and says that(s)he is the applicant 141111 (Name of indivi ual signing contract)above named, I--- (S)he is the (Contractor Agen ,Corporate Officer,etc.) of said owner or owners,and is duly authorized to rm 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. h Sworn before me this J day of I' I` ,20. tary Public TI✓RACEY L. DWYER NOTARY PUBLI STATE OF NEW YORK PROPEh�"( !i T �� w R NO.ol DW6� 6900 (Where the applicant is not the owvner lv l I DIED IN SUFFOLK JUNE E30,COUNT �i� aBION EI�iFiEB JUNG 3�ti, WP residing at_ 1,S s do hereby authorize �.. .. 4,wi V i" . . to apply on my behalf to the Tovrn Southold Building Department for approval as described herein. Date Owner's Signature Print Owner's Name 2 C H&C ONE CORP CONSTRUCTION 8305 Cox LN #6 Cutchogue, NY 11935 Office- 631 856 0066 Cell- 631 953 1386 hconecorp@mail.com Insurance information; General Liability Policy Number L068026874 05/07/2022- 05/07/2023 Worker' Compensation NYSIF Policy Number I2473019-4 05/08/2022- 05/08/2023 Suffolk County License HI-62286 Expires 05/01/2023 DATE(MWDWYYYv1 CERTIFICATE LIABILITY I I 5109/2022 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(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 statement on this certificate does not confer rights to the certificate holder in lieu of such erldoTsement(s . FAA;If PRODUCER GOTO LTM SPECIALIZE INSURANCE SERVICES �wIDNc S8I�8W 204 RTE. 112 RAIL SRU@SPECIALI EDINSURANCE.COfrN PATCH U Y 11772 ATLAN F �mm.__ NAJC ass cycle-etc, ANTIC CASUALTY WSURANCE CO 42846 � I I INSURER A: 46 INSURED INSURER e H&C ONE CORPORATION IN URERC. 8305 COX LN UNIT 6 ISIRER o I7r CUTCHOGUE, NY 11935 INusERE; , 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.POtMY EFF _ OF INSURANCE Y V wVn N L06902bt1 11C Y NUMBER IMAM D22 m 5 0172023�EACH OCCURRENCE LIMITS + m— lNISn COMMERCIAL J ADI7t,StiBR LEXP TT TYPEIALGENERA LIABILITY h 1,000,000 co a CLAIMS-MADE f OCCUR PR MISES CEO omuwrx) s 100,000 ExP(M one rson i _ 5,000 PERSONAL 8 ADV INJURY 1 000.'000 NERAL AGGREGATE s 2 000,000 CiEIJ"k„A1C�Is""RFk",A'TR LIMIT APPLIES PER: i GENERAL . ,+w P6 PRO. _ - ... JECT 00#.00Ow 'ShI4�Y� L ! LOC } PRnDlIC75-_COMP/OP AGG w ;..,mm," ,,,,,, OT'I°ER; S AUTOMOBILE LIABILITY„ C IN SUV LE LI IT S fEa Idonl� h ANY AUTO BODILY I INJURY(Per Fp eson).M.S OWNLU SCHEDULED BOOYINJURY(Pe atclDenl) AUTOS ONLY AUTOS .sSmm ^^ ..,TRO�PER �MAGIIRED NON-OVVNED AUTOS ONLY AU Y i 5 UMBRELLA LIAB OCCLR EACH OCCURRENCE S . ,...___� EXCESS LIAR Ea iWkT,rAIWG!i°. AGGREGATE ...._....., ,m..Saw,. ... � ,�,..,....o .., .OED. . RETENTIONS WORKERS COMPENSATION PEN UIH- AND EMPLOYERS'LIABILITY ANY PI 4OPMETCRMARTNERIEXECUTIVE IN N A EL EACH ACCIDENT $ OFrIGERIMEMBER EXCLUDED-? (Mandatory In NH) E.L-DISEASE EA EMPLOYE S ._.............. ..... .. ......_...... .�_,...,.e....�,,.-,.,,... »... If yes describe under .._ DE RIPTI NOF PERATI NS nebw E.L.DISEASE-POLICY LIMIT s DESCRIPTION OF OPERATIONS T LOCATIONS I VEHICLES (ACORD 109,Additional Remarks Schedule,may be attached H more space Is required) REMODELING,CARPENTRY,DRY WALL, ROOFING,SIDING INSTALLATION ,TILE,STONE,MARBLE,MOSAIC OR TERRAZO WORK CERTICATE HOLDER IS ADDITIONAL INSURED AS PER WRITTEN CONTRACT OR AGREEMENT CERTIFICATE HOLDER CANCELLATION' TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SEAN PETERS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2000 PARK AVENUE RIVERHEAD, NY 11901 AUTHORIZED REPRESENTATIVE NYSIF Now York Stale Insurance Fund PO BOX 66699,Albany,NY 12206 nysif.COm CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A 352654525 SPECIALIZED INSURANCE& SERVICES INC 204 ROUTE 112 PATCHOGUE NY 11772 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER H&C ONE CORPORATION TOWN OF SOUTHOLD 8305 COX LN SEAN PETERS UNIT 6 2000 PARK AVENUE CUTCHOGUE NY 11935 RIVERHEAD NY 11901 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12473 019-4 891474 05/08/2022 TO 05/08/2023 5/11/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2473 019-4, 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/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. PRESIDENT BAYRON CUESTAS VP MARIA MARTINEZ H&C ONE CORPORATION TWO 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 STAT SUR NCE FUND 4 4/ DIRECTOR,INSURANCE FUND UNDERWRITING