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HomeMy WebLinkAbout48961-Z TOWN OF SOUTHOLD �r BUILDING DEPARTMENT TOWN CLERK'S OFFICE k° 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#: 48961 Date: 2/24/2023 Permission is hereby granted to: Chapman, Russell c/o Cobblestone-Capital Adv 500 Linden Oaks Ste 210 Rochester, NY 14625 To: install generator as applied for. At premises located at 790 Vanston Rd, Cutcho ue SCTM #473889 Sec/Block/Lot# 104.-12-10.3 Pursuant to application dated 2/17/2023 and approved by the Building Inspector. To expire on 8/25/2024. Fees: ACCESSORY $100.00 ELECTRIC $85.00 CERTIFICATE OF OCCUPANCY $50.00 Total: $235.00 t1inspector WON— TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 i Telephone(631) 765-1802 Fax(631) 765-9502 htlj)s://NV'ww.soutliomdtown,tiv.ggv Date Received APPLICA 111011M 11,,,,DING P MIT For Office Use Only qm� La llJr I PERMIT NO. Building Inspettcr: FEB 179,02',1 Applications and forms must be filled out in their entirety.Incomplete (3U11 DING-i IX-P applications will not be accepted. Where the Applicant is not the owner,an "O NOFSM"'HIM.'i:l Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: -it 6 1 SCTM#1000- 0'4 1 -2— Project ..Project Address: 710 v4, Phone#: 5-SS-- -7`t - a-o Email: --S3 .. i . g.v Mailing Address: -7 V ^" .A4 I Ll 315' CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address:: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: G - lt2 Phone#: pq Email: co� . . A DESCRIPTION OF PROPOSED CONSTRUCTION ❑Ncvv au Uct-U c u a4uiaw.i -- - 9 w.. omnlit..... F_ 'mated Cost of Proiect: .....c+. .•+.. f-lna.�'+i., lul�ltor�+inn [,IRnn�ir nrlmm�litinn 1-Stl L6ther f -- w - Will the lot be re-graded? ❑Yes PKI01, Will excess fill be removed from premises? ❑Yes 9f46- PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ZNo IF YES, PROVIDE A COPY. [B/Check RDx',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 15 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 buUding(s)for necessary Inspections.False statements made herein are punishable as a Gass A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name): 1`� /�S �c/L• M.-Uthorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF SUVFOA— ) 06-C"� being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Gey r% r— (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 tx� day of 20 as of r Public EVE L.GATZ-SCHWA-MBORN `:OTAR Y PUBLIC.STATE OF NEW YORK T �" T ORI I III Registration No.OIGA6274028 .M ........... W Qualified in Suffolk County (Where the applicant is not the o r) mission(Expires Dec.24,20g��- Com � M residing a a—kru'o-�il lip. i1r, Z do hereby authorize 1 c(-� to apply on e„y al, rhe T n of Sou o Ruilding Department for approval as des ibe d rein, Owners S40ature Date Print OwnegAame 2 a; BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 u Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 ro err sdutholdtownn o seared southoldtownn . o APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: „s Electrician's Name: go License No.: /vx- 45—of]L Elec. email: Elec. Phone No: q--7 I'll 1 ❑1 request an email copy of Certificate of Compliance Elec. Address., J30X 5-1,°4 A.- el-3� JOB SITE INFORMATION (All Information Required) Name: G Address: 71v Z Cross Street: Phone No.: S'195'- -7 Ll Bldg.Permit#: email: vCke' ,—w-, 3 Tax Ma District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): I Square Footage:. Circle All ThAt Apply: Is job ready for inspection?: LLj YES NO Rough In El Final Do you need a Temp Certificate?: YES�O Issued On Temp Information: (All information required) Service Size F-11 Ph[]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground E]Overhead #Underground Laterals 1 M2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DIME WITH APPLICATION DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE1 09/02/202-2 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 endorsements). oy PRODUCER Josh Mitchell NAME: __. Freedom Coverage Corp PHONE 31)709-2777 80 Orville Dr Suite 100 � Jaa ht F�roodom ov r r pm aAIG# gco Bohemia, NY 11716 E IYtAIL _ INsuRER(SI AFFORDING COVERAGE ................_---- _ N 4 �... .- ......... 1.!NSURER MI v Iq l dP,fYllt�C,.OIl7.,Jany INSURED INSURERB: The HarkfOrd Ins COfI'tIRa,,ny .... 29424 Peconic Power Systems LLC INSURERc:mmmmmmmmm 315 Commerce Rd INSURER D: Cutchogue, NY 11935 INSURER E: .................... INSURER F: COVERAGES CERTIFICATE NUMBER: 0,0000166-42889 REVISION NUMBER. 4 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. 14T ............... TYPE OF INSURANCE R ........... POLICY NUMBER —POLICY EFF NPIM�dy I W ......_ ........ .----- - YYY LIMITS COMMERCIAL EERALLIOCCUR AVA_° S Eaaccca rscca $ -Q�Q��p A GLP1092481 05/28/2022 05/28/2023 EACH OCCUURRENCE $ 100 000 MED EXP Any one person) $ 5,000 ,.,,.,_ ..... .... .__ �.,.-..-....,$ ............s...._.�,,....7.. —0-0 GENS..........M..............� � PERSONAL&ADV INJURY $ .. OOO OOO L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1 000 000 IB0 �� POLICY❑JECTRO- ❑LOC PRODUCTS-COMPIOP A GG $ 290 000 OTHER: $ —�s AUTOMOBILE LIABILITY n SINGLE LIMIT8accide EINE accident) ANY AUTO BODILY INJURY(Per person) $- � - -� -__-� .- AUTOS ONLY AUTOS $ HIRED NON-OWNED Fora PRCrPERTYOAMAGE $ OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY AUTOS ONLY 4.Para I ...............-...-. $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB l CLAIMS-MADE AGGREGATE $ DED I �RETENTION$ $ B WORKERS COMPENSATION 12WECAT7UBP 09/02/2022 09/02/2023 _www STUTE X ER1 000,000 OFFICEIME BEELUD?PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH Y� N/A E.L.SEASECEAEMPLOYE $ 1IDENT $ '000,OOnOm (Mandatory In NH) If s,describe under DSRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) As pertains to insureds operations CERTIFICATE FOLDER.. CANCELLATION Town of Southhold- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Annex 54375 Main Road P.O. BOX 1179 AUTHORIZED REPRESENTATIVE Southold, NY 11971 ' ✓. !!�C JCM ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by JCM on 09/02/2022 at 12:45PM mm AQP AGE ,INC EALTH LAND 24 I / 0 0 3 00 0 N n t3 A 9 AiLf �a � r � „, „ '°� X IN ON i wh,� a . F 0