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HomeMy WebLinkAbout49097-Z ,r 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 APPRO'V'ED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 49097 Date: 4/6/2023 Permission is hereby granted to: Singer, Joel 100 W 57th St Apt 19D New York NY 10019 To: construct accessory in-ground swimming pool with hot tub as applied for per Trustees approval. Pool equipment must be located a minimum of 10' from side yard lot lines and a minimum of 40' from front yard lot line. At premises located at: 20575 Soundview Ave, Southold SCTM # 473889 Sec/Block/Lot# 51.4-11 Pursuant to application dated 11/15/2022 and approved by the Building Inspector. To expire on 10/5/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT .5 Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 l�Nt.A': wrrn. ertl.cla9tu�r�nr ,� v, Date Received APPLICATION FOR BUILDING PERMIT RA For Office Use Only PERMIT NO._ Building Ins ectorc_ 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: — n SCTM # 1000- Project Address 2- V 3- 7-6, �D�nal �/% ems✓ �J�'�w� Phone#: Z 72 7'�-6 3 3 D d Email: A, CO Al Mailing Address: /Dv kles-t 6-7 .....- CONTACT PERSON Name: I "i I Mailing Address: Phone#:. Email:. DESIGN PROFESSIONAL INFORMATION: Name: ��r Ie W. .. - C sT � n Mailing Address: P 17 �b �D G�A 1)IT I 1 ) 710 P Phone#: 631 Z(o z. 7 �D Email: Ci,�� �c u ✓c�; �FG� M� C I CONTRACTOR INFORMATION: Name. � - Na -1d Ga ✓ e SWi1019 . Mailing Address: P00 q 9 41— /V d 9� Phone#: I Email: DESCRIPTION Of PROPOSED CONSTRUCTION l ❑New Structure ❑ ❑ Addition Alterati n ❑Repair DDemolition Estimated Cost of Project: ❑Other X ' � '► + y7c_71te LaVICOO Will the lot be re-graded? XYes El No Will excess fill be removed from premises? ❑Yes :k�No 1 x 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 i this property? ❑Yes ❑No IF YES, PROVIDE A COPY. CtteC `BOX After Reading: The owner/contracttwrdesign professicwnaN is rtsfransibid far all alranage arwd storm water issues as proirfded by Clwpfer Zlr of the Town Code. APPLICATION IS HEREBY 0ttro the Building Nepardrn-ent for the issuanee of a Building Permif pursuant to tfre Iuildin Zone Ordinance of the Town of Southold,Suffolk,County,New York and other appliCabl Laws,Ordinances ar R egulatiohs,for the coaastruction ref tulldfnBs, 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 21U.45 of the New York State Penal Law. q �' Application Submitted By(print name). / ❑Authorized Agent wner Signature of Applicant: all 11"�� Date: /012-SI 2D ZZ Z STATE OF N9V4QRM AFP C)-,— SS: COUNTY OF L3 �J I being Y dui sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the 0 w i-1 e,✓ (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 ara (h ;end that the work will be performed in the manner set forth in the application file therewith. `• 07 A N .,Y. Sworn before me this60 / day of C� �/ , 20.-,)-`,)' , Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I residing at do hereby authorize 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 "uv r'�� rw.�.. �"rJ',"+� a t^,;. , •'"u'r„� �r rm r u ,.,,%� ,nuvw,m. r^,.7^"�r°" rr'i w�lr.;my h;. rr mr ,;',f"ri r'!r"�rn d�u "^�y„mw yn, �r ,"rm+ ✓ wt,A rd", .n^''"' "? v ''�>r ,irr ld.;,N�r',M 7,i W, "' �r �"u .a q A'&�",�,�M R, rw,rr+NaAr r �iur�., „i,,,. �/r' k !�, Irk, "Vfl R;, ,m;-y:71 r, rr ,+, r� �'�.�r�",..��h� .J,+aW, � f u:.r y�� Wilr�r���%�r ✓� �"„ �o� rv9ll�,^u�l�, PJ �?�u ,�J,a vq,,„��� � �rl� �r�PJ� � �3 s , �'l'"�^ 7,,wd✓ la ,;r�"lw"n,��*.w�l„° „''✓�r,k-.. d�'✓ ;.. l� � V/r4 VF n„n �i r, �R r (�ra"'r1,A,,✓"�'--' -�^�:;��R i'��Nli �SVPNf�»'"*^ .:;, r y, I+Vi;µ';I. �d�r m,"�v f ✓r�Ak,/w?,,A�J w�rl`»="^V.�w«^^A' =�a w.,..�„�+ �'rk „, c� .„,��u"'� A�a,,,„ �,w;ww.�wt Ga� ,� E��t r. Fa:�c.u., �;w-,V{rdr Gd ,rrww�,r.,wrw✓c� i., ,�� �r e�.,.�y ifµ �d'I ��.'a'w /.r �", .u��id� dre"""w`,." "�� .�' ,,..:ur�m °"'.:>' ,' wwwdr�°,,,-, � ��;�;- r (A ,JJr '� ' ��✓�,ar�J! � r�„ „.. _ �, w �. �(fir .s,A '%riVr"F r'/ ,i� it„s {�y ria��„9 a d;�»�r,, ,f.rr„�,�� A"�d / 91A „iy i ,�rnu� wq Jr'r`k”' ��rAlri llfMrn"i xk„ ' ✓ JR��iI,�yd`,''� wu;, tli r%�� �; ''� r✓ „ ,,w,��..., J r„. ,9,,,rt+„M,./,1/��n, w� r 2'�,✓_"�✓i e�� l(l!r r ,,.0 �..flL .�r��� lin r ,(�v'/!. �G� �r >° ✓rr n � r(�r U. �a�' � �dddV «.�vu. ,'. »'�;i'" MAr� d f �Q�l,", OP G r jj Vr rr r BOARD OF SOUTHOLD TOWN TRUSTEES %r� 9 SOUTHOLD,NEW YORK 0� i ri 'a�(x 9 o d � PERMIT NO. 10342 DATE: MARCH 1.5 2023 ISSUED TO: JOEL B. S1EgKR PROPERTY”ADDRESS: 20575 SQUNDVIEW AVENUE SOUTHOLD ............ �tl SCTM#1000-51-4-11 raur AUTHORIZATION ` Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on March 15.2023,and in � y, consideration of application fee in the sum of$250.00 paid by Joel E. Si „ge and subject to the Terms and ' w” Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to demolish existing 261x16.1' detached garage and construct a proposed 281x30' 1&y story detached garage with a 61x4'outdoor shower enclosure with a gravel base, and a proposed pool equipment area on a 31x14' pad at grade with a 36"high fence enclosure; y, construct a proposed 181x45'in-ground pool with an 81x8' hot tub enclosure inside the pool and w° ! new 48"high,471x98' pool enclosure fencing with gates; install a drywell for pool backwash; install a 48"wide by 55 linear foot long walkway;and existing gravel driveway with a proposed 30"maximum driveway retaining wall,beginning at steps,9' northerly,29'on the curve trunning 281,and 19' parallel to property line,to retain existing grade of the lawn;and as e depicted on the site plan prepared by Charles W.Kuehn,Architect,received on March 15, � rr 2023,and stamped approved on March 15,2023. A IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these presents to be subscribed by a majority of the said Board as of the day and year first above written. r ivf4 c � � ie d ✓ r r� r A r>r � r e, I � r, ^�,. ✓ r;' ar d.:r h rxt ¢dw frw :IA��/Vr�"µ�w, hid/1.,� �,p i J ^.m G al r v ✓' .fir,✓ o w'" �;. w :� :,,"n -+, ^V5 rJ' ro " R >�l'A`"r" "a r"'dl' M�,,�"�4 �„�r rlw✓rw �"�'r-tl'V V Adrl,:. �h u`r,�y m%'�''»�l r Ri r,Y » idf+V' o ��'� r�'�V1 I�`rr � ,�'{s� r'i,&G��. Od•,A,,..,iewiAl*mrinr4�.rv, ,�m u'r>'r � !'�„. ,rrw'N,:,.">✓�CMi 1 .-en „!,�!�` '�^rmr ,n -rivr„+5 .:r.D;, �rii% .,,ala '�°w.,� ,Arron N r�^”w P `d 4� ;CV tie r? r Rid mM � �AN y� x , (,�laN ,;vrt ➢ flAVR' " �;,'I ;i „ ” . �Vn rid �� " m _ ✓�r � ,�' «�,.u,1N � Glenn Goldsmith,President � � Town Hall Annex A.Nicholas Krupski,Vice President a" y 54375 Route 25 P.O.Box 1179 Eric Sepenoski Southold,New York 11971 Liz Gillooly Telephone(631)765-1892 Elizabeth Peeples Fax(631)765-6641 INN, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 22, 2023 Patricia Moore, Esq. 51020 Main Road Southold, NY 11971 RE: JOEL B. SINGER 20575 SOUNDVIEW AVENUE, SOUTHOLD SCTM# 1000-514-11 Dear Mrs. Moore: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, March 15, 2023 regarding the above matter: WHEREAS, Patricia Moore, Esq., on behalf of JOEL B. SINGER applied to the Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated January 23, 2023, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council and to the Local Waterfront Revitalization Program Coordinator for their findings and recommendations, and, WHEREAS, the LWRP Coordinator issued a recommendation that the application be found Consistent with the Local Waterfront Revitalization Program policy standards, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on March 15, 2023, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, 2 WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees have found the application to be Consistent with the Local Waterfront Revitalization Program, and, RESOLVED, that the Board of Trustees approve the application of JOEL B. SINGER to demolish existing 26'x16.1' detached garage and construct a proposed 28'x30' 1 '/2 story detached garage with a 6'x4' outdoor shower enclosure with a gravel base, and a proposed pool equipment area on a 3'x14' pad at grade with a 36" high fence enclosure; construct a proposed 18'x45' in-ground pool with an 8'x8' hot tub enclosure inside the pool and new 48" high, 47'x98' pool enclosure fencing with gates; install a drywell for pool backwash; install a 48"wide by 55 linear foot long walkway; and existing gravel driveway with a proposed 30" maximum driveway retaining wall, beginning at steps, 9' northerly, 29' on the curve running 28', and 19' parallel to property line, to retain existing grade of the lawn; and as depicted on the site plan prepared by Charles W. Kuehn, Architect, received on March 15, 2023, and stamped approved on March 15, 2023. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: $50.00 Very truly yours, Gle n Gold�m 4/rh President, Board of Trustees GG/dd J Mtoot SOUN 0 u \A Ri_ project # date note by ca NEW DETACHED GARAGE 1 12-10-22 REVISED PER HOMEOWNER INGROUND POOL & ADDITION TO sl— C— s t Z m 2675 SWND N ABU[ =r N SOUTHOLD, NY Client#: 12643 ISLAGUNI DATE(MMIDD/YYYY) ACORDn. CERTIFICATE OF LIABILITY INSURANCE 10/2512022 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1111 PHAOONECT :631 39019700 p kOrt ...... FX;'' aN p_,..,_ _ .. Edgewood Partners Ins.Center (Arc N� 631-390 9790 PHONE 40 Marcus Drive E-MAIL ADDRESS:1111... esep) rSom ' @Cbrokec1111.. NEcer�i- ...I I—— .... 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# 1747 Hartford _____ INSURER A Hartford Fire Insurance Company 19662 Melville NY 1.�,. 1111.. 1111 ... ..,...�1111.. ............ __ ,. _ 1111... _... INSURED INSURER B:Hartford Casualty Insurance Company 29424 Island Gunite SwimmingPool Inc. Pro e s Casual Ins Co of H INSURERC.Property ......_tiy "", .. � Hartford 34690 Sag PO BHaX1595 bor,NY 11963 INSURER E: Trumbull Insurance Company 27120 INSURE 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. ItdSFi !p 2 0912612023,EACH OCCURRENCE $1 u AR _., INSURANCE ADDL stwSR 12UUNOZ94 .PGI ICY EBF POLMCY EXP uMlrs LTR .. E POLICY NUMBER $VI1441' r4a"YYYY MMf6DFYY'Y!'M"„_. ,.. GE � ��-- TYPE O..INS COMMERCIALCLAIMS-MAD E XLIABILITY 18 9/26/202 .._ j000,000 NERAL ..� _PR" S.. 0 OCCUR MED EXP(Any oneEe person), $50, 1X11... Coy ntractual Lia b. ( Y P INJURY $..,-a 1,111. 1111 ., 1111 ......... c __1111.. ..., PERSONAL&ADV ( 1,000,000 GEN'L AGGREGATE LIMN jj ..... PRODUCTS_COMPIOP I,$.2"000100,0 T APPLIES PER: GENERAL AGGREGATE POLICY ^I PRO-ECT F LOC $ ,000 000 OTHER: ...,..... 1111-,...--1111. ... .. _, ....�._.._ _ ..........._. 1111 � AGG $... mm_...—. .. ..I D AUTOMOBILE LIABILITY Ex3aa'ar"1d,ruRy 0 "-� BODILY INJURY GPer pe ___ ­0 000 __ ANY AUTO ( M�V�n) $ 12UENOZ9833 9126/2022109/26/202 100 - OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSX AUTOS ONLY X.._ONLY AUTOS ------------- ....y$ NON- O-OWNEDAUS ONLY :( e a Vit)AMA{�E $...�. 1111. ,1111 B �X )( OCCURIMS MAD 12HHUOZ94 9 9/26/2022 1091 AGGREGATE $1,000"000 ... ... .. mm...W .e..,--,. 0 1 26)202 EACH OCCURRENCE UMBRELLA LIAB $1 EXCESS LIAB CLA E RETE TION AND KERS COMPENSATION ITY $10000 $ JC.. � � �.�� YIN ..,.... 12WEQD9B24 1111 .9/26/2022 09/26/202 �.. ..X �TATIJTF I JER" _ ANY PRODMETCmRJ'PAR'TI�PERVEXECUTIVE E L.EACH ACCIDENT $­1.1771=1100000 OF"FIC.ERIMEMBER E?GOLUC}E.D? � N/A E.L.DISEASE EA EMPLOYEE $ (Mandatory In NH) 1,000,000 If yes.de&c0be under 1111_ y __.___j_000.'000­­._.... . DESCRIP fl_ON 4F OPERATIONS below E L DISEASE POLIC LIMIT $1 _____ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached If more space Is regUlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 1179 ACCORDANCE WITH THE POLICY PROVISIONS. 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 #S4350088/M4324830 SS105 Client#: 12643 ISLAGUN'1 DATE(MMIDD/YYYY) ACORD MCERTIFICATE OF' 10/25/2022 IIS 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Edgewood Partners Ins.Center NAME:Commercial Support 40 Marcus Drive 3rd Floor PHONE(A1C,No,Ext):631-390-9700 FAX Melville, NY 11747 (A/c No);631-390-9790 E-MAIL ADDRESs:NEcertificates@epicbrokers.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Hartford Fire Insurance Company 19682 INSURED INSURER B:Hartford Casualty Insurance Company 29424 Island Gunite Swimming Pool, Inc. PO BOX 1595 INSURER C: ro PCasual Ins Co of Hartford 34690 Pert Y&Casualty Sag Harbor, NY 11963 INSURER D;Trumbull Insurance Company 27120 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 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, I IN TYPE OF INSURANCE IN L POLICY NUMBER POLICY EFF POLICY EXP LIMITS S S (' S R U (, R B R LT W R V D A X c 12UUNOZ9418 EACH OCCURRENCE $1,000,000 GENER PAS-MA X OCCUR DAMAGE TO RENTED $300,000 PREMISES(Ea occurrence) ctual MED EXP(Any one person) $55,000 PERSONAL&ADV INJURY $1,000,000 .TATE GENERALAGGF,=GATE $2,000,000 PER: PRO LOC PRODUCTS- P OMP/OP 82,000,000 AGG JECT X O $ D 12UENOZ9833 COMBINED SINGLE $1,000,000 LIMIT(Ea accident) X BODILY INJURY(Per $ person) O S wCHEDU BODILY INJURY(Per $ EIS accident) U'1'OS X H S X 4ON-OWPROPERTY DAMAGE(Per $ 1 14ECALJT accident) R )'S ONLY E D .9 $ B X UMBRELLA X OCCUR 12HHUOZ9419 2 EACH OCCURRENCE $1,000,000 LIAB EXCESS CLAIMS-MA LIAB DE AGGREGATE $1,000,000 DED X RETENTION$10000 $ C WORKERS COMPENSATION N 12WEQD9B24 PER O AND EMPLOYERS'LIABILITY /N ANY I X STATUTE T A PROPRIETOR/PARTNER/EXECUTIVE Y H OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) R IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.EACH ACCIDENT $1,000,000 E.L.DISEASE-EA 1,000,000 EMPLOYEE$ E.L.DISEASE-POLICY $1,000,000 LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED PO Box 1179 IN ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. 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