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Home My WebLink About49619-Z .:� TOWN OF SOUTHOLD 41 BUILDING DEPARTMENT TOWN CLERK'S OFFICE F o 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#: 49619 Date: 8/25/2023 Permission is hereby granted to: Turchiano, Jose h 350 Oak Rd PO BOX 289 New Suffolk, NY 11956 To: construct additions and alterations to existing single-family dwelling as applied for. At premises located at: 350 Oak Rd, New Suffolk SCTM # 473889 Sec/Block/Lot# 117.-2-3 Pursuant to application dated 7/3/2023 and approved by the Building Inspector. To expire on 2/23/2025. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $524.40 CO-ADDITION TO DWELLING $50.00 Total: $574.40 Building Inspector til bra TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.sotitlioldtowLiiiy Date Received APPLICATION FOR BUILDING PERMIT M LFor Office Use Only PERMIT NO. Building Inspector: JUL 3 Applications and forms must be filled out in their entirety. Incomplete l . li� applications will not be accepted. Where the Applicant is not the owner,an . Owner's Authorization form(Page 2)shall be completed. Date:. OWNER(S)OF PROPERTY: Name: -AviL ` SCTM#1000- 11-7 ;� 3 Project Address: b �d N1 It q% Phone#: O� —172 - �225 Email: al1Cti(t.SChrb2da,r 4 cDY�J Mailing Address: a' &KW CONTACT PERSON: Name: Li&' Mailing Address: 1V t4atkfulkqp yL Phone#: (0�1— 169 Email: Atmosv'i G( silYJS © fMIQI f,66F '1 DESIGN PROFESSIONAL INFORMATION: Name: ,WLS SV Mailing Address: L1o0 wv I)l 1�$ 1-1 { L Phone#: Email: 'AWLISG(EQXI[ASILi UIho0 �0� CONTRACTOR INFORMATION: Name: GAMS M I Mailing Address: Phone#: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ",Addition Iteration ❑Repair ❑Qemolition Estimated Cost of Project: ❑Other � $ zoo Will the lot be re-graded? ❑YesXNO Will excess fill be removed from premises? ❑Yes YNO 1 PROPERTY INFORMATION r Existing use of property: �S ��' Intended use of property: Guoia I Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to a this property? ❑Yes No 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 appilcable 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. Application Submitted By(print name): $Authorized Agent ❑Owner "J Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTYOF being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, I IT (S)he is the (Co ractor,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 � Notary Public N AfiY l'I t?t.l I wS d G Ys '6 w3�Yorlc (Where the applicant is not the owner) 1, Ise �ch(u� residing at �50 odic "ud Nuq SVtN do hereby authorize 1 ( to apply on my behalf to the Town of Southold Building Department for approval as described herein. 41 ��I'L� v-3 wne ''s Signature v Dkite I,se —%%chi do Print Owner's Name 2 ACS CERTIFICATE OF LIABILITY INSURANCE =M/DDffYYY) 2/2023 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). 'PRODUCERcoNT c' ANTHONY RICCI PHONENAMF, 631-939-6060 3 .............................. _� FAX ac Ifo.. 631-693- KENNETH MACNISH 1A/C Ne.Ext, 039 E-MAIL ANTHONY.RICCI AMERICAN- w_www_w_L.COM ._ 859 CONNETQUOT AVE ADDRE :S:„ � I�AT1Ol�A SUITE 12 INSURERES AFFORDING COVERAGE � NAIC# ........ _.. _...................._..._. _ 29963 ISLIP TERRACE NY 11752 INSURERA UNITED FARM FAMILY INSURANCE CO INSURED INSURER B. C&M CONTRACTING CORP INSURER C: ........ ....... .,,,, PO BOX 142 INSURER o ._. ........... INSURER E: CUTCHOGUE NY 11935 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. 1NSR TYPE OF INSURANCE AD SUBR POLICY NUMBER MIMIlDDNY F,F MM/DD EXP LIMITS LTRvdvn A ""' COMMERCIAL GENERAL LIABILITY 3102X6988 5/29/2023 5/29/2024 EACH OCCURRENCE $ 1,000,000 _. 5r CLAIMS-MADEFx] OCCUR 100,000 --------- MED EXP(Any one person) $ ...5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 7;�-/71PRO- ,�rw,,'POLICY�JEC'rt LOC PRODUCTS-COMP/OP AGG $ 2,000,000 17 OTHER; $ AUTOMOBILE LIABILITY SINGLI: LIMIT $ COMBINED ..._ .................�.- ANY AUTO BODILY INJURY(Per person) $ n OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS �. HIRED NON-OWNED PTY ROPEFCDAh9df $mm AUTOS ONLY AUTOS ONLY Pqr Tri ldrsnt I UMBRELLA LIAB OCCUR 64CH OCCURRENCE $ EXCESS LIABGATE CLAIMS-MADE AGGREGATE $� ._.. ........... DED RETENTION$ A WORKERS COMPENSATION 3104W7410 5/29/2023 5/29/2024S _] TH- AND EMPLOYERS'LIABILITY X PTATUTE ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 100,000 O FFICER/MEMBER EXCLUDED? ._.... (Mandatory in NH) E L DISEASE EA EMPLOYEE $ 100,000 �_--..._. _._ ............ it yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TU RCH IANO RENOVATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 350 OAK ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NEW SUFFOLK, NY 11956 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD �^ o � � oZ 2p o i pEx, �E, M � ''2 �; ` C\2 (s" b 4 h �` LO �tl mO1Qo Z� 4 0 U� phJ a�W ash h� ti 0 OWN, .00-0.91 4 .0 O 'sa ✓ .tom. N c ' $ 410IN .00 osi ��Sib S �/0 N �3[V0jy0 W �0/N N�Np3b > cJ� < �Eh U c5e�lcu VJO En E CV) �ym1 6 z * c� Lz:ya Z