HomeMy WebLinkAbout51624-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDIING 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#: 51624 Date: 02/11/2025
Permission is hereby granted to:
Frank A Koscheka
1350 Captain Kidd Dr
Mattituck, NY 11952
To:
Construct an accessory garage to an existing single-family dwelling as applied for. Must maintain a
minimum rear and side yard setback of 5 feet.
Premises Located at:
1350 Capt Kidd Dr, Mattituck, NY 11952
SCTM# 106.-2-44
Pursuant to application dated 12/13/2024 and approved by the Building Inspector.
To expire on 02/11/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $413.00
CO Accessory $100.00
Total $513.00
Building Inspector
F TOWN OF SOUTHOLD—BUILDING DEPARTMENT
t Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 littlis.//www.solitholdtoweny gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
L. .
PERMIT NO. � � � � Building Inspector: JK2Y
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: ...c .
OWNER(S)OF PROPERTY:
Name: �Ol 1�` �"J' 1Y1I� �_
SCTM# 1000- 10 6 — a — 14 q
Project Address: (3�J b " f h►�� 1"l
Phone#: �� W '� Email:
I '5
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address:. /
Phone#: Email; 0� � ..; ,
DESIGN PROFESSIONAL INFORMATION:
Name.
Mailing Address I " ,
Email:
#: :
Phone
1 _ � 4
CONTRACTOR INFORMATION:
Name: , IS p
Mailing Address
51�- � - z5�1�
Phone#: mail. 141 l S d
DESCRIPTION OF PROPOSED CONSTRUCTION
XNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes NNO Will excess fill be removed from premises? ❑Yes IgNo
1
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 SNo 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 4 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 buliding(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):
n(� Cam, ClAuthorized Agent Owner
f
��
Signature of Applicant: ".M. Date:
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(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 th ewith.
Sworn before me this
19 day of 20Z�
Notary Public
PROPER"rY 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
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from: Tristen Heidenrich tisten@yourchoiceadvisors.com
subject: certs
Date: Dec 5, 2024 at 12:59:06 PM
To: binkispd@icloud.com
YOUR. CNCE
ADVISORS °
Tristen Heidenrich
Your Choi Choige Advi§or , LLC.
Co-Owner
333 Jericho Turnpike,,Suite 220
Jericho, NY 11753
You cannot bind, altar or cancel coverage without speaking to a licensed agent. Coverage
cannot be assumed to be bound without confirmation from a licensed agent.
This email is intended only for the personal and confidential use of the recipient(s) named above. If
the reader of this email is not an intended recipient, you have received this email in error and any
review, dissemination, distribution or copying is strictly prohibited. If you have received this email in
error, please notify the sender immediately by return email and permanently delete the copy you
received. Furthermore, the contents of any attachment to this e-mail may contain software viruses
that could damage your computer system. While we have taken reasonable precautions to minimize
this risk, we shall not accept liability for any damage which you sustain as a result of such software
viruses. You should prudently carry out your own virus screening checks before opening any
attachments. Thank you
pd f 1222 (1).pdf
263 KB
ACCIR& CERTIFICATE OF LIABILITY INSURANCE °"'M'01M°°"Y"'
12105=24
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; Nthe cartilkate hokl*r Is eni ADDMdNAL INSURED,,Me poilcy(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 an
this eertlBcate does not confer dgbft to the oer"tMc lte holder in lieu of 9och endorsemantltsl.
FROOucERYour Choice Advisors,LLC
P.O.Box 397 SfB Ii14019 FAX
I�1fI 4Iti7
Amityville NY 11701 TtI I11 ourchoissedvisom-oom,
eisuREM)AFFOMMM COVERAGE N=e
INsmERA.Western World Insuranoe Company 13196
mum binkis property development Ilc I,a,,,,a,NYSIF 19=
1025 ceder drive po box 835 MMMc.Sheltar Point 81434
Southold ny 11971
WeuRERD:
INSURER E:
COVERAGES CERTIFICATE.NU REVISION NUNIBER
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.
TAW I YPMs _ A ,,_ 5.„. .. ... .
OF WUMANCE'
✓ CobaIERCA-E—ALLIA9ILITY to NPP0003603 0W2=024 512012025 EACH O11 CCURRENCE $2.000.000
I �.
CLAIMS-MADE ✓ OCCUR bSOO.000
II aERsoNaLaAmIN,ruRv $2,000,000
p OEML AGGREGATE UMIT APPLIES PER: OJEWERALAGGREGAM s4,000,000
✓ POLICY I JJEECOT LOC PRODUCTS-COMPIOP AGG s4,000.000
OTHER. s
COMB1.... SINGLE LIM B AUToroeLEUABam ✓ 48915Z06 112812024 112912025 $1 W0,000
s/ ANYAUTO I BODILY INJURY(Per prison) i w
OWNED j SCHEDULED 3
AUTOS ONLY AUTOS BODILY INJURY(Pctlde er aal)
be AIITTOOSONLY AUTOS ONLY aPROF'E7tTYDAMA s1,000,000
s
B ✓ UMBRELLALIAa OCCUR NPPBS03624 5/202024 115120=25 EACHOCCLwwZ CE i5,000,000
EXCESS LIAR CLAINIS4WE.I AGGREGATE $5,000,000
DED REMnoNt... $
0- WOMMS DOAMNSATI Nl 4771440 1 WO=24 DM3=25 ✓ PEATLITE 57
ECU`rAeOFFICERtMEMUREXCLUDED? n0 NIA EL EACH ACCIDENT S1.000,000
iMkr�+4 ery'dnNHp F.L.DISEASE.-EA EMPLOYEE S1,000,000
dGeur4w W -.'N OF ro y'S -.w E.L DISEASE•POLICY UE'MIT S7,000,000
DisablitylPFIL r D273435 24 r104,12M
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addib—d Rem rk.Scledub,may be ameLed If mare space is mguired)
CERTIFICATE CANCELLATION
town of Southold-Building Department-Town Hall Annex
375 Main Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL®BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
c11179 Box ACCORDANCE WITH THE POLICY PROVISIONS
Southold NY 11971-0959
AUT140RD7ED REPRESENTATIVE
01988.2015 AC1. rw All rights ro"rvod,
ACORN 26(2018103) The ACORD name and logo are registered marks of ACORN
Produced wftM Forme ease web—ftva e.www.FomreBoea.wm;y ImPmalMro I'ublW,ir,s e00• -1Y7T
'
pwrc Workers CERTIFICATE OF
I F =nsatlon NYSWORKERS' COMPENSATION INSURANCE COVERAGE
12105/2024
Is.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured
binkis property development 11c 516-366-8720
1026 cedar drive po box 836
southold n 11971 'ic.NYS Unemployment Insurance Employer Registration Number of
Y Insured
82-811627
Work Location of Insured(Only required If coverage is specifically limited to Id.Federal Employer Identification Number of Insured or Social Security
certain locatlons In New York State,Le.,a Wrap-up Policy) Number
46-4640996
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) NYSIF
Town of Southold-Building Department-Town Hall Annex
54375 Maim Road 3b.Policy Number of Entity Listed In Box"I a'
Po 1179 Box 11477 1"8
Southold NY 11971-0958
3c.Policy effective period
04/0312024 to 0410312025
3d.The Proprietor,Partners or Executive Officers are
✓ included.(Only dwmk box If all padwsloftere Included)
all excluded or certain partners/officers excluded.
This certfies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1a"for workers'
compensation under the New York State Workers'Compe Law.(To use this form,Now York(NY)must be listed under
on tare INFORMATION PAGE of the workers'compensation Insurance policy). The Insurance Carrier or its licensed agent will send
this Certificate of Insurance to the entity listed above as the certificate holder in box"2"
The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled
due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or
eliminate the insured from the coverage indicated'on this Certificate.(These notices may be sent by regular mail.)Otherwise,this
Certificate is valid for one year after this form Is approved by the insurance canter or its licensed agent,or until the policy
expiration date listed In box"3c",whichever is earlier.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder..This certificate does not amend,
extend or alter the coverage afforded by the policy listed„nor does it confer any rights or responsibilities beyond those contained in the
referenced policy.
This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect.
Please Note:Upon cancellation of the workers'compensation policy Indicated on this form,if the business continues to be
named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a
new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the
mandatory coverage requirements of the New York State Workers'Compensation Law.
Under penalty of pedury,I certify that I am an authorized representative or licensed agent of the Insurance carrier referenced
alcove and that the named insured has the covenege as depicted on this form.
Approved by: Joanne Chong
(Print name of authorised repreantstive or licensed agent of Insurance carrier)
"�
A « /pproved by: 11106/2024
"« (Date)
+arr�ra�,M mr r„r as o�tc
Title: Licensed Agent
Telephone Number of authorized representative or licensed agent of insurance carrier: 616-619-1019
Please Note:Only insurance carriers and their licensed agents are authorized to Issue Form C405.2.Insurance brokers am NOT
authorized to Issue IL
C-105.2(9-17) www•wcb.ny.gov
SURVEY OF P/o LOT Q5 )
LOT 152
� LOT
BLOCK 11 or o 135
MAP OF 136
o� S 86'00'30" E o LOT
CAPTAIN KIDD ESTATES P„,�,� 100.00
FILE No. 1672 FILED JANUARY 19, 1949 FENCE
SITUATE ' SMK FENCE
MATTITUCK o CAPPED ROUND E
EBAR D.4"S; 0.8'E
TOWN OF SOUTHOLD oCE
N 0.71
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-106-02-44 �' WZ o
15 zz
L
SCALE 1"=20' N M I LOT N
FEBRUARY 21, 2023
NOVEMBER 14, 2024 ADD PROPOSED GARAGE I
AREA = 12,000 sq. ft.
0.275 CIC. WOOD ALONG PLANTING o
COVERAGE DATA
EOGI BED D STEP DESCRIPTION AREA X LOT COVERAGE WOOD
► At c'''"�
STEP WOOD DECK
HOUSE 1,406 sq. ft. 11.7% — ,CONC.WNDOW WELL ms
aASEMENT
ROOF OVER WALK 43 sq. ff. 0.4%
34.5' M�NDOW WELL
PROPOSED GARAGE 576 sq. ft. 4.8 WOOD EDGING " "' CELL
ENTRATyCE
TOTAL 2,025 sq. ft. 16.9% BEDcoNc, CONIC.
t0 � ,, t.9' 30.0' N
MAXIMUM 2,400 sq. ft. 20% '"
U f 1 STORY FRAME t.5. CONc — —
HOUSE do GARAGE
N BRICK BASEMENT
N v WINDOW WELL
O 32.1'� ; 19.8' 0; CONC„
c WIMNEY
M "CONCH ui
� V) APRON' 4.2' C» 0
ELE14, '" CTF1dC
M p
OS 86'00'30" E Z "
79.27' FOUND " ; a IN % `*, N
OR ALTERATION OR ADDITION PIPE 0.5'N.TO THIS
., .. .
TO THIS SURVEY 6 A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE OVERHEAD WIRES
EDUCATION LAW. •• ", METE7t PFOPtIND
COPIES OF THIS SURVEY MAP NOT BEARING 1
THE LAND SURVEYOR'S INKED SEAL OR "
EMBOSSED SEAL SHALL NOT BE CONSIDERED
MaLBOX� N 86000930„ W —r
TO BE A VALID TRUE COPY. ad.
CERTIFICATIONS INDICATED HEREON SWILL RUN .., ; „ — �X 1 00.00.9 UTILITY
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED.AND ON HIS BEHALF TO THE a„ "" •. e v„ POLE
1111E COMPANY, GOVERNMENTAL AGENCY AND G A.
LENDING INSRTUTIO LISTED HEREON.AND ••"' .,I " " •w "4 a a m• EDGE OF PAVEMENT
TO THE ASSIGNEES OF THE LENDING INS I- " • " •• •• +r. ,.
TUIION. CERTIFK:A110NS ARE NOT TRANSFERABLE e, ` eM '" d
a THE EXISTENCE OF RIGHT OF WAYS
w
ANDIOR EASEMENT'S OF RECORD, IF a '
ANY, NOT SNOWN ARE NOT GUARANTEED. IN ACCORDANCE, CAPTAIN KID R
D
D
Nathan Taft Corwin III BY THE TI ,, , IVE
FOR SUM USE BY E NE YS
TITLE ASSOCIATION. a ww.wrx �. Ve °
Land Surveyor �• T Zr'
co ;
Successor To: Stanley J. Isaksen, Jr. L.S. —
Joseph A Ingegno L.S.
Title Surveys — Subdivisions — Site Plane — Construction Layout e + w j
A : 0
PHONE (631)727-2090 Fax (631)727-1727
MAILING ADDRESS
OFFICES LOCAIID AT . w 0$
1586 Main Road P.O. Box 16 41� *►«�"" y "
Jamesport, New York 11947 Jamesport, New York 11947 �g� �„�
E—Mail: NCorwin3Oaol.com N hip. 50467