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HomeMy WebLinkAbout51675-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE In 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#: 51675 Date: 02/24/2025 Permission is hereby granted to: Patrick Marchand PO BOX 55 Southold, NY 11971 To: construct deck addition to existing single-family dwelling as applied for. Premises Located at: 344 Terry Ct, Southold, NY 11971 SCTM#69.-3-6.4 Pursuant to application dated 01/17/2025 and approved by the Building Inspector„ To expire on 02/24/2027. Contractors: Required Inspections: FOOTING/REBAR, FRAMING/STRAPPING , DRAINAGE, FINAL, Fees: Single Family Dwelling- Addition&Alteration $635.00 CO-RESIDENTIAL $100.00 Total S735.00 Building Inspector ° ". 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 h ps://www.southoldt� wnn . ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO, Building Inspector: [ 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: Name: 'Fat-lI cIL Hu�C�cq�c� mv► �a�.cu�,�ct �� SCTM#1000- bg, Project Address: 344- ref( G-r i i5c Ncf 7-1 Phone#: Email:+-16LA4ec )6 Mailing Address: pO g�oyC _5 , S,ov41,7 :)LJ� P-� 1)13-1 CONTACT PERSON: Name: N �r4, '1-7, e ' Mailing Address: pd go y 5, S-:D✓4k-,AA , Py Phone#: cf j9 -qqi —G f-0l Email: •&b(/JALST 7 " DESIGN PROFESSIONAL INFORMATION: Name: LLO 41(A GZZ- MailingAddress: B.=0 r3 5i( 2-Z1 tlel' /°Ir1 Nl` boo)q Phone#: qj-7 2,cj o6'd_`f Email: CONTRACTOR INFORMATION: Name: Mailing Address: Phone#: d 9 2-3Email: V " V t l DESCRIPTION OF PROPOSED CONSTRUCTION ro ❑N Structure ❑Addition [--]Alteration ❑Repair ❑Demolition Estimated Cost of Project: Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property: Les�'� �`i Intended use of property: L��S> ✓r7l�l L Zone or use district in which premises is situated: C Are there any covenants and restrictions with respect to this property? ❑Yes ONo 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 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 building(s)for necessary inspections.False statements made herein are P punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. j Application Submitted By(print name): rp t- .Aq >,4 i?�>u pt5L ❑Authorized Agent 12,6wner Signature of Applicant: -µ ,mom Date: CONNIE D.BUNCH STATE OF NEW YORK) Notary Public,State of New York No.01BU6185050 SS: Qualif led in Suffolk County COUNTY OF ) ComrTllion Expires April 14,2 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 therewith. Sworn before me this day of , 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 CERTIFICATE OF LIABILITY INSURANCE °"'�011171202517/2025 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION CRANDLE MANFREDI AGENCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO BOX 1345 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR SOUTHOLD NY 11971 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: EVANSTON INSURANCE COMPANY EDWIN SALAZAR DBA E.SALAZAR HOME IMPROVEMENT INSURER B: 52 WILMARTH AVE GREENPORT NY 11944 INSURERC: INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .INSRADD-L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSRO TYPE OF INSURANCE POLICY NUMBER DATE MM/DD DATE MMIDD GENERAL LIABILITY UWASO 06/03/2024 06/03/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE x OCCUR MED EXP(Any on $ 105,000 X COMMERCIAL GENERAL LIABILITY PREMISES �omr arson) $ 5,000 X PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY SECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY li AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR EI CLAIMS MADE AGGREGATE m $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND - EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETMPARTNERtEXEC'UTIVE, E,L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 4'Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ P)yes,deechbe under E.L.DISEASE-POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER IS AN ADDITIONALLY INSURED CERTIFICATE HOLDEN CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TAMARA BUDEC&PATRICK MARCHAND DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 344 TERRY CT NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL SOUTHOLD NY 11971 IMPOSE NO OBLIGATION OR19M'ITY OF ANY KIND UPON THE INSURER,I OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rig' roved. The ACORD name and logo are registered marks of ACORD a° 61 w Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME l4-ROVEMENTLI0ENSE Name EDWIN E SALAZAR Business Name E Salazar Home Improvement This certlfies that the bearer is duly licensed License Number HI-67181 by the County of suffolk Issued: 07/28/2022 W"K4,T Rogers, Expires: 07/01/2026 Commissioner Suffolk County Department of Lobor, Licensing & Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 e DATE ISSUED: 07/28/2022 No. HI-67181 04 SUFFOLK COUNTY .dome Improvement Contractor License � This is to certify that Edwin E Salazar doing business as E Salazar Home Improvement 4 having furnished the requirements set forth in accordance with and subject to the provisions of applicable � g q J P Pp � ME laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct � .ibusiness as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. , NOT VALID WITHOUT p Nil Restrictions Additional Businesses DEPARTMENTAL SEAL AND A CURRENT H2-Painting; CONSUMER AFFAIRS H27-Handyman H36-Restoration Services-Fire/Smoke/Water ID CARD ff Rosaiie Drago Commissioner FRI t X �} �3. icy t ROBf k rc 00 SU e3 - CEW M Tog ! cm fmMFW WIM rMw STANDARMFOR APPROVAL DIMVUL gWrMS rM SMLE FAML YR� v- � . e b� tam rrd�J �t der rrd o, f date obt d tr a rm to COWNWI. 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