The URL can be used to link to this page

Home My WebLink About51785-Z 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 APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 51785 Date: 03/26/2025 Permission is hereby granted to: NF Community Club LLC PO BOX 1672 Mattituck, NY 11952 To: construct accessory structure (accessory carport with pavilion) as applied for. Premises Located at: 2050 Depot Ln, Cutchogue, NY 11935 SCTM# 102.-2-5 Pursuant to application dated 03/07/2025 and approved by the Building Inspector.. To expire on 03/26/2027. Contractors: Required Inspections: Fees: Accessory-New Structure $1,109.00 CO Accessory $100.00 Total $1,209.00 i Iff ui ding Inspector 'r13� r " 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 Iitt ://",V w.soLitholdt win . !L) . Date Received MPPLICMiION FOR BUILDING PERMIT For Office Use Only V>�a `� D PERMIT N0. Building ectar:� g Ins p J JUL 1 1 2024 Applications and forms must be filled out In their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an I1 G DEPT- Owners Authorization form(Page 2)shall be completed. B SOUT111,01 • Date: 7 C� OWNER(S)OF P OPE _ Name: OU C' 7gMVnI I CI_cI SCTM#1000- " s Project Address: 24575 662 L A-,/617 C. � (j C1 —. Phone#: 2 Z Email: a � I° Mailing Address: CONTACT PERSON: IL'-1 / I Name: 10 F-1 ' Mailing Address: Email Phone#: I Z CP' j E' i „ °t' ki (P DESIGN PROFESSIONAL INFORMATION: NameC �� I Mailing Address: P ° ' r Phone#: Email: h , I � � I � J CONTRACTOR INFORMATION: Name: SIfA CG' / Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION New Structure a kddition .,Iteration []Repair ❑Demolition Estimated Cost of Project: ❑Other r -Fi/"d%s $ Will the lot be re-graded? ❑Yes _No Will excess fill be removed from premises? WYes El No 1 PROPERTY INFORMATION Existing use of property:KIJ 16 S o cc,L-UI413 ,,f' ! Intended use of property: 51 1�&L,,E pA M , Lei- Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? Eyes 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 demoRtion 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 210AS of the New York State Penal Law. Application Submitted By(print name): , V j q ❑Authorized Agent Xowner Signature of Applicant: Date: Z ��f STATE OF NEW YORK) SS: COUNTY OFb1W(6 K r�tJ ('V .being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the ad N bv�71— (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. Swornefefore me this day of Jbi Notary Public CAVID J.JA NU M Notary Public, State of New York No, 0 J,A6,0525BS PROPERTY OWNER Ali T HOREA T i iON qualified in Suffolk County, Where the applicant ant is not the owner) Co mmi si nExpirea 21 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 Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) 2 3 A, 1, �.........__. .m... residing at .......__ _ ... ..... (Print property owner's name) _..... (Mailing Address) do hereby authorize ..... .......�... . �.._.m(Agent) J Aj� . _...... to apply on my behalf to the Southold Building Department. C.,-(Owner's Signature) (Date) f TL ri, _ (Print Own6's Nanie) —#J R, Albert J. Krupski, Jr. �� SUFFg/r 5 TO]KNI WAT 1E][, SUPERVISOR ( r �'] l��l[A\I�A\G]El��l[]EI� F SOUTHOLD TOWN HALL-P.O.Box 1179 p 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: [?,ev L o Date: p� - A 1110 Contact Infoi ion: ��v D �C c c=5 Cl,) Z C Z= �,' v s Z (E-Vlad&Telephone Nu 1 0 Property Address / Location of Construction Site: Z o 5,0 D/ S.C.T.M. #: 1000 District Section Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ❑ - Area of Disturbance is less than 1 Acre. No S.P.D.E.S. Permit is Required 1 - Project does Not Discharge to Waters of the State. No S.P.D.E.S. Permit is Required! ❑ - Area of Disturbance is Greater than 1 Acre & Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D_E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit. ❑ - Area of Disturbance is Greater than l Acre & Storm-water Runoff Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit through the Southold Town Engineering Department Prior to Issuance of a Building Permit. Reviewed By: / � � �sG� Date: S FORM # SMCP-TOS December 2024 DATE(NMIDONYYY) A CERTIFICATE OF LIABILITY INSURANCE 11/04/2024 6.0:z-� -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.. She Certificate holder is an ADDITIONAL INSU'REDr the pollcy('IOS)must have ADDITIONAL INSURED provisions or 6;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 lights to the certificate holder in lieu of such andorsement(s). PRODUCER Kate Maloney,Cali VRP Insurance Agency PHONE (631)738-7300 Ar-bl2 (631)738-7382 955 Main Street Arles: kate@makmy-malllrley.00m; Suite 2 INSU!yAk AFFORDING COVERAGE __NAdC# Holbrook NY 11741 INSURERA: Philadelphia Indemnity Insurance Company 18058 INSURED INSURER 8; Merchants Mutual Insurance Company 233 29 M 8 M Pools LLC INSURER C.. Shelterpoint Insurance PO Box 1302 INSURER o: INSURER E Hampton Bays NY 11946-0300 INSURERF. COVERAGES CERTIFICATE NUMBER: OL2472312788 REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTp, TYPE OFINSURANCE il, POUCYNUMaERPOU LIMITS COMMERCIAL GENERAL LIABILITY "GENERMIAGGREGATME $ 1,000,000 CLAIMS-MADE ®OCCUR S 1001000 aeO) I« 5. A Y PHPK2580404-003 07/23/2024 07/23/2025 URY s 1,000,000 GENILAGGRE0ATEUMITAPPLIESPER $ 2,000,000 POLICY r -1 CT Lc PRODUCTS-COMIWAAOG S 2,ODD,000 $ OTHER: COMLIINED SI S 1.000,000 AUTOMOBILE LIABILITY AER N �� -;,' ' ANYAUTO BODILY INJURY(Per person) S B OWNED SCHEDULED CAP1076370 07/23/2024 07/23/2025 BODILY INJURY(Par accident) S AUTOS ONLY AUTOS HIRED NON-OWNED Perscdde!at AG S AUTOS ONLY AUTOS ONLY $ UMBRELLALWB OCCUR EACH OCCURRENCE'. S EXCESS LIAB CLAIMS-MADE. ....... AGGREGATE. $ OW MVSMN$ R WORIKERS COMPENSATION AND EMPLOYERS'UABILF Y Y I N ANY PROPRIETCirtVI�,�4RTNERAXEOUTWE'� i�""""I NIA E.L.EACd$ACONDENT $ OFFICER/MEMSER EXCLUDED? �) �atarylnNH) E.L.O'15EASE-FAEMPLOY'EE gI1/ee� dar E,L.DISF,ASE-p4II.ICY.LIMTr $ OMRIPTtONOF'OPERATIOI below NYS DISABILITYIPAID FAMILY LEAVE DBL433241 01/01/2014 01/01/9999 STATUTORY L DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD101,Additional Remarks Schedule,may be attached if more space Is required) certificate holder is listed as an additional insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPT. AUTHORIZED REPRESENTATIVE 54375 ROUTE 25 SOUTHOLD NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks ofACORD Y workers' CERTIFICATE OF INSURANCE COVERAGE srnr Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that Carrie 1 a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured M&M POOLS LLC PO BOX 1302 HAMPTON BAYS,NY 11946 1c.Federal Employer Identification Number of Insured (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD BUILDING DEPT 3b.Policy Number of Entity Listed in Box"I a" 54375 ROUTE 25 DBL433241 SOUTHOLD, NY 11971 3c.Policy effective period 01/01/2025 to 12/31/2025 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. rl B.Only the following class or classes of employer's employees: Under penalty of perjury,W t ce fy that Iasi an authorized representative or licensed agent of the Insurance carrier referencdd above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 2/6/2025 8y (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title LeSton Welsh Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if sox 4e,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed BY (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) I�J°°°1°11°°°u°°111°11°111°°°IIII I