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HomeMy WebLinkAbout43387-Z 1f� Town of Southold 11/22/2019 P.O.Box 1179 53095 Main Rd l � it Southold,New York 11971 �r/afXAi�;Li CERTIFICATE OF OCCUPANCY No: 40881 Date: 11/22/2019 THIS CERTIFIES that the building ALTERATION Location of Property: 2435 Laurel Way, Mattituck SCTM#: 473889 See/Block/Lot: 121.4-17.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/7/2019 pursuant to which Building Permit No. 43387 dated 1/11/2019 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Sachs,Richard of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43387 10-31-2019 PLUMBERS CERTIFICATION DATED 09-24-2019 an Jame t o * Signature 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#: 43387 Date: 1/11/2019 Permission is hereby granted to: Sachs, Richard PO BOX 1261 Mattituck, NY 11952 To: construct interior alterations to existing single-family dwelling as applied for. At premises located at: 2435 Laurel Way, Mattituck SCTM # 473889 Sec/Block/Lot# 121.4-17.1 Pursuant to application dated 1/7/2019 and approved by the Building Inspector. To expire on 7/12/2020. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $270.40 CO -ALTERATION TO DWELLING $50.00 Total: $320.40 Bu ding Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses,or buildings and "pre-existing"land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00, Additions to dwelling $50.00, Alterations to dwelling$50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building$50.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential $15.00, Commercial $15.00 Date. IS/lq New Construction: Old or Pre-existing Building: ✓ (check one) Location of Property: � ISS l,./'1 O&L LA WL 04UL IJf W,_ House No. Street Hamlet Owner or Owners of Property: iZ1 CWKD 9 SHS Suffolk County Tax Map No 1000, Section 12-1 Block OLI Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: I� Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ So. 00 Applicant Signature CONSENT TO INSPECTION !!5Mb-5 , the undersigned, do(es) hereby state: Owner(s)Name(s) That the undersigned (is) (are) the owner(s) of the premises in the Town of Southold, located at 935 !Y942 L LAkfL a-jtx-. LAW" which is shown and designated on the Suffolk County Tax Map as District 1000, Section 12-1 , Block 0 4 , Lot ?I That the undersigned as have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: 6A ILolA) r That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: '3 CZignature) (Print Name) (Signature) (Print Name) OF SO(/lyol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 sean.devlin(a-town. us Southold,NY 11971-0959 y' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Richard Sachs Address. 2435 Laurel Way city Mattituck st: NY zip 11952 Building Permit# 43387 Section. 121 Block. 4 Lot: 17.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor DBA. Donnelly Electric Inc License No 4993-ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor X 1 st Floor X Pool New Renovation X 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph X Heat Gas Duplec Recpt 43 Ceiling Fixtures 1 HID Fixtures Service 3 ph Hot Water Gas GFCI Recpt 8 Wall Fixtures 7 Smoke Detectors 4 Main Panel 200A A/C Condenser 1 Single Recpt Recessed Fixtures 19 CO Detectors Sub Panel A/C Blower 1 Range Recpt Gas Bath Exhaust Fan 3 Pumps Transformer Appliances Dryer Recpt 30A Ceiling Fan Time Clocks Disconnect Switches 14 Twist Lock Exit Fixtures Combo SD/CO 2 Other Equipment: Notes: House Wiring Inspector Signature: Date: October 31, 2019 S Devlin-Cert Electrical Compliance Form.xls SOUI,�o� Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Gt • A Southold,NY 11971-0959 "v[11111, BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: n Id`1) 1 Building Permit No. Owner: 61cload S�C /n s (Please print) OCT - 9 2019 Plumber: R 61 A ' lCl r MeS (Please print) I certify that the solder used in the water supply system contains less than 2/10 of I% lead. ( / (Plumbers Signature) Sworn to before me this day of Ste'---, 20 9 J JEA:vANN LELLA Not ry P:�iic _ State of New York ?1567 7 u n " f"'aC Notary Public, e County ��� � ,,;r' �,_ ��/�1,... �o�yoF soulyo� # TOWN OF SOUTHOLD BUILDING DEPT. °`�rouKn ' 765-1802 INSPEC ON [ ] FOUNDATION 1ST [ ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: n r AL vl oCJ4V -C DATE 3 INSPECTOR *pf SOUryo� * # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: V�,� L ccr4 DATE 61-7 , INSPECTOR 4V7 SOF 50(/1, hod 06 # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPEC ION [ ] FOUNDATION 1ST [ GH PLBG. [ ] UNDATION 2ND [ 'INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] CTRICAL (FINAL) [ ] CODE VIOLATION [S- 4- mwillm CAULKING RE ARK ' OIC X4 3 Pi Voir DATE INSPECTOR 06. "Al Lj 143K �l hO�yOF SOUTyy �J7 6 J # * TOWN OF SOUTHOL BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) L% [ ] CODE VIOLATION [ ] CAULKING REMARKS: e' 9 1 ,�c a�� 'wa �z�—,►— diV DATE INSPECTOR # #qlf so TOWN OF SOUTHOLD BUILDING DEPT. °`"rou�rtr, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] RO GH PLBG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKI G REMA KS: oml yrJ DATE R INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) � ------------------------------------ _C 'FOUNDATION (2ND) a 1AA 3v OW 7 � ROUGH FRAMING& PLUMBING y i f INSULATION PER N.Y: y STATE ENERGY CODE I FINAL ADDITIONAL COMMENTS o u-Cs0, N o z d b H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: 631 765-9502 �j Surve Southoldtownny.gov PERMIT NO. U Check Septic Form N Y.S.D.E.0 Trustees C.O.Application Flood Permit Examined 20 D CO A Single&Separate - DTruss Identification Form JAN - 7 1019 Storm-Water Assessment Form Contact: I'VYc.U�aA ?_;*AT.6Z Approved ,20 ,rt_ �., Mail to: 2-0(a w4cow 61 ar Disapproved a/c TOWN OF SO �,U2fti't0 pD Phone:(6 1) 2VV)_0960 Expiration 20 But spector APPLICATION FOR BUILDING PERMIT Date LIMA" , 201_ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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, or 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 for necessary inspections. (Signature of applicant or name, if a corporation) A,W Voir tAAd I l�OZ3 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises ��L - C7_5�1s__ (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 11 1. Location of land on which propo ed w rk will be done: J 1J Ji 15- House Number Street amlet County Tax Map No. 1000 Section )2_1 Block 011 Lot :, Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ','� QE5I06A)CC b. Intended use and occupancy 6F a�5102NC( 3. Nature of work(check which applicable): New Building Addition Alteration C Repair Removal Demolition Other Work (Description) 4. Estimated Cost �361000 Fee ('fid bq paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units:on each floor If garage, number of cars I (-(L COACUD 6&M6C (,Cruin&) 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. t\))A 7. Dimensions of existing structures, if any: Front (151q I Rear (o�,Cl Depth X32 Height h' t/— Number of Stories 7 Dimensions of same structure with alterations or additions: Front G Rear Depth r\) C- Height C_ Number of Stories iiT 8. Dimensions of entire new construction: Front Rear C_ Depth G Height 0 Number of Stories C- 9. Size of lot: Front 1 Rear 1-7. IC' Depth 361. 6(57' 10. Date of Purchase �� �� Name of Former Owner, FJao W tCO Z 1&wLf P,16H 11. Zone or use district in which premises are situated —� 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO-X- 13. Will lot be re-graded? YES NO_><,_Will excess fill be removed from premises?YES NO i o a4raALPAaLOwAfF-y -1WrN 14. Names of Owner of premises /1lLO HS Addresswwyaak.Am 10023 Phone Not(o`i6)GZy—7661 Name of Architect Address 6 Phone N&OD2_00-2050 Name of Contractoi6f2LiJl06L 661J�PI J G�.Address Phone No(i31)25Y-3606 M' 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YESXNO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO_X * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OFnjjWUX P'lablym 51af-5 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the IwAly)-L (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 knowledge and belief, and that the work will be performed in the manner set forth in the application filed therewith. Swor t t9 before me thi "t`�'h day of 20 SAHRiNA1N BARN Signa re of A licant Notary Public,State of New York No.01806317038 Qualified in Suffolk County Commission Expires Dec.22,201� fF�KC BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTH Town Hall Annex - 54375 Main D a Southold, New York 1 -0959 Telephone (631) 765-1802 - F �( 31�,g6i 519 roger richertPtown southold.ny.us APPLICATION FOR ELECTRICAL INSPECTIMMNOFSOUEdi;L. Date: SZ REQUESTED BY: _ Company Name: 'GC ecTri� Name: - ,/ email: _ ,•�CGG e eC� v Toy✓ ��ti• N � License No.: T 993---- AIV 93 109a Address: Phone No.: 31 Co JOB SITE INFORMATION: (All Information Required) Name: Address: Z�3S g��� 6J9 !'''�ArTer��� Cross Street: Phone No.: email; BIdg.Permit#: Tax Map District: 1000 Section: Block: Lot: < BRIEF DESCRIPTION OF WORK(Please Print Clearly) Circle All That Apply= YES ! NO Rough In Final Is job ready for-Inspection?: Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: = # Meters Old Meter# New Service - Fre Reconnect- Flood Reconnect- Service Reconnected - Underground -Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form-As Scott A. Russell ,�d°SU '� ST0IkMWA\T]E]k SUPERVISOR Z MANAGEMENT SOUTHOLD TOWN HALL-P.O.Box 1179 v' 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) WA. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑�. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑0'C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑E3'/D. Site preparation within 100 feet of wetlands, beach, bluff or coastal ' erosion hazard area. ❑ . Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. 0511"F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department witFyour Building Permit Application. APPLICANT. (Property Owner,Design ProfessionAgent, ontractor,Other) S.C.T.M. *: 1000 Date: District NAME. L arK a) oLi Section Block Lot �1 `2277\\ 'J (� Q�� **** FOR BUILDING DEP RTMENT USE ONLY **** Contact Information t 4 C6 1_ ) 2-0 J -06 0 Reviewed By: — Date_ Property Address/Location of Construction Work: — — — — — — — — — — 2 L 2 j 1 al V�,rj LAI j�/ /'�'l l VC Approved for processing Building Permit. L J L-/ 1l/��:.GC. tJ rn-� 1(�tU Stormwater Management Control Plan Not Required. Lfttu L - Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM * SMCP-TOS MAY 2014 ��� T Jeffrey T. Butler, P.E. , P.C. 206 Lincoln Street Architectural and Engineering Services Riverhead, NY 11901 Tel: (631) 208-8850 Fax: (631) 727-8033 October 3,2019 Building Department Town of Southold P.O. Box 1179 Southold,NY 11971 RE: 2435 Laurel Way,Mattituck(Building Permit No.43387) To Whom It May Concern: Enclosed please find the Solder Certification for the above Building Permit. This should be the only item required to close out the Building Permit. Please forward the Certificate of Occupancy to me. Should you have any questions,please feel free to call. Sincerely, 0elissaButler OCT - 9 20119 New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) a. 'a ^^"^^^ 112755579 GREENIDGE CONSTRUCTION CO INC PO BOX 182 O' .w SHOREHAM NY 11786 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER GREENIDGE CONSTRUCTION CO INC TOWN OF SOUTHOLD PO BOX 182 54375 MAIN ROAD SHOREHAM NY 11786 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBERT POLICY PERIODDATE 11063602-5 404107 12/05/2018 TO 12/05/2019 1/3/2019 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORKSTATE INSURANCE FUND UNDER POLICY NO 1063602-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT DON GREENIDGE GREENIDGE CONSTRUCTION CO INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND C� DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:732121798 U-26.3 GREEN01 ACQRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) #%.� 1 08/30/2018 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 pollcy(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), PRODUCER 516-576-0166 NOMEACT Affiliated Agency,Inc. PHONE 516-576-0166 FAX 516-576-0168 255 Executive Dr.Suite 308 (A/C,No,Ext): A/C,No): Plainview,NY 11803 EDDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Utica First Insurance Company 15326 INSURED Greenidge Construction Co Inc INSURER B:Merchants Mutual Ins Co 23329 32 Royal Way Shoreham,NY 11788 INSURER C; INSURER D: 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 INSR TYPE OF INSURANCE DDL UBR U=wyn POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE OCCUR ART1312705-12 09/08/2018 09/08/2019 DAMAGE (RENTED rrrence $ 50,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 500,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY I JECT FILOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ 000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 300, E accident $ ANY AUTO CAP1057739 03/28/2018 03/28/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWN D PRerOP.ER ntDAMAGE $ AUTOS ONLY AUTOS 0 LY $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADEJ AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER TH- ANDEMPLOYERS'LIABILITY Y/N STATUT R ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OpFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE N OF SOUTHOLD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN ROAD ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Yom workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier la:Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of insured GREENIDGE CONSTRUCTION CO INC (631)744-5854 PO BOX 182 SHOREHAM,NY 11786 1c.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 112-75-5579 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New York State Insurance Fund(NYSIF) TOWN OF SOOAD 3b.Policy Number of Entity Listed in Box"l a" 54375 MAIN ROAD y ty SOUTHOLD,NY 11971 DBL 2035 14-6 3c.Policy effective period 10/06/1985 to 07/01/2019 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 B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named Insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 8/30/2018 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number (866)697-4332 Name and Title Melissa Jensen,Acting Head of Disability Insurance Unit IMPORTANT: If Box 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that can ier,this certificate is COMPLETE. Mail it directly to the certificate holder. if Box 4B,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 mailed for completion to the Workers'Compensation Board, DB Pians Acceptance Unit, PO Box 5200, Binghamton,NY 13902-5200 PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4C or 58 of Part 2 has 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 with respect to all of his/her employees. Date Signed By Signature of Authorized NYS Wor ers'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. DS-120.1 (10-17) Certificate Number 513190 TAP TO CALL A DEALER L 1.844-755-5585 FURNACES > XR95 GAS FURNACE XR95 The XR95 forced air heating gas furnace offers our highest energy efficiency in single-stage performance,which means more of your energy dollars go toward actually heating your home. More Details YOUR TRANE DEALER KOLB MECHANICAL CORP 3.9 ***** on Google Reviews Call to discuss this unit 1-844-847-6232 OESTIMATED PRICE $$$ Or schedule a dealer visit in Book Online Showing specialists for 11901 Not your zipcode?Change location OVERVIEW - Highly efficient performance The XR95 hot air furnace features a 95%AFUE rating. Durable construction Materials for all components are tested again and again for long-lasting performance and durability Cleaner,healthier indoor air Add Trane CleanEffects'"to your system for advanced air filtration that removes more dust,pollen and other irritants from conditioned air for a cleaner, healthier,more comfortable home. Product Brochure SPECIFICATIONS - XR9S UPFLOW/HORIZONTAL FURNACE MODELS Model Height(In.) Width(In.) Depth(In.) Nominal Capacity Output(Btuh) Afue TUHIB04OA9241A 40 17.5 28 38,000 95 TUHIB06OA9361A 40 17.5 28 57,000 95 TUHlB080A9421A 40 17.5 28 76,000 95 TUHlC080A9601A 40 21.0 28 76,000 95 TUH1C10OA9481A 40 21.0 28 92,150 95 TUHlD100A9601A 40 24.5 28 92,150 95 TUHID12OA9601A 40 24.5 28 104,500 95 XR95 DOWNFLOW/HORIZONTAL FURNACE MODELS Model Height(In.) Width(In.) Depth(In.) Nominal Capacity Output(Btuh) Afue TDHIB04OA9241A 40 17.5 28 38,000 95 TDH1B065A9421A 40 17.5 28 57,000 95 TDH1C085A9481A 40 210 28 76,000 95 TDHlD110A9601A 40 24.5 28 104,500 95 Every Trane hot air furnace is packed with high-quality components. Each helps ensure that time after time,your unit will provide total comfort your family can rely on.The XR95 forced air furnace includes: • Aluminized steel heat exchanger • Three row secondary heat exchanger • Direct-drive,multi-speed blower motor • Self-diagnostic microelectronic controller • Durable silicon nitride hot surface igniter • Multi-port, in-shot burners • Sealed combustion, 100%outside air option • Pre-painted galvanized steel cabinet • Hinged blower doors with easy-open door latches • Insulated heavy steel cabinet for quiet operation TRANE WARRANTY Protect your XR95 with one of our View Warranty > top of the line warranties www.digneinycli.com Of 0.1 YOF� CITYo www.call811.com i &0%15LANP (for other states) Ave ,md C, 800-212-4480 811 l-.t:A Eli, t, qo}�.d Ave By law,excavators and contractors working in For safety reasons, homeowners are strongly the five boroughs of New York City and Nassau encouraged to call as well when planning anys c and Suffolk Counties on Long Island must type of digging on their property. Homeowners contact DigNet, 1-800-272-4480 or 811,at least can contact us directly at 1-800-272-4480 or by a ei Y•:ori e 48 hours but no more than 10 working days calling 811,the national call before you dig (excluding weekends and legal holidays)prior to number.For excavation work completed on beginning any mechanized digging or excavation personal property,it is the contractor's SITE LOCATION work to ensure underground lines are marked. responsibility--NOT the homeowner's--to contact \ Excavators and contractors can also submit DigNet. Having utility lines marked prior to locate requests online,through ITIC. If you do digging is free of charge. LU not currently use ITIC,please call n 1-800-524-7603 for more information. PIPE LU 0, LOCATION MAP N o N.T.S. � SITE DATA: SITUATE AT: (Ti2435 LAUREL L,4<F= DRIVE �Q�QQ�� U.P. MATTITUCK, NY IIS52 MON. COUNTY OF SUFFOLK / TOWN OF SOUTHOLD / MON. SCTM ": 1000-121-4-11.1 WOOD STEPS ZONING DISTRICT: R-80 / [v / SITE DATA: AREA OF SITE: 40,819.91 SQ, FT, OR ACRES (NON-CONFORMING). 0 / SITE PLAN BASED ON / I ORIGINAL SURVEY BY: <ENNETH M WOYCHUK LAND SURVEYING, PLLC PROFESSIONAL LAND SURVEYING AND DESIGN P.O. BOX 153 AQUEBOGUE, NEW YORK 11931 rr ll / PHONE: (631) 298-1588 V cm U.P. / FAX: (631) 298-1588 ^ DATE: JUNE 26, 2018 �to / ELEC. / APPLICANT / OWNER: 91.4 r / METER �D / �� RICHARDS SACHS 2435 LAUREL LAKE DRIVE a/ O LAND N/F OF / / LAUREL, NY w X ERIC d VALERIE / / lD .4 O SHOENFELD -$ / / XZ EXISTING 1 STORY � � / GARAGE d tu CZ o/L 's�'" cj. T, cfJ 800 GAL, IN-GROUND PROPANE TANK O O 10' MIN, TO PROPERTY LINE EXISTING 1 STORY FRAME LOG DWELLING 9" 02435 / / APRON EXIST, SHED �0 ARCHITECT: \� RED A / ap , iA% 22;2 t/ ry/' / (0 O LAND N/F II 6 _ / OF JIE CAO !� 30826 4� 9I RICA DANIEL ti8E R.A. BRIC{� PATIO / 1.81; PSA TIo 0 / ,0 / EXIST. ROOF / z �M OVER BBQ AREA / O fs) m W LL U1 / 0 Lj) Z O a m4O � Ik I�--I d z O Q d !Z O O � i-- IL --1 � m SNO'RELINI= / ,n W �- --- - LL S 88°09130"88°09130" W 91.��� S S(o°28�0 19.39 O , Q� Z �Xw PAGE: UI LAUREL LAKE EXISTING SITE PLAN 1" = 20'-0" A- 000 N &i LAND N/F OF 10 b 0 20 50 100 M TOWN OF GRAPHIC SCALE I" - 20'-0" SOUTHOLD N v T THESE DRAWINGS AND ACCOMPANYING SPECIFICATIONS,AS INSTRUMENTS OF SERVICE,ARE THE EXCLUSIVE PROPERTY OF THE ARCHITECT AND THEIR USE AND PUBLICATION SHALL BE RESTRICTED TO THE ORIGINAL SITE FOR WHICH THEY WERE PREPARED.REUSE,REPRODUCTION OR PUBLICATION BY ANY METHOD,IN WHOLE OR IN PART,IS PROHIBITED EXCEPT BY WRITTEN PERMISSION FROM THE ARCHITECT.TITLE TO THESE PLANS SHALL REMAIN WITH THE ARCHITECT.VISUAL CONTACT WITH THEM SHALL CONSTITUTE PRIMA FACIE EVIDENCE OF ACCEPTANCE OF THESE RESTRICTIONS. e WALL LEGEND EXISTING WALL TO REMAIN r ——— EXISTING WALL TO BE REMOVED NEW WALL S'Y'MBOL LEGEND lY Ui lY SD SMOKE DETECTOR p it LU CO CARBON MONOXIDE DETECTOR cD EXHAUST FAN m Z O 0 N N W M SCOPE OF WO�;� 1. REPLACE 4 RELOCATE FIXTURES AND FINISHES IN EXISTING= MASTER BATH, BATH 2 AND KITCHEN. PROVIDE RELATED ELECTRICAL 4 PLUMBING WORK. 2. REPLACE EXISTING ROOFING AND GUTTERS. \ /3. REPLACE SHAKE SIDING W/ VERTICAL BOARD 4 BATTEN SIDING. 4. REPLACE SELECTED WINDOWS, 5. CONVERT HVAC TO GAS (PROPANE), WINDOW PERFORMANCE DATE: NEW DOUBLE HUNG WINDOWS BY / LE PAGE U=0.30, SUGG=0.31 DP=30, LOW E GLAZING. m 20' - ll" 10' - 9" 10' - 2 1/2" 9' - 6" 11 - 4 1/2" Q W w r= N AP '4'q- VED AS DOTED � V DATE: {, I B.P.t 3 iD 1 �/ O � FEE: � '/A BY: w c') x NOTIFY MXDING DEPAR k. AT X LL 765-12 AM TO 4 PM FOR THE z FOLLOWING'tNSPECTIONS: °mQ 1. FOUNDATION - TWO REQUIRED O FOR POURED CONCRETE =3: - S � 2. ROUGH - FRAMING & PLUMBING O � 8 II 3. ]INSULATION in O 4. FINAL - CONSTRUCTION MUST :r cv BE COk,',.%M FOR•C.O. t� r ALL COEMENTCTVI ° ,ALL MEET THE REMOVE — — — -- � / REPLACE � KITCHEN CABINETRY b YORK STATE. NOT RESPONSIBLE FOR / 4 COUNTER TOPS. EXIST. DINING DESIGN OR CONSTRUCTION ERRORS. w i EXIST. APPLIANCES i - TO REMAIN. / 108 EXIST. BEDROOM ' COMPLY WITH ALL CODES OF ARGI IITEGT: 0 110 {" O� NEW YORK STATE & TOWN CODES ��tER p r \ AS REQUIRED AND CONDITIONS OF �� \\EL A. �\ N EXIST. FURNACE , EXIST KITCHEN 00 Q' pP 6G��, � RD a ; EXIST. SLIDING DOORS TO STONE / Tf $ U) 1 / BE REMOVED. 19' - 11" 19' - 5° FIREPLACE 3 - 511 6 I - 811 41 - 9II REPLACE W/ SWING DOORS7 mo _ 1 (8:0 1 DANIEL A. BUTLER, R.A. O — — EXIST. LIVING ROOM STONE W N EXIST. BEDROOM EXIST. W.I.C. m EXISTING TOILET 4 SHOWER cn 109 /7/j/ 105 106 DC Q ` CUPANCY OR o Q TO BE RELOCATED TUB F_--A 'n (NO WORK) : 6 (NO WORK) (NO WORK) USE IS UN ° LJ U i A IG _777 EXISTING FLOORING TILE, �►��C>*s M AWFUL WITHOUT CERTIFICATE o FIXTURES 4 ACCESSORIES XfST. W.I� _ T EXIST. CL. OF OCCUPANCY H TO BE REMOVED � MASTER BATH O LJ 113 V CL, HWH LL EXISTING TUB TO NE LJ 111 I/ „ N EXIST. FOYE \`J� 1� ' �� ' } a BE RELOCATED cq LA — — — — — ---- WC 1 S WR (Y r' } -- - -1 - - 5 - 87�\ 11 100 CL. P Q a) i z Q REMOVE EXIST. WINDOW. F CL• F O Q RE-FRAME SHEATHE 4 NEW W _ ELECTRICAL "- II Q INSULATE AS REQUIRED N i MASITR�HO NEW z ,\ \ M �151 . AT 2 w Z Q Q INSPECTION REQUIRF � � N fY OL ` / � ' � _� ' K1 q 101 Q w o ST TOI EXIST. WALL TO 1116 o _ VENT TO ELEC. Q BE REMOVED — — — — J 111A - - EXTERIOR -� `4 P/+r1EL ( F-1 n/ � 'fit WC IJ LAID V, i 11�L - OQ IN Z j NEW DH DRYER WP NE OH NEW FULL SIZE STACKABLE PLUMBER CERTIFICATIONU O O VENT GFI WASHER 4 DRYER ON LEAD CONTENT BEFORE �---a m to L Q CERTIFICATE OF OCCUPANC P-4 N N RELOCATE EXISTING ELECTRICAL PANEL SOLDER USED IN WATER (ROTATE IN EXIST. WALL) WATER SHUT-OFF SUPPLY SYSTEM CANNOT O EXCEED ?110 OF 111 41 - 31 ?.Fq n 4' - 3 5' - ro 4' - 10" 3' - O" 6 - 511 2' - 011 4' - 1" 6' - 511 O O PLUME INGi '—' Q 21' - 1511 191 - 6" 14' - (o" 13' - 111 ALL'PLUMBINNG WASTE 1 - 9" Tc1 TIlNGBEFORATER ECNJE 68RING - "'NOF06ED 16T FLOOR FLAN 1 A- 20111 � N 1/4 = 11-011 O N �t T THESE DRAWINGS AND ACCOMPANYING SPECIFICATIONS,AS INSTRUMENTS OF SERVICE,ARE THE EXCLUSIVE PROPERTY OF THE ARCHITECT AND THEIR USE AND PUBLICATION SHALL BE RESTRICTED TO THE ORIGINAL SITE FOR WHICH THEY WERE PREPARED.REUSE,REPRODUCTION OR PUBLICATION BY ANY METHOD,IN WHOLE OR IN PART,IS PROHIBITED EXCEPT BY WRITTEN PERMISSION FROM THE ARCHITECT.TITLE TO THESE PLANS SHALL REMAIN WITH THE ARCHITECT.VISUAL CONTACT WITH THEM SHALL CONSTITUTE PRIMA FACIE EVIDENCE OF ACCEPTANCE OF THESE RESTRICTIONS. ELECTRICAL SYMBOL LEGEND SWITCH LOCATION DUPLEX OUTLET �nFI GROUND FAULT INTERRUPT q wfl GFi WATERPROOF GROUND FAULT INTERRUPT D E— DEDICATED OUTLET qp¢2" u�i OUTLET m 42" A,F,F, 0- ip 1/2 SWITCHED OUTLET LU QUAD OUTLET FLOOR DUPLEX OUTLET Z m o p FLOOR 1/2 SWITCHED DUPLEX OUTLET „ c LIGHT FIXTURE LEGEND RECESSED LIGHTING RECESSED LIGHTING - WALL WASHER ROUND SURFACE MOUNTED LIGHTING 2'x4' SURFACE LIGHTING ® PENDANT m a m W N CHANDELIER a O W � � X WALL SCONCE d E-� o z >� DOWNLIGHT STRIP O H 0- tY � 3: p CEILING FAN —1 W u�1 ARCHITECT: TRACK LIGHTING jE7D ARC A.EXIST PINING 100' s r c a �H26 I _ EXIST. BEDROOM O _ N - i� DANIEL A. BUTLER, R.A. EXIST. KITCHEN EXIST, FURNACE TO BE RELOCATED 101 Q CsFl ( U I � S -` Z U I � O 4-0 EXIST. LIv NCx ROOM LL lu EXIST, BEDROOM EXIST. 11114, } Ju O Q NEW TUB ` 1-� �, 0 _ - ACES Z IY IL EXIST. r� `\MASTER h ATH t EXIST. W.I.G. i a l 4 0 - - - 1 113 w n �,».. _ __. ... -5 NEW 13 F- ' WCLAV W QO co EXIST. FOYER SHWR +� m W. Uu-100 =3 O s NEW k '� � � - -.-.__ ('V ' ✓ E r � i N Ul EXIST BATH 2 I - LAV. NEW MA TOILET -3:! ,.. O __. MASTER SHOWER `_ I ELEG. su 11IA o -- E>CTERIOR PANEL lOI 11 G CsFI WC . � z DRYER T wr RELOCATE EXISTING ELECTRICAL U O Q PANEL (ROTATE IN EXIST. WALL) PAGE: fROPOSED ELECTRICAL FLAN CL CL 1 co 1/4" = 1�-O" IR 0 Lo rn 0 N d' THESE DRAWINGS AND ACCOMPANYING SPECIFICATIONS,AS INSTRUMENTS OF SERVICE,ARE THE EXCLUSIVE PROPERTY OF THE ARCHITECT AND THEIR USE AND PUBLICATION SHALL BE RESTRICTED TO THE ORIGINAL SITE FOR WHICH THEY WERE PREPARED.REUSE,REPRODUCTION OR PUBLICATION BY ANY METHOD,IN WHOLE OR IN PART,IS PROHIBITED EXCEPT BY WRITTEN PERMISSION FROM THE ARCHITECT.TITLE TO THESE PLANS SHALL REMAIN WITH THE ARCHITECT.VISUAL CONTACT WITH THEM SHALL CONSTITUTE PRIMA FACIE EVIDENCE OF ACCEPTANCE OF THESE RESTRICTIONS. T