Loading...
HomeMy WebLinkAbout44930-Z FF©j/rcaG� Town of Southold 3/19/2021 a P.O.Box 1179 0 o 53095 Main Rd �rj�l dao Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41895 Date: 3/18/2021 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 1100 Greenway W., Orient SCTM#: 473889 See/Block/Lot: 15.-1-22 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/16/2020 pursuant to which Building Permit No. 44930 dated 6/26/2020 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: "as built"additions and alterations, including wood frame entry, to existing single-family dwelling as applied for. The certificate is issued to Duffe,Thomas&Kathleen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44930 9/2/2020 PLUMBERS CERTIFICATION DATED 9/1/19it e r SUFFnc,r� TOWN OF SOUTHOLD BUILDING DEPARTMENT y z TOWN CLERK'S OFFICE oy • 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#: 44930 Date: 6/26/2020 Permission is hereby granted to: Watson, Dorothy 151 W Royalfern PI Beverly Hills, FL 34465 To: legalize "as built" additions and alterations to existing single-family dwelling as applied for. Additional certification will be required. At premises located at: 1100 Greenway W., Orient SCTM # 473889 Sec/Block/Lot# 15.-1-22 Pursuant to application dated 6/16/2020 and approved by the Building Inspector. To expire on 12/26/2021. Fees: AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $426.40 CO -ADDITION TO DWELLING $50.00 Total: $476.40 f Buildin 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 2110 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"Iand 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. �� - / �-�o2Q� Q New Construction: Old or Pre-existing//Building: (check one) Location of Property: /100 �fre•ch W �(�,�S�fi� 0)2 1&AI7— House No. S eet�/ / Hamlet O,vyner or Owners of Property: `Tt O AjA Suffolk County Tax Map No 1/000,Section S Block Lot .2 Subdivision &/Z r r=Al)qCR F5 Filed Map. ��� � Lot: 3 U Permit No. Date of Permit. Applicant:Ae-1-ldc-L /9rf-DOlfle 49n-llkC �,r. He#lth Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature Building Department,A bplfi ation AUTHOR IZA 'ION (Wherethe'Appltcanf.i 'not the:4wner),-' Q- residing at (Print prop'erty-owner's,name) (Mailing;Address� 015`Io hereby authorize,. 1 C NAG (Agent) T e, C.o�s���c�;QM . A)C-'tQ apply,ori.iny behalf to`•the Sotithold.Btiilding Department. Uk (Owner's Signature). (Date) v (Print Owner-'s-Name)_ �4 _ OF SOU��®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 sean.devlin62-)town.southold.ny.us Southold,NY 11971-0959 C4UN3Y,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Thomas Duffe Address: 1100 Greenway W city,Orient st: NY zip: 11957 Building Permit#: 44930 section: 15 Block: 1 Lot: 22 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Alan Hubbard Electrical License No: 4285ME SITE DETAILS Office Use Only Residential X Indoor X Basement X Service X Commerical Outdoor X 1st Floor X Pool New Renovation X 2nd Floor Hot Tub Addition Survey X Attic Garage X INVENTORY Service 1 ph X Heat Duplec Recpt 6 Ceiling Fixtures 4 Service 3 ph Hot Water GFCI Recpt 10 Wall Fixtures 8 Smoke Detectors 4 Main Panel A/C Condenser Single Recpt Recessed Fixtures 15 CO2 Detectors Sub Panel 80A A/C Blower Range Recpt 50A Ceding Fan 2 Combo Smoke/CO 2 Transformer UC Lights Dryer Recpt 30A Emergency Fixtures Time Clocks Disconnect FEI Switches 5 4'LED 1 Exit Fixtures Pump Other Equipment: Notes, " AS BUILT, NO VISUAL DEFECTS " Did Not See Rough Renovation of Bathrooms, Kitche Living Room and Basement Inspector Signature: , Date: September 2, 2020 S.Devlin-Cert Electrical Compliance Form xls SO Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFI—C—ATIO-N Date: Building Permit No. Owner: (Please print) Plumber: LS (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 ✓ 20 � D R SEP 0-0 L U BUILDING DEPT. Notary Public, county TOVVIN, G` TITHOLDt,, KELLY PAC'-GORYCKI Notary Public-State of New York No.01 PA6306634 Qualified in Suffolk County My Commission Exp.06/23/20-?,-A, qqqpof SO(/T�olo # # TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND - [ ] SULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE& CHIMNEY [ ] FIRE--SAFETY INSPECTION [ ] FIRE'RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION � ] PRE C/O REMARKS: & � •G��/i L �Ci S�-Vmo( i, a"fg) 0 �& vv C-41 C 1 pi at, Ivid, o_ /) S�14_ -toovoW CAvt . DATE INSPECTOR oe soulyO i s ! I d o D B N , TOWN OF SOUTHOL ILDING DLT.U e courm,��`' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE-& CHIMNEY- [ ] FIRE SAFETY INSPECTION [ ] FIRE.RESISTANT CONSTRUCTION [ '] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [� ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: lee-r- faw lsl:xe e / /j00_ DATE INSPECTOR y TOl •. ,, 77HOLD . . l��ii►!I!I! lii►III►i►111 IN92 5 11942 03-658036R 7 4 wyw i w �Q asp-!�V G 4 �, L 9b r r ------- PD) EQ�[MVL9r BE HOLD I .......... NL r •�j�,JvwY,ri �'��4_��ie f { i - � 1 .. t SEL B7 _ w i s, I I i f i Nicholas Vero Architects _ 'September 25, 2020 120 Mill Road Westhampton Beach, NY 11978 Duffe Addition / Renovation 1100 Greenway West 1 6 Orient, NY 11957 MAR 2021 Building Permit # 44930 ; Dear Southold Town Building Department, The construction of the aforementioned addition was completed in a conscientious and professional manor. To the best of my knowledge, all of the Foundation, Framing, Strapping, Rough Plumbing & Insulation work done on site conforms to all applicable Local, State and National Building and Energy Codes. .Sincerely, � ' ^%' Nicholas A. Vero FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) y ------------------------------------ FOUNDATION (2ND) z O H ROUGH FRAMING& PLUMBING STA TION.Y. DE FINAL ADDITIONAL COMMENTS b 6U4 A— -�-� c-Fl o -3v�a (Y4 CID P Oct%tAel 0 v' m X b � O z x r� H x d �1 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 q4q, 2ASurvey Sou f tholdtownny.gov PERMIT NO. Check Septic Form N.Y S.D.E.C. Trustees C.O.Application Flood Permit Examined 2 4� Single&Separate Truss Identification Form Storm-Water AssessrVent Form Contact:/H(Cho`e.l •�'Cc�DiJ-e Approved 20_d Maiillttoga. Disapproved a/c Phone: 6V-,275` 1'701 Expiration o 120 4 Building Inspector r -'' ,➢UN 1 6 2020 APPLICATION FOR BUILDING PERMIT Date 2020 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 pen-nit 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) l 07X;! ,j "56". /11-4p.1,1113 (Mailing a cess of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises /hip mA_5 (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. 42 ff- !jfr Other Trade's License No. 1. Location of land on which proposed work will be done: M90 !�frelw 44's House Number Street r Hamlet'" County Tax Map No. 1000 Section / Block ( 'tot Subdivision &REE/ 1qG1?F-S Filed Map,No. 3:540 Lot 35 2. State existing use and occupancy of pre ises and intended use a occupancy of proposed construction: a. Existing use and occupancy al b. Intended use and occupancy �5,4M1� 3. Nature of work(check which applicable): New Building Addition Alteration Z Repair Removal Demolition Other Work (Description) 4. Estimated Cost Tj� 000 ` Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units I Number of dwelling units on each floor If garage, number of cars i 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. r 7. Dimensions of existing strictures, if any: Front fir, Rear �� , Depth �2 6, , Height / 7 ' Number of Stories. d Dimensions of same structure with alterations or additions: Front (05 Rear Depth Height t7 Number of Stories P 8. Dimensions of entire new construction: Front i Rear —Depth Height G Number of Stories � a 2Q" 1 9. Size of lot: Front 133. � ' Rear 1 J O , 3G ' Depth l zue 10. Date of Purchase Name of Former Owner �6l F7f��/ 04 11. Zone or use district in which premises are situated l� � 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO� 13. Will lot be re-graded? YES NO x Will excess fill be removed from premises?YES NO__X_ –7740,Y* 30 3 r[.L fok, 14. Names of Owner of premises e/.Fv/ 1.?(,OFF[Addres�'6i►'rM of fl/. . /t7.?5Phone No.:!r/& ` 70 7-7!5 Name of Architect_IV/L'HO/–145 VEP,0 Address/X/)1/1RJ, PhoneNo (03 - gff /�!Fj Name of ContractorAe/70/V0: 6n54m eA0,1 Addressl. 4 one No. 275- VO VX S1136- Dot , 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO 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_X_ 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, trust 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 OFF ) eY/Ooz-�L� �. -"n'-e— being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the '�' 1?ejox-e- ,,a ( ontractor, 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. Sworn to before me this T Z NOTARY PUBLIC,STATE OF NEW YORK > t allot No.01SA6057098 Signature of Applicant Qualified in Suffolk County My Commission Expires: Scott A. Russell 4 10s%JF� STORIAWA\T)E)E. SUPERVISOR - hu][A\N A(G 1E1\M[)EN`]F SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEWYORK 11971 - Town of,Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) - -- - - - - - -- - DOES 'THIS PROJECT INVOLVE E ANY OF THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ❑DA. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑Excavation or filling involvingmore than 200 cubic ards of material y . � within any parcel or any contiguous area. ❑ ETC. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑E b. Sitere aration within 100 feet of wetlands beach bluff or coastal P A erosion hazard area. ❑ ite preparation within the one-hundred-year floodplain as depicted ; n FIRM Map of any watercourse. Ell 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 with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent Cpntractor. ther) S.0 T.M. #: 1000 Date- / q�' Dutnct M�/J NAME: /��1C lG u-c ed e_ 15 1 ;Zg 3-16, 0 (P-0 Section Block Lot FOR BUILDING DEP-A1'TN'ENT I—SE C)NL Contact Information 6,31- c2,7_�r — 701 RevieNved By- JA �) /� - - — — — — — — — — — — — — — — — — Date. U6 "o24-2.0/_✓,1 Property Address / Location of Construction Work. — — — — — — — — — — — — — — — — — / / /-/ / Approved for proce5�ing Building Permit h �(�6 �Ti"Lt°i✓1 l�✓a`H le6-r i — Stormwater Management Control Plan Not Required 4�_Z — — — — — — — — — — — — — — — 01'� k ❑ Stormwater Management Control Plan a Required (Forward to Engineering Department for Review) FORM # SMCP-TOS MAY 2014 BUILDING DEPARTMENT- Electrical Inspector 0�0 Gym TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road ,PO Box 1179 co' - Southold, New York 11971-0959 y p Telephone (631) 765-1802 - FAX (631) 765-9502 ��l rogerr(aDsoutholdtownny.gov - sea ndCcDsoutholdtownny.go_v_ APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2 �� Company Name: ab Name: &} H a License No.: Lf,� a-!5 —MC email: Address: �� ( (fib® Phone No.: G(1 @? 17 C5 JOB SITE INFORMATION (All Information Required) Name: Address: 'I-e a w rtn t— Cross Street: Phone No.: Bldg.Permit#: Yl,'720 email: Tax Map District: 1000 Section: /S Block: Lot: 2 2- BRIEF DESCRIPTION OF WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire 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 Request for Inspection Form As PERMIT# Address: Switches Outlets GFI's K Surface III( Sconces H H's UC Lts L Fans f Fridge HW Exhaust f Oven Dryer Smokes �. DW Service /Q- Carbon r Micro Generator Combo �I Cooktop Transfer AC AH Mini Special: Comments Town of Southold jf so����� Southold Town Hall Annex 54375 Route 25 (Main Road) Southold, New York 11971-0959 ®� C®USS Investigation-and Enforcement Unit(631) 765-1939 NOTICE OF VIOLATION TAX MAP# Case# Owner/Occupant: F Mailing Address: NOTIC(¢E I�Sa HEREBY GIVEN that the property'owned,-rented, occupied or otherwise controlled by you located P��.^.,?4 .-i x Y dr i. -IT" i N.Y. is in violation_of the Southold Town Code(s): 1 r DATA OF VIOLATION: VIO ATION(S)NOTED: YOU ARE HERBY DIRECTED TO CORRECT ALL THE ABOVE NOTED VIOLATION(S) MMIbVIEDIATELY O'W% ITHIN THIRY(30) DAYS CORRECTIVE ACTION: P ° 3 Failure to take corrective action() as noted may result in issuance of a suq mons.and court appearance. K NOTICE:full compliance with this order to remedy is required by _ e' [specify date],which is thirty(30)days after the date of this order.If the person or entity served with this,order to remedy fails to comply in full with this order to remedy within the thirty(30)day period,that person or entity will be subject to a fine of not more than $1,000 per.-day violation,or imprisonment not exceeding one year,or both. Officer Name Phone Number White Copy-Owner Canary Copy-Agency Manilla Copy-Posted A CERTIFICATE OF LIABILITY INSURANCE DATE(M zi12/ 0 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(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 on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCEq CONT SPECIALIZED INSURANCE S SERVICES PHONE - pAX 204 RTE.112 PATCHOGUE,NY 11772 AnDRLSS: SRU@SPECIALIZEDINSURANCE.COM Auto-Home-Business-cycle-etc. INSURERS AFFORDING COVERAGE NAICd INSURER A:ATLANTIC CASUALTY INSURANCE CO 42846 INSURED B: PEDONE CONSTRUCTION INC INSURERINSURERC: PO BOAC 543 INSURERD: CUTCHOGUE, NY 11935-0543 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS Id 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. ILTR TYPE OF INSURANCE AODL SUER POLICY EFF POLICY EXP POLICY NUMBER M1DD IMMRMI LIMITS COMMERCUILGENERALLIABILRY L266000361 EACH OCCURRENCE $ `-1,000,000 A Y N 2112(2020 2/12/2021 CLAIMS MADE ®OCCUR GE TO RENTE PREMISES occumincal $ 100,000 MED EXP(Any one arson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEITLAGGREGATELIMIT APPLIES PER: _ GENERAL AGGREGATE $ 2,000000 X POLICY JECT toc �` PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY CEOMBSINGLE UMTr $ e ANYAUTO BODILY INJURY(Per pamon) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(PeraccIdent) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Pergcclde0 $ UMBRELLALIAS OCCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y 1 N SER E OTH = ANY PROPRIETORIPARTNEWEXECUTIVE OFFICERIMEMBEREXCLUDED? NIA ELEACHACCIDENT $ (Mandl<tery In NN) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LocAT1oNS1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached U more apace Is requlmd) CARPENTRY INTERIOR,DOOR,WINDOW OR ASSEMBLED MILLWORK-INSTALLATION METAL,DRY WALL OR WALLBOARD INSTALLATION, TILE,ST9NE,MARBLE,MOSAIC OR TERRAZO WORK INTERIOR CONSTRUCTION,AND REMODqLING-INCLUDING ONLY THOSE CLASSES SHOWN ON THE REQUIRED FORM AGL-REM 0117 CERTIFICATE HOLDER CANCELLATION SUFFO�K COUNT(DEPT OF LABOR SHOULD ANY OF THE;ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LICENSING&CONSUMER AFFAIRS ACCORDANCE WITH THJSOLICY PROVISIONS. PO BOX 6100 HAUPPIAUGE,NY 11788 AUTHORIZED REPRES ' a � 14 1988-2015 AC D CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registers marks of ACORD I ` YORK CERTIFICATE OF STATE Compensation Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured PEDONE CONSTRUCTION INC 631-276-8701 PO$OX 543 CUTCHOGUE,NY 11935 1 G NYS Unemployment insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is speoffically limited to 1d.Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 82-4508932 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Endly Being Listed as the Certificate Holder) NORGUARD SUFFOLK COUNTY DEPT OF LABOR LICRNSING&CONSUMER AFFAIRS 3b.Policy Number of Entity Listed in Box"l a" PO�OX 6100 PEWC188398 HAyPPAUGE,NY 11788 3c.Policy effective period 02/12/2020 to 02/1212021 3d.The Proprietor,Partners or Executive Officers are- E] included.(only rhedc box if all partnem/Mcam Induded) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above In box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,Neve York'(NY)must be listed under Item 3A on the 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 7'. Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effectige period? E]YEs E]NO 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 cbverage afforded-by the policy listed;•nordoes it confer any rights or responsibilities beyond those 60i ntained in the referenced policy: ' This certificate may tie 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 caii6aef Issued by a ceitificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage,or other authorized proof that the business is-compMng with the mar)datory coverage requirements of the New York State Workers'Compensation Law. Undpr penalty of perjury,l certify that 1 am an authorize4 representative or licensed agent of the Insurance carrier referenced above and that the named insured has«lie coverage as6depicted on this form. Approved by: RICHARD A ROSSI _{Print name of a - iepresentativa o sed agent of insurance cartierj _ Approved by: _. Mir 3L -,/2 - 2- O (Date)- - Title:PRESD(ENT Telephone Number of authorized representative or licensed agent of insurance carrier. 631-758-6780 Please Note:Only insurance carriers and(heir licensed agents are authorized to issue Form_ C406.2.insurance brokers erg NO authoki W to issue it. C405.2 4g-15) www.wcb.ny.gov 1 ILr IV.�V��, ��-•/.... -"•,t '4w1 _9 nt'\, s'� .. r - E'.L:.y}}K','Ef�Y 1 - I _ •l \ /1 a - - r-��^�. /' - . 'z?',x 'cu'=, _ l Z- 1Jte`s, - 'E'"• :� �/ _ .5." e_c..e rpfe. --•. _ ..�. .R� ..tti:�{fir-''�q.�: �'k��%r� '� ii' L'r{ •� IL / ZOrYC/Z bl� "• .';;�;a''';'Lr` .r •,:>�• , - _ - Shediaf e,i f.v n �" ZJe' jai V Qy f7 Q =''„ '", {•=s:," r� - - - - - 1 I; ' � v — � � . . � 'b;1•���`y ,;nN'^�!r j .•`•)i.,T±F-J�t* - —'��",3f�h�'^'''Y{ry'D'��''��'y' f n -' '"".,- _ > -. 4 `+.i .,'�u;�Vea�, ;t;�� ha j = ,_. �„ - >Y�: .y7.�`''.,{ ,�r�;3 r• r ; 7,.^,i;'%a's '"�,.A;;';1�� ,-«C' ,., .« _�'�'�-•t`�-m'r-�'`a,�a,:�,JiF� _ - -''t,.. � ,._ � .Fr '_ � Ql � -_�'%�,1� ',a��'y''�(���',,,.<ia` ;y�i{'^;,�.,+� _ - _ 4•- ,,,rpt -� ,-'?'`Orn•=�=•;r+, ,- `y'; _fey ; :`r,`k=zSi,,',- _.� NZ, ,T r� 2, '±..r,`-r„h`3j ,;r,�`r�i. - '-nx,i`Y i��r > "� qF , -r:-:,' •,r;;t' _ - -"� - �sirsi�` cc- vMs �� S - --�, /u//�� /A` 1 // - �� 1 � //� ^� 1� • { . r -'� �Y r'C.'r.'�,�YI•'�rvYLww.�J"��t�?,�,.a:,,1 -�> - •la'�-1a'�'udi>�v - `•t=Y-^ `!` ,Y`.,`y%��`r ''°,4✓, has ,V `�-' •�,ri z,`a'ry: 3 di'rG".'•s-A- ryi1„i - - - - _,- . _ __ ,-''�'.."�`v '�.;�2>',•"i� _ .;,( ",�'; .;ir+ie_ - .. _ - �-eo,��MlI1NC, ...ra:liAil;♦n J. Ar^i.Oh •.�- F IJDE - - _ - 10 i. - - S A Y1=:A-.. CF - RWRITF.RS�ER� �.����• _ QUIR ���� '�'' '- scr :+\._� rl.: ,.,� _ ATe Gudra�tfieed to Go._..rr Abfraet Co 'Jrrc r,r RE ED ,-,,a .,,'. T .><;�er� +o exp'rwwac 5o.rirv75and Loan -Y •�•.�:a�°��, z�.. �:,-=> 1977 .�rr,J.►reH f 1` ;r.`r�;r',y�ya,.. , . _ - -�:_�";_- - - -- '�" :,�'r,, 1�"=-v ._.�tx,k"' s`, _ _ ' 25”,250 rly �...,.Ok$,� + ,sib` — "— s=�' ;;f=.`.;"�"' : - ,. ,.�',` -.ay•t:.>` /. 5u►- � r SMy -' _',Js, .x„ 1 WS .r- :�.' ,•. AIL-' - 9 9• EJcc k 4 , f O. :�.�= ';,� �< .* `�- . _ ' :�,. r, ,,>,.• - �` G rc�rrf.ort L oNtty Yort :;�:>s;, , ". / _ a�,��,'r''to��:�•i�c� , INjill_ .„-c o s�ule,.a� '•fy'a i"-i t •N,�.':1,•` �'+t.�4�i_ , 'i 7' y:,,�1`T.,:xiyl"��3�'ie+`' I� , �.t � _ =.,f ti�i:<:_' :d yr k. 0 .� - J '%g•K rY+ 1 ,1x• Y� J Y' h - - _ _ s _ - r Y � .fir•�. - - - .(�, _ _ _ _ _ - >F� S` - i• • , F _ f i+r - r .b"•r ♦ "`�, :w•' ^> r*4 t.pv - ?yz': _ ] -,- ->�r . iii ..-! 1 Y - •;i`s,'-'-* ''t' - - 'i+-�...zxr,_ ��+t�.':. •tel r:.-wC .r. „�„::,, - - � wWW - - _ - - "r.,,^�"`3od.- - - c1 :`- - S"' "•,L'vs,t 4:,_.. - FF - S�' _ - *,F= - •��`a 2.f _,1 .al.~ .. \: ,� - T -.>k-s•,+5t JS4-c�r,� t,!-'-i":i5.,�.�^y> :7"`�`-�i - .yG�1 1 3 -�"„�i�.• -x�f . 0 '.' -:Y. -. - _ - `'9ct-r•:>u •e - - 1�;i.'rix"..> .*F'aVr�. K . tw. �i: ._ _f' ••ti C _ :=- - -;Irh "} .� ��'?'`Y':�' '' a .'�,.;- * „',�;. . s r �.:=:''-7�'...'w^ �?���j.'�'qp• ,,, ��t,_M�', .`='�r.�- ;r. .'•� �... -t'r'-�`�a,' "`t , 'i4' �{. �.,p� [I'.A� Ii_ i�' 1�,!. i-•-�^,:'tom - _ .'.`'°`• ••I'1>a._ . .✓3� re4� '-%�J,-"' f•' - y•t a._•i.,n�a�Ta7n'- rl S' l'2 Fs.,,.+ ._+� •�'"� P K€�'2 YF F'«- - ,'.:. fZ•, ,�,;•Sw••T� '}^ !L� ,,2_ 1•... 1'=.-..�`�- `�`'�" :r_+''ja p(;G,:'��'��5+ 3'fY!..q'♦';N _ - _ r,t^�.ti:.'.".w w' '"';."�-r' ��,�}' #_ u1.in`,.-Pl?��'J-^_ `.' - ;.�."..'+w^;«ill �.2�.� eC�'•i:;'iei .."' '� - - dr' n T`.µS ,�; .;;« _ ✓.� - .. ;,�- „�;r��`.-'-Y�d. ,�v�;t^ t �Y- _ �"�- �'--� - - -G�'^ ,,,4y; •�'�s:->�k i�'�.,:���:= '��'�^;�:�:�'� •F,Tr- s'r. •C-'`':�' .�3 '.r`«-�,,^� _ �''x�,-.�t�' :-"� -'�-r_-� "6ti;.,> _yy.;3t`y "C.`,- •� - - �}�:� _ _ - __� s;=-^.,e'a,zr,.�. �x`•b,.�• s " .�� �y ��” �'. .,[i�;+r?�=`+r.,x+- :-�• •r �'���`-? 3�s cam', �... „��;,♦- =•.'rte•�'�� � w.:, s �'r_: ��_' a s��,�."`` ,3:• �• c'x <. ���n�"`�. _ U7.,�,h•�-.':=<` a=''��'s 'y? o"x,.'"".rS,• 2F.a�. •.r't tk",n ��s'� ' =' .s.,�rr�:'"S,.`Ki..��.1.��-� R _. Yom+.. ld {f I �.r7X ' oc O Bk. r9 ar fr ho 49-7.0 IND b ov2rRfRS Ccs •.Ti •.� - l'✓1aT'i'uCK f „,�il1TFC• _... .:'liwfl..�J: wv^T.Ory ' �UaDERWRITERS CER ,o T. C •_-:�- S w V1Ct•'L".Cr _�; ` REQUIRED nF1Cq� sf:�::,�:.\� :nf ��„ • :�•Tf c.c_. .�-,. Gucr-o�t�+eed to Go,.,.rr.� Ab�fract Co., /rrc -. , ro F_xpi�3,swac/ Federal 5o,li.�arrd Lose q 77. TL LicerrO4d C_arrd 5uw�•yot•� X99• aru ' - - --- ..—.---- --- ._.._.. ___-- / TJ ti.CACn'.v,i•_ a o. Wab-C.va Gre�tf°vr�t Nt►N Yort — t :f'? :.,r'�.^••,� ?r�•i •�..v1r..:.a.:a 4�r.r��w OVA _ • _ � .��.vS,•.cK7r.:,9,t"�'''".:��•:-`T7�•wr.;.�`-2t•a�. :-i.. �*� - �.��� - r" - _ - ° i` ;1`r[r--e.ti�L.Zct,.,;�4t.,i+r;iy' 'k''3.i-'•iF+ice:+:ij'�i', d9llP�SM •• t v • ; - - � r � �.'Si p :i,� .•,'1 w � _ :1i",*„ at "`a,"'.:'�` -moi'�.`�- L t _ r ..f•: y 1 {�+efr'S y •'a. .a } Y� '�`' �:r. t b': r''+_^"''`,tjg' 6�` - .^ .�• .'.`"P r, "� -. � �'�"L ..Q�� ( tits d 1 �Jt�� x,�i��•#'s,'� jR.. �}} �3CF `'*t..a .,: i'a` •f. -""e..•F sr g _ - i-.-p._..y:.,Yc s.x. .`}.. y»: ;},.w, �33St ".-�• ,_<w: .rfs�,�Ef%.�•rS. +�}Y.-.fi• .r �.;.^. �t �-_- _ti.�'ka4Z - APPRO ED AS NOMD w.�. f3d --- r_ p� 13A1'0. DATE: B.P.a 'CC: C.e t t-t sf G it( � ° ✓ FEE: BY: � eNOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE A� 2 c?e r-,° � FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED r,.fartG ,r .eT (J cv�.-t [ _ fix _ _ pf 1V_ - FOR POURED CO.' J„RETE _ N 2. ROUGH - FRAMING & PLUMBING 3. INSULATION T 4. BE COMPLETE FOR �p MUST -Z i — _ ([eft? G -, -- r ALL CONSTRUCTION SHALL MEET THE { I Lz3t����,. I� GI:�"Gs* ' \ REQUIREMENTS OF THE CODES OF NEW - ,✓ j -' ----- � YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 1 of 101 -0'v, x , - �'`H IT a r'`�-., r xl U - t COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CCNDITfONS OF i i I"rlLAr? GF � -s o c 1(-►1� 2 ,; NG B0ARG 0 j Ut v! r . � , r� T v F _ 'TR' STEES s',�/2 tar �,,.-- �G.!'C to G,r — --- ) ,n Oct aC< 7 vev/I `a OCCUPANCY OR ``�0 5f*f � USE IS UNLAWFUL WITHOUT CERTIFICA7 OF OCCUPANCY I _I' F.a.► to/wAra,no:e S "To r,'ff_ 1J r,.Tta!(a wir,1pe of G?ew -16 '� .e� r L Qc7�,, ' c+.s / r ,�'� tt,i!t ►xC.a UAt. 61-tor;-(t 0t1;..6 r4ev►e'A T f H£4� - - �, ����•, - v � 'RETAIN STORM WATER RUNQrf� 5'r-211.16c ` yr-C it _ _ - e ! 4J Z r�1 F ��r t �vA-z_L a, l PURSUANT TO CHAPTER 2.36 t'3 Ic.r'a,t, C,16-CS - .� ' .." tra rr �tG°a.! a c -<_/ C o;Kl c , c.a � r/� k �.e,e�:. r-i J, OF THE TOWN CODE. X CCoe�t .-l�1 F(j�trs/t,c? W�tCS ' -, -- : �Y�� K sir. �. x � Additional T- ; s11 77 �t s FW e r r r oz..•,, ., Z x CertificationNIL \ I A cc c s� �-7) 4 May BeRequired. . — I ELECTRICAL , INSPECTION REQUIRED r �1 i 1 f v` �i3r IM1i J ( � P 2 C-;r r i �,t /�.1`l t ';a'r o r.e4 e, oil 1iJT. At um, Soo -r�L-1 6y- V'A -,r _ CA kL .1.9 3 —2161 lop a