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HomeMy WebLinkAbout38682-Z �o�OSUFF Town of Southold 4/22/2021 P.O.Box 1179 o • l 53095 Main Rd ��Ol dao P� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41982 Date: 4/22/2021 THIS CERTIFIES that the building WINDOWS Location of Property: 1275 Nokomis Rd, Southold SCTM#: 473889 Sec/Block/Lot: 78.-3-30.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/6/2011 pursuant to which Building Permit No. 38682 dated 2/26/2014 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: Two window replacements(bathroom and bedroom)as applied for. The certificate is issued to Mirabella,Michael&Catherine of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED th riz 0 ignature 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#: 38682 Date: 2/26/2014 Permission is hereby granted to: Mirabella, Michael & Mirabella, Catherine 164 Willow Wood Dr Oakdale, NY 11769 To: replace one window in bathroom and one window in bedroom of an existing one family dwelling as applied for. Replaces BP 36426. -- r At premises located at: 1275 Nokomis Rd, Southold ' SCTM #473889 -- ----- Sec/Block/Lot# 78.-3-30.1 Pursuant to application dated tM*fW and approved by the Building Inspector. To expire on 8/28/2015. Fees: PERMIT RENEWAL $200.00 CO -ALTERATION TO DWELLING $50.00 Tota $250.00 1 I Building Inspe o�S��of loco TOWN OF SOUTHOLD BUILDING DEPARTMENT C4 z TOWN CLERK'S OFFICE o . SOUTHOLD, NY t 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#: 36426 Date: 5/26/2011 Permission is hereby granted to: Mirabella, Michael & Catherine 164 Willow Wood Dr Oakdale, NY 11769 To: Alter a Single Family Dwelling; Replace (2) windows, Bedroom & Bath, as applied for. At premises located at: 1275 Nokomis Road, Southold SCTM # 473889 Sec/Block/Lot# 78.-3-30.1 Pursuant to application dated 5/17/2011 and approved by the Building Inspector. To expire on 11/25/2012. Fees: CO -ALTERATION TO DWELLING $50.00 SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00 Total: $250.00 Building Inspector FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT / (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO_ 35718 Z Date JULY 19, 2010 Permission is hereby granted to: M & C MIRABELLA 1,275 NAKOMIS RD SOUTHOLD,NY 11971 for . I'NSTA-LLATJ:ON OF AN ;ULECTR1C SOLA;R. PANEL- ,SYSTEM TO,AN- EXTStTNG DWEi LING AS -APPLIED, FOR at. premises located'at 1275- -NO.€OMIS RD SOUTHOLD County Tax Map No, 473889 Section 078 _ Block 0003 Lot No. 030.001 pursuant to application dated JULY 1, 2010 and approved by the Building Inspector to expire oxx JANUARY 19, 2.012 - Fee $ 200. 00 Authorized Signature Rev. 5/8/02 _ n FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34278 Z Date NOVEMBER 6, 2008 Permission is hereby granted to: MICHAEL & CATHERINE M. MIRABEL 164 WILLOW WOOD DRIVE OAKDALE,NY 11769 for INTERIOR/EXTERIOR ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. at premises located at 1275 NOKOMIS RD SOUTHOLD County Tax Map No. 473889 Section 078 Block 0003 Lot No. 030 . 001 pursuant to application dated OCTOBER 23, 2008 and approved by the Building Inspector to expire on MAY 6, 2010 . P , • Authorized Signature Ul.Y/ \ COPY Rig , Form No.6, TOWN OF SOUTHOLD, BUILDING DEPARTMENT, TOWN MALL 765-1802 AM WAI TI 109,F`OR­40 !4417_10#1 116 application must be,filled'Mi' by,typewriter or ink'and submitted to-the Building Department With jhe,fblloW0&7' A. For new-buildingor�new wise: 14 Final survey of propeit' ,y with accurate location of all buildings,pr9perty'lines;streets and unusualoatural-or topographic features, 2. Final Approval from"Healt-h Dept.of water supply and sewerage-disposal-(S_:o form). 1. Approval of electrical-'installation from Board of Fire Underwriters. 4. :Sworn statement from,plumber certifying that the solder used in s less ffian,2/1 Opt 1°!°,lead. ,,5. Cdmhtdicial building,industriaVbWIdiq&,multiple residences"andsimilai buildings and installations,,a certificate '617 Cod&C6mplian66-ftom archft&ct or ginger"er responsible fb' r the-building. oard'Apprpval;of completed site plaikreq 6:. Submit Planning,P pirements. B. For,exniting buildings(prior to April 9,1957)non-conforming-uses,or buildings and-"preLexrsfing"'lin'd J. Aeruratesurvey iDfpropdrtyshovviiii'auproperty.Iin'es,stii6tsilinild4and unusual naturg-or' topographic features. - I. A,piopecompleted application and consent ta-mspect gigned'bythe-applicantIf a-Certih6aw bf,6citpadcy is d y oenied;the Building Inspector shall state-the,reasons therefor in writing tqthp applicant. -C. Fees 4, Certificate of Occupancy,­Niew dwelling$50.00,Additions t6,dwelling,$50. .00,Alterations'td 11,$5060" 1 1� , �'; 001i�g Swimming pool-350.00,Ac6e#oiY,building$50:00,"k"tions-1q,accessory, I � bpilding$5j0A",B-- 2. Cdfifi-c-at6of0ci,-upancyonPre-existingPOdin-- � ' I I Building-1100.00 3. Copy,of Certificate of Occupancy---$.25 4. `Updated Certificate-of-,Qccypapcy-'$50.005. DEC 2 3 2020 Temporary Cerop4tp,of Pecupa ancy-Residential$15.00,Commercial$15:00 7, Date: 12 LI) New Construction: bld.or Pre-existing Building:, (check one) Location,'of,rr9ppiIy:- 1275' *K0 MiS 9d "so uf�0 1 d House No. StreetHamlet Owner or6wner$:of-property:, CA114UI_A)E + Ackad A 44 fig SuIT461k-C Tai Map No,1000,Section � Block Lot, 3e:%,I __.,jiled N40, 'Date qf? Applicant:! pi e 'HeA&Depi.Approval: Vnderwriters) ppr§val:,_ Plai�nirig Board Approval:. Request for: Temporary Certificate Final C' ertificate:, Fee Submitted: $ ®® pplicaut Signature ���' Fey,No.6 TOWWOF SOUTHOLD BVIdi*G"DEPARTMENT TONYN'HA' LL"­ 765-1801 APPLICATION FOR eE_R"T' WICATE OF OiCeUPANCY This'applicatlbnxdust'be-filfted in bitype or ink and submitted to Building Department with the Ib —Y 4114 A. For 1. survey,ofpio '%�ith�,'Accuratelocafionof-aUbuildin i,and,unusual natural or • p gs,property lines,streets, MOV46 _M", 11 - 2. piY 3. A` aifoo �Mb 4. IN,Ift&-, 5,. 1 b 'and ih§tillailons,a.€ fificate, 'o �L- T '16L96 � 4o OF IM bulgs ri& 0' 1957146h�cQ I mmg wses,or b4M#gs an&Iipro,,qxtjt g"I'ta#ifuses: 1. :of*iV&Wshams,all proper ylmines,s,ftwts;building,abd"taxi tisual,natural or features. 2. AW e W 4y ycorqptdW' &46fili6dkonsentlb itispect signed by the applicant.If a Certificate of Occupancy is cletit bijd ;s6111 _' - ,th'er'eai'�ons-thereforinwnungp,theapp,liq*., Cli' Fe6 NdW,,dwqlifn&$50.K AdditiofigIo dwelling$50WjAljitrktionsjo ttwelling,$56.00, pancy '0 'bhildin'i50.,(0,`__' 9sory, 9 $100.00 A. I 'Copyw -S:25 4. ,i�6d upancy `$5.0.00! 5. kcaie4- sMeritial$15.00,Commercial$15.00 6 Pate, New Construction: Old or Pre-existing,Pilildifik: (6heck one) Location of Property:, House 1qo_ Street .Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000,SectioA Block Lot SubdiIvis-­lon Filed Map., Lot: PermitNo. Date of Permit: Applicant: fleafth,Dwt Approval: Underwriters Approval: °PIaming Board-Approval:, ke4up, st fcir': Temporary.Certificate Final C&tificate: (check one) Fee Submitted- Applicant Signature OF Sooty�6 — -- # # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 '1 N S-P ECT 1 O N - [ ] FOUNDATION 1ST Aj] FIRE GH P [ ] FOUNDATION 2ND [ lON/CAUIKING [ ] FRAMING/STRAPPING [ W [ ] FIREPLACE`& CHIMNEY [ -SAFETY INSPE ON [ ] FIRE RESISTANT CONSTRUCTION [ NETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O RE KS: . u v - ►vwr DATE INSPECTOR FIELD Il!iSPEQXON REPORT DATE Corv=NTS VOUNI?ATION(IST) FOUNDATION(2ND) o ROUG11 MABONQ& PLUNMING cl' INSULATION PER N.Y. H STATE ENERGY COPE FINAL r ADDITIONAL COMMENTS z be 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 Survey www.northfork.net/Southold/ PERMIT NO. 1 Check Septic Form N Y S D.E.C. Trustees Examined 20 `I Contact: Approved J5—— 20a Mad to Phone: Expiration_ — �� 20 Q-- ✓��//�J� Builldding Inspector APPLICATION FOR BUILDING PERMIT Date 1'fQ(� �O ,20 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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. t Pfil a�� (Signature of applidd or name,if a corporation) 2sb I S029QC-t Dim C.Itie�e rTN lq®13 (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder o�x�rro�1 cortil'r� oot�" — �awcr {-forte ZermdeA rx� Groc&p / Name of owner of premises I Il Yx - Cwheri ne M I rQ,)e-11Q, (As on the tax roll or latest deed) If applic i a corporation,signature of duly authorized officer ame and title of corporad officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which pro osed work will be one: 12-15 NaKomi s j2oa House Number Street Q Hamlet County Tax Map No. 1000 Section U Block Lot © ' Subdivision Filed Map No. Lot (Name) 2. State existing use and occupancy of premises ynd intended use and occupancy of proposed construction: a. Existing use and occupancy_S1 r)Q 10—--Fa.m i LU res i cA��w ho fns b. Intended use and occupancy r& &aM1r-4 Ili3. Nature of work(check which applicable):New Building Addition Alteration Repair _Removal Demolition Other Work (Description) 4. Estimated Cost 11 H Cori • Fee 250.0 (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars ..11 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot:Front Rear Depth 10.Date of Purchase Name of Former Owner 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 NOXWill excess fill be removed from premises?YES NO� lA 14.Names of Owner of premises4*ftiV dU 'A"Address lZg5 NR>!ornIS W. Phone No.(03(. 8r1q.QOM Name of Architect Nf Address Phone No Name of Contractor1 Address 1501 r Phone No. 42 4•*7 W..6335 )(21jZ(, 'w P S w PA Iao l3 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,must provide topographical data on survey. STATE OF NEW YORK) NOTARIAL SEAL SS: JAMIE LEE GARDEN COUNTY OFU� Notary Public ROOKHAVEN BOROUGH, DELAWARE COUNTY ��1k.Ng Saryus � 6> being duly sworn,deposeslid sa tfipf"lf ivt1e(applibant 23, 2014 (Name of individual signing contract))above named, zed (S)He is the co n�Ctor/Q ww-)oy C ed OIwy'-t (Contractor,Agent,Corporate Officer, c.) 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 day of I( )�N 20� & ova CPG 10 - Notary Public Signature o pplicant Southold Town Building Department ';FOI,t�oG P.O.Box 1179 y;4 54375 Main Road Permit#: 36426 0 Southold,New York 11971 Permit Date: 5/26/2011 �4 o�� (631)765-1802 Parcel ID: 78.-3-30.1 Expiration Date: 11/25/2012 BUILDING PERMIT RENEWAL LETTER FINAL NOTICE Dated: 10/15/2013 Applicant: POWER WINDOWS & SIDING Location: 1275 NOKOMIS ROAD SOUTHOLD Work Description: WINDOWS Alter a Single Family Dwelling; Replace(2)windows,Bedroom&Bath, as applied for. A FEE OF $200.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: MICHAEL& CATHERINE MIItABELLA Address: 164 WILLOW WOOD DRIVE OAKDALE, NY 11769-1629 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. THANK YOU, SOUTHOLD TOWN BUILDING DEPT. SOUjyol Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G • iQ Southold,NY 11971-0959 IroUNT(,N BUILDING DEPARTMENT TOWN OF SOUTHOLD March 4, 2014 Michael Mirabella ; 164Vrf10` ��� j Oa°krdlI14b Re: 1275 Nokomis Rd, Southold TO WHOM IT MAY CONCERN: The Fol/lowing Items(if Checked)Are Needed To Complete Your Certificate of Occupancy: ✓ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. (Contact your electrician) A fee of$50.00. Final Health Department Approval. Plumbers Solder Certificate. (AII permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. (Planning#765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept BUILDING PERMIT: BP 38682 - Windows `r UFF.CO.N[ALTH DXWr.""OVAL H.0.NO. OwmXR% DON ¢ L.INoA. LUoov 1275- lY.4KdMIS ROAL7 SO urHOI--C>/ NY 11K7l /+RAI►, 19,525 3Q FT asw� T. K\vA 5 N l K (vQ=mt) I- e• • t= taea•Zt'!~. - do-o � . wou FRoNostU K.y N`}= r t(1 Y3 4au6n O N.84•ZI'E. - IIQA i •• - i in dj uj fp, derv" $.$ri'2!`\Y. 1- 114.4 vi E 11 M I LL1,V00A HOMES LTD, SOMA: �r 13 mon"!6mt in :T:h � 1 •�� t .1 �:",CRY .. ✓ .. . ;..' Z UMAI"IIRItm A,ttrenaM o¢Aon,poM TO TEEM surv[Y,s rrc,wrior+a IFC,ION 7;cp of in;y:1i Yosr STATE MWCMIOr,uw. ' I ' coHS of i;15 NAPMOf EIARING IMI 4 rl �1 —495-^--x•{ _ ou;.e Ta•: ', .c.:,tipLµp•� If aArr �•' •r, 'r � •• i cu,:, L',• 1101 61Co1•" >rG7 13 ib ck M,4,- . :RUL `5ol�i'FsoSdr�.ctvi+•.gss I�UMIG - � AT as *urw,jwd tIoV.,Z4P,I97Z . BAYVIE'W '.MCQNPlCK VAN TUYt- P. C. Tow"OF Soixr;oLo.N.Y. L,C-LAND SURVRLYOKSR-G RT.N-Y. �VT FIO sure.CO.D✓rP'f.OF NRALTH P87i'VSC" sTATxmKkT Orf INTRHT humin 3. FOR APPROVAL Or CONS T"UCTION ONLY ;ycv,dy loon THR WATER SUPRLY AKQ; *fw^ f. Ii9kF gwvtl DIAPCOAL Nyfm!N t .Tk;Rf RPL. OWN= WN-4 Ccorpow, 'TQ THY .� cigar H.a.REP.tto.t 13<TANpAitOf OP fUF,PO�K Cp, DSS. Sand OF }iXA4TH. smvtcow, A"ROVW: R cw, APn.,CAr,T N n' �I r l..V 1 111t11J 1C.f11v1 Locate clearly and distinctly all buildings, whether existing or proposed, and. indicate all set-back du property lines- Give street and block number or description according to deed, and show street names and .Ln( ,interior or corner Iot. l S- N r Hz_0A1S P-0.) 131,o C•0 .Tf 3/ 'F U G � hY - V!. \ , Q ♦ j ��iJ�• ry in PROPOSE-- rr N � ••- �: . . � ., :• • o. 1`I,SA �I E. r 14.4 - ID x in Al µl00 r,\.. If Y■ �/ Roa , .00 rn`I ...may` ... 4 - , • Q. -�Z�.s..~ - • . , i '•. ' • ' ' . ,, • •• , : .- � W �&q'c;l,'�l. — x,14.4 ��..: - a�+�.,+d ����,Prf •, In . •• • ' , , '� d4+v� 5.�W w. �- 110.0 M 1 t t_W00P HOMES r C), + ...... .. ...... I Mi.Don I ubov 1275 Nahmim Rd J/ STATE OF NEW YO RI`, S S Soulhnld,NY 11971 COUNTY OF . . . . . . . . . . . . . . . . . OP ID: EL- '4 CERTIFICATE OF LIABILITY INSURANCE r DATE(MM/DDKYYY) 03/29/11 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 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 215-7234378 CONTACT NAME: Chad Lacher Lacher 8,Associates Ins Agency 215-723-8604 PHONE Ext;215-723-4378 AIDC No):215-723-8604 Lacher Insurance Group E-MAIL 632 E Broad St P O Box 64398 AOORESS: Souderton,PA 18964 PRODUCER POWER-1 CUSTOMER ID#. Chad Lacher INSURER(S)AFFORDING COVERAGE NAIC INSURED Power Home Remodeling INSURERA:Pennsylvania Manufacturers 41424 Group,Inc. INSURER B:Pennsylvania Manufacturers 12262 2501 Seaport Drive Suite B110 INSURER C: Chester, PA 19013 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE NSR WVD POLICY NUMBER MMIDDIYYW MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY 821000-66-20-96-7 09/22/10 09/22f 11 $Ea occurrence) $ 300,00 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ '1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOPAGG $ 2,000,00 X1 POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY Auto 151005-66-20-96-7 09/22/10 09!22111 (Eaacadent) $ 1,000,00 BODILY INJURY(Perperson) $ ALL OWNED AUTOS BODILY INJURY(Per ecadent) $ A X SCHEDULEDAUTOS PROPERTY DAMAGE $ A X HIREDAUTOS (Perecadent) A X NON-OWNEDAUTOS $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 EXCESS LIAR AGGREGATE $ 5,000,00 B CLAIMS�v1ADE 651000-66-20-96-7 09122h0 09/22N1 DEDUCTIBLE $ X RETENTION $ 10,000 $ WORKERS COMPENSATIONWCSTATU- OTH- AND EMPLOYERS LIABILITY YIN X, ORY LIMI S ER A ANY PROPRIETORIPARTNERIEXECUTIVE01000-66-20-96-7 09/22/10 09/22111 E L.EACH ACCIDENT $ 100,00 OFRCERIMEMBER EXCLUDED? ❑Y NIA (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 100,00 If yes,descnbe under DESCRIPTIONOFOPERATIONS below EL DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,Irmore space is required) CERTIFICATE HOLDER CANCELLATION SOUTNY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 P.O.Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier I a.Legal Name and Address of Insured(Use street address only) 1 b.Business Telephone Number of Insured POWER HOME REMODELING GROUP INC 610-874-5000 ATTN:DANIEL SCHAEFFER 1 c.NYS Unemployment Insurance Employer 290 BROADHOLLOW ROAD,SUITE 220 E Registration Number of Insured MELVILLE,NY 11747 1 d.Federal Employer Identification Number of Insured or Social Security Number 233030708 2.Name and Address of the Entity-Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Zurich American Insurance Company Town of Southold 58 South Service Road,Melville,NY 11747 53095 Route 25 P.O.Box 1179 3b.Policy Number of entity listed in box"1 a": Southold,NY 11971 4859716-001 3c.Policy effective period: 3/15/2011 To 3/15/2012 4.Polic covers: a. rX All of the employer's employees eligible under the New York Disability Benefits Law b. F1 Only the following class or classes of the 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 Benefits insurance coverage as described above. Date Signed 3/29/2011 By 4011 --5ze (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (631)845-2200 Title Operations Manager IMPORTANT: If box"4a"is 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"4b"is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,New York 12207. PART 2. To be completed by NYS Workers'Compensation Board (Only If box"4b" of Part 1 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 Benefits Law with respect to all of his/her employees. Date Signed By, (Signature of NYS Workers'Compensation Board Employee) Telephone Number Title Please Note:Only insurance carriers licensed to write NYS disability 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. PR-190 1 (5-06) 0 k� This page will enable you to search for business's with active licenses In Suffolk County. Do not assume that the party you are researching Is not licensed If no results are returned. For further verification,please call the Once or Consumer Affairs at(631)853-4600 htanday,through Friday,from gam to 4 pm. Additional Useful Information VjAULL cense Type s Online Forme r-Search Data — ---- - ----- -- --- ---- ----. . ---- Ucense and Picone Ucense Number Telephone Number 6311 owner - - ---- - --- ; FirstRame Last Name Business ' Name PowerHoal_R_a_n_odan, Street Address 2908_madhollowP_d City Melville State NY 21p 11747 There were 1 records found. Seatch Clear Screen Ucensee/Salesperson Name Company Phone Ucense ype Issue Date Expire Date Ucense Category Add KYLE BARRING POWER HOME REMODELING GROUP INC (631)674-5000 48568 07-Apr-11 01-Apr-13 H1-GC 290 BROADHOLLOW RD SUI yetsion 1.00 12/01/2010 3:30PI-I Copyright Suffolk County Information Technology Sarvices.All dents reserved. GnitxvlFcrFlfdt61lu1e'.rRe; �,_r-et5r�s,cl,•_t!cl Lr- e3•. LeOyi Fe:dan I of 1 4/8/20119:12 AM TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST 2. State existing use and occupancy of premises qnd intended use and occupancy of proposed construction: a Existing use and occupancy Sl Cbl 2 `FQJIn 1 LU f-2S 1 ClR.(l t ho r b. Intended use and occupancy r"& draMl rlt 3. Nature of work(check which applicable):New Building Addition Alteration Repair�X Removal Demolition Other Work (Description) 4. Estimated Costly (o'l •00 Fee 250.20 Mike and Catherine Mirabella ' (To be paid on filing this application) �` � � Power Home Remodeling Group 5. If dwelling,number of dwelling units Number of dwelling units on each floor N) Ipt � p April 2 , � '', 2501 Seaport Drive,Chester PA 19013 April 29,2011 If garage, number of cars --11 II " �� Phone 610-874-5000.Toll-Free 877-454-8955.www.powerhrg.com 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. Iy l� Project Specifications NY-1 323463 7. Dimensions of existing structures,if any:Front Rear Depth Height Number of Stories Windows: Bedroom 1 46.5"x45.5" Dimensions of same structure with alterations or additions: Front Rear Windows:Bedroom 1 46.5"x45.5" Depth Height Number of Stories P g 7 OPTIONS:Color Cocoa/Whitetyl Slider G dPattern: N ne I Remova Aluminum/Vinyl I Additional Details None 8. Dimensions of entire new construction:Front Rear Depth > � � Height Number of Stories 1 9. Size of lot:Front Rear Depth 10.Date of Purchase Name of Former Owner Windows: Bathroom 1 45.5"x46.75" 11.Zone or use district in which premises are situated Windows:Bathroom 1 45.5"x46.75"WINDOWS:Models SL 2700 Styles Slider Types 2-Lite Configs None OPTIONS:Color Cocoa/White: Grid Pattern: None I Removal Aluminum/Vinyl I Additional Details None 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES NO­X Will excess fill be removed from premises?YES NO_y - - - M)rabel1a 14.Names of Owner ofpretpisesK'�=C�Qiv fs Addressl2'YS �01711s1�• Phone No.roil. 3'7c1 70 l Name of Architect N f _Address Phone No Name of Contractor 1 Address Z 501 Phone No. 42 4•*13p.6335 X2`526 15 a Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES pp NO applicant a_, applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. authorized inspectors on premises and in building for necessary inspections. b.Is this property within 300 feet of a tidal wetland?*YES NO—X *IF YES,D.E.C.PERMITS MAY BE REQUIRED. ,t GrY1lZ�� C pttad c r .1 V D AS NOTE v (Signature of appli or name,if a corporation) 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 2561 Sf� '�'lY•c 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. r_ �� B.P.# (Mailing address of applicant) STATE OF NEW YORK) NOTARIAL SEAL ® 0 a 1 Q Q BY=ate whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder SS: JAMIE LEE GARDEN ��, BUILDING DEPARTMENT A --� COUNTY OF kW Notary Public �lglZgfOL� COr S�`rackor 95yicr f-brm- 12emciddi'm Grotty �O S �� fBROOKHAVEN BOROUGH, DELAWARE COUNTY :: $ AM TG 4 PMFOR TH 6 being duly sworn,deposes sa tfil MM@grUi6P'Ppii&mt Z3,2014 -'DING INSPECTIONS: �,� y t Name of owner of premises 1 It�2 Cheri n e �r0J)eJ(Q, (Name of individual signing contract) l above named, ' t�U N DATI ON TWO REQUIRED (As on the tax roll or latest deed) (S)He is the — C0 nAMCA0r!a WW-)0yl ZQd Oauct `OR POURED CONCRETE If applic i a corporation,signature of duly authorized officer (Contractor,Agent,Corporate Officer, �oUGH-FRAMING,PLUMBING, &A-4 c.) STRAPPING, ELECTRICAL 9 CAULKING CName and title of corporalk officer) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; 3 INSULATION that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be 4 FINAL-CONSTRUCTION S ELECTRICALBuilders License No. performed in the manner set forth in the application filed therewith. MUST BE COMPLETE FOR C.O. Plumbers License No. ALL CONSTRUCTION SHALL IIeET THE Electricians License No. Sworn to before me this REQUIREMENT&OF THE CODES OF NEVOther Trade's License No. day of VCa}N 20 t( YORK STATE. NOT RESPONSIBLE FOR CPttQ C, DESIGN OR CONSTRUCTION ERRORS. 1. Location of land on whi^c proposed work will be one: alv� 2 Notary Public Signature o pplicant I 2-16 I a gorni S �d SD1& 10 House Number Street Hamlet County Tax Map No. 1000 Section t U Block 3 Lot © � Subdivision Filed Map No. Lot OWE�rJ NATIONAL HEADQUARTERS I-IomeRemodeliingGroup® , 2501 Seaport Drive • First Floor Chester, PA 19013 11H 61,0-874-5000 EST. I992 PowerHRG.com Subject: Reopen permit to perform final iiispe''ction',4'­�' Y`'k •'if�'c: •rfF.pU'R' ,,1 i�li'v: ' �)ct��w ' "•r�ir'G" To whom it may concern, Enclosed is a check for$250 to reopen the window replacement permit at 1275 Nakomis Rd. so a final inspection can be done. Please contact Mr. Mirabella(homeowner) at(631)379-8036 to set up the final inspection. If you have any questions, please contact meat(888)736-6335 ext. 2391. Thank you. For more information on the job, please see below p� 0 Window Replacement: Mike and Catherine Mirabella 1275 Nakomis Rd. Southold,NY 11971 if' �} FEB 2 6 2014 \ L - —BLDG DEPT Sincerely, Ryan Gombar �,l rD WINDOWS o SIDING o ROOFING o DOORS ,ate =,° r aI.(mrimrs), = ,. ,'e'�'� �'�$�a�i a +p�'•;adv�<'a�aS'ewewa 7� -r a.;fiw;[�;i'�r5�'�#e rafst��rv��,x'€ '�6�n 3-�.�ncdvF� '��`��"`�v`ri;'�t€ .I;ag,Y�ty.„ex�;«ta �:;� a � ;�'4'k,° - ,a =%ool riAol LON e7. ' a TO, Akto :y �-yi'b`ct6�"� ga,c�''�:.`p a �a <€ , s�•t.., t " �t� "�.• r� tma' '�"�y��,�'T� ��x3�ka��t$x� 3i +'zr"a