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HomeMy WebLinkAbout47921-Z �"�SgFOL't y Town of Southold 7/26/2022 a P.O.Box 1179 N FYI z 53095 Main Rd y,1jo ,ao� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43291 Date: 7/26/2022 THIS CERTIFIES that the building HVAC Location of Property: 1255 Donna Dr.,Mattituck SCTM#: 473889 Sec/Block/Lot: 115.-16-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/3/2022 pursuant to which Building Permit No. 47921 dated 6/7/2022 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: central air conditioning system to existing single family dwelling as applied for. The certificate is issued to Urbank,John&Mary of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47921 7/18/2021 PLUMBERS CERTIFICATION DATED A o ize gnature o�SUFFoa,rco . TOWN OF SOUTHOLD �a aye BUILDING DEPARTMENT y x 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#: 47921 Date: 6/7/2022 Permission is hereby granted to: Urbank, John 1255 Donna Dr Mattituck, NY 11952 To: Install central AC system to existing single family dwelling as applied for. At premises located at: 1255 Donna Dr., Mattituck SCTM #473889 Sec/Block/Lot# 115.-16-12 Pursuant to application dated 5/3/2022 and approved by the Building Inspector. To expire on 12/7/2023. Fees: ACCESSORY $200.00 CO-RESIDENTIAL $50.00 Total: $250.00 Building Inspector \\OF SOUI�,oI 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin(-town.southold.ny.us Southold,NY 11971-0959 COUNTY,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: John Urbank Address: 1255 Donna Dr city:Mattituck st: NY zip: 11952 BuildinglPermit#: 47921 Section: 115 Block: 16 Lot: 12 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Heritage Electric License No: 5130ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic X Garage INVENTORY Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures 1 Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect 2 Switches 2 4'LED Exit Fixtures Pump Other Equipment: Notes: HVAC Inspector Signature: Date: July 18, 2022 S.Devlin-Cert Electrical Compliance Form pF SO�Ty ,�. f TOWN OF SOUTHOL44" UILDING DEPT. 631-765-1802 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 [ ] RENTAL REMARKS: V J t oke DATE1-4-A INSPECTOR f SOUlyO� TOWN OF SOUTHOLD BUILDING DEPT. �0 • �o �ycou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINALl/I�C/ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 1 WAVz CPA DATE '1i1i INSPECTOR 11 W4 FIELD INSPECTION REPORT DATE COMMENTS ro FOUNDATION (1ST) Q -------------------------------------- FOUNDATION (2ND) M O V , � cn ROUGH FRAMING& V y PLUMBING ...� 1 t r INSULATION PER N.Y. STATE ENERGY CODE �- Al *d ti& C C FINAL ADDITIONAL COMMENTS o z rn • Nro y WO x y x d b y�*fF0 Q 4 �G TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 �y�• oti fi� Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Afv Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: MAY Q 3 2022 c Applications and forms must be filled out in their entirety. Incomplete BUII_DINUR applications will not be accepted. Where the Applicant is not the owner,an TOWN OF SOU1H61D Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S) OF PROPERTY: Name: © � SCTM#1000- Project Address: Phone#: < V c J 7–c Email: ('V��' 11ND Mailing Address: ev4�J CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: *e- Mailing Address: 10-bo V oLe /pq0-7 Phone#: �� �..5 �- Email: DESCRIPTION OF PROPOSED CONSTRUCTION El New Structure ❑ ddition ❑Alteration ❑Repair ❑Demolition Estimated_Cost of Project: her � � $ l � Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes *0 1 PROPERTY INFORMATION Existing use of property: �f /�p Intended use of property: �. Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes o IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(pri me)�: ❑Authorized Agent Aclwner Signature of Applicant: �` Date: STATE OF NEW YORK) SS: COUNTY OF SU-E' OI ) �rt� g Ll b nk being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the 0 0.0m (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this �r_�— day of Maw 20 a nxv SNAA OA taryrRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DU1te r sg00 PROPERTY OWNER AUTHORIZATION QUALIFIED IN Sl,t=wraLK COUNTY (Where the applicant is not the owner) OMMISSION EXPIFiESJUNE30,2b�� I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 i3UILDINGDEPARTI!TIENT-Electri�allr�specg�� TOWN OF SOUTHOLD - r'" Town Hall Annex- 54375 Main Road i r;:r<�: ;�,,'•%�..;ry ad - PO Box 1179 Southold New York 11971-0959 ^.i.. Telephone (631) 765-1802 - FAX (639) 765-9502 a ro err fsouthoidtownny.00u.., seandi BUILDING DEPARTMENT-Electrical Inspector I'M Of 50UTHOLD Town hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAY (631} 765-9502 roc ..("'souiholdtown y.goyT se2l'�+�SOL:tho-i' :ito�Jianv.ar� APPLICATION FOR E'LE TRICAL INSPECTION ELECTRICIAN INFORMATION (Air Information Required) Date,4J'/iC Company Narne: k-cAC C GF( C(r rt C_ , Electrician's dame: License leo.: _i=iec. email: C Elec. Phone 1 request ars email copy of Certificate of Compliance Elec. Address.- )36-07 i3�vt�ocf� � ��7C�2a5�fJ�• f/ �� � JJOB SITE MFATIO (AI! Information Required) Address: Cross Street: " Phone No.. Bldg.Penrnit#: j q- � email —` Tax Map District: 1000 Section: �/�� �'�' Block-, Lot: BRIEr= D%CRIPTi NOF WORK, INCLUDE SQUARE FOOTAGI= (Please Print Clearly): a Square Footage: I cie AfII That Apply: Is job ready for inspection?: ❑ 'YES MNO F]Rough In 1-1 Final Do you need a T emp Certi-ficate?: F] YES [a NO issued On Temp Information: (AIl information required', Service Size❑1 PhF-]3 Ph Size: _A # Meters Old Meters FJ New ServiceR Fire Reconnec nFiood ReconnectOService Reconnect❑Untlercround00verhead �#Underground Laterals 01 2 'H Frame l] Pole VNork done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION i PERMIT# Address: Switches 1 Outlets GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon Micro. Generator Combo Cooktop Transfer AC �\ AH Mini J Special: q/ ( s L( Comments: G4� ( � zi C,4�, ` Y P��o _NE yo Workers' CERTIFICATE OF INSURANCE COVERAGE L� srATE Compensation Vr Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 3..To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that Carrie 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured KOLB MECHANICAL CORP 631-298-5527 ATTN:SHARON TUTHILL-FOHRKOLB PO BOX 106 MATTITUCK,NY 11952 1 c,Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,ie.,Wrap-Up Policy) 112892671 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company John Urbank 1255 Donna Drive 3b.Policy Number of Entity Listed in Box"1a" Mattituck, NY 11952 DBL286735 3c.Policy effective period 11/01/2021 to 10/31/2022. 4. Policy provides the following benefits: A.Both disabilityand paid family leave benefits. B.Disability benefits only. E] C.Paid family leave benefits only. 5. Policy covers: ❑X A.All of the employer's employees-eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following Gass or classes of employer's employees: Under penalty of perjury,I certify:that I am an author-ized,representative or Ilcensed 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 5/3/2022 g wil,ge Y (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number _.516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. If Box 413,4C or 51B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Pians Acceptance Unit,PO Box 5200,Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4B,4C or 5B have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DIB-120.1 (12.21) aI�IIPiu�iii1Q2ii0m1iiiili12mi2�1�li�l�llll Additional Instructions for Form 1313-120.1 By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier. 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 coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This Certificate may be used as evidence of a NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits policy indicated on this form, if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein,however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits and after January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (12-21)Reverse STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name&Address of Insured(Use street address only) Ib.Business Telephone Number of Insured Kolb Mechanical Corp and Kolb Service Corp (631)298-5527 1 1500 Sound Ave Box l 06 lc.NYS Unemployment Insurance Employer Registration Number of Insured Mattituck,NY 11952 Work Location of.Insured(Onlyrequire(lifcoverageisspecifically 1d.Federal Employer Identification Number of Insured limited to certain locations in New Fork State, i.e., a Wrap-Up or Social Security Number Policy) 11-2892671 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Liberty Mutual John Urbank 3b.Policy Number of entity listed in box"la" 1255 Donna Drive XWW58512966 3c. Policy effective period Mattituck,NY 11952 0 Ol 2422 to ONW1l2� 3d. The Proprietor,Partners or Executive Officers arc included. (Only check box if all partners/officers included) Mil excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New 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"T'. The Insurance Currier will also note the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premitmts that cancel the policy or eliminate the insured from the coverage indicated on!Itis Certificate. (These notices may be sent by regular mail.) Otlietwise,this Certificate is valid for ate year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in bow"3c",whichever is earlier: Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. 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 the coverage as depicted on this form. Approved by: Peter Sabat-NSA Insurance Agency (Print name of authorized representative or licensed agent of insurance cattier) Approved by: _ 05/04/2022 (Signature) (Date) Title: Sr. Partner Telephone Number of authorized representative or licensed agent of insurance carrier: 631-722-3500 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department,board,commission or office authorized or required bylaw to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department,board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contractunless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse e KOLBMEC-01 RKRAEBEL ACORO� DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 5/4/2022 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(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 CAONNT CT Neefus Stype Agency PHONE 711 Union Ave. (ac,No,Ext):(631)722-3500 (AAC,No);(631)722-3591 Aquebogue,NY 11931 Ao Amoss:info@nsainsure.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Ohio SecurityInsurance Co 24082 INSURED INSURER B;West American Insurance CO 44393 Kolb Mechanical Corp and Kolb Service Corp INSURER C:Ohio Casualty 11500 Sound Ave Box 106 INSURER D: Mattituck,NY 11952 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 ADDL SUER POLICY EFF POLICY EXP R SD POLICY NUMBER (MMIDDIYYYIA I LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE ®OCCUR BKS58512966 5/1/2022 51/2023 DEGEa RENTED 100,000 occurrence) $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[K JECT � LOC PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER_Contractual Liability B $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY OWNED o BAW58512966 5/1/2022 5/1/2023 BODILY INJURY Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS EE BODILY INJURY Per accident $ AUTOS ONLY g10jTNOs pNLy PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE US058512966 5/1/2022 5/1/2023 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 B WORKERS COMPENSATION X I PER _ $ AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y/N XWW58512966 5/1/2022 5/1/2023 STATUTE ER OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 1,000,000 yes,describe under story In N If E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes, DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE John Urbank THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1255 Donna Drive ACCORDANCE WITH THE POLICY PROVISIONS. Mattituck,NY 11952 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Note: ALL SUBSURFACE STRUCTURES; UNAUTHORIZED ALTERATION OR ADDITION , Area WATER SUPPLY, SANITARY SYSTEMS, TO THIS SURVEY IS A VIOLATION OF an40 By JM CHEM Or JM DRAINAGE, D LY, SANTELLS AND UTILITIES, SECTION 7209 OF THE NEW YORK STATE ft EDUCATION LAW. 207020 sq.ft. � � ANDWORADATA OBTAINED FROM OVATIONS THERS.SEPT. 2021 COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR 0.46 acres aaawwcNo- 21\DONNA DRIVE THE EXISTENCE OF RIGHTS OF WAY EMBOSSED SEAL SHALL NOT BE CONSIDERED AND/OR EASEMENTS OF RECORD IF TO BE A VALID TRUE COPY. ANY, NOT SHOWN ARE.NOT GUARANTEED. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE Premises known as: TITLE COMPANY, GOVERNMENTAL AGENCY AND # 1255 Donna Drive TONTD EGASSIGNEESO OFISTED THE LENDING INSTI- TUTION. GUARANTEES ARE NOT TRANSFERABLE. LOT 63 LOT 55 MAP OF DEEP HOLE CREEK ESTATES MAP OF DEEP HOLE CREEK ESTATES concrete FILED JANUARY 28, 1965 FILE NO. 4256 FILED JANUARY 28, 1965 FILE NO. 4256 monument 58719207 ° WQQ ' o .00 ° fence qstockade fence ��0.7E u ° fence car. ° 0.2S fence car. ' f \chain link fence ° 0.6S 0.1'W ® 40.3' ° 'fence car. w o well 28.0' 0.8 E °-0-0— w landing &steps A o 'sroRY LOT 62 FRAME N asphalt WolkRFS/DENCE enclosed MAP OF DEEP HOLE CREEK ESTATES y deck FILED JANUARY 28, 1965 FILE NO. 4256 Y 40.3' 1.1' 4J' f O ASPHLT LOT 56 A RIvLr WAAY go e MAP OF DEEP HOLE CREEK ESTATES v ragN DECK DRIVE / \ O FlLED JANUARY 28, 1965 FILE NO. 4256 222' f \\ planter o steps 0 E E asphalt walk p frame ret wall 'on on concrete pavers f � 121' o monument = planter ponds o shed �_ stockade fence fence_core-- -�- - - - 10.5' - fence O.iN -- --- - ------ -_ -- pla" nter II 001 fence car. ° wood fence chain link 0.2'N fence car, fence's meet N871920 11 1 0.7S 0.4S W fence end 0.7W fen's LOT 61 MAP OF DEEP HOLE CREEK ESTATES FILED JANUARY 28, 1965 FILE NO. 4256 0- NEIN1- �P �O\A IMTO 0 1� _ 0 y� �s 49866 Survey of Lot 62 MAP OF DEEP HOLE CREEK ESTATES FILED JANUARY 28, 1965 FILE NO. 4256 situate at Mattituck LAND SURVEYING Town of Southold v Mintoville@aol.com Suffolk County, N e w York SUBDIVISIONS TITLE & MORTGAGE SURVEYS TOPOGRAPHIC SURVEYS Tax Map #1000- 1. 15- 16- 12 SITE PLANS Scale 1 "= 30' September 9, 2021 John Minto, L.S. Jacqueline Marie Minto, L.S. GRAPHIC SCALE LICENSED PROFESSIONAL LAND SURVEYOR LICENSED PROFESSIONAL LAND SURVEYOR NEW YORK STATE LIC. NO. 49866 NEW YORK STATE LIC. NO. 51085 30 0 15 30 60 120 Phone: (631) 724-4832 P.O. Box 1408 Smithtown, N.Y. 11787 ( IN FEET ) 1 inch = 30 ft. APpoovED AS NOTED OCCUPANCY OR USE IS UNLAWFUL By. WITHOUT CERTIFICATE i IFY; BUILDING DEPARTMENT AT x.1802 ,4AM TO 4PM FOR-THE OF OCCUPANCY ALLOWING INSPECTIONS:. FOUNDATION. -.TWO REQUIRED FOR:POURED`_CONCRETE _' ?. ROUGH. =;.FRAMING &,PLUMBING 3.::1NSULATIck- 4." ck . 4.`FINAL .CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW CQ(VIPLY WITH ALL CO©ES OF YORK STATE. NOT RESPONSIBLE FOR -NEW YORK,STATE & TOWN CODES DESIGN OR CONSTRUCTION ERRORS. AS REQU , E.D.-ANO-'CONDITIONS OF TOWNZBA _-SOuMb TOWN PLANNING BOARD 'SOUTHOI:p TO TRUSTEES MQWN:�S;DEC RETAtN STORM WATE ER 23�FF PURSUANT TN CODE OF THE TOW f � kolb Load Short Form Job: 1255 Donna NAHU #7 Date: May 03,2022 H E AT I N G + C 0 10 L I NG By: FR Kolb Mechanical 11500 Old Sound Ave.,Mattituck,NY 11952 Phone:(631)298-5527 Email:info@kolbmechanical.com ® Information, For: 1255 Donna Residence 1255 Donna Drive, Mattituck, NY 11952 Elleslqnjnfor Htg Clg Infiltration Outside db (°F) 12 90 Method Simplified Inside db('F) 70 72. Construction quality Average Design TD (°F) 58 18 Fireplaces 0 Daily range _ M Inside humidity(%) 30 50 Moisture difference (gr/Ib) 25 49 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make Trane Trade n/a Trade TRANE Model n/a Cond 4TTR6042J1 AHRI ref n/a Coil TEM4AOC42S41++TDR AHRI ref 8703699 Efficiency n/a Efficiency 13.0 EER, 16 SEER Heating input 0 Btuh Sensible cooling 28700 Btuh Heating output 0 Btuh Latent cooling 12300 Btuh Temperature rise 0 'F Total cooling 41000 Btuh Actual air flow 1367 cfm Actual air flow 1367 cfm Air flow factor 0.055 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 1.00 in H2O Static pressure 1.00 in H2O Space thermostat Load sensible heat ratio 0.70 ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ftZ) (Btuh) (Btuh) (cfm) (cfm) ZONE#1 1500 24964 29017 1367 1367 AHU#1 1500 24964 29017 1367 1367 Other equip loads 0 0 Equip. @ 0.95 RSM 27566 Latent cooling 12375 TOTALS I 1500 I 24964 I 39941 I 1367 I 1367 Bold/italic values have been manually overridden Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. 4` wrightsof - 2022-May-03 08:49:58 Right-Suite®Universal 2021 21.0.08 RSU10077 ...al.i.S11255 Donna Res11255 Donna Residence.rup Calc=MJ8 Front Door faces:SW Page 1 Hk6lbAHU Building Analysis Job: May 03,Donna 202 �1 Date: May 03,2022 By: FR HEATING t COCILING Kolb Mechanical 11500 Old Sound Ave.,Mattituck,NY 11952 Phone:(631)298-5527 Email:info@kolbmechanical.com Protect Information) For: 1255 Donna Residence 1255 Donna Drive, Mattituck, NY 11952 Design.- • e • Location: Indoor: Heating Cooling Suffolk County AFB, NY, US Indoor temperature (°F) 70 72 Elevation: 67 ft Design TD (°F) 58 18 Latitude: 42°N Relative humidity(%) 30 50 Outdoor: Heating Cooling Moisture difference (gr/Ib) 24.6 48.9 Dry bulb(°F) 12 90 Infiltration: Daily range (°F) - 16 ( Method Simplified lifted Wet bulb(-F) _ 75 ) p Wind speed (mph) 15.0 7.5 Construction quality Average Fireplaces 0 • Component Btuh/ftz Btuh % of load Walls 5.0 5675 22.7 Glazing 33.1 7934 31.8 Vtklls Doors 22.6 1408 5.6 rel m Ceilings 0.9 1334 5.3 Floors 1.4 2169 8.7 Infiltration 4.5 6444 25.8 Ducts 0 0 Piping 0 Humidification 0 0 Roos Ventilation Adjustments p 0 Gating ailing; Total 24964 100.0 Ims Component Btu h/112 Btuh % of load Walls 2.1 2397 8.3 IDIS Glazing 48.5 11647 40.1 Doors 12.3 765 2.6 Ceilings 0.4 663 2.3 Floors 0.4 673 2.3 IrbTd Girl Infiltration 0.7 1022 3.5 Ducts 0 0 Ventilation 0 0 Daft Internal gains 11850 40.8 Blower 0 0 Adjustments 0 Total 29017100.0 �s Irtit im 'Spilms Latent Cooling Load = 12375 Btuh rgs Overall U-\value =0.075 Btuh/ftp°F Data entries checked. Bold/italic values have been manually overridden +_ W'igl7tasale$' Right-Suite®Universal 2021 21.0.08 RSU10077 2022-May-03 08:49:58 ...al'J's11255 Donna Res11255 Donna Residence.rup Calc=MJS Front Door faces:SW Page 1 I bAHU Project Summary Job: 1255 Donna k #7 Date: May 03,2022 By: FR HEATING + COOLING Kolb Mechanical 11500 Old Sound Ave.,Mattituck,NY 11952 Phone:(631)298-5527 Email:info@kolbmechanical.com Praiectinforon. For: 1255 Donna Residence 1255 Donna Drive, Mattituck, NY 11952 Notes: Desion 1hform- ation Weather: Suffolk County AFB, NY, US Winter Design Conditions Summer Design Conditions Outside db 12 'F Outside db 90 'F Inside db 70 'F Inside db 72 'F Design TD 58 'F Design TD 18 'F Daily range M Relative humidity 50 % Moisture difference 49 gr/Ib Heating Summary Sensible Cooling Equipment Load Sizing Structure 24964 Btuh Structure 29017 Btuh Ducts 0 Btuh Ducts 0 Btuh Central vent(0 cfm) 0 Btuh Central vent (0 cfm) 0 Btuh (none) (none) Humidification 0 Btuh Blower 0 Btuh Piping 0 Btuh Equipment load 24964 Btuh Use manufacturer's data n Rate/swing multiplier 0.95 Infiltration Equipment sensible load 27566 Btuh Method Simplified Latent Cooling Equipment Load Sizing Construction quality Average Fireplaces 0 Structure 12375 Btuh Ducts 0 Btuh Central vent(0 cfm) 0 Btuh Heating Cooling (pone) Area(ft2) 1500 1500 Equipment latent load 12375 Btuh Volume (ft3) 13500 13500 Air changes/hour 0.45 0.23 Equipment Total Load (Sen+Lat) 39941 Btuh Equiv.AVF (cfm) 101 52 Req. total capacity at 0.70 SHR 3.3 ton Heating Equipment Summary Cooling Equipment Summary Make n/a Make Trane Trade n/a Trade TRANE Model n/a Cond 4TTR6042J1 AHRI ref n/a Coil TEM4AOC42S41++TDR Efficient AHRI ref 8703699 Y n/a Efficiency 13.0 EER, 16 SEER Heating input 0 Btuh Sensible cooling 28700 Btuh Heating output 0 Btuh Latent cooling 12300 Btuh Temperature rise 0 'F Total cooling 41000 Btuh Actual air flow 1367 cfm Actual air flow 1367 cfm Air flow factor 0.055 cfm/Btuh Air flow factor 0.047 cfm/Btuh Static pressure 1.00 in H2O Static pressure 1.00 in H2O Space thermostat Load sensible heat ratio 0.70 Bold/italic values have been manually overridden Calculations approved by ACCA to meet all requirements of Manual J 8th Ed. wra�gN/�of*t' 2022-May-03 08:49:58 Right-Suite®Universal 2021 21.0.08 RSU10077 ...al Vs11255 Donna Res11255 Donna Residence.rup Calc=MJ8 Front Door faces:SW Pagel RN kofb Right-JO Worksheet Job: 1255 Donna MEariNn4 trOJLING ,4HU #1 Date: May 03,2022 Kolb Mechanical By: FR 11500 Old Sound Ave.,Mattituck,NY 11952 Phone:(631)298-5527 Email:info@kolbmechanical.com 1 I Room name AHU#1 ZONE#1 2 Exposed wall 160.0 ft 3 Room height 9.0 ft 9.0 ft 160.0 ft heaUcool 4 Room dimensions 5 Room area 1500.0 ft' ,50.0 x 30.0 ft 1500.0 ft Ty Construction U-value Or HT M Area (f t') I Load I Area (ftp) Load number (Btuh/ftp-'F (BtuhlW) I or perimeter (ft) (Btuh) or perimeter (ft) (Bt h) Heat Cool Gross N/P/S Heat Cool Gross N/P/S Heat Cool 6VLI120-Osw 0.086 ne 4.99 2.11 450 265 1321 558 450 265 1321 558 1D-c2ow 0.570 ne 33.06 44.59 150 0 4959 6688 150 0 4959 6688 D 11D0 0.390 ne 22.62 12.28 35 35 797 433 351 35 797 433 W 12D-Osw 0.086 se 4.99 2.11 270 270 1347 569 270 270 1347 569 1112D-Osw 0.086 sw 4.99 2.11 450 333 1661 702 450 333 1661 702 D 1 D-c2ow 0.570 sw 33.06 55.09 90 0 2975 4958 90 0 2975 4958 L D 11 DO 0.390 sw 22.62 12.28 27 27 611 332 27 27 611 332 W 12D-Osw 0.086 nw 4.99 2.11 270 270 1347 569 270 270 1347 569 C 16X19-50ad 0.020 0.89 0.44 1500 1500 1334 663 1500 1500 1334 663 F 19A-38bswp 0.029 1.45 0.45 1500 1500 2169 673 1500 1500 2159 673 6 c)AED excursion 0 0 Envelope loss/gain 18520 16145 18520 16145 12 a) Infiltration 6444 1022 b) Room ventilation 6444 1022 0 0 0 0 13 Internal gains: Occupants @ 230 5 1150 5 1150 Appliances/other 10700 10700 Subtotal(lines 6 to 13) 249641 290171 24964 29017 Less external load Less transfer 0 0 0 0 Redistribution 0 0 0 0 14 Subtotal 0 0 0 0 24964 29017 24964 29017 15 Duct loads 0% 0% 0 0 -0% 0% 0 0 Total room load Ai required(c m) 2 24964 29017 1 1 1 43671 964 293671 1 1 13671 13671 Calculations approved by ACCA to meet all reauirements of Manual J 8th Ed _ wrYgtntso — �^'� Right-Su ite®Universal 2021 21.0.08 RSU10077 2022-May-03 08:49:58 ..al'J's11255 Donna Res11255 Donna Residence.rup Calc=MJ8 Front Door faces:SW Page 1 Shee 1 ZONE#1 ERE Job##: 1255 Donna Performed by FR for: Kolb Mechanical Scale: 1 : 83 1255 Donna Residence Page 1 1255 Donna Drive 11500 Old Sound Ave. Ri ghtSu ite@ Universal 2021 Mattituck,NY 11952 Mattituck,NY 11952 21.0.08 RSU10077 Phone:(631)298-5527 2022-May-03 08:50:06 info@kolbmechanical.com ...nna Res11255 Donna Residence.rui Ducts Summary HEATING + COOLINC+ HU#9 Job: 1255 Donna Kolb Mechanical Date: May 03,2022 � BY: FR 11500 Old Sound Ave.,Mattituck,NY 11952 phone: (631)298.5527 Email:info@kolbmechanical.com MIN ® - 0 t For: 1255 Donna Residence 1255 Donna Drive, Mattituck, NY 11952 External static pressure Pressure losses Heating Available static pressure 1.00 in H2O Cooling Supply/return available pressure 0.70 in H2O 1.00 in H2O 0.30 in H2O 0.70 in H2O Lowest friction rate 0.179/0.121 in H2O 0.30 in H2O Actual air flow 0.080 in/100ft 0.179/0.121 in H2O Total effective length (TEL) 1367 cfm 0.080 in/100ft 354 ft 1367 cfm • Name Design Htg Clg Desi g Diam (Btuh (cn (cfm) (cfm) FR H X W Duct Actual ZONE#1 (in) (in) Matl Ftg.Egv ZONE#1-A h 3124 171 Ln (ft) Ln (ft) Trunk c 3627 171 0.080 8.0 ZONE#1-B 171 171 Ox 0 VIFx ZONE#1-c c 3627 171 0.080 8.0 Ox 0 41.0 170.0 SO c 3627 171 0.080 8 O VIFx 20.0 ZONE#1-D 171 171 Ox 0 VIFx 180.0 st1 ZONE#1-E c 3627 171 0.080 8.0 Ox 0 19.0 170.0 st2 c 3627 171 0.080 8.0 VIFx 20.0 190.0 ZONE#1-F 171 171 OX 0 VIFX st1 ZONE#1-G c 3627 171 0.080 8.0 Ox 0 21.0 170.0 st2 c 3627 171 171 0.080 8:o Ox 0 VIFx 20.080 5.0 105.0 st1 Ox 0 VIFx 180,0 st2 19.0 180.0 st2 • Trunk Htg Name Type (cfm) Cig(cfm) Design FIR n elloic Diam s t1 684 Rpm) (in) H x W Duct st2 Peak AVF 684 (In) Material 683 683 684 12.5 8 x Peak AVF 0.080 Trunk 0.080 683 12.5 8 x 18 18 ShtMetl ShtMetl ® � o Grille Ht Name Size (in) (cfm) (fm) TEL Design Veloc Diam F rb1 OR (fpm) (in) HIn W Stud/Joist Ox 0 Duct rb2 Ox 0 684 684 143.0 0. 080 490 16.0 ( ) Opening (in) Mad Trunk 128.0 Ox 0 0.080 490 16.0 Ox 0 VIFx rt1 VIFx rt1 -014- WrilBold/italic values have been manually overridden � Ob Rig ht-Su ite®Universa12021 21.0,08 RSU10077 al J's11255 Donna Res11255 Donna Residence.rup Calc=MJ8 Front Door faces:SW 2022-May-03 08:49:59 Page 1 • Trunk Ht Name Type (cfm) (cfm) D FR n Veloc Diam H x W rt1 (fpm) (in) Duct Peak AVF 1367 (In) Material 1367 0.080 Trunk 684 16.2 8 x 36 ShtMetl wNghts0 A+- ».,...... .. Right-Suite®Universal 2021 21.0-08 RSU10077 ...al VS11255 Donna Res11255 Donna Residence.rup calc=MJ8 Front Door faces:SW 2022-May-03 08:49:59 Page 2