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HomeMy WebLinkAbout48623-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE k SOUTHOLD, NY WHa " 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#: 48623 Date: 12/19/2022 Permission is hereby granted to: 150 Deer Run LLC 337 Merrick Rd L nbrook, NY 11563 To: construct single-family dwelling as applied for per SCHD approval. At premises located at: 560 Wa on Wheel Ln., Cutcho ue SCTM # 473889 Sec/Block/Lot# 108.-3-9.4 Pursuant to application dated 9/12/2022 and approved by the Building Inspector.. To expire on 6/19/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $3,525.60 CO-NEW DWELLING $50.00 Total: $3,575.60 Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT f` Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htt :/wwsutlaolcl'I�awin .��o Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: 2 2022 { Applications and forms must be filled out in their entirety. Incomplete VAA I lNG applications will not be accepted. Where the Applicant is not the owner,an ' Or ,��' ' J i Owner's Authorization form(Page 2)shall be completed. Date:9/2/2022 OWNER(S)OF PROPERTY: Name:150 DEER RUN LLC SCTM# 1000-108.00-03.00-09-004 Project Address:560 WAGON WHEEL LN CUTCHOGUE, NY 11935 Phone#:631-830-0200 Email:rd@daveylaw.us Mailing Address:c/o DAVEY LAW PC, 220 MAIN STREET CENTER MORICHES, NY 11934 CONTACT PERSON: Name:RACHAEL C. DAVEY Mailing Address:220 MAIN STREET CENTER MORICHES, NY 11934 Phone#:631-830-0200 Email:rd@daveylaw.us DESIGN PROFESSIONAL INFORMATION: Name:N&P ENGINEERING, ARCHITECTURE & LAND SURVEYING, PLLC Mailing Address:70 MAXESS RD MELVILLE, NY 11747 Phone#:631-427-5665 Email:rmcgrath@nelsonpope.com CONTRACTOR INFORMATION: Name:KAISER GROUP INC DBA KAISER BUILT Mailing Address:276 CEDAR AVE PATCHOGUE, NY 11772 Phone#:631-831-3801 =mail:garreft@kaiserbuilt.com DESCRIPTION OF PROPOSED CONSTRUCTION RNewStructure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $1,525,000.00 Will the lot be re-graded? WYes ❑No Will excess fill be removed from premises? ❑Yes IANo 1 PROPERTY INFORMATION Existing use of property:VACANT LOT Intended use of property:SINGLE FAMILY RESIDENCE Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R_80 I this property? RYes ONO IF YES, PROVIDE A COPY. Check Box After Reading., The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances, g buildin code, housing code and regulations and to admit authorized inspectors on premises and in buildings)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(print name):MICHAEL SCIARA BAuthorized Agent ❑Owner Signature of Applicant: Date: lop STATE OF NEW YORK) SS: COUNTY OF SUFFOLK MICHAEL SCIARA being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the ARCHITECT (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 _y day of 20 � I Notary Public Ashley L C Marciszyn PROPERTY OWNER AUTHORIZATION Notary Public, State of New York No. 01 MA6310007 (Where the applicant is not the owner) Qualified in Suffolk County nn(r Term Expires August 18, 20_% I, residing at y to apply on do hereby authorize my be alf to the own of Southold Building Department for approval as described herein. Owner's Sig tur Date Mmd naN & Print Owner's Name f Generated by REScheck- eb Software Compliance Certificate Project 560 Wagon Wheel Energy Code: 2018 IECC Location: Southold, New York Construction Type: Single-family Project Type: New Construction Orientation: Bldg. faces 270 deg. from North Conditioned Floor Area: 4,657 ft2 Glazing Area 12% Climate Zone: 4 (5572 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 560 Wagon Wheel Ln Cutchogue, NY 11971 Compliance: 4.1%Better Than Code Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements. Envelope Ass m lies Gross Area Cavity Cont. Prop. Req. Prop, Req. Perimeter Flat Ceiling: Flat Ceiling or Scissor Truss 813 50.0 0.0 0.026 0.026 21 21 Cathedral Ceiling: Cathedral Ceiling 1,445 50.0 0.0 0.021 0.026 30 38 North Wall: Wood Frame, 16" o.c. 1,077 21.0 0.0 0.057 0.060 55 58 Orientation: Left side Door: Glass Door(over 50%glazing) SHGC: 0.21 63 0.270 0.320 17 20 Orientation: Left side Window: Wood Frame SHGC: 0.27 55 0.270 0.320 15 18 Orientation: Left side East Wall: Wood Frame, 16" o.c. 1,863 21.0 0.0 0.057 0.060 87 92 Orientation: Back Solid Door: Solid Door(under 50%glazing) 21 0.210 0.320 4 7 Orientations: Back Door: Glass Door(over 50%glazing) SHGC: 0.21 141 0.270 0.320 38 45 Orientation: Back Window: Wood Frame SHGC: 0.27 169 0.270 0.320 46 54 Orientation: Back South Wall: Wood Frame, 16" o.c. 1,213 21.0 0.0 0.057 0.060 65 68 Orientation: Right side Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 1 of 8 W Gross Area Cavity Cont. Prop. Req. Prop. Req, Perimeter I Solid Door: Solid Door(under 50% glazing) 21 0.210 0,320 4 7 Orientation: Right side Window: Wood Frame SHGC: 0.27 60 0.270 0.320 16 19 Orientation: Right side West Wall: Wood Frame, 16" o.c. 1,833 21.0 0.0 0.057 0.060 90 95 Orientation: Front Door: Glass Door(over 50%glazing) SHGC: 0.21 49 0.270 0.320 13 16 Orientation: Front Window: Wood Frame SHGC: 0.27 207 0.270 0.320 56 66 Orientation: Front 1st Floor: All-Wood Joist/Truss 2,516 30.0 0.0 0.033 0.047 83 118 Bonus Room Floor:All-Wood Joist/Truss 513 30.0 0.0 0.033 0.047 17 24 Mechanical Equipmgnt Description Fueltype Efficiency Boiler 80 AFUE Air Conditioner 16 SEER Compliance Statement: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application.The proposed b "Iding has been de gned to meet the 2018 IECC requirements in REScheck Version : REScheck-Web and to comply with the manda y requirem is Ii ed in the REScheck Inspection Checklist. Mt SGJ.&A —Afw (.r Name-Title �g at Date Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 2 of 8 REScheck Software Version : REScheck-Web Inspection Checklist Energy Code: 2018 IECC Requirements: 61.0% were addressed directly in the REScheck software Text in the "Comments/Assumptions" column is provided by the user in the REScheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. Section Plans Verified Field Verified # Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions & Req.ID 103.1, Construction drawings and '❑Complies 103.2 documentation demonstrate ❑Does Not [PR1]1 energy code compliance for the ❑Not Observable building envelope.Thermal envelope represented on ❑Not Applicable construction documents. 103.2, documentation ion dr wins trate ❑Does Not ITITITITmmm 103.1, drawings and p Requirement will be met. 403.7 energy code compliance for ❑Not Observable Location on plans/spec: M- [PR3]1 lighting and mechanical systems. 801 Systems serving multiple ❑Not Applicable dwelling units must demonstrate compliance with the IECC Commercial Provisions. 302.1, p coolingequipment - g 9 p q 403.7 sized n erACCA Manual S based is atin Heating: 1❑Oc�m Cies Requirement will be met. Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: ❑Not Observable ,, Manual J or other methods Btu/hr Btu/hr approved by the code official. ❑Not Applicable Additional Comments/Assumptions: 1 High Impact (Tier 1) 2 Medium Impact(Tier 2) 3�Lowmlmpact(Tier 3) Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 3 of 8 M section # Foundation Inspection Complies? Comments/Assumptions & Reg..11�...__ 303.2.1 A protective covering is installed to ❑ �.._ _......................_.._ Complies i[FO11]2 protect exposed exterior insulation ❑Does Not Q, Ii„ and extends a minimum of 6 in. below ❑Not Observable grade. ❑Not Applicable 403.9 Snow-and ice-melting system controls ❑Complies Exception: RequireW-� - ment is not applicable. [FO12]2 installed. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 liigh Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 4 of 8 Section Plans Verified Field Verified # Framing / Rough-In Inspection Value Value Complies? Comments/Assumptions & Re_g.ID _ Door U factor, U__ U- ❑Complies See the Envelope Assemblies 1402.3.4 ❑Does Not table for values. [FRI]1 ❑Not Observable ❑Not Applicable 402.1,1, Glazing U-factor(area-weighted U- U- ❑Complies See the Envelope Assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, ❑ 402.5 Not Observable [FR2]1 ❑Not Applicable [ R4]1 are3 actorsITproducts fenestration ❑Com w pllies determined in accordance ❑Does Not with the NFRC test procedure or taken from the default table. ❑Not Observable ❑Not Applicable .,..__ ._, �., - ....�...., .........._.._..-----...-...-...�. ...... 402.4.1.1 Air barrier and thermal barrier ❑Complies [FR23]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable ❑Not Applicable 402.4.3 Fenestration that is not site built ❑Complies [FR20]1 is listed and labeled as meeting ❑Does Not tt4 AAMA/WDMA/CSA 101/I.S.2/A440 []Not Observable or has infiltration rates per NFRC 400 that do not exceed code ❑Not Applicable limits. __._..--------_----..... . _�� _..-.-_.....--........ 402.45 IC-rated recessed lighting fixtures ❑Complies [FR16]z sealed at housing/interior finish ❑Does Not and labeled to indicate :52.0 cfm leakage at 75 Pa. ❑Not Observable i❑Not Applicable 405.2 All ducts in unconditioned ­ _ _.. ' spaces R- R- � ❑Complies Requirement will be met. [FR25]1 or outside the building envelope ❑Does Not are insulated to >_R-6. ❑Not Observable Location on plans/spec: M- ❑Not Applicable 801 .,__.------._.---------_ 403.3.5 Building cavities are not used as ❑Complies Requirement will be met.. [FR15]3 ducts or plenums. ❑Does Not ❑Not Observable ❑Not Applicable ------------------------- .. --......_ 403.4 HVAC piping conveying fluids R- R- ❑Complies Requirement will be met. [FR17]2 above 105 °F or chilled fluids ❑Does Not below 55 °F are insulated to >_R- Location on plans/spec: M- �,i3 ❑Not Observable ❑ g01 Not Applicable _,,,,, 403.4.1 Protection of insulation on HVAC ;❑Complies Requirement will be met. [FR24]1 piping. ❑Does Not a„+ ❑Not Observable ❑Not Applicable ...... ,., .moo., _. .... _.-..._.._....-._--.- 403.6 Automatic or gravity dampers are ❑Complies [FR19]2 installed on all outdoor air ❑Does Not intakes and exhausts. '❑Not Observable ❑Not Applicable Additional Comments/Assumptions: �_ --__ 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 5 of 8 section rPianvs,.Verified Field Verified # Insulation inspectionValue Complies? Comments/Assumptions ORAD All installed . ..._ ...� .,. _ _ ......, �,�_ ._._.e._-P_..__.._m_..... insulation is labeled ❑Com lies [IN13]2 'or the installed R-values ❑Does Not AO provided. ❑Not Observable ❑Not Applicable 402.1.1, Floor insulation R value. . R- . R- ❑__...._ ... _�,. ..._... Complies See the Envelope Assemblies 402.2.6 ❑ Wood ❑ Wood ❑Does Not table for values. [IN1]1 ❑ Steel ❑ Steel ❑Not Observable ❑Not Applicable —- ._....__--.... w ..... - ---------------- I, 303.2, Floor insulation installed per ❑Complies 402.2.8 'manufacturer's instructions and ❑Does Not [IN2]1 in substantial contact with the underside of the subfloor, or floor ❑Not Observable 'framing cavity insulation is in ❑Not Applicable contact with the top side of sheathing, or continuous insulation is installed on the underside of floor framing and extends from the bottom to the top of all perimeter floor framing members. 402.1.1, Wall insulation R-value. If this is a R- R- ❑Complies See the Envelope Assemblies 402.2.5, mass wall with at least 1/2 of the ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ' ❑ Mass ❑Not Observable [IN3]1 exterior,the exterior insulation V requirement applies (FR10). E] Steel E] Steel ❑Not Applicable 303.2 Wall insulation is installed per ❑Complies [IN4]1 manufacturer's instructions. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) ._. m 3 Low Impact(Tier 3) Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 6 of 8 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? comments/Assumptions-s __. .. . 402.1.1, Ceiling insulation R vGlue, R- R- ❑.Complies . .. See the Envelope Assemblies 402.2.1, ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.2, ❑ Steel ❑ Steel ❑Not Observable 402.2.6 ❑ [FI1]1 Not Applicable 303.1.1.1, Ceiling � .-_-.-----.-._ ...... w .... -. insulation installed per ❑Complies 303.2 manufacturer's instructions. ❑Does Not [F1211 Blown insulation marked every ❑Not Observable 300 ft2. ❑Not Applicable 402.2.3 Vented attics with air permeable ❑Complies [F122]2 insulation include baffle adjacent ❑Does Not to soffit and eave vents that extends over insulation. ❑Not Observable ❑Not Applicable ....... :.. _.. 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 — ACH 50 = ❑Complies [F117]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable [02. 3 3� p cfm/100 pressure tested to Ducts are z z cfm/100 ❑Complies Requirement will be met„ 71determine air leakage with ft ft ❑Does Not either: Rough-in test:Total leakage measured with a ❑Not Observable pressure differential of 0.1 inch ❑Not Applicable w.g. across the system including the manufacturer's air handler enclosure if installed at time of test. Postconstruction test:Total leakage measured with a pressure differential of 0.1 inch w.g. across the entire system including the manufacturer's air handler enclosure. ........ ...... ..-- , 403.3.4 Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies Requirement will be met. [F14]1 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air handler @ 25 Pa. For rough-in ❑Not Observable tests, verification may need to ❑Not Applicable occur during Framing Inspection, 403.3.2.1 Air handler leakage designated ❑Complies Requirement will be met. [F12411 by manufacturer at<=2%of ;❑Does Not design air flow. ❑Not Observable ❑Not Applicable 403.1.1 Programmable thermostats ❑Complies Requirement will be met. [F19]2 installed for control of primary ❑Does Not heating and cooling systems and ❑Not Observable initially set by manufacturer to code specifications. able 403.1.2 Heat um thermostat installed '❑Co pliesc -....._...e ..._...— PP pump Exception: Requirement is [FI10]2 on heat pumps. ❑Does Not not applicable. ❑Not Observable ❑Not Applicable [03.5.1 Circulating service hot water ❑Complies Requirement will be met. 1112 systems have automatic or ❑Does Not accessible manual controls. ❑Not Observable Locatinn on lane/ever: P- ❑Not Applicable 801 _.._..........__ ...... _.......--_ ...... . 403.6.1 All mechanical ventilation system ❑Complies Requirement will be met. [F12512 fans not part of tested and listed ❑Does Not HVAC equipment meet efficacy and air flow limits per Table ❑Not Observable R403.6.1. ❑Not Applicable 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) EHigh Impact(Tier 1) Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 7 of 8 [:Section Plans Verified Field Verified# Final Inspection Provisions Value ValueComplies? Comments/Assumptions RegID 403.2 Hot water boilers supplying heat ❑Complies Requirement will be met. [F126]2 through one-or two-pipe heating ❑Does Not systems have outdoor setback ❑Not Observable control to lower boiler water temperature based on outdoor ❑Not Applicable temperature. 403.5.1.1 Heated water circulation systems ❑Complies Requirement will be met. [F128]2 have a circulation pump.The ❑Does Not system return pipe is a dedicated ❑Not Observable Location on plans/spec: P- return pipe or a cold water supply; 701 pipe. Gravity and thermos- ❑Not Applicable syphon circulation systems are not present. Controls for circulating hot water system pumps start the pump with signal for hot water demand within the occupancy. Controls automatically turn off the pump when water is in circulation loop is at set-point temperature and no demand for hot water exists. 403.5.1.2 Electric heat trace systems � � � .... ,. ,. ❑Complies Exception: Requirement is [F129]2 comply with IEEE 515.1 or UL ❑Does Notapplicable. 515. Controls automatically adjust the energy input to the El Not Observable heat tracing to maintain the ❑Not Applicable desired water temperature in the piping. 403.5.2 Demand recirculation water ❑Complies Exception: Requirement is [F13 0]2 systems have controls that ❑Does Not not applicable. manage operation of the pump and limit the temperature of the i❑Not Observable water entering the cold water ❑Not Applicable piping to <= 1042F. 403.5.4 Drain water heat recovery units ❑Complies Exception: Requirement is [F13 1]2 "tested in accordance with CSA ❑Does Not not applicable. 855.1. Potable water-side pressure loss of drain water heat ❑Not Observable recovery units < 3 psi for ❑Not Applicable individual units connected to one or two showers. Potable water- side pressure loss of drain water heat recovery units < 2 psi for individual units connected to three or more showers. 404.1 90%or more of permanent ❑Complies Requirement will be met. [1716]1 fixtures have high efficacy lamps, ❑Does Not ❑Not Observable =❑Not Applicable 404.1.1 Fuel gas lighting systems have ❑Complies Exception: Requirement is [F123]3 no continuous pilot light. '❑Does Not not applicable. ❑Not Observable ❑Not Applicable 401.3 Compliance certificate posted. ❑Complies [F17 12 '❑Does Not ❑Not Observable :FNnt Annlicahlp ....................... .........__ .......... _.�...... 303.3 Manufacturer manuals for ❑Complies Requirement will be met. [FI18]3 mechanical and water heating ❑Does Not systems have been provided. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact (Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 560 Wagon Wheel Report date: 08/30/22 Data filename: Page 8 of 8 Efficiency Certificate Insulation Rating R-Value Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 50.00 Ductwork (unconditioned spaces): Glass & Door Rating U-Factor SHGC Window 0.27 0.27 Door 0.27 0.21 CoolingHeating & Boiler 80 AFUE Air Conditioner 16 SEER Water Neater: Name• Date: Comments AAUTT New Construction: P. O. Box 38, Oakdale NY 11769-0901 (631)218-1148 August 30,2022 Rachel C. Davey,Esq Davey Law PC 220 Main St Center Moriches NY 11934 Re: Water Availability—560 Wagon Wheel Lane,Cutchogue SCTM#0900-103-2-29 BP#2000704820 Notification# 300089346 Dear Ms. Davey, We have received your request for information regarding availability of public water to the above referenced property. There is an existing water main available to the above captioned property on Main Road provided you obtain easements from the owner of Wagon Wheel Lane, Suffolk County Tax Map number 1000-108-3- 9.5. Connection fees,which include any applicable water main surcharges,an application and an inspection will be required for the house service line installation. SCWA recommends the use of smart irrigation control systems and drought tolerant plantings to promote conservation and minimize the impact of peak pumpage so as to ensure compliance with the SCWA Water Conservation Plan. SCWA prohibits the use of open loop geothermal systems. If you have any further question or would like to proceed with application for service,please contact at our New Construction Department at(631)218-1148 or the undersigned at(631)563-5610. Please be advised that should your requirements for service increase at any time following the issuance of this letter,you are urged to contact this office. This letter of availability expires 8/29/24 Sincerely, '§tephdn '�uber Assistant Manager"' ` SH:lap Exiting Main I , r r tia. � I✓/� l� J eoi 1 1' /i / Ir::�' % ,/r ,r���( ':✓ r �,.//�;//��'' a/;fir il�/n/%% ��/ /��l/r/r�"i� ������/ri r,, l !/% err/ �, //� i/, �I/Jr 1 r�i//ii ioi,/ ✓ r1„/ / ����a; � �//%// r r �g ,,,,io/ r/./ o � � � „ / �/, fir%„! ;, G rY„ °Ji ,,. 1,,,..�/ ,/r / �% /✓iii; r� ,,, '�,c, ✓ a-, ,,,,. �� .l�i/����ir////ri/��� ,...,�nl r���r%�<k�a,rl�I✓/;,�bwtiri.rm ri,a.,,.rm/,r�r� „a r,�H��,..dYw„„,,;,,,, ;, „r, ,,,,, i, ,,, ,,,,r„'..„r,//,///%�(rr�rr//rrry„r,,,,,c,.... /rrr/,��l6i l!// ,o r�... /Gr/a��C,r ;; Sffa1k Co n, De t. of �` Laoar, Licensing Sk Consumerffwirs r lid rr/ i� it lrta�; HOME IMPROVEMENT LICENSE Name GARRETT J KAISER y Business aMr e This certifies that the )eager is duly licensed KAISER GROUP INC DBA Dy the County of suffolk f y% License Numbers H-53302 Rosalie Drago r Issued: ComnTissioner IIII rr i% l /5;� NY � F New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a ^AAAAA 611731582 NICHOLAS DEVITO AGENCY 449 ROUTE 24AMV4. k MT SINAI NY 11766 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER KAISER GROUP INC DBA KAISER BUILT 150 DEER RUN LLC 276 CEDAR AVENUE DBA AH REALTY HOLDINGS PATCHOGUE NY 11772 150 DEER RUN SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12416430-3 96070 05/06/2022 TO 05/06/2023 7/19/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2416 430-3, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/[WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT GARRETT KAISER OF A ONE PERSON CORPORATION THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 6051198 �.„ .. o Workers' CERTIFICATE OF INSURANCE COVERAGE �� � s� � J Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrie 1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured KAISER GROUP INC DBA KAISER BUILT 631-831-3801 ATTN:GARRETT KAISER 276 CEDAR AVENUE PATCHOGUE,NY 11772 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,i.e.,Wrap-Up Policy) 611731582 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 150 Deer Run LLC DBA AH Realty Holdings 3b.Policy Number of Entity Listed in Box"1a" 150 Deer Run DBL449109 Southold, NY 11971 3c.Policy effective period 07/21/2021 to 07/20/2023 4. Policy provides the following benefits: © A. Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law, B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 7/19/2022 B 4t g y AW (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 46,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (only if sox 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. D13-120.1 (12-21) III I���1 1111111111111111111111111111111111111111111111111 DB-120.1 (12-21) Additional Instructions for Form D13-120.1 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 1 a 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 AC CERTIFICATE OF LIABILITY INSURANCE DATE`MM/°°'YY,"' 071912022 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). PRODUCER NAME:CONTACT Jennifer Heiser Nicholas Devito Agency, Inc. PHONE 631 509-6388 FtlX 631 509-0099 449 Route 25A E-MAIL ADDRESS: 'ennifer devitoa enc .com Mount Sinai, NY 11766 INSURER S AFFORDING COVERAGE NAIC# INSURER A: Penn Star Ins. Co. X673 _ INSURED INSURERB: _.r r $ IVe ,tV InS. Co. 2,42f0 Kaiser Group Inc. — DBA Kaiser Built INSURER C: 276 Cedar Ave. INSURER D Patchogue, NY 11772 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00033718.269762 REVISION NUMBER: 14 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 'A—DDE SUBR. �POCICY EFF POLICY EXP - ILTR TYPE OF INSURANCEIN212 A= POLICY NUMBER MM/DD / 9=1 LIMITS A X COMMERCIAL GENERAL LIABILITY PAC7229953 04/16/2022 04/16/2023 EACH OCCURRENCE $ 1 OOO OOO �. CLAIMS-MADE F x1OCCUR PR MI U (F„ar p,rren $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000000 JECT POLICY❑ PRO- LOC PRODUCTS-COMP/OP AGG '',$ 2000000 OTHER, $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B 02034523-2 oa/1s/2o22 04/16/2023 _Ea Dt $ 300,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED id P BODILY INJURY(Per accent AUTOS ONLY AUTOS ( ) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY r idem _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB __]:�CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OT'H- TAT AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A ---�--� (Mandatory in NH) E.L,DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE FOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 150 Deer Run LLC THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN DBA AH Realty Holdings ACCORDANCE WITH THE POLICY PROVISIONS. 150 Deer Run - Southold, NY 11971 AUTHORIZED REPRESENTATIVE J-H ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and loqo are registered marks of ACORD Printed by J-H on 07/19/2022 at 04:31 PM MAINTAlf+i'ED AND P4001FI'ED AS E REMOVED UNTIL DA-A: DWELLING, POOL, POOL SHED AND PATIO = 8,650 SF JURISDICTION. 6,750 SF x 2/12 = 1,125 CF REQUIRED MENTS• PROVIDED (3) 8' 0 x Y ED = 1,137 CF PROVIDED REQUIRED DA-B G WITH THE TOWN OF DA-A: DRIVEWAY: 2,000 SF OWNER/BUILDER/DEVELOPER. 1,900 SF x 2/12 = 317 CF REQUIRED OR MATERIALS DURING PROVIDED IGHT OF WAY DURING (1) 8' 0 x 8' ED =337 CF PROVIDED imnwi ..moH.... ... .m mw+wu�vam ����m�na w ,..gym mw,vnrry �1L,14, Rv Q g J/ ..,, • ,.. .. ��k F ii r a r A z f s �� l f r J itc 4 1 �• i 1 � I '� Y 12/12/22 ' ,� 'wj n R-22-1484 I a , �.. i II mn.W 11� K-0 R u, �nnm wmu +sf mmaav +,mea unw ¢N rroewuu REMOVED POOL SHED (AL 10-6-2022 REVISED AS PER SCDHS COMMENTS DATED 8-31-2022 9-1-2022 �. REVISION DATE WNER: i0 DEER RUN, LLC OVERALL PLAN 'O DAVEY LAW P.C. ?0 MAIN STREET FOR LIC NANT: I'ES NY 11944 PPLIC560 WAGON WHEEL LANE T: 0 DEER RUN, LLC SITUATED AT O DAVEY LAW P.C. r I ITr`V rl�11 C '0 MAIN STREET C R M H NY 11934 TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK S.C.T.M.; DISTRICT: 1000„ SECTION: 108.00, BLOCK ., 03.00, LOT:009,004 ♦ up ,,,E P engineers • architects • surveyors 70 Maxess Road,Melville,NY 11747.631.427.5665.nelsonpope.com _... r1 r1 w n DRAWN BY: RF CADD: 22085-SP.DWG SCALE;