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HomeMy WebLinkAbout46214-Z �o�OSUFF0 LI Town of Southold 12/5/2022 P.O.Box 1179 c _ 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43656 Date: 12/5/2022 THIS CERTIFIES that the building ACCESSORY GARAGE Location of Property: 400 Old Field Ct,Mattituck SCTM#: 473889 Sec/Block/Lot: 120.-3-8.24 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/3/2021 pursuant to which Building Permit No. 46214 dated 5/10/2021 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: accessoU garage as applied for. The certificate is issued to Richert,Kenneth&Danielle of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46214 10/20/2022 PLUMBERS CERTIFICATION DATED Aut ri d ignat �o�suF K TOWN OF SOUTHOLD °aye BUILDING DEPARTMENT y TOWN CLERK'S OFFICE "oy • �fi ' 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 #: 46214 Date: 5/10/2021 Permission is hereby granted to: Richert, Kenneth 100 Vista PI Cutchogue, NY 11935 To: Construct new accessory garage at existing single family dwelling as applied for. At premises located at: 400 Old Field Ct, Mattituck SCTM # 473889 Sec/Block/Lot# 120.-3-8.24 Pursuant to application dated 5/3/2021 and approved by the Building Inspector. To expire on 11/9/2022. Fees: CO-ACCESSORY BUILDING $50.00 ACCESSORY $580.00 Total: $630.00 Building Inspector ho��pF SO!/r�ol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road Vs P.O.Box 1179 roger.richerta-town.South old.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Kenneth Richert Address: 400 Old Field Ct City: Mattituck St: New York Zip: 11952 Building Permit#: 46214 Section: 120 Block: 3 Lot: 8.24 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: homeowner DBA: License No: SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor X 1st Floor X Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage X INVENTORY Service 1 ph Heat Duplec Recpt 12 Ceiling Fixtures 5 HID Fixtures Service 3 ph Hot Water GFCI Recpt 3 Wall Fixtures 1 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 100a A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 5 Twist Lock F1 Exit Fixtures TVSS Other Equipment: 1-egress light, 1-air compresser with 60 a disconnect Notes: Inspector Signature: iZe Z4 Date: October 20 2022 81-Cert Electrical Compliance Form.xls } V k w 1 i r i�. • f i� is �,tp. �-� p i I� �1 1 i ili7 V R i OCT 1 LULL i SOUI�°!o # # TOWN OF SOUTHOLD BUILDING DEPT. cou765-1802 -INPECTION. If- � .FOUNDATION 1ST [ ] ROUGH PLSG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE INSPECTOR VV SOf/T�° # # TOWN OF SOUTHOLD BUILDING DEPT. °`y�ou►m '' 765-1802 INSPECTION [. ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND- [ ] SULATION/CAULKING [ ] FRAMING/STRAPPING [ FINAL Ac& 6 & [ ] ,FIREPLACE& CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 0� �6'k& N(IN )1()e)- Y:7:v vVJ DATE q INSPECTOR FIELD:INSPECTION REPORT ATE GONIIVIENS (Z5 � FOUNDATION(1ST) H ............................ ...... FOUNDATION(2NA) r ROUGH FRAMING:& PLUMBING: INSULATION.PER N.Y. H STATE ENERGY CODE FINAL o-. - i c�tz- i G. ADDITIONAL CO c. lec Ye 018-75. 0 ab H TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0950 Telephone(631) 765-1802 Fax(631) 765-9502httys://www.southoldtoym.%zov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only MAY PERMIT NO. Building Inspector: - 2021 Applications and forms'must be filled out in their entirety.Incomplete rl TT;D YN" 1� P. applications will not be accepted. Where the Applicant is not the owner,an TO i"'ITV' y"r, Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)'OF PROPERTY: Name:Kenneth Richert SCTM#1000- Project Address:400 Old Field Ct., MaftituCk NY 11952 Phone#:631-484-3669 Email:KenRy?�_T�@msn.com Mailing Address:400 Old Field Ct., MattituCk NY 11952 CONTACT PERSON: Name:Ke-n-ne.t.h Richert-----.----.-- Mailing Address:400 Old Field Ct., Mattituck NY 11952 Phone#:631-484-3669 Emai[:KenQy2278@msn.com DESIGN PROFESSIONAL INFORMATION: NameTetterville Sales, Ivan Smucker Mailing Address:245 Fetterville Rd., East Earl PA 17519 Phone#:800-331-1875 Emaii:lvan fettervillesales.com CONTRACTOR INFORMATION: Name:lvan Smucker Mailing Address:245 Fetterville Rd., East Earl PA 17519 Phone#:80-0--3,31.-1 87�5___ Email:lvan@fe#q lesales.com DESCRIPTION OF PROPOSED CONSTRUCTION MNewStructure EJAddition EJAIteration E:]Repair ElDemolition Estimated Cost of Project: Elother $$45,000. Will the lot be re-graded? E]Yes ii No Will excess fill be removed from premises? RYes ONo PROPERTY INFORMATION Existing use of property:resldentla�.._,-_.___a.._ Intended use of property:resldentlal_ Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to AC reSldentla� this property? Dyes ©No IF YES, PROVIDE A COPY. 8 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(p i n e):Ken Richert ❑Authorized Agent BOwner Signature of Applicant: — ---- —- W- --- �- Date STATE OF NEW YORK) SS COUNTY 0 being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (24cM (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 day of 20 2 Not ry Public REGINA M. BLASKO NOTARY PUBLIC-STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION No. O1 BL6258145 (Where the applicant is not the owner) 6luolified In Suffolk County My Commission Expires March 26, 204 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 .r St'FIpL� BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD a = Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 ®0' Telephone (631) 765-1802 - FAX (631) 765-9502 a roQerr(c�southoldtownny.aov — seandCcDsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑1 request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All innfor' ' ReKuied) Name: � _(AY\ p Address: C \( Cross Street: Phone No.: I I^'41K L�^ Bldg.Permit#: 14 Z email: ��1h 2`Z—j SV,(b Tax Map District: 1000 Section: Block: Lot: BRIEF DES RIPTI N Cf WO K, I CLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES N-71 NO Issued On Temp Information: (All information required) Service Size❑1 Ph 73 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: nD [FQrE0'V[R AYMENT DUE WITH APPLICATION OCT 2022 HUMDING Drs � H(V 21 LA TOWN OF SOUTHOLI) . ® DATE(MMIDD/YYYY) -ACC)R v " CERTIFICATE OF LIABILITY INSURANCE 04/20/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 holderin.lieu of such endorsement(s). PRODUCER - CONTACT Certificate Department . . NAME: Robertson Insurance&Risk Management AHONN.E (717)625.3770 FAX No: (717)625-3777 3399 Jetstar Drive E-MAIL-- certs@robertson.insure. ADDRESS: _ - INSURERS)AFFORDING COVERAGE NAIC# Lititz PA 17543 INSURERA: Selective Way Insurance Company 26301, INSURED INSURER B: Selective.Insurance Company ofAmeric.a 12572 - FETTERVILLE POLE BUILDINGS,LLC INSURER C: DBA FETTERVILLE SALES INSURER D: 245 FETTERVILLE RD INSURER E EAST EARL PA 17519-9441 INSURER F': COVERAGES CERTIFICATE NUMBER: 2021-2022 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 - POLICY EFF POLICY EXP LIMITS' LTR INSD WVD " POLICYNUMBER MMIDDIYYYY) (MMIDDIYYYY X COMMERCIALGENERALLIABILITY_ - EACH OCCURRENCE $ 1,000,000 DAMAGE500,000 . 1 —1CLAIMS�MADE -�OCCUR PREMISES Ea occurrence $ - MED EXP(Any one person) $ 15,000 A S 2273820 01/02/2021 01/02/2022 PERSONAL&ADV-INJ URY $ 1,000,000. GEN'LAGGREGATE LIMITAPPLIES PER:. _ GENERALAGGREGATE- $ 2,000,000 POLICY PRO .F-.1 LOC PRODUCTS-COMP/OPAGG $. 2,000,000 JECT OTHER: - - $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ 1,000,000' - Ea accident X ANYAUTO BODILY INJURY(Per person) $ A _ OWNED SCHEDULED S 2273820 . 01/02/2021 .01/02/2022. BODILY INJURY(Per accident) $ .AUTOSONLY. AUTOS ent HIRED NON-OWNED PROPER-, DAMAGE $" X AUTOS ONLY X AUTOS ONLY Per accid X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 - A . - EXCESS LIAB. CLAIMS-MADE . S-2273820 01/02/2021 01/02/2022 AGGREGATE $ 1,000,000 DED I X1 RETENTION$ - $ WORKERS COMPENSATION X STATUTE TEROH _ AND EMPLOYERS'LIABILITY 500,000 ANY PROPRIETORlPARTNER/EXECUTIVE.YIN E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED?. NIA WC 9049332 01/02/2021 01/02/2022 (Mandatory in NH)' E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT "$ Job Site Limit $150,000 Builders`Risk Coverage 'A S-2273820 0.1/02/2021 01/02/2022All Locations- $300,000- Deductible $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of.Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road. AUTHORIZED REPRESENTATIVE Southold NY.11971 ©1988-2015 ACORD CORPORATION. All rights.reserved. ACORD 25-(2016103) ' The ACORD name'and logo are registered marks of ACORD N, STATE OF NEW YORK. -WORKERS'.COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.'Legal Mame&Address of insured(Use street:address only) IN Business Telephone Number of Insured Fetterville Pole .Buildings LLC 717.35477861 245-F'etterville Road. - East:Earl, -PA 17519 1c.NYS Unemployment Insurance-Employer Registration Number of Insured WorkLocation of hin.red(Only required if coverage is specifically .1d.Federal Employer identification Number of Insured. limited to certain tocations in-New York State, i.e., a Wrap-Up or Social Security Number. - Policy) 81-4813261 2:Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity.Being Listed as the Certificate Holder) selective'lasurance Company of America 3b.-Policy Number of entity listed in box"1a" WC9049332 Town of Southold 3c. Policy effective period _ 54375 Main Street . - 11211021 to 1f2/2022 Southold, NY 1971: 3d. The Proprietor,Partners or Executive Officers are- E]-included. (Only checkboxifallpartneralofi4cersincluded). - . Q an excluded or certain partners/officers-excluded. ' ''•This certifies that the insura-nce.carrier indicated above in box,"Y insures the business referenced above.in box."la"for workers' compensation underthe'NewYork State Workers'Compensation Law.(To use this form,New York(NY)mustbe listed under item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance_ Carrier or its licensed agentwifl a this Certificate of Insurance to the-entity listed above as-the certificate holder in box"2'. 71he Insurance Cari ler Will also note the above certificate holderwithin 10 days IF ct policy is canceleddtie io nonpayment ofpremiums or within 30 days IF1here are reasons other than nonpayment of premiums that cancel the policy oP eliminate the insured from the coverage. -indicated on.this-Cerci,ci ate.-(These notices May bye senCby regular mail.) Otherwise,this CW*1cate isvalid 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'%;,-whichever is earlfex Please.Notes Upon the caneellation-of the workers' compensation policyindicated on this form;if the business continues to be _ - named on a permit,license or contractissued by a certificate holder,the business mustprovide that certificate holder with anew f Certicate of Workers'Compensation Coverage-or other authorized proof that the_ business is complyingwith the mandatory coverage requirements of the New York State Workers'Compensation Law. Under,penalty of penury;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: : . . - � Justin Krantz - (Print name ofauthorized representative or licensed agentofinsarance carrier) Approved by:- 04/21/2021. (signature) (Date): . Title: — ow.. iaG L nesnaeiwsatar Telephone Number of authorized representative or licensedagent of insurance carrier: - Please Note:Only insurance carriers acid their licensed agenb.are authorized to issue Form C-1.05.2.Insurance brokers are NOT authorfzed to issue it _ C-105.2(9-07) www,wcb.statcmy.us - . Ac R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1*_� 04/20/2021 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYAND 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 Certificate Department Robertson Insurance&Risk Management PAHONE Ell: (717)625-3770 n/c,No: (717)625-3777 3399 Jetstar Drive ADDRESS: certs@robertson.insure INSURER(S)AFFORDING COVERAGE NAIC# Lititz PA 17543 INSURER A: Selective Way Insurance Company 26301 INSURED INSURER B: Selective Insurance Company ofAmerica 12572 FETTERVILLE POLE BUILDINGS,LLC INSURERC: DBA FETTERVILLE SALES INSURER D: 245 FETTERVILLE RD INSURER E: EAST EARL PA 17519-9441 INSURER F: COVERAGES CERTIFICATE NUMBER: 2021-2022 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ALMLIbUtIMI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DD MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED - PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A S 2273820 01/02/2021 01/02/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY ❑X JET LOC _ PRODUCTS-COMP/OPAGG $ 2,000,000 FIOTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE1LIMIT g 1,000,000 Ea accident X ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED S 2273820 01/02/2021 01/02/2022 BODILYINJURY(Peraccident AUTOS ONLY AUTOS ) $ X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLALIABX OCCUR' EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE S 2273820 01/02/2021 01/02/2022 AGGREGATE $ 1,000,000 DEXD RETENTION$ 0 $ WORKERS COMPENSATION /� STATUTE PERTH- ANDND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? N/A WC 9049332 01/02/2021 01/02/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Builders Risk Coverage Job Site Limit $150,000 A S 2273820 01/02/2021 01/02/2022 All Locations $300,000 Deductible $1,000 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 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name&Address of insured(Use street address only) lb.Business Telephone Number of Insured Fetterville Pole Buildings LLC 717-354-7561- 245 17-354-7561245 Fetterville Road East Earl, PA 17519 lc.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage isspeeffeally 1d.Federal Employer Identification Number of Insured limited to cerfsin locnfians in New York State, i.e., a Wrap-it Policy) p or Social Security Number 81-4813261 2.Name and Address of the Entity Requesting Proof of 3a..Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Selective Insurance Company of America 3b.Policy Number of entity listed in bog"la" WC9049332 Town of Southold 3c. Policy effective period 54375 Main Street 11212021 i/2/2022 Southold, NY 11971 3d. The Proprietor,Partners or Executive Officers are C]included. (Only check box if all pmInerstofitcers included) Q all excluded or certain partners/officers-excluded. This cep' tfies that the insurance carrier indicated above in box. 3 insures the business referenced above in box."Ia"for workers' componsationunderthe NewYork State Workers'Compensation Law.(To use this form,NewYork(NY)mustbelistedunrderl . on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent vviiisentt this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notify the above cert f cate holder within 10 days IF a policy b canceled due to nonpayment ofpremiums or within 30 days LF there are reasons Other than nonpaymen t ofprem iums that cancel thepolicy oreliminate the insuredfrom thecoverage Indicated an this Certificate. (These notices may be sent by regular mail.) Otherwise,this CeWicate is valid far 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 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 contractissued by a certificate holder,the business must provide that certificate holder with anew 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; Justin Krantz (Print name ofauthodzed representative or licensed ageatofinsurance carrier) Approved by; 04/21/2021. (sigumm) {Date) Title: Cnmrtlgrsinl I inss I Incl®rwretAr Telephone Number of authorized representative or licensed agent of insurance carrier: 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.statdmy.us - • '. -. ,� - ..7,v:VU-=7;GU-Uri=-�'::'U;�4=• _°.: =:� .,:...�- --�.�; < ;: -'.;.• ,. . .-. _ - - :GENE-RAL'-NOE.S..: Map No. 8808 Filed September 1, 1989 - G OCT 17 2022 ;0. - ✓e - __j - 22.3' .......__ . Lot 23 Ago 1 � t Y✓) 2 - as' i LJ i' A.5' n i 23.0' 1 N CA 10.5' i u pWd. i-v. '.Gar• C.J� _ _ - _ sn� 90 O e Lost . 22 .. CP StePy Fe.Cor. .. _ i gteQQ Z cj1:�l• (W - ' )0 _-•-- -_ i Fr.Fe o g Tap of -•-----.-•- Lot 22 Mas.Patio �9, N w o Farmveu Associates 5.7' Situated at "moi., .- � / •. .. .. Mattituck y c,. `�'r Town of Southold Proj. 18.067 Suffolk County, New York f ' 0 Lit 3 Surveyed ' � �; , Certfied Only To: Lot 2_ October 23, 2018 Fidelity National Title UNAUTHORIZED ALTERATION OR ADDITION TO TH15 SURVEY 15 A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION Insurance Company LAW. COPIES OF TH15 SURVEY MAP NOT BEARING THE LAND 00 SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED ATRUE VALID COPY. y Academy Mortgage Corj', o J nil CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY 15 PREPARED AND;ON H15/HER BEHALF TO THE TITLE COMPANY AND LENDING INSTITUTIONS LISTED BELOW AND Kenneth D. Reichert and ✓¢r3 F'� TO THE ASSIGNEE OF THE LENDING INSTITUTION. CERTIFICATIONS 30 60 ARE NOT TRANSFERABLE TO ADDITIONAL OR SUBSEQUENT ENTITIES. Danielle Reichert 4:• _ S�Z,CI�o. ,, ALL RIGHTS RESERVED. O 2018 ROBERT W.OTT. OUTSIDE OF THE ole j' '`y" TITLE TRANSFER LISTED BELOW,TH15 DOCUMENT MAY NOT BE F f REPRODUCED OR TRANSMITTED IN ANY FORM OR BY ANY MEANS WITHOUT WRITTEN PERMISSION FROM MUNICIPAL LAND SURVEY,P.C.. VSIONS)SHOWN HEREON FROM THE s` �_ Al I Vine AT1r)H1,nF ii S.C. T.M. # 1000- 120-03-8. 024 GENERAL NOTES ,. Map No. 8808 0, C) Filed September 1, 1989 (- N >n o hCIO r V r11. O' Cor. " 22.3' " � Greenhouse a0 -- -Ji " y � C7Sc 3.8'So + ` - V ti " i "v 1 r.- i 01 -10.5' 7u E Gar.- m " O Wd Shed i 0 N Lot 22 + w'3 Fe.Cor. Map of \ #A00 Farmveu Associates ,_•_ _-• I M ° 9 row -o - Ww 53, r 163 - 'A Situated at ° 6,PvGPe Mattituck J ' Town of Southold Proj. # 18067 Suffolk County, New York Surveyed _(,t 3 Certfied Only To: <:.! October 23, 2018 Fidelity National Title UNAUTHORIZED ALTERATION OR ADDITION TO TH15 SURVEY IS A f ViOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION Insurance Company LAW. COPIES OF TH15 SURVEY MAP NOT BEARING THE LAND o 5URVPYOR'5 INKED SEAL OR EMBOSSED 5EAL 5HALL NOT BE o CONSIDERED A TRUE VALID COPY. Academy Mortgage Corp. 0 CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY 15 PREPARED AND ON H15/HER BEHALF TO Kenneth D. Reichert and THE TITLE COMPANY AND LENDING INSTITUTIONS L15TED BELOW AND TO THE ASSIGNEE OF THE LENDING INSTITUTION. CERTIFICATIONS G4° ARE NOT TRANSFERABLE TO ADDITIONAL OR SUBSEQUENT ENTITIES, Danielle Reichert 6 0 30 0 ALL RIGHTS RESERVED. O 2018 ROBERT W.OTT. OUTSIDE OF THE TITLE TRANSFER LISTED BELOW,TH15 DOCUMENT MAY NOT BE REPRODUCED OR TRAN5MITTED IN ANY FORM OR BY ANY MEAN5 "`till = f WITHOUT WRITTEN PERMISSION FROM MUNICIPAL LAND SURVEY,P.C.. THE OFFSETS(OR DIMENSIONS)SHOWN HEREON FROM THE n !•t � ALL VIOLATIONS OF U.5.COPYRIGHT LAW5 WILL BE PROSECUTED. �`• MUNICIPAL LAND SURVEY, P.C. STRUCTURES TO THE PROPERTY LINE5 ARE FOR A SPECIFIC PURPOSE Fcd' 9n w t' AND USE AND THEREFORE ARE NOT INTENDED TO GUIDE THE ERECTION °° aF°'ho ?yh\t >i^ I HEREBY CERTIFY THAT I AM A PROFE5510NAL LAND SURVEYOR OF FENCES,RETAINING WALL5,POOL5, PATIOS,PLANTING AREAS, c° 5� 28 �... rte" LICENSED TO PRACTICE IN THE STATE OF NEW YORK,AND THAT TH15 10 SYLVIA LANE ADDITION TO BUILDINGS AND ANY OTHER CONSTRUCTION. PLAN IS 5A5ED ON AN ACTUAL FIELD SURVEY PREPARED UNDER MY MMEDIATE SUPERVISION. I FURTHER DECLARE,TO THE BE5T OF MY MIDDLE ISLAND, NEW YORK, 11953 ABSTRACT OF TITLE AND EASEMENTS FOR SUBJECT PARCEL AND �_(>`` 'f PROFESSIONAL KNOWLEDGE AND BELIEF,THAT TH15 PLAN 15 AN ADJOINING PARCELS NOT PROVIDED FOR THE PREPARATION OF THI51 ROhGI t W. O;t L.S. NYS LIG. #O�}9E2O ACCURATE REPRESENTATION REPRESENTATION OF THE CONDITIONS (631) 345-2658 SURVEY. ABSENCE OF EASEMENTS DOF5 NOT DENY THE EXISTENCE EX15TING A5 OF THE DATE HEREON. OF SAME. OCCUPANCY OR USE IS UNLAWFUL DO NOT SURVEY NOT PROCEED WITH APPROVED AS NOTED WITHOUT CERTIFICATE FRAMING OF FOUNDATION LOCATION DATE: 5-10,0-14 B.P.# g1v OF OCCUPANCY HAS BEEN APPROVED. FE- -02 BY: NOTIFY BUILDING DEPARTMENT AT 76� 302 8 AM TO 4 PM FOR THE Additional Fi:; ; '--"NING INSPECTIONS: TWO REQUIRED Certification l =-'=: JNDATION - COMPLY WITH ALL COBE; Oi= POURED CONCRETE A4aY Be Required. 2. -SGS:("�H - FRAMING & PLUMBING NEW YORK STATE & TOWN CODES 3. ;,N'�".,L.'TION AS REQUIRED AND CONDITIONS OF 4. F!,NAL " CONSTRUCTION MUST SOUTHOLDTOWNZBA BE COMPLETE FOR C.O. ALL COr,''TRUCTION SHALL MEET THE SOUTHOLD TOWN PLANNING BOARD REQUIREMENTS OF THE CODES OF NEW DUCOkLMSPECFMN REQUIRED YORK STATE. NOT RESPONSIBLE FOR SOUTHOLD TOWN TRUSTEES DESIGN OR CONSTRUCTION ERRORS. N.`i.S.DEC TRUSS PLACARDING REQUIRED fit:> 1 a _ d � 4 - F R} n t' $a -, A. ul „ai` !i t - _.4 V ^ .;k� { i Y• � # *'b 1 f � ,. _ r.' ! .{ --ik �yC 7 Y f 2,• x 'a h,y. 'M—} n1= ci t'i i p ° 1 y , f7lr WN � 7S � L„ kt Y - Y d - �� ��yY L - ! .1< �- � 4�1`.— ., 1- A } MA-•,,�-,3�-^ fr\I T{.,t{. '•es r - ur. � � i E ' { r�,>ir �+�v.t � r £ 4 i r *� _ a_s r < ,n.- t.i� rw k _ Y r 2 f'CLI ✓'� i4, r { ,a 7 ' zd';' ->i in, Jt Contract: 019FEIS21 ••••"°•• j0�`,r Free Standing Building installed on your level site ; f :�,� �i'•,�� , 30' width x 40' length x 12' inside height Roof System: 4' o/c trusses Pitch: 4/12 Loading: 30-5-5 '=`' = ' ' :Lt Walls: 8' o/c 3-Ply 2x6 Glulam Load-Bearing PostssS Walls: Smart Post Option Siding: 28 Gauge Painted Steel (Beige) Trim Color (Brite White), Base Guard (Beige) '''roti/ff111f1i\•\l\. Roofing Type: 27 Gauge Painted Steel with Ridge Vent (Charcoal) Special Conditions Overhangs: 12" Boxed Vented on 2-Sides & 2-Gables (Brite White) soffit and fascia * Finished Floor 1.5" Below Top Of 1 - 18 X 10 Insulated Steel-Backed (White) Overhead Door(s) #4300 with Skirt Board. 9 lite(s) Plain Short Insulated and Dutch Corners * Skirt Board: 1 Row Treated 2x8. 1 - XX 6'8" Fiberglass 9-lite Entry Door(s) For Contract: 019FEIS21 4 - 36" x 44" SingleHung Insulated w/ Half Screen Window(s) No Grids, White THIS BUILDING MEETS OR EXCEEDS THE 2018 NY IBC Cover Sheet BUILDING CODE FOR POST FRAME CONSTRUCTION Client Name: Ken Richert Contact: Al, Ivan• Smucker Fetterville Sales Address: 400 Old Field Court 800-331-1875 Ext. 100 245 Fetterville Rd. �rr Natti_tuck, NY 11952Email: East Earl PA 17519 Ivan@fettervillesales.com 800-331-1875 Phone: 631-484-3669 i CONFIRM FINISH FLOOR Floor Plan HEIGHT WITH CUSTOMER Personal use, 1200 sq. ft. 5'-0" 131-011 81-011 81_011 81-011 8 1-011 UN ` W W 3'x6'8" 9-Lite - 0 _1 i — — — — — O U I W °) °o u_ o I o - V) o I o 0 bo r > I ' Ridgeline o 0 O I° cu x00 I a (n W 1 CP 5 y a fes. 81-0118'-0 8 1-0 I 81-0 I 8 1-011 .•.0.7Y142,.�6• ' SS10��'E<<` 40'-0" Post Layout / Header Height is 11' 11" from Top of Skirt Board to Top of Header Scale:1/8"=1' Client Name: Ken Richert Contact: Ivan Smucker Fetterville Sales Address: 400 Old Field Court 800-331-1875 Ext. 100 245 Fetterville Rd. , I I ,! ' i Mattituck, NY 11952 Email. East Earl, PA, 17519 Phone: 631-484-3669 Ivan@fettervillesales.com 800-331-1875 Job Truss Truss Type Qty Ply StockIBC2015115MPH r 141406182 B904560 T30 FINK 1 1 Job Reference(optional) Superior Trusses,LLC, Ephrata,PA-17522, 8.330 s May 6 2020 MiTek Industries,Inc. Fri May 22 12:24:36 2020 Page 1 ID:rZORL4ZOUaGJ93VHBr7EeezPml2-zDQhldzSgZ mSB9gLyTgtO?4lhAnTWuyCwlpLmzDy4f - -10- 7-10-1 15-0-0 22-1-15 30-0-0 3?-10 -10 7-10-1 7-1-15 7-1-15 7-10-1 -10- Scale=1:52.6 5x8 1 4.00 12 2x4 2x4 rs 8'13 3 5 1 2 6 7 1;[0 o v 10 9 8 6 4x10 = 5x6 = 3x10 MT18HS = 5x6 = 4x10 = 10-0-8 19-5-8 30-0-0 10-0-8 8-11-0 10-6-8 Plate Offsets(X Y)— [2:0-0-8,Edge] [4:0-4-8,0-2-8],[6:0-0-8,Edge] [8:0-2-4,0-2-41,[10:0-2-4,0-2-41 LOADING (psf) SPACING- 4-0-0 CSI. DEFL. in (loc) I/dell Ud PLATES GRIP TCLL 40.0 Plate Grip DOL 1.15 TC 0.74 Vert(LL) -0.48 6-8 >734 240 MT20 169/123 (Roof Snow=40.0) Lumber DOL 1.15 BC 0.99 Vert(CT) -0.76 6-8 >465 180 MT18HS 197/144 TCDL 5.0 Rep Stress Incr NO WB 0.62 Horz(CT) 0.22 6 n/a n/a BCLL 0.0 Code IBC2015/TPI2014 Matrix-S Wind(LL) 0.15 8-10 >999 360 Weight:133 Ib FT=10% BCDL 5.0 LUMBER- BRACING- TOP CHORD 2x6 SP 240OF 2.0E TOP CHORD 2-0-0 oc purlins(3-0-9 max.) BOT CHORD 2x4 SPF 2100F 1.8E (Switched from sheeted:Spacing>2-8-0). WEBS 2x4 SPF-S No.2 BOT CHORD 7-10-0 oc bracing:2-6 REACTIONS. (size) 2=0-6-0,6=0-6-0 Max Horz 2=133(LC 9) Max Uplift 2=-529(LC 10),6=-529(LC 10) Max Grav 2=3112(LC 1),6=3112(LC 1) FORCES. (lb)-Max.Comp./Max.Ten.-All forces 250(lb)or less except when shown. TOP CHORD 2-3=-6921/1129,3-4=-5843/965,4-5=5843/965,5-6=-6921/1129 BOT CHORD 2-10=-971/6374,8-10=-539/4315,6-8=-971/6374 WEBS 3-10=-1795/404,4-10=-206/1877,4-8=-206/1877,5-8=-1795/404 NOTES- 1)Wind:ASCE 7-10;Vult=115mph(3-second gust)Vasd=91 mph;TCDL=3.Opsf;BCDL=3.Opsf;h=15ft;B=45ft;L=30ft;eave=oft;Cat. 11;Exp C;Enclosed;MWFRS(directional);cantilever left and right exposed;end vertical left and right exposed;Lumber DOL=1.60 plate grip DOL=1.60 2)TCLL:ASCE 7-10;Pf=40.0 psf(flat roof snow);Category Il;Exp C;Fully Exp.;Ct=1.20 3)Unbalanced snow loads have been considered for this design. 4)This truss has been designed for greater of min roof live load of 20.0 psf or 2.00 times flat roof load of 40.0 psf on overhangs non-concurrent with other live loads. 5)Dead loads shown include weight of truss. Top chord dead load of 5.0 psf(or less)is not adequate for a shingle roof. Architect to A 1 verify adequacy of top chord dead load. OF N E 6)All plates are MT20 plates unless otherwise indicated. 04 GA C O 7)This truss has been designed for a 10.0 psf bottom chord live load nonconcurrent with any other live loads. 8)Provide mechanical connection(by others)of truss to bearing plate capable of withstanding 100 Ib uplift at joint(s)except Qt=1b) (�� 2=529,6=529. 9)See Standard Industry Piggyback Truss Connection Detail for Connection to base truss as applicable,or consult qualified building designer, r I 10)Graphical purlin representation does not depict the size or the orientation of the purlin along the top and/or bottom chord. LU W v 9 FEsS10 May 22,2020 WIF ®WARNING-Veri/y design paremeters and READ N07ES ON TRIS AND INCLUDED MliEK REFERENCE PAGE MIF7473 rev.10/03/2015 BEFORE USE. Design valid for use only with MTek®connectors.This design is based only upon parameters shown,and is for an individual building component,not a truss system.Before use,the building designer must verify the applicability of design parameters and properly incorporate this design into the overall building design.Bracing indicated is to prevent buckling of individual truss web and/or chord members only.Additional temporary and permanent bracing MiTek° is always required for stability and to prevent collapse with possible personal Injury and property damage.For general guidance regarding the fabrication,storage,delivery,erection and bracing oftrusses and truss systems,see ANSIrrP11 Quality Criteria,DSB-89 and BCSI Building Component 16023 Swingley Ridge Rd Safety Information available from Truss Plate Institute,218 N.Lee Street,Suite 312,Alexandria,VA 22314. Chesterfield,MO 63017 2x4 #2 Roof Purlins 24" o/c 27 Ga Ptd Steel Roofing 12 Engineered Trusses 48" o/c 4 r- 2x6 Tie Down Block 1-12.51-lurricaneTies DOOR PLACEMENTS: 2 Ply Truss Supports Entry Door sets 1-1/2" Down 2x4x12" Support Block from top of Skirt Board Garage Door sets 2" Down 28 Ga Ptd Steel Siding Treated/Laminated Post Truss Support Size: 2-Ply 2x10 #2 SYP 12'-0" Inside Height Fastened Via 10-3 1/4" Coil Nails Per Connection 2x4 #2 Girts 24" o/c-----__,_ Truss Bracing: 2x4 Diagonal, B/C Laterals, Web Bracing Per Print .131 x 3-1/4" 12D Nails for All 2x4 &2x6 Girts, Purlins, Fascia ��qq1/111{Ittl/i//�� OF Rett�40, 2x8 Treated Skirt Board FINISH FLOOR HEIGHT: , 9�z� 1.5" Down from Top of Skirt Board t '' $e Grade Line 18" Diameter Post Hole %�� ''077''x2 ,••� ,�'ipa��S510��'ec�ar Conc. Footing 4000 psi 42" Depth ' u ,,, ««•°` C4) S l- l.PMT�'ERNS: er— 4 . Purfins-and-Al Sidiet 18 �� Typical Section View No Scale Client Name: Ken Richert Contact: Ivan Smucker Fetterville Sales address: 400 Old Field Court 800-331-1875 Ext. 100 245 Fetterville Rd. Mattituck, NY 11952 Email. East Earl, PA, 17519 Phone: 631-484-3669 Ivan@fettervillesales.com 800-331-1875 Truss Notched onto Post Purlin Attach Via 4 12D Nails Per Connection o Hurricane Ties 2x6 Truss Block Attach 2x10 #2 SYP o Via 5 3"x.131 Nails 10-3 1/4" 12D Nails Per Connection ' 2x4x12" Support Block o 0 Attach Via 12 12D Nails Girts Attach Via 6 12D Nails Per Connection o. 80 �wol,1i#1111*1S F Ng* yi, ��'�,�4 ••. ?7142,,.•' `ve pot roost I if%I Client Name: Ken Richert Contact E ` Ivan Smucker Fetterville Sales Address: 400 Old Field Court 800-331-1875 Ext. 100 245 Fetterville Rd. Mattituck, NY 11952 Email: East Earl, PA, 17519 I11 R 1 Phone: 631-484-3669 Ivan@fettervillesales.com 800-331-1875 '.t, 'I' y; t,. ',r; r�'y`' .y`.'%` �'�K'a'F jr • 'it' i kD i' r\ Front 12 FF OV NJPy� Rear ,2 3 9fr 9G: s LMS z� zw'` �%c ••.aria?,.••� .` r 30'-0" pofiEssto� ,.••� NUeuu1K Elevation View Scale:1/8"=1' Client Name: Ken Richert Contact: j Ivan Smucker Fetterville Sales Address: 400 Old Field Court 800-331-1875 Ext. 100 245 Fetterville Rd. ai H �' Mattituck, NY 11952 Email: East Earl, PA, 17519 `I TJEi l Phone: 631-484-3669 Ivan@fettervillesales.com 800-331-1875 tD LO J'- fe 'lT I 0 Left ® FFRI 1 -4 FFR 7 OF Retv O&F '4' 6" -714 SSO AteNtuieelta, 4 Right L _LLL� L 401-01T Elevation View Scale:1/8"=1' Client Name: Ken Richert Contact: Ivan Smucker Fetterville Sales Address: 400 Old Field Court 800-331-1875 Ext. 100 245 Fetterville Rd. WOM Mattituck, NY 11952 Email. East Earl, PA, 17519 Phone: 631-484-3669 Ivan@fettervillesates.com 800-331-1875