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TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE * SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED'ED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 48823 Date: 1/31/2023 Permission is hereby granted to: Levine Noah 360 Central Park W A t 12E New York NY 10025 To: construct single-family dwelling as applied for per DEC Non-Jurisdiction letter, SCHD & Trustees approvals. At premises located at: 4790 Blue Horizon Bluffs, Peconic SCTM #473889 Sec/Block/Lot# 74.-1-35.56 Pursuant to application dated 8/25/2022 and approved by the Building Inspector. To expire on 8/1/2024. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $2,876.40 CO-NEW DWELLING $50.00 Total: $2,926.40 Buil g Inspector to TOWN OF SOUTHOLD—BUILDING DEPARTME Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1 41959 Telephone (631) 765-1802 Fax (631) 765-9502 l�t�a,, vykv.vv.sotJth ��1 . J 1 202 . Date Re W �OF L'A)r' APPLICATION FOR BUILDING PERMIT For office Use Only PERMIT N0. lYff�_3_ Building Inspector: MAY Applications and forms must be filled out in their entirety. Incomplete ni applications will not be accepted. Where the Applicant is not the owner,an BUILDINGa�r Owner's Authorization form(Page 2)shall be completed. TOVVN OF SOIiTHO I, Date: OWNER(S)OF PROPERTY: Name:Jonathan Rebell/Noah Levine scTM#1000 -01-35.56 Project Address:4790 Blue Horizon Bluffs, Peconic, NY Phone#: JEmail:toM@hfswanson.com Mailing Address3 " C?Lt) 12U' New York, NY 1002-5' CONTACT PERSON: Name:John David Rose Architect P.0 AIA Mailing Address:596 Hampton Road Unit 1, Southampton, NY 11968 Phone#:(631)283-2051 Email:admin@jdrarchitect.com DESIGN PROFESSIONAL INFORMATION: Name:John David Rose Architect P.C. AIA Mailing Address:596 Hampton Road Unit 1 , Southampton, NY 11968 Phone#:(631)283-2051 Email:admin@jdrarchitect.com CONTRACTOR INFORMATION: Name:HF Swanson Construction & Associates LLC Mailing Address:P.O. Box 1897 East Hampton, NY 11937 Phone#:(631)324-6905 Email: ern a DESCRIPTION OF PROPOSED CONSTRUCTION Ig New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $1,460,oar-) Will the lot be re-graded? DYes El No Will excess fill be removed from premises? ❑Yes *No 1 PROPERTY INFORMATION Existing use of property:Residential Intended use of property:Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to RR/R-40 this property? ❑Yes BNo 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 B "nt name):John David Rose Architect P.C.AIA BAuthorized Agent ❑Owner Date: Signature of Applica : STATE OF NEW YORK) SS: COUNTYOF _ U -C-C)U< ) John David Rose Architect P.C. AIA being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the Agent (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 4 , 20 Zz& Notary Public "3111110y P�ubk State of N%wwr"o; No.of pt ? PROPERTY OWNER AUTHORIZATIONi ' "Ik Fjo0 (Where the applicant is not the o er) Noah Levine/Jonathan Rebell Iresiding at 133 W 22nd Street Apt 89, New York, NY, do hereby authorize John David Rose Architect P.C. AIA 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 Town Hall Annex M Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 Hr P.O. Box 1179 m" Southold, NY 11971-0959 BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TY"K"E CON STRUCTION PRE-ENGINEERED WOOD D CONSTRUCTION ANDIOR TIMBER CONSTRUCTION,, N, Date. Owner 3Clir Location of Property:4.21"WI . ...i �"+ Please take notice that the (check applicable line): ✓ New commercial or residential structure Addition to existing commercial or residential structure Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) ✓ Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including girders and beams (F) Roof framing (R) Floor and roof framing (FR) Signature: Name (person submitting this form), _6n ,, , ._.._ . �" Capacity(check applicable line): Owner Owner representative TrussReg15.docx Effective 1/1/2015 0 DATE(MMIDD/YYYY) ACC>R1DI` CERTIFICATE OF LIABILITY INSURANCE 01/24/2023 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). PRODUCERONTACT Barbara Dammers NAtMtE: RoyH Reeve Agency,Inc. PHONE (631)298-4700 (631)298-3850 No.Ext): AVC,No PO Box 54 E-Mbdammers@royreeve.com ADORESSa 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURER A: Southwest Marine and General Insurance Compa INSURED INSURER B: Merchants Preferred Ins CO 12901 HF Swanson Construction Assoc.LLC&H&F Construction Inc. INSURER C PO BOX 1897 INSURER D: INSURER E East Hampton NY 11937 INSURER F: COVERAGES CERTIFICATE NUMBER: CL221111.8019 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 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 AUDL 5U5K POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I SD O POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR PREMISES En aaccurrence $ 100,000 X Contractual Liability MED EXP(Any one person) $ 5,000 A Y Y GL2022LHB00359 10/12/2022 10/12/2023 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY E]PRO ECF1 LOC PRODUCTS-COMP/OPAGG $ 2,000,000 J' l. OTH'E): $ AUTOMOBILE LIABILITY COMBINED SINGLIE LIMIT $ 1,000,000 i E al ac_Cd da111 ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED CAP1067708 11/16/2022 11/16/2023 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - HIRED NON-OWNED PROPERTYDAMAGE. $ AUTOS ONLY AUTOS ONLY Par eccidar+b" UMBRELLALIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE EX2022LHBOO105 10/12/2022 10/12/2023 AGGREGATE $ 5,000,000 DED RETENTION$ 0 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PTATUTE oRH .ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as an additional insured with respect to General Liability as per the terms and conditions of form CG2010(07/04)Addl Insured Owners,Lessees or Contractors,Scheduled Person or Organization as required by written contract.Additional insured includes completed operations per form CG2037(1 0/01)Additional Insured,Owners,Lessees or Contractors Completed Operations. Coverage is primary&non-contributory&a waiver of subrogation applies. Additional insured and waiver apply to auto liability per form#MU8389(7/18)- Commercial Auto Broad Form Endorsement. Excess liability is a follow-form policy so the status of additional insured is implied as this exposure is covered by the underlying general liability. Blanket Waiver of Subrogation applies to umbrella by form#GX1100(03/1)and coverage is Primary&Non-Contributory perform#GX1101(11/13.)There is no exclusion for employee claims&3rd party over actions. 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. P O Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 t ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 113791393 H F SWANSON CONSTRUCTION ASSOCIATES LLC slmffl PO BOX 1897 EAST HAMPTON NY 11937 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER H F SWANSON CONSTRUCTION ASSOCIATES TOWN OF SOUTHOLD LLC P.O. BOX 1179 PO BOX 1897 54375 ROUTE 25 EAST HAMPTON NY 11937 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11464 751-5 739482 09/08/2022 TO 09/08/2023 1/23/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1464 751-5, 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:/IWWW.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 DIRECTOR,ISURANCE FUND UNDERWRITING VALIDATION NUMBER:849391014 U-26.3 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) rml A A A A A A 113791393 H F SWANSON CONSTRUCTION ASSOCIATES LLC µmaa PO BOX 1897 SCAN TO VALIDATE EAST HAMPTON NY 11937 AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER H F SWANSON CONSTRUCTION ASSOCIATES JONATHAN REBELL&NOAH LEVINE LLC 4790 BLUE HORIZON BLUFFS PO BOX 1897 PECONIC NY 11958 EAST HAMPTON NY 11937 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11464751-5 102969 09/08/2022 TO 09/08/2023 1/23/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1464 751-5, 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:/IWWW.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 THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 7k* DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:949094101 U-26.3 re Generated by REScheck-Web Software Compliance Certificate Project 4790 Blue Horizon Bluffs Energy Code: 2018 IECC Location: Peconic, New York Construction Type: Single-family Project Type: New Construction Conditioned Floor Area: 4,751 ft2 Glazing Area 30% Climate Zone: 4 (5572 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 4790 Blue Horizon Bluffs John David Rose Tom Baccarella Peconic, NY 11978 John David Rose,Architect, P.C.AIA NY Building Technology Group 596 Hampton Rd. 159 Rt25a Unit 1 Building 1 Suite 4 Southampton, NY 11968 Miller Place, NY 11764 (631) 283-2051 631-495-0289 admin@jdrarchitect.com Tom@nybtg.com Compliance: 8.8%Better Than Code Maximum UA: 570 Your UA: 520 Maximum SHGC: 0.40 Your SHGC: 0.28 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. 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. E eler)e Assemblies blie Sealed Attic-3" HD +R30 Roxul batt: Cathedral 2,233 50.0 0.0 0.021 0.026 47 58 Ceiling Wall-AGW-2" HD foam w/R13 batt:Wood Frame, 3,060 27.0 0.0 0.051 0.060 110 129 16" D.C. Door 1: Solid 21 0.200 0.320 4 7 Windows: Wood Frame 360 0.320 0.320 115 115 SHGC: 0.28 Glass Doors: Wood Frame 522 0.340 0.320 177 167 SHGC: 0.28 Floor over uncond-2"HD foam w/R30 Roxul Batt:All- 1,194 42.0 0.0 0.024 0.047 29 56 Wood Joist/Truss Basement Wall-2" HD foam: Solid Concrete or Masonry Wall height: 8.8' 446 0.0 12.0 0.059 0.059 23 23 Depth below grade: 6.0' Insulation depth: 8.8' Egress window:Wood Frame 48 0.320 0.320 15 15 SHGC: 0.28 Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 1 of 10 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 building has been designed to meet the 2018 IECC requirements in REScheck Version : REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Tom Baccarella 04/05/2022 Name-Title ure Date Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 2 of 10 REScheck Software Version : REScheck-Web Inspection Checklist st Energy Code: 2018 IECC Requirements: 100.0% 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 ' # I Pre-Inspection/Plan Review ue Value Complies? Comments/Assumptions & Req.ID Val 103.1, Construction drawings and '❑Complies Requirement will be met. 103.2 documentation demonstrate ❑Does Not [PR1]1 energy code compliance for the building envelope.Thermal ❑Not Observable envelope represented on ❑Not Applicable _ construction documents. 1103.1,..._. Construction drawings and '❑Complies �!Requirement will be meta 103.2, documentation demonstrate ❑Does Not 403.7 energy code compliance for [PR3]1 lighting and mechanical systems. ; ❑Not Observable Systems serving multiple ❑Not Applicable dwelling units must demonstrate compliance with the IECC Commercial Provisions. 302.1, Heating and cooling equipment is Heating: Heatingt ❑Complies I Requirement will be met. 403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA Coolin Cool'in Manual J or other methods g" 9a ❑Not Observable approved by the code official. Btu/hr ; Btu/hr ❑Not Applicable Additional Comments/Assumptions: TFHigh Impact(Tierl) 2 M.._..i_._�Imp .. � � _ ..Impact(Tier 3) edium Im act(Tier 2) 3 Low Im„mmm Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 3 of10 section Plans Verified Field Verified value _.Comments/Assumptions & Re ID _.. m�. mm �Foundation Inspection Value . _�. ry�V v Complies?� m � 402.1.1 ;Conditioned basement wall R- R- ❑Complies See the Envelope Assemblies [F04]1 insulation R-value. Where interior R_ R- ❑Does Not table for values. insulation is used,verification may need to occur during ❑Not Observable Insulation Inspection. Not ❑Not Applicable required in warm-humid locations in Climate Zone 3. _._ ........ 303.2 Conditioned basement wall ❑Complies Requirement will be met, [F05]1 insulation installed per ❑Does Not manufacturer's instructions. ❑Not Observable ❑Not Applicable 402.2.9 Conditioned basement wall ft ft '❑Complies See the Envelope Assemblies [F06]1 insulation depth of burial or E❑Does Not table for values. distance from top of wall. ❑Not Observable ; ❑Not Applicable 3.2.1 A protective covering is installed ❑Complies Requirement will be met. IF01112 to protect exposed exterior ❑Does Not insulation and extends a minimum of 6 in. below grade. ❑Not Observable ❑Not Applicable 403.9 Snow-and ice-melting system ❑Complies 'Exception: Requirement is [F012]2 controls installed. ❑Does Not not applicable. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: ,H19h...� 1� _ p T Low Impact(Tier 3) Impact(Tier 1) 2 Medium Impact(Tier 2) 3 .... .......... �mm Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 4 of 10 ID / RouFPlans, ection �'Fr.m�ngh-In Ins echo erified 9 p lue Complies? Comments/Assumptions RenVerifie ie402 1.1 po _ .��....._ Value Van.... Door U-factor„ U- U. ❑Complies See the Envelope Assemblies 402.3.4 ❑Does Not table for values. [FR1]1 ❑Not Observable ❑Not Applicable . ....................... _ .-._ _.� 402.1.1, Glazing U-factor(area-weighted U- U- ❑Complies see the Envelope Assemblies 402.3.1, average). i❑Does Not table for values, 402.3.3, 402.5 ❑Not Observable [FR2]1 ❑Not Applicable 303.1. are deter of fenestration products ❑Complies :Requirement � 303 1 3 U-factors p ent will be met. mined in accordance ❑Does Not with the NFRC test procedure or ❑Not Observable taken from the default table. -..- Applicable 402.4.1.1 Air barrier and thermal barrier � - .. .,.� �Cortri plies Requirement will be met. [FR23]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable r❑Not Applicable 402.4.3 Fenestration that is not site built ® ra plies Requirement Fe will be met. [FR20]1 is listed and labeled as meeting EDoes Not AAMA/WDMA/CSA 101/I.S.2/A440 ❑Not Observable has infiltration rates per NFRC 400 that do not exceed code ❑Not Applicable limits. 402.4.5 IC-rated recessed lighting fixtures ❑Complies :Requirement will be met. [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate :52.0 cfm leakage at 75 Pa. ❑Not Observable +❑Not Applicable Supply and return ducts in attics '. OCor Nies Requirement 403.3.1 p q ent will be met. [FR12]1 'insulated >= R-8 where duct is "❑Does Not >= 3 inches in diameter and >_ ❑ z; Not Observable ;R-6 where < 3 inches. Supply and return ducts in other portions of ❑Not Applicable the building insulated >= R-6 for ;diameter>= 3 inches and R-4.2 _ for< 3 inches in diameter. 403.3.2 'Ducts, air handlers and filter „ � � „ ❑Complies Requirement ..---- ...... will be met. [FR13]1 boxes are sealed with ❑Does Not Joints/seams compliant with ':International Mechanical Code or ❑Not Observable International Residential Code, as ❑Not ApphcabNe applicable. 3.3.5 Building cavities are not used as ❑Complies Requirement will be met. ![FR15]3 ducts or plenums. ❑Does Not �;❑Not Observable ❑Not Applicable 403.4HVAC piping conveying fluids R- _- R _� ❑Corunplies Require ...... ��� -.. .__. ment will be met. [FR17]2 above 105 -F or chilled fluids ❑Does Not below 55 9F are insulated to >_R ;❑Not Observable ; 3. ❑Not Applicable 403...4.1 Protection 11 of insulation on HVAC ❑Complies Requirement will be met. [FR24]1 piping. ❑Does Not ❑Not Observable ❑Not Applicable 403.5.3 Hot water pipes are to R- R ❑Complies p ._..._._...µ_... ..._.�... ...... .� ^ Requirement will be met. [FR18]2 >_R-3. ❑Does Not V, :[—]Not Observable ❑Not Applicable Medium Impact(Tier 2) 3 -_._ 3). ._ ,Low Impact(Tier 3) �1 Hi h ln'r act(Tier 1) � 2 M„ ..... . .� .� ........ Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 5 of10 tion Rough-in Inspe on, iare�v Vr eoBed� Field ueFied �Complies? .... ..Comments/Assumptions "�.. .._,. _ erwtslAsaar�#�tiorros 403 6 to'Automattiic or gravity dampers ure E]Complies Req&ment will he met. (FR191"2, Installed on all outdoor air ElDoes Not intakes and exhausts. ®blot Observable VIot Applhcable Additional Comments/Assumptions: High Impact Tier�) 2 " . _.� p mmIT edium impact(Tier 2) Low impact(Tier 3) Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 6 of 10 Section P PlanValuef�ed FielValuef�ed p ' ....... ._. # Insulation Inspection Com lies Comments/Assumptions 303.1 All installed insulation is labeled &IC'omplies Requirement will be met. [IN13]2 or the installed R-values ODoes Not provided. [-]Not Observable ' 9_.olNot Applicable ; 402.1.1, Floor........... loorinsulation . .u_ _ __..: ..__. .. . .. ... �_ ........ R-value, R- R- nComplles :See the Envelope Assemblies 402.2.6 E] Wood ❑ Wood ; Does Not table for values. [IN1]1 ❑ Steel E] Steel ;❑Not Observable ❑Not Applicable ._ w.. _..�... _.............. 303.2, :Floor insulation installed per UComplies Requirement will be met. 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. _ 402.2. mass wall with at least /z h the - ❑Do plies See t 402.1.1, t 'Wall insulation R-value. If this is a; R- R ❑Co the Envelope Assemblies E 1 ❑ Wood '❑ Wood es Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ;❑ Mass ;❑Not Observable [IN3]1 exterior,the exterior insulation requirement applies (FR10). E] Steel E] Steel ❑Not Applicable 303.2 Wall insulation is installed per .,.... p ❑Complies Requirement will be meta [IN4]1 manufacturer's instructions. ❑Does Not ❑Not Observable ; ❑Not Applicable Additional Comments/Assumptions: �g p ��� Impact(Tier 2) �yLow Impact 1. (Tier 3) Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 7 of10 # FinaL._._ Secti�on Value Value Plans Verified Field Verified Comments/Assumptions & Re D . ITmm ^ IT .... Inspection Provisions C ... ...�.._....._...._._._..... omplies..,. �.. ._.._...�. 402.1.1, :Ceiling insulation R-value. 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 ❑ [Fill' Applicable FI1] .. _ ...... _ _ ........... ............... 303.1.1.1, Ceiling insulation installed per ❑Complies Requirement will be met. 303.2 :manufacturer's instructions. ❑Does Not [F12]1 °Blown insulation marked every 300 ftp. t❑Not Observable ❑Not Applicable 402.2.3 'Vented attics with air permeable i ❑Complies Exception: Requirement is [F122]2 insulation include baffle adjacent ❑Does Not not applicable. to soffit and eave vents that extends over insulation. ❑Not Observable ❑Not Applicable 402.2.4 Attic access hatch and door R R- ❑.... ................ Complies :Requirement will be met. [F13]1 insulation >_R-value of the ❑Does Not adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 :Blower door test @ 50 Pa. <=5 ACH 50 ACH 50 = ❑Complies Requirement will be met. [F117]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable 1 ❑Not Applicable 403.3.3 Ducts are pressure tested to z cfm/100 z cfm/100 _ ❑'Complies handlersareAladucts and air [F127] determine air leakage with ft ft ❑Does Notlocated within either. Rough in test.Total conditioned space. .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 Exception:All ducts and air [F14]1 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not handlers are located within <=3 cfm/100 ft2 without air :conditioned space. ;handler @ 25 Pa. For rough-in ❑Not Observable 1 'tests, verification may need to ❑Not Applicable ,occur during Framing Inspection, ........_ .. .... _ _ 403.3.2.1 :Air handler leakage designated ❑Complies Requirement will be met. [F124]1 by manufacturer at<=2%of ❑Does Not design air flow. ❑Not Observable ❑Not Applicable (9] 1 :installed l of pr ❑DoNot .1able thermostats . .. ... _.. ❑ mpRequirement will be met. heating and cooling systems and initially set by manufacturer to ❑Not Observable .e.... ... code specifications. ❑Not Applicable ... ...... ,..... ��� � � �.�.. _ _ ........ �. 403.1.2 Heat pump thermostat installed ❑Complies Requirement will be met. [Fl 1012 on heat pumps. ❑Does Not ❑Not Observable ❑Not Applicable 403.5.1 Circulating hot water..... � �� �❑CompliesRequirement will be met. [FI11]z systems have automatic or ❑Does Not accessible manual controls. '❑Not Observable ❑Not Applicable 1 High Impact(Tier 1)mmmm 2 !Medium w IT ow Imm�t mm gp pact(Tier 3) Impact 2) 3 L � Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 8 of 10 Final Ins Plans Verified Field Verified Inspection Pro ...a p visions Value Value Complies? Comments/Assumptions Section 403.6.1 All mechanical ventilation system I❑Complies Requirement will be met. [FI25]2 '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 ..... ... ... ........ 40 ..._.: .. a.., a Fro,.. . ...: 3.2 Hot water boilers supplying heat ❑Complies Requirement will be met. [FI26]2 :through one-or two-pipe heating - ❑Does Not systems have outdoor setback control to lower boiler water ❑Not Observable temperature based on outdoor ❑Not Applicable temperature. ., .,. ._.. 03.5.1.1 Heated water circulation systems ` '❑Complies Requirement will be met. [FI28]2 have a circulation pump.The '❑Does Not system return pipe is a dedicated , return pipe or a cold water supply []Not Observable 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. . ..w ........_...._..... _. ..,...,�.._�_ ._.. ...... _ ...... 403.5.1.2 Electric heat trace systems ❑Complies Exception: Requirement is [FI29]2 comply with IEEE 515.1 or UL `❑Davos Not not applicable. 515. Controls automatically adjust the energy input to the ❑Not Observable heat tracing to maintain the ❑Not Applicable desired water temperature in the piping. 403.5.2 Demand recirculation water ❑Com lies Exce tion: Reqeq _ uirement is [F130]2 systems have controls that ❑Does Not not applicable. manage operation of the pump and limit the temperature of the ❑Not Observable water entering the cold water ❑Not Applicable piping to <= 104W. .Drain water heat recovery _ o�..,� 403.5.4 ry s unit ❑Complies Exception: Requirement is [F131]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. �.. � _ ......._....m......... ...... 404.1 90%or more of permanent ❑Complies Requirement will be met. [FI6]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 Compliance certificate posted. � �OComplies 'Requirement ent will be met. [F17]2 ❑Does Not ❑Not Observable (❑Not Applicable 1 h Impact(Ti............ ,.... —w ®_ g p er 1) 2 Medium Impact(Tier 3 Low Impact(Tier 3) Hi Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 9 of 10 setpon pr�al InspectionProvisions .Plans Verified Field r� iVerified .... Complies? �Yes ._ Comments/Assumptions Valpue Value 303E Manufacturer manuals for �Comp � Requirement will be met. (F'11813 mechanical and water heating UlDoes Not systems have been provided. 'Not Observable °ONot Applicable Additional Comments/Assumptions: �t. Hrt�h pmpact C1ier�) 7 Med�urrr N act(,... .qmm ___._ 9,ow Nmpact(T ... .. Project Title: 4790 Blue Horizon Bluffs Report date: 04/02/22 Data filename: Page 10 of 10 NYSIF New York State Insurance Fund PO Box 66699 AlbanY,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^ 113791393 H F SWANSON CONSTRUCTION ASSOCIATES %171 LLC PO BOX 1897 EAST HAMPTON NY 11937 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER H F SWANSON CONSTRUCTION ASSOCIATES JONATHAN REBELL&NOAH LEVINE LLC 4790 BLUE HORIZON BLUFFS PO BOX 1897 PECONIC NY 11958 EAST HAMPTON NY 11937 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11464751-5 781453 09/08/2021 TO 09/08/2022 4/5/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1464 751-5, 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:/MIWW.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 THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 STATE S7*1 GCE FUND 4 D I RECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 145892933 AC CERTIFICATE OF LIABILITY INSURANCE DATE(M �^ 04/055//22022022 Y) 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 CONTACT Barbara Dammers NAME; Roy H Reeve Agency,Inc. PHONE Ext); (631)298-4700 FAX No: (631)298-3850 JAIC,PO Box 54 E- AIt, bdammers@royreeve.com AODRESS. 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: Southwest Marine and General Insurance Compa INSURED INSURER B: Merchants Preferred Ins CO 12901 HF Swanson Construction Assoc.LLC INSURER C: PO Box 1897 INSURERD'; INSURER E East Hampton NY 11937 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2110715460 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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 POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD POLICY NUMBER MMIDDAYYYY MMDD/YYYY.. X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ' CLAIMS-MADE �OCCUR PREMIfSESTEa�occYurrenceE $ 100,000 ," Contractual Liability MED EXP(Any oneperson) $ 5,000 A GL202OLHBOO450 10/12/2021 10/12/2022 PERSONAL&ADV INJURY $ 1,000,000 GENAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYFX PROJECT 0 LOC PRODUCTS COMP/OPAGG $ 2,000,000 OTHFR'. $ AUTOMOBILE LIABILITY COMIBVNIED SINGIE�[TmM T $ 1,000,000 Ea accide�nlry ANYAUTO BODILY INJURY(Per person) $ B OWNED � SCHEDULED CAP1067708 11/16/2021 11/16/2022 BODILY INJURY(Per accident) s AUTOS ONLY AUTOS +' HIRED ^w„r NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY OfNI AUTOS ONLY Per accident) is X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE EX202OLHBOO123 10/12/2021 10/12/2022 AGGREGATE $ 5,000,000 DED TX RETENTION$ O $ WORKERS COMPENSATION PER I OTH AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) E-L,DISEASE-EA EMPLOYEE $ 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 HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Jonathan Rebell&Noah Levine ACCORDANCE WITH THE POLICY PROVISIONS. 4790 Blue Horizon Bluffs AUTHORIZED REPRESENTATIVE Peconic NY 11958 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ;A I� �,,�..f.,,� � ,Yww�,,,.:, r., ? „" d',m rt Ir.,,,,;,, . ter r4„ 1no-,.., _,,,....^•"•-.+�/ ��'.,,,�� Y f� '9d u4,.1'�.0 tl'�. ^,g.w r�,��h rJr. �Mk,:.m,.. �a�` f'''�, kr, ^"dr„�J , ,.ii,r'�;r rvnu ,,,✓u,1i� s�lw�r° ,,,, ,,w�c F,�,,,. ����� �tl� �; ,,, ,.r/, r �Nr ��ll��U Oar , ,��o ��hl� �l r`�r ,,,, nlwy�y f i,N�pk�u �„,�;k�, �0�a��„"�,'�r�� � err�,!!, ,rm, ,�y ".;�`t J. +p. ,,l.,r, ”.,r h'r .w✓na✓'',?,:," V4� N �"..",r»,w��' ,.J �j a I +F�i�""' ur+,� .. m�' uu,iu;� ,f ;vmim��m� '�' ,�. Y rwA 1'^,.-„� v, �• ,�.w„,u 4 � w i".,,ch �' w 4., yukkl. ,„� „� �'„ I , �'Wr'”, r;:� � s� 4..�.. 'p"•,t, ,� di �r' "fi:. r '� ,z'� ",f...„� �^�^i �, °� v' W,m ,M'� v, �,,,,�, �,✓l;�-, :.,G,»w M,µ- ;'17^✓, "'�,,,�� Yf,, d�^� ,d,� - ,�,J,�,�� ',4 � n �sao t�l�� �,�,.u�' i��` �,�b�, �r���� � � �w'Fl� ;�l��� b u,�-n ,✓„„u��. �+ '�' � fir”Y {'ill "�'�i rry. °�)i-Jw, �, �"'''"` r h,,f,���, Y IVIw( �n"7 � �pf �wA{� Y�19�AI ►+ CL —3 J" r o CD VI JM Er i.-r IP k CD to CD n mgCD rL a KP r CD- �i / it ,"^� �l ! � (�D 0 �i � tai ►� � � �` � C1JrA �" /u O O y ✓1F; IS Ej �. r� a pn 00 d0 � „ Cr7 c Ili 1 I �"" � a„r n4r, u� rr�� u��� ,�*I' � �. �;f�., ,, , ��"c I ^� 11 NOP! ,i•Pr.r �) ,^� wr, d�%' ��.w% "^ro,r „ ➢� ,tc t� ""`N � a,��,; ��t i,,.i ,;u�" i nj / �«u.,i�1. 'I.�,.;; wur�; qui PE,;�%',,,�°�: swtrir„��"/ i1 1��` �ya:,�np ,,,r•✓�&nr;/. r �iJPrc"w;� w,', n,w�,Fl�'wc;�°'. yrvp '""r, .,,;ra";lw/�”;ylPp Jq ,;«!`��"„"ah � /�.. ".li:; A% "ri it :r.. nvW... ✓ alm V',� :.ry � .:,,➢ rW,� P 'I�'W J! /rr, W.h "m W" �h� G J.. t ,, .IY't�i d�'�«� I �Y m,ro &��Wik�l,'�I..W�i 1.. G r�r ^flu„ /,i+•r wm” � 6 v qy, v ,� mf���ar alm �'' � ":,a;,,mn�� t� ,./�r/ m, ,/„, �nm r,� r r°�'en �4 rt „r., � r, Ih�i J9` W ,:",, ..� ,w. _,...,F ,al .,,.,d n ,,, ��,:: „� r.,„:%,.tlm Y,,)r ,,. •>, µ,o.N. 1�... , ,,,�,'; d ,. , « �„ „,�,; �^` r rd�mrmwmld��„,wmr „:,,"'mM ”"rtr ai��'w.r ,a w, i »-ww✓u w.rrl ,e w r/�r ew„uuc �w,w,., � ur,�✓:%��,"' rr+W.:�^.�w.; �.m w„�� li,.«.M u?r: a�a�^. fid,�,Jre�,u, t Glenn Goldsmith, president � �� d W Town Hall Annex 'roti q,,r e9 54375 Route 25 A.Niebolas isrupski,Vice President ��� ��-��t'� � l��� �� � P.O. Pox.1179 Eric Sepenoski Southold,New York 11971 Luiz Gillooly � Telephone(631) 765-1892 Elizabeth Peeples �� � l���� � Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10193A Date of Receipt of Application: July 11, 2022 Applicant: Jonathan Rebell & Noah Levine SCTM#: 1000-74-1-35.56 Project Location: 4790 Blue Horizon Bluffs, Peconic Date of Resolution/Issuance: August 17, 2022 Date of Expiration: August 17, 2024 Reviewed by: Elizabeth Peeples, Trustee Project Description: Conduct construction activity within 100' from the landward edge of wetlands for the construction of a new 1,786sq.ft. two-story frame dwelling with a 241sq.ft. screen porch, a 497sq.ft. deck with trellis and 69sq.ft. stairs to ground, a 255sq.ft. side porch with 121sq.ft. stairs to ground, an 800sq.ft. swimming pool; one (1) 8' dia. by 10' effect. Depth discharge drywell for the pool, new IIA sanitary system and removal of existing conventional sewage disposal system. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by Howard W. Young, NYSLS, last dated May 16, 2022, and stamped approved on August 17, 2022. Special Conditions: Installation of gutters to leaders to drywells to contain roof run-off to be installed more than 100 feet from the top of the bluff. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This i nota de t ination,fror ny other agency. Glenn Goldsmith, President Board of Trustees jv,a -21 ag z Z Lu CO to z F=" __ "° yqr - ,.✓" os vy $y wi 6" a ® o Z J m c w a ® UJ v sei ,�u N '`dd Czw ®moo N'. q H1 = O u V o d d a H zwz �a� ,- ° i g w Gzpw a O �! {�'`� awry Z p 3wF zrz 7 4"odar�xy a o ._ o w� o � W 'o`p`yezww g w ° N p n- g o ff 25 o c� Q&V y luL r : O "I In6 L....... ......... ' �� ✓ x 06 w ,w "`-• & ,' M ,A.. Fps iqv, OC I " n y pI i ass' 'e., -11 1,v 46 o ✓a �' i�w M '" k y .M' L », W1, ul fid- oi --2 n I �RIF 91 d I u �a No ® Qo �z �k WtHN 12w G 29 , is � o Gee � stip. >"•' // 5 -z,� ', o y°n z A g g < qmZ w 31: ® Zi Zgo ww®rcaG® w gza zd w c ° n g z`":� ;mow wFnny z�wJo z� M m! zF o Co o w �C z o MIN Cz Gz ooz NZ z '^ c z' �z �`"aGz H',zwu w a � t�o�zo F %nu v Gt�`� z Hod G h z J G z� 5 z z S� *j z GoaQ w o N o� u E, ® z oo z. o9- z ti p ° Eli, C Z o � ., Gwo � Z � w New York State Department of Environmental Conservation Division of Environmental Permits, Region 1 AOk SUNY @ Stony Brook dame 50 Circle Road, Stony Brook, NY 11790-3409 Phone: (631)444-0365 • Fax: (631)444-0360 Website: ,nv oov LETTER OF NO JURISDICTION TIDAL WETLANDS ACT July 19, 2018 Jonathan Rebell Noah Levine 360 Central Park West Apt 12E New York, NY 10025 Re: NYSDEC ID#1-0738-04611/00001 Rebell Property 4790 Blue Horizon Bluffs Peconic, NY 11958 Dear Mr. Rebell Based on the information you submitted, the Department of Environmental Conservation has determined that the portion of the above referenced property shown landward of the 'Crest of Bluff'as evidenced on the survey prepared by Howard W.Young, last revised July 09,2018 is beyond Tidal Wetlands Act(Article 25)jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations(6NYCRR Part 661) no permit is required for project activity proposed landward of the `Crest of Bluff. Be advised, no construction,sedimentation,'or disturbanceof any kind may take place seaward" of the tidal wetlands jurisdictional boundary, as indicated above,without a permit. It is your responsibility to ensure that all precautions are taken to prevent any sedimentation or disturbance within Article 25 jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the jurisdictional boundary and your project(i.e. a 15'wide construction area)or erecting a temporary fence, barrier, or hale bay berm. This letter shall remain valid unless site conditions change. Please note that this letter does not relieve yo of the res sibility of obt ii iy any necessary permits or approvals from other agencies or local n°i i icipalitie , w� S cerei n and e it�miinistr for cc: Thomas Wolpert NYSDEC-TW File % ........... ................ HEAL11-i OMPARTMENT USE NAUS,F'35"'-' f", 71 --------- ............. Id", ............. .................. sousv .......... x Mvl u 11P LINEA=, �.4 .1=P r ON 6112oirl r........... wikrr;'�� TAM coq q�QIXMAX"l Fk)ft SAM G6WIllp �'§T WKNIN Di�,,A",,�jqjqw pqr GF'SsT or By 42:HA LINM�;, j Io, r a _ . � s�ti ,� �� JJJJJJ Lr2 0DIA IP'ED -T FENCE STAKM --FIROPOSF�P 5CR=EN PORC4i C, PROPOSED POPCH PROPOSED ZlUGk— I oA Use ,q I. �I", CA ng I, 3 TEST HOLE FRO.FILED MAP c) CONVERT M' 4R 1G O yj, 5TRX71XfZ TO .. ..... ....... POOL Housr TOPSAIL B (> HINrIoN LOAM (OL) c4 011 SAND, FRCF05ED 5L 25'x&FORCH GRAVEL Ff CLAY SL F` QI E sSI; 5'DIA VED SAND 6RAVEL H P3 EX.SANITARY SYSTEM TO BE Af5AW D IN 4-r ORMAKCC WITH 5CO111,STANDARDS ........ 16 Or -7, NO WATER EN—�RED PROPOSED_ SANITARY vrsTem PROPOSED pRivEYiMl 5HIMM N5 POOL V I 51-HAr- DIA.x 47: 1p" W PROPOSED AATER Smvicr 12115TI115 WATER SERVICE To BE- ABANDONED WELL F] PCA DRIVEWAY TOE;E_ 7 RELOCATED LOT COVERAGE , EXISTrNC 1 STORY FRAME HOUSE 867 SQ,FT 1.6% ------------- TOTAL 867 SQ.FT. PROP05ED 2 STORY FRAME HOUSE 1,773 SQ.FT. 33% LPI SCREEN PORCH 255 SQ.FT 0.61 (2)V DIA I'll�n�ll- DECK =447 SQ.FT -0.9% PORCHES =270 SQ.FT =0.5% TOTAL 3,582 5Q.FT. =6.8% / . ll�P7