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HomeMy WebLinkAbout48592-Z g1}Ef01 o Town of Southold 3/23/2023 K Y P.O.Box 1179 N ap 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43936 Date: 3/23/2023 THIS CERTIFIES that the building ACCESSORY Location of Property: 3655 Pequash Ave, Cutchogue SCTM#: 473889 Sec/Block/Lot: 137.-2-20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/13/2022 pursuant to which Building Permit No. 48592 dated 12/13/2022 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: "as built"accessory pavillion(with mini fridge and BBQ)as applied for. The certificate is issued to AGK RE Management LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48592 3/6/2023 PLUMBERS CERTIFICATION DATED n �\ r\ 0 \3ji-v i Au o ized nature �o�sufFo� o TOWN OF SOUTHOLD C* BUILDING DEPARTMENT TOWN CLERK'S OFFICE o • �� 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#: 48592 Date: 12/13/2022 Permission is hereby granted to: AGK RE Management LLC 20 Midtown Rd Carle Place, NY 11514 To: Legalize "as built" accessory pavillion to an existing single family dwelling as applied for. At premises located at: 3655 Peguash Ave, Cutchogue SCTM #473889 Sec/Block/Lot# 137.-2-20 Pursuant to application dated 10/13/2022 and approved by the Building Inspector. To expire on 6/13/2024. Fees: AS BUILT-ACCESSORY $584.00 CO-ACCESSORY BUILDING $50.00 Total: $634.00 Building Inspector o��oF so�ryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin�D-town.southold.ny.us Southold,NY 11971-0959 Q�yCOU�'�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: AGK RE Management LLC Address: 3655 Pequash Ave city:Cutchogue st: NY zip: 11935 Building Permit#: 4$592 Section: 137 Block: 2 Lot: 20 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Island Power Electric License No: 52729ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 5 Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures 8 CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan 1 Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency StrobeHeat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Mini Fridge, BBQ Notes: Outdoor Kitchen Pavillion Inspector Signature: - Date: March 6, 2023 S.Devlin-Cert Electrical Compliance Form # TOWN OF SOUTHOLD BUILDING DEPT. 4ourm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINAL q,j,L 1 1090% [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: OL6 __-- nn M 1h S �( S DATE 1O?/7 INSPECTOR of SOUTyOIo L&9;712--- TS &.55 # # TOWN OF SOUTHOLD BUILDING DEPT. cou631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS:1411 1 n USEC'a 4244 4-� Oae 1) - wrs v c� r -' ed - e2 I DATE Z 3 INSPECTOR Tiderunner Engineering & Design, P.C. `1 7 Ridgewood St Bay Shore,NY 11706 (631)-839-4824 February 10, 2023 Building Plans Examiner Town of Southold 53095 Main Road Southold,NY 11751 Re: Pavilion Construction Certification Koutsogiannis Residence 3655 Pequash Avenue,Cutchogue,New York Dear Sir or Madam: I have visited the site and reviewed the construction records to determine the work completed. Based on this review and visual inspection I can certify the following: 1. The foundation work was completed per the approved plans and complies with the 2020 NYS Residential Building Code. 2. The rough framing complies with the 2020 NYS Residential Building Code. 3. All of the strapping was completed as per the approved plans. If you have questions please feel free to call SOSCHIyW 0 Sincerel , r �O 770os Louis Schwartz,P.E. pROFFSSIONP� 1 � � :k. jai 1f }� r, �4�t ° K.l+� �,��t��,t f� ti"1 f � i.•�� �;t '��'�` � 4 j 00, ws • 1 I� goo i � �' ,���_ ,.. ---- r . r _ j I - .�•--- .- ;._,...,,,,,cam _ _�, _._.., - - f:= i a r~ _..- •'•."..c....==�``wt's.✓ � ,, ..a. �,�,. ,f;. -- - ---^ws..•. �r. r ..�•..�.• ,n,.,i + :.I r, w - - v.,�i••- ..--_•:�..—�--_`';' S"'o+*'+-. ,�-f.r...:wG..+.. �„�... � �r.w�l.�,y,"rtt"rryt •t'��.I 1 4' s� s . r _ - r Imo. r,* f 7 ( I J � 1Y , r .. rye sa:,, '�,•� Y p....-..... r..; I1 Y � m. Y 4 - - ." u_ Of r wR i WR i 'IELD INSPECTION REPORT DATE COMMENTS 4zss 61b Fok;; OUNDATION (1ST) � '3 --------- �C o'�y FOUNDATION (2ND) Wo ROUGH FRAMING& H PLUMBING Q A INSULATION PER N.Y-- y STATE ENERGY CODE Aft a^— leof d FINAL ADDITIONAL COMMENTS �c lo5qbo -3 q t olz3 K. 2 1 2I — cmc o 31 Z - rA- S rn � k • _ pd W N y Z y x d r� b H S " as�FFotK�o�. TOWN OF SOUTHOLD—BUILDING DEPARTMENT N z Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 �y�• �o� ; Telephone(631)765-1802 Fax(631)765-9502 bttps://www.southoldtomLnw.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use only D [EC5EDVF- PERMIT NO. Ila 5q a Building Inspector: AA a C 1 OCT 3 2022 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an BUILDINGDEPT. Owner's Authorization form(Page 2)shall be completed. TOWN OF SOUTHOLD Date:October 4, 2022 OWNER(S)OF PROPERTY: Name:AGK RE Management LLC scrM#1000-137-02-20 Project Address:3655 Pequash Ave. Cutchogue Phone#:917-622-3821 Email:helen@agkmanagement.com Mailing Address:20 Midtown Road Carle Place NY 11514 CONTACT PERSON: Name:Joan Chambers Mailing Address:PO Box 49 Southold 11971 Phone#:631-294-4241 Email:joanchambers10@gmail.com DESIGN PROFESSIONAL INFORMATION: Name:Lou Schwartz Mailing Address:7 Ridgewood Street Bay Shore NY 11706 Phone#:631-41.0-6838 Email:tiderunnereng@gmail.com CONTRACTOR INFORMATION: Name: Mailing Address: Phone,#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION EINewStructure ❑Addition ❑Alteration 11Repair ODemolition Estimated Cost of Project: El Other As built pavilion beside swimming pool $ Will the lot be-re-graded? OYes 51 No Will excess fill be removed from premises? ❑Yes BNo 1 1 PROPERTY INFORMATION Existing use of property:single family res. Intended use of property:same Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 this property? OYes MNo IF YES,PROVIDE A COPY. IN 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 pass A misdemeanor pursuant to Section 210.45 of the New York State Penal law. Application Submitted By(print name):Joan Chambers INAuthorized Agent ❑Owner Signature of Applicant: Date: 10,4.22 STATE OF NEW YORK) SS: / L COUNTY OF S�fO I 1 J o A 0 Cbeing duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the h (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 "I -day of OL`(`(� e 2012�� aac") -;( ry Public TRACEY L. DWYER C,STATE OF PROPERTY OWNER AUTHORIZATION NOTARYPNO.I01DW630 900 EW YORK (Where the applicant is not the owner) QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2-02U I, �EwaN VUV t6Dc-1AtAUresidingat M ( 0rT0W(\.j PIP C L'( FL . P\4 11514-do hereby authorize �1� G l' 7n'� � to apply on my be If to the Town of Southold Building Department for approval as described herein. 10/7/2022 Owner's Signature Date Helen Koutsogiannis Print Owner's Name 2 BUILDING DEPARTMENT-Electrical Inspector 4 TOWN OF SOUTHOLD CD Town Hall Annex-54375 Main Road -PO Box 1179 y Southold, New York 11971-0959 y oma; Telephone (631) 765-1802 - FAX (631) 765-9502 ro_err southoldtownny.gov - seandOsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Alt Information Required) Date: Feb. 8. 2023 Company Name: island Power Electric Electrician's Name: AI License No.: 52729ME Elec. email: isiandpowerelectric@gmaii.com Elec. Phone No: 631-767-2755 01 request an email copy of Certificate of Compliance Elec. Address.: P.O. Box 591 East Setauket, NY 11733 JOB SITE INFORMATION (All Information Required) Name: Koutsogiannis Residence ( pool pavilion)AGK RE Management LLC Address: 3655 Pequash Ave. Cutchogue Cross Street: Old Pasture Rd. Phone No.: 1-917-622-3821 Bldg.Permit#: 48592 email:helen@agkmanagement.com Tax Map District: 1000 Section:137 Block: 2 Lot:20 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Applicances and lighting for outdoor kitchen in open pavilion. Square Footage: Circle All That Apply: Is job ready for inspection?: YES❑NO ❑Rough In Final Do you need a Temp Certificate?: F-1 YES 0 NO issued On Temp Information: (All information required) Service SizeF11 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service Fire Reconnect[]Fiood Reconnect[]Service Reconnect Underground[]Overhead #Underground Laterals 0 1 n2 0 H Frame n Pole Work done on Service? MY DN Additional Information: PAYMENT DUE WITH APPLICATION 2I FEB 1 0 2023 'R-ec l off'! SD �c�u�`of ni�n�nE� Lfl, �3 P -�, ,.t g S a�— k BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD J � ': Town Hall Annex-54375 Main Road - PO Box 1179 '>j tr Southold, New York 11971-0959 Telephone (631) 765-1602 - FAX (631) 765-9502 roc�err(�southoldtownny.gov -- seandp_southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Feb. 8. 2023 Company Name: island Power Electric Electrician's Name: AI License No.: 52729ME Elec. email: islandpowerelectric@gmaii.com Elec. Phone No: 631-767-2755 ❑I request an email copy of Certificate of Compliance Elec. Address.: P.O. Box 591 East Setauket, NY 11733 JOS SITE INFORMATION (All Information Required) Name: Koutsogiannis Residence ( pool pavilion)AGK RE Management LLC Address: 3655 Pequash Ave. Cutchogue Cross Street: Old Pasture Rd. Phone No.: 1-917-622-3621 Bldg.Permit#: 48592 email:helen@agkmanagement.com Tax Map District: 1000 Section:137 Block: 2 Lot:20 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Applicances and lighting for outdoor kitchen in open pavilion. Square Footage: Circle All That Apply: Is job ready for inspection?: � YES ®NO ®Rough In ® Final Do you need a Temp Certificate?: ❑ YES R]NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ®New Service®Fire Reconnect®Flood Reconnect®Service Reconnect®Underground DOverhead #Underground Laterals n 1 n2 H Frame F1 Pole Work done on Service? Y FIN Additional Information: "'PAYMENT ®UE WITH APPLICATION 211312-3 �a t'o� q 0 FEB 1 0 2023 'R-ec Sv PERMIT # Address: Switches Outlets GFI's Surface Sconces HH's UC Lts Fans Fridge HW Exhaust Oven WAD ' Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service Amps Have Used Special: Comments 3 Concerning: Permit#48592 I l�, t II WI !� AGK RE Management Koutsogiannis Residence I f FEB 1 0 2023 LD. . 3655 Pequash Ave. SUIWINGDEPT Cutchogue 70WNOFSOUTHOLD 2.10.23 John Jarski inspected the "as-built" pool pavilion at the above named property on January 30. 2023. On his ticket he requested a letter of certification from an engineer and an electrical inspection. Attached is the application for an electrical inspection and a check for 90.00 and the letter from the engineer. Please let me know when the CO is issued. Thank-you, Joan Chambers t r -0, 059Z D A-614 Concerning: MAR 0 9 2023 Koutso iannis Residence BU9,LL8InjuJJEP7 g TO�VN®FS+D49'd��®LD 3655 Pequash Ave. Cutchogue NY 3.7.2023 Attn. Sean Devlin You inspected the outdoor kitchen at 3655 Pequash on 2.27.23 and requested some improvements to the electrical devices. This work has been done and I am attaching photos of the alterations. I have also sent you these photos via email. Thank-you, Joan Chambers 631-294-4241 Bunch, Connie From: helen@agkmanagement.com Sent: Wednesday, March 22, 2023 9:35 AM To: Bunch, Connie Subject: RE:CO 3655 Pequash Avenue Cutchogue Thank you, hope you had a nice vacation. , From: Bunch,Connie<Connie.Bunch @town.southold.ny.us> Sent:Wednesday, March 22, 2023 8:19 AM To: 'helen@agkmanagement.com'<helen@agkmanagement.com> Subject: RE: CO What was the address on this? Thank you, Connie From: helen@agkmanagement.com <helen@agkmanagement.com> Sent:Thursday, March 16, 2023 3:41 PM To: Bunch, Connie<Connie.Bunch @town.southold.ny.us> Subject: RE:CO Hi, Hope all is well—would you be able to get me an update on if all is well with the electrical inspection? If that is ok—is the CO ready? Appreciate your help. Thank you! Helen From: Bunch, Connie<Connie.Bunch @town.southold.ny.us> Sent: Monday, March 13, 2023 8:34 AM To: 'helen@agkmanagement.com'<helen@agkmanagement.com> Subject: RE: CO The electrical inspector just needs to type up the certificate, however he does have a pretty large pile of typing to do. Connie From: helen@agkmanagement.com <helen@agkmanagement.com> Sent:Thursday, March 09,2023 3:04 PM To: Bunch,Connie<Connie.Bunch @town.southold.nv.us> Subject: RE:CO i Appreciate the confirmation. Have a good day. Helen From: Bunch, Connie<Connie.Bunch @town.southold.ny.up Sent:Thursday, March 9, 2023 3:03 PM To: 'helen@agkmanagement.com' <helen@agkmanagement.com> Subject: RE:CO Received both,thank you From: helen@agkmanagement.com <helen@agkmanagement.com> Sent:Thursday, March 09, 2023 2:58 PM To: Bunch,Connie<Connie.Bunch @town.southold.nv.us> Subject: RE:CO 2 of 2 From: helen@agkmanagement.com<helen@agkmanagement.com> Sent:Thursday, March 9,2023 2:58 PM To: 'connie.bunch@town.southold.ny.us'<connie.bunch@town.southold.ny.us> Subject: FW: CO 1 of 2 From: helen@agkmanagement.com <helen@agkmanagement.com> Sent:Thursday, March 9, 2023 2:56 PM To: 'connie.bunch@town.southold.ny.us'<connie.bunch @town.southold.ny.us>' Subject: FW:CO Helen Koutsogiannis 917.622.3821 2 Bunch, Connie From: helen@agkmanagement.com Sent: Wednesday, March 22, 2023 2:08 PM To: Bunch, Connie Eoufor n 1 Helen From: Bunch, Connie<Connie.Bunch@town.southold.ny.us> Sent:Wednesday, March 22, 2023 1:37 PM To: 'helen@agkmanagement.com'<helen@agkmanagement.com> Subject: RE:CO The CO should be ready this week.Where would you like it mailed to? Connie From: helen@agkmanagement.com <helen@agkmanagement.com> Sent:Wednesday, March 22, 2023 9:35 AM To: Bunch, Connie<Connie.Bunch @town.southold.nv.us> Subject: RE:CO 3655 Pequash Avenue Cutchogue Thank you, hope you had a nice vacation. From: Bunch, Connie<Connie.Bunch@town.southold.nv.us> Sent:Wednesday, March 22, 2023 8:19 AM To: 'helen@agkmanagement.com'<helen@agkmanagement.com> Subject: RE: CO What was the address on this? Thank you, Connie From: helen@agkmanagement.com <helen@agkmanaRement.com> Sent:Thursday, March 16,2023 3:41 PM To: Bunch, Connie<Connie.Bunch@town.southold.nv.us> Subject: RE: CO Hi, Hope all is well—would you be able to get me an update on if all is well with the electrical inspection? If that is ok—is the CO ready? 1 "NEw Workers' CERTIFICATE OF INSURANCE COVERAGE f_ YORK --� STATE!Lompensation �_- Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured MAE SHED PLAYGROUND LTD 631-451-2200 544 MIDDLE COUNTRY ROAD CORAM,NY 11727 " 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required ifcoverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 471615065 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 Koutsogiannis 3655 Pequash Ave 3b.Policy Number of Entity Listed in Box"1a" Cutchogue, NY 11935 DBL463827 3c.Policy effective period 04/24/2020 to 04/23/2022 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. E] B.Only the following Gass 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 4/12/2021gy l�41,a 4� (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 4B,4C or 513 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 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 Box 4C or 5B of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. e 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. DB-120.1 (10-17) III/IIID!B-°1°2�0IIIIIIIIIIIIIIIIII1117IliIIIIII�) NYS1F New York state insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE r• A^^^A A '471615065 LUPTON&LUCE INC 225 HOWELL AVE a RIVERHEAD NY 11901 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MAE SHED&PLAYGROUND LTD D/B/A KOUTSOGIANNIS WOOD KINGDOM 3655 PEQUASH AVE 544 MIDDLE COUNTRY RD CUTCHOGUE NY 11935 CORAM NY 11727 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12358989-8 430645 04/18/2020 TO 04/18/2021 4/12/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2358 989-8, 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.COWCERTICERTVAL.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 MAUREEN SCHNAPP MAE SHED&PLAYGROUND LTD (ONE PERSON CORP) 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 INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:97344410 U-26.3 NYSIF Nein;York State insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) AAAAAA 471615065 LUPTON&LUCE INC 225 HOWELL AVE ' RIVERHEAD NY 11901 �* SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MAE SHED&PLAYGROUND LTD D/B/A KOUTSOGIANNIS WOOD KINGDOM 3655 PEQUASH AVE 544 MIDDLE COUNTRY RD CUTCHOGUE NY 11935 CORAM NY 11727 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12358989-8 430646 04/18/2021 TO 04/18/20224/12/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2358 989-8, 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://VdWW.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 MAUREEN SCHNAPP MAE SHED&PLAYGROUND LTD (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:939716509 U-26.3 Suffolk County Dept of i Labor,'Licensing&Consumer Affair. f HOME IMPROVEMENT LICENSE A Name i a MAUREEN C SCHNAPP Business Name This certifies that the bearer is duly licensed MAE SHED&PLAYGROUND LTD DBA by the County of suffolk License Number:H-60014 RosalieDrago Issued: 04/11/2018 Commissioner Expires: 04/01/2022 This license is the property of Suffolk County Departmentof Labor,Licensing&Consumer Affair Possession of this license does not guarantee its validity. Additional Business Name WOOD KINGDOM License Category H99-Other ACCORD® CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) 04/13/2021 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 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 NAME: Russell Bond&Co.Inc. PHONE FAx AIC No Ext: A!C( No): 295 Main Street EMAIL ADDRESS: Suite 866 INSURER(S)AFFORDING COVERAGE MAIC# Buffalo NY 14203 INSURERA: Northfield Insurance Company 27987 INSURED INSURER B Wood Kingdom Mae Shed&Playground Ltd dba INSURER C: 544 Middle Country Rd INSURER D: INSURER E. Coram NY 11727 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I OCCUR DAM GE ORE ED PREMISES Ea occurrence S 100,000 MED EXP(Any oneperson) $ Excluded A WH003011 04/08/2021 04/08/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 X CL- POLICY❑JET F]LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea aWdent ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ UMBRELLALIABOCCUREACH OCCURRENCE EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA LE L.EACH ACCIDENT $ (Mandatory in NH) L.DISEASE-EA EMPLO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT Is A Property WH003011 04/0812021 04/08/2022 $100,000 Business Personal Property Included-Equipment Breakdown DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 Koutsogiannis ACCORDANCE WITH THE POLICY PROVISIONS. 3655 Pequash Avenue AUTHORIZED REPRESENTATIVE Cutchogue NY 11935 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD x i PEEVE \ OCT 1 3 2022 / \ '7 TGT Y \ so. ray \\aa, 6q vo. co ro X \ / SITE PLAN 1"=40'_O" 10.4.22 ti 1 / KOUTSOGIANNIS RESIDENCE so / 3655 PEQUASH AVE, CUTCHOGUE NY Ilk a 77006 X A'�OFESSION�� SURVEY OF PROPERTY N \, A T CUTCHOG UE TO WN OF SO UT HOLD ROBERT & PHYW s PHYLUS CALDWELL SUFFOLK COUNTY N. Y. RX p- 1000-137-02-20 0.2'5 + A / SCALE.• 1'=40 JULY 5, 1988 OCTOBER SEPTEMBER 488 9FOUNDA N) 93 (FINAL) + rp \ AUGUST 3, 2020 WOO + CMF >>, AUGUST 24, 2020 (PROPOSED POOL) �r3 0 AC UNITS T O ��t \,•R�i . CHIM. RE13AR O 13 PROPOSED �O O ryg• C� ry0, C. POOL FILTER p. / ` srsTEu g��F.Gov s7t N/O/F TIMBER `l' O`��Q�? WALL woo0 PORCH FEN COR. �2 RAYMOND & ROSE ANNABEL \WINDOW GP DAN �� _ PIPE FND. O• WELL 2ND FLR STEPS OQ�, a TIMBER / WINDOW OM TIMBER WINDOW WELL C_ 'V CLAIM. AS• '9�T ry0 "Q STEPS A36p�D�' A+�\srFrs o� ,SO�10 \ o�•� �,h LOT 3 s O F / PROPOSED \ �6. '`� \ X•A x SPA ° / PROPOSED POOL COMPLIANT FENCE •61 N/0/F ��!/• MARGARET CARNIVALEJ ° WELL® ` ?1, , cr PIPE FND. FEN.COR. `� D.Bw PIPE FND. S5V 55'1 0 r► 20.08' KEY °z PyQ�Tr 0 = REBAR s ® = WELL F(N.COR. UE �'� = STAKE OXE 0.4'E _ TEST HOLE N/O/F • = PIPE �sa�s' h WILLIAM I�OWlTZ 0 CT 1 3 2022 F ■ == MONUMENT � O WAT -V.fIFSr��,f P�Q � DEPT. WETLAND FLAG O," g BS FEN. TOWN O `�O7 = UTILITY POLE Ina. LOT NUMBERS REFER TO 'MAP OF PEQUASH ACRES" "pO FILED IN 7HE SUFFOLK COUNTY CLERK'S OFFICE ON MARCH 30, 1972 AS FILE NO. 5694. �� CDR. ` � LIC. NO. 49618 STAKE 0.3'E ANY AL7ERA77ON OR ADDITION TO 7HIS SURVEY IS A WOLA77ON OF SEC710N FND' o.4N AREA= 49,020 SO. FT. PECO L'�' S, P.C. 7209 OF 7HE NEW YORK STA7E EDUCA77ON LAW. EXCEPT AS PER SECTION (631) 765-5t 20 FAX (631) 765-1797 7209-SUBDIVISION 2. ALL CER77RCATIONS HEREON ARE VAUD FOR THIS MAP P.O. BOX 909 AND COPIES THEREOF ONLY IF SAID MAP OR COPIES BEAR 7HE IMPRESSED 1230 TRAVELER STREET SEAL OF 7HE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. 88-449 SOUTHOLD, N.Y. 11971 �I v �oa.ol APPROVED AS NOTED DATE1a-132s 13.P.#�9 0 I, BY COMPLY WITH ALL CODES OF NOTIFY BUILDING DEPARTMENT AT NEW YORK STATE & TOWN CODES 765-1802 8 AM TO 4 PM FOR THE AS REQUIRED AND CONDITIONS OF FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED ......SOUTHOLD TOWNZBA FOR POURED CONCRETE 2. ROUGH-FRAMING,PLUMBING, SOUTHOLD TOWN PLANNING BOARD STRAPPING, ELECTRICAL&CAULKING 3. INSULATION 4. FINAL-CONSTRUCTION &ELECTRICALSOUTHOLD TOWN TRUSTEES MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE N.Y.S.DEC REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. Additional Certification May Be Required. :x 22'-10'/.'FOOTING/POST CENTERS BUILDING CODES: I I ALL CONSTRUCTION SHALL COMPLY WITH THE , REQUIREMENTS OF ANY AND ALL APPLICABLE STATE, 11,- ---------------------------- COUNTY AND LOCAL BUILDING CODES AND REGULATIONS7"x T PT WOOD POST w/ ' INCLUDING BUT NOT LIMITED TO THE FOLLOWING: -— 8'x 8"VINYL SLEEVE(TYP.) UR-2020 RESIDENTIAL CODE OF NEW YORK STATE Z24"DIA.x 36"DEEP CONCRETE ENGINEERING NOTES: FOOTING AT EACH POST LOCATION -DESIGNED IN ACCORDANCE WITH ; (SEE CROSS SECTION SHEET 3 OF 3) 2020 RESIDENTIAL CODE OF NEW YORK STATE -WIND SPEED Vult= 130 MPH(EXP.C) ROOF LINE ABOVE ; -GROUND SNOW LOAD=25 PSF -SEISMIC DESIGN CATEGORY B,SITE CLASS D ' -FROST DEPTH=36 INCHES -FOUNDATION DESIGN BASED ON A MINIMUM SOIL N BEARING CAPACITY OF 1500 PSF w z , z w CONSTRUCTION NOTES: 0 -ALL LUMBER TO BE PRESSURE TREATED SOUTHERN a° 5 o PINE#1 GRADE,OR AS NOTED a -ALL GLULAMS TO BE 24F V3 SP/SP RATING z %o`� ; z ALL SHEATHING TO BE EXTERIOR GRADE o Qoy o -ATTACH ROOF SHEATHING TO EACH FRAMING ° �aG\ o MEMBER w/8d NAILS @ 6"O.C. o aF00� o -ALL HARDWARE TO BE GALVANIZED,POWDER-COATED OR STAINLESS STEEL,OR AS NOTED ' V -ALL SCREWS#10, LENGTH PER DRAWING,OR AS NOTED -ALL CONCRETE TO BE 3500 PSI(MIN.) NOTE: THERE HAS NOT BEEN ANY MECHANICAL,ELECTRICAL ; OR SITE ENGINEERING PERFORMED FOR THIS PROJECT. IT SHALL BE THE RESPONSIBILITY OF OTHERS TO ' OBTAIN DESIGN DATA FROM A LICENSED ENGINEER FOR THESE SYSTEMS.ENGINEERING SHALL CONFORM WITH ALL APPLICABLE LOCAL AND/OR STATE BUILDING CODES Ak AND REGULATIONS. ----- -------------------------------------------------------------@_ M I 22'-10YO FOOTING/POST CENTERS a a OCT 1 3 2022 FOUNDATION / POST LOCATION PLAN sm TOWN OF SOOT-HOI D PLOT DATE Thursday,Aptil 8,2021 MITCHELL S. WEAVER, RE. srreADDrzEss: 20'x 24'VINYL HIP ROOF PAVILION (4-POST) HONEY BROOK WOODWORKS 774 POWER ROAD KOUTSOGIANNIS RESIDENCE DATE 4/8/2021 SCALE 1/4"= V-0" U.N.O. 98 WILLIAMS RUN ROAD MANHEIM,PA 17545 3655 PEQUASHAVENUE CHRISTIANA PA 17509 P. N. 12-03 CUTCHOGUE,NY 11935 REVISIONS NEW YORK LICENSE No.087906-1 PH:610-593-6884 SUFFOLK COUNTY UNAUTHORIZED REVISIONS VOID THIS DOCUMENT I I SHEET NO. 1 OF 3 12 0-YEAR ASPHALT 12 6� SHINGLES �6 24'-9Y2'ROOF OVERALL a 22"LONG 4x4 CORNER BRACE - --------- : - -- ----------- -- (2)SIMPSON ST2215 STRAP ATTACHED AT EACH END w/ - - - - -- ---- ACROSS ALL RAFTER (4)3/8'DIA.x 6"LONG RSS ORK PLATE SPLICES SCREWS BEHIND ARCH TRIM, 8 TOTAL SCREWS PER BRACE I (TYPICAL) _� I (2)2x8 HIP RAFTERS 22'•10%'POST CENTERS F. 1 2x6 RAFTERS @ 24"O.G. Lok 1 ag I 8"HIGH POST I A 2x12 RAFTER PLATE BASE TRIM(TYP.) a TOP OF FOUNDATION LINE 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 J 1 1 1 1 ATTACH EACH DOUBLE HIP 1 1 W SIDE ELEVATION RAFTER TO RIDGE BEAM W/ ----_: ------ O (4)5/16"DIA.x 4'RSS GRK SCREWS (2)2x6 RAFTERS U- 0 (2)2x6 RAFTERS °' (2)2x8 N RIDGE BEAM ATTACH SINGLE 12 ASP RAFTERS AT TOP w/ 12 6 SH NGLES LT �6 (3)319 SCREWS w %"PLYWOOD w ROOF SHEATHING WARRIOR ROOFING a a ELEPHANT SKIN UNDERLAYMENT 30-YEAR ASPHALT SHINGLES POST BELOW I y 18'-10'/.°POST CENTERS 1 • 1 1 ROOF FRAMING PLAN I TOP OF FOUNDATION LINE SEAL 1 1 1 1 1 1 1 1 9 `f.t•i .. ��Y,,�1�� 1 1 1 1 END ELEVATION PLOT DATE Thursday.Apel 8,2021 MITCHELL S. WEAVER P.E. SMEADDRESS: 20'x 24'VINYL HIP ROOF PAVILION (4-POST) HONEY BROOK WOODWORKS „ , 774 POWER ROAD KOUTSOGIANNIS RESIDENCE DATE 4/8/2021 SCALE 1/4 =1-0U.N.O. MANHEIM,PA 17545 98 WILLIAMS RUN ROAD 3655 PEQUASHAVENUE CHRISTIANA,PA 17509 REVISIONS P.N. 12-03 NEW YORK LICENSE No.087906-1 PH:610-593-6884 CUTCHO 11935 UNAUTHORIZED REVISIONS VOID THIS DOCUMENT SUFFOLLKK COUNTY' SHEET NO. 2 OF 3 (4),T81 DIA.x 10"LONG RSS GRK SCREWS THROUGH TOP OF HIP RAFTERS INTO POST RAFTERS ARE FASTENED TO RAFTER PLATE w/(5)3"NAILS(ONE ON TOP INTO PLATE AND TWO TOE-NAILED INTO PLATE ON EACH SIDE) (1)SIMPSON A23Z ANGLE AT EACH RAFTER, (2)AT DOUBLE HIP RAFTERS 2x12 RAFTER PLATE ATTACH RAFTER PLATE TO HEADER 30-YEAR ASPHALT w/(2)3"WOOD SCREWS @ SHINGLES— 16"O.C.,USE(4)3%n"WOOD SCREWS TO ATTACH RAFTER PLATE WARRIOR ROOFING ELEPHANT (2)2x8 TO POST AT EACH CORNER SKIN UNDERLAYMENT RIDGE BEAM HEADER: 'Y2 PLYWOOD ROOF 3"x11"GLULAM ON INSIDE SHEATHING wl 2x12 ON OUTSIDE 12 514 x 6 FASCIA BOARD (x6 RAFTERS O.C.- 6 (2)2x8 HIP RAFTERTER S RAFTER CONNECTION DETAIL (1)SIMPSON A23Z ANGLE VINYL 12 SCALE:1'=V-0" AT EACH RAFTER, CEILING (2)AT DOUBLE HIP RAFTERS i C9 202 RAFTER PLATE uj 514 x 6 FASCIA BOARD HEADER: O HEADER: 3"x11"GLULAM ON INSIDE 2 3"x11"GLULAM ON INSIDE w/2x12 ON OUTSIDE , ° x w/2x12 ON OUTSIDE 18'-10/, FOOTING'/POST CENTERS I a a (4)GRK 3/8"RSS x 8" I O ad SCREWS I z ;. 7"x7"PT CORNER POST, v~i NOTCHED 1318° 7'x 7"PT WOOD POST w/ g ALL AROUND TOP w18"x8"VINLY SLEEVE +/,"X 11"x 11"POWDER-COATED STEEL BASE PLATE w/'/%x 5"W.x 12"H.TABS (4 SIDES)- (4)3'/"SCREWS ATTACH TO WOOD POST w/(8)'W x 3"LAG BOLTS- aD (4)GRK 3/8"RSS x ATTACH STEEL BASE PLATE TO CONCRETE $'SCREWS w/(4)h"x W SIMPSON TITEN HD SCREW ANCHORS TOP VIEW a D o (MINIMUM 5'/s"EMBEDMENT INTO CONCRETE) HEADER P�> 24'DIA,x 36"DEEP _ _ TOP OF FOUNDATION LINE _ _ - _ - _ _ _ - —_ W a e o > 3"x11"GLULAM ON INSIDE W COVER �. ,°p•� ,� •� CONCRETE FOOTING AT EACH POST LOCATION w/2X12 ON OUTSIDE z ti P �> ` P A> d Q °•-: c O (TYRSCREW----,, � ;4 �° (6)#5 VERTICAL BARS a D � a A � 6 m w W/(3)#3 HOOPS y (4)GRK 3/W RSS x LL 8"SCREWS"R) , SECTION THROUGH 24"DIA. FOOTING CROSS SECTION SCALE:1/2"=V-0" 7"x7"PT CORNER POST , SEAL VIEW"2"" " V--�E HEADER TO POST _ CONNECTION DETAIL NO SCALE EjJ'let PLOT DATE Thursday,Apra 8,2021 MITCHELL S. WEAVER, P.E. SITEADDRESS: 20'x 24'VINYL HIP ROOF PAVILION(4-POST) HONEY BROOK WOODWORKS KOUTSOGIANNIS RESIDENCE DATE 4/8/2021 SCALE 1/4p=1'-0° u.N.o. 774 POWER ROAD 98 WILLIAMS RUN ROAD ~ A.. 3655 PEQUASH AVENUE REVISIONS P.N. 12-03 MANHEtM,PA 17545 CHRISTIANA,PA 17509 : CUTCHOGUE,NY 11935 NEW YORK LICENSE No.087906-1 1 PH:610-593-6884 SUFFOLK COUNTY SHEET NO. 3 OF 3 UNAUTHORIZED REVISIONS VOID THIS DOCUMENT