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HomeMy WebLinkAbout48991-Z �O�OSUFfa1 pG� Town of Southold 6/3/2023 0 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44161 Date: 6/3/2023 THIS CERTIFIES that the building ALTERATION Location of Property: 200 Soundview Ave,Mattituck SCTM#: 473889 Sec/Block/Lot: 100.-1-25 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/24/2023 pursuant to which Building Permit No. ),48991 dated 3/6/2023 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: hot water heater to existing single family dwelling as applied for. The certificate is issued to Grodin,Jaclyn&Mendelson,Claude of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48991 5/2/2023 PLUMBERS CERTIFICATION DATED Aut riz d S' n tore r, �oGy TOWN OF SOUTHOLD g�FFOtK aA` BUILDING DEPARTMENT C, z TOWN CLERK'S OFFICE SOUTHOLD, NY r 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#: 48991 Date: 3/6/2023 Permission is hereby granted to: Grodin, Jaclyn 172 Montague St 15AS Brooklyn, NY 11201 To: Install new hot water heater to existing single family dwelling as applied for. At premises located at: 200 Soundview Ave, Mattituck SCTM # 473889 Sec/Block/Lot# 100.4-25 Pursuant to application dated 2/27/2023 and approved by the Building Inspector. To expire on 9/4/2024. Fees: FURNACE/BOILER-RESIDENTIAL $200.00 CO-RESIDENTIAL $50.00 Total: $250.00 Building Inspector ho��pF SOUTyoI 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin(c)town.southold.ny.us Southold,NY 11971-0959 Q�yCDUNTV,�c� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Jaclyn Grodin Address: 200 Soundview Ave city:Mattituck st: NY zip: 11952 Building Permit#: 48991 section: 100 Block: 1 Lot: 25 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: NH Ross License No: 4605ME SITE DETAILS Office Use Only Residential Indoor Basement Service Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water Elec. GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures 11 Sump Pump Other Equipment: Electric HW Heater-1 Notes: HW Heater Inspector Signature: Date: May 2, 2023 S. Devlin-Cert Electrical Compliance Form qSqql �OF SO(/T* # TOWN OF SOUTHOLD BUILDING DEPT. courm, 631-765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING ] FRAMING /STRAPPING [ FINAL WAO�A 4wh& [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE INSPECTOR F oF souryO� Lr 1° ,�o wl l v j��" v 4 L,-c # TOWN OF SOUTHOLD BUILDING DEPT. � � ao oourm, 631-765-1802 INSPECTION [ ] FOUNDATION IST [ ] 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: `✓( °"I�CT`r " DATE /2 INSPECTOR -- _ -- `— FIELD INSPECTION REPORT DATE COMMENTS OO FOUNDATION (IST) ------------------------------------ �0Ci FOUNDATION (2ND) t 7 No o O � ROUGH FRAMING& -- PLUMBING r INSULATION PER N.Y. "3 STATE ENERGY CODE A C -o ockv NAW ti c n FINAL ADDITIONAL COMMENTS N loq I x> o n b ry s x b y °SUF r�o� TOWN OF SOUTHOLD—BUILDING DEPARTMENT N x� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 hiips://www.southoldtovmny.govDate Received APPLICATION FOR BUILDING PERMIT Q For Office Use Only PERMIT NO. % Building Inspector: FEB 2 4 2023 Applications and forms must be filled out in their entirety. Incomplete BUIWINUOEP$ applications will not be accepted. Where the Applicant is not the owner,an TOWN®FS0UTwom 'Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name:Claude Mendelson scTM#1000-100.-1-25 Project Address 200 Soundview Avenue, Mattituck Phone#:617-851-7408 Email:claude.mendelson@gm,ail.com Mailing Address:200 Soudview Ave.vMattituck,, NY 11952 CONTACT PERSON: Name:Property Owner _. .._.. .._.._ _._ . Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name:N/A Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:NH Ross Inc. / Neal Ross Mailing Address:120 Middle CountryRd, Middle Island, NY 119513-- Phone 1953Phone#:631,-924-0677 Email:service@nhross..com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOther Installation of a Hybrid Electric HV"Water Heater $5,500.00 Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes 59 No 1 PROPERTY INFORMATION Existing use of property:Residential Home. Intended use of property:Resldentlal_- Zone or use district in which premises is situated: Are there any covenants_and restrictions with respect to this property? .Ye No 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 Arnlsdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name):Neal Ross Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) � nSS: COUNTY OF SVIIe-,11j: ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (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 thhis,� k day of e6bry&c!c 20 3 N O 'A110BUSLIC,ESTATE OF NEW Yo,u Registration'hlo.01 ROA883= Qualified in Suffolk CAunly Commission Expires.February 9,20&rj PROPERTY OWNER AUTHORIZATION - (Where the applicant is not the owner) Y) residing at 0 d in IyI., aiie ir � /til`hja,A "I�-Qdo hereby authorize I �l��l to apply on my behalf to the Town of Southold Building Department for approval as described herein. -WINa Owner's Signature ate r Print Owner's Name 2 BUILDING DEPARTMENT- Electri p 1 p�t4 TOWN OF SOUTHOL ��RR Town Hall Annex - 54375 Main Road Bo `"19�023 to , 5 Southold, New York 11971-095 SUJLD11YGDEPT —✓ 4,- ,ao`�`.;>` Telephone (631) 765-1802 - FAX (631) n-WU-rH®LD rogerr(a�southoldtownny.gov seand(aDsoutholdtownnrLgov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: NH Ross Inc Electrician's Name: Neal Ross License No.: 4605-ME Elec. email:service@nhross.com Elec. Phone No: 631-924-0677 ❑I request an email copy of Certificate of Compliance Elec. Address.: 120 Middle Country Road, Middle Island, NY 11953 JOB SITE INFORMATION (All Information Required) Name: Claude Mendelson Address: 200 Soundview Avenue Cross Street: Reeve Road Phone No.: 617-851-7408 Bldg.Permit#: email: claude.mendelson@gmail.com Tax Map District: 1000 Section:100. Block: 1 Lot:25 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Install a Rheem ProTerra 50 Gal Hybrid High Efficiency Electric Water Heater Square Footage: Ina Circle All That Apply: Is job ready for inspection?: YES ❑ NO F—]Rough In ❑✓ Final Do you need a Temp Certificate?: ❑ YES ® NO issued On Temp Information: (All information required) Service Size❑1 PhF—]3 Ph Size: A # Meters Old Meter# ❑New servicer-1 Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION FO BUILDING DEPARTMENT- Electri 1364 TOWN OFSOUTH LV. I:D Town Hall Annex - 54375 Main o Bcdy� 2023 Southold, New York 11 971-095a J 3gCL)E0_ ------ '99%ft"PPiHrULDt Telephone (631) 765-1802 - FAX (631) 7 rogerrCcDsoutholdtownny.-gov - sea nd(CD-southoldtown ny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: NH Ross Inc Electrician's Name: Neal Ross License No.: 4605-ME Elec. email:service@nhross.com Elec. Phone No: 631-924-0677 El I request an email copy of Certificate of Compliance Elec. Address.: 120 Middle Country Road, Middle Island, NY 11953 JOB SITE INFORMATION (All Information Required) Name: Claude Mendelson Address: 200 Soundview Avenue Cross Street: Reeve Road Phone No.: 617-851-74018 BIdg.Permit#: email:claude.mendelson@gmail.com Tax Map District: 1000 Section: 100. Block: 1 Lot:25 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Install a Rheem ProTerra 50 Gal Hybrid High Efficiency Electric Water Heater Square Footage: Tna Circle All That Apply: sti-9 -Iws, -LVO ',r&j] WW aAJ9 iDSCIALct. YES NO FV Rough In Final ] Is job ready for inspection?-. Do you need a Temp Certificate?: F-1 YES FV-] NO Is-sued On Temp Information: (All information required) Service SizeF_11 Ph[—]3 Ph Size: A # Meters Old Meterff ❑New serviceE]Fire ReconnectFFIood Reconnect❑Service Reconnect Elu nderg round[]overhead # Underground Laterals D 1 2 F-1 H Frame F] Pole Work done on Service? F-1 Y DN' Additional Information: PAYMENT DUE WITH APPLICATION �`?� ( Q%� re a I 2Z' PERMIT # Address: Switches Outlets G F I's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven, W/D Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service Amps Have Used Special: Comments _ 1 L 120 Middle Country Road Middle Island, NY 11953 www.nhross.com Email: service@nhross.com Call Ross To The Rescue at 631-9240677 IIwlIt 'Q MAR 14 2023 ID BUILDING®F-PT Dear Caitlin Westermann, To�'V or-Qtlii-11-sr3s;.. Enclosed is a check for Permit BP#48991. Can you please Mail the Permit to the address below.Thank you. Sincerely, Joseph Lombardi NH Ross Inc. Joseph@nhross.com 631-924-0677 Mailing Address: NH Ross Inc. 120 Middle Country Road Middle Island, NY 11953 YN EW ORK workers' CERTIFICATE OF PARTICIPATION STATE Compensation Board Disability or Disability and Paid Family Leave Benefits Group Self-Insurance PART 1.To be completed by Disability or Disability and PFL Benefits Self-Insured Plan Administrator 1a. Legal Name&Address of Insured(use street address only) 1 b.Telephone Number of Insured N.H.Ross, Inc. (631)240-0100 120 Middle Country Rd. Middle Island,NY 11953 1 c.Federal Employer Identification Number of Insured (if no FEIN then use Social Security Number) 11-2233200 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Self-Insured Plan(Association,Union or Trust) (Entity Being Listed as the Certificate Holder) Cardinal Disability Trust Town of Southold 3b.Insurer Identification Number 54375 Route 25 Southold,NY 11971 B-305506 / 3c.Coverage effective period 01/01/2023 through 12/31/2023 4. Group self-insurance provides: 0 A.Both disability and paid family leave benefits. B.Disability benefits only. 5. Group self-insurance covers: QX A.All of the employer's employees eligible under the New York State Disability and Paid Family Leave Benefits Law B!Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized P d istrator r authorized representative of the Self-Insured Plan referenced above and that the named insured has NYS Disability and/or Pai a av s insurance coverage as described above. Date Signed 12/27/2022 By (Si ure of Plan Administrator or authorized representative of the above named plan) Telephone Number 518-724-3583 Name and Title Matthew Mazzotta,Administrator IMPORTANT: If Box 4A and 5A are checked,and this form is signed by the Plan Administrator or authorized representative of that plan,this certificate is complete.Mail it directly to the certificate holder.If Box 4B or 5B is checked,this certificate is incomplete for purposes of Section 220,Subd.8 of the 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 4B 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. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only Plan Administrators or their representatives are authorized to issue Form DB-120.2. 111111 DB-120.2(10-17) °°°1°°11°°1°1°111°�°�!"!'!"IIIIIII J 1 ® DATE(MM/DD/YYYY) A��o CERTIFICATE OF LIABILITY INSURANCE 10/17/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: UNFCU Financial Services LLC d/b/a Industrial Coverage PHONE FAX 62 S Ocean Ave Ste 1 A/c No Ext• 631-736-7500 A/C No):631 Patchogue NY 11772 ADDREss: certs industrialcovera e.com INSURERS AFFORDING COVERAGE NAIC t INSURER A:Merchants Mutual Ins Co 23329 INSURED NHROSSI-01 INSURER B: N H Ross, Inc. 120 Middle Country Road INSURER C: Middle Island NY 11953-2519 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1349810645 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR D WVD POLICY NUMBER MMIDD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY BOP1061411 10/17/2022 10/17/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $500,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT ❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CAP9265309 10/17/2022 10/17/2023 COMBINED SINGLE LIMIT Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR CUP9139060 10/17/2022 10/17/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I X I RETENTION$in n,n PER OTH- $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Reimarks 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 Route 25 Southold NY 11971 AUTHORIZED REPRESENTATIVE USA i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSIF PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A 112233200 0 KEEVILY,SPERO-WHITELAW INC. 500 MAMARONECK AVENUE HARRISON NY 10528 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER N H ROSS INC TOWN OF SOUTHOLD 120 MIDDLE COUNTRY ROAD 54375 ROUTE 25 MIDDLE ISLAND NY 11953 SOUTHOLD NY 11953 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 824 595-3 345917 11/01/2022 TO 11/01/2023 10/20/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 824 595-3, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK,EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS' COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. 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, I SURANCE FUND UNDERWRITING VALIDATION NUMBER: 907803380 IIIpIIp IIIIIImm�mni11n111n111n11nn11n1111m1n111111111n11nmull IIII�i�IIII II II 00000000000108773138 Foran WC-CERT-NOPRMT Version 3(08/29/2019)[WC Policy-8245953] U-26.3 113 rononnonnommOR77313sironm-nnnnnR?4s9s3irs*rirls997-17urarr NnP-CERT 11m-DW11 Certifications indicated hereon signify that this plot of the property depicted hereon was made in accordance with the existing Code of Practice for Land Surveyors adopted by the New York State Association of Professional Land Surveyors. This certification is only for the lands depicted hereon and is not certification of title,zoning or freedom of encumbrances. Said Certifications shall run only to the persons and/or entities listed hereon and are not transferable to additional persons,entities or subsequent owners. AVENV� SD ,1 651'00" MONUMENT FOUND r I o I 66'`Lgr m ° vnRE FENS Q o al0 I m FE QDa. W ALK I0.9'E I MAS. C N"P PLANTER I r- 20.3' PLA 21.3' 'in n 23.3' W M W R/O I M W OD A Z 5WNG Am N Z' r 1 FE � � D Z14) Q1,,I C4 3 13.9'w Ida• 20 I {Y x a 63.2• f O h' O 7 0 I CIE DECK GA CONC. I O O OyL I FE W Q �, FENCE 2.4'E —I 3 o w x M a a s s w 0 I0. :O I x� (0 .— U) W 14 W,^ IIY r� 2 Z z a IV V I � 3 O I� FE La. ON MONUMENT LINE t;Es FOUND 0.7'E MONUMENT SHED 6N� FE FOUND a.6's S 73'00'3 W 125.00' LOT 6 I LOT 26 U.+: SURVEY NEW' SURVEY The offsets or dimensions shown from structures to the property lines are for a specific purpose and use,and therefore,are not intended io guide in the erection of fences,retaining walls, pools,patios,planting areas,odditions to buildings and any other construction. Subsurface and environmental conditions were not examined or considered as a port of Ibis survey. Easements,Rights-of-Way of record,if any,ore not shown.Property corner monuments were nor placed as o pod of this survey. © 2022 BBV PC Barrett Tax Map: DISTRICT 1000 SECTION 100 BLOCK 1 LOT 25 r+ Unauthorized alteration or addition to A �` Banacd & Map of: SALTAIRE ESTATES t4.�^•„�V%•, Van Weele PC 7202 of New York State EducaFon trn+• � Map Lot: 4 Map Block: - _ Engineers e Surveyors Planners Filed: 8/3/1966 No.: 4682 County: SUFFOLK 175A Commerce Drive Hauppauge,NY 11788 T631.435.1111r 631.435.1022 www.bbvpc.COM Situate:MATTRUCKr TOWN OF SOUTHOLD Certified to: Title No.: 7404-013603 Revision BY Dai Copies of this survey map not bear- JACLYN earJACLYN GRODIN 8r CLAUDE MENDELSON Ing the land surveyor's embossed seal and signature shall nor be con- FIDELITY NATIONAL TITLE INSURANCE COMPANY sidered to be a true and.•olid copy Surveyed by: B.S. Drafted by: J.F. Checked 6y: P.F. Project No.: A220107 Scale: I"= 40, Date: MARCH 15 2022 K:\Da22\A22010ADWG\A220107.dWg,TITLE,3/17/2022 3:00:59 PM,Barrett Bowed&Van Weete,P.C.,3F s APPROVED AS NOTX0 OCCUPANCY OR DATE:3-�-� B.P. � USE IS UNLAWFUL FEE�o?,�-� By. ' WITH NOTIFY BUILDING DEPARTMENTAT OUT CERTIFICATE 631-765-1802 8AM TO 4PM FOR THE OF OCCUPANCY FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 2. ROUGH-FRAMING&PLUMBING 3. INSULATION 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR f DESIGN OR CONSTRUCTON ERRORS COMPLY`WITH ALL CODES OF . NEW YORK STATE & TOWN.CODES AS REQUIRED AND CONDITIONS.0F, --_ UTHOLD TOWN ZSA $OUTHOLD TOWN PLANN(NG80AR . � °"REQUIRED SOUTHOLD TOWN TRUSTEES. N.Y.4,DEC_ ;74 PLUMBER CONT ON LEAD ENT BEFORE CERTIFICATE OF OCCUPANCY SOLDER USED IN WATER SUI'PLYSYSTEAII CW,lN(DT EXCEED 2/10 != I PERFORMANCE -PLATINUM eem,,, The new degree of comfort® PERFORMANCE PLATINUM"' ProTerra Hybrid Electric with LeakGuardTM is the most efficient water heater available Efficiency Operation Modes _ D3 Up to 4.07 UEF reduces operating 0 Energy Saver cost 0 Heat Pump *ENERGY STAR®rated Fl High Demand ' Performance El Electric is C3 Delivers hot water faster than most E i Vacation/Away: 2-28 days(or placed standard electric water heaters on hold indefinitely) 13 Ambient operating range:37-1450 F Plus... is widest in class,offering more days of HP operation annually;designed to ®Premium grade anode rod with meet Northern Climate Spec(Tier 4) resistor extends the life of the tank .. Easy Installation 113/4" NPT water inlet and outlet; 3/4" condensate drain connections a;fi PN a. E7 Easy access side connections D Incoloy stainless steel resistor , *Quick access to electrical junction elements box 0 Dry-fire protection ` *Easily replaces a standard electric 0 Easy access, top mounted washable water heater air filter Integration 0 2" Non-CFC foam insulation °^ LED Screen with built-in water ®Enhanced flow brass drain valve k„ sensor alert with audible alarm EJ Ira Integrated EcoNet®WF-connected' installed Temperature and pressure relief valve technology(2.4 GHz only)and free f� mobile app gives users control El Design certified to NSF/ANSI 372 over water systems,allowing for (Lead Content) customizable temperature,vacation Warranty PERFORMANCE PLATINUM settings, energy savings and system monitoring at home or away. 0 10-Year limited tank and parts Hybrid Visit Rheem.com/hybridsolutions warranty See Residential Warranty Certificate for complete 40, 50, 65 and 80-Gallon ®Integrated leak detection and information Capacities prevention system with factory 208-240 Volt/ 1 PH installed auto water shut-off valve Units meet or exceed ANSI requirements and have limits leaks to no more than 20 been tested according to D.O.E.procedures.Units Electric meet or exceed the energy efficiency requirements ounces of water2 of NAECA,ASHRAE standard g0,ICC Code and all state energy efficiency performance criteria. �LeakSense Built-in Leak Detection s System detects any leak large orBe— O small, internal or external3 -- *Demand Response Ready— CTA-2045 Port easily connects to C U� US utility programs Is LEED Points=3 IWO broadband internet connection required.2Source:Rheem Leak-Sensing Data;testing under a vacuum lock using 50-gallon See specifications chart on back. tank,no expansion tank,average tank pressure of 40 psi,assuming no additional faucets are opened.3 Water leaks from the heater only,as tested across scenarios including a minimum of 5.5mLlhr volume leak rate,using most common installation scenarios. 12/22 FORM NO.THD-PPEH5-30SO Rev.5 The new degree of comfort". I PERFORMANCE PLATINUM" • • Specifications Unlform''Esthfuted, Ht-to:. .Ht.to , Nominal Rated Electric' .Energy, ,Yearly ' First Hu Recovery .Tank Cold Inlet' Hot'' •Unit Approxi Ga)Ion.• Gallon `Model - Breaker "Factor Energy 'Element Compressor RaOng In G.P.H. Height ' .Dlam: :.8 Drain Outlet WL Ship WL Fuel Type Desc. Cap.'; .Cap.. Number. iSize', (UEF) Cost -Wattage, ''BtWH I G.P.H:,.901;F.Rise A , B Valve .&T&P „(LBS.) (LBS.), 1 OFF Tall 40 36 XE40T10HS451.10 30 3.83 $119 4,500 4200 60 26 63" 20-1/4" 3-5/8" .39-5/8"' 157 174 Tall 50 45 XE50T10HS45U0 30 3.88 $117 4,500 4200 67 27 62" 22-1/4" 3-5/8" 39-5/8" 178 218 Tall 65 59 XE65T10HS45U0 30 4.05 $171 4,500 4200 75 27 65" 24-1/4" 3-7/8" 42-3/8" 225 262 - Tall BO 72 XEBOT10HS45U0 30 4.07 $171 4,500 4200 87 27 75" 24-1/4" 3-7/8" 42-3/8" 244 281 2-Clearance Needed . 1 for T&P Release F J , e i B--►I ®® H A C E ® D 0 _DESCRIPTION!.`-: i " DIMENSIONS(SHOWNdN'INCHES)" NOMINAL GALLON - MODEL,- - '' `• - . GAPACM NUMeEn '" A. . g..' C D - E F. G'.- H 40 XE40T10HS451.10 62-5/16 20-1/4 47 3-5/8 39-5/8 23-3/8 20-1/2 787/8 22-3/8 23-1/4 50 XE50TIOHS45UO 61-3/4 22-1/4 47 3-5/8 39-5/8 25-3/8 22-1/2 78-5/8 24-3/8 25-9/16 65 XE65T10HS45U0 64-3/16 24-1/4 49 3-7/8 42-3/8 27-1/2 24-5/8 81-1/8 26-1/2 27-3/8 BO XEBOT10HS45U0 74-3/16 24-1/4 59 3-7/8 42-3/8 27-1/2 24-5/8 91 26-1/2 27-3/8 2 r Hybrid Water Heater Installation Guidelines to Provide Optimal Efficiency Heater: Not Ducted Heater: Not Ducted Room size:Smaller than 700 ft"(e.g.7'x 10'x 10'). Room size:Larger than 700 ft3(e.g.7'x 10'x 10'). Requirements:Full louvered door OR two louvers Requirements:No additional ventilation needed. top and bottom.See below. UU O O o Heater: Not ducted Room:Small Closet Requirements:*Air gap under door equal to 18 in2(0.75"clearance). *Louver must be.located the same height on door as the air exhaust on beater. *Heater air exhaust must be positioned towards louver within one foot of door. O Air exhaust .75" 24" I 12"Max Door Heater: Ducted with inlet OR outlet duct Heater: Ducted with inlet AND outlet duct Room size:Any size room Requirements:Air gap under door equal to 18 in2 Room size:Any size room (0.75"clearance) Requirements:No additional ventilation needed. u U LZ LI Lj 0 J L� 0 .75" 24• 3 11 The new degree of comfort". Hybrid Accessories List :DESCRIPTION _ ".USE FOR ' AP19134 Leak Sensor Automatic detection of internal and external leaks AP20180 Shutoff Valve Automatic shut off of water supply to unit SP21105 Inlet Duct Adapter Kit Allows for ducting to be connected on the top inlet SP17829 Outlet Duct Adapter Kit Allows for ducting to be connected to the unit SP20882 Earthquake Isolation Kit Installations in seismic regions SP20883 Vibration Isolation Kit Installation on non-concrete floors SP20884 8"Diameter UL Certified Termination Kit Termination to the outside or to the attic with 8"diameter SP20885 7"Diameter UL Certified Termination Kit Termination to the outside or to the attic with 7"diameter SP20886 6"Diameter UL Certified Termination Kit Termination to the outside or to the attic with 6"diameter SP20887 5"Diameter UL Certified Termination Kit Termination to the outside or to the attic with 5"diameter SP20888 8"Rheem Approved Damper Kit Exhaust only to the outside ducting configuration(no inlet duct) SP20889 25'Flexible 8"Diameter Duct Kit For up to 25'of ducting SP20890 Rigid Elbow Duct Kit Installation in tight places where space needs to be minimized e ■ice . ¢ .-. Leak Sensor Shutoff Valve Inlet Duct Adapter Kit Outlet Duct Adapter Kit i:,*}�t�` !r ✓� ,.,, m i„.�� ,i',..,. ” )t-,,,n�,^.'?.para a�^`-'+,. .z r 7 Earthquake Isolation Kit Vibration Isolation Kit 8"Diameter UL Certified 7"Diameter UL Certified Termination Kit Termination Kit *,� .K. `' p - -._-..._.. - � �ati'•piyt s,e,�,,.... '!y K ',�� '�pc= § � '".;,"&yr=' . . �pr;n i;,✓�ty �... a ' to +`+ ,- �. rr' =ti1 - 1''"�. .yam .-j- "�•'^i.r4.��a }.,�'�V„ ,;.r hdt� - .. 6"Diameter UL Certified 5"Diameter UL Certified 8"Rheem Approved Damper Kit 25'Flexible 8"Diameter Duct Kit Termination Kit Termination Kit Rigid Elbow Duct Kit In keeping with its policy of continuous progress and product improvement,Rheem reserves the right to make changes without notice. Rheem Water Heating • 1115 Northmeadow Parkway,Suite 100 Roswell,Georgia 30076 • www.rheem.com 4 12/22 FORM NO.THD-PPEH5-30SO Rev.5