HomeMy WebLinkAbout49760-Z TOWN OF SOUTHOLD
r BUILDING DEPARTMENT
x TOWN CLERK'S OFFICE
„ 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 #: 49760 Date: 9/21/2023
Permission is hereby granted to:
McGowan L 2021 Rev Trt
2555 Youngs Ave Unit 16E
Southold, NY 11971
To: Install egress window to existing single family dwelling as applied for.
Additional certification may be required.
At premises located at:
2555 Youngs Ave Unit 16E Southold
SCTM #473889
Sec/Block/Lot# 63.1-1-30
Pursuant to application dated 8/29/2023 and approved by the Building Inspector.
To expire on 3/22/2025.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $200.00
CO-ALTERATION TO DWELLING $50.00
Total: $250.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 https-/`/www.southoldtownn . Dov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only AUG 2 9 2023
PERMIT NO. Building Inspector:
Applications and forms must be filled out in their entirety.Incomplete Building Department
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owner's Authorizatioh form`(Page 2)shall be completed.
Date: S"
OWNER(S)OF PROPERTY:
Name: =S&M # 1000-
t' '�
Project Address: �(•� 5, J OL S &'�'
Phone#: // ' b ,3 l Email: M L��l y� � t� �uZ (' ✓h
Mailing Address: A
CONTACT PERSON:
Name: Mi C / a A
Mailing Address: �« 0,2 N A ne Svc /l1
Phone#: ?/ 7 ,/•- k`i 3 -; Email:
DESIGN PROFESSIONAL INFORMATION:
Name: ,3,4 1, ( ("C- op"(SS PD, y.
Mailing Address:
Phone#• �r� C;> 9-d- -7 S 7 Email:
CONTRACTOR INFORMATION:
Name: M A C
Mailing Address: L-2 S;, A-ue , ,,
Phone# S/L �/� - � -) Email: z
DESCRIPTION OF PROPOSED CONSTRUCTION
LINew Structure LAddition LAlteration L epair LLDemolition Estimated Cost of Project:
❑Other "115 e 5 S wt-j �J $
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes El No
i 1
rr� rc� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502I ttt2s://wwuv.soutliol(it,2v i n . ov
BUILDING PERMIT APPLICATION INSTRUCTIONS& CHECKLIST
• Applications and forms must be filled out in their entirety. Incomplete applications will not be
accepted.
• The work covered by this application, including land clearing/site work, may not be commenced before
issuance of a building permit.
• No building shall be occupied or used in whole or in part for any purpose whatsoever until the Building
Inspector issues a Certificate of Occupancy.
• Every building permit shall expire if the work authorized has not commenced within twelve (12)
months after the date of issuance or has not been completed within eighteen (18) months from such
date. If no zoning amendments or other regulations affecting the property have been enacted in the
interim, the Building Inspector may authorize, in writing, the extension of the permit for an additional
6 months. Thereafter, a new permit shall be required.
ALL APPLICATIONS MUST BE SUBMITTED WITH THE FOLLOWING MATERIALS:
❑ Building Permit Application: Complete, signed and notarized.
❑A survey/site plan, drawn to scale at original size, showing the location of lot and of buildings on
premises, relationship to adjoining premises or public streets or areas and waterways.
❑Four (4) sets of plans bearing the signature and original seal of a NYS licensed professional engineer
or architect illustrating compliance with the Building Codes of New York State.
❑Contractor's proof of insurance and Suffolk County license:
• Certificate of Workers' Compensation Insurance (C105.2 or U26.3) AND a Certificate of
Disability Benefits Compensation Insurance (DB120.1)
• Certificate of Liability Insurance
"Note: Final Fees will be calculated by the Building Department using the fee schedule. Fees will be
collected after the permit is written"
ADDITIONAL DOCUMENTATION MAY BE REQUIRED AS IDENTIFIED BELOW:
❑Suffolk County Department of Health Services Approval (original copy)
❑Approval of the Zoning Board of Appeals, Planning Board, and/or Historic Preservation Commission
(if applicable)
❑Electrical Permit Application (FILED SEPERATE'LY): Electrician must have an active license with Suffolk
County
El Flood Plain Develo rnent Permit Application (if applicable)
❑Southold Town Trustees Permits may be required: If any work will be done within 100' of a tidal or
fresh water wetland.
❑NYS D.E.C. Permits may be required: If any work will be done within 300' of a tidal wetland or 100' of
a fresh water wetland
❑1 copy of ComCheck/ ResCheck (if applicable)
L-1 I copy of Manual J, Manual D and Manual S (if applicable)
01 JUization of truss/pre-engineered wood timber construction form (if applicable)
❑Single and separate title search (if applicable)
❑Curb cut permit (NYS or Suffolk County form 239F) (if applicable)
El Original signed Owners Authorization: if applicant is other than owner.
3
12 4
New York State rr,
JL4Department of New York State and Local Sales and Use Tax
Taxation and Finance New
k;ertiflncate of Capiltal Improvement
After this certificate is completed and signed by both the customer and the contractor
performing the capital improvement, it must be kept by the contractor.
Read this form completely before making any entries.
This certificate may not be used to purchase building materials.
Name of customer(print or type) Name of contractor(print or type)
Long Island Egress Pros,Inc
Street address Street address
21A Edison Ave
City State ZIP code City State ZIP code
West Babylon NY 11704
Certificate of Authority number(if any) Certificate of Authority number(if any)
To be completed by the customer:
Describe capital improvement to be performed:
Egress Window Installation
Project name
Street address(where the work is to be performed City State ZIP code
I certify that:
—I am the V owner, ❑ tenant, of the real property identified on this form,and
—The work described above will result in a capital improvement to the real property within the guidelines of this form,and
—This contract(check one) ❑ includes, J;k does not include,the sale of tangible personal property that,when installed, retains its
identity as tangible personal property and does not become a permanent part of the real property.
I understand that:
—I will be responsible for any sales tax, interest,and penalty due on the contractor's total charge for tangible personal property and for
labor, if it is determined that this work does not qualify as a capital improvement,and
—I will be required to pay the contractor the appropriate sales tax on tangible personal property(and any associated services)
transferred to me pursuant to this contract,when the property installed by the contractor does not become a permanent part of the
real property;and
—I will be subject to civil or criminal penalties(or both)under the Tax Law, if I issue a false or fraudulent certificate.
Signature of customer Title Cate
�- Homeowner 08/ 8/2023
To be completed by the contractor:
I,the contractor,certify that I have entered into a contract to perform the work described by the customer named above.(A copy of the
written contract, if any,is attached.)
I understand that my failure to collect tax as a result of accepting an improperly completed certificate will make me personally liable for
the tax otherwise due,plus penalties and interest.
n
re of contractor or officer Title Date
( i 1108/18/2023
This certificate is not valid unless all entries are completed.
Suffolk County Dept. of r
Labor, Licensing &Consumer Affairs
�l
F-OIVF IMPROVEMENT LICENSE
Name
�s
GLEN P DALMAN
_
Busin-"-s Name
This certifies fiat We
rarer is duty licwsed LONG l -0 EGRESS PROS INC
)y the County of suf[oac
License Num c N-54832
Rosalie Drego, Issued: 1 015
ClfRln'•SSa@� Expires: 03101/2025
DocuSign Envelope ID:AB3083C7-B2EE-4653-921 F-43A88DCAA574
Workers' CERTIFICATE OF
YORK
STATC Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Board
la.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured
516-224-7576
LONG ISLAND EGRESS PROS INC
21 EDISON AVE UNIT A
WEST BABYLON NY 1174-1016 1c.NYS Unemployment Insurance Employer Registration Number of
Insured
Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security
certain locations in New York State,i.e.,a Wrap-Up Policy) Number
47-1187417
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Indemnity Insurance Co.of North America
SOUTHOLD BUILDING DEPARTMENT 3b.Policy Number of Entity Listed in Box"1a"
54375 NY-25 C51683407
SOUTHOLD,NY 11971
3c.Policy effective period
10/01/2022 to 10/01/2023
3d.The Proprietor,Partners or Executive Officers are
❑X included.(Only check box if all partners/officers included)
❑ all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers'
compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A
on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send
this Certificate of Insurance to the entity listed above as the certificate holder in box"2".
The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled
due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or
eliminate the insured from the coverage Indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this
Certificate is valid'for one year after this form is approved by the Insurance carrier or its licensed agent,or until the policy
expiration date listed in box"3c",whichever is earlier.
This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,
extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the
referenced policy.
This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect.
Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be
named on a permit„license or contract issued by a certificate holder,the business must provide that certificate holder with a
new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the
mandatory coverage requirements of the New York State Workers'Compensation law.
Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced
above and that the named insured has the coverage as depicted on this form.
Approved by:
(Pmt name
"�`�author¢ed representative or licensed agent of insurance carrier)
- ` 4/10/2023
Approved by: �wae iazrFTW468..
(Signature) (Date)
Title: AsajP199rarn Manager
Telephone Number of authorized representative or licensed agent of insurance carrier: 214-721-6248
Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT
authorized to issue it.
C-105.2(9-17) www.wcb.ny.gov
Acct#:2876747
A0 DATE(MMpDDlYYYY
4 EO CERTIFICATE 4F LIABILITY INSURANCE 411 ,r2�3
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 pollcy(les)must have ADDITIONAL INSU'RE'D provisions or be endorsed.
If SUBROGATION IS WANED,subject to the terms and conditions of the pollcy,certain pollcles may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsemen s).
PRODUCER CONTACT _
SPECIALIZED INSURANCE&SERVICES PHONE ...... -758-6780
), 1458-b
U Ko
204 RTE.112rwlL N "
PATCHOGUE,NY 11772 ADD E 'RUAII'�CDIk�SUl�AiCE.COi4A
INS ORDB°�Q�
Auto-Home-Business-cycle-etc. $ - �c p
,RyD�A_ATLANTIC CASUALTY INSURANCE CO 42846
..........................
INSURED INSLMER 0:
LONG ISLAND EGRESS PROS INC INSURER C:
21 EDISON STREET .,_,.. .�
ER D ..... ._
W BABYLON,NY 11704 INSURER E:
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.
ILN.11R TYPE 0..._.__ ADU AMR _.. .._.. LICY EFF a'OLICY E5R'P LrWT6
FINSURANCE POUCYNUMBER M
COMMERCIALGEHERALLIABILITY Y N L266000514-6 8/25/2022 8P25/2023.EACH OC E E_ 1,000,000
DAMAGETORENIED
CLAIMS-MADE ®OCCUR S �100,000
MED EXP one _j_ ; 5,000
PERSONAL B ADV INJURY ; 11000,000
GEML AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000,000
PRO- LOC PRODUCTS-COMPIOP AGG S��O
pOI�Y❑IECT [:1
OTH MI E
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Per accident) ;
AUTOS ONLY AUTOS
HIRED NON-OWNED 'PROPERTYDAMAGE '
AUTOS ONLY AUTOS ONLY E 1
;
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
. .
......... EXCESS LHIB CLARAS44ADE.I AGGREGATE E �
DED I RETENTION$ $
WORKERS COMPENSATION
OTH-
AND EMPLOYERS'LIABILITY YIN
ANY ETOR/PARTNERAMCUTNE NIA EL EACH ACCIDENT E
OFFICERMMSER EXCLUDED?
(MendaWryfiNN) E.L.DISEASE-EAEMPLOYEE S
iU. oder
R�TfS�t#LIF OPERATIIONS twAaw EL bISEASE-POLICII LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Addlkmal Remarks Scaladulo,may be attadied If more space Is required)
CERTIFCATE HOLDER IS ADDITIONAL INSURED AS PER WRITTEN CONTRACT OR AGREEMENT
v
CERTIFICATE HOLDER. CANCELLATION
SOUTHOLD BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
54375 NY-25 ACCORDANCE WITH THE POLICY PROVISIONS.
SOUTHOLD,NY 11971
AUTHORIZED REPRESENTATIVE ,.
I
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
�T workers CERTIFICATE OF INSURANCE COVERAGE
sa'"' +Compensation
Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrie
1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured
LONG ISLAND EGRESS PROS INC. 516-224-7576
21A EDISON AVENUE
WEST BABYLON,NY 11704
1a Federal Employer Identification Number of Insured
Work Location of Insured(onty required It coverage is specmcally limited to or Social Security Number
certain locations in New Yak State,i.e.,Wrap-Up Polky) 471187417
. _......_w
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) SheiterPoint Life Insurance Company
SOUTHOLD BUILDING DEPARTMENT
54375 NY-25 3b.Polley Number of Entity Listed in Box"19"
SOUTHOLD,NY 11971 DBL484785
3c.Policy effective period
04/14/2022 to 04/13/2024
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:
W A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law.
0 B.Only the following class or classes of employer's employees:
Underpasta ty of peY)ury,1 that I'am an izedi rape taltive or t of the insutf r ref need above and that the named
Insured has NYS Disability andfor Paid Family Leave Benefits insurance coverage as described above.
e
Date Signed 4/10/2023 By r
(Signature of Insurance carriers authorized representatN a or NYS licensed Insurance Agent of that insurance artier)
Telephone Number 516.829-8100 Name and Tiue Richard 1Nftlt6 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.
r
If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS 4
Disability and Paid Family Leave Benefits Law.It must be emailed to PAU@wcb.ny.gov or it can be mailed for
completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200.
PART 2.To be completed by the NYS Workers'Compensation Board(only if sox 4e,4C or 5B have been checked)
State of New York
Workers' Compensation Board
According to information maintained by the NYS Workers'Compensation Board,the above named employer has compbed with the
NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers`Compensation Law)with respect to all of their employees.
Date Signed By
(Signature of Authorized NYS Workers'Compensation Board Empbyee)
Telephone Number Name and True
Please Note:Only Insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS ficensed insurance
agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOTauthorized to Issue this form.
DB-120.1 (12_21)
1111111,1111111101111111 (17-21)
� o
o
PROVIDE WALK-ABLE GRATE
PROVIDE WALK-UP STAIRS
EGRESS WELL SHALL BE EQUIPPED WITH A
PERMANENTLY AFFIXED LADDER OR STEPS GRADE a
USABLE WITH THE WINDOW IN THE FULLY OPEN Q a
POSITION.LADDERS OR STEPS REQUIRED BY w w
THIS SECTION SHALL NOT BE REQUIRED TO Q
COMPLY WITH SECTIONS R311.7 AND R311.8 U z
z
Lu= o c�
CD W zm
cmui
8"CONC.FOUNDATION WALL Wl2#4 BAR TOP& W z
M BOTTOM CONT.OVER 16x8 CONCRETE T - ® uJ o
\� FOOTING Wl3#4 BARS CONT.Wl 2"x4"CONTINUOUS w w
KEYWAY C'7 (A a
c N
6"SAND-GRAVEL MIXTURE SOILS IN ACCORDANCE W
WITH THE UNITED SOIL CLASSIFICATION SYSTEM, CJ m
GROUP I SOILS,AS DETAILED IN TABLE R405.1. • • . w o
WINDOW WELL DETAIL - A 1 "= 1 '-0" REVISIONS:
DRAWN BY:R.ORDONEZ
r
SHEET NUMBI
y
3
OF
1 �
WOOD ACQ BLOCKING WITH CAULK
SEAL AROUND WINDOW PERIMETER
REMOVABLE WEIGHT BEARING T-z°
ALUMINUM GRATE AND POLY
COARVBEORANNAPTOELCYOCVAERRBON
AOTREEQUIVALENT
w a
5'•z" 0_
EGRESS PROS STEEL 56"X36"X60"WINDOW 6-o" Uo
WELL WITH STEEL ESCAPE LADDER IF w c w
OVER 44" m j
U
INSTALL DRAINAGE ROCK BASE,TOP o
OF GRAVEL BASE TO BE APPROX.8" CD O m
BELOW WINDOW SILL(TYP) w Z_ a
W m
W (n
o
d � o
U) W w
WINDOW WELLS REQUIRED FOR EMERGENCY ESCAPE AND RESCUE SHALL W N
INLET GRATING
HAVE HORIZONTAL DIMENSIONS THAT ALLOW THE DOOR OR WINDOW OF THE EMERGENCY ESCAPE AND (D m
RESCUE OPENING TO BE FULLY OPENED.THE HORIZONTAL DIMENSIONS OF THE WINDOW WELL SHALL w o
PROVIDE A MINIMUM NET CLEAR AREA OF 9 SQUARE FEET WITH A MINIMUM HORIZONTAL PROJECTION
AND WIDTH OF 36 INCHES AS PER 2020 I.R.C.R310.2.
REVISIONS:
WINDOW WELL DETAIL - B 1 "= 1 1-011 DRAWN BY:R.ORDONEZ
SHEET NUMBI
EIE
EXISTING 30x15 WINDOW TO BE REPLACED BY
EGRESS PROS INSWING QUICK RELEASE
31"X42"OR EQUIVALENT OR LARGER TO ANY WOOD FUR OUT OF ROUGH
PROVIDE EMERGENCY MEANS OF EGRESS AS OPENING ADJOINING CONCRETE
PER SEC.2020 IRC R310,REQUIRMENTS FOR SHALL BE ACQ OR EQUAL AS PER 2020
EGRESS WINDOW ARE AS FOLLOWS; IRC R317 AND R318
Lu ¢
U a
U) o °
MIN. NET CLEAR OPEN'G=5.7 SQ FT z 2a 3 z w
W V
MIN.NET CLEAR OPEN'G HEIGHT=24" U z
MIN.NET CLEAR OPEN'G WIDTH=20" Z
0 -1
MAX HEIGHT FROM INT.FLOOR=44" 4 6 m
Zm
uj S �
W (n ul
f/J U)LU z
¢
PROPOSED WINDOW WELL PER SECTION 2020 aX o
SWING TYPE WILL BE INSWING SEE MIN IRC R310,EGRESS PROS WELL SYSTEM OR W w
SIZES ABOVE SIMILIAR)IF WINDOW WELL IS DEEPER THAN W N
TIT MUST HAVE A FALL PREVENTION OR N
GUARDRAIL AS PER IRC CODE R312 m
W
EXISTING FOUNDATION MUST BE SAW
CUT TO ACCOMMODATE NEW EGRESS
WINDOW ALONG WITH NEW 2X6 REVISIONS:
HEADER OR 112"STEEL LINTEL
DRAWN BY:R.ORDONEZ
WINDOW WELL DETAIL - C 1 "= 1 '-O" SHEET NUMBI
3
0 3 oF\