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Home My WebLink About50969-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT k rP TOWN CLERK'S OFFICE e 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 #: 50969 Date: 7/19/2024 Permission is hereby granted to: Santosus Brian 212 Campbell Ave Williston Park, NY 11596 To: Construct addition to existing single family dwelling as applied for. At premises located at: 450 Paradise Shore Rd, Southold SCTM #473889 Sec/Block/Lot# 79.-5-12 Pursuant to application dated 5/30/2024 and approved by the Building Inspector. To expire on 1/18/2026. Fees: SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $385.00 CO-ADDITION TO DWELLING $100.00 Total: $485.00 Building Inspector N 1 TOWN OF SOUTHOLD—BUILDING DEPA Tl' :ENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southld,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-95021 :/1ww�v. oothojdto n . Ov Date Received ..........._.. APPLICATION FOR BUIILDI,NG PERMIT For Office Use Only PERMIT NO. 60% Building Inspector. ° Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. " Date:3/1/2024 OWNER(S)OF PROPERTY: Name:Brian Santosus J"T"1000- 79.-5-12 Project Address:450 Paridise Shore Road Southhold NY 11971 Phone#: 516 225-225-3341 Email. /ylac f�rwli fe ver�'ao�. of Mailing Address: 212 Campbell Avenue Williston Park NY 11596 CONTACT PERSON: Name:Angelo Katevatis Mailing Address:355 Sunrise Hwy. West Babylon NY 11704 Phone#:631 422-9190 Email:Angelo@shelIsonly.com DESIGN PROFESSIONAL INFORMATION: Name:Michael Angelone Mailing Address:4 Pond Place Oyster Bay NY 11771 Phone#:516 922-2024 1Email:Angell ss@verizon.net CONTRACTOR INFORMATION: Name:Dennis Katevatis Shells Only of Suffolk Inc. Mailing Address:355 Sunrise Hwy. West Babylon NY 11704 Phone#:631 422-9190 Email:Angelo@shellsonly.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure MAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other $ 65,000 Will the lot be re-graded? ❑Yes MNo Will excess fill be removed from premises? ❑Yes MNo 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 Residential this property? ❑Yes 99No IF YES, PROVIDE A COPY. 8 Check Box After Reading. The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): Angelo Katevatis BAuthorized Agent ❑Owner Signature of Applicant: Date: 30=24-- STATE OF NEW YORK) SS: COUNTY OF suffolk Angelo Katevatis 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 (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 t day of �,20 ' Notary Public GENNARO COZZOLINO Notary Public,State of New York Qualified In Suffolk County a1 PIMS Octa Where the applicant is not theOPERTY OWNER ow AUTHORIZATION rudy cornml�ssdor�Expires o 11,20 2� �°�"( owner) Brian Santosus residing at 212 Campbell Ave Williston park NY 11596 I do hereby authorize Angelo Ka tevatis to apply on my behalf to the T wn of Southold Building Department for approval as described herein. Owner's Signature Date Brian Santosus GENNAROCOzo New Notary Public,State of New York f Qualified In Suftk County Print Owner's Name No.01 C06249654 My Co mmi' ion Expires Oct 11,20 2 Generated by REScheck-Web Software Compliance Certificate Project SANTOSUS Energy Code: 2018 IECC Location: Southold, New York Construction Type. Single-family Project Type: Addition Climate Zone: 4 (5572 HDD) Permit Date: Permit Number: All Electric false Is Renewable false Has Charger false Has Battery: false Has Heat Pump: false Construction Site: Owner/Agent: Designer/Contractor: 450 PARADISE SHORES SANTOSUS SHELLS ONLY SOUTHOLD, N.Y 11971 450 PARADISE SHORES 355 SUNRISE HIGHWAY SOUTHOLD, N.Y 11971 WEST BABYLON, N.Y 11704 6314229190 Compliance: Passes using UA trade-off Compliance: 0.0%Better Than Code Maximum UA: 46 Your UA: 46 Maximum SHGC: 0.40 Your SHGC: 0.34 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 consWered in:the UA or peo orman e cornphance path in R 'Scheck, Each Slab-on-grade assembly in the spedfiied chmate zone must meet the mink-nurn energy code in.suladon R-value and depth requ.unrernents. Envelope Assetrues Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter Ceiling: Flat Ceiling or Scissor Truss 179 38.0 0.0 0.030 0.026 5 5 Ceiling 1: Cathedral Ceiling 75 21.0 0.0 0.048 0.026 4 2 Wall:Wood Frame, 16"D.C. 420 15.0 3.3 0.059 0.060 22 22 Window:Vinyl Frame 52 0.280 0.320 14 16 SHGC: 0.34 Floor CANT:All-Wood Joist/Truss 14 21.0 3.3 0.038 0.047 1 1 Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 1 of10 Compliance Statement. The proposed building design described here ull-,ing plans,specifications, and other calculations submitted with the permit application.The proposed bull 0 has beef Masi CIo rbeet the 2018 IECC requirements in REScheck Version : REScheck-Web and to comply with the mandatory+r'equlreme'nts Ifsec°ro"t're check Inspection Checklist. w 4- Name-Title Signature N7at Or rt ' 4 ,E,ri5 Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 2 of10 REScheck Software Version : REScheck-Web Inspection Checklist Energy Code: 2018 IECC Requirements: 0.0% 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 rnet 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 # Pre-Inspection/Plan Review Value Value Complies? Comments/Assumptions & Req.ID 103.1, Construction drawings and '❑Complies 103.2 documentation demonstrate ❑Does Not [PRJ]1 energy code compliance for the %❑Not Observable d buildling envelope.Thermal envelope represented!on ❑Not Applicable construction documents. 103.1, "Construction drawings and TIC=m Lies 103.2, documentation demonstrate ;❑Does Not 403.7 energy code compliance for ❑Not Observable [PR311 lighting and mechanical systems. ❑Not Applicable NO) ;Systems serving multiple dwelling units must demonstrate compliance with the IECC 'Commercial Provisions. 302.1, Heating and cooling equipment is Heating: Heating: ❑Complies 403.7 sized per ACCA Manual 5 based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: []Not Observable J Manual J or other methods Btu/hr Btu/hr ❑Not Applicable 'approved by the code official. Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 3 of10 section Foundation Inspection Complies? Comments/Assumptions tm Req.11 303.21 'A protective covering is installed to ❑Complies [FO11]2 protect exposed exterior insulation 1❑Does Not and extends a minimum of 6 in. below ❑Not Observable grade. ❑Not Applicable 403,9� 12) installed.w-and ice-melting system controls OComplies Does Not q1,0 []Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 4 of10 section Plans Verified Field Verified # Framing/ Rough-In Inspection Value Value Complies? Comments/Assumptions & Re .ID 402.1.1, Glazing U-factor(area-weighted U- U- ❑Complies See the Envelope Assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, ❑Not Observable 402.5 402.5 ❑Not Applicable 303.1.3 U-factors of fenestration products ❑Complies [FR4]1 are determined in accordance ❑Does Not with the NFRC test procedure or ❑Not Observable taken from the default table. ❑Not Applicable 402.4.1.1 Air barrier and thermal barrier ❑Complies [FR23]1 installed per manufacturer's ❑Does Not instructions. _ j❑Not Observable ❑Not Applicable 402.4.3 Fenestration that is not site built UComplies [FR20]1 is listed and labeled as meeting ❑Does Not AAMA/WDMA/CSA lol/I.S.2/A440 ❑Not Observable or has infiltration rates per NFRC 400 that do not exceed code j❑Not Applicable limits. 402.4.5 IC-rated recessed lighting fixtures "EComplies [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate:52.0 cfm j❑Not Observable leakage at 75 Pa. ❑Not Applicable 403.3.1 Supply and return ducts in attics ;❑Complies [FR12]1 insulated >= R-8 where duct is ❑Does Not >= 3 inches in diameter and >= ❑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 [FR13]1 boxes are sealed with []Does Not � joints/seams compliant with []Not Observable International Mechanical Code or International Residential Code, as ❑Not Applicable applicable. 403.3.5 Building cavities are not used as OComplies [FR15]3 ducts or plenums. ❑Does Not ❑Not Observable ❑Not Applicable 403.4 HVAC piping conveying fluids R- R- [lComplies [FR17]2 above 105 °F or chilled fluids ❑Does Not m below 55 °F are insulated to>_R- ❑Not Observable ❑Not Applicable - 03.4.1 1 Protection of insulation on HVAC �❑Complies 4 [FR24] piping. ❑Does Not � �❑Not Observable ❑Not Applicable 403.5.3 Hot water pipes are insulated to R R- ElComplies [FR18]2 >_R-3. Does Not ❑Not Observable ❑Not Applicable 403.6 Automatic or gravity dampers are ❑Complies [FR19]2 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable 1 High Impact(Tier 1) 2 ,Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 5 of10 Additional Comments/Assumptions: 1 IHigh Impact(Tier 1) Medium impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 6 of10 section Plans Verified Field Verified # Insulation Inspection Value Value Complies? Comments/Assumptions & Req.ID 303.1 ',All installed insulation is labeled ;❑Complies [IN1312 :or the installed R-values ❑Does Not J provided. ❑Not Observable ❑Not Applicable 402.1.1, Floor insulation R-value. R- R ElComplies see the Envelope Assemblies '402.2.6 ❑ Wood ❑ Wood ❑Does Not table for values. [IN111 ❑ Steel ❑ Steel ❑Not Observable ❑Not Applicable 303.2, Floor insulation installed per ❑Complies 402.2.8 manufacturer's instructions and :❑Does Not [IN211 in substantial contact with the ;❑Not Observable ,to underside of the subfloor, or floor 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. 402.1.1, Wall insulation R-value. If this is a R- R- OComplies See the Envelope Assemblies 402.2.5, mass wall with at least 1/2 of the ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ❑ Mass ❑Not Observable [IN311 exterior,the exterior insulation requirement applies (FR10). ❑ Steel ❑ Steel ❑Not Applicable 303.2 Wall insulation is installed per ❑Complies [IN411 manufacturer's instructions. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 7 of10 10 Section Plans Verified Field Verified # ' Final Inspection Provision Com s Value Value plies? ' Comments/Assumptions _F_ 402.1.1, 11'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 ❑Not Applicable [Fill' 303.1.1.1, Ceiling insulation installed per ❑Complies 303.2 manufacturer's instructions. ❑Does Not [F1211 Blown insulation marked every ❑Not Observable 300 ft2. ❑Not Applicable 402.2.3 Vented attics with air permeable ❑Complies [F[22]2 insulation include baffle adjacent ❑Does Not to soffit and eave vents that ❑Not Observable extends over insulation. ❑Not Applicable 402.2.4 Attic access hatch and door R- R- ❑Complies [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 [F117]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable 403.3.3 Ducts are pressure tested to cfm/100 cfm/100 ❑Complies [F127]1 determine air leakage with ft2 ft2 ❑Does Not either: Rough-in test:Total ❑Not Observable leakage measured with a ❑Not Applicable pressure differential of 0.1 inch 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 [F1411 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air ❑Not Observable handler @ 25 Pa. For rough-in ❑Not Applicable tests,verification may need to occur during Framing Inspection. 403.3.2.1 Air handler leakage designated OComplies [FI2411 by manufacturer at<=2%of DDoes Not design air flow„ ❑Not Observable ❑Not Applicable 403.1.1 Programmable thermostats ❑Complies [FI9]2 installed for control of primary ❑Does Not heating and cooling systems and ❑Not Observable 'initially set by manufacturer to ❑Not Applicable code specifications. 403.1.2_ ,Heat pump thermostat installed nComplies [FI10]z on heat pumps. Does Not -]Not Observable s❑Not Applicable 1 403.5.1 .Circulating service hot water '❑Complies [FI11]2 systems have automatic or ❑Does Not accessible manual controls. [_]Not Observable ❑Not Applicable 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 8 of10 Section �Plansified Field VerifiedFinal Inspection Provision Value Complies? Comments/Assumptions & Re .ID ,[]Complies 403.6.1 All mechanical ventilation system ' [F125]2 fans not part of tested and listed ❑Does Not HVAC equipment meet efficacy ❑Not Observable i and air flow limits per Table ❑Not Applicable R403.6.1. 403.2 Hot water boilers supplying heat ;❑Complies [FI26]2 'through one-or two-pipe heating ❑Does Not j systems have outdoor setback ❑Not Observable control to lower boiler water ❑Not Applicable (temperature based on outdoor ,temperature. 403.5.1.1 Heated water circulation systems ❑Complies [F128]2 have a circulation pump.The ❑Does Not ;system return pipe is a dedicated ❑Not Observable return pipe or a cold water supply; ❑Not Applicable pipe.Gravity and thermos- 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 I ;.when water is in circulation loop Pis at set-point temperature and no demand for hot water exists. 403.5.1.2 Electric heat trace systems ❑Complies [FI29]2 comply with IEEE 515.1 or UL ❑Does Not 515.Controls automatically ',;[:]Not Observable adjust the energy input to the heat tracing to maintain the ❑Not Applicable odesired water temperature in the piping. 403.5.2 Demand recirculation water ®Complies [F130]2 systems have controls that ❑Does Not manage operation of the pump ❑Not Observable and limit the temperature of the water entering the cold water ❑Not Applicable �pipina to <= 1049F, 403.5.4 Drain water heat recovery units ❑Complies [17131]2 tested in accordance with CSA r❑Does Not 1355.1. Potable water-side ❑Not Observable ,pressure loss of drain water heat recovery units < 3 psi for ❑Not Applicable individual units connected to one or two showers. Potable water- side pressure loss of drain water beat recovery units< 2 psi for 'iindividual units connected to ,three or more showers. 404.1 090%or more of permanent ❑Commplies [F16]1 fixtures have high efficacy lamps.` '❑Does Not a ❑Not Observable ❑Not Applicable 404.1.1 aFuel gas lighting systems have '❑Complies [FI23]3 :no continuous pilot light. ❑Does Not ❑Not Observable ❑Not Applicable 401.3 Compliance certificate posted. ❑Complies [F17]2 i❑Does Not ❑Not Observable i❑Not Applicable 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 9 of10 SectdoC PNns V, rNfed =FleldVerified e� Inspection Pr,rNsNcn Complies? Comrefis(dunatNcns Value & Re »N 303.3 Manufacturer manuals for ❑Complies [FI18]3 mechanical and water heating ",❑Does Not systems have been provided. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: L11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: SANTOSUS Report date: 05/13/24 Data filename: Page 10 of10 Energy Efficiency e i9 is te s . Above-Grade Wall 18.30 Below-Grade Wall 0.00 Floor 24.30 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): ® . . . . Window 0.28 0.34 Door Heating System: Cooling System: Water Heater; Name: Date: Comments Suffolk County Dept,of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name DENNIS M KATEVATIS Business Name This certifies that the SHELLS ONLY OF SUFFOLK INC bearer is duly licensed License Number H-10251 by the County of suffolk Issued: 11/01/1984 Jew,#,fer Ca4re4-o, Expires: 11/01/2025 Commissioner w NI Y S I F PO Box 66699,Albany,NY 12206 New York State Insurance Fund I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A A A A A A 112788055 1� HAMOND SAFETY MANAGEMENT LLC ,. 6800 JERICHO TURNPIKE SUITE 105W SYOSSET NY 11791 ° SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SHELLS ONLY OF SUFFOLK INC TOWN OF SOUTHOLD ATTN: DENNIS KATEVATIS PO BOX 1179 355 SUNRISE HIGHWAY SOUTHOLD NY 11971 WEST BABYLON NY 11704 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 978 701-1 914375 01/01/2024 TO 01/01/2025 11/22/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 978 701-1, 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. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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 kSURANCE FUND UNDERWRITING VALIDATION NUMBER: 670726547 III II1000 00000 6111111 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-9787011] U-263 2 (00000000000121441016][0001-000009787011][##G][16270-91][Cer1_NoP-CERT 1][01-000011 IDO C 0 CERTIFICATE OF LIABILITY INSURANCE DATE(MM5117120 4 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 INSURED provtseons or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain pollcies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of'such endorsements). YPY PRODUCER 6 GIACIZZO INC/GIACALONE INS.AGY PHONE �� - � No: 57 EAST MAIN ST, UNIT 3 MAIL GIACIZZOINC GMAIL,COM RIVERHEAD, NY 11901 ADDRESS, CONTACT:JEANINE GIACALONE INSURERS AFFORDING COVERAGE NAICR INSURER A:MT HAWLEY INS CO C/O RIPS INSURED INSURER B: SHELLS ONLY OF SUFFOLK, INC DBA INSURERG. _ COMPLETE HOME IMPROVEMENTS BY SHELLS INSURER D:_,, 355 SUNRISE HVVY UJSURERE: W. BABYLON, NY 11704 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. NSR ADDI.SIIBR F EFP F46Lf6 d ILTR TYPEOFINSURANCE POLICYNUMeER NYYYI LIM173 COMMERCIAL GENERAL LIABILFTY Y Y MOL0199612 4/29/2024 4/28/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F1 OCCUR PAgNIP91gLzempc $ 1001000 CONTRACTUAL MED EXP(Any one teen S 6,000 1 X BLANKET AI PERSONAL&ADV INJURY $ 1 000 000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 'L o O00 POLICY J7 LOC PRODUCTS-COMPfOPAGG 'S OTHER $ AUTOMOBILE UABILITY C17MBINE09 k S i ANY AUTO BODILY INJURY(par person) $ OWNED SCHEDULED 130DILY INJURY(Per accidenq $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _m cppp EXCESSLIAe CLAIMS-MADE AGGREGATE S OED I I RETENTIONS $ WORKERS COMPENSATION AND YIN Mandatary M NH)BER NIA LIABILITY E.L.DISEASE-EA ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT OFFICERlMEMBER EXCLUDED? R EMPLOYEEE ,,.w.... It ea,doNcObe under 0" RIPPON OF OPERATI NS W w E.L.DISEASE-POLICY LIMIT S k DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is requhed) k c GC-RESDIENTIAL CONSTRUCTION l 0 CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j PO BOX 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUTHOR IRE I. a4 :1988-2015 ACORD CORPORATION. All rights reserved, ACORD 25(2016103) The ACORD name and logo are registered matks of ACORD IrY"ORKWorkers' l Compensation CERTIFICATE OF INSURANCE COVERAGE Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PANT 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent or that Carrier 1 a. Legal Name and Address of Insured(Use street address only) 1 b. Business Telephone Number of Insured Shells Only Of Suffolk Inc 631-422-9190 Dennis 355 Sunrise Highway 1c. Federal Employer Identification Number or Social Security West Babylon, NY 11704 Number Work Location of Insured(Only required if specifically limited to 112788055 certain locations in New York State,i.e.a Wrap-Up Policy) 2. Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier Hartford Life And (Entity Being Listed as Certificate Holder) 3b. Policy Number of entity listed in box"la": LNY642068 Town of Southold PO Box 1179 3c. Policy effective period: Southold, NY 11971 01/01/2024 01/01/2025 USA 4. Policy provides the following benefits: _A. All for the employer's employees eligible under the New York Disability Law _B. Only the following class or classes of employer's employees: _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 _B. Only the following class 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 Benefits insurance coverage as described above. Date Signed 2/14/2024 By: David M Bore (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone No. 631 673 7600 Name and Title: President IMPORTANT: If box 4a is 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"is checked,this certificate is NOT COMPLETE for the purposes of Section 220, Sub. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit, 328 State Street, Schenectady, New York 12305 PART 2.To be completed by the NYS Workers Compensation Board(Only if Box 4C or 58 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-insured employer has complied with the NYS Disability Benefits Law with respect to all or his/her employees. Date Signed, By (Signature of NYS Workers'Compensation Board Employee) Telephone No. Title: Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS license insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance Brokers are not authorized to issue this form. DB120,1(10-17) Town Hall Annex y°a� "b°� P ( ) Telephone 631 765-1802 54375 Main Road JU Fax(631)765-9502 P.O.Box 1179 a$ ' Southold, NY 11971-0959 BUILDING DERARIMENI PE CONSTRUCTION.,PRE-ENGINEERED ANOtO Date: 05/13/2024 Owner: BRIAN SANTOSUS Location of Property: 450 PARADISE SHORE ROAD, SOUTHOLD,NY 11971 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): ANGELO KATEVATIS (AGENT) Capacity(check applicable line): Owner Owner representative TrussReg15.docx Effective 1/1/2015 Scott A. Russell pSUFFQIr ST0]KMWAT]E1K SUPERVISOR MANAG]EMLENT SOUTHOLD TOWN HALL-P.O.Box 1179 ] 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CATER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) I APPLICANT: (Property Owner, Design Professional, Ag t, Contractor, Other) i� NAME: � ?CfA-T S Date: �� 2 Ll Contact Inform ati n. IE-Mail&Telephone Numher) + Property Address / Location of Construction Site: . ' aSe b at, S.C.T.M. #: 1000 District Section Block Lot I_ TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT Area of Disturbance is less than 1 Acre. No S.P.D E.S. Peg nit 'i Re uir'ed I Project does Not Discharge to Waters of the State. No S.P.I .E.S. Pel`rii)t g Ike taired! - Area of Disturbance is Greater than 1 Adre&Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. PeraaW DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Buildin Permit. - Area of Disturbance is Greater than 1 Acre& Storm-water Runof r Flows Through Southold Towns MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit throw h the Southold Town En2ineer'in De artrraehit Prior to Issuance of a Building Permit. Lk-l"Reviewed By: Date: FORM # CM('P-T(1C(lrtnhw-?(114 (� e c e; red `1 1 q1a1 S.C.T.M. N0. DISTRICT: 1000 SECTION: 79 BLOCK: 5 LOT(S): 12 11 MON. `569� LAND N/F OF IAN BRANDT ^O` 00 j M.H. ] LAND N/F OF 334 MERYL HITTMAN g MON. ry GAS CONC. STEPS LAND N/F RlcHTOFFtAY / JAMES H RICOH III 96 P= s 6q"- 8?„ p N a ?I U.P. 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COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TUT70N LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TUT70N, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE S7RUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE 7HEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUfURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON 7HE PREMISES AT THE TIME OF SURVEY SURVEY OF: DESCRIBED PROPERTY - CERTIFIED TO: BRIAN SANTOSUS; MAP OF: FILED: SITUATED AT: BAYVIEW TOWN OF: SOUTHOLDKENNETH M WOYCHJK LAND SURVEYING, PAC SUFFOLK COUNTY, NEW YORK 2 Professional Land Surveying and Design �r P.O. Box 153 Aquebogue, New York 11931 FILE #224-50 SCALE:1 —30 ' DATE: MAY 8 2024 PHONE (631)298-1566 FAX (631) 296-1588 N.Y.S. LISC. NO. 050882