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HomeMy WebLinkAbout51059-Z TOWN OF SOUTHOLD t BUILDING DEPARTMENT 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 #: 51059 Date: 8/12/2024 Permission is hereby granted to: Cimino, Cono 92 Grandview Ln Smithtown NY 11787 To: install generator ae applied for. At premises located at: 155 W Shore Dr, Southold SCTM # 473869 Sec/Block/Lot # 80.-2-25 Pursuant to application dated 6/24/2024 and approved by the Building Inspector. To expire on 2/1 1/2026. Fees: ACCESSORY $125.00 ELECTRIC $100.00 CERTIFICATE OF OCCUPANCY $100.00 Total: $325.00 Building Inspector TOWN OF SOUTHOLD — BUILDING DEPARTMENT 4 Town Hall Annex 54375 Main Road P_ O. Box 1179 Southold, NY 1 1971-095 9 Telephone (631) 765-1802 Fax (631) 765-9502 https-//NvwNv.sci tholdtown o� Date Received APPLICATION FOR BUILDING PERMIT � 0 �g For Office Use Only PERMIT NO_ Building Inspector: _ 49 e� C. Applications and forms must be filled out in their entirety. Incompletev� applications will not be accepted. Where the Applicant is not the owner, an Owner's Authorization form (Page 2) shall be completed_ Date: OWNER(S) OF PROPERTY: Name: Cona Cimino SCTM # 1000- 80-2-25 Project Address: 155 West Shore Drive, Southold Phone #: 516-860-6001 Email: cono@appleice.com Mailing Address: CONTACT PERSON: Name: Ed Reiff / Gen Ready Mailing Address: 128 Pulaski Road, Kings Park, NY 1 1 754 Phone #:631-544-0400 Email:office@getgenready.com DESIGN PROFESSIONAL INFORMATION: Name: N/A Mailing Address: N/A Phone #: N/A Email: N/A CONTRACTOR INFORMATION: Name: Ed Reiff / Can Ready Mailing Address: 128 Pulaski Road, Kings Park, NY 11754 Phone #: 631-544-0400 1 Email:office@getgenready.com DESCRIPTION OF PROPOSED CONSTRUCTION =New Structure =Addition =Alteration =Repair =Demolition Estimated Cost of Project: i]Other Install a 26kw liquid prapane generator. L . _ � $ 12,150.00 Will the lot be re-graded? =Yes i—mNo Will excess fill be removed from premises? =Yes EgNo 1 PROPERTY INFORMATION Existing use of property: Residence Intended use of property: Residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 this property? (]Yes Isol 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 A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By (print name): Ed Rel / Gen Ready E3Authorized Agent Downer Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF Ed Reiff / Gen Ready 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 ?:�� day of AA 20-ZLV Notary P blic Rost=- IiAF Y FAIT-LLA4 P*iaTA 'd" PUI3LtC-SSTATE or- NEW ` 0fkK Qualified inSaffcliscscrccY 1lliere th e applicant is not the owner I�p ) I Cono Cimino residing at 6010 Soundview Avenue Southold, NY 11791 do hereby authorize Ed Reiff / Gen Ready to apply on my behalf to the To ref old Building Department for approval as describ" here' - Ovrher`s Signature Date Cono Cimino Print Owner's Name 2 BUILDING DEPARTMENT - Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1 179 Southold, New York 1 1 971-0959 - Telephone (631) 765-1 802 - FAX (631) 765-9502 searedar �-- southoldtc)wn t _ ov ro err, sotl-�c�sldtown _ o APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Gen Ready Inc. Electrician's Name: Ed Reiff License No.: ME-2740 Elec. email: office @getgen ready-com Elec_ Phone No: 631-544-0400 1 request an email copy of Certificate of Compliance Elec. Address.: 128 Pulaski Road, Kings Park, NY 11754 JOB SITE INFORMATION (All Information Required) Name: Cono Cimino Address: 155 West Shore Drive, Southold, NY 11971 Cross Street: Oak Drive Phone No.: 516-860-6001 Bldg.Permit #: ==-0-FD- 9 email: cono a@appleice.corn Tax Map District: 1000 Section: 80 Block: 2 Lot: 25 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): .Install a 26kw liquid propane generator. Square Footage: Circle All That Apply: Is job ready for inspection?: YES I I NO Rough In Final Do you need a Temp Certificate?: YES I; l NO Issued On Temp Information: (All information required) Service Size 1 PhF-13 Ph Size: A 4 Meters Old Meter* =New Service= Fire Reconnect[::]Flood Reconnect=Service Reconnect=Underground =Overhead Underground Laterals M 1 M2 M H Frame Pole Work done on Service? Y N Additional Information PAYMENT DUE WITH APPLICATION Mr. Faucet Service Co. Inc. nsta I IGas.com 201 Northwest Dr, STE 1 Farmingdale, NY 11735 Cono Cimino 155 West Shore Drive Southold , NY 11971 existing 499 gallon buried LP tank LP TANKS GENERATOR 1 " poly 18" deep w/tape and wire Suffolk Count Dept. o Labor, Licensing & Consumer Affairs MASTER ELECTRICAL LICENSE Name EDWARDSREIFF Business Name GENREADY INC This certifies that the bearer is duly licensed License Number ME-2740 by the County of suffolk Issued; 05/01/1980 Waq ,T. o-P Expires: 05/01/2026 Commissioner DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 0s/07/2024 THIS CEft-13FICAYE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEitTIFl4=A-rlE 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_ ItSUMMOOATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an ando soment. A statement on this certificate does not confer rights to the certificate holder in lieu of such andarSOMRrtM ._ PRODUCER 1GJA� ,7iCT FARM FAMILY CASUALTY Ne_.gx - N.- 859 CONNETQUOT AVENUE - EVIESS. ISLIP TERRACE, NY 11752 INSURER(S)AFFORDING COVERAGE NAIC# 631-277-7770 INsURERA: FARM FAMILY CASUALTY INS. CO_ 13803 INSURED INSURER B: OENREADY, INC. INSURER C' 128 PULASKI ROAD INSURER o: KINGS PARK NY 11754 IN URER Ec INSURER F: COVERAGES CERTIFICATE NUMBER- 125539 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. I TRTYPEE (JL. ` E?d POLICY EFF #G�I,3CY EIfP LIMITS OF INSURANCE 1NSD }N I POLICY NUMBER Mm/OI7/YYYY Ti14{€7_ _ A X COMMERCIAL GENERAL LIABILITY 31 52X1 390 05/07/2024 05/07/2025_EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE I OCCUR PREW �S rr T $ 100.000 MED EXP(Any one parson) S 5,000 PERSONAL e.ADV INJURY $ 2000 000 CEtTL.ACC' F—G.ATE LIMIT APPLIES PER: GENERAL AGGREGATE REATE $ 4,000,000 X pO ICY JPRO - = LOC PRODUCTS-COMP/OP AGG $ 4,000 OOO OTHER: $ A AUTOMOBILE LIABILITY 3152C4335 05/07/2024 05/07/202 i esearirnt} N - IT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X AUTOS ULED BODILY INJURY(Peraccident) $ X HIRED AUTOS X NON-OWNED _ ) AUTOS (Pr { $ A X UMBRELLA LIAB X OCCUR 3101 E1933 06/03/2023 06/03/202 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION$$10,000 $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N AT - ANY PRCIFRIETOPUPARTNER/EXECUTIVE� N/A'. E-L.EACH ACCIDENT $ OF nqG 5Rt Il HE�EXCLUDED? d zts , E-L-DISEASE-EA EMPLOYEE.. $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ OESCRIPTON OF OPERATIONS/LOCATIONS/VEHICLES(ACDRD 101,Additional Remarks Schedule,may be attached If more space In required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF SOUTHOLD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 MAIN ROAD ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD, NY 11971 AUTHORIZED REPRESENTATIVE 'IS68-2014 .CORD CORTzORATInN- All rights reserve i- ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD uk Lim Wcwkers' CERTIFICATE C)F INSURANCE COVERAGE Compensation NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW �VSVWPEBoard PART 1. To be completed by NYS 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 Gen Ready Inc 631.-544-0400 128 Pulaski Road 1 Kings Park, NY 11754 c. Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured (Only required if coverage is specifically 11-2763133 limited to 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 (Entity Being Listed as the Certificate Holder) Metropolitan Life Insurance Company Town of Southold 3b. Policy Number of Entity Listed in Box 1a 219266 54375 Main Road 3c. Policy Effective Period: Southold, NY 11971 January 1, 2024 to December 31,2024 4. Policy provides the following benefits: ® A. Both disability and Paid Family Leave benefits. o B. Disability benefits only_ o 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. M 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 and/or Paid Family Leave benefits insurance coverage as described above. Date Signed: January 73,7-07-4 By= SiA (signature of insurance carrlees authorized representative or NYS licensed insurance agent of that named insurance carrier) Telephone Number: ADPTS SPL,1 metli som Name and Title: Suzy Davis,State Plan Consultant IMPORTANT: If Boxes 4A and SA 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 56 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 emailed to EALJ cb.nv. e'sv 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 NYS Workers' Compensation Board (t>nly if Box 4Br 4C or 513 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 complied 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 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 OR-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) kw WairkersV ------ sm mpensation CERTIFICATE OF - NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name 8 Address of Insured (use street address only) 1 b. Business Telephone Number of insured ADP TotalSourca MI VII,LLC 6315440400 Shoo rk Windward Parkway Alpharetta, 30005 c. Unemployment 1 NYS Insurance Employer uC/F: Registration Number of Insured Gan Ready Inc 45-25394 5 128 POLASKI RD Ki. _ Employer Identification Number of Insured or Social Security Kings Park.NY 117540000 1d Federal Em p Y y Number Work Location of Insured (Only required/f coverage Is specifically limited to certain locations in New York State, i-e-, a Wrap-(Jp Policy) 112763133 2- Name and Address of Entity Requesting Proof of Coverage 3a_ Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) New Hampshire Insurance Co. Town of Southold 3b. Policy Number of Entity Listed in Box"1 a" 54375 Main Road, WC 034321564 NY Southold,NY 11971 All worhsite employees working for Gen Rea dy Inc paid under ADP TOTALSOURCE, INC's payroll,are covered under the above stated policy. 3c_ Policy effective period 12/28/2023 to 07/01/2024 3d.The Proprietor, Partners or Executive Officers are ®included. (Only check box if all partners/officers included) 0 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"la"for workers'compensation under the New York State Workers'Compensation Law_ (To use this form,New York(I Y) 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 cancelcd due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or elinunate 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: David McElroy (Print name�oF—thorized representative or licensed agent of insurance carrier) Approved by: - V-�e� 02/05/2024 (signature) (-Data) Title: CEO North America Telephone Number of authorized representative or licensed agent of insurance carrier: 800-743-8130 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-1.05.2- Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) Certificate Number: www.wcb.ny.gov Suffolk County Dept. of Labor, Licensing & Consumer Affairs MASTER PLUMBING JS s Name JOSE JIMENES Business Name certifies that the firer is duly licensed BHENRY INC DBA :Fie County of suffolk License Number: MP-63599 Rosalie Vrago Issued_ 02/09/2021 Comn-iissioner Expires: 02/01/2025 This license is the property of Suffolk County Department of Labor, Licensing 86 Consumer Affairs_ `` Possession of this License does not guarantee its validity_ Additional Business Name PIPE DREAMS PLUMBING License Category `VS I New York Stat6 Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^ ^ ^ ^ ^ 472378854 NEEFUS STYPE AGENCY INC 711 UNION AVE PO BOX 2340 AQUEBOGUE NY 11931 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 631 PROPANE INC TOWN OF SOUTHOLD PO BOX 1590 PO BOX 1179 SOUTHAMPTON NY 11969 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12382 065-7 882734 1 02/12/2024 TO 02/12/2025 L-1-6/10/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2382 065-7. 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 PORK, 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.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 FRANK FISHER 631 PROPANE INC (ONE PERSON CORP) 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_ N V` C)RK TAT S11 NEE FUND DiRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 11437778 U-26.3 631 PROP-01 V R E CERTIFICATE OF LIABILITY INSURANCE DAW1012024(MMiDDIYYYY' 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(les) 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 Ileu of such endorsement(s). PRODUCER CONTACT Neefus Stype Agency PHONE g31 722-3500 1 ,N�11 722-3591 711 Union Ave. (A/C,No,Ext ( ) Aquebogue, NY 11931 ,in #Selma re-Corn INSURERS AFFORDING_C_.VERAGE NAIC _A:Crum & Forster lndemni Com an INSURED I INSURER B=General Star Indemni Ins Co 37362 631 Propane Inc. INSUR-eR C: PO Box 1590 INSURER D: Southampton, NY 11969 INSURER E- _ - INSURER F• . OOVERA+GES CERTIFICATE NUMBER: REVISION NUMBEfZ= 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 IADDL.SUBR MaL3CY.FWF POLICY EXP L-rRTYPE OF INSURANCE s _ POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY 1 I EACH OCCURRENCE I $ 7'OOO'OOO CLAIMS-MADE OCCUR X 15 0 6 90 8 3824 _ 1/1/2024 1/1/2025 Pj0`MAGETORENTED $ 300,000 MED. . An. one arson _ 5,000 PERSONAL&ADV INJURY $ 1,000,000, .:IsEN'L AfaR: .t4E.LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 IGY PRO- LOC 2,000,000 JECT E PROAUCTS-GOMP/OP AGG $ OTHER:. I 94 $ A € [ asalIr sINL Liz r 1,000,000 AUTOMOBILE LIABILITY X ANY AUTO =5069083824 1/1/2024 1/1/2025 . BODILY IfM.1l.lRY rear �rsan _ OWNED SCHEDULED AUTOS ONLY I AUTOSWNEp { PPROa�I t AMAG Eaccidan. $$ AUTOS ONLY AUOTO ONLY 1 ' 13 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE .IXG678517 1/31/2024 1/1/2025 I AGGREGATE I $ _ - DED X RETENTIONS , 1 General Agg 1,000,000 WORKERS COMPENSATION t PER OTRH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE €— E.L.EACHACQlf:) NT [ $ O FFICER/M EMBER EXCLUDED? N/A (Mandatory In NMI _ - .E_L.01.SEASE-EA EMPLOY $ If yes,describe under OESGRIPTI.ON OF OPERATIONS belaw . . E..L.DISEASE-POLICY L1M1T $ - £ a DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORO Y01,Additional Remarks Schedule,may be attached tr more spec.is required) Cono Cimino, 155 West Shore Dr., Southold, NY 11971 is included as additional insured with respect to general liability as required by written contract. CEFZTIFICATE HOLDER CANCELLATIIDN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 1179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORO S.C.T.M. NO. DISTRICT: 1000 SECTION:80 BLOCK: 2 LOT(S):25 EL 12.0 EL 13.0 EL 14.0 LOT i 0 a• s. LOT 2 1 EL 17,0 LOT EN TOP I ELEY 17.4/ /rsrrrsi� LOT EL 19.0 s € 1$ U.P. LOT 5 � . :V M PO. EOP. POOL WELL 3{ > - 1 T&: " t EL 17.0 p - EL 15.0 ii ORg55/SIONE - . �s' I N86°21'30"W B. ( 30' t 226.40' LOT 8 1 IM LOT COVERAGE )—c k�v qiIAw,4(— EXIST. GARAGE: 312 S.F. i PROP. POOL & SPA: 644 S.F. DWELLING W/COVRED PATIO: 4352 S.F. 3 TOTAL 5308 S.F. or 17.93% REVISED 12-07-23 REVISED 07-06-23 ZONED R-40 FND LOC. 07-19-22 NON—CONFORMING LOT THE WATER SUPPLY. WELLS, DRYWELLS AND CESSPOOL LOCAT70NS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS AREA: 29,608 S.F. or 0.68 ACRES f ELEVATION DATU7A UNAVINOR12ED ALTERATION OR ADD1770M TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7203 OF THE NEW TURK STATE EDUCA77ON LAW COPIES OF MAP NOT BEARING THE LAND SUR4 YMRS EMBOSSED SEAL SMALL NOT DE CONSIDERED 70 BE A VALID TRUE COPY GUARANI S 1ND THIS SURVEY 7CAco HEREON SHALL RUN ONLY TO THE PERSON FOR WHaW THE SURVEY IS PREPARED AND ON HIS BEHALF TD THE 7771E COMPANY GOI RNMENTAL ACENCY AND LENDING INS77TU77DN LISTED HEREO'Y. AND TO THE ASSIGNEES OF THE LENDING INST71T7T1ON GUARANTEES ARE NOT 7RAN5F£f?A8LE THE 01FSETS OR DIMEN-9CWS SttOKW HEREON FROAf THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCEZ ADDITIONAL .STRUCTURES OR AND OTHER M(pROVEM£NTS EA TS ANDfL1R SUBSURFACE STT UMPES RECORDED O4 UNRECORDED ARE NOT GLIARAN7€ED UNLESS P14 CALLY E9+IDENT ON THE PREHI SS AT THE TIME OF SURWy SURVEY OF: LOTS 1-5 INCL. CONO CIMINO; - CERTIFIED TO: MAP OF: REYDON SHORES $` FILED: MAP No.651 4� SITUATED AT: BAYVIEW F T TOWN OF: SOUTHOLD ' d I I1 L 1I_?vi 1 t1lrCFIi Al4"D StI YITrT PLLC SUFFOLK COUNTY, NEW YORK ,: n Professional Land Surveying and Design P.O. Box 153 Aque ogee, New York 11931 FILE #18-104 SCALE:1"=30 DATE:AUG. 20, 2018 PHONE (831)298-1588 FAX (031) 298-1588 N.Y.S ISC. NO. 050882 maintaining the reoorda of Robert J. Hanneeay&Kenneth M.1Toyohuk