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HomeMy WebLinkAbout49800-Z ��O�og1lFfOt�-�,�y Town of Southold 7/9/2024 ate` P.O.Box 1179 o • ,c 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45336 Date: 7/9/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 555 Grandview Dr,Orient SCTM#: 473889 Sec/Block/Lot: 14.-2-3.28 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/23/2023 pursuant to which Building Permit No. 49800 dated 9/28/2023 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: accessory in ground swimming pool fenced to code as applied for. The certificate is issued to 153 Herricks LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 49800 4/23/2024 PLUMBERS CERTIFICATION DATED Au orize ignature �O�gOfFOI�- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o . SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 49800 Date: 9/28/2023 Permission is hereby granted to: Flecken, Leo 610 East Rd Cutchogue, NY 11935 To: Construct in ground swimming pool at single family dwelling as applied for, with no jurisdiction letters as issued by DEC and Trustees. *Note: construction of house must begin PRIOR to installation of swimming pool. At premises located at: 555 Grandview Dr, Orient SCTM #473889 Sec/Block/Lot# 14.-2-3.28 Pursuant to application dated 6/29/2023 and approved by the Building Inspector. To expire on 312912025. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector oF so�ryQl � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q ,�► • �o Southold,NY 11971-0959 sean.devlin(&-town.Southold.ny.us Q�yCOU�'�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Leo Flecken Address: 55 Grandview Dr city:Orient st: NY zip: 11957 Building Permit#: 49800 Section: 14 Block: 2 Lot: 3.28 WAS EXAMINED AND FOUND TO.BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Pro-Line Electric License No: 32279ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New X 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 GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt 1 Recessed Fixtures CO 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 Sump Pump Other Equipment: Pentair 30OW Driver w/ (2) Lights 120GFI, Pump 220GFI, Heater, Timeclock, Water Bond Notes: Pool Inspector Signature: Date: April 23, 2024 S.Devlin-Cert Electrical Compliance Form ' t`� aOE 50GTyolo ul`(_/�` # # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 IN ECTION [ FOUNDATION 1ST77,I J [ ] ROUGH PLBG. [ ] FOUNDATION 2ND M,✓ [ ] 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: n A R 04q DATE INSPECTOR �� yo qq6cow �v,e� � . pF SOUT h� `o # # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm��' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION tt [ ] PRE C/O [ ] RENTAL REMARKS: POO( BfovLlylo ;AAcJ DATE p�- 5 a INSPECTOR _ __ oPsouryOlo # # . TOWN.-OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 INSPECT[ON [ ] FOUNDATION 1ST/ REBAR [ ] 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 — DATE L4 1 Z4 INSPECTOR �V U �O��OF SOUIyo� _�- # # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ �li'NAL � [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: g 2cy ae., 40e O-P m fx- A4 eS k t� - -- are=.�a.: - -�I��� ce,�- �c•�c.. n.�.�.e�.;---- -- - - -- --- poop- 2�X&.s wAJ4.rz DATE -a3-a INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. °ycourm� 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [FINAL �da [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE a INSPECTOR v . All; �, - t t F" i �►•���Y''�l� �� t �r,f�:��. � ,�• � ��•�fir', �,� • �� FRS -•Jj~'�f � � ���n! ,J .����` , `'� r ���� ,Y s:' �l � "fry , Y-• �,+''9Y►1►�►��.3 r�f >��++� 'i`,� t;• � ,. '�}�*�"'fL _� yam+j� w r i;�, I'*! �''i�li i}• ►�i•f�•`k r 1 i �/�n1'. .���:,f r�7'.•2� w•_� •..(��'•-i ,`. �.., ' g;, ^�j'Ir,���I��y'�'F}�• i t L����ui`► .� .i-�°#1`a�`�,j•� - 'r 1' �[ 1_. May 9, 555 Grandvi Orient NY 1195 ;�, '. �. United States �•� �� , , -a" MELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) � ------------------------------- FOUNDATION (2ND) -41 O �3l H ROUGH FRAMING& y PLUMBING G uJ C7` O INSULATION PER N.Y. STATE ENERGY CODE �3,� S2cv/re o wipe. �h G- 'a Ape4e 4s;& or'mosA —All Atcc a-e'Aot- . Vel I.X� 4Xk 4 sf,/.4 41,0s6 IA a.0a i 14e-k 1_ oof hel-h he FINAL VVou,,-.-e. coo ale-, AVUSe C.b. ADDITIONAL COMMENTS a � 2 � t-c� �22''S � � S � tc re l� SZ►� — z 24 Q ec�-• WI a , � k b z x ►-J x d b H P®®Ce ofFox TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 goo• ��o£+. Telephone (631) 765-1802 Fax (631) 765-9502 https://www.sotitholdtowniiv.-gov. Date Received APPLICATION FOR BUILDING PERMIT -� For Office Use Only Xt PERMIT N0. Building Inspector: - JUN 2 3 2023 - 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: TLo-ice f p 23 OWNERS)OF PROPERTY: Name: Leo a/"Lk f��ic e\.�� �G`�eh SCTM# 1000- 4f - Project Address: Phone#: Email/ /: , Mailing Address: �,�(��, J2O4� ��•7LG-L2 C /V eCj) 7 4 / �+k / �7 3-f 'CONTACT PERSON: p� n Name: ' /'7 ` � 1�� Mailing Address: �q4JD\/ C ,, V EE, kE I B I�)�p / 'ty Phone#: '' � 'v 17 I`� �`�' Zi� ? Email: O J-90 fJ I I Q 1 KSW^CD DESIGN PROFESSIONAL INFORMATION: Name: 7-- �� IT)o (J ET fzl Mailing Address:Phone#: (IIC� !_`��� V C S' �- �`,( l 1 � V r t•L� g ) / f'�'7a/ � 1 6 9 I" l `f 1 Email: R i� C l r-C -CV) / HW' (- QA CONTRACTOR INFORMATION: Name: C '� C, C)I)Ei✓I Na T �i Mailing Address:`77 01410 9 ._.b It Phone#: 2 i 2 ' (,�C — Ct Email: N 1 DESCRIPTION OF PROPOSED CONSTRUCTION ;Flew Strur�,ire OAddition_ C7AIt_eration ❑Repair Cr7Demolition Estimated Cost of Project: Other )l3.? ' ro ` $ C4;n Will the lot be re-graded? ❑Yes o Will ex c ss fill be removed from premises? E2s El No 1 PROPERTY INFORMATION t 1 Existing use of property: V6-Lk,-,4,t 1&,, 0. Intended use of property: Zone or use district in which premises is situated: Are there any covenants as d restrictions with respect to this property? Dyes l O IF YES, PROVIDE A COPY. ftt-Check Box,After.Reading: The owner/contractor/desig6�professional.ls.responsible for all drainage and storm water issues as provided by Chapter236 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;Newyork and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal,or.deinolltion as tierein described.The'applicantagrees"to comply,with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized•inspectors on premises and in buildings)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): /43) 1?(17w CANIOC L'9'Authorized)Agent Downer Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ' ✓ ( '' N�� being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (Contractor,A nt,Corporate Officer,etc.) --T of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this i 2l day of 20 `3 tary Public moaf -majMki 1N0111ARY Ft1 NJC,SfATRf OF MW YO)RK PROPERTY OWNER AUTHORIZATIO 'W&O!M"M" (Where the applicant is not the owner) Q Comely 7 I, i-CO 01,k '(` c1n� ��2 F�eck�,r\ residing at G 10 C-ASr 9--8c-c �'.t. A.o�-t�ei do hereby authorize_&Q 2f'4A.1 Ar-0A,1100L to apply on my behalf to,�the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 „r 00 Glenn Goldsmith,President ����a� � Town Hall Annex A. Nicholas Krupski,Vice President. 54375 Route 25 P.O.Box 1179 Eric Sepenoski Southold, New York 11971 Liz Gillooly � Telephone(631) 765-1892 Elizabeth Peeples �� Fax(631) 765-6641 �Ileouff mot yS BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 7, 2022 Haiiey Jackson Islandwide Engineering & Land Surveying 751 Coates Avenue, Suite 22 Holbrook, NY 11741 RE: LEO & MICHELLE FLECKEN 555 GRAND VIEW ROAD, ORIENT SCTM#: 1000-14-2-3.28 Dear Ms. Jackson: The Southold Town Board of Trustees reviewed your letter dated November 18, 2022 along with the survey prepared by John Gerd Heidecker, NYS Land Surveyor, dated April 12, 2022, and site plan of Islandwide Engineering & Land Surveying, D.P.C., last dated November 1, 2022 and determined that the proposed construction of one story single family dwelling on the captioned property is out of the Wetiand jurisdiction under Chapter 275 of the Town 1/Wetland Code and Chapter 111 of the Town Code. Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. ' Please be advised, however, that no clearing, no removal of vegetation, no cut or fill of land or removal of sod, no construction, sedimentation, or disturbance of any kind may take place within 100' landward from the top of the bluff, or seaward of the tidal'and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without further application to, and written authorization from, the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. If you have any further questions, please do not hesitate to call. Sincerely, Glenn Goldsmith, President Board of Trustees GG:dd r / NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY cn;Stony Brook,50 Circle Road,Stony Brook,NY 11790 P:(631)444-0365 1 F:(631)444-0360 www.dec.ny.gov i I LETTER OF NO JURISDICTION FRESHWATER WETLANDS ACT January 31, 2023 Leo and Michelle Flecken 610 East Road Cutchogue, NY 11935 Re: Application #1-4738-04453/00002 Flecken Property — 555 Grandview Drive SCTM# 1000-14-2-3.028 Dear Applicant: Based on the information you submitted, the Department of Environmental Conservation (DEC) has determined that your proposed construction of a new dwelling and accessory structures is more than 100 feet from DEC regulated freshwater wetlands as per the plans by Islandwide Engineering &. Land Surveying D.P.C., last revised 01/05/2023. Therefore, no permit is required for this project pursuant to the Freshwater Wetlands Act (Article 24) and its implementing regulations (6NYCRR Part 663). Be advised, all construction, clearing, and/or ground disturbance must remain more than 100 feet from the freshwater wetland boundary. In addition, any. changes, modifications or additional work to the project as described, may require DEC authorization. Please contact this office if such activities are contemplated. Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. 1 Sincerely, Laura F. Star Permit Administrator cc: Islandwide Engineering & Land Surveying, D.P.0 BEH File �uaYOTy Environmental Department of l OPPON7VNIT/ �CrLVIfQnmentai Conservation ry . E C EIV E �Sufl ILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD C* .� �OCT 1 2 2023To all Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 wilding Departmele lep hone (631) 765-1802 - FAX (631) 765-9502 Town of SOuM84rc@-southoldtownny.gov — sea nd(aD-southoldtownny.gov S APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: PDO- L I a G 7 lC /VG Electrician's Name: P L License No.: 27_7c� Rig Elec. email: D TO W& P-0_ Elec. Phone No: 631 -71 tKrequest an email copy of Certificate of Compliance Elec. Address.: Q POVA/ JOB SITE INFORMATION (All Information Required) Name: D 0091v Cc2 Iviv z Address: !V% AIY Cross Street: Phone No.: & (41 Bldg.Permit#: q 00 email: D WAWvC I9/ 6CAV Tax Map District: 1000 Section: Block: 2 Lot: 8. a BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): l C� )e 32. �ooe / ,," oOW Square Footage: I a! Circle All That Apply: Is job ready for inspection?: ❑ YES 1/NIO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES�NO Issued On 7/1_12.3 Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A #Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 FJ2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION I 101 I Xpo 01fa- re. cA- ( os -71q �P L(gTo0 tru , E C E E as�FF '� ILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD t o rOCT 1 2 2023To all Annex - 54375 Main Road - PO Box 1179 va tiS Southold, New York 11971-0959 r yh0 uIlding®epartmelelepho'ne (631) 765-1802 - FAX (631) 765-9502 'town of Southa4rCap-southoldtownny.gov - seand southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: <O /i Company Name: W o_ L N G — lC NC Electrician's Name: P/L License No.: 7G} JLf� 7 Elec. email: Elec. Phone No: 63t -?/ t—LKrequest an email copy of Certificate of Compliance Elec. Address.: Q PR70/V 1 A NY JOB SITE INFORMATION (All information Required) Name: D 04 A C /V/c02 Address: S r A/� I/ /may Cross Street: Phone No.: (,(l Bldg.Permit#:4,9 rd 00 email: D ,COANIVC 6CV1 Tax Map District: 1000 Section: Block: 2 Lot: -2-91 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 16 t�'r Square Footage: 5f Circle All That Apply: Is job ready for inspection?: ❑ YES Q NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES �NO Issued On 7/1r-113 1Z/419:7 Temp Information: (All information required) Service Size❑1"Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect[:]Underground❑Overhead # Underground Laterals 1 2 H Frame 0 Pole Work done on Service? D Y N Additional Information: PAYMENT DUE WITH APPLICATION- 46l; I re. c -7 1 q P "Too ' LOT 24 w MAP OF GRANDVIEW ESTATES SOIL BORING ,� 'y33N zzz SITUATE ROY K. REISSIG �� �'� z ORIENT MAY 14, 2022 _ � ELEV 10.0 TOWN OF SOUTHOLD N.T.S. z 0 N W SUFFOLK COUNTY, NEW YORK PT TOPSOIL o FILED: JUNE 8,1982 0.3 BROWN MAP No: 7083 s' SM SILTY �dxs �c�� z \CTM#. 1000-14-2-3.28 * z 2.5 HIGHEST EXPECTED BROWN y GROUND SAND & 14' WATER GHAVEC ELEV 4.05 q _� o SECRON 014.00-DISTRICT 1000 SECTION 014.O0-BLOICRICT 1000 C`P N'F &NEAINp77gX LOT 00J.026 / NUBERC129 02.00-TRUSLOT I Jam( _ ROUND J AMILY 52S _ ELEV 1.0 RLEp MAP NO.B70BJWA7N 2 RHO AP NO4ELLCEC07 23 DOJ.027 ti� � WET w u z c O RESIDENC WATER ETWELL ENCENy 3 m N $2•1o.4p„ E ER WATER 3 a<H „� , BROWN m mou yp SAND & GRAVEL PROP NOS WELLED W r -4 — SP 14.0' AREA=R 95SF 1.274ACRESI SUFFOLK COUNTY WELL DATA PROP\ 26BUR ED D I WELL#S-16767.137 ELECTRICHIGHESTG.W.EL= 6.92(04/192010)Ip "!l Nl) G W EL CLOSEST TO TEST BORE=3.67(411822UEFFREY Pgry,OD By - 2"I'I zo22 °ry I 387.86' _ ) W1 � ROOF DRAIN :-'=:�r TDIFFERENCE IN ELEVA I 3.0 PROppOROOF D ESTIMA ED HGH G.W.EL.EL TEST BORE= O=4.05'0=2 3'(5/1422) FEN OSED SILT I B> L FILTER AC _ RAIN �.\ Fos R A AS 1 f 62o A70ER v. UNITS - �__ •_._- poll C O E I77l� Lu I x I 1 1 LM�r� 10. PROP � 0 oo� 1 1 _ r�r� MIN .:::::':.�.:::.::.:..:..: :: IRRIGA ram :::PROPOSED BELGAIPRMON oCK ob Z WATER SURFACEo.201%5/22) 1 \\ WALK WIN W LL "' OR VEWAY 6 1 ,00' W w S WE7FRESHWA7E \ ..PROPOSE wD 3 ECTION D1a.00_D151RICT T00o LAND OFFSER-/� ^p W OBELGIUMB.., --" Z a N/ BLOCK 02.Oo- LINE 7 1 ?x0 �> u_W LOCKCIIR -O i LEO&MI TAX LOT CN 0 -m U 0 \ Z J\ B y J ELLE 0 ER 2 e oo � e l _ Fl�O MAP N. ,.AGE gICETJ h� Q`u r,.'- :".I:'.:: W h ' \ N0. 708J-LOT 24 0 y Oiui A v, WLK 131 4 w �'< I z \ O WW W 0 g ui 2 7� I 126.88 O y ti STO Q m u O I 768.37 I NEPA710 WINL W ROOF RAIN B. o I u= Ory GRASS WELL _ aTELe LEAOp SED I W W I TREATMENT UNIT o HOLE a GALLEyg2X4, � O (� W LLI N / L _ , C.O. 3 50% I a� > Z 217.9 / 10'MIN O GRADE 2 EXP F� u — / GOF 0 LLI R I ,` DRAIN -N I Q I = cn 3 3 ►-, S 82 10 40" �y D_BOX z J — — PL p - Z O I Q M I Li SE N/F SALVATORE C U,0 00 CTRICT OTAX 00 •.-. .,. ... TPIL ((� O UB�P2960-E4i FAM//25Oi 3.02g TR Hy�-�" /R FlLED PACE TRUST �7MENT ryR CilOry gN500' '� °T /•1 I ~ O Z N N0.VACALOT VENT CO V Z _ t\ W �p � VACANT NTROL PgNEL .. Lu N 00. 352.0 7' I Q z LL" a 0Y� k W QZo,, POINT OF BEGINNING I °y w U I Z LO I O NOTES 1. ELEVATION DATA BASED ON NAVD 1988 I , _ O U. 2. NO NEIGHBORING WELL WITHIN 150'OF PROPOSED SYSTEM DESIGN CALCULATIONS - 1 SANITARY SYSTEM 110 GAUDAY X 5 BEDROOM=550 GAUDAY I ^T 4 y I 550 GAUDAY 11.5(GAUDAYISF)=367 SF 367 SF153 SFNNIT W 3. NO EXISTING NEIGHBORING SANITARY SYSTEMS 7 UNITS REQUIRED=419 GALS I I W WITHIN 150'OF PROPOSED WELL 8 UNITS PROVIDED=479 GALS = A`Olrn CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/1612023 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 Takach&Associates,Inc. Takach&Associates,Inc. (AIC No PHONE 631 366-2774 ( FAX 631 366-2739 112 Terry Road E-MAIL csr4 takachinsurance.com Smithtown NY 11787 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Falls Lake National Insurance Company 31925 INSURED INSURER B: GGC REMODELING INC INSURERC: 77 OHIO AVENUE INSURER D: NorGUARD Insurance Company 31470 MEDFORD NY 11763 INSURER E: Shelter point Life Insurance 81434 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 CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS 2 TYPE OF INSURANCE POLICY NUMBER (I fMMIDDIYYYYI X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $ 100,000 A CLAIMS-MADE �OCCUR PRE MES(Ea orrigrence) SKIP 2014729 11 09/21/2022 09/21/2023 MED EXP An one erson $5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X ❑ LOC POLICY❑ PRO PRODUCTS-COMP/OP AGG $2,000,000 JECT OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED $ AUTOS ONLY AUTOS ONLY $ i UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION WORKERS COMPENSATION X PER OTH- $ AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 D N/A GGWC312681 09/22/2022 09122/2023 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below E NYS DISABILITY&PFL D647872 09/22/2022 09/22/2023 NYS LIMITS R DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 10,1,Additional Remarks Schedule,may be attached if more space is required) E a CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 <SR> Southold, NY 11971 AUTHORIZED REPRESENTATIV __` ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I ' STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1A.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured GGC REMODELING INC (631)312-4474 77 OHIO AVENUE lc.NYS Unemployment Insurance Employer MEDFORD,NY 11763 Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York Sate,i.e.,a Wrap-Up Id.Federal Employer Identification Number of Insured or Social Security Number Policy) 832524333 2.Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) CompanyActualName) NorGUARD Insurance Company Town of Southold 3b.Policy Number of entity listed in box"1a" Town Hall 53095 Route 25 GGWC312681 PO Box 1179 Southold, NY 11971 3c.Policy effective period September 22,2022 to September 22,2023 3d.The Proprietor,Partners or Executive Officers are ❑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"la"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 will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayeurent of premiums of- 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. Please Note: Upon the 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 the 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 the form. Approved by: Takach&Associates. Inc. (Print name of authorized representative or licensed agent of insurance carrier) Approved by: June 2023 (Signature) �16 (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: (631)366-2774 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 (10-17) www.wcb.state.ny.us r 1 NEW ;Workers' CERTIFICATE OF INSURANCE COVERAGE YORK �, STATE 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 carrier la. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured GGC REMODELING CORP 631-312-4474 77 OHIO AVENUE MEDFORD, NY 11763 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 832524333 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold Town Hall 53095 Route 25 3b. Policy Number of Entity Listed in Box 1a" PO Box 1179 DBL647872 Southold, NY 11971 3c.Policy effective period 09/22/2022 to 09/21/2024 4. Policy provides the following benefits: ❑X A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. i ❑ C.Paid family leave benefits only. 5. Policy covers: ❑X 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 and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 6/16/2023 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B 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 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 Box 413,4C or 58 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 DB-120.1.Insurance brokers are NOT authorized to issue this form. DB_120.1 (12-21) Ill�ll�iiiiiii1ii2i0iimiiiiiii1ii2iiii2ii1iiiillll�l O z e : "11VtME01AT.ELLY : � T� `� ENCLOSE POOL TO:CODE.;;, o ? -UP;ON COiVIPLEfiION r. APPROVED AS NOTE® r ,� 1 PEER R'ONOF� DAT . '�a3 B-P.# ks-e7D w N 33'-sl, RE1A�N S�OROCD II CHPP���236 FEEm�� l�Y: 0 ¢ o p` NOTIFY BUILDING DEPARTMENT AT N IDII 32'-ID" P �"` C IDII 631-765-1802 8AM TO 4PM FOR THE ¢ m FOLLOWING INSPECTIONS: 1. FOUNDATION-TWO REQUIRED w z B��� a a B I 11 11 pg=IGLtItIvY— FOR POURED CONCRETE w IID-ID 12-ID IID-ID = 2. ROUGH-FRAMING&PLUMBING `) 0 0 3. INSULATION 4. FINAL-CONSTRUCTION MUST I- - - a I. 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