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Home My WebLink About51216-Z TOWN OF SOUTHOLD 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#: 51216 Date: 09/25/2024 Permission is hereby granted to: David N Posnett 11 E 87th St Apt 9G New York, NY 10128 To: demolish(as per Town Code definition)and reconstruct a single-family dwelling as applied for per SCHD approval. Premises Located at: 505 Skunk Ln, Cutchogue, NY 11935 SCTM#97.-4-3.1 Pursuant to application dated 05/03/2024 and approved by the Building Inspector. To expire on 03/27/2026. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition &Alteration $1,468.00 CO-RESIDENTIAL $100.00 Total $1,568.00 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 http:s:/fNvww. outlioldtownn �. to Date Received APPLICATION FOR BUILDING PERMIT yppp .n p 1n �.�eP�+ For Office Use Only PERMIT NO. Building Inspectors - 'r Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an ., i' p Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: Daw'� ` t35 xek SCTM#1000- Project Address: 909 ejY'VNK LICL- (S�-�V OO v 4 Phone#: 61�1 'yi _ aoxo Email: � . shl:'R Mailing Address: m r CONTACT PERSON: Name: Mailing Address: 1 � SLAY Phone#: 6'�l T lf� A' , 14} Email: (Avjourck" DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Po 0a [f-SV Gn f nw"W r Dl� 110i Phone#: � ;2� 4 L *4 +-eJ t ,� v,l►►�� , '� CONTRACTOR INFORMATION: Name: Mailing Address: �, �,�� i L Phone#: ( �i ' Email: Kc4i C`lK ail �� h�1C)G (Zt"V1 UtJl.K1Y f IlJhl lJf �"KLIf VSEU LOOS i� �� i 6 KUI.I flJiY P �C Crv�q) of Project: Alte ti�a� ostCher � � � ra r� ❑Re air DemolitionEstimated � , , New Structure Arldition iA ated C Will the lot be re-graded? ❑Yes XNo Will excess fill be removed from premises? ❑Yes 'KNO 1 Existing use of property: j;► .e M,J I PROPERTY INFORMATION ANCe Intended use of property: Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to this property? ❑Yes No IF YES, PROVIDE A COPY. ACheckBox Afte 'r eadln .' The owner/contractor/design professional is.responsible for all drainage and storm water Issues as provided by ch pter 236 of the Town,Code, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Suilding 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(]ass A misdemeanor pursuant to Section 210.45 of the New York State Penal law. Application Submitted By(print name): 'X4uthorized Agent ❑Owner Signature of.Applicant: Datee: CONNIE D.BUNCH STATE OF NEW YORK) Notary public,State of New York No.01 BU6166050 S: Qualified In Suffolk County COUNTY OF ) Commission Expires Apr" 14,2YPQI lTI being duly-Sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (Contra or,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 Ja of 20 v' Notary Public I IIR II°NERI. ER At„ mull, 111 I I (Where the applicant is not the owner) I, � ` residing at o 5 E do hereby authorize to apply on my bell iaif to use if3viin of,rvalu101d uuiIuing Dcp"aitmcnt for apprvva1 as d eSCrilucd ncrcln. /V �a� rol-Gcr. , 2 _ � p Owner's Signature Date -bAV0 T T' Print Owners Name 2 Building Department Application AU'THO ATIO N' (Where the Applicant is not the Owner) I, �� jV residing at (Print property owner's name) (Mailing Address) v www . do hereby authorize _ ) Odd (Agent) to apply on my behalf to the Southold Building Department. (Owner's Signature) (Date) (Print Owner's Name) �m m Scott A. Russell ` STO]KI��1 WAT]EIK SUPERVISOR TWANAG]ENCENT SOUTHOLD TOWN HALL-P.O.Box 1179 � Town of So 1.t th o G 53095 Main Road-SOUTHOLD,NEW YORK 11971 '� w� CHAPTER 236 _ STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) - - - - - - - - - - - - - - - - - - - - - — - - - - - - - - - - - - - APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) r NAME: Date: sdsa � o Contact Informatl n: (EMail 8 Telephone Number) Property Address 1 Location of Construction Site: S.C.T.M. #: 1000 s District Section Block Lot. TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT - - - � .�. � .... ,_ Area of- Disturbance is less than I Acre. No S.P.D.E.S. Permit is Re aired . Project does Not Discharge to Waters of the State. No S.P.D.E . Perma is Required! 1, - Area of Disturbance Is Greater than I Acre &Storm-water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.RD.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Buildrn Permit. Area of Disturbance is Greater than I Acre& Storm-water Runoff Flows Through Southold Town's 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 Enineering De artment Prior to Issuance of a(Building Perrnit, Reviewed B Y: / Date: 6 +� Fl1RM # CMf P Tf1C(lrtnhar 7n I4 �f_ c e; cue of 1ZGenerated by REScheck-Web Software Compliance Certificate Project 505 Skunk Lane Energy Code: 2018 IECC Location: Cutchogue, New York Construction Type: Single-family Project Type: New Construction Conditioned Floor Area: 1,629 ft2 Glazing Area 40% 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: 505 Skunk Lane David Sherwood AIA Architect Tom Baccarella Cutchogue, NY 11935 PO Box 1681 NY Building Technology Group Sag Harbor, NY 11963 159 NY 25A West Building,Suite B Miller Place, NY 11764 631-495-0289 Info@NYBTG.com Compliance: 2.9%Better Than Code Maximum UA: 343 Your UA: 333 Maximum SHGC: 0.40 Your SHGC: 0.32 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. Siab.on-grade tradeoffs are no longer considered in the UA or performance comphance path in REScheck. Each slab-on grade assembly in the.specified cUmate zone must meet the minimum energy code insulation R-value and depth requirements. Eny-elope. Assemblies Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter Ceiling-Sealed attic/vaulted-R30 LD foam: 1,825 30.0 0.0 0.034 0.026 62 47 Cathedral Ceiling Wall -To amb-3" HD foam: Wood Frame, 16"o.c. 1,344 21.0 0.0 0.057 0.060 46 49 Door-Main Entry Andersen 400 sw w/Sidelites: Glass Door(over 50%glazing) 51 0.320 0.320 16 16 SHGC: 0.32 Door-Andersen 400 series FW: Glass Door(over 50%glazing) 243 0.320 0.320 78 78 SHGC: 0.32 Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 1 of10 Gross Area Cavity Cont. Prop. Req. Prop. Req. Perimeter Window-Andersen Transom:Wood Frame 61 0.320 0.320 19 19 SHGC: 0.32 Window-Andersen 400 series TW: Wood Frame 172 0.320 0.320 55 55 SHGC: 0.32 Window Andersen 400 fixed (gables):Wood Frame 9 0.320 0.320 3 3 SHGC: 0.32 Floor-Over Unc basement:All-Wood Joist/Truss 368 30.0 0.0 0.033 0.047 12 17 Floor-Over crawl:All-Wood Joist/Truss 1,261 30.0 0.0 0.033 0.047 42 59 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2018 IECC requirements in REScheck Version : REScheck-Web and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Tom Baccarella - HERS Manager —w- '"'" 09/20/2024 Name-Title doWlIffe, Date Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 2 of10 REScheck Software Version : REScheck-Web Inspection Checklist Energy Code: 2018 IECC Requirements: 100.0% 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 met 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 &Re .ID 103.1, Construction drawings and " ❑Complies Requirement will be met. 114 o ow, documentation demonstrate Does Not [PR111 j energy code compliance for the °'� ��' " �, ; ;building envelope.Thermal ❑Not Observable� , lenvelope represented on ❑Not Applicable �o construction documents. 103.1, Construction drawings and "❑Complies Requirement will be met. 103.2, documentation demonstrate ❑Does Not 403.7 energy code compliance for [PR3]1 lighting and mechanical systems ❑Not Observable ;Systems serving multiple ❑Not Applicable dwelling units must demonstrate `;, „ �l compliance with the IECC Commercial Provisions. 302.1, Heating and cooling equipment is Heating: Heating: ❑Complies Requirement will be met. 403.7 ,sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA F Cooling: Cooling: ❑Not Observable Manual J or other methods Btu/hr Btu/hr approved by the code official. ❑Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 Medium Impact(Tier 2) 13 1 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 3 of10 Section # Foundation Inspection e"s? Comments/Assumptions &Ite .1i 3012A A protective covering is installed to []Complies Exception: Requirement is not applicable. [FO11]2 protect exposed exterior insulation IlDoes Not :and extends a minimum of 6 in. below tigrade. []Not Observable �CNot Applicable j 403.9 „Snow-and ice-melting system controls flComplies Exception: Requirement is not applicable. [FO12]2 installed. Does Not oNot Observable' Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 1 Medium impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 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, 402.5 i❑Not Observable [FR2]1 I j❑Not Applicable 303.1.3 ;U-factors of fenestration products ;%�„ �r /�j ❑Complies Requirement will be met. . ,�a�/ �� 1��, / /� [FR4]i are determined m 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 /"j ' /��jj;;,/�, " , ❑Complies Requirement will be met. / , [FR23]1 installed per manufacturer's ��/ %��' / ��/; ❑Does Not Instructions. i❑Not Observable ,❑Not Applicable 402.4.3 Fenestration that is not site built ]❑"'rice, /�„ Co pIies ;Requirement will be met. [FR20]1 is listed and labeled as meeting °�' -]Does Not AAMA/WDMA/CSA 101/1.5.2/A440 k1 i� " ❑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�/ "��/ "�� ❑Complies Requirement will be met. [FR16]� sealed at housing/interior � �� / / ❑Does Not Land labeled to indicate _2.0 cfm leakage at 75 Pa. / , /� „ ❑Not Observable ,,,M❑NOt Applicable 403.3.1 ;Supply and return ducts in attics '�i; "" ��/'/%ji�� „ ❑Com lies Requirement will be met. �� / FR12 :insulated inches in diameter and >_ Does Not q[ ]� / � ❑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 I for< 3 inches in diameter. „ �,,, ;, „' ,, ,, /�,,, � •;, 1 403.3.2 ,Ducts, air handlers and filter � ji,� /� ' �/% / ❑Complies Requirement will be met. [FR13]1 !boxes are sealed with Not joints/seams compliant with International Residential Code, as ❑Not Observable International Mechanical Code or Not Applicable applicable. +- 403.3.5 Building cavities are not used as )plies Requirement will be met. FR15]3 ducts or plenums. o,/ / , �/ , El Does Not o�% is "[-]Not Observable E ��''/" ,x❑Not Applicable 403.4 HVAC piping conveying fluids R- R-� flComplies Requirement will be met. [FR17]2 °above 105 °F or chilled fluids ❑Does Not below 55°F are insulated to>R- $3. 4❑Not Observable (❑Not Applicable 403.4.1 ;Protection of insulation on HVAC ❑Complies Requirement will be met. [FR24]1 ;piping. ❑Does Not ❑Not Observable ❑Not Applicable 403.5.3 o Hot water pipes are insulated to R- i R- ;❑'Complies Requirement will be met. �[FR18]� >_R-3. g❑Does Not ❑Not Observable tlNot Applicable 403.6 `Automatic or gravity dampers are ,� J,/,,� /,'� ❑Complies Requirement will be met. [FR19]2 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable g❑Not Applicable 1 High Impact(Tier 1) 1 2 IMedium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 5 of10 Additional Comments/Assumptions: 1 High Impact('Tier 1) 2 1 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 6 of10 Section Plans Verified Field',Verified# Insulation Inspection value Value Complies? Commentsf sumpti ns late »II) 303.1 ;All installed insulation is labeled '� ❑Complies Requirement will be met. [I 13122 or the installed R-values ��/�� /�" %i,/� , Does Not provided. °❑Not Observable ❑Not Applicable 402.1.1, Floor insulation R-value. R- R- I❑Complies See the Envelope Assemblies 402.2.6 ❑ Wood ❑ Wood ;❑Does Not table for values. [IN111 ❑ Steel j❑ Steel ;❑Not Observable " ;❑Not Applicable 303.2, tFloor insulation installed per ��'� ' %�% %,� :❑Complies Requirement will be met. / %ii i 402.2.8 .manufacturer's instructions and ��,i //�� /i� 1❑Does Not [IN2]1 in substantial contact with the `'❑Not Observable underside of the subfloor,or floor framing cavity insulation is in , �,i �j''°"„ �,j'j „j ❑Not Applicable contact with the top side Of �sheathing,or continuous /�/, / InSUlatlOn IS Installed On the /lii �/�� i /' irr underside of floor framing and extends from the bottom to the top of all perimeter floor framing y members. ? /%; 402.1.1, ;Wall insulation R-value. If this is a; R- R- ;❑Complies 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 [IN3]1 exterior,the exterior insulation u requirement applies (FR10). ❑ Steel ❑ Steel ❑Not Applicable 303.2 Wall insulation is installed per " �' " ' �� ' Complies Requirement will be met. p /il/j j p [IN411 manufacturer's instructions. i �// ❑Does Not 7XI 'r ' ��j// � O/�i/�r ��/j//// ' ' i�z❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 7 of10 Se�e . on Plans Verified Field Verified Final Inspection Provisions Value ValueComplies? Comments/Assumptions & RID 402.1.1, 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.E[Fill' ❑Not Applicable 303.1.1.1, Ceiling insulation installed per ° ,' '❑Complies Requirement will be met. 303.2 manufacturer's instructions. ?� ;%�i �'� ° „❑Does Not [FI2]1 Blown insulation marked every v❑Not Observable 300 ft2. L_J NotApplicable 402.2 3 ,'Vented attics with air permeable ' � �" / / "/, �IComplis ;Requirement will be met. [922] insulation include baffle adjacent ; ' i 3❑Does Not to soffit and eave vents that ❑Not Observable iextends over insulation. " t r `w❑Not Applicable �.. 402.2.4 Attic access hatch and door R- R- ❑Complies Requirement will be met. [FI3]1 insulation >_R-value of the ❑Does Not Fadjacent assembly. UNot Observable ❑Not Applicable 402.4.1.2 Blower door test @ 50 Pa. <=5 ACH 50 = ACH 50 = ,❑Complies Requirement will be met. [F117]1 each in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. r❑Not Observable [E]Not Applicable �EF .4.2 ;Wood-burningfireplaces have „ / , i/ f /j ❑Complies Requirement will be met. p i ti ht fittin flue dam ers andl 9 9 p ElDoes Not outdoor air for combustion. []Not Observable %,,,,, ❑Not Applicable �403.3.3 FDucts are pressure tested to i cfm/100 icfm/100 s❑Co mplies Requirement will be met. [FI27]1 determine air leakage with a ft2 ft2 j❑Does Not either: Rough-in test:Total ileakage measured with a ❑Not Observable ,pressure differential of 0.1 inch ❑Not Applicable w.g. across the system including Fthe manufacturer's air handler enclosure if installed at time of test. Postconstruction test:Total ,leakage measured with a pressure differential of 0.1 inch jw.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 Requirement will be met. [FI411 cfm/100 ft2 across the system or ft2 ft2 ❑Does Not <=3 cfm/100 ft2 without air ;handler @ 25 Pa. For rough-in ❑Not Observable tests,verification may need to ❑Not Applicable occur during Framing Inspection. r 403.3.2.1 fAir handler leakage designated % t, ;;❑Complies 'Requirement will be met. [FI24]1 by manufacturer at<=2%of / ' �' �, /i i ❑Does Not design air flow. ❑Not Observable „❑Not Applicable [FI9]2 installed for control of primary a %i i ;r / f/ A mplies Requirement will be met. 4011.1 Programmable thermostats ❑Does Not heating and cooling systems and / initially set by manufacturer to /;,, %%!, / % /�,� ❑Not Observable code specifications. /, , ,,j, , ❑Not Applicable 40 .1.2 Heat pump thermostat installed %„/,/% �i/'/�/ / il' i' i%� �% ❑Complies Requirement will be met. [ 10]2 r on heat pumps. ❑Does Not Not Observable � Applicable 1 IHigh Impact(Tier 1) 2 'Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 8 of10 Section Plans Verified Field Verified # Final Inspection Provisions Value Value Complies? Comments/Assumptions & Re .ID 403.5.1 Circulating service hot water ❑Complies Requirement will be met. FI11 2 systems have automatic or� /// r"r' [ ] Y j'iiiiiO rri/�//y%/� r.❑D025 Not accessible manual controls. ❑Not Observable ❑Not Applicable system All / / r / ❑Complies Requirement will be met. [Fl25] fans 1 ;HVAC equipmentt mechanical meet efficacy ❑Does Not and R403 it flow limits per Table ❑Not Observable ❑Not Applicable 403.2 ;Hot water boilers supplying heat Requirement will be met. Z �� j / ri////D rir/ / , r /� ❑ [FI26] (through one-or two-pipe heating �// �/� /�/, �r „✓ � / „'r �❑Does Not systems have outdoor setback ❑Not Observable control to lower boiler water r �aai,%r% ❑Not Applicable �tempperature based on outdoor A�ir�/rr`�/��j��„ �r q tem eratluPre. 403.5.1.1 Heated water circulation systems „ �/j� /��%//r�, �� %r/ /t �, q Complies Requirement will be met. [FI28]2 have a circulation pump.The ,❑Does Not (system return pipe is a dedicated ❑Not Observable return pipe or a cold water supply rii rrr,,i, f�/ ii//,,,,,,,/� /,,,,� ❑Not Applicable pipe.Gravity and thermos- r/1,��„/ //��r it//�, r � r ;syphon circulation systems are not present. Controls for ;circulating hot Water System ;pumps start the pump with signal / 4or hot water demand within the occupancy. Controls automatically turn off the pump r//�/ ,when water is in circulation loop ��%/ /, ,;' /'!'� "' ram" "j„�r%r is at set-point temperature and %�r "'i�r ;' �" ; �' ' �'� ,j ono demand for hot water exists FI29]z comply with IEEE 515.1 or UL /'j//j// / jj '%f ❑Complies Exception: Requirement is 403.5.1.2 Electric heat trace systems r/ r„ / ! , r„ii,� [ P Y ,rr �, / ❑Does Not not applicable. 515.Controls automaticall �, or /„ / / r y / �/ /ij% r ME ❑Not Observable adjust the energy input to the /�/ �,��„�,� �r °o/Mor heat tracing to maintain the `��"�� '�//'' i i/%/��` Not Applicable desired water temperature in the Piping• 403.5.2 Demand recirculation water �,, f%';%�/;/i;//� ';a % ' ❑Complies Exception: Requirement is z [F130] systems have controls that ❑Does Not not applicable. manage operation of the pump and limit the temperature of the "� "/�'�/'�/°D�'/�°� '��/�' ❑Not Observable ,water entering the cold water /,,,,,❑Not Applicable Piping to <= 1049F. 403.5 4 Drain water heat recovery units �� ;, jj �� %%l�rji/i/ %,ice �, ❑Complies Exception: Requirement is �� %, l / [FI31] tested in accordance with CSA � , ��j � „/,, r, El Does Not not applicable. B55.1. Potable water-side -[]Not Observable pressure loss of drain water heat ,❑Not Applicable recovery units < 3 psi for / Individual units connected to one or two showers. Potable water- side pressure loss of drain water j heat recovery units < 2 psi for Individual Units connected t0 ;three or more showers. 404.E i 90/o or more of permanent �r//i�/ ,,/// , /,�%,,,/�r/ , ❑Complies �Requirement will be met. F16 fixtures have high efficacy lamps. ��r [ ] 9 Y /i ❑Does Not ❑Not Observable ❑Not Applicable 404.1.1 Fuel gas lighting systems have '°"% %��!/j'�"'� i/�i/i �; j''�'�i '/%`❑Complies Exception: Requirement is g ' //%7 , ir, %/%,'/��,r� �, r� // [FI23] a no continuous pilot light. ; ri/ /�/iiij�j� �� /i�� ❑Does Not not applicable. ❑Not Observable �,,0Not Applicable 1 Hlgh Impart(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 9 of10 section Plans Verified Field Verified Fin Inspection Provisions feies Value i onapliesl' Comnments/A sumnptions 6�Re .11 401.3 Compliance certificate posted. ®Complies Requirement will be met. [FI7]2S Not �,,[]Not Observable EINotApplicable '°�� ElCom lies Requirement will be met. F� .3 ,;Manufacturer manuals for 1 j�� , � j �, j��j �;��j��; N g� q [1'18]3 mechanical and water heating ; Not i systems have been provided. �„ ®'Not Observable ,,11Not Applicable Additional Comments/Assumptions: 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: 505 Skunk Lane Report date: 09/19/24 Data filename: Page 10 of10 Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 30.00 Ductwork(unconditioned spaces): Ic . . . Window 0.32 0.32 Door 0.32 0.32 Heating System: Cooling System;. Water Heater: Name• Date• Comments Yard 'SV4 a, CAJ) �� 19� �r�CvNK lath RED o x^s lw p . ,._ G D. e. CA-mt, (Doe, :.ov.ab W-0+00 0".boo 4ra, �l C. .� G�ti I��a -ol�cc �- 04,0 -�a 44 Cam) 41 S BTIMGkci FROM tik VNk �.F NOT to tiUAL*P- Workers' YORK STATE LOmpensation. CERTIFICATE OF INSURANCE: COVERAGE ' 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 Ta —Legal—Name&Address of Insured(use street address only) I b.Business Telephone Number of Insured DUANE KONCELIK CONSTRUCTION CORP 631-680-6376 54 STRONG LN PATCHOGUE, NY 11772 1 c.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) 112738297 : and Address of Entity Requesting Proof of Coverage 3a.Name of Insurand e Carrier (Entity Being Listed as the Certificate Holder) Shelter-Point Life Insurance Company TOWN OF S O U T H O L D 3b.Policy Number of Entity Listed in Box"la" PO BOX 1179 DBL685787 SOUTHOLD, NY 11971 3c.Policy effective period 02/10/424 to 02/09/2025 4. Policy provides the following benefits: 0 A.Both disability and paid family leave benefits. F-1 B.Disability benefits only- F-1 C.Paid family leave benefits only. 5. Policy covers: F)-Cl 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 pencil equiry,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the narned insured has NYS Disability and/or Paid Family Leave BenOils insurance coverage as described above, Date Signed 3/14/2024 By a. tA (Signature of Insurance carrier's authorized representative or NYS Llcenwd 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, . e 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,!L!6x 413,�S_�r 58 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the ab6ve-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. i 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 farnfly leave benetitS.: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) 111l II ) NYSI F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 112738297 KIRK ASSOCIATES LTD 18 FIRST ST " RIVERHEAD NY 11901 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DUANE KONCELIK CONSTRUCTION CORP TOWN OF SOUTHOLD 54 STRONG LANE 54375 MAIN ROAD PO BOX 1179 EAST PA T CHOGUE NY 11772 SOOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12404 626-0 197983 05/19/2023 TO 05/19/2024 2/1/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2404 626-0, 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, 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'W'ESSITE AT HTTPS;I .NYSIF.COMICERTICERTVAL,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 DUANE KONCELIK OF A ONE PERSON CORPORATION 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 S T AT SU N E FUND 4 14 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1024816952 U-26.3 A R CERTIFICATE OF LIABILITY INSURANCE D"2/01 024 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 cerHHcate holder Is an ADDITIONAL INSURED,the poitcy(Illss)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 do not confer rights to the certificate holder In lieu of such endorsements. PRODUCER .. T ERIC KIRK KirkAssociates LTD PHONE i27 7767 FAX A c pig. 727-7941 18 First Street rlc ki1 @farrrl-famiiy.00M Riverhead, NY 11901 ... INSURE YI(S1AFFORDINGOOVERAG ........'.,_ NAIC M••••_,,, INSURER A: Farm Family Casu Insurance Corn an 113803 INSURED INS a ....... .... Duane Koncelik Construction Corp 11 c 54 Strong Lane INSURI=RD�__ _m.- INSURER E: East Patchogue NY 11772 BRUM F: COVIERAGIES CERTIFICATE NUMBED. 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. TYPE OF INSURANCE POLICY MI NUMBER MDD MM�Y LINKS A X COMMERCIAL GENERAL LIABILRY X X 31031-7413 06/01/2023 06/01/2024 EACH OCCURRENCE $ 1,000,000 1fAMGE-f6 FTEIJ�fI=tT— CLAIMS-MADE �OCCUR � $ 1 00'0w X Contractual Liability _MED EXP one p2T90 $ 5,000 PERSONALSADVINJURY S 1,000,000 GEN"L AGGREG ATE •._ REGATE $ 2,000,000 GENERAL GG _• X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER $ B AUTOMOBILELIABILRY 3101C3272 08A30A202308130j2024 COMBIN INULELIMIT $ 500,000 X ANY AUTO BODILY INJURY(Per peraw) $ ......_ OWNED _—SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED RTYDAAMAGE $ AUTOS ONLY AUTOS ONLY PROPI � ...•� UMBRELLALUIB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS—MADE, AGGREGATE $ QED I I RETENTION$ $ WORKERS COMPENSATION PER IOTH AND EMPLOYERS'LIABILITY YIN .. E.L.EACH ACCIDENT $ ANYPROPRIETORIPARTNER/EXECUTTVE � NIA — OFFICER/MEMBEREXCLUDED7 E. (Myyaeen In NH) L DISEASE-EA EMPLOYEE',$ OESeedebtuy CRIPTION MRATIONS below E-L DISEASE-POLICY LIMIT $ i i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,AddIdonal Remarks Schedule,may be atleehed If more space Is required) CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED Project address:505 Skunk Lane Cutchogue NY 11935 CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Main Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS_ Po Box 1179 Soouthold NY 11971 AUTHORD:ED REPRESENTATIVE Kirk Associates LTD 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2015103) The ACORD name and logo are registered marks of ACORD Workers' YORK s-uvi Compensatio CERTIFICATE OF INSURANCE; COVERAGE I n 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 ........................... . ..... 1 a.Legal Name&Address of Insured use street address only) Business Telephone Number of Insured DUANE KONCELIK CONSTRUCTION CORP 631-680-6376 54 STRONG LN PATCHOGUE, NY 11772 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required it coverage is specifically firnited to or Social Security Number certain locations in New York State.i.e.,Wrap-Up Policy) 112738297 ............... ................. 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 S O U T H O L D 3b.Policy Number of Entity Listed in Box"I a" PO BOX 1179 DBL685787 SOUTHOLD, NY 11971 3c.Policy effective period 02/10/2024 to 02/09/2025 ....... ... ........... ................................ ..... 4. Policy provides the following benefits: R1 A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: F)-Cl 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: perjury, —------ ...... 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 3/14/2024 By (Signature of insurance carrier's authorized repfc-SLnUhtivo 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 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 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 farnity leave bcnefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DS-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) III II 1111111111111111111111111111111111�111111111111111 .............. p r j�xb f; 1 i o ° U � 0 _ m LL W F" Q }n c o a U 8 ti zy¢ es _ 8 s a:Xm Lii oca¢aw . . . s A �€:,g x z N L tU a f? 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WELL � p ' .. 1 LLBEPRDVDmroTH� I I�� ...__ LAND N/F OF $ � �_ e �- •-- GREGG KONARSKI LN RAVEL 3.PROVIDE A 2'VENT PIPE FROM THE OWPS TO THE DWELLING AND CONNECT 70 THE SANITARY VENTING SVI'MINTIff HOUSE O WATER THE VENT PIPE SHALL BE PITCHED TOWARD THE OWES SO ANY LIQUID WILL DRAIN TOWARD THE OWES „�'�F p R o dr DWELLING 17' 4..AN EFFLUENT FILTER SHALL BE NSTAUID UNDER THE ACCESS COVER OF THE CENS UNIT MITRE OUTLET PIPE r ol v WNVELL WATER MAY 5,2023 W o r n K.WOYCHUKLS fl d+�PIIraEIc D3 525.2 T a�PosrrtulL FENCE ....�.�.. N 82 51 20 E ,.�L �_. 4'WIRE FENCE 1 DTJ a CD w IVE Up. 30 ti z 0 w c�g "" .. GRAVEL&U—E--A-Y'.'.�---�,— I J o m - . TO- REMOVED-- S ... .` Abandanr _ J I r STONE g �2f' GOflf04t L PATIO .�sU� .. 1 1 r WELL k i ra La I I I Ac, I I r�o Hu�wr:H,4c>vusry tli DECK ' C H ! 1 Y, -^•^'"'/�.ca.\� I'I tin 'R Z CD z 3 I I 26 WF J Imo" y J Y O ACCE� Qdn W J !"KMJKI m"h'1W1 S. PPROP f1:CK " 0 1 STY it—o I ^� ._.m....1 G,I v 'fit �' ELEC.SERVICE TO CONTROL PANELtb� 'OI Cq SDI I�C� L r y r t 'PROP AR NO 2 e `• � Call I r+I'1rw4T J�p . T. 'N�r'E3R I"rE� d 1 CChN'N'MDL PANEL AND AIR PUMP m O 22 advans ELECTRIC AND AIR SUPPLY HOSE TOOWTS LAND N EET i saaiE a� m ALBERT N P. DWELL m w r wITEra/ '.a; W/PUBLIC p ,5CITU � r F 15 m Ix I 30 ° �HLAnPv INLET DO sa,P. " z ¢ i m < � 6 % MIN GATE 6 C� Al UNK ti s �'c *� m ._� E' P E 0 m TM � SHED46 m� I8 m z z . .. . IC HI ry ITlrttltOvh I:r L 28 ASPHALT Co VEWAY �I 4A sa4 xn Nr }&CC L ` _.✓ 1,• 6'SCHEDUL ADAPTER T4 4Gad U CLEANOU W 8'SD U.P. U • MVp PIPI �I Q � MON. r.x �o o r n � ' �3'ELoac'r STOCKADE FENCE 1:N 04p23'00" W 524.51 F,11b S 82 51 20 W 0.60' OUTL T SOL NT WELDED TO 4" LONSTUB OF SCHEDULE 40 LAND N/F OF XNDN/FOF t PIPE CONN 0 TO FUJI MARY JANE SMALL covm A JOSEPH BEST PLUG TOSPAM CLEAN CE IT(TYP) DWELLING Trrvaracr3ag a rsn a•Gw. -~~~~�" -^^ DWELLING WIPUBLIC WATER _ SDRZPVCPIPEatEGUN LATERAL 8 INL T PORT + ; '` ADAPTERAVLL ORTS W/PUBLICWATER 150' R aE�,��MA RE MR 15a ARE 4-OPENINGS ® ® ® °�A"°"' FFL 32.0 (TYP) 4"SDR 35 ® ® ® LATCH 1/8"/FT em ®. E3gn ® ® ® ® ® ® on GRADE 30.0 GRADE 28.5 GRADE 5%MAX 300EG7ffF fWG ® ® ® ® m EL(28.5) C/O TO GRADE INV27.16 DIST INV 26.96 INV26.8 � INV27.61 INV27.3 INV27.06 BOX EL27.13 mm " 4"SDR 35 8'0x12 DEEP `"� PITCH 1/4"/FT 4 SDR CLEANOUT DETAIL PITCH 1/8"/FT LEACHING per, LEACHING POOL POOL p� NTS NTS 00000 GRADE EL22.4 OD�ODCT EL15.13 FUJI CENS HIGHEST EXPECT. GROUND WATER EL 0.9 A SANITARY INVERTS FYLSTINC, 7"INCRFn