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HomeMy WebLinkAbout51447-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#: 51447 Date: 12/06/2024 Permission is hereby granted to: Brendan J Mckeon 985 Track Ave Cutchogue, NY 11935 To: Construct additions and alterationsto an existing single-family dwellingas appliedforto include HVAC system. Premises Located at: 985 Track Ave, Cutchogue, NY 11935 SCTM# 137.4-25 Pursuant to application dated 09/30/2024 and approved by the Building Inspector. To expire on 12/06/2026. Contractors: Required Inspections: Fees: Single Family Dwelling- Addition&Alteration $1,540.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $1,640.00 Building Inspector TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 1 1 971-0959 Telephone 631 765-1802 Fax 631 765-9502 1114)s �rvrww sotitliolcitow 111 r 'o)V Date Received APPLICATION FOR BUILDING PERMIT G � For Office Use Only I CI PERMIT NO. ✓` 4 4 � _ Building Inspctsr°, 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. :f Date: 9 a1 A OWNER(S) OF PROPERTY: Name: �ZWE A 21 R ___..�...� ..��e�._...�.._._,�.,...-.. S CTM# 1000- 134 _ 1 —2 S Project Address: q%3 TRACK AVE C.II01 • $5 Phone#: C31 — 30G - 5150 Email: 5SIE , PI2If2 YAJ400-COM Mailing Address: 9213 MID" COUM7111Z cALVEQm►3 •NY •1)433 CONTACT PERSON: Name��� S P,2tQ Mailing Address 9213 rnlpptE COUA3199 RD � CA"ER.1010 •NY •))q33 Phone#: C31 — 300 - 5y50 Email: 54sE . putla yANOO.COm DESIGN PROFESSIONAL INFORMATION: Name: DA IE> rn a-nN3 - AQUJ1*CTS MAD Mailing Address )$ 1111p'IDtoN W « • • 11 I Phone#: 631 - 332 - 3p21 Email: CIM@- AaC W n*VC, Mr40-COS CONTRACTOR INFORMATION:— _ � ..... � �.. Name: y Cry ti� Cam. Mailing Address: Z � � t v .. �► ! c N �`� Itr" y --�"3 Phone#: 1 C� Email: �a�( � � DESCRIPTION OF PROPOSED CONSTRUCTION r1 ®Alteration [:]Repair ❑De ®New S' tkN�tliFi' r p � molition Estimated Cost of Project: O r + $� �jp(3.00 Wi eil'? ❑Yes M N o Will excess fill be removed from premises? ❑Yes ®No 1 PROPERTY INFORMATION Existing use of property: S�Ira6�_ Fgrntty flraEr;iN6 Intended use of property: &Waco- FAmiV flwEcc2v6 Zone or use district in which premises is situated; Are there any covenants and restrictions with respect to R_ 40 this property? ❑Yes IF No IF YES, PROVIDE A COPY. 90 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): P ❑Authorized Agent ®Owner Signature of Applicant: `t Y Date: 09 .,3 ZL4 STATE OF NEW YORK) c SS: COUNTY COUNTY OF :50 P- being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, O r --b/ S he is the�...... C..__.�.. ...�..__ ..... .._�... - (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�P2 wt �-t2 201 Notary Public LORRAINE A ANSMAN Notary Public.state of New York the applicant is not the y N0.0 n Stiff lk Co PROPER ���JU�"���� I _....�.� utsgiffet01AN f3923 9 (Where h pp owner) My Commission Expires May 28.2027 I, ...... ........ . residing at_..._..._. ... do hereby authorize _ 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 v "N Generated by REScheck-Web Software compliance Certificate Project Private Residence Energy Code: 2018 IECC Location: Cutchogue, New York Construction Type: Single-family Project Type: Addition Climate Zone: 4 (5572 HDD) Permit Date: Permit Number: All Electric false Is Renewable false Has Charger false Has Battery: false Has Heat Pump: false Construction Site: Owner/Agent: Designer/Contractor: 985 TRACK AVE PIRIR JOSE DAVID MARTINS CUTCHOGUE, NY 11935 4213 MIDDLE COUNTRY RD ARCHITECTS MAD CALVERTON, NY 11933 18 MIDTOWN RD 631-300-5450 CARLE PLACE, NY 11514 jose,pirir@yahoo.com 631-332-3021 dm@architectsmad.com IYt ^*Oa�� o'w r+ I 71vGrv�yJ V? � ) Y� �r1 .7 �' r yyr/� "�%dP d � 19�',�1 ✓''��..` .e 7�. Y.iD� k�r0;."°, �y' ��1�, Compliance: 11.1%Better Than Code Maximum UA: 244 Your UA: 217 Maximum SHGC: 0.40 Your 5HGC: 0.29 They%Via n'oi,4fW wser"l"'lhran Code Index m4llesct how Chore to crru°ovp:rOBenum C,ulhr,M house O5 Ibased a?corn^Itr,wdns-off rui0an, IIO,II:Yt'?k S IVI�'Yy�IImrovidc,an er.,lllvaeratlai;r fun:r^I irfl-gy 4A.a(ry a.n ft rw,Il,-.Y.lve to a rr70uetlrr'i0urY rode harne, c " 'l:. i.e1e III `I; d1Yebl Y-t.l'MG"u?!:'t 71�alhr-�yo�.ayo�:�,ll�. @I.aa.�y�:crlfi y ,.jury o'1n^� Oe'auYr;�n o �.�aou: I�d; euu��ere;i I"iol ulru�:� u�Je"a r�u Irar>r��er��rcoP�rYa:� �n.>Iurrrp,al`u :��a.� pay-'dP.IY uurl ICI elit� e �.0 o.M: �JS�,�:::un ud�lll�� ulru bI'ir, °11YtiTufor't Vuu�u.:wV'�� ra,nul<� Ilu:u �,P a oe'r�i_t101n�°ou iuuluruauuuu r�ny" fly r,oe'le, hv;1.0 nli )r' V allue �.aluvd o��..l�lll7 l�,fipu.uui uv iY..�. Enve1c p.e__A r-_ WesMEAN=, B Ceiling: Flat Ceiling or Scissor Truss 898 38.0 0.0 0.030 0.026 27 23 Wall: Wood Frame, 16" o,c. 1,918 19.0 0.0 0.060 0.060 100 100 Door: Glass Door(over 50%glazing) 81 0.270 0.320 22 26 SHGC: 0.29 Window: Wood Frame 166 0.270 0.320 45 53 SHGC: 0.29 Floor: All-Wood JoistfFruss 898 38.0 0.0 0.026 0.047 23 42 Project Title. Private Residence Report date: 09/27/24 Data filename: Page 1 of10 r u 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. N—ame-Title Date Project Title. Private Residence � _�._....._.�._.���..� � � Report ort date: 09/27/24 Data filename: Page 2 of10 REScheck Software Version : REScheck-Web Inspection Checklis-TAL CY(i Energy Code: 2018 IECC Requirements: 0.0% were addressed directly in the REScheck software Text in the "Coi-nmetits/Asst.lilll)tions" 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 iternized in a separate table, a reference to that table is provided compli ---'['-�0rnrnents/AssumptIons ed Pre-inspection/Plan Plans Verified Field Verified Value Value e s OComplies 103.11 Construction drawings and 103.2 documentation demonstrate F-lDoes Not [PR1]1 energy code compliance for the F-1Not Observable 'building envelope.Thermal E]Not Applicable envelope represented on construction documents. . ...... l 11 03.1 1, Co I n I s 11 tr I u"c I tio I n 1-dra 11 w I i I ngs and ElComplies 103.2, documentation demonstrate E]Does Not 403.7 energy code compliance for []Not Observable [PR3]1 lighting and mechanical systems, E]Not Applicable Systems serving multiple dwelling units must demonstrate compliance with the IECC Commercial Provisions. .......... 362,11., Heating and cooling ❑equipment is Heating: Heating: �Ico'Complies i es 4033 sized per ACCA Manual S based Btu/hr Btu/hr___ E]Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: E]Not Observable Manual J or other methods Btu/hr Btu/hr-._,,,,_ EJNot Applicable approved by the code official, .................—1 Additional Comments/Assumptions: Higi Impact 11 11-,1"1) 2 Medium Impact(Tier 2) 3 Low Impact (Tier 3) m p— t .......... Project Title: Private Residence Report date: 09/27/24 Data filename: Page 3 of 10 ��.�# .n...... Foundation Ins�pettio�n.�.,._._ �_..�. ,Complies. C� ..ents/ ssu._ .., _ .... �...�__ ...�..__w���..... ci tios 3032.1 A protective covering is installed to [e lComplies [11:: �b1.''.]2 'protect exposed exterior insulation ❑Does Not and extends a minimum of 6 in. below ❑Not Observable grade. ❑Not Applicable .�, ee, ..e ., m.. _ ...... .. . 403,9 Snow-and ice-melting system controls ❑Complies ('h'4,:1;i.2'12 installed. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: m._�. :M 1�High Lmpact(Tier 1) a edium Impact(Ti(Tier 2) 3 Low Impact(Tier 3) Project Title: Pnva.�_.�. ._. ........._. ww.�..._ ��...-.,.� -...... ...... _. _�.. .�-.... ..�. ..._—, .... ...mm—_r. ��.._,�.-..._...._� ITITmmm to Residence Report date: 09/27/24 Data filename; Page 4 of10 e ton Framin / Rough-in Inspection Plans Value FieIV lueT Complies? Comments/Assumptions &Ol21.1 Laver 9 U-factor(area-weig 11 hted U_ „L.0 _.... 60DoespNot �be for Assemblies ues 402.3.3, []Not Observable 402.5 ❑Not Applicable [FR2]1 PP 4� 303.1.3 U-factors of fenestration — on products ❑Complies [FR4]1 are determined in accordance ❑Does Not with the NFRC test procedure or ❑Not Observable taken from the default table. ❑Not Applicable 402.4.1.1 Air barrier and thermal barrier ❑Complies [FR23]1 installed per manufacturer's ❑Does Not instructions. ❑Not Observable ❑Not Applicable �402.4.3 Fenestration the. ..m,, t is not site built E JComplies [FR20]1 is listed and labeled as meeting ❑Does Not AAMA/WDMA/CSA 101/l.5.2/A440 ❑Not Observable or has infiltration rates per NFRC 400 that do not exceed code ❑Not Applicable limits. 402A4 5 IC-rated recessed lighting fixtures ❑Complies [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate .52.0 cfm ❑Not Observable leakage at 75 Pa. ❑Not Applicable 403.3.1 Supply and return ducts in attics ( ]Complies [FR12]1 insulated >= R-8 where duct is ❑Does Not >= 3 inches in diameter and >_ R-6 where < 3 inches. Supply and ❑Not Observable return ducts in other portions of ❑Not Applicable the building insulated >= R-6 for diameter>= 3 inches and R-4.2 for< 3 inches in diameter. �n.m. .....a, - 403.3,2 Ducts, air handlers and filter l]t',nmplies [FR13]1 boxes are sealed with ❑Does Not joints/seams compliant with ❑Not Observable International Mechanical Code or ❑Not Applicable International Residential Code, as applicable. 3.3.5 Building cavities are not used as ❑Complies [FR15]3 ducts or plenums. ❑Does Not 6 , ❑Not Observable ❑Not Applicable conveying R IT ❑Complies [ R17]2 abo e 105 °For chilled fluids Rm uids � ❑Does Not below 55 9F are insulated to >_R- ❑Not Observable 3. ❑Not Applicable 403.4.1 Protection of insulation on HVAC ElComplies [FR24]1 piping. ❑Does Not e ❑Not Observable ❑Not Applicable 3.5.3 Hot water pipes are insulated to R R-M m„ EDCornplies [FR18]? >_R-3. ❑Does Not �a ❑Not Observable ❑Not Applicable 403.6 Automatic or gravity dampers are ❑Complies [FR19]2 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable „ f 1 High Impact(Tier 1) 1 pp Medium Impact (Tier 2) I 3 Low Impact (Tier 3) 4 ,- ... Project Title: Private Residence ...� �._ � ..��' _........... __....m_.�..._ .. R�p......,, ��.... _...�. ort date: 09/27/24 Data filename: Page 5 of10 Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 j M p�Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Private Residence.�.�� Report date: 09/27/24 Data filename: Page 6 of10 ... .��. t _. .� Plans ea__ied�.� FN�lv�.d complies?�efiet)' .. �....� Co Val � ... ntslAss� �._. Insulaion lnspec;t6 r� ' ' rr meuniptions Re l 30:3,1 All installed insulation is labeled ❑C:omplies IIN1 f) or the installed R-values EIDoes Not provided. ❑Not Observable ❑Not Applicable 402.1.1, Floor insulation.,,.„.... _ ue. �R _ R .. � � mplies See the Envelope .., R val 5 . Assemblies 402.2.E �" Wood Woo es Not table for values. IINI] Steel Steel []Nol:Observable l INot Applicable 30 .2, ....Floor in sulation installed per 1 lConrrplies 402.2.0 manufacturer's instructions and C....boes Not IIN2,)1 in substantial contact with the underside of the subfloor, or floor IDNot Observable 'framing cavity insulation is in EINol Applicable contact with the top side of sheathing, or continuous insulation is installed on the underside of floor fran)ing and extends from the bottom to the top of all perimeter floor framing members, 4021.1, ;Wall insulation P.-value. if! this is 0con'lpfies :See the Envelope Assemblies ,table for values,f of '❑ vocr ❑ oesNotWooc 44 2.2,E wall insulation on the wall EJ EJ mass ONut Observable Ilhl3)'' ;exterior,the exterior insulation l' aSp requirement applies(FR10). ❑ Steel D Steel) ❑Not Applicable ��.� ?3012 manufacturer's instructions.p. ❑ li _. � Wall insulation is installed per G•.)(«ornlaiir's oes Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: er 4) 2 Medium Impact(Tier 2) 3 Low Im 1 Iir l l�rpucG {1i pact(Tier 3) s.. ., ,,.. Project Title: Private Residence Report date: 09/27/24 Data filename: Page 7 of10 —b W Final I Jr- X m - FPlans Verlueified Field Complies? Comments/Assam tions Section � Verified p Inspection Provisions P Value p p & Req.ID d._ g R ElComplles See the Envelope Assemblies 402.1.1, Ceiling in R-value. R 402.2.1, ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.2, ❑ Steel ❑ Steel ❑Not Observable 402.2.E [FI1]1 ❑Not Applicable 303.1.1.1, Ceiling insulation installed per OComplies 303.2 manufacturer's instructions. ❑Does Not [F12]1 Blown insulation marked every ❑Not Observable 300 W. ❑Not Applicable . 402.2.3 Vented..m.. ..... .. �.r„ ... .� , ,,�e.,.._.e,.e _ e,, attics with air permeable ❑Com li p i es [F122]2 insulation include baffle adjacent ❑Does Not to soffit and eave vents that extends over insulation. ❑Not Observable ❑Nat Applicable 402.2.4 Attic access hatch and door R- R- ❑Complies [F13]1 insulation >_R-value of the ❑Does Not adjacent assembly, ❑Not Observable ❑Not Applicable 402. Pa. <=5 4.1.2 Blower door test @ 50 � .. _.. ..� m....... ®,�.......,e., �.......,, .a.,, ._ ACH 50 = ACH 50 =�w OComplies [F117]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8, ❑Not Observable ❑Not Applicable 403...,,...... a..... __.__ _ ......,,, .. m.....,. .,, ®.rw. n 3.3 Ducts are pressure tested to cfm/100 cfm/100 OComplies [FI27]1 determine air leakage with ftz ft2 ❑Does Not either: Rough-in test:Total ❑Not Observable leakage measured with a pressure differential of 0.1 inch ❑Not Applicable w.g. across the system including the manufacturer's air handler enclosure if installed at time of test. Postconstruction test: Total leakage measured with a pressure differential of 0.1 inch w.g. across the entire system including the manufacturer's air handler enclosure. 403.3.4 Duct result test tightness g It of<=4 cfm/100 cfm/100 OComplies [F14]t cfm/100 ft2 across the system or ft2 ft' ❑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. 403.3.2.I Airmandulfactureage desi-gn�oea....,.,.. , _ .. ...,. _....,._,... ... ❑Does Nos. p [F124] y t design air flow. ❑Not Observable ❑Not Applicable 403.1.1 Programmable thermostats_... -..,.m,. .......,.. ElConnpVies [F[9]2 installed for control of primary ❑Does Not heating and cooling systems and initially set by manufacturer to ❑Not Observable code specifications. ❑Not Applicable 403.1.2 Heat pump thermostat installed ❑Comp lie s [FI10]2 on heat pumps. ❑Does Not ❑Not Observable ❑Not Applicable 403.5.1 Circulating service hot water ]Complies [FI11]2 systems have automatic or ❑Does Not accessible manual controls. ❑Not Observable ❑Not Applicable 1High Impact(Tier l) 0 2 Medium Im act (Tier 2) C 3 Low Impact(Ties 3) Project Private Residence _ _. ._....... .__ _.. ] Report date: 09/27/24 Data filename: Page 8 of10 �# Final Inspection Provisions Plans Verified-'-_..� -- � l,.. , Value Field Verified p e Value Complies? CommentslAssumptions 403.6.1 All me _- chanical ventilation system ❑Complies IF125]2 fans not part of tested and listed ❑Does Not HVAC equipment meet efficacy []Not Observable and air flow limits per Table ❑ R403.6.1, Not Applicable 4033.2 Hot e r boilers supplying p heating.. . m.d.o,.. �... . ....., ❑Do m ]� Not �.... ®,,,, systems have outdoor setback []Not Observable control to lower boiler water ❑Not Applicable temperature based on outdoor temperature. ��b, ...... circulation e,... 403.5.1.1 Heated water c � �on systems ❑Complies (F128]' have a circulation pump.The ❑Does Not system return pipe is a dedicated ❑Not Observable return pipe or a cold water supply pipe. Gravity and thermos- syphon Applicable syphon circulation systems are not present. Controls for circulating hot water system pumps start the pump with signal for hot water demand within the occupancy. Controls automatically turn off the pump when water is in circulation loop is at set-point temperature and no demand for hot water exists. 403.5.1.2 Electric.heattrace systems OCornplies I[F129]2 comply with IEEE 515.1 or UL ❑Does Not 515. Controls automatically ❑Not Observable adjust the energy input to the heat tracing to maintain the ❑Not Applicable desired water temperature in the piping. e . . systems. have controls. ate that . _ . .. .. m® ElDo m li 40[FI3 j.2 Demand . ,. recirculation water plies Not manage operation of the pump ❑Not Observable and limit the temperature of the water entering the cold water ❑Not Applicable piping to <= 1049F, 403.5.4 Drain water heat recovery units ❑Complies [F131]' tested in accordance with CSA ❑Does Not B55.1. Potable water-side ❑Not Observable pressure loss of drain water heat recovery units < 3 psi for ❑Not Applicable individual units connected to one or two showers. Potable water- side pressure loss of drain water heat recovery units < 2 psi for individual units connected to three or more showers. 403.10.1 Readily accessible switch on ❑Complies [F112]3 heaters for swimming pools or ❑Does Not permanent in-ground spas. ❑Not Observable Switch operation does not change heater thermostat ❑Not Applicable setting. Heater circuit breaker is installed independent of switch. Gas-fired heaters equipped with ignition pilots that are not continuously burning pilots. 11 swi tches 403.10.2 Timer ,w111 ._._ or oth �® er DComplies [F119]3 automatic preset schedule ❑Does Not control method are installed on ❑Not Observable heaters and pumps serving pools a of Applicable and permanent 1...�High impact (Tier 1) P, ......... g p�m Medium _ pact(Tier 3) Medium Impact (Tier 2} 3 Low Im ®„ Project Title: Private Residence � Report date: : 09/27/24 Data filename: Page 9 of10 iaa 'fir cI Fleka a fire oa � l ..a Comments/Assumptions.,_.. �� NrrS der ettuora arrl twrstaerrktaorr+Boras i 10 3 Outdoor heated pools arid lIComplies 1F6201:1 outdoor permanent spas have a I]Does Not vap;ror retard wit cover, nNot Observable I. INot Applicable ..�_ .e _ _mmm ... _ 404.1 9011A or riore of taerni anent rkor pfies IFN " HAures have laugh efficacy pampas. Ebner,Not nNot Obseu°viable B Not Applicable 4041 1 1 Fuel gas fighting systems have E lcoraap.rlies @l=l2 ls' rao coratlrwauorws pil"at lighl- E] oes Not CINot Observable EINot Applicable 4013 °arrar al once Certificate posted, Ekoniphes lFl 'J' ODoes Not.: �-JNot Observable EINot Applicable 303,3 uararu is for m.m....,,. , or�wa gala e,, ll=l a l 1 w�Manufacturer eclaaataic l ardt water Naeatura Elr)oes Not systems have been provided. I_'lNot Observable EINot Afaphcable Additional Comments/Assumptions: Jedrtu„ra B.._a _act 1.Irer ,n �tov laI.act(Tier IHigh,Irra l Q1ier f ., Project Title: Private _ ._.. _ �.. .... _ . .. _ .. _..._ l le. Privy erne port date 9/ 7/' 4 Data flletiaine; Page 10 ofJ. Efficilei"'icy Certificate Above-Grade Wall 19.00 Below-Grade Wall 0.00 Floor 38.00 Ceiling / Roof 38.00 Ductwork (unconditioned spaces): MW as" Window 0.27 0.29 Door 0.27 0.29 CIECEMIMMUNNUUMOM Heating System:,, Cooling System: Water Heater: Name: ate: Comments Town Hall Annex Mw " Telephone(631)765-1802 "� 54375 Main Road (631 765-9502 r, � �� � � Fax ) P. O. Box 1179 ° Southold, NY 11971-0959 h BUILDING DEPARTMENT NOTICE OF UTILIZATIQN OF TRUSS WOOD„CONSTRUCTION AN DI R TIMBER CONSTRUCTION Date- _ Owner: . . I �......_ _ Location of Property: qSS --- Please take notice that the (check applicable line): New commercial or residential structure Addition to existing commercial or residential structure Rehabilitation to an existing commercial or residential structure to be constructed or performed at the subject property reference above will utilize (check applicable line): Truss type construction (TT) ...... Pre-engineered wood construction (PW) Timber construction (TC) in the following location(s) (check applicable line): Floor framing, including girders and beams (F) Roof framing (R) X mm Floor and roof framing (FR) Signature: m..... ��,�"� _.... .... �._.... ._�_ ....... Name (person submitting this form): ___DAv._p_ Capacity(check applicable line): Owner X Owner representative TrussRegl5.docx Effective 1/112015 DATE(MMIDD/YYYY) "R CERTIFICATE OF LIABILITY INSURANCE 091301202 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 Lisa Marie Aspen Agency Inc PHONE FAX 631 471a575Inf4�i (. fAM-ftm40; _ _ ...... ry I., 631)389 2439 "AIL'191 Ronkonkoma Avenue AQD8ASP lisaaas n rcom .... ... INSURmw.�. .... .... ..........� w,... ROnI(OnlCOma NY 11779 _ ER�S)AFFORDINGCOVERAGE NAIL# ---. e...... INSURERA._Utica First Insurance...Co.... -_—....... r �...... .... ...e..w...._.- INSURED INSURER B: -- _ �. Pirir Construction Corp INSURER.c ................_. .. .. ... _ ,.... .... . ..... ...e 4213 Middle Country Rd wsuRER D: _ _ I... ......... — Calverton, NY 11933 INSURERS ..... ._ _....n.. _ .. - INSURER F s COVERAGES CERTIFICATE NUMBER: 00020547-610877 REVISION NUMBER: 30 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. ih§R. ., ,..�._TYPE OF INSURANCE .............. T1DDL SUTT'R' ....n..�POLICY NUMBERm..�...., e.... ......... PbU6YEFF.. .POLICY EXPLTR .....w... .. ...,,,., ., .....,._ ,....... .,_, ...-..-- IN �......... M DDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y ART3001273960 07/1112024 07/11/2025 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE I X OCCUR bAMME"PREMI�SEt F2 Nfil b 100,990 ' MED EXP(Any-2 ne person) $ 5,,000_ .- ................. ............... .... ..... ,. ........ _� _-PERSONAL&ADV INJURY $ 1 OOO,OOO GENT AGGREGATE LIMIT APPLIES PER : GENERAL 2 AGGREGATE _$ ,000,000 PROa • .., LocPRODUCTS COMPOP AGG $ 2,000,000 $ POLICY JECT OTHER' S1 AUTOMOBILE LIABILITY COMBINEDCOMBINEDtx.E�.LIMIT ANY AUTO BODILY INJURY(Per person) $ BODILY INJURY.(....... ...... . ._... OWNED SCHEDULED Per accident) $ AUTOS ONLY AUTOS FP{Jp ER'TY DAU�tA4aE HIRED NON-OWNED ' $ AUTOS ONLY AUTOS ONLY IP§rtS(Apnll...................... ­­11-------- $ CE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ . EXCESS LIAB CLAIMS-MADE AGGREGATE $ AND EMPLOYERS'............. ......_...,...._ ... ,..m- .... ».,.._... a.. ..... �, WORK ED RETENTIpN$ $ D ERS COMPENSATION STATUTE„ I FRPER H .. .. .. Mandato m NH Y 1 N OFFICER/MEMBER EXCLUDED? E ACCIDENT $ NIA - e .. ....ANY PROPryRIETOR/PARTNER/EXECUTIV E L DISEASE EA EMPLOYEE $ E It yes,describe under DESCRIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $ E.L.DISE DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) THE CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT FOR GENERAL LIABILITY UNDER BLANKET ADDITIONAL INSURED ENDORSEMENT CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Southampton ACCORDANCE WITH THE POLICY PROVISIONS. 116 Hampton Road Southampton, NY 11968 AUTH�ORI 7PRESENRTATIVE Lls ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by LIS on 09/30/2024 at 10:42AM NYSIF New York State Insurance Fund PO Box 66699,Albany, NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ®. „ A A A A A A 473963558 ASPEN AGENCY INC 191 RONKONKOMA AVE RONKONKOMA NY 11779 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER PIRIR CONSTRUCTION CORP TOWN OF SOUTHAMPTON 4213 MIDDLE COUNTRY RD 116 HAMPTON RD CALVERTON NY 119333905 SOUTHAMPTON NY 11968 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12405 340-7 801849 12/13/2023 TO 12/13/2024 5/20/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2405 340-7, 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 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 WEBSITE AT HTTPS:/IWWW.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 JOSE P PIRIR COTZOJAY PIRIR CONSTRUCTION CORP (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:414309069 U-26.3 1 YORK Workers' CERTIFICATE OF INSURANCE COVERAGE " StATF 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 1 a. Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured PIRIR CONSTRUCTION CORP 631-300-5450 4213 MIDDLE COUNTRYROAD CALVERTON,NY 11933 1c. Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is speciflcallylimited to certain locations in New York State,i.e., Wrap-Up Policy) 473963558 _--------__ _._._._ _..._. _._.._.._- 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 SOUTHAMPTON 116 HAMPTON RD 3b. Policy Number of Entity Listed in Box"1 a" SOUTHAMPTON, NY 11968 DBL666790 3c.Policy effective period 05/26/2024 to 05/25/2025 4. Policy provides the following benefits: Z' A.Both disability and paid family leave benefits. ❑' B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: 0 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 earner referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 9/30/2024 By /43EV41, (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) L2StOn Welsh.Chief EX@CUtIV2 Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is Telephone Number 516-829-8100 Name and Title 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 413,4C 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 46,4C 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 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) 11111111111 o1111111 THE EXISTENCE OF RIGHTS OF WAY UNAUTHORIZED ALTERATION OR ADDITION DRAWN MIJ CHECKED MM I DATE AUGUST 2024 1 DRAWING do JOB NO. 24-768 AND/OR EASEMENTS OF RECORD IF TO THIS SURVEY IS A VIOLATION OF ANY, NOT SHOWN ARE NOT GUARANTEED. SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. ELEVATIONS REFER TO NAVD 1988. COPIES OF THIS SURVEY MAP NOT BEARING Area- 17,900.5 s.f. Premises known as: THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED # 985 Track Avenue, Cutchogue TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI— /p TUTION. GUARANTEES ARE NOT TRANSFERABLE. zNVI \ p - b" 00 ap / �;.� 49 r , &o I / e 1919 log. 19lb I 's. __.` ,p 1� I .. 01 + Is / _ - v: / p` AT 1 OF Ne L v cl Survey of Lots 59 and 60 MAP OF SECTION 2, PROPERTY OF M.S. HAND FILED MAY 12, 1939 AS FILE NO. 128001 situate at Cutcoue Town of Southold Suffolk County, New York Michael W. Minto L.S.P. C. District 1000 Section 137 Block 1 Lot 25 LICENSED PROFESSIONAL LAND SURVEYOR NEW YORK STATE LICENSE NUMBER 050871 Scale 1 "= 30' Surveyed August 15, 2024 87 Woodview Lane GRAPHIC SCALE Centereach, N.Y. 117ZO 30 0 15 30 so 120 PHONE/FAX: (631) 580-1202 CELLULAR: (631) 766-9714 EMAIL: mikemintolspc®gmailxom ( IN FEET ) 1 inch = 30 ft.