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HomeMy WebLinkAbout51471-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#: 51471 Date: 12/12/2024 Permission is hereby granted to: BKM Prpts of Shoreham Inc 82 Cobblestone Dr Shoreham, NY 11786 To: Construct alterations to an existing two-family dwelling as applied for to include insulation, roofing, fixtures, electric and window upgrades. Premises Located at: 7600 Route 25, East Marion, NY 11939 SCTM# 31.-6-11 Pursuant to application dated 10/21/2024 and approved by the Building Inspector.. To expire on 12/12/2026. Contractors: Required Inspections: Fees: Single Family Dwelling- Alteration $790.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total 890.00 Building Inspector �s 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 Date Received APPLICATION FOR BUILDING PERMIT 4 For Office Use Only �, , ".`s" v R :: r 19 PERMIT NO. 5 H rJ Building Insp ctor.-...ems C I 2 1 ;,.. 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: OWNER(S)OF PROPERTY: Name: r,7r Lit rA oftC ILL SCTM#1000- Project Address: �� — � l ( 0 to Phone#: —I3 r7 Email d!� � A Mailing Address: !� b He CONTACT PERSON: ^' Name. I 1 0U 41, I'LA -J,"" Mailing Address: � t.,l Phone#: Email:�1 1'IN 1J DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: QNd GAvs4 D Phone#: Email: CONTRACTOR INFORMATION: Name: ' „ Mailing Address: 4 Pt ' (i -ni m Phone#: Lob I ~ J; 1*1 Email: ... P" L DESCRIPTION OF PR OSED CONSTRUCTIONA41L . `P stir a ost of project ❑Other ❑New Structure Additii�n D Alteration DRep alr ❑Demolition E Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? 7DYes A-1`051 1 PROPERTY INFORMATION Existing use of property: Intended use of propety:Z4e I Zone use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes o IF YES, PROVIDE A COPY. Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town code.APPLICATION IS HOMY MADE to the&&dim Department for the Issuance of a witting Permit pursuant to the&"ng Zone ordinance of the Town of SoudwK Suffolk.County,New York and other appYoble taws,ordkseron or lteguk►ton%for the construction of buMdings, additions,alterations or for removal or demolition as herein described.The apiftent agrees to comply with all oppfkable laws,ordhmmm,buN t code, housing code and regulations and to admit authorlud knspectors on premkes annd In bulMI nAsi for necessary Inspections.False statements made herein are Punishable as a Class A mkdemearw pursuant ties Snow 210AS of the New York State Penal taw. \��'O 11% s i� Authorized Ageent ❑Owner Application Submitted By(print name): ��, U Signature of Applicant: Date: � 111 STATE OF NEW YORK) _ SS: COUNTY OF U EEZQ i—e-. ?Rq--M�) fling duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, ri (S)he is the (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 s PP 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 __7_day of 20 Notary Public State of New York No. 5006882 lified in Suffolk County Ili°wi a i fir`�� d"u . ..,A U t, „ ffl 1i �n Expires January 11,20 (Where the applicant is not the°owrter) L_ c ) n 1t L) - residing at ( V I U 1� Yt l U L ry do,herebyauthorize on r 'y behalf to the T"ow of Sotlrl m wilding Department for approval as dejcribe,3 her in. ... �� LG Owhe igna ure Date hi I'd C' -LLI Print Owner's Name 2 Generated by REScheck-Web Software CNJ/ Compliance Certificate Project Main Rd. Residence Energy Code: 2018 IECC Location: Greenport, 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: 7600 Main Road East Marion, New York Compliance: Passes using UA trade-off Compliance: 3.2%Better Than Code Maximum UA: 347 Your UA: 336 Maximum SHGC: 0.40 Your SHGC: 0.27 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Slab-on-grade tradeoffs are no longer considered in the UA or performance compliance path in REScheck. Each slab-on-grade assembly in the specified climate zone must meet the minimum energy code insulation R-value and depth requirements. Envelope e r N"e Prop.-s Gross Area Assembly or Cavity Cont. Req. Prop. Ceiling: Flat Ceiling or Scissor Truss 1,423 30.0 0.0 0.035 0.026 50 37 Wall:Wood Frame, 16" o.c. 2,675 18.0 0.0 0.062 0.060 146 141 Door: Solid Door(under 50%glazing) 61 0.290 0.320 18 19 Window: Wood Frame 259 0.290 0.320 75 83 SHGC: 0.27 Floor:All-Wood joist/Truss 1,423 30.0 0.0 0.033 0.047 47 67 Compliance Statement,, The proposed building design described here is consistent with the building plans,specifications„and gather 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, C{ Date Name-Title Si nature 4>c 7" o Project Title: Main Rd. Residence J Report date: 09/27/24 Data filename: 9 o - Q , v Page 1 of 9 N REScheck Software Version : REScheck-Web Inspection Checklist Energy Code: 2018 IECC Requirements: 38.0% 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. Sect& Ryon PlanValuefied Field Verified ;.. ID �uv., � �. Comments/Assumptions Review Complies Comments/As 103. ConPre-inspection/Plandrawin sand � ,. Re Construction g �❑C'omplies Requirement will be met. 103.2 documentation demonstrate ❑Does Not [PR1]1 energy code compliance for the ❑Not Observable y building envelope.Thermal envelope represented on ❑Not Applicable construction documents. , .....�..�.. _WW_.w .. ,v,M W.W___�,� ........................... ......... ___--- 103.1, Construction drawings and ❑Complies 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 compliance with the IECC 'Commercial Provisions. 302.1, Heating and cooling equipment is Heating: Heating: ❑Complies 403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2]2 on loads calculated per ACCA Cooling: Cooling: ❑Not Observable Manual J or other methods gtu/hr Btu/hr approved by the code official. ❑Not Applicable Additional Comments/Assumptions: 1 Hi h Impact(Tier 1) a....... mmITIT�W p 2) 3 Low Impact(Tier 3) Medium Impact(Tier_ Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 2 of 9 Section 1C Foundation Inspect e _t_o. mpiiesT CComments/Assumptions ..' pe ..... _ ......._ .�. 303,2,1 A protective covering is installed to ❑Complies Requirement will be met. [FO11]2 'protect exposed exterior insulation ❑Does Not and extends a minimum of 6 in. below ;grade. ❑Not Observable ❑Not Applicable 403.9 Snow-and ice-melting system controls'❑Complies [FO12]2 installed. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: �1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low mpact(Tier 3) Project Title: Main Rd.Residence Report date: 09/27/24 Data filename: Page 3 of 9 section Framing / Rough-In Inspection Plans luefied Fiel ValuefiedT—C mplies. Comments/Assumptions O.1.1, ._ .. m....... _.. _� .... ... U_............� ODompes Not See the table Envelope Assemblies . .. 402 1 1, Door U-factor, U- [FR1]1 [-]Not Observable ❑Not Applicable 40.... ... GlazingU-factor(area-weighted U __„_a a.... .. "... g - U- ❑Complies See the Envelope Assemblies 402.3.1, average). ❑Does Not table for values. 402.3.3, ❑Not Observable 402.5 ❑Not Applicable [FR2]1 303.1.3 U-factors of fenestration products, ❑Complies Requirement will be met. [FR4]1 are determined in accordance ❑Does Not with the NFRC test procedure or taken from the default table. ❑Not Observable ❑Not Applicable 402.4.1.1 Air barrier and the -- � �rmal barrier ;❑Complies Requirement will be met, [FR23]1 installed per manufacturer's ❑Does Not t insructions. '❑Not Observable ❑Not Applicable that �, � ��'Co>'ri"�plies Requirement � i 402.4.3 Fenestration tt is not site built mITmm-mmmITITITITITIT� "�" � will be met. [FR20]1 is listed and labeled as meeting ❑Does Not u AAMA/WDMA/CSA 101/I.S.2/A440, ❑Not Observable or has infiltration rates per NFRC 400 that do not exceed code ❑Not Applicable limits. _a._. ....__ _..... ,.., 402.4.5 IC-rated recessed lighting fixtures` ❑Complies Requirement will be met. [FR16]2 sealed at housing/interior finish ❑Does Not and labeled to indicate <--2.0 cfm ❑Not Observable ..leakage at 75 Pa. ]Not Applicable [FR121 insulated >- R 8 where .. - ..,. _ _.._.... 403.3.1 Supplyand return ducts in attics ❑Complies 1 - e 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. .........._.._ _ . ....... 403.3.2 Ducts, air handlers and filter ❑Complies [FR13]1 boxes are sealed with ❑Does Not joints/seams compliant with ❑Not Observable International Mechanical Code or International Residential Code, as ❑Not Applicable applicable. 403.3.5 Building cavities are not used as ❑Complies [FR15]3 ducts or plenums. ❑Does Not ❑Not Observable ❑Not Applicable 403.4 H,,,. ........�.� .. VAC piping conveying fluids R- R- ❑Complies [FR17]2 above 105 °F or chilled fluids ❑Does Not below 55 °F are insulated to >_R- ❑3 Not Observable ; ❑Not Applicable m ....... ..HVAC Ek1JDornplies Not 403.4.1 Protection of insulation on [FR24]1 piping. ❑Not Observable ❑Not Applicable 403.5.3 Hot water pipes are insulated to R R- ❑Complies [FR18]2 >_R-3. ❑Does Not ❑Not Observable ❑Not Applicable ._ g _m act(Tier 1) 2 Medium Im act EE p 1 Hi h I� p p (Tier 2) 3 Low Im act(Tier 3) Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 4 of 9 5e �kMon Re IiC9 �_.. m. v Plans lar.... Pied Flel _Verified �raming I Rough-in Inspectl or Value valueComplies? om l ue_.s.....�...� anent &_..s_.u_m_.._.ion s - � 401 ,Automatic or gravity dampers are: ❑Complies Requirement will be met. ('FR19)2 installed on all outdoor air ❑Does Not intakes and exhausts. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: �p }}1 H'd h Impact(Tier 1) 2 Medium Impact(Ter 2) 3 Low Imp ac�t�(Tier 3) 1...._ . _ _..� _ ..� Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 5 of 9 Section Value Value Plans Verified Field insulation Inspection aloeLICOM-P-1ie-1—C-0 '� mments/Assumptions All instal 303.1 led insulation is labeled ❑Complies Requirement will be met. [IN13]2 'or the installed R-values ❑Does Not „a provided. ❑Not Observable ❑Not Applicable 402.1.1, Floor insulation R value. R- R -^ _ ❑Do spNot table for � Envelope Assemblies 402.2.6 ❑ Wood ❑ Wood es. [IN111 ❑, Steel ❑ Steel ;❑Not Observable ' ;❑Not Applicable 303.2, :Floor insulation installed per []Complies Requirement will be met. 402.2.8 manufacturer's instructions and ❑Does Not [IN211 in substantial contact with the (]Not Observable underside of the subfloor, or floor framing cavity insulation is in ❑Not Applicable contact with the top side of sheathing, or continuous insulation is installed on the underside of floor framing and extends from the bottom to the top of all perimeter floor framing members. 1 If this is a R- R ❑Complies 402.1. , Wall insulation R-value. � � _W ............ .__....-IT �M. _ -ITITmmm�m�. . See the Envelope Assemblies 402.2.5, mass wall with at least 1/2 of the ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.6 wall insulation on the wall ❑ Mass ❑ Mass ❑Not Observable [IN311 exterior,the exterior insulation requirement applies(FR10). ❑ Steel ❑ Steel ❑Not Applicable 303.2 Wall insulation is installed per ❑Complies Requirement will be met. [IN411 manufacturer's instructions. ❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: kwgh Impact(Tier 1) 2 Medium Im act(Tier 2) 3 Low 1m .. m . __ .. p _.. ....P . act..(Tier 3) Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 6 of 9 _Section Final Inspection Provisions PlanValuefied Field Valuefied Complies? Comments/Assumptions & Re ID _ 402.1.1, Ceiling insulation R-value. R R mmmITITITITmmIT ❑Complies See the Envelope Assemblies 402.2.1, ❑ Wood ❑ Wood ❑Does Not table for values. 402.2.2, ❑ Steel ❑ Steel ❑Not Observable 402.2.6 ❑Not Applicable [FI1] 303.1.1.1, Ceiling insulation installedll _ ITIT ..______..... ' g ' per , ' ❑Complies Requirement will be met. 303.2 manufacturer's instructions. ❑Does Not [FI2]1 Blown insulation marked every ❑Not Observable 300 ft2. ❑Not Applicable 402.2.3 Vented attics with air permeable ❑Complies Requirement will be met. [FI22]2 insulation include baffle adjacent - ❑Does Not to soffit and eave vents that extends over insulation. ❑Not Observable ❑Not Applicable 402.2.4 Attic access hatch and door R- �ITITITmmmmm❑ � WWWW--ITITITITITm R- Complies Requirement will be met. [FI3]1 insulation >_R-value of the ❑Does Not adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 Blower door test 50 Pa. <=5 ACH 50 — — A _ C ITITm.. �mmITmmITIT mmwi @ — CH 50 = ❑Complies Requirement will be met. [FI17]1 ach in Climate Zones 1-2, and ❑Does Not <=3 ach in Climate Zones 3-8. ❑Not Observable ❑Not Applicable 403.3 determine air leakage with ftz ft2 ... ._fm ❑Does -.— 403.3.3 Ducts are pressure tested to cfm/100 cfm/100 ❑Complies 1 Not either: Rough-in test:Total leakage measured with a ❑Not Observable 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. _ [03.3.4 Duct tightness test result of<=4 mm cfm/100 cfm/100 ElComm �........� -4 mplies 1411 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, 403.3.2.1 Air handler leakage designated ❑Complies [FI24]1 by manufacturer at<=2%of ❑Does Not design air flow. ❑Not Observable ❑Not Applicable _..._ — _......... ___..._.... 403.1.1 Programmable thermostats ❑Complies [Fl9]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 l ❑Complies [Fl10]z on heat pumps. ❑Does Not ❑Not Observable ❑Not Applicable ....... W� .. �m �� mm ��._�............ ........__ 403.5.1 Circulating service hot water ❑Complies [Fl11]z systems have automatic or ❑Does Not accessible manual controls. ❑Not Observable ❑Not Applicable Medium Im act(Tier�21 High Impact(Tier 1) 3 Low Impa ct(Tier 31 Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 7 of 9 Section Inspection.. PIanV luefied Fiel Valuefied ITIT P s? � ptions ments/Assum sions 403.6.1 AIIFmechanical ve tilat on� es.system , ;� I❑Compliels Com [FI25]2 fans not part of tested and listed ❑Does Not HVAC equipment meet efficacy and airflow limits per Table ❑Not Observable R403.6.1. ❑Not Applicable w 03.. .._. ,.. w .:� _ _ ..... ......._ .._.... 403.2 Hot water boilers supplying heat ❑Complies [FI26]2 `through one-or two-pipe heating ;❑Does Not systems have outdoor setback control to lower boiler water ❑Not Observable temperature based on outdoor ❑Not Applicable temperature. 403.5.1.1 Heated water circulation systems , ❑Complies [FI28]2 have a circulation pump.The ❑Does Not system return pipe is a dedicated return pipe or a cold water supply ❑Not Observable pipe. Gravity and thermos- ❑Not 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. x 403.5.1.2 Electric heat trace systems ❑Complies [FI29]2 comply with IEEE 515.1 or UL ❑Does Not 515. Controls automatically adjust the energy input to the ❑Not Observable heat tracing to maintain the ❑Not Applicable desired water temperature in the piping. ._ ........... 403.5.2 Demand recirculation water ❑ implies [F130]2 systems have controls that ❑Does Not manage operation of the pump and limit the temperature of the f [:]Not Observable water entering the cold water ❑Not Applicable piping to <= 104°F. _..._.� ........_�� i 403.5.4 Drain water heat recovery units ❑Complies [FI31]2 tested in accordance with CSA ❑Does Not B55.1. Potable water-side pressure loss of drain water heat [:]Not Observable 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. 404.1 90%or more of permanent ❑Complies [FI6]1 fixtures have high efficacy lamps. ❑Does Not ❑Not Observable ❑Not Applicable 404.1.1 Fuel gas lighting systems have a❑Complies [F[23]3 no continuous pilot light. ❑Does Not ❑Not Observable ❑Not Applicable 401.3 Compliance certificate posted, ❑Complies Requirement will be met. [FI7]2 ❑Does Not ❑Not Observable ❑Not Applicable I1 Hi h Impact(Tier 1) 2 M 3) pa..t(T _ - Mm e- ium Impact(Tier 2) ,Low Impact(Tier 3) Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 8 of 9 ectiori Plans Verified Field Verified Final)Inspection Pr±ovislons P P Ip,e INS "h�al�ae valuedorm Iles? �nu�nrrmer�ts�'Assua�a t oans .. 33:3 Manufacturer manuals for ElOomplies (='I18)3 mechanical and water heating 'ElDoes Not systems have been provided. (]Not Observable 'E]Not Applicable Additional Comments/Assumptions: :....... ., _L- ITX pa Med mctT Tier High Impact(Tier iump 3—) Project Title: Main Rd. Residence Report date: 09/27/24 Data filename: Page 9 of 9 Efficiency Certificate Insulation Rating R-Value Above-Grade Wall 18.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 30.00 Ductwork (unconditioned spaces): Door Rating U-Factor SHGC Window 0.29 0.27 Door 0.29 Cooling;Heating & Heating System: Cooling System. Water Heater.. Name: Date: Comments Suffolk County Dept.of Labor,Licensing&Consumer Affairs ROUE INPROVEA/ENT LICENSE Name RICHARD A HOVA.%EC Business Name This certifies:hat the 3esrer is Wy licecsed Easton Home Building Corp 3y the County of suffolk License Number:HI-64359 Rosalie Drago Issued: 11/16/2020 Comm;ssioner Expires: 11/01/2024 This IiCerkse is the property of Suffolk County „ Department of Labor.Licensing&C016Sumer Affairs. d"v .cs^wwaa wl 4lr. 8�t�:r irww.dnv!c.wit 0[5 Val r;aty. Additional Business Name License Category H1-GC NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE NAV, AAAAAA 113411622 EASTON HOME BUILDING CORP 1405 DEER PARK AVE N BABYLON NY 11703 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER EASTON HOME BUILDING CORP TOWN OF SOUTHOLD 1405 DEER PARK AVE 54375 RTE 25 N BABYLON NY 11703 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12633 657-8 309982 10/18/2024 TO 10/18/2025 10/18/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2633 657-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/NWVW.NYSIF.COMICERTICERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. 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 �/4 /2 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER_694172340 U-26.3 w ATE A CERTIFICATE OF LIABILITY INSURANCE D10/16/2024 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 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). Comm PRODUCER NAME. Twin Forks Insurance Agency PHONEt►u. 631-224..1.000AAL- 16 Station Rd,Suite#7 E-MAIL Bellport,NY 11713 . -_-- PRODUCER4 w.... .. ..,._.__ INSURER(S)AFFORDING COVERAGE NAIC# INSURED Insurance CO IntisutA Evanston,........ .... ..-__._._ .._r Easton Home Building Corp INSURERB: I 1405 Deer Park Avenue 'INSURER N Babylon, NY 11703 NsuRE c INSURER D; INSURER E: INSURER F;. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. III TYPE OF INSURANCE _ _ DL SUBF('. ......... PORKY U d,. ,,,., .........,,, .... NM MPOLNC� y .MMIODIYYY. .F......., LIMITS GENERAL LIABILITY 1,000,000 EACH OCCURRENCE S .__ �Y I OCCUR MED E�lAnr ona pe t $ 100,000 �E'7o I�EI �i COI!AIWEROIAL GENERAL L PREMISES(Ea Qccurren . A CLAIMS-MADE,' �3AA833980 rson) S 5 000 �.0/1nfl,�,�4 i30/"7LC�/25 1,000,000 1SONAL 8 ADV WJURY�S .. PER NERAL AGGREGATE S Oer,rl...AGGREGATE LIMIT,-.•. ........ ......... ...... ... ......._ 2,000,000 SPER pPRoDUCTS-COMP/OPAGG k$ APPLIES �. POLICY ..... PROm LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea ac adenQ BODILY INJURY(Per person) $ ALL OWNED AUTOS ..,.,. ........., ._ .... ..... . ....... BODILY INJURY(Per accident) $ SCHEDULED AUTOS "'— ....... '., .. �PROPERTY DAMAGE ' HIRED AUTOS (f'eracaden!) NIWOWNED AUTOS $ UMBRELLA LIAB OCCUR ' .EACH OCCURRENCE S OCCUR ... ....... � EXCESS LIAB MADE - AGGREGATE I Is DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION WC STATU !OTH AND EMPLOYERS LIABILITY Y/N � I 1 F xJ lr�t�T ! _I R (M ICERIMEMBEREXCLUDED" NIA E SE CIDENT 1$ ANFFCROPRIETOR PARTN aloly In NH) ERE7tECUITh6E ElE E.L.EACH AC EA EMPLOYEE;$ a El DISA _ IF ,,,describe des cnhe ter I E.L.DISEASE-POLICY LIMIT $ . ._ D SORIELIONund OPEI TIO'NS Gekw J DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE MOLDER CANCELLATION Town Of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 Rte 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold, NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 9)1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD . , YO workers' CERTIFICATE OF INSURANCE COVERAGE sME 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 carrie 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured EASTON HOME BUILDING CORP 631-586-6700 1405 DEER PARK AVENUE NORTH BABYLON, NY 11703 1c_Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specificaftylimited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 113411622 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 54375 Rte 25 3b.Policy Number of Entity Listed in Box"I a" Southold, NY 11971 DBL154522 3c_Policy effective period 10/31/2023 to 10/30/2025 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: Q 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 employers 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 10/16/2024 By lAtEV—P�S, (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Leston Welsh 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 48,4C 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) II�IIPDn°mii2ii12iiNii�ll SYMBOL LEGEND LD MONUMENT FND © MANHOLE � TEST HOLE BEARINGS SHOWN HEREON ARE BASED ® I.P. / I.B. FND M "A"—INLET TREE ON DEED BOOK 11136 PAGE 098 ® I.P. / I.B. 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STK FEN 6 6 t PVC O<6°� 0.8- SHDy f4Hs 0.1�f - $STOCKADE FEN. PVC t 4,9 I �—S _i0 A O r DILAP 6'STOCKADE FEN. RN 1 WATER TANK 13 '00 T� 9 O Li r0.9' PVC 1s' ---.------I t03� PIPE I ASPHALT I I GRAVEL I AREA TAX LOT 28.5 GRAPHIC SCALE 30 O 15 30 LOT AREA 17,388.58 S.F. ( IN FEET ) 0.40 AC. NMI 1 inch = 30 ft. \\ SURVEY OF PROPERTY �0!1- E � Am LE A OffSCALICE � _ . land surveying 7600 MAIN ROAD, EAST MARION, NEW YORK 11939 of mjslandsurvey.com P:631 -957-2400 SITUATE EAST MARION, TOWN OF SOUTHOLD 1 South Bay Avenue, Islip, NY 11751 SUFFOLK COUNTY, NEW YORK 0 �A ND DR.:MC CREW.:JM SCALE: 1" = 30' TAX MAP NO. DATE SURVEYED:05/14/2024 1 JOB No.S24-2362 1000—031.00—06.00—011.000 uW.121 v is +NUNo RVEroR s e T WOW MID 011,01, SEAL ARE c�AND� r 5~�i A. '€ t YAF THAT 5N€ § 1NflY' €TYi L4i'4 8Y THE a 4' STtw oulaRO"-- 'dffi . ARE NOT�' 1Oaa N ISO 0€TF1a ME F�cVSTM,@,ANY OR AKf,Tfi i m H c3 ,�«• �•MAF.(A7 Try r €t AT 45k ash ¢#_tom Ai H L -- .w T} (�1 TPA SN Ned FROM THE b0 9N€ & An A ! 1 AATIOS A NOC TO V$10�7 NOT SHOWN ARE NOT G Rimmis WALLS.POOLS.PGUMAM®. 'T AS (8); - WITH A raA raTTa STATKiL. i<a}THE a acNrs ov r�.r Arm/m€ ---- -_. . 2YL A#�7} E WAY ANY iF<i-Y N3F€ ilt '1 __ A' ARE NOT