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HomeMy WebLinkAbout50433-Z aof souls°�° Town of Southold * P.O. Box 1179 53095 Main Rd Utal�, � Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 45807 Date: 12/05/2024 THIS CERTIFIES that the building GENERATOR Location of Property: 850 Lupton Pt Rd Mattituck, NY 11952 Sec/Block/Lot: 115.41-16 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 12/20/2023 Pursuant to which Building Permit No. 50433 and dated: 03/14/2024 Was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory generator as applied for. The certificate is issued to: Scott Rosen ,Lori Rosen Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 50433 11/25/2024 PLUMBERS CERTIFICATION: 4 0Auto OeSignature 1FF0(� TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • SOUTHOLD, NY col Sao f, 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#: 50433 Date: 3/14/2024 Permission is hereby granted to: Rosen, Scott 9 Rodsfield Ct Huntington, NY 11743 To: install generator as applied for per Trustees approval. At premises located at: 850 Lupton Pt Rd, Mattituck SCTM # 473889 Sec/Block/Lot# 115.-11-16 Pursuant to application dated 12/20/2023 and approved by the Building Inspector. To expire on 9/13/2025. Fees: ACCESSORY $125.00 ELECTRIC $100.00 CERTIFICATE OF OCCUPANCY $100.00 Total: $325.00 Building Inspector OF SO!/jyol o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q �. • �o Jamesh _southoldtownny.gov Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Scott Rosen Address: 850 Lupton Point Road city:Mattituck st: New York zip: 11952 Building Permit#: 50433 Section: 115 Block: 11 Lot: 16 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Pinti Electric Inc. Electrician: Vinny Pinti License No: ME-33025 SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1 st Floor Pool New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph 200a Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel 200a A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch 200a UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: 26kw generac generator with 110 amp breaker, 1 200amp ats Notes: GENERATOR Inspector Signature: Date: November 25, 2024 850 lupton point rd gen of SO�T�°� # #, TOWN OF SOUTHOLD BUILDING DEPT. coum, 631-765-1802 INSPECTION [ ] FOUNDATION AST/ REBAR [ ] ROUGH PLBG. [ ] .FOUNDATION 2ND [- ] SULATION/CAULKINNG [ ] FRAMING /STRAPPING [VI FINAL 6&VW1/0-v [ ] FIREPLACE & CHIMNEY [ ] FIRE,SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] ,:FIRE RESISTANT PENETRATION [ ] ELECTRICAL(ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]. RENTAL RE ARKS: 4v-1- L 'DATE = 'INSPECTOR hO�a0E soUlyO� 5O s 50 kup"( E^IV t Pt # TOWN OF SOUTHOLD�BUILIhING DEPT. 631-765-1802 1 NSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND. { ] INSULATION/CAULKING [ '] FRAMING /STRAPPING [ ] FINAL [ ] 'FIREPLACE & CHIMNEY [: ] FIRE SAFETY INSPECTION [ I FIRE-RESISTANT CONSTRUCTION [ ]` FIRE RESISTANT PENETRATION [ .] .ELECTRICAL (ROUGH) [ _] .ELECTRICAL (FINAL)` [ ] .CODE VIOLATION [ . ] PRE C/O [- ] RENTAL REMARKS: �f ✓� E 11,Q a INSPECTOR ���■■■ ■ram :- �. err ■■■ T / ��' ,J_' x -+-,;�• ^_ .� - Jyf ol nr .01 •�r�f ���°1�� # Yl� ,ter•}-k4 �i ,��-�-� i:� f'• ����'E z . '� y / �; ° ��r'� f•,�1�%;�o yt,�� i,� t'� �\ � 0.�t�� ..cam N,- { Inn / ` Ar ° FIELD INSPECTION REPORT DATE COMMENTS t� FOUNDATION (1ST) C� ------------------------------------- FOUNDATION (2ND) z op o H ROUGH FRAMING& PLUMBING CA 1 �r INSULATION PER N.Y. STATE ENERGY CODE- 10 IPA FINAL ADDITIONAL COMMENTS O :O;lf }-c.o t-C—L Ke—C4 16 4a 29KViq e, (4Z � rn \b H ao 1 z x d b y f�Q�°SUFFo�K�o � TOWN OF SOUTHOLD—BUILDING DEPARTMENT g Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631) 765-1802 Fax(631) 765-9502 hgps://www.southoldtowLmj.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ( •�..t.T AYdj e✓•xfaf f.).4(' 1 J � •_,.J j`-lam\ PERMIT NO. Building Inspector: Applications and forms must be filled out in their entirety. Incomplete }� DEC 2 0 2023 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: 5 LOr 9056W SCTM#1000- Project Address: 650 L V E adds I.rV 9- Phone#: 61 � _ 53 Email: r Mailing Address: CONTACT PERSON: Name: t2 'cam G I L�vd'C,J /'�}vS Mailing Address: d -!3d 71 G 0 ' r Phone#: _ t Email "we .&C DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: .'5 I\ L I K E LO N U 0 AJ ILI C Mailing Address: W it• G N -� Phone#: — Z5A,- 2 8' Email: k.1/�. �. r !��-too corA- -DESCRIPTION OF PROPOSED CONSTRUCTION. ❑New Structture ❑Addition ❑Alteration ❑Repair El Demolition Estimated Cost of Project: Other &gA FrZA 1-Vr� $ Will the lot be re-graded? ❑Yes;JVo Will excess fill be removed from premise s ONO 1 J PROPERTY INFORMATION Existing use of property: l'1�6&r intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? []Yes P<No IF YES, PROVIDE A COPY. Check Box After Readi-18.' 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. �_4Im,e�� lqef�fuf 11 Application Submitted By(print name): �� �C&,/+/2 r-Z— JAuthorized Agent ❑Owner Signature of Applicant: C8AML i4tif/ 2 Notary Public,State of Ne York No.OIBU6185050 STATE OF NEW YORK) Qualified in Suffolk County SS: Commission Expires April 14,2�y COUN T Y CI F S'u f�,104 ) /"L//ff,44 & JvI-E being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the C a7 7�ZLE�//4_&Z0­4_ (Coritra'ctor,'Alkent, 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 0Ady of .�Pi_d_Y__� �. , 20 l 1 a1 Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) (, Sco%r i20SElu residing at )p 0-A)s do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner' ignature Date c o 7 j 2n,LLv Print Owner's Name 2 e ' ,14 Board of Trustees 4 February 14, 2024 En-Consultants on behalf of NORTH FORK PROJECT, LLC requests a One (1) Year Extension to Wetland Permit-#10084, as issued qn February 16, 2022. Located: 5775 Mill Road, Mattituck. SCTM#: 1000-106-6-3 0 ORIENTAL UNICORN, LLC requests the Final One (1) Year Extension to Wetland Permit#9833 and Coastal Erosion Permit#9833C, as issued on March 18, 2021. Located: 860 Willow Terrace Lane, Orient. SCTM# 1000-26-2-47 ,HII / // s En-Consultants-on behalf of KENNETH MADSEN & MICHELLE HARMON-MADSEN requests an(Administrative Amendment to Wetland Permit#10359 to eliminate to proposed 8'xl2' spa and to modify the dimensions and configuration of the proposed deck and swimming pool to increase the minimum wetlands setback to the proposed deck from 65 to 76 feet, resulting in a proposed 1,507sq.ft. deck (in place of existing 732sq.ft. deck), and 12'x39' swimming pool. Located: 1425 Meadow Beach Lane, . Mattituck. SCTM# 1000-116-7-6 cu wip 6J. Mark Schwartz, Architect on behalf of -GOT-T ROB RI ©EDERI Ra`S`E " v requests an Administrative Amendment to Wetland Permit#10071 for the addition of a buried 500 gallon liquid propane tank; install an A/C condenser on south-west side of dwelling; re ove ex'stinTgen-erato s a an -relocate fora new propane powered— generatGr,_o no h=_eaastsside—ofwd dlftng;`the as-built lower deck on the seaward east side has been reconfigured and cut back by 2'3" and also on the southern side (angular portion) ±5'8" further from the water with the approved 267sq.ft. square footage remaining the same; and as-built 5'8"x7' hot tub on upper deck. Located: 850 Lupton Point Road, Mattituck ��iTIGI#�i1[60b 1151 7. Eastern End Pools, Inc., on behalf of MARK ALBERICI requests an Administrative Amendment to Wetland Permit#9975 for one 91 sq.ft. total patio, in lieu of the previously permitted patios. Located: 115 East Side Avenue, Mattituck. SCTM#: 1000-99-3-19 Inter-Science Research Associates, Inc., on behalf of MIMN HOLDING, LLC c/o NICHOLAS NOTIAS requests an Administrative Amendment to Wetland Permit#10459 to construct a 4,710sq.ft. two-story dwelling in lieu of the originally proposed 5,144 sq. ft. two-story dwelling; construct a 910 sq. ft. pool in lieu of the originally proposed 960 sq. ft. pool; construct a 2,750 sq. ft. covered and open terrace in lieu of the originally proposed 2,907 sq. ft. covered and open terrace; construct a 460 sq. ft. entry[a/nd/fmudroom 61eA I/ irG ��?J✓C SV uMcf (J Glenn Goldsmith, President �®F sou Town Hall Annex A. Nicholas Krupski,Vice President �® �® 54375 Route 25p.0. Box 1179 Eric S ki l�Q Southold, New York 11971 Liz Gillill0000ly Elizabeth Peeples G Telephone(631) 7Q5z48'2'•` BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE #2190 C Date: October 31, 2024 THIS CERTIFIES that the construction of an approximately 69.4' long 2.5'tall masonry stone retaining wall with 10'wide built in stone stairs approx. 26 9' from bulkhead; addition of approx.48 cubic yards of fill/topsoil to grade area above to meet top of wall,• installation of an approx. 40 4' long 2 5' tall masonry stone retaining wall approx. 8'from bulkhead grade approx. 500sq ft area below and cover with stone chip; removal of existing deteriorating wooden stairs and replace with stone steps set in grade, • planting of area between stairs with non-turf ground cover mix such as creeping thyme golden oregano creeping phlox; planting of area between retaining walls with perennial beach mix andgrasses; planting top of upper retaining wall with evergreen shrubs,perennial mix and grasses; revamping of reduced lawn/turf area above upper retaining_wall; planting perennial mix around foundation of dwelling and deck; plant evergreen screen between generator and east pro e�rty line,• installation of 33 linear foot stepping stone path along east side of dwelling; installation of 46sq ft of stone chip around equipment area on east side of dwelling; installation of a 10' 4 7/8" of Thigh welded wire fence with gate on east side of dwelling,• installation of approx. 20' long evergreen hedge along portion of west prope - line At 850 Lupton Point Road,Mattituck Suffolk County Tax Map 91000-115-11-16 Conforms to the application for a Trustees Permit heretofore filed in this office Dated February 22, 2024 pursuant to which Trustees Wetland Permit#10569 Dated April 17, 2024,was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the construction of an approximately 69.4' long 2.5'tall masonry stone retaining wall with 10'wide built in stone stairs approx. 26 9'from bulkhead,• addition of approx. 48 cubic yards of fill/topsoil to grade area above to meet top of wall,• installation of an _approx. 40.4' lone 2.5'tall masonry stone retaining Wall approx. T from bulkhead grade approx. 500sq ft area below and cover with stone chip,• removal of existing deteriorating wooden stairs and replace with stone steps set in grade,• planting of area between stairs with non-turf ground cover mix such as creeping thyme, golden oregano creeping phlox;planting of area between retaining walls with perennial beach mix and grasses; planting top of upper retaining wall with evergreen shrubs perennial mix and grasses;' revamping of reduced lawn/turf area above upper retainingplanting perennial mix around foundation of dwelling and deck; plant evergreen screen between generator and east property line; installation of 33 linear foot stepping stone path along east side of dwelling; installation of 46sq ft of stone chip around equipment area on east side of dwelling; installation of a 10' 4 7/8" of Thigh welded wire fence with gate on east side of dwelling; installation of approx. 20' long evergreen hedge along portion of west properly line. The certificate is issued to SCOTT&LORI ROSEN owners of the aforesaid property. Authorized Signature B I D G DEPARTMENT- Electrical Inspector .;� 01 9091, LJ TOWN OF SOUTHOLD o _ i3U1Ll)i�4G'� n Hall Annex- 54375 Main Road - PO Box 1179 z :4 Southold, New York 11971-0959 �y� • �p Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(c_Dsoutholdtownny qov — seand(aDsoutho townny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN IN s R CATION (All Information equired) Date: Co an Name: C'�'�e-. e p y Electrician's Name: i nD ° License No.:ME S Elec. email: . ��'coy-)Elec. Phone N-o:&Z1, LA 3- )Zq! ❑1 request an email copy of Certificate of Compliance Elec. Address.: • �0 r)P-0 JOB SITE INFORMATION (((All information Required) Name: sco- ''�' 1� I Address: �� U � � Cross Street: Phone No.: BIdg.Permit#: - email: Tax Map District: 1000 Section: l Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Sq uare Footage: Circle All That Apply: Is job ready for inspection?: YES M60 []Rough In Final Do you need a Temp Certificate?: 1(ES NO Issued On I, Z;,o :Z3 Temp Information: (All information required) Service Size 1 Ph❑3 Ph Size: �(2 0 A # Meters _ Old Meter# ❑New Service Fire Rec ctOFlood Reconnect OService Reconnect[BUnderground Overhead # Underground Laterals al n2 H Frame 7 Pole Work done on Service? ElY n"I Additional Information: PAYMENT DUE WITH APPLICATION 01 C B I D G DEPARTMENT - Electrical Inspector 00 6 1091 TOWN OF SOUTHOLD n Hall Annex - 54375 Main Road - PO Box 1179 BUILDING! r Southold, New York 11971-0959 ` o • - y o� Telephone (631) 765-1802 FAX (631) 765-9502 rogerr southoldtownny.gov - seandCcpsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN IN ARATION (AI'Jl informationequired) Date: S �./7 � C Company Name: Electrician's Name: i nD ° License No.:(�E 33 ISElec. email: \;►fln ��n�1� C `-��-�nC co Elec. Phone No:&31•• yCI 3 1Z91 ❑I request an email copy of Certificate of Compliance EIec. Address.: JOB SITE INFORMATION (All Information Required) Name: Scow I�--en Address: �} Girl G-y-► Cross Street: Phone No.: Bldg.Permit #: email: Block: Lot: Tax Map District: 1000 Section: C 1 t BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Final Is job ready for inspection?: YES ©NO E]Rough In Do You need a Temp Certificate?: YES NO Issued On t Temp'Information: (All information required) Old Meter#: Service Size Ph❑3 Ph Size: j� O.A # Meters _, , ❑New Service[ Fire Recon ctOFlood ReconnectOService Reconnect�ndergro:undQOverhead _ n� # Underground Laterals 1 2 H Frame r--. Pole Work done on Service? �' Additional Information: PAYMENT DUE WITH APPLICATION I 01 \, . .4- 1lQ (n 1 PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's UC Lts Fridge HW POOL Fans Mini Fr. W/D Panel Pump Exhaust Oven Sump Heater Trnsfmr Smokes DW Generator Salt Gen. Carbon Micro GrbDis Water Bond Lights Heat Pucks ERV HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo Cooktop Minisplit Blower AC AH Hood Blower Service Amps Have Used Sub Amps Have Used Comments ' KUJ r� 000 kmp Clo Atk* YPa e� .4C0 D® CERTIFICATE DATE(M�uDamYY �.- ATE OF LIABILITY INSURANCE 7/O7/20Z2 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 TH>; ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, APORTANT: if the certificate holder is an ADDITIONAL INSURED,the poilcy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT SPECIALIZED'INSURANCE&SERVICES NAME: PHONE - 204 RTE.112 E_MAI•L� - I LALC,No PATCHOGUE,NY 11772 ADDRESS; SRU@SPECIALIZEDINSURANCE.COM Auto-Home-Business-cycle-etc, INSURERS AFFORDING COVERAGE NAIO M INSURED INSURER A!ATLANTIC CASUALTY INS.CO. 42846 STERLING CONSTRUCTION ING INSURERS: 100 CENTERSHORE ROAD INSURERC. CENTERPORT NY, 11721 INSURERD., STEVE✓MARTINICO INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUME3ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUER LTR TYPE OF INSURANCE POLICY NUMBER PO ICY EFF POLOCDY EXP .OM LIMITS COMMERCIAL GENERAL LIABILITY LA880280,3b A Y Y 2/20/2022 2/20/2023 EACH OCCURRENCE 1,000,000 CLAIMS-MADE ®OCCUR PRMAI a TO a NT Mce $ 100,000 MED EXP(Any one erson $ 5 QOQ PERSONAL a AOV INJURY $ 1 000 QQQ GENLAGGREGATE"LIMITAPPLIESPER:POLICY❑YET 0 LOC GENERAL AGGREGATE $ 2,000,000 X ' OTHER: PRODUCTS-COMP/OP AGG 2000000 AUTOMOBILE LIABILITY COMBINNEE(SINGLE LIMIT $ ANY AUTO OWNED SCHEDULED BODILY INJURY(Per penon) $ AUTOS IR DSONLY AUTOS NON-OWNED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY PeOPERTYgggi4gat AMAGE $ UMBRELLA LIAa OCCUR EACH OCCURRENCE $ EXCESS LtAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N TATUTE OFFICERIMEMBER EXCLUDED? NIA E.L.EACH.ACCIDENT $ (Mandatory In NH) I/yea,descr,be under E,L DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS batwr I F-L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) REMODELING,CONTRACTORS-SUBCONTRACTED WORK,DRY WALL OR WALLBOARD INSTALLATION CERTICATE HOLDER IS ADDITIONAL INSURED AS PER WRITTEN CONTRACT OR AGREEMENT., CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE P.O.BOX 1179 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTHOLD, NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a Q 1888-2015 A RD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AC R o STERCON-01 VPETRUNGARO CERTIFICATE OF LIABILITY INSURANCE EDAT7171 DlYY1f1� 7/7/2022 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 FLOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED ZPRESENTATIVE 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 CAONT CT J.W.Hirschfeld Agency,Inc. PHONE 326 New York Ave (vc,No,Et):(631 421-2525 (A/C,No):(631)421-3015 Huntington,NY 11743 _MAILS_BE $:info@jWhinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Merchants Mutual Ins Co 23329 INSURER B: Sterling Construction Inc INSURER C: 100 Centershore Road Centerport,NY 11721 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. ILTR NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER .POLICY EFF POLpCY EXP LIMITS I COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR EACH OCCURRENCE $DAMAGE TO RENTED PRE IS S c rP e MED EXP(Any one rson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JEOT LOC PRODUCTS-COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT SOO,000 ANY AUTO CAP1078692 AOWNED UTOS ONLY X SCHEDULED 4/15/2022 4/15/2023 BODILY INJURY Per person) $ AUTOSy� BODILY INJURY Per accident $ X ALTOS ONLY X AUT 3 ONN�� PROPERTY AMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY �,f N R._ �pFICEOwMReIMTgERwEXCLUDEp PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ (�i7andatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is requhed) CERTIFICATE HOLDER CANCELLATION ,—� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ` Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O.Box 1179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE r �j�44 ��/t l7L>�✓t ACORD 25(2016103) v 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD iY(ORK workers, CERTIFICATE OF sTATE ComBoard sa�tl®Ir 13®� NYS WORKERS' COMPENSATION INSURANCE COVERAGE r� �a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Sterling Construction Inc 631-754-2981 100 Centershore Rd 1c.NYS Unemployment Insurance Employer Registration Number of Centerport, NY 11721-1527 Insured N/A Work.Location of Insured(Onlyrequired if coverage is specfcallylimited to certain locations In New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security 100 Centershore Rd, Centerport, NY 11721-1527 Number 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) TOWN OF SOUTHOLD NorGUARD Insurance Company P.O. BOX 1179 3b.Policy Number of Entity Listed in Box"l a" Southold, NY 11971 STWC344857 3c.Policy effective period 05/05/2022 to 05/05/2023 3d.The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) XD all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3 on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2 �1 he insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage Indicated on this Certificate. (These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights,or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. i Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Dave Simmons (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 07/07/2022 ---• " (Date) Title: Vice President of Sales elephone Number of authorized representative or licensed agent of insurance carrier: 800-673-2465 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov + � Suffolk County Dept.of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name STEPHEN MARTINICO Business Name This certifies that the y nearer is duly licensed STERLING CONSTRUCTION INC ay the County ofsuffolk License Number:H-43286 Rosalie Drago Issued: 08/07/2007 Commissioner Expires: 08/01/2023 SCTM#1000-115-11-16 ° DESCRIPTION: TOTAL AREA LOT COVERAGE: z ' PROPERTY: 19.166.90 SQ.F7. 0.44 ACRES Q \ ESTIMATED GROUND ATED A AREANCE:OF 00 B0'a PT. j _ DEEPHOLE MOUSE: 28882 SQ.FT. 15.0% 902j, Lu CREEK RACE: 4�. Fr. 3.9% UPPER DKR: 6i0103 S SF 3.3% -- \ LOWER DEM MIS SF D.9% v FRONT PORCH: 53.0 SQ.F7. 0.3% AO �D �e1/R '� D \�\ 1�,, •\ 1 sEmC sysTEAI - .�- PT ^) �OI 611 DRYWELIS 'SA'O P P\ \ ` \ TOTAL 4226.2 SQ.FT. 23.0% 4 20.9' h' \ LO ERUPPER \ \ D CK CAB L _ DECK - ^b METES AND BOUNDS BY: T. EASON LAND SURVEYOR ' 2I.S. �,, DATE: 1/27/21 q CONDTNSOR ^ NOT TUB PRIVACY\ /- 7 WALL W O 0 z tan m.HOUSE / ! FIN.FL 19.62 'z `z El/ ...................... METER a \\ CD - ° / 00 l 16x9'MAS.PATI5'AFG cc, 1 ' ° ! GARAGE / EL SLAB 18.89 / O• /16 EL EL If 14'4"R L J' EX CONC.APRON d A s� 3e� / •t B h' IP.]9 `6s DRGRAVEL IVEWAY •'�' SITE PLAN 2 5�g �� ` SCALE: 1" = 30'-0" ' 90�/^ �" �a �[ UN ELECTRIC ND Yl 3 v O/� IB F F ,EL 9.07 E< I 1 /18.66 \ UTIUTY POLE \ 1A/20G C.1 O 0 _ E i C iL Southold' Tovyr, X !' DRAWN:MH IMS . Board of Trusiees 'P ,QBR: -- SBEETNUMBER: �� S-lb