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Home My WebLink About51893-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#: 51893 Date: 05/02/2025 Permission is hereby granted to: Michael Parisi 145-54 6th Ave Whitestone, NY 11357 To: Demolish an existing single-family dwelling and construct a new single-family dwelling as applied for per SCHD approval. Premises Located at: 1840 Delmar Dr, Laurel, NY 11948 SCTM# 127.-4-19 Pursuant to application dated 03/27/2025 and approved by the Building Inspector., To expire on 05/02/2027. Contractors: Required Inspections: Fees: DEMOLITION $698.00 Single Family Dwelling-NEW $3,250.00 CO Single Family Dwelling-New $100.00 Total $4,048.00 �fz tj Building Inspector r� urtrrrc,r TOWN OF SOUTHOLD—BUILDING DEPARTMENT gas Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 •» Telephone(631) 765-1802 Fax(631) 765-9502 htt) ://WWW.soutlioldto pp o Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only 13 PERMIT NO. 5 � Building Inspector: p, Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant Is not the owner,an Building Department (hunera Autbarization form(PageA shall he completed.,, Town of Southold Date: p OWNER(S)OF PROPERTY: Name: ( c1 SCTM#1000- oI / — Li-- /9 nnY I C>µ� Project Address. IJE Irr i,�, ve L�UY21 � ay Phone#: (� 1 �o �. a Email: m . eA rl I r 100 1 c ��` M I.v Mailing Address: \Lk 5 r S`� � � D� N'� 1 O--� j CONTACT PERSON: Name: �`If'-QS ��—AY► A Mailing Address: N 13S Phone f#: .. Email: cTj r i S l Ob DESIGN PROFESSIONAL INFORMATION: Name: o � Mailing Address: , \/_i , ,orl%,` r1Ve rNck\ . K) Phone#: 4 '1 VV3 _ Email: CONTRACTOR INFORMATION: Name: -15 o — A iM Mailing Address: 1 qt ,r, e r Y c "+ I Phone#: 1_ 9 1 @ — I g y Email: n � r e' CL Z(I I 1. \,..cVetN DESCRIPTION OF PROPOSED CONSTRUCTION ❑Other Estimated Cost of Project: P $ 450i D oa l�NewStructure ❑Addition ❑Alteration ❑Re air emolition E® Will the lot be re-graded? ❑Yes WNo Will excess fill be removed from premises? Pes ❑No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated:. Are there any covenants and restrictions with respect to this property? Dyes ❑No IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and stone water Issues as provided by Chapter 236 of the Town Code.APPUCATION 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 Cass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. r � �� pp y(p ); �' �� L3'Authorized Agent Owner Application Submitted B (print na Signature of Applicant: Date: ROBERTO VIOLA Notary Public, State of New York STATE OF NEW YORK) No, 01VI6189600 Irl SS: Certiticd in Queens County r COUNTY OF ) Commission Expires 06/3012CL it Y-e J being duly sworn,deposes and says that(s)he is the applicant Name of individual sign 'contract � g g )above named, ( 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 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. F Sworn before m his day of 20,_1� Notary ublic PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I lC k GIB P+:M'k r i S,( residing at I d Yo 0e ( r^a r ®Y ivy U V c INQ Y do hereby authorize A4 0.).. -4L ?II' j A rr,o,LA x to apply on my behalf to tIV Town of Southold Building Department for approval as described herein. &::5Z D I 1 17_�r Owner's Signature ROBERTO VI ate ,r Public, State of New York -,( C at No.OIVIS189600 Print Owner's Name Certi ed in Queens Count Commission Expires 6/3 1 0 Z f _ 2 a Generated by REScheck-Web Software Compliance Certificate Project Parisi Residence Energy Code: 2018 IECC Location: Laurel, New York Construction Type: Single-family Project Type: New Construction Project SubType: None Conditioned Floor Area: 2,525 ft2 Glazing Area 12% Climate Zoe; 4 (5331 NDD) 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: 1840 Delmar Drive Michael Parisi Joseph Mile Laurel, NY 11948 1840 Delmar Drive 84 VIDONI DR Laurel, NY 11948 MOUNT SINAI, NY 11766 631-473-5410 jmile@optonline.net Compliance: 7.2%Better Than Code Maximum UA: 373 Your UA: 346 Maximum SHGC: 0.40 Your SHGC: 0.31 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. Slla lb-oin_gliradc,,tiradeoffsa afire no loingcn coi o.,tiered in the,UA or peirf(:iinrnau'nce coumropliliair ce path iin RESc hz=ck, IEach slla b-oinr gm de a s aair bn y In the aropec litlied r:lluirrnaat:r zoi ne irrnauast rrieet:the irrnirnuirrnnurrn e neFrgy code lime>Qullaat.lio n fit-vaalnucw and arc°Ir th rrrata.uliira.rr eil t:sa. Envelope Assemblies- Prop.Gross Area Cavity Cont. Prop. Perimeter Ceiling 1: Flat Ceiling or Scissor Truss 1,735 30.0 0.0 0.035 0.026 61 45 Ceiling 2: Cathedral Ceiling 550 30.0 0.0 0.034 0.026 19 14 Wall:Wood Frame, 16"D.C. 2,268 21.0 0.0 0.057 0.060 114 120 Door FWG: Glass Door(over 50%glazing) 50 0.300 0.320 15 16 SHGC: 0.27 Window DH:Wood Frame 221 0.280 0.320 62 71 SHGC: 0.32 Floor 1:All-Wood Joist/Truss 2,285 30.0 0.0 0.033 0.047 75 107 Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 1 of10 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 mandator uirements listed in the N ESc eck Inspection Checklist, y1 Joseph Mile - Architect , �' •� � -5 Name-Title Signatyro Date op OF Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 2 of10 REScheck Software Version : REScheck-Web Inspection Checklist I Energy Code: 2018 IECC Requirements: 97.0% 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 Complies? Comments/Assumptions Value Value �docutruction drawings and � �a , ❑Complies :Requirement will a " 103.1, Construction I be met. 103.2 mentation demonstrate ❑Does Not [PR1)1 ;energy code compliance for the building envelope.Thermal """ ❑Not Observable ; !envelope represented on ❑Not Applicable l UI1S�l UlllUll documents. 41i1/loll//Oi��//�i//riyn�ioi i�/9, 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 compliance with the IECC ' _ Commercial Provisions. 302.1, :Heating and cooling equipment is Heating: Heating ,❑Complies Requirement will be met. 1403.7 sized per ACCA Manual S based Btu/hr Btu/hr ❑Does Not [PR2)2 on loads calculated per ACCA Manual J or other methods CooNin g' Cooling: tlNot Observable F approved by the code official. Btu/hr Btu/hr ❑Not Applicable Additional Comments/Assumptions: 111 High Impact(Tier 1) 2 1 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 3 of10 Section # Foundation Inspection Complies? Comments/Assumptions 303.23 A protective covering is installed to ❑Ctar�'mpiies Exception: Requirement is not p p q applicable. (FO 1 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 Exception: Requirement is not applicable. (Ft31 j2 installed. ;❑Doe Not ❑Not Observable; ❑Not Applicable { Additional Comments/Assumptions: 11 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 4 of10 Section Plans Verified Field Verified # Framing/Rough-In Inspection Value Value Complies? Comments/Assumptions & Req.ID 402.1.1, Glazing gU-factor(area-weighted e -�......... .� .. u..W-._A,.. ._. .-._-..._ _......... „� ..... - -weighted U- U plies 'See the Envelope Assemblies 402.3.1, avers ). ❑Does g Not table for values. 402.3.3, 402.5 ❑Not Observable [FR2]1 ❑Not Applicable 303.1.3 U-factors of fenestration products;, ❑Complies Requirement will be met. 1 i , „ , [FR4] are determined in accordance - ;: ❑Does Not with the NFRC test procedure or , �. ;taken from the default table. �� , ❑Not Observable ❑Not Applicable u �402.4.1.1 ;Air barrier and thermal barrier L, ❑Complies f Requirement will be met. [FR23]1 installed per manufacturer's ❑Does Not instructions. _-]Not Observable ❑Not Applicable ..... 402.4.3 Fenestration that is not site built ' ❑Complies Requirement will be met. ✓af %//rr%/il(�(0%Nr/,Ir�'ib�/rl4//%Al 11 JrfielH!%i��✓ui��a�%�,, yGli/�r',. [FI{zU]1 �is listed and labeled as meeting �" LJDoes Not AAMA/WDMA/CSA 101/I.S.2/A440 or has infiltration rates per NFRC ❑Not Observable r-. e400 that do not exceed code ❑Not Applicable r 4 limits. Y . 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 s2.0 cfm c/ ❑Not Observable leakage at 75 Pa. " ❑Not Applicable 403 3 1 Supply and return ducts in attics 7 ; ]Complies Requirement will be met. [FR12]1 insulated >= R-8 where duct is .❑Does Not Al._, >= 3 inches in diameter and >_ %❑ R-6 where < 3 inches. Supply and Not Observable F return ducts in other portions of %, ❑Not Applicable ;the building insulated >= R-6 for diameter>= 3 inches and R-4.2 jfor< 3 inches in diameter. n 403.3.2 Ducts, air handlers and filter ]Complies Requirement will be met. [FR13]1 boxes are sealed with ❑Does Not ,joints/seams compliant with �� ' ❑Not Observable International Mechanical Code or International Residential Code, as El Not Applicable ... ._ �applicable. ............................... r� 403.3 5 g `;Buildin cavities are not used as „, ,�� 1 �,� ;, `❑Complies ;Requirement will be met. [FR15]3 ducts or plenums. ❑Does Not s❑Not Observable % '❑Not Applicable .,. _. .... ...... 403.4 HVAC piping conveying fluids R- ; R I❑Complies :Requirement will be met. [FR17]2 above 105 °F or chilled fluids ❑Does Not below 55°F are insulated to >_R-3. ❑Not Observable ❑Not Applicable 403.4.1 ;Protection of insulation on HVAC ❑Complies ;Requirement will be met. [FR24]1 piping. ElDoes Not 1 � El Not Observable ❑Not Applicable 403.5 3 Hot water pipes are insulated to R- R- ❑Complies ;Requirement will be met. [FR18]2 >_R-3. ❑Does Not i ❑Not Observable ❑Not Applicable 403.E 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 1 hllg,h Impact(Tier 1) J 2 1 Medium(Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 5 of10 Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 6 of10 Section Plans Verified Field Verified Insulation Inspection Value Value Complies? Comments/Assumptions 1 ,Re AD R, All .. ... .... _.... ew ,o . .-. ........_....._. installed insulation is labeled ❑Complies [1IV13)2 or the installed R-values '❑Does Not provided. ❑Not Observable ❑Not Applicable 402.1.1, Floor insulation R-value. R- R °❑Complies See the Envelope Assemblies 402.2.6 j❑ Wood ❑ Wood :❑Does Not "table for values. [IN1)1 r❑ Steel a❑ Steel ;[]Not Observable ❑Not Applicable 303.2, Floor insulation installed per ❑Complies ;Requirement will be met. 402.2.8 manufacturer's instructions and rnDoes Not [IN2)1 in substantial contact with the � f underside of the subfloor, or floor; ❑No't Observable framing cavity insulation is in ❑Not Applicable ,contact with the top side of ishoathing, or continuouG GIG d Itry a�i6ii�/ ��,iiir �ii�i/�✓vi/DIG(1ii«/�%//i�//o insulation is installed on the underside of floor framing and extends from the bottom to the ;top of all perimeter floor framing , members. 402.1.1, ;Wall insulation R-value. If this is a R- R- BComplies ;See the Envelope Assemblies 402.2.5, mass wall with at least 1/2 of the °ElWood a❑ Wood ;❑Does Not I 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: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 7 of10 section Plans Verified Field Verified _ _.Value .... so Value _ .._ _ ...A P.�... s & Rec ID # Final Inspection Provisions Complies? omments Assum tion 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 402.2.6 [Fl1]1 ❑Not Applicable 303.1.1.1,'Ceiling insulation installed per ;❑Complies Requirement will be met. 303.2 manufacturer's instructions. .`=❑Does Not [F12]1 ;Blown insulation marked every 300 ft2. t❑Not Observable r ❑Not Applicable 402.2.3 Vented attics with air permeable _ " ❑Complies ,Requirement will be met. [F122]2 insulation include baffle adjacent ❑Does Not to soffit and eave vents that extends over insulation. []Not Observable ; ❑Not Applicable o 02 2.4 Attic access hatch and door R- R- ❑Complies Requirement will be met. irisulaLiuii cR-vicelue of Lhu ❑Does Not adjacent assembly. ❑Not Observable ❑Not Applicable 402.4.1.2 ;Blower door test @ 50 Pa. <=5 ACH 50 ACH 50 = �OCornplies 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 403.3.3 Ducts are pressure tested to ;i cfm/100 cfm/100 ❑Complies ,Requirement will be met. [FI27]1 determine air leakage with ft2 ft2 E❑Does 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. 403.3.4 Duct tightness test result of<=4 cfm/100 cfm/100 ❑Complies Requirement will be met. [F14]1 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 Requirement will be met. [F124]1 ;by manufacturer at <=2%of ❑Does Not design air flow. "� " �❑Not Observable ❑Not Applicable 1.1 Programmable thermostats � � � " � ❑Complies Requirement will be met. [Fl9]2 installed for control of primaryEl Does Not heating and cooling systems and initially set by manufacturer to ❑Not Observable Applicable code specifications. t ❑Not 403. ro" 1.2 Heat pump thermostat installed ❑Complies ;Requirement will be met. [Fl10 on heat pumps. " ❑Does Not ❑Not Observable :❑Not Applicable i 5.1 Circulating service hot water ❑Complies Requirement will be met. [Fl11]2 systems have automatic or ❑Does Not accessible manual controls. s ❑Not Observable �f ❑Not Applicable 1 ,High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 8 of10 Section Plans Verified Field Verified & # ID Final Inspection Provisions Value Value Complies? Comments/Assumptions Re . 4 3.6.1 falls not nic l vent to teed lati on ndslisted m .Complies -,- Requirementwillll b be met. Does Not HVAC equipment meet efficacy and air flow limits per Table "' „ ❑Not Observable 1 R403.6.1. °❑Not Applicable 403.2 Hot water boilers supplying heat ❑Colies Requirement will be met. [F126h through one-or two-pipe heating „ �' „ ❑L}pgs Not systems have outdoor setback ❑Not Observable control to lower boiler water temperature based on outdoor ';❑Not Applicable temperature. 403.5.1.1 Heated water circulation systems t❑Complies Requirement will be met. [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 El Not Applicable syphon circulation systems are not pracant f nntrnls fnr 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 t . ._ no demand for hot water exists. 403.5.1.2 Electric heat trace systems ;; " �� ❑Complies „Exception: Requirement is [F129]2 comply with IEEE 515.1 or UL ❑Does Not :not applicable. 515. Controls automatically adjust the energy input to the ❑Not Observable heat tracing to maintain the ❑Not Applicable desired water temperature in the piping. 1403.5.2 Demand recirculation water []Complies Exception: Requirement is �I[F130]2 ;systems have controls that % ❑Does Not not applicable. manage operation of the pump El Not Observable and limit the temperature of the ❑Not Applicable water entering the cold water piping to — 100F. 403.5.4 Dr ain water heat recovery units . Complies Exception: Requirement is [F131]� tested in accordance with CSA ❑Does Not not applicable. 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. ww, 404.1 ;90%or more of permanent ❑Complies Requirement will be met. 6]1 Mixtures have high efficacy lamps :`.❑Does Not t �i ❑ Not Observable � '❑Not Applicable 404.1.1 Fuel gas lighting systems have „ ❑Complies Exception: Requirement is FI23 no continuous pilot light. [ l3 P 9 Does Not not applicable. v % !❑Not Observable o ❑Not Applicable 401.3 Compliance certificate posted. ' " ;❑Complies ;Requirement will be met. [FI7]2z❑Does Not ❑Not Observable ❑Not Applicable 1 iiig!h impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 9 of10 Section PlanW Verlueified Field Verified # Final Inspection Provisions alue Complies" Cornments/A sumpt'lons 4r like .ICM L 03 mechanical r m ----LCO—Me _. m. 313:3 Manufacturer manuals for �� ❑Complies Requirement will be met. C ) d water heating �; ;o;;� C)Does Not systems have been provided. i �, of Observable a ONot Applicable Additional Comments/Assumptions: 1 iiizh#mpact(Tier'1) l#edium#mpaCt(Tier 2) Low#mpact(T'ier 3) Project Title: Parisi Residence Report date: 02/05/25 Data filename: Page 10 of10 ficate I nA/e[ Efficiency Cert�l 1 Above-Grade Wall 21.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling / Roof 30.00 Ductwork (unconditioned spaces): r . • . e Window 0.28 0.32 Door 0.30 0.27 Heating System: Cooling System• Water Heater: Name: Date: Comments IR -rJ4 2045 Route 112,Suite 5,Coram,New York 11727-3085 March 7, 2025 n��arisil C10�� a��ailrcor�� RE: 1840 DELMAR DR, LAUREL To Whom It May Concern: On March 7, 2025, our representative confirmed that the water services were physically disconnected at the above referenced location. Please advise your contractor that care should be taken not to damage the existing vault and /or curb box, as the cost of any repairs would be billed to the premise and no service initiated until the balance is paid. Sincerely r Ann Bailey New Construction Assistant Manager AB/db Evan T. Steffens N a t i o n a l gr i Senior Supervisor Gas Customer Connections,NY March 10, 2025 Michael Parisi 146-54 61h Avenue Whitestone, NY 11357 E-Mail: l lPAR1S1100 MA L COM ; NEALTREJO.MTA &�MA1L.CGM National Grid WO#: T 102660969 Service Address: 1840 Delmar Drive Laurel, NY 11949 To Whom it may concern, This Letter is to advise you that National Grid investigated your request and confirmed that the subject property does not have an active gas service line. By Law, excavators and contractors working in New York City and Nassau and Suffolk Counties must contact New York"811" at least 2 full business days, not including the day of contact, prior to digging by calling "811"or by using the website https://newyork- 811.com/. This confirmation letter of no active gas service line to the subject property does not relieve the excavator of contacting NY"811". If you have any further questions, kindly contact me at 833-359-0645. Respectfully, Evan T. Steffens Senior Supervisor Gas Customer Connections NY 1650 Islip Ave Brentwood NY 11717 T:833-359-0645 evAn.,stefl'ense4,naiional,fae,aorn nPradlirudiprocossing taon l rld;,�tt THE HARTFORD BUSINESS SERVICE CENTER THE 3600 WISEMAN BLVD January 29, 2025 HARTFORD SAN ANTONIO TX 78251 ry Town Southold 54375 MAIN RD SOUTHOLD NY 11971-4646 Account Information: Contact Us Policy Holder Details : MTA Quality Corp Need Help? Chat online or call us at (866)467-8730. We're here Monday- Friday, Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 u i E w Workers' YORK S_rAT Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured (use street address only) 1 b. Business Telephone Number of Insured MTA QUALITY CORP (631)987-1844 196 STANLEY DR CENTEREACH NY 11720 1c. NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured (Only required if coverage is specifically 1 d. Federal Employer Identification Number of Insured or limited to certain locations in New York State, i.e. a Wrap-Up Policy) Social Security Number 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Property and Casualty Insurance Company of Hartford Town Southold 34690 54375 MAIN RD SOUTHOLD NY 11971-4646 3b. Policy Number of Entity Listed in Box 1a": 12 WEC ACOPH5 3c. Policy effective period; 09/14/2024 to 09/14/2025 3d.The Proprietor, Partners or Executive Officers are Included.(Only check box if all partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier 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 them: 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 forum Is approved by the insurance carrier or,its licensed agent, or,until the policy expiration date lasted 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 Worker's 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. 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: Sara Seier (print name of authorized representative or licensed agent of insurance carrier) '5 594i , 01/29/2025 Approved by: (Signature) (Date) Title; O erations liana er Telephone Number of authorized representative or licensed agent of insurance carrier: 516-345-8000 C-105.2(9-17) Form WC 88 31 21 F Printed in U.S.A. www.wcb.ny.gov Page 1 of 2 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) REVERSE www.wcb.ny.gov Form WC 88 3121 F Printed in U.S.A. Page 2 of 2 Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. I. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any,general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein,. however„ shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. , The head of a state or municipal department„ board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment. defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into qny 5iinh nnnlract irnle9s proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensa ion for all employees has been secured as provided by this chapter, BM° DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03127 25 THIS CERTIFICATEIS ISSUED AS-A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ctktscAm DOES NOT AFFIRMATIVELY OR ktdAtivLY Amtkb, 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 lien of such enclorsensent;'s . CONTACT PRODUCER CONT Mad ,fin Barker,Breaker _ M B AGENCY PHC% tr63 0 7-7400 _ ��__m EI 606 Walt Whitman Road "e s. staff nn Insure.com Melville,-NY-11747 _ _....._ NAIL# INSURElt(S)AFFORDING COVERAGE -INSURER-A; Standard Security Life Ins C� ._.... .. ..... R B: . ...... __.. .INSURED 'INSURE ,m ...._.,�.. MTA QUALITY CORP INsuEL q_,; _.. .......... .......... 196 Stanley Drive E. 9__ .................._y .)I�tsuREft iNsuRE9°..- ........ .. m._ CENTEREACH NY 11720 uFsa R F LOVER,AGS 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. iNS DL SIaSR... POLICY EFF� POLICY E•X.E,. LIMITS.... TYPE OF INSURANCE AMen WV0 I POLICY'NUMBER A COMMERCIAL GENE IAEILITY DAMA 8 TO RENTED CLAIMS-MADE D OCCUR R'REMN Erx Eq " 'b S w PERSONAL tt ADV INJURY S w OEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AOCRE AT'E S POLICY"0 JER® 1:3 LOG PRODUCTS.•COMI""s F,AGG S S ..._ OTHER: AUTOMOBILE-LIABILITY COMBINED SINGLE LIMIT' a. _(L.d_wIEIt�l _ ANY AUTO ....BODILY INJURY(Per person) S- OWNED SCHEDULED BODILY INJURY(Per accident) S _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY eeeflu....... S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ •••••_ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED RETENTIONS S WORKERS COMPENSATION PLR OTH- AND EMPLOYERS'LIABILITY ,1 1 N W •••••• T ANY PROPRIESORPARTNCIT :XECU71VE_ E.L.EACH ACCIDEN S' OFFICER MEMBER EXCLUDED? NIA _ (Mandatory in NH) E.L DISEASE-EA EMPLOYE S hL,Zs,describe under C'RIPTION OF OPERATIONS belowE.L.DISEASE-POLICY LIMIT S A NYB Disability& IPFIL Z36016=000 03126125 03/26/26 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addltional Remarks Schedule,may be attached itmore space is required) Construction 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 ACCORDANCE WITH THE POLICY PROVISIONS: 54375 Main Road P O Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971-0959 Oc 1938.2015 ACORD CORPORATION. All rights reserved:. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ,.. z TOWN OF SOUTHOLD I.-LJ t o SUFFOLK COUNTY, NEW YORK46 z w U SCTM: 1000-127-4-19 LO j SITE PLAN Hz 0 15 30 � "'^ EXISTING „ �. STUMP TO ; o w EXISTING ONE STORY Sy 1 e Y"m � z �, m BE REMOVED � _ h. � ��u� w" 4 �_.«,� �"1�,� � _�� T�>b F SINGLE FAMILY DWELLING «, ti "� o J�-i�'I C.la di D '.Fr,r,Y W �Y m" TO BE REMOVED STORYONI IRAA `I}. ?`�'I I`11 tiY1 D....r"11 L°k rrl.�'a rn aeri Fnrr tl, f ,i r•i„�...r'rif'r i`d �'nll-7 �m,� ^� ' w J r A P, k I�U�YIi1mAd IGi q J } I"5 G . R O�S IAVELG � 1FF L.=532.085 '� °mlli"IV.,I 1`.��1N11V f`Nr:. III1Y I`d^:F. L1G.....`� O RIVEWAY �... ow;'m w TO REMAIN i 4/2025 s ) No R 25 0372 I, ,� Ili'I �, eem ,,rr �<a a r7 �Vr"��ml diJO �.'0I 4 ��f ua t'i�'1lr�ti i`;'�a oR� AV', Irr�l�kN1IJ,,IF OF AI�i��r.,,aul6M(. PROPOSED 0�' COVERED -: IC :....m f 1 ii i f, i"r It R rl,.f Z PORCH A I1LLJ� U) 13f?IIIm I, Idl ril_,.P.r IU", ",.;AI i]I",Il j itl.l,,r "'' PROPOSED ED. � PROPOSED COVER ,". COVERED REMOVE ALL FRONT PORCH , REAR PORCH EXISTING y,"::, ^, rv. °r'k ) "l ""i:N_.� ,7 �'i"1 �.'/,r r tJ-A lr��"i'„ )i^"' 1 PROPOSED ONE DILAPIDATED „. FAMISTORLY DWELLING FENCING r ' lines must�p SS " SINGLE FAMILY DWELLING 7 ^�^a TEST HOLE U '"^ ABANDON (NO GAS) �"„> r ..�..._ �^,,.... . �w SANITARY Suffolk,!� � 6' °.� Ith�'LI 0' r rs rr .,� SYSTEM 1ST FL=2,548 SF •• z`" Cali 6' 52-5754 hours in cp "' FF.EL.=31.3' '" .�r " advance, p�q �(m.� �k&y N a I' ppqq��yyN� gy w ie r vm in W .roirvw�mawwwwmrwwm"»aw« �*«„w.mwammowwrsw mmuww wv ii Z ..ti ,e Z W^y,"y, ' .wd1, y4 mxom�" ...Nww uara:.�•� ,�u /� 2 ti ![$}9� WATER SERVICE CONNECTION .^ $ UNLESS SPECIFIED OTHERWISE. WATER EXISTING WATER SE.RW ^+a w '' PROPERTY T P ) �I ....", 11 1� PROPOSED F1�MCn�"E EXMSTNNG e hA+' PROPOSED NOTES: a, .. d "'",� ��. q w 1. ALL PROPOSED SANITARY LINES TO BE 4"0 SDR35 PVC PIPE CONNECTION AND =' CONTROL f ` 2. NO SURFACE WATERS WITHIN 300 FT OF PR w u`. o METER TO REMAIN � 6 MIN CANEL �O 3. NO NEIGHBORING WELLS WITHIN 150 FT OF THE PROPOSED z z ". ^'' SANITARY SYSTEM. z J PROPOSED 0, L 4,. NO EXISTING DRY WELLS WITHIN PROPERTY LINES W I/AAIRLINE �PROPOSEDVA d W ��, PROJECT PROPOSED ELECTRIC LINE ors g �OCAT�O FUTURE PROPOSED VENT2" F-1 EXPANSION /�;� MPS@•.WI CHARCOAL ••••••••• FILTER MIN.TFROM LOCATION MAP Q DOORS/WINDOWS PROPOSED NORWECO HYDROKINETIC GREEN MODEL 600 VA OWTS TANKS>r EXISTING OVERHEAD a^ ( ) �'�14 » Z WIRES TO � ��+ PROPOSED ,,,-r"""EXIST.ORD=30.0'SC GIS MAPPING i � �o�'a 0.M'5' DARK BROWN OL BE REMOVE O "+ d.. s,. B DIAX12'EFF. 0✓ Q O Z m o .+�, 0,5'•3.0' BROWN SILTY ro -J O O N ,Y DEPTH LP �^ o PROPOSED J CO L) ✓� o �,. OVERHEAD SAND WIRES ', Z Lu ....... �� 0 CO Uo SYSTEM DESIGN CALCULATIONS '10, TANK CALCULATIONS:. LIP FLOW=(4 BED)X 110 GAUDAY=440 GAUDAY y� CAPACITY FOR NORWECO 51600=600 GAUDAY rr L LEACHING POOL CALCULATIONS: M 110 GAUDAY X 4 BEDROOM=440 GAUDAY 3.0'•17.0' SIR PALE BROWN 440 GAUDAY/1.5(GAUDAY/SF)=293.33 SF FINE SAND �'` o- 0 293,33 SFI 25 SF/UNIT=11.73 VF BORING BY:FEBRUMCDO A Y ,2025 VICES r r. IN. Q (DESIGNED FOR 300 SF SIDEWALL=12 VF) TAKEN ON:FEBRUARY 4,2025 wb w (1)-WOI X 12'FFF nFPTH I FACHINr,PDOL PROVIDED NOTE:NO WATER ENCOUNTERED oil