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HomeMy WebLinkAbout51291-Z �o�*uf souTyO(° Town of Southold * * P.O. Box 1179 �0 53095 Main Rd NV Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46025 Date: 03/06/2025 THIS CERTIFIES that the building COMMERCIAL ALTERATION Location of Property: 32845 Route 25 Cutchogue, NY 11935 Sec/Block/Lot: 97.-54.5 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 08/21/2024 I Pursuant to which Building Permit No. 51291 and dated: 10/17/2024 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: As-built interior alterations to Unit E for a barber shop as applied for. The certificate is issued to: 32845 Main Rd Cutchogue LLC Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 51291 2/26/2025 PLUMBERS CERTIFICATION: James Oliwkiewicz 12/2/2024 VSA Aut rite Si a ure ofSouTyo 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) i Permit#: 51291 Date: 10/17/2024 Permission is hereby granted to: 32845 Main Rd Cutchogue LLC PO BOX 591 Shelter Is Hghts, NY 11965 To: Unit-E-Legalize "as built"interior alterations to create an office and storage closet in an existing commercial space as applied for. The commercial space is intended to be used as a barbershop. Premises Located at: 32845 Route 25, Cutchogue, NY 11935 SCTM#97.-5-4.5 Pursuant to application dated 08/21/2024 and approved by the Building Inspector. To expire on 10/17/2026. Contractors: Required Inspections: DRAINAGE, FOOTING/REBAR,.FOUNDATION 1ST, FOUNDATION 2ND, FRAMING/STRAPPING, PLUMBING, ELECTRICAL-ROUGH, FIRE RESISTANT PENETRATION , ELECTRICAL-FINAL, INSULATION, FIRE SAFETY INSPECTION , FIRE RESISTANT CONSTRUCTION , FINAL, Fees: As Built Commercial $750.00 CO Commercial .$100.00 Total $850.00 Building Inspector SO!/r�Ql Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G • Southold,NY 11971-0959 �Q �ycOdJNT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Malon Industries Inc Address: 32845 Route 25 City: Cutchogue St: NY Zip: 11935 Building Permit#: 51291 Section: 97 Block: 5 Lot: 4.5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: AS BUILT License No: SITE DETAILS Office Use Only Indoor Basement F-71 Service 71 Solar I I Outdoor 17 1 st Floor Pool r Spa Renovation f7 2nd Floor r Hot Tub Ell Generator Survey rwl Attic (! Garage rl Battery Storage INVENTORY Service 1 ph Heat Duplec Recpt 12 Ceiling Fixtures Bath Exhaust Fan Service 3 ph n Hot Water GFCI Recpt 3 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 8 4'LED Exit Fixtures 3 Other Equipment: 2X2 Ceiling Tile Light(1) 2X4(6) Notes: " AS BUILT NO VISUAL DEFECTS " Barber Shop Inspector Signature: X Date: February 26, 2025 Sean Devlin Electrical Inspector sean.devlina—town.southold.ny.us 32845MainBarberShop Town Hall Annex Telephone(631)765-1802 54375 Main Road CD P.O. Box 1179 COD Southold, NY 11971-0959 We EC 2 2024 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. 51291 Owner: 32845 Main Rd Cutchogue LLC (Please print) Plumber: (D- //N C'(Please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plumbers Signature� Sworn to before me this -day of 1b ewif ib-pr 20 2-4 Notary Public, County BRITTANY A CONRAD Notary Public,State of New York Reg.No.olC06245154 Qualified in Suffolk County Commission Expires July 18.20—V �o� Hp� � J Jir1 E so TOWN OF SOUTHOLD BUILDING DEPT. `deft a� 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ j FOUNDATION 2ND ( ] INSULATION/CAULKING [ ] FRAMING / STRAPPING [ ] FINAL [ ) FIREPLACE & CHIMNEY [ ]° FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ]. FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE 'C/O [ ] RENTAL REMARKS: DATE v INSPECTOR OE SOUTyo� # TOWN OF SOUTHOLD BUILDING DEPT. °`ycoWon��'' 631-765-1802 INSPECTION ' [. ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. - [ ] FOUNDATION 2ND. I[ ] ULATION/CAULKING [ ] FRAMING./STRAPPING [ FINAL [ ] FIREPLACE.& CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE,RESISTANT PENETRATION- [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ , ] PRE C/O [ ] RENTAL RE ARKS: oda4v'v - i v� lvim t) DATE c ?70W INSPECTOR SOGTyOIo # # TOWN OF SOUTHOLD BUILDING DEPT. 'rouffm 631-765-1802 1 NSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]. INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY- [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION- [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION . ] PRE C/O " [ ] RENTAL REMARKS: )C'vLJ rM rjS- J4-0 r,012 I IJAA W440� -tv� -The, ter- I,*o �-14_, d- �J44eC4 LwA.�' P ' µ � ow-).. � Y CqA4 jvo% oV /n 4-ArOL)44 , 0"V S . DATE 1 INSPECTOR : OF SOUlho6 .5 / -2- // ✓ ( � # TOWN" JFsOUTH.OLD BUILDING DEPT. Courm��'' 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] .INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT-CONSTRUCTION - [ j FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ .] PRE C/O [ ] RENTAL .REMARKS: 4 I-V� 0:0 DATE 5 INSPECTOR �aOF SOUIyO TOWN OF: SOUTHOLD BULI3TNAD EPT. u l 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ]- ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [. ],'FIRE SAFETY INSPECTION- [ ] FIRE-RESISTANT CONSTRUCTION . [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [' ] CODE VIOLATION [ ] PRE C/O. [ ]. RENTAL REMARKS: ` ate E-L� - a DATE .INSPECTOR - SSE R Mq ® O SHERMAN ENGINEERING&CONSULTING P.A. F 14 NELMAR AvE Sr AuGusr[NE, FL 32084 E CD ECEI E FEB 13 2025 February 12, 2025 I Building Department Town of Southold Town of Southold PO Box 1179 Southold, NY 11971 Re: 32845 Cutchogue Unit E A representative of Sherman Engineering & Consulting PA inspected the unit noted above on December 10, 2024. The unit was inspected for compliance with applicable New York State building and fire safety codes. The area was found to be built out in substantial compliance with the buildout plan from Sherman Engineering dated November 28, 2023. Specifically, the unit was found to have 5/8" Type X fire rated gypsum on the newly constructed interior partition walls. The previously existing walls, bathroom, and other structures remain. The unit is equipped with life safety equipment including illuminated exit sign on each exit, smoke detector, fire extinguisher. Please contact me if you require additional information concerning this matter. Very truly our OF NElNY Matt w Sherman, PE s ' NYS is No 083584 ti� w 0o a a n , i 22 083504 9°FEss04 CIVIL ENGINEERING DESIGN SITE PLANNING PERMITTING -3 ,,,a[V�►onr��ea��arb Uuall WARR \1 \1. 4' Y. r Igo, � o L; �'g • W �AMW ^w 1 • - f { L ' ' ....'�...,��3 �,�:, \: - � tea' �✓./- ti Yyy: M1 • y "sEv • VIRGiNjA • OK LAHOMA ad HJW � 6 WWH -23 6226 F1 M4 'it v--- i -k c I T7 i ► I L- 1 � A. 1 4 V WK L RETURN CLO D r-A r 1 � aw d• 1 f 1 s Ilr • � i r �•Or. � /11 a ` r � � too ' • i� f .� x"!' -�,?;_, Y� I! F .'� 4 r �.�}} Y; tf :.� �.:. ggw '.�,... +. �,_... ��'v €:"a:Y Y y, 6 t fir.=�;,� b t"!r `� �� +5, �' O' a \`/ �.. �— N �! �� 4 J t .. �. r I �. I' r 1M� w � r Rw �C ? "1t STATE AND PIJt.L VYT FIRF+ri,WWOIGE WSi'£CTKh DOT CE RT A►©VANTA GE FIRE PROTECTION 151-21 W h*AVY Curt 0 DW Park, NY IIr29 (531) 464-5609 jj&U 20004, ED UY M CADER ,� CALDER S TULLY � r wATER AeC,"CNN ► a • €3C CA ICED SMOM • ems"oO>I MW K . AFFFfFPF �' . y * FE�36 1p • wATEiMALON IX" � Y1ST ' • �► FE-13 � Sl'ST'E�1 2024 / 2025 VOID I YN rF10M loo �f NEW REC FIELD INSPECTION REPORT DATE COMMENTS b FOUNDATION (IST) y ------------------------------------- C FOUNDATION (2ND) 2 �O ROUGH FRAMING& PLUMBING .� ti �r INSULATION PER N.Y. S'y STATE ENERGY CODE pr o v %A ov% r IC GO 1 M - FINAL & ✓+� ` tit o t J N ADDITIONAL COMMENTS -� k b v � O S x d b H oSF 'tco TOWN OF SOUTHOLD—BUILDING DEPARTMENT " Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 A o as Telephone(631) 765-1802 Fax(631) 765-9502 b=s://www.southoldtownny.gov lam: Date Received APPLICATION FOR BUILDING PERMIT '2r r`I'^.n. /nI For Office Use Only D PERMIT NO. I I Building Inspector: AUG 2 12024 Applications on must be,filled out in their entirety Incomplete Bulhling Department applications will not be accepted Where the*Applicant is not the owner,an Town of Southold , Owner's:Authorizationform(Page 2)shall be completed Date:11/29/23 ;OWNER(S)OF PROPERTY : . j Name:32845 MAIN RD CUTCHOGUE LLC SCTM#1000-97-5-4.5 Project Address:32845 MAIN RD UNIT E Phone#:631-902-4402 Email:hilyamused@gmail.com Mailing Address:PO Box 591 Shelter Island Hts NY 11965 CONI'ACT;'PERSON Name:James P Olinkiewicz Mailing Address:PO Box 591 Shelter Island Hts NY 11965' Phone#:631-902-4402 Email:hilyamused@gmail.com 7-7 -DESIGN,PROFESSIONAL JNFORMATION Name: Mailing Address: Phone#: Email: CONTRACTORS NFORMATION Name:Olinkiewicz Contracting Mailing Address:PO Box 591 Shelter Island Hts NY 11965 Phone#:631-902-4402 Email:hilyamused@gmail.com '.DESCRIPTION OF PROPOSED.CONSTRUCTION[--]New Structure ❑Addition INAlteration ❑Repair El Demolition Estimated Cost ofProject: ❑ ti Other $1 I ITf (Vr.S PAP- d'i►c, Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? []Yes ®No 1 PROPERTY:INFORMATION Existing use of property:Store Front Intended use of property:Store Front Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes @ No IF YES, PROVIDE A COPY. 8 Check BOX;Aft@r'Rea ding;;`7he owner/conttador/design professional is responsible for all drainage and storm water issues as provided 'l ii hapter 23fi ofthe'Town`Code."APPLICATION IS HEREBX,MADE to the Building Aepartment for ihessuance of a Building,Permrt pursuant to the Bulldmg Zone Ordinance of.the town'of Southold,Suffolk,County,New York.and'oiher•appl cable Laws,Ordinances or Regulations, or.the construction of buildings, " addi4ions,alterations or for removal'or,demolition as herein described..The'applicant agree comply with all applicable laws,ordinances,Building code; housing code and regulationsand to admit authorized inspectors on premises and M.buildings)for necessary inspections False statements made herein are ,.: punishable as a Class A misiaemeano'pursuant to Section 210 45 of•the New Yorti3tate Penal Law Application Submitted By(print na ):James P Olinkiewicz ❑Authorized Agent @Owner Signature of Applicant: _ Date: l STATE OF NEW YORK) 1 COUNTY OF wl Lam, being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Vyjne&— (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this e Gor day of &104e1Vl6 ,20,� `'Q _ JN(itary Public EMILY J REEVE Notary Public,State of New York Registration No 01 RE6059270 PROPERTY OWNER AUTHORIZATION Qualified in Suffolk County (Where the applicant is not the owner) Commission expires July 23,2025 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 s�FEQ(�c BUILDING DEPARTMENT-ElectricallnspectoSEC 2 2024 TOWN OF SOUTHOLD o Town Hall Annex- 54375 Main Road - PO o Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 1 iamesh(aD-southoldtownny.gov— seand(aD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 11/20/24 Company Name: 32845 Main Rd Cutchogue LLC (Owner) Electrician's Name: License No.: Elec. email: Elec. Phone No: 01 request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: 32845 Main Rd Cutchogue LLC Address: 32845 Main Rd Cutchogue NY 11935 Cross Street: Cox Lane Phone No.: 631-902-4402 Bldg.Permit#: 51291 email: Tax Map District: 1000 Section:97• Block: 5 Lot:4.5 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Legalize pre-existing office alterations Square Footage: 11016 Circle All That Apply: Is job ready for inspection?: YES ❑ NO ❑Rough In ❑✓ Final Do you need a Temp Certificate?: ❑ YES a NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A #Meters Old Meter# ❑New Service[]Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals D 1 2 0 H Frame D Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION � - d sq I ,�• l� Lti � 1i, i5 . ��SVfFBI�.c� BUILDING DEPARTMENT- Electrical InspectoQEC P �G2A a TOWN OF SOUTHOLD o Town Hall Annex- 54375 Main Road - PO 86i'1179 � x.r � ® Southold, New York 11971-0959 ® Telephone (631) 765-1802 - FAX (631) 765-9502 �1VV ' ��. iamesh@southoldtownny gov— seand ft—southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: 11/20/24 r Company Name: 32845 Main Rd Cutchogue LLC (Owner) Electrician's Name: License No.: ;� Elec. email: Elec. Phone No: D I request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: 32845 Main Rd Cutchogue LLC Address: 32845 Main Rd Cutchogue NY 11935 Cross Street: Cox Lane Phone No.: 631-902-4402 Bldg.Permit#: 51291 email: Tax Map District: 1000 Section:97• Block: 5 Lot: 4.5 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Legalize pre-existing office alterations Square Footage: 11016 Circle All That Apply: Is job ready for inspection?: R1 YES ❑ NO ❑Rough In ❑✓ Final Do you need a Temp Certificate?: ❑ YES[V_�NO Issued On Temp.lnformation: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect[-]Service Reconnect❑Underground❑Overhead # Underground Laterals 0 1 2 H Frame Pole Work done on Service? 0 Y FIN Additional Information: PAYMENT DUE WITH APPLICATION SZ d ` I PERMIT# ` Address: SwitchmicoI Outlets GFI's �v 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 1I11 c `t' UJ i\�'� A 0- (__C�,kh2f &11% /VA UJ k PAJ el A p., S.C.T.M. NO. DISTRICT. 1000 SECTION: 97 BLOCK: 5 LOT(S):4.5 LAND N/F OF EVERETT GLOVER NSI'09'4011-, 1 UMPSTER HE CONC.. ENCLOSURE • HEDGE • DRAIN DRAIN ni CONC.CU B DRAIN DRAIN DRAIN rm DRAIN DRAI ASPHALT • M.H. PARKING DRAIN • 0 DRAIN GJ GO 32 1 DRAIN 32 DRAIN BRICK 4 WALK LAND N/F OF DANIEL KAELIN ........ ........ z 1112 STY;.:::;;; . . . 0 BRICK:;;;;;:;:'_`. N. LAND N/F OF 13LDG N. , IN M S REALTY INC 2ND 'STY.: OVER DRAIN oM.H. BRICK ............ c-i ka ko z 0 8z 0 42.0' 13.7 92 7'i 29. o. DRAIN M.H. BRICK PATIO M.jp I CON-CU C�0 M.H. M.H. tn & 6, M.H. 0 M.H. OM.H. LAND N/F OF o ASPHALT DANIEL KAELIN PARKING iv OM.H. DRAIN DRAIN w RAIN DR IN CC NC.C1. 0----LIGHTPOLEI"O o 0 I SIGN GUY GAS GUY ON. 85.3S' W.M. SIDEWALK 15U�Uu' CONC. CONC, L.... APRON APRON p. CONC.CUM CATCH BASIN MAIN ROAD S.R. 25 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCA77ONS SHOWN ARE FROM FIELD OBSERV47IONS AND OR DATA OBTAINED FROM 07HERS. AREA:53,825.46 SQ.FT. or 1.24 ACRES ELEVA77ON DATUM: UNAU7HORIZED AL7ERA77ON OR ADD177ON TO 7741S SURVEY IS A WOLA77ON OF SEC77ON 7209 OF 774E NEW YORK ST47E EDUCA77ON LAW. COPIES OF 7HIS SURVEY MAP NOT BEARING 774E LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY GUARAN7EES INDICA7ED HEREON SHALL RUN ONLY TO 774E PERSON FOR WHOM 774E SURVEY IS PREPARED AND ON HIS BEHALF TO 774E 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON LIS7ED HEREON, AND TO 774E ASSIGNEES OF 774E LENDING INS77TU770N, GUARAN7EES ARE NOT 7RANSFERABLE. 774E OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE S7RUCTURES ARE FOR A SPECIFIC PURPOSE AND USE 7HEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD177ONAL S7RUC7URES OR AND 07HER IMPROVEMENTS, EASEMENTS AND/OR SUBSURFACE S7RUMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: DESCRIBED PROPERTY of NEW y CERTIFIED TO: 32845 MAIN RD CUTCHOGUE LLC; MAP OF: 0 JAMES OLINKIEWICZ; EMILY REEVE; FILED: -WESTCOR LAND TITLE INSURANCE COMPANY; SITUATED AT:CUTCHOGUE pc*3 EMINENT ABSTRACT, INC.; 0 TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK tp 05088 Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE #223-35 SCALE:1"=40' DATE: MARCH 22, 2023 N.Y.S. LISC. NO. 050882 I PHONE (631)298-1588 FAX (631) 2913-1588 1 Y Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier Ia.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured OLINKIEWICZ CONTRACTING, INC. 5 DICKERSON DRIVE,PO BOX 591 6317491014 SHELTER ISLAND HEIGHTS, NY 11965-0591 Work Location of Insured(Only required if coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) Carrier (Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York Town of Southold tY P Y PO Box 1179 3b.Policy Number of Entity Listed in Box la Southold, NY 11971 R08247-000 3c.Policy Effective Period 1/1/2014 to 10/28/2024 4. Policy provides the following benefits: XD A.Both disability and Paid Family Leave benefits. B.Disability benefits only. C.Paid Family Leave benefits only. 5. Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS disability and/or Paid Family Leave benefits insurance coverage as des d above. 4140 Date Signed 10/30/2023 Byill (Signature of insurance carrier's authoriAed representative or NYS licensed Insurance agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT:lf 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 4131,4C or 5B of Part 1 has 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 ltto'Issue this form. DB-120.1 (12-21) ��� 2i0 (i1iiiioii� Suffolk County Dept.of Labor,Licensing$Consumer Affairs HOME IMPROVEMENT LICENSE Name JAMES P OLINKIEWICZ Business Name This certifies that the OLINKIEWICZ CONTRACTING INC bearer Is duly licensed License Number H-52130 by the County of suffolk Issued: 08/14/2013 Rosadi,-Drags- Expires: 08/01/2025 Commissioner OLINKIE A R�� CERTIFICATE OF LIABILITY INSURANCE D 10130/202 YY) 10/30/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorsemen s. PRODUCER 631-673-0500 c ACT Cliff Brady Robert P.Brady Agency,Inc. PHONE 631-673-0500 FAX 631-423-0956 487 New York Avenue (A/C,No,Ext: A/C,No Huntington,NY 11743 E- AIL Clifford T.Brady INSURERS AFFORDING COVERAGE NAIC# INSURER A:Evanston Insurance Company Inc INSURED Olinkiewicz Contracting,Inc., INSURERS: PO Box 591 INSURER C: Shelter Island Heights,NY 11965 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. INSR TYPE OF INSURANCE ADDL SUB INSO WO POLICY NUMBER POLICY EFF POLICY EXPJJTL LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000.000 CLAIMS-MADE a OCCUR 3FF8324 1 oil 9/2023 10H9/2024 DAMAGE TO RENTED $ 100,000 once)MED EXP(Anyoneperson) $ 5,000 X Blanket Al includ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY❑%cof FI LOC PRODUCTS-COMPIOPAGG 2,000,000 OTHER: AUTOMOBILE LIABILITY COM IN BEDSINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOSWWryry��pp BODILY INJURY Per accident $ AUTOS ONLY AUTOONLY PPera clgt AMAGE UMBRELLA LJAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y I N OFFICEW RIETOR EXCLUDED??ECUTIVE ❑ NIA EL EACH ACCIDENT $ (Mandatory In ) E.L.DISEASE-EA EMPLOYE If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached H more space Is required) 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 To To BOX 1179 Sou ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENT Clifford T.Brady ACORD 25(2016103) ©1988-2015 ACORff CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NYSIF Now York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE limmilam 1 ^^^^^^ 112967435 SHELTER ISLAND AGENCY INC4 25 N FERRY RD PO BOX 539 �~'' SHELTER ISLAND NY 11964 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER OLINKIEWICZ CONTRACTING INC TOWN OF SOUTHOLD #5 DICKERSON DRIVE PO BOX 1179 PO BOX 591 SOUTHOLD NY 11971 SHELTER ISLAND HGTS NY 119650591 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11325 760-5 845645 06/16/2023 TO 06/16/2024 10/30/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.. 1325 760-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WESSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. JAMES P OLINKIEWICZ(PRES)OF OLINKIEWICZ CONTRACTING INC 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 STAT SU NCE FUND ��f' �V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:789674128 U-26.3 Meyer, Nancy From: Meyer, Nancy Sent: Wednesday, December 20, 2023 12:21 PM To: 'hilyamused@gmail.com' Subject: Unit E Good afternoon Liz, I am reviewing the plan and application which you dropped off for the interior alterations at the Cutchogue building, however there is info missing from the drawing. Can you please give us a location key indicating where in the structure this unit is located; additionally, how is the space used,what are the individual areas which have been created,etc. If you have any questions,feel free to reach out to the building department. Thank you, , . ancy.Meyer Building Inspector Town of Southold Building Department Annex Building 54375 Main Road Southold,NY 11971 (631) 765-1802 i Dwyer, Tracey From: Lizz Toth <hilyamused@gmail.com> Sent: Wednesday, October 9, 2024 12:14 PM To: Dwyer,Tracey Subject: Re: Unit E building application Just for storage and personal office. Lizz Toth Office Manager Olinkiewicz Contracting Inc Office: 631-749-3217 Mobile: 631-902-4402 E-Mail: hilyamused(�bgmail.com PO Box 591 Shelter Island Hts, NY 11965 On Wed,Oct 9, 2024 at 8:58 AM Dwyer,Tracey<tracey.dwyer@town.southold.nv.us>wrote: Good Morning, Attached is the floor plan you are proposing for a permit. Please label or email me what the newly created rooms are to be used for. Thank you, Tracey Dwyer i Mma i l Lizz Toth <hilyamused@gmail.com> Unit E Lizz Toth<hilyamused@gmail.com> Fri, Dec 22,2023 at 1:18 PM To: "Meyer, Nancy"<nancym@southoldtownny.gov> Hi Nancy, The permit app is for unit E on the floor plan. It is being used as a barber shop. The only areas created are the 2 rooms on the building plan. Lizz Toth Office Manager James Olinkiewicz Realty Inc eff - 9-631-90 -4402 mot./ /'�. 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Inn 1—)1 -A 0 c-,I ) /If In: 'Roct N a APPROVED AS NOTED r Q W M z ,..la'zm w � � o DATE:IO'I1 2-+ B.P.# 5 a I z z � 0 �6 FEES�J�• O� BY: we x NOTIFY BUILDING DEPARTMENT AT 631-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: FOUNDATION=TWO REQUIRED FOR POURED CONCRETE PRE-EXISTING ROUGH-FRAMING&PLUMBING ® Z IN?G b` BUILDING INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. m m ALL CONSTRUCTION SHALL MEET THE o REQUIREMENTS OF THE CODES OF NEW LIU NEW INTERIOR L YORK STATE. NOT RESPONSIBLE FOR PARTION WALLS 15' DESIGN OR CONSTRUCTION ERRORS Laj } METAL STUDS W / $ TYPE X GYP 2'-6" COMPLY WITH ALL CODES OF BOTH SIDE NEW YORK STATE&TOWN CODES REQUIRED AND CONDITIONS OF MUTOMMA, o 7'-6" T $9-6„ Z DM�TOWNUMNG BOARD 3' T=TRUSTEES o CtY.SOUMUHM S.DEC W SCl� 3' L 9' 3' 6" i n5 ff4l0n r-e u i red41 . 611 Q 0 w � wz0 i- o Q EX . 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