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Home My WebLink About33584-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33512 Date: 06/27/08 THIS CERTIFIES that the building ADDITION/ALTERATION Location of Property: 3160 BRIDGE (HOUSE NO.) County Tax Map No. 473889 Section 85 LA (STREET) Block ~ CUTCHOGUE (HAMLET) Lot 20 Subdivis~ Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated DECEMBER 4, 2007 pursuant to which Building Permit No. 33584-Z dated DECEMBER 13, 2007 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 ADDITIONS AND ALTERATIONS, INCLUDING COVERED PORCH, ENTRY AND DECK REPAIR TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to DAVID M & MARIA RADFORD (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPAR~ OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 121443C 05/09/08 PLUMBERS CERTIFICATION DATED OS/20/08 FRANK J MCINTOSH ~d ~ Signature Rev. 1/81 , Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 ftt"V :J '7 'vi "'" ~"-~S,.. Ckv..c?1o -</)/ //.1 }:r" APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or uew use: I. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/1 0 of I % lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. 1'>/1 Q/08 New Construction: Old or Pre-existing Building: x (check one) Location of Property: 3160 BRIDGE LANE House No. Street ('TTTClJOIJTTE Hamlet Owner or Owners of Property: DAVID & MARIA RADFORD Suffolk County Tax Map No 1000, Section ~5 Block ~ Lot .;;:l [) Subdivision Permit N033584 Date of Permit. 1/15/08 Filed Map. Lot: Applicant: DAVID M. RADFORD Health Dept. Approval: Planning Board Approval: Underwriters Approval: 121443C Request for: Temporary Certificate Final Certificate: x (check one) Fee Submitted: $ 25.00 C,.,o -2:.. 3 ~ ') I J- (2g C- 1\.f5lfY CER TIFICA TION S/Zolo'7? Date: Building Permit No. ~ ~ "58 i Owner:j)t\nd", N\f\R)~~c\t~r~ (please print) Plumber: lTQ.Vl /< S ,vi (:rVlJoS~ (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. z~ fU4(~ (plumbers Signature) Sworn to before me this ;( 0 day of (h(L~ . 20-'2..L 4:tv~"a' d~ - / / Notary PubIiC.~county PATRICIA GENOVESE Notary Public, State of New York No. 01 GE6043821 Qualified in Suffolk CounlY. / Commission Expires fJ' /;; '(. / t () --' Electrical Inspection Certificate Issue Date 5/9/2008 Electrical Inspection Service, Inc. 375 Dunton Avenue East Patchegue, New York 11772 (631) 286-6642 Application Number 121443C Issued To: Street: Village: Section: Mr. Dave Radford 3160 Bridge Lane Cutchogue Block: Zip: 11935 Lot: Town: South old Contractor: East Coast Electrical Contractors Lie. # 39080-ME Was examined and found to be in compliance with the National Electrical Code. D Commercial D NV Defects D Pool [J(] 1st Floor [J(] Indoor D Basement D Hot Tub IKJ Residential D Del. Garage IKJ Attic IKJ 2nd Floor D Outdoor IXI Addition D Survey Switches Receptacles Fixtures GFI Heaters AlC Fans 34 37 28 5 1 4 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Furnace Oil Gas Circulators Smoke Detector Bell Transformer 4 1 Meter Amps Phase UGlOH Jacuzzi Television CO Detector / 1/20a Bldg. Permit: 33584 Other Equipment '~f7 ;j / n I fAir Handler Disc.l1-Raintight AlC Disc. 20a I (l ,,//1 ~' Hugo S. rdi President ROU9h Inspection: 01/30/2008 Inspector: John Me Mahon III Final Inspection: 05/0712008 Inspector: John Me Mahon III This certificate must not be altered in any manner. Inspectors may be identified by their credentials. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33584 Z Date DECEMBER 13, 2007 permission is hereby granted to: DAVID M & MARIA RADFORD GLEN HEAD,NY 11545 for : ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 3160 BRIDGE LA CUTCHOGUE County Tax Map No. 473889 Section 085 pursuant to application dated DECEMBER Block 0002 Lot No. 020 4, 2007 and approved by the Building Inspector to expire on JUNE Fee $ 1,006.00 13, 2009. ORIGINAL Rev. 5/8/02 . '9Ql4VEYED FOR.. FOSTEl2. ( VACJl..NT)' .i; 'MJO~AElJ,'1. JESSI ~_, .2.. rnC:-"~'-1 !.o _'-...v.~.;.dd::_ L s-' . '. .Ys ,......--...... -, '-.. . .---. . 3.$!!:4 00 E. . 120.0 ~( ;;fi coi ;:~ .:~! STATEMENT OF INTENT THE WATER SUPI'L Y AND SEWAGE DISPOSAL sYsTEMS FO!,! l'HIS RESIDENCE WILL CONFORM TO THE STANDARDS OF THE SUFFOLK CO. DEPT. OF HEALTH SERVICES. ISI \ , i , AT. -. CUT(HQGUE mWN OF 9:ltJrHOL? N.~ ", f"~ \I) g lO APPLICANT ~. .~ .12 SUFFOLK COUNTY S-ERVICES - FOR CONJI"itUCTION ONL Y DAT&:: It; S. REF. NO.;' .eE>oso:'LZ AI'PRO\lED: \ ,,-\ . ~.~ \ \ ~ \\. . \\ . , ,. .\ ,\ \\ . , \ \. \ , " \ ' \--' \ , , , \ , DEPT. OF HEALTH APPROVAL OF :i~' .. .-.!. ':.. I . I - .j I ..... ;:':;. I . i ; / /. ----- / .p // SCALE' 50',( ~-;-42,.1:!.8 S.I': .;' .. SUFFOLK 00. TAX MAP DESIGNATION: D1ST. SECT. BLOCK PeL. 1.000. as . 2 cO OWNERS ADDRESS: W..t.Ak:E ;<:,:)!~!?_ SOUTHQL1?L ~~.'r~!_tp..i. "'3" :,1 , '"-." '~.' -- ....~ .- ..:..;5~~'c~':'r:.:: ;' ~ : ! (V"'-;'-'} c,) -~.... .' ~C"~~' .:;:~ I ot!""-k:-:. ~_ .L-.I:::::__ , . 11 ! STC~ F12.:-aQj ; " ._--~ g'l . , 1"""'1' / . ' .. !J..--...<.l ~. ., '.11 . , 7' ~ '" .. I 3 __~ ~'J C 1~ e .' i:!Q l I .1 :t i . " .-- -' ,,,? -r:65_:...~36 DEED: L. N/A . TEST HOL P. . :U 'r. Jr) L<'J ,f\J \\i ...... . , .~ i .(. i ~ . I we...V .---'j '.; ..' - 27?69 TO '-.t. R 12 - 1'1.55 la40 "N.. '3 " o ,"jo 01 .'" ~.t" . . 0- m If) '~.J:?~ .., . . ___ __' "r .::~ I.t..OI "T->S.f2F.FEtZ'fO r<tAP OF 15MAQ A\.:':E'~. " L~...., iN:n'l1: i;uFF:CO:CLi:r';~:S O;'FiCE-'~.s. ~~pr.,J.3'. S'.:3!2~ _4._ '._ ._ _______..__..__ "2.C:..~~;i,Jt<'S r:;;~Fer~ ',.0 MEAJ'~ SEA LEVEL... " . ...-----.-.---------.-. .- .. .-- STAMP 11"'\"1 ....,--;:>...,..,...,...... t~:I"ivrr .... .", ~~ ". ,~ ,~ .. .....:...,~... .,. .c..-..)<"; ;",~.' t>I thv N.._'....i" $1o'1C ":<-"".,It!io:oL.w, Cc:oi.. (III Itt+9. rrv9W ~ 1'01 t>tIari:og a...I.ncJ,.~7...""IKii...a;o. ~W~Ahal:rIQI"~ IObe.....1Fuecaow. Gu..--lnoIcattC..... -.al "'" ..".,tDthao.--forwhrJrntheaurYll\ .pr--......on..bMIelftoche.. *-~...._._._ltwI~.nd bIOnt InIIiIudan 1iIIIId..... aN ID the ~...,............ Iudoft. e............ ~_~.... ..~...........or........... -- ,r. .-- 3.I1rJJj NO<AfID735" . . ! " 0.. <( .'. ~ .t- .; l) " '. !U .J (- ii: U: (It Ill. : ': -"0; ....r~;:\ :~.. . ,: .;;. ::l~:t., .;: ," ~. ~~~~-~;'~;.;.~-:~,:. ~ . _:-~! .... '.. , .,' .*-l~.Mt' '~.n,J981LT" ..... 0-..."* ~ '" , J ~ . ,,;;fi-'~:5-. 3, "';'135,0 LAt.JE arZ1DGE SEAL '- , . ~-'>"?'~.:~-.'.' ~~:_.i~~t~~.~.... i-R~3l~NCEF< . , ".. .------ .- '';:;''::~'.:)- '. } 3St ~ :z-- TOWN OF SOUTHOlD BUilDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [~RAMIN~TRAPPIN~ [] FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRucnoN [ ] RRE RESISTANT PENETRATION REMARKS: - L.4.- ([) I ~ '" /11~~ tJ-~ lI'-'~ '\ '" Md-.~~~)L ~~~) DATE I-I f - 0 g INSPECTOR ~ ~ "- h-- -. "'"Il"":;"--~ ~ 33St'f :2- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. D<[ INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION REMARKS:~ t;/- - ~ - ~\d2, rJ-~S_o~ DATE INSPECTOR ~~ ~..... .--"._-~-.- ~" -...-- - 33S1Lf Z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] RRE RESISTANT CONSTRUCTION Yf ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRAnON REMARKS. ~ ~,rI-- . ,-. f ~~. ~ aN2.- 'lJ (\ , f . DATE J- -/:J-- O? INSPECTOR ~AdL , 335ft L TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] RRE RESISTANT CONSTRUCTION REMARKS: \ l..l"'U2.. ~ Itv"&1I _ --. [ ] INSULATION j>4 FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRAnON \~ . ;;V~ vi- ?~ DATE ~/S -0 f' INSPECTOR ~.~ ----~ -~ -------------...-- -- ---of""- ~~--------.-~ }JS-%'f :z... TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING I STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRucnoN REMARKS: [ ] ROUGH PLBG. [ ] INSULATION f{><j FINAL A-; [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION .~~}~ ~~Z~-~ cUL.Q eJ.... ~ DATE If-/f,-o t INSPECTOR ~~ . .. FIELD INSPECTION REPORT DATE I FOUNDATION (1ST) ------------------------------------ FOUNDATION (2ND) ROUGH FRAMING & PL lJ1\ffiING INSULATION PERN. Y. STATE ENERGY CODE FINAL COMMENTS \}.i vJ"" I.f\t'i o(\~ .-e;;; ('\l t.:: ~~ ~ / /' J(7 IV 1 2: 9 I 1-11--1 ~ 'FA. -. '\~ 0 Y ~~ /I' ~ _ ~ " 'A:d ( A-I.. / U -./.1' -71 J_ d;L" "oA (T ~ -,,'-~./, ~ No,,]) '~CT_n--...AJ.. 'I A~;" )-A- t( _ _ A- l/lr-~"u~lJ.o" ri-/) ./la~,b- ~ ~ ~. r~. .t. J#. ,,~~-r--.J'JL" ~~~~ v (/ IrA-oJ. v_oD ytl ).-f').. -r;"{- e ~.I.U - ().. V-A I>l- ...J ~a>.i-O!S.&Y) IJ..:-~!- - /J~ - - ..L, U; A" r>.A~. II a/vJ Ok ~ :r:: 1--___ #1.".' .hJ_ " ~!J.. 'v~ A ~\&... #AU IJ f:.. ~ t'i ..., u-' -- ~'" () ~ t'i ..., '~' i.f;,n - 'l h'^P~ _A .l)~ ~ .hh. v. a,,1' I ~. r: '/ J~-l...~ ..prrc~-o... - II . J I./-I-.-_~.A"P r;."<;<:::> ~ - '-TJ;I/J~ I ~J>>1.~4--/JA, e:.... ~ o,A-' &_ll-, -I" ....</" I 9(/. -..: ~_.. 1-1----11- D g t, _.1 a ~ A'" _ /IA A~ 11 -I-:J~A f"-.Ji1:.J . ., ~7,.':. P'r,'AL. ,"~ -h.-./iA j} ~~ L V/J..IF . '€ __ 7) "U"-if,J / G, /"" '.1" 01-' /'1. CO . . I &- ,o4tJ. rZV--. T-.f/l. ADDITIO"'" y/ J..OMMENTS --:- " .P /A #-. j' . . JI i Xn p I / l7/-~ I P .... 0 P-:z;; z ~ ><::. ~ . L , r--t'i \ ~ w~ \ ..., ~o ~2: ,~~ bt t'i "" ~ TOWN OF SOUTHOLD BUlLDIN'G DEPARTMENT TOWN HALL SOUTHOLD, NYJI9'h TEL: (631) 765-U02 FAX: (631) 765-9502 www.northfork.net/Southoldl BUILDING PERMIT APPLICATION CHECKLIST PERMIT NO. 33~~L Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. . Trustees. Contact: . Examined Approved Disapproved ale (?/ G :~~-T- Mail to: Expiration ,20_ Phone: ;):\ '8' - (0, I I e .-, -;-'r;;'-i0\~fArPLICA TION FOR BUILDING PERMIT ),JL.~ . '. ...:~ , , ~ '; QEG ..'{ j\ INSTRUCTIONS \. '" 1 .J a. This !tppttcljtion M~kp\2 com~etely filled m by typewnter or m mk and subnntted to the Butldmg Inspector wtth 4 sets of plans, accurajl:.plot-plait'tO:;scate.Fee accordmg to schedule. b. ProtpI;m showing location oflot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shaH be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. ,Thereafter, a new p~rmit shall be required. 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 South old, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as . escribed. The applicant agrees to co~ply with all applicable laws, ordinances, building code, ho s' code, and re d to admit authorized inspectors on premises and in building for necessary inspections. M. Date (l"'. '?:lO ,20~ (Signature of applicant 31 VJa\ter~ 5-t. 6Ientkai NY 11~-4:J ( allmg address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder e"Wue.~ Name of owner of premises 1.:b \/1iL1i..L.Ma n'Q.... Ra.dfOni (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. ;).b q-~;;> H-~ Q.q ''S M'<" 3'10 &6 M.E I. Location of land on which proposed work will be done: '3~ . e(~6r.e. I-A~ House Number Street County Tax Map No.1 000 Section <:!'lbdivision 95 ClaVIotOCfUe. k!M 'ftId., WJ5( Hamlet "3; .~,.,,:. Al.vW,,: ':. . :,' ';flr!llll Bl?ck .,( vJ'o? ~. Lp't;:~ "', 8JO Ptled Map NQ.._. 0, ,I" ".,. ':Lot "'",~.,,~ (Name) I 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: . a. Existing use and occupancy ~IU"l,.~ YA'Mlt.lt Rf.$~9~,1r-h .. b. Intended use and occupancy ~ I lie. Lt- fftmlVf ~t.p~"t~"" 'I. 3. Nature of work (check which applicable): New Building Repair Removal Demolition 4. EstimatedCos~EOI\)bO .DO Addition Other Work x Alteration X (Description) Fee 5. If dwelling, number of dwelling units If garage, number of cars (To be paid on filing this application) Number of dwelling units on each floor u/ll\ , 54"0" UfA I , I' H'" 6. Ifbusiness, commercial or mixed occupancy, specifY nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Height 1: ~4'''6'' Number of Stories 5~~O" I Rear Depth Dimensions of same structure with alterations or additions: Front 5' "~C'" Depth .f4.', 0" Height ~I" I~N Number of Stories Rear 54"0. ~ 8. . Dimensions of entire new construction: Front W Height "'/4 Number of Stories IJltt Rear I utA Depth ulrt If'th ulr1 I~~' Rear , 120 I r~~ 9. Size oflot: Front 10. Date of Purchase / ff '1 Name of Fonner Owner m~47' 11. Zone or use district in which premises are situated A v 12. Does proposed construction violate any zoning law, ordinance or regulation? YES_NO-1L 13. Will lot be re-graded? YES_NO L Will excess fill be removed from premises? YES_NO ~ 14. Names of Owner of premises O/lVI.O -eAgfut.17 Name of Architect WlWM.s. vJA\L.. e.A. Name of Contractor Address Address~!lUf~i9 ~ Address Phone No. Phone No ~Ib' VII. :Z.7tl Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO l * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES_NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF ) 17t\\lIO ~~~O~ being duly sworn, deposes and says that ~he is the applicant (Name of individual signing contract) above named, ' (S)He is the ~W~~ ~ ~fUv~fJ.-( (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have perfom1ed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in tl1e manner set forth in the application filed therewith. Sworn to before me this Pfl_" L daYOf~2o!..l &~~~ Notary Publi W1mam J. Wan . lIalIlJ Public. Slale 01 New M , No. 4182477 lIIltlflied in Nassau CounIJ, n I( c.m":lIon E;.piras Dacembar 31. 20.L..- ~u . e TOWN OF SOUTHOLD PROPERTY'.ORD CARD ~, eJVH9' '\1)-_ - ?..s/ -~ -,>2 0 STREET VILLAGE DIST. . SUB. LOT F /:l... c. rN JI/.b -IJiI, i> 11 E' (.Ie p I.J>lI 0. r ACR:9 / TYPE OF BUILDING E W LAND 9 FARM IMP. TOTAL Ytr /) ..j-6C' COMM. CB. MICS. Mkt. Value t //\' -:', 'U 00Cl I () c.{..) Ilou'.J 51.-00 4.oCl iTS-o 0 #1 ../Dll V"hl ciA An- f' J' .', <', \.l I. .':..J~ " rillable FRONTAGE ON WATER FRONTAGE ON ROAD I3s 'Ioodlond ^eodowlancl DEPTH BULKHEAD t.v 332 louse Plot 'otol . . . COLOR N <-+7 . TRIM w ~lla.. -. , I A -, ,t~L:'~,-' II - . -. I .4 rt . , ...d - ~. ~. .... 7 ,n I ~ I I ,. f1~ ..r t .,..,-- - -- - I I Jt-~ " , i;<L , " " M:'B1'.~ 2.<.,."; 2.~.. /.28\ '" ..r.2 "" Z"''>< z8" I L'.LlJ \-"\00 3,50 -4Qoo Extension ';2.><- \4 " ::ae.l .... Extension '. Extension Foundation f>.C- BaIh :z. Dinette PMch Bosement +- ,-.Jl_'- Floors k::>~_ww K. \ Jorch Ext. Walls .vel Interior Finish ~K LR. I 'gil.Jd:.",~j ,oj(,. Breezeway Fire Place ( Heat U \tJ 13B DR. I Garage :2. ';Z.. X ;2.,2 :: 4&4 1,')..5 1.,06 rype Roof (.:::~L.E- Rooms 1st Floor t- BR. -:L ~ :.~ IS 7"- ... ~;$ 4 eo ,~ \2.0 RKreatlon Room Rooms 2nd Floor FIN. B 0.11. Dormer DrIveway TQfal ..sr..ZS 'fbt'"c if~ ill. _ 172.= "'~}.r . ","'""-"S S'A-t CI .4f..e.v'A(v........ - 1100 -Y.P.S- 14, SI This certifies that the bearer is duly licensed by the County of SUffO~ f?i-I., ri. ti-I- -- SUFFOlK COUNTY ~CUTIVE'S . OFFICE OF coNsUMER AFFAIRS. HOME IMPROVEMENT CONTRACTOR LICENSE - ROBERT W SUESSER ~"- , ROBERTSUESSER . , ~- -.- 20983.H 0510111993 ~ft(JN()An 0510112009 \ " Gc;2399l7 ACORD.. CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYY) 11/30/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LoVullo Associates, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6450 Transit Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Depew, NY 14043 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. , INSURERS AFFORDING COVERAGE NAIC# -- ------ INSURED INSURER A: Essex Insurap,~_E?___~.9_TI!P~I}Y 39020 Robert W. Suesser 26 Roanoke Drive INSURERB - --- Sound Beach NY 11789 INSURERC. --- INSURERD -------- - I IINSURERE COVERAGES 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 POllCIE:3 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR :ADD'L - ---- - - -------- --Po"L~~.~FFECTIVE Pg~~EY,~~~~?ION ----- - _____n____ -- -- LTR tNSRD POLlCYNLMBER DATE M DO Y LIMITS r?ERAL LIABILITY 3CX2689 05/11/07 05/11/08 EACH OCCLRRENCE $1,000,000 A ~~=r~ERCIALGENE~LLlABILlTY : ~~~~~~~':~~~~u"r~~:-- $ 50,000 _ CLAIMS MADE !Xl OCCUR! !-M_~~~>s.~ (Allyo_ne person) !5 1,000 ----------------- PERSONAL & NJV INJURY 51,000,000 - --- ______n___ _L ----- ~ GFr:<Ef'<_~~~~GREGATE $2,000,000 GEN.LAGG~EFE ILlMIT APf=lS IPER , PRODUCTS - COM PlOP AGG $1,000,000 X ! POLICY ~rR-r LOC ---- ~LJTOMOBILE LIAl:lILITY COMBINED SINGLE LIMIT $ ANY AUTO {EaaccidentJ i -- - ALL OWNED AUTDS BOOILYINJURY $ SCHEDULED AUTOS (Per person) mum, " ---- --- ------ HIREDAU'TOS BODILYINJ',IRY --1 NON.OWNED Acms : I (Peraccjdcnt) $ , - PROPERTY::lAMAGE , {Pp.rFlcCid,,,..t\ , GARAGE LIABILITY , AUTOONLY-EAACCIDENT 1$ I-l EAACC I $ ~ ANY AUTO OTHER THAN I , AUTOONLV AGG Is I EXCESS/UMBRELLA LIABILITY , i EACH OCCURRENCE , - o CLAIMS MADE ------- S i OCCUR , AGGREGA T;:: , ----I DEDUCTIBLE , ------- - ' , , -------+------- ! RETENTION S I " WORKERS COMPENSATION AND WCS~ATU. _fl~- EMPLOYERS.lIAIiILlIY TORY.IMITS '__ EB.__i________________ ANY f'HOf'Hllo I OK.lI-'AK I Nl:;K.lLXLCU IIVL !-,,'cEACHACC'CENT, ,I $ I OFFIClR,IMcMBcR I::XGLUlJl::lJ? i ELDISEASE_EAEMPLOYEE $ If Y<OS,d",scrib" under , E.~, DISEA,;E. POLICY LIMIT $ SPECIAL PROVISIONS below OTHER I I I I DESCRIPTION OF OPERATtONS fLOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANYQF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ...!...Q...... DAYS WRITTEN MED TO THE LEFT, BUT FAILURE TO DO SO SHALL TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD NY 11971 ACORD 25 (2001108) OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENT TIVE @ACORDCORPORATION 1988 Page 1 of 2 _New York State Insurance Fund ~ Workers' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^^ ROBERT W SUESSER 26 ROANOKE DR SOUND BEACH NY 11789 CERTIFICATE HOLDER TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD NY 11791 POLICYHOLDER ROBERT W SUESSER 26 ROANOKE DR SOUND BEACH NY 11789 POLICY NUMBER I 1339 634-6 CERTIFICATE NUMBER 3102 PERIOD COVERED BY THIS CERTIFICATE 11/05/2007 TO 11/05/2008 DATE 11/30/2007 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1339 634-6 UNTIL 11/05/2008, 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 SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 11/05/2008 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE, THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND I~?M~ DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 U-26.3 VALIDATION NUMBER: 364076661