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HomeMy WebLinkAbout35669-ZFORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southo~d, N.Y. PERMIT NO. 35669 Z Date JI/NE 24, 2010 Permission is hereby granted to: for : INDEPENDENT GROUP HOME 62 PINE STREET EAST MORICHES,NY 11940 INSTALLATION OF ELECTRIC SOLAR SYSTEM AT AN EXISTING DWELLING AS APPLIED FOR at premises located at 52550 MAIN RD SOUTHOLD County Tax Map No. 473889 Section 061 Block 0003 Lot No. 001 pursuant to application dated JUNE 17, 2010 a_nd approved by the Building Inspector to expire on DECEMBER 24, 2011. Fee $ 200.00 / Authorized Signature COPY Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SouthoidTown.NorthFork.net Examined Approved 0(~¢, 20 Disapproved a/c Expiration [~f~ , 20 ( { PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST 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 Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone:~5- JUN I 7 2010 BLDG. DEPI. Fhis apDlic~n0[x~{)~ eomplot~ Building Inspector CATION FOR BUILDING PERMIT Date ~U~0- ~ ,2010 INSTRUCTIONS ly filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot 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 betbre 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 shall 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 permit shall be required. APPLICATION IS HEREBY MADE to the Building Depariment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suftblk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing co~q~, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. 7 (Signature o'fappli'cant or name/lf~n) }Ma~lifig'address of apt~hdant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Nameofownerorpremises )r'~kp(-l~d~-f~{~ &waldo nYn, (As on th~ tax-~oll 01: lat~}t deed) If,applicant is a corporation, signature of duly authorized officer 5CF OY" UtreC. c O,otraFtraq5-;t uDe k r- (Name and title of corporate officer) Builders License No. ~ C~C~ I ' '~ Plumbers License No. Electricians License No. ~,cl I ' · Cc_ Other Trade's License No. ~ Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section O~_[ Block (5~ Lot O } Subdivision Filed Map No. Lot State existing use and occupancy of premises and intended use and occupancy of proposed construction: 0 Existing use and occupancy b. Intended use and occupancy Nature of work (check which applicable): New Building_ Repair Removal Demolition 4. Estimated CosL.~ L~ 5, t~ (~ 0 If dwelling, number of dwelling units If garage, number of cars ~ Fee Addition Alteration Other Work ~r'~\/..[f r)¢l~ ~ i 11'x~fl ~[FI ,~, -' ' (To be paid on filing this application) Number of dwelling units on each floor 7. Dimensions of existing structures, if any: Front /4q,5 ' Rear Height ~ ' Number of Stories_ Dimensions of same structure with alterations or additions: Front Depth Height_ 8. Dimensions of entire new construction: Front Rear ~ Height Number of Stories '9. Sizeoflot: Front '~5 / Rear '-Tk/, qO _Depth (~ Date of Purchase Name of Former Owner If business, commercial or mixed occupancy, specify nature and extent of each type of use. ~, I Depth Numben of Stories Rear Depth 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO/ 13. Will lot be re-graded? YES__ NO /k/ Will excess fill be removed from premises? YES NO X 14. Names ofOwnerofpremises \L¢t L AddressO~/ M,~f Pho~. /o~l-~q(-~ ~ Name of Architect ~O~a~ ~. ~i~ Address ~ ~l~,~'~Phone No b~I2~- 7~ NameofContractor~Oe.~[%{ ~9~16~6~ Addres~TA qCffon~ PhoneNo. kBt'2~'Sfi%~ 15 a. Is this prope~y within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ~ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. 9. b. Is this propemy 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO ~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF~XJx~-'t~ \~S: / ~"x~) _N'F_D('~C "~kk._x~?2N~_.,'~ being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the ~ffX'~(~z~K- ~'~/~-~-~ t~ C5~)~ffC;t~3~-xx:3~'-,~ (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 tree to the best of his knowledge and belief; and that the work will be perfbrmed in the manner set forth in the application filed therewith. Swom to before me this y /~ ~ - Not~ Public ~ ..... No. 0~;.A~¢1'~ '-' Sign~tur~ of Applicant a Qualified ia Suff~ County j Commission Expires ~, 20~ ~ (N~: A~M~(~)~ea~~a~e~~ Y~ I~ ~ ~ ~ ~.~ ~;) ~1 s~ .~. · Is .em a Na.ml ~. ~u~ RU.n9 ~gh. S,e? Is ~is PmJ~t ~[n ~e Tmste~ ju~s~on or ~ln ~e H~r~ (1~] [~t of a Weaa~ or 9ea~? 6 Wi, ~e ~ Site ~epamfl~ ~ ~s~ng Grade 'Slopes ~ ~ ~ F~e~ (15) feet ~ Ve~l ~se to One Hundred (100') of Ho~n~l Di~?' 7 ~1I QHve~ys, Pa~ng ~'~ o~r Impels SuCres be ~o~ [o Dir~ S~-Wate~ ~n~ int~ ~/o~ in ~e di~on ora T~ ~ght~ ~ ~ . ' 8 any ~l~iSl(~ p~ed ~in~e Re~re.~e T~ PJght~f-W~ Pla~ent ~ of Road Maedal;S~d~ Re.raima? 0[ V~e~tioh' a~oc~e ~s~on ~is item ~tl NOT Inc~de ~e. I~l~flon of DHveway'.~ons.) ' 9 Wi~ this Pr~e~ Re~im Site Prepamfiod ~n ~e ~e Hundred (100).Year R~plain o~ ~y Water~e? NO~ IfAhyAnswertoQuesao~sOne~;0~ghN:nelsA~we~dwE~aCh~k~ln~eBex, aate~-Wa~r~Gm~ag, D~laage & ~oa Co.mi Plaa Is. ~qul~d and Must ~ sabml~ ~r Rev~w PHor to Iss~an~ of AW 8uad~g Pe~ ~a~: ................ - . YeS No D~ ~ ~ meet ~e minimum ~ndards f~ da~ ~ ~ ~l P~? N°': If You ~s'md Y" ' t"l' Que'o~ a 'o~'.ter..d,. D~in~e &:.s on Contml Plan is NOT Requ,., ............. (~ ~du~ s~ ~ ~IY ~m, de~s~ md ~ ~ ~shc ~.&e ~pU~t for p~ . .................. . ........... :.., ............ : ..... ............. (~; ~, ~ ~ ~. ~.) ........... '~ ~or ~c,~ve ~fne. O~r or O~'s, ~d h a~y ~d to ~ffom; or have peffo~ed ·.. ~ mum ~P~on ~ ~e to ~e ~t offs ~ ~d ~cfi ' ~.~e wo~ MIl ~ p~ m'~e ~n~ set fo~ in ~e ~p~ tiled' h~Mfi. ~.- , md 8~ ~fo~ n~s; D~NA ~N~A NOTARY PU8LIC, State of New Y6rk --:-:---:.:.: ....... .~........; ........... d~ypr...~~ ................... ~o.37 ' ~o. o,L~ooanz~4 ' ~a/ified in S~k Count -- __ - / Tdepho~ (6~ 1) 7~-18~ BUILD][lq(~ DEP~ TOWN OF SOUTHOW.rJ APPLICATION FOR ELECTRICAL INSPECTION *Address: · *Cross Street: *Phone No.: Permit No.: Tax Map District: JOBSITE INFORMATION: (*Indicates required information) ~oao Section: *BRIEF DESCRIPTION OF WORK (Please Print Ciearl~ .ot: / (Please Clmle All That Apply) *Is job msdy for Inspeolion: ~'Do you need a Temp Certtf'mate: Temp Inform~tion (If needed}, *8en~ce Size: 1 Phaee 3Ph~e *New Service: Re-conneot Additional Information: YES I NO ~! NO Rough In Final 100 150 200 300. 350 40o O~er Unde~round Numberof Me~ra Chenge of Service Overhead PAYMENT DUE WITH APPLICATION ~ C. 7 Pd Thomas D. Reilly P.E. Consulting Engineer every house is built by someone, but the builder of all things is God" Hebrews 3:4 Bezel Lane Smithtown, N.Y. 11787 Tel: (631) 724-7888 Fax: (631) 724-5740 ]une 11, 2010 Town of Sou~old PO Box 1179 Southold, NY 11971 Attention: Pat Solar Panel installation for IGHL 52550 Hain Road Southold, NY 11971 To Whom [t Hay Concem, APPROVED AS NOTED BY ,/Z- NOTIFY BUILDING DEPARTMENT FOLLOWING INSPECTIONS 1, FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH- FRAMING, ~LUMBING STRAPPING. ELECTRICAL & CAULK!N 3 3 INSU~TION 4. FINAL- CONSTRUCTION & ELECTRiCaL MUST BE COMPLETE FOR C 0 ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THF CODES OF NEW YORK STATE NOT RESPOnsiblE FOR DESIGN OR CONSTRUCTION ERRORS Please be advised that we have examined and analyzed the existing roof framing at the above-named location and have determined fi3at it is adequate to support ail antidpated super-imposed loads from the proposed solar panel installation without overstress in accordance with the requirements of the Residential Code of New York State. CERTIFICATION OF Addrdonal Design Criteda and Information: 1. RoofUveLoad = 20psf 2. Snow Load = 20psf 3. Wind Load(120mph) = 26psf NAILING & CONNECTIONS REQUIRED. UNDERWRITERS CERTIFICATE 4. Wind Uplift = 40psf REQUIRED 5. The mounting brackets meet or exceed NYS Code requirement~ for the above design criteria. 6. The actual in field attachment to the roof will meet or exceed Residential Code of New York State Requirements. Very truly yours, Thomas D. Reilly, P.E. RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OE THE TOWN CODE. IGHL - Main Street 6 11 2010.doc ALL COl%, J ;'HALL MEET THE P,E.;- ' .; ;3 OF THE CODES OF N~:,,='~ YO~:;K STATE. TDR:js Z MAIN ROAD 60° 54'00"~ 85.00 ' 'o 6i ° 30'00"W AREA = 15, 920 SQ. FT. Prepared in accordance wilh /he minimum standards /or lille surveys os esloblished by lila L.L.4.L.$. and approved and adoplad /or sucil use by Tile New York S/ale Land lille A$$oci~Hion. IS. LIC, NO. 49618 SURVEY OF PROPERTY AT SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY , N.Y. 1000 061 - 03 01 SCALE Y'= 30' JUl Y 8, 1992 ACORi=t CERTIFICATE OF LIABILITY INSURANCE LoVulIo A,e~:,~iales, Consbucfio~ Coml~ny, Inc, 112 Cedar Avenue ;slip, NY 11751 04/14/2010 THIS CERTiFiCATE IS ISSUED AS A MA'~ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW. COVERAGES ANY CONTRACT OTHER CERTIFICATE HOLDER CA .~C.-;I I ATION Southold, NY 11971 I © 1988-2.00~ ACORD CORPORATION..~il rights IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer fights to the certificate holder in lieu of such endomement(s). 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). DISCLAIMER This Certificate of Insurance doss not constitute a con'~act between the Issuing insurer(s), authorized representative or producer, and the cer',.iF~.ate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009R1) STATE OF NEW YORK WORKERS' COMPENSA'I ION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Address of Insured (Use street address only) Friendly Coustruction Co. Inc. 57A Saxou Avenue Bay Shore, NY 11706 Work Location of I nsu red (Ouly required ifcaverage is specificnlly 'iutited to eertain locations itt New York State, i.e., a Wrap-Up Policy) 2. Name and Address of thc Entity Reqnesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Towu of Southold Town Hall ;3095 Route 25 P.O. Box 1179 Snuthold, NY 11971 lb. Business Telephone Number of Insured 631-647-3402 lc. NYS Unemployment Insuraoce Employer Registration Number of h]sured Id. Federal Employer Identification Nnmber of lusured or Social Secnrity Number 1-2959027 3a. Name of lusurancc Carrier New Hampshire Insurance Co. 3b. Policy Number of entity listed in box "la" WCI009535 3c. Policy effective period 07/20/2009-07/20/2010 3d. The Proprietor, Partners or Executive Officers are Il included. (Onlychrckl)oxifallparmers/Id~ccrsinch;ded) X all excluded or certain partners/officers excluded. I his certifies that tile insurance carrier indicated above in box -3" insures the business referenced above in box 'qa" for workers compensatim~ under the New York Slate Workers' Compensation l.aw. (To use this form, New York (NY} must be steal under Item 3A on the IN FORM ATION PAGE of the workers' compensation insuranee policy). The Insnrance Carrier or its licensed agent ~ill send this Certificate of Insurance to the enti~ listed above as the certificate holder 'n box '2". 'lhe Insurance Carrier will etls~ no/i/i' the above cert~c'ate holde~ ~s ithin I 0 d~'s lb' or wilhin 30 dco's IF there are reasons other than nonpayment (ff'premitans /hat cancel'lhe polio3' or eliminate lite in.wtred fi'om the coverage indicated on this ('ert~ficate. (U~ese notices may be sen/h)' regular mail.) Otherwise, this Cert~cate ~ valid fi~r one year i~ter this~rnt is approeed by the insurance carrier or its liceused agent, or u,til the polk7 ~t~iratian date lt~ted ht box "3c ", whichever is earlier. Please Note: Upon Ihe caucellation of lhe workers' compensation policy indicated ou Ibis form, if the business continues to uamed on a permit, license or conlract issned by a certificate holder, Ihe business tnust provide that certificale 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 (hat I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as d~ted on Ihis form. Approved by: ~ ~>: ' /" ~( - {Dale) ,'elephone Number of audmrized representative or licensed agent of insurance cagier: Please Nute: OhO' ill.~'i#'a~lc'e carriers and Iheir licensed agents ~we ~tltlllorizt'd lo i~'sue f'~,'m ('-105.~. ]ll.~'tlrtuwe broker~ are NOT ttuthorized to issne it. C-105.2 (9-07) STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART I. To be corn e/ed bN Disubili~,- Benefits Carrier or Licensed Insuran~e~e~! oflhat Carrier I a Legal Name and .Addre.~ of In:;ured ti rse street address onl)) I b Business Telephone Number of In:raced Friendly Construction Co 57A Saxon Avenue Bayshore, NY 11706 D JlA 2 Nan~e and Address of the Enbtv Requesting Prc~ff of {"overage I Entlty Being Listed as the Certificate Itolder} Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Sc~old. NY 11971 4 Polio?, covers 631-647-3402 lc N5 S [ nemployment lnsunmce Emplmer Reetstratmn Num bet of hvmred ' ~ ld Federal Employer lden tlcat~on Number of Insured or Social Security Number ' 11-2!}5902 7 Zurich American Insurance Company ~b Policy Number of entity hsted m box "I a" 5368447-8 tc Policy effective period 072!)2(~0 to O72O2O12 a [] ?dl of the employer's emp o,,ees ehg ble under the Ne~ York Disabdity Benet)ts Law b [] Only the lbllowmg class or classes of the employer's emp o~.ees 1 lnder penalty of per urv. I certify ~t I ~m~ an authorized represe~t~ve or hcensed a~ent of the insurance career referenced above and that the named msnred has NYS ~)isability Benef ts lnsxlr~mce coverage as described a~bove I)ate S~gned I 0'26'200t} B; ~') ~ Telephone Number 163!)845-22(}(~1 Title Ad_nmts~at~veServ~cesB,~I3~n~ PART 2. To be completed by NYS Workers' Compensation Board (Only if box "4b" of Part I has been checked) state Of New York Workers' Compensation Board Accoldtl~ R* uffoHImtlOlt mauflamed b., lite NY,~ '¢,'olkelS' (?Olll[)ellv;allOll BOald. llm al~we-named emplo} el l~q.~ comphed wllh die NYS DIsabihh Benefils Law with lextel lo all oflus llei employees . D ~te S gn~ _ By Telephone NumbeL~ . ]htlc Please Note (rely lmt~ance carriers hcen~d to wrl~ NYS d~sabthty ~net~ts ~sumn~ pohc~es and NYS hce~ed u~smancc aacnts ot those insurance carnem are au~onzed ~ ]mue Foml DB-120 I hlstlrallce brokm's are NOT an~torized to msue fills lk)rlll DB-120 I (5416) Proposed PV Arrays HARVEST POWER PROGRAM by FRIENDLY CONSTRUCTION CO. INC. 52550 Main Rd IGHL I -- A Southold NY, 11971