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Home My WebLink About36217-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 11/26/2012 CERTIFICATE OF OCCUPANCY No: 36058 Date: I l/26/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: RESIDENTIAL ALTERATION 220 Critten Ln, Southold, Sec/Block/Lot: 70.-12-15 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 3/1/2011 pursuant to which Building Permit No. 36217 dated 3/4/2011 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: replace windows and doors, bay window and alterations to kitchen and baths in an existing one family dwelling as applied for. The certificate is issued to John & Kathleen Ammerman (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED ! 0/30/11 36217 7/2/12 ~l~.TBill Schwamb~ ~Tb~e~ature 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 #: 36217 Permission is hereby granted to: BAC Home Loans Servicing LP PTX - C35 7105 Corporate Dr Date: 3/4/2011 Piano, TX 75024 To: REPLACE ALL WINDOWS AND DOORS, REMODEL EXISTING KITCHEN AND BATHS, & ADD NEW BAY WINDOW. At premises located at: 220 Critten Ln, Southold SCTM # 473889 Sec/Block/Lot # 70.-12-15 Pursuant to application dated To expire on 9/212012. Fees: 3/1/2011 and approved by the Building Inspector. CO - ALTERATION TO DWELLING SINGLE FAMILY DWELLING - ADDITION OR ALTERATION Total: $50.00 $287.20 $337.20 Building Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 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 new use: 1. 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/I0 of 1% 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. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 New Construction: Location of Property: / ZZO House No. Street Owner or Owners ofProperty: '~,,~ /4~)tL/~. Date. Old or Pre-existing Building: Suffolk County Tax Map No 1000, Section Subdivision (check one) Permit No. .~ ~, 2. l 7 Date of Permit. -~ . tq - / / Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,5'~9 , Hamlet Underwriters Approval: Final Certificate: / (check one) Block / 2- Lot Filed Map. Lot: Applicant: /~B - ~ j:~g>q Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971 0959 Telephone (631 ) 765-1802 Fax (631) 765-9502 ro.qer, richert~town.southo d ny us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Address: 220 Cdttens Lane City: Southold St: NY Zip: 11971 Building Permit #: 36217 Section: 70 Block: 12 Lot: 15 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Warren Hubbs Electric LicenseNo: 4155-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only [~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage Service 1 ph 20L~Oa Service 3 ph Main Panel ~ Sub Panel Transformer Disconnect ~200a Other Equipment: INVENTORY Heat ~ DuplecRecpt ~ Hot Water GFCI Recpt NC Condenser Single Recpt AJC Blower Range Recpt Appliances Dryer Recpt Switches Twist Lock Ceiling Fixtures [~ HID Fixtures [] Wall Fixtures I 131 Smoke Detectors Recessed Fixtures[~ CO Detectors Fluorescent Fixture [~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures [~ TVSS 200a overhead service, 1-combination smoke/co detector, 3-exhaust fans 6-ARC fault circuit breakers Notes: Inspector Signature: Date: July 2 2012 81-Cert Electrical Compliance Form.xls Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 BUILDING DEPARTMENT TO~VI~ OF SOUTHOLD CERTIFICATION Date: Building Permit No. (Please pr'ink) mlumber:~-~,-t/ (Please print) lead. I certify that the solder used in the water supply system contains less than 2/10 of 1% Sworn to before me this /q"~-~ day 20 / / Notary Pub lic, k~ ~-~) k~. County (! COLLEEN A. MONTflOHY ~ Notary Publlo, State of New ~ No. 01M0613224~ Qualified in Suffolk Coull~/'}~,l ~ Commission Expires August 22, ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] RRE RESISTANT PENETRATION ~J~ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE ~ INSPECTO~~~----~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [,~ROUGH PLBG. [ ] F~NDATION 2ND [ ] INSULATION [,/~ FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE IIESISTANT CONSTRUCTION [ ] FIRE RESlSTAHT PEHETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAI~.~ (FINAL) REMAR .K,~S:~ DATE TOWN OF~G DEPT. [ ] FOUNDATION 1ST [ ] RO~/GH~LBG. [ ] FOUNDATION 2ND ~/] INSULATION [ ]FRAMING/STRAPPING [ ]'FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT C0#STRUCTION [ ] FIRE RESISTANT FENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTIQN [ ]FOUN~ION 1ST [ ]~QI~PLBG. [ ]~fl~IDATION 2ND [yj~NSULATION [,~ FRAMING / STRAPPING [ ] FINAL [ ] FI/.~CE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ,,~FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~ DATE INSPECTOR ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ]FRAMING/STRAPPING [ ] FINAL [ ]FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION -/1- [ ]ELECTRICAL (ROUGH) [,~__ELECTRICAL (FINAL) REMARKS: DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAPPING [ ] ROUGH PLBG. [, ] IN/~ON [~'FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ]ELECTRICAL(ROUGH) [ REMARKS: (/~'"~ ~.~T_(~I I=CTRICAL (FINAL) / DATE -~(~)~ INSPECTOR ~ ~/~ v'IlfiLD IN~PE ,C~ 0NREPORT[ DATE ] CO~T$ FO~O~ (~s~ ~A~ON PER N. Y. STATE E~R~ CODE ' '~ ' ~DITION~ cOUNTS " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.North Fork.net Examined 3/ Approved Disapproved a/c PERMIT NO. Expiration Building Inspector 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: APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS .2oll a. This application MUST be completely 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 belbre 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 properly 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 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 building, s, additions, or 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 for necessary inspections. - (~ign~t~r~o~ap~ic-~/~tt~{name, ifa corporation) (M~l,ri~ adare~ot~pphcant) ..... · State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name ofownerofpremises ~/'/,,],~1~ j[~_e/h ~/,},l. ef,,.m 00'3. (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. I. Loc~ion of la!ltl on which proposed work will ~be done: Hou-se-Number '' -- Stree-t ..... I - Hamlet County Tax Map No. 1000 Section '70 Block Subdivision Filed Map No. Lot /,C- Lot 2. State existing use and occupancy of premises and inti~nded,¢se and occupancy of proposed construction: a. Existing use and occupancy ,~3'1 ~,4)/,~ -/~,qa b. Intended use and occupancy ~l~/JI]-t' · 7''- - ' '" / "'- · ' 3. Nature of work (check which applicable): New Building Addition Alteratmn Repair Removal Demolition Other Work 4. Estimated Cost['O ]~d l)t~_~-~tr,Vlil~.~/../. 5. If dwelling, number of dwelling units If garage, number of cars Fee (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~'/.p ~t Rear ~ .Depth Height /(~ t Number of Stories / Dimensions of same structure with alterations or additions: Front Depth. '~ ~' Height Number of Stories 8. Dimensions of entire new construction: Front Height Number of Stories Rear .Depth 9. Sizeoflot: Front Rear Depth 10. Date of Purchase /~:'9//0 Name of Former Owner 11. Zone or use district in which premises are situated g~- ]-{ ~) . 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO_.~ 13. Will lot be re-graded? YES__ NO~_Will excess fill be removed from premises? YES NO ,9t/ 14. Names of Owner of premises r/)/13h'~'_~r.,~r?rx Address rr~)~v? ~'/} (Z2t,~_ Phone No. ~a3/- Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet cfa tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet cfa tidal wetland? * YES NO * 1F YES, D.E.C. PERMITS MAY BE REQUIRED. NO F 16. Provide survey, to scale, with accurate tbundation plan and distances to property lines. 17. If elevation at any point on property is at l0 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) SS: COUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, CONNIE O. BUNCH Nota~ Pub#o, State of N~# ~oev. (S)He is the NO. 01BU6185050 (Contractor, Agent, Corporate Officer, etc.) Quailed in ~ taoue4 _ _ Commlaelon Expre~ Apfi '1~ :~?~ ~ of said owner or owners, and is duly authorized to pedbrm 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 performed in the manner set forth in the application filed therewith. Sworn to belbre me this c~ day of (~::)C~.~W~t~ 201~ Notary Public ~ 81 ure Io/f Applicant TOWn of Southold Eresion, ~;edimentation & S~orm-Water Run'Off ASSESSMENT FOR_"J'_ PR~r'-i~ I ~' LOC~TIO~' S.C.T.M. ~k ' ' o a-vmw-wa URADIN DRAIN -- ; ..... ' R~lbkemenb of the ~PDF~ C, eneral IJm~b ..... . .. _ ~/oquall~dD~Pm~e~4mmlUce.sedhNewYork COUNTY o~..T:I..~:.~: ......... sS c-~compassing an,~ea in Exc~s of Flve ThouSand . ~ , (5,000'S.F.) Square Feet of Grou~ Surface? 6 Is ~em a Natural Water Course Running through.the or within One Hundred (1 ~ feet of a WeUand Or Beach? · which e'~ceed F~een (t5) feet of Verlicaf Rise to One Hundred (100') of HOrtZontalDtstan~? · ~--I -- 8 W'd! Driveways, Parldng Areas oroUer Impe~oua bite and/or In the direction of a Town rtght*of, vmy? g w',a ma erolect Requ~'e.U,e eacen~daate~ ~ # A~ ~ ~ ~ 0~ ~h i~W ~.~ ~ ~ ~ ' ~°flu'Wabr, ~ ~ & ~ C,~;,,~'~tm b bqdred f~jlbe Towfl M Notary Public, State o~ New York No. 01BU6185050 ,t~_., · ' Qualified In Suffolk County ~ , ~ ............. ~ ~'~c,~:='-: .- ............................. he;.. dui., .-..--- ~a ..... ..~_~ ,~ April 14, 2/.2/d-- ~d t~ h~h~ ;~ m~ ....... :. ............................ '~:~',c~r4~-~:~i ......................................... : .............. Owner and/or rcprcs~taUve of the Owner or Ownen, aad ~s dm~ authorizc4 ~o perform or have performed the said work and to raake and ~ this application; that ail ~tements contained in this application are true to the bezt of'his knowteds~ and beli~ and that ~ work wal be pcd'ormcd in d~e manner set ford~ in the application fded herewith Sworn to before mc this; ' FORM - 06/10 To'mi Hall Annex 54875 Mai~ Ro~d P.O. Box ! 179 Soul,old, N~ 11971-0959 TeJ¢l~one (681) 765-180~ BUrl.DING DEP~ TOWN OF $OWFHOLD APPLICATION FOR ELECTRICAl INSPECTION REQUESTED BY: Company Name: Name: License No.: Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: ~O *Cross Street: *Phone No.: Pe~ ~.: T~Map Di~: 1000 Se~ion: ~ ?~ Bloc~: Lot: *BRIEF DESCRIPTION OF WORK (Please Pdnt Clearly) (Please Circle All That Apply) *Is job ready for inspection: *Do you need a Temp Certificate: Temp Information (If needed} *Service Size: I Phase *New Service: Re-connect Additional Information: YES ~) YES / NO Rough In 3Phase 100 150 ('f200~x/ 300 350 400 Underground Number of Me~ Change of Service pAYMENT DUE WITH APPLICATION 82-Request for Inspection Form o 73'-~. tgo Final Other Overhead Architect/Engineer: W/~f~/ ~/i)~(~7/" /fjd((~7,~/'~' $CTM#1000- 7<~ /~- J~ Subdivision: Property Address: *Date Submitted: ,~/~ c~ ~/ .Date Reviewed: / / Estimated Cost: Zone: ~-2/~ Conforming?~ Building Permits (Open/Expired): BP__-Z / C/0 Z- , Info: BP__-Z / C./0 Z-__., Info: BP -Z / C/0 Z- 8hlgle & Separate Search Required? Y or N Determination: KEQ. Lot Size: ACT. Lot Size: R.EQ. Front__ ACT. From REQ Side REQ. Height. ACT. Height. Project DescriPtion: ~e~'/~ ~/' Waterfront?/or~ If yes, water body: Panel# BP__-Z / C/0 Z- , Info: , Info: BP__.-Z / C/0 Z- , Info: _ KEQ. Lot Coy. ACT: Lot Cov. ACT. Side REQ. Rear PROP. Rear -- __ Flood Zone: __ Bulkhead/Bluff Distance: ADDITIONAL APPROVALS REQUIRED Suffolk County Health: Y oe_~f yes, *Bed#: *Date: / _/__ *Permitg~ Town Septic: Y or ~/ - If no, certification required: Y or N Received: Y or N By: NYS DEC: PRE-OgC~a/TS Y or~'~-' Date: / / Permit #: or NJ Letter - Notes: Southold Trustees: Y or ~- ate __/ / Permit #: or NJ Letter - Notes: Southold ZBA: Y or.r.r.r.~ Date: / /__ Permit #: - Notes: Southold Planning: Y o~ Date: / / Permit #: - Notes: / / *NY~ CODE C~m,bl'la~-e~or N Town ~E: \ ' u .Fee Structure: Calculation: Foundation: SF 1. ( SF)- (_ SF)= SF X $ =$ First Floor: r,~ ~, SF + Initial Fee: $ Second Floor: SF + Additional Fee ( ): $ Other: SF 2.( SF)-( SF)= ~/~ SFX$ Total: SF + Initial Fee: $ + Additional Fee ( &/,/c~ ): $ TOTAL: $ NEW YORK STATE CODE COMPLIANCE CHECKLIST CLIMATIC/GEOGRAPHIC D~SIGN CRITERIA: · Grountl Snow Load: gO ,. Wind Speed; I20MPH__ igelsmle Design Cat(~goryi B . Weathering: Severe__ .-Frost Depth: 36" __Termite: M~H' Decay: S-M : Design Temp: 11 ·Iae Shield Underlay: YE$ , ltlo~d Hazards: USE/OCCUPANCY CLASSIFICATION: HEIGt~IT/FIRE AREA: .., TYPE OF CONSTRUCTION: DESIGN CRITERIA: ENGINEERED/pREscRIPTIVE FULL FR;AMING DESIGN ELEMENTS: Y/lq IIEADERS:/~ ~ WALL sTUDs~/N CE][LI[NG J~Isrs: Y~iN/) FLOOR JOISTS: LUi~BER SPECIES J~ND GRADE: GIIII)ERS: Y~ ROOF RA1FFERS: ~ WI2q'DOw AND DOOR SCHEDULE: · MISSLE TEST REQUIREMENTS: Y/N EGRESS 5.'7 S.F.: LIGHT 8% :Y/N '~rENT 4%: y/Ix[ NAILING/CONSTRUCTION SCHEDULE: MEANS OF EGRESS: Y/N PLUMBiNG RISER DIAGRAM: Y/N LOCATION OF FII<E PROTECTION EQUIPMENT: Y/N TRuss DESIGN: Y/N CERTIFICATION: Y/N ENERGY CALCS: Y/N TOTAL COMPLIENCE? Y/N (RETURN TO PAGE ONE) MAR-04-2011 11:13 From:VILLAGE OF GREENPORT 631 477 1877 To:97659S02 P.i~I EILEEN WINGATE 460 BOOTH ROAD SOUTHOLD, NY 11971 631.765.2743 3/3/11 Building Dcpartmcnt Town of Southold Groenport, NY 11944 Re: Ammennan Residence, 220 Critten Lane, $outhold, NY To Whom It May Concern, Please be advised the application submitted for the Ammerman residence has specified the instaUation of Andersen Windows 400 series, Iow E insulated glass, throughout the dwelling unit. All new windows meet or exceed all egress, light and vent requirements by the New York State Residential Building Code. If you have any further questions I' can be reached at 516-818-9754. Thank you. WORK~;RS' COMPENSATION BOARD CERTIFICATI~. Olr NYS WORIO~RS' COMPF. NSATION INSURANCE COVF. RAGE ia. Legal Name & Address orlnsured (Use street '4ddrcss only) J D CONSTRUCTION & LANDSCAPING INC. PO BOX 8 SMITHTOWN, NY 11'/87 Work Location of Insured (Ow/), r~q./red ~coverof s bspecift=al~, limited to cenoin locutions M New York State, L,'., u P/rap-Up Policy) 2. Nome and Addre~ of the Entity Requesting Pr.of oF Coverage (Entity Being Listed as the CeFtificot¢ HoldcO VILLAGE OF sOUTHOLD 5309S MAIN ROAD SOUTHOLD, NY 11971 I b. Buslnesa Telephone Number of Insured (631)'/66-0004 Ic. NYS Unemployment Insurnnce Employer Registration Number ut* Insured Id. Federal Employer IdentiflcutJon Number of Insured or 5ocinl Security Number 04-37945S2 3a. Name of Insurance Carrier FARM FAMILY CASUALTY INSURANCE CO 3b. Policy Number of entity li~ted in box 31S2W2401-P 3c. Policy effective period 03111/2011-03/I 1/2012 3d. The Proprietor, Partners or Executive Officers arc C3 included. (Ouly cheek box JFMI p~rlncfl/olF0eers Included) · all excluded or certain partnerslofllccrs excluded. This certifies that the insurance carrier indicated above in box "T' insures the business referenced above in box "18" for workers' compensation under the New York State Worker~' Compensation Law. (To use this form, New York (NY) must be IMM under IMm 3A on the II~ORMATION PAGE of the workers' compensation insurance poli~). The Insurance Ca~cr or its licensed ~ent will send this Certificate of Insurance to the entity listed above ;,~ thc certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 day~ IF a policy i~ canceled due to nonpayment of premium,~ or wahin $0 day~ IF there ore reasons other than nonpayment of premiums that cancel the policy or eliminate the insured/kern the coveraSje indicated on this CertO~cote. ffhese notices may be ~ent by regular mail.) Otherwise, tats Con~cote is ),elid for one yeer (after this form is approved by the ins#fence carrier or Its licensed agent, or until the policy expiration date listed in box "$c ". whichever ia eurl~r. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, irthe business continues to be named on a permJ~ license or contract issued by n ¢¢rtJficotc holder, the bosluezs must provide thet certificate holder with a new Certificate of Workers' Compensation Coyera~e er other MlthorJ~,ed proof thnt the business is compJylug with the mandatory coverage requirements of the New York S~ate Workers' Compensation Law. Under penalty of perjury, ! certify that ! Bm an authorized rcpresentative or licensed areal of the insurance carrier referenced above and that thc named insured has the coverage as depicted on this form. Approved by: VTNCENT C I)ALEY (Prim flame ~p~l~cl reprea~mdvc or II~a~cd aacnt of insumfl~e carrier) Approved by fftt~P*~0" ~ MN~gh_I I. 2011 (Sip~a~are) (Dine) Title: AG~ENT Telephone Number of authorized representative or licensed agent of insurance carrier: (6:31 ) 27%7770 Please Note: On(v insurance carrler~ and their licensed agents ore authorized to [~$ue Form C-105.2. Insurance broker~ are NOT m~thor~ed to issue it. C-105,2 (9-07) www.wcb.state.ny.us ® CERTIFICATE OF LIABILITY INSURANCE ¥1~15 CERllFICA'rE I~ IEEUED A~ A ~ OF INFORMAT~N ONlY AMO CO~ NO RIG~ UP~ ~E ~i~i~ATE HO~. ~ I CER~ ~ N~ A~IR~Y ~ ~Y A~, ~NO OR ALTER THE C~E A~ED BY ~16 CE~A~ OF INSU~E ~ ~T CO~S~E A CON.CT BE~BN ~E mSUl~ INSURES). A~ R~ENTA~E OR PR~, ~D THE CERT~I~TE IMPO~A~: If ~e ~Gi~ ~r ~ I~ A~AL INBRED, ~ pMl~l~) most be ended. ~ SUBR~A~N IS W~D, S~ ~ t~ ~s and =~o~ ~ ~ ~W, ~lfl p~llc~ m~y ~ulm an endomme~ A s~me~ on ~ Ge~c~ dm not c~r ~ ~ the FARM FAMILY C~UAL~ 8~ CONNE~U~ AV~UE ISL~ TERR~E, NY 117~2 631.2~-~0 J D CONSTRUCTION &LANOSCAPINO INC. PO BOX 8 SMITHTOWN, NY 11787 13803 ~U~EI~ A: FARM FAMIL~ CASUALTY INS CO ~ 18 TO CER~ T~T ~E PO~ ~ INEU~HCE ~ 8~OW HA~ 5E~ ~EUEO ~ ~ INSURED ~MED A~E FOk ~E P~CY PERIOD INDIteD, N~ANOING ANY REQUIR~, ~M ~ C~ON OF A~ CO~ OR O~ER D~U~ ~ REJECT ~ WHICH CERTIFICA~ ~Y BE ISSUED OR ~Y PERTAIN, THE INSU~CE AFFORDED ~ THE POL~IE80E~CRIGED HER~IN I~ SUBJECT ~ ALL ~E 3152W2401 -P {)3111/2012 PENDING NY DISABILITY STATUTORY CERTIFICATE HOLDER VILLAGE OF SOUTHOLD 53095 MAIN ROAD SOUTHOLD, NY 11971 FAX(631 )413-9330 CANCIILLATIO, H SNOULO ANY OF THE ABOVE DESGRIOED POt,lOll8 SE CANCELLED BEFORE THE EXPIRATION OATE THEREOF, NOT/CE W~LL 8E OELNEREO IN ACCORDANCE ~ THE POUCY PROVISIONS, ~) 1088-2009 ACORD CORPOi:bS. TION, All righm mewed, ACORD 25 (2009/09) The ACORD nome and logo om regbsteFed maws of ACORD Workers' Compensation Law Section S?. Restriction off issue ofpermit.q and the entering into contracts unte~s compensation is secured. I. Thc head cfa st~tc or municipal department, boa~d, commission or office authori~d or required by law to issue any pcrmit for or in connection with any work involving the employment ol'~mployees in a hazardous employment defined by this chapter, and no~vithstandinl~ any general or special stature requiring or authorizing thc issue of such permits, shall not issue such permit unless proof'duly subscribed by an insurance carrier is produced in a form satisfac~ry to thc chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as treating any llabiliPj on Lbo pa,-t of such state or mtmicipaJ department, board, commission or office to pay shy compensation m any such employee if so employcd. 2. Thc head of'a sratc or municipal department, board, commission or office authori~d or required by Jaw to en~' into any con,act for or in connection with any wor~ involving the cmploymcnt of employees in a hazardous employment dcfined by this chapter, notwithstanding any general or special statot~ requiring or authorizing m~y such contm~ shall not enter into any such contract units proof duly subscribed by an insurance carrier is pmduccd in a form satisfactory, to tho chair, that comp~nsatlon for all employces has been secured as pmvidcd by this chaptcr. C- 105.2 (9-0?) Reverse APPROVEDASNOTED DATF' B P # FEE BY NOTIFY BUILDING DEPARTNIENT AT 765-1802 8 AM TO 4 PM FOR THE PLUMBING ALL PLLIMSlNG WASTE & WATER LINES NEED '['ESTING BEFORE COVERING PLUMBER CER ON LEAD CONTENT E CERTIFICATE OF SOLDER USED IN WA TER SUt~PL Y SYSTEM CANNOT EXCEED 2/10 OF 1% LEAD. ELECTRiCAt_~L~- INSPECTION REQUIRED oCCUPA','4C"~ OR USE IS UNLAWFU~ '~N~THOUT CEIgTIFtCATE PROPOSED ALTERATION FOR KATHLEE N AHMERMAN 220 CRITTEN LANE SOUTHOLD N:Y 11971 4';~ 4"~--er u~N c~ FA)UT P~m~ ___ Io1,~il ),iF:,kJ GOtY,.)TF..~ H~ICrHI' 2 / "F 5C,AL-~ ~" = ILo" 2Oll GENERAL NOTE6: FOUNDATION NOTES: F'LUMDING ¢ HVAC NOTE,S: ALTER. NATIVE FOR. OPENING PP-.OTECTION TABLE I (;09. I .4 ELECTRICAL NOTES: FRAMING NOTES: FLOOR FI.AN NOTES: WINDOW AND DOOR. DCHEDULE /.o. 'F-_ooF PLUMBING RISER DIAGRAM NOT TO 5CAL~ WEND P-.E..~I.~TANT CON,~TP-.UCTION CONNECTOP-.5 CONSTRUCTION DETAIL.~ ¢ WIND LOAD PATH CONNEC~ON DETAIL~ NOT TO SCALE CONNECTION LOCATION: pAInT NUMBE~ NOTES: DFSIGN LOAD CALCULATIONE' MINIMUM UNIPOP. MLY DISTPJI~JTFD LIVP LOAD5 (Ibsf) TABLE R30 I .G CLIMATIC AND GEOGRAPHIC DESIGN CR.ITI=R. IA