HomeMy WebLinkAbout37995-Z Town of Southold Annex 7/23/2013
,;~d9 P.O. Box 1179
54375 Main Road
~ ~ ; Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 36412 Date: 7/23/2013
THIS CERTIFIES that the building RESIDENTIAL ADDITION
Location of Property: 910 Oriole Dr, Southold,
SCTM 473889 SecBlock/Lot: 55.-6-15.5
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this otficed dated
4/19/2013 pursuant to which Building Pernut No. 37995 dated 5/3/2013
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:
GARAGE ADDITION TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to Anderer, Denis & Anderer, Janet
(OWN BR)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37995 OS-03-2013
PLUMBERS CERTIFICATION DATED
Aut ~ ed Si atur
_~~~-°~~r-< TOWN OF SOUTHOLD
~s~t h` BUILDING DEPARTMENT
~ ` TOWN CLERK'S OFFICE
SOUTHOLD, NY
r''pl
' 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 37995 Date: 5/3/2013
Permission is hereby granted to:
Anderer, Denis 8~ Anderer, Janet
910 Oriole Dr
Southold, NY 11971
To: construct a 12' X 21' garage addition to an existing dwelling as applied for
At premises located at:
910 Oriole Dr, Southold
SCTM # 473889
Sec/Block/Lot # 55.-6-15.5
Pursuant to application dated 4/19/2013 and approved by the Building Inspector.
To expire on 11/2/2014.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $306.40
CO -ADDITION TO DWELLING $50.00
Total $356.40
Building Inspector
Form No. 6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN BALL
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 bu0ding or new-use:
1. Final survey of property with acctirate'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. Sw.om statement from plumber certifying that the solder used in system contains less than 7JI0 of 1% lead. .
5. Commercial building, irrdustrial building, mtiltiple 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 4, 1957) non-conforming uses, or buildings and "pre-existing" land uses:
1. Accurate survey o€property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly epmpleted 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.
G 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
- S- Temporary Certificate of Occupancy -Residential $15-00, Commercial $15.00
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 4<D O/2 rD~E' D,Q SDUTHfloL/~
House No. Street Hamlet
Owner ar Owners of Property:
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot
Pemvt No. ~ C~ ~ ~ Date of Pemvt. J " 3 ' 13 Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval: _
Request for: Temporary Certificate . _ _ Final Certificate: V _ (check one)
Ice Submiltcd $
_II - -
Api~licant Signal
rrmrr.-i,~
SuFFOC,rc
Town Hall Annex ~pp~~ Telephone (631) 765-1802
54375 Main Road ~ Fax (631) 765-9502
P.O. Box 1179 ~ ~
Southold, NY 11971-0959 cy~~ ~ ,*y0r~?~ rooer.richert(ciltown.southold nv us
~''~~~r~.m~.
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Anderer
Address: 910 Oriole Dr City: Southold St: NY Zip: 11971
Building Permit 37995 Section: 5j Block: 6 Lot: 15.5
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: home owner DBA: License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor 1st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage x
INVENTORY
Service 1 ph Heat Duplec Recpt 2 Ceiling Fixtures 1 HID Fixures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clacks
Disconnect Switches 1 Twist Lock Exd Fixtures TVSS
Other Equipment:
Notes:
Inspector Signature: ~\~,-~~1.~ C~'- Date: July 22 2013
Electrical Certificate.ds
C ~ ~o~~OF SOUTy06
'V
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
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS:
DATE ~ ~ 3 INSPECTOR
,daoF sours
TOWN OF SOUTFIOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ] FOUN ATION 1ST [ ]ROUGH PLBG.
[ ] F NDATION 2ND [ ]INSULATION
[ FRAMING /STRAPPING [ ]FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ICAL (FINAL)
REMAR S: d~
l
DATE Ll INSPECTOR
3 ~ ` G ~1~~ o~,~OF SOUIy
TOWN OF SOUTNOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ] RO H PLBG.
[ ]FOUNDATION 2ND [ ] SULATION
[ ]FRAMING /STRAPPING [ FINAL
[ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL/(ROUGH) [ ]ELECTRICAL (FINAL)
REMARKS: (~~-Cry ~
~l~i ~
- -
DATE ~ ~ ~ INSPECTOR
L /
TOWN OF SOUTNOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] I LA
[ ]FRAMING /STRAPPING [ FINA
[ ]FIREPLACE & CHIMNEY [ ]FIRES PECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH [ ]ELECTRICAL (FINAL)
REMARKS:
DATE ~ INSPECTOR
o~,~OF SOGry~
~
M~ i
TOWN OF SOUTNOLD BUILDING DEPT.
765-1802
1 NSPECTION
[ ]FOUNDATION 1ST [ ]ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ]FRAMING /STRAPPING [ ]FINAL
( ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [,Q~]~ ELECTRICAL (FINAL)
REMARKS:
DATE ~ 2 Z~ INSPECTOR
? ,
FIELD ON REPORT DA CO C\
. 3
,y,
FOUNDA~'ION (1ST) ~
Dy
UDy
FOUNDATION (ZND) u+ ~
ti
~C
d
3 ~ ~ ti Q y
} a~
ROUGH FRAMING & ~ y
PLUMBING
pi
t~
INSULATION PER N. Y. "j
STATE ENERGY CODE
8
FINAL
ADDITIONAL COMMENTS
d l
ii
~ cab ~ C br Ct~,¢-n$r 1~P~~ 01~~
0
z
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TQ~'~tN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIS"t
' BUILDING DEPARTMENT Do you have or need the following, before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 ~ 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 CC,, , ~ Survey Cam,?
SoutholdTown.NorthFork.net PERMIT NO. aJ7~<5 Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Permit
Examined ~ 3 , 20~ Single & Separate
Storm-Water Assessment Form
r / Contact:
Approved, 20 /.3 Mail to:
Disapproved a/c
Phone:
i
Expiration / , 20~
~ ' _ I Building Inspector
I I r,_"
i, r~ ` . ' U I APPLICATION FOR BUILDING PERMIT
u. Date / $ /3 , 20 ~3
~ INSTRUCTIONS
a.-TTiis 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 sU~eets or
areas, and waterways.
a 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 Penmit 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.
£ 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 Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, 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.
c1 ignature of applicant r name, if a corporation)
T/ Nd~r-c~c LAND _~tvEKNBKD
(Mailing address of applicant)
State whethe//r~~applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
C~~G'aE.egL CeuTyG~lcTO~,
Name of owner of premises ~C~//S /7/VD~Rr~z
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate o~ff}cer)
Builders License No. 3~9 22 - H
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
Gf/c' [72-~c'!~ p2i~~ Sc~v7th'~-~~
House Number Street Hamlet
4H._
Count Tax Ma No. 1000 Section ~ ' * ~ S
y p rj S "'Block Lot
;,'s.;
a_
Town of So?.athalt3 - Gh~p#er X36 - Stora~Ir~ater Managefneltt
~ SWPPP -Storm Water Pollution Prevention Plan Assessment Form
GENERAL INFORMATION: (All Requested Information is Required for a Complete Application)
APPU NT NAME: Onnw-Agant•ConsldgM-Conbaelor or Othw tCIrcM One) Propady l')WNEPo (C DIEered than Applkanq '
(~vv ~ neoxstt~
Address: / ~F«- l-A' td FkNEAD N. Address:
I
Tebphn,/(c DS~I_OSfF Faa ik~~I 5j( J 009kj TeImPMro A. Fax A:
I
E-Ma3 E. Mail:
I
Pmpadtr Address: 4!b DQ/b (.E DrQ. Sbt:TyOLL Brirrlkaaipfion ofCoashuction Acririty. Nopoxd SnucmralHMPa, Soil
S.GT.M.N: reap Stalulintioe BMP; Proje¢ Snipe and/or Scryenrc of Construction Activity I
orsa eHxe. aTa tae IAmue>drdwawwnrxmm;
I i
Name o[Cyy~~bador andlw Gntatl Perwn Re¢penaarb brlmpbmanblion d3WpPp: i I
~f/ (/owtYc LA lvtCNkAD -----~ju1?t~ -~t9tf--'i7-1;~------- i I',
Tobphwrs ik t-(` (S~O} Faz N. ~I
E-Maw •J 6 _
O
-------T-----------------------------------
Name o7 Persom Reaponalble for Inatallatbn 8 Mafntenan¢e of Erosbn coned Pracdrs: i
SRHF
Address: I
1 i
i
E-Mail: I .
Trial Area dAM _ _ I!
Trial Area of Lantl Charing
Pro(etl ParMb: anWOrGround Diswrbance:
rM)
Iss..aoc) is r _ _ _ _ _ _ _ _
Pmlect Duration' SLrt End
IAnWpateJ) Date: Dare:
tw.e.rdcd<ea.oml i_
WiN this Project Disturbs Live (5) or More Acres et ~
Arty One Tirrre During the RroposedDevelopmerA7 YOeS o i
r/YE3: Pleace Answer the FOllowlrlpl I -
a. Does the Appllcant have a Qualified Inspector On 0 0
Staff Te Conduct the Required Inspections ? Yes No II
b. Does the SWPPP Indicate How Frequently the Sita Q Q LAt the NAMES or desa'ryeon Drell Potentially Impa¢hd Wabrbodies andror wetlantl¢: ~ I
Inspections will Occur and for What Period of Time 7 Yes No !
c. Does the SWPPP Adequately Identify All Temporary Q I. ~
_ I
I
and or Permanent Soa SYabaifzatlon Measures ? Yes No I
. d. Dcesthe SWPPP Adequatey ldentifya Complete. ~ Q
Project Phasing Plan ? Yes No BUw¢ or rm seed wau I '
e. Dces the SWPPP Indicate Adddional Sile Spec'dic 0 P rbodyo leg. TMDI, rW(d) tilted, Impaired) ~ ~I~ I
i
PraUlces Nal Will be Utllized to Protect Water (lustily 7 Yes No
~ I
t. Has the Applicant Submldetl a Completed DEC Notlce Type al Impacted Walerbady-. (eg L he, Creek, Bey P nd, Sound, Freshwater Wetbnd_J
Of Intent and SWPPP Acceptance Fonn for Review ~ ~ CONNIE D. BUNCH I I
Dy the Town of Southdd 7 Yes No
- - _--N _ _
STA71~: OF NF.W YORK, o. Ot 6185050 I II i
COLTN170F SS Qusiified in Suffolk County
I
Commisslon F_xpires. April 14, 2~ I '
_ That I, being duly swum, deposes and says that he/she is the applicant for Permit, ~
And that he/she is the
[Name d maMa,al ¢NNns woar®rd) perComxd the said work and io I I
(Owner,f.2nbactw, Agent. CerparaEaOMUr,eee) -
Owner and/or ropresenmtive oCthe Owner or Owners, and is drily authorized to perform or have ~
make and file this application; that all statements contained in this applieation arc hue ro the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed herewith. ~ I
Sworn to before me this;
No~ty Public: ..._RC.L.Y..~.f4:L'..._..
~ ~ ~ ~ .
(sDnatwa d ApSvd) I
SWPPP Assessment FORM: 03-12 ~
e
~O~~Of SOpjho~
Town Hall Annex ~ # Telephone (631) 765-1802
54375 Main Road F - I
P.O. Box t 179 G ~ ~ roger.richert(a)towrisoU O nv US
Southold, NY 11971-0959 ~ + '
~'~~oualy
~i
BUILDING DEPARTMENT
TOWN OF SOUTHOI[.D
APPLICATION FOR ELECTRICAL INSPECTION 'I
REQUESTED BY: ~~i./r 5 AN D><;Rr 2 Date:
7 /
Company Name:
Name:
License No.: ~
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: f~fnrrs flr.rp~QER
*Address: 9!0 ~IQr~r_E ~Q
*Cross Street: ~is~ Coucr
*Phone No.: .L74 8,5-Z - a S-'f G
Permit No.: 3'7 9 9 ~
.S~- (o -i S S
Tax Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) L.1~2t 6AKR6 ~
i
(Please Circle All That Apply) ~
*Is job ready for inspection: ES NO Rough In / final
*Do you need a Temp Certificate: YES / NO ~
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
i
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for inspection Form
I
/ A
. •:F,~
~ r _ ~~c~_ ~ TOWN OF SOUTHOCD PROPERTY RECORD CARD
OWNER STREET C~ VILLAGE DIST. SUB. _ LOT ~
~'~V1iSM c~rL~f f~'~i~re.r'!, C~~~~Ic~ ~ _I +,~~,`i~~ ~ +-liu~~ :ar~~j ~~~„,u,,< I
J -
( _S IM1I'h`GtS.`'-ti ACR. ` REW~ARK r I
~~'"GI }U C.Y~lI'Y} ~ -r 72~ ~i- ~r.'-1~/~,`(/2-//r1P ~eyr_t i_l(~~i:yf ~~is
TYPE OF BLD.
~_I~aY~o< S ~~~,rr1 5/ ?,-i. ~~:-?Z~}-M ~~r1o~ U~_ Jh °~f'45Qs?~c
PROP. CLASS 7 / _ - - ~ _
`tl~'Cf~- ( li I kl.~\~i ~ ,t r' ~ G-~L.~ `Jr.3~ y• d~ F~~':-~ ii~/) .i',/f4ii"~~• /.i ~J'~ ~ ~-yl(7G
LAND IMP. TOTAL DATE ~~/3 9/ - ~ a / ~ - e AC^ . ; ~c< d ~ ~ r - ~ r.;';,
1 _ C~ j ~ , ~ z ~ Gi. 3 ~ _ ~ __U_®_~rc~eeQ,, //~,fl8-~~
r' ~ t . J~ ~ ~ f., ~ -L q (~~;y~ _ l A`) VV4 ~CI ~~Y1'1 '~'yS~P ~f L
Yom` 40 0 ~ Bock 3~~z~~~~ ~d 0(o'L I _!~77~,3_~l-__~?l~h rs-n fa~ ~',~r~,~9Ctr
~'c~'u %~"Loo ,S~GJc? Z z i L
R !'-o ~ 0 7. ~ ~ -
~
~ - s 3 ~ ~
FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
DEPTH MEADOWLAND
O?~Z
BULKHEAD HOUSE/LOT
TOTAL c~P ~ t
r
^~~;oF so~T,yol~.
Town HaLI Annex y Telephone (631) 765-I R02
54375 Main Road ~ Fax (631) 765-9502
P.O. Box 1179 G C
Southold, NY 1 1 97 1-095 9 ~ ~ ~0
~~~,~OIINiV
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
July 22, 2013
Denis & Janet Anderer
910 Oriole Dr
Southold, NY 11971
TO WHOM IT MAY CONCERN:
The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy:
Application for Certificate of Occupancy. (Enclosed)
t~J Electrical Underwriters Certificate. (contact your electrician)
A fee of $50.00.
Final Health Department Approval.
Plumbers Solder Certlf Cate. (Ali permits involving plumbing after 4N 184)
Trustees Certificate of Compliance. (town Trustees u ~s5-issz)
Final Planning Board Approval. (Planning # ass-rasa)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept
BUILDING PERMIT: 37995 -Garage Addition
~ h: ii [I~~~9f~ -
~ N` i:. SUFFOLK COUNTY DEPARTMENT D
°F~t'""~A~ar~ ~ MAY 21 2013
HOME IMPROVEMENT
CONTRACTOR
""'F BI~iG. D[PI.
ROY E TABORSKY TO ~ pi ~ ll'~ I1a0! D
+ .i....w~
This certifies that the rAeoR coRSTRUCraR co
barer is duy
licensed bY~ u~..wr m..w
County of Suffdk p04
34922-H
c~+r.~ I °""O1O"` 041012014
Southampton Town License Review Board
Home Improvement License
LICENSE NO. LODI406 E'XPBtES: }/132014
NAME: Roy Tehoraky
BUSINESS: 7alar Coo(s/Jt~rv~c~A~tio~oyQC~oy..
ANTRONY D'ITA`~L
A JR.
Chairmen License Rcview Hoard
3~ ~ .
~ ~
li
~ ~ ' STATE OF NEW YORK
MAY 2 1 2013 , U BtoRKERS• coMPENSwnoN BoAxD
I ~ CERTIFICA OF SURA?ICE COVERAGE TINDER THE AYS DISABII.ITY BENEFifS LAW
-
~ PART tkr To sa ' Try Ben is Carrier or Licen Insurance Agent o t at Carrier
i_-
la. Legal Norte and Address of Iusttred (Use street address onp') lb. Business Telephone Nttraber of Ltnred
ROY TABORSiCY (516) 852-0546
dba TABOR CONSTRUCTION lc. NYS UnnuployTnent Irunnurce Employer Registratiat
41 HOWELL LANE NttmbcrofLuured
RIVERHEAD, NY 11901
Id. Federal Etrtpbyer Idewificatim Nrmtlrer of Loured or
Social SecurirvNumber
123-34-4673
Name and Address of the Entity Rerpxstiug Proof of 3a. Nauae of Luttratue Carrier
Crn-erage (Entity Being Listed as the Cerrificate Holder) NEW YORK STATE INSURANCE FUND
Town Of Southold 3b. Policy Number of entity listed m box "la":
54375 Main Rd
PO Box 1179 DBL 6338 54 - 6
SOUthOld, NY 11971-1179 3c.Palicyeffectiveperiod:
05/15/2013 to 05/15/2014
4. rc}• covers:
a ®AIl of the rntpbyer's employees eligible carder the New York Disability Brnefits Law
b. Q Orrly tLe follmsting class or classes of the errgrloyer's etnpbyees:
Under peualrv of perjury. I certify that I aw an authorized represenlatite a licensed agent of the iostrrnnce carrier referenced abo~n
and that the ranted iuuaed has NYS Disability Benefits nrsttunce rnverage as described abort.
Date signed 05/16/2013 g}. ~O`"' Joseph J. Masi
ISiaret •ne of iravar~ a rri~YS aubriaetl regesertrti.~e of Mf5 lionrsed iraw rte Amara of tt" t irauranx o ~rler)
TelephoneNtwtber (866) 697-4332 Title D"recttor of Disability BeneBis Intsurance
LNPOAi,LVi: Ulsax -Ji is checked ud this fora ss sipad b1 the iasaacr cards asmwized repseseaWnx a NTS licensed Insaaace Apmt of dot
tattier. this cenifirm ss COMPLETE. >Lil N direeay b sae cetrifiralt 6olarz.
U box'ab- is c?ecMed his ceriLcate is NOT COMPLETE fa purposes of 5ettioa 220. Sstbd. S olthe Diabifiry BeatLts Iase. h ontst be ceded roc
tmspdetim b the N•osltns' [eayeesaiaa Bond DB Plans Accepraate Unt. 20 Pale Street. AAauy. Nest Yaak 1:201.
PA T 2. o comp y NYS W era' Corapensation Boa (O x" art 1 )
State Of New York
Workers' Cornpernation Board
Aceording to information meimamed by the NYS B'akers' Compensation llorud. We above-sMmed ewp{oyer has cootplitd with the Nl'S
Disabiliry~ BeueEts Law wtlh respect to ell of hiv1rer employees.
Date Sigrid By
ISipnmre of hYS waken' Cattprnsetioa aoar4 Etapbyroel
Telephone Ntwtber Title
Please Note: Only itwuatxr cartiers licensed ro wriu NYS disability benefits itLStuance policies and NYS licensed itestirraace agrnts of
tlwse insurance catTiers arc authorized to issrte Fonn DB-120.1. Insurance brokers are NOT authorized to issue this form.
DB-120.1 ts.ob> Certificate Number 207812
New York State Insurance Fund
Workers' Cornpen.;atirrn & Disafiiliry Benefrts Specialists S'tnce 1914
8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW VORK 11747-3129
Phona: (631)756-4300
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ROY TABORSKY D/B/A
TABOR CONSTRUCTION
41 HOWELL LANE
RIVERHEAD NY 11901
POLICYHOLDER ' CERTIFICATE HOLDER
ROY TABORSKY D/B/A TOWN OF SOUTHOLD
TABOR CONSTRUCTION 54375 MAIN RD - PO BOX 1179
41 HOWELL LANE SOUTHOLD NY 11971-1179
RIVERHEAD NY 11901
r POLICY NUMBER ~ CERTIFICATE NUMBER ~ PERIOD COVERED BY THIS CERTIFiGATE DATE
11448 377-0 1 521448 03/24/2013 TO 03/24/2014 4/19/2013
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 1448377-0 UNTIL 03/24/2014, 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.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 03/24/2014 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE,
30 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.
THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY.
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.
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NEW YORK STATE INSURANCE FUND
I) ~ 4/j
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
VALIDATION NUMBER: 14142858
U-26.3
LISA_ DRIVE SURVEY OF PROPERTY
~~6~~6
- SITUATE: SOUTHOLD
~ TOWN: SOUTHOLD
~N
SUFFOLK COUNTY, NEW YORK
(h (U
LOT NO. 3, HIGHPOINT MEADOWS, SECTION ONE
c~ FILED MARCH 79, 1990 MAP NO. 8910
t
NN t SCALE 1" = 20'
~J TAX MAP NO. 1000-55-6-15.5
x AREA = 22,065 S.F. OR 0.506 ACRE.
~ . MAP DATED: APRIL 16, 2013
33~ FIELD WORK COMPLETED: APRIL 11, 2013
19~ FE11N
LOT2 y7~
E ~ ~ ~
1
6 y "Unauthorized alteration or addition to a survey map
2Q~
Z N7 ~ 4' G~'F~ ~ O bearing a licensed land surveyor's seal is a violation of
~ ~C1 section 7209, subdivision 2, of the New Vork State
LL ~ ' ~ Education Law."
'i
2 ~4 ~ g8.4 ~ ~ "Copies of this survey map not bearing the land
G C ~ surveyorS red inked Seal and/or embossed Seal shall
0 ~ o ~ not be considered to be a valid true copy."
is C
W FE StuOCy to ~ X \ Q Q "Certifcdtions indicated hereon signify that this Survey
o qs Z 7 .(~Q, M ~ was preparetl in a<cortlance with the existing Code of
76'E ,~0\~' W Practice for Land Surveys adopted Dy the New Vork
F Jse Slate Association of Professional Lantl Surveyors. Saitl
~N r NO , ~ f ~ ~ certifications shall run only to the person for whom the
g' d .\°tl ~ C G survey is prepared, antl on his behalf to [he title
0 < ~ O company, governmental agency and lending institution
Cjr ~a° ~N~
p listed hereon, and are no[ transferable [o additional
J m tbg' V
`O institutions.
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O ° I desk ~ ~ - P°~e \ - O
O ~ WoodytePS fie' - ~g ~~b
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~ ` r nor' , NOTE:
a ~ 1. Lot numbers shown refer to map entitled "Highpoint
- ~ ~ ~~~Q_~`yy' r ~ ~~oms I Meadows, Section One" Filed in the office of the Clerk of
032 ~ ~ 4 C~L,~ 78' A6y3G LOT4 * Ui ~s~; 4 Suffolk County on March 19, 1990 as map No. 8910.
o r Z o3,E S Y I hereby ce y t at t w'a ~h de from an actual
survey comp y ~ 4/ Glenn Brewster Land Surveyor
5 ~ o ° 34 Howell Lane
o W Riverhead, N.Y. 11901
W U' ~-Denotes concrete monumem bond Glenn Louis Brews ~ .N.Y.$.- No. 50675
~ Phone 631.413.9626 Email Gbrewst@gmail.com
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NEW ADDITION ~i EXISTING NEW ADDITION EXISTING-~
Iz'-a" A KE,-naWEL A C~AR,4C~E ~ f-fOUSE EXTCC. DECK
Iz'-g"
NEW INTO EMC.
- ~ (TYPIGAU
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5 EYgO ry _ ~ - ~ I
E)YgO PROp~lY IYP. SHEARWALL SEGMEN .
~RIF~- s~~Rc )NE ExrG. PND. WAL15 (T1P )N~
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qck ~ 14i°W000HU
z (seEwrrcP. IFND.
ELOJ. 'r Tl'P. FND./ FTC. ~ EXISTING
4', wnYP.51WIYP. ANObR BOLT5
SCREEN PORCH
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UNEXGAVATED EXISTING GAR,4GE NEW GARAGE ~ I EXISTING GARAGE
I ' . I ~ I • USE 5/6' TYPE 'X' GWB, PER LODE
O ; 4' P.G. SLAB w/ 6"x 6'- ul0 WWM REINF. i
(SLAB ON GRADE) PITCH SLAB DN TO O.H. DOOR.
PITCH DN TO O.H. DOOR PER CODE, ON ry ~ PRA,/TOE NBJ s 3'4' oR1G.
N AND/OR GOMPA TEL D~FILAL"ns r~DED. La+,a=ED o~+NaLL n~IFr)
"'I BEARING RIDGE OPTIONS: O ALIGN I~1^I w/ EMC.
i, 2 - 13/4° x II I/4" LVL - - ~XTG. RIDGE
NOTE: (OW 2 II/I6" x II I/4' P5L 3-2x4 MIN.
~ VERIFY ALL EXACT BOLT LDLATIDNS, Bll. P05T (lYP)
OEFORE GAN51pIGTION. HOLD-DOhPb FOR
E 51 ANLHOR"E
5EL0lDARY. (SEETM
1YPILAL FTm. NOTES E DETAILS)
m To +
T1P. HOLD-DOl^UJ BOLTS
(SEE TYP. NOTES < DETAILS) ~
~ H' x 7' ht. O.H.DOOR =
' ~ Dk D' MIN PL_HNMLH IN SLAB ~ - EMe.OHDOOR OPNG.
- - - - - - - - - - - - 2-2x10 HDR FJCTG O.H DOOR
- - ' i
7-4~' 0' B° 2~v2 ~2'-6 _ g1-0- ~ 2-2o
'r T VERIFY RA. NI- dl`
VB21FY MA. A A EXTG. HOUSE WALLS (TYP)
FOUNDATION PLAN I~4°=1'-0" WG~ N FLOOR PLAN I~4°=I'-o"
TYPICAL FND. NOTES: NEW GARAGE ADDITION: 266 S.E.
FND./ FT6.:
H° THILK P.G. WALLS x 3 3' HT. (VERIFY) wfTYP. ANCHOR BOLTS, ON LONTINbUS 16°w. x 8°d. P.G. FOOTING; TO A MIN. DEPTH OF
36' BELOW GRADE - ON UNDISTURBED GLEAN GRANULAR SOIL w/ MIN. I TON PER S.F. BRG. CAPACITY. OPT. REBAR: 2-MS
BARS, HORIZONTAL - GONTIMXJUS AT TOP d BOTTOM OF WALL AND/OR IN FTC. w/ MIN. 3' DOVER TYPICAL NOTES
SILL/TYP. ANCHOR BOLTS: EXT. WALL:
2'x 4' P.TIPREY.~URE TREAlED151LL/50LE PLATE, (PRON. TYP. SILLh1ALL TIES, WHERE REO'D) OVER TERMITE 5HIELD AND SILL 2'k4" STUDS ®16'oL. w/ R-13 INSUL. (OPTIONAU SHEATHING: I/2' GDX PLYWOOD, EMBdD TO DOVER FULL TOP,
SEALER w/%'dla. ANCHOR BOLTS (1°MIN. EMBEDMENT AND 3"SQUARE WASHERS) ®36'oL. 6 28'oL. WITHIN H FT. OF GARNERS SOLE ! SILL PLATES. PROVIDE 15 IB. FELT or TYVEK WP. MEMBRANE (or equaU, VERIFY SIDING f FIN. TRIM (A5
' AND 12° MPJ(. FROM EACH BJD OF SILL PIELE. COORDINATE PLACEMENT whiOLD-DOVAI BOLTS, AB REQb. TO LONI~CT TO APPROVED BY OWNER).
SHEARWALL 5ND BRALKETS. (SEE DETAILS).
ROOFING:
SILL/WALL TIES: ARCHITECNRAL GRADE ROOF SHINE E5 (AS SELECTED BY OVAIER) OVER IS LB. FELT f I!2° GDX PLYWD.
REGtl11RED ONLY AT ROOF BEARING WALLS: PROVIDE 51MP50N 6520, (20 Gaye), I I/4' STEEL STRAP 1TE5 ®I6'oc (AT EA. SHEATHING. USE b NAILS PER SHINGLE F PROVIDE ICE SHIELD UNDERLAYM@1T AT FIRST 24" MIN. FROM ALL ROOF
STUD wAwIN T- ed NAILS, EA. END) WRAPPED UNDER E UP INSIDE FALE OF SILL, G1T TO LEN61H A5 REQ'D. (SEE DETAIL, DWG. U EDGES/BREAKS.
HEADER:
HOLD-DOWN BOLT: (2) 2'x 8' MIN. HEADER, UNLESS NOIID OTHERWISE N.N.O) ON PLANS. SPANS OF 6'-0" AND OVER; 5UFPORT W/ DBL.
SIMILAR TO 1YP. ANCHOR BOLT, EXCEPT SPACED AS REQ'D. TO ANCHOR SHEARWALL SEGMEN75. (SEE DETAllS). CONTRACTORS 5ND5, 9'-0" AND OVER; SUPPORT YU TRIPLE 51UD5. PROVIDE METAL 11E5 (51MPSON LSTA21, or EQJ FROM HDR ~ ~ Y
NA15T COORDINATE PLALEMBIT OF ALL BOLTS (BEFORE GONSTJ i0 IN°A1RE ALIGNMENT OF BOLTS 6 SND BRACKETS. OPTION: TO .LACK 5ND5 AT EXTERIOR WALLS AS RC9'D.
(INSTEAD OF HD2A§ 4 BOLTS): USE STRAP TIE HOEDOWN, SIMP50N 51HDI0 EMBEDED IN FND. WALL t EXTENDED UP OUTSIDE EXISTING WALL /PARTITION
FADE OF WALL A5 REQ'D. [SEE FLOOR PLAN FOR 5HEARWALL SEGMENTS]. FASCIA/ SOFFIT:
I"x (MATCH EMGJ FASCIA w/ SLREBVED, VENTED SOFFIT. VERIFY ALL MA'(fRIALS (INCWDING TRIF~ i0 MATCH - - - EXISTING WALL/PTN. REMOVED
SLAB: EXISTING, OR A5 SELECTED. INGWDE GU71ER5 6 LEADERS, ALL A5 APPROVED BY OWNER. ® NEW WALL /PARTITION
4' P.G. SLAB, ON UNDISNRBFD GLEAN GRANULAR SOIL AND/OR COMPACTED FILL AS NEEDED. USE EXPANSION AND CONTROL
JOINTS PER LODE, w/ b'x6"-1110 WI^UM REINF. < 6 MIL POLY VAPOR BARRIER UNDER SLAB. ROOF TIES: SHEARWALL SEGMENT
PROVIDE 51MPSON, L520 STRAPS, GUT TO LENGTH F/ MIN. H- 8d NAILS, EA. END, AT EACH RR/I6'oA. USED TO TIE
CONCRETE: ROOF RAFTERS TO WALL STUDS, BELOW. VERIFY PROPER ALIGNMENT OF 5ND5 /RAFTERS FOR CONNECTION OF - - CENTERLINE OF BEAM or HDR. ABV.
ALL C.ONLRETE TO BE STONE AGGRKATE, WITH A MINIMUM (2H DAY) STRBVGIH OF 3000 P51, EXCEPT U5E 3500 F51, FOR ALL TIES.
EXTERIOR USES; INCLUDING GARAGE SLAB, ETG S SMOKE S CARBON MONOXIDE DETECTORS,
AS PER CODE REQUIREMENTS,
VERIFY EXTG, ALL LOCATIONS.
EXISTING NEW ADD'N. NEW ADD'N. EXISTING ED A
GARAGE & HOUSE NEW GARAGE TO E [BEYOWD) E E~ARAGE TO GARAGE HOUSE ~4.7a\GS~ F• SE ph'TFOr
e - MATCH PRORL ? ? MATCH EXTG.
OF EXTG. GARAGE ~ DATE.
r 3s , 16 APR 2013
- ANEW ROOF SHINGLE , ACROSS NEW 6 EXTG. 4.30.13 REV.
- - =MaiGH ExrG oo~sELECrEO (mP) s ro 2t ~ ~y AS PER TOWN
~ NEW O - _
NEW SIDING T ~
PATCH TO MATCH EXTG d•=~ ~ DRAWN BY:
? AS NEEDED (TYPICAL/ ' MATCH EXT e ~ ~ I
VERIFY (iY NEw O.N DooR,
TQ MATE"EXTG ANDERER RESIDENCE DWG. NO.
I ~ ~ ~AR/4CE ADDITION
~ ~ ~ ~ GIO ORIOLE DRI~/E
REAR ELEVATION SIDE ELEVATION ELEVATION SCALE : I/8"=1'-0" FRONT ELEVATION TOWN OF SOUT]HOLD, NY of 2