HomeMy WebLinkAbout38771-Zy}jFiO[,�
Town of Southold
P.O. Box 1179
W
53095 Main Rd
Southold, New York 11971
631-765-1981
CERTIFICATE OF OCCUPANCY
2/13/2015
No: 37435 Date: 2/13/2015
THIS CERTIFIES that the building RESIDENTIAL ALTERATION
Location of Property:
SCTM #: 473889
195 Dogwood Ln, East Marion,
Sec/Block/Lot: 31.45-1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/28/2014 pursuant to which Building Permit No. 38771 dated 4/8/2014
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:
alterations and covered front porch addition to an existing single family dwelling as applied for.
The certificate is issued to Roensch, Melissa
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
38771
11/25/2014
PLUMBERS CERTIFICATION DATED 2/13/2015 Kevin Witt
�dlolizedsignaii`ure
vxz���-
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 #: 38771 Date: 4/8/2014
Permission is hereby granted to:
Roensch, Melissa
20 Park View Dr
Bronxville. NY 10708
To: Alterationt to an existing single family dwelling as applied for.
At premises located at:
195 Dogwood Ln, East Marion
SCTM # 473889
Sec/Block/Lot # 31.-15-1
Pursuant to application dated
To expire on 10/8/2015.
Fees:
3/28/2014
and approved by the Building Inspector.
SINGLE FAMILY DWELLING - ADDITION OR ALTERATION
CO - ALTERATION TO DWELLING
$275.60
$50.00
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 2/10 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.
B. 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
Date. 3 7 1 `%
New Construction: l Old or Pre-existing Building: / ,(check one)
Location of Property:: --
House No.
LL Street Hamlet
Owner or Owners of Properly: LS 1--7tC 114
sem
Suffolk County Tax Map No 1000, Section 3 t Block /S Lot O/
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone
Telephone (631) 765-1802
Fax (631) 765-9502
roger. richert(@-town.southoId.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Melissa Roensch
Address: 195 Dogwood Ln City: East Marion St: NY Zip: 11939
Building Permit#: 38771 Section: 31 Block: 15 Lot: 1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: DLT Electric License No: 4966-e
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service Only
Commerical Outdoor X 1st Floor X Pool
New Renovation X 2nd Floor Hot Tub
Addition Survey Attic Garage
Service 1 ph
Heat
gas
Duplec Recpt
31
Ceiling Fixtures
HID Fixtures
Service 3 ph
Hot Water
gas
GFCI Recpt
5
Wall Fixtures
8
Smoke Detectors
3
Main Panel
A/C Condenser
1
Single Recpt
Recessed Fixtures
4
CO Detectors
Sub Panel
A/C Blower
1
Range Recpt
gas
Fluorescent Fixture
Pumps
Transformer
Appliancesdw
Dryer Recpt
1-20
Emergency Fixture
Time Clocks
Disconnect
Switches
24
Twist Lock
Exit Fixtures fA
TVSS
Other Equipment:
2 -floor recpticles, 5ft lighting
track, 3 -exhaust fans, 3 -combination smoke/co detec
Notes:
Inspector Signature: Date: Nov 25 2014
81 -Cert Electrical Compliance Form.xls
CERTIFICATION
Date: r S
Building Permit No. 771
Owner: S-} c , ''�
(Please print)
Plumber:
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
Sworn to before me this
day of c�IP,br�ca 20 /S
XY 7L�
Notary Public, County
�.•' •-'� lam..:" ..,_�-
(Plumbers Signature)
MELISSA A. GIGUERE
NOTARY PUBLIC, STATE OF NEW YORK
[legislation No. OIG1620672I
Q060W in Suffolk County
Commission Expires May 26, 2t► _7
�o,\\pF SO(/jyo�
Cox
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION i ST [
] ROUGH PLUMBING
[ ] FOUNDATION 2ND [
] INSULATION
[ ] FRAMING /STRAPPING [
] FINAL
[ ] FIREPLACE & CHIMNEY [
] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [
] FIRE RESISTANT PENETRATION
[ELECTRICAL (ROUGH) [
] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [
] CAULKING
REMARKS:
DATE 5 � C INSPECTOR
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPEC ON
I FOUNDATION IST TROUGH PLUMBING
] �061NDATION 2ND INSULATION
,rFRAMING / STRAPPING FINAL
FIREPLACE& CHIMNEY FIRE SAFETY INSPECTION
RRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
CODE VIOLATION CAULKING
DATE -INSPECTOR
71,2 ----
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 7ST[ ] OUGH PLBG.
[ ]FOUNDATION 2ND [ INSULATION
[ ]FRAMING/STRAPPING [ ]FINAL
( ]FIREPLACE &CHIMNEY [ ]FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH)[ ]ELECTRIC AL)
REMARKS: �� l �/� I
DATE � � INSPECTOR /""`i
i
oF solzryo�
�-
TOWN OF SOUTNOLD BUILDING DEPT. N"SA.A
765-1802 �
M,,'-iSAF/« T 0 1 P 0
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AFOUNDATIONSPECTION
IST [
]ROUGH PLUMBING
[ ]FOUNDATION 2ND [
]INSULATION
[ ]FRAMING /STRAPPING [
]FINAL
[ ]FIREPLACE & CHIMNEY [
] FIRE SAFETY INSPECTION
[ ]FIRE RESISTANT CONSTRUCTION [
] FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [
]ELECTRICAL (FINAL)
[ ]CODE VIOLATION [
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REMARKS: ��1�tN
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
SPECTION
FFO, DATION I ST
UNDATION 2ND
FRAMING / STRAPPING
FIREPLACE & CHIMNEY
FIRE RESISTANT CONSTRUCTION
ELECTRICAL (ROUGH)
I CODE VIOLATIO14
REMARKS:
ROUGH PLUMBING
INSULATION
FINAL
FIRE SAFETY INSPECTION
FIRE RESISTANT PENETRATION
ELECTRICAL (FINAL)
CAU
JLXING
DATE AM 11 1 // I INSPECTOR
qso
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
FOUNDATION I ST
FOUNDATION 2ND
FRAMING/ STRAPPING
FIREPLACE & CHIMNEY
FIRE RESISTANT CONSTRUCTION
ELECTRICAL (ROUGH)
CODE VIOLATION
REMARKS:
ROUGH PLUMBING
INSULATION
]FINAL
] FIRE SAFETY INSPECTION
FIRE RESISTANT PENETRATION
ELECTRICAL (FINAL)
CAULKING
rwo'e, - 60<'
DATE - � '�?:
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TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown.NorthFork.net
Examined , 20__I_V
Approved , 20�
Disapproved a/c
Expiration O , 20_
BUILDING PERMIT APPLICATION CHECKLIST
PERMIT NO. �U T
MAR 28 2014
U.
F
7"T
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
Mail to:
Phone: 4 3l 4�,
0
APPLICATION FOR BUILDING PERMIT
Date .20
INSTRUCTIONS
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 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 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 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.
(Signature of applicant or name, if a corporation)
t!,� X ,
(Mailing address of applicaffil
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
�--� � / �,,.,L�-mac �✓
Name of owner of premises
illyle ls'rc �
(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. " q I --
Plumbers
—Plumbers License No. lye
Electricians License No.
Other Trade's License No.
Location of land o%jp��wJhich propos/`���j` work will be done:
/J c�/9--c Geon Q1 S�
House Number U Street
County Tax Map No. 1000 Section
Subdivision
Block /5
Filed Map No.
Hamlet
Lot Q /
Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
Nature of work (check which applicable): New Building Addition Alteration—.***
Repair Removal Demolition Other Work
4. Estimated Cost 11,0,014-1
Fee
(Description)
(To be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear.
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories,
Depth
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
Rear
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
14. Names of Owner of premises 45 Address /iS X,4 c. -o, .&LPhone No.
Name of Architect Address Phone No
Name of ContractorA/ `n, r.G It Address Phone No.
15 a. Is this property 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.
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.
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,
(S)He is the
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn before y e t
-
da of t l 1�.• �-� �
CONNIE D. BUNCH
"10taq Pubic, State of NOW
Notary Public No. 01 BU6185050 Sigifature of Applicant
Qualified In Suffolk County ,
Commission Expires April 14, 2L��
0
l'
Scott A. Russell ,��°S'r James A. Richter, R.A.
SUPERVISOR Michael M. Collins, P.E.
SOUTHOLD TOWN HALL - P. O. Box 1179] 53095 Main Road- SOUTHOLD, NEW YORK 11971
Telephone #: (631) - 765 -1560 Fax #: (631) - 765 - 9015
MICHAEL.COLLINS@TOWN.SOUTHOLD.NY.US�'t JAMIE.RICHTER@TOWN.SOUTHOLD.NY.US
Office of the Engineer
Town of Southold
STORMWATER MANAGEMENT CONTROL PLAN REVIEW COVER SHEET
( TO BE COMPLETED BY THE APPLICANT)
..... ........
PLEASE NOTE: All Contact & Project Information Requested by this FORM is Nessary for a Complete Application.
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
ADDRESS:
Telephone Number:
PROPERTY OWNER (If Different from Applicant) D
NAME:—.re
NAME: <�
ADDRESS:
Telephone Number:
Completed Applications can be picked up at the Engineering Department after being notified by the Department, or;
it can be Mailed to the Applicant with the submission of a Self Addressed 8.5" x I I" Envelope & Appropriate Postage.
DATE: SA7L/Z
Property Address / Location of Construction Work:
L.v
SCTM*: 1000 3/ 15
District Section Block Lot
Required Documents for Stormwater Review:
Copy of Complete Building Permit Application.
Stormwater Management Control Plan. (2 Sets)
Note: SMCP's are required whenever Grading or Excavations exceed 5,000 S.F, when New Impervious Surfaces are
created, and/or when existing Roof Systems, Driveways, Patios or other Impervious Surfaces are Re -Surfaced.
De Minimis Projects will NOT be Subject to the Submission of a SMCP During the Stormwater Review!
Note: These Projects would be Limited to Interior Renovations, Replacement of exterior Doors & Windows, Deck Construction
with Loose Fit Decking, Installation and/or Modification of Mechanical Systems or other similar Work.
A Complete Description of the Scope of Work Proposed under the Building Permit ApplicationLV.
A Completed StorT5qA Review Ch ckli t. If No or NA are Indicated, Justification is Required.
**** OR EN I EPARTMENT USE ONLY ****
Reviewed By: Date: J Z p
App- ved:
Addi Information Required:
� � ► � �t '� ''`iii � � � " �
SSU Ir
Q
2
CHAPTER 236
STORMWATER MANAGEMENT CONTROL PLAN CHECK LIST
DATE: +�D APPLICANT. (Property Owner, Design Professional, Agent, Contractor. Other)
a) -7 % pp
NAME: �— , Z� WwIt e"L
S C T M *: 1000 -31 Telephone Number: (o'� t' � � — 3G0
District Section Block Lot
S M C P - Plan Requirements: The applicant must provide a Complete Explanation and/or validation of all Information Required by this Checklist if it has not been provided!
1. A Site Plan drawn to scale Not Less that 60' to the inch MUST
show all of the following items:
YE NO
If You answered No or NA to any Item, Please Provide Justification Here!
NA Yer. If you need additional room for explanations, Please Provide additional Pa
P P
a. Location & Description of Property Boundaries
-.1% - t 4' 1 il
b. Total Site Acreage.
HI
c. Existing - Natural & Man Made Features within 500 L.F.
of the Site Boundary as required by § 236-17(C)(2).
d. Test Hole Data Indicating Soil Characteristics & Depth to Ground Water.
e. Limits of Clearing & Area of Proposed Land Disturbance.
t e- _e' i'A-
f. Existing & Proposed Contours Of the Site (Minimum 2' Intervals)
g. Location of all existing & proposed structures, toads,
driveways, sidewalks, drainage improvements & utilities.
h. Spot Grades & Finish Floor Elevations for all existing &
proposed structures.
1. Location of proposed Swimming Pool and discharge ring.
j. Location of proposed Soil Stockpile Area(s).
/ aN
k. Location of proposed Construction Entrance/Staging Area(s).
i. Location of proposed concrete washout area(s).
/ Iva 'W
M. Location of all proposed erosion & sediment control measures.
ore
2. Stormwater Management Control Pian must include Calculations showing
that the stormwater improvements are sized to capture, store, and infiltrate
on-site the run-off from all impervious surfaces generated by a two (21 inch
rainfall / storm event.
OOC. 1
3. Details & Sectional Drawings for stormwater practices are required for approval.
Items requiring details shall include but not be limited to:
a. Erosion & Sediment Controls.
b. Construction Entrance & Site Access.
c. Inlet Drainage Structures (e.g. catch basins, trench drains, etc.)
d. Leaching Structures (e.g. infiltration basins, swales, etc.)
e • • i6
27
hUKM S SWCN Check List - I US JAN 1(114
'pf soil
-
Town Hall Annex 41 .J� Telephone (6;
54375 Main Road
P.O. Box 1179 G O he S(
Southold, NY 11971-0959 �Q COQ
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name:
Name: 01)L '
License No.:
Address:
Phone No.: Zv �J
JOBSITE INFORMATION: (*In-d-ic�ates required information)
*Name:
*Address:� f �J' %� D 6 w 0 0 G� 1A CIS 7- D� �
*Cross Street:
*Phone No.:
Permit No.:
Tax -Map District: 1000 Section: j / . Block: /5 Lot: _
*BRIEF DESCRIPTION OF WORK (Please Print !early)
Xq
(Please Circle All That Apply)
Is job ready for inspection:
*Do- you need a Temp Certificate:
YES / O Rough In
YES
Final
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re -connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
.82=Request for Inspection Form
Town Han Annex
54375 Main Road
P.O. Box 1179
Southold, NSC 11971-0959
Telephone
BL.Du. DEPT.
TONIN 0'r souwo
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: yj' Q
Company Name: Z— lL
Name: '
License No.:
Address: (J �j< l/9
Phone No.:.
JOBSITE WFORMATION: (Indicates required information)
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.: 3 `7 Z
Tax -Map District: 1000 Section: 3 .
*BRIEF DESCRIPTION OF WORK (Please PTIn
(early)
9Y/sr) q sirI �1-e /
(Please Circle All That Apply)
Is job ready for inspection:
*Do -you need a Temp Certificate:
Block:
Lot:
In
YES / O Rough In�( Final
YES ! O
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re -connect Underground Number of Meters Change of Service Overhead]
Additional Information: PAYMENT DUE WITH APPLICATION
.82=Request for Inspection Form
5
Ur LIHdILI I T IIV0UMAN%.#C 1 02/26/2014 1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. 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 endomement(s).
PRODUCER Phone: (631) 298-4700 Fax: (631) 298-3850
CONTACT Roy H Reeve Agency, Inc.
ROY H REEVE AGENCY, INC.
PO BOX 54
13400 MAIN ROAD
PHONH 631 298-4700 AX �. (631) 298-3850
E Caul rhra@royreeve.com
INSURER(S) AFFORDING COVERAGE NAIC 0
MATTITUCK NY 11952
INSURER :Main Street America Assurance Company 29939
INSURED
MICELI CONTRACTING CO, INC.
INSURER B
47 HILL STREET EAST
INSURER
INSURER 0:
WADING RIVER NY 11792
INSURER E
INSURER F
t,VVCt(AUca \+CrCIIriVM I G llvwjww1 ". J..+va -------�- --- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,
CL SIO S NO SUCH P LICIES. LIMITS SHO MAY V BEEN REDUCED BY P I IMS
INSR
TYPE OF INSURANCE
lA L
SUER
POLICY NUMBER
�Y �
�Y EW
01/27/15
LIMITS
A
GENERAL L"'I IY
MPUB463F
01/27/14
EACH OCCURRENCE $ 1,000,000
DAtAAGE7D11Er B $ 500,000
PREIAISES (Fi aaourowe>
X COMMERCIAL GENERAL LIABILITY
MED. EXP (Arty one person) $ 10,000
CLAIMS MADE IJ OCCUR
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG $ 2,000,000
$
PRO-
POLICY cT LOC
COMBINED SINGLE tJM(r
AUTOMOBILE LIABam
lEa aooldeM $
BODILY INJURY (Per person) $
ANY AUTO
BODILY INJURY (Per axi lent) $
CHEDULED
ALL OWNEDUONOS
AUTOS
ED
PROPERTYDArrA $
HIREDAUTOSO
S
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE $
HCLAIMS-MADE
AGGREGATE $
EXCESS LIAs
DED RETENTION $
$
vuc srATu- o n+
WORKERS COMPENSATION
TORY Latrs ER
E.L. EACH ACCIDENT $
AND EMPLOYERV LIABILITY YIN
ANY MtovaETORIPARTNERIExEcunVE n
EL.DISEASE-EA EMPLOYEE $
OFFICERIMEMBER EXCLUDED? IF1
NIA
(Marmiam in Kdescribeunder
E.L DISEASE -POLICY LIMIT $
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space h required)
nrnRn 9. I2n4nmio--
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Southold
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
PO BOX 1179
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Southold, NY 11971
Attention:
Thomas A. Dickerson
nrnRn 9. I2n4nmio--
CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDD
2/26/201414
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. 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 endorsemen s .
PRODUCER
Automatic Data Processing Insurance Agency, Inc
1 ADP Boulevard
Roseland, NJ 07068
CONTACT
NAME:
PH NE FAX
arc No
E IL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIL #
INSURER A:NorGuard Insurance Company 31470
INSURED miceli contracing Co,.lnc.
Patrick Miceli
47 Hill St East
Wading River, NY 11792-
INSURER 0:
INSURER C :
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ITR
TYPE OF INSURANCE
POLICY NUMBER
L
MM D Y EXP
LIMITS
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE D OCCUR
EACH OCCURRENCE S
PREMISES Me occurrence)S
MED EXP (Any one person) S
PERSONAL & ADV INJURY S
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
JE
PRODUCTS - COMP/OP AGG $
S
AUTOMOBILE LIABI ITYBI
ANY AUTO
ALL OWNEDSCHEDULED
AUTOS AUTOS
ND
HIRED AUTOS AUTOSUTOS
SINGLE LIMIT
Ea accident
BODILY INJURY (Per parson) $
BODILY INJURY (Per accident) $
Per acciident) $
i
UMBRELLA LIAROCCUR
EXCESS LIAR
HCLAIMS-MADE
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION $
$
A
WORKERS COMPENSATIONX
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNEWEXECUTIVE Y❑
OFFICER/MEMBER EXCLUDED? N
(Mandatory M NH)
I yes describe under
DE3�RIPTION OF OPERATIONS below
N/A
MIWCi463662
8/1/2013
6/1/2014
WT RYA OTH-
ER
E.L. EACH ACCIDENT $ 100,
E.L. DISEASE - EA EMPLOYEE S 100,
E.L. DISEASE - POLICY LIMIT $ 500,
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Ronarks Schedule, I more apace Is required)
Town of Southold
p.o. Box 1179
Southold, NY 11971 -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Cd111CIM9llin Ar_nRn P-nRPARATInN All rinhtA rarprvPA
/
0 S
i
/ CESSPOOL 0
OSEPTIC TANK
NOVS� � 8
41° do ( 0 �0
30
SURVEY OF
LOT 79 AND P/0 78
MAP OF
GARDINERS BAY ESTATES
SECTION TWO
FILE No. 275 FILED SEPTEMBER 23, 1927
SITUATE
EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-31-15-01
SCALE 1 "=20'
FEBRUARY 28, 2014
MARCH 28, 2014 ADD PROP. DRAINAGE
AREA = 11,474 sq. ft.
(TO TIE LINES) 0.263 ac.
DRAINAGE SYSTEM CALCULATIONS:
ROOF AREA: 1,500 sq. ft.
1,500 sq. ft. X 0.17 = 255 cu. ft.
255 cu. ft. / 22.2 = 12 vertical ft. of 8' dia. leaching pool required
PROVIDE (2) 6' dia. X 6' high STORM DRAIN POOLS
UNAUTHORIZED ALTERATION OR ADDITION
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW.
COPIES OF THIS SURVEY MAP NOT BEARING
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
CERTIFICATIONS INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
THE EXISTENCE OF RIGHTS OF WAY
AND/OR EASEMENTS OF RECORD, IF
ANY, NOT SHOWN ARE NOT GUARANTEED.
PREPARED IN ACCORDANCE WITH THE MINIMUM
STANDARDS FOR TITLE SURVEYS AS ESTABLISHED
BY THE L.I.A.L.S. AND APPROVED AND ADOPTED
FOR SUCH US ,BY TRE -NEW -YORK STATE LAND
TITLE ASSOOVfT- �!
N.Y.S
a --
APPROVED :: 11°TED
-
DATE: 8` B.J. #
DES OF
Nom' "
ON LEAD CONTENT BEFORE
' , , = TOWN CODES
r7T,_�� Q tAS
FEE.
f i
-
NOT i Y BUILD! ,ITAT
765-1802 8 Ari TO u ';:! F�C:.R THE
FOLLO 11INCa .r�L� t I �J:
' ^� • ;..4 ++ i.. -ARD
1. F0UNDAT1(01`4 i ;':'0 FF0UIRII: C
OF THE TOWN CODE.
FOR r'OURD �,�I� ESE
�- —_� .�.. _ ��;�� "S
2. ROUGH - RHAMII"!G & ;'LUMZING
3. INSULATION
4. FINAL 0 1 7 -7, J r DN MUST
>
BE COMPLET, 0.
�.4 . CUI ANCY OR
ALL CONSTRUGTk_-N SI -:ALL MEET THE
JSE IS UNLAWFUL
REQUIREMENTS OF . HE CODES OF NEW
YORK STATE. NOT RLSF^NSIBLE FOR
WITHOUT CERTIFICATE
DESIGN OR CONSTRUCTION ERRORS.
OF OCCUPANCY
PLUMBING
PLUMBER CERTIFICATION
ALL PLUMBING WASTE
ON LEAD CONTENT BEFORE
& WATER LIMES NEED
TESTING BEFORE COVERING
CER TIFICA TE OF OCCUPA NC Y
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
RETAIN STORM WATER RUNOFF
EXCEED 2110 OF No LEAL).
PURSUANT TO CHAPTER 236
OF THE TOWN CODE.
3'0 ROOF VENT
1114
11/1 11r1 11/4 3 11/1 11/2 11N 11"
LAV SINK
W.C. W.C. 13'
R W.M. R D.W. FA1.
OR TN OR TN
11/1 3 2 p 3 J11" 2
C.O.
C.O. 12
3
1
0J TOAPROVED
SLOPE' 1/4" PER FOOT PITCH TO DRAIN TRADE SEPTIC SYSTEM
PLUMBING SCHEMATIC
N.T.S.
Generated by REScheck-Web Software
Lvi Compliance Certificate
Project
Energy Code: nolo New York Energy Conservation
Locaoen: Suffolk County New York
Consen—on Type: Single-famft
Project Type-Akeration
Ch—to Zane: 4 (5750 NDD)
Permit Datc
Pas it Number:
Construction S.roe: OWnedAgent: Designer/Contractor.
ROENSCH
195 DOGWOOD LANE
EAST MARION. New York
C—t,iInoe: 3-M 9ener Th—Cade MaalnWn UJ 322 Yaw U4: 325
TLr f d11r ww.w rtlw c.4. avn neRm Iwo M r a..t.10 rts t..,r i tr.a a r.v. Mall n1a.
e aaee xal.m� rn renrr.l rwo ur s wawYlir r • n:,inna"ari1 tiwr.
Envelope Assemblies
Floor. A0 -Wood Joistlrruss Over Incond Spero 1.163 30.0 0.0 0.033 38
Floor: Needed 56b-0,0,.de 54 21.0 0.992 54
Insulm000 depth: 0.3'
Ceiling: cothedrel 938 42.0 0.0 0.025 23
Ceikng: Flet or 5dssor Trove 529 21.0 0V 0.047 25
Well: Wood Frame, 16in_ o.c. 1.550 13.0 0.0 0.082 108
wmdow: Wand Frsale, 2 Pene wi Law -E 170 0.300 51
Door: bless 42 0.320 13
Dew: Solid prapm�d 21 0.290 6
c ola�dstil dna submined weth de used s�cxion. iir vibed he.e is —saWnt rmfl dw 6lildirg Plena. sPecificetions, and other
P PPl Proposal building hiss 6ev1 designed to meet the 2010 New York fnngy
Conservation Conatruction Code requirements in REScheck Version 5.5 .0 and to comply with the mandatary mquintt—ts listed in
the REScheck Inspection Checkks�
nature D—
Project Title- Report date: 03/04/14
Data filename: Page 1 of 7
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24'a4+y 9'-0'.4'-0' W. PIT Hr
20--0"
COVERED PORCH
REPLACE EX DECKING (5HX4)
&JOISTS (2X6 ACC, e16.OQ
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SCALE: 1/811 = 1111
UTILITY
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FRAMED IN DOOR OPENING
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SCALE: 1/4" = 11-0"
SHEET NO: