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HomeMy WebLinkAbout40613-Z ON Town of Southold 11/15/2016 P.O.Box 1179 53095 Main Rd 4A" Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38656 Date: 11/15/2016 THIS CERTIFIES that the building ALTERATION Location,of Property: 375 Lighthouse Ln., Southold SCTM#: 473889 Sec/Block/Lot: 70.-6-29.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/6/2016 pursuant to which Building Permit No. 40613 dated 4/13/2016 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: ADDITION AND ALTERATIONS TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR The certificate is issued to Pollert,Frederick of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40613 11-03-2016 PLUMBERS CERTIFICATION DATED 11-11-2016 Byron Withjack 4 �Ih� ed Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o 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#: 40613 Date: 4/13/2016 Permission is hereby granted to: Pollert, Frederick PO BOX 578 Southold, NY 11971 To: construct additions and alterations to an existing single family dwelling as applied for. At premises located at: 375 Lighthouse Ln., Southold SCTM # 473889 Sec/Block/Lot# 70.-6-29.2 Pursuant to application dated 4/6/2016 and approved by the Building Inspector. To expire on 10/13/2017. Fees: SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $520.00 CO -ADDITION TO DWELLING $50.00 Total: $570.00 Building Inspector Fol m No.6 `ro\NN 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- $100.00 3. Copy ofCertiflcafe"of Ocdupaiidy--$.z5 - 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15./ .,/� 0�0. / Date. / ` o ( / 6 New Construction: Old or Pre-existing Building: (check one) Location of Property: '3`7� oL"l�"r¢ j��f Cy2fir�t P k� P Y= House No. Street Hamlet Owner or Owners of Property: � °7 �G%� /7) `�j Suffolk County Tax Map No 1000, Section -70 Block Lot 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 SOUIyo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ UGH PLEIG. [ ] F UNDATION 2ND [ ] INSULATION [ FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE002r/.24A/ 2 INSPECTOR 1 � oF sooTyolo TOWN OF SOUTHOLD BUILDING-DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: a - -7i DATE' G INSPECTOR SO(/lyolo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: DATE l� �� INSPECTOR:l SOUTyplo �o �pTy�OUM'1��Q TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [XROUH PLEIG. FOUNDATION 2ND [ ATION FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARK lagid . DATE 111101 INSPECTOR r Vh ��OF SOUIyO / TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] R UGH PLEIG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: �, 110A �e' \(,&-I T n ov-xz 0 K -�e 0- df 0 lt*d s*k o44,•(A�r� DATE INSPECTOR GREAT DESIGNS, INC. ONE DUNE COURT SETAUKET NEW YORK 11733 TEL: 631-751-1910 September 21, 2016 Town of Southold Building Department RE: Alterations to Residence for Fred & Betsy Pollert Project No. 21518 Permit No. 40613 This is to certify that the insulation was installed per code. This is to also certify that the framing in the new bath has been modified to meet the required minimum ceiling height of 6' - 8". Finally, this is to certify that the insulation around the new windows and the firecode caulking have been installed to code. Very truly yo s, Mark Mi aels, RA. D CC�CfldC D0 SEP �P 2 s 2016 BUH DING DEFT. ¢ V TOWN OF SOUMOLD 0. 1 aa�° D i 'Y e �rl /� �I Wit STATE ENE.Rv • d✓. s_ r MOO DWI= MOM i _ n r TOWN OF SOUTHOLD BUILDING PERMIT-APPLICATION CHECKLIST 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 Survey SoutholdTown.NorthFork.net PERMIT'NO. ®� Check Septic Form N.Y.&D.E.C. Trustees C.O.Application Flood,Permit Examined ,20 D �j DD Single& Separate Storm-Water Assessment Form APR .. 6 2416 -Contact: Approved ,20 Mail to:'� Disapproved a/c 7ector TOWN F 'OPhone:. -,77' —7_id 2- Expiration o ,20 uildi >., APPLICATION FOR BUILDING PERMIT Date ��/�' , 20/f,� INSTRUCTIONS a. This applicationMUST 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 MADEJo 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 inspect' ns. (Signature of applicant or name, if a corporation) (Maiing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,`plumber or builder 0 611 A r&/ Name of owner of premises Fie&57- ->�/< R' ' ®� e-�� (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. 1. Location of land on which proposed work will$be'doiid.'-�`F'�'"�'1' 3 °75- 416 - evt;��' : House Number Street �; u� ' ' 1,11 Q : Hamlet County Tax Map No. 1000 Section �'� Block (P Lot �. �- Subdivision Filed Map No. Lot r 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 j? 5 r _V C 3. Nature of work(check which applicable):New Building Addition Alteration ;✓ Repair Removal Demolition Other Work " (Description) 4. Estimated Cost ` R ATo be paid on filing this application) If dwelling, number of dwelling units um ofdwe i- ' its on each floor *49WQ� If garage, number of cars a �; 6.. If business, commercial or,mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing stiuctures, if any: Fro l Tit s ;t :/ �3� R ar rl�`7 I Depth > 39 � Height Number of Stories Dimensions of same structure with alterations or additions:_ Front 5r0-f-4 C-7 Rear Depth Height .Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front-5� Rear Depth 10. Date of Purchase Name of Former Owner ,�z 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 Will excess fill be removed from premises? YES NO 14. Names of Owner of premises t 1110& iZr ,, Address?42•tye'>< 4-71? Phone No. �- Name of Architect/l'/wy H"-e,�waz_.g Address Phone No Name of Contractor 79 D 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 BEREQUIRED. 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) S: COUNTY OFA FIS&)-cr jc_ T61 If r+ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the Ca�� (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to,perforin 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 to before me this / TRACEY L. DWYER day of 20 A0 NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK Notary Public COUNTY, COMMISSION ig at re of Applicant pF SO(/jy®lo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 aQ roger.riche rt(cD-town.so utho Id.ny.us Southold,NY 11971-0959 O couffm BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Pollert Address: 375 Lighthouse Lane City: Southold St: New York Zip: 11791 Building Permit#: 40613 Section: 70 Block: 6 Lot- 29.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Rons East End,Electric License No: 4860-ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Only Commerical Outdoor 1st Floor Pool New Renovation X 2nd Floor X Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 33 Ceiling Fixtures 6 HID Fixtures Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures Smoke Detectors 4 Main Panel 1 OOA A/C Condenser Single Recpt 2 Recessed Fixtures 20 CO Detectors 1 Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt 2-30 Emergency Fixtures Time Clocks Disconnect Switches F24 Twist Lock Exit Fixtures TVSS Other Equipment: 2- Exhaust Fans, 7- ARC Fault Circuit Breakers Notes: Inspector Signature: Date: November 3, 2016 0-81-Cert Electrical Compliance Form.xls pF SD�pHQI � Town Hall Annex Telephone(631)765-1802 t 54375 Main Road Pax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 Q i BUILDING DEPARTMENT i TOWN OF SOUTHOLD NOV 1 4 2016 BUUMING DEPS = TOWN OF SOUTHOLD CERTIFICATION Date: Building Permit No. Owner: rr e o "- I cll (Please print) Plumber: yit��✓✓ Gf/- -Y/s✓�/��U_. _ - (Please print) I certify that the solder used in the water supply system contains less than 2/10 of I% lead. (Plumbers Signature) Sworn to before me this day of �cUcs� , 20 I k.,, CLINT S HURST Notary Public-State of New York No. 01 HU6156752 Qualified in Suffolk County My Commission Expires Dec 4,2016 Notary Public,_ Sc5 ",AV— ,County, i O��pf SO�jyo Town Hall Annex h 6 54375 Main RoadG _ P.O.Box 1179 ro er.rlChe , Southold,NY 11971-0959 �vurm,� SEP e 6 2016 BUILDING DEPARTMENT BUILDING DEPT. i TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION TOWNOFSOUTSOLD REQUESTED BY: Date: f Company Name: d A- a-,5 T &T*,AT� r=fir Name: License No.: 6D MG Address: 236 l QLtSo ,0 ez- ?'Lp� Phone No.: 63 I- -I -k4- 66(?01 JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: Z'I S LN *Cross Street: *Phone No.: ' Permit No.: --4-e- 14 0613 f Tax Map District: 1000 Section:---o - Block: E, Lot: 2F� . i *BRIEF DESCRIPTION OF WORK(Please Print Clearly) i (Please Circle All That Apply) *Is fob ready for inspection: YE NO Rough In Final *Do you need a Temp Certificate: YES/fin Temp Information(it 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 f �ac�UFFO�k Town Hall Annex Telephone(631-1802 54375 Main Road � P. O. Box 1179 Fax(631)734-9502 Southold, NY 11971-0959 � BUILDING DEPARTMENT NOTICE OF UTILIZATION OF TRUSS TYPE CONSTRUCTION, PRE-ENGINEERED WOOD CONSTRUCTION AND/OR TIMBER CONSTRUCTION Date: "� — &-7 Owner: Location of Property: Please take notice that the (check applicable line): New residential structure Addition to existing residential structure Rehabilitation to an existing residential structure -. to be constructed or performed at the subject property reference above will utilize FJO (check applicable line): Truss type construction (TT) Pre-engineered wood construction,(PW) Timber construction (TC) in the following location(s) (check applicable line)- A/0 Floor framing, including girders and beams (F) Roof framing (R) Floor and roof framing ' ) Signature: Name er on submitting this form): Capacity(check applicable line): Owner Owner representative TrussResReg15.docx Effective 1/1/2015 BMW 6" DIAMETER REFLECTIVE RED ROMAN ALPHANUMERIC PANT ONE-_- - -- - - - -- - - - -DESIGN-ATION OF-CONSTRUCTION - (PMS) #187 TYPE BASED ON SECTION 602 OF THE BUILDING CODE OF NEW YORK STATE DEEM 2" MIN. REFLECTIVE WHITE 4 112" STROKE --- --- ------- -DESIGNA-rtan-FORSMUCTURk COMPONENTS THAT ARE'OF TRUSS CONSTRUCTION "F" FLOOR FRAMING, INCLUDING GIRDERS AND BEAMS "R" ROOF FRAMING "FR" FLOOR AND ROOF FRAMING TRUSS IDENflFICATION SIGN COMPLIANCE 1NITH 19 W.CRR PART 1265,A rurToSCA.E cnoEs DIVISION DCA\/R-E TRUSS IDEN11R ATION SIGN DATE:03(0&/2005 NEVA YORK STATE DEPARTMENT OF STATE {,. k:DIVIS DIVISION OF CODE ENFORCEDENT AND ADMINISTRATION /t> >o �a - TOWN OF SOUTHOLD PROPERTX, -RECORD CARD OWNER STREET { VILLAGE DIST. SUB. LOT q- Ii'ir:1 w }u` ,"_= l✓I'1,�� PSe FORMER_ OWNER V-- ON Po 164r1- N E ACR n4e, f6 (t e-.r4- -o ups f -V1,p—G,C[y1�Q, -C, �PC) ((ev'-"I— S W TYPE OF BUILDING s '�/!a/:1�') 1 i/f�G l'`� 'f-4r ^��'���{C��C'7' l� �!���lvY --...—. ------- •- -- _-- •---- •- � --` - ... - RES-7 SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LANDIMP.IMP. TOTAL DATE REMARKS .i f L- q/%,,,6 Pl Sd A T- �uOc� ' �Uuc� ��) /o a as j J�Q�7=✓ y / ` ` r;'e,rr'�iov /� �Ne�e� cl o /,� �=-• 41- ar /-a Sr" - ' '� Sa -5l l9/—� l d?7.5. /� 1 (� �G l�r'� Ivy l` t-` I'J/ -- +.Jnr ,/ er' ,`0 oll Pr� GGSG y�,1 tA -71 1._., -I 60 (Per �3', bib" Tillable FRONTAGE ON WATER �9 @ "�� ,� Woodland FRONTAGE ON ROAD3�y Meadowland DEPTH House Plot BULKHEAD Total ■ ■■ f[l'�Q ■ ■ MEN■EN ■■NONE M III NONE161MI MIN JIMEMM t Y .. . ri NOON■■EM■■ [MEE! :NOON ■ME■■■ � NOON■©■■■■■N ■©��■� � ■■�■■■■ME■■■ ■■■■my,. 3■■■� .�1MEIN UNI■■■■■■■■■ ■■ OMEN ■■■ x ■■■■ME ONE ME 1M II■■■■■ ��®■■■ ■■ ■ �E■ NOON■■ MINES MR,M- .No'ommmmm MIM■■IMM■■MMMMMEN ■ Ore I ® r ■ E■■MM MEN■■■■ ■■E ■■■M■■■■ ■ ■■■■■■■■■■■� ■■■■ ■ ■■ MEN ON ONE ■ MEMOBasement ■ Foundation f T-1 VV444V& _ . . _ .. • ••- j .- Roof Rooms Ist FloorC• rke��-a-tionRoom ',Rooms 2nd Floor s1 d J GREAT DESIGNS, INC. ONE DUNE COURT SETAUKET NEW YORK 11733 TEL: 631-751-1910 D [9(9:RTV[g d March 19, 2016 APR - 6 2416 BUILDING DEPT. Town of Southold TOWN OF SOUTHOLD Building Department RE: Alterations to Residence for Fred & Betsy Pollert Project No. 21518 This is to certify that the existing sanitary system is adequate for the four bedroom design shown on the current drawings. Very ly yours, / a Mdrk Mic aels, RA. AR r Client#:7750869 NOWALL5 ACORD. CERTIFICATE OF LIABILITY INSURANCE D71011201166 /D 7/01/ 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 endorsement(s). PRODUCER CONTACT NAME: CBS Coverage AIC,PHONNo Et):E 516 938-9000 FAIC No): 5169387511 a division of Assured SKCG Inc E-MAIL 111 Express Street ADDRESS: Plainview, NY 11803 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Essex Insurance Company 39020 INSURED INSURER B: Nowak Allied Contractors Inc 281 Tyler Avenue INSURER C: Miller Place, NY 11764 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD MMIDD A X COMMERCIAL GENERAL LIABILITY 3EB5907 08/31/2015 08/3112016 EACH OCCURRENCE $1,000,000 CLAIMS-MADE a OCCUR PREMISES Ea o.currence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY F_]ECT LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall PO Box 1179 AUTHORIZED REPRESENTATIVE Southhold, NY 11971 1)19il&2014 A ORD ORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S346391/M322055 BRS New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 Phone:(631)7564300 -CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0 ❑■ AAAAAA 112712314 NOWAK ALLIED CONTRACTORS INC 281 TYLER AVE MILLER PLACE NY 11764 ❑ Scan to Validate POLICYHOLDER CERTIFICATE HOLDER NOWAK ALLIED CONTRACTORS INC TOWN OF SOUTHOLD 281 TYLER AVE BUILDING DEPARTMENT MILLER PLACE NY 11764 TOWN HALL SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 11207609-7 520995 06/29/2016 TO 06/29/2017 7/5/2016 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1207 609-7 UNTIL 06/29/2017, 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 06/29/2017 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. RICHARD J NOWAK PRESIDENT AND BARBARA A NOWAK SECRETARY OF NOWAK ALLIED CONTRACTORS INC (A TWO PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND d DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/certtcertval.asp or by calling (888)875-5790 VALIDATION NUMBER:296844975 U-26.3 r M Nowak Allied Contractors, Inc. Suffolk County Consumer Affairs License ##34514-H Ron's East End Electric Suffolk County Consumer Affairs Electrical License #4860M E Byron Plumbing & Heating Suffolk County Consumer Affairs Plumbing License #1567 - MP 5UR VEY OF PROPERTY o 51 TUArTE: SOUTHOLD N TOWN: SOUTHOLD 0 SUFFOLK COUNTY, NY / SURVEYED 05-11-20115 ,pG�P�`� o� ' W +-lel-l-1 E REVISED 04-05-2016 SUFFOLK COUNTY TAX # 1000 - 10 - 6 - 2ci.2 CERTIFIED TO: FREDERICK POLLERT 51°� ' x � www \ow 0 �1 00 s o N QpT�O � P°OL t—— 1 LL X61 x ow o 3 0V� 2 DAY �pME s STPN� Q O�41 6 2 StoRYa r, Qvool� a � 6z CA ol -- - 0 9 s 2y� pYl �� • g 1 W N ) 0 oW asphalt driveway 1 ' I ' � R � An Q .W 141.156 O ! i S 1 — I cl i�5phat;�o I �°rmerly oP: I hand °o Q VA06L " 1 1 r oNOTES: 0 p °s MONUMENT FOUND 0 1 AREA = 3q,064 50 FT OR O.qO ACRES 1 WETLAND IDENTIFER BAGHARUS BUSH 1 ELEVATIONS REF. NAVD '88 DATUM I WETLAND FLAGS SET BY SURVEYOR ON DATE OF SURVEY .11-1bn-addition tc o survey f Ik tr 0q,,b-d[ars eeal a Nolalbn o1 sectbn'1209,sJo-dlvisbn 2,1ot iM W✓ York'..tola Edxallon I®� 'Only<oples Iran lro orWb�al of thls survey ked Wth an ari94vl of fhe lod eurvey�r9 C4D5lairyed seal Wall be=lered 10 be valid kue copl-, -RO� ,, ( f * 'Lerttlkalbm IMkated heroon slgnlly!tit!Ihls i_ '+�?� a f ey wm prepared In accoreaee rRh tM ex- r _ Isllrg Godo or Pra<tk:e far Lurid Srreys odopled b'y the tbro York Stale Asw<latbn of Professional P/c La d SUrveyO 5 5ald<erllfkat ons shall fu only �rlM.l N V i n O� the person &—the s rvey Is p epa od, i�� _ and a,ws Behan to Iln ntle<anway.9a�' n,nee- K u1 2 tai o3eKy ad lend)Kj I Stllutfon UtO hater and ' 5� 5020 J t0 the ossly eee OI the lending hddlt bit e tlun<a- t10r6?e rot lrareFefoble to addllbnal hstltutlore JOHN C. EHLEISAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC SCALE 1"= 40' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REP.C:\UsersVohn\Dropbox\16\16-133 Reld.pro �Fir2pN 3.1�.aClH GVbse Vb-f3iJbIE (A> F-(04) E(CM4) FF - 61 Tv r I.T,-Jl:r-j 'Ix- o FOP ' zo 0: 4. HNAL U 1' (,'ONIP -C)H CC't. EX15TO KNEEV�ALL0"H EX15T6,KNEE WALL 45"H VENT TO EXT, 'Oi\;`�TRi 3!t, P-11 ALL G JOI'l."N' '3! X x FURR OUT AROUND CHIMNEY P� cr) n--- YoIfl� 'FATE NO-1 RESPON"IBtrz "l 'N 61111 H -0 (11 BEDROOM NO.2 04 - BEDROOM NQA 41 ate S ill C -MIHIJ(�'IION ERROW�' 7 % j/�% I OAK OAK 30 OAK y/q.1. 605 <1 1/211 111-1 15/16" ----------------- 141-111 FURR OUT ARO)ND CHIMNEY r-F ak LAUNDRY x OAK N GFJl VINYL ICE I 2'-III LJ I F� j-1, 1, fill 't A S Q F NK5&6A5 0�3 u') R It' L A 2065 EXHAUST FAN16T VENT THRU ROOP-- ----->l ol 20 a 11 EX.SKYL" d�l -'o�T11r L 1z L c) BATH / 11, 1 1 p s"m 6 F-—RT [u) 2-2"X4"MUL5 C) 2868-6L ENCLOSE Ex\vU6TmRK/ — — R -!�— — — — — — — — 2i Z74 51TTING 22"X VEN cy 0 Irl t 1021 HALL R OAK ALIGN OAK A [!7� ,UR 54' 3 21 J —' 13 UNLAWFUL NEW 15"X24"rvA5LF-VENT SOP&LI/R �R J V 56"H RAIL�- ONE PIECE ACRYLIC kV 5URROUNI THO r 1 -7— JA I UT CERTIFICATE NEC 26 A CE55 OR 01 (rel FWH 60611 OCCUPANCY 0 0 N E 4! 301-115/161, 20'-4 V 6" PLUMBER CERTIFICATION 7- ON LEAD CON rENT-BEFORE "'E CLOSIET CERTIFICATE OF OCCO ANCY SINK&CAB -P ew*& OAK F1 d BUILT-IN BOOKCASES-NJ C.— F [a F5 D'1 4 2 1-t 3,R 5IR SOLDER USED 1JV' WA Lo T SUppLySySTEMCAWOT p ........... EX6EED 2(10 OF I%`L a LL EX15TO,KNEE WALL 45"H PLUMBING ALL PLUMBING WASTE &'lNIATER t. tu TESTING BE-170,IE COVERING LIA U. -3: ATTIC Lu z ju LIVINO AREA 1 ,536 50. FT. 5ECONO FLOOR PLAN D Lu SCALE: 1/4" = 11-0" tu IMAT'le-, (77F()r5fRAf?H1C, -;Ie--jN CeRITERIA uaz zi tu WIND SUBJECT TO DAMAGE FROM Lu GROUND SEISMIC WINTER Ir-,E SHIELD ob q) GROUNDlLl SNOW LOAD DESIGN FROST LINE DE51ON UNDERLAY FLOOD AIR FRZIN(5 SPEED(MPH} r WEATHERING INDEX DEPTH TERMITE DECAY TEMP REO'D. HAZAR05 INDEX Lu X 45 120 6 SEVERE 561, 3: 1 MODERATE SLIGHT- 11 PEO.F. YES NONE 452 Lu v— TOHEAVY MODERATE tu < FENER L TES S-RECIAL E 5; ABBREVIATION5 1.THE REFERENCE STANDARD USED FOR THE DESIGN OF THIS PROJECT 15 THE 7�000 FRAME CONSTRUCTION MANUAL FOR ONE AND TWO-FAMILY DWELLINGS" 1. CONTRACTOR SHALL SECURE AND PAY FOR ALL PERMITS& FEES. BY THE AMERICAN FOREST AND PAPER ASSOCIATION-2001 HIGH WIND EDITION. 2. CONTRACTOR SHALL SECURE AND PAY FOR FIRE UNDERWRITER'S ALUM. ALUMINUM LEOEND 1--� AG.T. ACOUSTIC TILE CERTIFICATE AND FURN15H TO OWNER UPON COMPLETION. Q BLK, BLOCK 2. THE CONTRACTOR SHALL VERIFY ALL DIMENSIONS& CONDITIONS 3,ALL WINDOWS AND SLIDING GLA55 DOOR5 SHALL BE AS MANUF. UA Bo. BOARDIN THE FIELD. BY ANDERSEN-SERIES 400, FURNISH AND INSTALL GRILLES& SCREENS (D THERMOSTATcta B'C BOTTOM OF CURB FOR ALL WINDOWS & 5,G. DOORS CAB. CABINET3.THE CONTRACTOR SHALL COMPLY WITH ALL STATE, LOCAL,& 4. FURNISH& INSTALL NEW CASINGS AROUND ALL NEW& EX15TO.WINDOWS& DUPLEX ELECTRICAL RECEPTACLE ALL OTHER APPLICABLE CODES AND REGULATIONS. CER.T. CERAMIC TILE CURRENT STATE COVE 15 2010 RESIDENTIAL CODE OF NEN YORK STATE. DOORS. GA5ING5 SHALL BE 3 1/2", FJ FINE, PRIMED,- MATCH EX1576 PROFILE. 2 G. 0. CARBON MONOXIDE DETECTOR FLOOR DUPLEX ELF-GTR16AL COATS LATEX SEMI-GLO55 PAINT. FURN15H& INSTALL NEW BASE MOULDING IN ALL — GONG. CONCRETE RECEPTACLE4. FOUNDATION DESIGN HAS BEEN ASSUMED AT 5000 1-135/50.FT.. ROOMS&SPACES. BASE SHALL BE 3 1/211H,2 PIECE, FJ PINE, PRIMED, -MATCH LONG, BLK. CONCRETE BLOCK x lu tu DR. DOOR TELEPHONE RECEPTACLE ALL FOOTINGS SHALL BEAR ON UNDISTURBED& UNFROZEN SOIL. EXISTING PROFILE. ON, DRYNELL5. FINISH OAK FLOORS WITH 2 COATS STAIN AND 3 COATS POLYURETHANE. 5.ALL FRAMING LUMBER SHALL BE DOUG-FIR No.2; Fb,ALLOWABLE FL. , ELEV. ELEVATION G4 SINGLE POLE 5AITCH STRESSES AS PER LATEST OF NATIONAL FOREST PRODUCTS ASSOCIATION. OAK FLOOR SHALL BE SELECT OAK STRIP FLOORING. F.I- FIRE EXTINGUISHER (10#DRY CHEMICAL DOUBLE ALL J015TS UNDER PARTITION5 RUNNING PARALLEL& UNDER BATHTUBS. 6. INTERIOR WALL PAINTING: 1 GOAT PRIMER,2 COATS FINISH. THREE NAY 5NITCH DOUBLE ALL FRAMING MEMBERS AROUND ALL 51OF-5 OF ALL OPENINGS. INTERIOR WOODWORK& DOORS: 1 GOAT PRIMER,2 FIN15H COATS SEMI GLO55 FP5C FIREPROOF SELF-GLO51NO ALL HEAVERS SHALL BE 2-2"x8" UNLF-55 OTHERV415F-NOTED, 1. HEATING SYSTEM SHALL BE DESIGNED TO MAINTAIN'12 DEGREES INSIDE AIR FT67, FOOTING D M au SWITCH ON DIMMER RUN OAK FLOOR 5TRIP5 PERPENDICULAR TO JOISTS UNLE55 FL. FLOOR OTHE"15F NOTED. FURN15H& INSTALL 1/2"A/C FIR PLYWOOD TEMP.W/0 DEGREE OUTSIDE AIR TEMP, N1 15MPH JININO VELOCITY. FIN. FIN15H ®R 6"D, RECESSED HIGH HAT, 65N UNVERLAYMENT UNDER ALL FINISH FLOORS EXCEPT GONC. & OAK. EXTEND EXISTO DUCTWORK SUPPLY& RETURN SYSTEM TO ALL NEW at K FVN, FOUNDATION ALL HANGERS & FASTENERS SHALL BE COMPATIBLE WITH THE TREATED LUMBER USED. SPACES. UTILIZE EXIBTG MAIN SUPPLY& RETURN DUCTS 5HONN ON G.B. GYPSUM BOARD o Ur, UNDER CABINET HALOGEN L16HT FIXTURE DRAINING-75. FURN15H& INSTALL AIR CONDITIONING SYSTEM FOR ALL HDR. HEADER 6.THESE ORANING5 SHALL NOT BE USED FOR CONSTRUCTION NEW SPACES. SYSTEM SHALL MAINTAIN 15 DEGREES WITH bq`5 DEGREE L. LEADER (9 SMOKE DETECTOR UNLE55 SIGNED AND SEALED BY THIS ARCHITECT, OUTSIDE AIR TEMP. N.I.G. NOT IN CONTRACT (9 CARBON MONOXIDE DETECTOR F)AT E: MG. MEDICINE CABINET 1. CHANGES,ALTERATIONS, REVISIONS TO, OR RE-U5E OF S. FURNISH& INSTALL NEW SHELF& POLE IN ALL CLOTHES CLOSETS EXCEPT M.S. MARBLE SADDLE 0 COMBO SMOKE/CARBON THESE DRAWINGS WITHOUT THE ARGHITECT'5 WRITTEN WHERE OTHERN15E NOTED. FURN15H& INSTALL 5 SHELVES IN LINEN CLOSETS. PT FRE55URE TREATED MONOXIDE DETECTOR APPROVAL V0105 SEAL AND SIGNATURE OF SAME. 1)F-CF-M B E R 25, 2015 PTO, FAINTEDEXISTING 5. EMERGENCY OPENINGS: q. INSTALL TOILET ACCESSORIES FURNISHED BY OWNER. RELOG. RELOCATE, RELOCATED EXISTING PARTITION ALL SLEEPING ROOMS AND BASEMENTS WITH HABITABLE SPACE 10. INSTALL LIGHTING FIXTURES FURNISHED BY OWNER EXCEPT RECESSED HIGH HATS S.D. SMOKE DETECTOR SHALL HAVE EMERGENCY OPENINGS CONFORMING TO THE FOLLOWING STANDARDS: — 55 BTAINLE55 STEEL REMOVE EXISTING PARTITION MIN. NET CLEAR OPENING 5.1 5F EXCEPT GRAVE FLOOR OPF-NINC75�NHIGH SHALL BE 5.0 5F MIN. WHICH SHALL BE FURNISHED& INSTALLED BY THE GONTRACTOR. 5 C',A L F-: BTL. STEEL MIN.OPENING CLEAR HEIGHT SHALL BE 24". MIN.OFENIN6 CLEAR WIDTH SHALL BE 20" 11. FURNISH & INSTALL TILE BACKER BOARD UNDER ALL CERAMIC TILE WALLS. 5yq. 51DEIINALK NEW PARTITION MAXIMUM BILL HEIGHT SHALL BE 44"ABOVE FIN. FLOOR, 12. FURN15H& INSTALL WATER RESISTANT`GYPSUM BOARD ON A5 T.G. TOP OF GRATE ALL INALLAND CEILINGS P 1-,?,( J E i 6 T I T.C. TOP OF CURB IN ALL NET 5PA6E5 INGLUDINO BATH ROOMS AND LAUNDRY ROOMS. 21 b"I 6 T"(P, TYPICAL 15.ALL INTERIOR OOOR5 SHALL BE 6 PANEL, SOLID CORE- MATCH EXISTING DOORS. PRIMED,2 YO. YARD DRAIN GALV. GALVANIZED GOAT5 LATEX 5EMI-OL055, yNv. WOOD ALL ALL ELECTRIC RECEPTACLES SHALL BE OF-GORA BY LEVITON,WHITE. ALL BN17GHES SHALL BE (W'46. No. BLKG, 5 L 0 G KI N 57 BY LEVITON EXCEPT DIMMER 5NITCHF-5 WHICH SHALL BE BY LUTRON, ALL SNITCHES SHALL BE VNG' VINYL WALL COVERING, WHITE. 15. PATCH ALL DAMAGED OR 015TURBED AREAS TO MATCH EXISTING. ..................... ak 211 1-1/211 1-1/201 1-1/211 8 1- 1/211 211 0 (J HR 2nd. FL. Fy- 6.0 ---L cl.o. Z Z Lu Z m c.0. HOUBETRAF Lu 411 TO EX15TC7. < 5ANITARY 5Y5TEM > Z Lu lArILI tul PLUM Ril'ZER vRAM NOT TO SCALE ILL ILL ME q) to crz Ul z to q O Lu (L oc co tu 3: HH EX.R-1q FIBEROLA55 I- Lu 1-- T BATT INSUL N1 V.B. Lu LQ Ln ELE 2-2°X4"NO. PLATE < r- VATION 1 2X4"WD.STUDS lb"O.C. TYF�-- m SCALE: 1/4" = V-0" 2"X4"NO,SHOE, i- 1/2"(7YP. 5V.,TAFF-17,3 COATS SFACKLE,PTV. TYP.WALLS&CLG5. EX,R-13 FIBERGLASS OAK 0 C7, - BATT IN5ULN01.B. 15#BLDG. PAPER EX. PLYNO.5UBFLOOR iso ----------- C-3 ILI -: lu LLI VA ixvra DECEMBER 25, 2015 21516 BUILD (r-n; TION "All 01/46Y. ["10. SCALE: 1/4" = l'- 0" ILI t-- 1 > Z ILI ILI 040o6 z 1/2"TEMP z IL �011 45"VNTV 5KYLT5(2) Aj TF� LU 1x x KNEE YqALL +45"H KNEE VVALL+48"H LU C3 Q) 7-- . x EX15TC7. 1/2" CL?X PLYND 5UBFLOOR EX. CORBELLED MASONRY CHIMNEY, x 5TORAGEBATT INUL. ALL EX15Tr-,VIALLLS (R-13)& 61-65(R-1 q)ARE INSULATED VV FIBF-ROLA5E 5TORAC7E EX15TO.2- 14"X 2" 5UFFLY& LU 2- 5t ILI EGH cl0ll .1 RETURN DUCTS IN FLOOR LL ECH q5 1/2" ! I ( I i � TEMP SUPPORT 2"X 4;' 5TUD5 X4 5HOi-" ;�'-- — _ — — — — — — — — - tu -A STAIRLU r :D LU < KNEE WALL +46 1/2"H --I oa X LU WE in ATTIC, ILI T M %) EX15TO. SECOND FLOOR / DEMO PLAN 5GALE: 1/4" = 1 0" to :E ILI 11A %j Z Vccs - ILI af ®r �b DATE:: DECEMBER 25, 2015 6 A LE: (Yl E(-','r IAC .: 21518 c).