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HomeMy WebLinkAbout40591-Z ����cl1FFOCKc�Gy Town of Southold 11/7/2016 0 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38637 Date: 11/7/2016 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1470 Evergreen Lane, Cutchogue SCTM#: 473889 Sec/Block/Lot: 108.-3-8.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/28/2016 pursuant to which Building Permit No. 40591 dated 4/4/2016 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: accessory in ground swimming pool fenced to code as applied for. Note:Formerly known as 1470 Manor Hill Lane,Mattituck The certificate is issued to Dream Acres LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40591 7/12/2016 PLUMBERS CERTIFICATION DATED ho ed Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT y 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#: 40591 Date: 4/4/2016 Permission is hereby granted to: Messina Property Holdings LLC 1625 Aztec Ln Mount Pleasant, SC 29466 To: construct an in-ground swimming pool as applied for. At premises located at: 1470 Manor Hill Ln., Mattituck SCTM # 473889 Sec/Block/Lot# 108.-3-8.6 Pursuant to application dated 3/28/2016 and approved by the Building Inspector. To expire on 10/4/2017. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Buil ing ector 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 I% 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. ?—f7 New Construction: Old or Pre-existing Building: (check one) Location of Property: 70 vo Pw o* t�j L 'L Lmnv� House No. Street Hamlet Owner or Owners of Property: �c, Suffolk County Tax Map No 1000, Section Q Block Lot Subdivision / Filed Map. Lot: Permit No. 0 51 l Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �;o nt Signature ®��OF SOUTg®l - � o Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 CA P.O.Box 1179 , ® �Q roger.riche rt(aD-town.southoId.ny.us Southold,NY 11971-0959 lCOUNT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Dream Acres LLC (Messina Property Holdings) Address: 1470 Manor Hill Lane City: Mattituck St: New York Zip: 11952 Budding Permit#: 40591 Section: 108 Block. 3 Lot. 8.6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Custom Lighting of Suffolk License No: 38893-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel 80A A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 2 Twist Lock Exit Fixtures TVSS Other Equipment- Inground Swimming Pool to Include; Bonding, 1- Pool Light, 2- GFCI Circuit Breaker 1-Gas Pool Heater. Notes: Inspector Signature: Date: July 12, 2016 z Electrical 81 Compliance Form.xls �o��OF SOpr�o`o cOUPfi`I, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ 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 [ ] CAULK G REMARKS: DATE l INSPECTOR f4f s 0 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION IST ] ROUGH PLUMBING FOUNDATION 2ND 11 LATION 'ru FRAMING / STRAPPING FINAL ] FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATI N CAULKING REMARKS:-, DATE -10('0 INSPECTOR f I P" OF �o �o c0UN1V,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] IN ULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) ■ f REMARKS. � P r DATE � INSPECTOR V 4 oF souTy o coorm,N�' TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING / STRAPPING [\-(FINAL Pre L [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: i �royt QN+.eJipyvTOY- _01)DI ioyz-!fo� si e-c� a rLir Ong g, sev-u®S Y P fro 4A %, W, bA-4e,- o� no, M S OW 0A LorS 0►1 "gCO-VAl' No A-ca,�s -1-D Pn ot b, DATE `C' INSPECTOR Wl I FSo �0��0 Ury�lo OOUNTI,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] 1 SULATION [ ] FRAMING / STRAPPING [ FINAL k F,eoa..,, [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: - vxLk AA DATE y�7 INSPECTOR �� OF SOOT h O y O i TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ZROH PLEIG. FOUNDATION 2ND [FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] FIRE FETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAT N [ ] ELECTRICA (ROUGH) [ ] ELECTRICAL (FIN REMARKS: DATE 11111 INSPECTOR OF SOUTyolo -ouf `l TOWN OF SOUTHOLD• BUILDING-DEPT.• Lc 765-1802 INSPECTION " - I FOUNDATION 1ST [ ] 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: DATE . �"� INSPECTOR r t o • � • r . • i r IIIP • r� I ' all. STA#BNEROYCbm, -0 M7 7914,12 INIM M1211 I Ll A.II�� V '' .. 11�.:►.... ./ � i./. �� � � a � � -'' i' � / s Orli �.r'- ,r• 1 -�s�--r• urs - - -- • b 3 6�1•�' +1�Iw?lY i 1IVA A P4,101,OAF 1 A 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. ���7�✓ Check Septic Form - N.Y.S.D.E.C. Trustees --C.O.Application Flood Permit Examined ! 20 i `, Single&Separate MAR 2 8 M -storm-Water Assessment Form Contact: Approved ,20 B • —lba: � �4(�-^�''�'tJ Disapproved a/c T OF SDU1'�� jf 6 Sl0 6 3 0 6 f Phone: Expiration �� 120_L,;7— it 1 �G`L' /\/,y �t�-- a eo� Building-Inspcktor APPLICATION FOR BUILDING PERMIT Date VV rvt6i/ - �r�, , 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.iPlot 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. (Signatur of applicant or name,if a corporation) ASr (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder A Name of owner of premises AD R-r—AA1 (As n 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. "f / - Plumbers License No. Electricians LicenseNo. Other Trade's License No. 1. Location of land on which proposed work will be done: 4PW,Z,:- A 4A 1'7-1 Zr✓�j� House Number Street " ' '1 -` Hamlet County Tax Map No. 1000 Section Blocky;• ;-;:: Lot ° Subdivision Filed Map No. 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 3. Nature of work (check which applicable): New Building Alt ration Repair Removal Demolition Other Work rr (Description) 4. Estimated Cost1 1Fee -' =' - �J (To be paid on filing this application) 5. If dwelling, number of dwelling units °° NumD r @fSlw�.iling units'on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, spe ijy,nMreaand ex each each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 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 >C 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO X 13. Will lot be re-graded? YE/4 NO `— Will excess fill be removed from premises? YES N0>< 5C 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor g rr-A-P�i> `]A VV ky VJSV-lAddress b 1 IWPo� i Phone No.62, f Z$ 12 3 3 x 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. 7C 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 ) C�C rarI4 C. C G N) JD&5�'j being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the (Contractor, gent, 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 to before me this day of20)� TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK Notary Publi NO.01 DW6306900 Signature of pplicant QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2_ 1 Scott A. Russell ��-°� � 'r� ST0][ZlAWA'7C']E]EL SUPERVISOR r, � � IWANA\G IEMIEN T SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 iy d� Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORD SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY ®1F THE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ❑YA. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑®B. Excavation or filling involving more than 200 cubic yards of material ❑� within any parcel or any contiguous area. Site preparation on slopes which exceed 10 feet vertical rise to 9"'D. �/ 100 feet of horizontal distance. ❑Ll 'D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑ E. Site preparation within the one-hundred-year floodplain as depicted - - 6/F. -on FIRM Map-of any water-ter -- -- - ❑ Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. - - - - - --- -- ----- - -- ---- - - - If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT (Property Owner,Design Professional,Agen Contractor,Other) S.C.T.M. #: 1000 Date ,r� � ��/ y District /-� L / NAME �il��K f®'l/ y V��5i vy-��` jM6 wry i c Section Block Lot l FOR BUILDINCiT DEP A.RTN'll-.INT USL ONLY Contact Information. 2 2,��� -r<leyhone�wnnul Reviewed By: Da Property Address / Location of Construction Work: — — — — — — — — — — — — — — — — IAI70 JJn/- 9A / L � � Approved for processing Building Permit. //'7����jj �`�/i/V(� Stormwater Management Control Plan Not Required MA ;Q 1:1 Stormwater Management Control Plan is Required (Forward to Engineering Department for Review) FORM " SMCP -TOS MAY 2014 fA j/ Al1 _ s ��, +' `A:•,�� y' ��,+ y■■ b[" Ow :r��i a„��. - , � �� ,� �` ... � �\ L..tM�r I.w',`y ,+. r�«� •i�� �.�,lam�y� ,��r,. i `♦ � \ 1 14 ZA i � BMs ! �- .} :� � �:►- � _ � a4 ► 1 -r. ... � _:.71st ; t 1 iJ j ��:1`• Kms' �� - a " It1 4 R�, \ 1 "\ ,! �1�fy,�7�J` '' \0. , � :�.- �� �/ � tom;, .i� _,{,`j�. ��' �•� T � •� .. . 1l �i', )t4. :�. y�t 4 I h r orf � � ! i�• .�/��•/�e d Y �'. 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AT R \r°,, ._� ` •..-e `r r. y , �Js..L_-�Y e K t• ` s ,,e +�.., ice' ,.r��,ti� • 11' {y (��t `_`&_.'—V� _ `' xt i- :s.' ^ '- •• �� '!' ms's fig .ilk: �`�'V ,,.. _ --�- .-. � .�, -.. � .= 4 `�"��'�•__'' _ �� 41 .�Is C• i' ,r. ti '� yi�` Vi � w ., •. - � !- •fit 1 � �� 1+ ) i��:.4 ., ' ZIL W In VA • �L • .I h ��^ �', i. f ml's'�. n• ���I� \ K• t '4pw' , Nk A MIA via Wn ♦ ��? .,f ,���,� ��� � ~lily. �h�T �'�� � ��•���. ��}���� 1�� op . fit ► `.,, R .= qwell i tA 4W f 41Z' �•� ia71AU k 17 MAr i 1 Ica soft MIA r. • k f u "� ^, •, �.�'e/ \'-`ti �� � �♦.�� .ice• ... ♦d� I �,r,,,,.' 1 S ,�✓`lk la 4 F �1 A �s �,;. + rte» � :.��� ♦.,,,t`�,•� r +a't� , ���,` r - r s vu c l » 7� t Dwyer, Tracey From: michael saccio <michaelsaccio@icloud.com> Sent: Friday,July 29, 2016 8:09 PM To: Verity, Mike; Dwyer,Tracey; harvey herman Subject: 147o manor hill lane fence requirements Hi Mike It's Mario from On The Fence Inc we spoke last week about the job on 1470 Manor Hill LaneMattituck 1. I would like to propose that I add a post in between the existing post's so there's a post every 4 feet. 2.additionally add a bottom wire to the fence. 3.pull the fence tighter to make it less flimsy and zip tie the top wire tight to the top of the fence. Please see pictures attached and let me know if I can proceed so that it fills the requirements for code Thank you again Thanks again Mario i TOWN �SAUTfHi8L PR® ` OWNER STREET ,� � ' VILLAGE DIST. SUB. LOT A FORMER OWNER N " �� 'l'�:.. E 6 ACR. AnrnAwn Z_i aG cc>s s S J W TYPE OF BUILDING ' RES. SEAS. �VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 16 . U')sect Y5 E Col;e ✓r� �ocr- �n�1 1� �_ / / 8/r7l_ , - L 16P w 2,o4z),32!5- 5s, r_ U v 11 "/('k, S t, Q._ �"7C1- (�� `I`,r. i ~-- 3 Soo_ ��Z 1�� 1 - _ /, 4 6UA Q?YIrv4e-g ��G�.Ct�i �I� ''Ovyr Ad- 4 ' .1 _(✓ 1�l+� U ��f �6'Y- �_'�1C b� ('"t' G 1 S ��40 P11-1!I F-1'7 I/J�'� f "�i�r_t J�_.:'f� (hf Y�fO�YS 12 io ► Sia/ - ��o � �� « �r�f) '�� ������� $�o�p���. w01 ,4 ,6pP,91 (w 'i ce A-t, Gs-, ,e3c� 0- F, yy o �� 3 aoo `l 91ti 3 lam{ 1$1 Id ng N_vaoc) , _ __N ` f +NORMALELOW AB VE 1 o� (3 P 333 1 . laces B kA FARM Xcre Vole Per 32C?O - 1 --444 9 6 7 c re ` -7k, Z- 6 729 9 2 Tillable -- FRONTAGE ON WATER I `@ /Woodland 128ID ���� Ps� � l��asSi � r FRONTAGE ON ROAD -Meadowland ;'5539 �'``�`�' DEPTH �q � /� 'i House Plot �� I - vU BULKHEAD A ' I Total i ��� DOCK I s ay I 1q :.5i COLOR a Oa s" TRIM i ' --4�7a - 1st 2nd M BN� Foundation Cc Fin. B. Bath �` Dinette s� UL COMBO Ex1,ens Pn Basement FSAw PARTIAL Floors Kit. Extension Ext. WallsInterior Finish L R Extension Fire Place f Heat D R. o��r�4z 5-x10 Woodstove BR. 3 P rch�- kav- PSS6! Dormer Baths /� 3- -Deck." Dock Fam. Rm. f A.C. 11 Garage , 0.B. Pool SURVEY OF PROPERTY _ 51TUATE: MAtTTITUCK N TOWN: SOUTHOLD ' ' w E SUFFOLK COUNTY, NY LOT NUMBERS SHOWN HEREON i S REFER TO MINOR SUBDIVISION MAP OF "TOT'S ACRES" � SURVEYED 10-26-2015 SUFFOLK GOUNIY TAX # 1000-108-3-8.6 Suffolk Gounty,Dept. of Health Services oa Reference Number RIO - 03 - 0084 1l CO CERnI<'IDFM TO: 5- -9 Dream Acres,LLC Fidelity National Title N nsuuance Company { Mop LTO �\,AO t11a ,' \\ ' % �Sl��, � \ \ ry ��.p} I6• \M \ ry % ` J�I q� `1` '•`may \ ' \ C4 __------_�__.__. Nell \ Y` \ � i� , - 9� t` 3 i l �s O NO, O �i C 18�m 311 - CO !1 -CO /81 {rq2 Story _ W N _ ! 1 Ln 16' �-- �1126 �4 -� ---------------- DETAIL I 40 N ro•or - `fie ,�Q�pj..�`� <�. �� baoPory n Itcereod addilla t seal b II 1 thKulMxlzed allerallon or addlllon to a>ieve �N .nololla+a.eolbn•tzoa,sin-d—W z.of the N—Tock Stala EaL<allon t on' • * •ked.11hoar-,f'1'o the�lmdtoirvoyorb NOTS: �L st q sd seal.Mill be<oreldered to be valid true DC wpbs' ■ MONUMENT FOUND 7 •Corlft.tl lr te«hoer 1;,`al lstlrg Lode of Prance la Lmd Surveyzh Mpted o PIPE FOUND 2 CoQ �Lmd9u"�;s� { a,osrol r;� y V �� , to the person For Mom ilia svvey Is FQ Q. tlai r5 are robtehIarayrutolelrkm>lHealteo cabaetptlmy, pLr pr<sad- , SAND and—"' reweoadA STAKE FOUND ddltbMt1mlonS AREA = 1x8,36-7 5F OR 4.35 ACRES JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIC Sr-ALE I"= 100' RIVERHEAD,N.Y.11901 369-8288 Pax 369-8287 RERC:\UsersVohn\Dropbox\02102\02-234update 2015.pro 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)756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAA^A A 098663211 GERARD GAWLOWSKI DBA ARCHITECTURAL DESIGN RESTORATION&BLDG BY GERARD 61 TONOPAN STREET MASTIC NY 11950 POLICYHOLDER CERTIFICATE HOLDER GERARD GAWLOWSKI DBA ARCHITECTURAL TOWN OF SOUTHOLD DESIGN RESTORATION&BLDG BY GERARD 54375 RT.25 61 TONOPAN STREET SOUTHOLD NY 11971 MASTIC NY 11950 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 12120867-3 302370 11/29/2015 TO 11/29/2016 3/14/2016 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2120 867-3 UNTIL 11/29/2016, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 11/29/2016 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 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. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysitcom/cerUcertval.asp or by calling(888)875-5790 VALIDATION NUMBER:368120118 U-26.3 DATE(MM/DD/VYYY) ,aco�o® CERTIFICATE OF LIABILITY INSURANCE 03/14/2016 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(ies)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: BRAZIER AGENCY PHONE N -281 FAX -281-0160 ,1L 1490 MONTAUK HWY ADDRESs•BRAZIERTOM@a AOL.COM ADDRESS OR CITY, STATE ZIP INSURER(S)AFFORDING COVERAGE NAIC# MASTIC, NY 11950 INSURER A:MAIN STREET AMERICA ASSURANCE CO INSURED ARCHITECTURAL DESIGN RESTORATION&BUILDING BY INSURER B: GERARD INSURER C: 61 TONOPAN STREET INSURER D: MASTIC,NY 11950 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD/YYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY X MPV89358 06/27/2015 06/27/2016 EACH OCCURRENCE $ 1,000,000 GE TO CLAIMS-MADE FX—IRE OCCUR 'PREMISES(Ea occurrDenc. $ 100,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2 OOO 000 X POLICY1:1 JECTPRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acadent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ Pacci HIRED AUTOS AUTOS er dent UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N SPTER I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED) N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 1Dt,Additional Remarks Schedule,may be attached if more space is required) FRAMING,SIDING, INTERIOR CARPENTRY AND MASONRY. CERTIFICATE HOLDER IS LISTED AS ADDITIONAL INSURED AS PER WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. 54375 RT.25 SOUTHOLD, NY 11971 AUTHORIZED REPRESENTATIVE T" �GL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and l000 are registered marks of ACORD - SUFFOLK COUNTY DEPT OF LABO-&., G` LICENSING&CONSUMER AFFAIRV'7" HOME IMPROVEMENT ., CONTRACTOR E nay°° NAME GERARD'C GAWLOWSKI This certifies,that the BUSINESS NAME _ bearer is duly ARCHITECTURAL DESIGN RESTORATION-J- &BUILDING BY GERARD licensed by the w License Number Date Issued ,,County of Suffolk ` .� 14231-H 09/01/1987-*,'. Jt¢sz�/l�ct�/ellf Comm at- EXPIRATION DA7 09/01/2017 � '` 0 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)756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 098663211 GERARD GAWLOWSKI DBA ARCHITECTURAL DESIGN RESTORATION&BLDG BY GERARD 61 TONOPAN STREET MASTIC NY 11950 POLICYHOLDER CERTIFICATE HOLDER GERARD GAWLOWSKI DBA ARCHITECTURAL TOWN OF SOUTHOLD DESIGN RESTORATION&BLDG BY GERARD 54375 RT.25 61 TONOPAN STREET SOUTHOLD NY 11971 MASTIC NY 11950 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 12120867-3 302370 11/29/2015 TO 11/29/2016 3/14/2016 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2120 867-3 UNTIL 11/29/2016, 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, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 11/29/2016 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 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. NEW YORK STATE INSURANCE FUND 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:368120118 U-26.3 A' OCCUPANCY OR USE IS UNLAWFUL APPRO"'E'D AS OOTE ?)- WITHOUT CERTIFICATE DATE: I�- B•P.11 F OCCUPANCY FEE: �' � By, NOTIFY BUILDING DEPATIviENT AT 755-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTION& ��� , . � �y 1. FOUNDATION - TlVO REQUIRED FOR POURED CONCRETE - , OTA P TM ' RE LOBED_ 2. ROUGH - FRAIVIINC. & PLUivIiBING 3. INSULA T ION 4. FINAL - CO FTRt"IC T ION MUS T BE COMPLETE =0R C 0. ALL CONSTRUCTION SHALL MEET THE 2 10000 E REQUIREMENTS OF THE E CODES OF NEW N��osEpoOMP`E-��ON YORK STATE. NOT RESPONSIBLE FOR VPO� E„�A�ER' DESIGN OR CONST t;UCTION ERRORS. gEF®R - CODES OF ci &. T0',lVN JL/Et7 AS C'ONDITIONS OF 4f A • �a®,3.o......a..e<...__..—.. +T —^- p n ren Gl.1i. ,.gib. I6Y'N dqr. v BMAR J "RI -1 Hpl ARCH ITECTUPAL DESIGN & BUILDING 61 Tonopan St. Mastic, N.Y. 11950 Once: 631 2812334 Cell: 516 810 6306 Fax: 631281 8967/ E-mail: Arc4e5lOaol.com 1.1 vfl /� B C o C F c A =11k -� 1-��,ocw ire Cf HfT1K! �. S 36 l o t !3 3 3� tirt, !tB ' 3►00o �+u (As rerrvo) _ -M•nwl� '�nct� ,` A El W. .E. POOL P L AIS _ = E yr s+uu'1s r Fo ire Acrv.+�o+e a Nmi '_ G'zrJ Tx a iYf P'm_ "rriR u�.r:irrSut Fn = <jo ry fi r-arses VATE 1'WLL WT ex"r µlCdlx ittl;t{c1a-,or Tte cxU-isTwrL tr cAm-yy {{ f ezrst� uisttnr-G�d aELu hM� 4rr +4HA oEN/rtttlliY�c' MccuTl�, E.rru. pc r�wrnF.a- �.7�;Y�a_�. _ � � � - - _ til rr-t,+��+ . _�ro�rtis+► ' _ w•1 EP+ vrspos"H- h unrru;r"f&, RS[tOMIr, K t'� oKtit 2_ SURGFSI44AE I�O6�Fp"Nr�%N S�Lf h! O� t. 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