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HomeMy WebLinkAbout42052-Z yep : Town of Southold 1/17/2018 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39451 Date: 1/16/2018 THIS CERTIFIES that the building SHED Location of Property: 645 Southern Cross Rd, Cutchogue SCTM#: 473889 Sec/Block/Lot: 110.-5-27 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated p_. 10/6/2017 pursuant to which Building Permit No. 42052 dated 10/16/2017 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: RELOCATION OF AN EXISTING ACCESSORY SHED WITH ATTACHED OUTDOOR SHOWER AS APPLIED FOR The certificate is issued to Bohan,Peter&Julie of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42052 01-11-2018 PLUMBERS CERTIFICATION DATED 11-30-2017 Mat ck Plumbing uth d Signature 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#: 42052 Date: 10/16/2017 Permission is hereby granted to: Bohan, Peter & Julie 11 Cambridge Ave Stewart Manor, NY 11530 To: relocate "as built" shed with outdoor shower as applied for. Certification may be required. At premises located at: 645 Southern Cross Rd, Cutchogue SCTM # 473889 Sec/Block/Lot# 110.-5-27 Pursuant to application dated 10/6/2017 and approved by the Building Inspector. To expire on 4/17/2019. Fees: CO -ACCESSORY BUILDING $50.00 AS BUILT -ACCESSORY $275.20 Total: $325.20 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 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. 1 C) New Construction: yOld or Pre-existing Building: (check one)5- Location of Property. / S,-�c� 6-oss House No. r Street Hamlet Owner or Owners of Property: pel-TeeIE c9 k ay1 Suffolk County Tax Map No 1000, Section 1 in Block Lot O1_7 Subdivision Filed Map. Lot: Permit No. 4M050�- -Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ <�& roT�� Applicant Signature pF SO!/l,�ol Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 iQ roger.riche rt(-)town.southold.ny.us Southold,NY 11971-0959 Q �yMUM`I,Nct� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To. Bohan Address: 645 Southern Cross Road City Cutchogue st: New York zip: 11935 Building Permit#- 42052 Section: 110 Block: 5 Lot: 27 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Rocky Point Electric License No: 32644-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 1 CeilingFixtures 1 HID Fixtures Service 3 ph Hot Water 30A GFCI Recpt 1 Wall Fixtures 2 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 100A A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 2 Twist Lock Exit Fixtures TVSS Other Equipment: "STORAGE SHED" Notes: Inspector Signature: Date: January 11, 2018 0-Cert Electrical Compliance Form.xIs l Telephone(631)765-1802 Fax(6AIl MM09. P.O. Box 1179' Southold,NY 11971-0959 OV � BUILDING DEPARTMENT D ��� DD TOWN OF SOUTHOLD DEC 2 1 2017 BUILDING DEPT. TOO. OF SOUTHOLD CERTIFICATION �: . Date: Building Permit No. Z 0 �5 Z w Owner: 11 - v(Please print) Th Plumber: _ (Please print) I certify that the solder used in the water supply system contains less than 2/10 of I% lead (Plumbers S' ure) Sworn to before me this 36 '� . I , day of W? nbW , 20 1-1 CHELSEA L. CHALONE Notary Public. State of New York Registration #01CH6287106 Du.olified In Suffolk County Commission Expires Aug 5, 20 'M Notary Public, ` ` `Cou.nty' - -- + t .- ._ _ - _ _ _ ..- ...l,T_—•-moo v- _ ..,. — — - � SOUTyo� �o • �o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [rSLATION U _FRAMING / STRAPPING [ NAL AJ 90 Ll `SOW�S� [ ] FIREPLACE & CHIMNEY ( ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL REMARKS: Iry 610- WA qCi &ke� DATE INSPECTOR pf SOUI,yo� rco 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: AjivjL /< DATE INSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS O FOUNDATION (1ST) � y ------------------------------------ FOUNDATION (2ND) fi z - �o Irl _ ROUGH FRAMING& y PLUMBING J r INSULATION PER N.Y. y STATE ENERGY CODE 1 yt C3 FINAL ADDITIONAL COMMENTS r c� X � H � z - d 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 Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood PermiY.� Examined 20 Single&Separate Truss Identification Form Storm-Water Assessment Form `i Contact: Approved D ,20 Mail to: Disapproved a/c 4 Phone: Expiration 120 (/ DISDV -B din Ins or � E D OCT _ 6 2011' PLICATION FOR BUILDING PERMIT ING DEPT Date , 20 BUILD INSTRUCTIONS t TOWN OF SOUTHOLD , 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) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 0 W✓1Pw 1 - Name of owner of premises PeAe l- T3O ►� ✓1 (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of cor orate officer) 1 Builders License No. 3 y �6 1+ Plumbers License No. J-5_ Electricians License No. 3 7— Other Trade's License No. 1. Location of land on whichMj_ ed work will be done: nn 62 ti- 1` U House Number Street Hamlet County Tax Map No 1000 Sectionf w Block •Lot„,."�,Q ,,.,,,,^��„ cSE120:+i 1 tl -0 11 ' ,�•��sc..s:w;t<c�:4x?raiz:�mc0 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occu ancy of proposed construction: a. Existing use and occupancy my Vied '-5k b. Intended use and occupancy k e Cl Slko 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition OthrWork 5 D �i1e -i�►-0p y(Descriptio)+ 4. Estimated Cost � 61 �`1� _ Fee - l (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. Dimension of existing structures, if any: Front oft `1'" Rear l a` Depth ]AW 4- Height 1 6 Number of Stories 074 il, 54 A4 c- Dimensions of same structure with alterations or additions: Front tzi �„-1,.., ,dear Depth Height N u m b e 6f tp�i�s�,,i 1 -C-�, 8. Dimensions of entire new construction: Front N/Q Rear Depth I P. Height Number of Stories IR- u - ;J9 J 9. Size of lot: Front 1 o`-,Qj Feet Rear I I V Z,.Lt_D,pth f' L5 7.Q,t?�- ."IT 10. Date of Purchase 61// Z 00 S' Name of Former Owner 11. Zone or use district in which premises are situated (�eS i ACAZ�� 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 Address 645&oAern 0-ossPhone No.514- IgU - 5048 Name of Architect (014 Address Phone No Name of Contractor JE�Gr W ay-cL C-4&-4 0 Address 2 5 gM,lee Z01, Phone No. U31-1?54-4180 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. S0efore me thi O� day of 0 1 OC Signatur ,of Applicant Hata i ,Sato"NewYork No.01SA6051325 Qualified in Suffolk County Commission Expires November 20,20 Subdivision Filed Map No. Lot 2. State existing use and,occupancy of premises and intended use and occu an'cy of proposed construction: a. Existing use and occupancy my :5VIe ;fsllokeaf b. Intended use and Y occu anc k e ok ! :5,kko �, 3. Nature of work( pp check which applicable): , : New Building Addition Alteration Repair Removal Demolition Ot hr Work 5 ovi �O`''''l e --j-%,-O y(Description 4. Estimated Cost :46, (7-" - Fee l As f2> (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling un' s on each.floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. Cfit 7. Dimension of existing structures, if any: Frontoft �}-" Rear �. oft L}� Depth Height Number of Stories Ill `q .il u, >4 til Dimensions of same structure with alterations or,a'dditions:'Front ii to Rear Depth Height Numbe' f t&e 8. Dimensions of entire new construction: Front N/Q Rear Depth Height Number of Stories 9. Size of lot: Front 1.0jr,q `( �ee� Rear ( Depth � q. r gyp' e R:-.1: T. v_L J [•1f 7.A'•..'-�.Aw:rt:(��1. `. t 10. Date of Purchase F--1// Z (:)o E Name of Former Owner 3 ' 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulatio�,? YES NO ✓ 13. WWII lot be re-graded. YES NO Will excess fill be removed from ipremises? YES NO 14. Names of Owner of premises P9jj ,I� �O� 6 Address U45 uAe -'i Bross Phone No.514- 1 gU 3 0�g Name of Architect - N Address Phone No Name of Contfactor.Fd"W[Wd,-C-4Lft V Address 2 j'S S mg-v OA- 'Phone No. 834-4 IF t1 15 a. Is this property within 100 feet of.a tidal wetland or a freshwater wetland?"*YES NO V1 * 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. i 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 i (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorised to perform or have perform'ed,tlie saidjwork 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. S 04 efore me thi "/ day of O 1 OC Sigriatur ,of Applicant Nota i ,Sat o ew York No.01SA6051325 Qualified in Suffolk County Commission Expires November 20,20 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 So.utholdtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. . Trustees C.O.Application n Flood Permit, Examined V 20 Single&Separate Truss Identification Form Storm-Water Assessment Form f� Contact: Approved �/ ,20 Mail to: Disapproved a/c..-, Phone: Expiration _120 D L'Vg _Bu in Ins or D 6 2017 PLICATION FOR BUILDING PERMIT ' ING DEPT• Date , 20 BUMD INSTRUCTIONS TOWN OF SOUTHOLD .- a. 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 ldt 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 prernises 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 riot 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 exten"idn 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) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 0 W VIA PJVl- - Name of owner of premises �P�CSX �O ►')�.✓1 (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Narne and title of corporate officer) +1 Builders License No. 3 y 8'6 4 Plumbers License No. " Electricians License No. 3Z6 Other Trade's License No. 1. Location of land on which pro osed work will be done: 12 U. House Number Street Hamlet t County Tax Map No. 1000 Section ,�(3 Block Lot_ ""Y''"'"'�' !YR" __�,. �vr Io #� ` `Ibwn Hag Annex � T (6au 7651$02 t. 54875 B�Road r1i 2 7 P.O.Banc 1179 MOVE Sn,g�W.NY 1i97 BUMM DEPA� JAN 3 2018 TOW4 OF SOUTHOLD RUMDING DE". APPLICATION FOR EL CTRIINSPECTION Towiv of SOLTMOLD REQUESTED BY: Dam: Ia 1 ` corny Name: CV . ol-,Ur LC-2T� Mame: '�fy rOry i. License No.. _2, & dress: In2ne No.. JOBSITE INFORMATION: (*Indicates required Wbrmation) i *Name: *Address: _( S Sou-1--H Eg1L) c e ac s T,b cU i c H o GUS *Cross saw Z ,A { *Phone No.: CL311 .,?3 — q/f'O Permit NO.: O . Tax-Map District: 1000 Section: Bk do Lot; *BRIEF DESCRIPTION O RKY Print Cbedy) �- i Unease Circle All That Apply) *Is job ready for in n: (Aj�NO Rough In Fina! To-you need a Temp Certificate: YES NO Temp kdb m don(if-needed) ' Service Size: 1 Phase Whose 100 160 ' 200 300 350 . 400 Other "New Service: Rem Undm9mu nd NurNer of Meters avenge d Servide Overhead Additionai Informadon: PAYMEW ME MH APPLICATION 1/5.30 .BYAOWu for kq)eW=Form i O c LA ` o •V w O ' m n O � � LD Z pd mm �•,E.:JG 7 1?3(S SuRvE yt-4 l3�'" IN / �C x 5 m =.af h(-seKeo t, -Ae4KK Sacrfw7to ( To tni0 t c-4 P1zo MSFsp T� `•• ' a x • AWt iN w s i ova _ 16 Yom- • -r' - s," MAA OF' PTora-,q 7-Y' 5G•S4YE YE0 1f t 3� �•:+�.y A/vo- )USAN' j2Y,i • _ ' maw, �I•wN�r tN1M_ L�.If e �r - ,• • t ° ( Q... nosao LU rcK�u !t/ d �� QS l�LL . ,•\ I" � •I j 'C. G .•r T'T<F �'I.lI AI. l� = .•Arr. -!:.,/ f j 14— d3 •r31c=7e,_ ^Ing-u.i' _4•�_ `^GI�rtcL c �ootr��t �4• n•a[ •tom 7•_ - ~ �C?G�rrir. k {�AIt> Te,I. Cy !J%3�t-IGt� :1,R7� S�Kf�01s: %.?• -4,7, • �c IG. - i_.r coCD .- t➢ O i N i SOUjyol Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P O Box 1179 Gc� • Q Southold,NY 11971-0959 Q �yc4UM`I,� December 27, 2017 BUILDING DEPARTMENT TOWN OF SOUTHOLD Peter & Julie Bohan 11 Cambridge Ave Stewart Manor, NY 11530 Re: 645 Southern Cross Rd, Cutchogue TO WHOM IT MAY CONCERN: The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy: / Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of$50.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees#765-1892) Final Planning Board Approval. (Planning#765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept. Final Storm Water Runoff Approval from Town Engineer BUILDING PERMIT — 42052 — "As Built" Shed 'iSUFFOLK COUNTY-,DEPT¢Of�LA80R, t; LICENSING d CONSUMER AFFAIRS ..' .HOME IMPROVEIyI� �_ • CONTRACTOR � + 15 GATTO This Ceqf es that the.`bear �•i duly, r WARDOATTO�IN^Cz' a • -. A--;�licensed.6ythe - iai County of,Suffolk ""°""'"" r 5 t 5LL 'c• � ,:y. 34486-H - 3!tol"rlooa;� c« :.a»r r wrur.a an 03/01/2018 � r\ J F t - e New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE o a ^^A^A 113528926 EDWARD GATTO INC i 275 BAYER ROAD • MATTITUCK NY 11952 ❑ ■ Scan to Validate POLICYHOLDER CERTIFICATE HOLDER 645 SOUTHERN CROSS EDWARD GATTO INC TOWN OF SOUTHOLD 275 BAYER ROAD 54375 ROUTE 25 P O BOX 1179 MATTITUCK NY 11952 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11088153-0 871185 08/06/2017 TO 08/06/2018 10/5/2017 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 1088153-0, 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 YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/NWNN.NYSIF COM/CERT/CERTVAL.ASP THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. EDWARD GATTO PRESIDENT OF EDWARD GATTO INC (A ONE 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. NEWYORK STATE INSURANCE FUNC DIRECTOR,INSURANCE FUND UNDERWRITING '`eco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDfYYYY) `--�" 10/05/201.7 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, subjoct 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 Ilou_of.such endorsernont s. PRODUCER CONTACT FNAME: Timothy S Purdy E ExII: (631)821-2200 ac "e:(631)821-2296 45 Route 25A suite D2 ESS: Shoreham, NY 11786INSUR S AFFORDING COVERAGE NAIC0 ERA:Farm Farnily'Casualty Insurance Com an INSURED INSURER B: Edward Gatto Inc INSURER C: 275 Bayer Road INSURER D:. INSURER E: Mattituck NY 11952 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS'IVTO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEEN ISSUED-TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIOR 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 POUCY EFF, POUCY EXP LT POLICY NUMBER M DDIYMj IMWDDNyM LIMITS A X COMMERCIAL GENERAL LIABILITY 31521-7374 02/07/17 02/07/18 EACH OCCURRENCE S 1.000,000 CLAIMS-MADE t_:._J OCCURff— RE IES -ooccurrencoS 100,000 X Contractual Liability MED EXP(Any onoporson) S 5,000 PERSONAL B'ADVINJURY S -1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER ER: GENAL AGGREGATE $ 2,000,000' X POLICY*[--].EC LOC PRODUCTS-COMP/OPAGG' $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITY INED SIN E LIMIT $ Ea ecddontl. ANYAUTO BODILY INJURY(Por poraonj S; ALL'OMED SCHEDULED BODILY INJURY(Par accident) S' AUTOS. I AUTOS HIREDAUTOS NON-OMED PROPERTY DAMAG $ AUTOS Por aackdo S UMBRELLA LIAe -OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED 1 1 RETENTIONS $ WORKERS COMPENSATION P R AND EMPLOYERS'LIABILITY Y/N I ATUT ER ANY PROPRIETOR/PARTNERIEXECUIIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED9 (Mandatory in NH) E.L.DISEASE-FIA EMPLOYE $ If yyou dosaft under DES4ARIPTION OF OPERATIONS tiabw E.L.DISEASE-POLICY LIMIT. S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES.(ACORD 101,Additional Remarks Schodula,may ba alischad'If mora apace li roqulred) Residential Carpentry CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 50983.Main Street THE EXPIRATION DATE THEREOF: NOTICE WILL 'BE DELIVERED IN Southold, New York 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2013 ACORD CORRORATION..All rights reserved. ACORD 25(2013104) The.ACORD name and logo are registered marks of ACORD A AP48.p.#, AS NOTED DATE; ELECTRICAL FEE: BY: INSPECTION REQUIRED NOTIFY BUIL:)!*dG DEPti; 'i M T 765-1802 SAM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FPAH;;,; 1 PLUMBING Additional 3. INSULAT, Certification 4. FINAL MUST BE COMay Be Required, Mi � 4•..:'. ALL CONST SHALL MEET THE REQUIREMEP, - O;THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 COMPLY WITH ALL CODES OF OF THE TOWN CODE. NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF S�p�$�$WN-P�plpUp(CiBOARD Son TEES OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY Ib _ OD'd oo,i syk"vr .7>, S.ors.." 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