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HomeMy WebLinkAbout40335-Z -- : o 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#: 40335 Date: 12/10/2015 Permission is hereby granted to: K Mac Reality LLC 5 Acorn Ln Commack, NY 11725 To: Construction of an in-ground swimming pool as applied for. Replaces BP#39285 At premises located at: 405 Cedar Point Dr W, Southold SCTM # 473889 Sec/Block/Lot# 90.-2-27 Pursuant to application dated 12/10/2015 and approved by the Building Inspector. To expire on 6/10/2017. Fees: PERMIT RENEWAL $250.00 - Total: $250.00 9 buildA Inspector TOWN OF SOUTHOLD sad;��,;,,-:•:.r BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD NY 01 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#: 39285 Date: 10/20/2014 Permission is hereby granted to: McDermott, Kevin & Meah, Fatema 5 Acorn Ln Commack, NY 11725 To: Construction of an in-ground swimming pool as applied for. At premises located at: 405 Cedar Point Dr W, Southold SCTM # 473889 Sec/Block/Lot# 90.-2-27 Pursuant to application dated 10/3/2014 and approved by the Building Inspector. To expire on 4/20/2016. Fees: IN-GROUND SWIMMING POOL $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector rAf s 0 cou TOWN, OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION I FOUNDATION IST ] ROUGH PLUMBING ] FOUNDATION 2ND INSULATION FRAMING / STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESI NT CONSTRUCTION FIRE RESISTANT PENETRATION 1E TRICAL (ROUGH) ELECTRICAL (FINAL) (I CODE VIOLATION CAULKING REMARKS: 'Ajo/1�111� All 76" L/ P,6p DATE INSPECTOwi-r /// r �y � lcxx- d qv pf SOUIyo N O cOUMY,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL _ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS. 0." Q %� D���� ��^��. X11 • DATE �aa- IC6 INSPECTOR FIELD INSPEM MORT AAT COMMENTS FOUNDATI N(1ST) - --T----*--.'------....... ---�-- FOUNDATION(2ND) Co ROUGH FR MING& y PLUMBING INSULATION PEIt N.Y. - H STATE ENERGY COBE . 1 4 FINAL DA ADDZTb1Y .I,'C�?, .. NTS` ,._... . . rn 7�"1 Cott A. Mussell °Su Ir 1:6- STOI IMMA\T]EIK SUPERVISOR IMIAN \(G IEMIENT 40 SOUTHOLD TOWN HALL-P.O.Box 1179 � Town Of Southold Main Road-SOUTHOLD,NEW YORK 11971 C wEwE CHAPTER 236 - STORMWATER MANAGEVIE . nSHEET ( TO BE COMPLETED BY THE APPLICA T ) DOES TSS )PP OJIECT INVOLVE ANY OF Yes No (CHECK ALL THAT APPLY) (A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ®[ B. Excavation or f illing involving more than 200 cubic ards of material within any parcel or any contiguous area. ®[f C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ®® D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ®EdE. Site preparation within the one-hundred-year floodplain as depicted ®don FIRM Map of any watercourse. F. 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 hist Form to the Building Department with your Building Permit Application. APPLICANT (Property Owner,Design Professional,Age(Contractor,Other) S.C.T.M. 1000 Date Distric NAME JO �2 X �.��ll l �no Section Block Lot (Sigm"°`e' �AC FOR BUILDING DEPAR MENT USE ONLY**** Contact Information ��7 S'S_ Cr6 ph.,Numbed Reviewed By: — — — — — — — — — — — — — — — — Date. ®-3 Property Address/Location of Construction Work: — — — — — — — — — — — — — — — — LeW ',d (,�„ �^ , ® Approved for processtng utldtng Permit. �f p) OL�T l/ Stormwater Management ontrol Plan Not Required. T I /' Stormwater Management ontrol Plan is Required IBJ (Forward to Engineering epartment for Review.) FORM - SMCP-TOS MAY 2014 APPLICANT: S.C.T.M. #. 1000 CHAPTER c (Property Owner,Design Professional,Agent,Contractor, they) b0$UflQ/� TER 236 A Stormwater Management Control Plan CHECK LIST NjttuS section Block Loc PleasPant W S M C P -Plan Requirements: Provide ONE copy of the Building Permit Application " e Date: 1 * The applicant must provide a Complete Explanation and/or Reason for not providing aha all Information that has been Required by the following Checklist] Telephone humor 1. A Site Plan drawn to scale Not Less that 60'to the inch MUST If You answered No or NA to any Item, Please Provide Justification Herel show all of the following items: YES NO NA If you need additional room for explanations, Please Provide additional Paper. a. Location& Description of Property Boundaries 00� b. Total Site Acreage. �0 c. Existing-Natural & Man Made Features within 500 L.F. of the Site Boundary as required by§236-17(C(2) d. Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. 0 O✓ L e. Limits of Clearing & Area of Proposed Land Disturbance. 0 ✓�= ry , f. Existing & Proposed Contours of the Site (Minimum 2'Intervals) ©0� g. Location of all existing & proposed structures,roads, ©0� driveways, sidewalks, drainage improvements&utilities. h. Spot Grades& Finish Floor Elevations for all existing& proposed structures. „ I. Location of proposed Swimming Pool and discharge ring. 0✓ �� „-; ;; p j. Location of proposed Soil Stockpile Area(s). 000 ~ k. Location of proposed Construction Entrance/Staging Area W. 0 _ 1. Location of proposed concrete washout area(s). 00O n M. Location of all proposed erosion&sediment control measures. 0 2. Stormwater Management Control Plan must include Calculations showing that the Stormwater improvements are sized to capture,store,and mfiltiate on-site the run-off from all impervious surfaces generated by a two V)inch rainfall/storm event 3. Details&Sectional Drawings for stormwater practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion & Sediment Controls. b. Construction Entrance& Site Access. c. Inlet Drainage Structures (e.g.catch basins,trench drains,etc) �0 ✓0 d. Leaching Structures (e. . infiltration basins,swales,etc.) ****FOR ENGINEERING DEPARTMENT USE ONLY**** Additional Information is Required. Reviewed & ® Stormwater Management Control Plan is Not Complete. Approved By: — — — — — — — — — — — — — — — — — — — — — — — Stormwater Management Control Plan is Complete. Date: SMCP has been approved by the Engineering Department. FORM * SWCP Check List-TOS MAY 2014 IM MMO \ ,# x 'K - ' Y ,�• #' i„� �.�h i{. ,� ice`�•�" �; L owax f. I - - , y 6111* tz ' Y w - TR• i t1. - •s _ 1 _ ,T ��."�•' '+moi , x l z: � s » £ 4 / i � -•:�,":,- • 'mss; �t . - 1'fi. s� r � r., �j'•i ,�� ,,. , � . -fir. .'� ..1' .R� . AiL ML .' ...res• # _ '4•}. 4t 0 5 111 'I 2=.0,161-3'':y2 3 a^ 4. vJ% 41 47 t - + 4 77 AWL�. _ •_ ./=•.%'''• ; I _ ,., I. - • , ,.rte. rte, w�- } x ''� - 3 f „r;�, NIL 1 _ e .rr� -"t' I+ Yr ._'+rte y'•Y� � -_ '�..�• r �. w_ t!.. _-.: _ \ . � .Y r> )#-� to`�•' Y r. ;moi► � _ � , r . "�, � ti ,� _��# .. -� ., AA 'I-p4mv-PIll .I' JAi el .........�=' �, �'� r X0.5111 / 2016. 13Vr2 3 ,, IA Wr` 41 AO • J1711'fhe. Southold Town Building Department $%�FUh cGz P.O.Box 1179 Permit#: 40335 53095 Main Rd Permit Date: 12/10/2015 Southold,New York 11971 631( )765-1802 Expiration Date: 6/10/2017 Parcel ID: 90.-2-27 BUILDING PERMIT RENEWAL LETTER Dated: 11/9/2017 Applicant: K Mac Reality LLC Location: 405 Cedar Point Dr W, Southold Work Description: IN GROUND POOL Construction of an in-ground swimming pool as applied for. Replaces BP#39285 A FEE OF $175.0015 REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: K Mac Reality LLC Address: 5 Acorn Ln Commack,NY 11725 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department, P.O. Box 1179, Southold,New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. i�.;.eaoi'4`=.s°a `.Lr :n'�°'e - P�S'�*,,,a`eoo"1r,°r..�`,, 's:o�ae�°o"r?":��" rFi'•'fay.." i$lppp IY�d _ ,y ,:v got 44y°Ip'; v"pprtpP 4I°V,D�a'^ '' aC ippfQ PPI® :4'�;ibp°p Oi°p°"-°- - °"""a4iQ'r=oi°Y}.y' - oai'eP'>v.,'^�,Y l'r'ie'-. ✓ `4 091 ,i` ;e'�""'"'Y':. -•�.::s •.aL�:,,.i 1t,� s• ^�, o �•O' a.}.,g_ep Ir,<° _ _;t09p Y°D,.yl :..uti •itt 10jt 0 Y�„�,"` ;. tpp PY°°+y$ _ i� '"{Oo YlP>;t'' t " o n" ,� V._ i.➢'.••'ar'�u;�u^ww`�`"'. is�Qi1 �„ ',i"'�V"•`V �a'a�-'::`_ � 'q� .'(Y•�a`o': .L: r -'�: `s`�. ' L �,, _.'�� i ."_?: ;✓fC . � ;",a� c. err �� �':i�' 7'��y� '"ti'ta- /�r.�l •rI�1� � u ,�� -'.y~'^v,,'e •,f=.-1 :°*�^ '»' 'd%%a`\ ��=:.r r trnrr e ,n�nF-.„ s.,-r•, go,,,,w � w •:l��% _ __—____ -----. AT£-.'w�sn'�'_ �',�![t. ..,,...�'�"MC�.ITa 4k'.,�_ .73....7. �...,��rT�L'..'S-',.�..�...N��f...z..,.,�«�L ae„-tdLr.•,:�f'i.:aTe1,..,>l-<,..,.,3d..1`5t.`5'!�'L9'�"."�1'"".N.a.,,}rLx•.....7,S;vl�'E'3C'Sd'�S!!:'?�«r„�.s'°�'^:.,5"<.3:d3:yL'+�"tiA'L4!:�^E!!1$!S 7';'�� $2 :e Suffolk Count( Department of Labor Licensing & Consumer Affairs ` VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 `4 DATE ISSUED: 7/1/1978 No. 4436-H ' g I Y iS• SUFFOLK COUNTY Home Improvement Contractor License _ a This is to certify that ARTHUR J EDWARDS � �'� ✓ z ;f `" doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DDA ` having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. I� , .ra License Category °•' v4 ! NOT VALID WITHOUT Additional Businesses GC u Pools&Spas/Certified " x DEPARTMENTAL SEAL P AND A CURRENT ARTHUR J EDWARDS MASON Pools/Spas :.° e @< a CONSUMER AFFAIRS CONTRACTING CO INC DBA A ` ae ' ID CARD ARTHUR EDWARDS POOL&SPA CENTRE 4Yin< =,,; yll•i 81 -�...' w SUFFOLK COUNTY DEPT OF LABOR. \ T' .'> LICENSING 8 CONSUMER AFFAIRS Commissioner " HOME IMPROVEMENT H �,; Yoa y CONTRACTOR i Ftp Z' ! 4,P NAME ARTHUR J EDWARDSs "S NAME �^ ti � - • , This certifies that the ARTHUR J EDWARDS MASON - — ----- ----� �'� CONTRACTING CO INC DBA bearer is duly F,;; �;�marmx:r , +r'.� �,;� �:�Aisrrssszti .z cetoaas.s ��s�c rvrxs tr�sa ssu��:c�' ` ficensedb the ,I+,�� .fir,• J_ Via,-r�..;; .�;•:�l �,����=� _ a, �':< [=4436-H Date leaueA =y 't v "�» r,< ` • i�t �r v County of Suffolk 07/01/1978 4bb:. .,� eiO4°y�lbOras 'OC.•,sl4P rOApvtaf a ^°$i�i".a�lPy:;tn � '+:w1✓♦0°4,•i4A�R.•r F� Y•i�s��lAj v9vlrp;�"ir' °'9 I —1—ON DATE cemnimm�ar 07/01/2016 /4— AS -;;n- x V N g) A-4 WM R, Suffolk Co un tv E'xecutive's ve's Office of Cons am er ArTairs. VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NEST 11788 ............. 15 DATEISSUED: 5/1/80 No. 2740-NM SUFFOLK COUNTY 7-77 Master -L-lectrician License This is to certify that EDWARD S REIFF doing business as UNDERGROUND SPECIALTIES INC having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with andsubjectto the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. SUFFOLK COUNTY DEPT OF LAWR, Additional Businesses LICENSING&CONSUMER AFFAIRS MASTER ELECTRICIAN EDWARD S REIFF i J:-:==�::}-1 -0k=31 AZ-4 This certifies ftt the Tw"ranftAm GENREADY,INC.BOA x bearer Is duly licensed by the County of Suffolk D 05/01/1980 2740-ME 6XPMTM DAIX 05/01/2016 Ak� WE 31M[-75,�- W X� 4�4 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a. Legal Name and Address of Insured(use street address only) 1 b. Business Telephone Number of Insured ARTHUR J EDWARDS MASON 631-744-4455 ' CONTRACTING COMPANY INC 1c. NYS Unemployment Insurance Employer Registration 929 ROUTE 25A Number of Insured MILLER PLACE, NY 11764-2700 24-10871- 1d. Federal Employer Identification Number of Insured or Social Security Number 11-2377925 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) The Guardian Life Insurance Company of America TOWN OF SOUTHOLD 3b. Policy Number of entity listed in box"l a": ,. P.O. BOX 728 00984424-0000 SOUTHOLD, NY 11971 3c. Policy effective period: 07/01/2014 'to 07/01/2015 4. Policy Covers: a. ® All of the-employer's employees eligible under the New York Disability Benefits Law b. ❑ Only the following class.or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed: 07/01/2014 By: ltmvi W A W Stuart J.Shaw, FSA, MAAA Telephone Number: 1-888-278-4542 Title: Vice President,Group Insurance IMPORTANT: If box 4a"Is checked,and this form Is signed by the Insurance carrler's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate Is COMPLETE.Mail It directly to the certificate holder. If box"4b"Is checked,this certificate Is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law.It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit, 20 Park Street,Albany,New York 12207. PART 2. To be completed by NYS Workers'Compensation Board(Only if box"4b"of Part 1 has been checked) State Of New York Workers'Compensation Board According to information maintained by the NYS Workers' Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed: By: (Signature of NYS Workers'Compensation Board Employee) Telephone Number: Title: Please Note:Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (5/06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier.identified in box"T on this form is certifying that it is insuring the business referenced in box"1 d'for disability benefits under the-New York State Disability Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in box "2". This Certificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in box"3c': Please Note: Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY'BENEFITS LAW §220.Subd.8 (a) The head of a state or municipal department, board, commission br office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission°or office authorized or required by law to enter into any contract for or in connection with any work'involving the employment of employees in employment as defined in this article, and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribetl by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for;all employees has been secured as provided by this article. i, �f DB-120.1 (5/06) Reverse STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE C017ERAGE la.-Legal-Name and address of Insured(Use-street address only) 1b.Business Telephone-Number-of-Insured _ Arthur J Edwards Mason Contracting Company Inc. 516-250-7142 929 Rte 25A Miller Place,NY 11764 lc.NYS Unemployment Insurance Employer Registration Numberof Insured DBA:Arthur J Edwards Pool do Spa Centre Id.Federal Employer Indentitication Number of Insured or Social Security Number 112377925 Work Location of Insured(Only required if coverage is specifically limited to certain location in New York State,z.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Rochdale Insurance Company Town of Southold PO Box 1179 3b.Policy Number of entity listed In box"I a": Southold,NY 11971 RWC3319S43 3c.Policy effective period: 3/1/2014 to 3/1/2015 3d.The Proprietor,Partners or Executive Officers are: Included(Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la" for workers' compensation under the New York State Workers' Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certification of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier tivill also notify the above certificate holder within 10 days IF a policy is canceled dine to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremzums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate(These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box "3c'; whichever is earlier. -Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certifecate-holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury,ury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved By: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance carrier) f Alex— Approved Approved By: y +�% 2/24/2014 (Signature) (Date) Title- Underwriting Manager Telephone Number of authorized representative or licensed agent ofinsurance carrier.CarrierPhone Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form.Insurance brokers are NOT authorized to issue it. C-105.2(9-07) Workers' Compensation Lags, Section 57.Restriction on issue of permits and the entering contracts unless compensation is secured. 1. The head of a state or municipal department,board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however, shall be construed as creating any liability on the part of such state or municipal department, board;commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse ARTHU-1 OP ID:VM CERTIFICATE OF LIABILITY INSURANCE D0111512014Y) 01!15/2014 .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 ISSUINGINSURER(S), AUTHORIZED -- REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(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 Bagatta Associates,Inc. NAME, NE 823 W Jericho Turnpike Ste 1 A AIPHcONo Ext• 121Z,No Smithtown,NY 11787 E-MAILs Bagatta Associates,Inc. INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER A:Worcester Insurance Company 26182 INSURED Arthur J.Edwards Mason INSURER Contracting Co Inc.dba — Arthur J.Edwards Pool& INSURER C. Spa Center ' INSURER D. 929 Route 25A Miller Place,NY 11764 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SU13H POLICY EFF P ICY XP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDhTM (MMIDDIYYYYJ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGETURE=T A X COMMERCIAL GENERAL LIABILITY MPAOD000038BOlH 01/01/2014 01/01/2015 PREMISES Ea occurrence $ 100,00 CLAIMS-MADE FX_1 OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 X BLANKET ADDITIONA GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY JEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS PER ACCIDENT $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WG STATU- OTH- AND EMPLOYERS'LIABILITY YIN R I T ANY PROPRIETORIPARTNERIEXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? H NIA (Mandatory in If yes,describe under EL DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY''MIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION 0000000 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. Town Hall P.O.BOX 728 AUrHORIZED REPRESENTATIVE Southold,NY 11971 Oo 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD SURVEY OF LOT 146 a �a, �r.0 .- MAP OF CEDAR BEACH PARK FILE No. 90 FILED DECEMBER 20, 1927 . SITUATE rt BAYVIEW TOWN OF SOU THOLD FOLK COUNTY, NEW YORK S.C. TAX No. 1000-90-02-2 SEPTIC SYSTEM TIE MEASUREMENTS n, (USF SCALE '1 7�=30' HOUSE HOUSE S p�e�F<Ci MAY 6, .20 05 CORNER QA CORNER BO \ 2S : �c NG JUNE 22, 2005 ADDED SITE PLAN y 'QQ'. 125 14,G' OCTOBER 18, 2005 REVISED WETLAND NOTE.. SEPTIC. TANK 36, 14' 9 x ePRJ NOVEMBER 10 2005 REVISED SITE LAN COVER 2�' NOVEMBER 13, 2007 LATH OUT BUFFER LINE LEACHING POOL39, 27; O( AUGUST 4, 2009 LATH SET FOR SITE INSPECTION COVER 1 . : (/�� JUNE 5, 2012 UPDATE DATUM & FLOOD ZONES LEACHING POOL �2J x 9��C FEBRUARY 7, 2013, 2012 REVISE HOUSE LOCATION COVER 2 25'. 28' '' 3�" �qTF FEBRUARY 27, 2013 2012 REVISE PER SCDHS NOTICE 02/19/2013 E R /�' MMAY X14 6, 2013, 2012 ADD 20 3 FOUNDATION LOCATIONS ` STR 3�JwTFST �,39, FET) OCTOBER 3, 2013 FINAL SURVEY . AREA = 25,868 .sq. ft. , ^ <v / 4.• F (TO TIE LINE) 0.594 ac. Q)�. O CERTIFIED: 2 0 KEVIN McDERMOTT rj va p FATEMA MEAH 00 ?o p J.P. MORGAN CHASE BANK \� C\4 TEST STEWARDT TITLE R INSURANCE LtdCOMPANY �4T e:. 2 3Q a x O w w 6 FFc F H USF s, TES: �/ '� ArFR U� J w NO1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM 34�Co ..4 O O 49? ^ry• EXISTING SPOT ELEVATIONS ARE SHOWN THUS: 1120 J w ? EXISTING CONTOUR LINES ARE SHOWN THUS: —— —7= = — Q / ��o m o 2. FLOOD ZONE INFORMATION TAKEN FROM: (� �� o r/ FLOOD INSURANCE RATE MAP No. 36103COl69H . ZONE AE: BASE FLOOD ELEVATIONS DETERMINED ZONE X': AREAS OF 0.2% ANNUAL CHANCE FLOOD; AREAS OF 1% ANNUAL 0- 0 CHANCE FLOOD WITH AVERAGE DEPTHS OF LESS THAN 1 FOOT `oaCi OR WITH DRAINAGE AREAS LESS THAN 1 SQUARE MILE; 3� �3Q 4p' AND AREAS PROTECTED BY LEVEES FROM 1% ANNUAL CHANCE FLOOD. 9:5° T ° O N p I ? .00 Ileo.��� ` 1 0 O 41�Q£ THE NYS FRESHWATER Q p�V2� ♦ (F( SUFFOLK ERRONMENTAL CONSULTING IS EQUAL DRAINAGE INSPECTIONS ARE REQUIRED B) R�THE SURVEY PREPAR ULTING, ►nc. L To 765-1560 before J U Sr y{�` ` ED 6/22/05 AS DSD BY JOSEPH A. (NINE AS SHOWN Contact TOS Engineering at 3 = AKe 1 \ 4s ERMINED BY R. MARSH NON 9 28/05 Backfill,OR Provide Engineer's CertlfiCatiorr �� that the drainage has been imtaAed t�Codi, oN �7 . 1 S F NON_ S r fs 43'S� �V ` ` NON`DERSLU/p ZAT OtV NCE 8 25,, EROSION t'<SEDIMC!"IrT COPW'iF.4ls `� A' Shall include but not be limited to: 01 L rs�•S \ `9' A well maintained Construction Entrance, A Q PREPARED IN ACCORDANCE WITH THE MINIMUM A� X 45 v>6 pq� �J SS Wire Backed Silt Fencing,stabilization & STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED �y ACgNj �ZD Seeding Of expose TITLE ASSOCIATION. d and/or inactive soils. FOR SUCH USE BY THE EW—Y© STATE LAND O y OF ` S�' �•9 .c•� �C�. r p APPROVAL OF STORMt9dATER MANAGEMENT j' ERT CONTROL LA ' atn Code 2" � Approve by: i, . 7 t] M SU N.Y.S. Lic. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 72LA OF THE NEW YORK STATE ������ ��� Corwin ®r�'� "' EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR �� Surveyor EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY, CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE Successor To: Stanle J. Isaksen, Jr. L.S. TITLE COMPANY, GOVERNMENTAL AGENCY AND Y LENDING INSTITUTION LISTED HEREON, AND Joseph A. Ingegno L.S. TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. TQIe Surveys — Subdivisions — Site Plans — Construction'La out TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. Y y PHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 8 7 6 5 4 3 2 , H H 32' 24' y Z Z Z Z Z Z Z Z Z Z c N N F N� N F N N 16' N N E 14' 6' 4' E N N 26' N ro N ,L ° tib 2 2 2 2 2 2 2 2 2 2 D N p�Cyp� 1VGvt7 cu cu N N 10' APPROVED AS NOTED ca N N DATE: B.P.# — 7 1 FEE: BY: ea 2 2 -NOTIFY BUILDING DEPARTMENT AT B 765-1802 8 AM TO 4 PM FOR THE �,� S��®�1P�' B 8, FOLLOWING INSPECTIONS: -I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE Arthur Edwards Pools A 2. ROUGH - FRAMING & PLUMBING 18x36 Rectangle A 3. INSULATION _ P+62 B 1 7 1 6 1 4. FINALT- CONS&TR L I JUN NI 2 1 , BE COMPLE I -- — — -- ALL C—eNSTRUCTION SHALL--MEET THE _ F ENTS OF THE CODES OF NEW A— YORK STATE. NOT RESPO ru B— NOR CONSTRUCTION ERRORS. Skimmmn Ra4+rna ' p4D /Aluminum B B To F7tar Flom Fltte �(Flitar @Pump To Wo9tn- -To Rehima (Dry Wail Dpunoo RoOad Wall F Plan A Piping Arrangement Wdl sea" vw Li- µRebar KVO- OF N 42"Y cj-y® 101 Section B—B r son3500 PSL.Coney to H � � 10" FpA No, 04359 Section A—A Typical Wall Section SSlO���` NOTES 1) THIS IS A TYPE II POOL DEPTH AND SHAPE OFMM 'IV we POOL MEETS MINIMUM STANDARDS OF THE ��,��" INTERNATIONAL RESIDENTAL CODE 2010 :wss44`f(a6f�ar66e/a�� AG 103 1(ANSM SPI-5 2010)AND BOCA 2010 FOR POOL&SPA CENM RESIDENTAL USE WITH DIVING BOARD,AND APPENDIX G OF NYS RESIDENTAL CODE PERMACRETE WALL SYSTEM city I 3teta ' 2) MAXIMUM DIVING BOARD LENGTH IS 8' 929 Route 25A Miller Place NY 11764 (631) 744-7185 FAX (631) 744-0174 ( ' ) I 3) "NO DIVING"LABELS MUST BE INSTALLED Suffolk License #4436—HI AROUND SHALLOW END OF POOL - -- Nassau License #HI74450000