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HomeMy WebLinkAbout42513-Z �p�UFF�I'�c Town of Southold 6/18/2019 P.O.Box 1179 a co 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40451 Date: 6/18/2019 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 4225 Stanley Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-8-66 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/22/2018 pursuant to which Building Permit No. 42513 dated 4/2/2018 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 The certificate is issued to Koch, Gregg of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42513 06-11-2018 PLUMBERS CERTIFICATION DATED AA ' ed Signature SVFencK TOWN OF SOUTHOLD BUILDING DEPARTMENT o 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#: 42513 Date: 4/2/2018 Permission is hereby granted to: Koch, Gregg 4225 Stanley Rd Mattituck, NY 11952 To: construct accessory in-ground swimming pool as applied for. At premises located at: 4225 Stanley Rd, Mattituck SCTM # 473889 Sec/Block/Lot# 106.-8-66 Pursuant to application dated 3/22/2018 and approved by the Building Inspector. To expire on 10/2/2019. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Bui ' g nspector 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. 7, 1-2, � New Construction: Old or Pre-existing Building: (check one) Location of Property: 412,,:5 `��G, ,,�e R� ��G �. ,` C/ House No. Street Hamlet Owner or Owners of Property: &f e S G Suffolk County Tax Map No 1000, Section t o& Block Lot Subdivision 1 z pk ki a4- zfxci 04'&,o es Filed Map. B I -7 0 Lot: Z Permit No. Z5 3 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature CONSENT TO INSPECTION Y" �!/�a , the undersigned, do(es)hereby state: Owner(s)Name(s) That the undersigned(is) (are) the owner(s) of tl-w premises in the Town of Southold, located at LJ-7 L S-�o,r,e L— A— G W 4,,c , which is shown and designated on the Suffolk County Tax Map as District 1000, Section /C% -, Block ' 'S , Lot CL That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: That the undersigned do(es) hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon, to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances, rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: / 2 -PIZ, (Signature) CYe a► jz",r"A (Print Name) (Signature) (Print Name) pF SOUTh®l Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 G �Q roger.richert(cD-town.southoId.ny.us Southold,NY 11971-0959 '®lyc®U BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Gregg Koch Address: 4225 Stanley Road city,Mattituck st: New York zip: 11952 Budding Permit#: 42513 Section: 106 Block: 8 Lot: 66 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electric License No: 40557-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel 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 FixtureTime Clocks 1 Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: Inground Swimming Pool to Include: Bonding, Control Panel, 1- Pool Pump, Salt Generator, 1- Pool Light, 1- GFCI Circuit Breaker. Notes: R Inspector Signature: Date: June 11, 2018 0-Cert Electrical Compliance Form.xls OF SOUIyo� TOWN OF SOUTHOLD BUILDING DEPT. °`ycourm N�' 765-1802 INSPECTION, [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION, [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) 1/" ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE �1 j INSPECTOR z ��pE SOpT�o # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ rSLATUON FRAMING /STRAPPING [ NAL Fgds [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL'(FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: n . -0 -V;rr CAKDATE fejllhkM0 INSPECTOR - a FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) y ------------------------------------ FOUNDATION (2ND) M z o 4 � ROUGH FRAMING& PLUMBING H INSULATION PER,N.Y-. STATE ENERGY CODE FINAL ADDITIONAL COMMENTS to I t z , mm zar NJr� � o z d b H TOWN OF SO°UTHOLD BUILDING PERMIT APPLICATION CHECKLIST y 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 Permit Examined ,20� Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved ,20 Mail to: Disapproved N Phone: Expiration ,2 din Ins for o � D g MAR 2 2 201 APPLICATION FOR BUILDING PERMIT O 1 OHrpt Date , 201 BMD'SoUMOLID INSTRUCTIONS ,ro'WN 01 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. i 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 regula ' ,and to adm' authorized inspectors on premises and in building for necessary inspections. ®� (Signature of applicant or name,if a corporation) 11-22-5 0 &- (Mailing ad ress of applicant) State whether applicant is wne , lessee, agent, architect, engineer, general contractor, electrician,plumber or builder C>— Name of owner of premises C..." � � �► (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 done: G y 7-7, 5 <54 , � I�� 0J a House Number Street Hamlet County Tax Map No. 1000 Section Block I�K Lot Sub jlivisiom Fte, s r,,f- moo, 44"/6 Filed Map No. D '3 -7 O Lot 1 Z 2. State existing use and occupancy of pre ses and intended use and occupancy of proposed construction: a. Existing use and occupancy e-): b. Intended use and occupancy_1 r-­, 3. Nature of work(check which applicable): New Building----? Addition Alteration Repair Removal Demolition Other Work 5 t 0a d (Docrip ion) 4. Estimated Cost 0, Fee �®G (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear 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 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded?YES NO XWill excess fill be removed from premises?YES K NO woIA, 4/6L- 14.Names of Owner of premises 6✓�[Lco!n Address 2zS J 1 0 1. Phone No. i Jr ''Z 7b Name of Architect a v�.,.P� ���]/ l� Address aJA A�_41J,',l•do- No Zg x-711 6 Name of Contractor_ 0 L.1.w. Voo l Address f/o' Ve-4 4— Phone No._ rs-S--1 (/ �• d $rn•r,, 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 �S * 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. s 18. Are there any covenants and restrictions with respect to this property? *YES ,"/ NO * IF YES,PROVIDE A COPY. i 7 STATE OF NEW YORK) SS: COUNTY OF ) cp-e�) /SCG being duly sworn,deposes and says that(s)he is the applicant d (Name of individual signing contract) above named, (S)He is the Ot'.—Vt -e r (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 wijkbe performed in the manner set forth in the application filed therewith. Sworn to before me this day of 20 - GREGORY PIN PYX NOTARY PUBLIC,STATE 01,tyE Y, N ary Pu is NO.01-PI Signature of Applicant QUALIFIED IN SUFFOLK COUNTY Y MY COMMISSION EXPIRES APFUL 14,20j? BUILDING DEPARTMENT-Electrical Inspector a TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 oy�• a�� Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX(631) 765-9502 roger.richerttown.southold.ny.us APPLICATION-FOR ELECTRICAL INSPECTION REQUESTED BY: V,w r_ , a-�, �c?�IS-- _ - -- Date:: Z - Company Name: - � f[-r-c,4---, Com" Gc - '_''-- - - - _Name: -e>� _ -_- -_� (c mo --- -- - _ _- - License No.: '7 o_ �I_ _ email: - - - Address: -- -- + -�-7 L ; n c d l,., - Phone No.: Co I- 7.5-0 — 6 SSS JOB SITE INFORMATION: (All Information Required) Name:Address: LI-z z5 �.,o_l- - - (Z �_- S 14i i�k - - - Cross Street: _ ,, L Phone No.: - (� l — 0 S -�z�8' - BIdg.Permit#: - Z 5 _ _ --email: - - - — - Tax-Map District: 1000 Section: a G Block:__ ___ _ Lot:, (o-b BRIEF DESCRIPTION OF WORK(Please Print Clearly) c Circle All That Apply: Is job ready for inspection?: YES /kW)-) Rough In Final Do you need a Temp Certificate?: YES NO Issued On . Temp Information: (All information required) Service Size 1 Ph 3 Ph Size:- _ - A # Meters__ Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected -Underground - Overhead #-Underground Laterals _1 2 H Frame Pole Work done-on Service?_ Y N___ _ Additional Information: --- - - - ---- --- - - -- - -- - - - -- PAYMENT DUE WITH APPLICATION - - f� & 3 a� 62-Request for Inspecdon Form As 4�'14 7K Al soUryof Town Hall Annex 54375 Main Road Telephone(631)765-1802 P.O.Box 1179 G (631)765-0.1;()9 Southold,NSC 119714959roger.richerif 'o`wn.soutllotl nv us BUILDING DEPARTMENT TOWN OF SOUTHOI.D APED„ICATION FOR ELECTRICAL INSPE:CTiON tEQUESTED BY: 4�/� pe/� llrc�©� Date: ,ompany Name: :a �Q J o L, �57i, iUi ' v� Jame: .!cense No.: kddress: c o, r Am e, - o reo N. ) 174- 'hone No.: �4 �'" "? (0D �j IOBSITE INFORMATION: (*Indicates required information) Name: h �e JUS 7 2010 Address: BUILDING DEPT. "Cross Street: C\L t TO- O�OLD Mahone No.: a1 `j y 3� WN ''ermit No.: ��5�� -- ax-Map District: 1000 Section: Iulo Block: Lot: 13RILF DESCRIPTION OF WORK (Please Print Clearly) T>001 wl* F'Iease Circle All That Apply) Is Job ready for inspection: NO Rough In F�ina�l DO you need a Temp Certificate: YESN 'emp Information (if needed) Service Size: 1 Phase 3Phase 100 150 200 3003 5 50 400 04r_l dew Seivice: Re-connect Underground Number of Meters Change of Service Overhead .dditionai Information: PAYME T DUE WITH APPLICATION CCAS 82=Request for Inspection Form STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW ART 1.To be completed by Disab7ity Benefits Carrier or Licensed Insurance Agent of that Carrier I&Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number Of DUNRITE MANUFACTURINGCORP Insured 3510 VETERANS MEML HGHWY lc.NYS Unemployment Insurance BOHEMIA,NY 11716 Employer Registration Number of Insured Work Location Of Insured(Only required If coverage Is specifically limited To certain locations In y New York State,i.e.,a Wrap-Up Policy) Id-Federal Employer Identification Number of Insured or Social Security Number 11-2245133 2.Name and Address of the Entity Requesting Proof 3a.Name of Insurance Carrier of Coverage(Entity Being Listed as the Certificate Holder) WESCO INSURANCE Town of Southold COMPANY 54375 Main Street Southold,NY 11971 3b.Policy Number of entity listed in box .la.": 0403697 3c.Policy effective period: 1/18/2017 to 12/31/2018 4.Policy covers: a. 0 All of the employer's employees eligible under the New York Disability Benefits Law b. 0 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 1/18/2017 By (Signature of insurance carver's authorized representative or NYS Licensed Insurance Agent of that insurance camer) Telephone Number 800-535-2711 Title Vice President IMPORTANT: If box"4a"is checked,and this form is signed by the insurance carrier'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,328 State Street,Schenectady, NY 12305. 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 carvers 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(9-15) STATE OFNEW YORK VORIER'S COMPENSATION BOARD CERTIFICATE OF NYS WORKERS'COMPENSATION INSURANCE COVERAGE la.Legal Name andaddnss ofImmed([he sheet address o*) lb.Business 11cb:phone NumberefImmed Dunnte Mfg Group 516-543-1616 3510 Veterans Memorial Highway Bohemia,NY 11716 le.NYS Unemployment Insurance Employer Registration Number of lmured ld Federal Ek*yerindentifientlan Number of Insured Work Location of Insured(Only inquired coverage isspecrfically 17m lied to or Social Seen*Number certain location in New York State,r e.a Wrap-Up Policy) 112245133 2.Name and Address ofthe Entity ReguestingPaeofofCoverage 3a.Name ofimurance(:artier (EniityBeing Listed as the Certificate Holder) AmTmstInsurance Company ofKansas,Inc. Town of Southold 54375 Main Street 3b.Policy Number of entity listed in boa"la": Building Department KWC 1106427 Southold,NY 11971 3c.Policy effective period: 10/20/2017 to 10/20/2018 3d The Paoprieto;Partners orExecudve Officers an: 1J Included(Only check box ifall partners/officers included) ®afi excluded or certain partners/officers eaehrded This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"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"2'. Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? Yes Cl No L�J' - This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage'afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. 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 certificate 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,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 tamer) Approved By / 10/16/2017 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier.CamerPhone Please Note Only insurance comers and theirlicenred agents ore authonzed to issue the C-IO.Uform Jnsuronce brokers air NOT milhonzed to issue rt C-105.2(945) 77 IM- ;, ,� .. ~;.si;.:�.. i;t.,t,,±r,y .., "- }��rs ±ri;.r-'� •;�.w. ,'^�>t[i4t ,vfr.Ls .�cX �,t, ,.:Y� a2s. !�'2 �5+�' x.' -.. t , 't,,,,. .:...r, ���a'C'iK.�i,•�.;4,s � ..", rg�"�'�,".',,-Azy „-., v.,f •av:.�?*' 't,.. .. y,-; ^,,.: >C�c,..:SYyt^„•L. ,,,j✓ „,�. K �,..-._a.n fi '�i',7X.. t��� ,:F:'., :�l�:t�, .s..•.• --•: '="�7✓:aK, ,.- vl'- QR # �, t.' Y r ..-..x4 **"vyy�,�„ '.•. �.�arF'S:""<t(. pf ��X _ .� 3 ,,,.. a. 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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 have ADDITIONAL INSURED provisions or 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 845-783-2555 CONTACT Walter Rose Agency Inc Walter Rose Agency,Inc PHONE 845-783-2555 FAX 845-783-2425 8 Stage Road (A/C,No,Ext): (A/C,No): Monroe,NY 10950 E-MAIL .lisa@walterroseagency,com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Central Mutual Insurance Co 20230 INSURED Dunrite Manufacturing Corp INSURER B: Dunrite pools 3510 Veterans Memorial Highway INSURERC: Bohemia,NY 11716 INSURER D INSURER E: INSURER F: E CERTIFICATE NUMB R: 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 iKiqn SUB nl POLICY NUMBER POLICY EFF PO ICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE CLAIMS-MADE OCCURX CLP 9791864 04/01/2017 04/01/2018 DAMAGETISESORENTEDPRE occurrence) $ 100,000 ED EXP(Any one ersa 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000 POLICY❑X PRCT F0 LOC PRODUCTS-COMP/OP AGG 29000,000 OTHER AUTOMOBILE LIABILITY adiCO(EaMBINED nt,SINGLE LIMIT $ ANY AUTO BODILY INJURY Per arson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per.c%ent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$_ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STA ITI PR ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT OFFICER/MEMBE��EXCLUDED? N/A (Mandatory in NH) EL DISEASE-EAEMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMA �FSCRIe14QN,QF�pFRATLON$LLD�R►TLq�S1VEHI�I.ESIAG¢R�(Q7 pdpttiQgaLRerksCedr[RlCaytbe attached If nigre esuperceaeSPaceisrequired) previously issued Certificate. IUIV SCFLVICiC hL tttF'AIR IT ERTIFICATE HOLDER CANCELLATIQN EASTR-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of East Rockaway ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 376 Atlantic Avenue AUTHORIZED REPRESENTATIVE East Rockaway,NY 11518 6�4-1� ACORD 25(2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SURVEY OF _— LOT 12 OF THE FIELDSAAT MATTITUCK jail AUG 25 2015 I"JI SSE FILE No. 113 CH 31, 2006 SITUATE I=—_ J MATTITUCK 9 R S TOWN OF SOUTHOLD �!?s'Og" £ SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-106-08-66 SCALE 1"=30' o SEPTEMBER 26, 2014 JUNE 16, 2015 FINAL SURVEY � AREA = 51,735 sq, ft. [y j �,. LP 1.188 ac. 4�OQ' 8UFF0_K C. Atp qq l :�)•:._�'_T°-YLALTI,gchVlCC ` R•qB °Tpr`t' `� t^ •�tnti1.�YRcS•OcNCc ��4 / \ o $0 D SOH Z ..�Ir-�.w H:'D.•::,.;,,•:..,.-".I -••�'r Ezc.`:Iws:•f:_.-�:Y,. `e.E• AT N FOR A htF ,rI C_'-^^-Tta::.:,•aY-FL:z.ar�,.!bc� �.,7 ( A- �9 �" \ G c� �XL`JAtrv�_L°I '00Ms. 1NB4eTJ.tt115D,-I,P.-•, - ���� hoc• 'r � .S \ � ter�1ar18 ,�'( •�� Rc 5 meth caf -3 x �1'Vt 1V CaSg�O• OO 4 wo s7• 95 i\�/ � qA��. r � 77 ��F �tie 4`rPPPG m'a• \ v � o 11, � V 3 el yxv o. x g0 h 4 If- .00 • i3�o 00 \ O R� +O L.240.27• �o iwl SEPTIC SYSTEM TIE MEASUREMENTS O \ HOUSE HOUSE HOUSE \ O 00 CORNER QA CORNER 08 CORNEREE] / `Po. SEPTIC TANK 13.5. --- 23.5' COVER 1 STAND DSIN AC FORTITLESURVES AS ESTABLISHED COVERE WITH THE MINIMUM IN2 POOL 21• 23.5 ___ h BY THE LIALS AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCV\TION 0 rrF ?�� �y0 ogrtEP P .-. c4J�tO`off' , S 77-1 59 �AS�w���4 0� pEi 7 �A =��"t NYS Lic No 50467 TO THIS IZEDSURVEY ALIS A nONVIOLATION TI ADDITION I THIS SUMEY LS A VNEW ION OF SECIIDN 7109 OF TME NEW IRK STATE FNathan Taft Corwin III EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor THE SSEAND SEAL SHALL INKED SEAL SI EMBOSSED SEAL SMALL NOT BE CONSIDERED TO BE A VALID TRUE COPY CERTInCATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY Successor To StanleyJ Isaksen,Jr-LS 15 PREPARED,AND ON HIS BEHALF TO THE Joseph A In a no L 5 TITLE COMPANY,GOVERNMENTAL AGENCY AND P 9 9 LENDING INSTITUTION LISTED HEREON,AND Title Surveys—Subdrwsions — Site Plans — Construction Layout TO THE ASSIGNEES OF THE LENDING INSTI— TUIION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE(631)727-2090 Fax (631)727-1727 OFFICES LOCATED AF MAILING ADDRESS THE EXISTENCE OF RIGHTS OF WAY ! 1586 Main Road P 0 Box 16 AND/OR EASEMENTS OF RECORD,IF Jomesport,New York 11947 Jomesporl,New York 11947 ANY,NOT SHOWN ARE NOT GUARANTEED 34-160B • I i� - R 5 . aaaesz:v.air t9/L ; 2' PVC �f I Main L I Complies With: , i -Drains 2017 NYS Uniform Code Supplement Sec 8326 IDJb6l6•'� �'�"' FILTER ' SPAM.w ac 8326.3.3 in Ground Pools Shall Be In Conformance with ANSI/NSPI-5 CONGR=OR WOOD DECK uP m t I coPM or O7�,L� _ _ R326.5 Barrier requirements:Temp Fence must be installed at time of 1 S OPM 4WA7 FROM POOL PAWL 4WM? M WPM. Pool construction,and Permanent fencing is the homeowners responsibility 6RFFMOt MEMO) - _ Lord■,m.AWAR oe 8326.6 Entrapment Protection Installed r LONG WEIR P.ALUMem COA7MG Id TT8326.7 Swimming Pool and Spa Alarms must be installed 141 ° ».a wNYL UHM 2015 IECC PUMP 611ML WALL PACT Sec R 403.10.2 Time switches or other control methods that can run MOTOR Automatically tum off and on according toa preset schedule shall be I i 6TIM AN= �re a.,r BOL*W+ ■1 WA's' Installed for heaters and pump motors. Heater;and pump motors that - Owve ETAM Have built in time switches shall be in compliance with Sec R 403.10 2 3 CLL Fr.O1°'�WTM� • - 1 - SUCTIONS BE ° Y TFEGK WA91aED aarro PAID Ste eorrOM ! , are•wETMPatclrwo Fac l i C • - lu= , �uN. Io��1 _�,l� - � Tom` • _n 5 I r� �•_�- - 1 m'LONG Swm Famr-0RCM°R= ;�a S�• - - {� 18ID■TW9ED EAFLIN� = wo W1016w"10 U&IM TFIRONGN i-�• ,.� i jln �II =I MOM W OVITOM OF PAM .• -u 1 ur�1u gaui� 1_ DIV_ INCA HOARD u 1-WBum I'r- MM ZE A B •C D E F - 0 H K L N i• R1 R2 113 R5 GALLONS j 18x34-• 21'Y 33' T-r 8'-0" r-.ri" 14'-0" 0=0" N-0" 4'-Q" 1-41" 4'-9 8'-4"` 8'-0" $'•0" 5°-0" 22000 I � i ■ t w ■ ■ ■ F 1 1 1 n ■ 7• w / 1 18x40 23 6 40.5" 3.4 Ir-0 16-5 14.0 6.0' 4-0°. 4-0 IW-r, 4- 9.0 .9'-0 9'•0 5'-0 28000 �� F NEW W y0 ` �. t w ■ 8'-r e e n t w �- ti ■ w ■ ■ Q D 211143 20 10 43.4• 3.4 8.0 W- , 14.0. 6-� 4-0" 4-0":• 11•-1F 4 0;-10'-0 10.0 10.0 6.0 34000 - .�5 fro �r 14x20' 18'0' 28'•0` 3'•4■• 5'-0" 11'•6' 8'-0" :5'-Ol" 2'-611 :'-6n '0=4" 2'-64 7=0", T•0" T-0"1 'T•0" ' 17500 _ `rte > $ 1-ic-11 L--I-M-1 ■ w ■ 1` a «F' E r r . `t V r 3=0ry 6'-6" 5'-0" T4" 5'•0" 15x27 1T'•8 2T•0 3.4 S-0 10x6' t0'�0 4.•pt •3.��:_.,�,-Q"' 8�0 . ;�;.+�� • Dunritt Pools,Inc ' 'OR3S101/eterans Memorial Highway OFESS�� P j Bohemia New York 11718 POOL TYPE:ASPEN REV. SCALE: • NTS i JAMES DEERKOSKI,P.E: DATE: ; 260 DEER DRIVE ! MATTITUK,NEW YORK 11952 DRAWING NUMBER I i 1 ja. _ A , VED AS NOTED D4TI5 B.P.# oCJ� FEE:= BY: ELECTRICAL 'NOTIFY,BUILDING DEPARTMENT ,AT INSPECTION REQUIRED 7654802 8 AM TO 4 PM FOR THE FOLLOWING-INSPECTIONS: - 1'. FOUNDATION TWO REQUIRED FOR POURED CONCRETE - ' 2. ROUGH- FRAMING & PLUMBING 3. INSULATION , T SLY" 4. FINAL - CONSTRUCTION MUST _ ENCL'OSE POOL TO CODE BE COMPLETE FOR C.O. "UPON,COM,PLETION ALL CONSTRUCTION SHALL MEET THE BEEQRE VATER a REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES RETAIN STORM WATER RUNOFF AS REQUIRED AND CONDITIONS OF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. �7t�btBi�tl�BA—� OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY I i i SURVEY OF LOT 12 MAP OF THE FIELDS AT MATTITUCK � FILE No. 11370 FILED MARCH 31 , 2006 SITUATE MATTITUCK �AS�7P� h'�IFS I � O TOWN OF SOUTHOLD � 4A11:4 h:4''4 SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000- 106-08-66 S ��•2S, \� SCALE 1 "=30' E k SEPTEMBER 26, 2014 11 l y 3 20' AREA = 51 ,735 sq. ft. / `�► 1 .188 ac. / 0 c: Uj / \\ SII Tn C:I 40 40 `Y �, ?� iLro? r ev - in 0. ,s } cp 5 � �/ ti� SOP `V,J i ` � f •� { oti ^� o• <v s• � h a p • �,N `ice yf �y ,� c� •ry� J 0 0 eeio°� rlb a/J L=240.27' \ u Joe ON u 010,PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED 5 \ FOR SUCH USE BY THE NEW YORK STATE LAND \ —r' s TITLE ASSOCIATION--.-,,,-. ! ,tr;t a 61) '.,::y.`` _....,-•"'';rd``-' N.Y.S. Lic. No. 50467 UNAUTHORIZED ALTERATION OR ADDITION / TO THIS SURVEY IS A VIOLATION OF Nathan T of t Corwin III LA SECTION 72OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY Successor To: Stanley J. Isaksen, Jr. L.S. IS PREPARED, AND ON HIS BEHALF TO THE Joseph A. Ingegno L.S. LENDING TLE ^INSTITUTIONELISTIEDTHEREON, AND AL AGENCY ND Title Surveys — Subdivisions — Site Plans — Construction La out TO THE ASSIINSTI- GNEES OF THE LENDING NSFER Loyout CERTIFICATIONS ARE NOT TRANSFERABLE. PHONE (631)727-2090 Fax (631)727-1727 OFFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16 ANY/NOT SHOWN ARE NOT GUARANTEED. .Inm--f NIPw Ynrk 11447 Jamesoort. New York 11947