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HomeMy WebLinkAbout43544-Z CF04rO� Town of Southold 12/13/2019 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40928 Date: 12/13/2019 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 7635 Main Bayview Rd, Southold SCTM#: 473889 Sec/Block/Lot: 78.-9-30.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/4/2019 pursuant to which Building Permit No. 43544 dated 3/11/2019 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 McGowan,Andrew&Terry,Mary of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43544 05-22-2019 PLUMBERS CERTIFICATION DATED t Signature TOWN OF SOUTHOLD �SUFFock�o BUILDING DEPARTMENT ��0 Gym CA 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#: 43544 Date: 3/11/2019 Permission is hereby granted to: McGowan, Andrew & Terry, Mary 7635 Main Bayview Rd PO BOX 1205 Southold, NY 11971 To: construct an in-ground swimming pool as applied for. At premises located at: 7635 Main Bayview Rd, Southold SCTM # 473889 Sec/Block/Lot# 78.-9-30.1 Pursuant to application dated 3/4/2019 and approved by the Building Inspector. To expire on 9/9/2020. Fees: IN-GROUND SWIMMING POOL $250.00 WIMMING P OL $50.00 T tal: $300.00 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$15.00 Date. 3k 1�I 119 /1"New Construction: Old or Pre-existing Building: ��p (check one) Location of Property: �7 v35 ���^ v V F–cx• SG` So u� House No. Street Hamlet Owner or Owners of Property: _ H C �O Suffolk County Tax Map No 1000,Section U Block Q O Lot 3 O 6 G Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted:$ 5—b _. ipplic t Signa ue pr SO(/��®l Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-0959 ® y® roger.richert(W-town.Southold.ny.us Cou ' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To* McGowan/Terry Address: 7635 Main Bayview Rd City: Southold St: New York Zip: 11971 Building Permit#: 43544 Section. 7$ Block. 9 Lot 30.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA- Quinlan Electric License No: 4437-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New X 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 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 Fixtures Time Clocks Disconnect Switches 1 Twist Lock Exit Fixtures 11 TVSS Other Equipment In ground swimming pool to include, bonding, control panel, 2-GFCI circuit breakel 1-switch,salt generator,1-pool light,pool heat pump, 1-pool filter pump Notes: Inspector Signature: Date: May 22 2019 81-Cert Electrical Compliance Form.xls �O,*OF SOUTyolo # TOWN OF SOUTHOLD BUILDING DEPT. �ycourm, 765-1802 INSPECTION. [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ��,4 [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE 'S �v / INSPECTO _ lc LlOE 50UTyo S l # # TOWN OF SOUTHOLD BUILDING DEPT. �o • ,o Cour, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ �]' FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: Atn Coo e �� f �er or r/ f cooyl /03-rp Aj�am �-1 /P) PeACCIE ena i� DATE . d INSPECTOR * # TOWN OF SOUTHOLD BUILDING DEPT. Comm 765-1802 INSPECTION . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ SULA ION [ ] FRAMING /STRAPPING [ ] FINAL fOt-"" [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY,INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE INSPECTOR FIELD INSPECTKN PORT DATE COMMENTS �tS FOUNDATION (1ST) , ................... ----------------- 'FOUNDATION (2ND) cin ROUGH FRAMING& PLUMBING y • 1 INSULATION PER N.Y; , 3 STATE ENERGY CODE FINAL ADDITIONAL CO NTS qbto O 3- t z C� C, -9 0 1 _ ,H 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 Permit Examined ,20 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved `_,20 'Mail to: Disapproved a/c ( ,Phone. Z) �" b cl Expiration 120 D ector �flAR - 4 2019 APPLICATION FOR BUILDING PERMIT ^3 Date `� 520 1 °'�.x INSTRUCTIONS TOWN OF SOON 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 Bui'l'ding 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 Tor 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) o .(3cx [2 d S N 1 I et—1 1 - (Mailing,address of applic nt) State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder JCL�i MrM� KC Poe"( Name of owner of premises A l HC (T-c w�►�- � �```�� / err y� (As on the tax roll or latest_ deed) If applic a co or do ignature of duly authorized officer (Name and.title of corporate officer) Builders License No. 2 a 2 t`( Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: (e 3 S H ci,,1 V 1 z.,_-D House Number Street Hamlet 1 County Tax Map No. 1000 Section Block Lot 1 y. I Subdivision Filed Map No. Lot f i 2. State existing use'and occupancy of premi s and intended use and occupancy of proposed construction: a. Existing use and occupancy eS c� �, c b. Intended use and occupancy_ t 5' 1 Z Gc. �c it r Ac, �G S.eCli — 3. Nature of work(check which applicable): New Building Addition Alteration j Repair Removal Demolition Other Work S«„�,., ,`gn � (D@kiipti6nT 4. Estimated Cost 2 125z> Fee i (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 a 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. ' I ' 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height Number of Stories tilt l 8. Dimensions of entire new construction: Front Rea r_ V ! Depth Height Number of Stories 9. Size of lot: Front GS Rear 0 `� Depth 21 ' y 10. Date of Purchase Name of Former Owner e 11. Zone or use district in which,premises are situated /Z L-( 6 j 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO V Will excess fill be removed from premises?YESy NO 47- f34.1 14. Names of Owner of premises_ &.je.,,r w j Clr`/ Address S��t��r� Phone No.G31 Y 13 7EGG Name of Architect Tom—Address Phone No Name of Contractor �c� �f c S Address 4�1 Phone No. 3 18? �(,G, (,r Ntc% Cc�s 7 it 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. i 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 X * 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, CONNIE D. BUNCH i 4- - Notary Public,State of New York ( He is the oma/ 4e c iiia njBUSia�r�=0 (Contractor,Agent, Corporate Officer, etc.) Qualified in Suffolk County Commission Expires April i4.201),� 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. i Swo t before me this —day of rii'l 20_L'� y ,I Notary Public �T— Signature of Applicant i 4 i S�FFULA- Southold TownBoard, of Appeals t` MAIN ROAD - STATE ROAD 25 SOUTHOLD, L.i., N.Y. 11971 TELEPHONE (516) 765.1809 APPEALS BOARD MEMBERS GERARD P. GOEHRINGER, CHAIRMAN CHARLES GRIGONIS,JR. SERGE DOYEN, JR. JOSEPH H. SAWICKI JAMES DINIZ10, JR. aCTTON OF THE BOARD OF APPEALS Appl. No. 3884 Matter of DICKINSON/THOMPSON. Variance to the Zoning Ordinance, Article I, Section 106-20, (Article III, Section 100-32) , for approval of insufficient are in this pending division of land and bulk_and Parking regulations. Property Locatio: Main Bayview Road, Southold, County Tax map No. 1000, Section 078, Block 09, Lot 30. WHEREAS, a public hearing was held and concluded on December 19, 1989 in the matter of the Application of DICKINSON/THOMPSON under Appeal No. 3884; and WHEREAS, at said hearing all those who desired, to be heard were heard and their testimony recorded; and WHEREAS, the Board Members have personally viewed and are Familiar with the premises in question, its present zoning, and the surrounding areas; and WHEREAS, the Board made the following findings of fact: 1. The premises in question is located along the northwest side of Main Bayview Road, Town of Southold, and is identified on the Suffolk County Tax Maps as District 1000, Section 078, Block 09, Lot 30. 2. This is an Application for Variances from the Zoning Code Article I, Section 106-20, (Article III, Section 100-32) , for approval of insufficient are in this pending division of land and Bulk and Parking regulations. v Page 2 - Appl. No. 3884 Matter of DICKINSON/THOMPSON, Decision rendered January 22, 1990 3. Article III, Section 100-32, No building or premises shall be used and no building or part thereof shall be erected or altered in the Agricultural-Conservation District and in the Low-Density Residential R-80 District unless the same conforms to the Bulk Schedule and Parking Schedule incorporated into this chapter with the same force and effect as if regulations were set forth herein in full, as well as to the following bulk and parking requirements: 4. The subject premises for the proposed Division of land is known and referred to as being 22,898 sq. ft. on the southeast side and 22,910 on the northwest of Main Bayview Road. 5. In considering this application, the Board finds and determines: (a) that the circumstances of this application are uniquely related to the premises and its established nonconformities; (b) that there is no other method for appellants to pursue; and the dividing the land in any other location on premises will require other variance relief; (c) that the variance will not in turn cause a substantial effect on the safety, health, welfare, comfort, convenience, and/or order of the Town; (d) that in carefully considering the record and all the above factors, the interests of justice will be served by granting the variance, as applied Accordingly, on motion by Mr. Goehringer, seconded by Mr. Dinizio, it was RESOLVED, to GRANT a Variance in the matter of the application of DICKINSON/THOMPSON as applied under Appeal No. 3884. Vote of the Board: Ayes: Messrs. Goehringer, Grigonis, Doyen and Dinizio (Absent Joseph Sawicki) . This resolution was duly adopted. ti.i�✓:..4}: e��� -i�.} df 3 GERARD P. GOEHRINGER, AIRMAN Scott A. Russell �0°SIJ FFQx ST(o 1KMIWATEIR. SUPERVISOR z MEAN A(G IEMUENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 '.�rj�O Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) j DOES TOS PROJECT INVOLVE ANY OF TM FOLLOWING: r (CHECK ALL THAT APPLY) ' Yes No ❑ A. 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. ❑El 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. ❑E9 E.•Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. � ❑13 . 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 _ t 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 ozmation, Date & County Tax Map Number! Chapter zit)does not apply to your project. yo n veered YES to one or more Me above, please submit pies of tormwater Management Control Plan a completed Check List Form to the Bufl4ing Department with your ding Permit Application. •- -— ---- -._...._..._.. ._. _. .. . .. '��. ..... S.C.T.IV1. #: 1000 Date: PLICANT:(Prope Owner,Design Profess Agent,Contractor,Other) - DDistrid NAME 44111 '70 G -7 960 3 -3 I wr�a Section "Block Lot 176 FOR BUILDING DEPARTMENT USE ONLY Contact Infonnatiom — L 3--7800 v rrdMhW V. , Reviewed By: — — — — — --- — — — — — — — — — — — — Dater L Property Address/Location of Construction Work: — — -- — — — — — — — — — — — — — Approved for processing Building Permit. '7 S5 M t^ 8 v;Ic w 2� Stormwater Management Control Plan Not Required. S C)�� 1^o d ❑ Stormwater Management Control Plan is Required (Forward to Engineering Department for Review.) FORM * SMCP-TOS -jL20- mk�- �_a7-V 4 o� DBUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD �IAY 1 4 2019 own Hall Annex - 54375 Main Road - PO Box 1179 • Southold, New York 11971-0959 Telephone 631 765-1802 - FAX (631) 765-9502 �� S O D roger.richertp_town.southold.ny.us. APPLICATION FOR ELECTRICAL INSPECTION - - - = Date: REQUESTED B`-__, _jj.� i2+�_ 1� 1� Company Name: `� Name: IrC 1�`( License No.: email: '' f Address: Phone No.: z� JOB SITE INFORMATION: (AII Information Required) Name: i�� Address: ' i Cross Street: Phone No.: email: Bidg.Permit#: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please Print Clearly) r- Circle All That Apply= Final YE NO Rough In Is job read for inspection?:Y Do you need a Temp Certificate?: YESJ'livy' Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: = # Meters Old Meter# New Service- Fire Reconnect- Flood Reconnect- Service Reconnected - Underground-Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? 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PO Box 40 878-0966 East Moriches,NY 11940 1c.NYS Unemployment Insurance Employer Registration Number of Insured 1 d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 112520270 2.Name and Address of Entity Requesting Proof of Coverage 3a Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Property&Casualty Ins Co of Hartford 3b.Policy Number of Entity Listed in Box"1 a" Town of Southold 12WEQD9B84 53095 Route 25 3c.Policy effective penod Southold,NY 11971 02/28/2019 to 02/28/2020 3d.The Proprietor,Partners or Executive Officers are X❑ 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"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 Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums 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. 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 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: Leonard Scioscia (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 3/4/19 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 631-390-9700 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov Workers' CERTIFICATE OF aTE >~olmpensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Pinto Swimming Pool Service Inc. PO Box 40 878-0966 East Moriches,NY 11940 1 c.NYS Unemployment Insurance Employer Registration Number of Insured 1d.Federal Employer Identification Number of Insured or Social Security Work Location of Insured(Only required if coverage is specifically limited to Number certain locations in New York State,i.e.,a Wrap-Up Policy) 112520270 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Property&Casualty Ins Co of Hartford 3b.Policy Number of Entity Listed in Box"1a" Town of Southold 12WEQD9B84 53095 Route 25 3c.Policy effective period Southold,NY 11971 02/28/2019 to 02/28/2020 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"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 Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums 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. 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 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: Leonard Scioscia (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 3/4/19 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 631-390-9700 Please Note:Only insurance carriers and their licensed"agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.ny.gov i I GENERAL NOTES: ELECTRICAL: 1. ALL WORK TO COMPLY WITH THE STATE BUILDING CODE AND LOCAL i CONFORMS WITH 2015 IRC (RESIDENTIAL) CHAPTER 42 SECTION E4202 �t s���y �:;° ..rn.i�,•�:.:,�.w,;ze�I'Q1;'aYP�'%��� .�'miCODES AND ORDINANCES HAVING JURISDICTION: 3 �i7F`.'r.�„ic�L�� ' -� : ,.�.aS4t' y .�" � f•`,����°.-' 7"�e�' ,k•� .i,_.e:-^-„ `„;�, „tiv".'*.."'°'i'X-"*'"a�i.6G s.T�3,-;t�iL� ,`4f4;, e!s 'ivi� `M ': .s.4? 7':r,z5 �s,.ag ;h' =t^a , s'•"_y p ?Wit' 3', fi R;.. 'c-.g,asw•.v - h r ,y, .»`3�, J' d }�;4•'r 4,<,&,�;in,�r:`�'' a to _ .<..i;:.c:,si-ar by": e,.�� -Y rg,�e _:a"''z �J .a,E:ats'°c'Sa;7'.:a—w✓'st'NiF �'" •-�I:.� 3-_'-_ ti "=' i'.},.,,� ,'', ` s y ,�:?urnC� .g.fK""`-.<a..,.=„w`•. �c� £�'vNX .a.,-':'n<,..:.h..,,•:.'f,:.. F= y.. - ,g s":t�=-'r ,G. '�'.iy';..^_ _ r:,�:'�'..,� J"t,'_�h�,�,IS; .'� S+,y.�y • E: -'o of. :u=1 -t;,+; YY:=--sta s��r'r.."-`s.":^Y. g b':'.. -3 Jr's-,'i�,:s y:s', :"-gggl.! Fx�T _ �!-�, "�. ^ -TOB Zoning code Sec 85 891_ ,(Swimming,Pools) �.�' - �Cett�tal. F:� r _, �; _ k '��. "nu< :r...,,-., -.�..Y `�.'�'i�.' �. r 5 t�'.'�rx. 3'P �# �'� ..}'°t=n,. '--�" i.t„1:.� ._� ,�.�,..''°'`<�:<<. t 4--"�Y^�q �5.�,wr., '3 0 7a,� L�n•�'"r '1, � i' �•�f 3.^,�<- '4i= .-1°3 1:� J,iS"u� P- tilllg l©i S t1 f9r lTi On :. i..,c11i!(t11' Yrr< !-_Y„rlsle ►T1(1194 �°,a13rf µ iiroinasttitb� tlltbnitellne�cr�iciai `I3 yip t { -2016 NYS Uniform Code Supplement Sec R326 w s tales-iTs: eer�r to ( m lra1st1 `;.. M1 V13 .i �� =7J(7iTi=;a7♦ � ,'lL:L �� ' ',7_ ,b :+'< a Zr..''3-'L `Kya.:. �3 M..-c.,�<• .`: - ,:s'i% =:a�,."n•+; r .;' "?•x< af.,.a,<:., ... '�' •b=`:s b•"':etrF, "t 3.::r °?$ r.: Mx. 2015 IECC VI _R �:.:,�.�. FE~ CitTx 'x? + ��.t• ti : " '=.aw,.�tx ,t.-�v�+��' -``s`x% < .F, 's,Y zs:':< *.�4=;.��b�.tZ` ;:” 'x;—:::-d' -.,.'s'".s._:,• �'s��^.t'.ae�:,G�r�;�2<'-<ae�• .,. '=,.t'�' _ <"s'""' ,.�',r,.z-. r: - �,'}_•'�,,�=`•.1:.'- ':�'�,,:..' >c. x. - ,�:i::�;�W."'s-,v a.,'�.;>:::-- ��•',S.arr' F.r,:.: ...�'s,r+.-.^,@�?�..e�`?. t{:r 2. CONTRACTOR TO FIELD CHECK ALL EXISTING CONDITIONS AND CALL odtG` r PRG , Noysteilw2iese':tiiai�ked+Rattiim '"1t" =aiNR9'�� rSE-F tit �r._.., - ':=R►d�%.3i: `->.=k�',:,�.,rs`;rs, DR. 1:,�'�„ry�"x�s'�.,y�;�`'w�; -��>� NY-811 FOR UTILITY MARKOUT BEFORE COMMENCING WORK. gi sF =- ,». <,�. :_s, Q.��:a�y�'`s-k,- ,�,,<w h�.l.,.>'i4s-;s:.i-'"y'R�,`,:S��`,�C;.'�=y�,•5:'S°n�. ;'��k,�'� $>'"$' ..;:2::<3:f meq�r����a�„'*'."s`'�,,.`= 's: I POOL 3. SAFETY FENCING TO BE INSTALLED AROUND SWIMMING I - d ,-,s.-s tl f,� <c c. 'iix °�x ..r<< �:,;:,�� ,< `.:;�,✓ ;sem _ �itae7:G7i�.ti�.,�t✓✓�..��3.1"ilEC}.Ur�"31C3101i�7i1�C.s,`„!T EXCAVATION SITE DURING CONSTRUCTION AND MAINTAINED U _=z m . R� ,,.=.r ss, 1 _r1' PERMANENT FENCING IS INSTALLED PER R326.5.2 Y sTa:;�,<” ...�`�,";G•:=� _+;=<wn <,st9?f,s .�:r'�� ,, XY,E» :?ligf _ ..i�� _ .�....°r'"." �f�;=sL' f;�'_�t �,. _�'i38ii :>;t5iaa y_ -=;��:p �s�<,r,, "" ,�::.i'�' _a• V��= �;��.->; -rte,=. �:-" ;rte.;,. y,:�,_''g, �; _ STRUCTURAL: >Fr,' %' ' " ✓�?L'£?E"t-�7tmtl�:= - =:;�'�.'.'µ' ';rr� �=', .3i ..s •'�- _ ,<.S�r=''�,iu'r".„+�•,-�:,. 0S erir - S .s..k i>.k'T;x_",F'.+^ v{.+"•...:..<._ ^� :iY -,�k: H=- -,P,.�g ►taL -` ,i.• S+? _z, .,,Vis- :: "r ..x{„=%�;,i`%`;. 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T<_.>,, ,y'�:: ''�"s'.a;�,�--�o,�.�,��h"",3':%d'�:, '.l $ 3;#."1tiiFf_�`34i-»:-tka� :u` .-.`a1�"' " -ra `�S`✓�..:. ,., - iitr, i,:`sc- r,.. i=" " �.s^;. '•:=.-=' s.ea, _?Js i3iYi;:,f£t� .'F .+6ih#iSt '�I'6F13`ftSlfit£!is;�r�-'^•'` '.""r C: <:b. cft. - Yt:S+' ' �' ;?ar,k: •-£- :ff.` `�=5. <,"-"'-eN".y,',r. 2. 8 TO 12 FLARED WALL- POURED CONCRETE ( /3000 PSI) CONTINOUS c'tSU ,c..> `iY,F,a� Wi r Fr.*. S !'t;,.t•xc=,:z-.,y,.�-:'�F,. _ ..'y^ter„-<;.€. .>z S^�P '��.e�As",".r�� �,rr„ _ „s�' '��.abt - r�rx za •.r ':^-3s,,,- �.Atar `sa• °"":`.'i.'�z�lx-yK.q...,e j "'�''” �-��`;'�`:::*w2'-�--•mss'%'x°= _ei., ��-r"«'_4•�, ,:r""; -•�,-.=_.,ro ,tf=:',r ��`a: Y`• _ z r -•�.�. .1� mak` :,'. ::,a,s -�t��.� :•a-, ;u,•,a.e=1:.. ::.::a% 5y%:,'s.a•, r, ,•.tr, �^�;r',:e. .,Yt ;';,z.,"ms's ,_„-t,;;t�:.;'.: :*'%. _T<-, S .'... 'y,T'�n`x.Y "'>, - °}J cz'i•..,<R' #4 REBAR TOP AND BOTTOM DETAIL Al ,t ^ - . _ ~; = 4= X- �-.a,'E-� a'3 s.Y�r�P�'*"�E",`. ,.�s�•"� '@"1M� e,�.�'i e--.-5 ""n�r's ,�`: � - ,7,z' rT E3iase asi rudi 5 r > t"-n''._.. .t -`r°"��", .rk.,;�_. ^x;rs*'�'�`. a'• "�,r'„ j=ice°- Ft .---"`.. . 3. BACKFILL TO BE SAND OR OTHER NON EXPANSIVE MATERIAL. Y4I rea.r - .`5S'8��s-. L m `'.' v. 3,','.,t..�' =,:'= k _-»u•»"".<4 ��` S�enss'��strr� . �i,�idiv����;�e�s#��$� t"ri t ^" :eof �- s _r MA. `''*�,:�-. `�'" '�., ,a"" u,: z-,"`.ro; -< '4 •�; = �Sttd � E .�.CC.`��4 AS7'S"%�iit,Yk .> 4 .: tµ� „'�'`�, '',u-�p., r• i*" •T'.'�°_—s t sx;,,,Se' Yv, w:Y. ., SAFETY: ��; _ nrs� �r �mt- ..,. a=' -'NMIT _ . ` :s 7 Zi 3tQ tIi. 3t.R K 2 a p a' -TA anCk'42"1(F5`, < - "> ,,y L,'4" 3-•^- �,' 1. CONFORMS WITH ANSI/NSPI-5 (R326.3.1) Note: No Manufactured Diving ,:F ,' .F>.. ^<- „?�'tr° `*�*?: -3 .r, , .ri.k ,-p;�'+. '"t..�`-R=�..� ',r'J� .:>,.��:__ .:abr `.i�, n?r,�•-'^-.'.,z?.e?�,rx',< � equipment to be installed on this pool. 2. SAFETY COMPLIANT BARRIER PER SECTION R326.5 1. BONDING PER SECTION E4204 3. ENTRAPMENT PROTECTION PER SECTION R326.6 2. MINIMUM 8AWG BARE SOLID COPPER CONDUCTOR FOR EQUIPOTENTIAL - VGB COMPLIANT: DUAL MAIN DRAIN SPACED MIN. X-0" APART WITH BONDING 18 TO 24 INCHES FROM THE INSIDE WALLS OF THE SWIMMING COVERS CONFORMING TO ASME/ANSI Al 12.19.18M POOL FOLLOWING CONTOUR AND BONDING AT FOUR POINTS. 4. POOL ALARM PER SECTION R326.7 'T'ERRY RESIDENCE -SMARTPOOL-" POOL EYE" ALARM WITH REMOTE (MEETS ASTM F2208) 7635 MAIN BAYVIEW `� SOUTHOLD, NEW YORKLP Al, Bit • _ -�------ s .vtN�� LtNE� � t�c�vrZED CcNcP.rTt �yll F oAt-t -e "DIwCr , 2'o t3oTCo a—o' g 30'r'o r-t HIt��S�t3e.L. 'V- 'D 'D E TPc\4 /� S 4G►M M E PV t-\P 211 WASTE Z�! iZETJQtd TO Ih1L�.T l� gL6Off ,. o� lo' oy y-0�' y!o g!-o/' zl�o" Sc EMA,: IC- I�tP�VJC-- AV"T,kV3Gz-z IV-o" (N ,k coNrtc WGSty ut\Alp C--c )e - C-NA?TE?- 42� �uM t'� _ Nl�ywh�� SPS'-tooyS� � r 3�- Sw lMN�1�1CT t^'' �aL . ��-or:R�,�► �3►.L:. �e��� SPst �T� Col-%??LXP XV Pit-hkv\ -To 5c ALE el8 _ ��- o" ° yot5 \ec-C- ta4o3,to-Z. Ccr\Pt-SANT -� — EN-�RA�c1{G t�T Ytzo �crTtoN ]y�pcV \PciiJ r� 1t�}5 \ " '. ES�� C_t; d Z�• rvt_-t ►Yv�Y V �L..1E 1.1 E!°cT E�'• _- 1a Qy W R.� )A"F.A's pts 1�P l,v-,s" p51�{h-�f���.7i4�vlJ q7e } " IAe�C rrfao v�C3 cv��LtRt�-c f-s All' 2 I ta)TO ® P I tJC• 4 rt _ t CAST C-%A A1� A P, no' VE D AS NO g ED CompLY WITH ALL CODES OF DATE.3 I, , B.P.4 NEW YORK STATE &TOWN CODES nUDff IONS OF FEE _ � �ti' ���_ _ AS REQUIRED A -C- NO- IF`! BUILDiN DE;AR I ritiz AT 76 -1802 8`M TO Al Ptf+ FOR THE NGBOARD FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED TOWN TRUSTEES FOR POURED CONCRETE 2. ROUGH - FRAMING « PLUMBING N 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C 0. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW RETAIN STORM WATER RUNOFF YORK STATE. NOT RESPONSIBLE FOR PURSUANT TO CHAPTER 236 DESIGN OR CONSTRUCTION ERRORS. OF THE TOWN CODE. P �? CY 1"' UNLAWFUL �li�d•i T HCUT CERTIFICATE OF OCCUPANCY