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HomeMy WebLinkAbout43341-Z guFFat,(C Town of Southold 2/13/2020 P.O.Box 1179 a - o • 53095 Main Rd 4, �`� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 41077 Date: 2/13/2020 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2060 Gabriella Ct,Mattituck SCTM#: 473889 Sec/Block/Lot: 108.-4-7.47 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated' 12/14/2018 pursuant to which Building Permit No. 43341 dated 12/21/2018 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 Buckley,Christopher&Commander,Kathlee of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43341 04-01-2019 PLUMBERS CERTIFICATION DATED Aut o ' e Signature ti TOWN OF SOUTHOLD BUILDING DEPARTMENT C2 TOWN CLERK'S OFFICE oy_• 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#: 43341 Date: 12/21/2018 Permission is hereby granted to: Buckley, Christopher& Commander, Kathleen 2060 Gabriella Ct Mattituck, NY 11952 To: construct accessory in-ground swimming pool as applied for. At premises located at: 2060 Gabriella Ct, Mattituck SCTM #473889 Sec/Block/Lot# 108.-4-7.47 Pursuant to application dated 12/14/2018 and approved by the Building Inspector. To expire on 6/21/2020. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector r 9 Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets, and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of I%lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and f°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, dditions to dwelling$50.00 Iterations 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. p New Construction: Old or Pre-existing Build' (check one) Location of Property: '1 �� House No. Street mgAitidc L Hamlet Owner or Owners of Property: —P Suffolk County Tax Map No 1000, SectionO!Z Block Lot r (•� Subdivision Filed Map. Lot: Permit No. L Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval:. Request for: Temporary Certificate Final Certificate: V (ch&ck one) Fee Submitted: $_ AWSign—ature pF SOl Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ® ® �® roger.richertatown.southold.ny.us l�coutiff N, BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Christopher Buckley Address: 2060 Gabriella Court City: Mattituck St: New York Zip: 11952 Budding Permit# 43341 Section: 108 Block: 4 Lot 747 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 X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect 71 Switches 2 Twist Lock Exit Fixtures 11 TVSS Other Equipment In ground swimming pool to include, bonding, control panel,1-GFCI circuit breaker 1-time clock,2-switches, 1-GFCI recpticle, 1-pool pump,salt generator,pool lights Notes* Inspector Signature: Date: April 12019 81-Cert Electrical Compliance Form As oF souryO� # # TOWN OF SOUTHOLD BUILDING DEPT. courm, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. j [ ] 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 INSPECTOR YL 7 L( O�aaSO(/Th� l # # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 . INSPECTION [ ] FOUNDATION 1ST [ ]- ROUGH PLBG. [ ] FOUNDATION-21SID [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING F I N A*t�- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O REMARKS: _Q � (�� A��'fi� 1r 2N�'S� 1> f%fAvlv,4 SI� a/, Shc�� DATE MAI&O INSPECTOR (Cc 40 A-S' ;. 7[kRQ Air • • POOLWATCH �w Fnoe f e i' i .fNti •''/� :.r �+ to• ;.. �f � m V. 3:J10-1 NY ;" 4 f N'p r T �t r tom .,•N� S.l�tt't", '"+'«'7,T x .. '�1 j: ' , A91� w s ' t y, S F=Y � y t►i�r FIELD INSPECTION REPORT DATE COMMENTS �b FOUNDATION (1ST) ' �H ------------------------------------- 'FOUNDATION (2ND) � � O ROUGH FRAMING& 010 PLUMBING H INSULATION PER N.Y-. y STATE ENERGY CODE s1 fi�0 FINAL om ADDITIONAL MME TS °l. L t z z d b H t i TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BTJI><,DTt��iG DEPARTMENT TOWN HALL Do you have or need the following,before applying? SOUTHOLD,NY 11971 Board of Health TEL: (631)765-1802 4 sets of Building Plans FAX: (631)765-9502 Planning Board approval Southoldtownny.govPERNIIT NO. �3 Survey Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application J44— Flood Permit Examined 20L L �"--' \ -- i- ,� � ; Single&Separate DEC 201 Truss Identification Form � � Storm-Water Assessment Form Contact: Approved 20 ' =D Mail to Disapproved a/c —1 Phone: Expiration 20 Bui g In ector APPLICATION FOR BUILDING PERMIT 1 , INSTRUCTIONS Da � 20 a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition a ein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code d s,and to admit authorized inspectors on premises and in building for necessary inspections. S' n ure ant or name,if a corporation) ( fling address of app is nt) State whether applicant is owner, les ee a ent, arr itect, engineer, general contractor, ectriciln, 6i&er —r bolder A Name of owner of premises (As on the tax roll or lateo deed) If applicant is a corporation, signature of duly authorized officer (Name and title of co orateI off. er Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Loon 'ch ro osed wo k will b o e: 2 c f dA I l� �- House Number Street Hamlet j ry� T 4 County Tax Map No. 1000 Section ! U Block Lot_ Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work 4. Estimated Cost� Fee (Description) (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 Will excess fill be removed from premises?YES NO 14.Names of Owner o emis s Phone No. �-7 � Name of Architec ddress hone No Name of Contractor ess Phone No, 40 -2 Z, 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_x * IF YES,D.E.C.PERMITS MAY BE REQUIRED. 16. Provide survey,to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? *YES NO_X *IF YES,PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF I l4k� e yl fit'Ek- eing duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above nam , (S)He is the (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are.true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application Rgtherewith. 1M I///i�� Sworn to before me th' J1<1 day of °• OtMI823185T� S QUALIFIED IN SUFFOLK COUNTY Notary rublic 3 -coMM. xP. tt-29• •,� � ignat&e of Applicant Scott A. Russell slu. A: SUPERVISOR 4W UrEIR. WAINTAGHEAKIENIr 'SOUTHOLD TOWN Hart-F.0,Rox jj79 53095 Main Road-SOUTHOLD;NEW yOXK floe Town.. of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SIMET .( 1"0 BE COMPLETED BY*THE APPLICANT) i=`^^ =— '-- DOES MHS_]PROJECT INVOLVE ANY OF TM iFoLLoWING: Y&INo CNECK ALLIiAT 'APPLY) [IkA. Clearing, grubbing, gradingoT r stripping of land which affects more than 5,000 square feet Of gro-qnd surface, rA B. Excavation or filling involv. ing,more. than.200 cubic yards-of material within any parcel or any contiguous area. 0 C. Site preparation on Slopes. which exceed 10 feet Vertical rise to. 100 feet of'horizontal distance. [ID. Site preparation within 100 feet of-wetlands, beach, bluff or coastal erosion hazard area. [01 E. Site preparation within the one-hundred-year floodplain-as depicted 0 on 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 Man�gernent 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! 'Completethe-Applicant section below mith your lame, Signature,.Contact Information,Date &County Tax.ft*NprAber.1 'Chapter 236 doea not apply,to your project. If-you answered"YES to one-or more of the above, Please submit Two copies-of x5tormwater Management-Control plan and a completed-Check List.Form to the Building Department witIT—your Building Permit Application. APPLICANT (Property OmlerPesigli Pro-fessibnal,Agdnt,Corittacitor,Other) S'C'T.M. 1.000 q-7 Datt: Dat et NAME F1 —solitZ .814 Lot Contact Inromattoft. R BUILDING DEPARTMENT USE ON — — — — — — — — — — — — — — I Reviewed.By:N,_�__ , ion Work: I Date: PtOPerty Address/Location Of COnstrliet— — — — — -- - — — — — — — Apptoved for processing Building Permit. if Stormwater Management Control Plan-NDt Required. A f) Stormwdter Management Control'Plan i5 Required. (Forward to Engineering Department for Review.) FORM« SMCP-TOS MAY 2014 • o��o�so�ryo! - � o Town lull Annex l jt J [ Teleph 0110POInVus 31)'i65-1802, 54375 Main Road 75 ! ! 't• P.O.Box 1179 OQ rogerAchert to Southold,NY 11971-0959O`yC4UN� � � 5' MAR 1 9 2019 `I, BUILDING DEPARTMENT j' i • TOWN OF SOUTHOLD V; Y-D APPLICATION FOR ELECTRICAL INSPECTION :QUESTED BY: !\�©r-,M N\ M# r-C O 4C Date: 3mpany Name: jQ Q 121 tc-fri Cod aA m I �' tense No.: — M - -1eI 'dress: 1`ajZj`�` ���c o �v e, 01 L-,rop `!-- lone No.: J-- -ISO P (o -5 Y SITE,INFORMATION: (*Indicates required, inforrriation) ddress:, A C0(4r` loss Street: or hone No.: -� :emit No.: ix-Map District: 1000 Section: Q Block: Lot: RIFF DESCRIPTION OF WORK (Please Print Clearly) n [ease Circle All That Apply) job ready for inspection: YES NO Rough In Final o-you need a Temp Certificate: YES N 'mp-Information (If needed_ ) ervice-Size: 1 Phase 3Phase 100 150 200 300 350 400 Other :avv Servlce: Re-connect Underground Number of Meters Change of Service Overhead 'tlitional Information: nn PAYME T-DUE WITH APPLICATION �J I �'��f��2 C�, Y - Ur Ot+ e— w � 01n, UIS ,4 f/�p �" / G7q� ��� . -4' S-L (CA11 H0,M-e'0VJ1m_r �ceS / 82-Request for Inspection Form �� Pontino, Susan From: buckley <ksbuckley@optonline.net> Sent: Wednesday, February 12, 2020 10:20 AM To: Pontino, Susan Subject: Fwd: Buckley Pool Permit- 2060 Gabriella Court, Mattituck, NY Hi Susan, I am forwarding photos to show that the two open items on the permit have been complied with. If the inspector needs,to speak with me, he can call me at 917-373-5230. Thanks, Kathleen Buckley ---------- Original Message---------- From: Kathleen Commander<Kathleen.Commander n,bartlettllp.com> To: Kathleen Buckley<ksbuckley@optonline.net> Date: February 12, 2020 at 10:03 AM Subject: - f 0 �c l� 26 �p tip ' d 0k '` ` SURVEY OF LOT 1 - 0 'EL IJAHS LANE ES TA TES, SECT. 3 FILED OCT. 81998 FILE NO. 9912 �. "`0,,, A T- MA TTI TUCK TOWN OF SOU THOLD 2�g SUFFOLK COUNTY, N. Y. 1000 - 108 - 04 - PIO-7 r' 7. 4'� moo_ a2 f $ ryOScale. 1 40 �Ao foP;� "' 25a• � Dec. 4, 1996 ZF (� s PeP i� 26�e -- 5�G ex O / 3P P� 52 OF 0 0 `wo ��� O�� Q '1 S�OWN T.M�Tj0 0 lop AREA = 40,278 sq.ft. 446•a ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION l am famlllor with the STANDARDS A61? APPROVAL The Iodations of wells and ces.1poo/s OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW, AND CONSTRUCTION{ OF SUBSURFACir SEWAGE shown hereon are from field observations EXCEPT AS PER,SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS DISPOSAL SYSTEMS FOR SINGLE FA I/LY RESIDENCES HEREON A,RE*YALID FOR THIS-MAP-AND COPIES THEREOF ONLY/F and or from data obtained from -others. N.Y.S L/C. NO. 496/8 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR and will abide by the conditions set ford}''(herein and on the WHOSE SIGNATURE APPEARS HEREON. permll to construct. PE ON/C SU MORS, P.C. ., (516) 765 - 5020 ArDITIONALL Y TO COAIPL Y WI TH SAID LAW THE TERM AL TERED BY' P. O. BOX 909 ,1 UST BE'USED BY ANY AtV ALL SURVEYORS U /ZING A COPY ELEVATIONS ARE REFERENCED 1230 TRAVELER STREET OF ANOTHER SURVEYOR'S MAPA TERMS SUCK AS MTH THE AND •,.♦ i TO AN ASSUMED DA TUM. SOUTHOLD, N.Y. 11971 BROUGHT-TO-DA TE' ARE NOT AV COIIPL/ANGb WITH THE LAW, Y workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured FENCE KING OF ROCKY POINT INC.DBA SWIM KING POOLS&PATIOS 471 ROUTE 25A ROCKY POINT,NY 11778 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 113008276 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" 53095 Route 25 DBL37154 P.O. Box 1179 3c.Policy effective period Southold, NY 11971-0000 02/01/2018 to 01/31/2019 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. F1 B.Disability benefits only. F1 C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that 1 am an authorized representative or licensed agent of the Insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 2/2/2018 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are 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,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200,Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers' Compensation Board (Only if Box 4C or 513 of Part i 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 and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave 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. pp pp DB-120.1 (10-17) I�����piiiiiim1111iiiiiuiii( �jII yo Workers' CERTIFICATE OF STATiE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board I a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Fence King of Rocky Point,Inc. 631-744-8100 DBA Swim Kings Pools&Patios 471 Route Rocky Point.NY 11778 1 c.NYS Unemployment ment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to Id.Federal Employer Identification Number of Insured or Social Security certain locations,in New York State,i.e.,a Wrap-Up Policy) Number 11-3008276 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Sentinel Insurance Company Town of Southold 53095 Rt.25 PO Box 1179 3b.Policy Number of Entity Listed in Box"1 a"Southold,NY 11971 12WEOJ2677 30.Policy effective period 09/01/2018 to 0 9101/2 01 9 3d.The Proprietor,Partners or Executive Officers are QX Included.(Only check box If ail partners/officers included) all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box 7'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: Bethany Frabizio (Print name of authorized representative or licensed agent of insurance carrier) Approved by: &Tyy . OJara4g N pe ( nature) I- (Date) Titre:Account Executive Telephone Number of authorized representative or licensed agent of insurance carrier. 631-465-4000 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 D APPRO ED AS NOTED DATE: B.P.# 33 Lt FEE: D`DD BY: NOTIFY BUILDING DEPARAMW AT s RETAIN STORM WATER RUNOFF ti 765-1802 8 AM TO 4 PM FOR THE ; FOLLOWING INSPECTIONS: PURSUANT TO CHAPTER 236 1. FOUNDATION - TWO REQUIRED OF THE TOWN CODE. FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING ~`°'" 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR ELECTRICAL DESIGN OR CONSTRUCTION ERRORS. INSPECTION REQUIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODE AS REQUIRED AND CONDITIONS O, OAR[ ENCLOSE POOL TO CODE ',ON COMPLETION E�FORE"WATER° OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICA7 OF OCCUPANCY A A NOTES 4'X 8'PLASTIC STEPS 1. NO SOIL SURCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION ATTHE SHALLOW END,OR 6 FEETOF EXCAVATION ATTHE DEEP END t/1 2. TH15 POOL MEETS THE REQVIREMEM3 OFANSI/N5PI-5 AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROVND SWIMMING O POOLS'AND 1996 BOCA CODE-SECTION 421. DIVING EQUIPMENT 15 NOTALLOWED. v 5 SWIMMING POOL SHALL BE COMPLETELY AND CONTINUOUSLY SURROUNDED WITH A BARRIER CONSTRUCTED LAW REQUIREMENTS OF 0" SECTIONR326.5.3 OF THE INTERNATIONAL RESIDENTIAL CODE(2016)AND IN CONFORMITY W1TH ALL SECTIONS OF THE SOUTHOL.D2� TOWN CODE ACCESS GATES SHALL COMPLY WITH SECTION R326.5.2 OF THE IRC AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY o H2O N H2O LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED. ALL GATES ARE TO OPEN AWAY FROM THE POOLAREA. !nICO N 3'-6' 8'-0' t� p 4 DURING CONSTRUCTION THE CONTRACTOR SHALL ERECTA TEMPORARY BARRIERAROVND THE EXCAVATION LAW THE CODE OF THE Q .r- TOWNOFSOUTHOLD O o 5. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING A CHILD ENTERING THE WATER AND SOUNDING } AN AUDIBLE ALARM WHEN DETECTED THAT 15 AUDIBLE ATPOCILSIDE AND ATANOTHER LOCATION ON THE PREMISES WHEPE THE POOL u v 15 LOCATED. THE ALARM MUST BE INSTALLED,MAINTAINED AND USED IN ACCORDANCE WITH THE MANVFACTVRERS INSTRUCTIONS. Z Q Z THE ALARM MVSTMEETA5TMF220B "STANDARD SPECIFICATION FOR POOL ALARMS. THE DEVICE MV5TOPERATEINDEPENDENT(NOTLn- ATTACHED TO OR DEPENDENTON)OF PERSONS. Y v 0 CONC WALLS BCL 6. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS)MVSTBE PROVIDED WITH A COVER,IHATCONFORM510ASME/ANSI 45' A11219.8M ORA MINIMUM 18"x 23"DRAIN GRATE ORA CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MV5TBE EQUIPPED WITH ATMOSPHERIC VACUUM RELIEF IN THE EVENTTHE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OR BROKEN.SUCH to VACUUM RELIEF 5Y5TEM5 SHALL CONFORM WITH A5ME A1121917 OR BEA GRAVITY 5Y517EM APPROVED BY THE TOWN OF SOUTHOLD. PLAN POOL SHALL BE PROVIDED WITH A MINIMUM OF 2 SUCTION FITTINGS OF THE ABOVE MENTIONED TYPE.THE SUCTION FrMNG5 SHALL BE SEPARATED BY MINIMUM OF 3'AND MUST BE PIPED SUCH THAT WATER IS DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCE551BLE 4'x s'PIA5TIC STEPS POSITION,MINIMVM OF6"AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENTTO THE SKIMMER/SKIMMERS. rq Ln 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF NFPA 70(NEC)PRINCIPALLY ARTICLE 680 AND THE IRC SECTIONS " d 4201 THROUGH 4206 ALL ELECTRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS LABORATORIES AND BE PROTECTED BYA } GROUND FAULT CURRENT INTERRUPTER(GFC0 CVRRENTCARRYING ELECTRICAL CONDUCTORS EXCEPT FOR TH05E PROVIDING POWER U Z 2'E 4.5AND8070M a TO POOL LIGHTING AND POOL EQUIPMENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4203,5.ALL METAL ENCLOSURES, ,C FENCES OR RAILINGS NEAR ORADJACENTTO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHARGED DUE TO CONTACT QJ v WITH AN ELECTRICAL CIRCUIT SHALL BE EFFECTIVELY GROUNDED w qj 8 WATER SOURCE FILLING THE POOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE LAW NY5 PLUMBING CODE 608 SECTION A 9. ALL PIPING 15 DIAGRAMMATIC UNL.E55 OTHERWISE STATED. `O V 0 TOP OF WALL WATER LINE 10 WALKS IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM POOL EDGE. 0 U v 11 A MEANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED LAW AN5I/N5PI-5 SECTION 6, v m U iv 4' 12' 4' O a o 12. CONTRACTOR TO PLACE THE POOL LAW TOWN OF 5OVTHOLD CODE SETBACKS Q 0 .� O (a. C- I--' ri 13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SVB)ECT PROPERTY. 15. THE DESIGN 15 BASED ON A DRAINAGE SOIL WITH<10%SILT. GROUND WATER SHALL NOT EXIST WITHIN THE EXCAVATION. IF GROUND WATER EXISTS WITHIN 6'-0"FROM GRADE,DEWATERING FACILITIES WILL BE REQUIRED. m 16 ALL GAS AND OIL HEATERS(IF INSTALLED)FOR THE INGROVND SWIMMING POOL SHALL BE NATIONAL APPLIANCE ENERGY SECTION B CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATERS SHALL BE TESTED LAW AN517-21.56 AND SHALL BE INSTALLED LAW C) MANVFACTURERS SPECIFICATIONS, OIL FIRED POOL HEATERS SHALL BE TESTED LAW VL726. POOL HEATERS SHALL BE LOCATED OR ry GUARDED TO PROTECTAGAINST ACCIDENTAL CONTACT OF HOTSURFACE5 BY PERSONS. POOL HEATERS SHALL BE PROVIDED WITH TEMPERATURE AND PRE55URE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPASS SYSTEM,A BYPASS LINE SHALL BE INSTALLED FROM INLET TO OUTLET TO AD)U5T WATER FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE FOLLOWING ENERGY CONSERVATION MEASURES: U to n CHECK VT-/ V 161 AT LEAST ONE THERMOSTAT SHALL BE PROVIDED FOR EACH HEATING SYSTEM. 0. 00 16.2 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW SHUTTING OFF THE 00 PUMPFROM SKIMMER OPERATION OF THE HEATER,WITHOUT AP)USTINGTTHETHERMOSTAT SETTING AND TOALLOW RESTARTING WITHOUTRELIGHTING THE (} PILOT LIGHT. z 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQUIREMENTARE OUTDOOR POOLSDERIVING 20%OF THE ENERGY FOR HEATING FROM RENEWABLE SOURCES AS COMPUTED OVERAN OPERATING SEASON)16 4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BE 5ETTO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN BE SET W 0 h r NTOD" TO RUN THE MINIMVM TIME NECESSARYTO MAINTAIN THE POOL WATER INA CLEAN AND SANITARYCONDITION LAWAPPLICABLE �'a0 co DRYWSANITARYCODEOFNEWYORKSTATE z2'-2" 17. THIS DRAWING IS FORSTRUC7VRALSHELL ONLY.ALL ACCE550RIES AND APPURTENANCES ARE DEFINED BYOTHERS ([�COPING AND WALKWAY 3 ��� yDIVER (BYOTHERS) 10" z = G�a- d A VALVE GRADE 18 BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS. DO NOTALIOW THE HEIGHT BACKFILL 10 EXCEED THE HEIGHT THE r,, co X m WATER LINE 3 WATER IN THE POOL BY MORE THAN 8",OR THE WATER TO EXCEED BACKFILL BY MORE T1HAN 8" W N o`_'�� FILTER a 19. PLACE CONCRETE ON SANDY TO LOAM SOIL REMOVE ANY CLAY DEP051TAND REPLACE W/COMPACTED CLEAN BACKFILL VNDISTVRBED EARTH40 ra ,L7 3500 PSI POURED CONC. 4• - 20 THERE 15 NO MAIN DRAIN IN THIS POOL SUCTION FOR POOL WATER CIRCULATION 15 PROVIDED BY THE SKIMMERS ONLY.THIS MEETS O ry REQUIREMENTS OF THE IRC-SECTION R326.6 FOR ENTRAPMENT PROTECTION. V OF N E w 3/8'REBAP-2)TYP VINYL LINER 21. THE POOL WAS DESIGNED LAW THE FOLLOWING. T H y z'roa•sAND a 21.1. THE INTERNATIONAL RESIDENTIAL CODE(IRU-CHAPTER 42(2016) Q qs 21.2. THE INTERNATIONAL ENERGY CONSERVATION CONSTRUCTION CODE-SECTION R403.10(2015) 21.3. THE INTERNATIONAL FUEL GAS CODE(2015) - To RENRNs MmEffafm21.4. THE NEW YORK STATE CODE SVPPLEMENT-5ECTION R326 (2017) 21.5. THE NEW YORK STATE SANITARY CODE. I )<C3 _ w CHECK VALVE j 21.6. ANSI/N5PI-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. _ .,r=a_; � m lil VERTICAL 3/8'REBAR®3'OC 21.7 BOCA COPE-SECTION 421. n s Z (Nor SHOWN) 218. CODE OF THE TOWN OFSOUTHOLD, PDspt� C� 22. ALL BACKWA5H TO BE SELF-CONTAINED ON-SITE. F 08841'0 PLUMBING SCHEMATIC WALL SECTION AROFESS\ONP� N T.5. N,T 5