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HomeMy WebLinkAbout44163-Z ��o�gUFFO(,fCpG a Town of Southold 7/30/2020 0 A ; P.O.Box 1179 x 53095 Main Rd Southold,New York 11971 772YIJ1 CERTIFICATE OF OCCUPANCY No: 41299 Date: 7/30/2020 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 980 The Greenway, East Marion SCTM#: 473889 See/Block/Lot: 30.-2-36 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/6/2019 pursuant to which Building Permit No. 44163 dated 9/13/2019 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 Blond,Lori&David of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44163 10/25/2019 PLUMBERS CERTIFICATION DATED "'Otho ' e Signature ��SUFFot,r�oTOWN OF SOUTHOLD BUILDING DEPARTMENT W 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#: 44163 Date: 9/13/2019 Permission is hereby granted to: Blond, Lori 440 E 79th St 4E New York, NY 10075 To: construct accessory in-ground swimming pool as applied for. At premises located at: 980 The Greenway SCTM # 473889 Sec/Block/Lot# 30.-2-36 Pursuant to application dated 9/6/2019 and approved by the Building Inspector. To expire on 3/14/2021. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN FALL 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. New Construction: x Old or Pre-existing Building: (check one) '/�A Location of Property: 9 3 u 1V 1- 1r��� �f1`CAW �C1S1 1 Yla r, li House No. �` Street ++ Hamlet Owner or Owners of Property: LC)r l\ d- baV lD j Suffolk County Tax Map No 1000, Section 60 Block Z Lot 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: $ 12, App scant Signa e ti Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) 6 O via residing at qqC, I 19 I (Print property owner's name) (Mailing Address) •y NA0 5o hereby authorize MCS r 6VP (Agent) J to apply on my behalf to the Southold Building Department. (Owner's Sinature) (Date) fav (Print Owner's Name) } CONSENT TO INSPECTION LbYlMh V) 4he undersigned, do(es)hereby state: &�N Owner(s)/Name(s) That the undersiVNe-aarm is) (are)the owner(s) of the remises in the Town of Southold, located at ovr( which is shown and designated on the Suffolk Coun Tax Map as District 1000, Section 0, Block 2 , Lot 30 . . That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: I C, (L lo I U d w 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: (Signature XDILe- :6 (Print Name) ( gna ,.(-�riht Ngme)b so Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 G Q sean.deviin(a�town.southold.n us Southold,NY 11971-0959 y BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To Lori Blond Address: 980 The Greenway city East Marion . st. NY zip: 11939 Building Permit# 44163 Section- 30 Block 2 Lot- 36 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA TRC Electric Corp. License No- 46689-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1 st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph X 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 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 1 Twist Lock Exit Fixtures Combo SD/CO Other Equipment- Hayward Pool Panel-8 Circuit/ 7 Used, Pump, Bonding, Pool Heater Notes. New Pool Inspector Signature: Date: October 25, 2019 S Devlin-Cert Electrical Compliance Form As OF SOUTyO� Uf cl 6 3 � t�e * # TOWN OF SO THOLD BUILDING' DEPT.reeAvj4 �ycou765-1802 NSPECT-1ON [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ]" FOUNDATION 2ND -- [ ,] =INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL ] FIREPLACE & CHIMNEY " [ ] FIRE SAFETY INSPECTION w [ ] =FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ' ELECTRICAL (ROUGH) : .ELECTRICAL (FINAL)Too (/ [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ST 1 o l p®'a - i;af- DATE ZS INSPECTOR J �E SOpT�°lo * TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATIOWCAULKING [ ] FRAMING /STRAPPING [ vf FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION, [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE INSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS b FOUNDATION(IST) ------------------7----------------- C FOUNDATION (2ND) z �o O© c) ROUGH FRAMING& � PLUMBING A R - r INSULATION PER N.Y. y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS L Q- 0 rizm � >1 O Z14� � H C H BUILDING DEPARTMENT Do you have or need the following,before applying? -TOWN FALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 J� 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: - r,6, �/—anvQ �\ Approved ,20 IVMail to: 1 Ia �- -Disapproved a/c 5 3 M 1 Mk� (0�yN ed -o"- �u lhone: Expiration s_ .,; ir. 0 -- I. ✓ yy 1 ! s Bui dingnspector SEP - 6 2019 APPLICATION FOR BUILDING PERMIT sTib.yF�,T y�EPT. t�+ ri�i 107B�tJ`��R�.�,�y Date , 20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire-if the work authorized has not commenced within'12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations,for the construction of buildings, additions, or alterations or for removal or demolition as herein descr'bed. The applicant agrees to comply with all applicable laws, ordinances,building code,housing code d regula ions, and o admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name,if a corporation) (Mailing address of applicant) r State whether applican s owner essee, agent, architect, en ineer eneral o actor, electrician,plumber or builder LOK1' 9 I0 tAtmid Name of owner of premises LD r j ►C�I o b(A 1= ba Vid 81( d (As on the tax roll or latest deed)) If applicant is a corporation, signature of duly authorized officer A)/)4- (Name and title o corporate officer) Builders License No. ' 570U01 Lbftd Rb 14-flit 7c) Plumbers License No. N Electricians License No. +(aC— T C Other Trade's License No. A) %k 1. Location of land on which proposed work will be done: �So �eeri W AAA ri-D House Number Street ".Hamlet,, l�,......ti. T,... T,L..•.RT,. 1 AAA 0..,.4.:,.« �� T)1,.-1. -,i� -3,in �� 2. State existing use and occupancy of premises and intend use,andM'uSP&'j)'/,CL y of proposed construction: a. Existing use and occupancy S t /l b. Intended use arid'occupancy eQrw— 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work i mm j / ( escription) 4. Estimated Cost 1p�� 5� Fee (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 66 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 J / Number of Stories 9. Size of lot: Front 0 Rear Depth �o 10. Date of Purchase a� IqName of Former Owner 11. Zone or use district in which premises are situated kksl db'`'Q 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO� Will excess fill be removed from premises? YES-,A_NO 440 E . - q`-"' S-- 14.Names of Owner ofremises L6 rl- Vi Address.4 F. IAV NY /co'15Phone No.&* 'DS" Name of Architect lA Yir'l rAddress o 10 le 112 J2S- Phone No 631-475-O4a�a Name of Contractorl 4 Address W3 one No.(p�( � ` CQJ aYGf h"<. b17� 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO Y * 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 -C * 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 * IE.YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OT ) being duly sworn; deposes and says that(s)he is the applicant (Name of individualsigning contract)above named, (S)He is the (Contractor Agent, orporate Officer, etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Navicl J-(11k1 LAlggif Sworn to before me th' b day of &t 7 Mw r 20 jam_ ERLyWEIDNEP T-TINMcl 01WE5075335 r amu.,e�.�w n1 td9W Yank -s caunlffled I° r A My Co Injan Eons 0313 —�. IFQ Scott A. Russell , �°su '�� ST01[Z.MWA\TIE]k SUPERVISOR U MA NA\G]EM]ENT SOUTHOLD TOWN HALL-P.O.Box 1179 v' 53095 Main Road-SOUTHOLD,NEW YORK 11971 ° Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SKEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE )FO)L1,0WING. Yes No (CHECK ALL THAT APPLY) ❑® A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑® B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑® 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. ®® E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. Da F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT (Property O ner,Design rofessionl, ent,Con ractor,Other) S.C.T.M. #: I QQO Date District NAME 1 Section Block Lot FOR BUILDING DEPARTMENT USE ONLY**** Contact Information. 62 ( 4Tdepla�.�'"mbril q19 6 3 _a Reviewed By: Date: Property Address/ Location of Construction Work: — — — — — — — — — — — — — — — — — /� o 1 Y1� �a f �/ync, Approved for processing Building Permit. ��1 pStormwater Management Control Plan Not Required. Stormwater Management Control Plan is Required (Forward to Engineering Department for Review.) FORM # SMCP-TOS MAY 2014 ' RUILIDINb DEPARTMENT- Electrical Inspector I ; �'.� TOWN OF SOUTHOLD OCT 2 �TvrHall Annex - 54375 Main Road - PO Box 1179 , ,` ` • ` ";' Southold, New York 11971-0959 ;. -x ,.` Telephone (631) 765-1802 - FAX (631) 765-9502 f•err SQutholdtownn gov seand(c7ssooutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Name: G►o ktS .. Cry I w��cy� License No.: A-v email: 'R -/yZ e- Address; /� 1✓ ��+ -L�n��' _ ���e 1t2. - Phone No.: 63 /- 69°g--7953 ,JOB SITE INFORMATION (All Information Required) Name: l of Address: �® 1� G1Ze.eA� Cross Street:-1-7/e o Phone No.: D 33- Bldg.Permit 3jBldg.Permit#: L%�L'�� _ _ email: Tax Map_District: 1000_ Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) ..�.v6xouAid j�?oc>-/- Circle All That Apply: Is job ready for inspection?: S.SJ NO Rough In Final Do you deed 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: 120 PAYMENT DUE.WITH.APPLICATION 1� Request for Inspection FormAs I O ® New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Vince 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^"^A^A 112590890 e REGAN AGENCY INC 463 DEER PARK AVENUE BABYLON NY 11702 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POOL&PATIO INC TOWN OF SOUTHOLD 543 MIDDLE COUNTRY RD 53095 ROUTE 25 CORAM NY 11727 SOUTHOLD NY 11971 71 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 1243979 800623 04/10/2019 TO 04/10/2020 4/1/2019 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2439 791-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT MICHAEL DOMINICI LONG ISLAND POOL&PATIO INC (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND C� DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 1026690613 YORKation Workers CERTIFICATE OF INSURANCE COVERAGE TATe Compens ! 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 1 a. Legal Name and Address of Insured (Use street address only) 1 b. Business Telephone Number Of Insured LONG ISLAND POOL& PATIO INC 543 MIDDLE COUNTRY ROAD CORAM, NY 11727 Work Location Of Insured (Only required If coverage Is specifically 1 c. Federal Employer Identification Number of limited To certain locations In New York State, i e., a Wrap-Up Policy) Insured Or Social Security Number 11-2590890 2. Name and Address of the Entity Requesting Proof 3a. Name of Insurance Carrier of Coverage(Entity Being Listed as the Certificate Holder) TOWN OF SOUTHOLD WESCO INSURANCE COMPANY 53095 ROUTE 25 3b. Policy Number of entity listed in box"1 a.": SOUTHOLD, NY 11971 0222285 3c. Policy effective period: 8/15/2019 to 12/31/2020 4. Policy provides the following benefits: ®A. Both disability and paid family leave benefits. ❑B. Disability benefits only. ❑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 I 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 8/15/2019 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 800-535-2711 Title Vice President 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 413, 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.lt 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 5B 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 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 Title Plase 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. DB-120.1 (10-17) Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is cancelled 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 coverage indicated on this Certificate. (These notices my 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 Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220.Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (10-17) Reverse LONGI-7 OP ID: DO ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDKYYI)12/07/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) 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 631-669-3434 CONTACT Brennan P.Regan Regan Agency,Inc. PHONE 631-669-3434 FAX 631-669-3035 463 Deer Park Ave (A/C,No,Ext): (A/C,No): Babylon,NY 11702 ADDRESS Brennan P.Regan INSURERS AFFORDING COVERAGE NAIC# INSURER A:American Casualty Company 20427 INSURED Long Island Pool&Patio,Inc. INSURER B:State Insurance Fund 36102 543 Middle Country Rd. Coram,NY 11727 INSURER C: INSURER D: INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE DOL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 5099218546 12/20/2018 12/20/2019 DAMAGERENTED 100 5,000 Y PREMISESS(Ea occurrence $ MED EXP An one person) $ 5'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY F]jE&_ F] LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ BIND AUTOMOBILE LIABILITY ED a.,d.n SINGLE LIMIT $ ANY AUTO BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY A6 0 ONLY Rr.cdZDAMAGE Per ac R t $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION X PTR T ERH AND EMPLOYERS' ARTNITY 12439-791-1 04/10/2018 04/10/2019 100,000 OFFICERIMEMBER EXCLUDED?ECUTIVE Y❑ N/A E L EACH ACCIDENT $ (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ 1 OO,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT A Property Section 5099218546 12/20/2018 12/20/2019 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Certificate Holder is additional insured. CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 Southold, NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD = zr Suffolk County Dept of ae :L_•, Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Dame y MICHAEL J.DOMINICI Business Name LONG ISLAND POOL&PATIO INC This certifies that the bearer is duly licensed License Number H-45707 by the County of Suffolk Issued: 1/22/2009 Commissioner Expires: 01/0112021 This license is the property of Suffolk County Department of Labor,Licensing&Consumer Affairs. Possession of this license does not guarantee its validity. Additional Business Name se H26-POOLS&SPAS/CERTIFI Dategory H99-OTHER H3-POOLS/SPAS 4 From: Nancl Lange nanci3l @optonline.net Subject: Trc Date: August 19,2019 at 2:58 PM To: Nanci Lange Nanci3l @optonline.net Suffolk CO U Lab+�r, Licensing �' dept. �f g & COnsumer Affairs "ASTER ELECTRICAL LICENSE Name ROY D CH4►LMERS rs certlfres that the Business Name )ea ar is duly licensed T R C ELECTRIC CORP the County of Swffolk License Number: ME-46689 Issued: 09123I2DO9 C'orlr mIssioner Expires: 0910112021 Sent from my Phone i New York State Insurance Fund Workers'Can:pensation&Disability Benefur$pecialists Since-1914 CORPORATE CENTER DR,3RD-FLR,MELVILLE,-NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ! '._A^^^^ 270918601 SCHAEFER AGENCY INC 201 EAST MAIN ST . PO BOX 688 SMITHTOWN NY 11787 i SCAN TO'VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER TRC ELECTRIC CORP TOWN OF SOUTHOLD 16 VIVIAN LANE 53095 ROUTE 25 LAKE GROVE NY 11755 i SOUTHOLD NY 11971 i POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12219263-7 169764 07/09/2019 TO 07/09/2020 8/12/2019' THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE'IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY' NO. 2219 263-7, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK` WORKERS' COMPENSATION LAW-WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND,'WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE,EMPLOYEES ONLY: IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION-OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,,VISIT OUR WEBSITE AT HTTPS-IIWWW.NYSIF.COM/CERT/CERTVAL.ASP.-THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE-SUCH NOTIFICATIONS-. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND'CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS 'CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE�COVERAGE AFFORDED BY THE POLICY. IIS NEW YORK-STATE INSURANCE,FUND I I DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:978445237 i Y f YORK 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 la Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured T.R.C.ELECTRIC CORP 631-648-7958 16 VIVIAN LANE LAKE GROVE,NY 11755 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) 270918601 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 53095 ROUTE 25 3b.Policy Number of Entity Listed in Box"l a" SOUTHOLD, NY 11971 DBL342305 3c.Policy effective period 07/09/2019 to 07/08/2020 4. Policy provides the following benefits: ® A. Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers- R] A All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. rl B.Only the following class or classes of 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 and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 8/15/2019 By Ah ht (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 5B 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 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 dote:Only insurance tamers 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. DB-120.1 (10-17) 01III 111°11�° °°���a111°°��°o������1°�°�III IIII Blond ' . . . . Added 2 hours ago by Michael D. 0 Pool Studio i:. �•�•••+•'viii _ Long Island Pool and Patio� hfrke Dominici _ . Blond I a � I I I CONTRACT Date i12ar 1 tong island 543 Middle Country Rd. Hm.PhoneTT D Q Coram,NY 11727 Cell Phone981 LAG - S-e1631-698-4100 631-698 4111 fax �It�ail ,Orri" : i^ �Ist�r,v Iolv•s& % �. Cep infb(@LfPoolandPatio.com //�• Salesperson: Between Long Island Pool and Patio Inc., hereinafter referred to as "Seller" F)Q) I ---D6 I and n "Buyer",residing at 9s�j � (�r� b✓.�.� CityrgS,'1-- �r h�,/ ,NY, ZIP It' �,3 f . Cross Street 0r� Size y A Shape 9, Liner S le 6% ��� ty ey�P_�1r��fe C�Ingroundnd Q'- 'Id Hayward Cartridge Filter with 7Z HP Pump Depth: 8 Corner Radius ©D 1 Main Drain LTPooI Alarm ' Rr ater Purification 46— /0ys . 4ylt�,& C'o(-E„ Qes &Floats C'Commercial V cuum Set utomatic Vacuum. Model# e olor: G.�% fav Size: o ,a-��_ l�Step Jets ' etPAt r ��ao (�30 S CGi 0,'h ®-S-lide— @iTnderwaterLight 2--,-6 Tlectrical Hookup: Power Control Center&Timer Includes 70'of wife.Additional wire at$6.00 per ft. S1 er//C6r "k-C- Fbsiii-Y�rTZl'CTnCl'1jD� _ ® �d ria =atump Model UI'1'eat Pump Electric Feed(Includes 60'of wire) F'I-toL C �t c[c� i rv= L j�e��-®.•� Additional wire at$7.95 per ft. vo td -2 �v('n�rar• �ICnli� I-IAiT ' L�Basic Permits Filed (Town Fees Paid by Customer...Need check payable to Town) "Paver color included is"Standard" only. May be additional for Premium colors...Check paver catalog! *BUYER MUST FILE FOR CERTIFICATE OF OCCUPANCY* The SELLER agrees to supply the above materials and accessories.The SELLER also agrees to excavate and install the pool,rough grade a four(4) foot area around the pool and remove any excess fill.Note:Only one load of fill will be removed on Semi-Inground pools(Additional loads can be removed at$300.per 10 yards)After final payment for the pool,the SELLER will start the pool and instruct the BUYER as to its proper operation and will supply the BUYER with a written warranty,a copy of which is permanently displayed in the SELLER's showroom. ALL PAYMENTS MUST BE CERTIFIED BANK CHECK or WIRE TRANSFER ONLY! For and to consideration of said materials and services to be provided by SELLER,BUYER agrees to pay SELLER the sum 1 of. 0,-2 A % �ti-�z ��s6. � ,y ,,i ��td,z -Alr;e, DOLLARS ($ 0-3, C758 , 410 ) This contract constitutes the entire agreement between the parties hereto and is not binding upon the SELLER unless the same is accepted by an officer of Long Island Pool and Patio.This agreement constitutes the entire understanding between the parties and SELLER is not bound by any verbal agreements.NOTICE TO BUYER:Do not sign this agreement before you have read it in its entirety,front and back.The terms on the reverse side of this contract are included in this agreement and are part of this agreement the same as if they had been printed above.BUYER acknowledges receipt of a copy of this contract. "YOU THE BUYER,MAY CANCEL THIS CONTRACT AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION." � 11���_�, .1 9 � Total Price: S 23; g-58 Progress Payment Terms: I have read this entire contract,front and Down Payment: S -7', 000 Excavation: S 2,j, 0001 back,and agreem to all terms and conditions as Balance: S 230, 90 Pool Wall Install: S 2 a, ori o if tlrey ere prime above my signature. Liner Install: $ /6 y5'Q X L.S. Recommended B Patio Concrete Poured • L.S. Suffolk County Lic 07-1-1 and Material Delivered: S 2 O, ociz d Re p. Nassau County License 4 H2806330000 Completion: S :r '63 7 rP . Prom. Edlchael Domin[cl �o • �ublec� Entalpng;Herd �ptonitne,net aft July Is,gag at i.V0Pty _ 7b' Nanal�e nencial®optanlln�net Your e!s edyobe sntwe "4 he following lb or lMk laay�SAeo Sheet �' QTo Mae gong oom Anter utnte sec cryo cerwn tYAeeof ille�e-amproamme maypr®vent uK4►ang®to date eftao tdtaohmeltte; Check your a-mail rmine flow temente handied, THE MOST EFFICIENT WAY TO EXTEND THE SWIM � SEASON. . Eleetnonic tamparature control maximizas anergy savings while atlome r - - 9 you to specify the water Prafrlled jai,Patade creates " tomperatureloYuhhin i°F t•_ afficie ` et'i .............. _ _ .• ..y ..credibly quiet air flow t .....:.......... .:........................:....................... Vis: ': nnostaticell on valve :' V4 protett8 the ca poasi � _r�1�` Tftaniu�a®at , mpressorand C 0 :', `' exchaa wensures supplies exactly the right amount of i- -��" maximum heat transfer white ; refrigeranlforoctimalpertormarco. !` ' ofiaringsupol•icrrasistanceto ` tagardlessOfOutdoor heron pool chemicals tcmoorature ;; y -Y`s,; `i .. ................................ ...................................••••' ...... eamArassor - €.} cover provides an added layer of sound •s � �qI ;. a' AHRI r:erliifed .......................................... ,,••,::' andindependentl ' - fib-tested t y ` e ensure the highest Anti-cotro +ht®AUtafieeahFast d ;' - f quality perfarmenceand value rovldo9 ........................ P years of durability in �``'��� _•"" - "••••••••• a .. . . .. . ........... *von the harshest elimatea S•Year parts and 2-year labor wOrrandOR offer addedpeace of mind ................ .3 MV NIATINepSnRa C6 Ult280v) - -- �,�m6Lnt •—.•_.,..r...__...... . .... 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Ruai ...r. ndadma Efinimutn/MoshmanRq�i _ ,i!�Unetud► 8!rsnt 38to79'••.. , ........ _.�.... ®.,.,._ �i «--- ltiwx84dA37h,.._.,...r.....r.... s FPDWaghtfi4aJ..........._......................... __...... 245 ....,....._......_..... ...... 1 ' 888• ....._..r....._..,�_r.....:_2BD_...«�_. ..»....••m»., � °®TIJ and COP R,mii n =sea Eis lkaaialananwiUs - AHRI•tl6e l�crtonttanr�E+�stStgrinar� = , i + I by 11/1YINARD' 7QI1009 r • ' -7. 'tl' `y`�^f'�-'i*.F�g--`F<< - �.. - -'V c� �� - i � ., - _ � l i Bonding and Plumbing diagram Fig. 2 Pad House BIDOWBox 4 !; VUlre ocnduftand QmupcR6 1!9 113 Check Valve (Not Suppuam — -- BBYpessValves \Chsmlcal , [fT, , feeder •, i sr Pool Pump Heat Pump/- Fig. 3 r Ar"EN ax ban Ve(ve 9 ®VVNER'S MANUAL r r _ 7 U- r,- External C®ntr®[le TO connect the electronic board In order to control it remotely, use the P S terminals on the right side of the board. Next, access the P S menu and se- lect the desired mode, In internal mode, POOL or SPA mode can be adjusted by using this menu. In external mode,a normally open contact puts the board in POOL mode and a closed contact puts the board in SPA mode.Therefore, . a board Set to OFF in POOL,mode and to 80 degrees in SPA mode can be controlled with an external switch to heat up to 80 degrees. 9rlternal mode.- Ua®gh®j ,S m@d@®R the ms, civ®nu ema9 mode.- o ©p®n p®fngece_P(D®L.m®'09 0 99088@7 WBROW o SPA Uri@d@ C®ntrot using a switch To control the board using an external switch,follow these steps Turn on the heat pump. 1)Set POOL mode to OFF 0 S®t SPA mode to the desired temperature. o Access the setup menu. °Select mode E(external)on the P S menu. ® Pun twp J7(FILS)terminal wires from the HPEC-oo3 board to the NO switch terminals(see FIG.4). You can now control the operating mode by turning off the switch (open a POOL,closed®SPA.) Fig. 4 �a.be NSPa L xternal switch ool(open) (closed) 10 IM OWNER'S d<iMUAL I --�I:.��.•-=�=•c=^...�;�. .- _ i-�'�,,� .�-s..�--..�.,•_�.-_mss_-•--_-.—,;..nr�..,. ^ .a_ '_. - _' _- � , ..f; - �•tom - ---- '__ . . '.. .- - '��• - - =i'k`_':^^.nr�..!�-�5- . Electric al Connections &n�WAk N I N The installation of the pool heater should be p®rfarmed by a cartified electrician. To connect the @i@ctricitY, You must unscrew the five screws of the front panel, then slide the electric cable through the knock out located on the left or the right side of the base, and then insert it In the control box. The electrical diagram is located on the lid of the control box ' �®II as is this manual. ............................... ................ Power requirements Fig. _ Look at the name plate loca_ E.• ,.,�„ , , ted on the heat pump to know f' '� ` '{` 1•, f , the required amperage. �{S;R• ' ,_;-• �;�,���, ,5..;,. Please refer to Y® local .-, •�-��;i'•y�.y+r',��,�°=''��,.; °�,'' :_ �� •E,. , electrical code for additional s .r.}' ' , "� 't wiring requirements. .,µ�� � � .��:. •� r: ' `' :LR ,• S•..•.•..•... Ir gpgp Q ,•irk �r.,7.•r� � '�, Ground Jai 4 A Fri OWNER'S AMMANUAL l _ S'4 waive, ?5�� •.,r ',1+ yy��tl t • 1�A��f Brown BIOS'!1 Crap .*, ��` a•F`� 6j Big FM CAP HPIEC-003 s coeRrREssoR Contmf Board ° 1— uYc 24Vaccompresmr 1 4j 1 ' v m HP HP w w no noRe avec P S 00 00 a ® Bim Waterseneor Remole swirl, J 1� Pod(oper�etq ,, r: spa DeRostswtsnr YeIIow Black E �hPaw2ali II L9 a Cipand ox �� Blce O+an6@(240Vac) 1 ;, is, ae][ Loft/ 24 Vhc:ftwronW Red(206 Vim) opened t Flowsmamms Clowcfioyv Opow-notoM1 206/2SDVim. Ht 1 Phaca � , 91, I 1 «, I • r M SURVEY OF LOT 99 MAP OF PEBBLE BEACH FARMS rill too. 62" rlLm JUNE 11. 1975 SIMAMD AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY. NEW YORK S.C. TAX No. 10130--X-02--36 SCALE 1"=7-0• kUGtlST 14, 1997 OCMBM 23, 1991 REV= PROPOSED HousE AREA = 22.513.09 ft. ti4s 0.5117 cc. N+ ' Out Nr� Tk � . -00Zl fl TO RONALD CDRDAND JOANNE COADANO LAKE SHORE ABSTRACT Inc. l o � � x • • IVa A ' . �► 3 ' . 11. REFER TO FILED MAP fOR TEST HOLE VAT& ELEVATIONS S14O 'N THUS:JUARE REMENCED TO AN ASSUMED VikTUm. z 3. WINI[�UM SrPTLC TANK WACMES FUR A t TO A REDRMU HOUSE IS 1,000 GALLONS. —Z' MOE. 6• Y DEEP ` 4. UINIMUM LEACHING SYSTEM FOR A 1 TO 4 eEDRO U HOUSE IS 300 2q It SIDEWALL i FOOL, 12' DEEP. 8• dJd. •• , . �. �l114 S. IF CLAY IN THE LEACHING POOL AREA IS FOUND, IT' MUST BE L Tl �y4 EXCAVATED AND RE,PLACEO WITH CLEAN SMD EA Vf H CEP YD Id E! i foot. lit --�...,�.... ._ d tQVxL 117E�;x3P1.'C't'RtJC'�'101d i �. PN VIA q;r- flp� pot 'USISS �U5, .+ r Waud Dina Stan "Umcm Lw. too 0wo Zi 11{1 f0 1C A� >" �r a•�, 11E ft 04 "M Kmaz m THr OWILMM tit ftm Kw STM Leo Joseph A. I p�� n �.� Land Surveyor ' , * TU •-s, . — 3* pb. _ cam. , cww PHONE (51st' .7-2(no r4m (Slaym-Nm . tom, 49w- 0+• U rim S:P"* PA Oar 1231 . . •- ._.... ... _ .___ .., � t4� Yoek 'l59�1 r Ypro 11001 _ N� R APPROVED AS NO D DATE. 1 B.P.# FEE: �� BY-_ZU NOTIFY BUILDING 'DEPARTMENT AT r RETAIN STORM WATER RUNOFF 765-1802 8 AM 70 4 PM FOR THE FOLLOWING INSPECTIONS: PURSUANT TO CHAPTER 236 1. FOUNDATION - TW REQUIRED OF THE TOWN CODE. FOR POURED CONCRETE h 2. ROUGH - FRAMiNG & PLUMBING 3 INSULATION 4 FINAL - CONSTRICTION MUST BE COMPLETE FOR C.O. 4LL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NE\A FORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ELECTRICAL INSPECTION REQUIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF "+P BOARD SEES .®, N. . . DEC yy LY .ENCLOSE POOL TO CODE„ "PON COMPLETION SEFORE."WAT '� R- OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY �3 ILTERED WATER RETURN NUMBER l'> I FI OF NOZZLES VARIES PER POOL SIZE t COMPOSITE WALL POOL SYSTEM _ -�� *THIS DRAWING REPRESENTS CUSTOMER SPECIFICATION J *YOUR SIGNATURE ACKNOWLEDGES ACCEPTANCE. 0 22' X 44' RECTANGLE 90 DEG DWG#: CM-8908 DATE: 8/21/2019 REV: C PAGE 2- OF SIGN. DAA: KIMMER �rPooL—� L MAIN AREA(SgFt): 1,10 PERIMETER: 144' EST.VOL(US Gal): 37,950 DTRAINE 3'•0'MIN O SPACI G STRAINE 441-on z 8'-0" 2'0 TfP) = O Fto S ST 9001CR CG-720 CG720 CG720 CG-720 CG-720 CG720 CG720 CG-240 ST-9001CR 3'-411 in W CU-0601FCR CU-0601FCR C U SO T�z 11 CG240 CG360 4-O IRGINIA GRAEME BAKER S ACT APPROVED DRAINS NOTE DRAWING CONFORMS TO ANSI I APSP-7 SUCTION ENTRAPMENT AVOIDANCE CODES CG720 MAIN DRAIN PIPING SCHEMATIC CG72O (NOT TO SCALE) a CODE COMPLIANCE NOTES: s� IN ADDITION TO THE 2016&2017 UNIFORM BUILDING jig a CODE SUPPLEMENT,SECTION R326 REFERENCED c � \a AT THE BOTTOM OF THIS DRAWING,ALSO REFER TO: o o IIc 14'-0" 22'-0" CG-720L 5bl 2015 INTERNATIONAL RESIDENTIAL CODE 0-10- jai CG•720 SECTION N1103.10(R403 10)-POOLS AND o m @3 PERMANENT SPA ENERGY CONSUMPTION a 1 9 H SECTION N1103 10.1 -HEATERS a eD I` a SECTION N1103.10 2-TIME SWITCHES o CG-360 PIT-011 cG-240 SECTION N110310.3-COVERS °O a v p Cn U. 7' Cl)0116 �a 1131 -O11 o GENERAL NOTES: N o $a 4'-0" 1'-011 in ALL WATER EITHER OVERFLOWING OR EMPTYING 'I-° s' 11 ,Typ +( FROM THE POOL SHALL BE DISPOSED OF ON THE 21 i OWNERS LAND,AND PLANS SUBMITTED SHALL x EEke pa 7 uI 5'-0" 5'-0" a 11 SHOW PROVISIONS MADE FOR SUCH WATER FROM 31-0" 3-O FLOWING ON THE LAND OF ANY ADJOINING 3'-4" � S-ST-0000SP (1720 S-ST-000OSP PROPERTY OWNER OR INTO ANY ABUTTING __-... : e CG-480 CG720 CG-720 CG-720 CG-720 STREET. _ mw FUZION(2) BRACE SUCTION OUTLETS SHALL BE DESIGNED AND 0"11- INSTALLED IN ACCORDANCE WITH ANSI/APSP-7./� 3a H 31-4'1 3 a PROTECTIVE BARRIER NOTE: 81-011 DURING CONSTRUCTION OF THE POOL,A O) TEMPORARY BARRIER SHALL BE INSTALLED WITH F raW A MINIMUM HEIGHT OF 4'-0". UPON COMPLETION 0] OF POOL INSTALLATION,OWNER SHALL INSTALL A Q a Q PERMANENT BARRIER,MINIMUM HEIGHT OF 4'-0", no: WITHIN 90 DAYS. Z >- Z}N • �� INC. LL1 Z Q r LIJ .. lute Z 0:� - 0'z- 00z z} : 4'-0" 6'-0" 14'-0" ZO'-0" O leo ooZ ENGINEERS SEAL Z mw Q ¢oo ..aa�� l N��''AA�' Nor, DA:DIVING MAY f Only Alpha Pod Produce makes only nesse represr l®ons which are stated In its written werractV.Any other repre50ntatons,statements.or contracts made by the deate/cantractor to the CUMM regarding any MMPOI 10 IS Produced O� 7 �j®14 G. y��® 00 I— C�to RESULT IN SERIOUS by Only Alpha Pod ttroduas are atmbutable to dine dealer/a�trai=tang.The dealer or contractor who sds ta instak year pod s an indepr�a rt contractor and 1s not an agent or employee of Only Alpha Pod PnxkK .The construction 0 �] (n Z methods dlestrated here arew9gesoorls and apply orgy to normal ground conditions.There may be additional precautions and/or methods of exon The responsibility IS the contradoes.-A safety line,with buoys,Is robe NO DIVING INJURY GA DEATH. pa,, ,yy attached 1'-0"to the sihaitow We of the point of fust dope charge.-0iffe es methods and precautions maybe dictated by vanes ground condiuors.This is to be determined by and is the responsbillN of the contractor who 1� - �.. /Q� oG Q OJ 1s rice ah agent of the manufacturer of the componerrt parts.-Insdtatien Is to be done In accordance with a1 fedxal,state and local brnid�rhg codes,as well as AN.SI./N S-P.I.suggested standards.-BOTTOM SPECIFICATIONS MUST MEET �n � Ld Signage must be permanantly attached OR h7�E0 ANS.1.1N.SP.I./AP.S.P.RECOMMENDED STANDARDS=NO ONING sgnage must be prrmaneni yattedsedto the entire perimeter of the pod.See in&vucwm with Mmooe--IT 19 RECOMMENDED TO NOT INSTALL Paul PfUliUCLS � UJ DIVING BOARDS AND/OR SLIDING EQUIPMENT ON RESIDENTIAL POOLS.If diving boards and/or didreig esPdpinemtis uutailed W dire contraecnr,such eRvEng boards and dlding aeiuiprnent MUST SE INSTALLED around the perimeter of the pool. WITHIN THE GUIDELINES ESTABLISHED BY ANSI/NSP1I ASPA RECOMMENDED STANOTAR0.9,AND IN ACCORDANCE WITH ALL APPLICABLE STATE AND LOCALCODES AND REGULATIONS. ir r4 'r a N. N/A 0, CL Ui CTC i!k 06Q520�1 �� CHECM Or SGH "Opel—, A� AUGUST23,2019 AS NOTED ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2016&2017 NEW YORK STATE UNIFORM BUILDING CODE SUPPLEMENT,INCLUDING THE SPECIFICATIONS IN SECTION R326-SEE SHEET 2 OF 2 1 0 F 2 SECTION R326 3-SWIMMING POOLS;SECTION R326.4-SPA&HOT TUBS,SECTION R326.5-BARRIER REQUIREMENTS;SECTION R326.6.-ENTRAPMENT PROTECTION FOR SWIMMING POOL&SPA SUCTION OUTLETS;SECTION R326.7-SWIMMING POOL&SPAALARMS SECTION 326 SWIMMING POOLS,SPAS,AND HOT TUBS o R326.1 GENERAL 2 Openings in the barrier shall not allow passage of a 4-inch-diameter 101 The ladder or steps shall be capable of being secured,locked or R326.8 STANDARDS R326.1 The provisions of this section shall control the design and (102 mm)sphere. removed to prevent access,or A326.8.1 General m construction of swimming pools,spas and hot tubs installed in or on the lot of a one-or two-family dwelling 3 Solid barriers which do not have openings,such as a masonry or 10 2 The ladder or steps shall be surrounded by a barrier which meets the ANSI-American National Standards Institute stone wall,shall not contain indentations or protrusions except for requirements of R326.5 2,Items 1 through 9 When the ladder or steps are R326.3 SWIMMING POOLS normal construction tolerances and tooled masonry joints. secured,locked or removed,any opening created shall not allow the ANSI/APSP 7-13-Standard for Suction Entrapment Avoidance in R326.3.1 In-ground pools.In-ground pools shall be designed and passage of a 4-inch-diameter(102 mm)sphere Swimming Pools,Wading Pools,Spas,Hot Tubs,and Catch Basins constructed in conformance with ANSI/NSPI-5. 4 Where the barrier is composed of horizontal and vertical members (R326 6 1) and the distance between the tops of the honzontal members is less R326.5.4 Indoor Swimming Pool.Walls surrounding an indoor swimming cn R326.3.2 Above-ground and on-ground pools.Above-ground and than 45 inches(1143 mm),the horizontal members shall be located on pool shall comply with Section R326 5 2,Item 9 ANSI/NSPI-3-99-Standard for Permanently Installed Residential Spas z o o M on-ground pools shall be designed and constructed in conformance the swimming pool side of the fence Spacing between vertical (R326 4 1) a S with ANSI/NSPIA. members shall not exceed 1-3/4 inches(44 mm)in width Where there R326.5.5 Prohibited locations.Barriers shall be located to prohibit are decorative cutouts within vertical members,spacing within the permanent structures,equipment or similar objects from being used to ANSI/NSPI-4-99-Standard for Above-ground/On-ground Residential c R326.4 SPAS AND HOT TUBS cutouts shall not exceed 1-3/4 inches(44 mm)in width. climb them. Swimming Pools (R326.3.2) R326.4.1 Permanently Installed spas and hot tubs.Permanently installed spas and hot tubs shall be designed and constructed in 5.Where the barrier is composed of horizontal and vertical members R326.5.6 Barrier Exceptions.Spas or hot tubs with a safety cover which ANSI/NSPI-5-03-Standard for Residential In-ground Swimming Pools conformance with ANSI/NSPI-3 as listed in Section 326.8. and the distance between the tops of the horizontal members is 45 complies with ASTM F 1346 shall be exempt from the provisions of this (R326.31) inches(1143 mm)or more,spacing between vertical members shall not appendix R326.4.2 Portable spas and hot tubs.Portable spas and hot tubs exceed 4 inches(102 mm) Where there are decorative cutouts within ANSI/NSPI-6-99-Standard for Residential Portable Spas shall be designed and constructed in conformance with ANSI/NSPI-6. vertical members,spacing within the cutouts shall not exceed 1-3/4 R326.6 ENTRAPMENT PROTECTION FOR SWIMMING POOL (R326.4 2) inches(44 mm)in width. AND SPA SUCTION OUTLETS m a m w i R326.S BARRIER REQUIREMENTS - R326.6.1 General.Suction outlets shall be designed to produce circulation ANSI/ASME A112.19.8M-(1987,R-1996)Suction Fittings for Use in R326.5.1 Application.The provisions of this section shall control the 6.Maximum mesh size for chain link fences shall be a 2-1/4-inch(57 throughout the pool or spa.Single-outlet systems,such as automatic Swimming Pools,Wading Pools,Spas,Hot Tubs and Whirlpool Bathing co § � design of barriers for residential swimming pools,spas and hot tubs. mm)square unless the fence has slats fastened at the top or the vacuum cleaner systems,or multiple suction outlets,whether isolated by Appliances (R326.6 2) n8 3 These design controls are intended to provide protection against bottom which reduce the openings to not more than 1-3/4 inches(44 valves or otherwise,shall be protected against user entrapment. Jig Professionals a } a potential drownings and near-drownings by restricting access to mm) APSP-Association of Pool and Spa Z swimming pools,spas and hot tubs R326.6.1.1 Compliance alternative.Suction outlets may be designed and 7 Where the barrier is composed of diagonal members,such as a installed in accordance with ANSI/APSP-7. ANSI/APSP-7-13 Standard for Suction Entrapment Avoidance in Swimming o 0 �g R326.5.2 Temporary barriers.An outdoor swimming pool,including an lattice fence,the maximum opening formed by the diagonal members Pools,Wading Pools,Spas,Hot Tubs,&Catch Basins s in-ground,above-ground or on-ground pool,hot tub or spa shall be shall not be more than 1-3/4 inches(44 mm). R326.6.2 Suction fittings.Pool and spa suction outlets shall have a cover (R326.6.1) o 0 o fi surrounded by a temporary barrier during installation or construction that conforms to ANSI/ASME A112 19 8M,or an 18 inch'23 inch(457 mm u o � Ill and shall remain in place until a permanent barrier in compliance with 8.Gates shall comply with the requirements of Section R326.5.2,Items by 584 mm)drain grate or larger,or an approved channel drain system ASME-American Society of Mechanical Engineers u Section R326.5.3 is provided 1 through 7,and with the following requirements, E gg R326.6.3 Atmospheric vacuum relief system required.Pool and spa ANSI/ASME A112 19 8 2007-Suction Fittings for Use in Swimming Pools, oo �chOEX Exceptions: 8.1.All gates shall be self-closing In addition,if the gate is a pedestrian single-or multiple-outlet circulation systems shall be equipped with Wading Pools,Spas,Hot Tubs,and Whirlpool Bathing Appliances o a � 1 Above-ground or on-ground pools where the pool structure is the access gate,the gate shall open outward,away from the pool atmospheric vacuum relief should grate covers located therein become (R326.6.2) barrier in compliance with R326 5 3 missing or broken.This cauum relief system shall include at least one =LL o g 2.Spas or hot tubs with a safety coverwhich complies with ASTM F 8.2.All gates shall be self-latching,with the latch handle located within approved or engineered method of the type specified herein,as follows. ASTM-ASTM International a)Q _€ 1346 provided that such safety cover is in place during the period of the enclosure(i.e,on the pool side of the enclosure)and at least 40 1 Stafety vacuum release system conforming to ASME Al 12.19.17,or installation or construction of such hot tub or spa The temporary inches(1016 mm)above grade.In addition,if the latch handle is 2.An approved gravity drainage system. ASTM F 1346-91(1996)Performance Specification for Safety Covers and 3;s R! removal of a safety cover as required to facilitate the installation or located less than 54 inches(1372 mm)from the bottom of the gate,the Labeling Requirements for All Covers for Swimming Pools,Spas and Hot d "s IN construction of a hot tub or spa during periods when at least one person latch handle shall be located at least 3 inches(76 mm)below the top of Exception:Surface skimmers Tubs engaged in the installation or construction is present is permitted. the gate,and neither the gate nor the barrier shall have any opening (R326 5 2;R326 5 3;R326 5 6;R326.7.1) p� o greater than 0.5 inch(12 7 mm)within 18 inches(457 mm)of the latch R326.6.4 Dual drain separation.Single or multiple circulation systems o m e R326.5.2.1 Height.The top of the temporary barrier shall be at least 48 handle. have a minimum of two suction outlets of the approved type.A minimum ASTM F2208-2008-Standard Specification for Pool Alarms ­-—-- 21. ae inches(1219 mm)above grade measured on the side of the barrier horizontal or vertical distance of 3 feet(914 mm)shall separate the outlets. (R326.7.1) y which faces away from the swimming pool 8.3.All gates shall be securely locked with a key,combination or other These suction outlets shall be piped so the water is drawn through them child proof lock sufficient to prevent access to the swimming pool simultaneously though a vacuum-relief-protected line to the pump or NSPI-National Spa and Pool Institute y°< .,y W s11 m 1 R326.5.2.2 Replacement by a permanent barrier.A temporary barrier through such gate when the swimming pool is not in use or supervised pumps. lei shall be replaced by a complying permanent barrier within either of the ANSI/NSPI-3-99-Standard for Permanently Installed Residential Spas hogs o following periods: 9.Where a wall of a dwelling serves as part of the barrier,one of the R326.6.5 Pool cleaner fittings.Where provided,vacuum or pressure (R326 41) gsg 1 90 days of the date of issuance of the budding permit for the following conditions shall be met* cleaner fitting(s)shall be located in an accessible position(s)at least 6 installation or construction of the swimming pool;or inches(152 mm)and not more than 12 inches(305 mm)below the ANSI/NSPI-4-99-Standard for Above-ground/On-ground Residential 2.90 days of the date of commencement of the installation or 9 1 The pool shall be equipped with a powered safety cover in minimum operational water level or as an attachment to the skimmer(s). Swimming Pools O O construction of the swimming pool. compliance with ASTM F 1346;or (R326 3 2) F R326.7 SWIMMING POOL AND SPA ALARMS Q R326.5.2.2.1 Replacement extension.Subject to the approval of the 9.2 Doors with direct access to the pool through that wall shall be R326.7.1 Applicability.A swimming pool or spa installed,constructed or ANSI/NSPI-5-03-Standard for Residential In-ground Swimming Pools r t _< code enforcement official,the time period for completion of the - equipped with an alarm which produces an audible warning when the substantially modified after December 14,2006,shall be equipped with an (R326.3.1) a X permanent barrier may be extended for good cause,including,but not door and/or its screen,if present,are opened The alarm shall be listed approved pool alarm W Q>-04 limited to,adverse weather conditions delaying construction. in accordance with UL 2017 The audible alarm shall activate within 7 Exceptions: ANSI/NSPI-6-99-Standard for Residential Portable Spas W Z J f5 seconds and sound continuously for a minimum of 30 seconds after the 1 A hot tub or spa equipped with a safety cover which complies with ASTM (R326.4 2) z 0� - O j} R326.5.3 Permanent Barriers.An outdoor swimming pool,including door and/or its screen,if present,are opened and be capable of being F1346 O(D Z 100 v z an in-ground,above-ground or on-ground pool,hot tub or spa shall be heard throughout the house during normal household activities.The 2.A swimming pool(other than a hot tub or spa)equipped with an UL-Underwriters Laboratones,Inc. ENGINEER'S SEAL J O surrounded by a barrier which shall comply with the following, alarm shall automatically reset under all conditions.The alarm system automatic power safety cover which complies with ASTM F1346 CO= Z o< shall be equipped with a manual means,such as touch pad or switch, UL2017-2000-Standard for General-purpose Q J 9 U 1 .The top of the barrier shall be at least 48 inches(1219 mm)above to temporarily deactivate the alarm for a single opening.Deactivation Pool alarms shall comply with ASTM F2208,and shall be installed,used, Signaling Devices and Systems with Revisions grade measured on the side of the barrier which faces away from the shall last for not more than 15 seconds The deactivation switch(es) and maintained in accordance with the manufacturer's instructions and this through June 2004 O K' swimming pool The maximum vertical clearance between grade and shall be located at least 54 inches(1372 mm)above the threshold of section. (R326.5.3) ky� (G G. 00U) Z LO the bottom of the barrier shall be 2 inches(51 mm)measured on the the door,or �� �fZ ° Q 0 side of the barrier which faces away from the swimming pool.Where R326.7.2 Multiple Alarms.A pool alarm must be capable of detecting `The NSPI documents are available i W the top of the pool structure is above grade,such as an aboveground 9 3 Other means of protection,such as self-closing doors with entry into the water at any point on the surface of the swimming pool.If through APSP. co 0 pool,the barrier may be at ground level,such as the pool structure,or self-latching devices,shall be acceptable so long as the degree of necessary to provide detection capability at every point on the surface of 1) mounted on top of the pool structure Where the barrier is mounted on protection afforded is not less than the protection afforded by Item 91 the swimming pool,more that one pool alarm shall be provided. NIA top of the pool structure,the maximum vertical clearance between the or 9.2 described abovefi ex a t4 01A�' CTC top of the pool structure and the bottom of the barrier shall be 4 inches R326.7.3 Alarm Activation.Pool alarms shall activate upon detecting tS� 090A C4am=or (102 mm). 10 Where an above-ground pool structure is used as a barrier or where entry into the water and shall sound poolside and inside dwellling. f1� 60520' sGH the barrier is mounted on top of the pool structure,and the means of R_FESSIO% AUGUST 23,2019 access is a ladder or steps: R326.7.4 Prohibited Alarms.The use of personal immersion alarms shall AS NOTED not be construed as compliance with this section. 2OF2