HomeMy WebLinkAbout43698-Z U&F®l/(co� Town of Southold 8/25/2020
a
P.O.Box 1179
. 53095 Main Rd
f Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41383 Date: 8/25/2020
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 460 Fred St,New Suffolk
SCTM#: 473889 Sec/Block/Lot: 117.4-18.6
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore fled in this office dated
4/25/2019 pursuant to which Building Permit No. 43698 dated 5/1/2019
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 Auriemma,Linda&Paul
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 43698 11/1/2019
PLUMBERS CERTIFICATION DATED
th rize gnature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o . SOUTHOLD NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 43698 Date: 5/1/2019
Permission is hereby granted to:
Auriemma, Linda & Paul
PO BOX 317
New Suffolk, NY 11956
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
460 Fred St, New Suffolk
SCTM # 473889
Sec/Block/Lot# 117.4-18.6
Pursuant to application dated 4/25/2019 and approved by the Building Inspector.
To expire on 10/30/2020.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
(i
Buil ctor
/ 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 2110 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 1
Date. )4-2s 1
New Construction: Old or Pre-existing Building: (check one)
Location of Property: D� .dc) AA-{-Le.�-- �� �,ic
House No. Street Hamlet
Owner or Owners of Property: J_jj,\/t0r Ai,0194HA-
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. �llJ Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: - /
Request for: Temporary Certificate Final Certificate: l/ (check one)
Fee Submitted: $
f
pplicant Signature
rjv so
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 sean.devlinl-town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Linda Auriemma
Address: 460 Fred St city,New Suffolk sr NY zip: 11956
Budding Permit# 43698 Section Block Lot
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Leo's Electris License No: 2199-ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor 1 st Floor Pool X
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph X Heat Duplec Recpt Ceding Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt 2 Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 2 Twist Lock Exit Fixtures 11 Combo SD/CO
Other Equipment* Intermatic Pool Panel, Max-E-Therm Pool Heater, Salt Generator, Polaris Cleaner,
Pump, Pool Cover, Pool Lights- 2, Switch w/ Lockbox for Pool Cover
Notes,
Pool
Inspector Signature: Date: November 1, 2019
S Devlin-Cert Electrical Compliance Form As
bo
O �. (
F SOUIyo
# # TOWN OF SOUTHOLD BUILDING DEPT.
`ycout®ri, 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [" ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ' ] 'FIREPLACE &-CHIMNEY [ ] FIRE SAFETY INSPECTION
] FIRE RESISTANT tONSTRUCTION [: ] FIRE RESISTANT PENETRATION-
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) f
[ ]' CODE VIOLATION [ ] PRE C/O
REMARKS:
V, tJhl,
DATE INSPECTOR
SOF SOUI
TOWN OF SOUTHOLD BUILDING DEPT.
`ycaurm,��' 765.1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULAT ON
[ ] FRAMING /STRAPPING [FINAL et--�
[ ] FIREPLACE, & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REM RKS: r V G4 1, Vt.VCA
V
66
DATE /0 INSPECTOR /V L41
SOF so
# # TOWN OF SOUTHOLD BUILDING DEPT.
`yco 765-1802
INSPECTION _
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND, [ ] SULATIO CAULKING
[ ] FRAMING/STRAPPING [ FINAL, ,
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
o n , zo�
DATE INSPECTOR
' Macholz, Nancy<nancy@leoselectric.com>
GTdfi�tin flJIM(;iaarn riLlit rr��iF3
460 fred st new suffolk
1 message
Walsh, George<george@leoselectric.com> Thu, Jul 25, 2019 at 4:41 PM
To: Nancy Macholz <nancy@leoselectric.com>
Pool Bonding
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FIELD INSPECTIWORT DATE COMMENTS �►
FOUNDATION (1ST)
• �H
-------------------------------------
'FOUNDATION (2ND,)
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ROUGH FRAMING&
PLUMBING y �
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INSULATION PER N. Y-.
STATE ENERGY CODE
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FINAL AN&
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DE,P=ARTMENT` ":' ;; ''` . -
Do you have or,need the following,Before applying 7
TOWN HALL Board of Health
`WUTHOLD,NY 11971 3 sets of Building Plans
,:.TEL: 765-4802
b Survey
PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
C�
Trustees•
Examined ✓ .20 Contact:
Approved ,•20 4 Mail to:
Disapproved a/c —br
Phone:
Dt 'F[-a
D B din pector
APR 2 5 2019
APPLICATION FORBUM-DINGPERNIIT
TOWN OF SOUTHGAI D Date �C'����� .20
INSTRUCTIONS
a.This application`MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
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 a Certificate of Occupancy
is issued by the Building Inspector.
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+Southol&,,SuffolklCouhty;New'York,and other applicable Laws;'0iclinances,or
Regulations,for the construction of buildings,additions,or alterations or for removal or demolit' n as herein described.The
applicant agrees to comply withAl'applicable,laws;ordinanceiibuil`ding code,housing code, regulations,,,and°to admit
authorized"inspectors on premises,anddn building for necessary inspections.
(Signa .applicant o name;if a=c.orporation)
(Mailing,address of applicant),
State whether applicant is owner,lessee, agent,architect, engineer, general contractor, electrician,plumber.or.builder
Name of owner of premises 4,<)4 1416-e qg4
(as on the tax roll or latest,deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate-,officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done: '
tAA°° I -1:VQ4 f+"e---
House Number Street , ''Hamlet
i V 1 ifj
County Tax Map No. 1000 Section [ Block—4 Lott L'(0
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises.and intended use and occupancy of proposed-construction:
a. Existing use and occupancy_ \.�-h� Qp�� d
b. Intended use and occupancy_ ,�-�S� -✓ �y��rn �„/q ��
3. Nature of work(check which applicable):New Building Addition Alteration
Repair Removal, Demolition Other Work i%ru,, z,,j,m rA,-i9
(Description)
4. Estimated Cost 1,�i 00J 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
6. If business, commercial or mixed occupancy, specify natur' and extent of each type of use.
-J
7. Dimensions of existing structures,if any: Front .Rear �� ; ��'Y' `r' �a D
Height Number of Stories
Dimensions of same structure with-a'Iterations or�additions: f=ront Rear
Depth Height Number of Stories-,,•.`.= ' .T.,
8. Dimensions of entire new construction: Front_ Rears' Depth 8
Height Number of Stories
9. Size of lot: Front 3io0 Rear- Depth 20'7
10.,Date of Purchase Name of Forrner Owner
11. Zone or use district in which premises are situated;
12.'Does proposed construction violate any zoning law,ordinance or regulation:
13. Will lot be re-graded t''-xx Will excess.fill be removed from.premises(YES NO
14. Names of Owner of.premises)AM Ayet-enn Address4bo Fao 61#e'J&fff No.W(a-QG5--Zb7
Name of A�e�t`-R.�rtn� Qe,li �� Address 8¢ae`/�JrPhone'IVo (0 3 -7 2�—5��
Name of Contractorl `t�,•.L �o�aros cs Address � , /Gtz(`1�y�.f,11 Q phone No. -�18r'
15. Is thistproperty within-100-feet of a tidalvetland? *YES NO
IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE RE UIRED
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.
STATE OF NEW YORK)
SS:
COUNTY OF
�1 being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(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 filed therewith.
Sworn to before me this
2—o�'"' day of 20Iq
NkaryPublic Signature of Applit
a MARGAREF A. KIDNEY
Notary Public-State of New York
No. 01 K 16021 l 1 1
Qualified in Suffolk County
My Commission Expires March 8,20a3
}
Scott A. Russell d°su '� STOWMMIWAXIEIK
SUPERInSOR
IOWA NA,GrIEMTENT
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 119710 Town of Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING:
Yes No (CHECK ALL THAT APPLY)
®[2r 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.
❑dD. Sitere aration within 100 feet of wetlands beach bluff or coastal
P P ,
erosion hazard area.
❑E�E. Site preparation within the one-hundred-year f asdepicted
lain de icted
P P
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 Management
Control Plan was re-ceived 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 witlyour Building Permit Application.
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date:
P7 DlstNct
NAME: )-INON 1 / L l
Section Block Lot
a �
FOR BUILDING DEPARTMENT USE ONLY
Contact Information
��s-So�� **** ****
rrelept=Number) '
Reviewed By:
Property Address/Location of Construction Work: _ _ _ _ _ _ _ — Date_
�,eo K1,.-I� eef Approved for processing Building Permit.
� ❑ Stormwater Management Control Plan Not Required.
ElStormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
FORM * SMCP-TOS MAY 2014
_ OF SO�j�,o
Town Hall Annex
54375 Main Road W � Telephone(631)79ii5pp-1802
P.O.sox 1179 . O roger.richertCOW tt0wn Southol5.ny.us
Southold,NY 11971-0959
VVvv �
BUILDING DEPARTMENT
TOWN OF SOUTHOLD-
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY:' Date:
Company Name: L,e I S i✓(ect-Gle
Name: Je O
v.
License No.:
Address: 1 • J4 Mtf-m 40 by
Phone No..
JOBSITE INFORMATION: (*Indicates required information)
*Name: L%4'OA AURke o mA• ,
*Address: *oo F_YeD Site t
*Cross Street: eqnw, "
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: ..117 Block: Lot:
*BRIEF DESCRIPTION OF WORK/ (Please Print Clearly) Ax
l G dJW0 U�1►uV 6h/►mrn INq
(Please Circle All That Apply)
'FIs•job ready for inspection: YES / NO Rough In Final
*Do you need a Temp Certificate: YE_ / NO
Temp Information (If needed} •
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service -Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
bo
82-Request for Inspection Form
o VF I 0j4r'-. BUILDING DEPARTMENT-Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
ogenxibh
'L er" ftown.s6dfhol'd','.'hy—.'dt
ta-
APPI-i-bATiONFOR ELECTRICAL INSPECTION
REQUESTED BY: Date,, _3
Company Name:
Name:
License No.: �5 Ci,Jont-:;- email:. I-g-o-::i cS cc�--C
Address: I q A-,b rA k— -aa-a 76- J. NI-WN A U- J t S(.0�L
Phone No..," L31-
-'6B' SITE INFORMATION: (All information Required)
Name: Q( Tr
Address: LI&O r(nj
Cross Street:
Phone No.: Lf 417
'Bidg.Permit#: em mcgg
11f6x Map District: _ 1000 section: III Block:-,,u
BRIEF DE RIP.TION OF WORK(Please Print Clearly)
-----------7-
Circle All That Apply:
Is job ready for inspection?: YES NO Rough In Final
Do you need a Temp Certificate?: YES NO Issued On-,
Temp In'formationi (All information required)
1 Ph 3 Ph Size: #Meters., Old Meter#
New Service- Fire Reconnect- Flood Reconnect-Service Reconnected -Underground -Overhead
J#-Undeeground Laterals 1 2 H Frame Pole Work done on-Servic92-,,,
Y R:\V6=
Addition'61 Information* I D UE;:�
U -A
;PAYMENT'DUE WITH APPLICATION
82-Request for Inspection FormAs `0(D
ARTHUR EDWARDS POOL & SPA CENTRE
929 ROUTE 25A
MILLER PLACE, NY 11764
516-744-7185
FAX-744-0174
APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD
TOWN OF SOUTHOLD
MAIN ROAD (P.O. BOX 1179)
SOUTHOLD, NY 11971
(631) 765-1802
PAPERS ENCLOSED:
Nb APPLICATION FOR OUTDOOR POOL PERMIT
1p EROSION SEDIMENTATION &WATER RUN ASSESSMENT FORM
[ CERTIFICATE OF WORKER'S COMPENSATION
[� CERTIFICATE OF LIABILITY INSURANCE
[)dD SUFFOLK COUNTY LICENSE
-{�-- SUFFOLK COUNTY PLUMBER LICENSE
[ ] SUFFOLK COUNTY ELECTRICIAN LICENSE
NO 4 SETS OF PLANS - (3 STAMPED)
[� 3 SURVEYS with FILTER LOCATION
APPLICATION FOR ELECTRICAL INSPECTION
APPLICATION FOR CERTIFICATE OF OCCUPANCY
[ C.O.
[ ] TAX BILL
$400.00 CHECK FOR PERMIT FEE
SITUATE �EoRGE's
NEW SUFFOLK READ
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000- 117-04-18.6
SCALE 1 "=40'
SEPTEMBER 7, 2012
FEBRUARY 4, 2014 UPDATE SURVEY
AUGUST 29, 2016 FOUNDATION LOCATION
FEBRUARY 9 2018 UPDATE SURVEY
APRIL 3, 2016 STAKE PROPERTY LINES
AREA = 64,873 sq. ft. ez'%
1.489 ac.
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PREPARED STANDARDS FOR TIOTREANCE SURVWITH THE EYS AS ESTABLISHED �A14CAUM RjT.g SSCO m 208.3 ACT• CONCH
BY THE L.I.A.L.S. AND APPROVED AND ADOPTED ZLlCO g NCO/� DEED
MON.
FOR SUCH USE BY THE NEW YORK STATE LAND
TITLE ASSOCIATION. NAf�FE E
... ` ArESip Np O
HOMARD
a � f
1 >•�,CN S. Lic. No. 50467
■ SE UNAUTHORIZED ALTERATION OR ADDITION NOTES:
at h an oaf t�- Corwin®r w 1 n III THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE 1. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM
EDUCATION LAW. EXISTING ELEVATIONS ARE SHOWN THUS:
Land Surveyor COPIES OF THIS SURVEY MAP NOT BEARING 2. DEED REFERENCES ARE TO DEED LIBER 11840 PAGE 186
THE LAND SURVEYOR'S INKED SEAL OR
EMBOSSED SEAL SHALL NOT BE CONSIDERED
TO BE A VALID TRUE COPY.
Successor To: Stanley J. Isaksen, Jr. L.S. CERTIFICATIONS INDICATED HEREON SHALL RUN CERTIFIED T0:
Joseph A. Ingegno L,S. ONLY TO THE PERSON FOR WHOM THE SURVEY
'IS PREPARED, AND ON HIS BEHALF TO THE PAUL AURIEMMA
Title Surveys — Subdivisions — Site Plans — Construction Layout LE DING LE �INSTITUTIIONEUSTIEDTHE EON,AL AND LINDA
LINDA AURIEMMA
To THE ASSIGNEES of THE LENDING INSTEWART TITLE INSURANCE COMPANY
ZONE (631)727-2090 Fax (631)727-1727 TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE. WELLS FARGO
9FFICES LOCATED AT MAILING ADDRESS THE EXISTENCE OF RIGHTS OF WAY
1586 Main Road P.O. Box 16 AND/OR EASEMENTS OF RECORD, IF
-sport, New York 11947 Jamesport, New York 11947 ANY, NOT SHOWN ARE NOT GUARANTEED.
1
New York State Insurance Fund
199 CHURCH STREET,NEW YORK,N.Y.10007-1100
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
A A A A A A 112377925 Q �
LEVITT-FUIRST ASSOCIATES LTD
520 WHITE PLAINS ROAD,2ND FL '
TARRYTOWN NY 10591 }
t
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
ARTHUR J EDWARDS MASON TOWN OF SOUTHOLD
CONTRACTING COMPANY INC P.O.BOX 728
929 RTE 25A SOUTHOLD NY 11971
MILLER PLACE NY 11764
POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE
G 2438 491-9 765253 06/29/2018 TO 06/29/2019 06/12/2018
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2438 491-9, 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.
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 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
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER: 195404147 pp
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00000000000059684277
Focm WC-CERT-NOPRINT Vcrsion 2(0229/2016)[WC Policy-24384919] U-26.3
74 [000000p00000596842M[0001-000024384919][##GI[14901-08ICen NoP.CERT 1][01-00001]
} Suffolk County Department of Labor, -Licensing &
Consumer Affairs a `
VETERANS MEMORIAL, HIGHWAY * HAUPPAUGE,NEW YORK 11788 r '
sty DATE ISSUED: 0701/1978 No. H-4436 -
d''l'- L
K Suffolk County
Home Improvement Contractor License
d
This is to certify that ARTL-TIIR T_ EDWARDS
doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA (1 SUPP)
a: having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules
and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME F yY n§
IMPROVEMENT CONTRACTOR, in the,County of Suffolk. z}
teY License Category {
NOT,VALID YVITHUUT Additional Businesses
1• a "�
DEPARTMENTAL-SEAL. H26-POOLS&SPAS/CERTIFIED 1} 1
AND A dbt&ENT ARTHUR EDWARDS POOL& H3-POOLS/SPAS
CONSUMER AF'F'AIRS SPA CENTRE Hl-GC
ID
CARD _
Suffolk County Dept of i
Labor,Licensing&Consumer Affairs
ld -h i Commissioner p:h ,
HOME IMPROVEMENT LICENSE
$" Name
ARTHUR J.EDWARDS
Business Name ,? '
7iARTHUR EDWARS MASON
P- M
CONT.CO INC DBA `"
This certifies that the s
bearer is duty licensed License Number H-4436
by the County of Suffolk Issued: 07/01/1978 '
CommissionerExpires: 071011-2020
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APP. VED AS NOTED p�
DATE: B.P.# 3 O
FEE: BY: OCCUPANCY OR
NOTIFY Bl1ti:DING DEI AR ENT AT
765-1802 8 A TO 4 PM FOR THE USE IS UNLAWFUL
,FOLLOWING INSPECTIONS:
I. FOUNDATION - TWO REQUIRED WITHOUT CERTIFICATE
FOR POREb
2. ROUGH'-- fl
F_AMINGCRETE& PLUMBING OF OCCUPANCY
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEWaed til9`F 1 �mv
YORK STATE. NOT RESPONSIBLE FOR ENCLOSE POOL TO CpDE.
DESIGN OR CONSTRUCTION ERRORS. k RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236 i?ON COMPLETIU4
- OF THE TOWN CODE. ��;-�-_�E�®R�:-CATER
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODES
AS REQUIRED AND CONDITIONS OF
uV
S0�'�'�^rrneini of AAIAI__._Ils/` ELECTRICAL
BOARD
v "� •,�, r^' INSPECTION REQUIRED
SOUT TEES
h A
0
H 0F H AkWnin m
To nr" From
F45r&PwV
To To itrberr
fNwaOPW4
A - raoo.a ww<or F
Plan Piping . Arrangement
WON SecHan
42~
Section B—B r PSL Ca„d,e
10M
Section A—A Typical Wall Section
SIZE A B C D E F G H AREA CAP
FEET FT FT FT FT FT FT FT FT SQ. FT GAL. pardbaft
15 X 30 15 30 10112 5 3 3 9 450 15,000 "� `
POOL&SPA CENTRB
16 X 36 16 36 12114 6 4 4 8 576 21,600 PERMACRETE WALL SYSTEM
18 X 36 18 36. 12114 6 4 5 8 648 24,300 929 Route 25A Miller Place NY 11764 c"YStu"
20 X 45 20 45121114 6 4 5 10 900 33,000 (631) 744-7185 FAX (631) 744-0174
24 X 44 2444 18 14 8 4 8 10 798 35,000 ; Suffolk License #4436—HI PbM
24 X 48 24 48 20 16 8 4 6 10 900 38,500 f Nassau License #HI74450000