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HomeMy WebLinkAbout44831-Z SUE ` �OGy, Town of Southold 9/11/2020 A P.O.Box 1179 53095 Main Rd Southold,New York 11971 vzxxsz� CERTIFICATE OF OCCUPANCY No: 41436 Date: 9/11/2020 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2220 Skunk Ln., Cutchogue SCTM#: 473889 Sec/Block/Lot: 97.-3-18.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/12/2020 pursuant to which Building Permit No. 44831 dated ' 6/3/2020 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 Dwyer Christopher F Liv Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO.' 44831 7/28/2020 PLUMBERS CERTIFICATION DATED u o Signature i I i TOWN OF SOUTHOLD �sUFFD(,��GG BUILDING DEPARTMENT ��O y y a 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#: 44831 Date: 6/3/2020 Permission is hereby granted to: Dwyer Christopher F Liv Trt 2220 Skunk Ln Cutchogue, NY 11935 To: construct accessory in-ground swimming pool as applied for. At premises located at: 2220 Skunk Ln., Cutchogue SCTM # 473889 Sec/Block/Lot# 97.-3-18.4 Pursuant to application dated 3/12/2020 and approved by the Building Inspector. To expire on 12/3/2021. Fees: SWDAMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 i Builth g Inspector i i form No-6 TOWN OF SOUTHOLD BUILDING DEPARTMENT To WN TO S E S 2020 APPLICATION FOR CERTIFICATE OF OCCUPANCY B,UF,DP'TC,D,E ° • rn,(}�f�';:T`fir_i';1"_.j :I�OLD his application must be filled in by typewriter or ink and submitted to the Building Department with the following: For new building or new use: I. 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,acertificaie of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements_ For existing buildings(prior to April 9,19:57)anon-conforming uses,or buildings and"pre-existing" land uses- I- Accurate survey of property showing all property tines, 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. Fees I. 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_ w Construction: d (did or Pre_existi7%Building: _(check one) ation of Property: 7-2- n �,,, �[, / i•>s House No. Street amlet -ner or Owners of Property: C y o folk County Tax Map No 1000,Section Block _ Lot idivisiori aQ,,A (_Z� ��].� ro,A 6 k Filed Map. Lot: F -nit No. Date of Permit 3 0 Applicant: ��,,,��j_o_ SON .lth Dept.Approval: Underwriters Approval ming Board Approval: uest for: Temporary Certificate Final Certificate: (check one) i Submitted. $ rcant4-grt- Ap J CONSENT TO INSPECTION I er , the undersigned, do(es) hereby state: Owner(s)Nam (s) That the undersigned (is) (are)the owner(s) of the premises in the Town of Southold, located at '1.:L7-0 which is shown and designated on the Suffolk County Tax Map as District 1000, Section 04'1 , Block er, Lot ,Vq That the undersigned(has) (have) filed, or cause to be filed, an application in the Southold Town Building Inector's Office for the following: Ye 2 jGrw. TCD XZ >c 3 (100 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: (Signatu) (Print Name) (Signature) (Print Name) OF SOUr�®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.sox 1179 G Q sean.devlin(a-)town.southold.n us Southold,NY 11971-0959 y' yC®UNTI,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Dwyer Christopher F Liv Trt Address: 2220 Skunk Ln city.Cutchogue st: NY zip: 11935 Budding Permit#: 44831 Section 97 Block 3 Lot 18.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electrical Contracting License No: 40557ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Surrey Attic Garage INVENTORY Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel 1 A/C Blower Range Recpt Ceding Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 4'LED Exit Fixtures 11 Pump 1 Other Equipment: Intermatic Pool Panel, Pool Heater on 250 Breaker, Salt Generator, Lights on GFI Circuit, Pump on 220 GFCI Breaker Notes: Pool Inspector Signature: 2-- Date: July 28, 2020 S.Devlin-Cert Electrical Compliance Form.xls tf Syo� Li Li I z�zc� tS� ��k LA # # TOWN OF-SOUTHOLD BUILDING DEPT. °yrourm ' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)TOQ 101.1 [ ] CODE VIOLATION ] PRE C/O REMARKS: DATE a INSPECTOR - _uI l���I O��OF SOUlyol f # TOWN OF SOUTHOLD BUILDING DEPT. `yc0urm� 765-1802 INSPECTION . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. a [ ] FOUNDATION 2ND [ ] SOLATION/ AULKING [ ] FRAMING/STRAPPING [ FINAL [ ] FIREPLACE &CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT-CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: AlDATE INSPECTOR 1 JAMES J. DEERKOSKI P.E. 260Deer Drive Mattituck,NY 11952 (631) 774 7355 Date: July 24,2020 To: Town of Southold Building Dept. Re: Chris &Audrey Dwyer 2220 Skunk Lane Cutchogue,NY 11935 To Whom It May Concern: This letter certifies that the installation of the swimming pool at the above mentioned location has been built in conformance with the New York State Building Code, and is constructed to the specifications of the submitted plans. Any questions feel free to call. (ft NEWk y, iikw ,yam s e Q, �� 1Z14176'SiJ J eerkoski P.E. Fp tiQ o7 � / AROFE `� P nD D) J U L 3 0 2020 BUmPI 1G DEPT- ITHOLDI FIELD INSPECTION REPORT DATE COMMENTS + FOUNDATION(IST) y ------------------------------------ L FOUNDATION (2ND) H � ROUGH FRAMING& t ,H PLUMBING Tc- INSULATION PER N.Y. H STATE ENERGY CODE FINAL ADDITIONAL COMMENTS Z rn O z x x I e I y I TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWtN,HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey Southoldtownny.gov PERMIT NO. Check Septic Form 'N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20-0 Single&Separate Truss Identification Form Storm-Water Assessment Form 2 2020 Contact: Approved 2 � Mail to: Ounrf e Poo k Disapproved a/c ;- 37l0 VeAel C Phone.52 6111 OIL Expiration I Z ,20 Bu ing Inspector APPLICATION FOR BUILDING PERMIT Date lz , 20 26 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 described. The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. X�k� (Signature of applican r name,if a corpor ion) 'LZ ZC 'S &" I4�. L h (/—U-k)4c-�Le- (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder ® �,lilQr Name of owner of premises f.S (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title f co rate officer) I� Builders License No. ��F-4 Plumbers License No. Electricians License No. 'qQ S , Other Trade's License No. 1. Location of land on which sed work will be done: 2 2-zo 3^ � L� 9L� House Number Street Hamlet County Tax Map No. 1000 Section Block j Lot Subdivision � FiledMapNo. 11<6 Lot 2q-2 d 2. State existing use and occupancy of premises and ' tended use and occupancy of proposed construction: a. Existing use and occupancy ez, dell 1.14 b. Intended use and occupancy S I L"-k-S j 3. Nature of work(check which applicable):New BuildinAddition Alteration Repair Removal Demolition Other Work er s,.u,,,, i0 ego (Description) 4. Estimated Cost 72) (Description) ��� 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 nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 2 Rear --Z) Depth yLj Height —L0'-L\' Number of Stories 1— Dimensions 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 J5 Depth L, 4 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated R ^ 40 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded?YES NO X Will excess fill be removed from premises?YES 3< NO C 14.Names of Owner ofises riS �- 12r Address Phone No. Name of Architect �s -q k'6'k Address Zai e✓ h ��Adne*NS'Co 31 --)-ILI-735"S Name of Contractor - V&-,A--- Sc;--Is Address'i11G L--f,-L-> 14- Phone No. 631- 5Nf5-l G I f" 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO?C * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BEAEQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * 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 5444-) rev" roti I., 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 � day ofd2.0,Z GREGORY PINTO ARY PUBLIC;STATE OF NEW YORK 1-PI6090455 No is bVALIFIED IN SUFFOLK COUNTY ) Signature of Applicant NI MY,CO SSION EXPIRES APRIL 14,20_!:-_ i SUFF EVE BUILDING DEPARTMENT- Electrical Inspector D TOWN OF SOUTHOLD yJ L 2 1 202 own Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 y �� Telephone 631 765-1802 - FAX 631 765-9502 ,- � GDF p ( ) ( ) southoldtownny.gov —_seand(absoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIANIINFORMATION (All Information Required) Date: Company Name: 9VT"E CL r--1-F—C-TT.`CAL (-4 NT T? CT1 N& Lt Name: h7C—AfZ�, License No.: 40-5 5-1 NAE, email: Address: — L)�ncqJ,r•. V2A'Vl Phone No.: -- — CO 2 JOB SITE INFORMATION (All Information Required) Name: O P�1S �— �J11�1�f�—� D N'`1E�W— Address: 20 � vl,,n, (.!� C,UI Cross Street: 0 0, �PNt Phone No.: CIA r,i5; '7--7 Bldg.Permit#: j J email: Tax Map District: 1000 Section: Block: Lot: 18. BRIEF DESCRIPTION OF,WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES 4,NDO 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: VP-a S e_ QAJ MAr' p -;(e. W&s AA )� e i o. e— Q C OM +dr- CCAS PAYMENT DUE WITH APPLICATION Request for Inspection Form.xis SUFI: � D BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD iI 'L 2 1 2020 own Hall Annex - 54375 Main Road - PO Box 1179 Southold,- New York 119711-0959". ? DINGDEPT. Telephone (6 31) 765-1802 - FAX (631) 765-9502 ; - .. r(c southolctfownny.govTeandsoutholdfownn�tlov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: 9VT"F_�L M L-F—C-1-Re C.f L CON'"R CTI N& L'Tb Name: !J"T 'ArZ__ . L✓0 License No.: 40-5-- ' NAS email: �(2C.A o 0A1j 4.,A Address: 1- Li,ncoi'�. V2A 2..._ 0� Caa��:....�•;3 ;'1 Phone No.: -- �j JOB SITE INFORMATION (All Information Required) Name: C47-1'> DI/V 157Address: /Z;S'?O C;Al<1AAK, LAAE, �,U o Cross Street: 1 S Phone No.: Gt4 ;S; - -7-7 Bldg.Permit#:i email: " Tax Map District:; 1000 Section: Block: Lot: 18. BRIEF DESCRIPTION OF WORK (Please Print Clearly) - �tNj. \AAA;A& POO f-I 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 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: ?k-9_a-5e_ COJl) ov+r -p;Q_ WA^ AA )A e coM 9Aa#Vqywr- or ce�� PAYMENT DUE-WN"H-APPL-IC-/-TION — 'ab Request for Inspection FormAs Gem &A�01 (�<Le� 4r M.PL�/Y,- IMrA PDD) J U L 3 0 2020 BY71�D�+TQa IDEJTHOLD PT. July 28,2020 Town of Southold Building Department 54375 Main Street(NY-25)- P.O. Box 1179 Southold,New York 11971 Attn: Mr. Michael J. Verity,.Chief Building Inspector Re: 2220 Skunk L cho ue NY-Dwyer Garage Dormer Pool Permi 44831—Pool)Certification by James J. Deerkoski P.E. (Dunrite Pools) Dear Chief Building Inspector Verity: As owner of above referenced property, I am forwarding a letter we received from James J. Deerkoski P.E. on behalf of Dunrite Pools of Bohemia. , Enclosed you will find the following document to support your Department's review; James J. Deerkoslu P.E.'s letter dated 7-24-20 Should you require any additional information on this building permit submission do not hesitate ;to contact my cellphone (516-779-4776) Very truly yours Christopher F. Dwyer, Property Owner I " Y T apr�sation CERTIFICATE OF INSURANCE COVERAGE ' Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW I PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier I a Legal Name&Address of Insured(use street address only) ib.Business Telephone Number oflnsured DUNRITE MANUFACTURING CORP 3510 VETERANS MEML HGHWY BOHEMIA, NY 11716 ' 1c.Federal Employer Identification Number of Insured or Social Security Number Worts Location of Insured(Only required if coverageisspecd1callylimited to certain locations in New York Stale,i.e.,Wrap-Up Policy) 112245133 2.Name and Address of Entity Requesting;Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPolnt Life Insurance Company Town of Southold 530950 Route 25 3b.Policy Number of Entity Listed in Box"la" PO Box 1179 DBL593730 Southold,NY 11971 3c.Policy effective period 01/01/2020 to 12/31/2020 4. Policy provides the following benefits: © A Both disability and paid family leave benefits. E] B.Disability benefits only. n 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 S.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 3/5/2020 By (signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carver) 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 58 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 Lawwith 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. IIIIIIIIIuIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIII DB-120.1 (10-17) IIIIpDB-120. 1 (10-17) ulll� I Y® Workers' CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE RK 5TATE Compensation COVE RAG E Board -. 1 -1 1a.Legal Name&Address of Insured(Use street address only) 1 b. Business Telephone Number of Insured 516-543-1616 Dunrite Manufacturing Corp 3510 Veterans Memorial Highway 1c.NYS Unemployment Insurance Employer Bohemia,NY 11716 Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,i.e.,a 1d.Federal Employer Identification Number of Insured Wrap-up Policy) or Social Security Number 112245133 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) AmTrust Insurance Company of Kansas Inc Town of Southold 3b. Policy Number of entity listed in box"l a" 530950 Route 25 KWC1143762 PC Box 1179 Southold,NY 11971 3c. Policy effective period 10/20/2019 to 10/20/2020 3d. The Proprietor,Partners or Executive Officers are ❑included.(Only check box if all partnerslofficers Included) x0 all excluded or certain partnerslofficers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1a" 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 will also notify the above certificate holder 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 the cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Kevin McDonough (Print name of authorized representative or licensed agent of insurance carrier) Approved by: d' 3/5/2020 (Signature) (Date) Title: President of Walter Rose Agency, Inc Telephone Number of authorized representative or licensed agent of insurance carrier: 845-783-2555 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_state.ny_us i DUNRI-1 FOP ID: CH ,a► L7' TE CERTIFICATE OF LIABILITY INSURANCE 0 03!0055/122020020 ) I 03 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(ies)must have ADDITIONAL`INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ! 845-783-2555 c cT Walter Rose Agency Walter Rose Agency,Inc PHONE 845-783-2555 FAX 845-783-2425 8 Stage Road WC,No,Ext): (A1C,No): Mariroe, MY 10950 ! a DRESS:lisa@walterroseagency.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Central Mutual 20230 INSURED INSURER B: Dunr) a Manufacturing Corp D r Ie u00)S ' INSURER C: 39fMaierans Memorial Highway Bohemia,NY 11716 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXP W LTR ISD WMMID !YYYY) (MMIDDIYYYYI LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMSMADE FX�OCCUR CLP 979186404101!2019 04/01/2020 DAMAGE TO RPREMISES(EsENTED $ 300,000 MED EXP(Any one personi $ 51000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,000 3C POLICY JECT F-1 LOC PRODUCTS-COMP/OPAGG 2,0001000 OTHER* AUTONOBILE LIABILITY COMBINED eBINEDISINGLE LIMIT $ ' ANY AUTO OWNED SCHEDULED BODILY INJURY Per arson AUTOS ONLY AUTOS ; p BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY �e�accRnt AMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 1 N ER ANY FICEWM IEBER�EXCLUDED? CUTIVE ❑ NIA A EM E L EACH ACCIDENT $ {Mande;ory In NH} EL DISEASE-EA EMPLOYEE $ If yyes,describe under CESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT I DESCRIPTION of OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Swimming Pools-Installation,Servicing Or Repair-Below Ground CERTIFICATE HOLDER CANCELLATION SOUTH02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 530950 Route 25 PO Box 1179 AUTHORIZED Southold,NY 11971 iREPRESENrATPfE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 1he ACORD name and logo are registered marks of ACORD N/F SUZANNE TEGWEN HOOPER 5' POST& RAIL FENCE FEN 3.2'N FEN 1.0'N FEN 0.9'N �x-_ _ PROPERTY N 89'22'50" E 135.00' -------- ---NAIL SET SET y NAIL SET , OFi IN RDOT BASKET IN ROOT OF TREE WAREA k o o OF TREE FEN 2,1' w o�RT CHRISTOPHER F. DWYER LOT 1 I N/F I ON= ;, TREE I^ KATHERINE BRIT TO ; I MINOR SUBDIVISION MAP OF I 19Y Q'` r ------, DAVID S. & ELIZABETH T. BRANCH 6 cEbAR WOODED ry AREA CONC. MON. I 2 STORY I - LOT 1 xI 6CEDAR , 1 0.1'E AND , I I FRAME ON LINE N& S ——————— FEN 2.0 — , GARAGE i FILED:NOVEMBER 18, 1992 AS MAP N0.9290 ' W�I i q i --------- I I ---- I SITUATE AT I qa i "i k, o CUTCHOGUE EWAYNIF __ TOWN OF SOUTHOLD aU� II 6„r '\ ` I PAUL DOHERTY & CEDAR 11, -7 _ NANCY A. DOHERTY O I SUFFOLK COUNTY,NEW YORK Z x FEN S' W�I - - - - - - - - ---- - - - - - V I �_w axe• Z — CEDAR I JANUARY 4 ZOO7 _ \ 6 CEDAR BASKET I N/F ! ”PINE BALL x COURT ,� FEN 17N-\ CONC. MON. 2 STORY JEFFREY KRASNOFF �¢ I C I LINE 01 E I BURRING AREA OF PARCEL = 80,146± SQ.FT. OR 1.839± ACRE & AMY KRASNOFF wl 7 - _-----__--------- I Q h xle--i �3b11� -- 20' ^1 38.3'± ❑ l FEN 22' W S• 6, j,'�'`�CEDAR W 4J q'CED R113' 1% 1 SEPTI F-I I W ----- 65,6' O TAM( L ------ - I ROO OVERHA �i2 STY.y 1 �i. CEDAR 2 N/F 6' ` • FR. n i 'n 6„ O { g3� 2ti A3. KENNETH LEE DICKERSON, JR. ! 10 x10' l� GAR; 1'y0, :,-CEDAR O NOTES ti �I SHED 11 $, ---- 3 p FEN 0.3'E ( CESSPOOL \ Y CESSPOOL I N I I PUBLIC WATER 0.9'-"_ a" I I �L 1. MEASUREMENTS ARE IN ACCORDANCE WITH U.S.STANDARDS. C �'� CEDAR ASPHALT •�+ 6' STOCKADE FENCE , ,jI s\ (DOMESTIC) DRIVEWAY CONC. MON. 6• \ Z CELLAR o 0,2' W AND CONI. MON. O� 2. BEARINGS SHOWN ARE IN AN ASSUMED COORDINATE SYSTEM. FEN 2.3' W CHIMNEY 0.2'E AND 115 x11 ENTRY ON LINEN & S w O` 6' STOCKADE FENCE ON LINEN 8 S o t P c� 3 UNAUTHORIZED ALTERATION OR ADDITION TOA SURVEY MAP BEARING A LICENSED 50.3' ? Na 5 4 , „ , a o 1,1 sxa 2?, I 4- \ - LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209,SUBDIVISION 2,OF THE i I 11 N 89 51 30 E 150.00 _ 2 STORY 11,1' x—_ x x— x—z— x z 2 I r8s\ NEW YORK STATE EDUCATION LAW. x11,5'118'x a FRAME 5'POST & WIRE FENCE 1ZZ' -0- tf�\ BUILDING CVNC FEN ail S f �� 4, ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY MARKED WITH AN ORIGINAL OF II A/C FF=2021' SIDEWALK FEN 0.1' W ti ti FEN 2.3' 110, w�l UNITS 16.8• I THE LAND SURVEYOR'S EMBOSSED'OR INKED'SEAL SHALL BE CONSIDERED TO BE II WOOD STEPS WOOD STEPS AND ON LINE N & S 3 p0, EP SANITARY&WATER LOCATION DETAIL VALID TRUE COPIES. SEPTIC �-ear--- V ROOF FEN 0.8' W RJICE Z 1• CL SCALE 1�0" TANK 11.1"` WOOD OVERHANG 1.9'S A10 5E J o x7.06' 5 CERTIFICATIONS INDICATED HEREON SIGNIFY THAT THIS SURVEY WAS PREPARED IN FEN 2.2' W—�•' CESSPOOL(l�� DECK PUB��� `� w¢ '31,EP ACCORDANCE WITH THE EXISTING CODE OF PRACTICE FOR LAND SURVEYORS ' WOOD Q J ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND j x17 9 STEPS V AY - - Lal ti i J z W SURVEYORS. SAID CERTIFICATIONS SHALL RUN ONLY TO THE PERSON FOR WHOM IV Ss�J o TO THE TIT-E COMPANY CESSPOOL ASPNp47 DRIVE O �? Q 3 GOVERNMENTAL GENCYAND LENDING INSTHE SURVEY IS PREPARED AND ON HIS TITUTION ON LISTED HEREONAND TO THE a ASSIGNEES OF THE LENDING INSTITUTION. CERTIFICATIONS ARE NOT TRANSFERABLE DurnaDR UOj O TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS. I \FIREPLACE _ _ - IOw 1•p8,S?' CL 6. RIGHTS-OF-WAY NOT SHOWN ARE NOT CERTIFIED. y�N Zy�THE SURVEY CLOSES MATHEMATICALLY. f� \ VEGETATION , �r VEGETATION / / o �� �� �-• STS ®� SUFFOLK COUNTY REAL PROPERTY TAX MAP I — J ❑N q S 851'30" W 150,00' �2 1'10 x DISTRICT 1000 9. ~ � 1 SECTION 097.00 s 3/11/20 TLS UPDATE SURVEY TLS FEN 2.8 S BLOCK 03.00 s3' w LOT 018.004 s 5/2/13 TLS LOCATED IMPROVEMENTS DPJ LOT 2 3'POST 8 RAIL FENCE `� DATE BY DESCRIPTION APPROV. BY 050$2$ �� - REVISIONS IN/Fi 5Town of Southold FQL CHARLES A. RILEY II ^' A ND Suffolk County, New York & KEMING LUI 2220 SKUNK LANE I hereby certify that this map was made from an actual survey SOUTHOLD, NEW YORK I completed by me on 12/21/2006 and updated on 4/30/2013. SURVEY A�/ O L. K. McLEAN ASSOCIATES, P.C.C` ­0 — � CONSULTING ENGINEERS� 437 SO. COUNTRY ROAD, BROOKHAVEN, NEW YORK R TAMARA L. STILLMAN,P.L.S. Sheet Nc Surveyed By KG/JL Scde 1"= 60' N 5 WIDE> App NYSPLS No. 50528 D,-By, MA pate JANUARY 4, 200 fl E , Mar 12, 2020 - OBS6nm U' (49 roved By, DPJ R.No 00013,000 I PI\00013,000\Dwyer\dwg\SurveyUPDATE 2,dwg Lnyouti SURVEY d i APPROVED AS NOTFD LB.P3 °` ars ; DATE: .# LIVCLOSE POOL TO CQDg-i� FEE: �� BY• %�f,?OCOMPLETION NOTIFY BUILDING CEPAR NT AT r 1 N C PLT R"",', 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWG` REQUIRED FOR POURED r,JN;;RETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION ELECTRICAL 4. FINAL - CONSTRUCTION MUST INSPECTION REQUIRED COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF ING BOARD S USTEES OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ..gim a qua= mems • - - _ - . PVC ( e Mlin _ Complies With: • ::-•.. _ 2017 NYS tri®rm Code Supplement seg R326 - _ - _ - • • e R32633 in Ground Pools Shall Be is Conformance with ANSUNSPI-5 s ;p,,M*a'SELF PwuM - 8 SPA=.w 0= 83265 Barrier requirements:Temp Fence mast be installed at time of FILTER ' COHOMM°Rpmlar-•••..•°��TO eopetG Pool const metion,and Permanent fencing is the homeowners responsibility _O — _ =F'm A=YMOM POO1.PAM aummtun eaPAtG R326.6 Entrapment Protection Installed _� ' ®® 8326.7 Swimming Pool and Spa Alarms most be installed r LONG W" N a trp aum>galn rraamlG _ -� � a� 9 � i 20151ECC 1 I mL�rna» Sec R 403.10.2 Time switches or other control ;� methods that can run ���� 1 Mg s7.da,.P� Automatically turn off and on according toa preset schedule shall beO ®R Installed for heaters and pump motors. ffeaOers and pump motors that r emu.im m m,w Have built in time switches shall be in compliance with Sec R 403.10.2 Pwv�laras� SUCTIONS ( AM= Gymi j _ B q H 1°1H7CK°4M14f�P 8.41ID < 4 _ i { fB'LOIiG 97E3-7.AWG ROP a - { I@IDffiRd?2®PARtlt<tI OM LI1H 8ttA2PEP EARA° _' •.. '_ .NOtE4 M e0TTOP9 OF PAWL DIVIW.0 BOARD !j l F N E;V y • UNJESc�I,T• 6/YI°6 c�idi °�i}:' °�E11 ��3! USY� .�°=lIH °SIJ °�@9 tl'�U�O �D E%°`•� t°1�Y9 C4�a aJ�l'9� �5C9®® �[�C3�• • E`�i��•FIF. - Zr 00 04P ' iii � �4�°�° �``� ffi°� 9�_�" 9�°��° �°p�° �°m�°`. 4°=� ��°�°` �°• �°�® .�°�• ..�_� �°=fig 4 _, *' � s.a, . `sem � � I _ e W 1J lLl - C �° 07 undit Pads,Inc �- t - .-T • � - - _ ����1� �aet�R��tatlAt•l���6�81�aa� 2� C� C v�1G. L 4% eoheinla New YGYk 11-718 i s = POOL P9.'ASPEN REV. SCALE. JAMES®EERK059 lg P.E. ®A` o ' I 260 BEER®RIVE MuTITUKe NEW YOWK..1952 DRAWING HUMMER