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Home My WebLink About43937-Z Town of Southold 6/15/2021 0 P.O.Box 1179 o 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42081 Date: 6/15/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 470 Moose Trail,, Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.4-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/10/2014 pursuant to which Building Permit No. 43937 dated 7/8/2019 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 inground swimming pool, fenced to code as applied for. The certificate is issued to Nardo,Michael&Rosie of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43937 11/4/2014 PLUMBERS CERTIFICATION DATED A th riz S gnature TOWN OF SOUTHOLD �StlFFQt��oGy" BUILDING DEPARTMENT a TOWN CLERK'S OFFICE oy + 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#: 43937 Date: 7/8/2019 Permission is hereby granted to: Nardo, Michael 5 Willow Rd New Hyde Park, NY 11040 To: Construct an accessory inground swimming pool, fenced to code. Replaces BP#40981 At premises located at: 470 Moose Trail, Cutchogue SCTM #473889 Sec/Block/Lot# 103.4-12 Pursuant to application dated 7/8/2019 and approved by the Building Inspector. 'To expire on 1/612021. Fees: PERMIT RENEWAL $125.00 Total: $125.00 Bu mg Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT 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#: 40981 Date: 9/12/2016 Permission is hereby granted to: Nardo, Michael 5 Willow Rd New Hyde Park, NY 11040 To: Construct an accessory inground swimming pool, fenced to code Replaces BP#39193 At premises located at: 470 Moose Trail, Cutchogue SCTM # 473889 Sec/Block/Lot# 103.-4-12 , 'Pursuant to application dated 9/12/2016 and approved by the Building Inspector. To expire on 3/14/2018. Fees: PERMIT RENEWAL $125.00 Total: $125.00 Building Inspector �Su�nt��oTOWN OF SOUTHOLD BUILDING DEPARTMENT y 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#: 39193 Date: 9/17/2014 Permission is hereby granted to: Nardo, Michael & Nardo, Rosie 5 Willow Rd New Hyde Park, NY 11040 To: construct an accessory inground swimming pool, fenced to code At premises located at: 470 Moose Trail, Cutchogue SCTM # 473889 Sec/Block/Lot# 103.-4-12 Pursuant to application dated 9/9/2014 and approved by the Building Inspector. To expire on 3/18/2016. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 ELECTRIC $100.00 CO - SWIMMING POOL $50.00 Total: $400.00 Building Inspector -r- SO S !/p�®l Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ® �Q roger.riche rt(aD-town.southoId.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Mike Nardo Address: 470 Moose Trail City: Cutchogue St: NY Zip: 11935 Budding Permit#: rT q- UC_ 39193 Section: 103 Block: 4 Lot. 12 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 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: in ground swimming pool to include, bonding, 1-control panel, 1-GFCI circuit break 1-heat pump,2-pool lights, 1-60a disconnect Notes Inspector Signature: Date: Nov 5 2014 81-Cert Electrical Compliance Form.xls Of SOUTy�Io . . en ull .. O� ,TOWN OF SOUTHOLD BUILDING-DEPT. " 765-1802 INSPECTION ' . [ ] FOUNDATION-1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE-RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE d /s-A INSPECTOR # #gs TOWN OF SOUTHOLD BUILDING DEPT. �`y�ourm ' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] NSULATIOWCAULKING [ ] FRAMING/STRAPPING [ ] FINAL.PdL/' [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: PJA I k a DATE INSPECTOR q�q how*OE S0l/lyo6 # TOWN OF SOUTHOLD BUILDING DEPT. �y�nurm 765-1802 INSPECTION , [ ] FO.UNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION,2ND [ ] NSUL TIO CAULKING [ ] FRAMING/STRAPPING [ L�Wtl_� [ ] FIREPLACE & CHIMNEY- [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] COD IOLATION [ ] PRE C/O RERKS. --,F 144 ar( *4A V-V lvvv a, DATE LO INSPECTOR t• t t o . • . � • t t. � f ROUGH MUMN9 PLUMBING tINSULATION STATE ENERGY CODE /' A*, f o �� • • ,L � --—"�' TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applymg9 TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 �� Survey dT Southolown.NorthFork.net PERMIT NO. Check Septic Form NYSDEC Trustees Flood Permit Examined MAL Storm-Water Assessment Form rj Contact: A Approved l 20 Mall to �d 5'aCjl P �'i D(��0 Disapproved a/c ✓ S'f� COVO M f lrry1� Phone f�J �'�f ! 4oCJ Expiration 20 uilding Inspector PPLICATION FOR BUILDING PERMIT Date_ q® �b ,20 I INSTRUCTIONS se p�aT,his)application'MUST be co pletely filled in by typewriter or in ink and submitted to the BuildingInspector with 4 ns;`�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. REL RE—C '� "N C.L �eNUME-MATEL�YQ(y" �Signatureofa/p��lii�{ (tE} tal��f a ''�lit 1.6B ED ",9 F i EN1�LOSE rOOL TCS CC,dD L I � I� *�3 5_ J ,-. <.., i. ' UqP��,O��'''rrrN G+��t�+P,�LE,'1'�µGr�lpF.gS,N ff atimgaid s P Vbtp '�170RE N P 0.A 1 4.t-'Y� State whether applicant is owner,lessee,agent,architect,engineer,general contractor,-ele4 ii ,plumber or bui}�� owner ! BUIL, . �Ar,lni;NT T FOR THE Name of owner of premises am I�.p QSI (; Nf r 0- ).,. ,NIG IN.)P, S "1 J1 i(As on3the tax�oll or latest deed)- l� �'' - v,r�E If applicant is a corporation,signature of dui authorized officer i i 'ter )OURED of! «f E 1-� ,;1� �� Q INN Al IAl a z F•--uGH-FRAMING PWIrJIB�NG, (Name and title of corporate" 6 ` °° ' 9 S;rRAPPING, ELECTRICAL&CAULKING )--'' A �� € 1�I � �x�;...',�. � '�� 3 INSULATION Builders License No. l J ��b ��°�' I" �� & �� 4 FINAL-CONSTRUCTION &ELECTRICAL Plumbers License No. MUST BE COMPLETE FOR C C. Electricians License No. 4 Yid• y ALL CONSTRUCTION SHALL MEET THE Other Trade's License No. REQUIREMENTS OF THE CODES OF NEW 1. Location of land o which proposed work will be done: YORK STATE. NOT RESPONSIBLE FOR IGN OR CONSTRUCTION ERRORS House Number Streetpax Haallef RETAIN STORM WATER RUNOFF County Tax Map No. 1000 Section I o3 Block If Lot 12-,PURSUANT TO CHAPTER 236 Subdivision Filed Map No. Lot OF TNF T(11hIN CODE. � y ► 2. State existing use and occupancy of premis s and intended use and occupancy of proposed construction: a. Existing use and occupancy ��- b. Intended use and occupancy (', 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work Ir}Q L1 a E06 4. Estimated Cost T �� b Do J Fee (Description (To be paid on filing this application) 5. If dwelling,number of dwelling units .e Number of dwelling units on each floor If garage, number of cars 6. If business,commercial or mixed occupancy,specify nature and extent of each type of use. 7. Dimensions of existing structures,if any:Front Rear Depth Height Number of Stories (T� 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 I QQ-0-0 Depth 9. Size of lot:Front 100 -00 ' Rear 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO__� 13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES_NO 14.Names of Owner of premisesNarda iW ddress`'1,7Q IN flfl� lOX- IMI(I PhoneNo. 51�'��' Sy4� Name of Architect Address Phone No Name of Contractor LA 15 lond -7 Address 5 hone No. ComM 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO * IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED. b.Is this property within 300 feet of a tidal wetland?*YES NO-X *IF YES,D.E.C.PERMITS MAY BE REQUIRED. - 16.Provide survey,to scale,with accurate foundation plan and distances to property lines. 17.If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. 18.Are there any covenants and restrictions with respect to this property?*YES NO *IF YES,PROVIDE A COPY. STATE OF NEW YORK) COUNT OZJ S. i� ��1 07,rd D being duly sworn,deposes and says that(s)he is the applicant -A;W - (Name o mdtviduVa�l/signing contract)above named, war (S)He is the ® f ar (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. SwoM,jo beforeme thi of day off 20L PL IE SUC,Sfate,of New or Notary Pui u) c ntv Signature of Applicant No.01LA6124900 Commission Expires April 4, 1 r Scott A. Russell �a°Su m rIU01ELIM[WA�TIER SUPERVISOR IMLA NA\G IEMUENT a S013THOLD TOWN HALL-P.O.Box 1179 O 'own of,�'outholcl 53095 Main Road-SOUI BOLD,NEW YORK 11971 'Lj� CHAPTER 236 - STORMWA.TER MANAGEMENT-WORK SHEET (TO BE COMPLETED BY THE APPLICANT ) DOFS TIES PROJECT MWL - --- lFt3lvMWIN _ 1 (CHECK ALL THAT APPLY) l Yes No ❑[M A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. - 3 � j B. Excavation or filling involving more than 200 cubic yards-of material within any parcel or any contiguous area. ❑p C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. F1[A D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ►. El[A E. Site preparation within the one-hundred-year floodplain as depicted � on FIRM Map of any watercourse. ! [} F. Installation of new-or resurfaced impervious-surfaces-of 1-,OOQ square feet or more, unless prior approval of a Stormwater Management , 1 Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. ;k 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 Cbeck List Form to the Building'Department with your Building Permit Application. - - ---- —=--- __,_..--- -- - S.C_T.M. 1000 Date APPLICANT_ (Prop fy O�y�eneJDesion Profesional Agent,Contracto,Other) = District I!?— q,-9r� 11 NAME M,(charj r t Section Block Lot tom,....<a 'FOR BUILDING DEPARTMEi�NT USE O;1L COW30 Information �� - - Reviewed By: P-14 8 (,k% — — — — — — — — — — — — — — — — — — Date 9-9-4 Property Address/ Location of Construction Work= — — — — — — — — — — — — — — -- S� Approved for processing Building Permit- — — — on`7 — — Stormwater Management Control Plan Not Required. Stormwater Management Control Plan i5 Required- (Forward to Engineering Department for Review) FORM - SMCP- TOS MAY 2014 o'*OF SO�r�,ol . Town Hall Annex J Telephone(631)765-1802 54375 Main Road N �ax'(631)'765,95�� P.O.Box 1179 • O roger.dchertaf Wr1.SOU 0 .ny.us Southold,NY 11971-0959 BU LDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: Company Name: TR c, EIR i Name: _7thL)rffiS j��l rm r-,s License No.: 4�6 _ ME Address: I10 Vivion -..6 Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: -�-- D� " *Cross Street: *Phone No.: q410 Permit No.: Tax-Map District: - 9000 Section: 0 Block: 4 Lot: Cot, *BRIEF DESCRIPTION OF WORK(Please Print Clearly) oLw 1 1-� x 16 'L; 1-wroU�1a Vwr.— - (Please Circle All That Apply) *Is job ready for inspection: YES/� Rough In Final *Do-you need a Temp Certificate: YES NO Temp Information(If needed) *Service Size: 1 Phase 313hase 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 .824Request for Inspection Foamrr�� S i OF Q�IyD! Town Hall Annex 41 Telephone41 (631)765-1802 54375 Main RoadCA �xASQ2 P.O.Box 1179 •• O roendchert LOOu R'075.n v.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: ��6S �� 1,�iz.5 Date: !® Company Name: - Name: 1'//091,1-5 C)41X4Mz5 ' License No.: At Address: �G i,1ZV-rA.✓ 4,1y` L41-IE 6 Phone No.: 63 /-6� ��5� JOBSITE INFORMATION: (*Indicates required information) *Name: ��/CL= ,//✓3 fL�o *Address: yZ® /Ia®SE CQ rclfc)iL� !535' - Cross Street: I-/c /I *Phone No.: 5'/6 - Z32- 5-6 y° Permit No.: 393 Tax-Map District: 1000 . Section: - Block: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) , G(ZoU J1> 12o,o/_ (Please Circle All That Apply) *Is job ready for inspection: 6y&! NO Rough In Ffial *Do-you need a Temp Certificate; YES/6) - Temp Information(if needed) *Service Size: 1 Phase r- as�, 1- 0� 00 300 350 • 400 Other New Service: Re-con ct der rot�n g d—l�it�me o e#e rs Change of Service Overhead Additional Information: f P ME , UE WITH APPLICATION UJ OCT 2 3 _ BLDG DEPT 1 I UVVII Ur J u 82z-Request for Inspection Form (�� D Mal co N c e rA- n�a t,It � I D pD � MAA - a 01 �e ;'e BUILDING DEPT. TOWN OF SOUTHOLD SS13gF91�-�,oG� o � oy � Michael Nardo May 21, 2019 470 Moose Trail Cutchogue, NY 11935 Mr. Nardo, 1 Before the Southold Building Department can issue a certificate of occupancy for building permit# 41501,you will have to pay the enclosed renewal fees for the two (2) expired permits at 470 Moose Trail. Thank You, Building Department STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier ]a. Legal Name and Address of Insured(Use street address only) I b.Business Telephone Number of Insured LONG ISLAND POOL& (631)698-4100 PATIO INC I c.NYS Unemployment Insurance Employer Registration 543 MIDDLE COUNTRY ROAD Number of Insured CORAM, NY 11727 Id.Federal Employer Identification Number of Insured or Social Security Number 112590890 2. Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) NATIONAL BENEFIT LIFE INSURANCE COMPANY TOWN OF SOUTHOLD 3b.Policy Number of entity listed in box"1 a": 53095 ROUTE 25 SOUTHOLD, NY 11971 8-910-0222285 3c.Policy effective period: 02/25/2014 to 02/25/2016 4.Policy covers: a. QX All of the employer's employees eligible under the New York Disability Benefits Law b. E] Only the following class or classes of the 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 Benefits insurance coverage as described above. Date Signed 02/25/2014 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 box"4a"is checked,and this form is signed by the insurance earner'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"is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd 8 of the Disability Benefits Law It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,New York 12207 PART 2.To be completed by NYS Workers'Compensation Board(Only if box"4b"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 Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers'Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of chose insurance carriers are authorized to issue Form DB-120 I Insurance brokers are NOT authorizer!to issue this form. DB-120.1 (5-06) New York State Insurance Fund Workers'Compensation&Disahifitp Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 Phone:(631)756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAA1 112590890 LONG ISLAND POOL&PATIO INC 543 MIDDLE COUNTRY ROAD CORAM NY 11727 POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POOL&PATIO INC THOLD N OF SOU 543 MIDDLE COUNTRY ROAD TOWN ROU OU CORAM NY 11727 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE — DATE 12067755-5 5527 02/26/2014 TO 02/26/2015 ---- -- ------- ------ --------- _ -_ _ 2/25/2014 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2067 755-5 UNTIL 02/26/2015, 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 SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 02/26/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. MICHAEL DOMINICI(PRES) OF A ONE PERSON CORP LONG ISLAND POOL&PATIO INC 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 This certificate can be validated on our web site at https://www.nysif.com/cert/certva1.asp or by calling(888)875-5790 VALIDATION NUMBER: 152443729 U-26.3 tDPar �■ ■ ■ ■■.VV■ a�■��` 01/21/2014 k ERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS FICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES . THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. TA If the certfflcate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to ms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the to holder In lieu of such endorsements. NTA gency,Inc. NAME: Park Ave PHONE FAXNY 11702 "OExt No; ency,Inc. E-MAIL ADDRESS- PRiSD ME ID :LONGI-7 INSURED Long Island Pool 1 Patio,Ine. INSURER S)AFFORDING COVERAGE NAIC a 543 Mlddle Country Rd. INSURERA:CNA 343 Coram,NY 11727 INSURER B: INSURER C: INSURER 0: INSURER E: COVE GEStiNsuAEAF: CERTIFICATE NUMBER: REVISION NUMBER: THIS I TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIC 1 rED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTI ICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCILIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ou 909H POLICY NUMBFA MpM/D Y EFP MMIDC P GE L LUUIILrIY LIMITS A X COMMERCIAL GENERAL LIABILITY X 5099218545EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X❑ 12/20/2013 1220/2014 PREMISES Ea occurrence $ 100,00 OCCUR MED EXP(Any one Person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 OLICY Pita LOC PRODUCTS-COMPIOP AGG $ 2,000,000 ALM AOBILE LIABILITY $ COMBINED SINGLE LIMIT $ NY AUTO (Ea accident) LL OWNED AUTOS BODILY INJURY(Per person) $ CHEDULED AUTOS BODILY INJURY(Per accident) $ IRED AUTOS PROPERTY DAMAGE $ N-0WNED AUTOS (PER ACCIDENT) $ BRELLA LIAB $ �OCCURCESS LIAR EACH OCCURRENCE $ AGGREGATE DUCTIBLE $ ELATION $ WOR RS COMPENSATION $ AND PLOYERS'LJABILITY WC STA TH_ ANY OPRIEfORlPARTNER/EXECUTIVE Y/N OFFI EMBER EXCLUDED? a N/A (Men ory in NH) E.L.EACH ACCIDENT $ Hyes. scn'beundar E.LDISEASE-EAEMPLOYE $ nDESC1PTION OF OPERATIONS belowtySection 99216546 ELDISEASE-POLICY LIMIT $ p 71 I �gq oft N 1220!2013 1220/2014 l;8 f L IPT p 8 t gOF P tt01 tl e f LQC g(1 yI ry1011 a I(A�s u OR d'o1.Additional Remadce Schedule,N more space is required) CERTIFIrTEOLDER CANCELLATION SOUTHOLSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN n of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 95 Route 25 uthold,NY 11971 AUTHORIZED REPRESENTATIVE n rnno noon•noon n�nnnnwT�na� wu_,_a,.,,_��„�-_,, SUFFOLK COUNTYDEpTOFLAEOR - ':j LICENSING&CONSUMER AEFA Rs WHOMEriPROVEMEN T RACTOR ICE 5FM►VIC[This mrd that fhebearer Is dulyD POOL&-PATIO INCIf0ensed byfhe COImtl of Suriolk ' ' +01122=09OZIOit2M f I � - rais�art�ycoP,rtyorm.S�Ptonccmauyn.�„q��yy��6- _ �:atuvnQAtrass PorsxaoaeretiuGomaeacas�tg�uarto,cs r„W�c - Addillanai Business Hamas Ucense Ca[egp� - PaoLs/Spas " • 1 Certthcotians indicated herocn argnlfy iiat this plot Of the Frapeny depicted hercan was mods in accordance with Ilw emwing Cede of Proaica(«Load Survayus csdop:ec 'by the Now York State Association of Professional land Surveyors. Thts cwtnccation is only for the lands depicted hereon and is not certiftcauen of title, zcaulg or beedca of encumbrances- Sold certifications shall run only to the persona and/or entities luted here r n and are not transferable to add,:toryj persons,entities cr subuxluerrt ownets N1,10C)AWSrc TRAdL 1 ECCE C► PAVEMENT - N 77'27' 0" E 1 0.00 _ — ON Wit —OM OM -- MONUMENT WATER V ME TEA FOUND 176.97' 0.3N O.J'W i Zs � N UCH T CN 0 ^1 POST / ^, V� "� STOOP TEWALK `V STOOP ROOF OVE �' FE ria. OXE r0Ja4' H I 00 w d s W 1 1/2 r 5 7' W � n STORY GARAGE DWELLING W No. 470 a W 9•T 15 1' o 3 2nd Sn o i TY �* a/H $ SC4 <, h 15' 7E.3' 5 20.3' b/W PONO FE t O XE o — al � 3 y � 2-J'E W li r $z� x�� oti W U SJ�:(/�llj t LO`T''37 0 i Z W O o �o U) ��,,��, Q it1l� g Q to cV - - - F23) - D' F2 m MONUMENT re —" — DOG/r r:1iArTN'®"7C FENCE 'FE FOUND o•s's HOUSE acs's MONUMENT LOT 43 a Z,S UNE S 78824"40" W 100.00'0 2 w CN-UNE Lor 42 LOT 40 0.2E - . IlA Sl,'dVt7 4tl:1N: The oi4z.ets or dimensions shown from shuctums to the property lines are for a specrfie'pLapose and use,and therefore,ere not uuended to guide in the erea:on of fences,romiung wells, pools,patios,planting areas,additions to buU*ngs and any other corww on. Subsurface and envuorununtol conditions were not e:aanurad-a cans,dwed as a part of tfits suwy. Easements.Rights-of-Way of record,if any,are not shown.Property comer monuments were not placed as a part Of this suety. O 2010 BBV PC- Barrett Tax Map: DISTRICT 1000 SECTION 103 BLOCK 4 LOT 12 Bonacci & lklc tiurur!� O.Ic a czuscr.iu ' Map oF' MOOSE COVE �� f:u:,xvsy e a.m-:a:rxt al:wren Van Vi/eeler 7<.;1)C� I' :ter E;d:=.A Low Civil Engineers 175A Ccmmetce Drive Map lot 37 Map Block --- 1 Surveyors Hauppauge,W 11788 Filed: 8/30/1960 T 631.435.111 1 No.: 3230 County: SUFFOLK rLV Planners r 631.435.1022 www.bbvpceom Situate: EAST CUTCHOGUE, TOWN OF SOUTHOLD 9 -Cyrrfied to Tide No.:3001-327578 Revision By Dote HCHAEL G & ROSIE NL NARDO of r.,suv=y coup r cc L&,Gr- BETHPAGE FEDERAL CREDIT UNION r'9 :ha brsd su`v`�ef'`'rtiO .rd and Lgnpwe shail riot be con FIRST AMERICAN TITLE INSURANCE ud=td to halb lnw cad vcW copy COMPANY OF NEIN YORK Su ad 6)r R)i Drafted GC C},oczrd WJB Scala: 1" 30' Data: SEPTEMBER 23 201G f'roied No.: A10045 1.1:W'AID alCO454Wwa+AUCCA54-diva,9MPG10;a4626 A.'-L%1f.'utycT'ii5UZCAD_1.1 r 1 IILTERED WATER RETURN NUMBER FI R OF NOZZLES VARIES PER POOL SIZE COwMPOSHE WALL POOL SYSTEM �f -n1LS DRAWING REPRESENTS CUSTOMER SPECIFICATIONS ti 201 X 40'-4" X 2$'-4"TRUE ® - Meg/6"R 'YOUR SIGNATURE ACKNOWLEDGES ACCEPTANCE. O ----J— G B. SIGN- DATE: DWG#:CM-5064 DATE:9/4/2014 REV:- PAGE2 OF2 KIMMER AREA(SgFt):903 PERIMETER: 130' EST.VOL(US Gal): �rPUAL-�' UAL MAIN 40t�n DRAIN W 3'O'MIN O SPACI G STRAINE 1 C-720 C-72(1 C-720 C-720 IC-720 C-720 C-120 — 2.0 m,P) z ZO 3'-4" 0 rn VU W I O C-240 U S-CS-0000SP 9 1/4" 910 t azo - CU 590098 X-8 1/8n IRGINIA GRAEME BAKER S ACT APPROVED DRAINS 89'-0" NOTE DRAWING CONFORMS TO ANSI/APSP-7 SUCTION ENTRAPMENT 1'-0" AVOIDANCE CODES d c �2o MAIN DRAIN PIPING SCHEMATIC W M N z 12'-0" 20'-0" CU-72009RL (NOT TO SCALE) R5-0" NOTE: a&a € ALL WATER EITHER OVERFLOWING OR �• 28_4 EMPTYING FROM THE POOL SHALL BE z jig sj c_720 DISPOSED OF ON THE OWNERS LAND, d CU-540098 AND PLANS SUBMITTED SHALL SHOWRE0 9 3d PROVISIONS MADE FOR SUCH WATER n 4'-0" 2'-3 1/4" FROM FLOWING ON THE LAND OF ANY ° o o " S2� § ADJOINING PROPERTY OWNER OR a Le o8p B C-zao C-360 INTO ANY ABUTTING STREET. , f "I e� I aNa 0� IL co 4 Y ® I c-7zo c-720 C-720 c•zoo 4t-Otr PROTECTIVE BARRIER NOTE: RX 24'4' DURING CONSTRUCTION OF THE POOL, C g Ll- yl S CG121290TR A TEMPORARY BARRIER SHALL BE =3 o t t 4 4' 3'-3 7/8" INSTALLED WITH A MINIMUM HEIGHT C'CD FUZION(2)BRACE N C� ep OF 4'-0". UPON COMPLETION OF POOL m aS; Ss 0 3' - INSTALLATION,OWNER SHALL INSTALL o 2 " 3rd R9'-0` A PERMANENT BARRIER,MINIMUM o�; �-§ HEIGHT OF 4'-0",WITHIN 90 DAYS. t, o co Mg �.•t = X-4" 3t-4n o i o H _l -i€ 8'-0" l EpnH 11 HIM, III amowta ntsu.0 ,,,� 4'-0" 6'-0" 14'4" 1116-4" nnsc.q uDANGER:OMNG MAY T pr y�y,L a�onb those epres�dda swhktt ate sbtad H Its wA¢en wanemy.Arty a he repres IoM statemeno,ar mn racO made by the dealer/centrattor m the customer rtyar"any componems proA,ced b/ O �o ��$� RESULT 11 SERIOUS TdvNtorMtg w-am a tomutademthedeakr/mmattW'G'M*ThedLe'9Z«omoraCwrwrosdes«bataesy tPodlsanmdependaM=c=wand isnot anagrnwemployee ofTdwevwmFg ImThe cw"- nmWwds L(7 0 UJ 11 ,* INJURY OR DEATH. a��h^�are sggnceor s ard appy only to ro l ground const ns.Them may be admmnal preatAions aro/ar mettroes alcor sounan The rsporvaub s he mnhaaors A safety tre wm dcya m ro be parva remty M aDadtm I'-0•to the stnaow side of the port at flue mope surge.-Olyfamt methods aro pnn=d"may be dktabed by varlets ground cw4d rs.This is to be determned by and is De rrsporobgM of the coneacmr who Is not an Signage must be emlanantl attached ��of ha ma mfaoa.er M due comport pang.-ImmIlatlan is to be done m accordance wdh al federal,stare aro local building codes,as well as A.NS.IJN.AP.L suggested standards.-BORtAf SP�ffICATICKS MUST MEET OR p y DMEED A.N-'I4N.%Pd4A.P".REODMMENDED STANWJWS'NO DNING stgrtage mmt bepermanemly abed ed to the yore WLmettr of De pod.See 48b ctlaro vdtlt sig wge.IT 6 AKOMMEXDEDTO NOl INSTALL f t�_I P-_J..� J r Ll Q around the perimeter of the pool. DMNOBTlN.J SAN0j0RSLIDSNOEWWRENTONRESMUMALPOOM1fdivingboardsamd/ordldingequipmentbinafeBedbytlmcontract chdtWng6aardsadaBdfngequipment MUST BEINSfALIED FW IWY �� WITXIN TXE GUIOEUNES ESrABUSXED BY ANSI/NSPIIASPA RECOMMENDED SrANDIAROS,ANDIN ACCORDANCE WITH ALL APPLICABLE STATE AND IUDCAL CODES AND REGULATION& Z}N aW Z Qzr cl�(n LJJ LLa OZ ENGINEER'S SEALZ O O Z J ®� ��y C:) O ��o N G. ? Z OJ CO w (7 IL roe tr, N/A a Gi oPwvm ev CTC tSOp 060520'` SGC 90 FSSS, SEPTEMBER 8,2014 AS NOTED ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE RESIDENTIAL BUILDING CODE OF NEW YORK STATE 2010,INCLUDING THE SPECIFICATIONS IN APPENDIX G: awa�1 OF 1 SECTION G103-SWIMMING POOLS; SECTION G105-BARRIER REQUIREMENTS; SECTION G106-ENTRAPMENT PROTECTION FOR SWIMMING POOL&SPA SUCTION OUTLETS; SECTION G107-SWIMMING POOL&SPA ALARMS