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HomeMy WebLinkAbout44631-Z S�FFOt Town of Southold � o�. 7/18/2021 P.O.Box 1179 o • 53095 Main Rd y�01 dao ¢ Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42165 Date: 7/18/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 7260 Horton Ln, Southold SCTM#: 473889 Sec/Block/Lot: 54.-3-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/17/2020 pursuant to which Building Permit No. 44631 dated 1/28/2020 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 Jakob,L Rev Trust of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44631 5/24/2021 PLUMBERS CERTIFICATION DATED riz d ignature r:71.F a,1 TOWN OF SOUTHOLD BUILDING DEPARTMENT co 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 #: 44631 Date: 1/28/2020 Permission is hereby granted to: Jacob, Michael 201 Tulip Ave Floral Park, NY 11001 To: construct an in-ground swimming pool as applied for. At premises located at: 7260 Horton Ln, Southold SCTM #473889 Sec/Block/Lot# 54.-3-11 Pursuant to application dated 1/17/2020 and approved by the Building Inspector. To expire on 7/29/2021. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 IMMING POOL $50.00 Notal: $300.00 -Inspector Buildin6 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. Swom 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"landuses: 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. s 5--20ZO New Construction: ✓ Old or Pre-existing Building: (check one) Location of Property: r721a0 tvold House No. Street Hamlet Owner or Owners of Property: _�►c4 Ae-( JR-ywb Suffolk County Tax Map No 1000, Section Block Lot Subdivision f (� Filed Map. Lot: Permit No. `I lU� Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applica# Signature Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) I, N44-ed l Ioa residing at r'12(oO -&aoas (Print property owner's name) (Mailing Address) do hereby authorize &IUL (Agent) to apply on my behalf to the Southold Building Department. t_I-_232.0 (O er's Signatur (Date) (Print Owner's Name) oF so���®� Town Hall Annex L ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ® sean.devlin(cD-town.southold.ny.us Southold,NY 11971-0959 couff BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Jakob L Rev Trust Address: 7260 Horton Ln city:Southold sr NY zip: 11971 Building Permit# 44631 Section: 54 Block: 3 Lot: 11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA- Leo's Electric License No: 2199ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency FixturesTime Clocks 1 Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Pump on 220GFI Notes: Pool Inspector Signature: r e Date: May 24, 2021 S. Devlin-Cert Electrical Compliance Form.xls lE SOUTyo� **VW" 14 9 &r3/ l 2-& *0 �4K-rWv L Iv # TOWN OF SOUTHOLD BUILDING DEPT. co 765-1802 _ -INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/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:. DATE Z Z INSPECTOR ' -I - LVA laf so TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST I ROUGH PL13G. FOUNDATION 2ND ]�NSULATIOWCAULKING FRAMING/STRAPPING FINAL P�-u L- FIREPLACE & CHIMNEY FIRE SAFETY'INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O REMARKS: 0 DATE ..SPECTOR f Macholz, Nancy<nancy@leoselectric.com> mcma�m�mm Horton Lane Pool Photos Leo, Charlie <charlie@leoselectric.com> Wed, Jul 15, 2020 at 7:38 AM To: Nancy Macholz<nancy@leoselectric.com> Please save,just in case Charlie Leo Leo's Electric Corp. 1414 North Sea Road Southampton, NY 11968 T. 631-287-2200 F: 631-287-7347 E: Charlie@LeosElectric.com Website: www.LeosElectric.com 6 attachments Horton Lane#12.jpg 157K - x Horton Lane#11.jpg 111K - Horton Lane#10.jpg 88K A' Horton#9.jpg 99K Horton Lane#8.jpg 28K lit" Lt. Horton Lane#7.jpg n� 30K FIELD INSPECTION REPORT~ -DATE COMMENTS FOUNDATION (IST) ------------------------------------- FOUNDATION (2ND) z 0 ROUGH FRAMING& y PLUMBING D 5 r INSULATION PER N.Y. y STATE ENERGY CODE 77 W FINAL ADDITIONAL COMMENTS -A o ! 0 -DO e d o 711A Zo _ iv o r o z ' d r TOWN OF SOUTHOLD -BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT' ss5„"',.; Do you have or need the following,,before:applying 7 'TOWN,HALL Board of Health "SOUTHOLD,NY 11971 3 sets of Building Plans, 1:TEL:-765-1802. Survey PERMIT NO: f•/ Check Septic Form N.Y.S.D.E.C. 1 Examined ,20 Contact:Trustees Approved 20 Mail to. Disapproved a/c Phone:--/7_��? t PIw�5 Building Inspect 5 . JAN 17 2020 APPLICATION.FOR OUILDING:PE'RMIT, _} _ Date, 20 aQ INSTRUCTIONS a.This application MUST'lie 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`sohedule. 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 puipose wliat-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-Southold;-SuffolksCounty,New,York and other applicable Laws;,btdmances or- Regulations,for the construction of buildings,additions,or alterations or for removalor demoli 'on as herein described.The applicant agrees to comply with fall applicable laws,ordinances,,bui1lding code,housing code, regulations;>arf&td admit authorizd&'inspectors on premises,and�in building for necessary;inspections. • (SignaturW,applicant Vpamej if a-.corporation) 170/(/ .,(Mailing address of applicant),- State whether applicant is owner, lessee, agent,,architect, engineer, gener4l contractor, electrician,plumber;or.builder, Name of owner of premises Md,4el U49ZC (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. .2q q-m E Other Trade's License No. 1. Location of land on which proposed work will be done: 11 _72-60 Aogi s Lum House Number Street Haml%,,!?, A I BFIAORM11�1�1 J i 91ste - ) County Tax Map No. 1000 Section 64 Block 3 d�oY�ve11 1r,Lret>1 i{ ,q, Subdivision Filed Map No. y1ruo3,g1o11uL&tt 3Ei�6au (Name) ___02,s rt),s, a-4ugy3 nut-71,11 ; a 2. State existing use and occupancy of premises anA intended use and occupancy of proposed,construction: a. Existing use'and•occupancy 01,W& & b. Intended use and occupancy Je 16JIMMId L 3. Nature of work(check which.applicable):New Buildirng Alteration Repair Removal, Demolition Other Work 4. Estimated Cost _ Fee (Description) (to be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front - 101. Rear 01 Depth 27- 11(o Height Number of Stories f Dimensions of same structure wit(,'61teeation"s or�additions: Front `' 1 iRe`ar Depth Height Number of Stories, 8. Dimensions of entire new c oustn,�_ ctian: Front Rear 36 Depth 3 '1z (o Height Number of Stories 9. Size of lot: Front QO Rear l ocs, 'D 160 10. Date of Purchase Name ofFormer Owner 11. Zone or use district in which premises.are situated; 12. Does proposed construction violate any zoning law,ordinance or regulation: No 13. Will lot be-re.-graded �L Will-excess fill be removedfrom premises: YE -NO 14. Names of Owner of premises � AYWIS Address �o to .119-7( Phorie'No.911.7-912- KJV Name of Fac - ` D R,ll Pr- fAddre'sg 4 Ls► Sm�Na� Ph6rie°1Vo (931- 721-S7'f0 Name of Contractor A,-T,,t- aQAros &li Address g21, & 2�A ,llec.Phone No. bS1- 744-71 Er ocQ_ ovv ioiov 15. Is this property within.I00 feet of a tidal{'v'vetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES 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 1.0 feet or below,must provide topographical data on survey. STATE OF NEW YORK) • COUNTY OFZOffa2 ) S: vLbeing duly sworn,deposes and says that(s)he is the applicant Ln (Name of individual signing contract)above named, (S)He is the � �►L (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 of janJarV 202o _j No ary Public Signature of Aoftcant MARGARE-r A. KIDNEY Notary Public—State of New York No. 01 K16021111, (qualified in Suffolk County My Commission Expires March 8,2 'Q, Scott A. Fussell °s� '� S'7[ O]Kl��l WA\T]E][. SUPERVISOR _ � l��/1[A\NA\(Gr]EM]ENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 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) 09A. 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 orany contiguous area. a dc. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑[f D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. 0 f E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. ❑[f 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 Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date: „��p / District NAME: C�"Ick 54 v3 11 1-15-232-0 Section Block Lot �' (] �/ �] 1/ FOR BUILDING DEPARTMENT USE ONLY**** Contact Information: -11 /� 7��"�O /rJ7 rreleoom Numbed Reviewed By: — — — — — — — — — — — — — — — — — Date: — Property Address/Location of Construction Work: — — — — — — — _ _ _ r7 21 o +4x1, LJ Approved for processing Building Permit. `� Stormwater Management Control Plan Not Required. gold 1 J4-71Stormwater Management Control Plan is Required ® (Forward to Engineering Department for Review.) FORM * SMCP-TOS MAY 2014 APPLICANT: S.C.T.M.# 1000CHAPTER 236 (Property owner,Design Professional,Agent,Contractor,other) aQSt1 �. Stormwater Management Control Plan CHECK LIST NAM • lC�k� �J 1(l�6 Section Block Lot z S M C P -Plan Requirements: Provide ONE copy of the Building Permit Application. p`m`pb Date: ' �k The applicant must provide a Complete Explanation and/or Reason for not providing �l3-112.M 1-15--.232-0 �1 � all Information that has been Required by the following Checklists g-turc Tekpba N—bw 1. A Site Plan drawn to scale Not Less that 60'to the Inch MUST NO NA If You answered No or NA to any Item,Please Provide Justification Herel show all of the following items: If you need additional room for explanations, Please Provide additional Paper. a. Location& Description of Property Boundaries b. Total Site,Acreage. c. Existing -Natural & Man Made Features within 500 L.F. of the Site Boundary as required by§236-1702). d. Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. r/ e. Limits of Clearing & Area of Proposed Land Disturbance. f. Existing& Proposed Contours of the Site (Minimum Z Intervals) g. Location of all existing& proposed structures,roads, driveways, sidewalks, drainage improvements&utilities. ' h. Spot Grades &Finish Floor Elevations for all existing& proposed structures. I. Location of proposed Swimming Pool and discharge ring. j. Location of proposed Soil Stockpile Area(s). k. Location of proposed Construction Entrance/Staging Area(s). 1. Location of proposed concrete washout area(s). ✓' M.Location of all proposed erosion&sediment control measures. 2. Stormwater Management Control Plan must include Calculations showing that the stormwater improvements are sized to capture,store,and infiltrate on-site the run-off from all impervious surfaces generated by a two(21 inch rainfall/storm event. 3. Details&Sectional Drawings for stormwater practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion& Sediment Controls. b. Construction Entrance & Site Access. c. Inlet Drainage Structures (e.g.catch basins,trench drains,etc.) d. Leaching Structures (e. .mfiltration basins,swales,etc.) ****FOR ENGINEERING DEPARTMENT USE ONLY Additional Information is Required. IEl Reviewed& I Stormwater Management Control Plan is Not Complete. Approved By: — — — — — — — — — — — — — — — — — — — — — — — Stormwater Management Control Plan is Complete. Date: I SMCP has been approved by the Engineering Department. FORM * SWCP Check List-TOS MAY 2014 t � (9 ING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD cm tall JUL 20 20T9wn allAnnex- 54375 Main Road - PO Box 1179 r 4 Southold, New York 11971-0959 DUELDTNG DEft.lephone (631) 765-1802 - FAX (631) 765-9502 710"?Butholdtownny.gov - seandO-southoldtownny.-gov APPLICATION FOR ELECTRICAL INSPECTION. ELECTRICIAN INFORMATION (All information Required) Datet Company Name: Name: License No.: ,91c c1 r,0 email: DW-cc_p \-rosc_\rc,4,C_ Address:, Phone No.: t-7- o aL->z> JOB SITE INFORMATION (All Information Required) Name: yy-) GIC b Address: LV\_ Cross Street: Phone No.: 3��q_ Bldg.Permit#: email: Tax Map District: 1000 Section: Block: 'J 'tot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?: (YES NO Final 5), 1- Rou 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 1#Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information:. -PAYMENT DUE WITH APPLICATION 00 Request for Inspection Formals /03-ec) ��pf SOUI,�o Town Hall Annex Telephone(631)7651802 54375 Main Road V ro (631)765- 5 P.O.Box 1179 G , :Q ger.dchertdiown.soumOl5.nV us _ --_Southold,IVY 11971-0959 BUILDING DEPARTA4ENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: k&d � � Date: - 15-�2320 Company Name: Le6is Ocnr-�IC Name: 1z o icense No.: Address: 14.)4 &{-n, RD �`I� �,1 kY Phone No.: 3 I_ 2 _ V JOBSITE INFORMATION: (*Indicates required information) *Name: rfi1&i) , AiOP *Address: r72-(.10 A1622 S 101 *Cross Street: &JNQ Uig A *Phone No.: 1 t-7_ Permit No.: (06t Tax Map District: 1000 Section:_574 Block: 3 Lot: 11 *BRIEF DESCRIPTION OF WORK(Please Print Clearly) virwc (Please.Circle All That Apply) *is job ready for inspection: YES / NO 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 82-Request for Inspection Form PERMIT# Address: Outlets GFI'S Surface Co Sconces HH'S LIC-1-Lts Fans Fridge HW IN,haust Oven Dryer Smokes DW Service Wr-bbri M16ro Gen& Itar- Clombo Cooktop Transfer A C AH Wini Special: Gornmen'tv. C oa44� 0 1 C- PA — QA .041 L) 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: (� APPLICATION FOR OUTDOOR POOL PERMIT [ EROSION SEDIMENTATION & WATER RUN ASSESSMENT FORM [�(]� CERTIFICATE OF WORKER'S COMPENSATION CERTIFICATE OF LIABILITY INSURANCE j SUFFOLK COUNTY LICENSE - [-�- -SUFFOLK COUNTY PLUMBER LICENSE [ ] SUFFOLK COUNTY ELECTRICIAN LICENSE 4 SETS OF PLANS - (3 STAMPED) 3 SURVEYS with FILTER LOCATION APPLICATION FOR ELECTRICAL INSPECTION yj APPLICATION FOR CERTIFICATE OF OCCUPANCY 00 C.O. [� TAX BILL [ ] $400.00 CHECK FOR PERMIT FEE Certifications indicated hereon signify that this plat of the property depicted hereon was made in accordance with the existing Code of Practice for Land Surveyors adopted by the New York State Association of Professional Land Surveyors. This certification is only for the lands depicted hereon and is not certification of title, zoning or freedom of encumbrances. Said certifications shall run only to the persons and/or entities listed hereon and are not transferable to additional persons, entities or subsequent owners. A PRS VED AS TSD DATE: , B.P.#- Et.�IuL MISPECTION REQUXREO FEE: i BY- INC, LTAX OT EI^T��f T NOTI BUILDING DEPAR F ENT AT S S 0��9 765-1802 8 AM TO PM FOR THE 14.4 QF uxw T ��T FOLLOWING INSPECTIONS: TSF T E 0 C, 'yq R R(�j�yOF 1. FOUNDATION - TWO REQU�iP� r-GR Pour'.- '�r�F�T� FOUND S 42'52'40" E 100.00' D:9Wcoac TF/�2? F 2. ROUGH - FRAMIhIG & PLUMBIN(i 1.5's 3. INSULATION 0 4'w 4. FINAL - CONSTRUCTION MUST ;nftaeasp 24 BE COMPLETE FOR C.O. M - ALL CONSTRUCTION SHALL MEETITHE REQUIREMENTS OF THE CODES OF I ' W 33 YORK STATE. NOT RESPONSIBLE • DESIGN OR CONSTRUCTION .FRR ° SHED z' I$ 3� O . Q� ' - ^ ooD � C) RA O �- r I r 15.2' 30 W a`GAT u DECK MAS. ,'• W TAX TAX a a Wa o 3 LIOT LST WLLI 3 3� • . a 461' J� 10 = (a 1 STORY < 'Z, 3 O ODWELLING C 0 FE N N I <• . NO. 7260 " N 0 6'W n o— O A/C •13 3. • UNI GARAGE 81.7' OVERHANG n BAY q1} WINDOW N 5 Z MASONRY y`.�- Z WW 3 a a � � I a Z I o 0 Uj >� o ZO PIPE FE FOU' 0.5'N ® PIPE 0.5'W 0.9'E LS> -46'oo" E FOUND WALLS s o.z'w off off OH MASONRY' • 100.37 N 47 E;'009@ W CCIVIIPLY WITH ALL CODES Ov- uu -TOMS LANE N`*W YORK STATE & TOWiN CODE ' (NORTON LANE) F� ; AS REQUIRED � � IL. ' � SOUiHOLD TOW IUNLAWFUL _ SOUTH OWN PLANNING BOARD v i I H O U T E TI F I i S LITH _ ' RUSTEES � ESURVEY �I C�DE �l'� OCCUPANCY Themffse-rs o� a sions s o y from st ctures to the property Imes are for a specific purpose and use,and therefore,are not Intended to guide In the erection of fences,retaining walls, pools,patios,planting areas,additi s to buildings and any other construction. Subsurface and environmental conditions were not examined or considered as a part of this survey, Easements,Rights-of-Way of record, If any,are not shown Property corner monuments were not placed as a part of this survey. © 2019 BBV PC Barrett Tax Map: DISTRICT 1000 SECTION 54 BLOCK 3 LOT 11 BO(1GCC! & Ma of: PROPERTY Unauthorized alteration n addition to Map this survey Is a violation IL-rection (tBN V®n Weele PC _ - 72090 New York Stole duc Low ,- / Map Lot: - Map Block: - Engineers • Surveyors . Planners - 175A Commerce Drive Hauppauge,NY 11788 Filed: -- No.: - County: SUFFOLK T 631.435.1111 F 631.435.1022 www 66vpc com Situate: SOUTHOLD,TOWN OF SOUTHOLD Certified to: Title No.- SP42013-S Revision By Date MICHAEL JAKOB&LYNN JAKOB Copies of this survey map not bear- FIDELITY NATIONAL TITLE INSURANCE COMPANY ing the land surveyor's embossed SPANO ABSTRACT SERVICE CORP. seal and signature shall not be con- sidered to be a true and valid copy CITIZENS BANK,N.A.,its successors and/or assigns, _—--=_ Surve ed b : C.S. Drafted 6y: B.W. Checked 6y: C.W. project No.: A190368 as their interest may appear Scale- V'= 30' Date: JULY 9,2019 K\Da19\A190368\DWG\A190368.dwg,7/10/2019 2.3713 PM,BNW i - Workerif 1f®Itt{ CERTIFICATE OF INSURANCE COVERAGE tion DISABILITY AND PAID FAMILY LEAVE BENEFITS �tnd LAW PART 1. To be completed by Disability and Paid Family Leave Benefits Carrier or Licensees Insurance Agent of that Carrier 1 a. Legal Name and Address of Insured,(Use street address only) 1 b. Business Telephone Number of Insured, ARTHUR J EDWARDS MASON 631-744-4455 CONTRACTING COMPANY INC 929 ROUTE 25A _ 1c: Federal Employer Identification Number of Insured or MILLER PLACE NY,11764 2700 Social Security Number 11-2377925 Work Location of Insured(Only required if coverage Is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of 3a.-Name of Insurance Carrier Coverage (Entity Being Listed as the'Certificate Holder) 'The Guardian Life Insurance Company of America TOWN OF SOUTHOLD P.O.BOX 728 3b. Policy,Number of entity listed in`box"1 a": SOUTHOLD,NY 11974 00984424-0000 3c. Policy effective period: .,01/01/2020 to 01/01/ 021 4.;Policy provides the following benefits: ®A. Both disability and paid family leave benefits. q - t ❑ 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 or employer's employees: Under penalty of-perjury, I certify that I ain an authorized represerrtative or licensed agent of the•insurance carrier referenced above and that the named insured has NYS Disability and/or Paid'Fam11V Leave Benefits Insurance coverage as described above. Date Signed: 01/01/2020 By: f6ly's?zQ °j t9m.,kA. Raymond J.Marra (Signature insurance cwVes authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number: 1-888-278-4542 Title: Senior Vice President,Group and Worksite Markets 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 `Dlsability and Paid Family Leave Benefits Law:It must be mailed for completion to-the Workers'Compensation Board, DB Plans Acceptance Unit,PO Box 5200,Birmingham,NY 13902-5200. DB120.1 (1/18) :"fi:.2r'� 4.-.�y �a�'"y�"`< -:•�'"_ � _ �� .tom ` '„�,w� r�'�4�;. � a•"`1< .�� n r!"µ �”" c. - �3.i '.�`'��.y� �%r, ,u, ��,; '-' - mcZrsrL' •. a.o- _ .rsv,c4+�'``+_� 4 '•.. � a _��'fi �` "�- \S•*', `V'�'ED' yy�� - �y �a � f�" S�� �-^;=i, rr,` Jd�Y ° `' ��� ��^ - '� - - ---- �$ ��,•�' R° d+ey. £s. �^, � �r,,r.:.1�." - � pan %�r .P���; Suffolk County Department of Labor, Licensing & 1 Consumer Affairs i �* VETERANS MEMORIAL HIGHWAY * HAUPPAUGE,NEW YORK 11788 DATE ISSUED: 0701/1978 No. H-4436 Suffolk County T � Home Improvement Contractor License This is to certify that ARTE11IR J_ �+'nWd►RiiS `'" } �} doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DDA(1 SUPP) � 5 - ' 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 g IMPROVEMENT CONTRACTOR, in the County of Suffolk. c •, 7 License Category � c Additional Businesses 2` zr H26-POOLS&SPAS/CERTIFIED ^ �_ gig; a fD ARTHUR EDWARDS POOL& H3-POOLS/SPAS d 5 SPA CENTRE HI-GC `i t<FS -a c o c ` m r e Z Ze v► '�ac[ork'fla�tdelt°l t'' - s• : C � .�y C O o 3 n om�• Z O 0 . Commissioner y O cD w m 0 0 z n y m 3 A 04 ,e - = C1 fD Z CD r O cfl t G yZD � 0 T V w f O �-Oo G J Y CA) y N m c3D O O Z M 0 ; z C/) m �4�� � �• r _; -- d� -ter;..^.}r,^__r-��-rno.-fir .�.z�� a"`��- __ .�.+ic�w.:r:`•+,�- _ � i�.� }p cq. N '� ;"�q`, d, \�. 2 +z'.y'..a';-� �'a - :i.3.,G , � ��+:a.7�„:' ..F• '-*r'lk' 4`;h�ti' ;.,Lyr,,rs ��', � i�y.{5C t. A R'" a: `te„p°n•` ;sµ•iS�;• '�yr,"^dt ��, _ +i.�, •+ � _ ,� _ �y '' -�`. r_ .. ' '� � -�, -' F �s '+:bar,;,,""• M' n '� �,;6o+i.,en ,",e_'<' y,:'r'S,y`•`'m .'"?-,!„N j •"�^;,"'."` ti�Y vti�o-A`�` e(Fcs•>s rr �'`r/ j w� 1' h '�.a •�^y',.,, m :.9'+'SS• ,+�c��R. -tj°`a„ r "+,y„ * ` '^' y,�5.. .F. -3it- Y>3"- a-�• .Jw'T`�_•'a �� C 4 ,� ,,R ;hip d4, `s10- - -nz: •�iF;. �=':�a` `''a'''r „�•M -:,';g,•,ru;• �j4y .r q`C)R®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) -] 01/13/2020 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 CONTACT -NAME* GabbyLoiacono Liberty Risk Management, Inc. PH -IAI.NNe (631)569-5633 F�No:(631)569-5636 664 Blue Point Road,Suite A E-MAIL HOltsville, NY 11742 ADDRESS: Gabby@libertyrisk.org INSURERS AFFORDING COVERAGE NAIC INSURER Hartford Casualty Insurance Co. 29424 INSURED INSURER B Arthur J.Edwards Mason Contracting Company Inc. DBA Arthur J.Edwards Pool&Spa Centre INSURER C: 929 Route 26A INSURER D: Miller Place,NY 11764 INSURER E: - I INSURER-P. COVERAGES CERTIFICATE NUMBER: 00000005-554222 ' REVISION NUMBER: 13 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMID /YYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y 12 UUN OZ9039 01/01/2020 01/01/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) $ 300 000 MED EXP(Any one person) $ 10.000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2 OOO O00 X POLICY E PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea,cadent ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LUIBILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L DISEASE-POLICY LIMIT $ T1 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Southold is included as an Additional Insured,ATIMA,as requried by written contract,subject to policy terms, conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 728 Southold, NY 11971 AUTHORIZED REPRESENTATIVE GLI ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by GLI on January 13,2020 at 04 27PM New York State Insurance Fund 199 CHURCH STREET,NEW YORK,N.Y. 10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 112377925 0 LEVITT-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FL TARRYTOWN NY 10591 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 53244 06/29/2019 TO 06/29/2020 06/21/2019 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. e NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER. 506150454 I' I1111I 1100®11.11®I eu�ISI®1 IBII ell ilm IF11N I®11� I� 000000000071672400 Forth WC-CERT-NOPRMT Version 2(02/29/2016)[WC Policy-243849191, U-26 3 40 [00000000000071672400][0001-000024384919110GRI 5159-06HCeR NoP-CERT_H01-000011 A BB - eno B O , To Fir Fmm n&w Ek Pang To -To Rehes ftwa 00*00 Wok F Plan A Piping . Arrangement ®F I1EW YOQ� 42" �P� PSp.RE/ , CO SectionB—B r PSl C...ft rz j H 0" 0430b Pte' _ OFE���O� Section A—A Typical Wall Secti®n SIZE A B C D E F G H AREA I CAP FEET FT FT FT FT FT FT FT FT SCS.FT GAL. 15 X 30 15 30 10112 5 3 3 9 450 15,000 ]pet SPA C �b� � - -7 16 X 36 16 36 12 14 6 4 4 8 576 21,600 PERMACRETE WALL S�,EM CRY &qho IU r 18 X.146 18 36 12114 6 4 5 1 8 648 '24,300 .929 Route 25A Miller Place NY 11764 20 X 50 20 50 24114 8 4 5 10 1000 34,000 . (631) 744-7185 FAX (631) 744-0174 �j71 24 N4 24 44 18 14 8 4 8 10 798 35,000 Suffolk License #4436—M Nassau License #H174450000 24 X 48 24 48 20 16 8 4 6 10 900 38,500