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HomeMy WebLinkAbout45117-Z m- S�FFOL�c Town of Southold 8/25/2021 P.O.Box 1179 _ .p 53095 Main Rd A� �ao`r. Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42281 Date: 8/25/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1255 Stillwater Ave,Cutchogue SCTM#: 473889 See/Block/Lot: 103.-1-17 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/11/2020 pursuant to which Building Permit No. 45117 dated 8/17/2020 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: accesso in-ground swiming pool fenced to code as applied for. The certificate is issued to Spinelli,Joseph&Heather of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45117 1/8/2021 PLUMBERS CERTIFICATION DATED Aut riz d ig ature suE TOWN OF SOUTHOLD o�o� cor-1 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#: 45117 Date: 8/17/2020 Permission is hereby granted to: Spinelli, Joseph 2110 Frederick Douglass #4C New York, NY 10026 To: construct an in-ground swiming pool as applied for. At premises located at: 1255 Stillwater Ave, Cutchogue SCTM #473889 Sec/Block/Lot# 103.-1-17 Pursuant to application dated 8/11/2020 and approved by the Building Inspector. To expire on 2/16/2022. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector oF sovdy®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 sean.devlin(c�town.Southold.n us Southold,NY 11971-0959 y' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To Joseph Spinelli Address: 1255 Stillwater Ave city,Cutchogue st: NY zip. 11935 Building Permit* 451 17 section: 103 Block- 1 Lot. 17 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electric 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 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 1 Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceding Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixture Time Clocks 1 Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Intermatic Pool Panel, Salt Generator, Pump on 220GFCI Breaker, Solar Touch Notes Pool Inspector Signature: EL, Date: January 8, 2021 S.Devlin-Cert Electrical Compliance Form As Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets, and unusual natural or topographic features. 2. Final Approval from Health Dept of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 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"Iand uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. --I �2c, 120 New Construction: X Old or Pre-existing Building: (check one) Location of Property: � _L55 6(/ e.. House No. \ Street -'Hamlet Owner or Owners of Property: \A ejs ��l Suffolk County Tax Map No 1000, Section 10 -300 Block 010v —Lot-01 -10&0 Subdivision Filed Map. Lot: Permit No. 4 S I I 1 Date of Permit. Applicant: P e.e,-,K�r �p.s%e l k Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted:$ CGnt Signature i Building Department Application AUTHORTZATYON (Where the Applicant is not the owner) �, �ti. �`�^�►� `a..a residing at (Print property owner's name) ailing Address) E.,- ,�a�L,� do hereby authorize /-57y (Agent) to apply on my behalf to the Southold Building Department. ex' ature) (Date) e C (Print Owner's e) ho�aOF SOUIyOIo # # TOWN OFSOUTHOLD BUILDING DEPT: °`�courm Nf`' 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 [ ] PREF C/O REMARKS: `e � �--- DATE �^ '�- INSPECTOR �O���E SOplyo6 # TOWN-OF SOUTHOLD BUILDING DEPT. 765-1802 a INSPECTION [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] SULAT O CAULKING [ ] FRAMING/STRAPPING [ FINAL Pfft-� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION . [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION- [ ] PRE C/O REMARKS: 4 s 1Jo �- DATE INSPECTOR k u e Y'v i } t >y r � F Vi /v�N\ _ 1 i ow a < a� y 5• h }A < F � � � e iml � 3 r I : 45 h R� MIA iii 0, 5„gm �:• s , ip a "�<'° ..,�;:,.. e. ,x, °' x,?". .� „'fi ,r'•" ,: ,;^, F'A h5� rs,:s.ez��,� ,., �''4"� i},%;f,�.�p i .,;y. s"� ""NA 5r�01 MITI t ly "4 toot RON Vj Th tin CAL =k a A ; t it oil OU < q 9 JURY 14 A 317 loot;S AM n�.' - {. \ a v I � I 'limit a s n ` � r , � ?1 , n k o. ,.�... f^,c^ \•...' ..:'. A3. '.;N... na`:': �i....Y;. •.,r^"vim`_"+ �«xtcm..,,f�,• .r.. �Yeu�;i � ',•'�'.�.': t lH4 T-2 A U1 so, tTCH LISTED ........................... 4'-t!k� 5 IA,I Cmi All + �,4 R,!v 5 �a p 1 a, Ott �,ter' :•« ` Igurn r <. a y horn s t '. / y 1 � / i. 9 / / i e;(%p s� • u 3 its" s,�b lot a FIELD INSPECTION REPORT DATE COAEI TENTS FOUNDATION(IST) -------------------------------- FOUNDATION (2ND) rh ROUGH FRAMING& PLUMBING `3 RL • INSULATION PER N.Y. � y STATE ENERGY CODE ® Im 1A VAR w� FINAL ADDIT'lloxAL COMMENTS � g-a o • d TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 '` J Survey Southoldtownny.gov PERMIT NO. 7 �l/ Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined -,20 Single&Separate Truss Identification Form Storm-Water Assessment Form O Contact: Approved ,20 Mail to: Disapproved a/c Phone: Expiration ,20 J DBuilding Inspect AUG 1 1 2020 APPLICATION FOR BUILDING PERMIT BUDDING DEM. INSTRUCTIONS Date � � , 20 @� 9 OLD 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,housi e, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name,if a corporation) 1255 ��++.' q(Mailing address of applicant) W�c.lna /L-G --<— l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises 14 e- Ue ( t, (As on the t x roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer Builders License N0. �" Plumbers License No. Electricians License No. 4-PS5_"7 Other Trade's License No. 1. Location of land on which proposed work will be done: 2-515 I tea' -/ House Number Street Hamlet County Tax Map No. 1000 Section G Block Lot Subdivision Filed Map No. Lot 2. State existing use and occupancy of premiseand intended use and occupancy of proposed constriction: a. Existing use and occupancy bei; Ae,v4z i,I b. Intended use and occupancy �e_.,; �'"v l,- J 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work c*_- I r 3 (De 4. Estimated Cost l � Fee crip ion) (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 Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated �e �e j Lo, 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded?YES NO XWill excess fill be removed from premises?YES�<NO 14. Names of Owner of remises a far L Ke ' Address l2SS��,ll6-4,1-er Phone No. cfl'7 Name of Architect 16—e ev,,.v"V,,K k Address'Qv Dwi R,,.,-"*9 I4ifi!oe No Name of Contractor Address SL o, Lc,-6 14....E Phone No. 45-t-4'6— –13 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� * 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 Pe4-,-�He-� r!1 I being duly sworn,deposes and says that(s)he is the applicant (Name of individual s gning contract)above named, (S)He is the 0 u_ VL'& r (Contractor,Agent,Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this 2 day of ��� y 20 GREGORY PINTO 0 ARY PUBLIC,STATE OF NEW YORK Not ry Publ - 6090455 QUALIFIED IN SUFFOLK COUNTY 1 e of Applicant MY COMMISSION EXPIRES APRIL 14,20%i.- fFI7 V ""' UILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD o EC - 1 2020 Town Hall Annex - 54375 Main Road - PO Box 1179 CIOa Southold, New York 11971-0959 NE uSO0�' � OLD elephone (631) 765-1802 - FAX (631) 765-9502 gerr(a southoldtownny.gov - sea nd(a-)-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: 9VT"F�L MI-F.C-TRI CAL CO lel -RACTIN& JV , Name:- - -- -------------------- License No.: 40 -S - email: t tPL-OD n 0A`1Ae -A Address: �'` © LJ, A'co1'r" V- A_ dL 1 Phone No.: -- "15 JOB SITE INFORMATION (All Information Required) Name: Address: IZ`C7i* lW "- v-e-- GL'l 1 V&= Cross Street: JZ01A -C' Phone No::. Bldg.Permit "Tax Map District: , 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) �llv�J1�1/V1i ®d �f 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: - . = 1to5'e_:- CA 1 ov+r .F' --w; a� )A, e � eC . . . ...... ...... .. .... ._. PAYMENT DUE WITH APPLICATION Request for Inspection Form.xls a PERMIT# Address: Switches Outlets GFI's Surface Sconces HH's UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes D?W - Service Carbon Micro Generator Combo Cooktop Transfer AC AH Mini { Special: f.. � Comments �... �1� ' � �' . ' i �T 1 j 1,4 i" -k MB EGE14 Y x",�77 74 IV-, d F" '-14' p - w, sy OLIL Gy MEW P,A T -1;-J0sEPW- Owl D", y ER, fl' ,VAL*' RST---`AM ICA 'rel N= v, Al� i 11 EE tit* �c upmfou A,.,wp%t nAs ac: wiciSb cos, FE MCC. flAE w4wr AW, 0 WAMME Iv P� AT, PLOORO WIN. 1000w4rEL1. SAY MON 7 "CE ja CIE CEUAq-VTPI YARD N47 610 tM05CAj.0 AREA Jk r jacmtvro Mt- COME= J CREAR ) ,A. r co cQ 03 %A7E PA110 7, 28,7* AREA I smy TAX LOr 19.12 rix Z4 1 17 2&1" 4 7 '4; P V X-77ON q , A !6 w V-41 ,'21 -14907 750 1-� '01 PIP *40 00 jv64-08 13,6.70 �CALE G. STILLWATER AVENUE RAPIRC LOT AM- 20 11 . .0 10 w (.5o WIDE) iS.584.40 S.F. 0.36 AC, 20 fL e EW-, SGUSURVEY OF PROPERTYWY11N-(I- SURVEY FN EW' S7t ,Ms, SITUATE -n wa y s 0 -Point �HHOLD CUTCHOGUE, TOWN OF SOUT 99.wS Wgst,Hoffman I40flulf. Undenhumt, HaWYA U757 ey.im Phone; '�C631,126,*1406 &nail' OP07-14o4 R SUFFOLK COUNTY, NEW YORK 4, 11907 75-L EiL k r R� EW-, 20' X TAX MAP NO. ;DR.'.MC -sq*9--I SUFFOL a I .. .. - - - -'- 10010-.4d300-010 LAND Al-E SURVEYED: cr T-c vowwwt WV&ww'Na diad ,.)%D:0 ./;Ql­:� UOKWI ammt UK ja cm ftm%"w"c-mmcmrvjw 'I'M ?W&V lot- iiiii :111111,11,�1111!�l to armajawn•04 up*" I wm wu w-0—m-r I I I I I I I,Acumia" w" 'N"AN 01) mptmw ig �ja)r,14 ww of (V0,09 . secowkw na 0= we cm Lk� wawa 9WrWA to"w IN ImLamw 01:04 Dwom tv DUNRI-1 OP In-CH CERTIFICATE OF LIABILITY INSURANCE D 03127/2020I� 03/27/2020 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms,and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 845-783-2555 C T cT Walter Rose Agency Inc Walter Rose Agency,Inc PHONE 845-783-2555 FAX 845-783-2425 8 Stage Road a/ Ext: ANo /c Nol: Monroe,NY 10950 E- al :Iisa@walterroseagency.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Central Mutual 20230 AsuRnrite Manufacturing Corp ED -INSURER .Utica National of Texas 43478 Dunrite pools 3510 Veterans Memorial Highway Bohemia,NY 11716 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD -INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFiANY 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. II TR NSR TYPEOFINSURANCE ADD SUB POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY1,000,000 �OCCUR EACH OCCURRENCE $ CLAIMS-MADE CLP 9791864 , 04/01/2020 04/01/2021 DAMAGE TO RENTED 300,000 MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY 1,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 2,000,000 X POLICY❑PE0. PRODUCTS 2,000,000 LOC OTHER B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO 4822099 12/31/2019 12/31/2020 BODILY INJURY(Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident AVE ONLY AlO1TOS ONLY PPaO.ERTY 'dent AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETORIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? NIA E L EACH ACCIDENT and (Matory in NH) E L.DISEASE-EA EMPLOYE If yes,descnbe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMB DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached K 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 THE ATE Town of Southold ACCORDANCE EXPIRATION NTH THE POLICY PROVISIONS.NOTICE WILL BE DELIVERED, IN 530950 Route 25 PO BOX 1179 AUTHORIZED REPRESENTATIVE Southold,NY 11971 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CONSENT TO INSPECTION L 1� l�nP� it I the undersigned, do(es)hereby state: Owner(g)Name(s) That the undersigned(is) e) the owners of the premises in the Town of Southold, located at 1155 t 4-; // l,-q.+e 6v h , which is shown and designated on the Suffolk County Tax Map as District 1000, Section C� 3 , Block_�, Lot That the undersigned (has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: 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: _ (Signatur e tie GREGORY PINT®, (Print Name) NOTARY PUBLIC,STATE OF NEW YORK (Signature) No.01-PIg 90455 QUALIFIED IN SUFFOLK COUNTY �� my COMMISSION EXPIRES APRIL 14,20y (Print Name) voA�c 7� CompensationCompensationWorkers' CERTIFICATE OF INSURANCE COVERAGE T Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 16.Business Telephone Number oflnsured DUNRITE MANUFACTURING CORP 3510 VETERANS MEML HGHWY BOHEMIA, NY 11716 1c.Federal Employer Identification Number of Insured j or Social Security Number Work Location of Insured(Only required it coverage is specifically herded to certain locations in New York State,Le.,wrap-Up Policy) 112245133 � I 2.Name and Address of Entity Requesting Proof of Coverage U.Name of Insurance Carrier (Entity Being Listed as the Certificate Halder) I3heltsrPolnt Life Insurance Company Town of Southold 530950 Route 25 3b,.Policy Number of Entity Listed in Box"ta" PO Box 1179 i D131-593730 Southold,NY 11971 3c',.Polley effective period 01/01/2020 to 12/31/2020 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: © A.All of the emplayees employees eligible under the NYS Disability and Paid Family Leave Benefits Law. E] B.Only the following class or classes of employer's employees: I 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 coverige as described above. Date Signed 3/5/2020 By I awl (signature of insurance earner's authorized representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is sigped 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. I ; If Box 413,4C or 5B is checked, this certificate is NOT COMPLETE for purposes of Section 220,Subd.6 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 56 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disabifity and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-920.1.Insurance brokers are NOT authorized to issue this form. —J�lEw Workers' CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE YYT°ATE Compensation COVERAGE Board --- 1a.Legal Name&Address of Insured(Use street address only) Iib.Business Telephone Number of Insured 516-543-1616 Dunrite Manufacturing Corp , 3510 Veterans Memorial Highway I;c.NYS Unemployment Insurance Employer Bohemia,NY 11716 Registration'Number of Insured i Work Location of Insured (Only required if coverage is i specifically limited to certain locations in New York State,Le.,a Id.Federal Employer Identification Number of Insured wrap-up Policy) i or Social Security Number 1'12245133 2.Name and Address of the Entity Requesting Proof of3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) AmTrust Insurance Company of Kansas Inc Town of Southold 3!6.Policy Number of entity listed in box"I a" 530950 Route 25 KWC1143762 j PO Box 1179 - i Southold,NY 11971 3c. Policy effective period f 10/20/2019 to 10/20/2020 3i1. The Proprietor,Partners or Executive Officers are f j included.(Only check box if all partners/officers Included) ( x®all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box 7" insures the business referenced above in box "ia" for workers' compensation under the New York State Workers'Compensation Law:(To use this form, New York(NY)must be fisted under Item 3A on the INFORMATION PAGE of the woikers'compensation in4urance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above,as the certifilcate 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 ofpremiums or within 30 days IF there are'reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the i 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, t • I 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 holster, 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. I Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carver 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) I Approved b - ��- PP Y- 315/2020 (Signature) (Date) Title: President of Walter Rose Agency,Inc i 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 01" Suffolk County Dep rtment of Labor, Licensing & Cosumer Affairs 01 MW VETERANS MEMORIAL 11IGHWAY I HA-UPPAUGE,-NEW YORK 1.1788 DATEISSD:, 3/1/1977 No. 3585-H A S-C FFOLK COUNTY Home Improvement Contractor License This is to certify that KENNETH J BARTHMAN doing'business as I OUNRITE MANUFACTURING CORP having furnishe&the requirements set forth in-accerdance with and Subject to,the provisions of applicable laws,rules and regulati ns of the County of Suffijlk,.State-)f New York is hereby licensed to conduct business as a HOME IMPROVEMENT CO qTRACTOR, in the County of Suffolk. License Category ri F4 as- p-. N0TVAL1D* Pools/sp ITH0UT Additional Bu Other 4" DEPARTMENTAL SEAL DUNRITET DOLS AND A CURRENT C6NSUMERIAFFAIRS ID CARD 'StJ olk County Dept.of Labor,Li c ansing&Consumer Affairs' HOME MPROvEMENT LICENSE Commissioner Name KE NETH&BARTHIVIAN Business,Name DUNRITE ANUFACTURING CORP DBA Thisicertifies that the, bearer is duly licensed Licen Number H=358,5 by t tie,County of Suffolk 03/01/1077 Issue'. Expires: -0310112021 Commissioner . 1 APPROVED AS NOTED DATE%--(13)ZA B P � � Ct--,�MPL`! WITH ALL CODES O FFE• �A B,,,•... _ _ � NEW YORK STATE & TOWN CODES NOTIFY BUILD NIG DEPARTMENT AT AS REQUIRED A IONS OF 765-1802 a A,�>f TO .� ,^-,ul FOR THE SOUTHOLD TOW FOLLOWING 'INSPECTIONS: SOUTHOL WN PLANNING BOARD 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE SOOT OLD TOWN TRUSTEES 2. TOUGH - FRAMING & PLUMBING N`(.S. EC 3. INSULATION 1 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEVA RETAIN STORM WATER RUNOFF YORK STATE. NOT RESPONSIBLE FOR PURSUANT TO CHAPTER 236 DESIGN OR CONSTRUCTION ERRORS. OF TIE TOWN CODE. OCCUPANCY ORvj F®lATE-LY"- ' POOL TO USE I UNLAWFUL ENUPONECOMPLETIONDE WITHOUT CERTIFICATE BEFORE"WATER" , OF OCCUPANCY f ti POOLS •Withstep A B C D E F G H "K L M N: Gal I E -- ' - (4730',, 14x34 14 30, 3'4" 6.6" 6 14 6 4_ 4_ 6 , 4'-0" T-4° 12900 IW8'- I -16x32:' 16: -28 T4' 6'$" 6' :1Z`. -62, •.4 .:4 '8 4'-0" T-4', 13200 _ 16�f10,1 16x2416 20` ,3'-0"; :6';6"' 4_; $_ 4" :4. 4 8_ 4.0 Td" 9500 _ 16x30• = ?6x3A 16• .30" 3'-4". 6'$" -.8- .12 4: :4.• : '8 4'-0" 7'-4.- 14000 , •- - - - 10x16,`,. - 10#0. 10 •16,.. 3 °. ;4'. -6- ,-4.: -.�k. '•2" 2 :,ficr Y=0":•T-4= ;5500 , 12x26' 12x30_ 12 ,26_ 3'-4"- 6' - •6' •6- ?'10' 61 4_ "4-• , .4`K-W- TX,J2900 - ®�'..��- .•: `�_ -.�- '®. ..� - •, •.�'•• :�`, "�- �, .: 16x29:-. a 16730 .16 26 IW: 6=61-- .6 10.,- �6 74. •-4'- -:8...''a',�"'•T•a°: 13000 - <.. =:• 147Q0, ;-14x24: _14-. .•20 3'4"-• '6'-6". -'4a '8,- `4. -.4. ,:°4 6,: 4':0." T4" 9000 1( • -,. ��`..::= '�°._ °_ _�'° `_Mr W-W, �° ° �' .9° `4'-�°1 !�' '• ��� 1' `�' - �e Q .:26x481 -2oxga:, ..z6: ,44.; 3�•4'. .,8: `74__ .`ifa:. .iz a; ,.4.- :-12,: 4'-0':_rd zz00o f- .�' ` '-°-W` i' 9i1 • 9 :-20x42' .2CR46-- 20- ."42 ' 3 4" .-a . .14 :1z. -:iz`. =a 4•. , f2 ,, -0^•:r.,4,- 21609 �" •1�°!�[• °. -�° �° 9'!l �°!_ �r`� •:.�°�n<- ..9 - 18 8. . ...18x42--. 18:. ..36 3''4"-' -:8 :f0 Az'�=-12• `:•4 :4.-. --10; .4'-0". 'T3° .!9000 18 Ci0, 16x34:-. -18 30 ,-3<4� 6'li. .6_ =:16 :•1U. .4, .4;= -;10 4`�" ,T 4': 16500 [, _;'� _ _ - - �.° :� �• • VI' a?r: 'Z^s':'•6:.;.4-0":T•4"-; 12500 f8 c44` 18x48 f8 '44a:'_77-7= ra' -f4-.$1,-g.~ 3_: r 6:.;a e" r a• •2106moo ;gyp°-'�t d=en, RAW 4f - - Wy_6s -gg. 581g�% 0"®�7p, 4�47f° �q3,�L '�0n.^iC•. 'A�2a°y� B_u�F _.�®y�qu90,�n: _ 'gi69tl -- i ®�®� _ - ®�® FF_S�' ` Ya3'= _"�J• e'! �J` ®.� 92°_ 'i� '9%9- �1� �4SI �J`9'�UUA®=:. _. F � � • _ - _ . 0 ® - 91���FeiLS70? ,PlO� 030�F8� � r18N--3� woudd d 0®®®® ftb i m d -d �4 DMNG BOARD 3 ••.850�A - - -1geF ,9 P61P.Q8>&4 M'S ROM - V# amp verPGOLRAW • + Faar� a - TypICAL � +SE ~.. AT'mN' E Bek' y CORNER CONKCTION DEM9L nan amm d _ � o POOL SECTION , f I oun P®101.9,0 Inc Complies With g 951®Veterans bi, emorif6 Hightav 2020 Code Section 30321-303A Swimming Pools,Spas and Hot , 110heffila Now York 11716 Section R326 of the Residential Code of New York ------------- Section 3109 of the Building Code of New York _ Section N1103.12(8403.12)Residential Pools and Permanent Residential Spas POOL` E:RECTANGLE ` Rte, SCALE: Section 31093.12-3109.7.4 Pools and Spas Gates,Barriers Section G106 Entrapment Protection JAMES®���K®�K�' °�' PSCAL P • EL STIFFNER Section G107 Alarms 260 DEER DRIVE ®ATE: Section E4201-E4312 Electrical Connections for Pools MATFI UK,NEW YORK 11952 DRAWINS NUMBER ' I OF. 1