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HomeMy WebLinkAbout45552-Z ,`oSUFf°��coGy Town of Southold 10/9/2021 P.O.Box 1179 W .7 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42415 Date: 10/9/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 300 Marion Pl,East Marion SCTM#: 473889 Sec/Block/Lot: 31.-8-12.10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/12/2020 pursuant to which Building Permit No. 45552 dated 12/8/2020 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 Rann,Adam&Mastromarino,Maria of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45552 8/13/2021 PLUMBERS CERTIFICATION DATED L ori d ignature o�S�FFO TOWN OF SOUTHOLD �� ay BUILDING DEPARTMENT ca TOWN CLERK'S OFFICE SOUTHOLD, NY ?lpl ��yt 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#: 45552 Date: 12/8/2020 Permission is hereby granted to: Riedell, Judith PO BOX 198 East Marion, NY 11939 To: construct accessory in-ground swimming pool as applied for. At premises located at: 300 Marion PI, East Marion SCTM # 473889 Sec/Block/Lot# 31.-8-12.10 Pursuant to application dated 11/12/2020 and approved by the Building Inspector. To expire on 6/9/2022. Fees: SWDAMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Buil ing Inspector OF SOUPS®l Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ® sean.deviin(a)-town.southold.ny.us Southold,NY 11971-0959 .P couffm BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Adam Rann Address: 300 Marion PI city,East Marion st: NY zip: 11939 Building Permit* 45552 Section. 31 Block 8 Lot: 12.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: AS BUILT License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey X 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 Ceding Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures 11 Pump Other Equipment: Pump 220GFI, Jandy Pro Series, Intermatic Pool Panel 4 Cirrcuit/ 3 Used, Heater (1) Light Notes: " AS BUILT NO VISUAL DEFECTS " Pool Inspector Signature: �✓ Date: August 13, 2021 S.Devlin-Cert Electrical Compliance Form o�aOF SOUIy� d Alt # # TOWN- OF SOUTHOLD BUILDING DEPT. `ycOUrm��' 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] 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 f INSPECTOR ` �o��OE SOUI,yo� # # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION - FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL rAML [ ] FIREPLACE & CHIMNEY [ ] = FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION ' [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: oe DATE o INSPECTOR FIELD INSPECTION REPORT I DATE COMMENTS , FOUNDATION(IST) y FOUNDATION(2ND) . O � �n ROUGH FRAMING& H 9 PLUMBING d r INSULATION PER N.Y. STATE ENERGY CODE t 0 k a✓ FINAL ADDITIONAL COMMENTS � f� l 0444 Z 7m `1i L colK X � 1 Existing use of.property: Intended use ofproperty:.` - _ Zone of use-districtin which premises is situated: Are there any covenants and restrictions with respect to .this property? OYes O No IF YES,PROVIDE A COPY. X 1,It�dt�_1t1g; The�o`wner/coijir i iies�` rofessional'is - ' '' " = _�'Fpi Is espori`sl6leforalCdramageandsto'ririjva�erissue;•as rovidedb Cfiapter.•236 oftf e,Tovin Code.;APPLlWoM IS HEREBYPi", to the BEi ildin ,tie artrimeritfo =py " nof;5 g p - i:iheissuancd,ofa`BuildingPermrtpursuanEto;tteeBuilding,Zone;. Ordinance of tfie Tow oii4hold Suffolk;Cotihty F _ ,3, - _ , �ti,Yorkandothe�applicatileLaws;;O�dlnancesc�Regulations` onstiu "' addttltonsalterailonsorfo�removai'ordemn) `on as hereiri•,desciitied:Thea� ='f•" � ,"farthei cttan.ofbufldlrigs;�'. it! ppGcantagrees2ocomplywithalla'pkilicab7elaws,;ardtnagces;,build code =iiousio`g.'code anii,regalatiorisand to admitautfioriied insp"eGto`rs oh"piemises and in biilldin"" - ' g(s)for necessary inspections:false sfatemeiits triads herein are= 'pudistiable as a''Class A e�isdemeanor,puisuartto.3ection,2S0:45'0 = f the'NeivNoikState Penal_mw Application 5ubmitted,By(print name): Authorized Agent OOWner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ) 44 " duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, ,-(S)he is the (Contractor,Agent,Corporate Officer,etc.) of said owner or owners;and is'duly authorized to perform or have performed the said work nd to make and file this application;that all statements contained'in this application are true-to the best of his/her wledge and belief;and that the work will-'be performed-in the manner set forth in the application file.therewith Sworn before me this Ot P bI1C DAVID FREEBORN'' `Q } '° ' Notary Public,State of New Yorkk t No.01FR61379631" PROPERTY OWNER �IT101iliZAT)Oi Qualified in Suffolk Countyy ..°�' _ Commission Expires Dec.05,Z0 ^,' '(Where the applicant is not the owner) residing at --SvoG-tet <��do hereby authorize—&4-VNDf9'—P,*45 LZV 1��g3a�� , to apply I on my behalf to the Town-of Southold Building Department for approval as described herein. O'wner's Signature Date Print Owner's Name _ • 2 � �°s"IFQIr r1F 01K1\�J[��,�'Akr]F1E)E. ScO��l. A. Russell 00 SUPERVISOR �u][A\N A\(G IEMUENT z SOUTHOLD TOWN HALL-P.O.Box 1179 Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 O fid' CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT) -- - - - - - ----- ------ -- --- -- - - DOFS THIS PIaoJECT INvol vE ANY of THE FOLLOWING: (CHECK ALL THAT APPLY) i Yes No Flp A. Clearing, grubbing, grading or stripping of land which affects.more than 5,000 square feet of ground surface. B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑ _ Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑ 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 1,000 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, - .Signaiu,6ontact-Wopnation,-Date-&-Connt}-Tax-Map-Number —Chapter-23"oes-not_appl to-3�our proms^f 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. (Property owner,Design Professional,Agent,Contractor,other) District NAME: s L tA-hlt)I/� �c�JL 5 ��d D3 C'D v �o Secttion t 1 Block t of t 6.3 _...>> 1'Otl 13`iILDENG DE rI J.N-SC(�i�� Contact Informm ore Reviewed By: Date: Property Address / Location of' Construction Work- - - - - - - - - - - - - - - - - - 3d� ��ld � � ❑ Approved for emeBuilding Permit. — — — Stormwater Management Control Plan Not Required. ❑ Stormwater]Management Control Pian a Required. (Forward to Engineering Dep,ii tmenl for Review) F0P,M ` SNJCP - TOS MAY 2014 APPLICANT S.C.T,M. 1000 CHAPTER; 236 (l'rnperry Owner, Design Professional,Agent,Contractor,Other) ds��� eig �'R'ld Stormwater Management Control Plan CHECK LIST NAME ;nL !l3— ���L4V section Block Lot z S M C P -Plan Requirements: Provide ONEcopy of the Building P mit Application. Y�mr Date: * The applicant must provide a Complete Expla�natlon and/or Rea n for not providing 631'7a-? b� 01 �''� all Information that has been Required by the following Checklist! 7e4Ylmn<NnmLc, i I A : e Plan drawn to Scale Not Less that 60' to t] e inch MUST NO NA If You answered No or NA to any Item, ) lease Provide J 'tification Here! Show all of the following (terns: If you need additional room for explanations, Please Prov e additional Paper. a. Location & Description of Property Boundarl b. Total Site Acreage. c, Existing - Natural & Man Made Features wits 'n 500 L.F. of the Site Boundary as required by §2s6-n(C)( d. Test Hole Data Indicating Soil Characteristics&Depth t Ground Water. e. Limits of Clearing & Area of Proposed Land isturbance. I f. Cxisting & Proposed Contours of the Site (Min urnZIntervals) IIt g Location of all existing & proposed structure • roads, - driveways, sidewalks, drainage improvement &utilities. li, Spot Grades & Finish Floor Elevations for all existing & I proposed structures, 1 I. Location of proposed Swimming Pool and dis barge ring. I Location of proposed Soil Stockpile Area(s). k, Location of proposed Construction Entrance/Staging A ea(s), I. Location of proposed concrete washout area( . I nl. Location of all proposed erosion&sediment control mesures. 2. Sioi mwater Management Control Plan must include Calcul tions showing that the Stormwater improvements are sized to capture,stoi e,and infiltrate on-siie the run-off from all impervious surfaces generated by a two(21 Inch rainfall />torm event. 3. Details&Sectional Drawings for Stormwater practices are req fired for approval. I hems re uirin details shall include but not be limited to: a. Erosion & SedlMent Controls. h Construction Entrance & Site Access. 0 c. Inlet Drainage Structures (e.g,catch basins,trent drains,etc.) d. LeachingStructures (e.g. infiltration basins,swale etc.) ! i)It i:�ic,►1'I;I:IZ.iNCa 1)("PAtt'i'MENLIT I)SE )NLY;� Additional information is Required. Reviewed & 1 ® Stormwater Management Control Plan is of Complete. Approved By: - - - - - - - - - - - - - 5 — — — — — — Stormwater Management d ntrol Plan is omplete. Date: I ® SMCP has been approved b}' the Enginee ng Department. I i r. )Q nn u ctarr•D r•i.e i, 1 ,..+ _-rnc t e A v 0n t o BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(cDsoutholdtownny.gov— seandna southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: V\A Name: N a �, • 5 - N 1 License No.: email: 7 o k 2 d +o L" Phone No: ❑I request an email copy of Certificate of Compliance Address.: JOB SITE INFORMATION (All Information Required) Name: 4 Address: "0� �t ;� _ �r��,t�, t�3 Cross Street: Pk wog; a V\ Phone No.: - L 0 Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: Is job ready for inspection?: ❑YES ❑NO ❑Rough In ❑Final Do you need a Temp Certificate?: DYES ❑NO Issued On Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A #Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑1 02 ❑H Frame❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx ��Q/ t 2�J G� � 1 �J" G / y2� /� C� J � C I� G'U /� 11/2/2020 Certificate of NYS Workers'Compensation Insurance Coverage CERTIFICATE OF NEWWorkers' NYS WORKERS'COMPENSATION INSURANCE COVERAGE YORK STATE co"m ensation, Board Insured Detail la.Legal Name and address of Insured(Use street address only) 1b.Business Telephone Number of Insured Islandia Pools Ltd 631-727-6312 108 Fishel Avenue Riverhead,NY 11901 lc.NYS Unemployment Insurance Employer Registration Number of Insured Id.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain location in New York State,i.e.a Wrap-Up Policy) 112915558 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Company,Inc. Town of Southold Building Dept. 3b.Policy Number of entity listed in box"la": 53095 Main Road Southold,NY 11971 TWC3875091 3c.Policy effective period: 4/25/2020 to 4/25/2021 3d.The Proprietor,Partners or Executive Officers are: included(Only check box if all partners/officers included) 2 all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"211. The insurance carrier must notify the above certificate holder and'the Workers'Compensation Board within 10 Clays IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate,(These notices may be sent by regular mail)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c" whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced- policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved By: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance carrier) Approved By: V�, 11/2/2020 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier.CarrierPhone Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form.Insurance brokers are NOT authorized to issue it. hfps://wc.amtrustgroup.com/anawctPolicyNYCertificateOWclns.aspx?lndexld=299374&instanceld=eGffl656-b502-4f3o-bO6b-209d8c004Ol6 1/2 Client#:4647 ISLAP002 ACORM CERTIFICATE OF LIABILITY INSURANCE- DATE(MM/DD"YYY) 11102/2020 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-any rights to'the"certificate holder In-lieu of such-endorsement(s). PRODUCER CONTACT Edgewood Partners Insurance Ce Edgewood Partners Insurance Center HUN o Ext):631-390-9700 FAXAIC,No 631-390-9700 40 Marcus Drive ADDRE 3rd Floor SS: certificates@cookmaran.com Melville, NY 11747 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Co 18058 INSURED INSURER 8:Technology Insurance Company,Inc. 42376 Islandia Pools Ltd. INSURER C: 108 Fishel Avenue Riverhead,NY 11901 INSURER D: INSURER E: 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 OF ANY CONTRACTOR 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 INSR WVD POLICY NUMBER MMIDDNYYY) (MMIDPNYM LIMITS A X'COMMERCIAL GENERAL LIABILITY PHPK2127301 0412512020 0412512021 EACH gOCCURRENCE $1000000 CLAIMS-MADE a OCCUR PREMISES Ea oc uErrDence $100,()00 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PPOLICY JECPROT FX LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY PHPK2127301 4/25/2020 04/25/2021 COarBd D SINGLE LIMIT r1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Peraccident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X' AUTOS ONLY Per accident $ $ A X UMBRELLA LIAB X OCCUR PHUB720492 0412512020 04125/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE, $1,000,000 DED I X RETENTION$10,060 $ B WORKERS COMPENSATION TWC3875091 4/25/2020 04/25/2021PER ORT - AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/E)(ECUTIVE Y I N E.L.EACH ACCIDENT $1,000 000 OFFICERIMEMBER EXCLUDED? � NIA (Mandatory in NN) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION Town of Southold building dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE- DELIVERED IN 53095 Route 25 PO Box 1179 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S27667271M2722583 SMANL YR�K workersF STATE CERTIFICATE OF INSURANCE COVERAGE - Compensatioft 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) 1b.Business Telephone Number of Insured ISLANDIA POOLS LTD. 108 FISHEL AVENUE 6317276312 RIVERHEAD, NY 11901 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 1 1-291 5558 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed asl the Certificate Holder) Standard Security Life Insurance Company of New York Town of Southold Building Dept. Y P Y 53095 Route 25 3b.Policy Number of Entity Listed in Box"l a" P.O. Box 1179 69146-00 Southold, NY 11971 3c.Policy effective period 1/1/2014 to 11/1/2021 4. Policy provides the following benefits: ' 0 A.Both disability and paid family leave benefits. F1 B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: no A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. [] B.Only the following class or classes of employers employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as descylVed above. Date Signed 11/2/2020 By_ A. GL l_ (Signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES 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 413,4C or 5B is checked,-this certificate is NOT COMPLETE for purposes-of Section 220,-Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit,PO Box 5200,Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only If sox 4C or 5B 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 disability and paid family'leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to Issue this form. DB420.1 (10.17) a III�IIP°1°°1°2�0°°1°1°I�110-11711°�IIIII � ,r 1 �• a 1 FIS' '�t{�:1►'�'{ �� �!`, I i 'I E`, ,` F,I{ i �{ `,i� ��� ��'I '� ��' {E { {{I''%' 1 � 1 !. t �{•1 � ' {��I � , � y ty1 .. 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'. _ ,,. _. .,, ...,- i' 15 8 © 15 30 4500 75 90 105 120 135 SCALE: I"=30' DATE:AUGUST 20, 2002 ` ,131, Y A VENUE X"" , t rDGE OF PAVEMENT k 660,00' S20°05'40" ,,�i�►EwS34°72' 0"E 9.04' 40,199, r LL- �C3` j q - C� pyo r ' � ,� C)�-j O LL8 X40 0 $ � o Ar, ' z�0Lu Q� I N p s 1 if ui M c-Nk corm Nov ST4CKAtk Frlk E 4 00 �� '� 74'X891 ._.�. . ,�._.....�S34°12'•40"•E 150.00' st()Cl"'TFN-�F .. "_� i W si rac sr N r w F w +gin •-Nil 24.2' N GARAGE n+ u� / f • � � . ' 11.2' 24.2 uj 9 .40.8 Q 33,3' Z � © a cto � 1 � � focn S'9 " j i STORY W)ODrf-CK «\�� FRA Tc Elr#M,K CHIP te, C4 30.2' LL ' LL ; .0 °u�i --_ __..'.._..._ 1 f GOVERM �' 40,8# �• .t. u' + j '. wow ARCH 20.3 .._,._- _. ,_.. ,__. . o Zi j ` + I � __.._. .. ,tib U,cg Eli h ( I a uj ! {� _ I ; to �c # - cn - --. - -- S-349,12'40"-E,,300.00' •cove; 'to _ - �x•ea 4 N 3 ° 2'40"IN 57A5,_ LL j (NOT OPEN Or"� IN USE) �, n [ PLACE ^ Iza . _. .. � (PRI a ~ , o °t2�`0�"E�, 152.43� S 34 t (P AD �+ c to Nc 74. 777 34°12'40"W 350.00, _ , • , cap`' ' a .`,,,��' ._ ._. __._ _ '.. ._ _,: .__._ : ._. 1 ' , P ch� N 29 230"w �y 30'4,©I' o c.ANo Nol�J OR FORMERL Y of ' ~ : - - - JUDITH FRAMFELD - _._ . _ _ . ..._ . ._ _.._ , _ F-• ,- I � PAUL 6'F'AM;"F_LD LAND NOW OR FORPa<4F.RLY OF c>c ALBINA E. KIotSCH �` ANDREW'S. °KIR.)CN • J0.3 NO. 2002-351 CERTIFIED T0: WILLIAM PIEDE'LL ' t,,�,t�P NC. �. �� JUDITH N RIED'�LL' ,FILED: ��ti"� ���yo TELLUS ABSTRACT,,=#T-669 ! ' • REVISIONS: �.c y r ' ,;�a ' �Tifi/�.�/r.}�-c,q�AT,�� Co�,�• 9/1,11°r . . �. ', NLI rllt +, ,..' h t. a.. �� Ic 45 NOF;TN POAAD t'A 0""nTON EIA YS, NEV/YOPI/ 'TEL:(F31)-r2?•19u?'-F'AV`':(031)-T23-1320 LO-jA:7A:41,3 ` S FT -0. '`"ACR" ' •+N[) t1.'"TES ' E JU,"';'., Fig?Ll. `", ;". 1CI L'�;;`= S 3� o�3�2 LICENSE:N-0', 050-1�3 _ ;o V v APPR VED AS NOTED DATE: I B.P.# SJr-5 FEE: ? BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE ELEC'T'RICAL FOLLOWING INSPECTIONS: , INSPECTION REQUIRED 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE' 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTP'. MUST BE COMPLETE. ' ALL CONSTRUCTIC,,, 3-iALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE, NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 9:MIABOE IATELY.7! COMPLY WITH ALL CODES OF ENCLOSE POOL TO' obk,r" NEW YORK STATE & TOWN CODES UPON COivIPLETIO,N , AS REQUIRED AND CONDITIONS OF ;BEFORE"WATER'"' , WN ZBA S(1llTK9 NG BOARD S9JTHelLTfi6�N� USTEES OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICAT[- OF OCCUPANCY HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET November 3,2020 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of Rann Residence 300 Marion Place Southold,N.Y. 11939 will not require draining because the pool is constructed with a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not interfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private roads. Sincerely, HM E gineering P.C. rvo' arnika,P.E. POOL NOTES: TRACK FOR 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION PUMP VINYL LINER AND BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC FILTER CODE. VINYL LINER 2. POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1. SKIMMER • $,5" 3.SECTION R326.7 POOL ALARM REQUIRED. (TYP•) FOAM PADDING3,500 PSI 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4. CONCRETE 5.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE OF NYS SECTION R403.10: i d ° POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). \ i I STEPS a SECTION R403.10.1 HEATERS \ _ i SECTION R403.10.2 TIME SWITCHES RETURN &4 BOTBTOM AR TOP ° a a° 42" SECTION R403.10.3 COVERS I PROPOSED VINYL 6.REBARSHALL BE 3"MIN.CLEAR TO EARTH. SWIMMING POOL 7.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS 3� 576 S.F. ° c AND SHALL COMPLY WITH ALL LOCAL ZONING REQUIREMENTS. (MIN.) 16 ° 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME DUAL MAIN DRAINS WITH BAKER(VGB)POOL AND SPA SAFETY ACT. STRAINER (VGB SAFETY 9.SLOPE PATIO SURFACE 1/4"PER FOOT AWAY FROM POOL. /L — — \ ACT APPROVED DRAINS) ° ° 10.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR LARGE ROCKS). / \ 11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH ANSI/APSP/ICC 7. 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. 36' 12.5' , 13.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF TYPICAL WALL DETAIL POOL. 14.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 300 MARION PLACE, SCALE: 3/4" = V-0" SOUTHOLD,N.Y.11939 ONLY. POOL PLAN 15.NO DIVING EQUIPMENT PERMITTED. NOTE: 16.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A THIS IS A NON-DIVING POOL NOT TO SCALE NOTES: MINIMUM LAP OF 30 BAR DIAMETERS. .WALLS SHALL BEAR UNDISTURBED SOIL. 2.ALL CONCRETE SHALL 17.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL 2BE PLACED AS A MONOLITHIC POUR. LOADS WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION EQUIPMENT OR ANY OTHER LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING OR PROPOSED ADJACENT STRUCTURES.IF SITE CONDITIONS DIFFER FROM THIS PLAN,IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO CONTACT HM ENGINEERING,P.C. BEFORE ANY CONSTRUCTION BEGINS. 31-4" CONCRETE WALL 18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION 6_ (SEE SECTION MEANS,METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR, THIS SHEET) NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH THIS PLAN. � I — �� UNDISTURBED 3 COMPACTED EARTH 1 1/2- TO WASTE SAND 30 60 81 19, HAIR & LINT STRAINER PUMP FILTER AUTO SKIMMER POOL PROFILE NOT TO SCALE GENERAL NOTE: POOL BACK TO ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 POOL RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. PREPARED FOR: RANN RESIDENCE WITM�-IAIHYDROSA IC SCHEMATIC PIPING ARRANGEMENT VALVE AND 300 MARION PLACE NOT TO SCALE COLLECTOR TUBE SOUTHOLD, N.Y 11939 IN GRAVEL BASE NOTE: DATE: 11/03/2020 /WITH2RtAISED HM ENGINEERING, P.C.THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. _ SCALE: AS SHOWNUNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE l zozv P.O.BOX 914 EAST NORTHPORT,NY 11731SHEET: 1 OF1 NEWYORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel.(516)476-5392 Fax:(631)980-7671 www hmarnika@optonline.net RESIDENTIAL CONCRETE VO SEAL AND BLUE SIGNATURE VINYL LINER POOL PLAN