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HomeMy WebLinkAbout40652-Z �o�SUF�ol. r Town of Southold 11/9/2021 P.O.Box 1179 0 C* � 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42505 Date: 11/9/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 32275 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 14.-2-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/21/2016 pursuant to which Building Permit No. 40652 dated 4/27/2016 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 Kelso,Heidi of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40652 11/21/2017 PLUMBERS CERTIFICATION DATED Au rize gnature �S�fFot�c TOWN OF SOUTHOLD moo goy 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#: 40652 Date: 4/27/2016 Permission is hereby granted to: Kelso, Heidi 10 Sheridan Sq #213 New York, NY 10014 To: construct accessory in-ground swimming pool as applied for. At premises located at: 32275 Route 25, Orient SCTM # 473889 Sec/Block/Lot# 14.-2-16 Pursuant to application dated 4/21/2016 and approved by the Building Inspector. To expire on 10/27/2017. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 /r/1 B Idin�Inctor 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 2110 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"land uses: 1. Accurate survey of property showing all property lines,streets,building.and unusual natural or topographic features. 2. A properly cpmpleted 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$15.0 /Date. y New Construction: Old or Pre-existing Building: (11c--heck one) Location of Property:V" Z Z-? �,r Ro Housd No. Street Hamlet i Owner or Owners of Property: )o`S O Suffolk County Tax Map No 1000, Section Block z- Lot 1 Subdivision Filed Map. Lot: Permit No. V Date of Permit. Applicant.-. Health Dept.Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Sign ture pF SO(/l�,®� Town Hall Annex Telephone(631)765-1802 54375 Main Road y Fax(631)765-9502 P.O.Box 1179 roger.richert(a)-town.southold.ny.us Southold,NY 11971-0959 �® lac®UNTa,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Kelso Address: 32275 Route 25 city,Orient st: New York zip: 11957 Building Permit#: 40652 Section: 14. Block: 2 Lot- 16 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Pro Electric License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 60A A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 2 Twist Lock El Exit Fixtures TVSS Other Equipment: Inground Swimming Pool to Include: Bonding, 1- Pool Light, 60A Sub Panel, 2- GFCI Circuit Breakers. Notes: Inspector Signature: Date: November 21, 2017 0-Cert Electrical Compliance Form.xls r OF SO//jy� H O i Q m,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ -FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ], ELECTRICAL (ROUGH) [ ] ECTRICAL (FINAL) , EMARKS: �/PJSI/ ��! Chi C. �c y� �tAWU fit./ , -AS Co Zvi i�' Pi U �tPJ� r✓ 1 V� Alli l 0A.1-1 V4 ci�✓S 4? Du j ie� I IVA DATE l INSPECTOR SOUIy� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTIVAO' N ' [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION LECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE l INSPECTOi i " • +Ito ` ��OF SOUr'yo N o cou TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLRG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING / STRAPPING [ FINAL U," [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) 1,- I REMARKS: i vojwp geowr/ �h/ e* , era C 1 • y H aw 1� PAv 00414. IDA/t DATE YJ INSPECTOR 50i/ _ SOF SOUry� CA NV,Ncc� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION FRAMING / STRAPPING FINAL e [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ i] ELECTRICAL (FINAL) REMARKS: 0 G bad DATE D INSPECTOR qv so couto, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST ROUGH PLEIG. FOUNDATION 2ND INSULATION FRAMING /STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) 4k�fELECTRICAL (FINAL) REMARKS: DATE INSPECTOR Sep 0216 02:48p Matrix Development Corp. 631-728-7771 p.1 14o(�7 RONALD C, HANNA i ARCHITECT 399 Route 109 West Babylon,NewYork 11704 (631) 376-0784 August 29,2016 Town of Southold Town Nall—Building Dept, P.C. Box 728 tt�5 V LS DD Southold,NY 11971 SEP ® 2 2016 Re: Kelso Residence BUILDINGDEPr. 32275 Main Rd. TOWN OF SOUTHOLD Orient, NY Gentlemen: This is to certify that I inspected the steel reinforcing for the swimming pool being constructed at the ' subject residence,and to the best of my knowledge and professional opinion it meets the requirements, of the approved permit drawing. LVED AR Very truly yours, �jc .,,0 C. 4 Ronald C.Hanna Architect �,�l' CLafr}' f eh` StBia G 1 c s s . � � o . . . � . s . • � s� � r r fINOL.ATIO � 1 M MA • r C ;L u r T�OUTHOL-D— - BUILDING PERMIT-APPLICATIONCHECKLIST 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 5 �' Survey www. northfork.net/Southold/ PERMIT NO. D o� Check _ Septic Form N.Y.S.D.E.C. D On Trustees — Examined— . � ( C(J (`(7- \vv,/ COIItact._��. S-0 Approved 20 D -�iai�-to: l� —1 Disapproved a/c APR Z 2016 Phone: Expiration ,20 BUILDING D)EP'1L TOWPT OF SO>LTI'HOL1D1 Building Inspect APPLICATION-FOR BUILDING PERMI-T.... Date ­A ,20_U_ INSTRUCTIONS a.This application MUST be 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 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 ontised in whole or in parrfor any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,_in writing,the extension,of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. �A'sF-k Y, nF_,4.EoeM- ,' r-py- (Signature of applicant or name,if a corporation) po 80x -io33 114-«'tp'rpt_l f3rA-y5 ti �1`� . � l lq� (Mailing address of applicant) State whether applicant is owner, lessee, agent,architect, engineer,general contractor, electrician,,plumber or builder POOL FJu LU1122- 3U k r Name of owner of premises �cC�l 1LL�5U (As on the tax roll or latest deed) If applicant i tcorporatio signature of duly authorized officer P�5- (Nam and title of corporate officer) Builders License-No.- Plurmbers License-No- Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: S2Z-1S t'A&kLj P-D. House Number Street Hamlet County Tax Map No. 1000 Section d4 Block Z .Lot- `-6 Subdivision 1~iled Map,No. ' Lot (Name) 2. State existing use-and-occupancy of premises-and-intended_use-and occupancy of-proposed construction: a. Existing use and occupancy Sl U&Lam, tU-{ b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work 1 tJ$t*LU t_. 'Po p l_ (Description) 4. Estimated Cost 35�ObU_ '&f i A "a �._ U`'a'`''���°'(Tt��lie paid on filing this application) 5. -If dwelling,-numberof dwelling-units- umber-of dwelling units ori each-floor [f garage, number of cars 6. If business, commercial or mixed occupancy, specify�nature and extent of each type of use. r�..7 V..��v J �4{LTJ�e• �2.•r� ��'••}b�•� 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 12 Does-proposed-construction_violate-any zoning_law,_ordinance_or-regulation?YES NO 13. Will lot be re-graded?YES NO \/Will excess fill be removed from premises?YES NO �✓ 14.Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a•tidal wetland or a freshwater wetland? *YES NO 1/ * 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. STATE OF NEW YORK) SS: COUNTY OF KO'­C� yp6VVJk_V1"�_being duly sworn,deposes and-says that(s)he-is the applicant (Name of individual signin contract)above named, S He is the � `7 O M (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 1L• ay of� 20 1 ) yj 12 Notary Pu is Signature of Applicant CURIE KALHORN NOTARY PUBLIC,STATE.OF NEW YORK Registration No 01KA62OW3 Quaked in SUFFOLK AY COUNTY Commission Exp Scott A. Russell ,��°suFFQ'ry ST01MMINWAT]E]k SUPERVISOR AMIANA(G IEMIENIF SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK U971 Town of Southold CHAPTER 236 - ST®RMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE 1FOLLOWI[1NO Yes No (CHECK ALL THAT APPLY) ❑ , 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. ❑ D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑ E. Site preparation within the one-hundred-year f loodplain 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, Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. %k 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 Piofessional,Agent,Contractor,Other) S.C.T.M. '` 1000 Date u r t� n u Dutnct f NAME �1 t YJ�.U�16 1"�2✓�� Corp. 1 2 P 1 Vl ISection Block Lot �Zr� _ ���� ****FOR�BUILDING DEPARTMENT USE ONLY**** Contact Information cr,kyn—v„d,b�i Reviewed By, 19 _DU_j)Vj: - - - - -Dae_ "2/' �Property - - — Address/Location of Construction Work: t2(Ap�rc'ved �— �'7 Z for processing Building Permit. �` tormater Management Control Plan Not Required. Stormwater Management Control Plan is Required (Forward to Engineering Department for Review.) FORM # SMCP-TOS MAY 2014 S.C.T.M.NO DISTRICT.IWO SECTION:14 BLOCK:2 LOT(SY:16 � �F.L =-_ y,. II D N/F ID �\49 7.Y i CHRISTINE N.FIWIHE LAW NIF OF ROSANA ORIANSK1 + ... MARK OURS / 34 v "m I M _�N/F ._ s ON WAGE _ .�._--__"_ cHRiI CAROLA.A. AROU E NOGG V _-------- _=I .sm. � .....r._. I,b .MOI -.-.~`.'.L,':_ r-c cz OL 0- �y1 N HAO O FOS r PO1E N Q• OAW h 179.10' N70'OB'30"N 2(2.91' Im SUP. EGOS OF I%WUEM MAIN ROAD THE WATER SUPPLY"DRYBELLS AND CESSPOOL LOCATIONS SHOW ARE PROW 2E D VARONS AND OR DATA OBTAINED FROM OTHERS AREA: 19,730.2 S.F. OR 0.45 ACRES ELEVARON DATUM: UNAURIDRIZED ALIERARON OR ADDITION TO THIS SURVEY 15 A WOLATION OF SECTION 72D9 OF THE NEW YORK STALE EDUCATION LAN! COMES DF TNS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE COYSVERM TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR BHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE DRE COMPANY, F.OVERNMENTAL AGENCY AND LENDING INSRTURON LISTED HEREON,AND TO THE ASSIGNEES OF THE LENDING WSRWI M M ARANIEES ARE NOT TRANSFERABLE TH£OFFSETS OR DIMENSIONS SHOW HEREON FROM THE PROPERTY LINES TO THE STRUCNRES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES ADOTIONAL STRUCTURES OR AND ORDER MPROVEIIENTS EASEMENTS AND/OR SU85URFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON INE PRWSES AT THE TUI£OF SURVEY suRvEY OF: DESCRIBED PROPERTY; CERTIFIED TO: HEIDI KELSO; MAP OF: FIRST AMERICAN TITLE INSURANCE COMPANY; FILED SITUATED AT:ORIENT TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 T PHONE(681)28a-1888 PAX(091)2BB-1686 FILE 6 15-173 SCALE: 1-=30' DATE:OCT. 15, 2015 M Y.S. L15C,N0. 050887 m.Udala g wo nw.d.of Rube t J.9.nm.p A'Ifam..b W VlYd] k �guFFaj,f Town of Southold 9/19/2016 53095 Main Rd Southold, New York 11971 �Ql NOTICE OF VIOLATION - ORDER TO REMEDY . ISSUED TO: (Owner of Record) Kelso, Heidi - 10 Sheridan Sq#213 New York,NY 10014 RETURN DATE: 9/30/2016 REFERENCE NO.: 2016-1384 Regarding: 32275 Route 25 SCTM#: 14.-2-16 PLEASE TAKE NOTICE THAT the property described above, including any improvements thereon, which is owned, occupied or operated by you or in which you have an interest, is in violation of the Town Code of the Town of Southold and/or the Uniform Fire Prevention and Building Code as specified in the attached"MEMORANDUM OF VIOLATIONS". YOU ARE THEREFORE ORDERED AND DIRECTED to correct and comply with the law and to remedy these violations on or before the RETURN DATE noted above. p If you contend that there is no violation,you must notify the below code enforcement official in writing before the RETURN DATE noted above. This notice must stipulate the specific reason you believe the conditions noted on the attached MEMORANDUM OF VIOLATIONS is not in violation of applicable codes, rules or regulations. Your failure to correct these violations within the time noted above, and to comply with the applicable provisions of law may constitute an offense punishable by a fine or imprisonment or both. i For the purposes of applying the penalties described in this order, your first violation shall be deemed to have occurred as of the ISSUE DATE noted above. i Should you have any questions, please contact me at(631)765-1939. i i uFTown of Southold 9/19/2016 ,00h °may 53095 Main Rd co� Southold,New York 11971 S • ��� sol MEMORANDUM OF VIOLATION(s) ISSUE DATE: 9/19/2016 REGARDING: 32275 Route 25 SEC-LOT-BL K: 14.-2-16 ISSUED TO: Kelso, Heidi 10 Sheridan Sq#2B New York LAW TYPE: TOWN OF SOUTHOLD CODE SECTION: 144-8(A)(1) DESCRIPTION: No person, firm or corporation shall commence the erection, construction, enlargement, alteration, removal, improvement, demolition, conversion or change in the nature of the occupancy of any building or structure, or cause the same to be done,without first obtaining a separate building permit from the Building Inspector for each such building or structure. OBSERVED: On 9/16/16 during a swimming pool inspection, the building inspector observed interior renovation in the house with no permit. �Fdt� Town of Southold 9/19/2016 53095 Main Rd Southold,New York 11971 o� s 631-765-1502 COMPLAINT To: Kelso, Heidi Complaint#: 2016-1384 10 Sheridan Sq#2B SCTM#: 14.-2-16 New York,NY 10014 Follow-up Inspection Date: 1/1/1900 Location: 32275 Route 25 PLEASE TAKE NOTICE, a complaint has been registered-against the location described above, in that the above named individual(s) did commit or permit to occur the following offense: John noticed renovation of dwelling while inspecting swimming pool. There is no building permit for work on the house. This condition constitutes a violation of: When on 9/2/2016, I did observe the following: This property will be re-inspected for compliance on: 1/1/1900 John Jarski 0c SOUr�,®� Town Hall Annex ~ ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ® �� Own BUILDING DEPARTMENT n July 19, 2021 TOWN OF SOUTHOLD 1'v Heidi Kelso Dl 10 Sheridan Square #2B U New York, New York 10014 RE: 32275 Route 25, Orient NOTE:We are unable to process your Certificate of Occupancy for the pool until Building Permit 42815 for"as built"windows has been renewed and inspected The fee to renew is 2�. TO WHOM IT MAY CONCERN: The items marked below are required to obtain your Certificate of Occupancy0161 Chapter 236, Soil stabilization required. _�7'Z Electrical Underwriters Certificate. (Electric inspection form on website) Final Health Department survey. Plumbers Solder Certificate or Pex Affidavit Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. (631-765-1802) Storm Shutters required for all glazing Energy Test Results and Manuals required Final elevation certificate from surveyor. Spray Foam Insulation Certification from a NYS licensed architect or Engineer BUILDING PERMIT: 40652 (swimming pool) & 42815 (as built windows) MATRIA OP ID:VM �►CORL�" CERTIFICATE OF LIABILITY INSURANCE DATE 02112120/YID 02!121201,6 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 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 coNE`T Bagatta Associates,Inc. Bagatta Associates,Inc. PHOPE 631-864-1111 AjCNb:6S1-864-8274 823 W Jericho Turnpike Ste 1A WC7N,.E Smithtown,NY 11787 EMAIL Bagatta Associates,Inc. INSURER($)AFFORDING COVERAGE NAIC A INSURER A:Worcester Insurance Company 26182 INSURED Matrix Development Corp INSURERB:Wesco Insurance Company 25011 DBA Matrix Gunite Pools Karl Bonawandt INSURER C: P.O.Box 1033 INSURER D: Hampton Bays,NY 11946 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 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 WgHAVE BEEN REDUCED BY PAID CLAIMS. 'QTR TYPE OF INSURANCE POLICY NUMBER MM1DD MMI° LIMITS `A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED CLAIMS-MADE Q OCCUR MPA00000065795H 02101/2016 02101/2017 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 2,000,00 POLICY❑jE� LOC PRODUCTS-COMPlOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY -COMBINEDSINGLELIM1 $ 100000 Ea accident r B ANY AUTO VVPPI21600900 02/0112016 0210112017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ X AUTOS X NTOS ON OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVEF-1 NIA E L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (MandatoryIn NH) E L DISEASE-EA EMPLOYEE $ If yes,descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It more space is required) CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Town Hall AUTHORIZED REPRESENTATIVE Southold,NY 11971 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD E New York State Insurance Fund —11 m— PIP, 199 CHURCH STREET,NEW YORK,N.Y.10007-1100 (888)997-3863 q CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "A ll AAA 112399668 MATRIX DEVELOPMENT CORP 11 WOODED LANE P 0 BOX 1033 HAMPTON BAYS NY 11946 f POLICYHOLDER CERTIFICATE HOLDER MATRIX DEVELOPMENT CORP TOWN OF SOUTHOLD 11 WOODED LANE BUILDING DEPARTMENT ' P O BOX 1033 TOWN HALL i HAMPTON BAYS NY 11946 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE I Z 639 161-9 751589 02/28/2011 TO 02/28/2017 01/20/2016 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 639 161-9 UNTIL 02/28/2017, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK,TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 02/28/2017 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. I 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. z NEW YORK STATE INSURANCE FUND <4-1 11J DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif-com/cert/certval.asp or by calling(888)875-5790 VALIDATION NUMBER: 1002734706 MI II�11011,0I0LII0M0I901[O0000002 79951945t2ID181MJill Form MC-CERT-NOPRA'T Version I((13124!2014)[WC Policy-6391619] 12 U-26.3 1 [00000000000027594528][0001-000000391019][#4Z][14298-02[[Cer NOP-CERT 1][01-000011 i ;;,,•�i ' GENERAL NOTES: . it 1) The design Is based on a drainage soil with <10% slit, Ground 8.0 �fM �goK �AA" 4 qo cAL• ��K 9Ja water shall not exist within the limits of excavation. t1 groundwater exists within V-04 below grade, special dewatering facilities will be ` i •' .c• ee QAt..C 'ArA-GITV Ao4a required. 2) No surcharge allowed within 4'•0"of shallow end and 5-(•of deep I c; i i• ~,• o n 10' �r aQ Q/� end. 14 SiEEI PC-BAR SCP'Erv�t kyr,d' � N• JS�-to' e- t7 4,�l Com. 3)T11e pneumatically applied concrete (punite) shad be a 1.4 mix with DEPT►+: < 5'-0' > �'-0• O" �b;l.�' �f. ,� ti7'gG G1.�� a max of 6-112 gallons of water per sack of concrete. 1 WAS 7`9 , FILT" MORIZ. 12 O.C. 12 o C ,.. I . 4 Reinforcin steel shall be Intermediate rade cold buret steel with a -4" MAY' J g 0 pure '�uN1 I VERTICAL 12" O.C. 6' 0 C - 1c minimum iap of 30 bar diameters. .: j Or- -;,,p 414 0141N)V,0 6) Pool water le el maintained b fill spout, Pool to be kept full duain0 ' ' eorrou 12" O.C. 12' s, C 1"0 tNl �1 m j� ASi .IQP lreei(ng weather. Pump capacity to be sufficient to empty pool in 24 ° EACH WAY EAC►► w� �,A•t.CUt�^T'j � ' U � 1 Ty NN✓ lOt' 'Y��c�E�• .--- hours. , A R N+ ; :!! 6) Fill spout to be 3/4" gooseneck with a 12"pap between spout and TO wun t I' pool water ling. y MAllr ORA w• - , f --� t� �• • VAPP,t rouSr IJI I � 1 �• ' € ; ! 4"CONC. COVER--�_ S011t)Pr1EC�►St '1'biu is to crTivy thnt the comdrl+rtion ora Nwlmming IxK,i on the oicet pry iiRcs will (�) �• RE-BARS. DO �" not rrquir•e any special drainage IbOlitic q. f CONTINUOUS BONA • ""''c" PIPING SQ _ C PEAU All ApOUNn � ne of will br 1111rd b A direct /. 1 1tr N Itr ��� -- r jr s0A ss +Nt-E7__.,-� I'<' Y ' " 1111 r ut pihrd I'rc m t le hm ti rtml by n Orc T` rV AR, Kato valve at the hnuNt�. Th�:re ie +► rtninles�t ytrri kcuor+�•nrck nbc,��e Iho _ :1ping with n I?" Alp Mar between the fill Irl►nut and r ml. — - f ' API ED �•S NOTED ! PRECAST CONC.IPEC►++Nt1 'The rcK�i will tx c�n�tnlctecl orTrteumitle0y'rIpplitd stecl rcinrrrcc,6 c'jnclvl1- rind th+! b_� �• DATE: � .� t3.P.# .T COVE RADIUS �� w j+tre►1 water is dexiKncct c� cvnNnuc�ti►yly rc-t•ln ulntcd through the fTItG and rc��sai t'rom . VARIES - FEE: BY: . 6• yI►� year to vcar. 'f he drnina c 1"mtn shy (iltrr will nc�t interti±rc wi1Fi the t ?il�• water �nMrly. BUILDN ��- uAW POROUS SMVt] _ NOTIFY BU D NG DEr ART "'1T AT i F . °;; :';:Ili i::'• ' IWOOMvEI � W 111N t'X sti sanilnr)• terl 1t c , neighboring prrpert�lcs c►r pu�illchig}iwi+yw. 765-1802 8 AM TO 4 PM FOR THE 4 jO�LOVIDFTiOr�?T1h0 R� a `^ �=OUlRED i FOR POURED CONCRETE a, w 2. ROUGH - FRAMING & PLUMBING y4 RE-BAR. + `..,,:• !,; : :. 7�' SEE SCHEDULE . ' • l 11'•..'I•':'..�.:i. ' I..ri;;�:,.'�,;:•>!r, ' . SEE SCHEDULE 3. Ip.SJ!ATION . . '!1 '; 4. FINAL CONSTRUCTION MUST BE CO3VPLcTE F. rl C.Q. ALL CCNS! JCTI N SMALL MEET THE . •. !'r ' • �., D��^rc�� dv `` R-C:��JIIZ!=PJB�vTS C=THE CODES OF NEW s „ i V V G `•GRC�IINO WATER s LE FOR WAJ,� piE�A11.r - .I r •- DESIGN OI�cCOf'S'TJCT�!N TERRORS. �__ RETAIN STORM WATE RUNOFF 4 r Oa PURSUANT TO CHAPT R 236 �,. OF THE TOWN CODE.. COMPLY WITH ALL CODES OF Ov�UPA[i�fCY POOL.AI.AP.St � u1><��� t�t�.fi, J NEW YORK STAT OR -... E & TOWN CODES tll� ��� l.Y AS REQUIRED AND CONDITIONS OF USE IS UNLAWFUL tel- SE �t�OLT CODE EACH ReSIDINTlAt,SWIMMING POOL,iNSTAtII D,CONSTRVCTf0 OR MAP ENS o } B T NTMILY MOOIiI O A E A N -- - - C U,PUN CO%, IPLE ON 5V S A I£ AFT(A DECEMBER S , 2006 AND EACH t �ITf-BOUT KATE B �, CERTIFICATE E oRE "wAT ' w '';• ':1.l� , ; COMM ER(IAl SW3MMiNG PC1tjl tNSr/1ttE0, CONSTAVG'TEd OR � � � , SVBSTANTiAL.hY MODIFIED AFTER OECEMAER 14, 7006 SHALL Stc - ""' "' �� OF OC UPAN Y C EQUIPPED WITH AN APPROVED POOL ALARM WHICHl � =LECTRICAL -(ti"S'S C E " -CTIO 9 REQUIRED A. IS CAPAOLF OF DETECTING A CHitD gNTCRING THE WATER AND GIVING AND i LIDt8lE ALARM WHEN IT DETECTS A CHiLD ENTERING THE NVATTR O 8. tS AVOrr,E P001310E AND AT ANOTHER LOCATION AT THE , PREMISES WHERE THE SWIMMING POOL IS LOCATED I INSTALLED,VS@D AND MAINTAINED IN ACCORDANCE WITH h ? TH$MANVIACTURES INSTRVC'TIONS `f 0. IS CLASSIFIED BY VNDERWRITIRS LA60RATORTE4•INC. (OR — �~� � VC � �M1'L1�!'T" OTHER ' APPROVED MOEPENDeNT T115TiNG LAaORATOMES)TO REFERENCE STANDARD ASTM P;708, ENTITLED-STANDARD SPECOICATION ' FSR POOL ALARMS,AS ADOPTED iN 2002 AND EDiTORIALLY CORRt:CTF0IN JVNE 2005,PUBLISHED BY ASTM INTERNATIONAL I , 100 BARR HAA80R 0MVE.WEST CONSM011OCnEN,FA. 19428; AND IS NOT AN ALARM DEVISE LOCATED ON PEASON(S) OR WHICH IS DEPENDENT ON DEVICE (S)LOCATED ON PERSON(S) FOR ITS :.; PROPFR OPERATION _ P. MVITIPLE D44CJ►tARMS.A POOL ALARM INSTALLED I PURSUANT TO CODE MUST BE CAPABLE OF DETECTING ENTRY INTO - � :..� - T1it: FOOL if NECESSARY TO PROVIDE DETEC110N CAPAUIIITY AT EVERY ON POiNT ON THE SURFACE OF THE SWIMMING POB(,MORE THAN ONE ML pLOM SHALL BE INSTALLED }1•x•1• i A PA SUCTION OUTLETS ENTRAPMENT PROTECTION FOR SWIMMING POOL AND r AG106.1 GENERAL,Suctian outlets shall be designed to'produce circulation throughout the pool or spa. Single outlet systems such . j i` 85 automatic vacuum cleaner systems or other such multiple suction outlets whether Isolated by valves or etherwiso shall be protected against user entrapment, 4 ' - _ ,r I AG 106.2 SUCTION FITTINGS. All pool and spo suction outlets shall be provided with a cover that conforms with ANS11ASME Al 12.19.8M OR A 12'X 12' drain grate or larger, or an approved channel drain system. EXCEPTION: surface slimmers ! AG106.3 Atmospheric vacuum relief system required. All pool and spa single or muftlple outlet circulation systems shall be equipped with atmosphodo vacuum relief,should prate covers located thereon become missing or broken.Such vacuum relief �. I systems shall Include at least one approved or engineered method of th©type specltied herein as follows: 'I 1, safety vacuum release system conforming to ASME Al 12.19-17 or 2. An approved gravity drainage eystem i i AG106.4 DUAL DRAIN SEPARATION. Single or multiple pump circulation systems shaJ1 be provided with a ntlnlmum o1 two (2) _. suction outlets o1 the approved type. A minimum horizontal or vertical distance of three (3)feet shall separate such outlets.These 'i � -1i � ' r�••� _ suetlon outlets shall be piped so thot water Is drown through them stmultnneously through a vacuum relief protected line to the _ RED A ' - '1 `I� pump or pumps, ��� C• rF ' �- SSE RcyT `sem-7�- tF 1 PONALD C, HANNA . - dao �L � 1,; ...�;:t ��c��v�c�- A ��� Y � � x tie o 11 4 761 COATES AVE. SMITE 18 l r HOL01a00K, N..Y. 11701 1 631 286 • 7870 ;'