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HomeMy WebLinkAbout45538-Z �o\pSUFfot,��pG. Town of Southold 11/13/2021 a y� P.O.Box 1179 o • F 53095 Main Rd y,�o1 5t' Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42528 Date: 11/13/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1350 Bay Shore Rd, Greenport, SCTM#: 473889 Sec/Block/Lot: 53.4-33 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/23/2020 pursuant to which Building Permit No. 45538 dated 12/4/2020 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 1350 Bayshore Rd LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45538 8/14/2021 PLUMBERS CERTIFICATION DATED A ho iz ignature �$ 4r TOWN OF SOUTHOLD l BUILDING DEPARTMENT Ca TOWN CLERK'S OFFICE o • SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 45538 Date: 12/4/2020 Permission is hereby granted to: Higgins, Brian 33-47 167th St Flushing, NY 11358 To: construct accessory in-ground swimming pool as applied for. At premises located at: 1350 Bay Shore Rd, Greenport SCTM # 473889 Sec/Block/Lot# 53.4-33 Pursuant to application dated 11/24/2020 and approved by the Building Inspector. To expire on 6/5/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector Of so Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 sean.devlin(a)town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: 1350 Bayshore Rd LLC Address: 1350 Bayshore Rd city:Greenport st: NY zip: 11944 Budding Permit# 45538 section: 53 Block: 4 Lot: 33 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: BBS Electrical License No: 889ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1 st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt 1 Recessed Fixtures CO2 Detectors Sub Panel X A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 4'LED Exit Fixtures 11 Pump 1 Other Equipment: Intrermatic Pool Panel 8 Circuit/4 Used, (1) Light, Gas Heater 120GFI, Pump 220GF Notes: Pool Inspector Signature: �� Date: August 14, 2021 S.Devlin-Cert Electrical Compliance Form L OF SOUIyo� # # TOWN OF SOUTHOLD BUILDING DEPT. `ycoutm��'` 765-1802 INSPECTION [ - ] FOUNDATION 1 ST [ ] ROUGH PL13G. -[ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING -[ ] FRAMING /STRAPPING [✓] FINALY)01--- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE-RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ J ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: CIA DATE INSPECTOR uhwrvvj O�aOPSOUlyolo 5536 1� Eo TOWN OF SOUTHOLD BUILDING DEPT. °yu765-1802 �orm�' ANSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND - -[ ] -INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [F ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: I DATE I INSPECTOR �V�- FIELD INSPECTION REPORT DATE G4MME fTS FOUNDATION(IST) ------------------------ ATION(2ND) ' J C y ROUGH FRAMING.& y PLUMBING —41 INSULATION PER N.Y. ` H STAVE ENERGY CODE it .f FINAL ' ', '^ ` ADD ? CbS lbo 9ES t" '�q'c)• C CQ Cir"PG `" o.AF000 TOWN OF SOUTHOLD—BUILDING DEPARTMENT y� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 �y�o• ao� Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT ffice Use Only 1- 14 Y} D j k b \J 1 �J PERMIT N0. �553rl3uilcling Inspector: Ls _ a1> 'n4,kp;f..,u,w rv.J, • F �Uu SOV 23 2020 t Applications"sand.fo .51 Ustai°e filledsout in;tfieir entiret �Incom lete'� -applications'will°not�beraccepted:`°1NheretFierApplcar%t�is`:ri the°o_vvner;an�r- �� -.m O,wnei's Authofiiationtfdr`&,.(Page 2)ashall'be;"com � 'aa P_, raG,,r3";ea }'4id!°°,?u.z•.k +? a:z'*a"F'r': r6.q0 Date: '.,yµ ,"^ ,:+z�u,�.'u�..,�:�"',r,.w�•.;%'�r�,,`, _ "i�'r..:t ',r',,,, y ,1' }� !' ,1 _ •�' $7°','..'�•=:�Y, , NER . .�,r OWSOF`'PROPERTy M... .,,, ,<,.a, ,w•„E'w,, ;"'>s :' >w. ae.`;w.r:,., r =.:_ G ;. � �y"�t->:1w , 4` ti' .�-fi' ,n'a"�' � •^"_. `t r, ,':€� �">* �", ^4 w,""`, ,`t1`-,-„�� 1 ,7•_h "m -0.x Name: / ka ,v �L, SCTM#1000- y– Physical Address: 1350 Bey S,y,. ! -LoC ee? r _N-V.� /JfLl w Phone# 3 y7 �3 G' 11 ._. ..__.�.__• Email: Mailing Address: 7z$ �'SL9sV0V1ew L,t1.-.._G4'fgV_ -fir 'iP •^+�a ,",!#`°.°„8w,n.� wri��°o'y' .i">,.nt.,,., ,.}e r� 0 .1"' �,�di,.kM4"bri'y�.' «;ry,in;'s•`i_ .-�,.�`e' .`1'•r^ +X"r` :r'.x 3X i'`�` ,9�xr,:"t a i�rr�:=;<;o-,,.�.,�s,,."r e'^,.Pr�,•.,�`,�r .'�`� "'"t.� !i' i`+'�n,6'tdm d.M a^t'i(irmi'9",i„i�� a..�N`�`"^'o--�`r�u.�,�: rn� ��,�� „c .. `<K ,�a�'3`T�;,,'r,rAs°,;���i„�r=,+���,§��, ,,u��i'r'� 9r'�a�,� r�. �`�`,�"v-• ,�a;'s;:^"",w'��s, �^`�`���,�;'�m"v;'���^��°��zF*�� Name: Mailing Address: �82„ _—Pr Phone#• lj3l� 7Zp 3`��3 Email: . , `z-a,x c'�«:y;iT '�y ,.✓F, - _ _ _ _4'.` �,Sy' ",""a:S�t#�, �'"Sr�Y{.a 9,'ra rx,,�l�c`h+; ", .'raw'*<fi,`,;f'e.j;h Tn xr'fiu'- •.Na';.�;;"'';�X„ :>",�a'Tr,�'+;-"" w'a+ z;, ^.,*?<:agz. ,�",+'afp�r,.0„ni�p ,.,�,. ,t"'. s-1,. ^`l�, »BMJ, .4�, ''do- ra -t '�s,•+'�.,:.°'�,^-_-�� ,gid&.�,. �-�,�, �yl-c�;!'r.r �..�; DESI161Vr4^RROFESSIOIVi4L``-INEORMA7I,ON +, r ,.rir.i#�. ,���5+�,,,Xp,�S�°lh ri`<;1N,,, r� < _ ry �„s'*fes +�io• ""*ai.,, � �^�A"�,N,�. �a'r.^ rT� :✓r^�e: Name: Mailing Address: Phone#: Email: s25+ t'y. 'g^q tiCONT.RACI`QR`IIVF,ORI1/IATION ,,,• t. .,c _:,.;` r= r.M; :` ',.. «, r> ,_ , ,, rz ,.k �'s'1- Name: Mailing Address: A1Y 110 _ Phone#: CG 3jJ 72,1f-013 Email l�Q/� 4 /!L!• f �a, �a>�;,.:,' - - „,a^ +•r^ ��n, "rr�xiierA __..._�'+- u-}-- _- - __...._, r' , a E i,a;,_._4---r?..,,yfi� 'lqy r;^ ,' ",n %” ,•�l:0«'1+ 'Y.y"" r.4,a"�r, ,�rve ':'f''3}At;;^`'x ?1:.�, +r+"..F SJ •Jr' Y R-," ” tna� DESCRIPTION,FOF�PftOPO`SED„COIVSTRUCTI'OM°r�'��"'- �+�`• w,-�;' ;.�,„,"a��a�•°,,� � t +'a;, ,� � ;,* k )��' >, = � k=r WF i��•'ng.; n�.: iN i�;::l,:- �- ,.i^:-.','.,'R w;;w.�w 3 .�,o•,X,,� t41;.1';^ YNeWStructure ❑Addition ❑Alteration ❑Repair ❑Demolition Estite�Co��Project: ❑Other $ 3 ! ,00 FII lot be re-graded? Wes El No Will excess fill be removed from premises? es []No 1 4" 4� '-'+'y 14 Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? OYes Ao IF YES,PROVIDE A COPY. aBox'_ft storm, '"' A dfRed( ing:,,,Theownef/contractor design�r&es'sid6�ljiriespons bid forall,dramage'and" waterlssuesfag,provlded,by` %Chapter 236 of,the,Towh'Cbde,.,APPLICATION IS HEREBYMADE16the Building Department,for,the,issuancelof a'Building Permit pursu'arit161he'Building zone for cable Laws,-Ordina! ,,,ordinance cifthe',Toi ty,'`New,Yorkjnd'other'dppIi i ce o ibuildings,,- addl t,Ions,a Iteration i bffor'jei�oviloi,d'(!r'h'o'I'I'tionasherei4"'de's'eii'66d'.-,ihe,'applic t agrees io c;njply With,all aliplica'blejawt;ordinances,'building,code,-, ins4n uthorUd'inspeetors'on prem,Wes and ih`,building(i)'for;necessary nspections- False statiffi6tilihade herein are using code and,regdlaitli a ,,a St" e6a 1,Law.' �punliha�146s' Cl s"I'­ atdP" ' !sdemearfdr pursue 1 -1 1 1 - I — , "I prsuaritto,Sdic Application Submitted By(pri tr me): R'A*uthorized Agent ElOwner Signature of Applicant: Date: STATE OF NEW YORK) COUNTY OF %%AC411he Pt?jwa /6 kJe- being duly sworn,deposes and says that(s)he.is the applicant (Name of individual signing contract)above named, (S)he is the 4494+4ellog (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/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this day of 20X6 LAnxw V� Eryy��l Notary Public BARBARA KENNY Notary Public-State of NewYork NO.01 KE6207486 OPERTY OWNER AUTHORIZATION Qualified In Suffolk County My Commission Expires jun 15,2021 (Where the applicant is not the owner) /*.j PA.( *Zy residing at 194'o- no AfWAAr AY 1*1q do hereby authorizejwe,/ k.. . 4b4r to apply on my behalfown f d Building Department for approval as described herein. �Ln ///z V/v Owner's Signature Date A,,I#.(#Al_PZY Print Owner's Name 2 1ICE, V �O�OS�yFfQ( rCo 6UIL6ING DEPARTMENT-Electrical Inspector S E P 1 q 2021 TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 y � �- • L Cx A �: Southold, New York 11971-0959 Ti.T� �ao ,0�, elephone (631) 765-1802 - FAX (631) 765-9502 rogerrO-southoldtownny_-gov - seand(Qsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 09/14/2021 Company Name: BBS Electrical Name: William Stock PRIES License No.: 889E email: alek.bbselect@ gmail.com Phone No: 631-728-5053 01 request an email copy of Certificate of Compliance Address.: 1350 Bay Shore Road, Greenport JOB SITE INFORMATION (All Information Required) Name Address: 1350 Bay Shore Road, Greenport Cross Street: Wells Lane Phone No.: 631-728-5053 Bldg.Permit#: 45538 email: alek bbselect@ gmail.com Tax Map District: 1000 Section: Block: Lot: , - BRIEF DESCRIPTION OF WORK (Please Print Clearly) Pool Pool Pool Check All That Apply: Is job ready for inspection?: ❑✓ YES ❑NO ORough In [Z]Final Do you need a Temp Certificate?: DYES [ZNO Issued On 09/14/2021 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A #Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals 01 02 ❑H Frame❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION C>C) Electrical Inspection Form 2020.xlsx PERMIT# Address: 50 �QI � Switches C Outlets GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven W/D Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service Amps Have Used Special: /V Comments 49.W W4 9 041 -rte¢ ����✓� �6 y`SUFFO(k^ � BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Zt Q Town Hall Annex - 54375 Main Road - PO Box 1179 °, "7 Southold, New York 11971-0959 0 ap! Telephone (631) 765-1802 - FAX (631) 765-9502 I OM- rogerr southoldtownny.gov -- seand(a,southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Name: License No.: email: Phone No: 01 request an email copy of Certificate of Compliance Address.: JOB SITE INFORMATION (All Information Required) Name: Address: Cross Street: Phone No.: 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?: DYES ONO ❑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 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020 xlsx Form 8004(3/00)-Bargain and Sale Deed,,Aft Covesaab against llrentoes Acts-1ntlividual or Corporation.(Single sleet) CONSULTYOURLAWYER BEFORE SIGNPiGTAIS INSTRUMENT-TRIS P67RUMENTSHOULD BE USED BY LAWYERS ONLY. THUS INDENTURE,made the,(QMq of November 2020 BETWEEN P?Bn%1 in�'rv)du*and as Administrator ofthe and Fstate Ht' ' aatExeeutmt and sole devisee of the residing at 8046 Little Nock Parkway Floral Park ,NY 11004 party of the first part,and 1350 Bay Shore Road LLC ''tesidiog at 1/3 So~/�4—v'm/ pazrygfthesecond part, Six Hundred Twenty Five Thousand dollars WITNESSETH,that the patty of the first part,h consideration of too-thIR S and other valuable consideration paid by the party of the second part,does hereby grant and release unto the parry of the second part,the heirs or sueeemers and assigns of the party of the second pari forever, ALL that certain plot,piece or parcel of land,with the buildings and improvements#=On erected,situate,lying and being in the See Schedule"A"annexed hereto and made a part ItereoE "Being and intended to be the same premises described in the following deeds: By Deed made by Brian Igulas,James Higgins,Cathryn Higgins,lam Tohm and Kenneth Higgins recorded June 29,1987 in the June 29,1987 in the Suffolk County Clerkb Office in Liber 10352 page 489(as to 13%);by Deed from Cathryn Higgins,recorded December 17 1993 In the SUM&County Clerk's Office in Liber 11656 Page 590(as to 46%)and by Deed tram Margaret M. McConnell,as Executor of the Estate of]gimes P.'Iolan,under the Last Win and Testament ofJemes P.Tolen,deceased,recorded November 7.2009 in the Suffolk County Clark's Office in Liber 12571 Cp 073(as to 31%)By Deed from Brian Higgins,James Higgins,Cathryn Higllkw,James Tolan and Kenneth.Higgins,recorded June 29,1997 in the Sutlblk County Clerk's 06ee in Liber 10352 cp 489. Being the same promises known as and located at 1350 Bay Shore Road,Greco Naw Y041190' V. •'. 'T - TOGETHER with an right,title and tpterest,if RMI,or the parry of the fust part,in and to any streets and roads abutting the shove- d —ribed premises sto the center lines thereof,TOGETHER with the appurtenenoes and all the estate and tights of the party of the ftpart in and to said premises;TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or succeswrs and assigns ofthe parry of the second part forever. AND the parry of the first part covenants that the para'of the first part has not done or suffered anything whereby the saidremises have been encumbered in any way whatever,ewept as aforesaid. P AND the party ofthe first part,is compliancewith Section 13 of the Lien Law,covenauts that the party of the first part will receive the consideration for this conveyance and will hold fhe light to receive such consideration as a trust fund to be applled that for the purpose of PaYhr6 cost of the tmprovament and will ap ly the same fust to the payment of the coat of the improvement before wing any Part oftha total of the same for W other purpose The word "Party" shall be construed as if •t read "parties" whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the Party ofthe first part has duly executed this deed the day and you first above written. INPRESENCE 0F: d o )gdY mtliggins Of liteate o e ggma a FIDELITY NATIONAL TITLE INSURANCE COMPANY POLICY NO.7404-009359 SCHEDULE A (continued) ALL that certain plot,piece or parcel of land,situate,lying and being at Arshamomoque,Town of Southold,Suffolk County, New York,known and designated as the Southerly half of Lot No.94 and Lot No.95 on a certain map entitled,"Amended Map A,Peconic Bay Estates at Arshamomoque,Town of Southold,New York,dated May 12,1933,filed in the Suffolk County Clerk's Office as Map No.1124 which said lot and part of the lot when taken together are bounded and described as follows: BEGINNING at a point on the Westerly line of Bay Shore Road distant 86.93 feet Southerly from the Intersection of the Southerly side of Wells Lane with the Westerly fine of Bayshore Road; RUNNING THENCE along the Westerly side of Bayshore Road,South 44 degrees 12 minutes 40 seconds East 75.00 feet; THENCE South 45 degrees 47 minutes 20 seconds West 125.00 feet; THENCE North 44 degrees 12 minutes 40 seconds West 75.00 feet; THENCE North 45 degrees 47 minutes 20 seconds East 125.00 feet to the Westerly side of Bayshore Road at the point or place of BEGINNING. END OF SCHEDULE A Copyright American Land Title Association.All rights reserved. Wrr arrarr The use of this Form(or any derivative therooQ is restricted to ALTA licences and ALTA members In good standing as of the date of use. All other uses ate prohibited. Reprinted under license from the American Land Title Assoclatlom ALTA ownoro Policy(1011712006) RIMed 111620 03W pm NY-Fr+RV"lMU.431004SP3 27309•i 20.7404009369 S.C.T.M.• NO. DISTRICT: 1000 SECTION: 53 BLOCK: 4 LOT(S):33 1 DWELLINGS W/PUBLIC WATER U.P. 150' s � --BA-Y-SHO-R�¢ ROAR DRAIN WATER MAIN I ---- -- CL 9.7 CL 9.6 CL 19.5 EDGE OF PAVEMENT TCB 9.0 WIN :r CATCH BAMON.S 4412'40" E 75.00'PILI E FTi EL 9.6 86.93 W.M. 9.2 p� O � o 7 CN O F� P/0 LOT 94 P/0 LOT 94 LOT 95 LOT 96 -T DWELLINGS DWELLINGS W/PUBLIC WATER W/PUBLIC WATER 150' 150' EL 8.9 WOOD PLAT. WOOD DECK EL 17.5 mcr EL 8.8 Z) W m ti 1 1/2 STY, FRAME DWELLING W/WALKOUT CELLAR J1350 . W/WALKOUT CELLAR" FFL 17.6•. 'CELLAR 9.0. - - GRAVEL DRIVEWAY - :. '.. .25.3'..! - 15.8' EL 8.5 EL 9.0 W - if+ ® 1L 8.6 'ry �. O 00 Ln 2� .12.2'• o d '-n Z 9� 12.1 Un 9.2' �t EL 8.5 N EL 8.8 N 4412'40" W DWELLINGS 75.00' PIPE ' W/PUBLIC WATER 150' MAP OF AUGUST ACRES, SECT. 1 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCA77ONS SHOWN ARE FROM FIELD"OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS. AREA:9,375.00 SQ-FT- or 0.22 ACRES ELEVA77ON DATUM. _NAVD88; ___- _ UNAUTHORIZED.ALTERAAON OR ADDIT70N TO THIS SURVEY IS A WOLA77ON OF SECT70N 7209 OF 114E NEW YORK STATE EDUCA770M LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TUT70N LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. 7HE OFFSET'S OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO 714E STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADDIT70NAL STRUCTURES OR AND 01HER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE'STRU&7URES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF:PART OF LOT 94 & LOT 95 CERTIFIED TO: WINSTON ELY; MAP OF:AMENDED MAP A of PECONIC BAY ESTATES FIDELITY NATIONAL TITLE INSURANCE COMPANY; FILED: MAY 19, 1933 No. 1 124 SITUATED AT:ARSHAMOMOQUE TOWN ORSOUTHOLD KENNETH- M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying, and Design - P.O. Bog 153 Aquebogue, New York 11931 � PHONE (831)298-1588 FAX (831) 298-1588 FILE #220-120 SCALE.-J "=20' DATE: SEPT. 10, 2020 N.Y.S. LISC, NO. 050882 ' ,,mintatnink the record. of Robert 1. Henneaay & Kenneth M. Hoychuk vv"o K Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) lb Business Telephone Number of Insured Pooltastic Pool Works Inc 631728-3983 PO Box 112 631728-3983 Hampton Bays,NY 11946 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1d.Federal Employer Identification Number of Insured or Social Security Number 112953125 2.Name and Address of Entity Requesting Proof of Coverage 3a Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Twin City Fire Insurance Company Town of Southold 3b,Policy Number of Entity Listed in Box"1 a" 53095 Main Road 12WEQD9BD5 Southold,NY 11971 3c.Policy effective period 11/19/2020 to 11/19/2021 3d The Proprietor,Partners or Executive Officers are included.(Only check box if all partners/officers included) ® 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"1 a"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"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums 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: Leonard Scioscia (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 11/10/20 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 631-390-9700 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.ny.gov Client#: 8041 POOLPOO DATE(MMIDDIYYYY) ACORM CERTIFICATE OF LIABILITY INSURANCE 11/10/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Commercial Support Edgewood Partners Ins.Center PHONE 631 324-1440 FAX AIC,No,Ext: AIC,No 40 Marcus Drive A DD RESS: certificates@cookmaran.com 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Melville, NY 11747 INSURER A:Twin City Fire Insurance Company 29459 INSURED INSURER B:Merchants Preferred Insurance Co. 12901 Pooltastic Pool Works Inc POBox 112 INSURER C: Hampton Bays,NY 11946 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY 12UENQY2614 09/06/2020 09/06/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE �OCCUR PREMISES Ma o�ED nce $300 OOO MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER* GENERAL AGGREGATE $2,000,000 PRO- POLICY II JECT F�LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER $ B AUTOMOBILE LIABILITY CAP9117665 09/06/2020 09/06/2021 EO accld.ntSINGLE LIMIT $110003000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4 EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION 12WEQD9BD5 11/19/2020 11/19/2021 X IPER orH- AND EMPLOYERS'LIABILITYMIUIE ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) EL 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/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Main Road 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 #S2778987/M2778947 CCUMM "sr° E compensation CERTIFICATE OF INSURANCE COVERAGE Board under the NYS 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 Ia.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Pooltastic Pool works Inc PO Box 112 Hampton Bays, NY 11946 Work Location of Insured(only required if coverage Is specifically limited to 1c.Federal Employer Identification Number of Insured or certain locations in New York State,i.e.,Wrap-Up Policy) Social Security Number 11-2953125 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Guardian Life Insurance Co of America Town of Southold 53095 Main Road 3b.Policy Number of Entity Listed in Box"1a" Southold, NY 11971 985612-0000 3c.Policy effective period 08/02/1994 to 08/01/2021 4. Policy provides the following benefits: X[f A.Both disability and paid family leave benefits. [f B.Disability benefits only. E] C.Paid family leave benefits only. S. Policy covers: x0 A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. [j B.Only the following class or classes of employer's employees: Under penalty of perjury,i certify that I am an authorized representative or license t of thIiva nce carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits Insurance covera e s escribehove. Date Signed November 11, 2020 By (Signature of insurance carne s authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 964-2150 Name and Title Dan Saltzman — President 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 413,40 or 513 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 Box 4C or 58 of Part I 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 carders licensed to write NYS disablilty 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. D13-120.1 (9-17) III�III1H110111011111M1111111H1111111111111111111 DB-120.1 09--17 Suffolk County Department of Labor, Licensing & Consumer Affairs fw yyt VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 5/8/2017 No. 58524-H SUFFOLK COUNTY is & Home Improvement Contractor License 0 H This is to certify that EDWARD P LAUREANO doing business as 4 POOLTASTIC POOL WORKS INC having furnished the requirements set forth,in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. License Category , NOT VALID WITHOUT Additional Businesses Pools/Spas 't" DEPARTMENTAL SEAL AND A CURRENT CONSUMER AFFAIRS ID CARD g '2 4, W . A- Commissioner ; R iz IQF V APPROVED AS NOTED DATE: a � B.P.# 3 FEE: - I Dj BY. —4k— NOTIFY BUILDING �F°ARTMENT AT 765-1802 8 AM TO a PM FOR THE ELECTRICAL FOLLOWING INSPECTIONS: INSPECTION REQUIRED I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONS" MUST BE COMPLETE ALL CONSTRUCT%, �­ALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. RETAIN STORM WATER RUNOFF COMPLY WITH ALL CODES OF PURSUANT TO CHAPTER 236 NEW YORK STATE & TOWN CODES OF THE TOWN CODE. AS REQUIRED AND CONDITIONS OF �SO.USHOLC NNIN TOWN PLAG BOARD T _D TOWN TRUSTEES �.�.6EE�--- p8 3�f6APMEtS IAI'EL L " OCCUPANCY OR ENS'LbSEPOOLTOCoDE. USE IS UNLAWFUL FORE wAT COMPLj�" WITHOUT CERTIFICATE OF OCCUPANCY NOTE: QUANTITY OF WALL PANELS IPANEL r LENGTH DIFFER FOR EACH POOL SIZE. CONCRETE 2-1" 1 REFER TO TABLE BELOW. I RECEPTOR COPING �5ELF-DRLUNG 5 �f FASTENER ALUMINUM COPING , NOTE: ALL WALLS ' —`--0 3/g BOLTS 14 GA. GALVANIZED i CADMIUM iSTEEL- 80 EXTRUDED f.• — -——( \ALUM• COPING. i ix i. LATED I 42• ` I " I 1 I I GALVANIZED '91l\ I I i _� IRON 2" VINYL 1� A LINING• - \ UNDISTURBED SUBSTRATE` EARTH S i t i' BOTTOM y"` \12"- 12 x 14 GA s •'-.MATERIAL 1�r 1 2`14G .�,BEARING PLATE B A ANGLE REBAR�-- SCALE Ai E --ol -F—+ e EXCAVATION NOTES: PANEL SIZES 1, EXCAVATION SHALL BE 2"LARGER THAN POOL POOL DIMENSIONS QTYS READ ON ALL SIDES. POOL SIZE A B C DIE F G HIJ IK I L (0118,1911 2. BACKFILL SHOULD NOT EXCEED WATER HEIGHT 12'r 24'.4 12 24' 8' 7:616 2�6 Ei 7' Y-6 2fi-IO 4 6 BY MORE THAN 12: WA1 ER LEVEL SHOULD 14'+26'* 14' 26 IU -(;16 6" 6 '6 9' -6 29'-(,kr 2 4 4 NOT EXCEED HEIGHT OF TAMPED BACKFILL 16. V. 12' •16 12 _ 6' 4' IB'- 4" 8 3-6 35-9 12 BY MORE THAN D GRAVEL OR 3• BACKFILL TO BE SAN . ' • � _ 2;. 16"Y 36" {f� 3Ei $6 4" 8' 4" OTHER NON-EXPANSIVE MATERIAL. T ' ''��� ``�' ��,s�-.���'••,,�- ��',�j��};,� ,-t�5;v;.a-,� 8" IOW640'4'40'-3� 12 18 3Ei I8 36:f0 4• 4" I t ;" `��`•� �'`'` '';�. � �,.s PO 20' 40' 20 40 JZ l 4' 8' 4' 12' 4 4=8 4 12 ' ` U F {"•r, a 2 NO DIVING BOARD PERMITED � tj W '' 5•_:aY i5u;r -,�• .r e a nt;},n� t I ,��..� ti�3 X74 �,'�,,,Y '� a �'���.v +�i u:e���;��� �b��P ,4°x��'i�v�Ik'- •�. ,s' ',�-1�t,,s d 1 • •9,i ✓'tii ,. -:� „:k';!'-}: y���,r�a-17� laF'i+a f ? (ry;:� ya:"•��1�In'}�il�71I ,�:..'1��1�t: '1:.4+.VR14�iY ra4•� -.15:%;$T,Yc•{�L`i4:'. A3f F •.i�l'i