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HomeMy WebLinkAbout44277-Z SVEFOI,�cO Town of Southold 12/8/2021 a � P.O.Box 1179 0 C" 53095 Main Rd W�4,j o� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42588 Date: 12/8/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 215 Bridle Ct, Cutchogue SCTM#: 473889 Sec/Block/Lot: 102.-8-18 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/3/2019 pursuant to which Building Permit No. 44277 dated 10/10/2019 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 Weir,Glyn&Michelle of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44277 6/4/2020 PLUMBERS CERTIFICATION DATED 0- C iz d 'gnature TOWN OF SOUTHOLD BUILDING DEPARTMENT C a 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#: 44277 Date: 10/10/2019 Permission is hereby granted to: Weir, Glyn & Michelle 215 Bridle Ct Cutchogue, NY 11935 To: construct accessory in-ground swimming pool as applied for. At premises located at: 215 Bridle Ct, Cutchogue SCTM # 473889 Sec/Block/Lot# 102.-8-18 Pursuant to application dated 10/3/2019 and approved by the Building Inspector. To expire on 4/10/2021. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Bui nspector Form No.6 TOWN OF SOUTHOLD. BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets,and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957) non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and•unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool $50.00, Accessory building$50.00,Additions to accessory building$50.00, Businesses$50.00. 2_ Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. �O`Z� 9 New Construction: Old or Pre-existing Building: (check one) Location of Property: 1 Jr 9p,w le a+ ev l�( am(quif, House No. ll� Street Hamlet Owner or Owners of Property: Q l e� U1i�i 2 Suffolk County Tax Map No 1000, Section 10; Block g Lot Subdivision q��G�� 5��4�'�S Filed Map. �p'�37 Lot: Permit No. d'� Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: / Request for: Temporary Certificate Final Certificate: �,// (check one) Fee Submitted: $ Applicant Signature Building Depaftnient Application AUTHORIZATION (Where the Applicant is not tbe_Owner) r-I residing ab (Print property owner's name) (Mailing Address) 1 &��.'do hereby authorize. A,,�h.- Ecij"bs (Agent) ib dpoly on my behalf to,the Southold Building Departrnoht, Sei e 6r �)01 (OW r"Xign`atute) -bate) ,(Print Owner's Mfille) pE SOU��®� Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ® a� sean.deviinCcD-town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Glyn Weir Address: 215 Bridle Ct city,Cutchogue st: NY zip: 11935 Building Permit#: 44277 Section 102 Block. $ Lot: 18 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Leo's Electric License No: 2199ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1 st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 2 Smoke Detectors Main Panel A/C Condenser Single Recpt 2 Recessed Fixtures CO2 Detectors Sub Panel X A/C Blower Range Recpt Ceding Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 2 4'LED Exit Fixtures 11 Pump 2 Other Equipment: Salt Generator, Pump w/ single use outlet on 220GFI Breaker, Polaris Pump, Bonding Notes: Pool Inspector Signature: Date: June 4, 2020 S.Devlin-Cert Electrical Compliance Form.xls 1 OFS0Uly0� �. 27 7 2rs P�f # * TOWN OF SOUTHOLD BUILDING DEPT �„� ' 765-1802 INSPECTION [ ] FOUNDATION 1ST _ [ ] ROUGH PL13G. [ .] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ]- FIRE SAFETY-INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINALrp•b [ ] CODE VIOLATION ] PRE C/O REMARKS: DATE INSPECTOR t6.a 7__ J Li4 OF so — TOWN OF SOUTHOLD BUILDING DEPT. °y�ouxn '� 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING/STRAPPING FINAL FWL [ ] FIREPLACE & CHIMNEY= [ ]- FIRE SAFETY INSPECTION [ _] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: CAA&nAL w CL cid* WWI DATE INSPECTOR r �) FIELD INSPECTION REPORT •DATE COMMENTS FOUNDATION (IST) -------------------------------- FOUNDATION ------------------------------FOUNDATION (2ND) z 0 H ROUGH FRAMING& PLUMBING ®, coo r INSULATION PER N.Y. H STATE ENERGY CODE FINAL1.4 AQ ADDITIONAL COMMENTS AU 5��s 6o e p b vc e 7/6 e r Z m X b ®� o z H x d ro� H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATI(?N CHECKLIST y BUILDING DEVMrr-MENT- Doy ' - Do you have or need the following,before applying 7 TOWN HALL Board of Health }'tOUTHOLD,NY 11971 3 sets of Building Plans F:TEL: 765-1802 Survey PERMIT NO: Check Septic Form N.Y.S.D.E.C. Examined 20 Contact:Trustees Approved $20 Mail ( ' UJ A Disapproved a/c At �)Gj fie• 4 �_ d ; ( Building Inspector - OCT - 3 2019 ' APPLICATION FORBUILDING-PERMIT Date 1012 20A INSTRUCTIONS a.This application MUST be completely filled in by typewriter onin 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•shallbe.occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupancy is issued by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold;,Suffelk?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,,Al applicable laws,ordinances,building code,housing code,and°regulations,�and,,to admit authorized--inspectors on premises,and4n building for necessaryinspections. (Signa of applicant or name;if a,corporation) 215- E R 1011e- C� Cic��i.4e (Mailing.address of applicant), State whether applicant is owner,lessee, agent, architect, engineer, general contractor, electrician,plumber.ot'.builder Name of owner of premises 0-ryhf lei c (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate,officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proosed work will be done: House Number Street Hatftlet>i A 13HAORAIA Aide w90 to aisi2--61d►�9 VISI W11 County Tax Map No. 1000 Section Block Subdivisionah(QAO Filed Map No . .,Y10 (Name) -_ 1 2. State existing use and occupancy of premisep and intended use and occupancy of proposed construction: a. Existing We"atid'occuparicy �5jerJe¢ b. Intended use and occupancy_ &W&A*i �Wimmii✓g x"40 c. 3. Nature of work(check which applicable):New Building Addition Alteration Repan Removal Demolition Other Work in4ru✓mo V/7+ - �..✓� (Description) 4. Estimated Cost Fee (to be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars . 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures,if any: Front L _ ' _Rear .-73 Depth ' Z5 # Height Number of Stories / F Dimensions of same structure with''a'Iterations or�additions: Front Rear Depth Height Number of Stories 1 �Z�B 8. Dimensions of entire new construction: Frontx50 P�;JL Rear Depth Height , Number of Stories 9. Size of lot: Front W' - ' Rear- -sb Depth X90 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: No 13. Will lot be,,re-graded �(�� PIL Will,excess.fill be removed from premises: YES NO 16 QuoleC�' ' /s L 14.Names of Owner of premises y/J W2►�, Address__ di-M)),�, r'f�3�' 'Phone`No. X31- 710-'oZV J Name of Architect Addtess Phond No Name of Contractor rs Address Phone No. 63f'7��f-71�f 15. Is this property within.100 feet of atiddl:-wetland? *YES NO ® IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED 16. Provide survey, to scale,with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10•feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF &F;Fo� kthuu, J f,0►JiD S being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the ea-Yta(4x (Contractor,Agent, Corporate Officer,etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this day ofb-4, 20_Ll /4� of Public Signature of A#licant a MARGARE T A. KIDNEY Notary Public—State of New York No. 01 K16021111 Qualified in Suffolk County Commission Expires March 8,20x3 Scott A. Mussell °§� '� STO]KI��l[WA' IE)R�_ SUPERVISORMA\NA\GIEM]E1�� '7C' SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES TMS PROJECT INVOLVE ANY OF IM FOLLOWING: Yes No I (CHECK ALL THAT APPLY) ®9A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑ 413. 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. Q 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. 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 witTyour Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date: District NAME: ell I r )v��0- 8 je) 1012-h9 u Section Block Lot b2-41 ^ **** FOR BUILDING DEPARTMENT USE ONLY**** Contact Information JpV 2/n b— W 2.4 I lnlep%om Numbed Reviewed By: — — — — — — — — — — — — — — — — Property Address/Location of Construction Work. — — — — — — — — Date_ U ® Approved for processing Building Permit. Stormwater Management Control Plan Not Required. Co:I CWI , '1 3S- ZOO Stormwater Management Control Plan is Required (Forward to Engineering Department for Review.) FORM * SMCP-TOS MAY 2014 it �•- ' ! ' MAR 2 7 2020 l = SgUcA.� BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD :r, L Town Hall Annex- 54375 Main Road - PO Box 1179 �3Coe> Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr .southoldtownnv.gov - seanda-southoldtownny.gov 4 i APPLICATION FOR ELECTRICAL INSPECTION, ELECTRICIAN INFORMATION (All information Required) Date- Company Name:, Gi - - Coco - Name:- - - - - - -- _- License No.: C?J q Ct m C email: Address: d L41 �_ _ Scc, % f � _ _ Ii���•_ Phone No. 3 CP Y - as0� f JOB SITE INFORMATION (All Information Required) Name: - r Address: Cross Street: Phone No.. - Bldg.Permit email' 1 C 12 k, \_c Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?- YES NO Rough In Final Do you need a Temp Certificate?: YES / �O Issued On y Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: _ _A # Meters Old Meter# ._ _� New Service - Fire Reconnect- Flood Reconnect-Service Reconnected - Underground - Overhead i #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N ' Additional Information':. PAYMENTMUE WITH APPLICATION s Request for Inspection FormAs 9 j 0 Town Hall Annex Telephone(631)765-11802 54375 Main Road cn roger.richert a(Mown soUtf101tl.nV.US P.O.Box 1179 Q Southold,NY 11971-0959 1y�41/N'i`I, BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: 34 �ep Date: Company Name: Name: AxHvAq License No.: !� Address: 1414 t-n &4- RO dw4m-7-14011) by Phone No.: 631_ _r73V7 JOBSITE INFORMATION: (*Indicates required information) *Name: 0,10 W-CAe. *Address: 215' iA If f -�{► ice, *Cross Street: Rlo � *Phone No.: Permit No.- 277 Tax Map District: 1000 Section: Block: Lot: 1 g *BRIEF DESCRIPTION-OF WORK(Please Print Clearly) 11 P � X 1Pj rOJIA3 Vin'i tsm mYA in✓ t (Please Circle All That Apply) r *Is•job ready for inspection: YES NO Rough In ` Final *Do you need a Temp Certificate: YES NO Temp Information (If needed) - *Service Size: 1 Phase 3Phase 100 1,50 - 200 300 350 400 Other *New Service: Re-connect Underground Number-of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION AIM 82-Request for Inspection Form 7d /() PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's UC Lis Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon Micro Generator Combo Cooktop, Transfer AC AH Mini Special: Comments ! r ldf 1 1 0� 2� �0 Lot 22 • X5\0 � �'`� `ss'� - p o co, h60 `.�•, r A V . d 25 g. 0� `,�• � .tU� a �v fo Ob / Go'� IL1 01 it v it \ �v 213:9'-' 21' a At 61. s 2Z0' '900 R=25.00' s s �1p��� L =2/.03 o �o a� X051 �o •oo. Q�-� ��4 2� S 6 � 8:25.00 ' o L=45.08 ' • 20 UFFO •^ , Lpt LK COUNTY HEALTH I)EPARTUMm SURVEY FOR DATE I MOHR/NG ENTERPRISES, INC. D , RAF• �'1 LOT'NQ. 2/, " HIGHLAND ESTATESI uG. 16, , 1983 The £CWaAo dipo7sl ` ''a v'�ter s3u 1 AT CUTCHOGUE DATE: ✓ULY 25, /983 fact lii � ; ;'o;' p� Y TOWN sS have been 1 OUTHOLD ,SCALE: / = 50 to be satj b�r t!11 `� Ana' "nodi 4F and found SUF�WK COUNTY, NEW YORK !NO, 83 553 sfQctory. 4 J� , •® _ N UN(IUTN 1=ED ALTERATION OR ADDITION TO THIS l4 (/J14�IJ Jn S Rel IS VIOLATION Of SECTION 72017 OF THE i+''r"`W' "• Chief Of General Engineer W RK TATE EDUCATION LAW E ref NEW y � N CI S THIS SU1tVEY NOT BEARING THE LANG r . O Services SURVE R INKED SEAL'OREMBOSSED SEAL SHALL � �� �1J W. Y0 NOT B!� CO SIOEXED TO'qE A VALID TRU E COPY , 0 KGUARAN ES INDICATED HEREON SHALL RUN ONLY TO 'T `� �,�'TT HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE� FOR WHOM rHE SURVEY IS PREPARED 897 A AND' H1 • BEHALF TO THE TITLE COMPANY GOVERN- III NEAREST W MAIN—MI._ *SOURCE OF WATER, PRIVATE�PUBLIC_ Al ENT A!{ENCY AND LENDING INSTITUTION LISTED 1 III 4pj;n: :5• y N SUFF CO: TO MAP DIST 1000 SECTION 142_BLACK�_LOT 18 HEA�01�,A!(p TO THE ASS GNEES OF THE LENDING •�������''� NTHERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY INSTITVTIOfI GUARANTEE ARE NOT TRANSFERABLE OTHER THAN.THOSE SHOWN NEREON.'' TO ADDITIOOAL INSTITUT ONS OR SUBSEQUENT ,�o Rw• a 0 N THE WATER SUPPLY AND SEWA9E DISPOSAL SYSTEM FOR THIS RES IDEHM OWNERS -, WILL CONFORM TO THE STANDARDS OF THE SUFFOLK COUNTY DEPARTMENT TO ExlDIT T MSS iTpUCTURESWN EON FROM ME FOR A OSPECIFIC LINES rV��i4ip I ZtgAt,P`�p OF HEALTH SERVICCS. PURPOE 11�Np ARE NOT TO BE USED TO ESTABLISH Oa*L EN61NE�p APPLICANT PROPEL TY LINES OR FOR'THE ERECTION OF FENCES ADDRESS r 'C% •/ Y/"' TEL YOUNG YO 400 OSTRANDER.AVENUE a� UNG RIVERHEAD, NEW YORK NOTE ' ■ = MONUMENT O = STAKE 54180/V/5/0N MAP F/LED/N THE OFF/CE OF THE CLERKOF ALDAN W.YOUNG,PROF&SSIONAL ENGINEER SUFFOLKCOUNTYON APR.26,/977 ASF/LENO.6537 ANWLAND SURVEYOR N.Y.S.LICENSE NO.12845 li * THE LOCATKIN OF WELL(W),SEPTIC TANK(Si)8 CEVASlIOOLS(Cr)SHOWN HEREON HOWARD W.YOUNG, LAND SURVEYOR 1 N.Y.S.LICENSE N0.45893 ME FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHER f _ 1 BRANDIS & SONS, INC. 1619 �,�y�'`fir" �'�a� - t _ ���"'°' " .#=`�T - 1•_ -�^-_ � z ..�;p'w �u"1 ����'-`<`s�,•,� u :nay'••y. ,.-x,,�. �;+�Z.'�`'3' �^"� s yi.�� - � ;":^.4�,t'+..« ,,,v+„'S--� .. ?.. env:. - `f. y\ .. - •_ v v ..� -!�+ ,I/.-• $q�l %4Y%.[ •'ir-'tr /mT..�- � «. ��1 `�/:� J�C°�`�n�y ar � � SUJ od County Department of Labor, Licensing & Consumer Affairs ' VETERANS MEMORIAL HIGHWAY * HAUPPAUGE NEW YORK 11788 DATE ISSUED: 0701/1978 No. H-4436 =' Suffolk County Home Improvement Contract®r Licenser `u This is to certify that ARTMIR I EDWARDS >r�� w doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA(I SUPP� Y`be 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 ROME } , t IMPROVEMENT CONTRACTOR, in the County of Suffolk. - 4��/ -3r fol �,� License Category �;' .E r Additional Businesses H26-POOLS&SPAS/CERTIFIED i' ARTHUR EDWARDS POOL,& 113-POOLS/SPAS r a, SPA CENTRE Hl-GC til = Cr r CD Z t a r y (D o 9 .q T p 1o C m�'U � G =� ' C s O CommissionerLZ< U2 4 ' fr 2 n N Z z C xEx: i - o °°' fAwd� a ai� jj n y� z (0 r, cos. rtl at 7a _ n.a - '�.E''. •a � ''�•t- �.r=�.�-��•' '7. -,,,,\ _ �� ,v7y�-t��•b`- N y - �v •arc i��� �?a taz �, - '3'".'� s3'-:'S• � ��< _ •,�=yam''+, � 4'''�` �• d�`,`�'•-�`� �:-.,���v w`5v,a.� =o - •'731 '�U yI'r"'�. •:,,w+f lm3 `s�""'•� "L.�. 'r _s X�y v .y ��- n.` _ * - 'D _ •.. `.,, •dam: •. �,.,. h L:-a.y�i� _ °s„`-'�vis,:r-rk 3_q�"��ai�-�'Air:+� '`�n• <.c'r'� - ��`+'ep.�.,i�"`�,-• y+ "a .s,:ra'c. .'' r ....�y�P ^e'er /~ Y'Y- Sr--a..rt"" ~tial,. ...'' '''•�,r � vs r. e.*r�a !e'. 1 ® DATE(MMIDD/YYYY) ACRO CERTIFICATE OF LIABILITY INSURANCE 01108/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Brendan J Smith Liberty Risk Management,Inc. PHONE (631)569.5633 1 FAAIX No):(631)569-5636 664 Blue Point Road,Suite A A4006B• brendan@llbertyrisk.org Holtsville, NY 11742 INSURERS AFFORDING COVERAGE NAIC M INSURERA: Hartford Insurance company INSURED INSURER B: Arthur J.Edwards Mason Contracting Company Inc. INSURER C• DBA Arthur J.Edwards Pool&Spa Centre INSURER D 929 Route 25A INSURERS: Miller Place,NY 11764 INSURERF: COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 2 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTR TYPE OF INSURANCE L SUB R POLICY EFF POLICY EXP LIMITS POLICY NUMBER (MWDDADMffl A X COMMERc1ALGENERAL LIABILITY 16 UUN OZ8691 01/01/2019 01/01/2020 EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES a occurrence $ 300 OOO DAMAGE TO RENTED MED ECP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1.000 000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY1:1 JEST �LOC PRODUCTS•COMPlOP AGG E 2.000 OOO OTHER: O AUTOMOBILE LIABILITY Ee aBrdden SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per scads f UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ TH- WORKERS COMPENSATION STATUTE ERER AND EMPLOYERS'LIABILITY Y I N ANY PROPRIE'rOR/PARTNERIEXECUTNE F—] N NIA E L.EACH ACCIDENT $ OFFICERIMEyIBER ECCLUDED9 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ IfyS describe under DESCRIPTION OF OPERATIONS below BL DISEASE-POLICY OMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addltlonal Remarks Schedule,maybe attached H more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. P.O.BOX 728 AUTHORIZED REPRESENTATIVE Southold,NY 11971 BJS ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by BJS on January 08,2019 at 12.50PM °W'olfkerf ffly(t C� � CERTIFICATE OF INSURANCE COVERAGE 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 1 a. Legal Name and Address of Insured(Use street address only) 1 b. Business Telephone Number of Insured ARTHUR J EDWARDS MASON 631-744-4455 CONTRACTING COMPANY INC 929 ROUTE 25A 1 c. Federal Employer Identification Number of Insured or MILLER PLACE NY Ill 764 2700 Social Security Number 11-2377925 Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) The Guardian Life Insurance Company of America TOWN OF SOUTHOLD -' P.O.BOX 728 SOUTHOLD,NY 11971 "3b. Policy Number of entity listed in box 1 a": 00984424-0000 3c. Policy effective period: 01/01/2019 to 01/01/2020 4. Policy provides the following benefits: ®A. Both disability and paid family leave benefits. ❑ B. Disability benefits only. ❑ C., Paid family leave benefits only. 5. Policy covers: ®A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes or employer's employees: Under penalty of perjury, I certify that I 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 described above. Date Signed:07/o3/2019 By: faRaymond J.Marra (Signature insurance c fs authonzed representabve or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number: 1-888-278-4542 Title: Senior Vice President,Group and Worksite Markets IMPORTANT: If Boxes"4a"and 5a are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed I Insurance Agent of that carrier,this certificate is COMPLETE.Mail It directly to the certificate holder. If Box"4b,4c or 5b"is checked,this certificate Is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be mailed for completion to the Workers'Compensation Board, DB Plans Acceptance Unit,PO Box 5200,Birmingham,NY 13902-5200. DB120.1 (1/18) (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that the payment of disability benefits for all employees has been secured as provided by this article. D6120.1 (1/18) New York State Insurance Fund 199 CHURCH STREET,NEW YORK,N.Y. 10007-1100 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 112377925 0 ❑■ LEVITT-FUIRST ASSOCIATES LTD " 520 WHITE PLAINS ROAD,2ND'FL TARRYTOWN NY 10591 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARTHUR J EDWARDS MASON TOWN OF SOUTHOLD CONTRACTING COMPANY INC P.O.BOX 728 929 RTE 25A SOUTHOLD NY 11971 MILLER PLACE NY 11764 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G 2438 491-9 53244 06/29/2019 TO -06/29/2020 0612112019 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2438 491-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK,EXCEPT AS INDICATED BELOW. IF YOU WISH TO 'RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 506150454 I miIl00000000000077167240011111 Forth WC-CERT-NOPRINI Version 2(02/29/2016)[WC Policy-243849191 U-26 3 40 [0000000000007197240010001-CM24354919114YG)(15159-05][Cer NoP-CERT 1101-000011 Pr 66Ld APPROVED AS NOTED DATE: B.P.# RETAIN STORM WATER RUNOFF "FEE: BY: PURSUANT TO CHAPTER 236 NOTI Y BUILDING DEPARTM AT OF THE TOWN CODE. 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: fib. 1. FOUNDATION - Ttn10 REQUIRED FOR POURED CONCRETE 2: ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR CO. ALL CONSTRUCT;, :) SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. .,,7JM 9 DlATELYrr ENCL,bSE POOL TO COBE `>;lixPON COMPL'ETIdN COMPLY WITH ALL CODES OF BFQRE',WATER"a, NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF r-�� �r�ani n Tnin�ni pi enippOARD TEES nI v s ns;r, ® ELECTRICAL INSPECTION REQUIRED OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY A <3- B jB Akw*mm Ta F Fres F �� To T® t�wa A �a9 k� F Plan Piping . Arrangement %w Satan %w Uto F4 ftftw 42 OF Sects®n P—P P.SI aMPSD. ,yO 10 Section —A Typical Wall Sects® 01 SIGN SIZE A B C D E F G H AREA CAP FEET FT FT FT FT FT FT FT FT SQ. FT GAL. R 15 X 30 15 30 10 12 5 3 3 9 450 15,000 `�6(�i �l5 {►J�lilt C7 16 X 36 16 36 12 14 6 4 4 8 576 21,600 F®L SPA CENTRE PERMACRETE WALL, SYSTEM O AtWq� N�f 18 X 36 18 36 12 14 6 -4 5 8 648 24,300 929 ROute 25A Miller Place NY 11764ML 20 X 50H24 50 24 14 8 4 5 10 1000 34,000 . (631) 744-7185 FAX (631) 744-01674 1 q3 24 X 44124144118 14 8 4 8 10 798 35,000 , Suffolk Mcense #4436—M 24 X 4848 20 16 8 4 6 10 900 38,500 Nassau ltcemmse4 ®®®®