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HomeMy WebLinkAbout46015-Z �o�oSUF O,Ly Town of Southold 12/7/2021 a P.O.Box 1179 0 o • 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42580 Date: 12/7/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3300 Haywaters Rd., Cutchogue SCTM#: 473889 Sec/Block/Lot: 111.-11-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/10/2021 pursuant to which Building Permit No. 46015 dated 4/1/2021 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 Zip Zap 1 LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46015 11/8/2021 PLUMBERS CERTIFICATION DATED ut o 0 d Signature S�FFQI� TOWN OF SOUTHOLD �o� Day BUILDING DEPARTMENT y x 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#: 46015 Date: 4/1/2021 Permission is hereby granted to: Courtien, John 51 Bay Way Bay Shore, NY 11706 To: construct accessory in-ground swimming pool as applied for. At premises located at: 3300 Haywaters Rd., Cutchogue SCTM #473889 Sec/Block/Lot# 111.-11-12 Pursuant to application dated 3/10/2021 and approved by the Building Inspector. To expire on 10/1/2022. Fees: CO- SWIMMING POOL $50.00 SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 Total: $300.00 it Inspector OF SOUry®� Town Hall Annex ~ ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 �l • �o� sean.devlinitown.southold.ny.us �c®uv,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To. Zip Zap I LLC Address: 3300 Haywaters Rd city Cutchogue st: NY zip: 11935 Building Permit#: 46015 Section 111 Block: 11 Lot: 12 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: AS BUILT License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixture Time Clocks 1 Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Intermatic Pool Panel 4 Circuit/ 3 Used, Jandy Chlorinator, Heater, Pump 220GFI, Intermatic Tranny 3 Lights 120GFI Notes: " AS BUILT NO VISUAL DEFECTS " Pool Inspector Signature: �— Date: November 8, 2021 S.Devlin-Cert Electrical Compliance Form SUfd�k © _ BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD c, Town Hall Annex - 54375 Main Road - PO Box 1179 wSouthold, New York 11971-0959 � � Telephone (631) 765-1802 - FAX (631) 765-9502 . ro-gerrasoutholdtownny.aov — seanda-southoldtownny.aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: "3 2 Company Name: � Name: IDA uSD0 License No.: email: Jb 1J ` .Z3 Ifyc. Phone No-*. /51 _6- ly I I request an email copy of Cert' icate of Compliance Address.: W449 JOB SITE INFORMATION (All Information Required) Name: C-4 '5rLQiA Address: A --5 Cross Street: Phone No.: l-7 —5) Bldg.Permit#: (D(,j �j email: 5i/vy -? yywgka. . Tax Map District: 1000 Section: Block: Lot: , BRIEF DESCRIPTION OF WORK (Please Print Cle rly) Gv�'�'}iM ?CVJ Z�� Check All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES O. 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 o�aoF souryo! 00[ # TOWN OF SOUTHOLD BUILDING DEPT. �o�y onm � 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [' -] SULATION/CAULKING [ ] FRAMING/STRAPPING [ FINAL D� 1 [ ] FIREPLACE &`CHIMNEY " [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ,[ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PE C/O MARKS_: •C/ /O ��- m • i wu r ko k1f0 IK (om4e" DATE 0 ti INSPECTOR,)k z —162�0 UF SOUIyo H TOWN OF SOUTHOLD BUILDING/DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [- -] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: a e D1 ell 19a a fI tt c_ a IA 62/'lX_ DATE INSPECTOR �`- y I �aOF SoOlyo # # TOWN OF SOUTHOLD BUILDING DEPT. �ycouto N 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEG. [ --] ,FOUNDATION-2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ]` FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [- ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: i ?0Z� DATE < < ' a INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) (® ------------------------------------ O 'FOUNDATION (2ND) - z - o ROUGH FRAMING& y PLUMBING i 1 INSULATION PER N.Y. y STATE ENERGY CODE tf�V Y �nl 4 �o wi e 419Wk43 FINAL 5� K AIA s ADDITIONAL COMMENTS z r S' H O z d - tai O14g'AFFBI 't BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 a {, Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a)southoldtownny.gov - seandasoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Name: p License No.: -h-f email: Tb pj �1-1�0 )-e,, Phone No: 5 ® v �/Irequest an email co of Certi icate of 7 5 1copyCompliance_ Address.: 1.-7 Qk)91 v,-1 AI-" lLy JOB SITE INFORMATION (AII Information Required) Name: �jrLvf{� Address: .4r? 0e ,� S Cross Street: Phone No.: Ll-7 -51 Bldg.Permit#: L4(0 email: 'jj vY 2 rnaG�..�iv. Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Cle rly) GV/Y)7M n Z-- frgi Check All That Apply: Is job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: YES 0. - Issued On Temp Information: (Ad[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 t r Saffal/c G BUILDING DEPARTMENT- Electrical Inspector y1 TOWN OF SOUTHOLD o x Town Hall Annex - 54375 Main Road - PO Box 1179 ca c _ Southold, New York 11971-0959 4-4 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr ccbsoutholdtownny.gov — seand c(rbsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Name: � p X CA 2 CC_ License No.: email: Phone No: 6,3 � _2 c6 S g-j\❑I request an email copy of Certificate of Compliance Address.: JOB SITE INFORMATION (All Information Required) Name: C j vA C �,nQr7::, Address: Cross Street: .r Phone Nd.':-"'� _ -c:u `-Cl o--�s t`-t -6 BIdg.Permit#:T �� -- - - -- -- -- -- :email:- - - - -- - ---- --�- ---- -- - -- x , =- Tax'Map District: 1000 Section: ( Block: l Lot: I BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: - - - _ Is job ready for inspection?: YES NO ❑Rough In ❑Final Do you need a Temp Certificate?: DYES []NO Issued On Temp Information: (Ail information required) % f" Service Size ❑1 Ph ❑3 Ph Size: A. # Meters Old Meter# f - New Service, ❑ Service Reconnect ❑ Underground,❑Overhead # Underground Laterals 01 [:]2 [:]H Frame ❑Pole Work done on,Service? [:]Y [:]NJ Additional Information: PAYMENT DUE WITH APPLICATION �SC-) _ lel Electrical Inspection Form 2020.xlsx — — Y PERMIT# Address.- Switches ddress:Switches Outlets J G FI's Surface Sconces H H's UC Us , Fans - Fridge. ,exhaust Oven =" W/D --- -- — - •,; Smokes--- --- -- - - - -- - - -.pW-- ---�-- - -- ---- - .- _--------- - --; ---- -- -- ,-- °Carton _ IVl;icro' den`e'rato,r ` - - - r t LL � •fir ' r. .-. � , + ! �" M. - e - .- �' i . _ _, ..'r ... 'C = '= ' �`_ • AC- F AH Hood -Seruice, Y t - - ---- - - - -- - -- -- - -- s-- • � . .. _ - -- -- . .:_ -_ . -. •- - - � ----- - ---- --•--_._- - -------- =q-'tri�p --- -`Ffave � Use-� - Special: Comments — �jr r 4 I*d � � Vj 6-V,( Q CARRINGTON ROAD LOT 412 OUTDO PARCEL FETON1 Ix NIF CARRINGTON 1 FE 100FENCE x—x w1RE x—x—x—x 260.00' , x—x—x— n HM NO POSE _ MON CM FO N 76°53'30"E _ FD 00 N O b Q O In o O O 3000It AC 121'. WELL 9775' HEAD U) O, LOT d1 N v 1 STY w a ! 1. O o FR RESLLLJ Ca7 Z N •S.O� f LOT 413 ON #3300 "MAP OF SECTION D, NASSAU POINT aa asa p ,.14x, /1 98.23' APRON l'!i/�1 BELGIAN � CLUB PROPERTIES, INC." , /,{j LL BLOCK SITUATE AT CUTCHOGUE i ' g //i/f I JI' f'�'/' CONC. 'Q TOWN OF SOUTHOLDHM ?!c'i§ P POSED P!- \� \ BLUESTONE DRIVEWAY f O MON h SEPTIC !�'! oI RAILROAD SUFFOLK COUNTY, NEW YORK �� FD cli ; / �TIECURBScn w. FILED: MAY 7 1926, FILE#806 CERTIFIED TO: Z 29N SILVIA CAMPO aNO POSS. 1VN S 80°23'30"W 235.00' o DAVID HERMER NOTE EXICTINGSEPTIC I-MATIONSARE LOT 414 FIDELITY NATIONAL TITLE INSURANCE COMPANY APPROXIMATE AND BASED ON FIELD VERIFICATIONS SCALE 1'=30' LAND SURVEY LONG ISLAND.COM SCTM SURVEYED:1 1 OECEMBER1,2020 ` WARD BROOKS LAND SURVEYOR 11 OCEAN AVENUE } `,. ' - -,J;l SLI BLUE POINT, NY. 11715 \•ti ' { Jl-• cCOPYR,GHT AZO WARD BROOKS ALL RIGHTS RESERVED,DUPLICATION OF THIS DOCUMENT IS A VIOLATION OF FEDERAL COPYRIGHTI-W. 631 576-7794 631 363-3179 �` / `e� K)THIS SURVEY HAS BEEN PREPARED IN ACCORDANCE WfTH THE CODE OFPRACTICEADOPTEO BY THE NEW YORK STATE ASSOCIATION OF 1/ 1/ � vV /// r� PROFESSIONAL LAND SURVEYORS CER7IFICATIOh SHALL RUN ONLY TO THE PERSON THEIR INTERESTAND ORASSIGNS " ` � CERTIFiCATNS ARE NOT TRANSFERABLE.WA R D B R O O KS O @ G M A I L.C O M �� THE MOSTENCE OFR1G11TS OF WAY.AND'OR EASEMENTS OF RECORD.IF ANY HOT SHOWN ARE NOT GUARANTEED ANY ALTERATION OR APOITIO14 TO THIS SURVEY IS A VIOLATION OF SECTION 7209-2 OF THE NEW YORK STAB EDUCATION LAW. FILE#11017 DO NOT SCALE FENCES OFFSETS SUPERCEDE,NO DORMERS.NO SOLAR HM ENGINEERING P.C. P.O.BOX 914 EAST NOMPORT,NY 11731 TEL 516476-6392 EMAIL HMARNIKA60PTONUNE.NET Febnumy 22,2021 Revised March 19,2021 MAR 22 2021 Town of Southold Building Department '7,1,�7eN Town Hall Southold,N.Y. 11971 Dea I r SkMadam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of: Campo Residence 3300 Haywaters Road Cutchogue,N.Y. 11935 will;not require draining because the pool is constructed with a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not hiterfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private to Sincerely, HM gmeermig P. P.E. JlJILVL I Certificate of NYS Workers'Compensation Insurance Coverage Workers'YQ CERTIFICATE OF K NYS WORKERS'COMPENSATION INSURANCE COVERAGE Sfi4TE Compensation Board ' Insured Detail la.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Islandia Pools Ltd `631-727-6312 108 Fisher Avenue Riverhead,NY 11901 lc.NYS Unemployment Insurance Employer Registration Number of Insured ! ld.Federal Employer Identification Number of Insured Work Location of Insured On required i coverage is or Social Security Number ly f g specifically limited to - 112915558 certain location in New York State,i.e,a Wrap-Up Policy) i I 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Company,Inc. Town of Southold Building Dept. 53095 Main Road 3b.Policy Number of entity listed in bog"la": Southold, 1'11971 TWC3961844 3c..Policy effective period: 4/25/2021 to 4/25/2022 i I 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 certifiers that the insurance carrier indicated above in box 113"insures the business referenced above in box"la"for workers'compensation under the 14 e 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 nod fy the above certificate holder and the Workers'Compensation Board within IO days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated on this Cetfiftcate: (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 13c';whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved By: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance carrier) JF& Approved By: Z. 3/3/2021 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier:CorrierPhone Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 fonn.Insurance brokers are NOT authorized to issue it. hfps://wc.amtrustgroup.com/ANAWC/PolicyNYCertificateOfWclns.aspx?lndexld=329590&lnstanceld=ddda0l8f-80bb-1cc2-9x63-d722398ee00e 1/2 Client#: 4647 ISLAP002 A-('D`RDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/03/2021 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 CT Edgewood Partners Insurance Ce Edgewood Partners Insurance Center a/c°ONro,Ext 63190-9700 FAX 63190-9700 AIC,No Marcus DriveE-MAILD 3rd Floor ASS: certificates@cookmaran.com 3r Melville,NY 11747 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Co 18058 INSURED Islandia Pools Ltd. INSURER B:Technology Insurance Company,Inc. 42376 108 Fishel Avenue INSURER C Riverhead, NY 11901 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDIDIYYYYY POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2127301 4/25/2020 04/25/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 PRO- POLICY�JECT a LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER' $ A AUTOMOBILE LIABILITY PHPK2127301 4/25/2020 04/25/2021 'ccdeDSINGLELIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED X AUTOS ONLY X PROPERTYDAMAGE AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR PHUB720492 4/25/2020 04/25/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$10,000 $ STAT B WORKERS COMPENSATION TWC3875091 4/25/2020 04/25/2021 PER OT AND EMPLOYERS'LIABILITY YIN H- AND PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT S1 OOO OOO OFFICER/MEMBER EXCLUDED? � N I A (Mandatory in NH) EL DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I 51,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold 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 tl.S74717311M97-9si3 KPFLIR Islandia Pools, Ltd. Sales Ordbr' 108 Fishel Avenue Riverhead, NY 11901 Salesperson 1: John wysoczanski Phone: 631-727-6312 Fax: 631-727-8419 Email:john@islandiapools.com Web: www.islandiapools.com Sales Type: Inground Vinyl Pool a Revenue Center: Sales inground poo _r Invoice 73779 11111111111111111111111 lip 111111111111111 I N Created: 1/26/2021 11:36:41 AM Completed: 2/16/2021 10:11:09 AM Customer Id:9874 Register. JOHN IIIIIIIIIIIIIIIIIII111111111111111 SILVIA CAMPO H: C:917-470-5146 300-HAYWARDS RD W: F: Email: silviacampo23@gmaii.com CUTCHOGUE, NY 11935 Qty Part Number Description Price Discount Amount 1 16X32 VINYL POOL 16X32 1/26/21 52,702.00 52,702.00 (CAMPO)2 3500 P.S.I poured concrete with steel reinforcing pool construction with limited lifetime guarantee(non-prorated)20 gauge virgin vinyl liner, automatic skimmer,2 hydro returns, all 801b pressure pipe and all necessary plumbing, quick.disconnect-unions on all plumbing lines *Excavation -Dirt removal&rough grading up to 4' round -Boxed extrusion -Stainless steel ladder -Fine washed sand for base -Vacuum set see-below -Personalized training in maintenance of pool -Starter chemicals up to$100.00 -Rigid PVC pipe 2" -CARTRIDGE FILTER -VARIABLE SPEED PUMP 7 HAY-25-1644 WALL FITTING INLET SP1411 1 -PER-35-770 LADDER JIG 20"CENTER ALUMINUM 1 SRS-35-1260 LADDER SS COPING MOUNT 3 CYCOLAC TREAD 2 HAY-25-1527 SKIMMER VINYL WIDEMOUTH 13 CAR-811-030 EXTRUSION TM ALUM 8'X 3"WIDE 2 GAD-60-6169 WALL FOAM ROLL1/41N X 421N X 125'2LB 12 GAD-801-6169 SPRAY ADHESIVE SUPER 72 1 TLD-10-2127 ZODIAC 230V 2.7HP VARIABLE SPEED PUMP 1 TLD-05-118 JANDY PRO SERIES CV CARTRIDGE FILTER 1 PVU-37-303 EQUIPMENT PAD 36 X 36 X 2 BLACK PLASTIC 2 AAA-37-5052 PORTLAND GRAY CEMENT 94 LB TYPE 1 1 AMG-40-2219 ROPE& FLOAT KIT 16FT 2 AMG-40-2226 ROPE STRAP ANCHOR ALUM 15 AAA-56-4137 PVC PIPE 21N X 20FT SCH 40 Invoice: 73779 SILVIA CAMPO Wednesday,March 03,2021 Page I of 5 25 LAS-56-0602 ELBOW 90 21N SWEEP 4 LAS-56-4056 TEE 21N SOC X SOC X SOC 7 LAS-56-4090 MALE ADAPTER 21N MPT X SOC 25 LAS-56-4080 COUPLING 21N SLIP X SLIP 3 LAS-56-4073 ELBOW 45 21N SOC X SOC 3 LAS-56-4595 UNION 21N SOCKET SCH 80 2 LAS-56-4110 PLUG-1 1/21N MPT 1 UEL-60-5040 PRIMER CLEAR PVC 1 QUART 1 UEL-60-5259 CEMENT CLEAR PVC QUART 1 HAY-25-1031 MAIN DRAIN VINYL 21N W/AV COVER 2 PAK 2 PAC-56-4102 PENTAIR 3 WAY VALVE 21N 2 HAY-25-1546 EYEBALL 3/4"OPENING WHITE 1 AMG-60-5034 DUCT TAPE 21N X 180FT STD 1 PBM-40-2079 ALARM IN-GRD W/REMO POOLGUARD- 1 START UP START UP CHEMICALS FOR NEW POOL CHEMICALS FOR NEIN POOL Chemicals are non returnable due to safety reasons. 1 HAY-40-2158 VAC HEAD W/WEIGHTS DELUXE HAYW 1 HAY-25-1538 SKIM VAC SP1 106 1 PSL-40-9545 VACUUM HOSE POOL FLEX 45' vaccuum and filter hoses are non returnable if they were--placed in water,OR if the bag is open. 3 JDY-30-0745 JANDY LED WHITE LITE 24W/100' CORD 1 LOOP LOC COVER LOOP LOC COVER 16X32 NO STEP STANDARD 16X32 N/STEP 2 BHD-801-615 STEP ROD CLIPS 12 PAK 2 LINER UP GRADE LINER UP GRAND FOR CONCRETE STEPS FOR STEPS 18FT 2 BHD-801-616 STEP RODS(FG) 3 PAK 1 LAR-15-501 JANDY JX1400 PROPANE HEATER 1 INTI-30-749 JANDY TRANSFORMERIDOW FOR LED LIGHTS 1 JDY-45-9877 JANDY TRUCLEAR SALT CHLOR 35K GAL NO UNION 28 23240 BIOGUARD MINERAL SPRING. BEGINNINGS 27.91-6 Chemicals are non returnable due to safety reasons. Non-Taxable Items —Consists of both Taxable and Non-Taxable amounts Sub Total $52,702.00 Total' $52,702.00 State Tax $0.00 City/County Tax $0.00 Amount Due $52,702.00 Amount Paid $21,080.80 Balance $31,621.20 Pa ments Invoice: 73779 SILVIA CAMPO Wednesday,March 03,2021 Page 2 of 5 Type Approval Code Id Numbers Amount Date of Trans Type Reference# Date Received Employee Name Check $21,080.80 1/29/2021 P 101 1/29/2021 Dave Freebom Special Comments: This Quote was created on 12/31/2020 2:24:01 PM ESTIMATE IS FOR 16X32 VINYL SWIMMING POOL. LADDER, ROUGH GRADING AROUND POOL, DRY WELL AS PER TOWN CODE, POOL ALARM,POOL, PERMIT AND LOOP LOC COVER FOR WINTER IF WANTED, THESE ITEMS CAN BE ADDED TO THE ORIGINAL PRICE OF THIS POOL: MINERAL SPRINGS SALTS SYSTEM--------------INCLUDED JANDY PROPANE HEATER--------------=---------- INCLUDED (CUSTOMER IS RESPONSIBLE-FOR PROPANE INSTALLATION) ELECTRIC-WORK UP TO-60-FT__----_-__------INCLUDED ELECTRICAL WORK AFTER 60,FT-----------------$21.50 PER FT. STEPS ACROSS WIDTH OF SHALLOW END---INCLUDED LED WHITE LIGHTS-----------------------INCLUDED ANY TREE WORK, DEBRIS ,BRUSH, CLEARING WORK OR BIG ROCKS WOULD BE AN EXTRA CHARGE QUOTE IS GOOD UNTIL END OF JANUARY 2021 AGREEMENT OF SALE: Contract between(Seller)hereinafter called the corporation and Purchaser hereinafter called the customer(Owner)hereby orders from Seller subject to all terms,conditions and agreements contained hererin,and the ADDITIONAL PROVISIONS printed on the bottom of this page hereof.1 Entrance to property to be determined by Customer. Customer Sign X TERM OF PAYMENT TOTAL DEPOSIT 40% EXCAVATION 30% INSTALLATION OF WALLS 25% INSTALLATION OF LINER 4% START UP BALANCE NOTE:This is subject to the written acceptance of an authorized officer of the Corporation. Purchaser's deposit will be retumed if not accepted. ACCEPTED BY SELLER: NAME DATE ALL CHANGES TO THIS CONTRACT MUST BE MADE IN WRITING. COMPLETE COVERAGE ON WORKMENS COMPENSTATION AND PUBLIC LIABILITY INSURANCE: Licensed and Insured#16641-HI Seller is responsible to obtain a permit for the pool up to cost of$250.00. Purchaser is responsible for all costs for surveys, inspections and other items necessary to obtain said permit or Certificate of Occupancy or varriance. Purchaser is responsible to apply for and obtain the Certificate of Occupancy for the pool as items such as fencing,self-latching doors and electrical certificates may be required but are outside the scope for the contract. SIGN X I HAVE READ AND FULLY UNDERSTAND THE PAYMENT SCHEDULE: Invoice: 73779 SILVIA CAMPO Wednesday,March 03,2021 Page 3 of 5 SIGN X ISLANDIA POOLS LTD. IS NOT RESPONSIBLE FOR DAMAGE TO ANY SIDEWALKS, CURBS, PATIOS, DRIVEWAYS,TREES, SHRUBS, FENCES,SPRINKLERS OR OTHER ITEMS THAT INTERFERE WITH INGRESS AND EGRESS OF ANY TRUCK OR EQUIPMENT THAT IS USED BY SELLER OR ITS AGENTS IN PERFORMING ANY ACT REQUIRED TO COMPLETE SELLERS OBLIGATION UNDER THIS CONTRACT. SIGN-X CUSTOMER HAS THE RIGHT TO CANCEL THIS CONTRACT WITHTIN THREE(3)BUSINESS DAYS OF THE SIGNING OF SAID CONTRACT.ALL PAYMENTS WILL BE PROGRESSED PAYMENTS IN ACCORDANCE WITH THE LIEN LAW. NO PAYMENT WILL BE HELD IN ESCROW. SIGN X DEWATERIZATION EXTRA CHARGE IF NEEDED.ANY DIRT LEFT ON PROPERTY BY CUSTOMERS REQUEST WILL NOT BE REMOVED WITHOUT AN ADDITIONAL CHARGE. SIGN X ADDITIONAL PROVISIONS The owner,contracting with Islandia Pools Ltd.agrees to direct the pool location on his property and to be responsible therefor, all measurements are approximate. The pool site shall be accessible for excavating equipment and trucks,site preparation shall be the responsibility of the owner. The ground to be excavated shall be free of rock and/or obstructions;any extra cost incurred by reason of foreign matter shall be paid for by the owner,this includes a hight water table which will increase the cost of installation. There shall be no responsibility by seller for damge to lawn,shrubs,trees, curbs,sidewalks,etc;there shall be no obligation for restoration of landscaping or grounds by seller. Seller shall work with all possible speed but shall not be liable for delay caused by strikes,weather conditions or acts of God and the same shall not be grounds for owners violation of this contract. Warranty, Islandia Pools Ltd.warrants all materials used in the installation will be new, of best quality,and the work done in a competent and workmanlike manner. The assemblies or units(such as heaters,pumps,motors,etc.)and standard fittings or accessories furnished are subject to manufacturers guarantee and any recourse for defective materials shall be against the manufacturers only. The buyer agrees that any recourse against the seller for defective/negligent installation is limited only to repair and/or replacement of the defectively installed assembly or unit and does not cover any consequential damages. This warranty is the only warranty applicable to this contract and is expressly in lieu of any warranty or conditions otherwise implied by law, including but not limited to implied warranties of merchantability or fitness for a particular purpose. The remedies under this warranty shall be the only remedies available to the buyer or any other person and neither the seller or any authorized agent of the seller assumes any other obligation or repsonsibility to the condition of the purchased item,and neither assumes or authorizes anyone to assume for the seller,any additional liability. Any work stoppage caused by owner shall be paid for by owner at the rate of$200 per day. Owner agrees to waive trial by jury. He shall give promptly all necessary information to secure financing whenever required and indicated in the contract; his failure to do so will be a breach of contract on his part. If owner should refuse to pay for additional cost incurred,or to be incurred; by reason of presence of rocks,obstructions etc.,then seller shall have the right to forthwith discontinue work and immediately remove his equipment,and have no further liability to owner. Seller responsibility is to obtain permit from a municipal authority to construct the swimming pool. Owner responsibility is to have the pool inspected and passed as to proper construction by the proper authority. Title to the filter and all other removable equipment shall remain in Seller until payment in full of the contract price. Seller shall have no duty or responsibility for any other inspections or certificate of occupancy. Owner agrees to pay seller balance of contract price in full on START UP. Fencing,electrical work,retaining walls, deviation of existing water drainage flow,dry wells, heater gas connection,etc., and any and all other work necessary; not contained in the above contract,shall be the sole responsibility of the owner. The pool warranty is not valid until final payment of the pool installation is paid and this warranty is signed by an officer of this corporation. Where electrical,fencing,dry well, retaining walls,and etc.are included therein,the seller responsibility is limited to recommending a contractor for such work and the payment of his fees once received from purchaser. Fees included herein for such work are estimates only and any excess cost determined from vouched invoices shall be paid by purchaser/owner. Contractor once accepted by owner/purchaser are contractors of purchaser/owner. Purchaser represents and warrants that he is the owner of the real property on which the pool is to be constructed or that he is other wise authorized on behalf of the owners to enter into this agreement. Purchaser/owner agrees to obtain at his own cost and expense any and all special licenses,variances,and/or permits in excess of$50.00 of cost for the installation of said pool from any and every regulatory authority state,county,town or municipal, having jurisdiction thereof. Purchaser agrees to provide ingress and egress to and around the ground area of the pool site for necessary vehicles and equipment. He shall pay the expense of the site preparation including removal or protection of trees and other vegetation, removal or change in piping, wires,drains or any other type of obstruction, underground or otherwise. Purchaser agrees to hold Seller harmless from any and all claims arising while Seller, its agents,servants,and/or employees are on or not present on the site. Purchaser agrees that,if for any reason whatsoever, any Town, City, County, State or other municipal board having jurisdiction of the installation shall require the installation of a dry well or other water waste facilities,etc., or additional construction such as fences, retaining walls, etc., either before or after the costruction of the pool, Purchaser will hold Seller harmless from cost or Invoice: 73779 SILVIA CAMPO Wednesday,March 03,2021 Page 4 of 5 responsibility therefor. ALL GUARANTEES AND WARRANTIES ARE NULL AND VOID UNTIL BALANCE ON POOL IS PAID IN FULL. This agreement constitutes the entire agreement between the parties,and may not be altered or amended except in writing executed by the parties hereto, and shall be binding upon the executors, heirs,successors and assigns of the parties hereto. It is understood that all liners are not 100%wrinkle free. Cosmetic defects in the liner are not the responsibility of the Seller. Purchaser agrees that if Islandia Pools Ltd.institutes action to collect the sums due,any and all attorney's fees shall be added to the amount due. SELLER PURCHASER PURCHASER Invoice: 73779 SILVIA CAMPO Wednesday,March 03,2021 Page 5 of 5 4a APP V D AS NOTED f RETAIN STORM DATE: B.P.# WATER RUNOFF F : G�`• PURSUANT TO CHAPTER 236 EE � NOTIFY BUILDING ^_�ARTMENT AT OF THE TOWN CODE, 765-1802 8 AM TO a PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUC"10N MUST BE COMPLETE F-)F CO. ALL CONSTRUCTION S.;ALL MEET THE REQUIREMENTS OF THE CODES OF NEW ELECTRICAL YORK STATE. NOT RESPONSIBLE FOR INSPECTION REQUIRED DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF 11THOLD TOWN ZBA S BOARD SOUTHOL tlN-TRTEES t�IMiMEk.)IATELY,� ENCLOSE POOL TO CODE.- -.UPON ODE- -•UPON COMPLETION ,,BEFORE"WATER'' OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATC OF OCCUPANCY ,Y POOL NOTES: TRACK FOR 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION PUMP AND BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC FILTER VINYL LINER CODE. SKIMMER VINYL LINER 2.POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1. 3.SECTION R326.7 POOL ALARM REQUIRED. (TYP•) 8.5" 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4. I_�T FOAM PADDING 3,500 PSI 5.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE CONCRETE OF NYS SECTION R403.10: d POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). ° SECTION R403.10.1 HEATERS SECTION R403.10.2 TIME SWITCHES II PROPOSED VINYL #4 REBAR TOP SECTION R403.10.3 COVERS & BOTTOM ° 'q° 4.2" 6.REBAR SHALL BE 3"MIN.CLEAR TO EARTH. RETURN I I SWIMMING POOL 7.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS 3' AND SHALL COMPLY WITH ALL LOCAL ZONING REQUIREMENTS. MIN. 512 S.F. 16 ° v 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME ° BAKER(VGB)POOL AND SPA SAFETY ACT. DUAL MAIN DRAINS WITH 9.SLOPE PATIO SURFACE 1/4"PER FOOT AWAY FROM POOL. STRAINER (VGB SAFETY v 10.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR ACT APPROVED DRAINS) ° LARGE ROCKS). I/ , 11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH` STEPS ANSI/APSP/ICC 7. 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. 13.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF 32 12.5 POOL. TYPICAL WALL DETAIL 14.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 300 HAYWATERS ROAD, CUTCHOGUE,N.Y.11935 ONLY. SCALE: 3//4" = 1'-0" 15.NO DIVING EQUIPMENT PERMITTED. 16.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A NOTE: NOTES: MINIMUM LAP OF 30 BAR DIAMETERS. THIS ISA NON-DIVING POOL. 1.WALLS SHALL BEAR ON UNDISTURBED SOIL. 17.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL POOL PLAN 2.ALL CONCRETE SHALL BE PLACED AS A MONOLITHIC POUR. LOADS WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION EQUIPMENT OR NOT TO SCALE ANY OTHER LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING OR PROPOSED ADJACENT STRUCTURES.IF SITE CONDITIONS DIFFER FROM THIS PLAN,IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO CONTACT HM ENGINEERING,P.C. BEFORE ANY CONSTRUCTION BEGINS. 18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION MEANS,METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR, 6' 3'-4" �—CONCRETE WALL NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE _ _ _ _ (SEE SECTION FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH 3 71 THIS SHEET) THIS PLAN. 1 ® - UNDISTURBED - 1 1/2" TO WASTE EARTH (TYP.) HAIR & LINT STRAINER 3' 6' 8' 15' PUMP 3" COMPACTED SAND FILTER AUTO SKIMMER POOL PROFILE NOT TO SCALE --------I�Z POOL BCK TO GENERAL NOTE: POOL ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. PREPARED FOR: 2 MAIN DRAINS CAMPO RESIDENCE SCHEMATIC PIPING ARRANGEMENT WITH HYDROSTATIC VALVE AND 300 HAYWATER ROAD NOT TO SCALE COLLECTOR TUBE IN GRAVEL BASE CU CHOGUE, 1193 DATE: 02/22/2021 NOTE: Al", HM ENGINEERING, P.C.THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P,C.. /� ' / � SCALE: ASSHOWN UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE e �/ � vz/ P.O.BOX 914 EAST NORTHPORT, NY 11731 SHEET: 1OF1 NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. sssFTel-(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.net RESIDENTIAL CONCRETE ID WITHSEALANDBLUESIGNATURE VINYL LINER POOL PLAN