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HomeMy WebLinkAbout46061-Z �o�oS�FFUt�-�PGy Town of Southold 1/15/2022 P.O.Box 1179 CD o _ ze 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42687 Date: 1/15/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 300 Corey Creek Ln, Southold SCTM#: 473889 Sec/Block/Lot: 78.4-7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/19/2021 pursuant to which Building Permit No. 46061 dated 4/12/2021 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: accesso in-ground swimming pool fenced to code as applied for. The certificate is issued to Colon,Nick&Stellato,Colleen of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46061 9/3/2021 PLUMBERS CERTIFICATION DATED Authoriz Signature �o�SUEEat/( TOWN OF SOUTHOLD Gy BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE SOUTHOLD, NY dol � ya� 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#: 46061 Date: 4/12/2021 Permission is hereby granted to: WH Crumb LLC 1365 Watersedge Way Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. At premises located at: 300 Corey Creek Ln, Southold SCTM # 473889 Sec/Block/Lot# 78.-4-7 Pursuant to application dated 3/19/2021 and approved by the Building Inspector. To expire on 10/12/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 BL ng Inspector SO!/Tyol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Sean.devlin(M-town.south old.ny.us Southold,NY 11971-0959 oly�0UNT1,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Nick Colon Address: 300 Corey Creek Ln city:Southold st: NY zip: 11971 Building Permit#: 46061 Section: 78 Block: 4 Lot: 7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Electric Joe License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor 1st Floor Pool �( New 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 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 Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Pentair Easy Touch, Heater, Pump 220GFI, J&J Tranny, Salt Generator, Sub Panel Notes: Pool Inspector Signature: C�� Date: September 3, 2021 S.Devlin-Cert Electrical Compliance Form OE SOUTyOlo # 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: G rw A-(, tx:� DATE INSPECTOR SOUlyolo # * TOWN OF SOUTHOLD BUILDING DEPT. co 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. " [ ] FOUNDATION 2ND [ ] SULA ION/CAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRESAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: � S OVA PIAM1 tv DATER INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION _ [ ] FOUNDATION- 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] 1NSULATIOWCAULKING [ ] FRAMING /STRAPPING [ 'FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ _ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: . �• 0 DATE 4 (3I�22 INSPECTOR F IELD.INSPECTION REPORT -DATE GOIVIM NTS 77777 777-- ►d Q FOUNDATION(1ST) FOUNDATION(2N)?) ' O. ROUGH FRAMING:& H PLUM-BIN.G.' . INSULATION.PER N.Y. y STATE ENERGY CODE J t t of t FINAL Coe ADDITION C.O AENTS 14*4 • . . . lib D , • 4.01 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny..ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. �lJ� Building fns ector: � L•.-.•'` MAR 1 9 2021 Applications and formsrnnust be filled out°;m their entirety Incomplete applications wili not be�accepted Where�the Apphcant�is not the owner,an .A. . __ � ;:, , r , � O+nrner's Authorization form(Page 2j shall be completed � �'�� � �• Date:09/09/2021 Name Nick Colon SCTM#Z000 Project Address:300 Corey Creek Lane, Southold, NY 11971 y Phone#:516-721-7584 Email:nick.colo.n@gmail.com Mailing Address 300 Corey Creek v Lane, Southold,w NY 11971 x - Name:Jason Simmons Mailing Address:P,O. Box 133,1, Hampton Bays NY 11946 Phone#:631 324-7844 Email:office asons ools.com DESIGN PROFESSIONAL#INFORMATION Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION Y Name: Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTt2UCTION t ❑New Structure ❑Addition ❑Alteration ❑Repair El Demolition Estimated Cost of Project: Other 20'x 40'vinyl swimming pool $54,726.00 [Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property Intended use of property _ .,.,,,.. _ .esldentia__,�___ _. . ,._ _. _ _._,_ . _ _ .M.__M.Residential . .. . Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ®No IF YES, PROVIDE A COPY. r 8 Check BOX After Reading The owner/contracf'or/design professional is responsible for all drainage and=storm water issues as provided by s ^ Chapter 236 of the Town Code APPLICATION IS HEREBY MADE to the.Budding'Department for the issuance of a Building Permit pursuaklo the Building Zone aOCdinance of the Town of Southold,Suffolk,County,New York and other applicable LavuS;Ordinances or Regulations;for the cohstruction of buildings, atlditions,alterations or for removal or demohfion as herein tlescnbed The applicant agrees to'comply w�tli`ail applicable laws:ortlmances,budding housing code andregulations and to admit authorised inspectors onJpremises'and m buildmg(s)for necessary inspections Falsestatements made herein are; punishable as a Class A misdemeanor pursuant toSection E210 45 of the NeHr York State penal Application Submitted By(print name):Jason Simmons IRAuthorized Agent ❑Owner Signature of Applicant: Date: 3/9/21 STATE OF NEW YORK) SS: COUNTY OF SjAffDjV ) Nick Colon being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is theJason Simmons (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 M day of Ma� �(�h , 20 r t ' 1 1a ','►►q,,i Notary Public o°_c, ,, 10 e PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) Nick Colon 300 Corey Creek Lane, Southold, NY 11971 '��.,,► �RES ���.��`��� I, residing at do hereby authorizeJason Simmons to apply on my behalf to the Town of Southold Building Department for approval as described herein. / a Owner's Signature Date Nick Colon Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector % TOWN OF SOUTHOLD x F Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 � )Y'' rogerr .southoldtownny.goV—seandasoutholdto nnu.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ali information Required) Date: f f f1 ' Company Name: �ovrc Sar. • i �-r«� Name: B J License No.: LI!R u h-a -- ME email: i cr c n k r Phone No: . L� _ MI request an email copy of Cert ificat. of Compliance Address.: &vc 11 -722 JOB SITE INFORMATION (All Information Requii ed) Name: Address: 9b . Cross Street: Phone No. BIdg.Permit#: t4C0 fvemail: Tax Map District: 1000 Section: Block: Lot: BRIEF('DESCRIPTION OF WORK (Please Print Clearly) ;,� t') tP,Ckrr-'J0 c�At U Check All That Apply: Is job ready for inspection?: [2YES ❑NO ❑Rough In ❑Final Do you need a Temp Certificate?: ❑YES [DNO Issued On Temp Information: (All information required) Service Size ❑l Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect [] Underground ❑Overhead #Underground Laterals 01 02 OH Frame❑Pole Work done on Service? QY ❑N Additional Information: PAYMENT DUE WITH APPLICATION 1 IA (0 Electrical Inspection Form 2020.xlsx 0 1 I � t PERMIT# Address: Switches L Outlets 1 G F I'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: Comments. LT 01 ��b� BUILDING DEPARTMENT- Electrical Inspector , TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 `i C42 Zr ?Y Southold, New York 11971-0959 , dam Telephone (631) 765-1802 - FAX (631) 765-9502 -rogerr southoldtoWnny.gov - sea nd(o_southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Name: License No.: email: Phone No: ❑I 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; Y; Is job ready for inspection?: DYES ❑NO ❑Rough,In ❑Final Do you need a Temp Certificate?: DYES,, ❑NO Issued On; Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑1 02 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.x1sx S.C.T.M. NO. DISTRICT: 1000 SE011ON:78 BLOCK:4 LOT(S):7 1 MON.I � 9 EL 15.0 S�'48g0" F !P0� Z EL 17.4 ' c LOT 4 EL 18.5 p ^i EL 1a.5 o. A-91: F rc1 (r��}� $ LOT 5 ....•;.;:':::•. i+ , I (kegyy�� J 1 ',:.,,}•,••,� 3y478. MON. I EL 1&2 ip w rhR '-•'-• - IT !y ' IV 78016'20, N ;-�1 CRY r .. .-j3 W I l fipyyy� I LOT a STKK EL 18.4 208• 60' EL 18.0 MON i n SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES APPROVAL OF CONFTRIIMDWORKS FOR Qate ID rz NOV 2 0 2020 H.S.K6 NO. L g-00-C®q0 The seRage disposal and nater aaptay fa MISS et ms IOMUOn haus bean Inspected and/or cedi6ed by NIs Dep oroar Poncks and found to bosalldactmyF RAMAXMUWQt. 44 BEDROONM,S, DRAINAGE CALCULATIONS: ' `�• _ A)awaJAG Foo1PRINr-i,800 Sam 1.100 x 0.161-29&80<291d REOUIRM ZONED R-40 Cra;3 Knepper,P.E.,Chief (2)e'DA x 4'DEEP DRYWELL.338d PROWIDED NON-CONFORMING LOT DRNEWAY- sa.Fr. FRONT YARD: 40'MIN Offlce Ot Wastewater Management 155s) x 0.166ass-15901 REAR YARD: 50'MIN (1)8'DA x 4'DEEP D1rt1Ya1.�7694 PROWIDID SIDE YARD: 15'MIN 35'TOTAL FINAL SURVEY 10-09-20 THE WATER SUPPLY, WELLS DRYWELLS AND CESSPOOL FND. LOC. 06-22-20 LOCATIONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS AREA:25,881.83 SQ.FT. or 0.59 ACRES ELEVA170M DATUM: NAVDBB UNAUTHORIZED ALTERA77ON OR ADD17701V TO THIS SURVEY IS A 140LA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA710M LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM 7HE SURVEY IS PREPARED AND ON HIS BEHALF To THE 717LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS777VI70N LISTED HEREOA;AND TO THE ASST61PEEM OF THE LENDING INS77TU770N, GUARANTEES ARE NOT TRANSFERABLE THE OFFSETS OR DIMENSIONS SHOWN,gf0,V FROM TH;-PROPERTY LINES TO THE STRUC7URES ARE FOR A SPECIFIC PURPOSE AND USE 7HEREFORE THEY ARE NOT INTENDED TD MONUMENT THE PRO ,MTY LINES OR�.'O GUIDE THE EREC770N OF FENCES,ADD177ONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EA"FJV7S AND/OR SUBSURFACE STRUe7URES RECORDED OI =QOED ARE Nor GUARANTEED UNLESS PHYSICALLY ENDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF:LOT 5 w CERTIFIED TO: SLIGO CONSTRUCTION' MAP OF. COREY CREEK ESTATES ba FILED: AUGUST 15, 1967 No.4923 T o SITUATED AT:BAYVIEW rowN OR SOUTHOLD �1 KENNETHMM TPOYC K I A�SUR�G, PLLC SUFFOLK COUNTY, NEW YORK ��U1 Professional Land Surveying and Design P.O. Box 159 Aquebogue, New York 11951 FILE d 19-185 SCALE: 1"=30' DATE:DEC. 18, 2019 Y PHONE(891)298-1688 FAX(691)298-1588 N.Y.S. USC. NO. 050882 1 mamUmtn8 the mordo of Robert J.H=neetq 8 Kmnolh H.Boyohnic r ,- S:4 o `SLS;. o-Si.2ch ixv - GFIbA':.7a i3 ci<::•!. w;,j 5j;7 (. � t AL d E. 5G S7p 48i^sA .. c p b '``_ 0 s - - �� ;. _yr• � � :. _ ��F/f 1t� w��,c �f� * i�.�p�2A�: 1 t'+r' . U Ear 3 t~as••^srQ stray: ff{{r'f 1'�/ � e w 4x� G.1 s is .. .iA,�H z, -•_^�...,, "�.-:- y 1v',nuc t�a ' > 'r_'�` -. 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'8; 2,19 Y LiS ,.G: J ;2 ..teas tAt,Ir1K n, oras u. ra:e,rrt J.lk a Y k Ken-111 JI.Wk-huk 2 N workers' .STATE Compensation CERTIFICATE OF INSURANCE COVERAGE Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed_Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b:Business Telephone Number of Insured MARYMEG INC DBA BILL'S POOL SERVICE 631-324-7844 DBA Jason's Pools P.O BOX 1331 HAMPTON BAYS,NY-11946 1c.Federal Employer Identification Number of Insured Work Location of Insured(Drily required if coverage is specifically limited to or Social Security NumbeP certain locations in New York State,i.e.,Wrap-Up Policy) 113168202 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) $helterPoint Life Insurance Company Town of.S6i thold Building Depaftment 3b.Policy Number of Entity Listed in Box"1a" Town Hall Southold, NY 11971 DBL446593' 3c.Policy effective period .. 01/01/2020 to 12/31./202.1_. 4. Policyprovides 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 of employer's employees: W. 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 11/9/2020.' By "Of 1 (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier): Telephone Number . 516-826-8100 Name and Title Richard.White; Chief Executive Officer 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 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,.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 5B of Part 1 has been checked) State of New Yolrk Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied.with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10.17) �IIIIIP1°°°1°20°°1°°111111°�17°1°I�I�I NewWorkers' sr°aT Compensation :Board CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of insured(use street address only) 1 b.Business Telephone Number of Insured MARYMEG INC DBA JASON AND BILLS POOLS 1c.NYS Unemployment Insurance Employer PO BOX 1331 Registration Number of Insured HAMPTON BAYS NY 11946 Work Location of Insured(Only required if coverage is speccally 1d. Federal Employer Identification Number of Insured or Social SecurityNumber limited to certain locations in New York State,i.e.a Wrap-Up Policy) 11-3168202 2 Name and•Address of the Entity Requesting Proof of Coverage(Entity Being Listed as`the Certificate Holder) 3a,Name of Insurance Carrier Town of Southold Property and Casualty Insurance Company of Building Department: Hartford 34690: TOWN HALL SOUTHOLD NY 11971 3b.Policy Number of Entity Listed in Box'1a": 12 WE 0.12629 3c.Policy effective period: 03/23/2020 to 03/23/2021 3d.The Proprietor,Partners or Executive Officers are 0 Included.(Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that.the insurance carrier indicated above ih box"3" insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"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 insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whicheer is earlier.he This certificate is issued.as a matter of information only and confers no tights 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 Worker's 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 narried 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;1 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:. Daflielle Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved by. -.4 yjn 9i (2&, ,z 04/01/2020 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: (877)853-2582 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) Form WC 88 31 21 F Printed in U.S.A. `Nww.wcb.ny.gov Page 1 of 2 ,�►C R DATE CERTIFICATE OF LIABILITY INSURANCE 1012612020 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 endorsements. PRODUCER CONTACT. BARSON ASSOCIATES INC . PHONE. • 631 689-6106 FAX Nn: (631)689-6084 207 HAllock Rd.Ste 1 . E-MAIL Stony Brook,NY 1.1790 , INSURERS AFFORDING COVERAGE NAIL 0 INSURER A': XL ftecialty Insurance 37885 INSURED INSURER 6: . Ma me Inc&6 Jason Pools rY 9, - .. PO BOX 1331 INSURERD: . Hampton Bays;NY 11945 INSURERE:. INSURER F: COVERAGES.:.:".': _ CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE,TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN_SR ADDL SUER LTR -_ TYPE OF INSURANCEmm 01 POLICY NUMBER- MMlDDY EFF PM1DD EXP YYyi LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1 OOO OOO' CLAIMS-MADE X' OCCUR DAMAG O!NT PREMISES Me occurrence 3 2,000,000 MED EXP(Any one person) $ 10,000 A.: NPC4003117-00 3/2312026 3123/2021 PERSONAL&ADV INJURY $ 1,000,000 ��G//ENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000,000 /X .POLICY jE� LOC PRODUCTS-COMPIOP AGG .S .. 2,000.060 S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acc; ent $ 1;000,000 X ANY AUTO BODILY INJURY(Per person) S OWNED. SCHEDULED A AUTOS ONLY AUTOS NBA-1003121-00 3/23/2020 3/23/2021 BODILY INJURY(Per accident) $ HIRED NON-OWNED RTY DAMAGE $ PE AUTOS ONLY AUTOS ONLY Per PROPE dent $ P _4 11MF3RECLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR .• CLAIMS•MADE" 3/23/2020 3/23/2021 AGGREGATE g DED RETENTIONS_- $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS`UAMLITY. - STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? r N I A (Mandatory In NH). I[yes;describeunder E.L.DISEASE-EA EMPLOYE $ - ': DESCRIPTION OF OPERATIONS.tielow E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It 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 BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. TOWN HALL SOUTHOLD,NY 11971 AUTHORIZED REPRESENTATIVE ©19 8-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Jason's Pools Estimate PO Box 1331 Hampton Bays, NY 11946 Date Estimate No. 631-324-7844 Fax 631-329-5127 3/4/2021 3763 Colleen Stellato Colleen Stellato 300 Corey Creek Lane 300 Corey Creek Lane Southold NY 11971 Southold, NY 11971 Date Description Qty Rate Total Installation of a 20'x 40'Vinyl Swimming pool. 29,750.00 29,750.00 Pool Includes: 10" poured concrete walls Liner Color of choice(27 mil) Standard 45"Shallow end with an 8'deep end Full length stadium steps 20 200.00 4,000.00 3 Skimmers&4 Returns 4 Pentair LED Glo-Brite Lights with transformer 4 350.00 1,400.00 1 Pentair Variable Speed pump 1 450 Sq. Ft. Sta-Rite Cartridge Filter 5'deepend bench Drywell as required by town code 1 pool alarm Pool includes all plumbing 2"poly underground and 2" rigid above ground. Sand cement mix bottom of pool (hard bottom) "Final grade of affected area around pool is included in base price" Sta-Rite 400,000 BTU HD LP Heater. Price does not include gas work. 1 4,900.00 4,900.00 Pentair IC40 IntelliChlor salt system with power supply. Includes initial salt 1 2,800.00 2,800.00 start up(Roughly 1000 lbs) Removal of roughly 180 cubic yards of fill. Fill to remain on site 0 25.00 0.00 Loop-Loc Mesh Green Winter Safety Cover 1 2,000.00 2,000.00 Installation of 2"x 12" natural stone coping 128 24.00 3,072.00 2"x 12"Thermal bluestone coping.Additional coping options available 128 18.00 2,304.00 Pentair Easy-rouch automation system with ScreenLogic(Smart device 1 4,500.00 4,500.00 control) """Due to the large machinery used during this process access to pool area is needed.We do not re-install fences, gates etc..Due to the large machinery used during this process your landscape, grass and irrigation will get damaged.We will do our best to limit the damage caused but repair work(to be done by others)will be required after we are done. Electric not included. Subtotal Tax(0.0%) Date: Signature: age 1 Total Jason's Pools Estimate PO Box 1331 Hampton Bays, NY 11946 Date Estimate No. 631-324-7844 Fax 631-329-5127 3/4/2021 3763 Colleen Stellato Colleen Stellato 300 Corey Creek Lane 300 Corey Creek Lane Southold NY 11971 Southold, NY 11971 Date Description Qty Rate Total `If cement truck can't access entire back yard, a boom truck will be needed. $1,350 Subtotal $54,726.00 Tax(0.0%) $0.00 Date: Signature: age Total $54,726.00 t\j i G SIO k � C� �ncr� DW y 2 I r c C „C4 f7l S-r 2-L(" n 3Ic:.► crus►--�c:� coy-e-L-A CA's t l GA A, - • �DIVfNC OOAAG - A, INCE.T - /LACOER.. X d INLET"FITTING` t UTO A � KIIA MER UNOERWA-r" LICIIT IOPTIO14AU•' O 0 . <,- • ,' MAIN DRAIN PLAN Iz• ` THE OES1C$.t5 SASEO ON A DRAINAGE SOIL'WITHC.IG./:SIL T,. ' TILE FACtHG WA7 EA. i „ 1 _ SE(;TP ,A_A ` ROVNO WAVER SHALL NOT-EXIST wTHIN'THE L:M ITSbR, E , It •`L. LINE Ez[AYATIQH,u CApUNO Wa7ER ..CXISTS WITHIN 8�-.0'BELOW.. r• (• -� CRAOE.SP.ECIAL,OEWATEAING•FACILITIES WICL'9E AEOt1IAE0, �: 1%2•WASTE - �' WATER DISPOSAL IS L:41TE0 TO OWNERS P •� f ' ROPER77, 3 - `.PUMP .. •I `, y I;a.: o .. HAIR a LINT �. I• ATCHER �SKfMHEq a .THE WELMATICALL C •T'APPLIEO COHCAE TE ICJHITE I SHALL CONT.B0NO BEAN I: y n _ - _ DC A f•4 EHz WACX� CF CCAENT,ITH A MAXIMUM OF 3j2 GALLONS Oc WA.ER v - .ALL AROUNO ' CA• MARBLE rVZ,.RETURN 7C E - I -WATER S � iNLEr.- . S DUST REINFORCING S 12-0C BILLET STEEL WITH A, 01 GqAOCSTEEL SHALL BE INTERMFl{",T k O BAAUM LAI.OF SDIA+[iERS, . Z< ; MAIN OFtAjN L' POOL W47fA SUPPLY SY 0@'NEA•S-GAAOEN E. POOL 70 sf EPT HCS ' r,• /t ' fc. FULL DURI""REEZIN.O WEATHER, - PVi7P CAPACITY TO BE'SVcf1C1 ENI TO••EN.PTT POOL t IN 24 HOUAS.. 1 RADIUS,VARIES �; 1 6•1a 24`SNA LIAWSCHE4tATI.0 2S• UP OH,DEEP EN ° ._ PIPING A-RRANGME:N; • �`S STEEL ` i • y�J 4 F.- •• tN.POR C.CD . IAL I SEC .( DEPtN <S;_D. CONTRACTOR. TIQN' `I, r+Dgiz. 12"v:c e„D:c � !� VERT. 12" OC a' O c r. FLOOR tz-OC'EAcHWAY OR OWNER HES" EOUIVALEN7 9 •� + )r S �d�'.°.°0.3.7 g'S� \�` ---'- •. h� V DQ, APp 0 ED AS NOTED DATE: B.P.-# I FEE:- 3 BY: NOTIFY BUILDING DEPARTMENT AT RETAIN STORM WATER RUNOFF 765-1802- 8 AM TO 4 PM FOR THE PURSUANT TO CHAPTER 236 FOLLOWING INSPECTIONS: OF THE TOWN CODE. 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE 1:0r C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ELECTRICAL INSPECTION REQUIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF i rri lr n—effl rn a.rtfwIING BOARD �S01-4ri 0 m q��gTEES nr_n ENCLOSE POOL 1-O.0,0DE,. . UPON COMPLETION -:{BEFORE."WATER!'-,-- OCCUPANCY WATER"OCCUPANCY OR USE IS'UNLAWFUL WITHOUT CERTIFICA s OF OCCUPANCY 0 Bonding Wire connected to all 40' SUCTION hardware WASTE FILTER HAIR& PUMP SKIMMER i WATER LINE 2"RETURN TO INLET MAIN DRAIN b` MIN N PIPING SCHEMATIC 3'APAR l1 ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF 2015 IECC i PUMP FILTER I - >; 2'2" K - 2 POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE DETECTING A CHILD HORIZONTAL 4/8" REBAR 4 PLACES ENTERING THE WATER AND SOUNDING AN ALARM AUDIABLE AT POOLSIDE AND AT ANOTHER ri LOCATION ON THE PREMISES WHERE THE POOL IS LOCATED.THE ALARM MUST BE INSTALLED, 10.1UNDISTURBED EARTH MAINTAINED AND USED IN ACCORDANCE WITH MANUFACTIRER'S INSTRUCTIONS.THE ALARM RETURN : 40„ MUST MEETASTM F2208'STANDARD SPECIFICATION FOR POOL ALARMS'.THE DEVICE MUST VINYL LI EP OPERATE INDEPENDENT(NOT ATTACHED TO OR DEPENDENT ON)OF PERSON. CONC.MIN.3500 PSI VERTICAL 1/2"REBAR PLACED 4'0.C. 3 WATER SOURCE FILLING THE POOLSHALL BE EQUIPPED WITH A BACKFLOW PROTECTION SYSTEM. i WALL CROSS SECTION G ALL PIPING IS DIAGRAMMATIC UNLESS OTHERWISE STATED.ALL PIPING TO BE POLYEfHELYNE. NTS 5 POOL SHALL BE GREATER THAN 10 MEASURED HORIZONTALLY FROM ALL OVERHEAD WIRING. 12' 15' I 8' I 5' POOL DESIGN INCLUDING DRAINSWILL MEETALL2017 CODES. i Complies With: j Section R326 of the 2020 Residential I Code of New York F NEW Jasons Pools Section N1103.12 (R403.12) Residential . pE Y0 - Pools and Permanent Residential Spas 300 Corey Creek La kP Section R326.4 Barriers , '- .4';,4 X' Southold, NY Section R326.5—R326.6.5 Entrapment �T Avoidance d cf� yo POOLTYPE: 20x4O REV SCALE: NTS Section R326.7 Swimming Pool and p 7 , �, Spa Alarms i �ROFF ,n a� JAMES DEERKOSKI, P.E. SS 260 DEER DRIVE DATE: 3/15/2021 MATTITUK, NEW YORK 11952 DRAWING NUMBER 1 OF 1