HomeMy WebLinkAbout47558-Z ° st TOWN OF SOUTHOLD
BUILDING DEPARTMENT
f
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#: 47558 Date: 3/16/2022
Permission is hereby granted to:
20.—tGrover, .v A t 5F_.______..
New—
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Andrew
th _
.w a York,
NewYork NY... 1 011 ...._...._..___ �...........�__.�..._w...�...._. ._._..�.�_....... . ..
To: construct accessory in-ground swimming pool as applied for per Trustees & ZBA
approvals.
At premises located at:
...0 The Strands East Marion
SCTM # 473889
Sec/Block/Lot# 21.-5-8
Pursuant to application dated 2/16/2022 and approved by the Building Inspector..
To expire on 9/15/2023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE _ 250.
$ 00
CO- SWIMMING POOL $50.00
Total: $300.000
ro
Building Inspector
Of` TOWN OF SOUTHOLD—BUILDING DEPARTMENT
07Town 179 Southold,NY 11971-0959
Telephone l(31) 765-1802 MFax(631)
P.
0.
Date Received
A P I CATHINJI F )i R B U I L D UNJI G F e'E11',1",M 1 v,u�'
For Office Use Only
PERMIT NO. � Building lnspector._
Applications and forms must be filled out in their entirety.Incomplete r V$f ,0i
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:December 27, 2021
OWNER (S)OF PROPERTY:
Name: D. Mazzarini, A. Grover =SCTM #1000-21-5-8
Project Address:90 The Strand, East Marion, NY 11939
Phone#: 412-779-3443; 651-343-9653 Email: dan@badmdesign.com, andy@andygrover.com
Mailing Address:35 W 9th Street, Apt 9C; New York, NY 10011
CONTACT PERSON:
Name: Judy Card, Binder Pools, Inc.
Mailing Address: PO Box 1960, Shelter Island, NY 11964
Phone#:631-774-9429 Email: Judy@BinderPools.com
DESIGN PROFESSIONAL INFORMATION:
Name: Judy Card, Binder Pools, Inc
Mailing Address: (as above
Phone M Email:
CONTRACTOR INFORMATION:
Name: Darrin Binder, Binder Pools, Inc
Mailing Address:PO Box 1960, Shelter Island, NY 11964
Phone#: 631-749-2110 Email: Judy@Binderpools.com
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other 16'x32'in-ground gunite pool with 8'x18'patio $ $115,000.00
Will the lot be re-graded? []Yes R No Will excess fill be removed from premises? RYes []No
1
PROPERTY INFORMATION
Existing use of property: residential summer home Intended use of property:residential summer home
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Residential R-40 this property? Yes EJ No IF YES, PROVIDE A COPY.
Check Box A Q Q e r The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
MIMm-Bin
.
dere Binder Pools, Inc.Application Subrnitt ��nt
Authorized Agent ❑Onner
Signature of Applicant:
Date: 4
STATE OF NEW YORK)
SS:
COUNTY OF
Darrin Binder of Binder Pools, Inc. being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Contractor
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief;and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of U __ 20 P2.z
No,ary .+iY S OGAR
Notary Public, State of New York
No 52-8200218, Suftolk Count%t q�
J'°�D 1IY� � � At.)`!''��"„��C�"��il��l ��1��11f Ill ��° l'�,j(,,omm�sslori LxpnesAugust 31, c�
Where the applicant is no. ".. „ ) .,_
(Where� pp . t the owner)
I, Andy Grover residing at 90 The Strand, East Marion, NY 11939
Darrin Binder/Binder Pools, Inc.
do hereby authorize to apply on
my bel o e Town of Southold Building Department for approval as described herein.
January 3, 2021
Owner's Signature Date
Andy Grover
Print Owner's Name
2
BOARD MEMBERS Southold Town Hall
Leslie Kanes Weisman,Chairperson "" 53095 Main Road•P.O.Box 1179
Southold,NY,11971-0959
.Patricia A porn
�. cie11'simi
Eric Dantes Town Annex/First Floor,
Robert Lehnert,Jr. �� 54375 Main Road(at Youngs Avenue)
Nicholas Planamento Southold NY 11971 -
� � V
http://southoldtowmy.gov f / 312477
ZONING BOARD OF APPEALS � AUG 2 3 2021
TOWN OF SOUTHOLDTel.( )765-1 Fax(631)765-9064 O O
ld Town Clerk
FINDINGS,DELIBERATIONS AND DETERMINATION
MEETING OF AUGUST 199 2021
A FILE:#7524
NANIE F PLIC Daniel a ' ' and Andrewrover
PROPERTY LOCATION: 90The Strand(Adj.to Long Island Sound),East Marion,NY.
SCTM No. 1000-21-5-
$ _Qg IE� °1 1" 1A MQN. The Zoning Board of Appeals has visited the property under consideration in this
application and determines that this review falls under the Type II category of the*State's List of Actions, without
further steps under SEQRA.
L II is application was referred as required under the Suffolk
County.Administrative Code Septions A 14-14 thru A 14-25 and the Suffolk County Departrnent•of Planning issraed
its reply dated June 1,2021 stating that this application is considered a matter for local determination as there appears
to be no significant county-wide or inter-community impact.
Iwtj)1441L] 1 Q is application was referred for review under Chapter 268,Waterfront Consistency
review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy
Standards, The LWRP Coordinator issued a recommendation dated July 14, 2021. Based upon the information
provided on the LWRP Consistency Assessment Form submitted to this department,as well as the records available,
it is recommended that the LWRP is INCONSISTENT with Policy 4.1 of the standards and therefore
INCONSISTENT with LWRP. It is noted that a 1975 Covenant and Restriction (Liber 7969 page 274) placed on
the lot within the subdivision known as Pebble Beach Farms prohibits the construction of any part of a dwelling
northerly of an approximate 100-foot bluff setback line unless approved by the Town of Southold. It has been
determined that the terns of the subject Covenants were imposed by the Homeowner's.Association and not by the
Town of Southold. Both Chapter 275 Wetlands and Shorelines and Chapter 280 Zoxairig of the Southold Town Code
minunize impacts on thenatural protective feature and protect structures from damage and loss due.To setback is to
requirespool and related structures to a bluff system– The intent
1 g rr�as and
erosion over time. In the event the action is approved, a 0-foot-wide landscaped buffer landward from the top of
bluff is recommended. The placement of a landscaped buffer landward of the top of the bluff would therefore deem
this action as CONSISTENT.
d ILt ) iJ .l" " 1. :3 " r 1 I l l "1 C2 )31-51K1: This application was referred for an
evaluation and recommendation to the Suffolk County SWCD. According to the information provided in a letter
from the agency dated June 1 ,2021,following an inspection conducted on June 7,2021,the agency described the
backyard as well-vegetated with turf grass with little to no soil exposure. Both sides of the property/fence line am
planted with hedgerow privet, which continues along the edge of the backyard, at the top of the bluff. There does
not appear to be any significant signs of storwater runoff issues present that lead from the dwelling towards the
Page 2,August 19,2021
#7524,Grover
SCT M NO. 1000-21-5-9
bluff, There is,however,evidence of erosion along the top of the bluff associated with the garden bed buffer located
along the top of the bluff, Upon further inspectiort, irrigation lines were discovered in these garden beds,which is
likely partially one cause for the significant bluff erosion issues present at this site. A few of these hTigation lines
appear to discharge down into the-face of the bluff.
13ie top of the bluff and the upper portion of the face of the bluff initially appear to.be fairly vegetated and the-bluff
appears to be 'in sora'ewbat stable condition,,however, the lower portiol'i of the bluff face and the entirpty of the toe
of the bluff is in poor condition. The face of the bluff appears to have sloughed off and there is a nearly verticAilface
where minimal to no vegetation is established on or near this vertical-face.on either side of the staircase to-the beach.Underneath the staifcas6 there is considerable signs of soil erosion down the face of the bluff. Some recent attempts
to mitigate the vertical face can be seen. This includes several small retaining walls which ran'undemeath and
perpendicular to the staircase. There are three or four of these structures several feet above before the vertical face.
These walls come out roughly two or three feet from either side of the staircase,and there is extensive evidence of
soil erosion where these structures are located which appears to have fanned out closer to the toe, This is apparent
by the brtre soil, sheet and rill erosion, and gaps between the boftorn of some of these walls and the ground. On the
beach front there are 4 foet wide by 4.5 feet high stacked SaTidbags that run pandlel to the toe of the bluffi These
sandbags seem to be an additional attempt to reduce the tidal or storm impact from eroding the already compromised
the bluff toe. Out,,possibility of this severe slough near the toe of the bluff could likely be a,result of lateral scepage
from somewhere further upland. There doesn't appear to he any drywells on the property,at least according to the
Survey of the Property Map, Almost all gutters on the dwelling are discharged into thc-,ground,with the expectation
of at,least one gutter on the northwest corner of the dwelling,which discharges into the flower bed along the existing
deek on the back of the dwelling. There are, rninor signs of stormwater,runoff from this gutter. The use of heavy
machinery should not be allowed near the top of the bluff and proper erosion and sediment oontrol/stormwater
structures and polices should be put into place to prohibit any ninoff or sediment from leavinj the construction site
as demolition of the structure and adding,an in the ground pool isplarmed. There are signs of erosion Hot at the top
of the bluff along the edge of the hedges and garden bed(probably due to'the ptsense of irrigatioh,lines which has
already been menfioned). There shoidd tv no intentional diqeharging, of any water near' onto, or down the bluffi.
Eliminating any potential runoff frons s
tornawater, greywater pipes, irrigation water lffies/he4ds, pool water
discharge,'hnd/or other runoff from being discharged on or near the bluff is also highly recommended to red=
erosion issues. The existing lines should be cut offfi-orn the irrigation system or safely and carefully removed without,
affecting the bluff.
The bluff should have a natural buffer of native bluff plant species to further protect the bluff, Gmarnental
landscaping and garden beds near the top of a bluff can impact stability, The face and toe of the bluff should also
have a diversity of"native bluff'species, The careful removal of any non-native andlor invasive plant species and
trimming of dead limbs or branches, is high encouraged if applicable. Structures like geotextiles can be install with
these native bluff plantings to help establish vegetation,cover any bare soil,and hold sediment in place.The Suffolk
County Soil and Water Conservation District recommends the homeowner seek the help and advice from an engineer
who specializes in bluff restoration.
MQ The subject property is a nonconforming 29,816 square foot parcel located
in the Residential R-40 Zoning District.The northerly property line measures 72.42 feet and is adjacent to the Long
Island Sound, the easterly property line measures 232.13 feet and continues southerly at 90.00 feet, the southerly
property line is 62.47 feet and is adjacent to The Strand,the property then runs northwesterly and measures 45 feet
and the westerly property line measures 238.28 feet, 'rhe parcel is currently improved with a one-story ftame
residence which will be demolished as shown on the survey inap prepared by John T, Mctzger,LS and last revised
July 27,2021.
Request for Variances from Article IV, Section 280-18; Article XXII, Section 280-
116A(1);and the Building Inspector's April 13,2021 Notice of Disapproval,renewed and amended on July 29,2021
............
Page 3,August 19,2021
#7524, Grover
SCTM NO, 1000-21-5-8
based on an application for a permit to demolish and reconstruct a single-family dwelling and construct an accessory
in-ground swimming pool located in the Subdivision of Pebble each Farms;at 1)located less than the code required
minimum side yard setback of 7.5 feet-,2)located less than the code required minimum combined side yard setback
of 17.5 feet;3)swimming pool located less than the code require 100 feet from the top of the bluff.
13�jE true I -f an
1�: The applicant requests variances to demolish and reconstruct a sing e amily dwelling d
construct an in-ground accessory swimming pool, The proposed dwelling on this nonconforming 29,816 square foot
parcel in the Residential R-40, is not permitted pursuant to the Pebble Beach Farms subdivision approval from the
Southold Town Planning Board,which requires a minimum side yard setback of 7.5 feet and combined side yard
setback of 17.5 feet. The proposed construction shows a minimum side yard setback of 6.5 feet and a combined side
yard setback of 13 feet. In addition,the accessory swimming pool is not permitted pursuant to Article XXII Section
280-116A(1), which states; "All building orstnictures located on lots upon which there exists a bluff landward of
the shore or beach shall be set back not fewer than 100 feet from the top of such bluff." Th6 survey shows the pool
at 815 feet from the top of the bluff.
ADDITIONAL INFORMATION: There was one letter of opposition from a neighbor, The agent for the applicant
submitted-other,comparable prior approvals by the Zoning Board of Appdals for swimming pools at less than the
code required 100-foot minimum bluff setback in the same community.
ZBA File#4801 Approval to construct a pool 63 feet from the bluff.
ZBA File#4245 Approval to construct and deck area no closer than 50 from top of bluff.
ZBA File#4750 Approval to construct a 16 x32 foot in-ground pool no less than 60 feet from the actual top
of the bluff.
ZBA File 44794 Approval to construct a.20 x40 foot in-ground pool no less than 50 feet from the top of
bluff.
ZBA File#5629 Approval to construct 20 x 40 feet in-ground pool no less than 64 flet from top of bluff..
ZBA File 46027 Approval to construct an 18x 36 foot in-gr'ound pool no less than 70 feet from the top of the'
bluff.
The applicant has agreed to install a new Suffolk County approved Innovative Advanced(IA)septic system,
lK , MEA..
The Zoning Board of Appeals held a public hearing on this application on August 5,2021 at which time written and
oral evidence were presented. Based upon all testimony,documentation,personal inspection of the property and
surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant
and makes the following findings:
1. Grant of the variances will not produce an undesirable change in the character of
the neighborhood or a detriment to nearby properties. The proposed pool will not be visible to the street and there
are numerous swimming pools on the seaward side of homes with non-conforming bluff setbacks in this community
that have received prior variance relief.,including the applicant's adjacent neighbor, Given the conditions imposed
herein,the-impacts to the bluff will be mitigated.
2. Town Law §2L)7-_b(3JL b1Q. The benefit sought by the applicant cannot be achieved by some method, feasible
for the applicant to pursue,other than area variances for the side yard setbacks.The existing dwelling was constructed
under a prior Cluster Zone Subdivision which allowed reduced side yard setbacks. The exterior walls of much of the
house are being preserved and the applicant proposes to construct a 39.9 square foot,2 feet by 11 feet second-story
bay window projecting into the side yard to capture views of the water from the,interior of the home which will not
interfere with the existing clear passage along that entire side yard. The proposed front and rear yard additions
Page 4,August 19,2021
#7524,Grover
SCTM NO. 1000-21-5-8
maintain the existing side yard setbacks. The benefit sought for the proposed in ground pool can be achieved by
some method other than variance relief. The front yard is very steep and a pool cannot be located in a conforming
front yard on this waterfront property. However,If the proposed screened porch addition on the seaward side of the
dwelling was eliminated,a pool could be constructed with a conforming bluff setback.
3. Town Law §267-_b3 li3 The variances granted herein are mathematically substantial. The relief from the
code for the proposed swimming pool setback from the bluff represents 175%relief-, the single side yard setback
represents 13%relief;and the combined side yard setback represents s 25.7%.relief.The pool setback is quite small
in comparison to other existing in-ground pools in the neighborhood. However, the side yard setbacks are also
consistent with other properties in the subdivision as the lots are generally long and narrow.While the survey shows
the distance of the proposed pool at 82.5 feet from the bluff at the closest point most of the pool will be located
approximately 90 feet from the top of the bluff which would reduce the relief to 10%; and the conditions imposed
herein will mitigate any adverse impacts to the bluff
4. Town L w $267-b(3)(Oj4 . No evidence has been submitted to suggest that a variance in this residential
community will have an adverse impact on the physical or environmental conditions in the neighborhood. The
applicant must comply with Chapter 236 of the Town's to Water Management Code, and follow the
recommendations of Suffolk County Soil and Water,the LWRP,and gain approval from the Southold Town Trustees
to protect the bluff from erosion.
5. Town Law$267-1.iQXb . The difficulty has self-created. The applicant purchased the parcel after the Zoning
.ha
Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on
the use of the parcel under the Zoning Code in effect prior to or at the time.of purchase.Although the Subdivision
has its' own C&Rs many of the homeowners have not complied.
6. Town Law §267-b. Grant of the requested relief is the minimum action necessary and adequate to enable the
applicant to enjoy the benefit of a new dwelling and an in-ground swimming pool while preserving and protecting
the character of the neighborhood and the health,safety and welfare of the community.
RESOLUTION OF TEE BOARD:In considering all of the above factors and applying the balancing test under New
York Town Law 26.7-B,motion was offered by Member Ac porn,seconded by Member Lchnert,and duly carried,
to
GRANT the variances as applied for, and shown on the survey map prepared by John T.Metzger,LS,last revised
July 27,2021,and the design development drawings prepared by James Deekowski,P.E. last revised July 22,2021
S LBJECT 7'0 TLIE FOLLOWING CON rngpiai
I. The existing 10-foot-wide garden bed buffer along the top of the buff shall be replaced with a 30 foot wide
non disturbance landscaped buffer landward along the entire top of the bluff and planted with drought tolerant
native species.
2. The sprinkler head(s)at the top of the bluff shall be removed.
3. No heavy machinery shall be located near the top of the bluff and proper erosion and sediment controls shall
be put into place during construction of the pool and the dwelling.
4. The proposed improvements must be approved by the Southold Town Board of Trustees.
5. The new dwelling shall have proper downspouts and gutters that draw stormwater away from the bluff
pursuant to the recommendations of the Suffolk County Soil&Water Conservation District.
6. Pool mechanicals shall be placed in a sound deadening enclosure.
7. A drywell for pool de-watering shall be installed.
PMO 5,Aug=19,2021
#7524,Grover
SCTM O.1000-21-5-8
This approval shau not be deemed dffeedve unffl the reqmhvd condwons how been meL At the&crdion of
e Board ofAppeals,failure to comply wkk the above condidons may render dds decision null and
void
That the above condidons be w tor's CM*?M&of OCUVORCY,when laueA
7he Board reserves the right to substitute a s° IIW h de , ' in naturefor an akeration that don not
increare t , degree of nonconformity.
Any devkelonfrom the swfty,site p air archilectwwl drawthp cried In Ihh decWm wdi result ht delays
or apoulble dental by dx,8sdIdtng DePwIment of a huildtngpermit,and may require a new qpplkallon and
public haring befwv the Zoning Board ofA pe
Any de ion from the miance isin as shown on the architecaird&awings,$iie plan anWor=TeY
ciled above,mich ay alterations,eztensi .or demolidons,ov not authorized uruier thisapplication when bwolving
noncor#brmiries undo the zoning code This action doea not audwrite or condone any c orfidw usesetback
or olherfeaswv of the subject property that nw vlowe dw zoning CoA other Om nwh uses, sesbach and of
her
features as are eVressly s"red in this action; In the event Ow tW is an Wprovd subject to condNwm, the
approval shaU not he deented qffective until such Mm that the foregoing fail to comply
therewith wilt render this approval null and void
Pursuant to Cba ter 2MI46(B)of the Code of the Town of Southold any variance granted by the
Board of Appeals shatbeconte,oull and void whom •Ce of Occupancy. of ben
leµ . P"ah "9 h subdM4j6n hp s notbooneo u C-.Ierl4,wIthin three
y e te. u h gra ce n e. o off'..a ,u on
u W or to t' gin, t e n not to c th , . e one
Vow of •A Wannum° (Cbahperm,A (5-0)."
Leslie Kanes Weisman,Chairperson
Approved for Ming 0'/ t2021
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BOARD OF SOUTHOLD TOWN TRUSTEES �
SOUTHOLD, NEW YORK
PERMIT NO. 10020 DATE: OCTOBER ER 20 2@ 21.
ISSUED TO: ANDREW GROVER& DANIEL MAZZARINI °
PROPERTY ADDRESS: 90 THE STRAND,EAST:" MARION
ii
SCTM# 1000-21-5-8
AUTHORIZATION
Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in pJ
Nr accordance with the Resolution of the Board of Trustees adopted at the meeting held on October 20,2021, and
Sin consideration of application fee in the sum of$250.00 paid by Andrew drover & Daniel Mazzarini and
subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees
rr
authorizes and permits the following: �I
' Wetland Permit to demolish existing dwelling and reconstruct a new single family dwelling
(1,456.5 sq.ft.), new foundation for proposed addition ( 4 SF),addition to first floor bedroom ;r
n � 319 sq.ft.), new second floor (1,365 sq.ft.), new decks 784 sq.ft.),new covered porch 342
sq.ft.); new 16 x 32 in-ground pool with one (1) foot surround (512 sq.ft.),with pool enclosure
i fencing and pool drywell; proposed gutters and leaders to drywells; and new UA OWTS septic
r system; proposed new dwelling footprint will be 2,484.48 sq.ft; with the condition to establish
and perpetually maintain a 30' wide non-disturbance buffer landward of the top of the bluff,
and as depicted on the survey prepared by Peconic Surveyors P.C.,last dated October 18,2021,
and stamped approved on October 20,202x1. 1`
IN WITNESS WHEREOF, the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these
� n presents to be subscribed by a majority of the said Board as of the 20th day of October,2021.
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YORK Workers' CERTIFICATE OF INSURANCE COVERAGE
rArr Compensation
Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW
PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrie
1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured
BINDER POOLS INC 631-749-2110
F10 130X 1960
S II ill:ill..:A Il lR IISLAlND,II Y 11964
1 c.Federal Employer Identification Number of Insured
or Social Security Number
Work Location of Insured(only required If coverage is specifically limited to
certain locations in New York State,i.e.,Wrap-Up Policy) 113368250
2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company
Town of Southold
P O Box 1179 3b.Policy Number of Entity Listed in Box"ll a"
DBL397420
Southold, NY 11971
3c.Policy effective period
01/01/2022 to °i�/31/2.022
4. Policy provides the following benefits:
F A.Both disability and paid family leave benefits.
If�..]
B.Disability benefits only.
C.Paid family leave benefits only.
5. Policy covers:
0 A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law.
E] B.Only the following class or classes of employers employees:
Under p cl aity of perjury,I certify Haat l am aaa author°Vzed representative or Ilcensed agent of the insurance carrier referr aced above an that the na i
insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above.
Date Signed 1/5/2022 By
(Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier)
Telephone Number 516-829-8100 Name and Title ICf andhtit •, 'iitjt E ecIf"rwg 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 emailed to PAU@wcb.ny.gov or it can 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 4B,4C or 5B have been checked)
State of New York
Workers' Compensation Board
According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the
NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their 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 (12.21) 111111 IIIIDB120.1 (1 ? 1 )
Client#: 23825 BINDERPO
ACORD =021
CERTIFICATE OF LIABILITY INSURANCEDIYYYY)
'M
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.
ficate holder is an ADDITIONAL INSURED,'the poIicy(ies)must have ADDITIONAL INSURED-provisions '� ' ._ ..
IMPORTANT:ff the certi� 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 A C Kimberly^L Schuerlein
Amaden Gay Agencies,Inc. PHONE "` __...
11 Gay Road E-MAIL 0.E kschuerl n amaden a corn . � 8 N„)°6313240671
_._
P.O.Box 5004 D )..,._._... .. ......_..__. .. _..... _....__._ . ..
East Hampton, 37 INSURER A: _y... _M.._...._w.. __ ...... _ ..
INSURER(S)AFFORDING COVERAGE NAIC#
ast am ton NY 119.__ __w._ ,._ _.___....... ..
Valle Fore
American Fire and Casual Ins.Co.NSURED INSURER B Continental Insurance Company
Binder Pools Inc INSURER C. Casualty 24066
PO Box 1960 _ _... .. _.
Shelter Island,NY 11964
INSURER D Ohio Security Insurance Company 24082
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.
LTR TYPE OF INSURANCE jAI7 YL SUBR POLI F POLICY EXP
LTR It1S.iI). ._..._ . .POLICY NUMBER........ ww.. i m...,!) iMMIDDIYYYY.� ._ ...._ ... ,,..,,.11MITS—111111-11- _...
A X COMMERCIAL
M CLAIMS-MADEE� X LIABILITYRAL [ X X 5084911313 9/25/2021 09/25/202 EACH OCCURRENCE $1,000000
to TCY RENTCD
occuR nn� s �a r�r,�cluxr�Pr�i S 100 000___
X PD Ded:1,000 ...w_ MED EXP Anq ane arson) $15 000
PERSONAL&ADV INJURY $1 OOO OOO
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2 000,000
....
X{1V POLICY JECT LOC PRODUCTS COMPIOPAGG $2,000,000
HER: u
LIABILITY X X BAS60950488. _ .... . ._._.. .............
D AUTOMOBILE � $
5/29/2021 05/29/202aMit�Eia BiN LI LII�I
$1,000,000
ANY AUTO BODILY INJURY(Per person) $SCHEDULED
u
AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $
H REDD NON OWNED
P♦C7PFR1 u'I NAMA%aE ...............
.... .
AUTOS ONLY
AUTOS ONLY X _fib?(r aeMr df n4 $
..ww
B X UMBRELLA LIAR X OLAIMS MADE; X X 5086496894 9/2512021 09/25/202 EACH OCCURRENCE $1000 000
a m,,,
EXCESS LIAR I AGGREGATE $1 OOO OOO
C. .AND EMPLOYERS*COMPENSATION
OMP ETENTIO N A TION 111100 XWA6... . .... ......... _ ......
WORKERS COMPENSATION 0950488 1010112021 10/01/202 11PER {OTH
ISTATIJTF q.ER
ANY PROPRIL"I ORIPARTNERIE' ECUTIVE Y I N E.L EACH ACCIDENT $1 OOO OOO
OFFICVRIMEMBLR EXCLUOEO"7 � NIAIf z., a...._.. ...
(Mandatory In NH) E.L.DISEASE-EA EMPL
DE. describe N'9 ION Oder
F OPERATIONS below E.L. ISEASE POLICY LIMITS $1 000,000
_......_ .........._ w......_._. .w_w. _ ... ............ _.....__-------.- _.............................. $1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
**Workers Comp Information**
Proprietors/Partners/Executive Officers/Members Excluded:
Darrin Binder
Certificate Holder is an additional insured as required by written contract.
CERTIFICATE HOLDER CANCELLATION
Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN
54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 1179
Southold,NY 11971 AUTHORIZED REPRESENTATIVE
O 1988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S69403/M69375 KLH
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE
1 a. Legal Name and address of Insured(Use street address only) I b.Business Telephone Number of Insured
631-749-2110
Binder Pools,Inc.
PO Box 1960 1 c.NYS Unemployment Insurance Employer Registration
Shelter Island,NY 11964 Number of Insured
Work Location of Insured (Only required if coverage is specifically I d.Federal Employer Identification Number of Insured or
limited to certain locations in New York State,i.e.a Wrap-Up Policy) Social Security Number
11-3368250
2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier
Coverage(Entity Being Listed as the Certificate Holder) LIBERTY MUTUAL INSURANCE COMPANY
TOWN OF SOUTHOLD 3b.Policy Number of entity listed in box"la":
54375 MAIN ROAD XWA60950488
PO BOX 1179
SOUTHOLD,NY 11971 3c. Policy effective period:
10/01/2021-10/01/2022
3d. The Proprietor,Partners or Executive Officers are:
❑ included. (only check box if all partners/officers included)
X❑ all excluded or certain partners/officers
excluded.
This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "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"T'.
The Insurance Carrier will also notify the above certificate holderwithin 10 days IFa policy is canceled due to nonpayment ofpremiums
or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the
coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after
this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c; whichever is
earlier.
Please Note:Upon the 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: AMADEN GAY AGENCIES,INC.
(Print name of authorized representative or licensed agent of insurance carrier)
Approved by: 10/01/2021
(Signature) (Date)
Title: VICE PRESIDENT
Telephone Number of authorized representative or licensed agent of insurance carrier:
631-324-0041
Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT
authorized to issue it.
C-105.2(9-07) www.wcb/state.ny.us
iLMON County Dept,of
Labor,I.,fla'rvensiii q&Cormumer Affaliir
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HOUSE AREA
1611x16' top step
5'x18" bench with step (4) 14 x16 stairs
3 LED lights skimmers
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16`X32' Gunite Pool Binder Pools, Inc. Designed by: s
Phone:631-749-2110 aN_
with auto cover, PO Box 1960 Judy Card Designed GROVE'R A=
24"' Fax: 631-749-3529
coping, and pail Shelter Island MY 11964 10/26/21 for:
k"',.. , ,fin- ��, iY" :,:s'� ....�-_ ',,,r-,�, .._ - •� x-r. -,-^<Y-,' . r,,..-.�.s - as- '» � e.r -�,�
B U L D SET HOUSE AREA
16"x16' top step
5'x18" bench with step (4) 14"x16' stairs
3 LED lights 2 skimmers
1 autofill
8 ft. 8 ft.
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10 ft, 3 ft.
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3 returns �2 ft.
30" coping on cover box 24" coping
16'X32' Gunite Pool Binder Pools, Ince Designed by:
PO Box 1960 Phone:631-749-2110 Jud
with auto cover and y Card Designed GROVER .r
Shelter Island NY 11964 Fax: 631-749-3529 10/26/21 for:
2411coping -
�.�.ax
ULD SET
Patio haunch
Autocover box 24" coping
(22" beam)
5'x18" bench with step
16'° of water on bench 16"x16' top step
3 LED lights 32 ft. (4) 14"x16' steps
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5 fte
3 ft. 6 ft.
3 ft. 10 ft.
16'x32' Gunite pool Binder Pools, Inc. phone:631-749-2110 Designed by:
Side view PO Box 1960 Judy Card Designed GROVER
Shelter Island NY 11964 Fax: 631-749-3529 1!512022 for:
10.5"
12"
Coping Pavers
Mortar 4" Compacted Sand
6 lie
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DATE: 5.19.19 Typ Pool SI#ERMM ENGINEERING
SGAI f AS NOTED ® 6 $s CONSULTING P.A.
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Cross Section 14148WARAVENUE
ORAINNG NUAfBER S C ; 1 AUGUSTTNE,OL32084
1 631.831.3872
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