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HomeMy WebLinkAbout45980-Z Os����l� $ Town of Southold 2/26/2022 Oso P.O.Box 1179 W �T 53095 Main Rd oy � T.v Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42812 Date: 2/26/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 671 Summit Dr.,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-1-46 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/19/2021 pursuant to which Building Permit No. 45980 dated 3/25/2021 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 Raptis,George&Akaterini of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45980 2/23/2022 PLUMBERS CERTIFICATION DATED rthorjSignature �S11EF � TOWN OF SOUTHOLD BUILDING DEPARTMENT a TOWN CLERK'S OFFICE y�• ao� � 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#: 45980 Date: 3/25/2021 Permission is hereby granted to: Morris, Julie 204 Huntington St Apt#3E Brooklyn, NY 11231 To: construct accessoryinround swimming-g g pool as applied for. At premises located at: 671 Summit Dr., Mattituck SCTM #473889 Sec/Block/Lot# 106.-1-46 Pursuant to application dated 2/19/2021 and approved by the Building Inspector. To expire on 9/24/2022. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 B ing Inspector *pF SO���,Ql . 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.deviin(-town.southold.ny.us Southold,NY 11971-0959 Q C0UN1`1 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: George Raptis Address: 671 Summit Dr city:Mattituck st: NY zip: 11952 Building Permit#: 45980 Section: 106 Block: 1 Lot: 46 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: ACR Electric Corp License No: 4178ME 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 Surrey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 2 Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 2 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 Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump 2 Other Equipment: (2) Pumps 220GFI, Pool Cover Motor 115GF1, Heater 220GFI, Pentair Intellitouch, (3) Lights 115GFI Notes: Pool Inspector Signature: Date: February 23, 2022 S. Devlin-Cert Electrical Compliance Form OF SOUThO�o v l &` l # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING� [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: . cz 7 DATE INSPECTOR 671 7D- rz # TOWN OF SOUTHOL-D,BUILDING DEPT.;' �ycnurm ''�� 765-1802 _ INSPECTION [ ] FOUNDATION 1 ST [ ] 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',oi_ 4!�frl ili;r6v`f�4//,)0,QA , �AA DATE ANSPECTOR OF SOUIyo� # # TOWN OF SOUTHOLD BUILDING DEPT. cou765-1802 _ - � INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG: [ ] 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 R MARKS: . . �� f A(MAll VI_ WA./_ _�(.lo/) ._ . DATE t2� INSPECTOR / q �� - OF SOUI �� G � �~ TOWN' OF SOUTHOLDUILDING DEPT. _ � • � TO `yrnurm ' 765-1802 . 1'NSPECTION .[ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ` ', .[ ] INSULATIOWCAULKING [ ] .FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY -` °[ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) 71�4 ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 541 _J_cg� Zj DATE INSPECTOR. < ��" STIVIN 101KIR LNNDSCOPING, INC. JAN 272n22 BUILDING DEPT. TOM,,OF SOUTH LD January 26, 2022 Town of Southold Attn: Building Department Town Hall Annex 54375 Main Road P.O Box 1179 Southold, NY 11971-0959 Raptis Residence (671 Summit Drive, Mattituck)— Drywell Certification Letter This letter serves as the certification of (1) drywell installed at the property referenced above. The drywell was installed on July 23, 2021 as per the approved design plan prepared by Steven Dubner Landscaping, Inc last revised March 18, 2021 (Permit #45980). The drywell measures 8' wide x 4' depth with a solid reinforced concrete cap and was installed in ratable soil (primarily sand) at a depth of 8'. Photos of the installation are attached with this certification. Please review and call if you have any questions or if additional information is required. Regards, Steven Dubner Landscaping, Inc. Henry Sombke, RLA Page 1 of 1 505 Grand Street I Westbury, New York 1 I T. 631.777.1800 1 F. 631.777.1806 1 StevenDubnerLandscaping.com ® E c E 0 U F n S11 VIN OURNI JAN 2 7 ?n97 � LflNDSC0PING, INC. BUILDING DEPT. TOM OF SOUTHOLD January 26, 2022 Town of Southold Attn: Building Department Town Hall Annex 54375 Main Road P.O Box 1179 Southold, NY 11971-0959 Raptis Residence (671 Summit Drive, Mattituck)— Pool Re-Bar Certification This letter serves as the certification of the steel re-bar installed in the swimming pool shell at the property referenced above. The re-bar was inspected on June 13, 2021. The re-bar was installed as per the approved design plan entitled SPCD-1 (Swimming Pool Construction Details) as prepared by Cody Mack Engineering, P.0 dated February 16, 2021 (Permit#45980). Please review and call if you have any questions or if additional information is required. Regards, Steven Dubner Landscaping, Inc. Henry Sombke, Page 1 of 1 "moo 505 Grand Street i Westbury, New York 1 I T. 631.777.1600 1 F. 631.777.1806 1 Steven 0ubnerLandscaping.com 19� --YEARS--, i s• yaw Air Al -1 lir- sit ► A s • +4 • z kill M � wr r .. r _s r w :•.1.7 'r �*. { " �_i,,.;_✓.c""r:.•t,f' ',,..�, x(.44 y �l eP./,s„�r, 40t 3L`• �� ';� i .rte' �� � .%. r . t \ - s S�tie it� a 1 �¢ a r . 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It —1 � ' •�` •• t:�' " .f;.t . xv IS iN 11 tlm,1046 r/ �,,. � '� ri � 6,� ���- r��'r� � �. °'� !I � f_ �p ca`" Vic, � Ems,• � )�:: {'� +`! } •E / _ ¢"� 'fir"5 .. .s,..'A ,1Cz, �i `it e. + � z_� �` •C k � Fri '" -:��� t [ ;�', ,fie♦- f ��--�., �, 1��, �`y` � '� ' J f t ,y, �� FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) � y V 'FOUNDATION(2ND) 77!t t=i . z cn ROUGH FRAMING& tai tr a PLUMBING y ce INSULATION PER N.Y: H STATE ENERGY CODE a • L Ad-'rl� h 6e FINAL ADDITIONAL COMMENTS -a.7- H C . z d =oma°S�fEol��ooy� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 >�ol dao Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use,Only PERMIT NO. �j Building Inspector: "1 2021 Applications and forms must be filled out m their entirety':Incomplete. ; applications will not be accepted.'-,.Where the Applicant is not the owner,an r Owner's Authorization form(Page,2)shall be;completed Date:2-16-21 OWNER(S)OF PROPERTY. Name:George•Raptis SCTM#1000-106-1-46 Project Address:671 Summit Drive Mattituck, NY 11952 Phone#:917-577-2656 Email:georgexraptis@gmail.com Mailing Address:671 Summit Drive Mattituck, NY 11952 CONTACT PERSON: _ Name:Henry Sombke Mailing Address:505 Grand Street, Westbury, NY 115,90 Phone#:631-777-1800 Email:hsombke@sdlco.com DESIGN PROFESSIONAL INFORMATION, Name:Henry Sombke Mailing Address:505 Grand Street, Westbury, NY 11590 Phone#:631-777-1800 Email:hsombke@sdico.com CONTRACTOR INFORMATIONS Name:Steven Dubner Landscaping Mailing Address:505 Grand Street, Westbury, NY 11590 Phone#:631-777-1800 Email:info@sdlco.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: EOther Swimming Pool $65,000 Will the lot be re-graded? DYes ®No Will excess fill be removed from premises? ❑Yes BNo 1 PROPERTY INFORMATION , Existing use of property:Single Family Residential Intended use of property:Single Family Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-4.0 this property? ❑Yes ®No IF YES, PROVIDE A COPY. Ail Check Box After Reading; 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. Application Submitted By(print name):Henry Sombke RAuthorized Agent ❑Owner Signature of Applicant: Date: 2/16/2021 STATE OF NEW YORK) SS: COUNTY OF SuFFdb< ) Henry Sombke being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Agent (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. WENDY MASTER Sworn before me this NOTARY PUBLIC-STATE OF NEW YORK No.02MA618571 day of , 20 v 1 Qualified in Suffolk Co _ mmission Expires 04 21-2024 tary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) George Raptis residing at 671 Summit ®rive, Mattituck NY 11952 do hereby authorize Henry Sombke to apply on my behalf to the Town of Southold Building Department for approval as described herein. 2-16-2021 901, HP3 Owner's Signat a Date George Raptis Print Owner's Name 2 BUILDING DEPARTMENT- Electrical Inspector - y TOWN OF SOUTHOLD H z. Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 oyo a0� Telephone (631) 765-1802 - FAX (631) 765-9502 roaerrsouth oldtownny.gov — seand(a-southoldtownny gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 7/20/21 Company Name: ACR Electric Corp Name: Craig Fasano License No.: 4,178 email: acrelectric1 @optimum.net Phone No:-631 774 2806 ❑✓ I request an email copy of Certificate of Compliance Address.: 635 Commack Rd Commack NY 11725 JOB SITE INFORMATION (All Information Required) Name: Ra tis Residence Address: 671 Summit Drive Mattituck NY 11952 Cross Street: Phone No.: 516 779 0548 Bldg.Permit#: 45980- email: Tax Map District: 1000 Section: 106 Block: 1 Lot: 46 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Pool Check All That Apply: Is job ready for inspe6b6- ?: ❑✓ YES ❑NO. E]Rough In Q � Final Do you need a Temp Certificate?: DYES [—]NO Issued On Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A #Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑1 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.x1sx \ PERMIT# Address: Switches a Outlets GFI's - Surface Sconces. HH's UC Lts Fans Fridge HW Exhaust • Oven Dryer Smokes- DW Service :Carbon Micro: ..Generator. Combo. Cooktop Transfer C AH Mini Special: f�f f Comments: G e. ' �T ( 1Ch o, - L11 THE AREA OF THIS PROPERTY IS 23,372 S.F. OR 0.537 ACRES r ' �� STDNf{yA A. _G •y pF o STD Oa F x G6 eA(3(,�r� PD PAnD 0 S�p`a�poV �QD oL �iyo % eP O k'ACC... �P F 0 oa �, �\ PD pC�pQQ WOOD D£C/C � PG,PO,yN' fQU�P�.4 pF �tij1 x� Sl ?8,3'Y r1 Dc 2 x OR Y 'A/C £<<�N� GARAGE 'may .�1�• �,�• W io cy UNDfR c� O ND H'-�l H w �+ 99.4' 0/�� WD 1 & � �L W.q�00 of 'A x • SAPS n Q I cc� C II � \000 y9�F0 4 ti9�T o O pi < z LJ VOW�L1—L1 9� a ~ 0 J eo cS�, ,— OLa h a o W v l j (o 1 � o � 7 OF NFA\` i J�� J O c5'�O oUg.�y �Q CERTIFIED T0: Julie Ottmar Morris and Robert Andrew Morris UPDATED SURVEY 10/15/2021 Fidelity National Title Bank of America, 1SA0A. GUARANTEES INDICATED SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY/S PREPARED AND/OR AGENCY, AND ARE NOT TRANSFERABLE. S.C.T.M. N0. 1000 — 106 — 1 — 46 SURVEY OF: PART OF LOT 13, BLOCK 1 MAP OF CAPTAIN KIDD ESTATES GARY BENZ, L.S. FILED JAN. 18, 1949 — AS No. 1672 SITUATED IN: MA7-RTUCK TOWN OF: SOUTHOLD Surveying and Land Planning SUFFOLK COUNTY, NEW YORK 527—B Hawkins Avenue Ronkonkoma, N.Y. 11779 DATE: 3/8/2017 JOB NO. G17-2739 SCALE: 1" = 30' GaryBenzLS®Yahoo.com / (631) 648-9348 THE EXISTENCE OF RIGHT OF WAYS, WETLANDS, UNDER UNAUTHORIZED ALTERATION OR ADDITION TO COPIES OF THIS SURVEY MAP NOT BEARING THE LAND GROUND UTILITIES AND/OR EASEMENTS OF RECORD THIS SURVEY lS A VIOLATION OF SECTION 7209 SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL IF ANY, NOT SHOWN ARE NOT GUARANTEED. OF THE NEW YORK STATE EDUCATION LAW. NOT BE CONSIDERED TO BE A VALID TRUE COPY. STIVIN HIM | � � D � � � � y � � INC. � umuwux � / mw, / mwU� MAR P 4 2021 March 18. 2O21 Town of Southold Attn: Building Department Town Hall Annex 54375Main Road P.OBox 1178 Southold, NY11871-U959 ATTN: Amanda Nunemokar Rmptis Residence(671 Summit Drive, &8attXtmck)—Pool Permit Application Dear Ms. Nunemohor. Enclosed you will find 4 revised site plans for the above referenced residence. As discussed, the deck is removed and replaced with on grade patio and the pool was shifted/resized to fit within the legal rear yard. Should you need any further information or additional feea, p|aooe ham| free to contact ma at 831-777-18UOorvia email hnombke@ad|co.00m. Regards, Steven OubnerLandscaping, Inc. Ce n ry S(m b RLAI - � Project Manager Page 1of1 ! Suffolk County Dept.of f Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name r' STEVEN DUBNER Business Name This cerffies ttrat the STEVE DUBNER LANDSCAPING INC bearer is duty licensed by the County of Suffolk License Number: H-10151 Issued: 05101/1984 Fra.4e.Na.rdt1.1.l Expires: 05/01/2021 f Commissioner f E �+S� 4". #pw�` 'd, ♦j ... 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'si,-...�Tr' `vim..• .`�i•,{� ii.,; ...'?G'�.`f':_,. _�,;. ,�i�t''r� +Iti��}. � `. {"����' 1+�� �'���v'•. , '"",,r'�. f �y Ns�. 44II r NYSI F New York State Insurance Fund 199 CHURCH STREET,NEW YORK,N.Y. 10007-1100 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE D � A A A A A 112120751 LOVELL SAFETY MGMT CO., LLC 110 WILLIAM STREET 12TH FLR �� NEW YORK NY 10038 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER STEVEN DUBNER LANDSCAPING, INC. TOWN OF SOUTHOLD-BUILDING 505 GRAND STREET DEPARTMENT TOWN HALL ANNEX WESTBURY NY 11590 54375 MAIN ROAD P. O. BOX 1179 SOUTHOLD NY 11971-0959 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z 998 204-2 50709 04/01/2020 TO 04/01/2021 2/8/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 998 204-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATEINSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE DOES NOT APPLY TO THOSE JOB SITES WHICH ARE COVERED BY OTHER INSURANCE AND ARE SPECIFICALLY EXCLUDED BY ENDORSEMENT. THE POLICY INCLUDES A WAIVER OF SUBROGATION ENDORSEMENT UNDER WHICH NYSIF AGREES TO WAIVE ITS RIGHT OF SUBROGATION TO BRING AN ACTION AGAINST THE CERTIFICATE HOLDER TO RECOVER AMOUNTS WE PAID IN WORKERS'COMPENSATION AND/OR MEDICAL BENEFITS TO OR ON BEHALF OF AN EMPLOYEE OF OUR INSURED IN THE EVENT THAT, PRIOR TO THE DATE OF THE ACCIDENT, THE CERTIFICATE HOLDER HAS ENTERED INTO A WRITTEN CONTRACT WITH OUR INSURED THAT REQUIRES THAT SUCH RIGHT OF SUBROGATION BE WAIVED. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR',INSURANCE FUND UNDERWRITING VALIDATION NUMBER:8705383 <NTOWK workers' CERTIFICATE OF INSURANCE COVERAGE ATE Compensation 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 1 a. Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured STEVEN DUBNER LANDSCAPING, INC 505 GRAND STREET 631-777-1800 WESTBURY, NY 11590 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 11-2120751 2. Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TOWN eOFLSOUTHOLD - BUILted as the Certificate DING Company of New York Standard Security Life Insurance Com an DEPARTMENT 3b.Policy Number of Entity Listed in Box"1 all TOWN HALL ANNEX R08236-000 54375 MAIN ROAD P.O. BOX 1179 3c.Policy effective period SOUTHOLD, NY 11971 1/1/2014 to 2/7/2022 4. Policy provides the following benefits: F. A. Both disability and paid family leave benefits. ❑ B. Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: F. 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: 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 des ' d above. Date Signed 2/8/2021 By 441�uit (Signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBUPOLICY SERVICES 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 56 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance 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) 11111111°°!�!°!�°1°�1(10-17)1 1° 111 1111111 Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law. The.Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed 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 cancelled 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 coverage indicated on this Certificate. (These notices my be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c, whichever is earlier This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability and/or Paid Family Leave Benefits cor tract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits pollicy 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 NYS Disability an Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LA §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing,herein, however, shall Ibe construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b) The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract,-shall not enter into any such contract unless proof duly subscribed by an insurance carrier is-produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. D13-120.1 (10-17) Reverse DUBNE-1 QP ID- SH �►co/�®� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 02/08/2021 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER 518-373-8700 CONTACT Jeffrey W.Wodicka NAME- Fournier Group-New York PHONE 518-373-8700 FAX 518-373-8799 510 SW 5th Ave,#701 A/C,No,Ext): A/C,No): Portland, OR 97204 EAI -ML ,jeff@casswood.com Jeffrey Wodicka INSURERS AFFORDING COVERAGE NAIC# INSURERA:Hiscox Insurance Co INSURED INSURERB:Merchants Mutual Insurance Steven Dubner Landscaping Inc National Indemnity Group 505 Grand Street INSURER C: P Westbury,NY 11590 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 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 H POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDLSUB J=Wyn pOLICYNUMBER POLICY EFF POLICY EXPI TR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO REND CLAIMS-MADE [X] OCCUR X MPL180117420 04/01/2020 04/01/2021 PREMISES (Ea occur ce) $ 300,000 A X Contractual Liab. MED EXP(Any oneperson) $ 5,000 A X EBL 1,000,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATE'LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY F_X] jE& F—] LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: C AUTOMOBILE LIABILITY C a aBINEDtSINGLE LIMIT $ 1,000,000 ANY AUTO X 73APB0044111 72XAS0061 12/31/2020 12/31/2021 BODILY INJURY Perperson) $ OWNEDSCHEDULED AUTOS ONLY X AUTOS BODILY INJURY Per accident $ X HIRED NON OWNED IR PE idenDAMAGE $ AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE X CUP0002314 04/01/2020 04/01/2021 AGGREGATE $ 5,000'000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PERATUOTH- AND EMPLOYERS'LIABILITY TE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate Holder is named as an Additional Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION TOWNSOU SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT Town Hall Annex AUTHORIZED REPRESENTATIVE ` 54375 Main Road R 0. Box 1179 3� Southhold NY 11971-0959 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Suffolk County-Dept.of Labor,Licensing&..Consumer Affairs MASTER PLUMBING Name I s- JOSEPH L RUDDEN ¢ This certifies that the RUDDENS PLUMBING&HEATING bearer is'duly.licensed SPECIALIST t by the County ofsu olk LicenseNumber:MP-45238 9 Issued: 09/03/2008 �{ Rosalie'Dra o 6ammissioner ! Expires: 09%0112022, 72/11/2021 E(MM/DDYYY) ® /YCERTIFICATE ®F LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER Bradley & Parker, Inc. NAME: Bradley&Parker, Inc. 320 South Service Road A/C.No.Ext): 800-445-3393 ONE NC No): 631-981-7681 Melville, NY 11747 E-MAIL ADDRESS: certificates Bradle - arker.com INSURER(S)AFFORDING COVERAGE MAIC# www.bradley-parker.com INSURERA: Ohio Security Insurance Company 24082 INSURED INSURER B: Joseph L. Rudden dba Rudden's Plumbing & Heating Specialist INSURERC: 680 Roosevelt Avenue INSURER D Lindenhurst NY 11757 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 60111309 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A `/ COMMERCIAL GENERAL LIABILITY ✓ ✓ BKS58651170 6/11/2020 6/11/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE DAMAGE TO RENTED ✓ OCCUR PREMISES Ea occurrence $300,000 MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $2,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY BKS58651170 6/11/2020 6/11/2021 (CMEaaBINEDtSINGLELIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate Holder is included as Additional Insured under the General Liability where 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 WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold NY 11971 AUTHORIZED REPRESENTATIVE I Wynne D.Nowland ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD c ni 111— I DT-n— I ­ — I �/ii/­ nM fn ) I D.— 1 ..F 1 YORK workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation 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 JOSEPH L.RUDDEN D/B/A RUDDEN'S PLUMBING AND HEATING 680 ROOSEVELT AVENUE 631-243-2340 LINDENHURST,NY 11757 Work Location of Insured(Only required if coverage is specifically limited to 1 c. Federal Employer Identification Number of Insured certain locations in New York State,i.e., Wrap-Up Policy) or Social Security Number ,11-3236753 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Standard Security Life Insurance Company of New York 53095 Route 25 3b. Policy Number of Entity Listed in Box"I a" PO Box 1179 R94017-000 Southold, NY 11971 3c.Policy effective period 1/1/2014 to 2/10/2022 4. Policy provides the following benefits: ❑m A. Both disability and paid family leave benefits. ❑ B. Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: F. 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: 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 des�kd bove. Date Signed 2/11/2021 By ' (Signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent ofthat insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES 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 513 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance 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) III IIII1111111111111111111111111111111111111111111 DB 120. 1 (10-17) NYSIF New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE, NEW YORK 11747-3129 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^ 113236753 JOSEPH L RUDDEN D/B/A RUDDENS PLUMBING&HEATING SPECIALIST ' f 680 ROOSEVELT AVENUE LINDENHURST NY 11757 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER JOSEPH L RUDDEN D/B/A RUDDENS TOWN OF SOUTHOLD PLUMBING &HEATING SPECIALIST 53095 ROUTE 25 680 ROOSEVELT AVENUE PO BOX 1179 LINDENHURST NY 11757 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11125513-0 59523 08/20/2020 TO 08/20/2021 2/11/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1125513-0, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:/MIWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR, PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 369380638 Suffolk County Dept.of N Labor,Licensing&Consumer Affairs # MASTER ELECTRICAL LICENSE Name CRAIG FASANO 'I Business Name ACR ELECTRIC CORP This certifies that the bearer is duly licensed by the County of suffolk License Number:ME=4178 Rosalie Drago Issued: 03/0111992 Commissioner Expires: 03/01/2022 ACREL-1 OP ID7 JJ ACORO` DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE F02/10/2021 THIS CERTIFICATE IS ISSUED AS-AMATTER OF INFORMATION ONLY AND CONFERS NO'RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE.DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, •EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 631-421-2424 CONTACT Intermarket Insurance Agency NAMEO Intermarket Insurance Agcy Inc PHONE 631-421-2424 FAx 631-421-2004 205 E Main Street,Suite 3-4 (A1C,No,Ext): A/C,No): Huntington, NY 11743 E-MAIL certificates@intermarketins'.com Intermarket Ins Agency,Inc INSURERS AFFORDING COVERAGE NAIC# " INSURERA:Hartford Fire Insurance Co 19682 INS�I R�p INSURERs:Twin City Fire Insurance Co. 29459 ACR Electric Corp.' STANDARD SECURITY LIFE INS.CO 69078 635 Commack Rd INSURER C: Commack,NY 11725 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 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. INSR TYPEOFINSURANCE ADDLSUBR pOLICYNUMBER POLICY EFF POLICY EXPI TR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F_X] OCCUR 12SBABC8599 04/01/2020 04/01/2021 DAMAGE REMI ETO RENTED ENT once $ 300,000 X Contractual Liab. MED EXP(Anyoneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY® PE& LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY Ee aacid DISINGLE LIMIT $ ANY AUTO BODILY INJURY Per person $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY. Per accident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5'000'000 EXCESS LIAB CLAIMS-MADE 12SBABC8599 04/01/2020 04/01/2021 AGGREGATE $ 5'000,000 DED X I RETENTION$ 10000 $ B WORKERS COMPENSATION X PER OTH- ANDEMPLOYERS'LIABILITY 12WECKS6360 04/01/2020 04/01/2021 T T ER Y/N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMrr C Disability L73376 04/01/2020 04/01/2021 DBL Statutory DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Southold is included as additional insured for general,automobile and urnrbella liability if required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION TOFSOUH SHOULD ANY OF THE ABOVE'DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Southold THE EXPIRATION DATE ACCORDANCE WITTTHE POL POLICY PROTHEREOFVISIONS.NOTICE WILL BE DELIVERED IN Town Hall Annex Building 54375 Route 25 • AUTHORIZED REPRESENTATIVE P.O. Box 1179 NY Southold;NY 11971 � .. ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD voaK Wortcers' CERTIFICATE OF INSURANCE COVERAGE. STATE Compensation 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) 1 b.Business Telephone Number of Insured A.C.R. ELECTRIC CORP. 631.5434431 635 Commack Rd COMMACK NY 11725 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State;i.e.,Wrap-Up Policy) or Social Security Number 11-2219896 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Standard Security Life Insurance Company of New York 3b.Policy Number of Entity Listed in Box 1 a" Town Hall Annex Building 54375 Route 25 L73376-000 P.O. Box 1179 SOUTHOLD;NY 11971 3c.Policy effective period 4/1/2013 to 242022 4. Policy provides the following benefits: x❑ A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: XQ 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:. 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 insuran coverage as described above. Date Signed 2/10/2021, By (Signature of insurance carrier's aut orized r eta ive NYS L cen Insurance Agent of that insurance carrier), Telephone Number (212)355-4141 Name and Title Bebi Ishmail,Supervisior-DBL/Policy Services IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C 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 York Workers' Compensation-Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and.Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance 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) DB 120.1 (10-17) NEW Workers' STATE Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE' 1 a. Legal Name and address of Insured(use street address only) 1 b..Business Telephone Number of Insured A. C.R. ELECTRIC CORP 631-499-6608 635 COMMACK RD 'COMMACK NY 11725-5403 1c. NYS Unemployment Insurance Employer Registration Number of Insured WorkLocation of Insured (Only required if coverage is specifically limited to certain locations,in New York State, i.e. a Wrap-Up Policy) 1d. Federal Employer Identification Number of Insured or Social Security Number 11-2219896 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Property and Casualty Insurance Company of Town of Southold Hartford Town Hall Annex Building 34690 54375 Route 25 3b.Policy Number of Entity Listed in Box`'1 a": PO Box 1179 12 WEC KS5360 SOUTHOLD NY 11971-0959 3c. Policy effective period: 04/01/2020 to 04/01/2021 3d.The Proprietor, Partners or Executive Officers are ❑ Included. (Only check box if all partners/officers included) N all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "1 a" for workers' compensation under the New York State Workers' Compensation Law. (To use this form,'New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will.send this Certificate of Insurance to the entity listed above as the certificate' holder in box"2". The-insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a. policy is canceled due to nonpayment of-premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box."3c'`,whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it"confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a 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 named on a permit, license or contract-issued by a certificate holder, the business must provide that certificate holder with anew 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: Danielle Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved by: rlvr�.wl �z 02/10/2021 (Signature) (Date) Title:. Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 631-421-2424 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. www.wcb.hy.gov Page 1 of 2 ANT T 5 G M E D U L E OTY. COMMON NAME BOTANICAL NAME SIZE TREES 3 SERVICEBERRY AMELANCHIER CANADENSIS -7-S' I CEDAR JUNIPERU5 VIRG►NIANA I0-12' S TORUL05A JUNIPER JUN IPERU5 CHINEtd515 'TORULOSA' - YYY �4' BLACK CHAIN LINK SHRUBS ADAC 10 FENCE 3 TOROLOSA JUNIPER µ,• W~ �-� ., • CONFERTA..-.�.�..JUNI PER — 27 HYDRAPJGEA HYDRANGEA 'NIKKO BLUE' 2.5-3' 10 STEEDS HOLLY ILEX STEEDS ROSA 77 CONFERTA. JUNIPER JUNIPERLIS GONFERTA 2.5-5' » W A ... - •_ ' ' ` RUIG05 &OSA ROSE Ie-24:: e ` -- ;� :�a,. a.�_:6.: -• - .. � 200 ROSA A P.0 r e e w e / y a , _. .... ._ ._.__....w ��_ - 5 ' MOUNTAIN' 2.5-51 y � BOXWOOD GREEN MOUNTAIN BUXU GRE._�N 3 AMELANCHIER 26 9 ' WALL 5 3' BAYBERRY MYRICA PENSYLVANICA 2 - X. + + P _ E 5, RA55E5 AND GROUNDGOVER, -� REtdN I ALG 4' TALL NY5 POOLCODE. 54 ADACIO MISCANTHUS SINENSIS 'ADAGIO' A COMPLIANT ESTATE PENCE`` �ga I WITH SELF CLOSING, SELF « ' 50 SEDUM ,..__ .LATCHING GATE . 64 LIRIOPE LIRIOPE PP 4" of 9 CEDAR + PROPOSED , '`--1- + PATIO ON `� + ::., f EX. WOOD DECK ` + EL: +S&5 rr +; GRADE `` _ _ EXISTING AUTOMATIC POOL + _.P`i ._ _.._. .. __...... _ - _ DRIVEWAY _. + <';; :. ___ ._.,_. . U 21 MYRICA y',e FROFOSED COVERA&E COYER °' f=w .�' _. . _ + °- �. ,'\ EXISTING " � AREA S�tL'A.RE FEET ' 1 21 HYDRANGEA s VEGETATION TO -. T2 LIRIOPE RFMA114 TOTAL LOT AREA 25,372.v IO' MIN. + x SETBACK + BLE 2O/ MAXIMUM ALI.OWA �44 5 MYRICA + _ q GREEN MOUNTAIN - ` BOXWOOD 5 TOROLOSA �, r� r;�__. PROPOSED COVERAGE JUNIPER ,4 PROP05ED ,.%'�'' E X 15 T I N & ,.�, y`~Y~G« - -- EXISTING RESIDENCE 1,210 4 SWIMMING � e�` ,�' .,,� N......... .. :i � '. .., TI ''� E 5 1 D E N G , '',- ✓ tm. .._ .._ EXISTING DECK '141 _ POOL ✓' EL, +e&.0A FFE: +58.5 >' PROPOSED POOL 544 l ti PLANTER BED ;, r ✓ �'` f' PROPOSED PATIO 61015 D 6' x OI0 ILEX STEEDS TOTAL 5,1-7a.0 13.6% SPA �' ,3y. �� �0.'-;,o/ `? '�j'�'^ ,✓r e `- MAXIMUM ALLOWABLE... 4,5-7 ,4 20.0% d EAR YARD L '� SETBACK _ + \ NATURAL BOULDER \ NALL / DWI ``'0 tG ✓' ` / i?' WIDE Xl + STEPPING 4- DEEP/ 5TONE5 \ + , _ 4' TALL NY5 POOL CODE COMPLIANT ESTATE FENCE J , WITH SELF CL051NG, SELF N6 » . t - - 52— — EXISTING CONTOUR +E523 FR-OP05ED SPOT ELEVATIOiI — — PROPERTY LINE EXI5TING SHARED DRIVEWAY EASEMENT LINE -;' HEIGHT ALUMINUM FENCE '4 a--�—o- 4' BL ACK CHAIN LINK FENCE ® PR OP05ED DRA I N EXISTING, VEGLTATION TO PEMAIid + O PROPOSED TREES AND SHRUBS TI TREE TO BE PEMOWED KODAH WALL SYSTEM BY NICOLOCK � I COLOR: YORK BROWN I�E R A Ls NOTES : 12° FINISHED GRADE 1. EXISTING CONDITIONS INFORMATION OBTAINED FROM THE 51TE SURVEY TOPSOIL / PREPARED BY GARY BENZ, L.S. DATED MARCH S, 201"7. FINISHED GRADE 2, EXISTING ELEVATIONS OBTAINED FROM THE SITE SURVEY PREPARED BY 12" MIN. RODERICK VAN TUYL, P.G. DATED JUt'1E 12, 1,:115 24" MA<. TREE REMOVAL. 5CiHEDUL E 5. REFER TO DRAWING '5NIMMING POOL 00145TRUCTION DETAILS' CREATED BY X, g' ? ' :Y, > I SOLID REINFORCED -- 4'-0" CONCRETE DOME STEVEN DUBNER LANDSCAPING, DATED FEBRUARY I , 2x21 FOR 5NIMMING GEOGRID ` EXTENSION 6" SDR S5 PIPE WITH POOL DETAILS ' CODE SIZE COMMON NAME KEEP REMOVE (TYP.) SOLVENT WELD OR {if%;',-�,-A ,' ,, �%'• 6A5KET TYPE FITTI1`165 rg °> •;% w. i' TI 12" CEDAR X F 7 5 R E 5 1 DENGE T2 I CHERRYNORTH X SUMMIT L-)RIVE ;z•,/, ;, ® ® ® ® I® ® ® MA771 1 UGK, N �N 'T'ORK y4y6 L'NATIVE" BOULDERS 4A::AND SECTION106/ �3L.OGK I, LOT SOIL BACKFILL RANDOM SIZES - APPROXIMATELY COMPACT TO 15% MAX. DENSITY ® ® ® ® ® ® ® 1a" DIAMETER - 42" DIAMETER EXISTING GRADE �11NDSCAp ' FILTER FABRIC 3' MIN V MN. TOPSOIL c" I F� GRAVEL BACKFILL ® ® ® ® ® ® ® SC�. L 1 {' "" ' " ?AUL so �c 4" DRAINAGE PIPE VEGETATED SLOPE - BE APPROXIMATELY TOP501L — — — — — — — :2' t I. 5EE PLANTING PLAN 5 DEGREES (TYPICAL) I I , ' GROL4ID OUTSIDE DIAMETER: V-O" FREE-DRAINING, SANDY O 1 ,,•� 2O ,•-�� �< f' rr BACKFILL 501 L (TYP.) �' MINIMUM PENETRATION INTO RATEABLE SOIL *COLLAR MATERIAL NON-WOVEN CEO-TEXTILE 45"MAX FlEIGHT �j, LANDSCAPE FABRIC ��?��� y0e (TYPICAL) DATE: FEBRUARY I6, 2021 />1 UNDERLAYING SAND AND GRAVEL STRATA F NE 3'l�'zI :Yi1.. ,. ..::;:, h ,• CRUSHED STONE BASE „ I BOULDER AT BASE OF WALL SHALL�8E EMBEDDED E\/: MAR(:, H I P', 2021 ,,• . .. I. COLLAR 15 HOT REWIRED WHEP� RATEABLE MATERIA) EXISTS FOR FILL DEPTH. INTO SUB-GRADE A MINIMUM OF 12 OR HALF IT IS A VIOL.ATIOI!OF WE LAN FOP,Atrr Flk-P-501I, COMPACT TO q5% MAX. DENSITY z I m 2. THE MATERIAL USED FOR THE COLLARING SHALL BE COMPRISED OF SAND AND THE DIAMETER OF THE ,.: . ;.,.t•:: f' „ VIRGIN 5)5GRADE GRAVEL FILTER MATERIAL CONTAINING LE55 THAN 15 PERCENT 'FINE SAND, 5 GREATER) BOULDERS SHALASE BLOBE KEYEDULDER INTO ONE OF � + sri€t�55 IO=�rE�s st t nER TW lT�+sTn�un t�t�r,TION OF THF iRM� INDIVIDUAL PR id t 551�i1 WEA F f� PRIMARY Tep SILT ATlD CLAY. (SILT AND CLAY FRACTIONS ARE NOT TO EXCEED 5 PER604 , AW I 51 r���.Tl �t Y�sls>a rJ�IN�0 4 ANOTHER FOR A STABLE WALL FACE. w nky. S 6MNT D SLOGfC Vel LL DETAIL T`I'C'I GAL. DR`rNEL.L. T`I'C'I GAL. BOULDER RETA I N I INCA NALL NOT TO SCALE NiZT TO SCALEHOT TOSTEVEN r DSC I C. z. . �x.•f SOSGrand Street I Westboro, Now York 11500 19'. 631.777.1000 I r. r,31.777.18116 ( SlecelllluhnerLandseapin0.conl I ba APPRO ED AS NOTE DATE: B.P:# . FEE:, BY: NOTIFY'.,B' DEPARTMENT AT . 765:;1802"..8'AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION -:TWO REQUIRED FOR POURED CONCRETE RETAIN STORM WATER RUNOFF 2. ROUGH' FRAMING & PLUMBING PURSUANT TO CHAPTER 236 3.. INSULATION: OF THE TOWN CODE, 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. .. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF ELECTRICAL NEW YORK STATE & TOWN CODES INSPECTION REQUIRED AS REQUIRED AND CONDITIONS OF A S _ FRIG BOARD SO��qMTTOWnMTEES OCCUPANCY OR �9� DtiAT�LY" :. USE] UNLAWFUL ENCLOSE POOLT'C„�Dl� P;UPON COMPLET10N _r WITHOUT CERTIFICAl FQRE:"WATEF " OF OCCUPANCY 5ULLN05E POOL COPING BOND BEAM Q 3�APPROXIMATE WATERLINE —'� AUTOMATIC POOL—\, FROST PROOF TILE COMER 0.4 ASTM &RADE 60 REBAR AROUND PERIMETER OF PO, =L v REBAR TIES AT 12" SPACIN6 MAXIMUM -t" MIN. WALL THICKNESS LATCH MECHANISM 5NALL BP MA&NALATCH VERTICAL PL+LL 5AF-TY LATCH LOCATED ON IN51DE OF 5ATr(POOL SIDE) �i"SPA.GINS BrTI EI 4 TSIIP �I i?,TIG�L 1�MB�P-S CE nr7P.LiIlE5 OF PAIL5 1YP� TOP PAIL S V I #4 ASTM &RADE 60 VERTICAL REBAP, C4 I #4 A5TM 6RADE 60 HORIZONTAL REBAR w. PNEUMLIEI ALLYAPP �� J v CONCRETE (1:4 MIX RATIO) � ��`'• PROPOSED 5WIMMING • i>� 45"H`15§sTT BTV '�t{ POOL - \ \ s� TOP AND BOTTOM \ " MARBLE DUST POOL FIN15H PAIL-MINIMUM \ APPLIED BY HAND \_ I 4 • —'T" MIN. N4LL THICKNESS VIRGIN SOIL 4 Vii' X ' (FILL COMPACTED TO I �� s^MAX.CLEARANCE L At V 5PA 15% MAX. DENSITY) BIS 5D EN 61 *FENCE STYLE SHALL BE.IFPITH BLACK ALUMINI,T1 PADE 12" MAX. 12" MAX. L ' 12" MAX. I ESTATE FENCE -STYLE: OVA7"I011 BOTTOM RAIL FIN1514W&RAD!: T`rP I GAL. CSU 1N I TE FOOL. VNAL.L. SECTION T`i'p'I GAL- ESTATE E FENCE ANI7 GATE I-.�ETA I L-0FLAN V I ESI SCALE: ( I-0 .'.RAIN LINK FENCE NOTES NOT TO SCALE SCALE: 1" = 10'-0" ALL CHAIN LINK FENCE SNARL BB 4'TA1,L BLACK VINYL COATED 0 o THE 5WIMMIN6 POOL AS DESIGNED WILL NOT REOUIRE SPECIAL DRAINAGE FACILITIES. Ti ,E POOL WILL BE CONSTRUCTED OF PNEUMATICALLY APPLIED, STEEL REINFORCED 6UNITE AND THE POL L WATER 15 DESIGNED TO BE CONTINUOUSLY RECIRCULATED THROUGH THE FILTER AND REUSED FROM YEAR TO 'EAR. THE DR.AINA&E ASTM 6P.ADE ESO REBAR SPACING FROM THE FILTER BACKWASH 15 PIPED TO THE DRYWELL AND WILL NOT INTERFERE WITH 'HE PUBLIC KATER SUPPLY, THE EXISTING SANITARY FACILITIES, NEI&HBORIN& PROPER, PUBLIC HIGHWAY OR -RIVATE ROADS. DEPT OF POOL LESS THAN 5'-0" GREATER THAN 5'-0" o SWIMMING POOL HEATER 15 A 400,000 btu MAX-E-THERM NATURAL 6AS HEATER WITH EL _CTRONIC IGNITION HORIZONTAL SPACING 12" ON CENTER 12" ON CENTER MANUFACTURED BY STA-RITE (PENTAIR). THIS HEATER COtIFORM5 TO THE NEW YORK 5TY-TE ENERGY CONSERVATION CODE E.C. 5045 (I.B.C) 2001 EDITION. VER11CAL SPAGI146 12" ON GETITER 6" ON CENTER o THE SWIMMING POOL 15 DESIGNED 014 THE UNDER5TANDING THAT THE SOIL DRAINS FREEL (. IN THE EVENT FLOOR 12" ON CENTER IN BOTH DIRECTIONS GROUNDWATER 15 PRESENT CONTRACTOR SHALL INSTALL DEWATERING DEVICES BELOW ' 'HE BOTTOM OF THE POOL SHELL. WATER SHALL BE PUMPED TO STORAGE FACILITIES ON THE SUBJECT PROP ARTY. 0 SHAL.1- HI-VH; A M1tiiNII)M r,0\sFR OF 3" OF GLINIT'F • SWIMMING POOL TO CONFORM TO AMERICAN IIATIONAL STANDARD FOR RESIDENTIAL IT46 ROUND 5WIMMING POOLS AN51/APSP/IGG-5 2011, APPROVED APRIL 22, 2011 o T':sr- SWIMMIN6 POOL SHALL BE STEELED WITH #4 A.5TM &RADE 60 REBAR. o REFER TO SITE PLAN FOR LAYOUT OF POOL ENCL05LIPE FENCE. POOL AND PROPERTY ` G CONFORM WITH NEW o R.;;BAR SHALL HAVE A MINIMUM LAP LENGTH OF 40 BAR DIAMETERS (20 INCHES) YORK STATE RESIDENTIAL CODE APPENDIX G 200'7 EDITION. OENERAL- DOTES R7::I NFORG I N& ROD SCHEDULE C5EN RAL NOTES : I. THE INTENTION OF T H15 PLAN 15 TO ACCOMPANY A PERMIT APPLICATION TO INSTALL A GUNITE 5WIMMING POOL 2. REFER TO DRAWING 'LANDSCAPE PLAN' CREATED BY STEVEN DUBNER LANDSGAPIPdG, DATED FEBRUARY 16, 2021 FOR LAND5GAPING PLAN AND SITE LAYOUT �I /^ 5l/�l I MM I NO FOOL C,0N5TRUCT I ON � T �I Les '—APPROXIMATE WATEI"'�I..INE AUTOMATIC SKIMMER P T ( S R E 5 I r.? E N �i a 6-71 51.0IMM I T Z7R I VE NORTH M TTITUGK, NEN YORK `® IN (2) LED PENTAIR m STEEPEST ALLOABLE SLOPE 120V ITITELLIBRITE W0 SECTION 106, L_OGK LOT, OT 46 BEFORE BREAK- I:'7 POOL L16HT5 � A NOTED STEEPEST ALLOWABLE SLOPE D SCALE: AS I OTED 5 AFTER BREAK- 1:5 1 4 3 :z 0 6-0" MINIMUM DISTANCE BEFORE BREAK 0 MAIN DRAIN WITH I-YDROSTATIG VALVE AND GOL..EGTORDATE: iF= BRURY 16, 2021 TUBE IN GRAVEL BASE % DSSHH L BCOVERS V AG M�PLIIA NTG c: � W A'R� E�/� REV: �" f IT 15 A VIOL.ATIOII OF TI-F-LAA FOP ANY SEE TYPICAL 6LINIT6 UNLE55 ACTIN6 UNDER.THE DIPFCTION OF THE FIPM/ EE T WALL &UNIT! >Ti O I� INDIVIEVhL PP-OFE551OIIAL,Y+1sIO HAS THE PPIMAPY ALITH-'P5+41P Or HA5 5FAI.ED THIS DOGUM`'_NT,TO ALTEP f 'e ! w ANY ITEM OP PORTION OF THI5 DOCUMENT IN ANY HAY. � F17�'� ty� SECTIONTHROU&H L ENOTH Or SWIM1\11NO POOL _ 080 71 oilSCALE. 1/2" = 1'-0" DUBUR M LANDSCAPING,103 NINTH STREET INC, ;� `' � > °� GARDEN CITY, NEW YORK 11530 TEL/FAX (515) 738-7243 SOS Grand Street I Westburp,New York IIS90 I T.631.779.1800 I r.63(.777.1806 I Sleven0uhnerLandscaping.eom I