HomeMy WebLinkAbout46146-Z gaFF04e Town of Southold 4/2/2022
o y� P.O.Box 1179
o _ 53095 Main Rd
4N- dao ;?r Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42972 Date: 4/2/2022
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 110 Sound View Rd., Orient
SCTM#: 473889 Sec/Block/Lot: 15.-3-33
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/17/2015 pursuant to which Building Permit No. 46146 dated 4/26/2021
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 Wisdom Ventures LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42938 5/20/2019
PLUMBERS CERTIFICATION DATED
Aut ze ature
"S�FFoc,� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
x TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 46146 Date: 4/26/2021
Permission is hereby granted to:
Wisdom Ventures LLC
277 Northern Blvd Ste 200
Great Neck, NY 11021
To: Construct in-ground swimming pool as applied for.
Replaces BP#42938
At premises located at:
110 Sound View Rd., Orient
SCTM #473889
Sec/Block/Lot# 15.-3-33
Pursuant to application dated 4/26/2021 and approved by the Building Inspector.
To expire on 10/26/2022.
Fees:
PERMIT RENEWAL $150.00
Total: $150.00
Building Inspector
ga�Fo TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 42938 Date: 8/13/2018
Permission is hereby granted to:
Wisdom Ventures LLC
277 Northern Blvd Ste 200
Great Neck, NY 11021
To: Construct in-ground swimming pool as applied for.Replaces BP# 40026
At premises located at:
110 Sound View Rd
SCTM # 473889
Sec/Block/Lot# 15.-3-33
Pursuant to application dated 8/13/2018 and approved by the Building Inspector.
To expire on 2112/2020.
Fees:
PERMIT RENEWAL $125.00
Total: $125.00
Buil ector
' TOWN OF SOUTHOLD
�S�nocp�OG
�o BUILDING DEPARTMENT
y a TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 40026 Date: 8/20/2015
Permission is hereby granted to:
GPMDE Inc
359 Harrison Ave
Miller Place, NY 11764
To: Construct in-ground swimming pool as applied for.
At premises located at:
110 Soundview Rd, Orient
SCTM # 473889
Sec/Block/Lot# 15.-3-33
Pursuant to application dated 8/17/2015 and approved by the Building Inspector.
To expire on 2/18/2017.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Buildi ector
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings;property lines, streets, and unusual natural or
.topographic features.
2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of IWlead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6: Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses:
1. Accurate survey of property showing all property lines,streets,building.andunusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant_
C. Fees
1. Certificate of Occupancy-New dwelling$50.00, Additions to dwelling$50.00,Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building$50.00,Additions.to accessory building$50.00, Businesses $50.00•.
2. Certificate of Occupancy on Pre-.existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
Date. V5
New Construction: Old or Pre-existing Building: ' (check one)
Location of Property: I I � �Pt1n�l�eyf _����X_�
House No. Street ., Hamlet
Owner or Owners of Property: A-Q
Suffolk County Tax Map No 1000, Section Block 13 Lot c�
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
PaJ
pplicant Signature
'�'oF so�ryQl
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road C Fax(631)765-9502
P.O.Box 1179 G @
;e• •nrrV
Southold,NY 11971-0959 �o roger.richertCaD-town.southold.ny.us
Qlyc®U191
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Wisdome Ventures LLC
Address: 110 Soundview Rd City: Orient St: New York Zip: 11957
Building Permit* 42938 Section: 15 Block: 3 Lot: 33
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Puccio Electric License No: 4086-ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
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 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 2
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1
Disconnect Switches 2 Twist Lock Exit Fixtures TVSS
11
Other Equipment: In ground swimming pool to include, bonding, time clock,1-pool pump,2-switches,
3-GFCI circuit breakers, 1-Polaris pump,1-pool light,gas pool heater
Notes:
Inspector Signature: Date: May 20 2019
81-Cert Electrical Compliance Form.xls
T I� �pE 50U1y
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ply UNiV,O�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL.(FINAL)
REMARKS: Si VV : 'n (Al I b#t✓rW
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DATE b v? INSPECTOR
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* # TOWN OF SOUTHOLD BUILDING DEPT.
°`ycourm,�f'' 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I ULAT N
[ ] FRAMING /STRAPPING ( FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS-
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DATE INSPECTOR
CoAti SOUTy��
TOWN,OF SOUTHOLD BUILDING DEPT.
7654 802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] NSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ FINAL PVVL�
[ ] FIREPLACE &CHIMNEY-- f ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS: I �rqvlvr"�_'
ow
DATE (O1014 1 NSPECTOR
�apF SOUTyO
# TOWN OF SOUTHOLD BUILDING DEPT.
co 765-1802
:
INSPECTION
[ ] FOUNDATION 1ST-' - [ ] ROUGH PLBG.
[ ] FO.UNDATION2ND - [ ] 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:
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DATE INSPECTOR
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TOWN OF SOUTHOLD BUILDING DEPT.
�ourm ' 765-1802
INSPECTION.,[ ] FOUNDATION 1 ST [ ] ROUGH PL13G.
[` ] FOUNDATION 2ND [ ] I ULATION/CAULKING
[ ] FRAMING/STRAPPING .[U/FINAL .Q,�
[ ] FIREPLACE 4 CHIMNEY=. [ `] FIRE SAFETY INSPECTION
[ ] FIRE-RESISTANT CONSTRUCTION [ ] -FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: 765-1802 nn Survey
PERMIT NO. U Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined ,201- Contact:
Approved ,20_L5 Mail to:
Disapproved a/c
Phone:
expirak6n
Buildin s or
Ppb ATION FOR BUILDING PERMIT
Jfl AUG 7 I J, Date
M5
1
INSTRUCTIONS
a.T 's application MUST be complete filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans;accmat-e-glettlm4G,s n ording to schedule.
b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c.,The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what-so-ever until a Certificate of Occupancy
is issued by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described.The
applicant agrees to comply with all applicable laws, ordinances,building code,housing codManegulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signatur applicant o e,if a corporation)
qA p�- �s� pliie, p(QcQ ((AV
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises 6enopao tic fo --c
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. 'T'1� 4 ' T
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done: L
110 &AAoview �o 044-1-1
House Number Street Ham'14 `- � �"`44•f lfmi
County Tax Map No. 1000 Section 1 Block
Subdivision Filed Map No. Lof'
(Name)
2. State existing use and occupancy of premisesd intended use and occupancy of proposed construction:
a. Existing use and occupancy k'&de&g-
b. Intended use and occupancy. ja i deAk &jMj41Na
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work1&l ,f'ojng Vl/ik Si jmlv-Jq ,�fl
(Description)
4. Estimated Cost Ni Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear 3 Depth
Height Number of Stories
9. Size of lot: Front Rear 1621
Depth Zl '
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation:
13. Will lot be re-graded &L k-eo( a\L"j Will excess fill be removed from premises: YES NO
14. Names of Owner of premises 6roopl , Address 113 3UOVia1 kn Phone No. W-bggq
Name of A-�-&tM�n,�JAgf�Wk�
Address R/,J , yi1XbrJ PhoneNo -2ZY-16'
of Contracto _ Address G ZEA Phone No. -7W-Th-
Name
Hiller LOCQ (Oby
15. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BER QUIRED
16. Provide survey,to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below,must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF�
Aw�v'- 1 (/ QdW S being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the r
(Contractor, Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
day of nn 20 �S
No ry ublic Si ature of licant
MARGARET A. KIDNEY
Notary Public-�State of New York
No..0I K16021111
Qualified in Suffolk County,
My Commission Expires March 8,2o-d
Scott A. Russell
0�°suFFQ/� STOP] I��1[WA TIE] .
SUPERVISOR AMIA,N \G IEAM[IEl F
SMain
TOWN HALL-P. Box 1179 0 Town of Southold
530955 Main Roaad-SOUTHOLD,NEE W YORK 11971
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOLES THIS PROJECT INVOLVE ANY OF THE FOLLOWINQ
Yes No (CHECK ALL THAT APPLY)
ffA. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
❑[''B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
Er C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
❑0"D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
Q["E. Site preparation within the one-hundred-year floodpl in as depicted
on FIRM Map of any watercourse.
❑f5 F. Installation of new or resurfaced impervious surfaces of 1,000 square
feet or more, unless prior approval of a Stormwater Management
Control Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project.
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with your Building Permit App'cation.
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date:
District 0121)5-NAME: C Akra �Q 15_ 3 33 0121) _
(P0.0 Section Block Lot
em
22`Slgw`ur`'1 tr / ****FOR BUILDING DEPAR _MENT USE ONLY****
Contact InformatiorL J�' 6D T' o q 9 q
(Telephone Numbed
Reviewed By:
- - — — — — — — — — — — — — — — � z� (S
—
- - - - - Date:
Property Address 1 Location of Construction Work: _
i 1� -'b)A��1�eh! �D Approved for processing uilding Permit.
�(�f I I i( Stormwater Managemen ontrol Plan Not Required.
��e�� y" ` I,�, — Storinwater Management��ontrol Plan is Required
(Forward to Engineering llepartment for Review.)
FORM # SMCP-TOS MAY 2014 -
I
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o���F SQ�j�yo
Town Halt Annex L Telephone(631)765-1802 ('
54375 Main Road y �r (6313 761 11A.
P.O.Box 1179 G • O roper.richertlrW OWrl.souf loltl.ny.us
Southold,NSC 11971-0959 �Q �
BUILDING DEPARTMENT i
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
' I
REQUESTED BY: ` c �,�� kr�L Date: ; P
Company Name: EA
Name:
CD
License No.:
Address:
Phone No. _
JOBSITE INFORMATION: (*Indicates required information)
*Name: 150�,�/Y1 V e4_ _?,tFe
*Address:
Cross Street: lacy - � e_
`Phone No.: ( _ •`�� . ,��•
Permit No. c'1-c1
Tax-Map District: 9000 Section: __1_57_ Block:-'.3i Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply)
*Is job ready for inspection: YES N0 Rough In Final
*Do-you need a Temp Certificate: YES :NO
Temp Information(If needed)
*Service Size: 9 Phase 3Phase 100 950 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
AdditionatInformation: PAYMENT DUE WITH APPLICATION
W-Request for InspecOon Form
O�FFQj BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
CD Town Hall Annex - 54375 Main Road - PO Box 1179
-- -vim Southold,-New-Y-or*,1-1974-0959-- ----------
Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr(a-),southoldtownny.gov - seand dnsoutholdtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
0 V L
Square Footage:
Circle All That Apply:
Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final
Do you needa Temp Certificate?: ❑ YES ❑ NO Issued,On_..,
Temp Information.: (All information required)•
Service"Size❑1 PhF-]3 Ph Size: A # Meters Old Meter#
❑New service[-]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground LateralsF-] R2 H Frame Pole Work done on Service? OY N
Additional Information:
1
PAYMENT DUE WITH APPLICATION
�`-� l ITS __._
PERMIT# Address:
Switches
--O----------------------
utlets ---------------- ----- -----
GFI's
Surface
Sconces
H H's
UC Lts
Fans Fridge HW
Exhaust Oven W/D
Smokes DW Mini
Carbon
micro . Generator
Combo Cookto:p Traxisfe;r
Ac*.- AH Hood Service
Amps Have Used
Special: .
Comments: �r
t . .
ARTHUR EDWARDS POOL & SPA CENTRE
929 ROUTE 25A
MILLER PLACE, NY 11764
516-744-7185
FAX-744-0174
APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD
TOWN OF SOUTHOLD
MAIN ROAD (P.O. BOX 1179)
SOUTHOLD, NY. 11971
(631) 765-1802
PAPERS ENCLOSED:
APPLICATION FOR OUTDOOR POOL PERMIT
[ EROSION SEDIMENTATION &WATER RUN ASSESSMENT FORM
[lp CERTIFICATE OF WORKER'S COMPENSATION
CERTIFICATE OF LIABILITY INSURANCE
SUFFOLK COUNTY LICENSE
SUFFOLK COUNTY PLUMBER LICENSE
SUFFOLK COUNTY ELECTRICIAN LICENSE
4 SETS OF PLANS - (3 STAMPED)
[ ]� 3 SURVEYS
APPLICATION FOR ELECTRICAL INSPECTION WITH $100 CHECK
[�Q APPLICATION FOR CERTIFICATE OF OCCUPANCY
[ ] C.O.
[ ] TAX BILL
$300.00 CHECK FOR PERMIT FEE
Southold Town Building Department
��� guFfOl,y�oGy P.O.Box 1179
Permit#: 40026
53095 Main Rd
o •
Permit Date: 8/20/2015
Southold,New York 11971
:yo. moo ' (631)765-1802 Expiration Date: 2/18/2017
1.. Parcel.ID: 15.-3-33
BUILDING PERMIT RENEWAL LETTER
Dated: 10/4/2017
Applicant: GPMDE Inc
Location: 110 Soundview Rd, Orient
Work Description: IN GROUND POOL
Construct in-ground swimming pool as applied for.
A FEE OF $250.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT.
Owner: GPMDE Inc
Address: 359 Harrison Ave
Miller Place,NY 11764
The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please
submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building
Department, P.O. Box 1179, Southold,New York 11971
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
Southold Town Building Department
s��}FFtdl,tc,� P.O.Box 1179 Permit#: 40026
53095 Main Rd
Southold,New York 11971 Permit Date: 8/20/2015
(631) 765-1802 Expiration Date: 2/18/2017
Parcel ID: 15.-3-33
BUILDING PERMIT RENEWAL LETTER
Dated: 5/16/2018
Applicant: GPMDE Inc
Location: 110 Soundview Rd, Orient
Work Description: IN GROUND POOL
Construct in-ground swimming pool as applied for.
A FEE OF $125.00 IS REQUIRED TO RENEW TRIS BUILDING PERMIT.
Owner: GPMDE Inc
Address: 359 Harrison Ave
Miller Place,NY 11764
The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please
submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building
Department, P.O. Box 1179, Southold,New York 11971
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
v -[I sZ i r-11b :;;t® E94'�c l'T� �aes�l��leC�3a
I .
ANY ALTER.4TlON OR ADDITION TO THIS SURVEY IS A VIOLATION The �locallons of wells and- cesspools - SCOHS Ref.# R/0-11-0045
OF SECTION 7209A SOF THE-NEW YORK STA T9 6DUCATION LAW. , shown--her�son are from field observations PROPOSED SEP77C SYSTEM LOT COVERAGE t
EXCEPT AS PER SECTIQN 7209 - SUBD/V1,WON C ALL CERTIFICATIONS and or fr�in data obtained from olHer-s, fSBEDRO0A�S1lG.�RAGE rlTt/ EXISTING
HEREON ARE VAAJ FOR THIS MAP AND COPIES THEREOF ONL SURVEYOR
Therefore their locallons and or existence S4VIARY rACX,*TIES1 HOUSE 2376 SOFT
SAND MAP OR COPES.BEAR THE IMPRESSED SEAL OF THE SURVEYOR - GA'RAGE 5T6- Sa.FT.
WHOSE SIGNATURE APPEARS HEREON. is not guaranteed .
'9 LAG 'y 2000 Oat 10'0 x 4' Llgtdd Depth SEPTIC TANK
2952 SO.FT.
ADDITIONALLY TO COMPLY WITH SAID LA If TERM 'ALTERED BY ' OwEL 150 � � r" IQ'0 x !.S' �p.L�i1C�lAl�i PQ�,L-WITH l WITH PROP. PECK 8
MUST-BE USED BY ANY AND ALL SURVEYORS UTILIZING A COPY C.P. over �• Bp\Hp ($ CALCAR BOTTOA/ 3' min ABOVE GROUND STOOL'S -442 SOFT
OF ANOTHER SURVEYOR'S MAP. TERMS SUCH ' INSPECTED '-AND WA TIER 3394 SO.-F
-
' BROUGHT - TO - DATE 'ARE NOT/N COMPLIANCE WITH THE LAX.
39L20 x`94• _ ►6.3
97
CERTIFIED TO, DWESpG. RAIN RUNOp'F CONTAINMENT. 6 /20794 661 Sa.FT
= 3.2%
Cp, vl4a• ; HOt[SE 2656 sq./l • 19.5
FIDELITY NATIONAL TITLE G RAQE 610- fi
INSURANCE COMPANY OF NEW YORK - . DRIVEWAY A1'wo�l
THORND/KE WILLIAMS
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3 O ark 1 t o 06 P, - AND CONSTRUCTION OF SUBSURFACE SEWAGE
SOD g'"' 1 ' r =1kF_ DISPOSAL •-SYSTEMS FOR SINGLE FA WL Y RESIDENCES
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LOT 79 9.4 N.Y.S. L/C. NO. 49618
t= DWELLING EYORS, P.C.
- (63/) - 5020 FAX (631) 765 - 1797
DWELLING �1 LOT 80 P. 0. BOX 909
well over 150' well AREA = 20,794 SC]. ft1230 TRA VELER STREET_ SOUTHOLD, N.Y. 11971
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a
Suffolk County Department of Labor Licensing &
taF Consumer Affairs
a� VETERANS MEMORIAL HIGHWAY * HAUPPAUGE,NEW YORK 11788
w :
DATE ISSUED: 7/1/1978 No. 4436-H
E f SUFFOLK COUNTY
j Home Improvement Contractor License
i
This is to certify that I '
fS' ARTHUR J EDWARDS
? � doing business as
w ARTHUR J EDWARDS MASON CONTRACTING CO C DBA
IN
having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules
and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME
IMPROVEMENT CONTRACTOR, in the County of Suffolk.
SUFFOLK COUNTY DEPT OF LABOR, License Category
LICENSING 8-CONSUMERAF FAIRS
HOME IMPROVEMENT Additional Businesses GC i
CONTRACTOR Pools&Spas/Certified
LICENSE ARTHUR J EDWARDS MASON, Pools/Spas
NANE
ARTHUR J EDWARDS CONTRACTING CO INC DBA .b
ARTHUR EDWARDS POOL&SPA '
This certifies that the Bum-
""NE CENTRE
ARTHUR J EDWARDS MASON
bearer is duly CONTRACTING CO INC DBA 5 �
licensed by the ,
U-NumDe^ ORebwM
County of SuffolkI
4436=H 07/01/1978 Commissioner
Camrtb"bmr EIffIRATON DATE _ + 4'° ;.,:"`
07/01/2016
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r�1 ARTHU-1 OP ID:VM
ACRO- DATE(MMIDDIYYM
�.� CERTIFICATE OF LIABILITY INSURANCE F01122/2015
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(les)must 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 CONTANAME: Bagatta Associates,Inc.
823 W Jericho Turnpike Ste 1A PHONE 831-864-1111 AIc No: 631-864 274
Smithtown, NY 11787 EMAFL
Bagatta Associates,Inc. ADDRESS:
' INSURER(S)AFFORDING COVERAGE NAIC/
INSURER A:Worcester Insurance Company 26182
INSURED Arthur Edwards Mason INSURER B:
Contracting,Inc.DBA
Arthur J.Edwards Pool 8, INSURER C:
Spa Center INSURER D:
929 Route 25A
Mlller Place,NY 11764 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.
I�TRR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY) IMMIDDNYYYI LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENT EIT_
CLAIMS-MADE a OCCUR MPA00000038801 H 01/0112015 01/01/2016 PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,000
X BLANKET ADDITIONA PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
POLICY F-1JECT LOC PRODUCTS-COMPIOP AGG $ .2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Peraccident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORIPARTNERIF�CUTIVE
OFFICERIMEMBER EXCLUDED? D NIA E1.EACH ACCIDENT $
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD'101,A'ddldonal Remarks Schedule,maybe attached Ir more space Is required)
J
CERTIFICATE HOLDER CANCELLATION
0000000
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.
Town Hall
P.O.BOX 728 AUTHORIZED REPRESENTATIVE
Southold,NY 11971
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
STATE OF NEW YORK
WORKER'S COMPENSATION BOARD
CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Ia.Legal Name and address of Insured(Use street address only) Ib.Business Telephone Number of Insured
Arthur J Edwards Mason Contracting Company Inc. 631-744-7185
929 Route 25A
Miller Place,NY 11764 lc.NYS Unemployment Insurance Employer
Registration Number of Insured
DBA:Arthur Edwards Pool&Spa Centre
Id.Federal Employer Indentification Number of Insured.
or Social Security Number
112377925
Work Location of Insured(Only required if coverage is specifically limited
to certain location in New York State, i.e. a Wrap-Up Policy)
2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) Rochdale Insurance Company
Town of Southold
Town Hall 3b.Policy Number of entity listed in box"1a":
P.O.Box 728
Southold,NY 11971 RWC3363984
3c.Policy effective period:
3/1/2015 to 3/1/2016
3d.The Proprietor,Partners or Executive Officers are:
0 included(Only check box if all partners/officers included)
all excluded or certain partners/officers excluded
This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box"Ia"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
Certification of Insurance to the entity listed above as the certificate holder in box "T'.
The Insurance Carrier will also notify the above certificate holder 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.
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: Henry C.Sibley
(Print name of authorized representative or licensed agent of insurance carrier)
�Yr F �,a�rfi
Approved By: i v4 �, 3/4/2015
(Signature) (Date)
Title: Underwriting Manager
Telephone Number of authorized representative or licensed agent of insurance carrier:CarrierPhone
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)
Workers' Compensation Law
Section 57.Restriction on issue of permits apd the entering,contracts unless,compen sation is secured.
`i. 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 a hazardous employment defined by this
chapter,and notwithstanding 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
compensation for all employees has been secured as provided by this chapter.Nothing herein,however,shall be construed as
creating any liability on the part of such state or municipal department,board, commission or office to pay any compensation
to any such employee if so employed.
2. 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 a hazardous employment defined by
this chapter,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
compensation for all employees has been secured as provided by this chapter.
•
C-105.2(9-07)Reverse
f
STATE OF NEW YORK
WORKER'S COMPENSATION BOARD
CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW
PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier
1 a. Legal Name and Address of Insured (use Street address only) 1 b. Business Telephone Number of Insured
ARTHUR J EDWARDS MASON CONTRACTING MILLER PLACE
COMPANY INC 1c. NYS Unemployment Insurance Employer Registration
929 ROUTE 25A Number of Insured
MILLER PLACE NY 11764-2700 2410871
1d.-Federal Employer Identification Number of Insured or
Social Security Number
11-2377925
2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier
Coverage(Entity Being Listed as the Certificate Holder) The Guardian Life Insurance Company of America
TOWN OF SOUTHOLD 3b. Policy Number of entity listed in box 1 a":
P.O.BOX 728 00984424-0000
SOUTHOLD, NY 11971 3c. Policy effective period:
07/01/2015 to 07/01/2016
4. Policy Covers:
a. ® All of the employer's employees eligible under the New York Disability Benefits Law
b. ❑ Only the following class or classes of the 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 Benefits insurance coverage as described above.
Date Signed: 07/07/2015 By: S hxti t
Stuart J.Shaw, FSA,MAAA
Telephone Number: 1-888-278-4542 Title: Vice President, Group Insurance
IMPORTANT: If box"4a"Is 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"Is checked,this certificate Is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability
Benefits Law.It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,
20 Park Street,Albany,New York 12207.
PART 2. To be completed by NYS Workers' Compensation Board(Only if box"4b"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 Benefits Law with respect to all of his/her employees.
Date Signed: By:
(Signature of NYS Workers'Compensation Board Employee)
Telephone Number: Title:
Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed
insurance agents of those insurance carriers are authorized to issue Form DB-120.9. Insurance brokers are NOT
authorized to issue this form.
DB-120.1 (5/06)
if
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"la"for disability benefits under the New York State Disability 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". This
Certificate is valid for the earlier of one year after this form is approved by the insurance carrier or its licensed agent, or
the policy expiration date listed in box"3c
Please Note: Upon,the cancellation of the disability benefits 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 NYS Disability Benefits Coverage or other authorized proof that the business is
complying with the mandatory coverage requirements of the New York State Disability Benefits Law.
DISABILITY BENEFITS LAW
§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 for all employees has been secured as provided by this article.
Nothing herein, however, shall be. ;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 for all employees has been secured as provided by
this article.
I.
i
DB-120.1 (5/06) Reverse
ELECTRICAL
INSPECTION REQUIRED
ENCLOSEvPOOL TO CODE
UPON COMPLETION
APRO`�ED ASOTED I t3EFORE"WATR'�
DATE: b.p.4146WI0
FEE: d� Y:
NOTIFY BUILDING DEPARTMENT AT
765-1802 8 ANI TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - _PNO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
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
NEW YORK STATE &TOWN CODES
AS REQUIRED AND CONDITIONS OF
BOMB TM PLANNING BOARD-
vv
►9 =
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
OF THE TOWN CODE.
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Section A—A Typical Wall Section NO.
SIZE AB CD E F G H AREA CAP.
FEET FP. FP. FP. FT. FT. FP. FT. FP. SQ.FT. GAIT. pn vhL
16132' 16' 32' 8' 14' 6' 4' 4' 8' 512 19,000 �6lsf(.L�nL �ZQI�
16'136' 16' 36' 12' 14' 6' 4' 4' 6' 576 21,600
POOL&SPA CENTRE °°�
PERMACRETE WALL SYSTEM
16'136' 18' 36' 12' 14' 6' 4' '5' 8' 648 24,300 929 Route 25A Miller Place NY 11764 cay state
20'140' 20' 40' 16' 14' 6' 4' 6' 8' 800 30,000 (631) 744-7185 FAX (631) 744-0174
24'144' 24' 44' 18' 14' 8' 4' 6' 10' 798 30,000 Suffolk License #4436—HI Ph=a On code
\ 2448' 9 48' 20' 16' 6' 4' 6' 10' 900 30000 Nassau License #HI7445OOOO