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HomeMy WebLinkAbout46013-Z �o�OgilFFUlr Town of Southold 5/14/2022 0 y� P.O.Box 1179 co 53095 Main Rd `4,j o� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43074 Date: 5/14/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1905 Oaklawn Ave., Southold SCTM#: 473889 Sec/Block/Lot: 70.-3-22.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/10/2021 pursuant to which Building Permit No. 46013 dated 4/1/2021 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in-ground swimming pool fenced to code as applied for. I I I The certificate is issued to Zehil,Charles&Laura i of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46013 3/4/2022 PLUMBERS CERTIFICATION DATED C\ Aut ri ed Si n tore osu FF o eco TOWN OF SOUTHOLD BUILDING DEPARTMENT x TOWN CLERK'S OFFICE "oy . 0.� 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#: 46013 Date: 4/1/2021 Permission is hereby granted to: Zehil, Charles 1905 Oaklawn Ave Southold, NY 11971 i To: I construct accessory in-ground swimming pool as applied for. At premises located at: 1905 Oaklawn Ave., Southold SCTM #473889 Sec/Block/Lot# 70.-3-22.1 Pursuant to application dated 3/10/2021 and approved by the Building Inspector. To expire on 10/1/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Build in` nspector I *pF SOU�yo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 Q sean.devlina-town.southold.nv.us Southold,NY 11971-0959 Q a �yOOUNV I BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Charles Zehll Address: 1905 Oaklawn Ave city:Southold st: NY zip: 11971 Building Permit#: 46013 Section: 70 Block: 3 Lot: 22.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electric License No: 40557ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures Smoke Detectors i 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 1 Disconnect Switches 4'LED Exit Fixtures 11 Pump Other,Equipment: Intermatic Pool Panel 4 Circuit/4 Used, Heater, Hayward Salt Generator, Pump - 220GF1, 4 Lights 30OW Transformer Notes Pool Inspector Signature: Date: March 4, 2022 S.,Devlin-Cert Electrical Compliance Form �- y Of SOUIy� # TOWN OF SOUTHOLD BUILDING DEPT. �`yrouwnr��'' 765-1802 ` INSPECTION [ ] FOUNDATION 1ST [ } ROUGH PL13G. ] 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: DATE INSPECTOR o13oFso�la GoLk PoLv-10A * # TOWN OF SOUTHOLD BUILDING DEPT. �o • io `yCOUN,v� 765-1802 INSPECTION '. [. ] "FOUNDATION 1ST [ ] ROUGH PLBG. ] FOUNDATION 2ND [ ]- INSULATION/CAULKING' :_ - ] FRAMING /STRAPPING [ ] FINAL [ ]` FIREPLACE'& CHIMNEY [ .] FIRE'SAFETY-INSPECTION j -] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH)- ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O REMARKS: ` GD'L bu,4- CC�4 eve l A-/P- on,A DATE INSPECTOR _ - - o��OE 50UTyO! 1/f C915 l 6 5 o * TOWN OF SOUTHOLD BUILDING DEPT.- co EPT.courm N 765-1802 INSPECTION.. .. . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. ['- ].': FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL ] FIREPLACE &-.CHIMNEY - [ ] FIRE SAFETY INSPECTION [ ] FIRE.RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) 1?6 ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: ., 4i-0 DATE 2Z ` INSPECTOR ��` ` i ` a31 of s . o TOWN OF SOUTHOLD BUILDING DEPT. 631-365-1$02 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLEG. [ ] FOUNDATION 2ND . [ ] IN8;ULATI®IV®Ce4ULICING ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ l ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C®® [ ] RENTAL REMARKS: i � V� on -t o (o DATE INSPECTOR ,� VrJ p v` w , f ALL S 03- Dfi l-1-,01 ' i WT �r . 1 I e . r�ws�e..r.nwan . _ � � _ ..., ,a i �, - r �_��• � .moo.—s.. �1�. +?�a „ �*µ }.� i a .. M � � '�u Ar .. � I �� -' - _ .` _` � �• �� f .�' a �.� '� �r _ .._,;. `'� -��y. _.. ;� � � ,.. -,' � 1 �y� YT ��� � t�� r%, � r � i' l� e ,.,�� j �� yr�za. ;' . .. .. .. .. .. ... �. ,`�� .,. i. `, per.: k 2+' k I L' i r it Mir • ... \ �i.1. a � e't y. � b j .? •�� � y� 4Ar IC I z rt fF.W 3 \.. $f f"e3 lSq� .,;lk ., a .,tl t • ter. ` - »',` N Zm k+ .-w"- ,�V••���� � � �. j y - ,,,, '-t ' r � �F K Ys:; 4 A�.,Y•'i' i Z.' ��°.. Y t4 j; - t y l41 i- �. 64 wis Now- • nA�•1 ~ y r S�• L. y i P$ FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) ------------------------------------ 'FOUNDATION (2ND) 77!l [�17 z o 0 o� J ROUGH FRAMING& y V` PLUMBING ` I -S INSULATION PER N.Y: STATE ENERGY CODE e �✓ l .ov U FINAL ADDITIONAL COMMENTS l V to—�t—z 0 y %3z H b N TOWN OF SOUTHOLD-BUILDING DEPARTMENT w . Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ao��,y Telephone (631) 765-1802 Fax (631) 765-9502 htths://NNw���.south «un� oldto � ov Date Received APPLICATION FOR BUILDING PE MIT For Office Use Only ( ) i� •� L Yr l� PERMIT N0. � Building Inspector: MAR 1 0 2021 Applications and forms must be filled out in their entirely Incomplete n, applications will not be accepted ':Where the Applicant is not the owner,an r , O'ndr'sAuthciriz6 ion form(Page 2)shall be completed _ n ; Date: 69,1 a1 Q4I +►14ER�=S° P(?PTY . : ...1� Ack,r��.e,5-._ _ ZIEI-A_ SCTM# 1000- -70 �P.I,yslcal Addressr c 0-5-. cn Ic,lGt,,c��� H Vp I C/-t- S L?✓+k 0 1 rV 1. 19 -1 &PhonWei (011 ,`��4,C�'i l `l. Er>iail: CZP-kL <Q q cul l COQ .. Ma�,iling_Acldress„...�_q s �U(C(Gt.v3, ... v. �.v-�•=JUv �O CIl .1.17.7 2i F CONT, C PERSON t ' Name: _mCjc _. 1 - C' Mailing Address: - Phone#: DESIGU PROFESSIONAL:INFORMATION ,; Name: Mailing Address: -44wAik m, ✓ . On klan _ = Phone#: Email: b Cr CONTRACTOR,INFORMATION:` Name: . . Aar ... Mailing Address: f)VC iai Chib_.O Phone#: -- -cas 3R Email: S •7YYt ,DESCRIPTION OF•I?�ROi?OSED CONSTRUCTION i ❑New Structure ❑Addition ❑Alteration []Repair ❑Demolition Estimated Cost of Project: 50 father 1Cl�.iy►�tA�GE �on� $ _. ... .,Cco. `'0-., . [W—ill the lot be re-graded? ❑Yes' }ao Will excess fill be removed from premises?` Pes ❑No 1 PROPERTY'INFORMAT ION' .Existing use of property: r�s���� Intended use of property: S-Cvyv , Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes 0 No IF YES, PROVIDE A COPY. 'Check BoicAfter'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 premise's and in building(s)for necessary inspections.False statements,,made'herem are punishable as a Class'A misdemeanor'pursuant to Section 210.45,of the New York State Penal Law. Application Submitted By(print name): `Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) C__ SS: COUNTY OF `-,u4r)L 4 ) Ca zi t5 —Zck I being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the �J� (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before methis day of ��4 20�� Notary Public REBECCA A LUCAK Notar Public-State of New York P.,R,'Q,,RE RYXiO 139' � � � MEN �*I No.01LU6.386882 Oualified in-Suffolk County (Where the applicant is not the owner) My commission Expiraa FOb-04,2023 residing at aim erss e P L{ k lat-W do hereby authorize CA(10 ( t�j Q D l.I a)LG�O i�o apply on my beh f to the To of Southold Building Department for approval as described herein. ZoZl awn�l�s 5ignaturre -��,ate� Print Ouu-ne'�=s Name 2 OS�FEO(,t-C BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 . o • Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerrCa.southoldtownny.gov - sea ndCED-southoldtownny_gov APPLICATION FOR ELECTRICAL INSPECTION' ELECTRICIAN INFORMATION (All Information Required) Date: CI 2 Company Name: ,�-)� IC4 G . -ln Electrician's Name: v r .� License No:: 4 WS 5`77 M;F Ele:. email: Elec.'Phone No: (��I-�.Sb-Co5 ❑ L'request an.email'copy of Certificate of Compliance. Elec. Address.: .Jv- JOB S,ITE INFORMATION --(All Inforrnation.,Required)-- 'Name: Address: 1A-0-Q .: )64 Cross Street: Phone Nd.:. BIdg.Permit#: : Tax Map.District:- 1000.- Section: .76.: . .. . Block: Lot: . J. BRIEF.DESCRIPTION,OF.WORK, INCLUDE SQUARE FOOTAGE.(Please Print'Clearly): Sq pare Footage: ..:Circle All That Apply: :Is job ready for inspection?: QYE�S' /.NO Rough In Fina Do you need a Temp Certificate?: / NOIssued On Temp Information: (All information required) Service:Size T Ph 3 Ph.. Size:. . A :# Meters... Old,Meter#. New Service- Fire Reconnect- Flood,Reconnect=Service Reconnected -Underground - Overhead # Underground.Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION - 21 PERMIT# Address: Switches C Outlets Surface Sconces H H's UC Lts Fans : Fridge HW Exhaust Oven W/D Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service . Amps Have Used Special:. Comments: ----------------------------- P. .F s Suffolk County Dept,of Labor,Licensing&Consumer Affairs P°"+ HOME IMPROVEMENT LICENSE Name f DIETER SPECHT Business Name This cerdesthat the bearer is,duly.licensed SPECHT-TACULARPOOLS INC by the County of'suffoik License Number:H-27415 Fra.�+Jt,NardzU;i, Issued: 08/20/1999 Commissioner .Expires: 08/01/2021 j I i ACO® DATE(MMIDDNYY`) �� CERTIFICATE OF LIABILITY INSURANCE 09122/2020 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 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 CONTACT NAME: Gene Romano Liberty Risk Management, Inc. PHOAICNE (631)569-5633 FAX No; 631)569-5636 664 Blue Point Road,Suite A ao Ips; gene@jibertyrisk.org Holtsville, NY 11742 INSURERS AFFORDING COVERAGE NAICN INSURER A: Hartford Fire Insurance Company 19682 INSURED I INSURER B Specht-tacular Pools Inc INSURER C: 265 Brookfield Avenue INSURER D: I Center Moriches, NY 11934-1001 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000072-881385 REVISION NUMBER: 3 THI%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. ILTR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP INSO POLICYNUMBER MMIDD MMIDD LIMITS A 'X COMMERCIAL GENERAL LIABILITY Y 12 UUN OZ8606 09/18/2020 09118/2021 EACH OCCURRENCE $ 1,000,000 CLAIMS MADE DOCCUR REAM SES Ea occurrence $ 300 000 MED EXP(Any one person) $ 61000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPUESPER: GENERAL AGGREGATE $ 2.000.000 X POLICY 1:1Jr LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 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 $ I UMBRELLALIABOCCUR' EACH OCCURRENCE $ EXCESS LLAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERSCOMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY �,/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ (Mandatory In If yes,describe under E.E.L.DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) TowA of Southold is included as additional insured,ATIMA,as required by written contract,subject to policy terms, conditions,and exclusions. I I f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Main Street,Town Hall j Southold, NY 11971 AUTHORIZED REPRESENTATIVE I _ I GGR ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by GGR on September 22,2020 at 12:29PM I 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 1a.Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured 631-696-3900 Specht-tacular Pools, Inc 1c.NYS Unemployment Insurance Employer Registration 265 Brookfield Avenue Number of Insured Center Moriches,NY 11934 1d.Federal Employer Identification Number of Insured j or Social Security Number 010648957 i 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being listed as the Certificate Holder) The First Rehabilitation Life Insurance Company of America 3b.Policy Number of Entity listed in box"1a": ToIWn of Southampton D152822 11I Hampton Rd 3c.Policy effective period: Southampton,NY 11968 09/26/2020 to 09/26/2021 I 4.Policy covers: I a. ❑✓ All of the employer's employees eligible under the New York Disability Benefits Law b.F� Only the following class or classes of the employer's employees: I I I 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. /17 Date Signed 9/26/2020 By (Signature of insurance carrier's authorized representative or YS Li ed Insurance Agent of that insurance carrier) Tel6phone Number 516-829-8100 Title Sr. Vice President IMPORTANT:If box"4a"is checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent I 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 the purposes of Section 220,Subd.B of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,NY 12207. PART 2.To be completed by NYS Worker's Compensation Board(Only if box"4b" of Part 1 has been checked) I State of New York Worker's Compensation Board According to information maintained by the NYS Worker's 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 Worker's 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-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (5-06) i NEW Workers' YORK Compensation CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a.Legal Name and address of Insured (use street address only) 1b. Business Telephone Number of Insured SPECHT TACULAR POOLS INC (631)696-3900 265 BROOKFIELD AVE CENTER MORICHES NY 11934 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location 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 01-0648957 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Hartford Accident and Indemnity Company TOWN OF SOUTHOLD 22357 BUILDING DEPARTMENT 3b. Policy Number of Entity Listed in Box"1 a": MAIN STREET TOWN HALL 12 WE QD9B81 SOUTHOLD NY 11971 3c. Policy effective period: 10/17/2020 to 10/17/2021 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 "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved 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 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: Danielle Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved by: S-L�;nVC , � 10/20/2020 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier: (877)853-2582 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) Form WC 88 3121 F Printed in U.S.A. www.wcb.ny.gov Page 1 of 2 LOT AREA= 41.768 sq. ft. LOT NUMBER 13 _ S• 4'.11�0.�E ?25.01' __� W---o FENCE CHAIN LIN FENC 0.0'E 1 01) o lb, �• . L op z C) r4, 6 i= W t Q N FC _F .- 0.1' ®� Do z o 51- P: 1.P 13.5,— I 2 STY FR a) I Qf. GAR DWELL a ¢ N 41.4• o I 23.7' m O LL. 3 I `— Q Ld 5' 49' c P� � -•� rte,. -`I;� �.':m-. _ -4T :54:�—. � . LTJ Z I I a LO g I U) I I water service U I I — — — — 1.2 z N Lu 125.00' 0'8W i 20DRAINAGE EASEMENT N 23"23'50"W 125.00' NOTE: CESSPOOL, SEPTIC TANK & WATER SERVICE LOCATIONS BY OTHERS. . OAKLAWN AVENUE 7HE'E1GShTICE OF RIGHT OF WAYS AND OR EASEMENTS 9-1-2004 FINAL SURVEY OF RECORD. IF ANY, NOT SHOWN ARE Nor GUARANTEED. 6-6-2003 LOCATED FOUNDATION THE OFFSETS (OR DIMENSIONS) SHOWN HEREON -FROM THE STRUCTURES TO THE PROPERTY LINTS ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT JOB No. 01-617 FILE No. PECONIG DEVEL .CORP.. INTENDED TO GUIDE 1HE ERECTION OF FENCES; RETARaNG WAIM POOTS. RATOS, PwaNG ARFAS.-AmmoN TO 9UIumrs,-OR-ANY-OTHER CONSIRUCRDN: _ SURVEYED FOR CHARLES J. & LAURA C. ZEHIL UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION LOT NUMBER 1 7209 OF THE NEW YORK STATE EDUCATION LAW. MAP OF PECONIC DEVELOPMENT CORP. AT SOUTHOLD GUARANTIES INDICATED HERON SHALL RUN ONLY TO THE ESN FOR WHOM THE -- ` SURVEY IS PREPARE.AND ON HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL SITUATED AT SOUTHOLD - AGENCY AND LENDING INSRRJDON LISTED HEREON.AND TO THE ASSIGNEES OF THE LENDING INOTUTION.GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS TOWN OF SOUTHOLD – SUFFOLK COUNTY N.Y. OR SUBSEQUENT OWNERS. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOWS INKED SEAL OR SCALE 1" = 50' DATE 12-20-2001 EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. FILED MAP No: 10723 DATE 12-27-2001 CERTIFIED ONLY TO: TAX MAP No.(REF ONLY) 1000-70-3-22.1 DISK 500 CHARLES J. & LAURA C. ZEHIL COMMONWEALTH LAND TITLE INSURANCE COMPANY HAROLD F. TRANCHON JR. P.C. HSBC MORTGAGE CORPORATION LAND SURVEYOR P.O. BOX 616 1866 WADING RIVER-MANOR RD. WADING RIVER, NEW YORK, 11792 HAROLD F. TRANCHON JR. N.Y. E N. LIC. No. 218159E 631-929-4695 'I I RETAIN STORM WATER RUNOFF ! NOTES �� PURSUANT TO CHAPTER 236 ELECTRICAL �v OF THE TOWN CODE. 194SPECTIONREOUIRED 1. NO 50ILSUPCHARGE PEP MIMI)WITHIN 4 FEET OF EXCAVATION AT THE SHALLOW END,OP 6 FEET OF EXCAVATION AT THE DEEP ENE). Z 2. THIS POOL MEETS THE REQUIREMENTS OF ANSI/AP5P/ICC-5"AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROUND SWIMMING APROVED AS NOTED B POOLS"AND1996BOCACODE-5ECTION421.DIVING EQUIPMENT ISNOTALLOWED. 0 10" 4O 10 3. SWIMMING POOL SHALL BE COMPLETELY AND CONTINUOUSLY SURROUNDED WITH A BARRIER CONSTRVCED IAW REQUIREMENTS OF DATE: b B.P.# Ol� SECTION 8326.4.2.1 THROUGH 8326.4.2.6 OFHE NEW YORK STATE RESIDENTIAL CODE(2020)AND IN CONFORMITY WITH ALLSECTIONS d OFTHESOUTHOLD TOWN CODE.DWELLING WALL(S)MAY 5ERVEAS PARTOF THE POOL BARRIERA5 PER SECTION 8326.4.2.8 AND CONDITION(1)ARE MET.OPERABLE WINDOWS IN THE WALL(S)USED AS A BARRIER SHALL HAVE SELF LATCHING DEVICE.ACCESS GATES FEE: RY; SHALL COMPLY WITH SECTION 8326.5.2 OF HE NY5 RE5IDENTIALCODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY Q NOTIFY: UILDING DEPARTMENT AT . LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED.ALL GATES ARE TO OPEN AWAY FROM HE POOL AR A. JJ� v 0 765-1802qj .8 AM TO 4 PM FOR THE 4. DURING CONSTRUCTION THE CONTRACTOR SHALL ERECTA TEMPORARY BARRIER AROUND THE EXCAVATION IAW THE CODE OF THE U FOLLOWi G_ INSPECTIONS: TOWN OFSOUTHOLD. Q Z A H2o o H2O 5, POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING ENTRY INTO THE WATER,AND SOUNDING AN Q v 1. FOUN TION - TWO REQUIRED 3"-a" B"- MAINTAINEDDIBLE ALARM AND UPON DETECTION D IN CCO DA AT ISNCEAUDIBLE WITH THE MANU ACTURERSINSIDE INSTR INSTRUCTIONS. THE ALARM MUST MEETA5TMINSTALLED, 208 FOR P URED CONCRETE "STAN PARD SPECIFICATIONFORPOOLALARM5. THE DEVICE MUST OPERATE INDEPENPENT(NOT ATTACH EDTOORDEPENPENT ON)OF = 00 � 2. ROUG FRAMING & PLUMBING PERSONS. W 2 3.. INSUL ION " 6. POOL5UCTION FITTINGS(EXCEPT FOP,SURFACE SKI MM ER5)MUST BE PROVI DEP WITH A COVER THAT CONFORMS TO ASMEIANSI N U 4. FINAL GONSTPICTION MUST o A112.19.8MORAMINIMUM18"x23"DRAINSKATEORACHANNELDRAINSYSTEM, POOL CIRCULATION SYSEMMU5TBEEQUIPPED WITH BE CO RLETE �`_ CON(.WALLS ATMOSPHERIC VACUUM RELIEF IN THE EVENTTHE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OR BROKEN. SUCH Q, VACUUM RELIEF SYSTEMS SHALL CONFORM WITH A5ME A112.19.17 OR BE A GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD. ALL .CON RUCTION SHALL MEET THE PLAN SARA ED YAMIOL SHALL BE NIMUM OF3ANIDMUST BEPPEDSUCH THAT WAER15DRAWN HROUNIMUM OF2 SUCTION FITTINGS OF THE ABOVE OGHEH MP SIMULTANEOUSLY HROUGHA E.THE 5UCTION FITTINGS SHALL BE REQUIRE ENTS OF THE CODES OF NEW N.T.5. VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCESSIBLE YORK ST E. NOT RESPONSIBLE FOR POSITION,MINIMUM OF6"AND NO GRATERHANI2"BELOW THE MINIMUM OPERATIONAL WATER LEVEL ORBEANATTACHMENTTO THE SKIMMER/SKIMMERS.A REQUIRED POOL ATMOSPHERIC VACUUM RELIEF SYSTEM SHALL BE INSTALLED AS PER NYS RESIDENTIAL CODE DESIGN CONSTRUCTION ERRORS. 16'VINYL COVERED CONCRETE STEPS 8326.6.3(2020)AND IN ACCORDANCE WITH TOWN CODE. CO 1PLY WITH ALL CODES OF7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF NFPA 70(NEC)PRINCIPALLY ARTICLE 680 AND THE NYS D NEW 1 ORK STATE & TOWN CODES RE5IDENTIALCODE SECTIONS 4201THROUGH 4206.ALL ELECTRICAL DEVICES MUST BEAPPROVEBYUNDERWRITERSLABORATORIE5AND BE PROTECTED BY A GROUND FAULTCURRENT INTERRUPTER(GFCI)CVRRENTCARRYING ELECTRICAL CONDUCTORS EXCEPT FOR THOSE Q� AS RE U1RED AND CONDITIONS OF PROVIDING POWER TO POOL LIGHTING AND POOL EQVIPMENTSHALLMEET HR ESEPARATIONEQVIREMENTSOFTABLEE4203.S.ALL V z'T'o a'SAND BOTTOM METAL ENCLOSURES,FENCES OR RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHARGED DUE TO CONTACT WITH AN ELECTRICAL CIRCUIT SHALL BE EFFECTIVELY GROUNDED. '107 :3 V I 8. WATER SOURCE FILLING THE POOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE IAW NYS PLUMBING CODE 608. N j O cv i T AI PI ANNING BOARD SECTION A 9, ALL PIPING 15 DIAGRAMMATIC UNLESS OTHERWISE STATED. o Z Sni runl i l m�ninl TAI IcTEES N.T.5. 10. WALKS IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM POOL EDGE. N O O WATER LINE TOP OF WALL v 11. A MANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED IAW AN51/APSP/ICC-5 SECTION 6. v p QJ Ln N• ��� a' s' 4' L. 12, CONTRACTOR TO PLACE HE POOL IAW TOWN OF SOVHOLD CODE SETBACKS. d v Ti r 13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SUBJECT PROPERTY. O ®CC PANCY OR � 15. THE DESIGN 15 BASED ONADRAINAGE 501LWIH<10%SILT. GROUNDWATER SHALL NOT EX15TWIHINTHE EXCAVATION. IFGROIUND �0�&�3 �� S'��®/�� WATER EXISTS WITHIN 6'-0"FROM GRADE,DEWATERING FACILITIES WILL BE REQUIRED. C ENCLOSE POOL TO CODE 16. ALL GAS AND OIL HATERS(IF INSTALLED)FOR THE INGROUND SWIMMING POOL SHALL BE NATIONAL APPLIANCE ENERGY O USE I UNLAWFUL CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATERS SHALL BE TESTED IAW AN51 221,56 AND SHALL BE INSTALLED IAW SECTION B UPON COMPLETION MAN UFACTUREK5 5 PECI FICATIONS. OIL FIRED POOL HEATERS5HALLBEE5TEDIAW UL726. POOL HAERSSHALL BELOCAEDOR BEFORE "WATER" GUARDED TO PROTECT AGAINST ACCIDENTAL CONTACT OF HOT SURFACES BY PERSONS. POOL HAER5SHALL BEPROVIDED WITH WITH UT CERTIFICATE N.T.S. TEMPERATURE AND PRE55UKE-RELIEF VALVES. FOR HATERS NOT PROVIDED WITH AN INTEGRAL BYPASS SYSTEM.A BYPASS LINE SHALL BE O INSTALLED FROM INLET TO OUTLET TO ADJUST WATER FLOW THROUGH THE HATER. POOL HATERS SHALL BE PROVIDED WITH THE A� r OF ® CUPANCY FOLLOWING ENERGY CONSERVATION MEASURES: Nw. 00 0 16.1 AT LAST ONE THERMOSTAT SHALL BE PROVIDED FOR EACH HATING SYSTEM. 16.2 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW SHUTTING OFF THE z OPERATION OF THE HEATER WITHOUTAP)U5TING THE THERM05TAT5ETTING AND TO ALLOW RESTARTING WITHOUT RELIGHTING THE CHECK VALVE 2'-2" Qj N PILOT LIGHT. ,,, o FROM SKIMMER COPINC AND WALKWAY 10" 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQUIREMENTAREOUTDOOR POOLS W 4) r N p �T PUMP O (BY OTHERS) F GRADE DERIVING 20%OF TFIE ENERGY FOR HATING FROM RENEWABLE SOURCES AS COMPUTED OVER AN OPERATING SASON) Q v co co ai y WATER LINE 16.4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BE SET TO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN 6E SET z Y 9 TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN A CLEAN AND SANITARY CONDITION IAW APPLICABLE ^" aZ ti ti 8 SANITARY CODE OF NEW YORK STATE. R pica ^^p a VNDISTVRBED EARTH t i�� S O%-r�j V N TO DISPOSAL/ • - 17. HIS DRAWING 15 FOR STRUCTURAL SHELL ONLY. ALL ACCESSORIES AND APPURTENANCES ARE DEFINED BY OHER5. W n V, (v� DRYWELL ''>SOD P51 POURED CON(. 4:. < 3/8"REBAR,2)TYR _ I 16. BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS. 70 NOTALLOW THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHT OF THE Y4C' r•. WATER IN THE POOL BY MORE THAN 8", OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8" a y DIVERTER O VINYL LINER VALVE 2'T04'SAN0 e 19. PLACE CONCRETE ON SANDY TO LOAM SOIL. REMOVE ANY CLAY DEPOSIT AND REPLACE W/COMPACTED CLEAN BACKFILL. pF N E 20. THERE IS NO MAIN DRAIN IN TH15 POOL.SUCTION FOR POOL WATER CIRCULATION 15 PROVIDED BY THE SKIMMERS ONLY.THI5 MEETS FILTER REQUIREMENTS OF THE NY5 RESIDENTIAL CODE-SECTION 8326.5 FOR ENTRAPMENT PROTECTION. ��; ��R HOM 21. THE POOL WAS DESIGNED IAW THE FOLLOWING: "I' VERTICALS/8'REBARO�O.C. I 21.1. THE NEW YORK STATE RESIDENTIAL CODE-SECTION R326(2020) (NOT SHOWN) 21.2. THE NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE-SECTION 8403.10(2020) �_ 1 / TO RETURNS 21.3. THE NEW YORK STATE FUEL GAS CODE(2020) n U = o CHECK VALVE) 21.4. TH E N EW YORK STATE SAN ITARY CODE. ;t� -J 21.5. ANSI/APSP/ICC-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. WALL SECTION 21.6. BOCA CODE-SECTION 421. PLUMBING SCHEMATIC N.T.S. 21.7. CODE OF THE TOWN OFSOUHOLD. A' 088415 N.T.S. i 22. ALL BACKWASH TO BESELF-CONTAINED ON-SITE. �OFES SIO ' I `