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HomeMy WebLinkAbout47722-Z �OS1l at Town of Southold 6/4/2022 �o Can Town P.O.Box 1179 o - �' 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43127 Date: 6/4/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3955 Park View Ln., Orient SCTM#: 473889 Sec/Block/Lot: 15.-1-33 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/13/2015 pursuant to which Building Permit No. 47722 dated 4/21/2022 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 as applied for. The certificate is issued to SEEORIENT LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39692 5/7/2015 PLUMBERS CERTIFICATION DATED th rize ignature O�Og�FF01,r�o TOWN OF SOUTHOLD a Gyp BUILDING DEPARTMENT N 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#: 47722 Date: 4/21/2022 Permission is hereby granted to: SEEORIENT LLC PO BOX 136 East Marion, NY 11939 To: Construction of an in-ground swimming pool as applied for. Replaces BP#41540 At premises located at: 3955 Park View Ln., Orient SCTM #473889 Sec/Block/Lot# 15.-1-33 Pursuant to application dated 4/21/2022 and approved by the Building Inspector. To expire on 10/21/2023. Fees: PERMIT RENEWAL $150.00 Total: $150.00 Build g Inspector g�fFnt ; TOWN OF SOUTHOLD :0�9;'�.•'�oa ,'� 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#: 41540 Date: 4/18/2017 Permission is hereby granted to: Scialabba, Sarina PO BOX 45 Orient, NY 11957 To: Construction of an in-ground swimming pool as applied for. Replaces BP# 39692 At premises located at: 3955 Park View Ln., Orient SCTM # 473889 Sec/Block/Lot# 15.-1-33 Pursuant to application dated 4/18/2017 and approved by the Building Inspector. To expire on 10/18/2018. Fees: PERMIT RENEWAL $125.00 Total: $125.00 Building r SUFFotTOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE "o SOUTHOLD, NY t 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#: 39692 Date: 4/20/2015 Permission is hereby granted to: Seeorient LLC PO BOX 352 Orient, NY 11957 To: Construction of an in-ground swimming pool as applied for. At premises located at: 3955 Park View Ln, Orient SCTM # 473889 Sec/Block/Lot# 15.-1-33 Pursuant to application dated 4/13/2015 and approved by the Building Inspector. To expire on 10/19/2016. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 V . 1 Building Inspector 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 1%0 lead. 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 and unusual 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, wimmin ool$50:0 Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2, Certificate o ceupancy 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$15.00 Date. New Construction: Old or Pre-existing Building: (check one) �} 2 Location of Property:^�39 �65 y4u( f uD L-a(n P,, 0 n-enf- �I - NB I ! House No.. Street rr,,,, Hamlet Owner or Owners of Property: a Y i y S ("I-, Qd CL(J ba." Suffolk County Tax Map No 1000, Section t Block Lot J Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one). rr-�, .00 Fee Submitted:,$ �D V an i r o��OF SO(/l�ol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 io roger.richertP-town.southold.ny.us Southold,NY 11971-0959 OOUNTV BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Scialabba (Seeorient LLC) Address: 3955 Park View Lane City: Orient St: New York Zip: 11957 Building Permit#: 39692 Section: 15 Block: 1 Lot: 33 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Kel-Rob Electric License No: 37725-ME i SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 1 A/C Blower Range Recpt Fluorescent Fixture- Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: In Ground Swimming Pool To Include, Bonding, 1- GFCI Circuit Breaker, 1-Electric Pool Heater Notes: <�7 Inspector Signature: Date: May 7, 2015 Electrical 81 Compliance Form.xls S0UTy0lo # TOWN OF SOUTHOLD BUILDING DEPT. courm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL�� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 0 r -op �, 04r SI L DATE 4V Y'� INSPECTOR A„ a t.�11• ,'� , � I ,re. � ,� f�l �"` ,I � ,. �y. `'� 'h ' �3 � j�.`S- ��.'�,!'PyY /,}� :�� ►. IS. []'f STSs S7 R. 1 � •f 4' � ��,- ..[tom �:'�4 .� �` � : +fin 4:•�� � L' �, i .t-� .'� of 46, * '!�' ± ra ;*: •�� �. � ti,• S �� �' r ih.. '- � 4�'`I[ r qty �t 1 a1' �.+ �:' a "�� ..� ��• +tom•^r, ��7, Y-. tia• 1 all. 1 + +..�` �' . ,,KIf''� Y} i' L:' y'l yd�,db N 1W Iq�♦♦"y. * �.r. •+''1 1 �y J 1 I SSI� � - � YJN r _ ^, 4'� 1� J'f' p 1 P �,.•_ L• � '',',,,.�'' �} ��'�4� �t�� t 1.�i���T� .kyr .1. ' t..�..} '���ii��1, t. s ?r. 1j,s% �.•�s� r - }-�!�^�...+. -:.. �s�'"f''-.~ay��� Ifs.., xw+S7 .� tt �'%` ` - �✓�,,t �Ica .�� � �- .. L' 7t"�.�_ -- _ -ax, a r.T 7x• - r Hyl , rl I } i n t Bunch, Connie From: daniel finne <finnecontractinginc@gmail.com> Sent: Sunday, May 22, 2022 9:12 AM To: Bunch, Connie Subject: 3955 park view Kane orient �TTii` y ` ' h. ',� rel , rr•• .�� �A' '��� �b_ lei- "\ ,r'• ,� _ �-:ly`�'_'i 6 y STl.T J• 4 3 ' i- 'a�.�Ls ��• j-- ..I frt ,� 4�-� a.. �� �.3c F ., �. ..�. +'�,s�}r/��'1t`�p�',!:{� *'�"r � �, JL�y••4„a.'p .r:ay. �! S�.':,�'.'�•h tc V P� 4 4� �!2 7 ," f' 4�it S.'�" _ G '•� t J'�11,_• y� •• 1•`�••' ii { i 1 � - 1 Y' ..,_#; _ .. •FSM,! � <re�:��. i-� irl 7" ;ij CAI 9T Tit* •�•.,a�' � � 4 .irk? '�-• - .A•...<' i F' "���}I�s_~•�b� lily ..�`7-�i' �. }+ f+ ��" c� Y � _�,, L , "�'•��.� -��Y'�^'�i.' ..{ rn� n..^ J ../fes- l� 1I�1 - 1 h � ♦ :C,� . 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J.'TOWN,HALLBoard of Health SOUTHOLD,NY 119714 sets of Building Plans TEL: (631) 765-1802 Dlanning Board approval FAX: (631) 765-9502 urvey : wwvv.northfork.net/Southold/ PERMIT NO�7( �Q heck- !:r .... eptic Form .. ;E .Y.S.D.E.C, `.:Examined LIZ, 20 Cnntact rustees G H r' Su��a Cel can C� Approved ,20 1 vlail to: S LU i M Te-ckl !9O OI S mil l er �1au • Disapproved a/c (4t o mvi l Cl W r7 I hone: US)-U'L a U93. Expiration ,2oz& _j :2 Building uA,�pector - EJ) r APA 13 2015 .-i -'I CATION FOR BUILDING PERMI L Dat e a420 1 60 , 20 15 B11G. DEPT FOV!11'.of SOUTHOLD INSTRUCTIONS',' ; a. This application MUST be completely filled in by typewrites or in.ink and submitted to the Building-Inspector.With 4 sets of plans, accurate plot plan to scale Fee according to schedule. b. Plot-plan showing location o lot and of buildings on premises,relationship to joining premises or public streets or areas, and waterways. c. The work covered by this ap lieation may not be commenced before issuance Building Permit. d. Upon approval of this applic' tion; the Building Inspector will issue,a Building flermit to the applicant. Such a permit shall be kept on the premises available or inspectio.a througho.kt the V-Vork:' e.No building shall be occupie or used in whole or in r,art for anypi.xposr what o ever until the Building Inspector issues a Certificate of Occupancy f. Every building permit shall e pirc if the work authorized has not c.:nrnenced v, titin 12 monthL:.after the date of issuance or has not been completed wit i z 18 months from such date. U no zoning amend lents ,r other regui,.tions affecting the property have been enacted in the interim, the Building Inspector may authorize, in writin ,the extension of the permit for an addition six months.Thereafter, a new permit shall be required. APPLICATION IS HEREBY ADE to the Building Department for.the issuance of a')uilding 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, ur alteratiocs or for removal or d molition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code, housing cdde, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. Swim _h s Pools (SiVnatd app icant or name,if a corporation) l)1 l(9L ailing•address of applicant)':: State whether applicant is owner, lessee,agent, architect, engineer, general contra or, electrician;plumber o builder L s _ Name of owner of premises 1 i Sc, I l cLb4 b a- (As r:n the y ax`rolI.or iat-,t 114d) If applicant is a corporation, signatme of duly authorized ^-dicer (Name and title of corporate' fficer) Builders License No. I Q 1 — Plumbers License No: Electricians License No. Other Trade's License No. 1. Location of land.on which proposed work will be done- -S9 S 20�r i House Number Street Hamlet County Tax Map No. 1000 Sec ion l Jc� Block Lot" 3 Subdivision Filed Map bio. Lot (Name) Z. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupahe-y b. Intended use and occupancy Cmgt 1 Uh Q`(� 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal. _Demolition. Other Work (Description) 1. Estimated Cost Fee_- _ I , (To;be paid on filing this application) i. If dwelling, number of dwelling units______ Number of dwelling units on each floor If garage, number of cars i. If business, commercial'or mixed occupancy, specify nature and extent of each type of use. 1. Dimensions of existing structures, if any: Front. Rear Depth Height Number of Storms Dimensions of same structure with altereitiops;or additions: Front Rear Depth Height Number.'of Stories—— 3. Dimensions of entire new construction.: Front.. Rear Depth Height Number of Stories_ _ a. Size of lot: Front near Depth 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, dinance or regulation? YES NO 13. Will lot be re-graded? YES_ NO_—Will exbess fill be removed from premises? YES NO 14. Names of Owner of premises Address .Phone No. Name of Architect Address `....Phone No Name of Contractor Address " Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E:C'. PERMITS MAY BE REQUIRED. b. Is this property within 300 feet of a tidal wetland?'* YES___NO>5-- - * IF YES, D.E.C. PERMITS MAY BE REQUIRED. + 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. 3TATE.OF NEW YORK) SS: --OUNTY OFSgg-01Y–) :e 21 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing.eoiitract) above named, 'S)He is the C-L) toro (Contractor, Agent, Corporate Officer, etc.) )f said owner or owners,and is duly authorized to perform or have po.•formed the said work and to make and file this application; llat all statements contained in this application are true to the best of his knowledge and belief; and that the work will be )erformed in the manner set forth in the application filed therewith. Sworn to before me this (0-+n day of Dai 1 20 V5 Notary Public =: ignature of Ap licant CeAo no Ns oio," -4-\),.tolls ,;Acet-e o CoLL\(-x4-\j e-c-p - march ,23.--Lo 19 Scott A. Russell ;��°�U�� ST0]K11`NWA\'lC']EIK SUPERVISOR MANAGEMENT EM]ENT SOUTHO,LD TOWN HALL-P.O:Box 1179 O ; 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEIMENTWORK SHEET ( TO BE COMPLETED BY THE APPLICANT) ........_..........._....._._................_............._........_._...--..__.._._................_.... - ...........__..... ._...._.._._....- ............ - .._..._........-- ............. -............_....__.._..__..__._._..........._.........._..._........................_ DOES TIES PROJECT INVOLVE AN1Y OF TIED FOLLOWING: (CHECK.ALL THAT APPLY). Yes 'No j! j; il? ❑ A. Clearing, grubbing, grading or stripping of land which affects.more lj { than 5,000 square feet of ground surface. ,: ❑ B. Excavation or filling involving more than 200 cubic yards of material it within any parcel or any contiguous area. ❑ C. Site preparation on slopes which exceed 10 feet vertical. rise to �I 1.00 feet of horizontal distance. l D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. I ❑1 E. Site preparation within the one-hundred-year f loodplain. as depicted i on FIRM Map of any watercourse. i ,H ❑ 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 I 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 Application. ..... _................... .....................-- _ .� __._........_._ APPLICANT: (Propeity Owner,Design Professionar,Agent,Contractor,:Other) S•G.T.M: :: 1000 Dater Distrrct NAME: Section Block Lot FOR BUILDING DEPARTME F USE ONLY i CoiitacClnformation arm w�a ? a Reviewed.By: I iI i I � Date: ; Property Address/Location of Construction Works — — — — — — — — — — — — — — — — — 'i II Ii i; ,l Approved for processing,Building Permit. n� ; ( Storm�Yater Management Control.Plan Not Required. ' ? E' ) mi ug ElStorm��rater Management Control Plan is Required ` (Forward to Engineering Department for Revieti,.) FORM 1� SMCP—TOS MAY 2014 S��ryD! � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q roger rlchertf-tOo7agOld0p22 nV us Southold,NY 11971-0959 0 �O BUELDI SIG DEPARTMENT TOWN OF SOUTHOLD APPLICATION-FOR ELECTRICAL INSPECTION REQUESTED BY: S c)j b16y-eq' 0(;0 Date: a& 19, .Company Name: Name: BOID Ihr curio License No.: Address: Phone No.: 631 - a� 1- b y l JOBSITE fNFORMATION: (*Indicates required information) - Name: Sclo (a kko- 'Address: .3� SS p�r �y.;tw q �Y� �n`� lqS _ 'Cross Street: 'Phone No.. 3ermit No.. rax-Map District: 9000 Section: I _ Block: I Lot: ----- `BRIEF DESCRIPTION OF WORK(Please Print Clearly) Is rn Please Circle All That Apply) 'Is job ready for inspection: NO. Rough In anal Do-you need a Temp Certificate: - YES! NO Temp Information(lf.needed) Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other New Service: Re-connect Underground Number of Meters Change of Service Overhead idditional Information: PAYMENT DUE WITH APPLICATION -82=Request for Inspection Form � b�� ■Tr :. ' "� wR . ITU �tlFFQL.iC •' 'TAX•� •, L. • .. .. •� .. .�gkIFId1L roGi��+9.� j�n,�ic4'�pa 8 � - 50 ' r+ Z5 v. , .36) y F :1r ,� 1•. tea' � ti o' 4' w. LA v� �1iOf.,Iu le l or 0. . .• '� :, •..( • i � M- •.� 7NWt1o1'�a>t� Itat).Rfoa,;Ov,a0�1, •asm!Ila!4a.'a RMIYry' .: Asa a►a,•Ipa f 1}•sritta:)�D iVq'.t da i( . tt�dh�Yan W s�csoA„77a4, m— . aoroa ),.•af Ttr' Yt1,NnreElolr,u 'a•: � ••, .. •bn"if'Cs6iq.1'"•' �.ib'iiwt.til nlilf•fuirrVY •... _...;.. ., r. 9M''1140 y1y4tMh.aSID71N1.o I.W' iPD::Wry . .. �.. . .'. •CRt•!'t;aaq�:.� �W�.'ll0f�'WO.:JtiR Y 5p't�l�� . . SAVIl�OS AND;I�T�N -�� L.Wr. ..•,['VYY.Bi>ti�i>V aY et1�R�.r Yal•1t '!p MCJ'.N.. . :1`('T FOV ND rano '�,~�►�•,�. rr��.�r�.��r� - •�Otho� roa .d>?( ,s.vesei�•n�•a���' li �..; +++}}!Y iaY:+oenex•iai 'A•�i�afsWYfgri iivks wwu FFOIJi*Ip. . .: ni M�i�N •OF.N ''Y to t�,r..ovl.1/a♦ ',,IIY�it ,7Mtlf1lt� I X UA ' sf,?laa...kqt•►C.l+ALs�!Jklta+lpl,4faA�`K•,uKrtloe► •..'' :` .HSP. E �4f?E.�• _ �;22,�:75'•5F QR•'.,C�5.1� AG1�5 � - � •' P � :rlo LE r-�? TD 'SPQR Client#:42822 SWIMP002 DATE(MM/DD/YYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1/30/2015 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 CONTACT -NAME: Southampton CommercialPHONE 631 324-1440 F A/C No Ext: A/C No): Cook Maran&Associates E-MAIL ADDRESS: 300 Hampton Road INSURER(S)AFFORDING COVERAGE NAIC k Southampton,NY 11968 INSURER A:National Fire Ins.of Hartford 20478 INSURED INSURER B:Merchants Mutual Ins.Co. 23329 Swimtech Pool Services,Inc. INSURER C: 467 Miller Place Rd Miller Place,NY 11764 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MWDD (MM/DDIYYM A GENERAL LIABILITY 5099324804 2/01/2015 02/01/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY D MAGES( RENTED P MAGES ER occurrence) $10%000 CLAIMS-MADE DIOCCUR MED EXP(Any one person) s5,000 X Contractual Liab. PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEMLAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMP/OPAGG s2,000,000 X POLICY PRO LOC $ JECT B AUTOMOBILE LIABILITY CAP1660260 3/10/2014 03/10/201 Ea SINGLE LIMIT ecce".. $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY IER ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? 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(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) 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 ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S687865/M687640 KL3 Certilacate of NYS Workers'Compensation Insurance.Coverage Wage 2.of'3 STATE OF.NE'4V YORK, WORKERIS COMPENSATIONBOARD CERTIFICATE.OF NYS WORIMRS' COMPENSATION INSURANCE COVERAGE' Ia Legal Name and address.of Insured(Use street sddress.only) 11:.Biisi4ess,Telephone;Nomber.oLInsured Swim Tech:Pool Services;:Inc 631-473'=7665 467 Miller.'Place Road Miller Place,NY.11764: lc NYS Unetnploynient Insurance.Employer Registration Number.ofInsured ' Id Federal'Fmployer hidentification:i trot er of lnsurcil or.Sociai.securti Number WorkLoeation of Insured(Onlyke4tdred rf coverage_rs specffieally-ltintied ty to.certarn7ocalion in New'YorkState,t e..a Hlrap-Up Pol/cyJ 1:12855800: 2.Name and.Qddress:of the Entity Requesting Proof of Coverage 3a Name of Ibsurance.Carrier (Entity Bt ipg lasted as,the Certificate Holder) Rochdele.Insufance Company Town of Southold ,53095Rouww95i P;O.Box 1 iZ9 3b.Polley Ntimber of entitylisted in box Southold,NY 11971. RWC3354805 3c.P,.oticy.etfective period: 129/2014 to:12lf9r20I5 3d;:r.hc Proprietor;Partners or Executive Offvers are: 2"included(Only check box if all partnetstofficers included). i all excludedor certain parti erstoificers excluded 7bis.certifies that the insurance carrier indicated'above in box"3"insures the business referenced above in.liox"Its"for workers' i compensation:under the New State Workers'Compensation Law..'(To use.this form,New York(NY)'must'be lisfed under,Item 3A on the INFORMATION PAGE"of the workers'compensation insurance policy).The.Insurance Carrier or its licensed agentwiil send this Certification of Insurance to the entity listed above as the certificate;holder in box,'2 The 1nsurance•Carr!er will also notify the above certificate holder within,10 days N a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment ofpremiums that cancel the policy or eliminate the insured from the coverage indicated omthis Certificate(These notices may be sent by regular snail)Otherwise,this Cert nate is vAlld for ori¢year after this form is approved 6y 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 conti,uesao.be. named on a permttlieense 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.ma4dat6iy coverage requirements ofthe New York State Workers"Compensation Law: Under penalty Operjury,d"certify that I am an authorized representative or..licensed agent,ot'66'insurance carrier referenced above and'thatthe named insured has the coverage as,depicted on this form_ .. Approved By: Henry C.Sibley (Print uame.of authorized representative or licensed agent of insurance carrier) Approved By: r 1 V 3!2412015 (signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier.CarderPhone Please Note:Only insurance carriers and titer,Licensed agents are authorized ro Ltsue the C-105.2 form..Insurance brokers are NOT auihorizedto issue it. C-105.2(9-07) l i. t t https://ao.amtrustgroup.com/anawc/PolicyNYCertitiicateOfWeIns.aspO ndexjd -1&Instars... 3%241201.5. -,r5 c1F r �"'e�—�-`,—� �iL,.S.. Vv�— OCE V01`rf 'L i� TOWN-8FPPR ` M S J�()TED P v REQ`l�RED > DATE:A`�?° e.P.; ��-� BOARD FE . BY: . C NOTI Y BUILDING DEPARTMENT AT S ` 0!!'it''��N 765-1302 8 AU! TO 4 PM FOR THE FOLLOWING INSPECTIONS: -1. FO.UNDATiO - I vvu E�."inc FOR POURED CONCRETE 2. ROUGH - FRA1r,ING & PLUI01BING 36' 3. INSULATION ,A FRAMES DETAIL DECK SUPPORT DETAIL �. FINAL - GNSl"RUCT _ SHORT BRACE E_E T E FOR C.O. "T— pL G;, ' JCTION SHAL_ 11EEA THE t2 R QU REM NTS OF THE C .1. -S C ELS-dV 7'-9• Y ARE sTAi7E. NOT SF i l5;:;I, PANEL 6' JI:Sl�."1 r' CONSTOff fid)d E`'- ORS. ' LUZ 2'-6' OR LDNGBRACE 1 Y STAKE ��`` MANDATORY ROPE AND HORIZONTAL U`V 6WFROMTSLOPE C12 HANGE E IS UNLAWFUL DACE MNP 23 NON—DIVING POOL cNP��E� WITHOUT... CERTIFI T ��. n'(�v 1) DEPTH AND SHAPE OF POOL MEET MINIMUM STANDARDS BURS�, 0\� � �� OCC - PA C 1 -.OF THE INTERNATIONAL RESIDENTIAL CODE 2009 AG103.1 (ANSI/APSP-5) FOR RESIDENTIAL USE. A MEANS OF EGSS FOREND AND FINISHED 3'-4. X-6' PANEL 2) SHALLOW END OF THE POOLOTH MUST BETHEDEEP PROVIDED AS THE FINISHED 6. DEPTH HEIGHT REQUIRED BY ANSI/NSPI-5 SECTION-6. DEPTH 3) BUILDER TO PROVIDE A MEANS OF EQUIPOTENTIAL BONDING IN ACCORDANCE WITH NEC SECTI❑N 680. 2' SAND OR 4)ALL A-FRAME BRACES WILL BE MOUNDED WITH A VERMICULITE MINIMUM OF (1) CUBIC FOOT OF CONCRETE, OR A 6' POURED CONTINUOUS CONCRETE PERIMETER COLLAR. 2•-6• 5) 'NO DIVING' LABELS TO BE INSTALLED AROUND PERIMETER OF THE POOL. 6) ENTRAPMENT AVOIDANCE MUST BE INSTALLLED IN ACCORDANCE WITH ANSI/APSP-7. INTERNATIONAL SWIMMING POOLS NOTES SWIMMING POOLS ARE DANGEROUS WHEN USED IMPROPERLY. NEVER DIVE IN THE SHALLOW END OF ANY POOL. CONSULT WITH THE DIVING BOARD AND SLIDE POOL PERIMETER: 96' I N T E R P ❑ ❑ L MANUFACTURER(S) AND THE ASSOCIATION OF POOL AND SPA PROFESSIONALS (2111 EISENHOWER AVENUE POOL AREA: 432 SgFt ALEXANDRIA, VA 22314 (703-838-0083)PRIOR TO INSTALLING DIVING BOARDS AND/OR SLIDES ON THIS POOL TO ENSURE THE POOL MEETS THE EQUIPMENT MANUFACTURERS MINIMUM STANDARDS FOR VOLUME: 15,100 APPROX. GAL. ALLOWABLE INSTALLATION OF THEIR PRODUCT(S) ON THIS POOL. INTERNATIONAL SWIMMING POOLS IS r el THE RESPONSIBLE LEEEFORTS AT14E POOLANDINTER113 .DETAIL, RATHER DS. IT �HETLINER HE MANUFACT MANUFACTURERMUST ENSURLDERS. 10�1,��EDlATEL 12 X 36 RECTANGLE TOWN OFFICIALS AND POOL OWNERS TO FOLLOW ALL SAFETY GUIDELINES OF THE A.P.S.P., LOCAL -1ENCLOSE POOL TOGO ORDINANCES, AND EQUIPMENT MANUFACTURERS. UPON COMPLETION DATE: 04/07/15 SCALE: NONE BEFORE"WATER" DRAWN BY: P.T. ACADREF:PNRT1236 90 DEGREE 90 DEGREE VERTICAL VERTICAL FILLER $, 8, 8, 8, 4' FILLER BILL ❑F MATERIALS QTY. DESCRIPTI❑N 1 4' STRAIGHT PANEL 6' 6' 4 6' STRAIGHT PANEL 37'-Ili' 7 8' STRAIGHT PANEL 6' 3 90 DEGREE VERTICAL FILLER Z4 1 1 6' X 6' TRUE 90' CORNER STEP (REFE'R TO 6TNSSCP.DWG.) s, 8' 81. 6' 90 DEGREE 6' X 6' TRUE 90' VERTICAL CORNER STEP FILLER INTERP ❑ ❑ L 12' X 3.6' RECTANGLE DATE: 04/07/15 SCALE: NONE DRAWN BY: P.T. ' ACADREF:PNRT1236 BILL OF MATERIALS J � 6' QTY. DESCRIPTI❑N PART # R6" ❑PTI❑NAL 1 90 DEG TOP CORNER A I + STEP G 1 GREC. STEP MID. LEFT B 1 GREC. STEP MID. RIGHT C 1 6 GREC. STEP BOTTOM S; �, LEFT D 1 GREC. STEP BOTTOM E RIGHT �9 1 STEP SUPPORT F y 1 STEP SIDE PANEL G NOTT INSTALLED LEFT HE'M 1 RIGHT STEP SIDE PANEL H STEEL STEPS 1 SET(3) STAIR RODS 29991 SIDE VIEW PR❑FILE � 1 SET(12) STAIR CLIPS 29990 `� NTT INSTALLED 1 90 DEG ANGLE IRON I HERE 1'-2 1'-2 1'-6• 1 6° RAD TOP FILLER J NOTE: IF STEP IS ORDERED WITH OPTIONAL 8' LINER TRACK BEAD RECEIVER, PLEASE NOTE IT IS ONLY INSTALLED IN LOCATIONS HILIGHTED WITH THE DASHED LINES. ----- 10 3' 4-DEPTH DEPTH 10$, 3'-6-HEIGHT I N T E R P ❑❑ L 4 FINISHED TRUE 90 DEGREE CORNER STEP RISER 10Ji•RISER - "" " " HEIGHT 1 -0� DEPTH DATE: 05/04/04 SCALE: NONE DRAWN BY: T.F CADREF: 6TNSSCP