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HomeMy WebLinkAbout45311-Z �o�g�EFo1,fc Town of Southold 6/11/2022 a y� P.O.Bog 1179 0 C4 _ 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43151 Date: 6/11/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 602 Reydon Dr, Southold SCTM#: 473889 Sec/Block/Lot: 79.-5-14.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/30/2020 pursuant to which Building Permit No. 45311 dated 10/8/2020 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 Stock,Jason&Buitron-Stock,Cristina of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45311 5/20/2021 PLUMBERS CERTIFICATION DATED u or' aSignature TOWN OF SOUTHOLD ��o�gdFFnl BUILDING DEPARTMENT 'rc Gy�' 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#: 45311 Date: 10/8/2020 Permission is hereby granted to: Stock, Jason 43 Irma Ave Port Washington, NY 11050 To: construct accessory in-ground swimming pool as applied for. At premises located at: 602 Reydon Dr, Southold SCTM # 473889 Sec/Block/Lot# 79.-5-14.6 Pursuant to application dated 9/30/2020 and approved by the Building Inspector. To expire on 4/9/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Bui ng ector o�*OF SOUTyoI Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 o sean.devlin(cD-town.southold.ny.us Southold,NY 11971-0959 ..` o�yCOU�,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Jason Stock Address: 602 Reydon Dr city,Southold st: NY zip: 11971 Building Permit* 45311 section: 79 Block: 5 Lot: 14.6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: LC Electric License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures 1 Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 4'LED Exit Fixtures 11 Pump 1 Other Equipment: Intermatic Pool Panel 8Circuit- 3 Used, Salt Generator, Heater, Pump on 220GFI, Notes: Pool Inspector Signature: ��v-- Date: May 20, 2021 S. Devlin-Cert Electrical Compliance Form.xls 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% 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, 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. New Construction: Old or Pre-existing Building: (check one) J 1 Location of Property: 4 G Q n �(`1C_ �a House No. C Street Hamlet Owner or Owners of Property: c�SO C) Suffolk County Tax Map No 1000, Section Block ©5 Lot l� Subdivision Filed Map. Lot: Permit No. ?2 k1 Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �-�(� Applican ignature Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) I 55\ sn So residing at Re � � (Print prop rty�� 1 owner's name) (Mailing Address) ^� Y 1 �O � � � I do hereby authorize f � (Agent) POO C. to apply on my behalf to the Southold Building Department. ( er's Signature) (Date 3G n Soo c, K (Print Owner's Name) 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 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey '� �4 ( : Fit r - Southoldtownny;gov PERMIT NO. Check Septic Form } N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20A Single&SeparateUP !,. � r ,• Truss Identification Form' fI_, t. Storm-Water Assessment Form y� Contact: �a kr--.C I� /le Approved 6 "20A Mail to: 14 Disapproved a/c Nlo,no���1(e .IJ`1' 1191 �1 Phone: Expiration 20 131 b03 S 9 L �� Buil Ing Inspector APPLICATION FOR BUILDING PERMIT Date �� , 20,9Z) INSTRUCTIONS a.This application MUST be completely filled in by typewriter 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 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 the Building Inspector issues a Certificate of Occupancy. . f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within-1.8 months from such date. If no zoning amendments or other regulations affecting the property have-been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. 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 code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections I ,�� �`�i�Ic�LS aD�S �ac• (Sin ure of pplicant or,name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll.or latest deed) If applic nt isla corporatio , signature of duly authorized officer and title of cor orate officer) Builders License No. Su- Plumbers License No. Electricians License No. 3 -,t-(� Other Trade's License No. 1. Location of I�anOd,Qn which proposed wot w�ilbe done: House Number Street Hamlet County Tax Map No. 1000 Section Block Lot l Subdivision Filed Map No. Lot 2. State existing use and occupancy of premise and in ended us and occupancy of proposed construction: a. Existing use and occupancy � �Q 5�0�7 �> v ,00 se d sapyt b. Intended use and occupancy SckmQ, 6LA w;4 h a0 w-(y s w1w1m@p . 3. Nature of work(check which applicable):New Building Addition Alteration _. Repair Removal Demolition Other Work. u lCN (Description) 4. Estimated Cosi tj Fee ,i�; ' I (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 Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner( 11. Zone or use district in which premises are situated 4- - I D 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES NO�Will excess fill be removed from premises? YES NO '' II'' Address (O0 �Jdon. ID'• f•"�►�'hone No. 14.Names of Owner of premises a5� Stl� Name of Architect VeC—'�Cr-- Address 1&g)N 't ` one No Name of Contractor {� N,)147 c��SAddressJ a � zo�I� G�e�'hone No. 43r 9gct 6y LI� 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO PJ-- 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 * 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. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) I S: COUNTY OF� uvl" Me �tel T . /Pr'Lick T60Ulbeing duly sworn,deposes and says that(s)he is the applicant (Name of individu I signing contract)above named, (S)He is the Aiej\.k—/ c (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 -F�, day �off [ �p 20 JA(3", O� . Notary Public gna re of Applicant - TRACEY L. D1IVYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2)CRZ qf SOpl�o # # TOWN OF SOUTHOLD BUILDING DEPT. �y�uxn 765-1802 -INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] SULATIOWCAULKING [ ] FRAMING/STRAPPING [ FINAL i l� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 4, DATE ?D INSPECTOR pE SOUlyolo # # TOWN OF SOUTHOLD BUIL[fII<IG DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. =[ ] FOUNDATION 2ND [ ]ANSULATION/CAULKING [ ] FRAMING /STRAPPING [. ] FINAL [ ] °FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] =FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) -/ - ELECTRICAL (FINAL) [ ] CODE VIOLATION [, ] PRE C/O .ry. REMARKS; c ( � �cy o JWqT lamv,- 7-H6,Y AfTutol-o, DATE INSPECTOR s_ 50Ulyo� I / # # TOWN OF SOUTHOLD BUILDINIM DEPT. • �o y 765-1802 INSPECTION, , [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [- ] FOUNDATION 2ND [ ] -INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL f ]' FIREPLACE & CHIMNEY [ `: ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: aa`t� _ cv/ DATE vc-� ZI INSPECTOR LSL castf So # # TOWN OF SOUTHOLD BUILDING DEPT. ��ycourme�' 765-1802 INSPECTION 0 [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ NSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL PC�L--- [ ]='FIREPLACE-& CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O R RKS: -0jo(A*b 9--\t - 104dnt DATE INSPECTOR Jeffrey Sands Architect June 8,2€ 21 Property/wfirnming PM1location; 602 Reydon 16ye . o old, NY R9: Swimmih oo1 rebar and dr&eIrinspection Attend n.'lowh of Southold buildilng-Pop#Mnent l#pn inecttng itnrning poi rear and_d all 3atalfatinn'at the above rtnt€oneci property td both to have been installed to ria t current bulldin ode,requirements, [ncrely NIX Jeffrey Benda Architect 6 Evergreen Lane, East Quogue„New York 11942 phone-631•-375-5997,tax,639-576-8916 qtr ,' ,� .. ►t�,��-- - I { f :s �i I C1`t .7A iL t i ' e '► ` a r e as - 1�i • i • � Ar . 4 r +Y w at 3 ' 6'x r •"F.-,.�•\• _sem. -. ,� •SELF s$ ;rte f�'�'"'� �•, "� �4M�Y�� �:�, �(g;� _ �''t � -f '` .�"s. AA `�~^,� � fir` 1 r✓�� - . -.�.. ` ru „E�.° t♦ %y����+f'„_� ;p � ! 4L'_rY r r - �c - �« Y W P 1�,�:.• 'FS_; ���4.,j'�3}ri ,*j ii �:` �rr.��� O' 3s � �,: ,."� `p' r �''• i71►•' ti �' �` � M r r s,Cry t _ u._ il .aR- a r�'<4'- r s� ef-. i.�v, 4a �,. m.1 s" F �+'. �P+ rl�=.`�n r ''� r. •.1� �. �Ai'�Nr�,�i'!'" �' '� t�{ L r ..P. ���G'J� � ��",r T ,et� � _ p ;',:,. � 0. '�`//.� `'-_•P,,- ��:'F,r •{. '�.;~ ��! ,tlryya-, �{ r ,h,'. R�� ' � •, s, �'' r tf 1 r•w� � <��.-��C�.�'^ '{ y'�..� ���r I t r -r -•' 1MtJ�,,�.iv _ ,�� Y+ \+�� s 1i1S/...afi ti,i, r PS:.+ h n.�, A'rlo�' $e (A yF Y'"•D + « �?i[� P �/ ' ( �IY �TI� ^#�!{ rQ`, '7 •�� ;C� C '' � �� `.�a '-yr-�.��`'0••. 'L�' �iJ �rJ4 �p�e"'Sl T ,�.�, iy4 �-�► •�.` f __,- ( ,�t 7R, -�, , t r .a S v�itj4:.-i a _j a� r 4b'r'",.'� ,- . .._gyp n ^�� .✓ter, * �� v,a`� y�'i}� �y *�.•;� f a'�i"C�7t/a}�;�'"z�q a.7 ?rLa - r, ��t. ���`!i� r j.� ��.4T`� .,'i � �' ! ��. t--A'`, ��.'14t, V a � ,�..�,.. :i�:�4"�`x; �J!�a. > * ^?%t•'�.,z,•' �.r.v�4�h l�C�e . OV Aj 4f f 0. ,,.:.''''fir, .,tn � -e�^. •'ter.; p. 1��•; ..:,� �, r►, ... ., � � r j�.40 -All a -ol a 1 I o: t �f }� r '•/i�it .�.�,' � •_-:,,,,..�.� L FOUNDATION(IST) . ------------ • 1 • • s t •PLUM: i �► � a CODE-STkTE. ENERGY `, +•' ;;r..e $, ` ;} 1^rt, j PUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Q. (BAR 1 5 202Town-Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 --.--Telephone (631) 765-1802 - FAX (631) 765-9502 &rr@southoldtownny.gov - seandAsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 3/9/2021 Company Name: LC Electrical Contracting Inc. Name: L1,--vvcj cAvc f,rc License No.: ME-38043 email: office@ Icelectricalcontracting.com Phone No: )_%-7y_01,gS' ❑✓ I request an email copy of Certificate of Compliance Address.: ,,aa.. WO,a a �vv �.�.��. r. s Alvaie'K!5 1124 JOB SITE INFORMATION (All Information Required) Name: 97Vc-r__ Address: 6 0-a- 9r N /)P- So Cross Street: Phone No.: Bldg.Permit#: 45311 email: office@Icelectricalcontracting.com Tax Map District: 1000 Section: 'I q Block: 5 Lot: jq. BRIEF DESCRIPTION OF WORK (Please Print Clearly) Swimming Pool Swimming Pool Swimming Pool Check All That Apply: Paoo Is Joh ready for inspection?: YES - ❑Rough In E]Final Do you need a Temp Certificate?: DYES ✓❑NO Issued On 3/9/2021 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑1 ❑2 ❑H Frame [—]Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION pO Electrical Inspection Form 2020.xlsx il' BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD a Town Hall Annex - 54375 Main Road - PO Box 1179 o - Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a�southoldtownny.gov — sea nd(a)_southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Alf Information Required) Date: Company Name:: LC_ 1 A^'f c Name: License No.: email: Address: Phone No.: JOB SITE INFORMATION (All Information Required) Name: Address: & Pe Cross Street: Phone Bldg:Permit#: email: Tax Map District:"I'.1 1,000 Section: fockr Lot: BRIEF DESCRIPTIOWOF WORK (Please Print Clearly) Circ'Ie.Alll That Apply: i Is job ready for inspection?: YES / NO- Rough In Final .._..Do.yau..`need a-Temp o Service Size-1 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,APPL-IC'ATION Request for Inspection Form.xls PERMIT# Address: Switches Outlets 1 GA's Surface Sconces H H's ` UC Lts. Fans Fridge HW Exhaust Oven Dryer Smokes Dmr,._.. ...._...._ Se-rvice, Carbon __.. Micro.. . _...._.._. _..._ _ .Ge.eerator� Combo Cookto „. . AC _.. - : .. AH _. u MifiF Special: Comments: ( a.> =¢fir 3. .r r r :r , • C� � � LA Scott A. Russell °SU '�a� STOIkMWA\TIE]k SUPERVISOR CO) MANA\{G1IEMIENT 50UTHOLD TOWN HALL-P.O.,Box 1179 � 53095 Main Road-SOUTHOLD,NEWYORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS :PIW3lECr HNWOLVEi ANY OF THE 70I,I;OWING: Yes No (CHECK ALL THAT APPLY) ❑IR A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑E" B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑ErD. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. ❑EYF. Instaflation 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 Application. APPLICANT (Property Owner.Design Professional,Agent,Contractor,Other) S.C.T.M. : 1000 Date: //0 M District 1 J C NAME � Section Block Lot ***FOR BUILDING DEPARTMENT USE ONLY**** Contact Information rnamx:o�;vu„t� Reviewed By: — — — — — — — — — — — — — — — — Date Property Address/Location of Construction Work: — — — — — — — — — — — — — — — — ��1 Approved for processing Building Permit. E Stormwater Management Control Plan Not Required. i '"� L�"1 ❑ Stormwater Management Control_Plan is Required. (Forward to Engineering Department for Review.) FORM # SMCP-TOS MAY 2014 Of SO(/ryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G • Q Southold,NY 11971-0959 cOUNTV,� � BUILDING DEPARTMENT May 19, 2022 TOWN OF SOUTHOLD Stock, Jason 43 Irma Ave Port Washington, NY 11050 RE: Submit pictures of relocated gate latch release to inside pool barrier. TO WHOM IT MAY CONCERN: The items marked below are required to obtain your Certificate of Occupancy Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of$50.00. Final Survey with Health Department Approval. Plumbers Solder Certificate or Pex Affidavit Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. (631-765-1802) EnergyTest Results Final Elevation Certificate required. Final Storm Water Runoff Approval from Town Engineer Spray Foam Insulation certification from a NYS licensed architect or Engineer BUILDING PERMIT: 45311-Z In-ground Swimming Pool SURVEY OF PROPERTY _ 'MAP OF REYDON SNORES, BLOCK 'C" AT BAYVIEW FILED JULY 2, 1931 FILE NO. 631 LOf 44 LOT 45 LOT 46 TOWN OF SOUTHOLD i5`TJFFOLK C`OUIITTY, N.Y S69'50'2a E 170.a' (DEED} N \W S69"7s'rs`E 171.59' (ACTUAL) 1170G�-79-Q5—I4.B 2 sN sxo n iv SCALE' 11209 , NOV 29,200`710ERT7FICATIONI s a �U cl zt c�na C cl NAIF GEORGE 1St OPAL AKSCIN N/0/F FREDERICK & MELANIE FIEDLER m a im - ! Q � g gw O �tbe� C L�- asy 42a' (DEED} G' a1r w „may � P � � rcr S6950'20°E 4!8.69' ACTUAL e�f N 1 A'..wx r O FE QroQ05t&- N69`50 20 V1 s 20Y�tJPObf 1 ~, �' 419.65' ACTU L) 'a OCT 419.36' f DEED � � sroounE oeare . N69'48 4 W;, t 7Q aq it N/OlF PHELAN y o ? N10/F JOAN AKSC4N °� �O CERTIFIED To, - PAMELA J. DaFRIEST NOLQTX 911 YYIEW ROAD ;uvq 17=MONUMENT rl :.''. •-PIPE !/r,t , ,f t.v. N.>:S. LIC. NO. 496 ANY ALIERA71ON OR ADOIDON TO WS SURWY IS A WOLAnON I'ECdNlC 5U??tEYdRS, P.C. OF SECRON 7209OF THE NEW YAW!STATE EDUCATION LAK EXCEP7ASPER SEC77ON 7209-�SUDDIWMaV 2. ALL CER77FiCAnONS (631) 765-5020 _AX (&JJ) :765­79 ?;r'';'.. ri';';.•.`:,%'`:, P.O. Box 309 HEREON ARE VALID FOR 7141S MAP AND COPIES rHEREOF ONLY Ir � ��� : So.-Fr SA70 YAP QR COPIES BEAR 774E IMPRESSED SEAL OF THC SURVE,>OR 1230 RA t/ELER STREET ry_1 Q t ucrrear cenu nioc �nvtevc uCCCMI clif ITW)i r) .vv 11077 f 1✓C. YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured 631-996-4687 Patricks Pools Inc PO Box 3024 East Quogue NY 11942 1 c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of insured or Social Security certain locations in New York Slate,i.e.,a Wrap-Up Policy) Number 262929943 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Co Town of Southold 3b.Policy Number of Entity Listed In Box"1 a" 54375 Main Rd WWC3465462 PO Box 1179 SoutholdNY 11971 3c.Policy effective period 05/13/2020 to 05/13/2021 3d.The Proprietor,Partners or Executive Officers are Included.(Only check box if all parinersloificers included) QX all excluded or certain partners/officers Excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days.IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy_ expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'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:. Nicholas Zulkofske (Print name of authorized representative or licensed agent of insurance carrier) Approved by: (signatur (Date) Title:Authorized Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 631-441-4113 Please Note:Only Insurance carriers and their licensed agents are authorized to issue Form C-106.2.Insurance brokers are NQJ authorized to issue it. C-105.2(9-17) www.wcb.ny.gov DATE 1 (MMID ,4OC RO' CERTIFICATE OF LIABILITY INSURANCE 07/73/2020 DrrvYn 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 NTA COCT Brookhaven Agency,Inc. PHONE 1131 941-4113 FAXC.FA631 941-4405 AIL 100 Oakland Ave,Ste 1 -nR; . certificates brookhavena enc .com Port Jefferson,NY 11777 INSURER(SI AFFORDING COVERAGE NAIC e INSURERA.• Philadelphia Indemnity Insurance Co. INSURED INSURERS;Wesco Insurance Co. Patrick's Pools,Inc RE C•Merchants Mutual Insurance Co. PO BOX 3024 INSURER D East Quogue,NY 11942 JNSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DL UB wun POLICY NUMBER POLICY EFF POLICY EXPIm LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS MADE a OCCUR DAMAGE TO RENTED $100,000 X X PHPK2103006 0212812020 0212812021 MED EXP rAny oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY EJ PELT r LOC PRODUCTS-COMP/OP AGG s2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $500,000 C Ix ANY AUTO BODILY INJURY(Per person) 3 ALL OWNED SCHEDULED )( X CAP9267113 07/12/2020 07/12/2021 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ HIRED AUTOS X AUTOS on S UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ D I I RETEWN $ WORKERS COMPENSATION X I PER ro 1, AND EMPLOYERS'LIABILITY ANY PROPRIErOR/PARTNERlEXYIN N!A W WC3465462 05/13/2020 05113!2021 E.L.EACH ACCIDENT S100.000 EXECUTIVE B OFFICERIMEMBER FXCLUDED7 Y (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100,000 H s,di sedbe under OPERATION- l - E.L.DISEASE-POLICY LIMB I S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101;Additional Romarke Schodula,maybe attached if more space is required) Town of Southold is included as additional insured CERTIFICATE HOLDER CANCELLATION Town Of Southold SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE 'CC'C> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD *, l APPLOIED AS NOTED DATE: B.P.# RETAIN STORM WATER RUNOFF FEE: BY: PURSUANT TO CHAPTER 236 NOTIFY BUILDING DEPART NT AT OF THE TOWN CODE. 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO 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 ELECTRICAL YORK STATE. NOT RESPONSIBLE FOR INSPECTION REQUIRED DESIGN OR CONSTRUCTION ERRORS. 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