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HomeMy WebLinkAbout45964-Z O�OS�fFUt p Town of Southold 6/11/2022 yam'; P.O.Box 1179 rn 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43149 Date: 6/11/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2610 Orchard St., Orient SCTM#: 473889 Sec/Block/Lot: 27.-3-2.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/4/2021 pursuant to which Building Permit No. 45964 dated 3/22/2021 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 2610 Orchard LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45964 10/21/2021 PLUMBERS CERTIFICATION DATED 0 - A o ized ature 4�Sitf n�a�i�� TOWN OF SOUTHOLD BUILDING DEPARTMENT CO- g TOWN CLERK'S OFFICE " • Thr 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#: 45964 Date: 3/22/2021 Permission is hereby granted to: 2610 Orchard LLC 24 W 130th St New York, NY 10037 To: construct accessory in-ground swimming pool as applied for. At premises located at: 2610 Orchard St., Orient SCTM #473889 Sec/Block/Lot# 27.-3-2.4 Pursuant to application dated 3/4/2021 and approved by the Building Inspector. To expire on 9/21/2022. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector OF SOUjyol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q roger.richert(rD- y' town.southold.n us Southold,NY 11971-0959 CoUm��' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: 2610 Orchard LLC Address: 2610 Orchard St City: Orient St: New York Zip: 11957 Building Permit#: 45964 Section: 27 Block: 3 Lot: 2.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: REP Electric License No: 46288=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 Survey 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 X A/C Blower Range Recpt Fluorescent Fixture Pumps 2 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures f] TVSS Other Equipment: In ground swimming pool to include, bonding, control panel, electric pool heater, 3-GFCI circuit breakers,2-pumps-1 filter pump, 1-Polaris pump,1-pool light Notes: Inspector Signature: Date: October 212021 81-Cert Electrical Compliance Form.xls { �o�aUF SOUTyo� # # TOWN OF SOUTHOLD BUILDING DEPT. cou765-1802 INSPECTION. [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND -INSUL'AT.IOWCAULKING [ ] FRAMING /STRAPPING [ FINAL [` ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION- [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: �v DATE i0 ?� INSPECTORAo- w FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) �y 'FOUNDATION(2ND) t� a ROUGH FRAMING& y PLUMBING fi Q r� INSULATION PERK.Y: ,y STATE ENERGY CODE FINAL ADDITIONAL COMMENTS Z �. G _2 ,2 o C-LQ C2R6C Q.P � . � Z rn • d . b H � .o S�FIFaq- - — _..o�oS -000y, - -- - - TOWN OF:SOUTHOLD' BUILDING-DEPARTMENT Town Hall:Annex 54375:Main.Road P. O: Box 1179 Southold NY 11971=0959 . . N, 'Z 7 w'y • o� Telephone (631)_ 765-1802; Fax'(631) 765-9502 hiips://www.-southoldtom2m.gov Date Received. APPLICATION FORSUILDING PE MIT: = Y ( fil \,, aA 6.r For Office Use Only ! C J =—' PERMIT NO. Building Inspector:," Applications and forms must-be filled out-in their entirety.Incomplete applications will oot be accepted. Where:the'Applicant is not:the owner,an: �,* Owner's.Authorization form'(Page 2)shall•be completed: .Date:: -3-L1=�otil OWNER(S)'OF PROPERTY: :: . . Name: (--c �S -�1.)�-S�tI�r� SCTM#1000- Physical Address: l�lo C) er }.1- lIQ-51-1 .Phone#` Email: )_6:� — bIAI; Mailing Address.. = CONTACT PERSON: : Name: Ca- Mailing Address:. .. l Phone#: Email: '1 (05: $ ?�� - =MQ . . . DESIGN PROFESSIONAL INFORMATIONi - Name: 1_v� �S�o,r Mailing Address, Phone#: Email: k co. CONTRACTOR-INFORMATION: � - _ Name:.. .. --D,r\Ss�o�:r� :oc� Mailing Address: v. vc�c� 1`'lc� %r� �:� O\ d\V `� \ \Q7 1 Phone#: Email:.: (03\.�: h .. .�5 DESCRIPTION OF PROPOSED:CONSTRUCTION New Structure.❑Addition: ❑Alteration ElRepair._ ElDemolition Estimated.Cost of Project: ❑Other $ O Will the lot be re-graded?. %Yes:O No Will excess fill be-removed from premises? "C�Yes ❑No PROPERTY INFORMATION -Existing use of property: Intended use of property: Zone or use district in which premises is situated:ted_: Are there any covenants and restrictions with respect to this property? lees ElNo IF YES, PROVIDE A COPY. ph-pt heck Box:After Reading: Theowner/contractor/design professional is responsible for all drainage and'storni water issues as provided by er 236 of the Town Code. APPLICATION IS HEREBY,MADE to the Building Department for the issuance of a Building Permit;pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,,New York and.other applicable Laws,Ordinances or Regulations,for the construction:of buildings, - additions,'alterations or for removal or demolition as herein described.the applicant agrees to comply with all applicable laws;ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the-New York State Penal Law. - Application Submitted By(print name): uthorized Agent ❑Owner Signature ofApplicant: Date �J:"'.,1 • Z` STATE OF NEW YORK) COUNTY OF 5c'-2i-ex-8'f V-9- being duly sworn;deposes and says that(s)he is the applicant ::(Name of individual-signing contract)above.named,, -:-: or (S)he is the (Contractor, en porate Officer,etc.) of-said owner-or owners; and is duly-authorized to perform or have performed the said work and to make and fiie 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 me this :- day of I" ` a:rc I .. N -.. - - try Public .. ::.. - TR ACEY L. DWYER NOTARY PUBLIC,STATE OF NEMA!YORK PROPERTY:OWNER'AUTHORIZATION: IEb IN SUFFOLK, - QUALIFIL=D:IN SUFFOLK,COUNTY .-... (.Where the applicant is not the Owner .COMMISSION EXPIRES JUNE 30,2� residing at - � �� do hereby authorize /� � jd/V Rod` Cf�32 { p y)On my behalf to the Town of Southold Building.Department for approval as.described herein. v- :.. --- Owner's'Signature Date .. 6(14 -Print Owner's Name ... . . . FiF ��j 2 a 2021ILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD + DEPT -TOWN OF OUTHOL9'own Hail Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 " Telephone (631) 766-1802 - FAX(631)765-9502 �roaer:r chertt towns sou hold onus AP.PLICATfON.-FOR ELECTRICAL INSPECTION REQUESTED BY: Electrician Date. 10/27/2021 Company Name: REP Electric LLC 114amo.: Robert E Paladino License.No.:. 46288N1 E entail: REPelectricl@gmaii.com Ad i. PO Box 635 i—A T"lUCit Nk-t 119 5-D ress: Phone No.': 63.1-767-6034..._..... ..... JOB SITE INFORMATION: (All information Required) Name: Lars Westvin Address: 2610 Orchard St Orient Cross Street: Halyoke.Ave Phone No.: / 7 7_ Bldg-.Permit#: 45964. _ email: Tax Map District: 1000 Section: Block;.. _.. _Lot BRIEF DESCRIPTION OF WORK(Please Print Clearly) Swimming Pool Circle All That Apply: Isjob ready for inspection?: RQxxxxxxxx xln Final Uo you need a Temp Ceftificate?: YES i ivu Issued On,.. . 'Temp Information: (Ail information required) Servie6,Size 1 Ph 3 Ph Size: A #Meters. Old Meter# New Service - Fire Reconnect- Flood Reconnect-Service Reconnected -Underground -Overhead #;lJnderground Laterals _1 2 H Frame Pole Work done on Service? Y N dd A . itional Information; ltl 131 09 PAYMENT'DUE WITH APPLICATION 82-Request for Inspection FormAs o" HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET March 03, 2021 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of- Westvind Residence 2610 Orchard Street Orient,N.Y. 11957 will not require draining because the pool is constructed with a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not interfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private roads. Sincerely, /HMngineering P.C. Marnika, P.E. 11/12%2020 Certificate of NYS Workers'Compensation Insurance Coverage CERTIFICATE.OF W&kers!-' : NYS WORKERS'COMPENSATION INSURANCE COVERAGE comp iii-si-24; Insured Detail Ia.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Long Island Pool Care Corp: 631-765-8285 50000 Main Rd. _ PO Box 1.690. lc.NYS-Unemployment Insurance Employer .:Southold,NY:11971n Nu Insured.:Registratio ri►ber of I ed. Id.Federal Employer Identification Number of Insured or.Social Security Number Work Location of Insured'(Only required if coverage is specifically limited to 275174033 certain lacatton in New York State,i.e.a.Wrap-UpYolicy) ws 2.Name and Address of the Entity Requesting Proof:of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder)- -Wesco Insurance Company:'.' Town of Southold Building Department Town Hall Annex _ 54375 Main Rd.. : : 3b.Policy Number of entity listed in box"la!!: P.O.:Box 1179 . Southold,NY 11971 WWC3465186 3c.Policy.effective period: 4/19/2020 to 4/19/202:1wr :'. 3d.The Proprietor,Partners or_Executive Officers are: -0 included(Only check box if all partners/officers included) wo . all ex cert rs/o lude • a excluded or ain partne fficers excluded,, . This certifies that the insurance carrier indicated'-above in box'"31!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(N.Y)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 2".The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceleddue to nonpayment of preniitims or within 30 days-IF there are-reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from(he coverage indicated on this Certificate.."(These notices be sent by regular.mail)Otherwise,this Certifcate 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 73c",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 Covetage or oth6t.'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): Approved By: : '- 11/12/2020 (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, https://wc.amtrustgroup.comtdnawc/Pd.icyNYCertificateOfWclns.aspx?lndexld=315660&Instanceld=7cebtl8fe-6c8b-432d-bb5d-f70d8dfde517:-. 1✓2 11/12/2020 Certificate of NYS Workers'Compensation Insurance Coverage C-105.2(9-17) www.wcb.ny.gov Workers' Compensation Law Section 57.Restriction on issue of permits and the entering contracts unless compensation is secured. 1.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(9-17)REVERSE https://wc.amtrustgroup.com/anawc/PolicyNYCertificateOfWclns.aspx?lndexld=315660&lnstanceld=7cebO8fe-6c8b-432d-bb5d-f70d8dfde5l7 2/2 ® DATE(MMlDDiYYYY):" .a► Rn CERTIFICATE OF LIABILITY INSURANCE 11712/2020 .:THIS CERTIFICATE IS ISSUED AS A MATTER OF.iNFORMATiON ANLY.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 ,-the'holder is an,ADDITIONAL INSURED;the policy(ies)must have ADDITIONAL INSURED'provisions or.be endorsed.. If SUBROGATION 19 WAIVED;subject'to the terms.and conditions-of'the policy',certain policies.may require.an endorsement. A statement•on this cerfificate.does not confer rights.to the:certificate.holder in,lieu of such endorsement(s)." .: PRODUCER--. g .. .Y :.: :.: - :.: CONTACT - . NAME: Morstan General A enc P 0 Box 9005" �"I NN (631)578-0890 a/c No: 631)682-1412 E-MAIL' New-Hyde Park-. a NY : 11040 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A. Century Surely.Company 36951 INSUREDp Long:Island Pool Care Cor .G INS uRERB: PO BOX 1690. INSURERC. INSURER 0: ucOUth01d'.: .. NY.. 11.971: .: INSURER E INSURER F: COVERAGES- CERTIFICATE NUMBER: : REVISION NUMBER: TH18AS TO CERTIFY THAT:THE'POLICIE$'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=T_O ALL THE:TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES..LIM_ ITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . INSR TYPE : ADDLSUBR P'OLICYNUMBER MMID�fY FF MMDD EXP' LIMITS LTR' " X. :COMMERCIAL GENERAL Ll9BILITYLyr EACHOCCURRII : - $ 1,000;000' _ EN DAh9AGE TO 100,000' CLAIMS- PREMISElEa occrronoo $ .. . A CCP898176 4/30120 4/30/21MED EXP(Any one person) $. 51000 PERSONAL 8 ADV INJURY- $. 'f;000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERALAGGREGATE $. 2,000,000 X POLICY: JEC LOCPRODUCTS-COMPIOP AGG..$_ 1:,000,000 OTHER:. $ AUTOMOBILE LIABILITY COM8INEDSINGLELIMIT $ Ea accident ANYAUTO BODILY INJURY(Por person) $ OWNED SCHEDULED —. :AUTOS ONLY .: AUTOS-: - BODILYINJURY(Par accdent) $ - HIREDNON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS•ONLY :Per accident UMBRELLA LIAR :OCCUR EACHOCCURRENCE $ EXCESS LIAR CLAIMS•MADE .. AGGR EGATE. $ DED: RETENTION S $ WORKERS COMPENSATION .-w .. - AND.EMPLOYERS'LIABILITY .) S ATUTE ERH ANYPIiOPRIETOR/PARTNERIEXECU7iVN!AE, ❑ E.L.EACH ACCIDENT: $' OFFICERJMEMBEREXCLUDED?-'i', (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ .. Ups;describe under DCRIP IDN OF OPERATIONS bolmy .:E.L.DISEASE.POLICY LIMIT $: -DESCRIPTION-OF OPERATIONS I.LOCATIONS J VEHICLES-(ACORO 101,Additional Remarks Schedule,may'bo attachad,if more space Is required) SUBJECTTO COMPANY TERMS;CONDITIONSAND EXCLISIONS CERTIFICATE HOLDER .: :: CANCELLATION Town of Southold Building Department SHOULD ANY.OPTHE,ABOVE DESCRIBED POLICIES BE CANCELLED BEFQR2 ... THE-EXPIRATION- DATE THEREOF, NOTICE WILL BE-DELIVERED -IN- Town Hall.Annex +" ACCORDANCE WITH THE.POLICY PROVISIONS. PO Box,1119 Haiti, Southold;NY 11971. AUTHORIZED REPRESENTATIVE ©:1988-2015 ACORD C - P ATIq N::AI •ghts.re erved. - ACORD'25(2016/03) The.ACORD name and logo.are registered,marks-of ACORD -YORKNEW 1Norkol�s° :CERTIFICATE:OF INSURANCE COVERAGE:.- NEW' " 'STATE Compensation Board : DISABILITY AND PAID FAMILY LEAVE:BENEFITS LAW..- PART 1:To be completed by Disability.and Paid Family Leave Benefits.Car.rier or Licensed Insurance Agent of that Carrier 1a:legal Name&Address of-Insured(use streefaddress only) 1b.Business Telephone Number of:lnsured LONG ISLAND POOL CARE CORP 631:765-8285.: 50000 MAIN ROAD- SOUTHOLD,NY 1197.1 1 c.. .. ... Federal Employer Identification Number.of Insured: .:. - or Social Security Number_ Work Location of Insured(Only required if coverage is specifically limited to ... certain locations in New York State,i.e.,Mao-Up Policy) "" 275174033 2.Name.and Address.of Entity Requesting Proof of Coverage. .3a.Name of Insurance Carrier " (Entity Being Listed as the Certificate Holder) ShelterPoint.Life Insurance Company 'Town.of Southold _ 3b.Policy Number of Entity.Listed in Box"la" - DBL357404 :. 3c.Policy effective period 04/19/2020 to. . 04/18/2022 . 4. Policy provides-the following:benefits: A.Both disability and paid family leave benefits. 0. B.Disability:benefits only.: C.Paid family leave benefits only.: 5: Policy covers: ❑X A.All of the employer's employees eligible under the NYS:Disability and Paid Family Leave Benefits Law. B.-Only the following class or classes of employer's employees: jesl­ ahA . Under.penalty of-perjury,I certify.that I am an authorized representative e.-licensed agent of the insurance carrier referenced above and that the.named insured has NYS Disability.and/or Paid Family Leave Benefits insurance coverage as described above. . qr Date Sined 1/12/2021: g 9 y . (Signature-of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-820-8100• Name and Title:'.Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by.the insurance carrier's authorized representative,or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE .Mail it directly to the certificate holder: If Box 4B,4C or'56 is checked,this cerfifcate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS . Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board-,-Plans Acceptance Unit,PO Box 5200, Binghamton, NY 13902-5200. :: - ... PART 2.To be.completed by the NYS Workers'Compensation Board.(Only if Box 4Cor 513 of Fart 1 has been checked). -.-ntlb. State:of New York Workers' Compensation Board According to informatlon maintained.by tfie NYS Workers'Compensation Board,the above-named employer has complied with the - . NYS Disability and Paid Family Leave Benefits Law with respect to all:of his/her employees. Date Signed. By. : .. . (Signature of Authorized NYS Workers'Compensation Board Employee), Telephone Number Name and Title Please Note:Only insurance carriers licensed:to.write NYS disability and paid family.leave benefits insurance policies and NYS:licensed insurance agents of.thoseinsurance carriers are authorized to issue Form-D8-120.1.Insurance brokers-ate NOT.authorized to issue this form. . W. :DB-120.1 (1017) _ III IIIIPiiiiiiiiiiiiioiiiii iiii�i�iiiiiiiiiiiiiilllllll - �••1 TASiK;8•! f 2.COh�G t.ALL JMM- _ _ s iNE sEFnc I ON A ldINF i Icr min I -"4 O c ` S :114= `BS r� X40 4 =' 1 TE i J o 1ST`C w T = .. 1 O O -u zx c /^��- i.•/i ����� dd � (3vQ -10 pip „ `r 3� D� /� .:i;,1 /qtr o O �C Ay x12 9 lu X r; Al 4 -40» m 'moo / o N cV _ m • r �' �jo<</,y� , 10.X, �j 28.29- : r rte. 01+ WELL CESSPOOL O l ov APPROVED AS NOTED DATE: x B.P.# FEE: u PY: NOTIFY BUILDING -rEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED ELECTRICAL FOR POURED CONCRETE INSPECTION REQUIRED, 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTR'.'"ll)N MUST BE COMPLETE G_ = O. ALL CONSTRUCTICI, 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 RETAIN STORM WATER RUNOFF AS REQUIRED AND CONDITIONS OF PURSUANT TO CHAPTER 236 �OUTHOLD TOWN A OF THE TOWN CODE. gam_„ I G BOARD erHIPq" rillATELY" ENCLOSE POOL,TO CQDE UPON COMPLETION BEFORE VATE.R". OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY TRACK FOR POOL NOTES: VINYL LINER 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION AND FILTER PUMP SKIMMER BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC CODE. (TYP.) VINYL LINER 2. POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1. 5" 3.SECTION R326.7 POOL ALARM REQUIRED. FOAM PADDING 3,500 PSI 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4. CONCRETE S.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE OF STEPS ° NYS SECTION R403.10: 1. POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). RETURN PROPOSED VINYL 10" SECTION R403.10.1 HEATERS ( •) SWIMMING POOL • A. SECTION R403.10.2 TIME SWITCHES a SECTION R403.10.3 COVERS 3' 600 S.F. 15' 6.REBAR SHALL BE 3" MIN.CLEAR TO EARTH. (MIN. I (4 _ 3 .. a 7.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS AND DUAL MAIN DRAINS WITH ,REBAR v ° 413 " SHALL COMPLY WITH ALL LOCAL ZONING REQUIREMENTS. STRAINER (VGB SAFETY 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME BAKER / ACT APPROVED DRAINS) <'4 (VGB)POOL AND SPA SAFETY ACT. 9.SLOPE PATIO SURFACE 1/4" PER FOOT AWAY FROM POOL 10.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR LARGE e ROCKS). 11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH ANSI/APSP/ICC 7. 5"' 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. a 13.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL LOADS POOL PLAN NOTE: WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION EQUIPMENT OR ANY OTHER NOT TO SCALE THIS IS A NON-DIVING POOL. LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING OR PROPOSED ADJACENT STRUCTURES. 14.NO DIVING EQUIPMENT PERMITTED. TYPICAL WALL DETAIL 15.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF POOL. 16.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 2610 ORCHARD STREET,ORIENT, SCALE: 3/4" = V-0" N.Y.11957 ONLY. NOTES: 17.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A MINIMUM 80_0. 3'-10' CONCRETE WALL T.WALLS SHALL BEAR ON UNDISTURBED SOIL LAP OF 30 BAR DIAMETERS. (SEE SECTION 2.ALL CONCRETE SHALL BE PLACED AS A MONOLITHIC POUR. 18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION MEANS, THIS SHEET) METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR,NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH THIS PLAN. UNDISTURBED EARTH (TYP.) 4' 29' 7' 3" COMPACTED 1 1/2" TO WASTE SAND HAIR & LINT STRAINER POOL PROFlLE PUMP NOT TO SCALE FILTER AUTO SKIMMER GENERAL NOTE: POOL ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 BACK TO RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. POOL 2 MAIN DRAINS WITH PREPARED FOR: SCHEMATIC PIPING ARRANGEMENT HYDROSTATIC VALVE AND COLLECTOR TUBE WESTVIND RESIDENCE NOT TO SCALE IN GRAVEL BASE 2610 ORCHARD STREET ORI NT, N.Y. 119 7 DATE: 03/03/2021 NOTE: HM ENGINEERING, P.C. SCALE: AS SHOWN THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. /n 7�3� Z� SHEET: 1 OF 1 UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE G/> P.O.BOX 914 EAST NORTHPORT,NY 11731 NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. v D WITHO/RAISEDSEALANDBLUE SIGNATURE Tel:(516)476-5392 Fax:(631)980-7671 Email:hmarnika@optonline.net RESIDENTIAL CONCRETE VINYL LINER POOL PLAN i CAST IRON FRAME & COVER IF UNDER PAVED AREA FINISHED GRADE 8' MIN. - 12' MAX. BRICK LEVELING COURSE M21 tLi NOTES: CONCRETE COVER ..J 1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST CONC. COLLAR 27 6' MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND AS REQUIRED MAX BACKFILLED WITH SAND AND GRAVEL TO BOTTOM OF BASIN. PRECAST 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE REINF. CONC. SUBSTITUTED WITH APPROVAL OF THE ENGINEER. DOME 4'0 PVC 3. LOCATION! OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. MIN. SPER INVER FOOT ® ® ®910 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. ® ®®❑ NON-SHRINK ®®� 5. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR GROUT FULL DEPTH. ®Ox 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND _ AND GRAVEL AND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, a COLLAR (TYP) a a ALL AROUND H a SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) rn PERCENT. PRECAST REINF, o CONC. LEACHING •� RINGS ot H W W \y W rr 8' DIAMETER �s �> tiW v v DRYWELL CALCULATION: Zz BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF) DRYWELL CAPACITY = 1,263 GAL. (168.8 CF) Z 6' MIN. PENETRATION Tu a INTO VIRGIN STRATA GROUND WATER gy OF SAND & GRAVEL DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: WESTVIND RESIDENCE 2610 ORCHARD STREET 71DWITHI NT, N.Y. 11 7 Y DATE: 03/03/2021 NDTE: /UTRAISED HM ENGINEERING, P.C. SCALE: NOT TO SCALE THESE PLANS ARE ANINSTRUMENT OF SERVICE AND ARETHE PROPERTY OF HM ENGINEERING P.C.UNAUTHORIZED (( SHEET: 1 OF 1 ALTERATIONS OR ADDITIONS TOTHESE DOCUMENTS ARE AVIOLATION OF SECTION 7209 OF THE NEW YORK STATE � (i / �� P.O.BOX 914,EAST NORTHPORT,NY 11731 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. V SEAL AND BLUE SIGNATURE Tel:(516)476-5392 Fax:(631)980-7671 Email:hmarnika@optonline.net DRYWELL DETAIL