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HomeMy WebLinkAbout45917-Z , �Osu icor Town of Southold 7/17/2022 P.O.Box 1179 N 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43262 Date: 7/17/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 4510 Rocky Point Rd.,East Marion SCTM#: 473889 Sec/Block/Lot: 21.-3-26.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/24/2021 pursuant to which Building Permit No. 45917 dated 3/11/2021 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 with deck fenced to code as applied for. The certificate is issued to Gans,Allison&Wolfe,Erin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45917 8/11/2021 PLUMBERS CERTIFICATION DATED 0 Au ori ed i nature o�SUFFet�,co TOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE "o • 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#: 45917 Date: 3/11/2021 Permission is hereby granted to: Gans, Allison 584 Pacific St#2 Brooklyn, NY 11217 To: construct accessory in-ground swimming pool with deck as applied for. At premises located at: 4510 Rocky Point Rd., East Marion SCTM # 473889 Sec/Block/Lot# 21.-3-26.1 Pursuant to application dated 2/24/2021 and approved by the Building Inspector. To expire on 9/1.0/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 ACCESSORY $204.00 CO- SWIMMING POOL $50.00 Total: $504.00 Bu' Ins r OF SO�ryol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q sean.deviinCaD-town.southold.ny.us Southold,NY 11971-0959 COWN BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Allison Gans Address: 4510 Rocky Point Rd city:East Marion st: NY zip: 11939 Building Permit#: 45917 Section: 21 Block: 3 Lot: 26.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: LC Electric License No: 38043ME 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 2 Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures 6 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 2 UC Lights Dryer Recpt Emergency FixturesTime Clocks Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Pump 220GFI, Heater, Salt Generator, Pentair Tranny w/ (4) Lights on Pentair Trann (6) Wall Lights on Pool Transformer Notes: Pool Inspector Signature: �. Date: August 11, 2021 S.Devlin-Cert Electrical Compliance Form �apF SOGIyp Pl 17 4 ✓ 1® # # TOWN OF SOUTHOLD BUILDING DEPT. °`yrouan '' 765-1802 _. .F INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION-2ND. [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING` [ ] FINAL [ ] FIREPLACE & CHIMNEY ' J- ] FIRE-SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION . [ ] FIRE RESISTANT PENETRATION ELECTRICAL:(ROUGH) ' [ ] ELECTRICAL (FINAL) ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE 17 11,5 INSPECTOR sal # f TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ Y" NSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINA4)mte____ [ "] FIREPLACE-&-CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATI N [ ] PRE C/O REMARKS: P� G4 Y � uY DATE ? ` INSPECTOR rqji so * TOWN «lOF SOUTHOLD BUILDING DEPT. `yco 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) 's9 ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: a 0— in - "/,4 ,p r " r �clo a n�_N� noo el is- Juolex in jecof . I — , hal I - I . DATE INSPECTOR SOUIyo� L4 —7 \ f V7� # * :TOWN OF SOUTHOLD BUILDING D� �ycourmN�' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING a [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE'SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL-(FINAL) [ ] CODE VIOLATION [ ] PRE C/O' REMARKS: 0-t,- I! �l DATE �i" INSPECTOR c SO(/lyolo f # TOWN OF SOUTHOLD BUILDING DEPT.' cou765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] NSULATIOVSPECTION G [ ] FRAMING /STRAPPING [ FINAL FIREPLACE & CHIMNEY [ ] FIRE SAFET [ ] ­FIRE RESISTANT CONSTRUCTION [ ], .FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: voolf�l t T ►1 b DATE l I 1 INSPECTOR OJO" tiOfSOUTyO _< TOWN OF SOUTHOLD WILDING DEPT • io °`y�ou►m��' 765-1802 -INSPECTION [ ] FOUNDATION 1ST. [ ]'- ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] 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 l INSPECTOR LANs 95q ) 7 Jeffrey Sands Architect June 12, 2021 Property/swimming gool location: Erin Wolfe 4510 Rocky Point Road East Marion, NY RE: Swimming pool rebar inspection et'OKYWOLL Attention Town of Southold Building Department: Upon inspection of swimming pool rebar and drywell at above mentioned property, I find all to have been installed to meet current building code requirements. Sincerely; R MA&C'Si �27a9� yOQ OF NES Jeffrey Sands Architect 6 Evergreen Lane, East Quogue, New York 11942 phone-631-375-5997, fax, 631-576-8916 email—Jeffrey sands(c)-hotmail.com FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) H ------------------------------------ 'FOUNDATION (2ND) _ z • _o C> ROUGH FRAMING& PLUMBING n . 1 INSULATION PER N.Y: STATE ENERGY CODE 1 617A ?i 3f 10 FINAL Q.. Ap �t IY V - _ V ADDITIONAL COMMENTS t �75 v� 0 rn r . � O - z d b H o� cGy TOWN OF SOUTHOLD—BUILDING DEPARTMENT y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.jov_ Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only �• tr`,:y i 1+ PERMIT NO. I� Building Inspector: Applications and forms must.be`filled out in.their entirety. Incomplete applications will not be accepted. Where the Applicant is not-the owner,an a o,-,ner sAuthoeizatioh'form(Page 2)shall'be completed. 8. 2 4 2021 Date: y ac)0, OWNER(S),OF PROPERTY: ,::.:.T.. .«. Name: E Uv0 I 17`I�s �1"' SCTM# 1000- 1 Ir�•4V1.\ Project Address: ( � 119 Phone#: --1.SQ-,Ao.4 q Email: <n Wo` r ' t < 2� co Mailing Address: CONTACT PERSON: Name:—Ka6in6 WO Mailing Address: mon \101e-1 z Phone#: G� - U0I v( y- S 115a� mail: rrvy 1f1C� r) IS + DESIGN,PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR-INFORMATION: Name: S -ZYIQ. Mailing.Address: ` 4 ©U ve K314 > q L4 a Phone#:�31- 0 -o(-(0-61'Jcig-(DS ICY Emal . L DESCRIPTION OF PROPOSED,CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other MI,,•V A C(`?. S�YVUyye-- &L-Mm m Ln 4 6 $ (,0-1 , Din 0 Will the lot be re-graded? ❑Ye No Will excess fill be removed from premises?Pyes ❑No 1 PROPERTY)N FORMATION , Existing use of property: S � � - Intended use of property: .. ... __._. ._.._.._..._ Du �� �, µ SuuI m r Pocs"l Zone or use district in which premises is situated: Are there any covenants and restrictions wl respect to this property? ❑Yes Ivo IF YES, PROVIDE A COPY. Check Box After: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, -additfons,°altejrat ons br for removal"or'demolition as herein described.Theapplicant agrees to comply with-all applicable laws;ordinances;buil"ding 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 Glass A'enisdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): OYMOL Y-1 Authorized Agent ❑Owner Signature of Applicant _ Date: 6LL4a�� l STATE OF NEW YORK) Notary Public StateEof New York A-) NO.OIPA6262470 Qualified in Suffolk County COU NTY OF ) My Commission Expires May 29,2024 kafihlP,rC�.�f � �being duly sworn; deposes and says that(s)he'is the applicant (Name of individual signing contract) above named, (S)he is the ty)�. (Contractor,Ag t,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 me this 1iol day of re 20 D� Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 Building Department Appiication AUTHORIZATION (Where the Applicant is not the Owner) I, �►'i' UJ 61f-C residing at 451 u 90 CAI(-LI�Dk V*V " A (Print property owner's name) (Mailing Address) clS,+ VUI A&I-I ,'N l ck3 do hereby authorize In I(V)U 0-,Ue/1. (---L/ (Agent) 7b1 y\C,�-S?®[s\S Tv L- to apply on my behalf to the Southold Building Department. (Owner's Signature) (Date) Ute, W6 (Print Owner's Name) � (I BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD APR 1 g �021 TownHall Annex - 54375 Main Road - PO Box 1179 New York 11971-0959 Southold, Telephone (631) 765-1802 - FAX (631) 765-9502 roger.r.(a-southoldtownny.gov sea ndna southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 7 a o Company Name: LC Electrical Contracting Name: License No.: ME-38043 email: off ice @ LCElectricalcontracting.com Phone No: 6'31_ _ok � ❑✓ I request an email copy of Certificate of Compliance Address:: W,,e� 6, ,E_ 4 �l t JOB SITE INFORMATION (All Information Required) Name: ( , ,s sa,✓ Address: S� �oclC or.,� %A ier✓ Cross Street: Phone No.: Bldg.Permit#: z1,5-11:2 email: office@LCElectricalcontracting.com Tax Map District: 1000 Section: Block: �j Lot: t BRIEF DESCRIPTION OF WORK (Please Print Clearly) Qom/ Check All That Apply: Is job ready for inspection?: ❑YES ❑NO ❑Rough In ❑Final Do you need a Temp Certificate?: ❑YES' ❑NO Issued On 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 A Io Electrical Inspection Form 2020.xlsx q 1-2,+ 17j� PERMIT# Address: Switches Outlets 1 G FI's Surface Sconces H H's �J UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon Micro Generator Combo Cooktop Transfer AC AH Mini Special: Comments: (S-F s ti YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured 631-996-4687 Patricks Pools Inc PO Box 3024 East Quogue NY 11942 1c.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 State,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"i a" 54375 Main Rd WWC3465462 PO Box 1179 SoutholdNY 11971 3c.Policy effective period 05/1312020 to 05/13/2021 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers 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"l 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 1 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: Vic (Signatur (Date) Title:Authorized Agent Telephone Number of authorized representative or licensed agent of insurance carrier: 631-941-4113 Please Note:Only insurance carriers and their licensed agents are authorized to Issue Form C-105.2.Insurance brokers are I�QI authorized to issue'IL C-105.2(9-17) www.wcb.ny.gov l Workers' Compensation Law Section 57. Restriction on issue of permits and the entering Into 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 YK workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1,To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier Ia.Legal Name if Address of Insured(use street address only) 1b.Business Telephone Number of Insured PATRICK'S POOLS INC 631-941-4113 PO BOX 3024 EAST QUOGUE,NY 11942 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only wquired 11 coverage is specifically limited to or Social Security Number certain locations In New York State,i.e.,Wrap-Up Policy) 262929943 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) SheiterPoint Life Insurance Company Town of Southold 54375 Main Rd 3b.Policy Number of Entity Listed in Box"1 a" PO Box 1179 DBL318565 Southold NY 11971 3c.Policy effective period 05/13/2020 to 05/12/2021 4. Policy provides the following benefits: [M A.Both disability and paid family leave benefits. E] B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: ® A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employers employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. I Date Signed 7/17/2020 B wid,y (Signature of insurance carrier's authorized representative or NYS tkensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 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 5B is checked,this certificate 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 4C or 513 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability 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 those insurance carriers are authorized to issue Form DB-120.1.insurance brokers are NOT authorized to Issue this form. DS-120.1 (10-17) IIIIIP!uim1o2i0m1�i«(i10iui17)ii�IQl A CERTIFICATE OF LIABILITY INSURANCE p7/13E(MMI DNYYY) 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 Ileu of such endorsement(s). PRODUCER CONTNA ACT Brookhaven Agency,Inc. PHONE ,).(6311941-4113 Fax 631 941.4406 100 Oakland Ave,Ste 1 -Matt ADDRESS. certificates brookhavena enc .com PortJefferson,NY 11777 INSURERS AFFORDING COVERAGE NAIC a INSURER - Philadelphia Indemnity Insurance Co. INSURED INSURER B:Wesco Insurance Co. Patrick's Pools,Inc - E c: Merchants Mutual insurance Co. PO BOX 3024 -INSURER 0: East Quogue,NY 11942 SURER E, INSURER 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. ILTRNSR TYPE OF INSURANCE DL UBR POLICY NUMBER POLICY EFF POLICY EXP XU(MWI)DNYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 _ A CLAIMS-MADE E OCCUR PRFMIqFDAMAGES(Fn occurrence)RENTED $100.000 X X PHPK2103006 02/28/2020 02/28/2021 MED EXP An one on $69000 PERSONAL&ADV INJURY S1,000,000 GERL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 X POLICY M JECT ED LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $600,000 C X ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED )( X CAP9267113 07/12/2020 07/12/2021 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIREDAUTOS X AUTOSWNED PROPERTYDAMAGE $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ XCESSLIAO CLAIMS-MADE AGGREGATE $ EXCESS N $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIF.XECUTIVE Y/N E.L.EACH ACCIDENT $100,000 B OFFICERIMEMBER EXCLUDED? Y❑ NIA W WC3466462 06/13/2020 05/1312021 (Mandatory In NH) E.L.DISEASE-EAEMPLOYEE $100,000 H s,describe under ON OOPERATIONS below E.L.DISEASE-POLICY LIMIT S 600,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required) Town of Southold is included as additional insured 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 64376 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD S.C.T.M. NO. DISTRICT. 1000 SECTION:21 BLOCK:3 LOT(S):26.1 LAND MIF OF MARIE DALLI LAND MIF OF KONSTANTINO MASTORAKIS 264-41 NON. O&N 1.2W N 82o54'40 UA 0 NON. D N,( WAY O T 102.9'- LAND M/F OF 92.1' PAUL MWHOS .............. CIA ............. ............ 128.8" w-3 D DR&rWAY O O No MON. d237.Sl' MON, .5 86o49'20"W •, EDGE OF PAVEMENT SOUTHERN BLVD, THE WATER SUPPLY WELLS, DRYWELLS AND CESSPOOL 111 LOCATIONS SHOW ARE FROM FIELD OBSERVATIONS 04-10-20 SET MONUMENTS AND OR DATA OBTAINED FROM 07HERS. AREA:98,725.07 SQ.FT. or 2.27 ACRES ELEVATION DATUM., UNAUTHORIZED ALTERATION OR ADD117ON TO THIS SURVEY IS A WOLA77ON OF SEC770Al 7209 OF THE NEW YORK STATE EDUCATION LAW, COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY To THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TU770N, GUARANTEES ARE NOT TRANSFERABLE, THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRU&YZJRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PRFMISES AT THE TME OF SURVEY SURVEY OR DESCRIBED PROPERTY CERTIFIED TO: ALICE R. DZENKOWSKI; MAP OF: FILED: SITUATED AT: EAST MARION TOWN OR SOUTHOLD KENNETH M WOYCHUK..LAND SURVEYING, PLLC SUFFOLK COUNTY,'NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 PHONE (031)298-1568 FAX(631) 298-1588 FILE#220-26 SCALE 1"=40' DATE:FEB. 19, 2020 N.Y.S. LISC. NO. 050882 1 aftdia th.—,d.of R.b.rL L 9--y&X—th If W-Y-b-k �V 1. AP R VED AS NOTED DATE:Ew B.P.# FEE: BY: RETAIN STORM WATER RUNOFF NOTIFY ,BUILDING DEPARTMENT AT PURSUANT TO CHAPTER 236 765-1802 8 AM TO 4 PM FOR THE OF THE TOWN CODE. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOP, �;.0. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW ELECTRICAL YORK STATE. NOT RESPONSIBLE FOR INSPECTION REQUIRED DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF OARG ENCLOSE POOLt6t--J�Ew OUT STEES ;`.UPON COMPLETION OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY OVERLAPPED CORNERS 1"OVERHANG OF KEBONY CLEAR DECK BOARDS(TYP.) DOUBLE RIM JOIST OF 2x6 PRESSURE TREATED PINE(TYP.) 1x6 KEBONY CLEAR FASCIA(TYP.) civ v DOUBLE 2x6 BEAM OF PRESSURE TREATED PINE(TYP.) BF28'BIG FOOT FOOTING' 12"SONOTUBE FOOTING WITH CONCRETE 36"BELOW GRADE _, ( GALVANIZED STANDOFF POST BASE ANCHORED TO FOOTING 2x6 BLOCKING OF PRESSURE TREATED PINE(TYP.) 2x6 JOIST OF PRESSURE TREATED PINE SECURED TO DOUBLE 2x6 BEAM WITH JOIST zO HANGERS(TYP.) 10"W,.GUNITE POOL WALL(TYP.) 9 GALVANIZED STANDOFF POST BASE ANCHORED TO GUNITE POOL WALL+ELECTRICALLY BONDED(TYP.) SECURE 4x6 KEBONY DECK BOARD TO UNDERSIDE OF DECK VISIBLE FROM POOL S > NSTRUCTI® N DETAIL 0 1 2 ANS CE Marion, New York Date: 2021.03.03 Scale 1/2" = V-0" POOL CONSTRUCTION SPECIFICATIONS: WOLFE GANS -FORM, REBAR +SHOOT GUNITE AS PER PROPOSED PLAN -PROVIDE+ INSTALL ALL NEW RIGID PVC PLUMBING FOR POOL TO THE AREA OF PROPOSED EQUIPMENT RESIDENCE - PROVIDE + INSTALL NEW TILE + MARBLE DUST (TILE SAMPLE AND MARBLE DUST COLOR TO BE APPROVED BEFORE INSTALLATION) 4510 Rocky Point Road -PROVIDE+INSTALL PIPING, FITTINGS, GRATES AS NECESSARY OR AS PER PLAN (COLOR TO BE APPROVED BEFORE INSTALLATION) East Marion, New York -PROVIDE + INSTALL (4) JANDY JLU4C20W150 LED LIGHTS WITH 150' CORDS + (1) 300 W PENTAIR 12V TRANSFORMERS (DECK BOX BY POOL EQUIP) -PROVIDE+ INSTALL (1) JANDY VSPLUSHP VARIABLE SPEED PUMP -PROVIDE+ INSTALL (1) PENTAIR TR 100 WITH 2"MULTIPORT VALVE AND 'GLASS PACK' FILTER MEDIA - PROVIDE+ INSTALL (1) PENTAIR MASTERTEMP 400,000 BTU PROPANE HEATER OR APPROVED EQUAL -PROVIDE+ INSTALL JANDY PLC 1400 SALT WATER CHLORINATOR FOR POOL - PROVIDE +INSTALL BACKWASH LINE PIPED TO DRYWELL -PROVIDE+ INSTALL AUTOFILL DEVICE AND WATER SUPPLY -PROVIDE+ INSTALL POOL OVERFLOW PIPING INTO DRAINAGE SYSTEM OFoOL PROPOSED DECK - REMOVE ALL DEBRIS FROM POOL CONSTRUCTION. PRESSURE TEST PLUMBING, BACKFILL+ COMPACT TRENCHES IN 6"LIFTS (BY OTHERS) -SEE SK-1 FOR DETAILS * POOL COPING NOT IN SCOPE OF POOL BID marshal) poetzel * GAS HOOKUP AND LINE VOLTAGE ELECTRICAL WORK NOT IN SCOPE OF POOL BID * POOL CONTRACTOR IS RESPONSIBLE FOR PROVIDING INSTRUCTION TO CLIENT AS PART OF SCOPE LANDSCAPE ARCHITECTURE * NO EQUIPMENT SUBSTITUTIONS WILL BE ACCEPTED UNLESS AGREED TO IN WRITING 5175 Route 48 I Mattituck,NY 11952 phone: (631)209-2410 --- fax: (631)315-5000 o email: mail@mplastudio.com rn 6'-0"L.x V-6"W. AUTOFILL DEVICE 6"TILE BAND TO SURROUND SWIM-OUT BENCH ENTIRE POOL (5)WALL RETURNS SURVEYOR: Kenneth Woychuk LS 2o'-s" 0 1a-s 6 9" N.Y.S.Bo153 Licensed Land Surveyor P.O Aquebogue, NY 11931 (631) 298-1588 V-11"O.C. 9'-2" "- 3'-11" V-2"O.C. 9'-62"O.C. (2)CODE-COMPLIANT FLOOR STEP(TYP.) r GRATES TO CONCEAL SUCTION+ FLOOR RETURN LINES i PROPOSED 16' x 46' GUNITE SWIMMING POOL "INTERIOR FINISH+COLOR TBD BY OWNER PROPOSED PROPOSED LAWN PATIO (BY OTHERS) SITE DATA: SCTM# 1000-21-3-26.1 o" Lot Area: 98,725.07 SF (or 2.27 acres) PROPOSED 10"POOL BEAM(TYP.) i 10" 13'-0"DEEP END 19'-6"SHALLOW END 10" 6" NOTES: (8'4-DEPTH) 13'-6"SLOPED FLOOR (3'-6"DEPTH) 1. Existing conditions based on survey prepared by Kenneth Woychuk Land Surveying dated 09.25.2020. 11'-6"O.C.(TYP.) (4)JANDY LED POOL LIGHTS 6"W.MASONRY SLAB SHELF SET 6" 2. This drawing is for the purpose of BELOW TOP OF POOL BEAM(TYP.) obtaining permits only. NOT FOR CONSTRUCTION. 3. Unauthorized alteration of this plan is a o violation of NYS Education Law. a (3)SKIMMER BOXES REVISIONS DATE DESCRIPTION i 14'-0"O.C.(TYP.) #i-. 14'4"O.C.(TYP.) i PROPOSED PATIO OF POOL (BY OTHERS) S e a / 12"W.COPING-TBD WATER LEVEL Ep+ r SUN SHELF+STEPS 12"W.COPING-TBD - - -- -- _ 6 W.MASONRY SLAB SHELF SET 6 }ka PROPOSED DECK(BY OTHERS) 7 " "� � BELOW TOP OF POOL BEAM d TITLE: 0- F o.. EDGE OF BUMP OUT a a 10" ° 3'-6"SHALLOW END d ° dd d a d POOL PLAN a PROPOSED BENCH d 4 ° ° d d 4 d ° ° ° ° fD d d d 4 C 4�0,009Ld 5V C 0 1 2 d 4 FLOOR GRATE 4, Scale 1/2"8'-0"DEEP END ° d = 1' ° ° ° d� d ° DRAWN BY: d 4 d4 d N.COLLINS CHECKED BY: L 1 S.PAETZEL,RLA DATE:2021.01.25 DRAINAGE PIPE REVISED. SHEET 1 OF 1 i WOLFE GANS RESIDENCE 4510 Rocky Point Road ..� N/O/F East Marion, New York PAUL MISTHOS ---�� 402.43' PROPOSED 8'x4'POOL BACKWASH DRYWELL J SEE DETAIL 1 " P� o: �— �I 'v 0 PROPOSED 5 DRAIN PIPE marshall poetzel _ DRAIN P LANDSCAPE ARCHITECTURE PD-1 � h i n PROPOSED— i PROPOSED H-FRAME 5175 Route 48 260 SF ��_ ❑O i FOR POOL EQUIPMENT Mattituck,NY 11952 I DECK _ PROPOSED POOL _ \ i EQUIPMENT I phone: (631) 209-2410 PROPOSED \ (1 fax: (631)315-5000 16'X 46'POOL \ \ email: mail@mplastudio.com / (SEE DETAIL 2) \ / ! SURVEYOR: PROPOSED 560 SF PROPOSED 4'H.NYS POOL CODE OWGRADE'\ COMPLIANT DOUBLE GATE+FENCE Kenneth Woychuk LS MASONRY PATIO N.Y.S. Licensed Land Surveyor \ P.O. Box 153 I I \ Aquebogue, NY 11931 \ 1I (631) 298-1588 I Cz I N � I I I EXISTING STOOP (D TO REMAIN BILCO EXISTINGSHED _ EXISTINGI� IL TO REMAIN I M 1 \ EXISTING I W EXISTING \ / STEEDS TO REMAIN A/C UNIT J PROPOSED 4'H.NYS POOL CODE COMPLIANT GATE+FENCE EXISTING RESIDENCE ` I EXISTING PROPANE TANK CAP I � O 77 --- ------------------------- I I EXISTING STOOP SITE DATA: PROPOSED TO REMAIN I � I PROPOSED 4'H.NYS POOL CODE DRIVEWAY I I I COMPLIANT GATE+FENCE SCTM# 1000-21-3-26.1 Lot Area: 98,725.07 SF or 2.27 acres EXISTING DRIVEWAY ( ) I I TO BE REMOVED 3 O I I = I ) co � I I I NOTES: 1 on survey re Existing ared by Kenneth Wo based chuk Land I I I Surveying dated 09.25.2020. I 2. This drawing is for the purpose of obtaining permits only. NOT FOR w CONSTRUCTION. violation tof rNYSdalteration of is plan is a Education Law. I EXISTING GATE ` USE EXISTING GRAVEL DRIVE FOR CONSTRUCTION ACCESS REVISIONS \ _ _ DATE DESCRIPTION N 07°05'29'W 385.29' EXISTING UTILITY POLE(TYP.) EXISTING DRAIN ROCKY POINT ROAD EDGE OF PAVEMENT(TYP.) S e a I 3Cgp� %4� .��.,asl•lFat�F� q,,� PRECAST CONCRETE DOME co rne, tit L rG SDR 35 PVC INLET PIPE SEE PLAN FOR A PIPE SIZE GRADE TOP OF DRYWELL , �', 1 13r� MAX (SEE PLAN FOR6"X 6 "TILE FACING ELEVATION) SDR 35 PVC BACKFILL 3'-0"MINIMUM m OVERFLOW PIPE [I ❑ ❑ ❑ 11 AROUND DRYWELL WITH #4 STEEL REINFOFCED WATER LINE TITLE: SEE PLAN FOR Q ❑ ❑ 1 4"-1 �"MEDIUM COARSEA 3" PIPE SIZE Q ❑ O ❑ SAND/GRAVEL DEPTH <5'-0" >5'-0 ;Q• ° ae < PRECAST CONCRETE HORIZ. Wo.c. 10o.c. STORM DRAIN RING VERT. 10"o.c. 5" • J L E G E N D POOL PERMIT SEE PLAN FOR DEPTH - --------------------- --- ❑ E] 11NOTES: FLOOR 10"o.c. EACHH WAY ;.° FU- b El = 11 ° '< W bo SITE 4'-0"MINIMUM PENETRATION INTO RATEABLE SOIL. V I T E PLA N 0 ❑ ❑ ❑ —— PROPERTY LINE III111111111111111111 PROJECT LIMITING SILT FENCE (3)#4 BARS CONT. •° �• X p ❑ ❑ ❑ 25'-0"MAXIMUM DEPTH BELOW GRADE BOND BEAM ALL AROUND TIES 10"o.c. a � 2'-0"MINIMUM ABOVE GROUND WATER #4 BARS — — 50'RIGHT OF WAY E PROPOSED ELECTRIC LINE 2'0" IN PNEUMATICALLY MARBLE DUST FINISH MIN SEE PLAN FOR WIDTH 2'-0"MAXIMUM ACCESSCHIMNEY(IF NECESSARY) APPLIED CONCRETE GROUND WATER LINE RADIUS VARIES 6"TO 24" EXISTING STRUCTURE NON-RATEABLE SOIL THICKNESS OF WALL ! G PROPOSED GAS LINE 6'-0" DRYWELL TO BE INSTALLED AS PER STATE AND VARIES 6"TO8"MIN, ��— ON SHALLOW END ---------- TO BE REMOVED LOCAL CODES a 25"AND UP ON DEEP END 0 10 20 MIN a SAND AND GRAVEL-RATEABLE SOIL ! ° ______ PROPOSED POOL BACKWASH CLEAN MEDIUM PROPOSED DRYWELL CONNECTION tPD-11 DRYWELL COARSE FILL H4=1 Scale 1"=20'—O" DRAWN BY: 04RECAST CONCRETE DRYWELL ,Z TYPICAL GUNITE POOL WALL SECTION N.COLLINS P CHECKED BY: Section Not to Scale Section Not to Scale S.PAETZEL,RLA DATE:2021.03.03 REVISED. SHEET 1 OF 1