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HomeMy WebLinkAbout46386-Z ��o�oguFfaLp coGy� Town of Southold 10/1/2022 P.O.Box 1179 o ® 53095 Main Rd �yfj0 00�fr Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43465 Date: 10/1/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 745 Golf View Ct.,East Marion SCTM#: 473889 Sec/Block/Lot: 30.-2-132 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/11/2021 pursuant to which Building Permit No. 46386 dated 6/8/2021 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 inr�gunite swimming pool with fence to code as applied for. The certificate is issued to Benson,Dulcinea&DeCarlo,Frank of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 386 8/31/2021 PLUMBERS CERTIFICATION DATED i tr/AAjhc' i ed ignature i TOWN OF SOUTHOLD ��SUFFacK�D� BUILDING DEPARTMENT ' 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#: 46386 Date: 6/8/2021 Permission is hereby granted to: Benson, Dulcinea PO BOX 2022 Shelter Island, NY 11964 To: Construct in ground gunite swimming pool at existing single family dwelling as applied for. At premises located at: 745 Golf View Ct., East Marion SCTM # 473889 Sec/Block/Lot# 30.-2-132 Pursuant to application dated 5/11/2021 and approved by the Building Inspector. To expire on 12/8/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector pF SOUj�ol Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q sean.devlin(Mtown.southold.n us Southold,NY 11971-0959 y' COUP�lT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Dulcinea Benson Address: 745 Golf View Ct city,East Marion st: BY zip: 11939 Building Permit#: 463$6 Section: 30 Block: 2 Lot: 132 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Genovese Electric License No: 60644ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage X INVENTORY Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt 1 Recessed Fixtures CO2 Detectors Sub Panel 100A A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer 300W UC Lights Dryer Recpt Emergency FixtureTime Clocks 1 Disconnect Switches 1 4'LED Exit Fixtures Pump 1 Other Equipment: (2) Lights Notes: Pool w/Sub in Garage r Inspector Signature: Date: August 31, 2021 S.Devlin-Cert Electrical Compliance Form ho��OF50Glyo� ��� —7�� ��►� ��� f # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm��' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ]. FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [" ] ELECTRICAL (ROUGH) [, ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: G� log vf(4 a DATE INSPECTOR rAf SOUTyO� # # TOWN OF SOUTHOLD BUILDING DEPT. °`ycnurm a 631-765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] NSULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINALp ) C [. ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] -FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [. ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMA KS: ff,,i DATE �� INSPECTOR E P"114, c� c� SHERMAN ENGINEERING&CONSULTING Et� 14 NELmAR AvENuE 3'r AuGUSTINE,FL 32084 C631.831.3872 ,p�nlC & Gow 7 February 11, 2022 FEB 1 C 202 Building Department 70W�BUILDiNG DE pLD Town of Southold OF Re: Pool steel inspection; Permit#46386 Benson 745 Golfview Ct East Marion, NY SCTM 1000-30-2-132 Building/Zoning Official, This certification is for the foundation steel installed at the above referenced property on or about August 14, 2021. The rebar was installed with #4 bars at 10" each way throughout the bottom and #4 bars at 10" horizontal and 5" vertical in the walls. All steel was spaced to be in the middle of the 8" concrete shell and 10" beam with appropriate laps and intersections tied in accordance with acceptable building practices. This certification is limited to the installed structures and does not include, nor does it address plumbing, electrical, site placement, or any other aspect of construction. Please contact me if you have questions or require clarification for this certification. Very truly ur Sherma En Bring & Con ulting, P.A. Matth w Sherman, P.E. 'C�OF NEty Y JA1,,V 0 0 ►�— > Cr mry ,e ;�r Z LU 0835i3b, Ali= v 9OFES S 1D\A CML ENGINEERING DESIGN SITE PLANNING PERMITTING p M w s FIELD INSPECTION REPORT. DATE COMMENTS FOUNDATION(1ST) ------------------------------------ FOUNDATION(2ND) t�i7 • � O vs ROUGH FRAMING& PLUMBING C9 INSULATION PER N.Y. STATE ENERGY CODE 0.1 ClIf FINAL ADDITIONAL COMMENTS . tea; �Q C- l ` O z �m Nb Oce H r z- • d ,O�SutF9tk.�o" TOWN OF SOUTHOLD—BUILDING DEPARTMENT �`' Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959 Pyo a°! Telephone(631) 765=1802 Fax(631) 765-9502htt2s://www.southoldtownny.gov Date Received APPLICATION FOR RUILDING PERMIT oi'gice Use Only PERMIT NO. 5-a 7- 2::� Building Inspector: -- M AY 1 1 2021 Applications and forms must be filled•out in their entirety.Incomplete , applications will not be accepted. Where the Applicant is not the owner,an I7, Owner's Authorization form(Page 2)shall.be completed. Date:04/30/21 OWNER(S)OF'PROPERTY: Name:Dulcinea Benson T;UMT,000-30.-2-1321 . Project Address:745 Golfview Ct, East Marion, NY 11939 Phone#:9-178386217 Email:dulcinea.b6nson@att.net Mailing Address:745 Golfview Ct, East Marion, NY 11939 CONTACT PERSON:Judy Card,631-774-9429 Name:Judy Card/Binder Pools, Inc. Mailing Address: PO Box 1960, Shelter Island, NY 11964 Phone#: (W)631-749-2110/(m)631-774-9429 TTMail: judy@binderpools.com DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:Binder Pools, Inc/ Darrin Binder Mailing Address: PO Box 1960, Shelter Island, NY 11964 Phone#:(w)631-749-21-10/(m)631-774-9429 rEmall'jydy,@binderppols.com DESCRIPTION OF PROPOSED CONSTRUCTION []NewStructure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: (]Other Pool $60,000.00 Will the lot be re-graded? ❑Yes BNo Will excess fill be removed from premises? ❑Yes ®No 1 C PROPERTY INFORMATION Existing use of property: residence I Intended use of property: residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R_80 this property? ❑Yes ®No IF YES, PROVIDE A COPY, i 8 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, 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 210.45 of the New York State Penal Law. Application Submitted By(print name): Darrin Binder/Binder Pools, Inc. 12Authorized Agent ❑Owner Signature of Applicant, - Date: 5-4—Z\ STATE OF NEW YORK) `} SS: COUNTY OF�J: Lu=FO1y" ) Darrin Binder/Binder Pools, Inc. being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the Pool Contractor (Contractor,Agent,Corporate Officer, etc.) of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief;and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this y*\day of �I(a ,20A_ Notary ublic SHARON O.JACOBS Notary Public,0A5081168 State of w��yY►► No. York �� PROPE9�TY'®VIlNER AUTHORIZATION—oqualified in Suffolic Coun mmiiss'ron Expires June 30,2f` 3 (Where the applicant is not the owner) I� Dulcinea Benson residing at 745 Golfview Ct, East Marion, NY 11939 do hereby authorize Darrin Binder/Binder Pools, Inc. to apply on my behalf to the Town of Southold Building Department for approval as described herein. 4/30/21 Owner's Signature Date Dulcinea Benson Print Owner's Name 2 17 BUILDING DEPARTMENT- Electrical InL ctor ' .®�®SU�FO�;. .... TOWN OF SOUTHOLD AUG 2 7 2021 Town Hall Annex- 54375 Main Road -,PO Box 1179 Southold, New York 11971-0959 BUITDIINGDEPT. Telephone (631) 765-1802 - FAX (631) 7A!1650 rogerr(c-southoldtownny..qov - seanda-southoldtownny..qov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: , Name: 6"If,A YX 2 a License No.: email: Phone No: E]l request an email copy of Certificate of Compliance Address.: ('VIM'A � tCa Aare JOB SITE INFORMATION (All Information Required) Name: Address: LV- 4 Cross Street: Phone No.: Bldg.Permit#* e-13 email: Tax Map District: 1000 Section: ',S 0 Block: -1�1 Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) 22 o,,.A ji,et 10 ezo :Dmz) :r1u:sloo-ti. Eel is ws'� � Check All That Apply: Is job ready for inspection?: [](ES EJNO DRough In E]Final Do you need a Temp Certificate?: ❑YES R[N 0 Issued On Temp Information: (All information required) Service Size E]l Ph ❑3 Ph Size: A # Meters Old Meter# F-1 New Service ❑ service Reconnect [] Underground [—]Overhead 1#Underground Laterals E]l 02 E]H Frame E]Poie Work done on Service? Additional Information: PAYMENT DUE WITH APPLICATION .d qcoq Electrical Inspection Form 2020.xlsx BUILDING DEPARTMENT-Electrical ln'$p �ctor AUG 2 7 2021 TOWN OF SOUTHOLD Town Hail Annex 54375 Main Road =PO Box 1179 Southold, New York 11971-0959 BUIT,-DINTG DE,PT. Telephone (631) 765-1802 - FAX (631) 76� X50 - seand(cb-southoldtownnV..qov rogerr(cD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: . CZerJop09F_ JW Name: e1i 011-A nf-7 --.License-No.: i—email- -,Phone No: 01 request an email copy of Certificate of Compliance Address.: (,-ewc coAtv% "414 JOB-SITEIN-FORMATION---(All-information-Required)--- . ..... Name: , ew ao�, Address: Cross Street:k+cg-�5. Phone No.: Bidg..Permit email: Tax Map District: 1000 Section: 7S_0 Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) A)etA..) QQ llu$4-a-r.t. Equad"', :z%Pfz&a-.2 Check All That Apply: Is job ready for inspection?- RES F-INO E]Rough In ❑Final Do you need a Temp Certificate?: EDYES RrNO Issued On Temp Information: (All information.required) Service SizeE]l Ph [--13' Ph Size: - A # Meters Old Meter# M New Service FJ Service Reconnect ❑ Underground E]overhead J# Underground Laterals ❑1 ❑2 Frame Pole Work done on Service? Additional Information: 101r,64- DCYJ zamgn� PAYMENT DUE WITH APPLICATION d goy Electrical Inspection Form 2626.Xisi_ PERMIT# Address: Switches Outlets G FI's Surface Sconces H H's UC Lis Fans Fridge HW -- --- --------------- -- --------- ---- - ----------------- Exhaust ------------Exhaust -Oven W/D Smokes DW Mini Carbon Micro G.ene.rator Combo . Cooktop Transfer . AC AH Hood Service Amps Have -Used Special: VG . Comments: ` !` tom` C�/' l✓17P�/1i►��� �i I f I SURVEYED FOR: DULCINEA BENSON & FRANK DeCARLO LOCATED AT: EAST MARION,T/O SOUTHOLD,SUFF.CO.NY- LOT: 1 N MAF' OF: "MINOR SUBDIVISION OF GOLF VIEW" o S.C.T.M.# 1000-30-2-132 a SCALE: 1 "=50' ORS 3$2° a y NATE: �oiwed '/' `\ m Ali proposed structures shown with dimensions and property'line setbacks °. o as well as location of subsurface Sat t2 SeoK ZS��t�EO d sanitary areas per owner info and/or a ��� ° c Architect design., o\ a e� / \ 5A• wat v 3 G) IN tns 9 Steps o i 00 0� N o_ N 'lK at X26• � •���-�` ,50t �. Sit ftia O �. p!�-�a.is - tsart'n ��. umP: o e 3 2 GR "0�` 2 2 2 7TANcr SP`;ta,; d�n�` y4 m 0� 7a p iF G&NSG R1-16-2019E LAYOUT �O ° °Pe° �.P`��� STAKE LAYOUT T � a 90 11-15-2019 0 REVISED O� ®.� � _ 04-30-2019 \,0 FILE# 52528 rG �P f VOLLIAM R.SIMMONS 3RD.L.S.P.C. 128 CARLETON AVE, EAST ISLIP,NY,11730 PH 631-581-1688 FX 631-581-1691 i DATE:12/13/2017 SCALE:1"=50' BRAWN BY:E.S. 1 ,i 3 Client#:23825 BINDERPO ACORU, CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) _ 12/03/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER C NTACT NAME; Kimberly L.Schuel•leun Amaden Gay Agencies,Inc. Pn"ic631 324-0041 A/c No; 6313240671 P. O.Box 5004 Gay Road E-MAILD Pss : kschuerlein@amadengay.com P. East Hampton,NY 11937 INSURER(S)AFFORDING COVERAGE _ NAIC# INSURERA:Valley Forge INSURED INSURER 13:Continental Insurance Company Binder Pools Inc PO Box 1960 INSURER C:American Fire and Casualty Ins.Co. 24066 _ Shelter Island,NY 11964 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. ADDL SUBR POLICY EFF INSR POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/Y MWDD LIMITS A X COMMERCIAL GENERAL LIABILITY X 5084911313 09/25/2020 09/25/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE }: OCCUR DAMAGE EaoNxTu soca $100000 X PD Ded:1,000 MED EXP(Any one person) s15,000 PERSONAL$ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000;000 X POLICY❑JECT LOC PF:ODUCTS-COMP/OPAGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBI NED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ AUTOS ONLY SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per acc dent $ B X UMBRELLA LIAB X OCCUR X 5086496894 09/25/2020 09/25/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED X RETENTION$10000 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y I N )CWA60950488 10/01/2020 10/01/2021 PER TH- STA PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE_$1,000,000 If yes,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate Holder is an additional insured as required by Written contract. 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 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S65034/M65033 KLH 1 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NO'S WORKERS" COMPENSATION INSURANCE COVERAGE 1 a. Legal Name and address of Insured(Use street address only) 1 b.Business Telephone Number of Insured 631-749-2110 Binder Pools,Inc PO Box 1960 1 c.NYS Unemployment Insurance Employer Registration Shelter Island,NY 11964 Number of Insured Work Location of Insured(Only required if coverage is specifically 1 d.Federal Employer Identification Number of Insured or limited to certain locations in New York State,i.e.a Wrap-Up Policy) Social Security Number 113368250 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) LIBERTY MUTUAL INSURANCE COMPANY Town of Southold 3b.Policy Number of entity listed in box"Ia": XWA60950488 3c. Policy effective period: 10/01/2020—10/01/2021 3d. The Proprietor,Partners or Executive Officers are: ❑ included. (Only check box if all partners/officers included) X❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrierwill also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured f•om the coverage indicated on this Certificate. (These notices maybe sent by regular mail.) Otherwise,this Certi)7cate is valid for one year after thiis forne is approved by the insurance carrier or its licensed agent,or until thepolicy 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 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: _AMADEN GAY AGENCIES,INC. (Print name of authorized representative or licensed agent of insurance carrier) Approved by: . 12/03/2020 (Signature) (Date) Title: VICE PRESIDENT Telephone Number of authorized representative or licensed agent of insurance carrier: 631-324-0041 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT akK I 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 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured BINDER POOLS INC 631-749-2110 PO BOX 1960 SHELTER ISLAND,NY 11964 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,L e.,Wrap-Up Policy) 113368250 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 3b.Policy Number of Entity Listed in Box"l a" DBL397420 3c.Policy effective period 01/01/2020 to 12/31/2021 4. Policy provides the following benefits: ® A.Both disability and paid family leave benefits. B.Disability benefits only. ® C.Paid family leave benefits only. 5. Policy covers: ® 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: 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. Date Signed 12/3/2020 By (W/ a Gt (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Execrative 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 56 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. DB-120.1 (10.17) 1IJill I'i0�isii��iiaii�iBiiiiiii{��i�oi�iee�isiii11lll1 1 N D E P 0 0 L S Name: Dulcinea Benson Date: March 12, 2021 Pool Address: 745 Golfview Ct., E. Marion Pool Size: 12'x24',4'-6' depth Swimming Pool Contract Proposal Pool Includes: • 8" Shell, 10"beam e Plans and permits e %2"Rebar(10" centers, 5"verticals) * (2) Main Drains ® Rough grading * White or gray marble dust finish ® Porcelain 6"x 24"tile (55.95 sq.ft.) ® Pre-fab cement equipment pads e .High grade 2" solid PVC plumbing ® (2) skimmers ® StaRite Modular Media Filter(or equivalent) ® (2)returns ® Pentair Variable Speed Pump a Stairs as per plan o Pentair,,Chlorinator a Individual Suction Lines ® 300 ft.Ele. conduit(electric by others) 0 Jandy never lube valves and unions o Letro standard autofill ® (2) 12v LED Lights Features Included. .Payment Schedule: AquaSeal pool shell sealant$1,500.00 Deposit upon signing: 40% 4'x8' Dry well$2,500.00 Shell Installed: 40% 12"x 2"Bluestone coping$2,660.00 Back-fill: 10% (2)Loads of water$1,200.00(allowance) Ready for finish: 5% Fill removal$3,000.00 Start up: 5% 12'x14"Hollywood stairs$1,500.00 *'Total Price: $61,360.00 (This proposal is good for 60 days from mailing date.) IP,l es p " c tcl el ac ,l a cnr. c�=i gi`a la hid '•f n eeied fet ir� ,.tt rernTl:�RMTMR ue top or oil ond'.t o fc rina°t g o e. 1 '',p?:pane ga az�stalla ion a o 1R ��p,starr yon � e ,dv�inte sa�� ^ov r i, •o car rlq r al•z z�s t e�iaal, ea .iia �er o.• z��lke• ���' Adrlidional 01)tiorts: Pool finish and tile up-grade information available upon request. While we will do our best to protect the aristing environment,Binder Pools is not responsible for any damage to driveways, sidewalks,patios,sprinklers,septic systems, water wells, lighting, lawns or plantings.We are not responsible for obtaining certificates o,f occupancy. Initial I agree that this contract,including the General Terms and Conditions Contract and the White and Colored Pool Interior Finish Agreement,which I have read and to which I agree, constitutes the entire agreement relating to said sale, and I have received a true copy thereof. Agreed: Date: 03/13/21 P.O.Box 1960 -30 S.Cartwright Road- Shelter Island,New York 11964 631.749.2110 • Fax 631749.3529 Email: heybinder@optonline.net OCCUPANCY OR USE IS UNLAWFUL APPROVED AS NOTED WITHOUT CERTIFICATE DATE: B.P. 4,364OF OCCUPANCY FEE BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS; I. FOUNDATION -:TWO REQUIRED 'IMMEDIATELY" FOR POURED-CONCRETE ENCLOSE POOL TO-CODE 2. ROUGH FRAMING & PLUMBING UPON COMPLETION- 3. INSULATION B)rFOF(E W AtERb 4. FINAL - CONSTRUCTION.MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. "QtIIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES RETAIN AS REQUIRED.AND CONDITIONS OF STORM SOUTHOLD TOWtvZBA - PURSUANT TO WATER RUNOFF OF THE CHAPTER 236 SOUTHOLD TOWN PLANNING BOARD TOWN CODE SOUTHOLD TOWN TRUSTEES N.Y.S.DEC 18"x18" corner seat 12" bluestone coping 2 returns 1 12'x14" to . 2 LED lights { ) p step g (4) 12'x1211steps 7.24 1 '�: N��� C.: t":e �,.' a '1 -^r y M a� S RcaS�i�.• T h. tew Yds.":,, v. ,� 4• ",' 4 Cit '� y`,.w,�i. ;�.�' .iti$fi� t '� "zT '`�'�$ �� t� 3a��,'^,2M�c's:o:�, ', ? ', ::ci"Ai`•, >..``- � m �.1• +,� �. s, T:..., o-, ��.�. .,. as y d<f�';Sc k�ri� `t KZ rsrer wager .,� y W�g� r . ' S? ?�s 's�•u`*:.Ha. 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M x �Rf'C'q`:_ -. ?., a ss;. e - Si„$^ � ,. xMM11 x . fir. . " 'f' 1 ';; .loan, 'rc .,:va'w Via+ „�- ' kip"-`::�X`'.:,. "�y:t`.a.�ti r 'G � ,�,'.�.•i,,a; °::ti;t•,. ' "t'; .'-. < ca',i•... ?:"S::} � 'bw• e. n:, fi f, c.•xt"=�i'"`=P t_r f _ +.S �r ,t... w;<1e�!tii;"�„y.^ 5•:. ..r'��`r-' t � >:4'< t.w.+ -s dw, 2 skimmers 2 main drains 1 autofill 12'x24' Gunite Pool Binder Pools, Inc. Phone:631-749-2110 Designed by: 4-6 feet deep P® Box 1960 Judy Card Designed BENSON Shelter'Island NY 11964 Fax: 631-749-3529 3%'i 2%2021 for: 12`!x2" pool �12x14" top step coping (4) 12'x12°1steps p 18"x18" corner . Pool tele seat 24 ft. O 0. . . ; _ 7 - xfxs fG d 3'c.—' r - ✓. - ( `- r - - siN ^taAf 7 ft. 6 ft. 11 - ft. 12' x 24' Gunite Pool . Binder Poole, Inc. Deigned by: ' 4'-6' Deep PO Box 1960 Phone:631-7.49=21.10 Judy Card Designed BENSON Side view Shelter Island NY 119.64 Fax: 631-749-3529 3/12/2021 for: 10.5" 12„ Coping Pavers Mortar 4" Compacted Sand 6" Tile 12"Bond Beam " Marble Dust Concrete .#4 rebar (4) .#4 rebar 1'0" o.c. throughout " cont. through verticals"5 o.c. where bond beam• water depth exceeds 5' O. O 12" TO 36" Radius Compacted Soil O O Minimum specifications; Shotcrete Gunite 4,000psi minimum Grade 40 rebar (conf to ASTM A615) All work to be in compliance with ACI-318 F N Y 4�N Opp/ 4" min. thick " Gravel base o: �835$Ar tMM00 AVOWN OR AMM 10 RS DRAWN AND RRAMfD DDCUYM IS A MAIN OF SEC 7209 OF TIE N.r.S IDOnav MW RIFE S S 10NP JOB#: binder DATE: 5.19.19 Typ Pool `'��RM44' SHERMAN ENGINEERING SCALE: AS NOTED ® ® &CONSULTING P.A. Cross Sections 00": 14 NELMAR AVENUE DRAWING NUMBER a STAUGUSTINE.FL32O84 1 A v 631.831.3872 dddfp0 i co�9