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HomeMy WebLinkAbout46727-Z ��p�OgHFFD1 Town of Southold 9/15/2022 o �. . P.O.Box 1179 W �a 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43407 Date: 9/15/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 620 Royalton Row, Mattituck SCTM#: 473889 Sec/Block/Lot: 113.-7-19.38 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/12/2021 pursuant to which Building Permit No. 46727 dated 8/24/2021 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 vinyl swimming pool fenced to code as applied for. The certificate is issued to Choi,Michael&Kelly of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46727 8/19/2022 PLUMBERS CERTIFICATION DATED 0 ut r' e Signature o�SUFFot�.�o TOWN OF SOUTHOLD BUILDING DEPARTMENT C, g TOWN CLERK'S OFFICE "oy • 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#: 46727 Date: 8/24/2021 Permission is hereby granted to: Marratime Cap LLC 71 15th Ave Sea Cliff, NY 11579 To: Construct in-ground vinyl swimming pool at existing single family dwelling as applied for. At premises located at: 620 Royalton Row, Mattituck SCTM # 473889 Sec/Block/Lot# 113.-7-19.38 Pursuant to application dated 8/12/2021 and approved by the Building Inspector. To expire on 2/23/2023. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL 00 Total: $300.00 Building Inspector 0f SO�T�ol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 ., sean.devlina-town.southold.ny.us Southold,NY 11971-0959 OIyCCUNm�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Michael Choi Address: 620 Royalton Row city:Mattituck st: NY zip: 11952 Building Permit#: 46727 Section: 113 Block: 7 Lot: 19.38 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Ground Electric License No: 46309ME SITE DETAILS Office Use Only , Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New 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 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 Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: Intermatic Pool Panel 8 Circuit/ 3 Used, 1 Light 100W Tranny 120GFI, Salt Gene, Pump220GF1, Heater Notes: Pool is Inspector Signature: Date: August 19, 2022 S.Devlin-Cert Electrical Compliance Form OF SOUTy�Io L4 &17 27 6 (ice # TOWN OF SOUTHOLD BUILDING DEPT. , cou765-1802 :5 -INSPECTION [ ` ] FOUNDATION 1ST- [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ 11 INSUL"ATIOWCAULKING [ ] FRAMING /STRAPPING [' ] FINAL [ ' ] ,FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [., ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS:- -y -moi ALC DATE i INSPECTOR 1 �OF SO(/T��� # # TOWN OF SOUTHOLD BUILDING DEPT. 41v cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [pq FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Q P�ec.z (_cG fG o,v ( _PDor��6a6 cc� G�c. G& 5 CGc6z017) c9 L9657x�zc row . DATE S-13— z_z— INSPECTOR �f�� OF SOUTH° -Ll_ 7 2..,-7 W (IV Y # # TOWN OF SOUTHOLD BUILDI DEPT. coum, 631-765-1802 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) ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O [ ] RENTAL REMARKS: �i"bPry DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ rFINAL ULATION/CAFRAMING /STRAPPING po%tlw--1 [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION ( ] PRE C/O [ ] RENTAL REMARKS: ni virJ IV . ovo DATE INSPECTOR FIELD;INSPECTION nPO,RT 'DATE .COIVIlV!'�N'1'S 777 FOUNDATION (IST) J ---------------------------------. ----- J: • FOUNDATION(2ND zzz : . ROUGH FRAMING.*& .� PLUMBING: : . .. 7. INSULATION.PER NY. y STATE'ENERGY CODE FINAL: ADDZT�ONA CO.:. TfiSzh 1 0.0 �: . . . . .. . � 72, �. . . • moo. ' kyo c :. Z TOWN OF SOUTHOLD—BUILDING DEPARTMENT 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.,goy Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only D 59 OV[E PERMIT NO. Building Inspector: AUG 1 2 2021 *pp lcatiorr's'aric!fo iris"tYrust'ae fil(eci out:rt,ttreir'ent"irety:'Incpmplete ' applicati(iris"Auii[I.r otrbe accepted;-Where'.t6.4pplica6t is not iiiaiu r$*r';an`,;" T Qvuriees Auth6riiatiion.form.(Page 2j shall,l�e:cornpleted, BUILDING O DEFT. TO VNN OF SOU THOLD Date: ;ta1NNER S ( j,QP'PROPERTY• N a m e: 1._.+c..^._L- SCTM#1000- i 3 -Q-J - 01 , r r� Project Address:_C �_ ._��' �_ . (-1 Y Phone# � 2Email: C y"o -L ` 3�5 Mailing Address: l P (n � �el`[` N l of G®N'tACT. PERS©RI:: ^ lr k NameTs� ii� Mailing Address: Phone#:C 4,3 � ) (.� 1 _ b�Q� Email:a l Looxdi rn `l DESfGN;-iE?RQi`ESStONAt>tNFtJ�RNi�tT10Nt ;R• ;`' r: Name: Mailing Address: Phone#: Email: a. ;CClNTRAC7'OR:INFOitN1Ai'ION: Nam!L—SWt1.� _g Mailin Address: Phone#: Email: 5v m Hq, DESCRIPtfON�.OF"PRaROSEQ;`COIUSTRUCTION , h ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other 1 Q P00 $ L—k0 OL-Ap Will the lot be re-graded? es ❑No Will excess fill be removed from premises? Yes ❑No 1 - PRDPERT=Y.INFORMATiON ;-, Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to . � � this property? Dyes ONO IF YES, PROVIDE A COPY. D.CKeck Bax After Reading: The oviiner/contractor/design prafessfional is'responsible for-'all drainage anif story»itiater issues as provided by; Chapter z86 of the Town Code. APPOCATIgN IS HE MADE to.the Building Department for,the issuance of a,Building.Permit pursuant to the,Building Zone"- Ordinance:of the ToWn ofSouthold,Suffolk,,County,.New York grid other applicable Laws,Ordinances or,Regalations,'for the construction of buildings,V additions;alterations or for removal or demolition as herein described.The-applicant agrees to comply with-all appiicable laws;;ordinanoes,building code; housing code and,regulations aiid to admit authbrized inspectors oii p'remise's and in 6uitding(s)for necessary mspectians.False statements'nnade' ee' fi are puinishable asaClass'A misdemeanor pursuant to Sectlon 2iOAS•of the,Newrk'State Penal Cavi: Application Sub a rint name): 2 Authorized Agent ❑Owner Signature of Applicant- Date: STATE OF NEW YORK) COUNTY OF ) C7 �- QL- fns Ck-CJ being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the LU)Dtk Ili (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 day ofN�A7__, 20L9 Notary Public Lauran Margaret D'Agostino Notary Public, Sate of New York PROPERTY OWNER AUTHORIZATION No.01D :0157853 (Where the applicant is not the owner) Qualified in ...'folk County Commission Expires April 30,2023 I, �/lSfct�'ll�l�o I°�QrrCc residing at [/ /5""' / iV& AA— 19 .c efir&. Ny do hereby authorize -5ioeencys ?aa/ jG'✓ice to apply on my behalf to the Town of Southold Building Department for approval as described herein. 5/y�Z�z, Owner's Signature —T Date Print Owner's Name 2 202 �O0FFO(,��0„Y J BUILDIN DE ARTMENT-Electrical Inspector fd BUILDING L' p `� rowN of souTH LDTOWN OF SOUTHOLD y ; Town Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Od ®�; Telephone (631) 765-1802 - FAX (631) 765-9502 ro err d.own ov - seandl_(a�southoldtownnv aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date- Com ate: - - Company Name: �vc v�r>l e c � � Electrician's Name:' ,n C �p�� License No.: Elec. email Elec. Phone No: �" `��end e c Iv, �! Cov1� X 31^��-( Elec. Address.: zi 12 aLj V-"a,,,o I reque ,tan email copy of Certificate of Compliance ' A- Lot: 111t3? JOB SITE INFORMATION (All Information Required) Name: IV 4t,, f2 r.a� Address: z0 R oLd cc(-S-oe--) }20 c cs( iss Street: �� i rPhane No.: 5 1 (� Cj ( aBldg.Permit#: ? "� � aemail: J w,a wa DaTax Map District: 1000 Section: "I L 3 Block: �. BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Plea:se Print Clearl : c-(�C�,,q) _ w Comte,-�c iiu�� (S . v) 3" 10"' DeP44q C5Lalloul') 4-z> G D-z-P44-1 D-ap-e,,,0) W1 G7 1-9" con e Circle All That Apply: I Square Footage: Is job ready for inspection?: �. YES �NU �Rough In Do you need a Temp Certificate?: Final YES EINO Issued On Temp Information: (All information required) j Service Size F11 Ph 03 Ph Size: A # Meters � Old Meter# []New Service[]Fire Reconnect QFlood Reconnect[]Service Reconnect[]lJnderground # Underground Laterals 1 2 H Frame Pole (Work done on Serviog? -verhe ad Additional Information: Y N I i PAYMENT DUE WITH APPLICATION �0 IIS E ��� ` QS 01 JAN JAN BUILDIIN DE ARTMENT-Electrical Inspector �Q �G BUILDING r)tf' . TOWN OF SOUTH t oTOWN OF SOUTHOLD N y Town Hall Annex - 54375 Main Road - PO Box 1179 y Southold, New York 11971-0959 Telephone 1631} 765-1802 - FAX (631) 765-9502 ro err southoldtownn ovseandl(a�southoldtownny aov APPLICATION FOR ELECTRICAL INSPECTION. ELECTRICIAN INFORMATION (All information Required) Date: . Company Name: �ro U — Electrician's Name: �0 C .o�� License No.: .........( Elec. email' Elec. Phone No: q1`-6Ulnd e-t e c c °- vr1�� • Com c request an email copy of Certificate of Compliance Elec. Address.: yl 1zay,,,,tio�o �,l . . . 1Igt53 JOB SITE INFORMATION (All Information Required) Name: C & Address: Z 1�1 o�d -(4- s's Street: p CL X, Phone No.: Bldg.Permit#: 13 email: d ma.�k 0a YY1Q G yy� Tax Map District: 1000 — Section: "I t ': Block: BRIEF DESCRIPTION OF WORK,INCLUDE SQUARE FOOTAGE (P easy) e Print Clearly): w �'X 3� roc � )� •w ��-1 Con �;e e a� (S . I off .6ep+h Csk i:(o ) G ` Dt.p4-� (� D-etp j� w - `iS L3-pT Lit," _iS` Circle All That Apply. Square Footage: Is job ready for inspection?: YESNU Doyou n �Rough In Final y need a Temp Certificate?: YDS NO Issued On Temp Information: (All information required) j Service Size❑1 Ph 03 Ph Size: A j # Meters _ Old Meter4[10ve'r�ead[]New Service[]Fire Reconnect[]Flood Reconnect[]Service Reconnect E]Underground# Underground Lateralsal Q2 [� H Frame [� Pole Work done on Servion? YAdditional Information. i r PAYMENT DUE WITH APPLICATION . L ,� I rn�' a'' �� ��� v ��� � ��`� �� ��C ' �' ` LO �C�-G- A� CERTIFICATE OF LIABILITY INSURANCE EDAT5/05/2OlY1 05/05!2021 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 pollcy(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 cartiflcate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: John Sheren Agency Inc PHONEh 631-821-4300 FAX 691 Route 25A E-MAIL r"^IL johnsheren@allstate.com A : Miller Place,N.Y.11764 INSURERS AFFORDIN()COVERAGE NAIL# INSURERA: Utica First Insurance Company INSURED INSURER B: _ Ground Electric Paul Clark DBA INSURERC: 21 Raymond Ave INSURER 0: Middle Island,NY 11953 INSURERE: 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 ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POUCYNUMBER MMIDOrYYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000.00 CLAIMS-MADE OCCUR DAIWI E TO RENTED PRIEMISES Ea occurrence $ MEo EXP(Any one person) $ 5.000.00 ART 5129110 05/17/2020 05/17/2021 PEI tsONALBADV INJURY S 1,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000.00 X POLICY 0 JECT El LOC PRODUCTS-COMPIOPAGG $ 2,000,000.00 OTHER: S AUTOMOBILE LIABILITYC MB NED SI GL I $ Ee accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED X BOOILYINJURYPeraccidenl S AUTOS AUTOS ( ) NON-OWNED PROPERTYDAMAGE $ HIREDAUTOS AUTOS Peraccrdenl S UMBRELLA LIAB HOCCUR EACH OCCURRENCE S _ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANYPROPRIETORIPARTNERIEXECUTIVE El EACHACCIDENT $ OFFICERIMEMBER EXCLUDED? F7 NIA (Mandatory In NH) El DISEASE-EA EMPLOYEE S Ir yyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be altachad If more space Is required) Binder/Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Suffolk County Department of Consumer Affairs ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 6100 AUTHORIZED REPRESENTATIVE Hauppauge NY 11788 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Workere, R T Sy(V K E nsAtion, CERTIFICATE OF NYS WORK-ERS'COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(use street address only) I b.Business Telephone Number of Insured 0043)-0409 Sweeney's Pool Service Inc. I c,NYS Unemployment Insurance Employer Registration 1740 Ch4rch Si Number of Insured ,Holbrook,,NY.1 174.1-5918 Id.Federal Employer Identification Number of Insured or: W6rk.LocAtion of Insured(Only required if coverage is'spgcifically Social Security NOmber IiMited,to certain locations in Nem;York State,i.e.q, Vrap4lp POicy 473990169 2.Name and Address of'Entity Requesting Proof of Coverige.(Eptity li.,Narnc of Insurance Carrier Bein-L i-ted,as the Certificate Holder) Continental.1ndeninity Co. Town of Southold 1b.Policy Nurnbcr of Entity Listed in,Box"Ie' 54375 NY-15 Southo4d,NY 1197.1 37-587949-01-01 3c.Policy'effective period 06/22/21 to _ 06/22/22 3d.The Proprietor,Partners or Executive.Officers Officers are included.(0tilyd"-bei if all all excluded or certain partners/officers-excluded, J This certifies that the insurance carrier indicated above in box 1"insures the business referenced above in bo I WlforworkeW compensation under the New York State Workers'Compensation Law. (To use this form,New York(NY)must be listed under Hem 3A on the INFORM NTION PAGE of the workers'compensation insurance policy). The lnsurahce Catrief.or its licensed agent will send this Certificate of insurance to the entity listed above as the certificate holder in box"T'. The insurance.carrier must notify the above certificate holder and the Workers'Compensation Board within 10 day's IF a policy is canceled due to nonpayment of premiums or within 30 daysIFthere are reasons other than nonpayment of pr6iiiialls,that cancel the policy or eliminate the insured from the cOvetage indicatedon this Certificate.(Those.notices may be sent by.regvul6r mail.) Otherwise,this Certificate'is valid for one year,afteirthis form is approved by the insurance carrier or its llcepstd'ggent,or until the po-licy expl6tion date listed in box gel;whichever is earlier. 'chis certificate is issued n a'mattei of information only..and confers no rights'upon'the c6dificateholider. This certificate-does not amend,extetid.or atter 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!i! 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 bolderi the business must provide that certificate holderwitli a new Certificate of Workers'Compensation Coverageor 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 cartler referenced above and that the named insured has the coverage as depicted on this form Fipprovcd by: Todd Div"yn (Print name bf1ligkorized representative or licenced agent of insurance carrier) Approved by: 08/0312021 (Signature) (Bate) Title. Autbori zed Represeniati ve Telephone Numb&of authorized representative or license'd agent'of insurance carrier: (877)234-4424 Please Note;Only insurance carriers and their licensed of are authorized to issue Form'C-165.1. Insurance brokers iire.NOTanthoriz6d to issue it. *vvvVWc6.hy.gqV AC4!>RV CDATEtMERTIFICATE OF LIABILITY INSURANCE INOW312011 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(ies)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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Vr insurance Agency Inc, NAME* DKM Insurance Agency Inc. HaNa 631 363-5200 FAX 631"163-7649 -1A&VQ III: AIC.N.I: One Rabro Drive,Suite 11 &MAIL ADDRESS, coi@dkminsurance.com Hauppauge,NY 11788 INSURER(S)AFFORDING COVERAGE ..................... NAIC 11 INSURER A:ATLANTIC CASUALTY INS CO INSURED INSURER B: ntinental Indemnity Co 'SWEENErS POOL SERVICE INC.. INSURER C. 1740 CHURCH STREET INSURER D; HOLBROOK!NY 11741 INSURER E: INSURER F': COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE•POLICIES OF INSURANCE11ISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD 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. r[NITRI ADDL SUBRI POLICY EFF POUcYEXP LTRI TYPE OF INSURANCE POLICY NUMBER (MwDDIYYYY1 (MMI DIYYYY1 LIMITS 7XI A COMMERCIAL GENERAL LIABILITY Y TBD 8/0712021 8/07121]122 Y EACH OCCURRENCE $ 1j000,000 qLAIMS-MADE r_1 OCCUR -MELLIq9a En-- ED—, .. S 100,000 MED EXP(Any one parson) S 5 0-—OQ --- L PERSONAL&ADV INJURY 41 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0 JPEF'COT- F-1 LOC PRODUCTS',COMP/OP AGG IS OTHER: Is AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ed accidentl ANY AUTO BODILY INJURY(Per Parson) OWNED SCHEDULED BODILY INJURY(Pw;;;ZW)"S AUTOS ONLYAUTO$ HIRED NON-OWNED PRUPERTY DAMAGE AUTOS ONLY AUTOS ONLY — -LPqr swicent) P I 1 1 $ UMBRELLALIABpCGUR EACH OCCURRENCE S EXCESS LIAR AGGREGATE r DED I I RETENTION$ WORKERS COMPENSATION 368620.1 PEREW AND EMPLOYERS!LIABILITY YIN 6/22J20211 612=022 ER-- ANY PROPRIETORIPARTNEWEXECUTWE C1,EACH ACCIDENT i.S 1,000,000 B OFRCERIMEMSER EXCLUDED? IN(A N (Mandatory,In NH) ly I 'E,L,DISEASE-EA EMPLOYEES S If' descne6 under DES86RIPTION OF OPERATIONS below E.L.DISEASE 7L DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES(ACORD I(H,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE L HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 54375 NY-25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Southold,NY 11971 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1988-2015,ACORD CORPORATION. All viahts reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD NEW 'Workers, -CERTIFICATE OF INSURANCE COVERAGE Biiard DISABILITY AND PAID FAMILY LEAVE.BENEFITS LAW PART 2.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance.Agent of that Carrier Ia.Legal Name,&Address of Insured(use street address only), 1b.Business Telephone Number of Insured SWEENEY'S POOL SERVICE INC. 631-431-0498 1.740 CHURCH STREET HOLBROOK,NY 11741 11c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required lf coverage is specifically 11mite.d to [A Now York State,,i.e.,Wrap-Up Policy) 473890168 2.Name and Address of Entity Requesting Proof of,Coverage 3a.Name of Insurance Carrier (Entity BeIng'Llsted as the Certificate Holder) ShetterPoInt Life Insurance Compa6y 'TOWN'OF:SOL 54375 NY-25 3b.,Policy Number of-Entity Listed in Bax'is" SOUTHOLD, NY 11971 DBL470388 3c.Policy effective,period 08/.08/2020 to 08167/2022 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. B.Disatilility benefits only. C.Paid family leave benefits only, 5. Policy covers: X,All of the employees employees eligible Linder the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of pejury,I coft that I am an authorized representative or licensed agent of the insurance carrier referenced almve.and that the named Insured has NYS Disability and/or Paid Family Leave Benefits Insurance coverage as described above. Date Signed 8/3/2021 BY (Signature of Insurance carrier's authorized representative crNYS Licensed Insurance Agent of that l6surance canter) Tel6phdne Number 516-829-8100 . Name and tide RidhardWhite,-Chief ExedutiVe Officer IMPORTANT-.' If Boxes 4Aand5A are checked,and this-form is signed by the insurance carriers authorized representative:or NYS' Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mad It directly to the certificate holder. If Box 4B,AC of 513 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 Bok.6200,Binghamton,NY 13902-52010. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 56 of Part I has been checked) Stal:6 of Now York Workbrs` Compeftation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has compiled with the NYS Disability and Paid Family Leave Benefits Laws with respect to all of his/her employees. Date Signed By {Signature ofAulhorized.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,11cansed,insurance agents or those insurance, .carders are authodz6d to issue Fbfiri DB420.1.Insurance brokers are NOT authorized to issue this/.{tart. DB-120.1 (10.17) Ilfl� Ei� ti20� ���i«� ai'i� o�� ll HM ENGINEERING,P.C. P.O.BOX 914 , EAST NORTHPORT,NY 11731 TEL:516.476-5382 EMAIL:HMARNIKAQa OPTONLINE.NET July 11, 2021 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is tocertify,that the drainage facilities to be used exclusively for the construction of swimming l on'the premises of 'poo . Nlarreoh.Development Corp.. 620 Royalton Row Mattituck;N.Y: 11952 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 a%ackwash will be;piped,to,a.dry„well'located on,the,siibiect lot and,will not interfere with the public water, supply system, existing sanitary faeilities, adjoining property' owners,;public, highways or pri'v'ate roads. Sincerely, jHM� giicneern /Jiro.h � i1Tmaika, P.E. QQ TOP 39 98 LOT 9 TOE 38.80 SUBDIVISION MAP ESTATES AT ROYAL TON" FILED 22 FEB,2018 AS MAP NO. 12105 po �9�0 �� TOP 39.77-, �cs�o LOCATED AT MATTITUCK, TOE3a72 0ago TOWN OFSOUTHOLD, V 1 O + 'row Z� CO.OF SUFFOLK STATE OF N.Y. v i •. o O iP ry C 1� TOPAP 38.00V, SCALE: 1'=30' 01 NOTES L \ v eyGt� p1'� ,YpP oq O NOTES \\ h* 55a 38.66 NG �/ 9� `Rmo 69104 y SURVEYED:I7 SEPT 2020 MAP=DATA PER FM NO 12105 ,36.88 Acwbryyb,• 'ESTATESAT ROYALTON" S,♦ `39.99 TO ' i" p 1/ 13776 PAP ��y No.nro m, A3,�,oF ■ =CONC.MONUMENT TYPICAL 40 1 \. �i ♦=FOUND 2'X 2'HUB TYPICAL \ GUY WIRE 38.31 P 1 i m I T PAP 37: �-- / y0 NG 39.63 1 TOE OF STOCK PILE �CP/ 7.44' o =LAMP POST 0. 39.77 NO TOESP 39.74. -t / \\ e •rn 1 63899 \\ 1\i\ TOE PILE 38.66 •�\.�„^.\P 71" O C;L '®+ =UTILITY POLE \TO `{ ®=WATER METER -mlF A 40.13 TOESP ` o=WATER SHUT OFF VALVE ° h \ 3 =WOODEN FENCE AC.-ASPHALT \ '9a �a y \' TOE E3&16 37.7T TOP AP.ANGLE PONT O COL:COLUMN ^� si •��' G 38.48 T 93$ SODLDRAINAGEINLE EPEDGEOFPAVNO FH:FIREHYDRANT O \c-' l W. LS:LGHTSTANDARD '40.291.\ vOX0 MAS:MASONRY SG( 6 MOC:MIDDLE OF CURVE OH:OVERHEAD LINES POB:POINT OF BEGINNING 1 u db 35� \ i o•o `c'O �� PRC:POINT OFREVERSE CURVE ,P. CD SDMH:STORM DRAIN MAN HOLE m"Irl X40 ` I 1 \3774 SP:STOCK PILE P OpE ) TOE PILE SRF:SPLIT RAIL fENCE pEM" NG 1.03 `- UP:UTILITYPOLE ` BUILpIN WHF:WOOD HORSE FENCE \ Q < , OIFAL 40.40 TOE PILE WM:WATER METER 1 Y 4pIN �.• •\ WSR_WOOD SLAT FENCE WS V.•WA TER SHUT OFF VALVE f/ NG 42.24 $Z Z$ 1 c 1.� O •V) tat THE STRUCTS CSAR ENSIGNS SHOWN NER SEAN E. PR EFOM U ES TO g MAP�$$ $68 �C TIC 1g. NO SMElUiDND�7OSMONUMExr 1HE PROPCR ss oaulo n+scnoN y R�100•p0 SGt(1iLpt / OF FENCES,ADDUTONAL STRUCTURES OR ANY OTHER IMPROVEMENT. UNAUTNORfiFD ALTERAPONs ORAODMONS TO 7741S SURVEVISA WOIATKNI OF / \ g.tALdND.ft/A4v�yJAYg JAVL� SECnMN SUBOMSON nOF7TENEW VORKSTATEEWGTM AW.COPIES ' \ OF TMS SURVEY MAP NOT BEARING THE l SURVEYORS/NT D SEAT.OR / / PETER A.GROBEN FMSD.SSED SEALSHALLNOTBECONSIDE TO BEA VALID TRUECOPY. yp,11 CERT/FlGn ERNMENTAGANDE ONS INOKATEO HEREON SHALL RUN ONLY TD THE PERSON FOR V/f 1GM A 4179 ,42.82 NG A2 / \ LAND SURVEYOR NY LIC.50869 IS D,D ONN WERRSOOsr 0TW Dpi+.COWACEFmAciN'GOV- •• •�• 00.00 / �''�19 g7 \ Y P.O.BOX 704 RIDGE,NY 11961 ARENOT TRANSFHtA mAWMON MnWlro ORSUMEMEWOWNER& v� R' // / y 0'1 /'� , Y 631.849.4750 SNUOSSREURRFFACFAERERAEAiSSe MS SUU SUNOFACE UUTMRIR SANNOR A p / / S06 1 STRUCNRES W OR OUTOFEASEMFNTS IF SO PROVIDED. SCTM 1000-113-07-19.38 I , CAST.IRON'FRAME A..COVER , IF UNDER PAVED AREA. FINISHED GRADE 8'..MIN. W,MAX. . . I' BRICK LEVELING,COURSE � MIN CONCRETE COVER '1. UNSUITABLE MATERIAL ,SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST:CONC,'COLLAR M 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 .F;LAT SLAB CAN BE REINF. CONC. SUBSTITUTED WITH 'APPROVAL OF THE ENGINEER. 'DOME 4'se.PVC; 3. LOCATION;OF DRAINAGE.POOL'TO BE ,DETERMINED BY OTHERS. MDV. SLOPE ' PER FQDT,' INVER ,® ® ®ED 4. ALL DRAINAGE ,PIPES 'MUST ''BE PROVIDEO.'WITH'A MINIMUM 2'-6" COVER. t I,M3910 5. COLLAR..'IS`NOT 'REQUIRED 'WHEN RATEABLE MATERIAL,EXISTS 'FOR NON_SHRINK' '�0 'GROUT ®a FULL DEPTH: 3' 'MIN. SAND a 6. THE MATERIAL USED •FOR' COLLARING SHALL';BE COMPRISED OF 'SAND AND GRAVEL �', AND. ,GRA'VEL: CONTAINING LESS THAN FIFTEEN.`'{15) PERCENT FINE SAND, COLLAR ,(TYP) o I�i SILT 'AND CLAY. SILT'AND'CLAY FRACTIONS ARE NOT TO'EXCEED (5) ALL AROUND vs PERCENT:' lil y . PRECAST. CONC�LEACHING RINGS 1, �r e' DIAMETER BACKWASH ,FROWN POOL 70 GPM. ®'5 MIN. 350 .GAL. (47 CF) i' = DRYWELL:;CAPACITY 1,263 GAL. (168:8'"CF) III �;a.'. ..:, .•��� ..�•., ::.•. •0..,�• ..•�.• ..'�.• , `,,; W.,MIN,;PENETRATION INTO',VIRGIN STRATA GROUND''WATER,; 'OF• SAND..Il;,GRAVEL " ". DRAINA'GE�';POOL`DETAIL AUG 1 2 2021 PREPAREDFOR: ' TDEPT. MARRCON'DEVELOPMENT CORP. TOWN OF 5017 HOLD 120.,ROYALT0 rROW.` M ITUCK,'N' . 1195 EAE - . :'07/11/2021 HM ENGINEERING, P.C. SCALE:'. NOT TO SCALE , THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.UNAUTHORIZED P:O.BOX 914,EAST NORTHPORT,NY 11731 1'OF;1ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORK STATETel:(516)476-5392 Fax:(631)980-7679 Email:hmamika optonline.net EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. I YMLL DETAIL V ID W UT RAISED SEAL AND BLUE.SIGNATURE r , APPROVED AS NOTED OCCUPANCY OR USE IS UNLAWFUL ,ATE: �� -- B.P.� � a WITHOUT CERTIFICATE -c_ �--�'BY: ' 'I FY BUILDING .DEPARTMENT AT OCCUPANCY :5-1802 8AM TO 4'PM FOR THE -;._OWINGINSPECTIONS: FOUNDATION: --TWO REQUIRED =OR POURED CONCRETE ROUGH - FRAMING & PLUMBING 3. INSULATION i FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. CC)SPL`( WITH ALL CODES OF 1LL CONSTRUCTION SHALL MEET THE NEW YORK STATE & TO"i.,"N CODES -gEQUIREMENTS OF THE CODES OF NEW AS REOUIR D AND CONDITIONS OF YORK STATE. NOT RESPONSIBLE FOR :'SIGN OR CONSTRUCTION ERRORS. SOUTHOLD TOV,, Z3A SOUTHOLD TOVA PLANNING BOARD SOUTHOLD TC',dM TRUSTEES N.Y.S.DEC UAp�p'com : „ RETAIN STORM WATER RUNOFF � R�._w, ;`�.• PURSUANT TO CHAPTER 236 OF THE TOWN CODE. mow,VCWWMN PI:QUuw fov mph vs-�- "bz V POOL NOTES: 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION TRACK FOR AND BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC PUMP VINYL LINER CODE. FILTER 2.POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1. SKIMMER VINYL LINER 3.SECTION R326.7 POOL ALARM REQUIRED. (NP•) 10" 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4. FOAM PADDING 3,000 PSI 5.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE a CONCRETE OF NYS SECTION R403.10: POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). v SECTION R403.10.1 HEATERS SECTION R403.10.2 TIME SWITCHES SECTION R403.10.3 COVERS I I PROPOSED VINYL #4 REBAR TOP ° 6.REBAR SHALL BE 3"MIN.CLEAR TO EARTH. RETURN I I SWIMMING POOL & BOTTOM r < 1 42n 42" 7.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS AND SHALL COMPLY WITH ALL LOCALZONING REQUIREMENTS. 3' 648 S.F. 18' ° a 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME MIN.)I I I v BAKER(VGB)POOL AND SPA SAFETY ACT. DUAL MAIN DRAINS WITH 9.SLOPE PATIO SURFACE 1/4"PER FOOT AWAY FROM POOL. STRAINER (VGB SAFETY <'4 10.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR — — ACT APPROVED DRAINS) LARGE ROCKS). I STEPS11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH o` ANSI/APSP/ICC 7. ° 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. 13.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF 36' POOL. 1-8 r 14.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 620 ROYALTON ROW TYPICAL WALL DETAIL MATTITUCK,N.Y.11952 ONLY. 15.NO DIVING EQUIPMENT PERMITTED. SCALE: 3/4" = 1'-0" 16.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A POOL PLAN MINIMUM LAP OF 30 BAR DIAMETERS. NOTE: 17.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL THIS ISA NON-DIVING POOL NOT TO SCALE NOTES: LOADS WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION EQUIPMENT OR 1.WALLS SHALL BEAR ON UNDISTURBED SOIL ANY OTHER LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING 2.ALL CONCRETE SHALL BE PLACED AS A MONOLITHIC POUR. OR PROPOSED ADJACENT STRUCTURES.IF SITE CONDITIONS DIFFER FROM THIS PLAN,IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO CONTACT HM ENGINEERING,P.C. BEFORE ANY CONSTRUCTION BEGINS. 18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION MEANS,METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR, 6' 3'-4" CONCRETE WALL NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE (SEE SECTION FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH 3 — THIS SHEET) THIS PLAN. 1 ® I ' UNDISTURBED 1 1/2" TO WASTE EARTH (TYP.) D HAIR & LINT STRAINER 3' 6' 8' 19' PUMP 3" COMPACTED SAND A U G 1 2 2021 FILTER AUTO SKIMMER POOL PROFILE � ��'D�G DE�' NOT TO SCALE TOWN Off';SO MHO�,A POOL BACK TO POOL GENERAL NOTE: ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. PREPARED FOR: 2 MAIN DRAINS MARRCON DEVELOPMENT CORP. SCHEMATIC PIPING ARRANGEMENT 620 ROYALTON ROW NOT TO SCALE MA (TUCK, N.Y 11952 111/202 HM ENGINEERING, P.C. fSHEET: 07SHOW1 THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. AS SHOWN UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE 400 ! Z� P.O.BOX 914 EAST NORTHPORT,NY 11731 1 OF 1 NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.netENTIAL CONCRETE V ID WIT UT RAISED SEAL AND BLUE SIGNATURE LINER POOL PLAN