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HomeMy WebLinkAbout47446-Z #��OSUFFOLkcpGy Town of Southold 9/15/2022 P.O.Box 1179 C:1 W z 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43409 Date: 9/15/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 135 Dogwood Lane Ext.,East Marion SCTM#: 473889 Sec/Block/Lot: 37.4-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/13/2022 pursuant to which Building Permit No. 47446 dated 2/11/2022 was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in-ground swimming pool fenced to code as applied for. The certificate is issued to Matzen,Lawrence of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47446 - 8/29/2022 PLUMBERS CERTIFICATION DATED u ori Signature TOWN OF SOUTHOLD �o�SUFF01��0 Gym BUILDING DEPARTMENT y z 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#: 47446 Date: 2/11/2022 Permission is hereby granted to: Matzen, Lawrence 601 Gulf Dr N #105A Bradenton Beach, FL 34217 To: Construct in-ground swimming pool at existing single family dwelling as applied for. Pool equipment to be located in the rear yard, minimum 3 feet from property lines. *Building permit is required for accessory shed prior to issuance of pool C.O.* At premises located at: 135 Dogwood Lane Ext., East Marion SCTM #473889 Sec/Block/Lot# 37.-1-10 Pursuant to application dated 1/13/2022 and approved by the Building Inspector. To expire on 8/13/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector 0�*0 SOUjyol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 Q sean.deviin(M-town.southold.ny.us Southold,NY 11971-0959 Q COW ,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Lawrence Matzen Address: 135 Dogwood Lane Ext city:East Marion st: NY zip: 11939 Building Permit#: 47446 Section: 37 Block: 1 Lot: 10 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: AS BUILT License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor - X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: 1 Light 120GFI, Pump 220GFI Notes: " AS BUILT NO VISUAL DEFECTS " POOL Inspector Signature: - r Date: August 29, 2022 S.Devlin-Cert Electrical Compliance Form OF SOyOlo TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND NSULATJPWCAULKING [ ] FRAMING /STRAPPING [ FINAL otll-� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL R ARKS: a 9p26z aAi Z S Kv f--7v cz DATE ')/ INSPECTOR FIELD:IlvsPECTIN,REY''ORT•. AfiE Cb:N[1VIENS . FOUNDAT`IO1V:.(1ST); H C" FOUNDATION .2ND. ' (., )' til. iF - V V ... ~•`t"�rf'1::•`';''11'"'t'fi:i`:..iLlf,Ci;.".i'''�ga`ir.:,� - H L1 RQUGH. RAF' •&� .IylINC'� PLUM. '....... .' - • , "may` •;ri- V vii;':;••,:�i O _ '.i=_-';f;-Fri:%•`�;:�'•`, Y INSUT,ATIQN.pl., R.N;:' STATE ENERGY•COD�� . . RIP FINAL ,.,. y�^yam/ - vl�/.•/,.,,,��s,._.�'.�,~,�,',,��'i.Yl�:�:..'."�� 4.1 V.•••. _(/]f�,tier;�-;.`+:•:.••.�•` .. - , 011%(7 d r4. b + .-y oz's° o�2 TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 o Telephone(631) 765-1802 Fax(631) 765-9502 httos://www.southoldtomm.jzov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ® C 11� PERMIT NO. Building Inspector: JAN 13 2022 _ BUILDiNG DEPT. Applications and forms must be°filled out in aheif-entirety.Incomplete:;;' TOWN OF SOUTHOLD applirrations will not be accepted. Where.the,Applicant is not'the;owner;an Owner's Authorization,form(Page 2)shall be completed x Date:12/3/2021 s PE TY:. ;OWN ER S OF PRO R Name:Jennifer and Anthony Fernandes SUM#1000-Section:37 Block-1 Lot(S):10 Project Address:135_Dogwood Lane Extension, -East Marion, N.Y. 11939 Phone#:516 967 5702 Email:'Jspoons hotmail.com Mailing Address:81 Sandy Hollow road,- Port Washington, N.Y. 11030 CONTACT PERSON:; Name:William Spooner,Jr Mailing Address:P.O. Box 51, Mattituck, N.Y. 11952 Phone#:516_658 5302 Emai[:WSpoonerirE@icioud.com DESIGN'PROFESSION'AL INFORMATION: Name:Dilandroandrews Engineering PLLC Mailing Address:158 County Road 39, Southampton, N.Y. 11968 Phone#:631 259 3959Ercall:megan@dilandroandrewscom _ ''CONTRACTOR INFORMATION Name:Cavatini Builders Mailing Address:P.O..Box 51, Mattituck N.Y. 11952_ Phone#:516 658 5302 Email.wspoo.' _ @icloud.com D NS TRUCT O N DESCRIPTION OF PROPOSE CO S ❑New Structure EIA ddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: P(0ther.s4)//;1 41 IANC 001 $--'R C" 6.00 Will the lot be re-graded? ❑Yes%Vo Will excess fill be removed from premises? Ves ❑No 1 4 r' .PROPERTY 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? ❑Yes ❑No IF YES, PROVIDE A COPY. 0'Check"Box Aft r"Reading: The owner/contractor/design.professio nal 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 buildings)for necessary inspections:False statements made he are' punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law: 'Id Application Submitted By(print name): �ll�l�s�°�7 S�C>�NAuthorized Agent ❑Owner Signature of Applicant: Date: / I�`�C?Z Z STATE OF NEW YORK) SS: CO\U,NITY OF SL ) VVI 1 (�(ti') being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (Contract ,Agent, rporate Officer,etc.) -- of said owner or owners, and is duly authorized to 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 lb—dayof DZW LI a rl.( --, 20 I C I (Jqotary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEIN YORK NO.01 DW6306900 PROPERTY OWNER AUTHORIZATION QUALIFIED IN SUFFOLK COUNTY (Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,2-e2,dL, residing at 91,4���� ��// ✓ " � �!/l�l'/U�" -0 do hereby authorize .4-lv /1e4 to apply on mybehalflo a Town of Southold Building Department for approval as described herein. 01A n 's Signature Date o0ul 6e-S Print Owner's Name 2 - �Ea 1 1 2022 Bt11LDING OBPT SUfFO� NOF SOUTHOLD BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD o Town Hall Annex- 54375 Main Road - PO Box 1179 Me o - Southold, New York 11971-0959 y7j O� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(-Dsoutholdtownny.gov - seande-southoldtownny.gov , APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: baa,, Company Name: (�6 br) �72,!Fc x Electrician's Name:Aoam A izy License No.:J 14i a 1a: Elec. email: p1111,4A11,2oo_,- a ,QoL; cd N4 Elec. Phone No: y a55 7� 55 ❑I request an email copy of Certificate of Compliance Elec. Address.:,;?oR 5aR4,A)/ ,po , -ouT' JOB SITE INFORMATION (All Information Required) Name: VEi✓Ai/1!�61? Address: lis Cross Street:a6 O ,Q Phone No.: -514 SSB 53,617- Bldg.Permit 61zBldg.Permit#: email:)sPooIV61e v Co' Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): I Ltwo Square Footage: Circle 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# EJ New Service[]Fire Reconnect[]Flood Reconnect[-]Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 D H Frame 0 Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION .Z l00 J�I�� ..... FpBUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD C= �\�l own-Hall Annex - 54375 Main Road - PO Box 1179 "* Southold, New York 11971-0959 T. 'e � one (631) 765-1802 - FAX (631) 765-9502 ,rogerr6Wt1tholdtownny.aov — seand(aDsoutholdtownny.aov NG DEPT APR6W_R0'X*R ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 4 /'. Company Name: /,(Jf��1i,/�'�1/�l'tJd►/ �L��T�jz Electrician's Name: License No.: , / !'p er Elec. email: 114w wl 2-b6 S lgez , Q l Elec. Phone No: , 7,9T5 ❑I request an email copy of Certificate of Compliance Elec. Address.: R f6RV , r, IC),b 4MyM 10 < JOB SITE INFORMATION (All I formation Required) Name: ` "��� i /�'��'/,�':✓ Address: moo G J� c� l S!�i9k1e,aJ/" � Cross Street: Phone No.: BIdg.Permit#: — email: S,A 00-W) Tax Map District: 1000 Section: Block: / Lot: Za BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 2-- Square Footage:., Circle All That Apply: Is job ready for inspection?: YES NO ®Rough In 13 Final Do you need a Temp Certificate?: ❑ YES NO Issued On Temp Information: (All information required) Service Size F-11 PhF-]3 Ph Size: A # Meters Old Meter# ❑New Service[]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals M 1 2 H Frame Pole Work done on Service? Y FIN Additional Information: PAYMENT DUE WITH APPLICATION O��SUFFU(KC BUILDING DEPARTMENT- Electrical Inspector. a� �dy1 TOWN OF SOUTHOLD o Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 ti O� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(o.southoldtownny.gov — sea nd(aD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: = Company Name: Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑I request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) t Name:- Address: Cross Street: Phone No.: Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle 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 F11 PhF-]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect[]underground[-]Overhead # Underground Laterals D 1 2 H Frame Pole Work done on Service? Y MN Additional Information: PAYMENT DUE WITH APPLICATION rc ► � S.C.T.M. NO. DISTRICT: 1000 SECTION: 37 BLOCK: 1 LOT(S): 10 P O LOT 83 FC 2.O'E (p• PIPE ti<30.7'W r,,� PO LOT 83 0. 1 'spi PORTION TO BE REMO'/ED ���G� PROPOSED 00.7p �W �.P POOL WASTE WATER DRY WELL PIPE REVISE V S9 6 SHED 0.7 N 4'Ox4'DEEP 0 3 W LOT 84 r _ U'` (8x12 ) ROOF OVERd' _= Q� Q���L- PIPE > ® OUTDOOR5� 0, ____= FC _ 0. 1 'S 6X0 N9ER � _ 6l •� 0.3'W EXISTING ROOF OVER _ WOOD DECK TO BE REMOVED B1LC0 rO PORTION OF EXISITNG DECK T BE REMOVED LP GAS O o' y PROPOSED OPEN �ro� PERGOLA STYLE ROOF c;• .o, � O GUY L.P. 0� L.LP. 1 � TK. PROPOSED L I ADDITION 1 .4'S ® LOT COVERAGE ® ���o� /• ,� 0� EXISTING GRAVEL DRIVEWAY 20% MAX COVERAGE: 1545 S.F. TO BE REMOVED STK. DWELLING: 871 S.F. PROPOSED ADDITION: 59 S.F. 1 .o'S PROPOSED REVISED FRONT DECK: 216 S.F. PIPE C§) DRIVEWAY PROPOSED POOL: 288 S.F. 0 SHED: 96 S.F. OUTDOOR SHOWER: N/A ON GRADE CONC. PATIO: N/A z TOTAL: 1530 S.F. or 19.8% REVISED 02-08-22 ADD COVERAGE 02-03-22 REVISED 12-06-21 ADD PROPOSED POOL 11- 12-21 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 7723 SQ. FT. or D. 18 ACRES ELEVATION DATUM: UNAUTHORIZED AL TERA TION OR ADDI TION TO THIS SURVEY IS A VIOLA TION OF SECTION 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 INS TI TU TION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRbCTURES 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 S TRUC TURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND SUBSURFACE STRUO-TURES RECORDED OR UNRECORDED ARE NOT GUARANTEED JNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 97 CERTIFIED T0: ANTHONY FERNANDES; 0 F N E��� MAP oF: GARDINERS BAY ESTATES SEC. 2 A\ M We O JENNIFER FERNANDES; FILED: SEPT. 23, 1927 No. 275 �� �?� CITIZENS BANK, N.A., ISAOA—ATIMA; SITUATED AT: EAST MARION Y FIRST METROPOLITAN ABSTRACT CORP; '— OLD REPUBLIC TITLE INSURANCE COMPANY; TOWN OF: SOUTHOLD KENNETH M W OYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK 1s 050882 Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE # 221 - 160 SCALE: 1 "=20' DATE: AUG. 19$ 2021 PHONE (631)298-1588 FAX (631) 298-1588 N. YS. LISC. NO. 950882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysitcom CERTIFICATE OF WORKERS' COMPENSATION INSURANCE W � ""^^^^ 342025241 ENZO CAVATINI ENTERPRISES, LLC DBA CAVATINI BUILDERS M POBOX 51 MATTITUCK NY 11952 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER 135 DOGWOOD LANE EXT ENZO CAVATINI ENTERPRISES, LLC TOWN OF SOUTHOLD BUILDING DEPT DBA CAVATINI BUILDERS TOWN HALL ANNEX BUILDING P O BOX 51 54375 ROUTE 25, P.O. BOX 1179 MATTITUCK NY 11952 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12474387-4 224846 05/25/2021 TO 05/25/2022 12/7/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2474 387-4, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. BY CAUSING THIS CERTIFICATE TO BE ISSUED TO THE CERTIFICATE HOLDER, THE POLICYHOLDER UNDERTAKES TO PROVIDE THE CERTIFICATE HOLDER 30 CALENDAR DAYS' NOTICE OF ANY CANCELLATION OF THE POLICY. NEW YORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 574052156 U-26.3 GS903226 ARe, 044/19/19CERTIFICATE OF LIABILITY INSURANCE DATE /DD/20022 1 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 NAME- Kim Swann W.N. Tuscano Agency Inc. AVC,o E.): 631-477-1680 _FAX No 31-477-8930 PO Box 1027, 950 Highland Ave. ADDRESS: kim mcmann rice.com GREENSBURG PA 15601 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA.Underwriter's at Lloyds 1123000 INSURED INSURER B: Enzo Cavatini Enterprises LLC dba INSURER C: Cavatini Builders 360 Sebastion Code Road INSURER D: MATTITUCK NY 11952 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICYNUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ M'MAGE TO CLAIMS-MADE FIOCCUR PREMISES(Ea occuirence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY F__]PRO- ❑LOC JECT PRODUCTS-COMPIOPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ . -$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ERH ANYPROPRIETORIPARTNERIEXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Ifyes;describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability ANE479065121 04/16/202 04/16/202 1,000,000 Per Claim 1,000,000 Aggrega e DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Architects, Engineers, and Construction Managers Professional Liability Coverage CERTIFICATE HOLDER CANCELLATION 1. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 1179 AUTHORIZED REPRESENTA Southold,NY 11971 /Ori(����� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD SIZE : SHAPE : HAND : DWG# 12 ' x 24 ' RECTANGLE N/A - 0 0 t2 APPROVED :POOLAREA : V L . 10530. DArE . 29/ 11 / 201 26v76 m2EITE21 . 95 POOL AREA . . DRAWN B L r LINER AREA : � PROFILE : STANDARD I " / I N UIN Lj �,j DECK 1P�sNOF BOLTS : 1 Pcs nI L IN I\J 5 ARE IN E10. ...... ....... ..... . .... . .... . .. . ..... .. ..... USE OF DIVING EQUIPMENT IS PROHIBITED ALL DOES NOT MEETS DEPTH AND SHAPE MINIMUM STANDARD ANSI/NSP15-2003 S g 31-4114' $�� Skimmer _ aGGu�A�!cY �. Retu rn AWHY A " �� "�1 L )0� sNor D USE IS U��1L-AvJ 0a oO�G ,qTF. a.P WITHOUT GCR i Ir IGATE 0c CO —Z--2y& c OCCUPANCY j�(' ',TIFY BUILDING DFoA 21 1 i '802 SAM TO 4r*" r'�THET 2 :r-OWING INSPECTIom '70UNDATION - TWO ,,., IRIED R POURED CONCP! 4' I 1 1 1 717 GH - FRAMING & ' L,,MRIING '.>�.1LATION ^+4� CONSTRUCTION MUST C� f'L`P W1 1-t r,f..L CODS 3 " MPLETE FOR C.O. fJF1N YORK STATE & To ��nJSTRUCTION SHALL MEET THE AS REQU�R D AND Cp(1►p TI WN CO )US EQUIREMENTS OFTHE CODES OF NEW f 1K STATE. NOT RESPONSIE =OR ..,,SOUTHOLDTOV'IIVA I "d" _SIGN OR CONSTRUCTION ERRURS. SOUTHOLC'TO1*11FL4N-7WGE )AR SOUTHOLD Toy- 8 V.Y,S.DEC � E'VCLOSE�I L�O �..DtE 121 41 I - 8 Light UPON COMPLETit; , � BEFORE "WATEF S nn ern"' nr +,r r ('ETI;.i��l �TO�r6'�:I �~�f-,I�:R Pj�rvt�f-F r .7r.':eu.a,a�?: F!JnSLJ,WT TO CHAPTER 236 t!a�._ ,rReid OF THE TOINI� CODE. 41 I 1 1 1 1 I 2 ' 2 ' p°� 900 81 81 8 1 0-cl Return f 24' 4 rQES � RI � TIONQTY .�,r 1 10 7 1 2 ' STR 4 — 900 S ' STR 4 �' ° CORNER �_ 11 Water31-411 3 4 POOL WALL ° BRACE S ' STIR 13 1 S STR RTN 2 8� 0 6" PVC r S ' STR S K1 4 .811 INSERT 900 O/C 4 : r• I .. [j 4 INSERTS REQUIRED A- FRAMES � 'jie'14`Pr t.n STID HARDWARE 1 KIT X 24S42H8 SIZE : 1 i 2. 1 X 2 ^Y ' SHAPE . RECTANGLE """ D : NSA DWG# � � � � 0 0- PERIMETER : 72 ' POOL AREA : 288 . 00 ftz VOL . : 10530 gal . us DATE : 29/ 11 / 2012 APPROVED : PERIMETER : 21 . 95m POOL AREA : 26 . 76 mz VOL . : 39870 liters DRAWN BY : ALG 0 i 04 U T ZD� TAKL QM � 11 ' Lt�` � 28' zo 8 Skimmer $ 81 Return coo c� 2 ' 2 ' 1Qj 8 ' Light $ 1 26' 1p„ 2 ' 2 ' 81 81 81 1 ,P0.0--c' Return KIT REF # PPRECTANGLE6R12X24S42H8 SIZE : SHAPE : HAND : DWG# 12 ' x 2 4 ' RECTANGLE N/A F" F:11 3 — 0 0 1L PERIMETER : 72 ' POOL AREA : 288 . 00 ftz VOL . : 10530 galus DATE : 29/ 11/ 2012 APPROVED : PERIMETER : 21 . 95m POOL AREAE. 26 . 76 mz VOL . : 39870 liters DRAWN BY : ALG �n ` 1 WT 81 DESCRIPTION QTY Skimmer $ ' 8 ' STIR - 1 8 ' Return 2STIR - 2 31 3 ' STIR + 2 6 FT G"N E N + 1 A- FRAM ES + 2 cn M v 3 ' 8 ' 81 $ 1 Return � 2 81 DESCRIPTION QTY Skimmer $ 1 g ' Return 8 ' ST�R - 1 1 r-� 7— 8 FT GEN + 1 21 co cnM 2 ' 81 81 81 Return KIT REF # PPRECTANGLE6R12X24S42H8