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HomeMy WebLinkAbout47806-Z o g'FFU( 019,t� Town of Southold 10/26/2022 a y� P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43535 Date: 10/26/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3663 Rocky Point Rd.,East Marion SCTM#: 473889 Sec/Block/Lot: 21.-6-3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/12/2022 pursuant to which Building Permit No. 47806' dated 5/11/2022 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 around vinyl swimming pool fenced to code as applied for. The certificate is,issued to Keenan,Brian&Jenna of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47806 8/9/2022 PLUMBERS CERTIFICATION DATED Au hoiz d Signature ��ooSOFEoa c TOWN OF SOUTHOLD BUILDING DEPARTMENT cz x ' TOWN CLERK'S OFFICE '°y • NSOUTHOLD, NY 10 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#: 47806 Date: 5/11/2022 Permission is hereby granted to: Keenan, Brian 3663 Rocky Point Rd East Marion, NY 11939 To: Construct inround vinyl swimming g y g pool at existing single family dwelling as applied for. Minimum 15 foot setback as required from property lines to pool and / or pool equipment. At premises located at: 3663 Rocky Point Rd., East Marion SCTM #473889 Sec/Block/Lot# 21.-6-3 Pursuant to application dated 4/12/2022 and approved by the Building Inspector. To expire on 11/10/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector pF SO!/T�QI Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.deviin(d-)town.southold.ny.us Southold,NY 11971-0959 �QlyCOU BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Brian Keenan Address: 3663 Rocky Point Rd city,East Marion st: NY zip: 11939 Building Permit#: 47806 Section: 21 Block: 6 Lot: 3 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Island Power Electric License No: 52729ME 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 X A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 4'LED Exit Fixtures Pump 1 Other Equipment: Sub 12 Circuits 7 Used, 2 Lights 120GFI, Heater 220GFI, Pump 220GFI, Salt Generator Notes: Pool Inspector Signature: Date: August 9, 2022 S.Devlin-Cert Electrical Compliance Form OF SOpr�,O� �..�-7 to - # # TOWN OF SOUTHOLD BUILDING DE T. °ycouto, 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: DATE INSPECTOR (f� ho�10F SOUTy�Io ✓LI # TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I ULAT ON/CAULKING [ ] FRAMING /STRAPPING [ FINAL P� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 1/ on DATE0 INSPECTOR (� OE SOUIyo� q-7 # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm, 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINAL fa� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] -CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: I 1� ham h DATE INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) -------------------------------------- FOUNDATION -----------------------------------FOUNDATION(2ND) 1 c-#j � W-- 1 ROUGH FRAMING& T* / A� PLUMBING 0 INSULATION PER N.Y. � H STATE ENERGY CODE I FINAL — b Q ADDITIONAL COMMENTS Pb 13 2 .- .,d. S/13 2 � ` too n z 0 a� A° o � y tC t� b y TOWN OF SOUT HOLD-BUILDING DEPARTMENT , . Town Fall Annex 54375 l [airi Road P. 0. Box 1179 Southold;NY.11971-0959 Telephone (631) 765=1802 Fax.(631) 765-9502 hiWs://www.soiitholdtoW.ngy,.gov Date Received APPLICATION FOR BUILDING PERMIT ' For Office Use Only w E PERMIT NO. / Building Inspector: APR 2 2097 t ti�e'fill.ed"ouf in tfieire'ntire� ;"In.complete,��;�=�=- BUILDING DEPT. P;pplicatiS`is TOWN OF SOUTHOLD F�a' licatiins inrill not beaccepte'd.`.lA/Fiere_'fFie Applieant'is:not'the�oenrner;an._;�°.,; , =,'Oeerrier's Authorization fo�rri(Page 2p shall be corinpleted: "' Y -off;. ; Date: -I-22 - E �TY: �•�... FPR - Off' N - 1A1 Name: SCTM#•1000- -- (�eaa n 1�� �4 n Project Address::3�0 Phone-#: Email: . q n-Q23 7b�fS. . Mailing Address: .�__,- - - - _ -- rpt..•:TM.F'• -_-a..4.,._ - -- - - .ytta- - ,r - ^5=-_.- _ _ - :YT; ;g; .,a =P�ERSO 4 �; .r�_, ,-s+, '•:.'.4,4:5:~cc`y�.' _"Y.-:-- __ - .. . ". - Mailing Address: QQ O+ 2_74 O L � Pau Q. ��10 Phone b3}-��y-7l�S.. Email: . CS 1ee @- �aL5 '_S:: - u.W:.E::•�l�-:'6''s, rh Yi _- �rTl N'• _ ,.NFO •�w.. `NAL'�I - SIO �R"FES ai Name. �t1Q ' MailingAddress: Phone#: Email: i - - __ __ - .�Y=. .ri'_s..' - .�,_ti _ - _ ,K..•z ter. ,.[;^. - _'"`!r': - t :. .. •tY �� `x - it• - - - K, FORMA Name: ` hJlc.: Z�DYJflS �J Mailing Address: Q.ZQ/ . z�� h'�� -Zt- Plae� Phone#: &3l- ���f- ���� Email: :t- .Y. - .I,.:.�. �,t_ DUCT 0 �,�- -'w.• //''!! eeT. -'L90"N:7 ❑New.Structure ❑Addition❑Alteration ❑Repair ❑Demolition Estimated.CostOf:Project- 5 the cwt ii'L c- m rJ < $ 3d,GW Will,the lot be re-graded? C Yes ❑No pe -�Q C�y Will'excess fill be'removed from.premises? :XYes ❑No . 1 F ERTY-INF.ORI IATION r; PROP , - - - • Existing use of property: � t�2�� Intended use.of property: ; Zone or use district in which premises is situated: Are there any covenants,and restrictions.with respect to this property?. OYes [Xlo IF YES, PROVIDE A COPY. `0.6hf:clC 86 -After'RE-dt11 Tfie ovuner%ontractor/design professional is responsiblerfor all drainage and storm waterJssues ai�proviiled g,.. Chapter•236 of the Town Code..:APPII('JITION IS HEREBY MADE to the Bwlding Department for_6e issuance of-a Building Permit pursuant to•therBuitding Zone yOrdinance'of'the Town,of Southold,Suffolk„County,New York.and,othec appficabli'Laws,Ordinances or Regulations,for.the construction of buildings;. -.,,. additions,alterations or for removal or demolition as herein described.The applicant agre®s,to comply with alGapplicatile laws,ordinance's,building code, ?housing code and,regulalionsand to ad'mk authorized iri;pecit ',on premises-and'in building(s)•for necessary inspections.,Ealse�statements:made herein are y} punishable as a Class A misdemeanor pursuant,to Section 210.45 of the Idgw,'_York State Penal Law:', n Y p Y(p ) 1jp,'Ian Keen C1� Authorized Agent . 0Wner A plication Submitted (print narne Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OFLbG ) _E`(k Q_ '1 being duly sworn;.deposes and says that(s)he is the applicant -(Name of individual signing contract)-above named; (S)he is the (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 andfile 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 _jLday of 202 iUc .e�Qr - CZ Notary Public MARGARE•r A. KIDNEY Notary Public_State of New York No. 01 K16021111 Qualified-in Suffolk County, PROPERTY OWNER AUTHORIZATION My Commission Expires March S,2093 (Where the applicant isnot the owner) 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 https//ny-southold2.civicplus.com[Docur6entCenter/View[7852/Electrical-Inspection-Form-Fillable-PDF?bidld= t��Ffld� L BUILDING®EPARTPJIEFIT-Electrical InspMor 4r;," TOWN OF SOUTHOLD to Town Hall Annex-54375 Main Road-PO Box 1179 r . Southold, New York 11971-0959 `...� �'� Telephone (631)765-1802-FAX(631)765-9502 roerrcRsoutholdtownrty.aov se.and5southoldtownn+r.aov. APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All lnfwmet-con Required) Date: 6/5 22 Company Name: ksland 2QwcrC �D Electrician's Name: JQhn kromcr L-leense No.: M E- 5 2-'7 Z 9 Bec.email: 1.3 ouJerclen . .G aina Elec. Phone No: p3 C I request an email copy of Certificate of Cam lance Elec.Address.: P0 ()X - -3 JOB SITE INFORMATION (All Information Required) Name: " � e n Qn Address: 3 (0 3 CLIV 80int knad < Cross Street: Phone No.: 6 31-3R3 -222 4 Bldg.Permit#: -4700& email:bgr,cnam aul 9#?C71/L� Tax Map District: 1000 Section: 61 Black: 40 Lot: 3 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE(Please Print Clearly): iY-9yourld v1ny1 JVVIAMMY Poo/ Square Footage: I t9 d Circle All That Apply: Is job ready for inspection?: 0 YES❑NO 7 Rough In Final Do you need a Temp Certificate?: 0 YES L]NO Issued On Temp Information: (All information required) Service Size 01 Ph L]3 Ph Size: A #Meters Old Meter# []New SetviceDFire Reconnect[]Flood Reconnect0-service Reconnect OUnderground Obverhead Underground Laterals 1 2 H Frame 0 Pale Work done on Service? LJY N Additional Information: PAP YMENT DUE WITH APPLICATION AUG 0 fJ 2022 8U1LunvG utNT TOWN OFSOUTFIQLD httpal y-southold2.civicplus.com/DocumeritCenterNiewi7852/Electrical-Inspection-Form-Fillable-PDF?bid Id= t�FF04 BUILDING DEPARTMENT-Electrical inspector k�0 TOWN OF SOUTHOLD 3 Town Nall Annex-54375 Main Road-PO Box 1179 Soulhofd, New York 11971-0959 Telephone (631)765-1802-FAX(631)765-9502 ro errt5southoldtQwnnLggv. -qegn4@,sQ�uthQLIAtovinri �.gm.. APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All tnlbrmet�onRequired) Date: 616-122— Company 1 22— Company Name: kslonli Pobucr — ' C e- �o Electrician's Name: JQh0 groalr-. c License No.: M E- 517 2 2 Elec. email ¢,�l - ^ � i�� � OQ 1,(,0 M Elec_ Phone No: ?) s 7' J 1 request an email copy of Certificate of Comitiance Elec.Address.: X - L1 ? ' ,JOB SITE INFORMATION (All Infwmation Required) Name: adau ffmw) Address: 3 C Ll !y 1 T D Cross Street: Phone No.: /-3E�3 -e2244 BIdg.Permit#:-,-4 700(o email: b �C p)0Q 1,'Z)20 Olako Tax Map District: 1000 Section_ o? Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE(Please Print Clearty): in-91,10und vinyl jVVM-m11vy 0 , S uare Footage: 1 &40 Circle All That Apply: Is job ready for inspection?: YES a NO Rough In Final Do you need a Temp Certificate?: 4 YES n NO Issued On ernp Information: (A11 information required) Service Size 01 Ph 03 Ph Size' A #Meters Old Meter# []New serviceDFire Reconnect[]Flood Reconnect Lservice Reconnect Underground LOverhead Underground Laterals 1 LJ2 H Frame Pole Work done on Service? LJ Y E1,N dditional Information: i r PAYMENT DUE WIlITEH APPLICATION A�lu 3 PERMIT # Address: Switches Outlets GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven WAD Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service Amps Have Used Special: Comments L sL�N APR. 1..2 2022 ARTHUR EDWARDS,POOL &:'.SPA CENTRE BUILDING DEPT . . TOWN OF SOUTHOLD'' 929 ROUTE 25A :MILLER PLACE, NY: 11764. 516-744-7185 FAX-744-0174 APPLICATION .FOR A'SWIMMING POOL PERMIT: _SOUTHOLD TOWN OF SOUTHOLD . MAIN ROAD (P.0..BOX 1179) SOUTHOLD, NY 11971 (631) 765-1802 PAPERS ENCLOSED:. APPLICATION FOR OUTDOOR=POOL PERMIT CERTIFICATE-OF WORKER'S COMPENSATION. ', CERTIFICATE OF LIABILITY INSURANCE. [ ' -CERTIFICATE OF DBL INSURANCE [ SUFFOLK COUNTY LICENSE , [� 4.SETS OF STAMPED PLANS 3 SURVEYS with FILTER-LOCATION n�, .TAX BILL . 11 $400.00 CHECK FOR PERMIT FEE NYSIF-. ' 199 CHURCH STREET,NEW.YORK N.Y.10007=1100 Plevb York.Staie Ipsurance,Fund:. : I pelf dom.. CERTIFICATE OE UVORKERS'COMPENSATION INSURANCE A A A A A. 112377925 LEVITT=FUIRSTASSOCIATES LTD': 520 WHITE_PLAINS.ROAD,2ND FL TARRY TOWN NY 10591' . . r. 'SCAN TO;VALIDATE. . ' �~ AND SU SCRIBE POLICYHOI:DER. . CERTIFICATE HOLDER . ARTHUR'J EDWARDS MASON TOWN OF SOUTH 0 ' CONTRACTING`COMPANY INC, P.O.BOX-728 929:RTE.25A : :SOUTHOLD NY' :11971 MILLER PLACE;NY 11764 `POLICY NUMBER :' CERTIFICATE;NUMBER.' POLICY PERIOD' DATE • G 2438491-9; .633479 06/26/262"1'-TO''06/29/202206/16/2021 TIFY THAT THE.POLICYHOLDER.NAMED ABOVE:IS INSURED WITH THE,NEW.YORK STATE:.INSURANCEf THIS.IS TO.CER •FUND. UNDER.POLICY.NO.._2438 491=9,.COVERING''THE.ENTIRE OBLIGATION OF-THIS.POLICYHOI.DER..FOR::WORfCER6'. COMPENSATION.UNDER THE NEW YORK WORKERS'.COMPENSATION!'LAW WITH-.RESPECT TO.ALL OPERATIONS IN THE STATE OF NEW YORK;EXCEPT AS INDICATED I3ELOW.l, 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.NYSIO.d.OMICERTI CERTVAL:ASP:THE_NEW YORK STATE INSURANCE.FUND ISNOT LIARLIE,IN THE EVENT. OF.FAILURE':TO.GIVE'SUCH. NOTIFICAITIONSr. THIS 'CERTIFICATE IS,ISSUED AS:A MATTER: OF INFORMATION ONLY-AND:'CONFERS NO RIOHTS=.NOR INSURANCE.' '. COVERAGE UF*Ok."THE CERTIFICATE HOLDER..THIS CERTIFICATE DOES'NOTAMEND;EXTEND OR:ALTERTHE'bOVERAGE' AFFORDED,BY THIE.POLICY: lK . EW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE:FUND UNDERWRITING: . VALIDATION NUMBER: 391257892 000 0 000 0®4220 36N Form WClMT-NOPWT Version 3(9/29/2919)[WC Policy-243849191- -.. U-26.3'.• - • A9 - - n.wwwwnnnnwn.......n..ww.rwwn.wwwn...u.......rw..rr....n .... .'..�.nn. - Workers' CERTIFICATE OF INSURANCE COVERAGE sr� Compensation Board DISABILITY AND PAID FAMILY LEAVE-BENEFITS LAW PART 1.To be completed by bisability and Paid Family Leave Benefits Cagier br Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured ARTHURJ EDWARDS MASON CONTRACTING COMPANY INC 929 ROUTE 25A 6317440174 MILLER PLACE,NY 11764 Work Location of Insured(only required if coverage is specifically limned to 1 c.Federal Employer Identification Number of Insured, certain locafians In New York State,Le.,Wrap-W Policy)` or Social Security Number 11-2377925 2:Name and Address of Entity Requesting Proof of Coverage U.Name of Insurance Cartier (Entity BeingListed as the Certificate Holder) Standard Security Life Insurance Company of New York Town of Southold PO Box 728 3b.Policy Number of Entity Listed in Box'1a" Southold, NY 11971 Z06874-000 3c.Policy effective period 7/1/2020 to 6/9/2022 4. Policy provides-the following benefits: 0 A.Both disability and paid family leave benefits. B.Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: R] A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. E] 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 desc d above. Date Signed 6/10/2021 By 4APt (Signature of Insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number (212) 355-4141 NameandTitle SUPERVISOR-DBUPOLICY SERVICES 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 than. DB420.1 (1047) IIIII'iBiiv1�2i0ii1iui(i10iii17)ii8110 Additional Instructions for Form D13-120.1 By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed 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 cancelled 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 coverage indicated on this Certificate. (These notices my 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 Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits 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 NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business Is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) 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 employment as defined in this article, and not withstanding 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 the payment of disability benefits and after January first,two thousand and twenty-one,the payment of family leave benefits for all employees has been secured as provided by this article. 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 disability benefits to any such employee if so employed. (b)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 employment as defined in this article and 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 the payment of disability benefits and after January first,two thousand eighteen,the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (10-17)Reverse -0v Ad 77 1A, p -WY i Ztv-Ll�,W7 � o ACCO" CERTIFICATE OF LIABILITY INSURANCE DA7E(MMIDDlYYY1� 12/2212021 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: N the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certHicate does not confer rights to the certificate holder in Hou of.such endoreemen a. PRODUCER W.GT Matthew Ruperto Liberty Risk Management,Inc. PHS 631 568.5633 FAz No: 631 5696636 2333 Route 112 ADS: matthewColberWrIsLorg Medford,NY 11763 INSu s AFFORDING COVERAGE NAICr INSURERA: NIP/Greenwich INSUREDINSURER B Arthur J.Edwards Mason Contracting Company Inc. DBA Arthur J.Edwards Pool&Spa Centre INSURERC: 929 Route 25A INSURER°` Miller Place,NY 11764 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000005-1323810 REVISION NUMBER: 23 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. rA TYPE OF INSURANCE ADDL U R POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCI I.GENERAL LIABILITY NPC-1004300-01 01/01/2022 01/01/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEIF--- CLAIMS-MADE 7 OCCUR PREMISES(Eaoccurrence) $ 300,000 MED EXP OM one n S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2.000,000 POLICY IFX71 JECaT F1 LOC PRODUCTS-COMPIOPAGG $ 2.060.000 OTHER $ Ea AUTOMOBILE LIABILtrLIABILITYCOMBINED SINGLE LIMIT $ eoolderd ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY S UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESSLM CLAIMS-MADE AGGREGATE $ DED I I RETENTION S WORKERS COMPENSATION I STATUTE EOR AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIE(ECUTIVE —I N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Renwlu Schedule,may be attached H mon space Is rsqulrsd) Town of Southold Is included as an Additional Insured,ATIMA,as requrled by written contract,subject to policy terms, conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Hail ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 728 AUTHORIZED REPRESENTATIVE Southold,NY 11971 or-OAV iLp&t' MJR ®1988 2015 A ORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by MJR on 12/22/2021 at 01:26PM Certifications indicated hereon signify that this plat of the properly depicted hereon was made in accordance with the existing Code of Practice for land Surveyors adopted by the New York State Association of Professional land Surveyors. This certification is only for the lands depicted hereon and is not certification of title,zoning or freedom of encumbrances. Said certifications shall run•only to the persons and/or entities listed hereon and are not transferable to additional persons,entities or subsequent owners. OPEN SPACE ® E 1°I E N 76'54'10" E 150.0' 3� APR 1 2 972 BUILDING DEPT. TOWN OF SOUTHOLD O WELL lyx , Pat �4t LOT Zi' tnl 10' F SHEfro ' ° ' C4 co 124O.r N C4 ty O RAMP REBAR LOT I I FOUND 4 — — 3 W a tt 10 I DECK 11.5' N 22.1' U I ^ T 30.7' o A/C .0 , �rIT M M 1 STORY r- ;°,a N DWELLING Z No. 3663 pq 30.D' 35.6' t3 w LOT R/O DECK 6.5' a I 2 O lV 22.3' or- O ' REBAR FOUND 321.81' Z S 76'54'10" W 150.0' 0 a RIGHT OF WAY LOT I �_ 5T — I IREBAR ' LOT FOUND LOT Y 6 7 N V " n 0 M OD I I . OP's PcS�R' +. UA: SURVEY r -VIfiW: SURVEY " ..©'201.9;BBV f?C.' The offsets or dimensions shown from structures to the properly lines are for a specific purpose and use,and therefore,are not intended to guide in the;erection.of fences,retaining walls,pools'patios,planting areas,addiiions 6.buildings,and any- other construction. Subsurface and environmental conditions were not examined or considered as`a part of this survey.Easements,Rights-of--Way of record;if'any,;an not shown.Property corner monuments were.not placed as a part o6lh.is'survey. Barrett Tax Map: DISTRICT 1000 SECTION 2.1 BLOCK {!, Unauthorized alteration or,addition to this surveyas a vio• Bonacci & Map of: EAST MARION WOODS lotion of sedion7209 of New'York State Education law Van Weele, PC Map Lot: 3 Mdp.Block Engineers' e Surveyors e Planners File Date:06/07/1989 File No:: 8759 ;Counya' " :k SUFFOLK 175A Commerce Drive Hauppauge,NY 11788 t 7631.435.1111 F 631.435.1022 ' "� '.is: ' www.bbvpc.com Situate: EAST MARION,TOWN'OF SOUTHOLD'j. ;.. Certified to: Title No.: AMB19-74617S Date By '" :', Revision•_' 1 BRIAN KEENAN&JENNA KEENAN y Copies f'4is. rveymap;no{bearing'ihe,land INSURANCE COMPANY LAND TITLE f AMBASSADOR ABSTRACT LLC 1` i i;, I` isurveyor's.embosse.!seal and signoture shall,not `r.;i';' CITY NATIONAL BANK "" 'Y t•. ,; r'. be consid'ered.tq be a'irue and v`ali&copy Surve ed b : R.B. 'Dr'difed;b 'B:W``;_'r., :''':'V: .CHecked:b C:W. Date: SEPTEMBER'30 2019 ;r- "Seale':^`'1��+='40' Project No.; A'190537 OCCUPANCY OR USF IS UNLAWFUL APPROVED AS NOTED A�ITHOUT CERTIFICATE DATES 'aa BY #k �� ^1 p OCCUPANCY FEE:_030V•� BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE COMPLY WITH ALL'CODES OF 2. ROUGH - FRAMING & PLUMBING ;NEW YORK STATE & TOWN CODES 3. INSULATION AS REQUIRED AND.CONDITIONS OF 4. FINAL ' CONSTRUCTION MUST SOUfHOID TOWN ZBA BE COMPLETE FOR C.O. 7 ALL CONSTRUCTION SHALL MEET THE MOOLDTOWN PLANNINGBOARD REQUIREMENTS OF THE CODES OF NEW SOUTHOI.OTOWN TRUSTEES YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. N.Y.S.DEC IMMEDIATELY'• RETAIN STORM WATER RUNOFF ENCLOSE POOL"TO CODE. PURSUANT TO CHAPTER'236 UPON.COMPLETION OF THE TOWN CODE. BEFORE"WATER" to JOR1l[GL DISPEMON REQUIRED A 0 samm.. R�tums • O B Neu. B E FFrom ro F9hx . Fahr t Pimp To ww o Re un ft wall OPW4 Rolled WoY F Plan . A Piping Arrangement w�Section 14ftbw 42" �:O Section B—B Psi con�w. �} o - < .o F E 0 U nn LHA c"s APR 1 2 7097 o" '1 �V3,595 � BUILDING DEPT. S . Typical Wall Section Section A—A ES P�-�� TOWN OF SOUTHOLD S I ON SIZEA B C D E F G H AREA 'CSP aura.. FEET FT FT FT FT FT FT FT FT SQ.FT GAL. 12 X 26.' '12 26' 9 .10 4 3. 3 6 312 10,500 ]Plpicw— .�OL'&SPA CENTRE 6 40 '16 40` �M PERMACRETE WALL SYSTEM 18 X 36 18 36 12 14 6 4 5 8 . 648 26,700 929 'Route 25A Miller Place NY 11764 20 x 40 20 40 16 14 . 6 4 5 10 800 33,000 (631) 744-7185 FAX (631) 744=0174. Fhow 24 X 44 24 44 181.14 8 4 8. 10' 798 .35,0001 Suffolk License #4436—HI. 24 X 48 24 48 20 16 .8 4 6 10, . 900 38,500 Nassau License #HI74450000