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HomeMy WebLinkAbout46372-Z �SpFFOIY Town of Southold 11/17/2022 P.O.Box 1179 0 y 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43619 Date: 11/17/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 100 Eds Rd, Southold SCTM#: 473889 Sec/Block/Lot: 78.-9-68 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/19/2021 pursuant to which Building Permit No. 46372 dated 6/7/2021 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in-ground swimming pool and spa fenced to code as applied for. The certificate is issued to Kayel,Timothy&Michelle of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46372 8/16/2022 PLUMBERS CERTIFICATION DATED uthri d ignature o�SufFo�M D TOWN OF SOUTHOLD a cGy BUILDING DEPARTMENT x TOWN CLERK'S OFFICE "oy • �� SOUTHOLD, NY mol � Sao 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#: 46372 Date: 6/7/2021 Permission is hereby granted to: Kayel, Timothy PO BOX 369 Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. At premises located at: 100 Eds Rd, Southold SCTM #473889 Sec/Block/Lot# 78.-9-68 Pursuant to application dated 3/19/2021 and approved by the Building Inspector. To expire on 12/7/2022. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building ector P pF SOUT�oI Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 a roger.riche rKED-town.southoId.ny.us Southold,NY 11971-0959 UNTV,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Timothy Kayel Address: 100 Eds Rd City: Southold St: New York Zip: 11971 Building Permit#: 46372 Section: 78 Block: 9 Lot: 68 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: REP Electric License No: 46288 ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only 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 HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main.Panel A/C Condenser Single Recpt 4 Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 4 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock Exit Fixtures TVSS Id Other.Equipment: In ground swimming pool to include, bonding, control panel, 4-GFCI circuit breakel 2-transformers for low voltage pool lights, 1-electric pool heater, 1-pool filter pump, 1-overflow pump, 1-jet pump, 1-spa filter pump, Notes: 1-spa blower, 1-spa sub panel with 3-20a GFCI circuit breakers. Inspector Signature: Dater August 16 2022 81-Cert Electrical Compliance Form.xls OE SObTyo6 # # TOWN OF SOUTHOLD:BUILDING DEPT. �`y�ourm 765-1802 INSPECTION [" ] FOUNDATION IST [ ] 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: OleL,Z-� �P�ell 2.� C,g_- 6a, Z'o L-(,p DATE 2 -Z- INSPECTOR V� pF SOUTyO� # TOWN OF SOUTHOLD BUILDING DEPT. coutm N 765-1802 1 INSPECTION G� [ ] 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 REMARKS: �&.)lA4 A-f DATE ` Zv INSPECTOR r OF SOUIyO� - - - - -- ✓� # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL�d [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMAR S: Ot 66t&- DATE �' ?��/ INSPECTOR 17 i,-\.. / vc ,,y�i ♦ M r , A 14 4 �._ 1 I � � - •. �;;���I' ���� raja �-'"� _ II 4, — ti • r, k r , f Y r,l - 7q� � _I tli"Ii IrY 'N IyFi a��4�•yi _ ' — �- 4 , is f � a -TAL, 1�1 PA t `•• ��. r 1. -MA 4, - y,j�. r `+ G [,�i', 1 fit'=•^ FIELD INSPECTION REPORT DATE COMMENTS , � b FOUNDATION(1ST) J y FOUNDATION(2ND) t� z 0 ROUGH FRAMING,& t� PLUMBING ' y 1 INSULATION PER N.Y. y STATE ENERGY CODE q �ti tit a reS� hd Wurs�— b koos Pohl FINAL ADDITIONAL OM NTS o,� 7 t- "* i.l--- Kq o b y y° TOWN OF SOUTHOLD � BUELDING DEi PAR MENT x$ Town.Dalt Annex 54375 Main Road k 0.Box 1179 Southold,NY 11971-0959 4 W v Ah '.Telephone(631)765-1802 Fax(631) 7659502 hgps:8ww v.soutj joldto {r y.go Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only f� ApAficabons aril forms must be.filled Qut In their entirety 1r►co _plate :<spp6tcaticsrns vs31 not be accepted tikllsetl�e {sfabca £,is na$ he 4umer+an` , " srner's Aa!$¢araat�ora`$oma(gags ►email be anrsleai ,s 2 1) �a$t��e�Q:2/8/2029 $� - Name: n G e SUM#1000- Project Address: -ProtectAddress: 8 ��f Phone#: 3+2.s' Email. IVo fTfir Mailing Address: 0. .�,� ` —77777777777 7. A Name: Mailing Address: P d ��k, S—9 Phone#: . Ercall: ' �.iDESlClt3_l?119�SS6®101A1.11�4F1�R11r'�lSld�i6t _ Name:SJ Steinbrecker Mailing Address-217 Sebonac R. Sootharnpto , NY 11698 Phone# 1 8 7292325 Email: �5. ) - bgstp_,,y@optonline.net Name:JoSeph Cuomo Mailing Address:9 80 #fst End ave, Shirley, NY. 11967 Phone#'631-655-2710 . 531-555 2790 Email:islandoasisii@yahoo.corn DE5CRl ; 4F PRDi&E P,CONSMUCTIObi s ONew Structure DAddition DAlteration Dlte air DDemolitlon Estimated Cost of Project: ❑other New Gunite pooUspa combo $70,000.00 Will the lot be re-graded? RYes®No Will excess tail be removed from premises? WYes ElNo t d E 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? $Ves[]No IF YES,PROVIDE A COPY. rv, d ift iWig ss 'd dksAfterl1dad VibiM db#, 4 addTeons,afceratsons orim'teenovst nr demai:rioaas herein 8esen'bed.'rhe pphcarrt agrees to ceemplyv�h aikappiFcabie lavas ordufarioas„banding ode, ::.;`` Application Subrititted By(print name): DAuthorized Agent *wner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF 6 4A- //�'a71-f'9 beirig duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the C9 LA/"/7e.,t-,1 (Contractor,Agent,Florporate 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 his1her 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 of rr-4 ,2o 2-1 r)(4 4 L1,LA Notary Public 0, .. PROPERTY 0WfJR AUTHORIZATION ......... ((Where the applic int is not the oN3 •%wner) 0 p S residing at lao ljlmn OZ40 hereby authorize 19e— to apply on -jej L my behalf to the To=ofSoutholdBu, ing Department fo approval as described herein. wnce--es SiMratire— Date / e2 'r Mitt Owner's Name 12 o�Os�FF014,ea BUILDING DEPARTMENT- Ele r I Ins86e1tora 2022 , G TOWN OF SOUTH ISA g {LDING U[N I. o - Town Hall Annex - 54375 Main Road - Pt 16MOLD Southold, New York 11971-0959 o4,- �a0�� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(absoutholdtownny.gov — seand(aDsoutholdtownnygov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required Date: Z Z Company Name: 2E. 0L Electrician's Name: License No.: f Z / Elec. email: C �' 1 VK 141 Z c ,r ev"L Elec. Phone No: �_3/ 6 p I request an email copy of Certificate of Compliance Elec. Address.: P0 Z O r.�3 r J JOB SITE INFORMATION (All Information Required) Name: t ye Address: 6 0 ©a O til 4 Cross Street: Phone No.: G3 Bldg.Permit#: 7 Z email: Tax Map District: 1000 Section: Block: / Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Nfw O 0 Square Footage: Circle All That Apply: Is job ready for inspection?: YES-�NO F Rough In O Final Do you need a Temp Certificate?: El YES O NO Issued On Temp Information: (All information required) Service Size01 Ph 03 Ph Size: A # Meters Old Meter# EJ New Service0 Fire ReconnectOFlood ReconnectOService Reconnect OUnderg round❑Overhead # Underground Laterals 1 2 H Frame D Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION VICTORIA DRIVE N 29D 57' 20" E 166.00' ------------62.0' _2 of dEUAE hung se IW M EXERTMd DMWAY C) L ELLm"mo 42.*— TOOD DEaF LV u -7—- FaMPED o",u, #"Mwo I I MOL OOD DECX PROP PODL ------- -------- - ---------- -------------- -Q ------------------- —-------—---------------------------------------------------------------•—------------------------------—j S 29D 57' 20" W 166.00' c 4 SITE- PLAN SCALE: I"=20'-0" S.C.T.M.# 1000-78-09-68 PROPOSED SITE PLAN FOR THE KAYEL RESIDENCE 100 ED'S ROAD TOWN OF SOUTHOLD, NEW YORK WJS DESIGNS REVISED POOL/SPA LOCATION-03/30/21 SOUTHAMPTON, N;Y. 516-729-2925 02/08/21 �t-� a�" + _ �y `� 'psi- �+� ��` � -'`� �L .syY; '�,i"�a'``e;�jf. - .;6 ie o`�8�.-` + e ;tr$� � �- � .5.,,•. K Y t e f t 1 n l��i�1 ``?; _ �s, �ti\•'- _;.;; �r"lll w�.�-, � !r' •' �, -x •' !r"7�C �'-'' "-r'': x?%�''' ' °. •.l `1 ^:,�.�-�;,'� Il,,� ^. IN �, _ ,z� xti„~ zw*• �e�t�� �:rs**�3a+>�t�.¢a��anTM �:s���set?err; :Qe�r.�.�: :�; •::;as�:�.�sau. �c �-,� �l Suffolk County Department of Labor, Licensing & e , Consumer Affairs - VETERANS MEMORIAL HIGHWAY * HAUPPAUGE,NEW YORK 11788 �sa DATE ISSUED: 07/26/2018 No. HI-60938 Suffolk County T { Home Improvement Contractor Licensef' This is to certify that J()S1P.PT4 r C1 TCIM() doing business as ISLAND OASIS EXTERIOR DESIGN AND MASONRY having furnished the requirements set forth in accordance with and-subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME {/ TMPROVEMENT-CONTRA-CTOR, m e ounfyof"Suffolk. r i License Category NOT VALID WITHOUT Additional Businesses DEPARTMENTAL SEAL H26 - Pools and Spas/Certified } ' AND A CURRENT 1. CONSUMER AFFAIRS _ H8 - Masonry ID CARD : k lr Commissioner NYSIF New York state Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE D D A A A A A^ 843100705 COLLERAN INSURANCE AGENCY INC/ THE CLAUSEN AGENCY 333 ROUTE 25A SUITE 150 ROCKY POINT NY 11778 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ISLAND OASIS POOLS&SPAS, INC TOWN OF SOUTHOLD 180 WEST END AVE BUILDING DEPARTMENT SHIRLEY NY 11967 54375 MAIN STREET SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12456697-8 240651 10/30/2020 TO 10/30/2021 3/16/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2456 697-8, 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. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JOSEPH CUOMO SOLE OFFICER-ONE PERSON CORP ISLAND OASIS POOLS&SPAS,INC 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. THIS POLICY IS CANCELLED EFFECTIVE 03/31/2021. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:509733088 U-26.3 Yoeic 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 ISLAND OASIS POOLS&SPAS, INC 180 WEST END AVE 6316552710 SHIRLEY, NY 11967 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 84-3100705 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier _(Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company of New York Town of Southold, Building Department 3b.Policy Number of Entity Listed in Box"la" 54375 Main Road 82724-00 Southold, NY 11971 3c.Policy effective period 3/9/2020 to 2/18/2022 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: 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 descV17ed above.' Date Signed 3/19/2021 By Aa;t (Signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY 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 56 of Part I 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) 111111111°°°1°1°1°°1°1°�11°!�°�!°!�!°111111 Additional Instructions for Form 1313-120.1 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. 1313-120.1 (10-17)Reverse �1 ISLAOAS-01 DINSERRA ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 3/16/2021 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 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER COME:NTACT The Clausen Agency,Inc. acc,No,Ext):(631)744-1393 FAX No):(631)744-1732 333 Route 25A,Suite 150 Rocky Point,NY 11778 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A.Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B:Standard Security Life Insurance Company Of NY 69078 Island Oasis Pools&Spas,Inc. INSURER C: 180 West End Ave INSURER D: Shirley,NY 11967 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 ADSDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR MMIDDNY LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PHPK2171465 8/15/2020 8/15/2021 DAMAGE TO RENTED 100,000 PRM ES Ea occurrence) $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY®JECT r] LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EOM"M SINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HRED NON-OWNED PeOPER nDAMAGE $ AOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION TH- AND EMPLOYERS'LIABILITY Y/N STERATUTE E R _ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT B Disability Benefits 82724-00 10/3012020 10130/2021 Statutory DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southhold-Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 P ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Road Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Suffolk County Dept.of 'Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE .im Name JOSEPH C CUOMO Business Name This certifies that the ISLAND OASIS POOLS&SPAS,INC. bearer is duly licensed by the County of suffolk License Number:HI-60938 Rosalie Drago Issued: 7126/2018 Commissioner 1 Expires: 7/l/2022 s p;<•_• This license is the property of Suffolk County Department of Labor,Licensing&Consumer Affairs. 2�. ;• Possession of this license does not guarantee its validity. Additional Business Name License Category H26-Pools and Spas/Cedi ied;H8-Masonry p RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF?HE TOWN CODE, ELECTRICALis„� .�ELS„ APPR VED AS NOTED INSPECTION REQUIRED �E9,10'tSSE FOOI,1'Q;CD DATE:_ - B.P.# 7,9 ON'COMPLE rld s $EPORE."WATER `':L FEE: c BY: "` NOTIFY:BUILDING DEPART AT 12” COPING 1' 76 -1802-',8 AM .TO 4 PM FOR THE FO LOWING.INSPECTIONS: '-6" 1' 1' 1' 1' 2'-6" 3' 1.' OUNDATION TING REQUIRED DN 1'-6" SWIM OUT OR POURED CONCRETE - 1' 2. IOUGH - FRAMING & PLUMBING 1, 3. I SULATION 1' 12" COPING 4. f INAL - CONSTRUC.ION MUST 1' E COMPLETE FOR 4.0. _ ALL CONSTRUCTION S`J4LL MEET THE 1 REQUIREMENTS OF THE CODES OF NEW 16'x32' SWIMMING POOL YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. IL 8'x8' a a U U U a $HALLOW END SLOPED DOWN 16' WATER DEEP END 0 N SPA N 14'-6" N 16, , 10'-6" 32' WATER1' COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODE 1' 12" COPING A REQUIRED AND CONDITIONS O StflV,.D YOIL 1 SGUTHOLDIMTRUSTEES 12" COPING 1' ' Ilk 4�. SWIMMIN 'rul - -- POOL P LA N'll -4 SCALE: 1/4"=1,-0" ;r rA;. 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