Loading...
HomeMy WebLinkAbout47861-Z d^r_� �Sew fFa1 0�0 Town of Southold 2/8/2023 y� P.O.Box 1179 o - 53095 Main Rd oy o� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43829 Date: 2/8/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 605 Gus Dr,East Marion SCTM#: 473889 Sec/Block/Lot: 38.-7-10.19 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/19/2022 pursuant to which Building Permit No. 47861 dated 5/26/2022 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 Proteus Properties LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47861 10/25/2022 PLUMBERS CERTIFICATION DATED A edignatur� OfFa k o TOWN OF SOUTHOLD �yf BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy . SOUTHOLD, NY dol �a° 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#: 47861 Date: 5/26/2022 Permission is hereby granted to: Proteus Properties LLC 171 Farragut Cir New Rochelle, NY 10801 To: construct accessory in-ground swimming pool as applied for. Pool equipment must have a minimum setback of 10 feet from all lot lines. At premises located at: 605 Gus Dr, East Marion SCTM #473889 Sec/Block/Lot# 38.-7-10.19 Pursuant to application dated 4/20/2022 and approved by the Building Inspector. To expire on 11/25/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector pF SOUjyol � 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 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Proteus Properties LLC ' Address: 605 Gus Dr city:East Marion st: NY zip: 11939 Building Permit#: 47861 Section: 38 Block: 7 Lot: 10.19 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: JC Sullivan Electric License No: 36121 ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1 st 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 Disconnect Switches 4'LED Exit Fixtures 11 Pump - Other Equipment: Intermatic Pool Panel 4 Circuit/ 3 Used, 2 Lights 120GFI Intermatic 100W Pool Tranny, Salt Gene Notes: Pool Inspector Signature: Date: October 25, 2022 S.Devlin-Cert Electrical Compliance Form of s 7cv 05-4 I V * T 0 DE )IN OF SOUTHOLD' BUILDqIN PT. 631-765-1802 INSPECTION .. I FOUNDATION 1ST ROUGH PLBG. I FOUNDATION 2ND ] 'INSuLATIOWCAULKING I FRAMING/STRAPPING I FINAL I FIREPLACE & CHIMNEY I FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION r,A ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O ]' RENTAL REMARKS: c ok DATE 0,16 L2,t, INSPECTOR t f ���✓ , � 0 d 5 ���' � � .: �— ���� g � � � ' OF SOUIyO� l -7 * # TOWN OF SOUTHOLD BUILDING DEPT: °�ycmnm '' 765-1.802 INSPECTION j ] FOUNDATION 1 ST [ ] 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: GoL n o. DATE b INSPECTOR N` �w►n # TOWN OF SOUTHOLD BUILDING DEPT. cou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] ULAT WCAULKING [ ] 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: eo s 1VA d � m be �� , � ��� nth • +AZ DATE l l INSPECTOR S �r. di 8 �aN:kE R MA ® ® SHERMAN ENGINEERING&CONSULTING 70 MAGNOLIA DUNES CIRCLE ST AUGUS nNE,FL 32080 S E F 631.831.3872 p DE E 0 1 .9 BUILDING DIS September 1, 2022 'Io"OFSOU M M Building Department Town of Southold 53095 Route 25 Southold, NY 11971 Re: Pool steel inspection; Permit#47861; Proteus Properties LLC 605 Gus Drive East Marion SCTM 1000-38-07-10.19 Building/Zoning Official, This certification is for the foundation steel installed at the above referenced property on or about July 26, 2022. The rebar was installed in substantial compliance with the approved design with #4 bars at 10" each way throughout the bottom and #4 bars at 10" horizontal and 5" vertical in the walls. All steel was spaced to be in the middle of the 8" concrete shell and 10" beam with appropriate laps and intersections tied in accordance with acceptable building practices. This certification is limited to the installed structures and does not include, nor does it address plumbing, electrical, site placement, or any other aspect of construction. Please contact me if you have questions or require clarification for this certification. Very truly yours Sherman .ne ' g & C nsulting, P.A. Matthe Sherman, P.E. CF NEy, W 0 835$ �. AROFESS103 CIVIL ENGINEERING DESIGN SITE PLANNING PERMITTING rle,L,L Jul Orr,%.liviv ncrvr;i liner. ---—-- -- .-�P V b 00 CrJ FOUNDATION(1ST) y ------------------------------- LA Cl FOUNDATION(2ND) "Q 05 00 ROUGH FRAMING& . PLUMBINGLA y n Im Q INSULATION PER N.Y. STATE ENERGY CODE V 1 fp e must FINAL ADDITIONAL COMMENTS Ir pG !$ 1 O(`) et6 loaq N vl �z (Ar x E� �d • b y 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.southoldtowymy:gov Date Received APPLICATION FOR BUILDING PERMIT i 'R For Office Use Only C PERMIT NO. '41W P BuildingIns ector: APR 1 9 2022 Applications and forms must be filled out in their entirety.Incomplete applications will,not be accepted. Where the Applicant is not the owner,an BUILDING DEPT OFSOUTHOLD Owner's Authoization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: Rt.�. Ve nv_+o V_b S SCTM#1000- 3$ - - O lq Project Address: lvt�� v X15 Q r%ve, -U-,- CA.St- NM CV t V'-) Phone#: 1, - 101 y - �t13o Email: K LZ Mailing Address: 1 Ct IrG►e. -o-w 12pCh2lk e- Del`J I obo CONTACT PERSON: Name: t--Ct u Yen IJ-Q�'So rl' 12Ce_d_k CLn C /%tTo C_,FLh Mailing Address: i.l�gt� (Y\0.tln S� ppr} Phone#: t5iIV gypq Email: L � �adiC�Qn�1-1U+matLC.OM1 DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: TTM CONTRACTOR INFORMATION: Name: �►1deo 0 I Mailing Address: Phone#: (o-7) 7LIGV' 2tt0 Email: hc. der- Q C)pi-onl.%r\e.•nia_ - DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Derriolition Estimated Cost of Project: ?Other 'POO $ �6 D �OD0 Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? .fYes ❑No 1 PROPERTY INFORMATION f 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. ❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.'False stateme6ts'made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(print name): ❑Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF ) 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 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 of ,20 Notary Public PROPERTY OWNER AUTHOWATIOlN (Where the applicant is not the owner) I, 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 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. ❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as,provided by Chapter 236 of the Town Code.APPLICATION•IS HEREBY MADE to the Building Department for the,issuance of a Building Permit pursuant to the Building zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for,removal or demolition,as herein described.The applicant agrees to.comply,with all applicable laws,ordinances,building.code, housing code and regulations and to admit authorized inspectors on premises and in buildings)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penbl Law. Application Submitted By(print name): I eXuy"1,4,CkSon ®Authorized Agent Downer Signature of Applicant: Q�q��y` Date: 9 -14 -22- STATE -14 -2ZSTATE OF NEW YORK) SS: COUNTY OF 01-1(-eco being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the t�4 on-'c (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 q �� ! day of jDA2E;1 ZyZZ 20�Z ZZOZ`EZ Aln('saaldxS uolsslWWO0 AW Notary Public fqunoO 3ilognS ul pelgllen®. f ZbtPeL998:1 t.0'ON I XJOA MGN gO ebl3$S-ollcind JUMPROPERTY OWNER AUTHORIZATION kj3SVUA A 3NNVSnS (Where the applicant is not the owner) residing at b I fJzl f LCII r do hereby authorize to apply on :;AWZ77 apartment for approval as described herein. 114 2L. Onet's Si gnat Dat p� Print Owner's Name 2 i �1F1j,� Q22 U LDING DEPARTMENT- Electrical Inspector 1 � 2 TOWN OF SOUTHOLD ,. � TOWN of:SOUTH oa�vn Hall Annex- 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 royerr(�southoldtownny.Nov - sea nd(�southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ali Information Required) Date: Z Company Name: 5C. 5,111 r VV4 Electrician's Name: 6b-,',s ft,)rtl A License No.: 3�19-1 AL . EIec. email• Elec. Phone No:76- _ p ❑1 request an email copy of Certificate of Compliance Elec. Address.: dv� a�� ;�� ��,, /(/ . 1 -7-7 JOB SITE INFORMATION (All Information Required) Name: fti)teu5 -0(bp- -r' -e5 LLC Address: Cross Street: Phone No.: Bldg.Permit#: �4 email: Tax Map District: 1000 Section: Block: -7 Lot: 10J BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): J Square Footage: Circle All That Apply: Is job ready for inspection?: EfYES ❑ 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# ❑New Service[:]Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 D H Frame Pole Work done on Service? Y F1N Additional Information: PAYMENT DUE WITH APPLICATION )®® I� 11 FQ Inspector AUG t U LDING DEPARTMENT- Electrical Ins 1 � 2�2� � p TOWN OF SOUTHOLD N ;1`"DFS�u Itmwn Hall Annex - 54375 Main Road - PO Box 1179 o ® Southold, New York 11971-0959 4 p� Telephone (631) 765-1802 - FAX (631) 765-9502 ��'� rogerr c(bsoutholdtownny.gov - sea nd(a)southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: �C S lf.v�a Electrician's Name: License No.: 31,12..1 ,ME Elec. email: �,��/j✓ah E/�L� L. �� Elec. Phone No:-)76- U- ❑1 request an email copy of Certificate of Compliance Elec. Address.: ( &)/e, �J- off L4!, /v . 1 7-74 JOB SITE INFORMATION (All Information Required) Name: �;rJe1Jd> -PliOff_�-6�5 Address: ()5 S af -�51 ,,©,-7 Cross Street: Phone No.: Bldg.Permit#: q7 �61 email: Tax Map District: 1000 Section: 8 Block: - Lot: J()J BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That'Apply: Is job ready for inspection?: YES ❑ Nd, Rough In ❑ Final _Do you need a.Temp Certificate? ❑ YES �O Issued On Temp Information: (All information required) Service Size 1-11 PhF_13 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect[]Flood'Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION D C) PERMIT # Address: Switches Outlets GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven W/D Smokes DW Mini Carbon Micro Generator Combo Coo kto p Transfer AC AH Hood Service Amps Have Used Special: Comments J THE AREA OF THIS PROPERTY IS 31,721 S.F. OR 0.728 ACRES ALL ELEVA TIONS REFER TO NA VD '88 DA TUM R-40 ZONING n CLEARING CALCULATIONS LJ�I EXISTING CLEARING IS 31,721 S.F. (1007.) COVERAGE CALCULATIONS ALLOWABLE COVERAGE IS 6,344 S.F. (207.) S� EXISTING COVERAGE IS 0 S.F. (07.) 17 O Z/ �P S2?? 1 .5' xnPA,YSFc 110,1, i 4 t oRyF� c N piN �• �q 3N �Rikc' v O M 0)10 J� � J3W 2s i2� FG• 14.5' /0 of 6 � FGJ 5�� SO FOON RoA<<y /aFC,/ q Fo��y w 4 6'4 OSS e p, gnQA1 / 5' ooy ONS T OgboyM~'• �^'oF ' / �<Y oy/ p J .� � 78 / 'jAiWq0. 0 6 k 4� •� i .•\ �`�� �FNT FMN �" /• Fo x 13 7' OQ•• //`N Cq '1 6> 0Uy0A CST �• 06W cC � 2 N/ % �1� •\\mss S00 -- �� - — - - -- - --• 6% rj •\ aN •'\ �• °` V3 ..\ �• ry ��yo. ry 13.5 6J000�. � Q ,� o� 13. ,�E OF /V 2 O n 2cS'�D 0 0829 CERTIFIED TO: 'AND S- Colossus Construction Management, LLC FOUNDATION L OCA TION SURVEY 10/15/2021 GUARANTEES INDICATED SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY /S PREPARED AND/OR AGENCY, AND ARE NOT TRANSFERABLE. S.C.T.M. N0. 1000 — 38 — 7 — 10.19 SURVEY OF: LOT 31 MAP OF SUMMIT ESTATES, SECTION 3 GARY BENZ, L.S. FILED MAY 21, 2002 — AS No. 10769 SITUATED IN: EAST MARION TOWN OF: SOUTHOLD Surveying and Land Planning SUFFOLK COUNTY, NEW YORK 527—B Hawkins Avenue Ronkonkoma, N.Y. 11779 DATE: 9/15/2020 JOB NO. G20-6100 SCALE: 1" = 40' GaryBenzLS®Yahoo.com / (631) 648-9348 THE EXISTENCE OF RIGHT OF WAYS, WETLANDS, UNDER UNAUTHORIZED ALTERATION OR ADDITION TO COPIES OF THIS SURVEY MAP NOT BEARING THE LAND GROUND UTILITIES AND/OR EASEMENTS OF RECORD THIS SURVEY IS A VIOLATION OF SECTION 7209 SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL IF ANY, NOT SHOWN ARE NOT GUARANTEED. OF THE NEW YORK STATE EDUCATION LAW. NOT BE CONSIDERED TO BE A VALID TRUE COPY. ID WITH IN GUS DRIVE IMPRJVD WITH ELEC,BOX DWELLING ELM TRAW--pgigy I�SBt.Ic wnTEn G�TAL KATER TEST HOLE I\ / N EL 15 1 , TOPSOIL S, 14.5 (2)e'-0DEPTH n •vIA.x a' al *71 R; fly Lp r YY a•TRAFFICE BR&.covet nN/ gi ° ._�•"'K I I I O LO .,� LEACHING POOL BACKFILLED WITH CLEAN SAND AND GRAVEL NmJ ti EP ; I i N 13 MIN.TOTAL 400 S.F.SIOEWALL N Til 4'-0'DIA DISTRIBUTION POOL / I I I IMPROVE?WITH /i ; i IG WATER VEL PROPOSED 2000 GALLON / � � To 10'-0'DIA WITH MAX LIGUID / DEPTH OF 610• r ❑O ET41R1' 'p I 6W-O PORCH SAND d GRAVEL p Yea j ORY FRAME GSW91INO 1C, 15,_60 I / 11 22'-0' FF.E.•16 -2 PUBLIC,WATER I GARAGE 14 53'-0' I Y ST HO .4 Q OPEN SGR�Y I LE I FROM.'ESTATES,SECTION B DECK PORCH i4 AT EAST MARION,TOM OF SOUTHOLD MARCH I,2001 j I - I I YOUNG YOUNG LAW SURVEYORS bTRAFFPRB1,Ae ARI STOP PRECAST COLLAR �1 u I NON SS♦WNKIN6 EL.145 // \ X40'POOL W/ i GROUP p .. EL.IDS PITCHED m I/0,/1' " -�• '°`'' / I \ I I S'-0SAND AND (2)4 X il —`— PRECAST I i GRAV'E COLLAR RINGS / / w 12 / ®® mN< 4. ? 1 • EL.4E4 1 ------------ J ---- ------� LOT AREA v 91.721 5F O \ _ _ _ ALLOWABLE CWE¢AGE 6°'544 5 v \ i T Y P L.P -GYM GA ?• PROPOSED COVERAEE 2598 2 STORY FRAM DWELLING 1 / PROPOSED 6 BEDROOM SEPTIC,SYSTEM I N NT5 C BASIS�0r 1,427 SF `9F$ FIRST FLO _,^—I4-1-.p SYMBOL OR • 169 f S\So 2ND FLOOR 1;441 SF � /9 � �.J'DRYWELL PROPOSED LEACHING POOL ® PROPOSED SEPTIC TANK "ZOVED KITH SCTM DIST.1000 SEG 056 BLK 09 LOT 10.19TEx ® 50% MAP OF SUMMIT E5TATE5,SECTION 3 EXPANSION FILED DATE:05/21/2002 AS No.10'169 LOT 51 N' -W_ EXISTING,WATER LINE SITUATE IN,EAST MARION TOWN OF,50UTHOLD SUFFOLK COUNTY,NEW YORK \� -US —V&E UNDERGROUND ELEG.LINE SITE PLAN �\ EXISTING WATER LINE I" = 50,_O., �FtEDARc SITE INFO BASED ON SURVEY BY GARY BENZ LAND SURVEYING dglg m qpR C(/ DATED 09 20 �U�\S c iN�p Awn GENERAL NOTES: 1.COMMUNITY HAS PUBLIC WATER. ` : } 2.ALL HOUSES WITH IN 150 FEET OF ALL PROPERTY LINES HAVE PUBLIC WATER. 5.NO HOUSES WITH IN 150 FEET OF ALL PROPERTY LINES HAVE WELLS. (P 4.ELEVATION,PROPERTY ELEVATION 15 RELATIVELY FLAT. �,9 01 e135 yO S.ELEVATIONS BA5ED-ON NA14D-0-16b) FIN 6.LOT 51ZE 51,121 50.FT. VICTOR CUNEO ARCHITECT P.C. Project Name and Address 154 LAUREL ROAD 605 GUS DTZ- EAST NORTHPORT,NY 11731 EAST MARION,NY (631)261-2744 Client#:23825 BINDERPO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 09/302021m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRoouceR NWeC Kimberly L.Schuerleln Amaden Gay Agencies,Inc. PHONE 631 324-0041 F 6313240671 A1C No Ext: AIC No 11 Gay RoadDADRESS: kschuerlein@amadengay.com P.O.Box 5004 INSURER(S)AFFORDING COVERAGE NAIC# East Hampton,NY 11937 INSURER A:Valley Forge INSURED INSURER B:Continental Insurance Company Binder Pools Inc INSURER C:American Fire and Casualty Ins.Co. 24066 PO Box 1960 INSURER 0:Ohio Security Insurance Company 24082 Shelter Island,NY 11964 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD SUB POLICY EFF POLICY EXP LIMBS LTR INS WVD POLICY NUMBER MWDD MMIDD A X COMMERCIAL GENERAL LIABILITY X X 5084911313 9/25/2021 09/25/202 EAA(C�HgOCCURRENCE $1,000,00 CLAIMS-MADE I OCCUR PREMISES goc�c�uErrence $100 000 X PD Ded:1,000 MED EXP(Anyone person) $15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY F—]JECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ D AUTOMOBILE LIABILITY X X BAS60950488 5/29/2021 05/29/202 Ea aciiden SINGLE LIMIT 1,000,000, ANY AUTO BODILY INJURY(Per person) $ OWNED SONLY X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident B X UMBRELLA IUXB X OCCUR X X 5086496894 9/25/2021 0912512022 EACH OCCURRENCE $110001000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I X RETENTION$10000 $ C WORKERS COMPENSATION XWA60950488 10/01/2021 1010112022 TATI IPER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N EL EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED7 r N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EJ--DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) **Workers Comp Information** Proprietors/Partners/Executive Officers/Members Excluded: Darrin Binder Certificate Holder is an additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1968-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S69403/M69375 KLH Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. 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 a hazardous employment defined by this chapter, and notwithstanding 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 compensation for all employees has been secured as provided by this chapter.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 compensation to any such employee if so employed. 2. 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 a hazardous employment defined by this chapter,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 compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse STATE OF NEW YORK WORKERS'COMPENSATION BOARD t CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured 631-749-2110 Binder Pools,Inc. PO Box 1960 1 c.NYS Unemployment Insurance Employer Registration Shelter Island,NY 11964 Number of Insured Work Location of Insured(Only required if coverage is specifically 1 d.Federal Employer Identification Number of Insured or limited to certain locations in New York State,i.e.a Wrap-Up Policy) Social Security Number 11-3368250 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) LIBERTY MUTUAL INSURANCE COMPANY TOWN OF SOUTHOLD 3b.Policy Number of entity listed in box"la": 54375 MAIN ROAD XWA60950488 PO BOX 1179 SOUTHOLD,NY 11971 3c. Policy effective period: 10/01/2021-10/01/2022 3d. The Proprietor,Partners or Executive Officers are: ❑ included. (Only check box if all partners/officers included) X❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"T'. The Insurance Carrier will also notijy the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe 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. Please Note:Upon the cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: AMADEN GAY AGENCIES,INC. (Print name of authorized representative or licensed agent of insurance carrier) Approved by: 10/01/2021 (Signature) (Date) Title: VICE PRESIDENT Telephone Number of authorized representative or licensed agent of insurance carrier: 631-324-0041 Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb/statemy.us 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 NYS Disability and Paid Family Leave Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)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 may 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 NYS 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 Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS 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 (12-21)Reverse YORK Workers' CERTIFICATE OF INSURANCE COVERAGE STATE i Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrier 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured BINDER POOLS INC 631-749-2110 PO BOX 1960 SHELTER ISLAND,NY 11964 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specillcallylimited to certain locations in New York State,i.e.,Wrap-Up Policy) 113368250 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold P O Box 1 179 3b.Policy Number of Entity Listed in Box"1 a" Southold, NY 11971 DBL397420 3c.Policy effective period 01/01/2022 to 12/31/2022 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: A.All of the employers employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 1/5/2022 By ��dI/p'e. (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can 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 sox 4B,4C or 513 have 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(Article 9 of the Workers'Compensation Law)with respect to all of their 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. D113-120.1 (12-21) 1111111 PjIII °�°°11°1°1111°1°'21°��°°���III IIII Suffolk GOLInt'Dept,Of Labor, Licensing&Consumer Affairs Name D A R,R 1 N'C B;.N'D,E SusinessNa-rie h;C C e FS e S 'h at 4', Darer ii S I t-1 D ER PO OL S UNC License Nui-nber:',-.'-37-,79 Rosalie Orago Issued: 041-'�2%2005 Exp;res: Cj4iQV-9O2Z* This license is the property of Suffolk c--nty UePartment.of Labor,Licensing&Consumer Affairs P.Sserssfor cf:'1`5 licanse�.oesnc- 1�v Additional Business Name License Category HS-PC 0:5"Se-'as:H-721-P-COls crud spa s'cc rff ea I oa APPROVED AS NOTED DATE: B.P. FEE2., BY: RETAIL STORM WATER RUNOFF NOTIFY BUILDING DEPARTMENT AT . PURSUANT TO CHAPTER 236 765-1802: 8 AM TO 4 PM FOR THE OF THE TOWN CODE. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE .2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUC ,0N MUST BE COMPLETE FCS, C.0. ALL CONSTRUCT!,'-.N SHALL MEET THE ELECTRICAL REQUIREMENTS OF THE CODES OF NEW INSPECTION REQUIRED YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF egCLOSE PO Sol 0�-'fQ!'�fi3'. 5 BOARD ; POI CO�/IPLE 6N- r f C(U ITHG n z ,o,:.-k Ili,•. .. ),:i ::1:.. '`.ti..n..•i ", ,,,rrn.dN-TRUSTEES OCCUP,I NCY OR mt &4- hk ( oca-(-e USE I$ UNLAWFUL WITHOUT CE R IF1CA T OF OCCUPANCY S .8✓ 1 D E R P L V Name: Radigan Contracting Date:April 12, 2022 Pool Address: 605 Gus Drive,E. Marion,NY Pool Size: 20'x40', 3.5'-8' depth Swimming Pool Contract Proposal Pool Includes: • 8"Shell, 10"beam • 2 Pool drawings • %2"Rebar(10"centers, 5"verticals) • (2)Main Drains • Rough grading • White or gray marble dust finish • Porcelain 6"x 24"tile($5.95 sq.ft.) • Pre-fab cement equipment pads • High grade 2"solid PVC plumbing • (2)skimmers • StaRite Modular Media Filter(or equivalent) • (4)returns • Pentair Variable Speed Pump • Small rounded corner stairs • Pentair Chlorinator • Individual Suction Lines • Jandy never lube valves and unions • (2) 12v LED MicroBrite Lights Features Included: Payment Schedule: Pentair Ichlor Salt Cell Deposit upon signing: 40% 4'x8'Dry well Shell installed: 40% 12"x 2"Bluestone coping Equipment installed: 10% 400k HD Heater(Jandy or StaRite) Ready for finish: 5% Fill removal by others Start up: 5% *Total Price: $80,000.00 (This proposal is good for 30 days from mailing date.) *Does not include electrical contracting,autofill waterline,dry well,fill removal,patio,fencing,tree removal, sand or stone due to poor soil conditions,forming over 18",debris dump fees,propane installation/hookup, ground water elevation test, surveyor fees, winter safety cover, pool or door alarms, indoor equipment placement,thermal barrier,or finished grade.As an industry,we are currently dealing with a Force Majeure event due to the pandemic. The unknown progression of this situation may have an effect on your project pricing and completion date as we face unprecedented product price increases,along with labor and supply shortages. (The term "Force Majeure" is described as "unforeseeable circumstances that prevent someone from fulfilling a contract".) While we will do our best to protect the existing environment,Binder Pools is not responsible for any damage to driveways,sidewalks,patios,sprinklers,septic systems,water wells,lighting, lawns or plantings.We are not responsible for obtaining certificates of occupancy.Initial I agree that this contract,including the General Terms and Conditions Contract and the White and Colored Pool Interior Finish Agreement,which I have read and to which I agree,constitutes the entire agreement relating to said sale,and I have received a true copy thereof. Agreed: Date: P.O.BOX 1960-30 S. CARTWRIGI IT ROAD-SHELTER ISLAND.NEW YORK 11964 (631)749-2110 FAX(631)749-3529-EMAIL: I-IEYBINDER i3OPTONLI1NIE.i\'ET 10.5" 12° Coping Pavers Mortar 4" Compacted Sand 6" Tile CF--0 12" Bond Beam O Marble Dust � Concrete #4 rebar X(4) #4 rebar 10" o.c. throughout 70 7„ cont. through verticals 5" o.c. where bond beam water depth exceeds 5' O /)�O)' 12" TO 36" Radius Compacted Soil �O Minimum specifications; Shotcrete Gunite 4,OOOpsi minimum �O Grade 40 rebar (conf to ASTM A615) / All work to be In compliance with ACI-318 NIV r 4" min. thick./ " Gravel base , w UNAUDTDRO AITEPAIJON OR AMR TD 10DRAWING AND REIAIED DOCUMENTS IS A NADAN OF SEC. 7209 OF INE AM=11TON LAW oR'FE S S 10��\, JOB#-. R binder T Pool $$ DATE: 5.19.19 ��'1' SHERMAN ENGINEERING DAYp SCALE; AS NOTED ® 6 &CONSULTING P.A. Cross Section 14 NELMAR AVENUE E DRAIMNG NUMBER w STAUGUSTINE, 7 32084 �. -0..~i 631.831.3872 BUILD SET 12"x2" bluestone Round cake steps coping 30" top step w/ (3) 12" steps 18'°x18" corner seat 40 ft- `I 0 .------� ;. 10 . po po � d- vi 2„ 07 10 12 f. 18 ft. 2 main drains Binder Pools, Inc. Designed by: ~- _--- - 20'X40' Gunite Pool p® Box 1960 Phone: 631-749-2110 Judy Card Designed Fax: 631-749-3529 Side view 605 Gus Drive Shelter Island NX 11964 4/11/2018 for: '�'ri-s ',}' s y•s' .%�I-may:` ,Yn.;c, " ,.y_".. +,•' _ ^"sem•" 1 F�,✓.'I3 t iP,,_•n%b<v.e lY.-.:�.....w._..+ 1K n:=,_..;i. +r�� �—.w._....,�. =:..J.'<aw.fhrvy"" V ^.?�w,' .' ".E.:a_ :{'. _ - .�.,..._A 30" top step r. BUILD SET HOUSE AREA (3) 12 11 stairs 18"x18" corner seat 4 returns 2 LED lights 8 ft. 8 ft. 8 ft. 8 ft. 8 ft. 40 ft.f j `,0„ - 10 ft. I I I I ' I I I I I � NT 00 I �p I M 04 I I I I 10 ft. I 12 ft. 18 ft. I I 12" bluestone coping 2 skimmers 20' x 40' Gunite P001Binder Pools, Inc. Designed by: Phone: 631-749-2110 PO Box 1960 Judy Card Designed 605 Gus DriveY Shelter Island NY 11964 Fax: 631-749-3529 4/5/2022 for: