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HomeMy WebLinkAbout46660-Z �o\pSUFFot,��a Town of Southold 3/17/2023 P.O.Box 1179 a 53095 Main Rd oy o�Fr Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43928 Date: 3/17/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 830 Sunset Dr,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-8-37 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/27/2021 pursuant to which Building Permit No. 46660 dated 8/6/2021 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, fenced to code, as applied The certificate is issued to Macros, Steven&Michelle of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46660 12/06/2022 PLUMBERS CERTIFICATION DATED 40 Au o ize S gnature TOWN OF SOUTHOLD BUILDING DEPARTMENT CD TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 46660 Date: 8/6/2021 Permission is hereby granted to: Macros, Steven 830 Sunset Dr Mattituck, NY 11952 To: Construct in-ground vinyl swimming pool at existing single family dwelling as applied for. At premises located at: 830 Sunset Dr, Mattituck SCTM #473889 Sec/Block/Lot# 106.-8-37 Pursuant to application dated 7/27/2021 and approved by the Building Inspector. To expire on 2/5/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector oF so�ryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlina-town.southold.ny.us Southold,NY 11971-0959 OIyCCU�e�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Steven Macros Address: 830 Sunset Dr city,Mattituck st: NY zip: 11952 Building Permit#: 46660 Section: 106 Block: 8 Lot: 37 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: MRJ Industries License No: 41853ME 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 Surrey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 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: 30A 12 Circuit Pool Panel / 6 Used, Jandy Pro Series, 1 Light 120Gfi, Pump 220 Gfi, Heater Notes: Pool Inspector Signature: Date: December 6, 2022 S.Devlin-Cert Electrical Compliance Form hO�aUf SOUIyo� �/,� 1(✓V 01 V A- # # TOWN OF SOUTHOLD BUILDING DEP7.?e/ 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) "&A ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: IVA�t� � ,G�i(21G -az DATE I o INSPECTOR �' a �._ f* e� r+ � n )� � � ,. � � �--1 ...�,.. ..� i �...i `= / ti �` �`�T�. '�'�. ,; . -s - - --- r � .�:.�•.t'- ice.=.«...»,»;� 1 ' V `i ,i ~ ti k r I � tj f • dub an R 1 FIE LD:INSPECTION REPO]tT. 'DATE COIFS FOUNDATION(IST) G y FOU�IDATION�(2ND clo ROUGH FRAMING:& y PLUMBING' INSULATION.PER N.Y. y STATEIARGY CODE FINAL .. ADp�TIOA R ® 1 ETD � o m F04°p > TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 °y�o• �at�"k Telephone (631) 765-1802 Fax (631) 765-9502 htt2s://www.southoldtowm.$Zov Date Received APPLICATION FOR BUILDING PERMIT _ For Office Use Only i V Lr-31 I 1 PERMIT N0. /� d Building Inspector: JUL L 2 7 2021 Applications and#orms.must befilled out.in their entirety...lncomplete "applications will not be accepted. Where the Applicant.is:not,`the owner,"arr` IaITIT,PING Dr,Ip°'; Owner's Authorization form.(Page 2)shall be completed;:`; Date:7/12/2021 OWNER(S)OF'PROPERTYi';;.. _. Name:SteVen Macross scTM#Z000-106-8-g_37 Project Address:830 Sunset Drive,Mattituck NY 11952 Phone#:516-443-5410 'galata-s3l@hotmaii.com Mailing Address:830 Sunset Drive Mattituck 11952 ."CONTACT PERSON: Name:John J Wysoczanski (Islandia pools)., Mailing Address:108 Fishel ave Riverhead NY 11901 Phone#:631-727-6312 Email:joh'n@islandiapools.com :DESIGN PRO FESSI.ONAL'INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION::. " Name:lslandia Pools LTD Mailing Address:108 fishel ave Riverhead NY Phone#:631-727-63,12 Email: DESCRIPTION-.OF PRO POSEUCONSTRUCTI.ON ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ROtherSwimming pool $40,000.00 Will the lot be re-graded? *Yes El No Will excess fill be removed from premises? ®Yes ONO 1 PROPERTY'INFORMATION .. . Existing use of property: Intended use of property: sWlmCplrl,g pool Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes WNo IF YES, PROVIDE A COPY. ® Check BOX After Reading:'�The owner/contractor/design professional'is responsible for alfd' rainage 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 of 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 statements made herein are punishable as a Class A misdemeanor pursuant to,Section 210.45 of the New.York State Penal Law. Application Submitted B ) ""� G ��`�^�� �� ®Authorized Agent ❑Owner pp y(print name Signature of Applicant: \. Date: STATE OF NEW YORK) SS: COUNTY OF ) John J Wysoczanski being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the Agent (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said wor n to make and file this application;that all statements contained in this application are true to the best of his/he kledge and belief; and that the work will be performed in the manner set forth in the application file therewit . Sworn before me this -1;7� day of 1�/ , 20Z) Notary ublic PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) Steven Macros residing at 830 sunset dr Mattituck do hereby authorize John J Wysoczanski to apply on my behalf to the To n of Southold Building Department for approval as described herein. -;r_krroear:+..,+.r:n.�xn�•s+ar_�"[ea.v�r�eam.�:tex�rsunnsu3s3 Owner's Signature Da !` DAVID Notary Public,State of New rint Owner's Name , i`.' No.OIFR6137963 Qualified in Suffolk Coun ' v Commission Expires Dec.05, +� ;d BUILDING DEPARTMENT- Electrical InspectcNov 0 9.7097 TOWN OF SOUTHOLD L y Town Hall Annex - 54375 Main Road - PO Box 1179 ® Southold, New York 11971-0959 Ny Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr@southoldtownny.gov— seandasoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: j2 a_j v �l C=S Electrician's Name: m.— License No.: Elec. email: o ;cL-- Elec. Phone No: —>yj/❑I request an email copy of Certificate of Compliance Elec. Address.: -17D-7 /� ys / 9el-� JOS SITE INFORMATION (All Information Required) Name: CSC c od Address: E 3 C7 n Cross Street: oc i S Phone No.: 2 ,21s 7 1c Bldg.Permit#: G// D email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): /t/(I'`) '1290 Square Footage: Circle All That Apply: Is job ready for inspection?: YES ❑NO Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size A # Meters Old Meter# ❑New Service❑Fire R ect Flood Reconnect❑Service Reconnect tEL ❑Overhead # Undergr aterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION 1 2Z 7s-0a--0-- IRP--c - ©-31-0 6 BUILDING DEPARTMENT- Electrical InspectcNo.V TOWN OF SOUTHOLD - _ - f' Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 d -.l�,Y pa .S .rte„Y'''• � cerE1south GFdtownnv.Qov "'” sC;fCsQLZtii 47idl.owS�ri\ ov ....'..'fr. — APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: IV 0-71 =� Z= 6 Electrician's Name: c�6,44 / �s License No.: 1-1�g 55 Elec. email: 2,[7,)oo--5 Elec. Phone No: LIL request an email copy of Certificate of Compliance Elec. Address.: /Q � JOB SITE INFORMATION (All Information Required) Name: GiC cr'�S Address: vC� Cross Street: Phone No.: Bldg.Permit#: �✓ O email: ry Gy�r— Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): f Ij '1200 Square Footage: Circle All Than Apply: Is job ready for inspection?: YES ❑ NO Rough In ❑ Final Do you need a Temp Certificate?: F] YES Issued On Temp Information: (All information required) Service Size❑1 PhEe 3 Ph Size A # Meters Old Meter# New S=aterals ct Flood Reconnect❑Service Reconnect❑Underground[]Overhead # Undergr 2 H Frame Pole Work done on Service? DY N Additional Information: PAYMENT DUE WITH APPLICATION I is D i �a-31-b6 �� �e �0 s � al- -2, ��� � HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET July 17,2021 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of. Macros Residence 830 Sunset Drive Mattituck,N.Y. 11952 will not require draining because the pool is constructed with a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not interfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private roads. Sincerely, 7HM gianeerg P.C. 1n • Z arnika, P.E. ril X78 N o � a N oN crC, CD 11,11 o � .,�. L, OA� m " d •/ � y . ® 0, 10 �A # o r NOTIFY 6v h % UILOlN ARTMEN -r 'ryn� 765-1802 g TO 4 FOLLOW! PM FOR TH8 D o V N p o INS, INSPECTIONS: I- FOUNDATION - TWO REQUIRE® FOR POURED CONCRETE 2. ROUGH'_ FRAMING & PLUMBING 3. INSULATION 4. FINAL � \ CONSTRUCTION MUST BE C"A^pl ALL r-TE FOR C. 0. �� C CONSTRUCTION SHALL MEET I \ Z THE RFS' 11R � r- AENTS OF THE N. Y.. \ u') STArI. CnNSTRUCTION & ENERGY R1 CC SFS. t`!OT RESPONSIBLEF 5 �eI.82 A CONSTRUCTION ERRO cn 1031tic . y a, C, - 1 .\ o ati, p Ieco i7 Q0. La L '0p00 \ it Area - 11986 , '•�"e —� 011 � ••' G 4 'r {y i�i�� zz S'61037 3 �q ' (619 � �I 1•S ;.. ,` �� a� � NOTE. m=MONUMENT SUBDI V I SIM MAPF/L ED IN THE OFF/CE a'McCl-ERIC OFSUFFOLK COUNMN APR.9,/970ASF/LEND. 5448• REVISIONSYOUNG; & i OU PTE OF ✓UNE 8,1978 400 OSTRANDER AVENUE, RIVER A� fp ALDEN W. YOUNG py�OWAR[J Y'b NG PROFESSIONAL ENGIN¢ER AND RV�.YN LAND MURVSYOR. N.Y.S. LIC. NO. 12048 - N� DO • SURVEY FOR: UNAUTHORIZED ALTERATION OR ADDITION TO R. Q. HOUSTON S SONS,INC. THIS SURVEY 19 A VIOLATION OF SECTION 7208 OF THE NEW YORK STATE EDUCATION LO/7- NO. 5O, „SUNSET KNOLLS® S 4j LAW. COPIES OF THIS SURVEY MAP NOT BEARING Sf�lAND THE LAND SURVEYORS INKED SEAL OR EMBOSSED DEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY AT NA TTI TUCK. GUARANTEED TO: SECUR/TY r/TLE 9 GUAR4NTYCQ GUARANTEES INDICATED HEREON SHALL RUN TOWN OF SOUM01-0 SAV/NGS BANK ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED,AND ON HIS BEHALF SOU THOL.D TO THE TITLE COMPANY,GOVERNMENTAL AGENCY AND LENDING INSTITUTION LI37ED SUFFOLK .Y. BY �/fQ/1�U HEREON.AND TO THE ASSIGNEES OF THE CO.,., LENDING INSTITUTION. GUARANTEES ARE p NOT THAN SFERAULE TO ADDITIONAL SCALE: �N= �O/ DATE: Y15 /97� . NO. TS-PTO INSTITUTIONS OR SUBSEQUENT OWNERS. / DATE(MM/DD/YYYY) ACoRL? CERTIFICATE OF LIABILITY INSURANCE 07/13/2021 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 CONTACT NAME: Commercial Support Edgewood Partners Insurance Center PHONEFAX 40 Marcus Drive 3rd Floor C No Ext: (866) 414-7475 (FA/C. A/C No:(631) 390-9700 E-MAIL msmcertscm@epicbrokers.com Melville NY 11747 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:HARTFORD FIRE & CASUALTY GROUP 00914 INSURED INSURER B:Technology Insurance Company, In 42376 Islandia Pools Ltd. INSURER C: 108 Fishel Avenue INSURERD: Riverhead NY 11901 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 316 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR FF POLICY NUMBER MM/DD/YYMM/DDYLIMITS LICY EXP LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMACLAIMS-MADE a OCCUR 12UUNOZ9731 04/25/2021 04/25/2022 PREM To(Ea oocurr0ence) $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY FX]PE� 7] LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 • ANY AUTO 12UENOZ9729 04/25/2021 04/25/2022 BODILY INJURY(Per person) $ OWNEDX AUTOS SCHEDULED AUTOS ONLY BODILY INJURY(Per accident) $ X HIREDX NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR 12HHUOZ9730 04/25/2021 04/25/2022 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ B WORKERS EMPLOYCOMPENSATION EMPLOYERS' Y/N TWC3961844 04/25/2021 04/25/2022 X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEM BER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ r r $ 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Main Road AUTHORIZED REPRESENTATIVE Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD'25(2016/03) The ACORD name and logo are registered marks of ACORD NEW 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 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured ISLANDIA POOLS LTD. 108 FISHEL AVENUE 6317276312 RIVERHEAD, NY 11901 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 11-2915558 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Standard Security Life Insurance Company of New York 53095 Main Road 3b.Policy Number of Entity Listed in Box"1 a" Southold, NY 11971 69146-00 3c.Policy effective period 1/1/2014 to 7/12/2022 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: ❑X 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 descpqed above. Date Signed 7/13/2021 By C/ 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 sox 4c or sB 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 form. D113-1120.1 (10-17) 11111111111111111°����������������°���°��������'1111111 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 OCCUPANCY OR APPROVED AS NOTED USE IS UNLAWFUL DATE: d'� B.P.# `&& ,o WITHOUT CERTIFICATE FEE: 415 00-t"-2 BY: OF OCCUPANCY NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST COMPLY WITH ALL CODES OF BE COMPLETE FOR C.O. NEW YORK STATE & TOWN CODES ALL CONSTRUCTION SHALL MEET THE AS (REQUIRED AND CONDITIONS OF REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR SOU HOL')TOWN ZBA DESIGN OR CONSTRUCTION ERRORS. SOUTHOLD TOWN PLANNING BOARD SOUTHOLD?OWN TRUSTEES N.Y,S.DEC '�iMMEDIATELY" ENCLIOSE;POOL TO CODE UPON COMPLETION RETAIN STORM WATER RUNOI BIEFOREVATER" PURSUANT TO CHAPTER 236 OF THE TOWN CODE. a� CAST IRON FRAME & COVER IF UNDER PAVED AREA] — FINISHED GRADE 8' MIN. - 12' MAX. 24' x NOTES: BRICK LEVELING COURSE CONCRETE COVER1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST CONC. COLLAR 27' 6' MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND AS REQUIRED MAX BACKFILLED WITH SAND AND GRAVEL TO BOTTOM OF BASIN. PRECAST 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE REINF, CONC. SUBSTITUTED WITH APPROVAL OF THE ENGINEER. DONE 4'0 PVC 3. LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. MIN. SLOEFOO RT ® ® ®®❑ 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. INVER ® ®® NON-SHRINK ®®� 5. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR GROUT FULL DEPTH. ®o o 3' MIN. SAND x 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND AND GRAVEL AND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, COLLAR (TYti ccu SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) a ALL AROUNDUND 0 PERCENT. m PRECAST REINF. n CONC. LEACHING ~ RINGS p>p� M W Wa \y W " im 8' DIAMETER wa W vDRYWELL CALCULATION: C-3 BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF) DRYWELL CAPACITY = 1,263 GAL. (168.8 CF) III '••o'0...'.•o.••, W •::o.:�.••:,:;0;;. ,.0, z 6' MIN. PENETRATION a a INTO VIRGIN STRATA w OF SAND & GRAVEL GROUND WATER DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: MACROS RESIDENCE 830 SUNSET DRIVE- MA (TUCK, N. .1195 c.� DATE: 07/17/2021 I �� HM ENGINEERING, P.C. SCALE: NOT TO SCALE THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.0.UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE NEW YORK STATE 111 17 P.O.BOX 914,EAST NORTHPORT,NY 11731 SHEET: 1 OF 1 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. DID W OUT RAISED SEALAND BLUE SIGNATURE Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.net DRYWELL DETAIL POOL NOTES: TRACK FOR 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION AND BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC PUMP VINYL LINER CODE: FILTER 2.0 SHALL CONFORM TO ANSI/.APSP/ICC 5 STANDARDS 11326;3.1: VINYL LINER 3.SECTION, POOL ALARM REQUIRED. SKIMMER $.5'', 4.PQOL SHALL COMPLY.WITH BARRIER REQUIREMENTS SECTION 11326.4. TYP ( ') FOAM PADDING . 3,500 PSI 5,POOL SHALL COMPLY WITH 2020.ENERGY CONSERVATION CONSTRUCTION CODE CONCRETE OF NYS SECTION 11403,10:' POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY.). ° SECTION.R403.10.1 HEATERS STEPS `g ' SECTION R40310:2 TIME SWITCHES PROPOSED VINYL 4 REBAR TOP SECTION F4 3.x.0':3 COVERS n 6.REBAR SHALL BE 3"MIN,CLEAR TO EARTH. RETURN SWIMMING _ POOL & BOTTOM 42 7,LOCATION"OF PROPOSED,SWIMMING POOL AND POOL EQUIPMENT.BYOTHERS 3' $00 S.F. Q AND.SHALLCOMPLY;WITHALLLOCALZONINGAE.QUIREMENTS. 20' ;'a `0 4':. 8.ACl DRAIN. COV ERS.TO.MEET ALL:R'ECWIREMENTS OF THE.VIRGINIA GRAEME I 'DUAL MAIN DRAINS WITH BAKER(VGB)POOL AND 5PA'SAFETY ACT.- STRAINER (VGB $AFE'IY 9.SLOPE PATIO SURFACE 1/4"PER FOOT'AWAY FROM POOL' ; ACT APPROVED DRAINS) a 10.'BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR LARGE ROCKS). 11:'SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH ANSI APSP I C 7. 12:ENTRAPMENT PROTECTION REQUIRED SECTION R326,5.. '77`7, 13.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF POOL: TYP ,C L, . L DE"�`AIL 14;THIS PLAN IS,FOR CONSTRUCTION ON PROPERTY AT 830SUNSET,bRIVE _._.Le eL_.. ,..--- `�--- rj... MATTITUCK;N.Y;11952,ONLY: SCALE: 3/4°; _ ;1�==:0" 15.N0 DIVING''EQUIPMENTPE11MITTED. pO�� PI N I.'A"INFORCING STEEL 5HALl BE INTERMEDIATE GRADE BILLET STEEL WITH A NOTE: NOT'`-TO .SCALA N07 „ MINIMUM LAP OF 30 BAR DIAMETERS: - - THI nI A NON-DIVING,POOL 17.PC101 WALLS,ARE NOT;DESIC�NEp'FOR SURCHARGE LQADS;EXERTED BY WHEEL 1 WA4LS SHALL BEAR ON UNDISTURBED SOIL LOADS:WITHIN SIX 6 ;FEET OF,POOL'WALL FROM CONSTRUCTION ECtUIPMENT,OR E PLACEDAS'A MONOLITHIC POUR. )C 2-Alt CONCRETE SHALL`8 ` ANY OTHER;LOADING', ONDITION IIVIP.OSED'ON THE POOLSTRUCTURE:BY EXISTING OR-PROPOSED;ApJACENT STRUCTURES:IF SITE"CONDITIONS DIFFER FR011A THIS;:„' PLAN.IT ISTHE RESPONSIBILITY OFTHE.CONTRACTOR TO CONTACT,HM: ENGINEERING',',' t. BEFORE ANY'CONSTRUCTION BEGINS. ' n 18 .HM,,ENG{NEERING�,P.G..SWALL NOTi RESPONSIBLE FOR CONSTRUCTION„ '�-4 'CONCRETE, WALL MEANS,METH,ODS,TECHNIQUES OR RROCEDURES UTILI2ED•BY,THE,CONTRACrOR, '- '- (SE'E SECTION NOR FOR THE:SAFETY OF THE'PUBUC OR CONTRgCTOR'5 EMPLOYEES;ORT 1. THIS SHEET) FAILURE OF THE CONTRACTOR TO'CARRY OUTTHE-WORK'IN ACCORDANCE UVITH THIS'PLAN.',' UNDISTURBED.'. EARTH (:TYP) 1 ty2„ To".WASTE '4'. 10' 12� HAIR &,,LINT STRAINER 3” COMPACTED 'SAND . PUMP FILTER AUTO SKIMMER POLL.. PR0 I F Not,TO 'kALE POOL BACK TO" GENERAL NOTE: POOL ALL';MANUFACTURED ITEMS AND CONSTRUCTION SHALL COIVIPLY.WITH T,HE 2020 RESIDENTIAL,COD'E OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION 11326. 2 MAIN -DRAINS PREPARED.FOR: SCHEMATIC PIPING ARRANGEMENT wiTH,HYDROSTATIC . VALVE AND' ', , MACROS_RESI,DENCE NOT, TO SCALE CALVE AN'b' UeS 830.SU.N:SET'D IN'GRAVEL;EJASE M 'TUCK, NOTE: !.� rAE: 07/,17120.21 THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. / HM ENGINEERING, P.C. LA AssHow" UNAUTHORIZED ALTERATIONS QR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE (�7�` 7/ � P.O.E30X 914 EAST NORTHPORT,NY 11,731 ET 1 OF 1NEW YORK STATE EDUCATION LAW.'INFRINGEMENTSWILL BEPROSECUTED. Tel:(516) .476-5382 Fax:(631)960-7671 Email:hmarnika@optonline.net SIDENTIALCONCRETEOID W OUTRAISED SEAL AND BLUE SIGNATURENYL LINER POOL PLAN