HomeMy WebLinkAbout48619-Z �O�Og�EFlll Town of Southold 5/31/2023
P.O.Box 1179
y 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44094 Date: 5/12/2023
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 265 Old Field Ct,Mattituck
SCTM#: 473889 Sec/Block/Lot: 120.-3-8.20
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/20/2022 pursuant to which Building Permit No. 48619 dated 12/19/2022
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:
"as-built"accessory in ground swimming pool fenced to,code as applied for.
Corrected 5/31/2023 for CO number only.
The certificate is issued to Cacace,Emilce
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48619 3/31/2023
PLUMBERS CERTIFICATION DATED
1
Au hor* e Signature
ti�O�S�FFO!y Town of Southold 5/12/2023
a P.O.Box 1179
53095 Main Rd
atj Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 48619 Date: 5/12/2023
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 265 Old Field Ct,Mattituck
SCTM#: 473889 Sec/Block/Lot: 120.-3-8.20
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/20/2022 pursuant to which Building Permit No. 48619 dated 12/19/2022
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:
"as-built"accessory in iiround swimming pool fenced to code as applied for.
The certificate is issued to Cacace,Emilce
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48619 3/31/2023
PLUMBERS CERTIFICATION DATED
ori d ignature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y: a TOWN CLERK'S OFFICE
"o • F 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#: 48619 Date: 12/19/2022
Permission is hereby granted to:
Cacace, Emilce
322 W 57th St Apt 41 K
New York, NY 10019
To: Legalize as-built in ground swimming pool at existing single family dwelling as applied
for.
Additional certification may be required.
Must maintain minimum 15 foot setback to side / rear property lines from pool and
equipment.
At premises located at:
265 Old Field Ct, Mattituck
SCTM #473889
Sec/Block/Lot# 120.-3-8.20
Pursuant to application dated 10/20/2022 and approved by the Building Inspector.
To expire on 6/1912024.
Fees:
AS BUILT- SWIMMING POOL $500.00
CO- SWIMMING POOL $50.00
Total: $550.00
Building Inspector
pF SO!/T�ol
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 aQ sean.devlin(cb-town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Emilce Cacace
Address: 265 Old Field Ct city:Mattituck st: NY zip: 11952
Building Permit#: 4$619 Section: 120 Block: 3 Lot: $.2
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: Electrician: Ground Electric License No: 46309ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service
Commerical Outdoor X 1st Floor Pool X
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt 1 Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors
Disconnect Switches 4'LED Exit Fixtures EJ Sump Pump
Other Equipment: Sub 12 Circuit/ 6 Used, Lights 120GFI on 100W Transformer, Auto Cover 120GFI,
Cleaner Pump 220GFI, Pump 220GFI, Heater
Notes: Pool
Inspector Signature: Date: March 31, 2023
S.Devlin-Cert Electrical Compliance Form
# # TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
( ] CODE VIOLATION ] PRE C/O [ ] RENTAL
REMARKS: �a
AA usl �oj em c ig / if cc o%-k
4i4ri i2n-d=h 41,a-6k'ei-'-j
DATE INSPECTOR
OF SOUTyy� d --r,Q C4 ��-
# # T WN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: P
AA I G
DATE Z 7 Z -Z3 INSPECTOR
�, hO�aOF SOUTyo�
# # TOWN OF SOUTHOLD BUILDING DEPT.
Cour, 631-765-1802
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ]. FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ELECTRICAL (ROUGH) [ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
DATE 27 INSPECTOR
k,y
pf SOUlyolo
# * TOWN OF SOUTHOLD BUILDING DEPT.
cou631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [FINAL GI"�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATIO [ ] PRE C/O [ ] RENTAL
REMARKS: �1�,mlj 6mI h
p"elle, In oa e�&
�0 1 L l� s ,e Lo�acd of j ris►d
gz, c todui or I A_ 5111
he, WI41 4 a _Dm
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DATE 4TO_V�
R4- s�
'd-0- a- INSPECTOR
r.
oF SO(/Tyo�
# f TOWN OF SOUTHOLD BUILDING DEPT.
cou 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULAT N/CAULKING
[ ] FRAMING /STRAPPING [X;r"FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ . ] PRE RO [ ] RENTAL
REMARKS:
DATE S' Y INSPECTOR
ELD INSPECTION REPORT I DATE COMMENTS
r�
FOUNDATION (1ST) y
-----------------------------------
FOUNDATION (2ND)
No
ROUGH FRAMING& Q.y
PLUMBING
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INSULATION PER N. Y. y
STATE ENERGY CODE
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(712 44 yl /1 e -Q,,mce ►n o xo rope,e- V"
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ADDITIONAL COMMENTS
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TOWN OF SOUTHOLD-BUILDING DEPAA.TMENT
A� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
ay �+
Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.
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Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector:
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Name: �(��� �d�1a �1 eZ. SCTM#...1000-1.
Project Address: 2.
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Phone#: il
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Mailing Address: Y- 1' Ce! C6(.CQC,2 CO, R
Name: ,,
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Mailing Address:
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Phone#: (0 �j �_ 3 '_ dy cr Email: Swee-n s OOlSJ eC✓
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❑New Structure ❑Addition ❑Alteration ❑Repair F-1 Demolition
Estimated Cost of Project:
Other NcuJ G,-cu -, D 0+ln + l Lkhe� -P . $-
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ONO
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Existing use of property: a,, Intended use of property: a-(
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Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
........... ...............
this property? E]Yes Eiko�IF YES, PROVIDE A COPY.
Cheek Box A
'd 1 ng:,-TFIe o nerjr�ontraatbr(destgn professional is tesponsiiite.for�ti drainage anti stoma water issues as provided by
,_ChgO.tOt"136.df'thik--,ToWnCode���APPLICATION;15HEREBY MADE'to;thd',BUilding.Deoidfti601prilm-Issuaric of iigWl ingper
Ordinance of the Town of Southold,Saffotk�County,Newyork and other apphceble Laws,Ordinances o'r lteguiaUons,forthe constructldn ofbuildings, k
addiYions,atterations orfar removal or`demoiitiorrashere�n descnbed The�pplicant agrees to comply with attapp4cable7aws,ocdmances,builtlmg code, _
fojrw!s end,in builtling(s)
punishable aS`.a Class A qtOki to Section
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Application Submitted By( ri name): MT-7 Jew Authorize Agent ElOwner
Signature of Applicant: J Date: CQ_
STATE OF NEW YORK)
COUNTY OF �'A I cj_
l" far lav 1 C-et'lewo being duly sworn, deposes and says.that (s)he is the applicant
(Name of individual signing contract) above named,
-q(S)he is the 44 1117 641 (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
6—day of 9"4emt t P_ 20 Z_ 2'
LI/ Notary Public
KATHLEEN SEATON
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATIM Registration Number#01 SE6067286
Qualified In Suffolk County
(Where the applicant is not the owner i Com mission Expires Dec.03,202_s�
I Fa 61'0 G,0 ry-)e Z_ residingat 2-G5 018 1P71 <- COu 1"+
Mao- f+a CV- N 1IqSZ do hereby authorize SCl rV Lce-- =_nC .
I —to apply on
my beh If o the Town of S hold Building Department for approval as described herein.
wner's Signature Date
EA 61(2 -, 00C-2 -
Print owner's Name
2
BUILDIN DEPARTMENT Electrical Inspector
TOWN OFSOU HOLD
' Town Hall Annex - 54375 Main road - PO Box 1179
y Southold, New York 11971-0959
�.��� Telephone (631) 765-1802 - FAX (63.1) 766-9502
rogerr(c�southoldtownny.gov'� sean�1C)a southoldtownn . ov
APPLICATION FOR ELECTRICAL INFO'
ELECTRICIAN INFORMATION (All Information Required) � Date.
Company Name: u 4 �:. ( � t CQ.c �, t G( �
Electrician's Name: V Gtu �. ck -
License No.: M C-C4(o J09 Elec. emaiii L)fid e.(0 c+L. a" Ci M C+?( • awin
Elec. Phone No: I.reqt.ue� an email-_copy of Certificate of Compliance
Elec. Address.: z ��� eve {-li le51r� v1G� �`�S_"'�
JOB SITE INFORMATION (All Information Required)
Name: a rn e Z
Address: 2--C.0 C�- 0 C� C(� 7c�C(C (�
Cross Street:
Phone No.: c c
Bldg.Permit#: email:J16Lbi o �b-t u s Inwlr-s 4vd os co v�
Tax Map District: 1000 Section; Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle AII That Apply: Final
Is job ready for inspection?: YES NU Q Rough In
Do you need a Temp Certificate?: YESNU Issued Ori
Temp Information: (All Information required) i
A # Meters Old Meter#
Service Size❑1 Ph[]3 Ph Size: -`
[a ect®Flood Reconnect Reconnect[]uncierground[overhead
New Service®Fire Reconnon servias'?
4 Underground Laterals7i 2 H Frame Pole Work done Y N
Additional Information:
PAYIVIEI T DUE WITH APPLICATI®.N
oSUFF04,f
ore
6EPARTIWEjVT..EI�r:ti'ical Inspector
Town ®,q,�� pet�or
. Hall Annex543
s � [®
V.:
Sathold 64375 Main Road _ PO
Te h , New York 1 ox 1179
err ISP one (631) 765.1��O2Yor02 '1971.0959
outhoidtownnF�aX (631) 765-9502
ov
AP--pL CA,q 1®u FOR °Vn�l southoldtown_ n
ELECTRICIAN INP ELECj-RI�
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Company Name: (Air information
Electricia Y v Required)
n s Name; i ��u _...� Cr ( - Date.
License No,; M n .
Elec, Phone No. Cx'( Elec, email
Elec.Address.: Zi .�.
I. ��� t an ernail Cio1:11- ✓Yl CQ l 1 rUv
PY of rtificate ra3
®� �IT� oNFORMATP®Iy �e Corr��fr�rice
(AH information Re j S 3
Name: �—��' O 4uire#)
Address:,
I m e Z
Cross Street. Z
Phone No.:
E31dg-Perrnit M
Tax Ma District:
1000 Section; amaii: rib,o
SRIEF on.,
OF Block-
OF: �b, s PACO s
WO�� INCLUDE Ivdros ca
SQUARE F Lot:
0O7�GE (Plea.." Print Clearly
i )
Circle All That q j
Is Job ready for in pply.
Square Foo
inspection?: .
Do you need aTemp Certificate?� yf='5
NOCRoughYDS In
Teonp Information; NU Issued Final
(All informatlon Orr
Service Slzeal PE]
required)
3 Ph Size: 1
New Senrlce ___ - A : �*Meters
®Fire ReconnectC]Flood '-~ Old Meter#
�Underground Laterals Reconnect
z Old
Reconnect j] g --®"
Additional information: H Frame Under round y
Pole Work done o a verhead
n servias? Y
N
PAENT Due .... APPLIC
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. RECEIPT
SUFFOLK COUNTY GOVERNMENT
DEPARTMENT OF LABOR, LICENSING,AND CONSUMER AFFAIRS
COMMISSIONER ROSALIE DRAGO
P.O. BOX 6100, HAUPPAUGE, NY 11788
(631)853-4600
Today®ate: 03/29/2022
Application: H-53211-REN01 , License#: H-53211
Application Type: Home Improvement License Renewal
Receipt No. 441695
Payment Method Ref. Number Amount Paid Payment Date Cashier ID. Comments
Credit Card $400.00 03/24/2022 PUBLICUSER18722
.................................................._.....-----------.................------.........--------........
Total: $400.00
Contact Info:. _.....SAVE-�-NIiY`S-P40��SER�4EE'INC:...:::._�._._�_...- :�. .. . . .... . _.�.,:.: .:.:... .......__.. .: .
KENNETH M SWEENEY
1740 CHURCH STREET
HOLBROOK, NY 11741
Work Description: _
Su.011rcounty bopt.of
+ -Labor,Licensing&Consumer Affairs
HOME 11APROVEMENT LICENSE
Name
KENNETH AA SWEENEY
ausilness Name
>certtfies that the SWEENEY'S POOLSERVICE INC
wer is duty licensed
:he Courty of suf'olk
License Number.H-53211
Rosalie Drags Issued: 04103!2014
Commissioner Expires: 4/1/2024
DATE(MWDDrrYYY)
CERTIFICATE OF LIABILITY INSURANCE 9/28/2022
THIS CERTIFICATE IS ISSUEDAS.A"MATTER OF INFORMATION.ONLY AND CONFERS-NO RIGHTS UPON THE CERTIFICATE.HOLDER.
CERTIFICATE DOES NOT-AFFIRMATIVELY'OR NEGATIVELY'AMEND,:EXTEND OR ALTER THE:COVERAGE:AFFORRED,BY THE POLICIES
BELOW. THIS.'CERTIFICATE OF:INSURANCE DOES.,.NOT'.CONSTITUTE,A,CONTRACT BETWEEN THE ISSUING INSURER(S),.AUTHORIZED.
REPRESENTATIVE.OR PRODUCER;ANp'THE CERTIFICATE i1OLDER:.
IMPORTANT: If the certificate.holderis.an ADDITIONAL INSURED,the.policy(les)must have ADDITIONAL.INSURED.provisions-or be endorsed.
If SUBROGATION IS WAIVED;subject to the terms and conditions of the policy,certain policies may require.an:endorsement. A statement on
this,.certifacate does not confer rights'to the certificate holder in lieu of:such endorsement(S):.
.PRODUCERCONTACT.
NAME::,� _
DKM Insurance Agency Inc.. PHONE . . X363=5200"` " FaXr%tv mg
3i`363-7649"�;"
One Rabro Drive,Suite 11 Ea l xi); -- �- TTFAX
Hauppauge;NY '11.788
DDREss: coi@dkm1nsurance,com
_ INSURERS•AFFORDING COVERAGE MAIC#
I
NSURER A:_ATLANTIC CASUALTY,INS CO
INSURED, R 8,
SWEENEY'S.POOL SERVICE.INC. Ro1740CHURCHSTREET HOLBROOK,NY 11741 R a R E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:: .
THIS IS TO CERTIFY THAT THE..POLICIES.OF:INSURANCE LISTED.BELOW:HAVE BEEN.ISSUED;TO THE INSURED NAMED.ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITH$TANDING:ANY REQUIREMENT,.TERM OR CONDITION OF ANY:CONTRACT OR:OTHER DOCUMENT.WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE,ISSUED OR MAY PERTNN,'THE INSURANCE:AFFORDED.BY THE POLICIES_DESCRIBED HEREIN.IS:SUBJECT,TOALL THE.TERMS.,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.IIMITS.SHOWN MAY HAVE BEEN REDUCED.BY PAID.CLAIMS.
INSR. ADDLS BR POLICY EFF 'POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER M IDDIYYYY MMIDD/YYYY I. LIMITS.
COMNIERCIALGHNERAL;LIABILITY 43260D0337:D: EACFI OCCURRENCE. $ 1.,000,000
q. � Y Y - 8/07/2022 ..810712023. Gt r�i"_eR'1"Eb
a CLAIMS-MADE LIJ OCCUR J PREMISES E8bCCuptqncqL 100,000
{ MED EXP_Any one:person) s 5;000
i PERSONAL&ADV INJUR_..Y _I S A,000,000
GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE Is 21000;000
X POLICY JEC LOG PRODUCTS-CO_MPIOP_AGG.t S _INGL_UA_�'
OTHER: $ .
AUTOMOBII E.UABILITY COMBINED SINGLE LIMIT $
Ea acci ent _
ANY AUTO BODILY.INJURY(per person) S'
OWNED. SCHEDULED BODILY INJURY.peracc;denl $
AUTOS ONLY AUTOS ii ( ) _
HIRED I NON-OWNED I PROPERTY DAMAGE S.
AUTOS ONLY AUTOS ONLY Per accident)"
UMBRELLA LIABpCCUR EACH OCCURRENCE �..
EXCESS LIAB 1 CLAIMS-MADE A�G`GREGATE. $
DED 1. RETENTIONS.
S
WORKERS COMPENSATION I PER OTH
AND EMPLOYERS'LIABILITY y/N STATUTE. R
ANY PROPRIET6WPARTNERIEXECU1nve: E.�.EACHACCIDENT $
OFFICERIMEMBER EXCLUDED?:.". F-1
NIA - - - - -- - - -
(Mandatory to NH).. I E.L,DISEASE•.EA EMPLOYE $
If yes,descnbe under - -
DESCRIPTION OF OPERATtONSbelow ( E.C.DISEASE-POLICY LIMIT $
f. E
DESCRIPTION OF OPERATIONS(LOCATIONS I VEHICLES(ACORD 101,Additlonal Remark9 Schedule,may bo attached.tf more space to iequtredl
CERTIFICATE HOLDER CANCELLATION
Towh of Southold, SHOULD ANY OF THE ABOVE DESCRIBED.POLICIES BE.CANCELLED�BEFORE
54375._NY-25 THE EXPIRATION DATE THEREOF,:'NOTICE WILL BE DELIVERED IN
ACCORDANCE MATH THE,PoLltY PROVISIONS.
Southold,14Y 11971 .
AUTHO RkEO REPRESENTATIVE
,A.v(,svjdycel
O'1988-2018'ACORD CORPORATION: Ail•rights reserved..
ACORD.25(2016/03) The ACORD name and logo are registered marks of ACORD
w.. w°rkers'
�onsation: CERTIFICATE,OF INSURANCE CO, /ERAGE
Y4Ut1tK
srattpe .
Board: NYS DISABILITY'AND PAID,FAMILY..LEAVE BENEFITS LAIN .
PART 1.To be:completed by NYS disability and Paid.Family Leave benefits carrier or licensed insurance agent.of that carriell
la.Leg6l.Namp:8 Address,of.lnsured(use street address onj 10.Business Telephone Number of Insured
S WEENEY'S POOL SERVICE INC. 631-43-1-049.8
1.740:CH6RCH STREET
HOLBROOK,NY 11741
le-FederatEmployer,Identiflcation.Numberof Insured.
or Social Security Number
Work Location.of.l n$ured(Only requfred if Overage is apecif tally limited to
certain tocailons In,New York State.l:e.,.Wrtip-Up MICA 473$9.0168
2.Name and Address of Entity Requesting Proof:af Coverage 3a:Name of Insurance Carrier .
'(Entity Being Listed as the Certificate Holder) SlielterPoint Life insurance Company
TOW(1 of Southold3b.:Policy.Number of.Entity Listed.ih Box"i a"
DBL470388
54375 NY-25 ..
Southold, NY 1191 3c.Policy effective period'
08/08/2022 to 08/07/2023
4. Policy,provides the.following benefits:
® 'A.Both disc-bility and'paid family leave beriefits.
B.Disabilkv benefiits only.
C.Paid family leave benefits only.
5. .Policy covers:
® A.Ali ofahe bmployers.employees eligible under the NYS Disability and.Pald Family Leave Benefits Law.
B.Ohly theJollowing Class or classes of employer's employees:
Orider penalty of perjury,I certify that I-am an authorized representative or licensed agentof:the Insurance carrier referenced.aboye and.thai the named
insured has NYS Disability,and/or Paid Family LeaVe:Benefits Insurance coverage as described above.
9/28/2022. g' � W U . .
Date Signed Y
(Signature of it sutance carriers authorized representative or W5 Licensed Insurance:Agent of that insurance carrier)
TelephoneNurnber. 516429,8106 '. NameandTitle Richard Whitt? thief'EXeCutiVe Offer
IMPORTANT .If Boxes 4A.and:5A are checked,and this form is slgned by the insurance carrier's authorized tative or NYS
Licensed Insurance Agent of.that carrier,this certificate is COMPLETE.Mail,it directly to-the certifiicate holder.
If Box 4B,4C:or 5B.is checked'i this certificate Is.NOTCOMPLETE for purposes of Section_220,Subd,g.of the NYS
Qisabitity and.Paid Family Leave Benefits.Law:lt must be emailed to PAL1@wcb.ny.gov or it cari be mailed for
cornpletion to.the Workers"Compensation Board, Plans.Acceptance:Unit,.PO.Box.5200,Binghamton;NY 1;3902-5200.
PART.2.To.be completed:by the.NYS Workers'Comperlsatiorr Board(only it:Box:4B,.4C or 56-have.been.checked)
State of-New York
Workers':Compensation._Bt>'ard
According,to information maintained by the NYS Workers'Compensation Board;the:above-named arnployer has complied with the
NYS Disability:and Paid.Family i:eave.Bertefits Law(Arricle,9 of the Workers'Compensation Law)with,respect,to all of:their.employees.. .
Date-Signed 8Y
(Signature of Authorized NYS Workers'[ompensailon Board Employee)
Telephone:Number,. Name and Title
Please Nate:Onlylnsurance carriers ficensod to write NYS disabl(ity and paid family leave benefits insurance.policies.and NYS'licensed insuragae:
agents-of those.insurance carriers are authorized to issue Form D8-170:fi:Insurance brokers are NOT authorized to issue this form.
`�I��I�IIUIIIIi[II111111hllllltllli�lillll�{llJlll 11.
�Fllf N .
YO121( '9! orkors
CERTIFICATE OF
E. Con'i0ensatibn NYS.W RKERS' COMPENSATI®N INSURANCE COVERAGE
Board
1a.Legal Name&Address,ofinsured.(use:street address.oniy) Ib.Business Telephone Number of Insured
Sweaney`s Pool Service,Inc: 631 431.0498 .
1.140 Church Street
1io16rook;NU.11741 • 1c.NYS UnemployrrientInsuranceEmployer.Registration Number of
Insured-
Work.Location
nsuredWork.Location;of insured(Only requiredif.coverage is Specifically NOW to 1d.Federal Employer tdentificationNumber•ofInsured or Social Security
certain locations.in New York state,i.e.,a Wrap iLlp Policy) Number.
47-3890168
2..Name-and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier
(Entity Being Listed 6t the Certificate Holder) Continental Indemnity
Town of Southold 3b,Policy:Number:of Entity Usted.in.Box"1 a"
54375 NY 25 37-58' 979-01=01
Southold,NY 11971
3c..Policy.effective period
06/22/2022 to 06/22/2023
3d:The Proprietor,Partners or Executive Offcers:are.
Q included.(Only check boxif all partners/officers included)
[X] all excluded or,certaimpartnerslofficers excluded.
This certifies that the insurance carrier indicated above in box"3"insures the business referor ced:aboVe in box"1a"for workers'
compensation underthe New York State Workers'Compensation Law.(To usethis form,NewYork(NY.)must be:listed under:item 3A
on the INFORMATION.PAGE-of the.workers'compensation insurance policy). The insurance Carrier or itslicensed-a eht will send
this Certificate of Insurance to the entity listed above 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 canceled
due to.nonpaymeni of premiums or within.30 days IF there ate reasons otherthan.16hpaymerit:of premiums that cancel the policy or
eliminate the insured from the coverage indicatedon 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 fisted in box:"W%whichever.i5 earlier.
This certificate is:issued.as.4 matter of information ohly 6nd-66nfers no rights upoh 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 thosecontained in the
referenced.policy.
This certificate may be used as evidence of a:Workers'Compensation contract of insurance onlywhile the underlying.policy is in effect:
Please Note:.Upo,n Cancellation'of the workers'compensation policy.indicated.on this:fortn,if the business continiresao be
named on.a permiti license or contract.issued by a certificate holder;the business must.provide that.certificate holder with a
new Cbr ificM6 of Workers.'Compensation Coverage or other authorized proof that:the business..is complying with.the
mandatory coverage requirements.ofthe New York State Workers'Compensation L:W.
Under penalty of perjury;l.certify that'1.am an authorized representative.
:or licensed agent of the insurance carrier referenced
above and,that the:name&insured has.,the coverageas depicted on this form.
Approv y: `.Ann 1 ce
( r'PAIRame of authorized representative or licensed agentof insurance carrier)
Appro. d.by:
(Sig ture). (pate)
Title:AccountSup r
Telephone Nurrmber:of•authorized ,representative or licensed.agent of insurance carrier: 631 363-5200
Please Note:.Only insurance carriers and their licensed agents are'authorized to issue Form C-106.2.Insurance brokers are NOT
authorized to issue it. .
0;105.2(9-17) www;wcb.ny.gov
NOTES: SURVEY OFPROPERTY
1.PROPERTY KNOWN AS TAX NIVP# 1000-120.00-03-008.020
2.LOT AREA-40,000 SO.Fr. 0.918 ACRE(S))
3. THIS SURVEY WAS PREPARED USING A TRIMBLE LOT 18
S3 ROBOTIC TOTAL STATION.
4.PROPERTY CORNER MONUMENTS WERE NOT SET AS MAP OF
PART OF THIS SURVEY. FARMVEU ASSOCIATES
FILED: SEPTEMBER 1, 1989 - MAP #:5808
SITUATE
AlATTITUCK
(60•� TOIFN OF SOUTHOLD
OLD FIELD COURT SUFFOLK COUNTY, N.Y.
N 70°19'30" E 1+25.001 SURVEYED: MAY 19[ 2022
0 0
o � o
M h CERTIFlED TO:
�, N3 EMILCE CACACE FASIO COME2
4 A&D MORTGAGE I.I.C.ITS SUCCESSORS MIO/OR
ASSIGNS,AS AN INSURED,AS THEIR INTEREST MAY
APPEAR
Af
FIRST AMERICAN TITLE INSURANCE COMPANY
1HE JUDICIAL TITLE INSURANCE AGENCY LLC
EXIST, BUILDING COVERAGE INFO:
31.1' LOT AREA-40,000 SOFT.(0.918 ACRE(S))
722 _7• COV.Y 00 PoA[tl
[ RESIDENCE 1,565 SOFT.
PORCH; 278 SOFT.
2 Story TOTAL 1,843 SOFT./4.6%
Fm 6idence
EXIST, TOTAL LOT COVERAGE INFO:
LOT AREA-40,000 SOFT. (0.918 ACRE(S))
40.0, 21.7' * RESIDENCE 1,565 SOFT.
FE441 PORCH: 278 SOFT.
SHP STEPS: 30 SO.FT.
TOTAL: 1,873 SO.Fr./4.7%
i LOT 17
i
LOT 19
/
i
i
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CME CN9)SSCD SUL SW:L UOT DEMNSBEPED 70 DE A VkQ CQPI,
LOT 12 E
i
i MICHAEL K. WICKS
` LAND SURVEYING
8
16 FROWEiN ROAD- SUITS E2 E
i CENTER MORICHES. NEW YORK 11934
VOICE.• 631.874,0166 - FAX: 631.909.3846
www.wickstandsurveying.com Y
RECORDS OF RICHARD C. DRAKE
0
SCALE: SURVEYED BY: DRAWN BY: SHEET:
MICHAEL K WICKS. RLS. #60390 1'-30' M.W. J•VV.W. 1 OF 1
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C ffA
APPROVED AS NOTED
DATE: d' 9 a2 13.P.# �S�/ OCCUPANCY OR
FEE'5�. 00 BY: USE IS UNLAWFUL
NOTIFY BUILDING DEPARTMENT AT WITHOUT CERTIFICATE
631-765-1802 8AM TO 4PM FOR THE OF OCCUPANCY ;
FOLLOWING INSPECTIONS:
1. FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH-FRAMING&PLUMBING
3. INSULATION
4. FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O. !,A L,- K171-1 ALL CODES Oi=
ALL CONSTRUCTION SHALL MEET THE C,I4:'vV YORK STATE & TOWN CODES
REQUIREMENTS OF THE CODES OF NEW AS REOUIR AND CONDITIONS OF
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTON ERRORS SOUTHOLD TOWN ZBA
SOUTHOLD TOWN PLANNING BOARD
SOUTHOLD TOWN TRUSTEES
"IMV MEMATE�LY" N.Y.S.DEC
ENCLOSE POOL T&CODE
UPON COMPLETION
Sr.-FORE "WATER"
RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
Additional OF THE TOWN CODE.
Certification
May Be Required.
HM ENGINEERING P.C.
P.O.BOX 914
EAST NORTHPORT,NY 11731
TEL:516-476-5392
EMAIL:HMARNIKA@OPTONLINE.NET
September 20, 2022
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:
Gomez Residence
265 Old Field Court
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,
HMgineering P.0
� A
Marnika, P.E.
POOL NOTES:
TRACK FOR 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION AND
PUMP VINYL LINER BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC CODE.
FILTER 2.POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1.
VINYL LINER 3.SECTION R326.7 POOL ALARM REQUIRED.
RETURN SKIMMER ° ° a• I ---_ i--- 1 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4.
It-1:11
(TYP•) T(TYP•) 11 1 _. _ _ a S.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE OF
r- FOAM PADDING 3,5 ---00 PSI _ NYS SECTION R403.10:
BENCH a. a CONCRETE {I{ POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY).
SECTION R403.10.1 HEATERS
SWIM-OUT
8 _
(TYp,) i —_ I i SECTION R403.10.2 TIME SWITCHES
° 0" _ -- SECTION R403.10.3 COVERS
UNDISTU
70 RBED— 6.REBAR SHALL BE 3"MIN.CLEAR TO EARTH.
PROPOSED VINYL SUNDECK EARTH I-- 7.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS AND
#4 REBAR �_ i SHALL COMPLY WITH ALL LOCAL ZONING REQUIREMENTS.
3,
SWIMMING POOL TOP, MIDDLE 48„ _ 1 �_w 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME BAKER
(MIN.) 20' & BOT. ° i (VGB)POOL AND SPA SAFETY ACT.
9.SLOPE PATIO SURFACE 1/4"PER FOOT AWAY FROM POOL.
AUTO DUAL MAIN DRAINS WITH d I I I 1 .BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL NO CLAY OR
COVER— STRAINER (VGB SAFETY LARGE ROCKS).
I
a 0 C (
VAULT I I I ACT APPROVED DRAINS) ° _I - l `- - 11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH
I I I I I 1 ANSI/APSP/ICC 7.
————-1- I STEPS ( 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5.
13.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL
LOADS WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION-EQUIPMENT OR ANY
OTHER LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING OR
L _ I � PROPOSED ADJACENT STRUCTURES.
I 14.NO DIVING EQUIPMENT PERMITTED.
15.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF POOL.
16.THIS PLAN F101952 ONLYUCTION ON PROPERTY AT 265 OLD FIELD COURT,
TYPICAL WALL DETAIL MATTITUCK,N.Y
NOTE:
POOL PLAN SCALE: 3/4„ = 1'-0” 17.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A
THIS IS A NON-DIVING POOL. NOT TO SCALE MINIMUM LAP OF 30 BAR DIAMETERS.
18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION MEANS,
NOTES: METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR,NOR FOR THE
1.WALLS SHALL BEAR ON UNDISTURBED SOIL SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE FAILURE OF THE
2.ALL CONCRETE SHALL BE PLACED AS A MONOLITHIC POUR. CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH THIS PLAN.
5'-6"
t lb
CONCRETE WALL
(SEE SECTION 1 1/2- TO WASTE
THIS SHEET)
2" COMPACTED HAIR & LINT STRAINER
SANDUNDISTURBED
EARTH (TYP.) PUMP
2' 8' 10' 20'
FILTER AUTO SKIMMER
POOL PROFILE POOL
NOT TO SCALE BACK TO
POOL
GENERAL NOTE:
ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 2 MAIN DRAINS
RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. PREPARED FOR: SCHEMATIC PIPING ARRANGEMENT
GOMEZ RESIDENCE NOT TO SCALE
265 OLD FIELD COURT
JOID
TITUCK, N.Y. 1952
DATE: 09/20/2022
NOTE: HM ENGINEERING, P.C. SCALE: AS SHOWN
THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. ��D SHEET: 10171
UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE D '/�v�ZZ P.O.BOX 914 EAST NORTHPORT,NY 11731
NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.net
MA
CONCRETE
UT RAISED SEAL AND BLUE SIGNATURE VINYL LINER POOL PLAN
CAST IRON FRAME & COVER
IF UNDER PAVED AREA FINISHED GRADE
\ L'___ oo�
8' MIN. - 12' MAX. 24' X NOTES:
BRICK LEVELING COURSE �� MIN
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.
DOME
4'0 PVC 3. LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS.
MIN. SPER FOOT ® ® ® ®� 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.
®❑ 3' MIN. SAND 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND
F AND GRAVEL AND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND,
W COLLAR (TYP) a th
ALL AROUND y a SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5)
a y PERCENT.
PRECAST REINF. :3
CONC. LEACHING
L- RINGS W
L)
fL
W
y
�� ;r 8' DIAMETER
wa
N
y
W o o DRYWELL CALCULATION:
Za BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF)
DRYWELL CAPACITY = 1,263 GAL. (168.8 CF)
LLI
Z 6' MIN, PENETRATION
Fu a INTO VIRGIN STRATA
GROUND WATER
oe OF SAND & GRAVEL
DRAINAGE POOL DETAIL
NOT TO SCALE
PREPARED FOR:
GOMEZ RESIDENCE
265 OLD FIELD COURT
MrTITUCK, 1195
v v DATE: 09/20/2022
NOTE: HM ENGINEERING, P.C. SCALE: NOT TO SCALE
THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED N SHEET 1 OF 1
ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE P.O.BOX 914,EAST NORTHPORT,NY 11731
EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. (( Tel:(516)476-5392 Fax:(631)980-7671 Email:hmarnika@optonline.net DRYWELL DETAIL
DID
T RAISED SEAL AND BLUE SIGNATURE