HomeMy WebLinkAbout49525-Z � r TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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#: 49525 Date: 7/28/2023
Permission is hereby granted to:
Guddat, Steven
54 W 16th St Apt 15B
New York, NY 10011
To: construct accessory in-ground swimming pool as applied for per Trustees approval.
Swimming pool and pool equiment must be located at a minimum of 25' from lot lines.
At premises located at:
36581 CR 48 Peconic
SCTM #473889
Sec/Block/Lot# 68.4-23
Pursuant to application dated 6/21/2023 and approved by the Building Inspector..
To expire on 1/26/2025.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
Buii rng Inspector
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 haws, -south l towl n t-V
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT N0,
Building Inspector'r
AN 2 1 2023
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:06/09/23
OWNER(S)OF PROPERTY:
Name:Steven Guddat/ Torey Acri SCTM#1000-68-04-23
Project Address:36581 County Rd. 48, Peconic NY 11958
Phone#:
�; , �17568-4422
sguddat@gmail.com
Mailing Address:same as above
CONTACT PERSON:
Name:Steven Guddat
Mailing Address:36581 County Rd. 48, Peconic NY 11958
Phone#:(g17) 568-4422 Email:sguddat@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:n/a
Mailing Address:n/a
Phone#:n/
:EEmail:n/a
CONTRACTOR INFORMATION:
Name:David Freeborn Islandia Pools Ltd
Mailing Address:108 Fishel Ave. Riverhead NY 11901
Phone#: �Email:dave
(631)727-6312
DESCRIPTION OF PROPOSED CONSTRUCTION
:Z:gated Cost of Project:
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition 00.00
Dother 18x36 inground vinyl swimming pool
Will the lot be re-graded? ❑Yes ANo Will excess fill be removed from premises? DYes [:]No
1
PROPERTY INFORMATION
Existing use of property: L-e Intended use of property:
Zone or use district in which premises is situated: Are there any cove ants and restrictions wqth respect to
this property? E]YesZNo IF YES, PROVIDE A COPY.
'tjj�Gheck 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 Bullding 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 statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By Tint a e): Aut ori ed Agent ❑Owner
Signature of Applicant: Date: 4
STATE OF NEW YORK)
S .
COUNTY OF
X-) being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the W� La 2i ---,/ �'"
(Contractor,Agent, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work a to make and file this
application; that all statements contained in this application are true to the best of his/her k edge 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 U , 20�
a C
w, Nc I ii l,�York
49�ik9 7i 4 k� �n
PROPERTY OWNER AUTHORIZATION.
,.. U5 20
(Where the applicant is not the owner) ommission 6vire
w
I, O residing at 3ro5� C
r i� do hereby authori " ~I � to apply or,
my behalf to the Town of outhold Building Department for approval as describe herein.
Owner's SigKaturl D4te
-11Z.Aj l�
i��
Building Ike artment A plication
AUTHORIZATION
(Where the Applicant is not the Owner)
I
residing at w-366-9-1Gt ��(
(Print property owner's natne) (Mailing Address)
G t-J
do hereby authorize ��
(Agent)
A�.D A L to apply on my behalf to the
Southold Building Department.
`'
L,5
Date
( Wnet s Stgnatu ) ( )
S716YO &VP
(Print Owner's Name)
Scott
A. Russell po
SUPERVISOR " hM[A NA\�G�]ETWIENT
SOUTHOLD TOWN HALL-P.O.Box 1179 `wXa� Z
53095 Main Road-SOUTHOLD,NEW YORK 11971 T� � -- 1 own o,f Southold
CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM
------ ( APPLICANT INFORMATION
ATION TO BE COMPLETED BY THE APPLICANT
;;I ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. )
APPLICANT Design(Property Owner, Des n Professional, Agent, Contractor, Other)
NAME:
Date;
"i K:N I1 91Y�`tl m n mmm � .�
Contact Informa fon. " _. ..._ . .........
L-Mad R-I elephnoe Numheu y
Pro ert Address / Location of Construction Site:
S.C.T.M. #: 1000
_.--
.... .. .._.
02-11
Section
.11
- .._ .._.......� __.� ....m. — Block Lot..
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
... - i
Area of Disturbance a less than 1 Acre, No S.P.D.E.S. Permit is Re aired .
S.
it is
Project does Not Discharge to Watel the
& Storm-�aterPR rnof�fPDLsclhargeeDrrectdly
Area of Disturbance is Greater than 1 Acre
to Waters DIRECTLY From FtronSNtY.Sf DeE C Prior t THE
nuance c f a Bui)dIIUS P OBTAIN a S.P.D..E.S. Permit,
- Area of Disturbance is Greater than 1 ,Acre & Storm-N•\ater Runoff Flows Through Southold
Town's MS4 Systems to Waters of the State of Ne\,\ York, THE APPLICANT MUST OBTAIN
a S.P.D.E.S. Permit through the Southold Town Enarneerin De artment
Prior to Issuance of a Building Permit,
n Date. 6µ
Rei levv ed By. k—jAiJ
. ..fix _�� ........�.__.�.�..�...,--_rm. ....�...,,. ._ .. .�.... �
F'np M (-,Nr('P-TnC nrtnhp. )n l c) / n I
ti
Glenn Goldsmith,President �Q � Town Hall Annex
A.Nicholas Krupski,Vice President ""b 54375 Route 25
P.O.Box 1179
Eric SepenoskiAV
Southold,New York 11971
Liz GilloolyTelephone(631) 765-1892
Elizabeth Peeples Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 15, 2023
Robert W. Anderson
Suffolk Environmental Consulting, Inc.
P.O. Box 2003
Bridgehampton, NY 11932
RE: STEVEN GUDDAT & TORREY ACRI
36581 C.R. 48, PECONIC
SCTM# 1000-68-4-23
Dear Mr. Anderson:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, June 14, 2023:
RESOLVED that the Southold Town Board of Trustees grants a One (1) Year Extension
to Wetland Permit#9992, as issued on September 15, 2021.
This is not an approval from any other agency.
If you have any questions, please do not hesitate to contact this office.
Sin rely,
44���
Glenn Goldsmith
President, Board of Trustees
GG:dd
G
BOARD OF SOUTHOLD TOWN TRUSTEES
SOUTHOLD,NEW YORK
PERMIT NO.9992 DATE: SEPTEMBER 1S 2021
ISSUED TO: STEVEN OUDDAT&TORREY ACRI
PROPERTY ADDRESS: 36581 C.R.48,PECONIC
SCTM#1000-68-4-23
AUTHORIZATION
Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in
accordance with the Resolution of the Board of Trustees adopted at the meeting held on Se tember 15 2021,,
and in consideration of application fee in the sum of$250.00 paid by Steven Ouddat&Torrey Acri and subject
to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and
permits the following:
Wetland Permit to construct a 229sq.ft.addition onto existing 2,118sq.ft.two-story dwelling
with attached garage; construct a 1,673sq,ft.addition to existing deck; install a 744sq.ft.
swimming pool;install a 211sq.ft.cabana/pool house; and to construct a 749sq.ft.detached
garage and parking areas thereon; establish and perpetually maintain a 10'wide non-turf
buffer landward of the edge of the freshwater wetlands; and as depicted on the site plan
prepared by Sean Q.Madigan,AIA,last dated on September 11,2021,and stamped approved
on September 15,2021.
IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these
presents to be subscribed by a majority of the said Board as of the 15th day of September,2021. g
n
VIC .m
: w.'�r ° a.,��+ �. rhn�.�„. , 'r• ;,-aaa�° „�+w�,�rw,v�w°�.. a, � s¢.tmrrk "avf�q�r„.a„,r � � ¢
[ s..•` ,`_ _. ] SITE PLAN NOTES o - STEVE GUDDAT&TORREY ACRI
��� /� BU{lDJNGAREAARALYSIS.
PRIVATE
I N"EEXISPEINGBULDINGAREA ZIISSF RESIDENCE
,.
ADDRIO.BUILDIMGAREA 2295E _ 3
HOUSE IS= 36581 ROUTE 4B
�- EXSTINGDECK 782 SF PECONIC,NY 11958
q PR DOECKAREA 9,673 SF
114,1
Z p I 9 �l PRGPOSED AfiFA Y465i - -
�.' T { g PRER^SERCABANAAREA 297 IS
SeanT FAndffian,ABA I
• ny 3 4 PR DPOLL PATIO ARES wIF ARCHRECT
.ARCHITECT <2sgn�502
GARAGE H-P-13 y.w Iwo
EDSTGRAQIAAGCEAR£4- 749 IF
Ems" =at I 1(831)23&9749
e 3�f f'�f l� i I T6TdL F365Tihti BUftffiNGARE4: 2,ms, f]ilaiWro MdomkaENEnO�EiceenPLLc
'n@,
fff s' t _j TOTAL ALLOWABLE 9URZOIG AREA: 37,633 SF
TOTAL PROPOSED BUiLDWG AREA, 7,M6 SP ®IL4NDRO ANDREWS 858 County Road 39,S.A.90
S.W. PIPAI9 49888
f 639 23
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. P, ;�r j . j - ..' `a•4 .�—su+a amu,es EMSTINENxaBs=: ss•a'
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PROPOSED K" 44'4'
PROPOSED
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PROPOSED PKKP.LPATtl9
C /' f �` .� FFESBnnhA WEaUv�u PIn ROPOSEDP CARANA: 994'5° eDsh6 b—D..[*. By Chah
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PROPOSED GARAGE 2878• 9 9597127 TRUSTEES SS SON SCm
k M1121M1121i TRUSTEES RESPONSE 8IX'A SEM
EA3MNGMMNHWSE W-2'a361' i _
AOCOTiEUSE fdAIN HdDSE:POWHJ1 Ya2.7
GREU&YORAGE 35Ya2PS `
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PE9uMc,uruss3 — h \-- - -SHEET NOTES
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tUSURyEyORS,ED.DATED NOVEMBER IM.r`
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APPRO BY
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DATE PAR—mw-_ltvN:t
GAS Fff 694STORES: 82F772956TORIES ~ 3
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ABMTOTAL %YtA5T `S '+g £• T z f `i&.<
ABN REARYAiD GET dR `
AccEssmstRucnnEs _/ � fR�ncu
MAX WJGHF. BFf 1. �� _ SITE PLAN
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€ ? iffll j— -T.',€IMT Route 48-Stove GaddaBV74 N4odeisA29092 36584 RPN 45 M
N
"YOR workers' CERTIFICATE OF INSURANCE COVERAGE
N
TATE 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
1 a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured
ISLANDIA POOLS LTD.
108 FISHEL AVENUE 6317276312
RIVERHEAD, NY 11901
1c. Federal Employer Identification Number of Insured
Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number
certain locations in New York State,i,e.,wrap-up Policy)
11-2915558
�_................ _ _.... ............ ..
2.Name and Address of Entity Reque '-)f of Coverage 3a. Name of Insurance Carrier
(Entity Being Listed as the Certific—1 ! Standard Security Life Insurance Company of New York
Town of Southold 1
53095 Main Rd 3b.Policy Number of Entity Listed in Box 1a
Southold, NY 11971 69146-00
3c. Policy Effective Period
1/1/2014 to 6/14/2024
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:
Q 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 penaltyof perjury,
that
p � ry, 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 descr' ,d above.
0 U-
Date Signed 6/16/2023 By of insurance carrier's atati or d represcntat or NYS licensed insurance agent of that insurance_ - rrie�.
_ _. .
"'� "" carrier)
(Signature
41 Name and Title SUPERVISOR-DBL/POLICY SERVICES
Telephone Number �212� 355-41 � �..-�--
IMPORTANT:lf 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 Box 4B,4C or 56 of Part 1 has been checked)
__..._.. ...__ _-
State of New York
Workers'' Co peni atio 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(Artic)e 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
y n licensed tNYS s 'ty an�Paid Family Leae benefits policies
'ard NYS licensed
suane agentts of those urance carriers aeauthorrized o seForm DB-120.1. nsu ante brokers are NOT authorized
lo issue this form.
DB-120.1 (12-21) 1111111111111111111111111111111°11°111°°°111°1111111
CYORt< Workers' CERTIFICATE OF
... sTATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE
Board
1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured
Islandia Pools Ltd. (631) 727-6312
1c. NYS Unemployment Insurance Employer Registration Number of
108 Fishel Avenue Insured
Riverhead NY 11901
Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of Insured or Social Security
certain locations in New York State,i.e., a Wrap-Up Policy) Number
112915558
2. Name and Address of Entity Requesting Proof of Coverage
3a.Name of Insurance Carrier
(Entity Being Listed as the Certificate Holder) TECHNOLOGY INSURANCE COMPANY I
Town of Southold 3b.Policy Number of Entity Listed in Box"1a"
TWC4239232
53095 Main Road
Southold NY 11971 3c. Policy effective period
O4 25 2023 to 04 25 2024
3d.The Proprietor, Partners or Executive Officers are
included.(only check box of alt partners/officers included)
all excluded or certain partners/off icers excluded.
...�. �.•.•. aboveThis icated Ip box"3" insure(the business
compensationes at New York insurance Stateier d Workers'C
referenced above in box"1 a"for workers'
p 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°2".
The insurance carrier must notify the above certificate hotder and the Workers'Compensatnon Board within 10 days IF a policy is canceled
due to nonpayment of premiums o�r within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or
etiniinate the insured from tfle 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 these contained in the
referenced policy.
This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect.
Please Note: Upon 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: Commercial Support
(Print name of authorized representative or licensed agent of insurance carrier)
001-�
Approved by: aa-
(Signature) (Date)
Title: ... ..........�_....
(631) .390-9700
Telephone Number of authorized representative or licensed agent of insurance carrier: __ � .. .
Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT
authorized to issue it.
C www.wcb.ny.gov
-105.2 (9-17)
DATE(MM/DDIYYYY)
A CERTIFICATE OF LIABILITY INSURANCE 06/16/2023
..w
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
TEND OR ALTE
BELOW,
CERTIFICATE
CERTIFICATE FIRMATIVELY OR OF INSURANCE DOES NIOTLCONST CONSTITUTE CONTRACT BETWEEN R THE COVERAGE
SSUINGFINSURER(S)ORDED BY TAUTHOR ZHE IED
BELOW. T
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) 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).
tCONTACT Cozruslez alo t
PRODUCER ""'"°""
Edgewood Partners Insurance Center PHONE 631} 390 9700 _ �„(AIAC,No),;_(631) 390-9790
(AJC Zp �0 4X)
40 Marcus Drive 3rd Floor EMAIV
ADD1�E55 ;NCSMR:ertSC@+F !a rs �
Melville NY 11747
pNSURER�sI A FCS tDING C2 com
COMPANY I 42376 1111
_..._ pNSURERA TECHNOLOGY INSURANCE '
_ 27120
INSURER B TRUMBULL INSURANCE COMPANY
INSURED ._ ,.w..,, ...... ...., 0..,
Islandia Pools Ltd. UP 100914
_ TY GR
_INSURER C HARTFORD FIRE & CASUAL
108 Fishel Avenue iVJSIR D
Riverhead NY 11901 INSURER E..:..�. ........�._- .......-..� .-...� ._- �. . � -..-AI—_,......... -
INSURER IF z
COVERAGES CERTIFICATE NUMBER:Cert ID 18855 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
DILATED. 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
PE OF 1L1....1..11 .AbdL5ub6i...,_... POLICYNINMBER ..... REDUCEDb,ad'MBY 1C�"fEIXPS LIM...,
" n, MMIDDPYYYY PAID CLAIMS
1111",.._._ ..._---. .
TEEXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN
n. ITS
ltd
�— 1,000,000
w MMERCIALGENERALLIABILITY 04/25/2023. OAMMOCCURRENCE ..e $ 1111. ...
EACH OL LN'EO 300 000
X �co
CLAIMS-MADE X OCCUR 12UUNOZ9731 04/25/2024 MEDLEXE (Ect `arises el $
�.P�Arryonepeesea) �����$ 5 000
GENERAL AGGREGATE 5 �2 000,000
_ ®, ,.. ... .........�.._...�—...._.�.�...._.�...., 000
PERSONAL&ADV INJURY $ 1 000,
GEN-L AGGREGATE LIMIT APPLIES PER: $ _
�.L POLICYX CPRO-PT LOC 000p.000
PRODUCTS COMPIOP AGG $ 2
AUTL1'fFIEt ..IT $ 000 000
L -0ct ILD SINGLE LIM
AUTOMOBILE LIABILITY COME1'I'(ge_Nl 1 '" ••
C
]3
ANY AUTO 12UENOZ9729 04/25/202.304/25/2024 BODILY INJURY(Perpersor,)111.$
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY X AUTOS 01LOPi"='i 1 Y DAM:I/•xG'L
HIRED -OWNED NON 1Pee Iida l ..,. — ...w
AUTOS ONLY IX AUTOS ONLY $
OCCUR 12HHUOZ9730 mmmOCCURRENCE $ 1,000,000
C X ' EXCESS LIAB
AGGREGATE
- UMBRELLA LIAB X ( CLAIMS MADE, „1 000 000
�� GATE $ v
09/25/2023 09/25/2024 EACH
�S
DED X RETENTION$ 10,000 RPI'rd
WORKERS COMPENSATION COMPENSATION TWC4239232 04/25/20'23 04/25/2024 ._. !�" :) -- + -•-• "'
A AND EMPLOYERS'LIABILITY Y/N
ANYPROPRIETORIPARTNERIEXECUTIVE $ 1 e 000,000
E L EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? p NIA E L.DISEASE-EA EMPLOYEE $ 111 000 000
(Mandatory in NH) '""
If ti�rec,s.,describe under El DISEASE•POLICY LIMIT $ 1,000,000
'mnAFTION OF OPERATIONS boo
S
1111
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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
ACCORDANCE WITH THE POLICY PROVISIONS.
Town of Southold
53095 Main Road AUTHORIZED REPRESENTATIVE
Southold NY 11971
O 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
HM ENGINEERING P.C.
P.O.BOX 914
EAST NORTHPORT,NY 11731
TEL:516-476-5392
EMAIL:HMARNIKA@HMENGINEERINGPC.COM
June 02,2023
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
Guddatt/Acri Residence
36581 County Road 48
Southold,N.Y. 11958
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,
HM Er inrng P.C.
ry;M�arnika,P.E.
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
FILTER PUMP VINYL LINER CODE.
SKIMMER VINYL LINER 2.POOL SHALL CONFORM TO ANSI/APSP%ICC 5 STANDARDS R326.3.1.
RETURN , 8.5;; 3.SECTION R326J POOL ALARM REQUIRED.
(TYP. of 2)
(�•) 4.POOLSHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4. . .
FOAM PADDING 3,500 PSI 5.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION,CONSTRLICTION CODE
CONCRETE OF NYSSECTION R403.10:,
''a POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY).
SECTION 11403.10.1 HEATERS
SECTION R403.10.2 TIMESWITCHES
I I PROPOSED VINYL #4 REBAR TOPSECTION 11403.10.3 COVERS
SWIMMING POOL & BOTTOM ° 42° 6.REBAR SHALL BE 3"MIN.CLEAR TO EARTH.
648 S.F. a', 7.LOCATION OF PROPOSED SWIMMING POOL,AND POOL EQUIPMENT BY OTHERS
3° 18@ AND,SHALL'COMPLY WITH ALL LOCAL ZONING REQUIREMENTS.
(MIN. 8.ALL DRAIWCOVERS TO MEETALLREQUIREMENTS OF THEVIRGINIA GRAEME
DUAL MAIN DRAINS WITH BAKERPOOL AND S
(VGB) PA SAFETY ACT.
STRAINER (VO SAFETY 9.SLOPE PATIO SURFACE i/4"PER FOOT AWAY FROM POOL
ACT APPROVED DRAINS) ; 10.BACKFILL MATERIAL TO.BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR
LARGE ROCKS).
` STEPS ' 11:SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH
ANSI%APSP/ICC 7.
12.ENTRAPMENT RROTECTION REQUIRED SECTION R326.5. ,
1-3..CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF
12.5: POOL..,
36' 14.7HIS PLAN.IS FOR CONSTRUCTION ON PROPERTY AT 36581 COUNTY ROAD 48
TYPICAL WALL 'DETAIL' SOUTHOLD;-N.Y.119SEI ONLY.
15.NO'DIVING EQUIPMENT,PERMITTED.
SCALE: 3/4" = 1'-,0" 16:REINFORCING,STEEL'SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A
MINIMUM LAP OF 308AR DIAMETERS. .
rOTEf POOL PLAN Norl 17.POOL -ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY:WHEEL
A NON-DIVING POOL i—linATLS SHALL BEAR ON UNDISTURBED 501 LOADS WITHIN SIX
,(6)FEET'OF POOL WALL FROM CC+IVSTRUCTION EQUIPMENT OR
NOT TO SCALE 2,ALLCONCRETE'SHALL BE PLACED ASA MONOLITHIC POUR. ANY OTHER�LOADING CONDITION IMPOSED ON THE•POOLSTRUCTURE BY EXISTING
OR PROPOSED.ADJ,ACENTSTRUCTU.RES:IF;SITE'CONDITIONS DIFFER FROM;THIS
PLAN,ITIS THEAESPONSIBILITY OF THkONTRACTORTO CONTACTHM•
ENGINEERING :P:C. BEFORE ANY CONSTRUCTION BEGINS.'..
3'-4" CONCRETE WALL 18.HM ENGINEERING;P.C.SHALL NOT
BE'RESPONSIBLE FORCONSTRUCTION;
8.1 MEANS,METHODS,TECHNIQUES.OR PROCEDURES UTILIZED'BY THE`CONTRACTOR,
(SEE SECTION NOR FOR THESAFETY OF THE'PUBLICOR CONTRACTOR'S EMPLOYEES,OR FOR THE`
THIS SHEET) FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH
THIS PLAN.
UNDISTURBED 1 1/2° TO WASTE
EARTH (TYP.)
4� ��-- 6� 14' 12� HAIR & LINT STRAINER
PUMP
3" COMPACTED
SAND FILTER AUTO SKIMMER
POOL..PROFILE
NOT TO`SCALE POOL
BACK TO
GENERAL NOTE: POOL
ALL MANUFACTURED ITEMS AND CONSTRUCTION,SHALL COMPLY WITH THE 2020
RESIDENTIAL CODE OF NYS,,INCLUDING•THE SPECIFICATIONS IN SECTION R326.
PREPARED FOR: 2 MAIN DRAINS W.TH
SCHEMATIC PIPING ARRANGEMENT
GUDDATT/ACRI RESIDENCE HYDROSTATIC'VALVEAND COLLECTOR TUBE
365581 COUNTY ROAD 48 NOT TO SCALE IN GRAVEI. BASE
SOU HOLD, N.Y. 11958
t� DATE: 06/0212023
NOTE: ��(///►►��✓��GG HM ENGINEERING, P.C. SCALE: ASSkOWN
THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. y
UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE f� U L/ �3 P.O.BOX 914 EAST NORTHPORT,NY 11731 SHEET: '1 'OF 1,
NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@hmengineeringpc.com RESIDENTIAL CONCRETE
VOID I RAISED SEAL AND BLUE SIGNATURE VINYL LINER POOL PLAN