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HomeMy WebLinkAbout48791-Z Town of Southold 5/24/2023 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44124 Date: 5/24/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 245 Rachaels Rd,Mattituck SCTM#: 473889 Sec/Block/Lot: 108.4-7.43 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore riled in this office dated 12/22/2022 pursuant to which Building Permit No. 48791 dated 1/24/2023 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 Gull Dip LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48791 4/24/2023 n PLUMBERS CERTIFICATION DATED A h riz S gnature o�SUFFotK�o TOWN OF SOUTHOLD BUILDING DEPARTMENT y 2 TOWN CLERK'S OFFICE "o • 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#: 48791 Date: 1/24/2023 Permission is hereby granted to: Gull Dip LLC 30 Staller Dr East Quogue, NY 11942 To: construct accessory in-ground swimming pool as applied for. At premises located at: 245 Rachaels Rd, Mattituck SCTM #473889 Sec/Block/Lot# 108.-4-7.43 Pursuant to application dated 12/22/2022 and approved by the Building Inspector. To expire on 7/25/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector SOUjyQlo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 a sean.devlin(a-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Gull Dip LLC Address: 245 Rachaels Rd city,Mattituck st: NY zip: 11952 Building Permit#: 48791 Section: 108 Block: 4 Lot: 7.43 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Proline Electric License No: 32279ME 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 Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency StrobeHeat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Heater, Pump220GF1, Timer, Pentair 30OW Pool Trans w/2 Lights 120GFI Notes: Pool Inspector Signature: Date: April 24, 2023 S.Devlin-Cert Electrical Compliance Form SOUIyO� u&7q ! f - - # f 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 KELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Gtil._ , GFob./ rf Aa DATE INSPECTOR /� / SOOTyolo * # TOWN OF SOUTHOLD BUILDING DEPT. �ycourm��' 631-765-1802 -INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) /[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE [ INSPECTOR so 79 / TOWN OF SOU I HOLD BUILDING DEPT. cou 631-765-1802 INSPECTION FOUNDATION 1ST ROUGH PLBG. FOUNDATION 2ND INSULATIOWCAULKING 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 IINSPECTOR�� qg so TOWN OF SOUTHOLD BUILDING DEPT. 'cou 631-765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PL13G. FOUNDATION 2ND [/NSAULATIOWCAULKING FRAMING /STRAPPING FIN L fovl?� FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O RENTAL RJEMARKS: vi,\) DATE 4 17,R vn INSPECTOR h_�0 a4+ 4e� .*�T�.111" �.� � ►� j o '8:t-1 r ► ,,a ,y, .� +�ii • fe YYt Lf -.h.���1 y r ���� 1 .yK• ♦11 rr ,t1�7` ♦ 1. r �-6t ;y � y a�" a � � 4 � ♦�'. , •y a by _ Sf s } fp., l'i t �,`.¢, +'a�. ',r hr+f' A ~Y^'': & ►'k^. 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'-at,�'• � 1`�°�,E y'� +:" v, i'ya , ,y,-,'''' ` �!i;� w��{ 1 e � �' `1 � T t A �Z�� 4 �`'. ryt hL"" �' 9M .ails ✓ •i'r'r!, E� !{�,�k'�"� 1��� ,S`��}�`4f `J•� SFr r a�r ii-. r� A7 •.moi fi/H 12 RAY DONER, ARCHITECT ARCHITECTURAL DESIGN INTERIOR DESIGN PLANNING A DEVELOPMENT RESIDENTIAL•COMMERCIAL-INDUSTRIAL 95 RICHMOND AVENUE S.AMITYVILLE, NEW YORK 11701 Phone/Fax: (631)6914718 EMAIL:RDARCHITECT@YAHOO.COM February 9, 2023 Town of Southold Building Department Annex Building 54375 Rte. 25 Southold,New York 11971 RE: CERTIFICATION of INSTALLED POOL REBAR NEW RESIDENCE for GULL DIP LLC @ 245 Rachael's Lane,Mattituck. BUH DING PERNM NO: 48791 S.C.Tax Map#:1000-108-04-7.43 To Whom it May Concern: This Letter is to Certify that the Re Bar as Specified on the Approved Engineer's Plans was Installed Matching those Plans and Meets All Applicable Building Construction Codes. I Acknowledge that the Southold Building Department is relying on this Affidavit to issue a Final Certificate of Occupancy for the above Construction. Sincerely, �,�ERED qRc Ray Doner, Archite t. / ' ���� MONO a! Un 9� 0 8U4 4� FOfNEw�Q. IELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) ---------------------------------- FOUNDATION (2ND) N z Q Q ROUGH FRAMING& �4 PLUMBING - Cb W -- r r� INSULATION PER N. Y. STATE ENERGY CODE - -- �r FINAL ADDITIONAL COMMENTS -Al 3=-. a3 . e c i CSC - p,o Z - r _ r n, t� l�SufrOtt�a�� TOWN OF SOUTHOLD—BUILDING DEPARTMENT �z Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 �O�P Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only D t4V, �� PERMIT N0. Building Inspector: DEC 2 2022 Applications and'forms must�be'filled.out in theirenfirety.`Ineomplete - ����iiYG DEPT :;applic 'fio swill not be accepted.'Where the Applicant is not the owner,an ' OFSOU `D ;'.Owner's Authorizationiorm.(Page-2)illiA'be completed: Date:12/8/22 .OWNER($)OF.PROPERTY: Name:GULL DIP LLC SCTM#1000-108-4-7.043 Project Address:245 RACHEL'S RD, Mattituck, NY _ Phone#:646 413 4604 Email:adkoninc@gmaiLcom _ MailingAddress:$7 Sandy Ct , RIVERHEAD NY 11901 'CONTACT PERSON: -- Name:MONIKA MAJEWSKI _ Mailing Address:30 STALLER DR, EAST Quogue, NY 11942 Phone#:9178923758 Email:mon benit msn.com `DESIGN:PROFESSIONAL INFORMATION:: :- P-G--------------- ______._-_ Mailing Address: -- 1 Phone#: �' (� g — (,I (,4$ Email: 'CONTRACTOR.INFORMATI 'N _ Name: I-_o_ Q E Z _T Poo�/Po/,.o L 5U2y I Mailing Address . _,V.Q_5_ S� UTH/7- _p Phone# �J- Email: LOPa _-�ooc.SG GM��t.GoM DESCRIPTION OF-PRO POSED CONSTR UCTION".: ❑New Structure ❑Addition Alteration ❑Repair ❑Demolition Estimated Cost of Project: 51&her_ALL,0 00ot ' K 21 $ Will the lot be re-graded? Aes ❑No Will excess fill be removed from premises? Yes ❑No 1 '�PROPERTYINFORMATION Existing use of property: si;p�y�j'� Intended use of property: krjl,o 0 " 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 M of the Town Code. APPLICATION IS HEREBY,MADE to the.Building'Depaitnient for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold;Suffolk,tCounty,New York and;other'applicable laws;Ordinances or Regulations,for the construction of buildings, additions,alterations or for rertioealor demolition at herein described.The applicant agrees to comply withal)applicable laws,ordinances;building code, housing code and regulations and to admit authorized inspeciorspn premises.and in buildings)for necessary inspections:Falsestatements made herein are punishable as a Class A m'isderrieanor pursuant to.Section 210.45 of the New York State Penal Law. Application Submitted By(print name): 2 �t Authorized Agent Owner _ _ _ _/�al _N ❑_ __.._.____._._.-----._w__.__._.__ Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF &-D eJ(IN �CQ N i,a IL being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)heisthe 49,0v-,ei�" (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 that the work will be performed in the manner set forth in the application file ther with. Monika Majewski NOTARY PUBLIC,STATE OF NEW YORK Sworn before me this , RegistIationNo.0IMA6392440 Qualified in Suffolk County day of Commission Expires 05/28/2023 ZA 20�%O �—t�/ � Notary Public PROPERTY OWNER AUTHORIZATION (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 BUILDING DEPARTMENT- Electric I ect r TOWN OF SOUTHOLD .3 7 2093 Town Hall Annex - 54375 Main Road - PO Bcw1617u.0 3 p TninrAonronii PT r Southold, New York 11971-0959 Telephone (631) 765-1802 ' FAX (631) 765-9502 rogerr(aDsoutholdtownny.aov seand(aD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: I P2,612 Company Name: EQ _ L I N E OL cC TEi C i A/C Electrician's Name: -)e E6 P I L F-S L License No.: 32 Z77 Q�F- ,EElle�c.c. email: C)F tCC� /D�._L l tiE ELG--C!12(c, O/1� Elec. Phone No: , �/ 2, 77-,317/ Ly'► request an email copy of Certificate of Compliance Elec. Address.: 2 O '0Y .6' (4 • �.(�7_0 V L4— Y JOB SITE INFORMATION (All Information Required) 4 Name- 6 (>L.L D/P LLC _ Address: 2 5 �� Cid=L Z (L0 / / 1 %vC(C Y Cross Street: JF L l i'-y S L A) k Phone No.: (Z I �- f Bldg.Permit#: _' email: ' 6D CC)fu /V�'O CS4 It L Tax Map District: 1000 Section: (OQ Block: Lot: -7. LP BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 7000L r✓L C_7C7"2 i C . p Square Footage: Circle All That Apply: Is job ready for inspection?- ❑ YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?- ❑ YES [aNO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# I ❑Flew Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead >` Underground Laterals 1 2 H Frame Pole Work done on Service? Y N 1Additional Information- I PAYMENT DUE WITH APPLICATION I9 P,, F � v BUILDING DEPARTMENT- Electric I ectQr TOWN OF SOUTHOLD SAN 3 1103 t Town Hall Annex - 54375 Main Road - PO B #,6c17&,DEPS Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roaerr(a southoldtownny.gov se and(a-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: L2,612 Company Name: 0 - L i N E EL CC TP-1 C .c, AIC Electrician's Name: (2) CE6 I L ES L j -- License No.: 32 Z-7 q�� -Elec. email: ���iC�@- � ._L /JCL CiI2rC, OIL/- Elec. Phone No: �' ' 2--77- ,317/ Ly'1 request an email copy of Certificate of Compliance G�l r Elec. Address.: '_T)0 'B6 (-� IWP_®/Vf�- %(s y E.JO SITE INFORMATION (All Information Required) Name. 0 I P L LC Address: 2 Lii C i I LL 'S Z'.� 1U 7-7 i l LAC(C Y Cross Street: ._y I P2 S L Iv E Phone No.: 6J- Bldg. 1 Bldg.Permit email: � �C�rUiIVCC� C'/C{A�Cay9 I ax Map District: 1000 Section. 109 Block: 14 Lot. �] h BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): `TO(QL_ CL CCT 2 ( C Square Footage: Circle All That Apply: Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES [2rNO Issued On Temp Information: (All information required) Service Size❑1 PhF—]3 Ph Size: A # Meters Old Meter# ❑New Service[]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead nderground Laterals r"_1l l n2 H Frame n Pole Worn done on Service? Y "v U Additional Information: l ' l L --— PAYMENT DUE WITH APPLICATION �� 4 I -/ fM Q� � YOEW Workers' CERTIFICATE OF INSURANCE COVERAGE STATE 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 . CUBIAS CONSTRUCTION CORP 516-439-3670 76 GARDNER AVENUE HICKSVILLE, NY 11801 1 c. Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,i.e., Wrap-Up Policy) 114786049 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 53095 ROUTE 25 3b.Policy Number of Entity Listed in Box"l a" PO BOX 1179 DBL605178 SOUTHOLD, NY 11971 3c.Policy effective period 12/18/2021 to 12/17/2023 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 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 described above. 9 Date Signed 9/28/2022 By Udo, X (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 413,4C or 56 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 413,4C 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. D13-120.1 (12-21) IIIIIIIP°1°°1°211°°1°11111°11°2°111°I�IIII YORK Workers' CERTIFICATE OF aTATE iL®in ensata®n NYS �V®f�d CERS° ®MPEAlSA1tlIC)�9 INSURANCE OV 1ERAC�E BO3ff� 1a.Legal Name&Address of insured(use street address only) 1b.Business Telephone Number of insured LOPEZ JR POOL SERVICE CORP 631-252-5838 PO BOX 6053 1c.NYS Unemployment Insurance Employer Registration Number of Insured Southampton, NY 11969 N/A Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer Identification Number of insured or Social Security certain localions In New York State,i.e.,a Wrap-Up Policy) Number 82-4530810 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wellfleet New York Insurance Company TOWN OF SOUTHOLD 3b.Policy Number of Entity Listed in Box"1a" 53095 RT 25 N9WC737338 PO BOX 1179 3c.Policy effective period Southold, NY 11971 11/13/2022 to 11/13/2023 3d.The Proprietor,Partners or Executive Officers are F1 included.(Only check box if all partners/officers included) Q 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"1 a"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 7'. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled 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 the 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 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: Rakesh Gupta (Print name of authorized representative or Ilcensod agent of insurance carrier) Approved by: _ x+40, '` 12/12/2022 . 0�1 (pate) Title: Chief Operations Officer Telephone Number of authorized representative or licensed agent of insurance carrier: 844-472-0967 Please Note:Only Insurance carriers and their licensed agents are authorized to issue f=orm C-105.2.Insurance brokers are LOT authorized to Issue it. C-105.2(9.17) www.wcb.ny.gov DDlYYYYJ 0 CERTIFICATE OF LIABILITY INSURANCE DATE(M 12/1212022 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 )NSURER(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 N ME' GIACIZZO INC/GIACALONE INS.AGY PHONE - - (PA1331-208-X A!C Nol: 57 EAST MAIN ST, UNIT 3 E-MAIL GIACIZZOINC@GMAIL.COM RIVERHEAD, NY 11941 ADDRESS: CONTACT:JEANINE GIACALONE INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:ATLANTIC CASUALTY INS CO 42845 INSURED INSURER B; LOPEZ JR POOL SERVICE CORP INSURERC: PO BOX 6053 INSURER 0: SOUTHAMPTON, NY 11969 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AODL SUER POLICY NUMBER POLICY IIDDIYYYY POLICY M ODIYY P LIMITS LTR A COMMERCIAL GENERAL LIABILITY 4/19/2022 4/19/2023 EACH OCCURREDAMAGE TO NCE, $ 1,000,000 L068U26693-1 CLAIMS-MADE ®OCCUR PREMISES Ea accunence $ 100,000 MED EXP Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY EC1:1 JT LOC PRODUCTS-COMP/OP AGG $ 2,600,000 OTHER; AUTOMOBILE LIABILITY (COMBINED SINGLE LIMIT $ Ea acclden ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Pre dent UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEO I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ST T[T.. ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMSE13 EXCLUDED? (Mandatory In NH) E.L.DISEASE-Fla EMPLOYEE $ If 9S describe under DESCRIPTION OF OPE TIONS bekxv E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) POOL SERVICE/INSTALL CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 RT 25 THE ACCORDANCE NOTICE WILL BE DELIVERED IN CE W TH THE POLICY PROVISIONS. PO BOX 1179 SOUTHOLD, NY 11971 AUTHOQIZED REPRESENTATIVE a ` ©1988-201`5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD MAP OF PROPERTY N SIT UA TE M � MATTITUCK ZIP ��� TOWN OF SOUTHOLD ti � SUFFOLK COUNTY, NEW YORK 00 S.C. TAX No. 1000- 108-04-7.43 SCALE 1 "=40' OCTOBER 14, 2022 20222 DD ROOPO�D HOUSE ,1Q .S �r� p`" O'' y"�y. CERTIFIED T0: ' y \��' °yjy� s GULL DIP, LLC F ° 00 �%&<;f, PHILIP MCCOMBE V , Oe 10 %&<; \ ABSTRACTS INCORPORATED. \ "yd's°,,, TITLE No. 563—S-15616 r0a ��;°'9j� FIRST AMERICAN TITLE INSURANCE COMPANY k.` \� �� �`.� o�4S ��. �, NOTES: g �•� �.'m � ; 'o� ;�°;ooh 1. THIS PROPERTY IS SHOWN AS LOT 1 ON "SUBDIVISION MAP OF NORTH FORK HOUSING ALLIANCE" % �,\s `���Fo�`ii `,� :.o a° 'r n°G APPROVED BY THE TOWN OF SOUTHOLD PLANNING • �9. \s ,� � v� yy BOARD ON AUGUST 25, 1989 2. MAP MADE FROM OFFICE RECORDS. 3. ELEVATIONS ARE REFERENCED TO N.A.V.D. 1988 DATUM n :: EXISTING ELEVATIONS ARE SHOWN THUS: r, ,. • ::......:::::•::•::•..�:::.::::::::.... •• �•:........:. DRAINAGE SYSTEM CALCULATIONS: .::. ...............:::::::............... .. o .:!o ............................... :.... :c...........: C�� 9 ROOF AREA: 1,985 s ft. 1o, t' ` :^:.::: .. .............: ::x.'.•:;:.:`':::• li\�::::i �c� 1,985 sq. ft. X 0 17 = 338 cu. ft. ,......, nq �y 338 cu. ft. / 42.2 = 8 vertical ft. of 8 dia. leaching pool required ::•:•::o;: .:•:.:::;:. PROVIDE (1) 8' dia. X 8' high STORM DRAIN POOL .. 'DO gsLR�eti .. ., �e®• 'C,� ems` `�S �� ��S`, _ -ICA mFPF� HCl TEST HOLE DATA TEST HOLE+ lk F� \ / 1� 2� 0% 1 0 �. (TEST HOLE FROM SUBDIVISION MAP) 7 O j PREPARED I_y__ACC.ORDANCE WITH THE MINIMUM EL 12.2' STAN a SURVEYS AS ESTABLISHED O' E Ipe PROVED AND ADOPTED D OK6�BROWN LOAM (PT) Re�ISB"���`K STATE LAND BROWN SILTY LOAM (OL) j 2.5' PALE BROWN SILTY SAND (SM) � P' r� PALE BROWN COARSE SAND (SP) ' t9 Q1�O Olt 17• '�.• L11of 4M7 N.Y.S. Lic. No. 50467 �,4L�o 40� UNAUTHORIZEDTHISSURVEY ALTERATION TI ADDITIONFNathaN- 5SVCorwin III TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. CLand Surveyor COPIESPIESOF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S. ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno LS. IS PREPARED,AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys — Subdivisions — Site Plans — Construction Layout LENDING INSIT UTION USTED HEREON,AND TO THE ASSIGNEES OF THE LENDING INSn— PHONE (631727-2090 Fax (631)727-1727 TUTION.CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 15B6 Main Road P.O. Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 O z ELECTRICAL RETAIN STORM WATER RUNOFF INSPECTION REQUIRED PURSUANT TO CHAPTER 236 OF THE TOWN CODE. N c\1 o LL 0 < A PR VEDAS NOTED 0 z DATE: B.P.# q( m" 32'-m"321-011 01 lo FEE: BY: 6j z -j 6i NOTIFY BUILDING DEPARTMENT AT < 101-011 L) 101-01, ^B IT-O" -------------------7.1 765-1802 8 AM TO 4 PM FOR THE U) n 0 FOLLOWING�INSPECTIONS: 1. FOUNDATION - TWO REQUIRED — — — — --- FOR POURED CONCRETE H -G FRAIOING & PLUMBING 3. INSULATION T Z 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR C.O. �j ALL CONSTRUCTION SHALL MEET THE 0 cm < REQUIREMENTS OF THE CODES OF NEW CNI Imil 5. m.. I I�-o" < YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. _j > Lu LLi 015 z o COMPLY WITH ALL CODES 0 NEW YORK ST ATE & TOWN Cc 4s; o AND CONDITION ENmDF�� 0 DD AS REQuiR, An,! DR4N o cy 0 '7RA Tn S`LT'��!-NG 0ARD I J V E D ;A TC L rj Lo CLOSE POOL TO C,( )D,E, Lu q EN UPON COMPLETIOP 1. 0 Z)N NO z 0 Z. 'BEFORE"WATER" 0 Z:(D 4 4-j Lu LIGHT „ MTT c L!csHT-,-,2 cy kD 0 U) YO E L,u u- ro cn NEVV UJI Y. 4-J cl) 0 ul) 0 Oil (01 (01 51 -011 51- -011 -011 -011 51-011 o 101-011 121-011 101-011 0 321-011 0 s U) z POOL NOTES 0 OCCUPANCY OR I-ALL WE WALL WAVE A MR 28 DAY SMEW OF 400 PSL > w 2-STEEL KNFORCEM�T NALL N WADE 60 CafMM TO ASTM A615 of JSE 1&UNLAWFUL 3-UELDED WE FABRIC KNORCE1W NALL BE COLD DRAUN CZW-MWs TO AST =.AAPPI V11 1-ALL WOW WALL BE N ACCORDANCE UUH M LATEST ACI CODE IVITHOUT CER-rIFICAT, 8-LEGS OF REM ACCESSORIES NALL BE PLASTIC TIFFED.ALL WKIES AND UIALL FDMTIONS 5-SIALL BE CLEANED 4 Wff FfPAJFS TO FFSJZE COFROSION 10-ALL DIMEWS GMN SHALL 5E CWIDM A MK CMRACTOR MAY NQWAE ]IFOCCUPANCY TO PROVIDE FOR DONS 4 Copm > w 11-WEER COffFZM NWECTION REL UAS 2-CaR!ACTOR TO PROVIDE POOL PENCE AS MR WS 2021 NILDM CME AND LOCAL CODES 32'-0" 0 Z 0" 10'-0" 12'-0" 10'-0" 0" 0 TOP OF WATER \ W LL N 9 \/� z o Ln \ } X/ = 16'-010 O 2'-0° 7-7 /j\/r /, cn o MAN DRAM \jam\j�\/\� ,• . .: - \\/\��\\�\\�\\' �/`��� Z SECTION o � °- 1 c III-all w z J L) Q � Z O W Q Ur h- f1 10" 10" Of L0 O) 0 N C3 U 24" COPIN 24" COPING SAND OR BAND OR �' CLEAN FILL '/\\ 5X5 TILE 5X5 TILE a \ \\/ CLEAN FILL w N \ \ TOP OF WATER--J 10" X 10" P.G. ' //� f 04 REBAR FOR 04 REBAR FOR 10" X 10" P.C. c N U BEAM \\i \ WIDTH OF POOL WIDTH OF POOL \`\ BEAM F NE VV }• 04 REBAR 9 12" C.C. #4 REBAR a 12" O.C. I•.. \� ��' L&� '� Lu Lu�w co N MARBLE DUSTO O MARBLE DIJBt ``s �' 16'-0" X 32'-011 / a \/ * W ` ki Q L n a�ko - ' \ I- Lll w t,H L,- 8" i 8" GLWITE a� 8" GLINITE ^W '�OFESS' � / w STONE OR BAND BASE �� / Q MAIN DRAIN STONE OR BAND BABE \\ POOL NOTES cn I-ALL GINE SHALL NAVE A MIN 28 DAY STREW OF OW PSL w 2-STEEL REINFORCE ENT SHALL BE GRADE 60 CafOR'IMG TO ASTM Abb w 3-WELDED WW FABRIC RfDFORGEP'ENT SHALL BE COLD DRAIN CCTFORMMG TO AST 1-ALL WORK SHALL BE M ACCORDANCE WRN TEE LATEST ACI CODE 8-LEGS OP FSM ACCESSORIES SHALL BE PLASTIC TIPPED.ALL WKIES AND UXL 2 s CT I O N TBMIONS GM�BE OMOM A faff MR RED TCONFFEME iFA OR MAY MC�E SCALE:3/8" = V-0" TO PROVIDE FOR NAM 1 COPING > II-ENGPEER CONTROLLED K5KCTION REQUIRED w 2-CONTRACTOR TO PROVIDE POOL HNCE AS F'ER NTS 2021 BUILDNG CODE AND LOCAL CODES