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HomeMy WebLinkAbout45787-Z ��o�oS�EFO( y� Town of Southold 7/17/2023 P.O.Box 1179 CD 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44325 Date: 7/17/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 300 Private Rd#8, Cutchogue SCTM#: 473889 Sec/Block/Lot: 97.-3-18.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/9/2020 pursuant to which Building Permit No. 45787 dated 2/5/2021 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 for. The certificate is issued to Oliva,Catherine&Conti,Robert of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45787 9/9/2022 PLUMBERS CERTIFICATION DATED Aut orized i ature :.z=;- gUffOi TOWN OF SOUTHOLD o� BUILDING DEPARTMENT C* z TOWN CLERK'S OFFICE "oy • � � 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#: 45787 Date: 2/5/2021 Permission is hereby granted to: loveno Sr, Peter PO BOX 1172 Cutchogue, NY 11935 To: construct an in-ground swimming pool as applied for. At premises located at: 300 Private Rd #8, Cutchogue SCTM #473889 Sec/Block/Lot# 97.-3-18.7 Pursuant to application dated 12/9/2020 and approved by the Building Inspector. To expire on 8/7/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 To $300.00 uilding Inspe OF SOUjyol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin(a-)-town.southold.ny.us Southold,NY 11971-0959 Q�yCOU�'�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Catherine Olivia Address: 300 Private Rd #8 city:Cutchogue st: NY zip: 11935 Building Permit#: 45787 Section: 97 Block: 3 Lot: 18.7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Linear Electric License No: 34402ME 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 X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 2 4'LED Exit Fixtures Pump 1 Other Equipment: Heater, AutoCover120GF1, Pump220GFI, Light120GFl Notes: Pool � r Inspector Signature: l Date: September 9, 2022 S.Devlin-Cert Electrical Compliance Form laf so # # TOWN OF SOUTHOLD BUILDING DEPT. it co 765-1802 ' . an 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 REMARKS: r DATE / Z- INSPECTORri � pF 50UTy�� Lk<-1g1 * # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm,N 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND - ' J '] INSULATION/CAULKING [ ] FRAMING /STRAPPING FINAL poor_ [ ] FIREPLACE &CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) . [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 61 Pt-Am xv&&r S.W g L C f2 G14TC-s k I T C 14 Pfy c- s-c �E(?,2CJ��2E�_ Not- S-Tads wat ('197 AIC-C- !; To Xc— ( FLC CF f-.-Chi CORETX P T&,TG C� �oTT cry► CF PWI- (�,q R2xE2 No MOie& T HATAI DATE INSPECTOR o��OE SOUTyo # TOWN OF SOUTHOLD BUILDING DEPT. °ycou631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ NAL #moo [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE INSPECTOR iz Step handrail bonding 3 � _ \ '� '�. .' ��a�•;" -ate.�," rTrn r _ • i ._ �� r�i�aw 1 1 P'1 � S S l ti►C.� `FSG N`� W 12 Bunch, Connie From: Robert Conti <rcl3615@gmail.com> Sent: Monday, July 18, 2022 2:27 PM To: Bunch, Connie Subject: BP #45787 - 300 Private Road AKA 1 Banks Street Cutchogue Please see below for pictures that were sent previously and approved by Sean: Deep end ladder bonding ATTENTION: This email came from an external source.Do not open attachments or click on links from unknown senders or unexpected emails. r t�n ho le It.115; ,. 'tf .+� V` •�� v .1 1�,�+1 •3V, t 1, r 1 Brass bonding lugs(zoom in)on each cover bracket. Wire#8 bare to each bracket 1 - 4 t y'G` •" . , 51'x' * ; r� I Jj:i f i .� -•.. t.. - .,+.fir,� �� e,, t Ir •,_� ?•�+• a iia�� ,.. .,-j _�.�" � - �_ - • Thank you. Robert Conti 516.286.3855 4 From: Robert Conti r03615@gmail.com B Subject: Pool Alarm Date: July at 12:57 PM To: Robert Conti rc13615@gmail.com Y PAT Sounds alami if children or pets fall into your PO-01 . K1CYL A1.AIIY WUNi 6 AT *8S dt• 10 Ft"T'0* 3 MIrM . rr. f � r � JUL 1 7 2023 OWNERS MANUAL BUILDING DEPT. ------ TOV-N l'!'01-n Aum J ow SOMbP Afad0 S+rr•'r Ai'orms 11111111PUM x 14r4o"144060040ft • . 8e!d, a. MI 4t • wwat� ol.c.orr� fi,,r• --�. _74 PATRC 1.. v'. - ................ . . Arun<1.5(jwrm t/rhildwit or lett fall hoo txxrr 1x-11 r 41 I:+ d i• rf 'r�'r a.. t + tet: -�. ��` .;r,•' ... .:•"r".- "�i�� t+ r tit.�'.�� -,G�"�f'6. ._i -�A�C-c ; �" -• - .'. Jri'` 'w ^711+1 ..�: �•i '. Fr-1 v_ •a 'WI r { dye r' "y*��"�'i �.-� r ,w.+Z..�..+PI✓.�' 6•�� �s `a "..�^t '?� �. " � �Y iI f ��f ��♦ � R ^S S.�{r„ Imo-'"�-' 'fit Y`° Vim. 1r . iY Z .T's"r'�''��'..5 i`,x'K„I!•]+�J�� l� - � A '�-f✓"'^ t a 1 � +w �1•� '+ 'off ,+.ti.:� # rg�,� ,+ ,r' � '. ,. ^ .".�.r+ • w y 41 t.��"'1'"�1"�I�, wry ire+-�;��� "�'�" "� „"� '..J t~ •'`Y - �. . ' 1�y t[ • r .01 ,. FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(1ST) --------------------------------- FOUNDATION(2ND) '3r h� Ai, ROUGH FRAMING:& PLUMBING c W hey f �Ly INSULATION PER N.Y. tti F° STATE ENERGY CODE PEaw+.TbgV - �Q 2 F}T� rcu 1 EGC�s S n„ AEC Ona-l- Sr3 4166W e — +. (;©Tro.j-► C,F 9' 1- C /lAQ2 Z' E FINAL .. D ONAL COMMENTS. y ql2.,f - X 'ky ` If 4 ' I.s z 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 littps://-vwnN7.soLitlioldfoi -ytin ov Date Received For Office Use Only PERIVIrrN0.. Building Inspector. f DEC 9 2020 Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an Ownees Authorization form(Page 2)shall be completed. Date:12/9/2020 OWNER(S)OF PROPERTY: Name:Catherine Oliva/Robert Conti FUM#1000- Physical Address:300 Private Road #8 AKA 1 Banks Street Cutchogue, NY 11935 Phone#:703-981-6527 Email:coliva518gaol.com Mailing Address:PO Box 958 Cutchogue, NY 11935 CONTACT PERSON: Name:Catherine Oliva Mailing Address:PO Box 958 Cutchogue, NY 11935 Phone#:703-981-6527 Email:coliva518@aol.com DESIGN PROFESSIONAL INFORMATION: Name:Tsunami Pools Inc DBA Platinum Pools Mailing Address:74 Elwood Road Northport, NY 11768 Phone#:631-942-6302 Tim—;,7i--pl—atinumpools.mark@gmaii.com CONTRACTOR INFORMATION: Name:Mark Turnsi Mailing Address:74 Elwood Road Northport, NY 11768 Phone#,631-942-6302 Tm7li-—platinumpools.mark(ftmail.com DESCRIPTION OF PROPOSED CONSTRUCTION igNew Structure DAddition DAlteration DRepair ElDemolition Estimated Cost of Project Bother Pool $54,275.00+ Will the lot be re-graded? ElYes 8 No Will excess fill be removed from premises? E]Yes MNo PROPERTY INFORMATION Existing use of property: Residential Intended use of property: Residential Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Southold/Cutchogue this property? ❑Yes *No IF YES,PROVIDE A COPY. li3 The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings, additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False 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( rint name): �u IP.r'!Y1� �[/�v�— ❑Authorized Agent 2/0 ner Signature of Applicant: G� Date: /A/jp1.p0-2a STATE OF NEW YORK) SS: COUNTY OF SLkr P0% ) Catherine Oliva being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the ( WV\e (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 �—C & -qday ofm�� o ry Public E L.GATZ-SCHWAMBORN NOTARY PUBLIC.STATE OF NEW YORK Reeistration No.OIGA6274028 Qualified in Suffolk County (Where the applicant is not the owner) Commission Expires Dec.24,204b 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 b BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex -54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 3/6/2021 Company Name: Linear Electrical Contracting Name: Conti/Oliva License No.: 34402ME email: tonypubins(g)gmail.com Phone No: 703-981-6527 ❑✓ 1 request an email copy of Certificate of Compliance Address.: 1 Banks Street AKA 300 Private Road#8 PO Box 958Cutchogue 11935 JOB SITE INFORMATION (All Information Required) Name: Conti/Oliva Address: 1 Banks Street AKA 300 Private Road#8 PO Box 958Cutchogue 11935 Cross Street: Eugenes Road Phone No.: 703-981-6527 BIdg.Permit#: 45787 email: tonypubins@gmail.com Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please Print Clearly) Inground pool Inground pool Inground pool Check All That Apply: Is job ready for inspection?: ❑YES ❑NO []Rough In ❑Final Do you need a Temp Certificate?: [-]YES [:]NO Issued On 3/6/2021 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A #Meters Old Meter# ❑New Service ❑Service Reconnect ❑ Underground ❑Overhead #Underground Laterals ❑1 ❑2 ❑H Frame Opole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION ,c,\ Electrical Inspection Form 2020.xlsx c BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town,Hall Annex -54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail information Required) Date: 3/6/2021 Company Name: Linear Electrical Contracting Name: Conti/Oliva License No.: 34402ME email: tonypubins@gmail.com Phone No: 703-981-6527 Ell request an email copy of Certificate of Compliance Address.: 1 Banks Street AKA 300 Private Road#8 PO Box 958Cutchogue 11935 JOB SITE INFORMATION (All Information Required) Name: Conti/Oliva Address: 1 Banks Street AKA,300 Private Road#8 PO Box 958Cutchogue 11935 Cross Street: Eugenes Road Phone No.: 703-981-6527 BIdg.Permit#: 45787 email: tonypubins@gmail.com Tax Map District: 1000 Section: 7 Block: Lot BRIEF DESCRIPTION OF WORK(Please Print Clearly) Inground pool Inground pool Inground pool Check All That Apply: Is job ready for inspection?: [:]YES NO ❑Rough In ❑Final Do you need a Temp Certificate?: ❑YES ❑NO Issued On 3/6/2021 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A #Meters Old Meter# ❑New Service ❑Service Reconnect ❑ Underground ❑Overhead #Underground Laterals DE]? ❑H Frame[—]Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION ` '13, g� Electrical Inspection Form 2020.xlsx �- J PERMIT# Address: Switches Outlets GFI's . Surface Sconces , HH's UC Lts Fans Fridge HW Exhaust Oven Dryer Smokes .DW Service .Carbon. micro.. Generator Combo: Cooktop Transfer AC AH Mini Special: Comments: .� C'JU� Q r v C- �,Ni, a)•Q 10.-r THE HARTFORD =s . BUSINESS SERVICE CENTER THE"" 3600 WISEMAN BLVD HARTFORD SAN ANTONIO TX 78251 October 16, 2020 Town of Southold 53095 ROUTE 25 PO Box 1179 SOUTHOLD NY 11971 A642 Account Information: �Q Contact Us Policy Holder Details : TSUNAMI POOLS INC DBA PLATINUM POOLS Business Service Center Business Hours: Monday- Friday (7AM-7PM Central Standard Time) Phone: (877)287-1312 Fax: (888) 443-6112 Email: agency.servicesO-thehartford.com Website: https:Hbusiness.thehartford.com Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any questions or concerns. Sincerely, Your Hartford Service Team WLTRO05 '4�O�RU® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDONYYY) 10/092020 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER7IFlCATE 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(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 F_* NCustomer Service Department Gaslamp Insurance Services PHONE (g00)920 4125 Ar Ext: No: (800)920-4107 E-NIHIL 3238 Grey Hawk CL ADDRESS: Carlsbad INSURER(S)AFFORDING COVERAGE NAIL• CA 92010 WSURERA: Preferred Contractors Ins Co. 12497 INSURED Platinum Pools INSURER 8: 74 Elwood Road INSURER C INSURER 0: INSURER E: Northport NY 11768 INSURER F: COVERAGES CERTIFICATE NUMBER' GL20-21 REVISION NUMBER- [IN HIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD DICATED_ NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEDFINSURANCE OIL bUISH INSO WVD POLICYNUMBER POL Q EFF POLYM E EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0000 CLAIMS-MADE ® 0Q OCCUR GE TO RENTED PREMISES occunence $ 50,000 A MED Exp(Any ore person) $ 5,000 PCA5024PC390032 01/29/2020 01/29/2021 PERSONAL aADVINJURY $ 1,000,000 GENIAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000.000 POLICY❑JDCT EJ LOC PRODUCTS-COMPlOPAGG $ 1,000.000 OTHB2: _ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMB ANYAUTO (Ea accident $ OWNED SCHEDULED BODILY INJURY(Per pemon) $ AUTOS ONLY AUTOS BODILY INJURY(Per accident) S HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ (Per accident UMBRELLALIAB � OCCUR EXCESS LIAB EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION., $ AND EMPLOYERS LIABILITY _ PER OTH YIN STATUTE ED ANY PROPRIETORIPARTNERIE XECUTIVE OFFICE RIMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory In NH) Ifyes.describe tmder EL EMPLOYEE $ DESCRIPTION OF OPERATIONS below F.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS!VEHtCi (ACORD 7(H.Additional Remarks Schedule,may be attached If more space Is required) Verification of Coverage `Subject to all policy terms,exclusions and conditions• CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEI LIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 PO Box 1179 AUTHORRED REPRESENTATIVE Soothed NY 11971 �� J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) TheACORD name and logo are registered-marks of ACORD aEw Workers' Compensaflon CERTIFICATE OF Board NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1a. Legal Name and address of Insured(use street address only) 1b.Business Telephone Number of Insured TSUNAMI POOLS INC 1c.NYS Unemployment Insurance Employer 74 ELWOOD DR Registration Number of Insured NORTHPORT DR NY 11768 1d.Federal Employer Identification Number of Insured or Work Location of Insured(Only required if coverage is specifically Social Security Number limited to certain locations in New York State,i.e.a Wrap-Up Policy) 20-2730919 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Hartford Underwriters Insurance Company Town of Southold 30104 53095 ROUTE 25 PO Box 1179 3b.Policy Number of Entity Listed in Box"1 a SOUTHOLD NY 11971-4642 76 WEG ZS5176 3c. Policy effective period: 10/04/2020 to 10/0412021 3d.The Proprietor,Partners or Executive Officers are ❑ Included.(Only check box if all partnemlofficers included) M 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'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 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 Worker's 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, l certify that 1 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: Danielle Clausen (print name of authorized representative or licensed agent of insurance carrier) Approved by: �} ;i„ .:�;'=, � ,.a,�r; �� 10/16/2020 (Signature) (Date) Title: Operations Manager Telephone Number of authorized representative or licensed agent of insurance carrier. (877)287-1312 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C405.2. Insurance brokers are NOT authorized to issue it. 0405.2(9-17) Form WC 88 3121 F Printed in U.S.A. www.wcb.ny.gov Page 1 of 2 7 Workers' Compensation Law Section 57.Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a-form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C405.2(94 7)REVERSE www.wcb.ny.gov Form WC 88 3121 F Printed in U.SA. Page 2 of 2 \ MAP OF MAJOR 5UDDIV15ION PREPAP.FD FOP. F'AP4C' r: !`; '; ,UP.7_•; t. TOWN OF 5007-1lOLD COUNIY Or 5UFFOLP. 5TATE OF NCW:'ORr' D15TRICT 1000 5ECTIpN 097 DIOCr. 3 LOT -• TH15 5URVEY WA5 PREI'AKtU f0k CAIfIERINL'OLIVA.AND ROF3CR"C(•ITI )ON E _ ll'OODENfENCC % Fitt tor l i rAY LOT 0/M,� ` I I I FRAME y 7r.2 cARn I I= YARD C f1ZtlN� Ic T j — nI° W 2�' BOOL IAWN I I• u `1 G --� �` j. S 9HED I I TAY 4071 i/1/ a I" rAl O ' TREE LINE �I _ iRfl w,t , W LOT 1001MANIC - I` MAP OF MAJOR/5UBDIV15ION PREPARED FOR fRANC15 GREENBU7-GER ,NCIS GP.EENBURGCR• C1 1�1j�iy 'hoc L - �� y EUGENE'5 AND ROBEPT C014TI 2Cj 9 � ,CT CORP. `i Z O t t. r �'"•' y TURANCE COMPANY rCYh (-ikTacy 5c' �,wC•,•-( i •, JLY TO THE PER50N FORWHOM THL 5URVEY 15 PREPAY-ED AND ON TnEIR I,�E"ALF;O fnE'IT;E L1,•,•.�r,i ILCN:.;•.•.,, a .. �,P \}_-f I N5TITVT:ON GUARANTEt5 OR CCRIINCATIONS ARE NOT TRANSrERA%l TO ADDMCNAL"I"!' <LQ-t,1.,r•,• t.,. I15 5URVEY NATION OF 5ECTION-770.`!Of Tl+r NDW TORR 51ATt tDI/GATIJN LAW D ��• W ORIGINAL Of T•iF LAND 5UP" )R','I'll'I SEAL OR H,5 EMB..55t J.`I�,•.`irA,I L,t ,:!'•N-,L 1,:1 ff TTTtt 15 PURN4511ED TO lIq 5URVtt41R t,P,AI WA'UR COUR5t5 PJ'f4 PRO'194rtICLPT A5 SNOWN ON T•1'S JJC\1, s POOLS BLDG. PERMIT # : 1 Rebar 2 Electric Certificate 3 Door & Window Alarms UL2017 4 Surface water alarm (s) F2208 5 Barrier — Min. 48" w/top rail 6 Mesh type wire — max 1" square openings 7 Gates : swings away from pool, self-close & self-latch release 54" min. from outside grade NOTES : 1' a(._of NOTES 40' T TYPICAL CONTTRETE C 1. NO SOIL SURCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION AT THE SHALLOW END,OR 6 FEET OF EXCAVATION AT THE DEEP END. FRAME CONC NUOL)5 LLAR 2. TH15 POOL MEETS THE REQVIREMENTS OF AN51/APSP/ICC-5"AMERICAN NA11ONALSTANDARD FOR RE5IDENTIAL INGROVND SWIMMING POOL5"AN1)1996 BOCA CODE-SECTION 421.DIVING EQUIPMENT 15 NOT ALLOWED. 0�� a 3. SWI MM I NG POOL 5 HALL BE COMPLETELY AN 1)CONTI NUOUSLY SUR ROUN PEP WITH A BARR I EP,CON5TP UCTED IAW REQUI REMENT5 OF V) SECTION R326.4.2.1 THROUGH 8326.4.2.6 OF THE NEW YORK STATE RESIDENTIAL CODE(2020)AND IN CONFORMITY WITH ALL SECTIONS OF THE SOUTH OLD TOWN CODE.D WELLI NG WALL(S)MAY SERVE AS PART OF THE POOL BARRIER AS PER SECTION 9326.4.2.8 AND O CONDITION(1)ARE MET.OPERABLE WINDOWS IN THE WALL(S)USED ASA BARRIER SHALL HAVE ASELF LATCHING DEVICE.ACCESS GATES O SHALL COMPLY WITH SECTION R326.5.2 OF THE NYS RESIDENTIAL CODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY Hzo LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED.ALL GATES ARE TO OPEN AWAY FROM THE POOL AREA. y� �! A � SA 11 L�`�T$�q 4. DURING CONSTRUCTION THE CONTRACTOR SHALL ER ECT ATEMPORARY BARRIER AROUNDTHE EXCAVATION IAW THE CODE OFTHE TOWN OFSOUTHOLD. M ENCLOSE OOL TO COD 5. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING ENTRY INTO THE WATER AND SOUNDING AN UPON`, OMIPLETION ,. ° . AUDIBLE ALARM UPON DETECTION THAT IS AUDIBLE AT POOLSIDE AND INSIDE THE DWELLING. THE ALARM MUST BE INSTALLED, O z o EF11 ER, MAINTAINED AND USED IN ACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS. TFiEALARM MUSTMEETASTM F2208 O v Et , 5 ti - - "STANDARD SPECIFICATION FOR POOL ALARMS.THE DEVICE MVSTOPERATE INDEPENDENT(NOT ATTACHED TO OR DEPENDENTON)OF I v m af•'Aj�u 6 2 q Lj E 0y PERSONS. m e ¢ Po "a Y ��� U 6. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS)MUST BE PROVIDED WITH A COVER THAT CONFORMS TO ASME/ANSI � j= 9 `° A112.19.8MORA MINIMUM 18"x23'DRAIN GRATE OR A CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MV5TBEEQUIPPED WITH N `� �� ATMOSPHERIC VACUUM RELIEF IN THE EVENTTHE GRATE COVERS LOCATED WITHIN THE POOL BECOME M155ING OR BROKEN, SUCH ���� VACUUM RELIEF SYSTEMS SHALL CONFORM WITH A5ME A112.19.17 OR BE A GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD. vv` P LAN POOL SHALL BE PROVIDED WITH A MINIMUM OF SUCTION FITTINGS OF THE ABOVE MENTIONED TYPE. THE 5UCTION FITTING55HALL BE �y p- /`�(i �� �� N.T.5. SEPARATED BY A MINIMUM OF 3'AND MUST BE PIPED SUCH THAT WATER 15 DRAWN THROUGH THEM 5 1 M ULTA N EOL15 LY Ti ROUGH A f�J6F 6V$A6�_ � VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCESSIBLE �L IN$p POSITION,MINIMUM OF 6"AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENTTO &c10(v RETHE SKIMME9/SKIMiMER5.A REQUIRED POOL ATMOSPHERIC VACUUM RELIEF SYSTEM SHALL BE INSTALLED AS PER NYS RESIDENTIAL CODE VINYL COVERED QD °9326.6.3(2020)AND IN ACCORDANCE WITH TOWN CODE. CONCRETE SEEPS ' _ 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF NFPA 70(NEC)PRINCIPALLY ARTICLE 680 AND THE NYS APPROVED ���] � y4] RESIDENTIAL CODE SECTIONS 4201 THROUGH 4206.ALL ELECTRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS LABORATORIES AND C IIS BE PROTECTED BY GROUND FAULT CURRENT INTERRUPTER(GFCI)CURRENT CARRYING ELECTRICAL CONDUCTORS EXCEPT FOR THOSE S ,/ ` / PROVIDING POWER TO POOL LIGHTING AND POOL EQUIPMENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4203.5.ALL DATE: �' R P•(=�+ �z'to4 SAND BOTTOM METAL ENCLOSURES,FENCE50RRAILINGS NEAR OR ADJACENTTO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHAP GED C DUE TO CONTACT WITH AN ELECTRICAL CIRCUIT SHALL BE EFFECTIVELY GROUNDED. v FEF_: ., Com_ BY: 11 CCIvIPL l WITH ALL CODES OF 17 r ` S. WATER SOURCE FILLING THE POOLSHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE TAW NY5 PLUMBING CODE608. Ln NOTIFY BUILDING DEPARTMENT AT NEW YCR�MIAJJTF_4 TOWN CODES 9. ALL PIPING IS DIAGRAMMATIC UNLESS OTHERWISE STATED. 765 1602 8 AM TO 4 PM FOR THE AS REQUIREDNA NS OF 0 � � z 10. WALKS IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM POOL EDGE. FOLLOWING INSPECTIONS: 11. A MEANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED IAW AN51/APSP/ICC-5 SECTION 6. v 0 1. FOUNDATION - TWO RcQUIRED SOUTHOLD TOWN A AL U co FOR POURED CONCRETE SOUT4q LI PLANNING BOARD 12. CONTRACTOR TO PLACE THEPOOLIAWTOWNOFSOVTHOLDCODESETBACKS. O 0 m V "c. ROUGH - FRAMING-& PLUMBING 13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE5UB)ECTPROPERTY. 3. INSULATION SOOT FROM SKIMMER 15. THE DESIGN 15 BASED ON A.DRAINAGE 501L WITH<10,5511-f. GROUNDWATER SHALL NOT EXI5T WITHIN THE EXCAVATION. IFGROVND WATER EXISTS WITHIN 6'-O"FROM GRADE,DEWATERING FACILITIES WILL BE REQUIRED. 4. FINAL CONSTRUCTION_MUST ;J`'.�.DEC BE COMPLETE FOR C.O. 10DI5P05AU 16. ALL GAS AND OIL HEATERS(IF INSTALLED)FOP.THE INGROVNP SWIMMING POOL5HALL BE NATIONAL APPLIANCE ENERGY ry ALL CONSTRUCTION SHALL MEET THE DRYV L CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATERS SHALL BE TESTED I.AW AN51 221.56 AND SHALL BE INSTALLED IAW MANUFACTURERS SPECIFICATIONS. OIL FIRED POOL HEATERS SHALL BE TESTED IAW UL726, POOL HEATERS SHALL BE LOCATED OR REQUIREMENTS OF R 14 OF NEW GVARPEI)TOPROTECT AGAINST ACCIDENTAL CONTACT OFHOT SURFACES BYPEP SONS. POOL HEATERS SHALL BE PROVIDED WITH P? n1 DIVERTER O TEMPERATURE AND PRESSURE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPA55 SYSTEM.A BYPASS LINE SHALL BE YORK STAT POL Wa §J ,'FF FOR VALVE INSTALLED FROM INLET TO OUTLET TO ADJUST WATER FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE y;,Sµ�y� B7OYERRORS• FOLLOWING ENERGY CONSERVATION MEASURES: L� DESIGN OR CO YA[E�TdLP 0. CEI,,wy EOR WOOP 00 L ALUM COPING CA PECK(PY OTIiERS)VP uR\renn uR ro coP'.G FILTER 16.1 AT LEAST ONE TH ERMOSTAT SHA LL BE PROVIDED FOR EACH HEATING SYSTEM. p 16.2 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW 511UTTING OFF THE K'ATERVNE OPERATIONOFTHEHEATERWITHOUTADJUSTINGTHE THERMOSTAT SETTING AND TOALLOW RESTARTING WITHOUT RELIGHTING THE z TO RETURNS PILOT LIGHT. M 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQVIREMENTARE OUTDOOR POOLS F+• CHECKVALVE y ti U CORNER CONNECTION ALTERNATIVE RIM LOCK COPING DERIVING 20%OF THE ENERGY fORHFATINGFROM RENEWABLE SOURCES ASCOMPUTED OVERANOPERATING SFA50N) w ��mC-4 7 PLUMBING SCHEMATIC 16.4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BE 5ETTO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN BESET w Q- N.rs. Nrs. NOTE DECK/IERR,VN TO BE PI,GHEDAWAY FROM POOL N.T.S. TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER INA CLEAN AND SANITARY CONDITION IAW APPLICABLE z e 5AN ITARY CODE OF NE W YO RK STATE. -o ALUM.COPINGCAP vP..6,sia•Lc,HeC HP. 17. THIS DRAWING 15 FOR STRUCTURAL5HELL ONLY. ALL ACCESSORIES AND APPURTENANCES ARE DEFINED BY OTHERS. Z to p_T BOLT&11)FNT W'AH5ER 'A'rRM1E BASE STEEL °h WCIS ELP-1OlTRMALVMINE!ED W P COATING O\ER hELDS STEELANGLEPRI\2 SHAKE WELD$ON SIDE OF PANELi'-1-12' h C--, I0 NATER LINE LO NO.INELDEPTOP&EOITOMAS 18. BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS. DO NOTALLOW THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHTOF THE (y o .. `, v ALVMINVMCOPING SHOWN,&ALVANIZEDCOATINO WATER IN THE POOL BY MORE THAN 8", OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8" c 3/e'-th x f'LG.HEX OVER WEIPS. STEELPANEL HP.BOLT,HEKNL" 7A" &(1)FLAT w DNMIL WASHERS(117 5M'1NRFMEDRODBOTH ENDS 19. PLACE CONCRETE ON SANDY TO LOAM 501L REMOVE ANY CLAY DEPOSITAND REPLACE W/COMPACTED CLEAN BACKFILL MIN. IONGS,EEEI. PANEL wGIE STEELPANEL 5/4'r..srPIPE 20. THERE I5 NO MAIN DRAIN IN THIS POOL.SUCTION FOR POOL WATER CIRCULATION 15 PROVIDED BY THE SKIMMERS ONLY.THIS MEETS t✓v Y0 2'704'L1NP 10MIL MIN. MFFEN A-�+E CONCRETE CODAR REQUIREMENT50FTHE NY5 RESIDENTIAL CODE-SECTION 8326.5 FOR ENTRAPMENT PROTECTION. _ MIN.14'.6' J Hp hiq 21. THE POOL WAS DESIGNED IAW THE FOLLOWING: ' '! S 21.1. THE NEW YORK STATE RESIDENTIAL CODE-SECTION 8326(2020) r 5 lh 9� y 10•mNO RE-BARDRI\'E 21.2. THE NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE-SECTION 9403.10(2020) C' - 11 I TNM VNDISIIIREEP FARi11. SHORT STEEP 14'x6•CONCRETECOLIAR HOWIAN-AL BRACE O , w USEHOLES INPANELPASE� ANGLE 1s•.rxr,-,acA 21.3. THE NEW YORK STATE FUEL GAS COPE(2020) ATPOOLPERIMETER UNDISTURBED EARTH 'A'FRAME BAS STAKE 21.4. THE NEW YORK STATE SANITARY CODE. {{ , 15'.1.5'x14'-IS GA 21,5. AN51/APSP/ICC-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. a A-FRAME WALL SECTION TYPICAL PANEL STIFFENER ALTERNATE A-FRAME DETAIL 216. BOLA OF THE TOWN 421. 21.7. CODE OF THE TOWN OFSOVTHOLD. N.T6. N.TS N.TS. _• ` �-- '` 22. ALL BACKWASH TO BE SELF-CONTAINED ON-SITE. A o B O� 23. POOL TO BE EQUIPPED WITH AN AUTOMATIC POOL COVER. ✓S�� PROFE`J�\