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HomeMy WebLinkAbout47815-Z �g11fFOl�CVG Town of Southold 7/22/2023 P.O.Box 1179 ocm _ 53095 Main Rd y o�+ fiSouthold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44345 Date: 7/22/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 400 Diedricks Rd., Orient SCTM#: 473889 Sec/Block/Lot: 18.-3-11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/13/2022 pursuant to which Building Permit No. 47815 dated 5/16/2022 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: accessory in-ground swimming pool fenced to code as applied for. The certificate is issued to Solution East LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL i ELECTRICAL CERTIFICATE NO. 47815 6/29/2023 PLUMBERS CERTIFICATION DATED t ze gnature yTOWN OF SOUTHOLD �SUFFOIIr c� BUILDING DEPARTMENT co TOWN CLERK'S OFFICE 0_1 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#: 47815 Date: 5/16/2022 Permission is hereby granted to: Solution East LLC 110 East Side Ave Mattituck, NY 11952 To: construct accessory in-ground swimming pool as applied for. Pool equipment must be located a minimum of 25' from lot lines. At premises located at: 400 Diedricks Rd., Orient SCTM #473889 Sec/Block/Lot# 18.-3-11 Pursuant to application dated 4/13/2022 and approved by the Building Inspector. To expire on 11/15/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector OF SO(/ryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlin(cbtown.southold.ny.us Southold,NY 11971-0959 �y�OUNT`l,Nc� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Solution East LLC Address: 400 Diedricks Rd city:Orient st: NY zip: 11957 Building Permit* 47815 Section: 18 Block: 3 Lot: 11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Rays Electric License No: 5141 ME 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 3 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 Strobe Heat Detectors Disconnect Switches 2 4'LED Exit Fixtures Sump Pump Other Equipment: Pump 220GFI,4 Lights 30OW Trans. 120GFI, Heater, Auto Cover 120GFI Notes: Pool Inspector Signature: Date: June 29, 2023 S.Devlin-Cert Electrical Compliance Form f _ Trot ho�OF SO ,�°�# # TOWN OF SOUTHOLD BUILDING DEPT. u 631-765-1802 IN PECTION [ ] 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: 0 n rN r) oy- l DATE INSPECTOR ho�a�FSOGTyO� by . GD �►� c��r # # T N OF SOUTHOLD BUILDING DEPT. coum, 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: AtC ,-� ci DATE gJ 1d ?,I, ANSPECTOR OF SOGT # TOWN OF SOUTHOLD BUILDING DEPT. courm, 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: DATE 22 INSPECTOR OF SOUI / - -L-100 TO OF SOUTHOLD B G # N / LDIN DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] 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: l� DATE INSPECTOR so TOWN OF SOUTHOLD BUILDING DEPT. cep cou 631-765-1802 INSPECTION I FOUNDATION 1ST ROUGH PLBG. FOUNDATION 2ND ULA FRAMING/STRAPPING FINAL rLKING FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O RENTAL REMARKS: (n \Aiw b�/;�f5D DATE - INSPECTOZ 40c) \?k CDRkCtz �?D L pool permit no.47815 S a c.v-n oN C-ft5T C_LC y` ,P r- w 2 r'b �. li ti I A, it toW AX All t t t .r 4 r. 4 of � / • � � ,✓� 5,11 r' ,• � .�ytti:'. ?,� . A, All. r •7FIr' r J, 1 y ( l jj r a ry • J , • e f . r, r r 1 • f I ' (� .r r.. .Y'�k .•'. `°� �'rf � �sy ,, •i. � ��,} �.. .ice' , t 't t Jtt` r _ ��' •.� < i '� r�. i ,. ..yam, .._ •.ar•�,., " •' r • � ♦ �0,�r: , � . LL i♦w :C 1 •�,��. ��' '��`d 9�. t �+;' fir. r. F• i'' :,,, -���' ', r .. � - �I---elf t •1c_-li G�.,t'.� , v "�( ,�i" ; 1• �• �.� -4 \ � i �1 Mrs, ■r ow low r � �■� n / � ►Yjw.' �� �' rr ►� � f�vim• 15%'x,� �� i;sh. p:'I�.. �� ���r`���• 191 r awow Amy Mill } ilii i��i►..�="�►� �� �`�,, r•. ; } . trw Vo,ICAi If tf r i � r •' •' •!_ IL Amk r • �" • � • 00• Its M Vk O -r 1Ilk 4,1 �� �•`rte is `-- .,. 1/•. v i • �7 �m W 1 , i .•r a, � • k .t r _ aww 1 _ .4 • r y n, 1.4 Nq tly a. a v o , a I F st rr t f �.� dipr / �+ 4. • .: .. �. *" it � ti' _ r -�• fk .40 mob AIW X � � r • ; O r r r ' PPVAPO 01 * • • s do • "` !' +� CA 1� .►i •' ' Ir +� a A }1 FIELD INSPECTION REPORT TE COM NTS 000, tloor FOUNDATION (1ST) ^' V 1'� ------------------------------------ �1 C FOUNDATION (2ND) z O H ROUGH FRAMING& PLUMBING r INSULATION PER N.Y. STATE ENERGY CODE u 2. �l FINAL ADDITIONAL COMMENTS Leo du Ttl,� lb9 Ll� gr o L ou � o z H x d r� b y c,UflO(k TOWN OF SOUTHOLD—BUILDING DEPARTME Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 N M r tiy�o ao� Telephone(631) 765-1802 Fax (631) 765-9502 https%//www.southoldtowm..Ezov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: APR 1 3 2022 Applieationsand forms must.be filled out in the' eriti`rety.;lncori plete ap,plicatioris will"not beaccepted Where the Appli6M,is°notthe owner;ani``: BUILDING DEPT. 1 11 TOWN OF SOUTHOLD Owner!.s Authorization'form,(Page 21.shall,b'e'completed.` Date:April 11, 2022 'OWNERS'OE'PROP ERTY Name:Solution East, LLC SCTM# 1000-18-3-11 Project Address:400 Diedrick Road, Orient, NY Phone#:516-971-5871 . Email:annemarino440@gmail.com Mailing Address:PO BOX 283, New Suffolk, NY 11956 NTA PERSON' : : Ns 0 Name:Chuck Kitz Mailing Address:110 Eastside Ave., Mattituck, NY 11952 Phone#:516-971-5871Email:harkenconstruction@gmail.com IV t b "DESIGN°PROFESSIGNAL' INFO,RM'AT IO Name: Jaynes J. Deerkowski , Lic. #072502 Mailing Address:-260 Deer Drive, Mattituck, NY 11952 Phone#: 631-298-5506 �. _..._................ ........... Email: jdeerkowski@yahoo.com FOR ATIO N: ':. INFO -� ,CON TRACTOR . Name: PiCO Pools LiC.# HI 61148 _ Mailing Address: 81 Beach Road, Wading River, NY 11792 Phone#: 631-655-6071 Email: pete@picopools.cOm L' D _. r, " A _ CT OIPTI N'0FPR D:C 0 STR SC - - El New Structure ❑Addition ❑Alteration []Repair ❑Demolition Estimated Cost of Project: �Otherin-ground swimming pool(18'x 40') 75`000;00 Will the lot be re-graded? ❑Yes R No Will excess fill be removed from premises? DYes ❑No 1 PROPERTY INFORMATION residential _ Intended use of property:residential Existing use of property: .._._a,.__-__a...�..•�..,_v Zone or use district in which premises is situated: LAre there any covenants and restrictions with respect to sro ert ? ❑Yes *No IF YES, PROVIDE A COP . p p Y 8 Check Box After'Reading:,The owner/contractor/design professional is,responsible for'all`dralinage and storm•water Issues as.provlded by Chapter.236 of the Town Code. APPLICATION IS HEREBY.MADE to the Building Department for.'the Issuance of a`Bullding 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 authoirized inspectors on premises-and In buildings)for necessary,inspections.False statements made herein are ,,;pun hable as'a Class'A'misdemeanor pursuant to Section-210.45 of the,New, York St1 .ate,Penaf Law., Charles M. Kitz Application Submitted By(pri n e): ❑Authorized Agent BOwner Date: Signature of Applicant: 1, - - - STATE OF NEW YORK) S. 1 COUNTY OF L' �+ SVK,,, •TZ.� being dui sworn, deposes and says that(s)he is the applicant lnr�r Ips M • �� _ y (Name of individual signing contract) above named, (S)he is the OW n<P, (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 .�pp �h 1�day of_�T�ir 1 202Q- 0� Notary Public TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY�.l�� (Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,2� 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 ho��pF SO[/lyol . 0 Town Hall Annex 4 4 Telephone(631)765-1802 54375 Main Road y (631)765995Q2 P.O.Box 1179 o Q roger.d hertCa-own.southold.ny.us Southold,NY 11971-0959 ® i AUG 0 ZQZZU) BUILDING DEPARTMENT TOWN OF SOUTHOLD Bu1LL)1h,' ,DEPY TOWN OF SOM-HOLi) APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: L Date: Company Name: Name: License No.: �i�► Address: Phone No.: JOBSITE INFORMATION: (*Indicates. required information) *Name: *Address: �� *Cross Street: 27 r, f - *Phone No.: Permit No.: 7,21 Tax Map District: 1000 Section: Block:— Lot:_j *BRIEF DESCRIPTION O/F�.111/;ORK-(Please Print Clearly) (Pfe�fse C I r de'2I That A�Bply, *Is.job ready for inspection: YERough In Final *Do you need a Temp Certificate: YE;/ NO Temp Information (If needed} *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION .82-Request for Inspection Form ��v GLA— c''C'V -it lW SO(/ry°l O Town Hall Annex Telephone(631)765-1802 54375 Main Road ....f�ax(631)765- 512 P.O.Box 1179 G Q ro_ger.dchert(a�town.sout�iod.nv.us Southold,NY 11971-0959 COU � ""7u, �� � �,�1 �� - .\, I`�1 "n t V1 BUILDING DEPARTMENT TOWN OF SOUTHOLD sL'iLL}<<•c DEPI, T0VWQ ui APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: f� __2� Date: Company Name: Name: License No.: Address: ,% ' ,✓�-� ��,�? ' C-�; J�e> �' Phone No.: �I_ l _'_S / JOBSITE INFORMATION: (*Indicates required information) *Name:_ *Address: 1 ?iL G,��J 12,0 *Cross Street: 2- *Phone No.: Permit No.: �� � 21,3 'Y7f _5 Tax Map District: 1000 Section: Block: _ Lot: *BRIEF DESCRIPTI0 F.-WORK(, se Print Clearly)_ (Pfeise Cirdel l That *Is job ready for inspection: YERough In Final *Do you need a Temp Certificate: YE.;!/ NO Temp Information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 300" 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 82-Request for Inspection Fonn } j V 1 Lv G�s�-C � �� . _L__ PERMIT # Address: Switches Outlets G FI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven W/D Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service Amps Have Used Special: Comments NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 23 I A A A A A 832112270 2 NEEFUS STYPE AGENCY INC 711 UNION AVE ? PO BOX 2340 mAm AQUEBOGUE NY 11931 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER FCERTIFICATE HOLDER PICO POOLS&SPAS INC OWN OF SOUTHOLD T/A SA MARBLE DUSTING 4375 MAIN RD 81 BEACH ROAD OUTHOLD NY 11971 WADING RIVER NY 11792 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12453 329 1 408530 09/13/2021 TO 09/13/2022 4/13/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2453 329-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF,COM/CERT/CERTVAL.ASP. THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRES PETER IFKOVITS PICO POOLS AND SPAS INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND 4 DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 843155206 PICOPOO-01 GANCONA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 4/13/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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). PRODUCER CONTACT Neefus Stype Agency PHONE 711 Union Ave. A/C,Nxf 0 A/c,No:(6-411722-3591 Aquebogue,NY 11931 E-MAIL !11 .com- FFORDING COVERAGE NAIC# INSURERA Indemnity Ins Co 18058 INSURED INSURER B PICO Pools&Spas,Inc.dba SA Marble Dusting INSURER C 81 Beach Road Wading River,NY 11792 INSURER D: 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 SUBJE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CT TO ALL THE TERMS, INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP S POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 000 000 EACH OCCURRENCE $ CLAIMS-MADE X OCCUR X PHPK2336676 11/15/2021 11/15/2022 DDAMAGETORENTED $ 100,000 _PR occurrence) .MED EXP(Any one erson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECT LOC OTHER: PRODUCTS-COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO )-- $ OWNED SCHEDULED BODILY INJURY Per person) $ AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY AMAGE AUTOS ONLY AUTOS ONLY er accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION PER TUTF OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETO�R�/PXCLUD D.? u"'_ ❑ E.L.EACH ACCIDENT $ EI OFFICERry5nNH)EXCLUDED N/A (Mandato Fi) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Certificate holder is listed as additional insured in respects to general liability per written contract. CERTIFICATE HOLDER CANCELLATION -7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 NY-25 ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VET8�NS hs&mer 'bor .LLC nATr ISS AZUO�.L ItG `4ffa p e-qSS&, � p�/27/2px �Ay - . �: �•�8 UppAUG� . _ ,NT VV yOR� 11788 1 7 x.- Suffolk co gs nie I ty �48 This is to ce Amp -Pet doing yc CO, } busine s asthar �L It having furnished quire �C aP Zlee, and regulations ot/1e tnents set for PICA P se County of suffo forth in accordance OpS 8L SFAS ' . �, �, State of With and su ' { RO coN ev, York is he�biect to the Provisions ' TRACxpRin the licensed to coofaPPReable laws .- N©T�AD� County o fSu olU busineSS as a Iaws, rule,les r D.UP wrT FlO A.�,AENTAL SEgt AcI `�•-�z ' .. ' C�NSUjyIE`�R(? �'C ditiona;Busiacss a R�P r es { ID CARD .License Category .:tip I S26-paL CER�S A`IEYDD SPAS/0 f � •t. J _ �_ sioner _,usinesses ?. Rosalie Drago �.. Commissioner Ais ' ,iy - �+.-�� G-ij � �fij '•.. :i I 0."x •' e _ •~•=" .0 .,` � •. 'r�_"C-,'�L.' w� � : 7G:. "j' � ���, .r�' ���y ./+i os+.'1`•.� f��.��ia' � .'n` � �i a:.`•� _%5�.� :.'�''�1? t `moi � a��:.:�� ,-S,� ��� �Jli'•!i~d '�� i..J.S•:��/" �::.tti~�/ 4•.�� �1.��•'� f .t. � f �w=��i• �.•",.a•ti PICOPOO-01 JWILLIAMS T DATE(MMIDDIYYYY) ACORO" CERTIFICATE OF LIABILITY INSURANCE 4/12/2022 THIS E CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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). CONTACT PRODUCER AME: Neefus Stype Agency PHONE p A/c No Ext: (631)722-3500 ac N.):(631)722-3591 711 Union Ave. E-MAIL IR .info nsainsure.com Aquebogue,NY 11931 INSURERS AFFORDING COVERAGE NAIC# INSURERA:Philadelphia IndemnityIns CO 18058 INSURED INSURER B PICO Pools&Spas,Inc.dba SA Marble Dusting INSURER C 81 Beach Road INSURER D, Wading River,NY 11792 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 PAIPOLICY EFFD POLICY EXP INSR ADDL SUBR POLICY NUMBER LIMITS TYPE OF INSURANCELTR 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED 100,000 CLAIMS-MADE �X occuR PHPK2336576 11/15/2021 11/15/2022 $ 5,000 MED EXP(Any one Rerson $ 1,000,000 PERSONAL&ADV INJURY 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY❑Mo El LOC OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY BODILY INJURY Per erson ANY AUTO OWNED SCHEDULED BODILY INJURY Per accident AUTOS ONLY AUTOS P OPERdY AMAGE HIRED NON-OWNED er aca ent AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ pER OTH- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PA RTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT OFFICER/rM E�2 EXCLUDED? NIA E.L.DISEASE-EA EMPLOYE $ (Mande ory in N ) If yes,describe under E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 NY-25 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LOT AREA = 105,028 SQ. Fr. 17-73 2.41 acres 21-225 22-41 22-49 22-2t9 -- NOW OR FORMERLY MARnN I I I 11 / dmlo N 48'29'00•E 4J8.38' NOTE: CESSPOOL, SEPTIC TANK, WELL and / DRYWELL LOCATIONS BY OTHERS. Nm I6-19-2023 I I REVISED 5-23-2023 FINAL SURVEY 10-13-2022 UPDATED, LOCATED GARAGE 3-10-2022 LOCATED FOUNDATION AND WELL 12-16-2021 STAKED PROPOSE BUILDING W/ 20' OFFSETS I i i nA• li `�� LOCATED NEIGHBORS DRIVEWAY TO THE NORTH and NEW ELECTIC METER Do, I} 11-30-2021 REVISED PROPOSED GARAGE ■ I I I I � - �otaw TOME , 1 1-16-2021 ADDED PROPOSED WATER LINE Ao,u t0-10-2021 REVISED PROPOSE HOUSE and GARAGE w II Ll I a 3-14-2018 ADDED HEALTH DEPT. INFO and DWELLING C7 > DATUM NAV.D. 1988 py. ; l` L` ——————— �\ \ — ` nc wrrxm cm mmommn sass wanK mar nR rmxnso m wE Pmww Y u! JR rm A WEDM PUP=/Ma um AND rlcw R MIL NOT Mut Qr„t I r •rrnom to DUOL PC V=n of roma O T.—O MIA roal/,pal• ——— ——— / ` \ �.• �rm.aa.r o ff n.Wnm AISA&Manor TO sautm a Wr 0X0 awnurcrcn. \ r•a. A. UMMmra=XTVW N a ADaroM To THS senora A VELD DM OF SM" O \ \11 r esr OYW ar w- ! \ rra v ng Mn TOOK lrar MCOM us. ! ! 0 -1 t� n ` I o of auAOAMIm•crwtm Maw soot MUM olaY ro nrL raLw FOR slat nd DUL � 2 tOOtuY a IMraMrm•Aro w to raowr ro na mtt oarAMr,aowarOruL \h ON+bM, � *IV .mor NO morn ItMO M Lff=Matas M O ro W ASMM or mL 5 u'05'201y \\ L� J l o *4 It nRI D L MM AN Nor T Maaorrc ro A00MOMM.9dl9Uif06' \ ! N TQ25'40'W PC 13.80, R COMM ar nu SAKY W Mar KAl•MO M UAD LOYCYar]u•®MAL Oil \ 1 ! ia OADI•m IMfeML MDT BE"W0="W0=ro rt A%04Mn TMOUMI con _ I a ! o m aw O �+w JOB No. 16-246 FILE No. 992 F o LYNDO M11ES t �WE1tRA I i w!! py S �OIy + N SURVEYED FOR ' / ! NOW 04 Fl,,My Jr w 04 AOC �,,i,��r.�• ! -�r SITUATED AT ORIENT TOWN OF SOUTHOLD, SUFFOLK COUNTY, N.Y. SCALE 1' - 60' DATE 10-20-2016 Y FILED MAP No. DATE CERTIFIED/ -- - - -- IED ONLY uF ;._� ra TAX MAA No.1000-18-3-11 DISK 2016 AN HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR P.O. BOX 616 A'h'ogD a 1866 WADING RIVER-MANOR RD. WADING RIVER, sY �o. 0-0t1�9ti +� NEW YORK, 11792 Pt 1 IC.No.048992 HAROLD F.TRA L t) N.LIC.No.2115-E 631-929-4695 I V3 e a. LOT AREA = 105,028 SO. FT. _ 17-73 2.41 acres 21-225 22-41 NOW OR FORMERLY MARTIN g C N 48'29'00"E 436.58' m (�' n�] ARM 9t��0I �otyin9 lJ V blk, fd�k se ee 3 O 2 oJir°j/ , eI°��L� �waL APR 1 2U�2 " box Pole r I I 0 m a"o BUILDING DEPT. I I I I I 9 TOWN OF SOUTHOLD Z Ilii i� i " 3-10-2022 LOCATED FOUNDATION AND WELL 12-16-2021 STAKED PROPOSE BUILDING W/ 20' OFFSETS o PRo�s�� �vDL Ct8`rxBs�' ' MON LOCATED NEIGHBORS DRIVEWAY T O THE NO RTHc +a�' and NEW ELECTIC METER 11-30-2021 'REVISED PROPOSED GARAGE 411-16-2021 ADDED PROPOSED WATER LINE 10-10-2021 REVISED PROPOSE HOUSE and GARAGE4 43-14-2018 ADDED HEALTH DEPT. INFO and DWELLING 230 Ct I.I I I } DATUM N.A.V.D. 1988 Pole I — y THE OFFSETS (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE \I ai�j PROPERTY ONES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT 1 �b Y'ZT I d® °h C ��` c3$ INTENDED TO QUIDE THE ERECTION OF FENCES, RETAINING WALLS, POOLS, PATIOS, \L / Gfl 1 PLANTING AREAS, ADDITION TO BUILDINGS OR ANY OTHER CONSTRUCTION. 8OL 24, I 'E 3 �y UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION PIPE I \ \ \ R(OET►OF WAY I M Z Z 7209 OF THE NEW YORK STATE EDUCATION LAW. / PC sood) N GUARANTEES INDICATED HERON SHALL RUN ONLY TO THE PERSON FOR WHOM THE _ SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENT& \ s Apot retl 1 ofl�El `�,2Iy AGENCY AND LENDING INSTITUTION LISTED HEREON,AND TO THE ASSIGNEES OF THE i` Mo S 54'05'20"W \ �mn \JS / 0°W\ /pH LENDING INSTITUTION. GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSIRUTIONS \\ / N 28'25'40'�ot•sOR SUBSEQUENT OWNERS. \ \ N I 314.98' 13.80 0.41w sHW W COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR !� xS p EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VAUD TRUE COPY. / forme drn 1 1 a I FR SHED T< z 1 �, S �_ R� "� " JOB No. 16-246 FILE No. 992 F a � LYNDO MYLES R FORMERLY sspp'loft GG:is SURVEYED FOR A & ROBERT GUERRAI I I m c I I I NOW OR FORMERLY NOW 121.p0 +T+ I j I JAMES & DEBORAH MICHTA q G OR�R,y SITUATED AT ORIENT / e I TOWN OF SOUTHOLD, SUFFOLK COUNTY, N.Y. SCALE 1 60 DATE 10-20-2016 / / o I FILED MAP No. DATE / I CERTIFIED ONLYYTO��,= ,� ar TAX MAP No. 1000-18-3-11 DISK 2016 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR e, P.O. BOX 616 I AD 1866 WADING RIVER—MANOR RD. WADING RIVER,NEW YORK, 11792 HA RlO D '� �'' `n ,'iN.Y. . No. 048992 631-929-4695 L F.;T.RANCHQN,JR, PENN. LIC. No. 2115—E Cal APPROVED AS NOTED DATExx� P.# FEE: U BY: RETAIN STORM WATER RUNOFF NOTIFY BUILDING DEPARTMENT AT PURSUANT TO CHAPTER 236 765-1802 8 AM TO 4 PM FOR THE OF THE TOWN CODE. FOLLOWING INSPECTIONS: . 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE , 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE ELECTRICAL REQUIREMENTS OF THE CODES OF NEW INISPECTIOPI REQUIRE' YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF perL �$9UT�8L$TOWNZ3{>~, IAT ae� HOS D TOWN 1NG BOARD ENCLOSE POOL TO..CODE. COIVIPLET- ft SQR4% eM-TP STEES f5FQRE:"WATE N.Y,� OCCl P�MNCY 0R USE IS UNLAWFUL WITHOUT CERTIFICAT, n� < <' u. w S DFOCCUPANCY � n GENERAL NOTES QE 1.WWI pool in accordance with approved site plan,local zoning and construction codes,2020 Residential Code of New York State and 2020 Energy Conservation ' Construction Code of New York State. Q 2.Locate patio,pool,pool equipment and fencing as specified on approved plot plan. 11-011 6X6 TILE FACING Install all products in strict conformance with manufacturer's instructions. All warning L z labels to be permanently affixed. M O 3.Install pool in free draining subgrade. Backfill with clean select granular fill. InI �1�l�I/r7 Z E IJ lJ 3 4.Water treatment plant to conform to the following minimum specification. Pump to •a %. tum 1 volume in 18 hours. Filter to pass no more than 5 gpm/s£ 1 skimmer. ——— 5.Provide potable water supply in pool area. — __r (2) #3 REBAR X WATER UNE (.Provide dedicated electric circuits of capacity sufficient to service water treatment — I 1 CONIINOUS AROUND Q 1 3 2022 r—— —T BOND BEAM ` A R plant All electric in pool area to be protected by ground fault interrupt Install all electric in accordance with the N-E.0&local requirements.There shall be no overheado I I electric lines within 10'of the pool I I I I PNEUMATICALLY f 131 iLDING DEPT. 7.Slope deck 4'per foot away from pool. All concrete to be 3,500 psi,5-7%air I I I I APPLIED CONCRETE, r. TOW OF SOUTHOLD Z entrained unless otherwise noted. 3000 PSI AT 28 HYDRZZO FINISH -1 8.Install a temporary 4'high construction barrier about the pool during its installation. —I — .+ _ _ — I _ _ _ I DAYS, MIN. 0- Maintainsuch barrier until apermanent barrier isinplace. I I I I RADIUS: 2-24" IN SHALLOW —i END AND GREATER THAN 9.Install erosion controls prior to the start of construction as required and specified I I O hereon.Maintain such controls during construction I I 25" IN DEEP END D_ 10-The permanent barrier about the pool area shall comply with local ordinance,the Residential Code of NYS Chapter R326-Swimming pools,Spas and Hot Tubs I I REBAR SCHEDULE o- Section R326.42 and conform to the following minimum specifications. LMI N.———— I DEPTH <_5' >5' 6", ~ z a.The top of the barrier shall be at least 48 inches(1219 mm)above grade measured — —I--——— —— J on the side of the barrier which faces away from the swimming pool The maximum WALL HORIZ. 12" O.G. 12" O.G._ � Z vertical clearance between grade and the bottom of the barrier shall be 2 inches(51 WALL VERT. 12" O.G. 6" O.G. (n 0 mm)measured on the side of the barrier which faces away from the swimming pool. Z Y W Q Z Where the top of the pool structure is above grade,such as an aboveground pool,the FLOOR 12" O.G. BOTH IAAY51 = a barrier may be at ground level,such as the pool structure,or mounted on top of the o C V1 C. pool structure. Where the barrier is mounted on top of the pool structure,the POOL PLAN maximum vertical clearance between the top of the pool structure and the bottom of the barrier shall be 4 inches. b. Openings in the barrier shall not allow passage of a flinch-diameter(102 mm) sphere. —I r 1'-6• -�•-6•-1 ---6�----� 2 WALL DETAILS c.Solid barriers which do not have openings,such as a masonry or stone wall,shall not contain indentations or protrusions except for normal construction tolerances and tooled masomyjoints. W A B C D E �A-1 NONE o d_Maximum mesh size for chain link fences shall be a 225-inch(57 mm)square unless the fence is provided with slats fastened at the top or the bottom which reduce the openings to not more than 1.75 inches(44 mm). e. Gates in the barrier shall be self closing,self latching and be secured with a key or combination lock or other approved child proof mechanism. Pedestrian gates shall open away from the pool- Where the self latching mechanism is less than 54 inches HEIGHT OF WATER above the bottom of the gate the latching mechanism shall be on the pool side ofthe barrier and the gate and barrier shall have no opening greater than 1'within 18"ofthe OPTIONAL HEATER WITH TIMER latch and its releasemechanicm "' PUMP WITH TIMER v SWITCH. PROVIDE THERMAL £The permanent barrier shall be erected and functional no later than 90 days after the v N SWITCH FILTER POOL COVER. completion of the pool. v 11.Where the design uses a wall of the dwelling as a part of the permanent pool CHLONE GENERATOR RI barrier installer shall provide one of the following access control measures. RETURN JET SKIMMER a.Operable windows within the wall shall have a latching device located no less than WASTE 48 inches above the floor.Openings in operable windows shall not allow the passage of a 4 inch diameter sphere when the window is in its largest open position b.All doors with direct access to the pool through that wall shall be equipped with an 2�—s• l.7 12 alarm which produces an audible warning when the door and its screen,if present,are ------------ opened The Mum shall sound continuously for a minimum of 30 seconds AFFIX TAG 2"0 SCH 40 O immediatelyafter the door isopened and becapable ofbeing heard throughout the LATERAL SECTION THROUGH P 0 PVC, IYP. rn house during normal household activities. The alarm shall automatically reset under all F NEW STATING "MAIN O r r conditions. The alarm system shall be equipped with a manual means,such as touch (� ' DEER a DRAIN" O pad or switch,to temporarily deactivate the alarm for a single opening. Such C �Sd deactivation shall last for not more than 15 seconds. The deactivation switch(es)shall •• Q' z be located at least 54 inches(1372 mm)above the threshold of the door,or * rh�� ` ati 18X23 BOTTOM c.Other means of protection,such as self-closing doors with self-latching devices, r i '�= !� Lu DRAIN, IYP. OF 2 Z z/1 F =,y;, which are approved by the governing body,shall be acceptable so long as the degree of 0 ; fix. I 2 D 88 tr protection afforded is not less than the protection afforded by Items 4.a or 4.b 2 ..�► O z/1 z described above. 12.Install all suction fittings in accordance with Section R326.6 "Suction Outlets". Single and multiple outlet systems shall be protected against user entrapment as �oAROFE$$ 3 WATER T R EAT ill E N T detailed herein or ANSI?SPSP/ICC 7. 1 POOL D ETA I LS a.Single and multiple pump systems shall have a minimum of 2 suction outlets � O separated by aminimum distance of 3 feet A_1 T.S. A-1 NONE �. U b,Suction outlets shall be equipped with a cover conforming to ANSI/ASME ~ Al(2.19.8 or have a drain grate with a minimum projected dimension of 18"by 23"or have an approved channel drain system. (n m c.Provide Atmospheric Vacuum Relief System conforming to ASME Al 12.19.17. Z d.Pool cleaner fittings,if provided,shall be located in an accessible area and be — located between 6 and 12 inches below the minimum operational water level or be an attachment to a surface slimmer.