HomeMy WebLinkAbout48461-Z i
Town of Southold 8/26/2023
.t ? P.O.Box 1179
y FIft 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44489 Date: 8/26/2023
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 3960 Wells Rd,Peconic
SCTM#: 473889 Sec/Block/Lot: 86.-1-14.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
10/21/2020 pursuant to which Building Permit No. . 48461 dated 11/7/2022
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 Provence Chez Patrick LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48461 8/22/2023
PLUMBERS CERTIFICATION DATED 0
Auth ize Sin e
TOWN OF SOUTHOLD
ay . BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 48461 Date: 11/7/2022
Permission is hereby granted to:
Provence Chez Patrick LLC
173 E Broadway Apt#613
New York, NY 10002
To: DO NOT CO - NEEDS ZBA construct an in-ground swimming pool as applied for.
Replaces BP #45401
At premises located at:
3960 Wells Rd, Peconic
SCTM #473889
Sec/Block/Lot# 86.-1-14.1
Pursuant to application dated 1/1/1900 and approved by the Building Inspector.
To expire on 5/8/2024.
Fees:
PERMIT RENEWAL $150.00
Total: $150.00
Building Inspector
zT: TOWN OF SOUTHOLD
fSUFFocKc
o ° BUILDING DEPARTMENT
yi
a -4¢' TOWN CLERK'S OFFICE
"o • ,• SOUTHOLD, NY
s`
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#: 45401 Date: 11/2/2020
Permission is hereby granted to:
Mizrahi, Patrick
173 E Broadway Apt 613
New York, NY 10002
To: , construct an in-ground swimming pool as applied for.
At premises located at:
3960 Wells Rd, Peconic
SCTM #473889
Sec/Block/Lot# 86.-1-14.1
Pursuant to application dated 10/22/2020 and approved by the Building Inspector.
To expire on 5/4/2022.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
ota : $300.00
Building Inspector
pF SOUryDlo
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 aQ sean.deviin((-town.southold.ny.us
Southold,NY 11971-0959 Q�yCOUm��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Provence Chez Patrick LLC
Address: 3960 Wells Rd city:Peconic st: NY zip: 11958
Building Permit* 48461 Section: 86 Block: 1 Lot: 14.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: Electrician: LC Electric License No: 38043ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service
Commerical Outdoor X 1st Floor Pool X
New 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 X A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transfer Switch 2 UC Lights Dryer Recpt Emergency StrobeHeat Detectors
Disconnect Switches 4'LED Exit Fixtures Sump Pump
Other Equipment: Pentair Intellitouch, (3) Pumps 220GFI, Blower, (2) Pool Transformers,
AutoCover w/ Locked Key Pad 120GFI
Notes: Pool w/ Spa - Was Moved
Inspector Signature: ate: August 22, 2023
.01
S.Devlin-Cert Electrical Compliance Form
pF SOUj�ol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 Ol • COQ sean.devlin(Q-town.south old.ny.us
�OOUMy,�c�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Patrick Mizrahi
Address: 3960 Wells Rd city:Peconic st: NY zip: 11958
Building Permit#: A4W'1 Section: 86 Block: 1 Lot: 14.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: LC Electrical Contr. License No: 38043ME
SITE DETAILS
Office Use Only
Residential X indoor Basement Service
Commerical Outdoor X 1st Floor Pool X
New 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 X A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer 2 UC Lights Dryer Recpt Emergency Fixture Time Clocks
Disconnect Switches 4'LED Exit Fixtures Pump 3
Other Equipment: Pentair Intellitouch, (3) Pumps 220GFI, Air Blower, (2) Pool Transformers,
Pool Cover w/ Locked Key Pad
Notes: Pool and Spa
p ( - d
Inspector Signature: Date: July 22, 2021
S. Devlin-Cert Electrical Compliance Form
L4
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#
TOWN.OF SOUTHOLD BUILDING DEPT.
`eco tom ' 765-1802
-
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ '] FOUNDATION 2ND [ ] 1NSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE &CHIMNEY ' [ ] FIRE-SAFETY`INSPECTION
[ j FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
o� TvF)
:TdE . Lrz� ARM �V&
DATE INSPECTOR
# # TOWN OF SOUTHOLD BUILDING DEPT.
`y�ouxn ' 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
REMARKS: I ��1� 72DOW-D I" _
DATE INSPECTOR
�Of so
# # TOWN OF SOUTHOLD BUILDINM DEPT.
cou765-1802
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
REMARKS: �/�7s
O
tzA 4t�- -
D 04
DATE INSP C OR
r n�
OESOUTyO L4�gV Wetl,�- U
# # TOWN OF SOUTHOLD BUILDING DEPT.
cou765-1802
INSPECTION
j ] 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
REMARKS:
DATE INSPECTOR. �_
0610
pE SOUTyO�
# # TOWN OF SOUTHOLD BUILDI-NG DEPT.
co 765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND- [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING VFINALf0bL---
FIREPLACE
& CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS_ :
4A
3 SGv - Wwt' ,- Ao.- Arv/ 5 Wf
DATE �� 6 ��� INSPECTOR
�g qb( SOUIyO
# # TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SULAT N/CAULKING
[ ] FRAMING /STRAPPING [ FINAL W
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
Wto
DATE ?•O ?A INSPECTOR
OE so � �t
# # TOWN OF SOUTHOLD BUILDING DEPT.
631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) LECTRICAL (FINAL)
[ ] CODE VIOLATIONm
] PRE C/O [ ] RENTAL
REMARKS: a� r�lv�-
OAJ, LIV f 1-@
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DATE . 7 7�0 INSPECTOR
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STATE
ENMI�GY CODE...l.
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 4 sets of Building Plans
TEL: (631)765-1802 Planning Board approval
FAX: (631)765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined —,20 Single&Separate
I1 Storm-Water Assessment Form
l 1 Contact:
Approved v 20 Mail to:
Disapproved a/c
on
Phone:
Expiration ,20
UuilInspector
OCT
-APPLICATION FOR BUILDING PERMIT
Date 20 Z1>
DUILDING DEIN'`. INSTRUCTIONS —T
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans,accurate plot plan to scale.Fee according to schedule.
b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas,and waterways.
c.The work covered by this application may not be commenced before issuance of Building Permit.
d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit
shall be kept on the premises available for inspection throughout the work.
e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector
issues a Certificate of Occupancy.
f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of
issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the
property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an
addition six months.Thereafter,a new permit shall be required. ,
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,or 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 for necessary inspections.
(Signature of applicant or name,da corporation)
�'a h
13 3 1 H irn.e-All, A6 y9
(Mailing address of applicant)
State whether applicant is owner,lessee, agent,architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises �/ r!G 1y�/ Z.�'ti A 1,
(As on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
f� /-/ �'^'� lee'-QS'r�2h 7
and title of corporate officer)
Builders License No. -7 9 C9
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
3 4 G b 6/f,/b M & 1 ( C,
House Number Street Hamlet
County Tax Map No. 1000 Section ef 6 Block Lot l
Subdivision Filed Map No. 3 d 6" Lot
2. State existing use and occupancy of premises and intepA-d use and occupancy of proposed construction:
a. Existing use and occupancy A r) e-
b. Intended use and occupancy ,ro, '4.,- IJ
3. Nature of work(check which applicable):New Building Addition Alteration
Demolition Other Work 1("1
Repair Removal 1 n
A ® - (Description) 1
4. Estimated Cost 7�t / 1 8 Fee 0p—f PTY
(To be paid on filing this application) S�a,
5. If dwelling,number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10.Date of Purchase Name of Former Owner
11.Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO
13. Will lot be re-graded?YES NO i�! Will excess fill be removed from premises?YES ANO
14.Names of Owner of premises A-te, k ALLr, Address Y760 1,,attr V Phone No. 2/
Name of Architect Address Phone No
Name of Contractor-ti- ,/as It Address/'o ,130 r /.??I Phone No. 6.7I- 7181- Y'6- g
N•B ✓iiy �i�y6
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO 1,-'
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO
* IF YES,D.E.C. PERMITS MAY BE REQUIRED.
16.Provide survey,to scale,with accurate foundation plan and distances to property lines.
17. If elevation at any point on property,is at 10 feet or below,must provide topographical data on survey.,
18. Are there any covenants and restrictions with respect to this property? *YES NO—�Z—
*IF YES,PROVIDE A COPY.
STATE OF NEW YORK)
COUNTY O
tlr-� being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the ka 2- t
(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 tgtr®44us knowledge and belief;and that the work will be
performed in the manner set forth in the application W �Wo
�Sw m to before me th s
�day of 20 � g4cA 'I
i`7l oLa a
6 •.c 'eP a
otary Public °y�y�iJ.�y,�'' ��� 1gnature of Applicant
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
I, _ J A � t k ��I rI*I , residing at .79 1 0 1,/,d I r
(Print property owner's name) (Mailing Address)
Ado hereby authorize �,), �.rPn -rl,.,.,ems,Grt
(Agent)
to apply on my behalf to the
Southold Building Department.
(O er's Signature) (Date)
otncL
(Print Owner's Name)
CONSENT TO INSPECTION
f 1 ,the undersigned,do(es)hereby state:
Owner(s)Name(s)
That the undersigned(is)(are)thg owner(s)of the premises in the Town of
Southold,located at 3 9 6 D �jlJ Xd f er.a-1tc A# ,
which is shown and designated on the Suffolk County Tax Map as District 1000,
Section F-L ,Block I Lot ,y I
That the undersigned(has)(have)filed, or cause to be filed, an applica n in the
Southold Town Build' g Inspector's Office for the following: �,�s�,q/� •-,
a � �n � f T
That the undersigned do(es)hereby give consent to the Building Inspectors of the
Town of Southold to enter upon the above described property,including any and all
buildings located thereon,to conduct such inspections as they may deem necessary with
respect to the aforesaid application,including inspections to determine that said premises
comply with all of the laws,ordinances,rules and regulations of the Town of Southold.
The undersigned,in consenting to such inspections,do(es)so with the knowledge
and understanding that any information obtained in the conduct of such inspections may
be used in subsequent prosecutions for violations of the laws, ordinances,rules or
regulations of the Town of Southold.
Dated: `0 / A")Z1
Al�,Awt&P (S,a
'r�nG�a e Izyq K i
(Print Name)
(Signature)
(Print Name)
BUCLDINGDEP4RfGETInpector
TbW .
SOUTH.OLD
T6wn Hall.Annex>- 54375 Nfai n Road:-'PO Bax 1:179
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Reg4lest.for Inspe�NanxFomi,xl"s
PERMIT# Address:
Switches
Outlets
GFI's :.
Surface
Sconces
H H's '
UC US
Fans Frid a `.'HW
Exhaust Oven Dryer
Smokes DVV _.. ._ ... Service
Carbon' ---Micro,. ._.... Generator
Combo k. Cookto" = > Transfer f
.
Special:
Comments:
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4
S.C.T.M. NO. DISTRICT: 1000 SECTION: 86 BLOCK: 1 LOT(S): 14.1
LAND N/F.OF
PELLEGRINI PECONIC LLC 4+
& PECONIC LAND TRUST
ZONED R-80 Qwy
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MGN.
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POOL�\\`) O�o SANITARY LOCATION
c` EOP. V .r POINr'A•I POINT S'
,�ohr .;•'•,'yt�'g�;.O .,�v � SEPTIC TANK 83' 48•
X01'.''•'•'.''IJOc3o• �i•' •7 5�°A �.� LP/1 74' 44'
I LP#2 84.5
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S59 o 45'30"E 74.93'*'� ° S _ _ 20'
MON. + '74.93'.*'
:3 PROPERTY I ME
OPOSED
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LAND N/F OF e�
PELLEGRINI PECONIC LLC �:•:: � o° , ;;:.�,::,�;.: ti• �I�•B.
& PECONIC LAND TRUSTQ 4 WR oOM . p�
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1. GAL. SEPTIC TANK
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EL 11.7
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EL 11.4
EL 10.2
MGN' N59045'30"W 249.29'
EL 10.9
0GE OF PAVEMENT
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.- EXISTiNO WATER MAIN WEDS /50�� DO /�
CL 9.2 CL 9.5 l Ij,
CL 9.7 CL 9.3 CL 9.0 CL 8.7
U.P..#28 -D.P./27
Ln ZONED R-40 �-
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RICHMOND CREEK FIRM ZONE PANEL 162
FIRM ZONE X
FINAL SURVEY 02-02-19 ZONED R-80 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL
FND. LOC. 10-15-17 NON-CONFORMING LOT: FRONT 50'MIN LOCA77ONS SHOWN ARE FROM FIELD OBSERVA77ONS
REAR 60'MIN AND OR DATA OBTAINED FROM OTHERS.
SIDE 20'MIN (40' TOTAL) NGVD 1929
AREA: 40,000.67 SQ.FT. or 0.92 ACRES 209 LOT COVERAGE ELEVA77ON DATUM: ___�_________�____�_
UNAU7HORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARAN7EES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TUT70N, GUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADDIT70NAL S7RUC7URES OR AND OTHER IMPROVEMENTS EASEMENTS
AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY
SURVEY OF: LOT 1 CERTIFIED TO: PATRICK MIZRAHI;
MAP OF: ESTATE OF SKWARA
FILED: FEB 17, 2015 No.1 1985
SITUATED AT: PECONIC
TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
" P.O. Box 153 Aquebogue, New York 11931
FILE #13-206-1 SCALE: 1 =40 DATE: DEC. 22. 2013 PHONE (631)298-1588 FAX (631) 298-1588
N.Y.S. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Wcychuk
I
S.C.T.L. DISTRICT: 1000 SECTION: 86 BLOCK: 1 LOT(S): 14.1
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SEPTIC TANK �' 46'
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IIARY SYSTEM °
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MO" N59045'30"T 249.29'
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RICHMOND CREEK FIRM ZONE PANEL 162
FIRM ZONE X
FINAL SURVEY 02-02-19 ZONED R-80 THE WATER SUPPLY, WELLS, DRYWELLS NO CESSPOOL
FND. LOC. 10-15-17 NON—CONFORMING LOT: FRONT 50'MIN LOCA77ONS SHOWN ARE FROM FIELD OB ERVA71ONS
REAR 60 MIN
SIDE 20'MIN (40' TOTAL). AND OR DATA OBTAINED FROM OTHERS
AREA: 40,000.67 SQ.FT. or 0.92 ACRES 20% LOT COVERAGE ELEVA77ON DATUM: _NGVD 1929
UNAUTHORIZED ALTERA77ON OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES QF THIS SURVEY
MAP NOT BEARING 7HE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED SHALL RUN
ONLY TO THE PERSON FOR WHOM 77-IE SURVEY IS PREPARED AND ON HIS BEHALF TO 7HE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INS77TU770N, GUARANTEES ARE NOT TRANSFERABLEE,
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM 7HE PROPERTY LINES TO 774E STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE CREC77ON OF FENCES, ADD177ONAL STRUCTURES OR AND OTHER IMPROVEME IS. EASEMENTS
AND/OR SUBSURFACE STRUf7URES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY
SURVEY OF: LOT 1 CERTIFIED TO: PATRICK MIZRAHI;
MAP OF: ESTATE OF SKWARA
FILED: FEB 17, 2015 No.11985
SITUATED AT:PECONIC
TOWN OR SOUTHOLD KENNETH M WOYCHUK LAND .SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional land Surveying i4d Design
P.O. Bog 153 Aquebogue, New York 11931
FILE #13-206-1 SCALE: 1"=40' DATE: DEC. 22. 2013PHONE (631)298-1688 FAX (631) 298-1588
maiatei
N.YS. LISC. NO. 050882 nins the records of Robert J. Hennessy !e Kenneth M, Woyohuk
I
WOrkemx
>romc Compensation CERTIFICATE OF
Board NYS WORKERS`COMPENSATION INSURANCE COVERAGE
la.LOW Name wW address of Insured(use sweet address mW 1b Busies Terme Number of trued
MIARYM€GINC DBA JASON AND 81115 POOLS 1a NYS ttnernptoyrnerd Insurance Emplgrer
PO Box 1331 P.W;l O ion; oElnmred
HAMPTON BAYS NY 119
Id drat Employer identification Number of irwir+ed or
Work Location of t aired(Oona requked ff voverap is qxmAjb&W Sociei:Serxrrily►Nmsmbet
atID.QWM ftaftwInNow Yat*S'taft Le.a Vhmp4JpPoky) 1131138201
2. Name oul Address otthe EntityRaWasift Proof of 3e:Name ofinsurance
Cove tEntfty Beft tas the Cer ate tioider)
Property and Casualty Irmnance Company of
.Tom-of-Southold of,Sotthotd Dartford .
�- 3b.Polimy Number-af:Entity Lid In Sox'le.
SO[T,HOLD lalf 11971 12 WE OJzW
i
3a Po�cy.effec +ie periock
to 03123/2921
3d 7ba Pmproior.,Parbms.or Executiva.of&m s are
Li lRdlttled.{E7Wyd�eeJcicweii�par�arsiof�oeiaindctded�
0 aff Lxduded.or padremkffmwsexduded
This certifies that the hwrance carrier indicted above in box 97 insanes the.business referenced above in box"1s for
workets'compensation under the New York State Workers'Compensation Law.(To use this form.New York(NY)must
be under 3A on the INFOMA'tM PAGE of the:workers! compensation insurance policy) The
insurance Brier or its licensed agent will send this Certificate of Insurance to do enbly lid above an the.fie
holder In box le..
The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a
policy is canceled clue to nonpayment of premiums or within 30 days IF btrere are reasons vomer 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 Beans-ad agent,or untit the policy expiratlont date lisp In bo "3c.whichever Is earner
This certificate is issued as a matter of information only and confers no rights upon the tartififate hoklm:This carMate
does not amend,extend or alter the coverage afforded by the policy lis 4 nor does it confer any rights or responsibi les
5eytarid#hose coritained in the fefiatenoad policy.
This cedftate may be used as evidence of a VUod Ws Compensation contract of insurance only while the underlying
poky is In elfea
Please Not m Upon cancetiation of the workers` compensation policy its: on this.foram, N the busiAew
continues to be named on a permit,Rearm or contract Issued by a Abe holder,the bushwas must provide
that certificate holder with a new Certificate of Workers Conmpensathm Coverage or other autholzed proof that
the business is complying witfi the mandatory coverage requirements of the New York Stabs Workers'
Compensation Law.
Undwpenatly ofparyuryr,I certify that I am an authorlzed;. -or-llcensed agentof the insurance carrier
refeemed above and that the named insured has the coverage as depicted on this form.
AWoved hy: Danielle Clausen
(print name of authorized representative or licensed agent of Insurance carrier)
Ttiie Operations WARM
Telephone Number of authorized representative or licensed agent of insurance carrier. (SM 853-2582
Please Nobe:.Only Insurance carders.and their licensed agents are authorized to issue Form C-1.05.2.Insurance
broloecsare,�'�aim b isslte 11.:
40&2(947) Form WO 88 3121 F Printed in U.S.A. www:we t ny.gov Page 1 of 2
1
APPROVED AS M0 4 ED
C�/ C-!:% ,``?LYWIrHAL LC�'Di=S OE=
DAFE:,/—b� ? B.P.I ��> ��1 'YV YORE'; ST,ATc &TOWN CODES
FEE:- BY: �- � � AS ri"QUIREG F
;.-1011 FY BUILr;;N;., Cr''ARTh,9ENT AT
765-1302 3 Alii TO 4 FM FOR THE -
FOLLO'NING INSPECI1ONIS): S RD
FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE - SQJA6eierlrFd- U EES
2. ROUGH - FRAMING & PLUMBING N.1rpi €e'-
3. INSUL.ATIU
4. FINAL - C01",ISTRUCTION MUST
BE COMPLETE F'OR C.O.
ALL CONSTRUCTION SHALL MEET THE U,P lr-",11 GY i
ES OF NEW
YORKI STATE.REQUtr NOT RESPOOF THE NSIBLLE FOR �..�`�s'� iloo UNLAWFUL
DESIGN OR CONSTRUCTION ERRORS. Vviff 6_gOT CERTIFICATE
OF OCCUPANCY
ELECTRICAL INSPECTION REQUIRED
11IMM :IATEL1l„
EJ40LOSE POOL TO CODE
UPON COMPLETION
BEFORE VA,TER:
i,
Bonding Wire connected to all
hardware
40 !
I
RETURN WASTE FILTER HAIR&
'I
VET
UMP SKIMMER
t
WATER LINE
MAI\1
j
DR N
MI
3' ART
� PIPING SCHEMATIC
IDU
FIL 1 ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF 2015 IECC
J1
i
212" E—
HORIZONTAL 4/8" 2 POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE DETECTING A CHILD
v4 REBAR 4PLACES ENTERING THE WATER AND SOUNDING AN ALARM AUDIABLE AT POOLSIDE AND AT ANOTHER
LOCATION ON THE PREMISES WHERE THE POOL IS LOCATED.THE ALARM MUST BE INSTALLED,
UNDISTURBED EARTH MAINTAINED AND USED IN ACCORDANCE WITH MANUFACTIRER'S INSTRUCTIONS.THE ALARM
SUC ON SUC ONSUC CN 4511
MUST MEETASTM F2208'STANDARD SPECIFICATION FOR POOLALARMS'-THE DEVICE MUST
:F OPERATE INDEPENDENT(NOT ATTACHED TO OR DEPENDENT ON)OF PERSON.,: .t
VINYL CONC.MIN.3500.PSI.
LINER
'=h VERTICAL 1/2' REBAR
PLACED 4'0.C. 3- WATER SOURCE FILLING THE POOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION
I
= - SYSTEM.
WAS!L CROSS SECTION q ALL PIPING IS DIAGRAMMATIC UNLESS OTHERWISE STATED.ALL PIPING TO BE POLYETHELYNE.
°D NTS
=5 POOL SHALL BE GREATER THAN 10 MEASURED HORIZONTALLY FROM ALL OVERHEAD WIRING.
POOL DESIGN INCLUDING DRAINS WILL MEET ALL 2017 CODES.
' I
21'
E '►ENJ v� Jasons Pools
Complies With: : Q�� ) D �j` 'Q'f'
3960 Wells Rd.
2020 Code Section 30321-303A Swimming Pools,Spas and Hot Tubs . ..
q I w Peconic,NY
Section R326 of•the Residential Code of New York
Section 3109 of the Building Code of New York C), i s zs
Section N1103-12(11403.12)Residential Pools and Permanent Residential Spas �,_
wl N POOL TYPE: 20 x 40 Rectangle REV SCALE: NTS
Section 31093.12–3109 .7.4 Pools and Spas Gates,Barriers j FO o 0 2
SectioriG106Entrapinen_tProtecdon AROFESS JAMES DEERKOSKI, P.E. DATE: 10/19/2020
Section G107 Alarms 260 DEER DRIVE .
Section E4201–E43ti2Electrical Connections for Pools MATTITUK, NEW YORK 11952 DRAWING.NUMBER
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