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HomeMy WebLinkAbout47910-Z ,fi��gOFFQi�`�r Town of Southold 9/24/2023 P.O.Box 1179 j9 53095 Main Rd y T i ysj�l �oo� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44570 Date: 9/24/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 580 Old Shipyard Ln, Southold SCTM#: 473889 Sec/Block/Lot: 64.-2-45 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/29/2022 pursuant to which Building Permit No. 47910 dated 6/3/2022 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 per ZBA#7531, dated 9/16/2021. The certificate is issued to Keller SA Revoc Trt of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47910 5/17/2023 PLUMBERS CERTIFICATION DATED "fh ignature SOFF c TOWN OF SOUTHOLD BUILDING DEPARTMENT rn x ' TOWN CLERK'S OFFICE "o • SOUTHOLD, NY y�ol � ,jaa�is 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#: 47910 Date: 6/3/2022 Permission is hereby granted to: Keller SA Revoc Trt 11 Moffitt Blvd Bay Shore, NY 11706 To: construct accessory in-ground swimming pool as applied for per ZBA approval. At premises located at: 580 Old Shipyard Ln, Southold SCTM #473889 Sec/Block/Lot# 64.-2-45 Pursuant to application dated 4/29/2022 and approved by the Building Inspector. To expire on 12/3/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Buil g Inspector } QF S0UTyOI O Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.deviinC(D-town.southold.ny.us Southold,NY 11971-0959 Own BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Keller SA Revoc Trt Address: 580 Old Shipyard Ln city:Southold st: NY zip: 11971 Building Permit* 47910 Section: 64 Block: 2 Lot: 45 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: HomeOwner License No: 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 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency StrobeHeat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Hayward Aqua Plus Panel 8 Circuit/ 7 Used, Pump 220GFI, Heater 240, Lights 120GFI 30OW Trand, Salt Generator Notes: Pool Inspector Signature: Date: May 17, 2023 S.Devlin-Cert Electrical Compliance Form o��0FsoUTyo �? 10 580 0l p � yaur A 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) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Q butt NO Acc255 DATE . W INSPECTOR Af so -7 ct to yovoe, TOWN OF SOUTHOLD BUILDING DEPIP. cou 631-765-1802 INSPECTION FOUNDATION 1ST ROUGH PL13G. FOUNDATION'2ND INSULATIOWCAULKING FRAMING/STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) . CODE VIOLATION PRE C/O [ ]' RENTAL REMARKS: 4ecAs 60vJ w�rt +0 +��VtS4�rmf-r 4 pool lieik+ Jeck boX . CLuJo ccooer �rack vice 'u, - I -1., 0 &r---7- A,.-, J, tj CIM64 i I T '- / 0' "" c-r DATE INSPECTORq�z,� OoF SOUTyo� - # f TOWN OF SOUTHOLD BUILDING DEPT. e `ycourm,��' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] ISULATIO 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- I/L DATE JV[W7 INSPECTOR SOUTyoID a ( v c �� # # TOWN OF SOUTHOLD BUILDING Di��YAI C, �O • ,O lycouto��'' 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: Ca►t/ Ok— DATE 7 INSPECTOR ' o��OF SOUT,yo//__ h `o # # TOWN O SOOT LD BUILDING DEPT. 631-765-1802 I 'NSPECTION [ ] 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: Af (Xv �:M t/ VK AKV L/ DATE INSP TOR 7/27/23,10:21 AM Amazon.com-Order 113-1052644-1676217 amazon corn• Final Details for Order #113-1052644-16716217 Print this page for your records. i LD Order Placed: July 24 2023 ' Amazon.com order number: 113-1052644-1676217 ! j Order Total: $180.87 JI-1i 3 1 2023 Shipped on July 25, 2023 BURMING DEPT. ')JAI�'. Items Ordered Price 3 of: PoolGuard DAPT-2 Water Hazard Pool Door Alarm, White $55.50 Sold by: SNM Enterprises LLP(seller profile Supplied by: SNM Enterprises LLP(seller profile) Condition: New Shipping Address: Stephanie Keller 580 OLD SHIPYARD LN SOUTHOLD, NY 11971-1518 United States Shipping Speed: FREE Prime Delivery Payment information Payment Method: Item(s) Subtotal: $166.50 Visa I Last digits: 1654 Shipping & Handling: $0.00 Billing address Total before tax: $166.50 Stephanie Keller Estimated tax to be collected: $14.37 Nickerson Corp ----- 11 Moffitt Blvd. Bay Shore, Ny 11706 Grand Total:$180.87 United States Credit Card transactions Visa ending in 1654: July 25, 2023:$180.87_ To view the status of your order, return to Order Summary. https://www.amazon.com/gp/css/summary/print.html?orderlD=113-1052644-1676217&ref=ppxyo2ov_dt b invoice 1/2 7/24/23,10:46 AM Amazon.com-Order 111-4237952-8465042 amazoncoin Final Details for Order #111-4237952-8465®42 Print this page for vour records. Order Placed: July 17, 2023 Amazon.com order number: 111-4237952-8465042 Order Total: $60.54 Shipped on July 18, 2023 Items Ordered Price 3 of: Yardgard Door and Window Pool Alarm, Child Safety UL 2017 Compliant Alarm for Pool Gates and Sliding Doors, -$18.58 Weatherproof, Wireless, Work as a UL Compliant Siren, ETL Certified, Easy to Install, White Sold by:Amazon.com Services LLC Supplied by: Other Condition: New Shipping Address: Stephanie Keller 580 OLD SHIPYARD LN SOUTHOLD, NY 11971-1518 United States Shipping Speed: - FREE Prime Delivery Payment information Payment Method: Item(s)-Subtotal: $55:74 Visa I Last digits: 1654 Shipping &-Handling: $0.00 Billing address Total before tax: $55.74 Stephanie Keller Estimated tax to be collected: $4.80 Nickerson Corp 11 Moffitt Blvd. Grand Total:$60.54 Bay-Shore, Ny 11706 United States Credit Card transactions Visa ending in 1654: July 18, 2023:$60.54 To view the status of your order, return to Order Summary. https_//www.amazon.com/gp/css/summarylprint.htmi?orderlD=11114237952-8465042&ref=ppxyo2ov_dt b invoice 1/2 F oolouard Alerts You Whet)Y60f 15 'A and When Your Mor 41 Not Been ! a= seams or��n�um�r f f MODEL-DAPS` MEM UL 2017 The horn 1s 85 dB at 10 feet t °. 74, � x E . a. w a .: III�W Id 6 �x a L a w� M 4: C �l: 3 I �rp �✓T 777777700 \. �, � ` 1 r ..tom f 1 ' i � S` Ij rj� JUl 4 2023 , � f 1 � � r . i 7 J U i_ 2 4,'023 I. .. i 1 GING DE s t u lit i yc . y JUL 24 ,nrNG nE t I11 11 N � A It C a' • O 0 O �✓ W c Meets Barrier V Z W Mounting Hardware Included o Q a Battery Operated a 1 VVV �O 9 t Jut 2 4 20� B �r71 r - . i /Mimi. i WJE ' �, • •� 1 GATE, DOOR, WINDOW WATER HAZARD ENTRANCE •• e e D pour poste , portiilon et fenetre larme': d 'entrie., Peau risque L Conforms To Ul STD 201'7 rtified 1'o CSA STD C22.2 No. 205 Cert' ie UL et CSA C22.2 No. 205 q { -�CHITECT MARK SCHWARTZ&ASSOCIATES 28.195 Nkiin (toad• 110 Box 933•Cutchnguc, i\Y t 193 { -- --631.7346 185 1 www.mksarchitcci.cum j j i July 20,2022 j D RDDdD Southold Town Building Department D 54375 Main Road Southold,New York 11971 ,J U L 2 0 2022 I I Re: Keller Property j 580 Old Shipyard Lane BIJTLDING DEPT. Southold,New York TOWN OF SOUTHOLD i SCTM#1000-64-02-45 t To whom it may concern, I have been on site during the initial pool construction phase and the pool rebar(by W P Pools 8: j Masonry Inc 177 Beachview Street Copiague,NY 11726-3601)have been set and constructed as per plan and to the best of my knowledge meets or exceed NYS code requirements. Please call this office with any questions you may have. ; Sincerely, M 'coo Mark Schwartz AIA : F, 1 FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) --A O� -------------------------------------- FOUNDATION (2ND) z � o Oy 1 ROUGH FRAMING& Q. PLUMBING r INSULATION PER N.Y. y STATE ENERGY CODE I IL Q1 u( S Gl.✓ S � l77f N FINAL ADDITIONAL COMMENTS do v✓ r` *t.Nl — 0 �o Q, i - 10 o b Nz l� x d o�Dsot rJr4°0 TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 Telephone(631) 765-1802 Fax (63 t) 765-9:502 lhttps:i;ww�%..southi>IdtownLiy.g :y Date Received APPLICATION FOR BUILDINGP RMIT For Office Use Only PERMIT NO. Building Inspector:__,.___ _ APR 2 8 2022 Applications and forms must be filled out in their entirety.Incomplete BUILDING uc_r i. applications will not be accepted. Where the Applicant is not the owner,an TOWN OF SOUTHOLD Owner's Authorization form(Page 2)shall be completed. Date: 2Z OWNER(S)OF PROPERTY: Name: A: BEY Ti�US"7" SCfM#1000- 46' Project Address: Z-442% S"00771 y Phone#: 5-14" " .1?w -1-6 s-9 Errai��� Mailing Address:1 M Al0 6 CONTACT PERSON: Name: Mailing Address: ('l Z � `� (� �1��✓ s (��t7�,C W t1716 Phone#: 6a 1 -7Oe—5— 75-8 Email: (lobldA,p 7 C9 qpI Di'1AMe DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: 33 C LTC F N 11 93 Phone#: J� o -73 l Email: CONTRACTOR INFORMATION: Name: We S, ` OOLS I Mailing Address: -7"7 60PtP-&u gr it 7) Phone#: 631 -70Y 5_1 5-S � Emall: ✓a;tedP7 8 �04-"e DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure `iAddition _'Alteration L]Repair ODemolition Estimated Cost of Project: 00therC-QdJ ;E[l1rT y-� Will the lot be re--graded? ]Yes ii3No Will excess fill be removed from premises? -.'Yes kNo Y PROPERTY INFORMATION Existing use of property:RFS. ®�� � Intended use of property: OA- � Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes No IF YES, PROVIDE A COPY Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by C apter 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(print na e): � pg,4AJIF. � r� ❑Authorized Agent 00wner Signature of Applicant: ^� Date: d STATE OF NEW YORK) SS: COUNTY OF StkFFOLL� _) I Elep ho 6Y i e. 4 l` P2 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the GAN N Fk- (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 a6'11 day of (� a� LQ. , 20 vt Notary-Public Sarah J.Greeley Notary Public, State of New York Registration#01 GR6037169 PROPERTY OWNER AUTHORIZATION Qualified in Suffolk County (Where the applicant is not the owner) My Commission Expires Feb. 14,20&6 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 BOARD MEMBERS Southold Town Hall Leslie Kanes Weisman,Chairperson. ����SD(J�y0 53095 Main Road •P.O.Box 1179 Southold,NY 11971-0959 Patricia Acampora . Office Location: Eric Dantes i9 Town Annex/Frst Floor, Robert Lehnert,Jr. 54375 Main Road(at Youngs Avenue) - Nicholas Planamento U D http-//southoldtownny.gov 7 ZONIIVG:BOAI2D-OF APPEALS ; SEP 2 0 20 7 TO- OF S.OiJ.THOLD41tA Tel.(631)765-1809•Fax(631)765-9064 Southold 'Town,Clerk FINDIN-6%llELIBEIRATIONS AND DE'TERMINA.TION EN 'QT-SEP'T1VIB);R 1.6;2021 ZBA.FILE:.#753 i NAME OF APPLICANT:. .Stephanie A.Keller Rev.Trust - PROPERTY LOCATION: 580 O1d.Shipyard Lane, Southold,NY, SCTM41000-64-2-45 SEORA DETERMINATION:.The Zoning Board of Appeals,has visited the property under consideration in this application and determines that this review falls under the.Type If category.of the State's List of.Actions,without further steps under SEQRA. SUFFOLK.-COUNTY ADNMSTRATIVE CODE This appMatioa was not required to be referred to the Suffolk :. .County department of IPlan#iin unger••the Suffolk C vnty Administrative Code Sections.A 14--14_to.23, ` I TItP IDETEI DATI(3N--The:cali f,•permit,.Qr interpretation, t•equested .in�phis application.is.listed-under.tl>e ----- -.1Vlinor Actions eXexiipt list'aud is-p©t subj�ect•to review unde.r.Cl apter 268. PROP Tl'FAt✓TS7JJ�ESCRTPTI(OI�T Tli subiectproperty is an'I f,250'square foot parcel locafed ill the I esrderitial R-40•Zeroing District. me-northerly#operty line measures 73:00 feet;the:easterly property liiie.measures 150.06- i feet,the southerly property.line measures 7 .00 feet�and is adjacent to Old'Shipyard'Road,and the westerIV property line measures 150 feet. The property is uxipioved with an existing two-story frame dwelling with ap'attached one- car garage as shown on the survey map prepared by Peter A.Groben,LS,and dated September 11,2020. BASIS OF 'APPLICATION: Request for Variances from Article XXIII, Section 280-124 and the Building Inspector's May 18,2021 Notice of Disapproval based-on an application for a permit to.demolish and reconstruct a single-family.dwellitg and"t4 coristructIn.acc0ssory in-ground swimming pool;at; 1)single family dwelling located less than-the code required minimum[-front yard setback,of 35 feet; 2)more than the code permitted maximum lot coverage of 20%; located at 580 Old Shipyard Lane;Southold,NY. SCTM#1000-64-2-45. RELIEF REQUESTED: The applicant requests variances to demolish and reconstruct a single-family dwelling and construct an accessory in-ground swimminig pool.. The proposed construction,on this nonconforming 11,250 square foot lot in the R-40 District is not permitted pursuant to Article XXIII Section 280-124 which states; lots measuring less than 20,000 square feet in total size require a front yard setback of 35 feet and a maximum lot coverage of 20%. The site plan notes the front yard.setback of 33.1.feet and the lot coverage at 20.85% prepared by.Mark Schwartz, Architect and dated April 20,2021, ADDITIONAL INFORMATION: The applicant proposes to eliminate the nonpermitted side yard setback. The applicant will use the existing foundation rebuilding the first and the second floor and will maintain the current septic system. There have been variances in this neighborhood for front yard setbacks and non-conforming lot coverage: F Page 2,September 16,2021 #7531,Keller SCTM No. 1000-64-2-45 ZBA File 6561 Front.yard setback of 34.1 feet when code required 40 feet. *ZBA File 6638 Front yard setback of 20.5 feet when code required 35 feet. ZBA File 6702 Front yard setback of 26 feet'when-code required 35 feet'. ZBA File 7018 Front yard setback of 30 feet when code required 35 feet. ZBA File 7113 Front yard setback of 25 feet when code-required-35•feet. ZBA File 4aO'9,. lot coverage of 28:66% ZBA File 3M: loot coverage of 23.1%. ZBA File 7355:Lot.coverage of 23.6% FINDI1yGS OF FACT/REASQNS FOR BOARD ACTION:, . 'The-,Zoning Board of Appeals held a public hearing on this application ori Septemlier 2.,2021 at which tune written aiid-or4l.6viderice were presented: Based upon all testimony,document4.tion,'persofial inspeetjon of the property ' -and;. i. roundnng neighborhood,and other evidence,the Zoning Board finds.the following.facts to.be true and . relevatrt and makes'theMlowing findings: 1. T6wn'Law•§2'67rbL)(b)(1). Grant of the variances will not produce�an undesirable'change in the character of the neighborliood'.o`r a detriniant to nearby properties. The lots in the.siibject hgig'hboTh'd:are;sma'Ithnd.manyof the-hdrnes in this'•alder-neighborhood have beeri improved .over the.year$•in.limn'qi fash brr:to.�liat the applicant pxbposes,The:propos d poo in tlie.rear yard will not be seen.from"the street and roti+:e-onformirrg fr..out 4rd,s.opacks ar`e fi common ii�:ttie area.. .•,t c'." an l r in j e+ rar%a ted a the:=frari: °set i` o` a nl° a' ys�:n, aw &l��:T:°b1 1101. T rl r e Y. 0 .`e. :Delo".�:1'he 1 t err"fle''tiI• ;�", .u�r 's`thstaijl�a�l`':re•'resrV-:rjet'ef•f�rom:t[i froYn e code:` r1d'i�s`:ilQt.sul stairtial air "is ss.'tnaii 4 on.00 Perc esiertt: or n n : :. :` .. ren': frAnt: altd.*tb#kA� d'e�cessive lfl�eovorag� n`the'su17#ecttie�. 4:- Tovnpr Law: 267�b(35 b3(4). N.o.evidence has Been submitted to sug'gest:that:°a:variapgo'iil this.:residential corrtniuhity will have•aii adveikse-im' p' act' on the physical or environmental conditioris"In the neighborhood-. Tlie applicant must comply with Chapter 236 of the Town's Storm Water Management Code,-- 5. Town Law §267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel after the Zoning.Code was in-effect and it is.presumed that the applicant had actual or constructive.knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the-time of purchase. The applicant was asked.to amend the plans to bring the lot coverage into compliance. 6.Town Law§267-b. Grant of the requested relief is the minimum action necessary to enable the applicant to enjoy the benefit of a reconstructed dwelling and accessory in-ground swimming pool while preserving'and protecting the character of the neighborhood and the health,safety and welfare of the community. RESOLUTION OF TIE BOARD:In considering all of the above factors and applying the balancing test under New York Town Law 267-B,motion was offered by Member Weisman(Chairperson),seconded by Member 1 lanamento, and duly carried,to GRANT the variances as applied for and shown on the site plan and architectural drawings by Mark Schwartz, Architect dated April 20,2021 and labeled S-1, S-2and A 1-A-It., y Page 3, September 16,2021 #7531,Keller SCTM No. 1000-64-2-45 SUBM61T TO THE FOLLOWING CONDITION: 1. T applicant shall install a six(6)foot-high solid fence and/or a row.of evergreens that must be c ntinuously maintained along the entirety of botli side yards for privacy from adjaceni.neighbors.' properties. This approval shall not he deemed effective Until the required conditions have,been met..At the discretion of the Board of Appeals,failure to compily with-the above conditions may render this decision null and void That the above conditions be written into the Bui0figlnspector's Certificate of Occupancy, when issued. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. 'Any deviation from the suivey, site pkat and/or.architectural drawings cited in this.decision will.result in delays and/or apossible denial by the Building Department of a b.uildingpermit, andmay require a new application and public hearing before the Zoning Board ofAppeals: , Any-deviation from the.v{ti iance(s)-granted herefn-as shoivn..ott'the architect. al drawipgs,.site�plan and sz+puey cited above,sitcF:as alters tions;extensions, or�ti�tivlattari�;.-rale;>z��Authorized i"n this app ieati9n when'inuo�ly#ng : ':; hbricnn orr>Qttie trtCer tli zgtzng-:epde: ts; tlixt does fat;aiiihck ire oN car)Ci'940,J ti}�..curY�nt cyryttur .use, tbiXk .' ivy- - r 's'tbae >a nd ''lie ich yes #, `d. e. dti:. e t_:. 1' ` Jae dot , :d t th. _s. u.. ks. . �iir other.. eatu�eo ''ect:�ri5"eritjt tlta' rria<`vz�r.;�t,l �,,.,tzg: o.. .,. ;�t",.. .Y: V - yr h• .C.. �Gt a RitS t to :,-inti'` �%t. .�-`eft .t. T.. , �.:.... red'�',1., � .h� rX. .h. .la' .7 ., ,+ ... J... ,..;.. }. - - t Q "art r hi net A0 4 a ✓: y 'tziell d:> ,.v. 'r. -d" P 1 - y. N4 : : `: leo" 1 . , 4 tt '. .c� a .�., - .o��o i �-.. . �:b lIi �l Yee ou C1eI' 7iV " :' d tlir':t c.,. r:a stbdt`vi iain:i .'I.aS nflt., Pl_ 1...1. r.. . •, �ro�tired�nlnllo s ,:p:. ..+:�:, .�. _ : (3.)ye. rs from'th "date`s�xcla v�iriaa�ce ryas":gz�a><t�ti9 �'h�'Bh�>r� o�A�ip��ls tiaay' uj oii written request prior to the date of expiration;g'rant'•ah extti s.16n'.ii4i''to:eXCe6dihr:66(�):ConSCclltiVe' one (Y)year terms. Vote of the Board.' Ayes: Members Weisman (Chairperson), Dante, and Planamento (Member Acai- o and Lehnert Absent). This Resolution was duly adopted Q-0). Leslie Kanes Weisman, Chairperson Approved for filing 7 //7 /2021 i ,,BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTFIOLD ®� Town Hall Annex - 54375 Main Road - PO Box 1179 ^ Uit DINU v"_ Southold, New York 11971-0959 y • ®� �vt�QI so��T3,OL Telephone (631) 765-1802 - FAX (631) 765-9502 JIIl a�,,, 0 rogerr@southoldtownny.gov - seand@southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: c 1( /4� r Electrician's Name: „z License No.: e745[// -/.,E Elec. email: fr- C — � c Elec. Phone No: -73,r ICC ❑1 request an email copy of CEffificate of Compliance Elec. Address.: S/ G Al acA o n,, JOE SITE INFORMATION (All Information Required) Name: /,�� Address: p 1�/ vgoO Cross Street: Q 6,C1 `'4 Phone No.:_ Sf q�' ( q ra Bldg.Permit#: , G� GC7 email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE F00TArF (PIP---- ^-' t Clearly):_ � 1 - t , Square Footage: Circle All That Apply: Is job ready for inspection?- YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: YES ❑ NO Issued On Temp Information: (All information required) Service Size�1 Ph❑3 Ph Size: 2 GO A # Meters f Old Meter# O1 q e3 1 115YI VNew Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect[:]Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION r PERMIT q Address: Switches Outlets G F I'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: omments S%3FFOt BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD lY Town Hall Annex - 54375 Main Road - PO Box 1179 �+ Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roaerrCcDsoutholdtownny.gov — seand(aD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Electrician's Name: License No.: Elec. email: Elec. Phone No: ❑1 request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: Address: Cross Street: Phone No.: Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On Temp Information: (All information required) Service Size❑1 PhF—]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals 1 2 D H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION PERMIT # 71 C Address: isgo G Switches Outlets G F I'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: 1 I Comments P�Cl.l��Glf(� /aC �lO�- P�UlS � 1 g 80 poo qd ApA MA For poD t l e k+S a 1� aevt i LOT 79, TESTHOLE / "SUBDIVISION MAP OF FOUNDERS ESTATES" EL=19.4 FILED 10 MAY, 1927 AS FILE NO.834 Brown Gayey Sand SC 19.14 EP\ V-01 q01 ATSOUTHOLD, -- 3 19.45AC �RG�®�0 TOWN OF SOUTHOLD rc 19.40 SUFFOLK CO.,N.Y. FL18.95 po:; GQ / Brown Fine Sand SP NG 19.39. n i:.::;::•::�.:......:• G TIGHT IN ECT ROOF \ "�,.yZ�r_;,.-• -.EP18,92° SCALE* 11=20' VNIN CASTIRON WDIA.X12'PRECAST 21.3 FF CONC.SLAB iCOVER LEACHING POOL ♦ 17' •:_�` - ,:19.18AC,::-,:_'0 1 19.t Nd I .a 935tf�•.,.a:.,.' `= '+'::�3 CRAWLSPACE 19.7 NG l EL= � oia 1D G:':'`r'�- _ ' "'' ^ ^ ^ ^ •: Comments:No Water Encountered 89- Ts 02 L 7l-/,777,-/77,-77,-,7=, MIN 2% 18.7 MW.1% / 4B• SX - q �- 0- , 18.0 IN •v,n� _ 17.9 5 g.35$ - y Q� Dy' MINA•- fzbsNoo-Gal ns our•.-:. fzo9v _'.. � DATE OF TEST HOLE:2I AUG,2020 ��5s 'NG45 9p0..:::.:�'.:-.,..•. "� ..� IL`I QQI� APPROVED PIPE PRECASrST , •• � BY:MCDONALD GEOSCIENCE G <""m •`:- ` �¢�'�1r®l TYPICAL -�.. m;•"_o .. ..._(R 122 = I--).:=...4. `. N H• RRSP __ _ : .p.p y.N s.z=^�.mac" $ ,-_.'...':.: '`'-. 1�G (&OM�N01- Go BLOPOL 1AP 18.50 9 - MIN 3'CLEAN§AND I� : R�p,, 1'Py`'�`:F::;.° ANO GRAVEL-- S.4 `.f -'..I PGI�O,tQP 1pP 1 �g63 .`- 'Ne \ NOTES: ;_"::.`:`.;i';-;':! SI1�� �;dE $�OPO� 1gZ �Q.�.Q?:"-tE�O 381. z `'�� `•BSE `:"-w..: �m - AC:ASPHALT 24;` O i9.48:GAR4P^': :; :i'i_'S� Q .. R Cr- `t c < fig. 85 �'.:� a - ANANGLE POINT G NG 19.05 1g.� 5t• 5� u� ,9,.9 F�:°...D...: o / ® I I BB:BELGIAN BLOCK 0�0 Z14 - S'``.:'0 SMQpLy ����ppCf �O� �,o N" 186:.r': :".'`:�o�= BLD:BUILDING P^�d wo �'' _ r� r� CL CENTERLINENG rpA X00°E gg6P �'A y _Oµy_=` Y1Pg DFSCGPP oa p0 OfT +':c,` .,±.-:'O :;. / APR L'!� 2092 I EIGSS.LAT. EXIST �i0 N ��� GPR� ao 195 66 ��19��P 1963 �Oi�im C SEWER LATERAL 0 1 s NG 4 vN'F�a o ' 18.80..,0 "0 FF:FINISH FLOOR aQJA p 15 u+^� 4 1I ,� DEPT ccp N LO , f�tinL' BUILDING D FHV:HYDRANT VALVE `I F �] 5H O\ 19• -. y I°' T A'77, I -r GB:GRADEBREAK- `\ BLDAPJ9.089.f48 15SO pY0 11A( j33 Ow�°�8 51, 9'00 ;:GSM0IWE�ST.,� F�P�IEo�Qp �I SQJ:'.; ; GL:GAS LINE 0119 Do 5' � by fAu .%13 �W XO y OO G AC 67 V � SIOG 1� eG� NG:NATURAL GROUND V Icy P� m N pP fiyE. i:; G® PCC:CONCRETE 00 CMFD 17.48 17.28 SRFBG EFP (E0�0 1Zg ' ie6a$`0 �p +a94'Fc c��•. POL:POINT ON LINE 84 (=PROPOSED) �$ i 511,ON�1�G oog N 36 �,� PGAac$ 18' .. o''.., SRF:SPLIT RAIL FENCE 91 SSMH:SEWERMANHOLE og $�OSOPP G�Nn amu, hg50Pp15N�SI{Odo G�FO�g ` L 18.41 EP \ TBR:TO BE REMOVED 6 j \ ra q0• q9• 0. w :. .. N TC:TOP OF CURB a p r� �Q' QA1� `� ?; -` 18.55 'fy TG:TOP OF GRATE 0 Z \ QG� TCPOC 19.30 SDAP 2,p8 PP q9 6 � 193gS y�,_ NG 18.95• 5 EG,:',` AC TW:TOPTHOLE 0 OFWALL ��< a� a78 TC i>` \ 551'GIGI)RB oOCOL�BegRC'B9 QO 195 EC '94pSyh �9p G 18.N6G 18.30FL �GGO UIP:UTILITY POLE O eIqA WF:WOOD FENCE O 9O> >g O V Q `� Q O JF$ O o WV:WATER VALVE r0 O� ..\ MOC 18.88 B9 B 0rV�O A w ry O y 19.49 ECAP N VF:VINYL FENCE t� Oe 8C 18.78 A Ow °' _0 105 OF Net O 18.21 �N MOC 18.82 CBC 88.97 93 0�S��1aQ�4 Ic ^l $$tip10 98Cs5 1 Q�� co�Q' A. GRO rip WSV 18.50 EC 18.80 MOC 0g0 '�� w 0 1g Z1 9 A5 IV '� WMMo THE OFFSETS OROIMENSIONS SHOWN HERONFROMTHE PROPERTYUNES TO me A5�aGig.u, iO \�,w/ 51)1-"4°050 \ / THE STRUCTURESAREFOR A SPECIFIC PURPOSE&USE.THEREFORE THEYARE \ P 0 Oct g�{b 5 r3 ®•` D�I n� �./ NOTINTENDED TO MONUMENT THE PROPERTYUNES OR TO GUIDE THE ERECTION a c•� ' ENGE v ILS PIVY - `18.47 OF FENCES,ADDITIONAL STRUCTURES OR ANY OTHER IMPROVEMENT. , jg•'b vl�yl•p a fol 10 ,� �, CMFD UNAUTHOR�D ALTERATIONS ORADDMONS TO THISSURVEYISA WOLA77ON OF \ Q lap GL` G�� �jB D`I /B JjVLI o SECT7ON7MSU9OMSON 20OFTHENEW YORK STATE EOUCATIONLAW.COPIES J� AOF THIS SURVEY MAP NOT SEARING THE LAND SURVEYORS IN?XD g1 C�1\� � `O `J •W EM80SSEDSEALSHA[LNOTBECONSIDEREDTOBEAVAWTRUECOPYSEALOR N-` CV $5$G GQ P I2�iAV8R�EN CERTIFICATIONS INDICATED HEREON SHALL RUN ONLYTO THE PERSON FOR WHOM CSNw 95 ■ =CONC MONUMENT LAND SURVE�I LIC.50869 N THE SURVEY IS PREPARED,AND ON THEIR BEHALF TO THE TITLE COMPANY.GOV• J�' P.O.BOX 704 RIDGE,NY 11961 N SLENDING AIOUS¢ L481 \ ARE NOT TRANFERABLETDADo NLINSTITUTIONSORSUSSEENTOWNERS. UNDERGROUND UTILITIYLOCATIONS ByOTHERS 951.640.4899 �O� SURVEYED:11 SEPT 2020 NO.RESPAERLRITYIS EASEMENTS, UB THE UNDERSIGNED FOR ANDI OR STRUCTURES CE•SUB- SURFACE, �-�- ELEVATIONS SHOWN HEREON ARE REFERENCED TO NAVD 88 �p► AERIAL EASEMENTS,SUBSURFACE UTILITIES AND/OR STRUCTURES \ W IFSCTM 1000 64•O2 45 OR OUT OF EASEMENTS SO PROVIDED. I - SITE DATA 1000-64-02-45 N 25°55'00"W LOCATION AREA LOT% EXCAVATE FILL - 75.0' PROPERTY WMSP 023Se MIN DISTURBANCE 7500 SF y POOL 5 z EQUIPMENT' 1 D F%!STING HOUSE ._4SF Z. •el EXISTING GARAGE 420 SF TO REMOVE • Q O EX.EAST PORCH 24.75E TO REMOVE M1, Q OOR SH EX.OUOWER 372 IF TO REMOVE t-7 O TDp16IJ/ pz9/ Ltd x 225' 30XIS INC0.0UND POOL 725 PROPOSED ADDITIONS: 4013 IF 35691, 70 CY 15 CY U3 PROPOSED SCREENED PORCH: 168.0 IF IA9% 25 CY 5 C SO` PROPOSED STOOPS 7505F 0.7% BC 4C F-I PROPOSED WEST BALCONY: 1020SF 0.90% PROPOSED EAST PORCH: 62IF Q6% BC 3C �¢7 PROPOSED POO 450 40% 1500 75C 5 .r--____—_—___1Y ! Dl ZI II {oNCRET>< WASHOHT PROPOSED DRVWEIJS (2)8X5 15C SC PROPOSE •--- SEPTIC TO REMOVE• • SOC 75 C 0 HAY BALE OR SILTFENCII, 2NO.FL.DCK EXISTING NROOM PROPOSEDNEWEPHCS75CY 21 CY W > I pNmpE�,yRw�E I --- TO BE REMOVE? m E NOPAAIO���OMSAUDM ._____!xv__ :.__--, � INgGTFDONsO[H.W °i :ORYWEIIi '" 168375E .3085. '. 401C 2070 � ST x w Gl PROPOSE➢ ~ F%IfI1NG FOO'TPRIM=1562 3 SQ FT ��] 0 IIXISTWG O.O.SHOWFR ODP if f PROPOSED FOOTPRINT Q'1' TOREMOVED PROPOSED (NOT INCLUDING POOH RE y I i PROPOSED _ SCREENS N RECEIVED STORM WATER MANAGEMENT DETAILS PORCH —1 yS I ' _.... ' 1 IXHTING E BE Y JUN U 2021 OVE REMo N:T.S. �i WRAGETOBE SITE PLAN D ` EXISTING STY HOUSE H- 2NOFLOORT2OBEREBUILT ° 1ST PROPOSED zoning Board of Appeals SCALE:1"=201-0" IR 1 {'1 II 1 I� msnm..-new.n v • gX5''• -_________ ELOCA 0 ` l�E��11,111 'IIV/J/�/J ®.w I'.DRYOVEIk RELOCATEGASMETERy o 006��"�1O""'� .__:'•.• PROPOSED NERIFV 1FY.w/OWNER) m•d '� in '•-_ _ STORAGE [rinEErcu7 \ EXISTING•• , 10.1 -CC TO VERIFY B"°" •�nm�= I AND MAINTAIN 6 O PROPOSED-D MIN 10 SETBACK 6 3 1•LOORLOFTABOVE W S PROPOSED IXISTING PORCH A�a�ae O TO BE O — COVERED PORCH Z © Z REMOVED p 5 .w.. Iu`,se°� oa,..�,��.a.•. ay- II -t '. TE➢EGY O O 0 ST Ll o LCAOORIV\Zo o Eo r 1,13 MAP P ' to L-—- —m ---' CONSIAUCDON En - Z FINAL.. MA — --- ENTPANCE — r r REVIEWED BY ZBA 5 25055'00" E 75.0' j SEE DECISION # DATED OLD SHIPYARD LANE s-� I 1 0 I SWIMMING POOLTOEEEXCAVATED ONE TO OF OVDLDEAGNSPECINCATIONSAND 1 SOILTO BE LEFT ON PROPERTY.SOILTO BE STOCKPILED ORRUFF GRADED(AS PEROWNER)ONTIE DAY OF EXCAVATION ONLY UNLESS SON.UTIO BE CARTED \ / POOL IPMEM p( AWAY. \ / F 2 ALL FILL BENEATH CONCRETESLABSTO BE COMPACTED W 17 UFTTTO Tnh 3DDO pa TO 95%DENSrNAfTM D4M.COMPACTION TESTREQUIRM(FEESTO BE PAID BY O ERJnMNGTOBEPERFORMEDBYSOILMECHANICSDMI G,5162213333. GENERAL CONTRACTOR IS RESPONSIBLE FOR ARRANGINGTESTNG. 6DIA%2'DEEP OVERFLOV/D0.YWFU z 3.SWIMMING POOLSFRUC AND A MATE OFRAP TRA0.EBARTED,KS Q ON CENSER FOR WAILS AND FLOOA,VON CENTER FORALLTPMISIT0:1 BRUI(f AND BOND BEAM 4.THE POOL SHEIITO BE MADE OF IG.DRY GROUT GUNFIE NX SHOT INTO THE STEEL Q CAC#ATATHICKNESS OF NO LESSTHAN Ir ON THE TOP EDGE OFTHE POOL (BOND BEAM)AND NO ISS THAN 9-ON THE WALLS AND FLOOR.INTERIOR FINISH OF POOL TO BE-MBLE TECM DURABLE FINISH.COLORS AS PER OWNER. 5 CONCRETE 40ODPA STEF3:6050. 6 PROVIDEWAIMSPIGOTAT PO OLFORAUTOMATICWATERFIUSRETURN OL RETURN FOOL 7.POOL UGHSS TO BE NEKKUf MELODYBIANCOIN lFD WITH Dl P%iW TRANSTORMHt (TYp) LIGHT (TS•PI UGH VAIN REQUIRED CORD. RETURN B-POOLFRTUTDNTOBESfM SYSTEMMODULAP.MEDUFlLTEIL 30'-0" (TYFI p 9 POOL PUMPTOBEPENrAIRDIrSinOENERGYEFFKnW4MOVARLSBIESPEEDPWS SVRE WNH(2)2•QUICKDHGONNECT UNIONS MAIN DRAIN SHALLOW END IO.POOL SKLNMERf IO BE BLACK PFMAIRINOEPENDENT.Y CONNECTWf[H 2•R'C PIPET O En q'.Q yp WITH SEPERATE VALVES AND TILED ON SIDEAND BASE OF MOUTH off O IL REfDRHTO BF BIAOCHAVWARD DIRECfK)NAL FiLN/VAhl wcsTOPi ����s MAP pq N 12 PIPNOTO BEPVCSCHEDUUD4DWKHYSURK)NUNES,Q]V2•REfURNLWESWITH IPm OILiIYY FILA Igtm 1TS- P) CEHl2 p P)VY AIR HAMMER EQUAIIIER 11q�{pI Spee��'ppp 13.INSTALLTRACERWIREONTOPOFPIPNGAND RUNBACKTOSYSTEM WITHYALVE REVIEWED IEWED BY ZBA BOX TO LOCATE PIPES FOR FUTURE REPAIRS, 9 STET 14.MAINDRANf WITH PVC WATER STOPSTNTOGETHERWUH WATERWAY I2•JF12•FRAME SEE DECISION# � - SKIMMQI AND GRATES / ) J 15 OVERFLOW DRAIN TILLED IWO DRE(MLLMA AUTOMATIC FDL DATED-1 v / O•' �l $gry 16.PROVIDE CONCRETE SUB FOR POOL FILTER AND PUMP. da �g 17.SUPPLY AND WSTALL7TICCK X 24•WIDETiERASAL BWESTONE COPWG.COPING TO SE � NfTAUFDWITHSPEW.SIXPRE-B MEDMORTARFORSETTWGMATERIALSANOTECACLU COLORPREMNMGROUTTNTHPRSB OWCOLORXONSFORCONSISTAHCOLORTO jj � 8 MATCH STONE 8 2 18.INSTALL-30-p LOAD CENFER(IBD 6Y ELECTRICIAN)FOR POOLEQUIPMENT.LIGHTING.— III. IGHTING.etcI9.DELIVER REQUIRED LOADSOF WATERTO FILL SWIMMING POOLAND SPA- 20. PA20.SUPPLYAND INSTALL(3)POOLSONIK SOLAR POOLAND SPA AWNS WITH POOL SONIX BASE UNIT AND REMOTE KEY FOB 21.F%CIIVATFD MATERIAL FOR POOL TO BE LEFT ON SPIE TO BE USED TO RADE GRADE BY PAVERS MORTAR COPING O CONTRACTOR/LANDSCAPER.ORGANIC DEBRI AND AUTERLLL WASTE TO BE CARTED OFF SITE , f 22.UPM N OFGUN suPPLYANDWSTAILCLFAN SAND LLNDERALL PATIOSCOMPACTEDINIFTSTO PREVENT SETTING. - -••."1:r..� =71,+ 'r Uma 'It "�F iE_.Y��:•:�. /Ew.-J••n .; • - f .ry F ^..'fes' � d ,•••�•f:'. 1.'Y��•.+M:Y:S-ryi:4::1.'�•'.:'r 'r..:y:,l'.31LAIIQJ/FND,�1'•r._'V`.•. •X` l - 23.POOLCONSRACTORISRSPONSIBLEM PROVIDETFMPORARY FENCING AROUND POOLAND .^;j..;._":. •. •01 - IqT-•..MARBUr ':i'��:"• �,q.p••.".�"i (� EPA AND ALLWORKWG HOOKUPS TORUN SYSTEM POOLCONTRACTORSHALLAUDSUPPLY REQUIREDLLNDFRVAURERE CERIIFiCATE •r' r 6'-7- �,1_ , 'i'�:i Y:�•,, .2..i-:•'i;+t:: x y `'+•:,ii`::,_.•::�J,yY.;l'.,�W�,ny'd:�;a"':.'..a"{'r,.G!.•A:...i.� p EU �i M„A:'_:•. •...:'.rl. ..�""� wBARs 6elvoc�w / 12136-RAIN POOL PLAN ""SUES' 'DECEIVED SCALE:NOT TO SCALE JUN 4 G 2D21 ryIt• 6�.: Zoning Board of Appeals .. S-2 N Y S ' F New York State Insurance Fund PO BOX 66699,Albany,NY 12206 1 nysifcom CERTIFICATE OF WORKERS!COMPENSATION INSURANCE AAAA AA 204302533 WP POOLS&MASONARY INC 177 BEACHVIEW ST COPIAGUE NY 11726 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER NEW POOL CONST WP POOLS&MASONARY INC TOWN O SOUTHOLD 177 BEACHVIEW ST 54375 MAIN ROAD COPIAGUE NY 11726 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 11447389-6 828859 03/08/2022 TO 03/08/2023 4/15/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1447 3896, 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 HTTPSJMIWW.NYSIF.COWCERT/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. WOJCIECH PANEK PRES WP POOLS&MASONERY 1 OF 1 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 STA SU NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:305685578 U-26.3 Yo workers' CERTIFICATE OF INSURANCE COVERAGE STATE COfnpensatiOR Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that Carrie 1 a.Legal Name$Address of Insured(use street address only) 1 b.Business Telephone Number of Insured WP POOLS AND MASONRY INC. 631-598-7196 177 BEACHVIEW STREET COPIAGUE,NY 11726 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,wrap-up Poricy) 204302533 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShetterPoint Life Insurance Company Town of Southold 54375 Main Road 3b.Policy Number of Entity Listed in Box"1 a" Southold NY 11971 DBL248123 3c.Policy effective period 03/02/2022 to 03/01/2023 4. Policy provides the following benefits: ® A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: © A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. r Date Signed 4/15/2022 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 46,4C or 50 have been checked) State of New York Workers' Compensation Board According to information maintained by the NYS workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers ane authorized to issue Form DB-120.1.insurance brokers are NOT audrodaed to issue this form. DB-120.1 (12_21) IIIl1'iBi-1i2i0ii1�iu(i12iii21)iilll WPPOO-1 OP ID-CH CERTIFICATE OF LIABILITY INSURANCE DATE/19120 2 04/19/2022 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 845-783-2555 c ACT Walter Rose Agency Walter Rose Agency,Inc PHONE 845-783-2555 FAX 845-783-2425 8 Stage Road A/c No Ext): AIC No): Monroe,NY 10950 EbmA,'Ls,.Amy@walterroseagency.com INSURERS AFFORDING COVERAGE NAIC# INSURER A•Central Insurance Companies 20230 INSURED INSURER W P Pools&Masonry Inc 177 Beachview Street NSu E C• Copiague,NY 11726-3601 INSURE 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TRTYPEOFINSURANCE ADDLSUBR pOLICYNUMBER POLICY EFF POLICYEXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR CLP 9918178 06/20/2021 06/20/2022 DAMAGE TO RENTED $ 300,000 MED EXP(Anyone arson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY E]JECT F�LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBIN I. SINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-0V/NED PROPERTY AMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/NTE ISTATU ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,descdbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Swimming Pools -Installation,Servicing Or Repair-Below Ground CERTIFICATE HOLDER CANCELLATION SOUTH06 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 54375 Main Road AUTHORIZED REPRESENTATIVE Southold,NY 11971 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A ball, N 25055 '00" W 75 , 0' SITE DATA 1000-64-02-45 ;�CUPANCY OR LOCATION AREA LOT % EXCAVATE FILL �4 JSEIS UNLAWFUL PROPERTY 11,250 SF 0.258 acres O I � ESTIMATED DISTURBANCE 2000 SF - - - O WITHOUT CERTIFIC/',;_, a OFOCCUPANCY HOUSE 1535.5 SF 13.6% 8'dla, 4'deep __ Ln UNCONDITIONED STORAGE: 117.2 SF 1.0% OBACKWASH N I SCREENED PORCH: 168.0 SF 1.5 • 0 DRYWELL i i O EAST PORCH: 62.5 SF 0.6% O M ` WEST STOOP. 65.8 SF 0.6% �..{ Ln 0 O e--� POOL PROPOSED 28X14 POOL: 392.0 SF 3.5% 150 CY 75 CY 1-t-1 EQUIPMENT' MIN In /h .' 5' / a) �]��V�� PROPOSED DRYWELL: 8'X 4' 6 CY 2 CY 26.0' 21.0' 2341.0 SF 20.8% 156 CY 77 CY METES AND BO DS BY: 28X14 INGROUND POOL i PETER GROBEN, LAND SURVEYOR SEPTEMBER 11, 2020 I , ---- --., APPR VED AS NOTED z I �I DATE: 3 B.P.# `� >' lI V FEE: /� COMPLY WITH ALL CODES OF `' w � TOP SOIL � � NOTIFY BUILDIPiG �?y�A, NEW YORK STATE & TOWN CODES i LOCATION 7v RTMENT AT AS REQUIRE ND CONDITIONS OF a' Z 765-1802 8 AM TO 4 P,.4 FOR THE �-+ q .� 06 -- I FOLLOWING INSPECTiONS: -u ' CONCRETE 1. FOUNDATION - TVA O REQUIRED HAY BALE OR SILT FENCING ___ - WASHOUT _ _ _ _ FOR POURED CONCRETE ' BOARD ►-a o 2. ROUGH - FRAMjtJG & PLUMBING (,7� LIMITS OF CLEARING TO BE I -- �� - �w TRUSTEES O NO MORE THAN 20' FROM 3. INSULATIONCn PROPOSED WORK AS ~ 18.1' 4. FINAL - CONETRCJ( -Vq MUST ol INDICATED ON SITE PLAN BE COMPLETE FC O. ALL CONSTRUCT,'Dr� S,iALL MEET THE REQUIREMENTS OF THE CODES OF NEW i YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. o N v ' 10.3' rn M STOOP POOL SITE PLAN m 211 ELECTRICAL o C';' o 18.8' I SCREENED-1 INSPECTION REQUIRED SCALE: 1" = 10'-0" O X PORCH t� I CZ W IT r° ;j m IJ nj - r-_� c 2 Ln U CO C cx. "o C!] (N; n• Vit:.. ON CMboO v v H 7 o w O �. .'ENCLOSE POOL TO CODE fru srooP A; C Q w — — — — — -o— — 2"SCH_467-1 PIiTG O � 0 —2"SCH 40 PIPING ::3_ 7rj==Eil=_- 1.SWIMMING POOL TO BE EXCAVATED ONE FOOT OVER DESIGN SPECIFICATIONS AND ® 2"SCH 40 PIPING SOIL TO BE LEFT ON PROPERTY.SOIL TO BE STOCKPILED OR RUFF GRADED(AS \ POOL EQUIPMENT \ \ PER OWNER)ON THE DAY OF EXCAVATION ONLY UNLESS SOIL IS TO BE CARTED \ 1 AWAY. 2.ALL FILL BENEATH CONCRETE SLABS TO BE COMPACTED IN 12"LIFTS TO min.3000 psi 1 1 (T] TO 95%DENSITY ASTM D-689.COMPACTION TEST REQUIRED(FEES TO BE PAID BY I Y OWNER)TESTING TO BE PERFORMED BY SOIL MECHANICS DRILLING,516-221-2333. GENERAL CONTRACTOR IS RESPONSIBLE FOR ARRANGING TESTING. 0 3.SWIMMING POOL STRUCTURE TO INCLUDE A MATT OF 3/8"STEEL REBAR TIED,10" 8'DIA.X 4'DEEP ON CENTER FOR WALLS AND FLOOR,5"ON CENTER FOR ALL TRANSITION BREAKS OVERFLOW DRYWELL AND BOND BEAM. SCH 4�PIPING 4.THE POOL SHELL TO BE MADE OF 1-4 DRY GROUT GUNITE MIX SHOT INTO THE STEEL I C CAGE AT A THICKNESS OF NO LESS THAN 12"ON THE TOP EDGE OF THE POOL I O a (BOND BEAM)AND NO LESS THAN 8"ON THE WALLS AND FLOOR.INTERIOR FINISH Q OF POOL TO BE"PEBBLE TECH"DURABLE FINISH.COLORS AS PER OWNER. 5.CONCRETE:4000psi,STEEL:60ksi a Z 6.PROVIDE WATER SPIGOT AT POOL FOR AUTOMATIC WATER FILLS W x Q RETURN URN RETURN RETURN C/1 0 7.POOL LIGHTS TO BE NEXXUS MELODY BLANCO 12V LED WITH (1) PX100 TRANSFORMER (TYP) (TYP) (TYP) (TYp) �4 Q �" WITH REQUIRED CORD. v h_4O E-+ 8.POOL FILTRATION TO BE STA-RITE SYSTEM MODULAR MEDIA FILTER. DEEP END pip 6'-0" I 1� � C/1 9.POOL PUMP TO BE PENTAIR INTELLIFLO ENERGY EFFICIENT 4X160 VARIABLE SPEED PLUS 2 SVRS WITH 2"QUICK DISCONNECT UNIONS N 10.POOL SKIMMERS TO BE BLACK PENTAIR.INDEPENDENTLY CONNECT WITH 2"PVC PIPES _ WITH SEPERATE VALVES AND TILED ON SIDE AND BASE OF MOUTH. MAIN DRAINS SHALLOW END �+ 11.RETURNS TO BE BLACK HAYWARD DIRECTIONAL FLOW WITH PVC STOPS. (MIN.3') 4'-0" H A 12.PIPING TO BE PVC SCHEDULED 40 WITH 2"SUCTION LINES,1/2"RETURN LINES WITH r-+ 1/2"AIR HAMMER EQUALIZER. N v 28'-0" m o 13. INSTALL TRACER WIRE ON TOP OF PIPING AND RUN BACK TO SYSTEM WITH VALVE rn v BOX TO LOCATE PIPES FOR FUTURE REPAIRS. I m m o +� rn 14.MAIN DRAINS WITH PVC WATER STOPS T'd TOGETHER WITH WATERWAY 12"X12"FRAME � R. o AND GRATES. POOL POOL w � LIGHT SKIMMER SKIMMER LIGHT SKIMMER 15.OVERFLOW DRAIN TILIED INTO DRYWELL VIA AUTOMATIC FILL. (TYP) (TYP) (TYP) o 00 v �n ,, 16.PROVIDE CONCRETE SLAB FOR POOL FILTER AND PUMP. 17. SUPPLY AND INSTALL 2"THICK X 24"WIDE THERMAL BLUESTONE COPING.COPING TO BE W ^ 4 INSTALLED WITH SPEC-MIX PRE-BLENDED MORTAR FOR SETTING MATERIALS AND TEC ACCU I ire U r-+ COLOR PREMIUM GROUT WITH PREBLENDED COLOR JOINTS FOR CONSISTANT COLOR TO �_ U) MATCH STONE. — — — — ® _ — — — — °N° W 18.INSTALL min.30amp LOAD CENTER(TBD BY ELECTRICIAN) FOR POOL EQUIPMENT,LIGHTING,etc. \ B �- — —�- — — — 2"SCH 40 PIPING p"' 19.DELIVER REQUIRED LOADS OF WATER TO FILL SWIMMING POOL. 20.SUPPLY AND INSTALL(3) POOL SONIX SOLAR POOL AND SPA ALARMS WITH POOL SONIX BASEEon, Cn UNIT AND REMOTE KEY FOB. W H 21.EXCAVATED MATERIAL FOR POOL TO BE LEFT ON SITE TO BE USED TO RAISE GRADE BY POOL PLAN CONTRACTOR/LANDSCAPER.ORGANIC DEBRI AND MATERIAL WASTE TO BE CARTED OFF SITE. O SCALE: 1/4" = 1'-0" 22.UPON COMPLETION OF GUNITE,SUPPLY AND INSTALL CLEAN SAND UNDER ALL PATIOS COMPACTED IN LIFTS TO PREVENT SETTLING. 23.POOL CONTRACTOR IS RESPONSIBLE TO PROVIDE TEMPORARY FENCING AROUND POOL AND SPA AND ALL WORKING HOOK UPS TO RUN SYSTEM. POOL CONTRACTOR SHALL ALSO SUPPLY N REQUIRED UNDERWRITTERS CERTIFICATE. PAVERS MORTAR COPING U 6"TILE BAND' $" 4 .. MARBLE DUST. . ,• .. •, . O #4 BARS @10"OC ew flitR 9 R 12"-36"RADIUS ' { (VARIES) siL �; ie DRAWN: wx- r� SCALE: JOB#: rr "r ` 4/8/2022 A i'��de,*•,v,', .t w SHEET NUMBER: A- 1