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HomeMy WebLinkAbout45860-Z O�SsaFFO(4' c oG 9/30/2023 Town of Southold a� y P.O.Box 1179 0 o _ e 53095 Main Rd y�ol * �ao�;;> Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44620 Date: 9/30/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 7980 N Bayview Rd., Southold SCTM#: 473889 Sec/Block/Lot: 79.-7-52 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/12/2021 pursuant to which Building Permit No. 45860 dated 3/1/2021 was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in-ground swimming pool fenced to code as applied for. l The certificate is issued to Galligan,John&Marion of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45860 4/20/2021 PLUMBERS CERTIFICATION DATED tho ized nature TOWN OF SOUTHOLD ¢¢o�SufFot,r�oG BUILDING DEPARTMENT C4 x ' TOWN CLERK'S OFFICE "oy • o� SOUTHOLD, NY t,dol �a tip'' 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#: 45860 Date: 3/1/2021 Permission is hereby granted to: Galligan, John 7980 N Bayview Rd Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. REQUIRES MINIMUM 15' SETBACKS. At premises located at: 7980 N Bayview Rd., Southold SCTM #473889 Sec/Block/Lot# 79.-7-52 Pursuant to application dated 2/12/2021 and approved by the Building Inspector. To expire on 8/31/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 1 Bu i g Inspector oF so�lyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q sean.devlin(a-)town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: John Galligan Address: 7980 N Bayview Rd city:Southold st: NY zip: 11971 Building Permit#: 45860 Section: 79 Block: 7 Lot: 52 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: South Electric Inc License No: 58024ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1 st 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 A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 2 Disconnect Switches 4'LED Exit Fixtures 11 Pump Other Equipment: Intermatic Pool Panel (8) Circuit, 250GFI Heater, 220GFI Pump, 220GFI Pool- Cleaner, (2) Lights Notes: Pool Inspector Signature: �� Date: April 20, 2021 S. Devlin-Cert Electrical Compliance Form.xls -7 # # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm N�' 765-1802 INSPECTION - [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ..] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ '] 'FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION LJLFIREILESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FIN [ ] CODE VIOLATION [ ] PRE C/O REMARKS: i DATE 2,0 `lir INSPECTOR �J OF SOGTyOIo f # TOWN OF SOUTHOLD BUILDING DEPT. courm, 631-765-1802 1�58'0'0 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ eSULATION/CAULKING FRAMING /STRAPPING [ NAL PM I [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL ZREMARKS: A1( Y A401-J& WWA.& U Lim l� DATE a �DO- INSPECTOR 1Y D o�aq SOUIyo! , � o * TOWN OF SOUTHOLD BUILDING DEPT. `yQurm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ]�ULAT'ON/cp KING FRAMING /STRAPPING [ FINAL Re- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: A IVZ Ic 617AZ wl, DATE INSPECTOR HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET February 8,2021, Town of Southold Building Department Town Hall Southold,N.Y.'-11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of: Galligan.Residence 7980 North Bayview Road Southold,N.Y..1.1971 will not require draining because the pool is constructed with a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not interfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private .roads. J Sincerely, HM E ineering P.C. of a,P.E. S FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) ------------------------------------ Vun 'FOUNDATION (2ND) z . • o Al ROUGH FRAMING& PLUMBING y S r INSULATION PER N.Y: H STATE ENERGY CODE l KC - f S v- J L 1 o FINAL ADDITIONAL COMMENTS z m W " N � d lei b _ H 4000`' -' BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 --Tblephone (631) 765-1802 - FAX (631) 765-9502 roge rr(cD-southol dtown n Y.gov ~ sea n d(@.so utholdtown ny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: , SooA-k--N G\e_c_-Vv;�c, Name: License No.: email: Phone No: L,23i g �570 I,() Eg(request an email copy of Certificate of Compliance Address.: . ��cN, WI-t:k 1 cl5_ JOB-SITE INFORMATION (All Information Required) Name: Soh Y--, Address: o K) sc)o- �k-A Cross Street: Phone No.: Bldg.Permit#: Lk S g 6C) email: 1 Tax Map District: 1000 Section: Block: Lot: 5,-,1, BRIEF DESCRIPTION OF WORK (Please Print Clearly) C� V--rVJC\C, C.0 k,(-!e Check All That Apply: Is job ready for inspection?: [2YES EJNO E]Rough In OFinal Do you need a Temp Certificate?: EE�'ES [:]NO Issued On Temp Informal Ph F-13 Ph Size: A # Meter n: (All information required) Service Size 1 Si �, Old Meter# ❑ ;91 - - New Service ❑ Service Reconnect E] underground U21/overhead 1# Underground Laterals [—]l E]2 E]H FrarneE]Pole Work done on Service? F]Y F]N Additional Information: 7, PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx 2..,2lC_V_-tk;- D-USS 400"' BUILDING DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 --�T61ephone (631) 765-1802 - FAX (631) 765-9502 T. rog rrc@-southoldtownny.gov— seandCcD-southoldtownny.gov APPLICATION FOR-ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: . 4,l'1 Company Name: --:�_r)c, Name: k\A0-cLy,,r,_,eq_ License No.: email: UK go 0 caXe"4-Z, - Phone No: request an email copy of Certificate of Compliance Address.: , , JOB-SITE INFORMATION (All Information Required) Name: Gc:xA\ cI Address: 1 cts-C) o C.) Cross Street: Phone No.: Bldg.Permit Lk S Q L'ol email: -Tax Map--District: 1000- Section: Block: —Lot.. 5a-__ -- BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: Is job ready y for inspection?- ERYES E]NO [—]Rough In DFinal Do you need a Temp Certificate?: E9'eYES EjN0 issued On Temp Information: (All information required) Service Size [Ell Ph F-13 Ph Size: A # Meter Old Meter# D New Service El Service Reconnect [:] Underground Overhead I# Underground Laterals [—]l [:]2 [:]H Frame[:]Pole Work done on Service? Ely EIN Additional Information: PAYMENT DUE WITH APPLICATION -Electrical-Inspection Form 2020.xlsx PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's UC Lis Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon , Micro Generator Combo Coo kto p Transfer AC AH Mini -Special: Comments: 010 /L Z_C �i . o�g�FFO(K�oG TOWN OF SOUTHOLD—BUILDING DEPARTMENT ? y� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax (631) 765-9502 https://www.southoldtowmy.gov . 9F Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only / j l PERMIT N0. O( Building Inspector: FEB 1 2 2021 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form,(Page 2)shall be completed. "- Date: it. app OWNER(S)OF PROPERTY: p�� Cjc,�����ca n SCTM#1000- Name: — Physical Address: $0 Phone#: s\to —((0 Email: � 1� o�+-�'MU3 (LD CX-m Mailing Address: CONTACT PERSON: Name: MailingAddress: 6bo0U Phone#: ('Q� —I �5�� � Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: SU 00C) �p� (�� 2��kA 1"'"� L19 '1 Phone#: TFM cz,P60t c CONTRACTOR INFORMATION: Name: Mailing Address, Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: 160ther foo $ Koo 6 Fi the lot be re-graded? RKes El No Will excess fill be removed from premises? 5:1)(6s [--]No 1 1 PROPERTY INFORMATION Existing use of property: Intended use of property: (sem S f"�.+Gt= 7"�/t►ds#-� �t�e�E Zone or use district in which.premises is Situated: Are there any covenants and restrictions with respect to �L- ► this property? ❑Yes l�No IF YES,PROVIDE A COPY. LJ,-.,/ ASL Check BOH After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the Issuance of.)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 name): L"lj Authorized Agent ❑Owner Signature of Applicant:-2_ Date: STATE OF NEW YORK) COUNTY OF being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the f � (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 t� - �day of � 20�� --Jaw N Public WITAIRY 6gll,`` Lie,STATE OF Ldl!EMJ7 YopX PROPERTY OWNER AUTHORIZATIM.cimna3mm (Where the applicant is not t86 'WEED IN SUFFOLK cOUNW ON EXPIRES JUNE 30,2 U o', I �/oNN 4,4-L/a,!�All residing at 0 1.0 /,/`� do hereby authorize �dfr(� c.b�'��ooL CA-:44' to apply on my behalf to the Town o uthold Bu lding Department for approval as described herein. Owner'sSiqlature T— Date Print Owner's Name 2 Mejia, Evelin From: Mejia, Evelin Sent: Wednesday,August 30, 2023 3:07 PM To: 'LI.Poolcare@gmail.com' Subject: Open items on BP#45860 Attachments: ####45860tix_20230830150251.pdf Good afternoon, i The following items are needed in order to close out Permit#45860 for the property located at 7980 N. Bayview Rd, Southold NY: 1. Add Fencing for Pool Barrier up against PVC Fence that is existing 2. Door and Window Alarms-Listed UL2017 Attached is the Final Inspection ticket on file. Thank you Evelin Mejia Town Of Southold Building Department Annex Building 54375 Main Road Southold, NY 11971 (631)765-1802 i a,�yv�E�ri R R,Q39?q s�� s9 3 p F �qD 4 r�.sn+wcato auWnet.ce.tftttmi � �� ca Tpq_4tlT r_a NarArraN W 1 E,00, vow.71t•at Te M,Ta $il rt A C-.rs Cf FL Uhl 4W",llnaNG ii.Li t L ..:i.IN Ta•A,ot �O Y S ! "t— �.i.tib:.k 1 L ox,&afm aA a r.. .u.wr IrKs�k1ALL 6!I \ 111 i u; :N x.f:^-R:t tray au:raYlT is m:1.•:J.Lt t.W P. Hc • t Mr L•x•— -:.T.L.nU..A.A.L.XV AND 1 nNtl- AAP.r.....�.I-f-tl•.p..A I ` r0 r �'f G'ut d iw:uatea NIF V / O T.ci•..a.+uauus u i,a T,wL:roAgc ! O TD Aa-rYaMt a6Tm�Wr+s aA wcaomrt �Q' .4i gam``• ti jj n .h0 t, a gosa♦ �e `l ' O ��t, A i d 1•til e�, gqr" t o MONUMBHT Az • •+-�— `A=' SIMPIVISXy XAP LED IN THE OFFICE OF ME CLERIC • s ,K s'�`�� FIOF SUFFMIf CWV 4521Z.�yi � . TY 0/i VM 4,197/AS MAP NO.5559 u O Rtevtstoas YOUNG & YOUNG 400 OS7RANOER AVENUE. RIVERHEAO. NEW YORK ALDEN W YOUNG HOWARD W.YOUNG I yy^ e.• PRDPR9RIC"AL ama1NC[R AND LAND sLRYC—R JQQO LAND SNaV6TOIL ILT.B.LK.M0.%aaAs N.T.a.LIC.NO•A.627 j •O SURVEY FOR: j( W11-41AM RE6 OORO r j' YOT NO. 3 ^WO W.. '+ F • sy 30 LEEOd�ARD siGRE3 A. �9 J AT' B.QYY/EW s A7 .0 � J 00TOWN FM NOF roww c�SOUTMOLD 4sT8EGo •` SUFFOLK CO., N.Y. / SCALP-- Wo.DATE: — . / a 90 MAR30/9T3 T3 PBT I I ��• - AI's S 7. VA : . EI ' I 1_ ATE' F"C Ii B'II_�' Y';IhISUF At I E -l-VA2 o 0 " . . ... .. . .. THIS';41tTffIGATE?.1$:.ISSUED°AS.A_NiATTER OF`dNFORM�1AlON'<ONL1f`AND.CONFERS NQRtGHtS::tIPON THE CERTIFICATE HOLDER." . I GEI�LIFIG(1'JE;;:pOES;};NOS.:/�FF142M/�TI)IELX•OR NEW' {MEND,::EXTENDaR!�t:.TER THE.COVEItACE',AFFORDED BY THE POLfC1E8 j;Ojx.. IFyrA7E - IS1ll�►NCEi_Dt'1E5 NO1";GONY3filklT&'A": QIItIRl11G7•BEEINEEN THE;<.ISSUING',INSURER(S .AUT,HORIZED ':R�PRE�Efi17'ATIVE OFf�'!ItODUCE.Rf>/4ND�'�'HE<� TIFIi�A'tE�IOLDEi+�a•. "or lie:en. ' ;IMPiJii<�ANT�:. 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FN�Ii" IS C fitFi 4 1Jfh3-BE i58ElEQ_ ::hA�1K.F f Rftl,;,f 1.E 1lISi KAfi1�P:; BY T�iE POLI�aES DES> RIBED HER�IM`,IS 5llg)ECT 70 AI L,THE TERMS exruSt Cob c5F su :l � &1.ua(FrS taA t;' ri,t + IC ; ? QAa t ... . . .. .ems= =aax Fxt .0. 4Ei ;,Pci" ,N1fii�B�k=• ID Ib[i LINdB '71(Pfi:pRMt� 000 413= MVfJ "... ON t< t: OAI! t�;I�DA �5r'Ii�;NJ t►�:��n : .s uMbu' paS � 3. fVx.>..: ..,. E Li btSi ASoEN.r.: . Y RA R7P- � •. p,: .. .... E=.EA'EMPLGYEE S ' :Ir►" ... : ......be". 6:L'tDh3Ey45I-ifUl'iiiYL11JI1T' r. ... :iYtir" .'fi6Nst,uocl�r�gNs#:Y +pFki✓a lco. ..... "�rt� ' .. ; B;IEixY�'OI N1E?A.Y' E2Nia,E CITiEJ O �aANI E Lt tflk"FMATE HOLOER . '�QW(1o( 0 1)IGt1d s Ati�F`OFfitE 18OYEDEBGRIBED:iPOUC !g`P.E:�D:l3EF- sHa1 , Bulfi � r( RErk.. ; l�lE? DiPlitiA?bM ;C?ATE'7FIERCQFi''N071C . WILL :.BE :DEL11/ER®:; IN 'down Ha11:l1nrrex AGCtOI�PAtEVllltll: 'PltC ' if19)AN�:" . 3outlioliij'-.►+Iy`!i:'I"19.�1" ;�u'r►�R!?�u;ReRttESEpxa?rve , QA"8*2Iy:1;5:AC0RDc fi .i Tris AC.tlt n e end logo;are".moi itirerl markav Ai±Ol2b AOORD:`l5(2g'I$1.t13.): ,. • 11/12/2020 Certificate of NYS:Workers'Compensation Insurance Coverage _..... .;• CERTIFICATE OF ! l NYS WORKERS'COMPENSATION INSURANCE COVERAGE 1 Insured:Detail in.Legal Name and address of Insured(Use street address only) lb:Business Telephone Number of Insured Long Island Pool Care Corp 631-765-8285 : 50000 Main Rd PO Box 1690 lc.NYS:Unemployment Insurance Employer Southold,IQI'11971 Registration Number of Insured 1d:Federal Employer Identification Number of Insured or Social Security Number Work.Location of Insured.(Only required if coverage isspecif:cally limited to 27:5174033 certain location in Neto Yark State,i.e.a Wrap-Up.Policy) 2.Name and-Address of the Entity.Requesting Proof of Coverage - 3a.Name,of Insurance Carrier (Entity Being Listed as the Certificate Holder) . N co-Insurance Company Town of Southold:Building Department Town Hall Annex i 54375 Main Rd. *4olicy Number of entity listed in box"la!': P.Q.Boz 1179 C34651$6 WW . Southold,NY.11971 3c:,Policy effective period: 4%19!2020 4/to 19/2021 . 3d.The Proprietor,Partners or Executive Officers are: E)included.(Only check box if all partners/officers included) , . . ®all excluded or certain partners/offs Jude cers:exc d This certifies1hat the insurance carrier indicated above in box!'3'!insures:the business:referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this.form;.New York(NI')must be listed under Item 3A on the .. INFORMATION PAGE.of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate o Insurance to the entity listed above as the certificate holder.in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonptryment of prebdums or within:30 days IF there are retrsons other than nonpayment of premiums that cancel the policy or eliminate the insured .... .... from the coverage indicated on this:Certificate.(These notice$may be sent by regalar mail)Otherwise,this Certificate is valid for one,year after this form is approvedby the insurance carrier or its licensed agen4 or until the policy expiration date listed in box"3e';whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend;extend or alter the coverage afforded by the policy listed;:nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate maybe used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that.the:business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. I am an authorized representative or licensed agent of the insurance carrier referenced above and that Under penalty of perjury,I certify that the.named insured has the coverage as depicted oil.this form. Approved By: Henry C.Sibley (Print na ne of authorized representative or licensed agent of insurance carrier) r Approved By: , 11/12/2020 (Signature). . (Date) Title: Underwriting Manager Telephone Number of authorized representative,or licensed agent of;insurance carrier:CarrierPhone Please Note:Only insurance carriers.and their licensed agents are authorized to issue the C-105.2 form.Insurance brokers are NOT authorized to issue it https://wc.amtrustgrou p.com/anawc/PolicyNYCertificateOfWclns.aspx?lndexld=3156608Instanceld=7cebO8fe-6c8b-432d-bb5d-f7Od8dfde5l 7 1/2 11/12/2020 Certificate of NYS Workers'Compensation Insurance Coverage C-105.2(9-17) www.wcb.ny.gov Workers' Compensation Law Section 57.Restriction on issue of permits and the entering contracts unless compensation is secured. 1.The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2.The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. , C-105.2(9-17)REVERSE https://wc.amtrustgroup.com/anawc/PolicyNYCertificateOfWclns.aspx?lndexld=315660&lnstanceid=7cebO8fe-6c8b-432d-bb5d-f7Od8dfde5l7 2/2 YEW workers' CERTIFICATE OF INSURANCE COVERAGE srArE Compensat1.ion Board. DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured LONG ISLAND POOL CARE CORP 631-765-8285 50000 MAIN ROAD SOUTHOLD,NY 11971 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,Wrap-Up Policy) 275174033 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity Listed in Box"1a" DBL357404 3c.Policy effective period 04/19/2020 to 04/18/2022 4. Policy provides the following benefits: © A.Both disability and paid family leave benefits. E] B.Disability benefits only. E] 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. E] 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. B ht Date Signed 1/12/2021 y AW, (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 46,4C 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 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 4C or 513 of Part 1 has 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 with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) IIIIIIIP1°°°1°211°11°1°°1111°11°111°1111111 cc APPROVED AS NOTED DATE:3 B.P.# l s� 6 FEE: 3 .0 U By NOTIFY BUILDING DEcARTMENT AT . RETAIN STORM WATER RUNOFF 765-1802, 8 AM TO 4 PM FOR THE PURSUANT TO CHAPTER 236 FOLLOWING INSPECTIONS: OF THE TOUVIV CODE. 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTP!'"�'--ION MUST BE COMPLETE � � - 0. ALL CONSTRUCTIC'N HALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ELECTRICAL INSPECTION REQUIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF S9UTH9LANN11DlG BOARD SOU USTEES (res —_— I s X4-6 Q �S OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATI OF OCCUPANCY 11,I'-� 1 POOL NOTES: TRACK FOR 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION AND VINYL LINER BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC CODE. FfF3' PUMP SKIMMER 2.POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1. (TYP.) VINYL LINER �0" 4.POOL 3. OSHALL COMPLN R326.7 OY WITH BARRIER REQUIREMENTS SECTION R326.4. FOAM PADDING 3,500 PSI 5.POOL SHALL COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE OF NYS a CONCRETE SECTION R403.10: POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). SECTION R403.10.1 HEATERS RETURNPROPOSEDVINYL SECTION R403.10.2 TIME SWITCHES (TYP•) SWIMMING POOL #3 REBAR e. SECTION R4"MIN.3 COVERS TOP, MIDDLE n6.REBAR SHALL BE 3"MIN.CLEAR TO EARTH. 800 S.F. STEPS Z0� & BOT. 42 7.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT BY OTHERS AND SHALL ° COMPLY WITH ALL LOCAL ZONING REQUIREMENTS. I DUAL MAIN DRAINS ° ° 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME BAKER(VGB) WITH STRAINER (VGB POOL AND SPA SAFETY ACT. L__ SAFETY ACT APPROVED a,d 9.SLOPE PATIO SURFACE 1/4"PER FOOTAWAY FROM POOL. DRAINS)I 10.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR LARGE ROCKS). 11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH c ANSI/APSP/ICC 7. 'w. 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. 13.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL LOADS WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION EQUIPMENT OR ANY OTHER POOL PLAN NOTE: TYPICAL WALL DETAIL LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING OR PROPOSED ADJACENT STRUCTURES. NOT TO SCALE THIS IS A NON-DIVING POOL. 14.NO DIVING EQUIPMENT PERMITTED. SCALE: 3�4 = 1 —0» 15.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF POOL. 16.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 7980 NORTH BAYVIEW ROAD, SOUTHOLD,N.Y.11971 ONLY. 3'-4' CONCRETE WALL NOTES: 17.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A MINIMUM LAP _ $� (SEE SECTION 1.WALLS SHALL BEAR ON UNDISTURBED SOIL OF 30 BAR DIAMETERS. 3 THIS SHEET) 2.ALL CONCRETE SHALL BE PLACED ASA MONOLITHIC POUR. 18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION MEANS, 1® METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR,NOR FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR THE FAILURE OF THE CONTRACTOR TO CARRY OUTTHE WORK IN ACCORDANCE WITH THIS PLAN. 4' 6' 14' 16' UNDISTURBED 3' COMPACTED EARTH (TYP.) SAND 1 1/2- TO WASTE POOL PRORLE HAIR & LINT STRAINER NOT TO SCALE PUMP FILTER AUTO SKIMMER LPOOL BACK TO POOL GENERAL NOTE: ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. 2 MAIN DRAINS WITH PREPARED FOR: SCHEMATIC PIPING ARRANGEMENT HYDROSTATIC VALVE AND COLLECTOR TUBE GALLIGAN RESIDENCE NOT TO SCALE IN GRAVEL BASE 7980 NORTH BAYVIEW ROAD SO THOLD, N.Y 11971 DATE: 02/08/2021 NOTE: !� HM ENGINEERING, P.C. THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. l SCALE: AS SHOWN UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE ®�j� ja �i� P.O.BOX 914 EAST NORTHPORT,NY 11731 SHEET: 1 OF 1 NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmarnika@optonline.net RESIDENTIAL CONCRETE V [DWI UTRAISEDSEALANDBLUESIGNATURE VINYL LINER POOL PLAN CAST IRON FRAME & COVER IF UNDER PAVED AREA FINISHED GRADE 8' MIN. - 12' MAX.BRICK LEVELING COURSE �� M < NOTES: CONCRETE COVER , .. 1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST CONC. COLLAR 27' cZOn 6' MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND AS REQUIRED MAX BACKFILLED WITH SAND AND GRAVEL TO BOTTOM OF BASIN. PRECAST 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE REINF. CONC. SUBSTITUTED WITH APPROVAL OF THE ENGINEER. DOME 4'0 PVC 3. LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. MIN. SPER FOOT ® ® ®®O 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. INVER ® ® ® NON-SHRINK ®®� �� 5. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR GROUT FULL DEPTH. 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND _ AND GRAVEL AND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, a COLLAR (TYP) o w0 AROUND 0 N SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) rn PERCENT. > PRECAST REINF. o CONC. LEACHING ~ RINGS ce M a w e' DIAMETER 0 SW v o DRYWELL CALCULATION: ZZ BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF) DRYWELL CAPACITY = 1,263 GAL. (168.8 CF) ~ z 6' MIN. PENETRATION to o INTO VIRGIN STRATA 1z OF SAND & GRAVEL GROUND WATER DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: GALLIGAN RESIDENCE 7980 NORTH BA IEW RO D SO THOLD, N.Y 1'1971 �J DATE: 02/08/2021 NOTE: _y /!/'�b THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED HM ENGINEERING, P.C. SCALE: NOT TO SCALE � / Q ��� ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE NEW YORK STATE ®�/Q u P.O.BOX 914,EAST NORTHPORT,NY 11731 SHEET: 1 OF 1 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. 111 ID WITHOUT RAISED SEALAND BLUE SIGNATURE WTel:(516)476-5392 Fax:(631)980-7671 www.hmarnika@optonline.net DRYWELL DETAIL