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HomeMy WebLinkAbout50193-Z TOWN OF SOUTHOLD 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#: 50193 Date: /9/2024 Permission is hereby granted to: Wohltman, Lucy _ 98 Crown Ter Scisco, CA 94114 an Fra..nm --- ....e.....------ .....-m__— �._ ..... To: Construct an accessory 15' x 50' inground swimming lap pool as applied for per Trustees and ZBA approvals. Flood permit is required. Pool equipment must be elevated as per code. At premises located at: 4955.uvuJJW Moores Ln, Cutchomcque . .m�....__. ._� ..... ......w...... .... ....... �..._... SCTM # 473889 Sec/Block/Lot# 116.-2-3 Pursuant to application dated _ 412/7/2023 and approved by the Building Inspector. To expire on 7 /2025. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Flood Permit $150.00 Total: ...........$................. ._._, 550.00 Building Inspector " + TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 '� Telephone (631) 765-1802 Fax (631) 765-9502 htt.s://www.soutlioldtownn ov �� . Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector:• . "— 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: December 6th 2023 OWNER(S)OF PROPERTY: Name:Lucy Wohltman SCTM#1000-116-2-3 Project Address:4955 Moores Lane, Cutchogue, NY 11935 Phone#:631-734-7923 (Agent) I Email:creativeenvdesign@yahoo.com Mailing Address: P.O. Box 160, Peconic, NY 11958 CONTACT PERSON: Name:David Cichanowicz Mailing Address:P.O. Box 160, Peconic, NY 11958 Phone#: 631-734-7923 Email: creativeenvdesign@yahoo.com DESIGN PROFESSIONAL INFORMATION: Name: Agent/Contact Mailing Address: Phone M Email: CONTRACTOR INFORMATION: Name:Agent/Contact Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOther inground pool, patio, pool fencing, pool drywell and pool equipment area $212,000.00 Will the lot be re-graded? RYes El No Will excess fill be removed from premises? ❑Yes RNo 1 fir �r r i 7,77 FI YIN . ........... 7 7 117— -7, El(IStInP Use Of property 1tft / Zone or use district in which premises is siti�afe / d/ fite / �/�faf►fftir1ftr/ �Pa "�� ,w.,.,. ,�«m .<�.�.,«��m.;,���..rr„,r xr,n pw!✓w u, �rtr�➢�GJYf / /I��/ �� / / „y /� r/ /��/y�f�/ r//r// p{/ t// A ma ff rhd,, (Contra'ctor,Agent,'Corporate OfFder,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 VI IM, 11 r 1 f, Ildl .�i �f r f. , Ifill i rr, I lJl h V / 4 II N / r / r r ro, SAN r,,,,,, /, , ,, r, // , �% r � /� / r r up '0' irr r rig/rig TOWN OF SOUTHOLD—BUILDING DEPARTMENT p Town P � ) � � � —Southold,NY 11971-0959 ' Telephone nel 631)765-1802 MFax 63 d P65-9502 htt 9r„/l m� a�ttaQ-1dtt"k:�-I , :m R. Date Reserved , APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT 1\10. � � Building Inspector_�„, -6t,.&. 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: December 6th 2023 � OWNER(S)OF PROPERTY: ..... � SCTM# 1000- 116-2-3 Name:Lucy Wohltman Project Address:4955 Moores Lane, Cutchogue, NY 11935 Phone#:631-734-7923 (Agent) Email:creativeenvdesign@yahoo.com Mailing Address: P.O. Box 160, Peconic, NY 11958 CONTACT PERSON: Name:David Cichanowicz Mailing Address:P.O. Box 160, Peconic, NY 11958 Phone#: 631-734-7_923 Email: creativeenvdesign@yahoo.com DESIGN PROFESSIONAL INFORMATION: Name: Agent/Contact Mailing Address: Phone#, Email: CONTRACTOR INFORMATION: rName:Agent/Contact Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION I ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑� Other inground pool, patio, pool fencing, pool drywell and pool equipment area $212,000.00 Will the lot be re-graded? *Yes El No Will excess fill be removed from premises? ❑Yes ®No 1 .......,„,.,, mr,,,,,�„�iWrrm7"nr7m m r�u pro m7i1m1�JJ1J1a'%y1 ,Mo.P.�,wIlla Foll l.mv 11014. / '^ «,�»��,,,.r,w,w nw w ..,rc^�. ;�wi �i-/;6�,w�,'rr:,(w✓✓r� r �:w:wN��^efr YyfyNkr 1iJ �NJ yr �✓lr/ �/!� �� J , �; ,�,,, „^ ,', ;%�r//%r��///%�i%/ r�/%/// ///iii!'/ r ri;^�r//�G %%r / / ,�✓/!j� i rill/ lJl rr/vp�l/�,%/r /// ,., Zane or use district in,Nhich�prefnises Ir I fir,✓� ��,, i fe ME b / r/ Ica,a ; /,yloo- r ,/, ,,, -,r, "v ,/ rr/ /r.,/,//,��r �/ � � /�/l,l �/�/f/r f �/�;/.r/� /Ilr/, //„/,/r//r/✓%%/ ' r �,//� 1, „// r '� Y � ✓i/,/ /",I%, air,, 1�i//rr riJ/� „%/„ ��,,;,',.,' J//�i/�%� ���/J%fir/r /jN%i //i� t r I 4 /r//�rr,�, -,,�f Gi/� ,%/ ✓ / �� / r�i ��/G/,///��/r /% 3Y Sc3fCi�J 95!r?F_'S}l7 �Ur!'r�SS,.�3�Ef I�^1�41iy 0S;3tilOrile[,10 pGrfOlIT)c F ioaVe()Pr�C) 1?'`)f-+""� r•7�"cilfl ti 4?5 e3RL�to<"S33tie €�fJ S;i ,y c jJ�J�ECZrf�lri,, thataN staterneas contained 4' r this application are tru3 t6 tl * best JT hl'S[ r"Kn FJlE^C�g2 Sfi� rrr/r ��! /��✓//f�. / I ri r r�iN r / rr r � BOARD MEMBERS Southold Town Hall Leslie Kanes Weisman, Chairperson o � 53095 Main Road-P.O.Box 1179 Patricia Acampora , Southold,NY 11971-0959 Eric Dantes Office I ocati Robert Lehnert,Jr. Town Annex/First Floor Nicholas Planamento � , 54375 Main Road(at Youngs Avenue) �` �, �� Southold,NY 11971 DECEIVED http://southoldtownny.gov ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 Southold Town Clerk FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF JUNE 15,2023 ZBA FILE: 7787 NAME OF APPLICANT: Lucy Wohltman PROPERTY LOCATION: 4955 Moores Lane, Cutchogue,NY SCTM No. 1000-116-2-3 SE RA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. SUFFOLK COVNT '" ADMINISTRATIVE CODE;: This application was not required to be referred to the Suffolk County Department of Planning under the Suffolk County Administrative Code Sections A 14-14 to 23. LLWRP DETERMINATION: The relief, permit, or interpretation requested in this application is listed under the Minor Actions exempt list and is not subject to review under Chapter 268. PROPERTY FACTS/DESCRIPTI,N: The subject property is a42, 902 sq.ft. conforming parcel located in an R- 40 Zoning District. The parcel has a 146.29 feet frontage along Short Road,then runs west for 319.78 feet to Moore's Lane,the property then turns south for 149.73 feet along Moore's Lane before returning 269. 8 feet back to Short Road. The property is improved with a two-story frame residence,with a brick patio and trellis. All as shown on a survey prepared by Kenneth M. Woychuck, Land Surveyor dated August 5,2022. (Proposed pool to be relocated) BAST OF APPLICATION: Request for a Variance from Article III, Section 280-15 and the Building Inspector's February 15, 2023 Notice of Disapproval based on an application for a permit to construct an accessory in-ground swimming pool at; 1) located in other than the code required rear yard; located at 4955 Moore's Lane, Cutchogue, NY. SCTM No. 1000-116-2-3. REIJ'E REQ11ESTED: The applicant requests a variance to construct an accessory in-ground swimming pool in the non-conforming side yard, instead of a conforming rear yard location. ADDITIQ? LNFN'FQRMATIO_ N: The property has two road frontages,butthe property address is listed as Moore's Lane. The existing residence currently has a Certificate of Occupancy,410459,dated April 17, 1981 for the existing dwellirig,and another Certificate of Occupancy#40957 dated December 23,2019 for alterations to the dwelling. The applicant's representative presented a landscape plan, depicting landscaping that will create privacy screening from both road frontages, prepared by David Cichanowicz, dated November 10, 2022 showing the pool location being shifted further east toward Short Road and set back 110 ft.7 in.from the front yard property line. The applicant was asked to provide a signed and sealed site plan or survey by a design professional with the revised location and distances. Page 2,June 15,2023 #7787,Wohltman SCTM No. 1000-116-2-3 PINUfN(t „FACT/RRA G I _F l�OARPi, TION: The Zoning Board of Appeals held a public hearing on this application on June 1,2023 at which time written and oral evidence were presented. Based upon all testimony,documentation,personal inspection of the property and surrounding neighborhood,and other evidence,the Zoning Board finds the following facts to be true and relevant and makes the following findings: 1. Town Law 267-b b J . Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The house is sited on the property with two front yards, such that the side yard is the functional rear yard of the house. The placement of the pool will not have any undesirable change to the character of the neighborhood. It will be screened from view by existing and proposed landscaping 2. Town Law 267-b 3 b 2 . The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. Due to the property being a"through lot" with two road frontages,any placement of an accessory structure on the property would need variance relief. 3. Town Law '267-b 3 b 3 . The variance granted herein is mathematically substantial, representing a 100% relief from the code. However, due to the fact that the property has two front yards,the side yard is the functional rear yard of the property.Additionally,the pool is proposed as far from the wetlands along Moores Lane as possible and,as proposed, conforms to all the setback requirements for an accessory structure. 4. Town Law fr267 bQ b)(4). No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant must comply with Chapter 236 of the Town's Storm Water Management Code and conditions of this board. 5. Town Law '267-b b . 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. 6. Town Law2�7-b. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an 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„-THE IGARD:In considering all of the above factors and applying the balancing test under New York Town Law 267-B,motion was offered by Member Lehnert,seconded by Member Planamento,and duly carried, to GRANT the variance as applied for,and shown on the Landscape Plan prepared by David Cichanowicz and signed and sealed by Robert I.Brown,R.A.,dated June 2,2023. "SUBJECT TO THE FOLLOWING CONDITIONS: 1. Pool pump equipment/mechanicals must be located a minimum of 20 feet from any property line or be contained in a shed type enclosure with a lot line set back that is in conformance with the bulk schedule for accessory structures 2. Drywell for pool de-watering shall be installed. This approval shall not be deemed effective until the required conditions have been met.At the discretion of the Board of Appeals,failure to comply with the above conditions may render this decision null and void Page 3,June 15,2023 #7787,Wohltman SCTM No. 1000-116-2-3 That the above conditions be written into the Building Inspector'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. IMPORTANT LIMITS ON THE APPROVAUS GRANTED HEREIN Please Band Carefully Any deviation from the survey,site plan and/or architectural drawings cited in this decision,or work exceeding the scope of the relief granted herein, will result in delays and/or a possible denial by the Building Department of a building permit and/or the issuance of a Stop Work Order, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variances)granted herein as shown on the architectural drawings,sitep/an and/or survey cited above,such as alterations, extensions, demolitions, or demolitions exceeding the scope of the relief granted herein, are not authorized under this application when involving nonconformides under the zoning code This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code,other than such uses,setbacks and other features as are expressly addressed in this action. TIME LIMITS ON THIS APPROVAL, Pursuant to Chapter 280-146(B) of the Code of the Town of Southold any variance granted by the Board of Appeals shall become null and void where a Certificate of Occupancy has not been procured, and/or a subdivision map has not been filed with the Suffolk County Clerk,within three(3)years from the date such variance was granted. The Board of Appeals may, upon written request prior to the date of expiration,grant an extension not to exceed three(3) consecutive one (1)year terms. IT IS THE PROPERTY OWNER'S RESPONSIBILITY TO ENSURE CONIP'L!6� NCE WITH THE CODE RE TIRED TIME FB,. .ME DESCRIBED HEREIN. Failure to comply in a timely manner may result in the denial by the Building Department of a Certificate of Occupancy, nullify the approved variance relief, and require a new variance application with public hearing before the Board of Appeals Vote of the Board: Ayes: Members Weisman(Chairperson),Acampora, Dantes, Lehnert,and Planamento(5-0). Leslie Danes Weis an Chairperson Approved for filing � //L/-; /2023 if � �6�' I� ,"l;,�r �2��7�✓� f �„"u� i,l'��hr�p„ �"`�,,I fl�'I�", ,, .*°" ,rim'., " villa w I �� 7 ��''+✓ �� �!r w, I, 7' '�kU(� r r � '�'„vi ,�' ,�. r ��, rrrwiui 7rN �� ii� w,rvN, viii?��>��u�7ld�rtiiNurr r raNw�„ r!n��V6rvr�✓ 71� rw+mW rcv air�fu!U a i � 7 � �� i r✓ I i i vl Nu Ir'Y r f 7, 7 BOARD OF SOUTHOLD TOWN TRUSTEESt , SOUTHOLDNEW YORK f7 may PERMIT NO. 10501 DATE: NOVEMBER 15,2023 I( ISSUED TO: LI.ICY W01=ILTMAN PROPERTY ADDRESS: 4955 MOQMS LANE CUTCHOCUE SCTM# 1000-116-2-3 ` ' AUTHORIZATION Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in &` accordance with the Resolution of the Board of Trustees adopted at the meeting held on November 15,2023 and in consideration of application fee in the sura of 12� paid by l upy Wo ltman. and subject to the Teres and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: Wetland Permit to construct a 151x50' in-ground lap pool;a 121x25' patio on the southeast side of pool and a 10' patio surrounding the pool; install pool enclosure fencing with gates; finstall a pool drywell and pool equipment area; and to install and perpetually maintain a 10' wide vegetated non-turf buffer area using native species located along a portion of the south property line between the pool area and the edge of tidal wetlands using approximately 125 plantings;with the condition of the removal of the miscanthus"fountain”grass between the pool and the wetland area; and as depicted on the site plan prepared by David Cichanowicz, / Creative Environmental Design,received on November 15,2023,and stamped approved on November 15,2023. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed,and these presents to be subscribed by a majority of the said Board as of the day and year first above written. o a FOL I r I r ' �✓ „„.�. ... ,_ 1'�. ; a i nir' a a„ a�r ov✓i rs�n w,✓W�. �i+�„u/,�i✓,�eiAd4 �r ,Br�h .,,p;. r ,,'-. 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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(les)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 co ifer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NYT Matt Daley Farm Family Insurance PHONE 631-744-3350 TAX _..� .._W...-..__ �....... ...�.......... x' 631-744-3383 85 Echo Ave-Suite 2 E-MAIL malt,d,ale INSURI~R S AFFORD(��mmIT .._ Miller Place, NY 11764 ADDRESS._•�, y�Irm farnily.com No CovE'RA'GE NAICfR .__.. . ........._ ............m. _._...._.....__..-.. _._..INSURER A: F�arrin Family Casualty�� ..... 13803 INSURED INSURER B ......... .. .,..,.�.... .. ..... .......-.. Indian Neck Corp. DBA Cr at"r've Environmental Design INStIRFRC: PO Box 160 -- _...._�_. __. .._........... IN SURER 0 Peconic NY 11958 INSURER . E .._ �.--._.... .._...__ INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT T E 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, ONS AND CONorrio S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ...........-w ............ ... POLIC.NU- _- PS)LICY'EFF F'{3L1.,._ R;7tP..- 1IP' R EXCLUSIONS ADDL LTR TYPE OF INSURAN E Y MBER VA�M(DO Y MMtDD YYYY LIMITS A COMMERCIAL GENERAL L ABILITY 3152X2360 06/01/23 06/01/24 'EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 0 OCCUR PREMISES,(Ea accurrenceL $ G 100,000 x Select Business P MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT ADPLL X POLICY JECT ES PER: GENERALAGGREGATE $ 2,000,000 r CT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER; $ AUTOMOBILE LIABILITYCO 51UIMNED SINGLE P..MPT $ mm ANY AUTO BODILY INJURY(Per person) $ OWNED SC{EDUCED AUTOS ONLY A'U OS BODILY INJURY(Per accident) $ HIRED N -OWNED PI.OPE TYAulAr3Eti AUTOS ONLY AU OS ONLY P,dreaddangY $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LU\B ....._ $ ....... -.... CLAIMS-MADE __± AGGREGATE PED RETENTION'$ $ WORKERSCOMPE'NSATION IPER OTH- AND EMPLOYERS"LIABILITY Y/N .._.......STA TUTE Lw w_ER... ...�............ ..�__. ANVPROPRIETOFVPARTNERfEXF UTIVE E.L.EACH ACCIDENT OFF ICE�MMEMSEREXCLUDED? N/A (Mandatory In.NH) Id E.L.DISEASE-EA EMPLOYEE. $ yos„describe under _._. - DESCRIPTPUN OF OPERATIONS De ow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOC TIONS t VFHICLaS(ACORD 101,Additional Remarks Schedule,maybe attached IF more space is required) MASONRY/LANDSCAPING/CARPENTRY CERTIFICATE HOLDER CANCELLATION Town of South ld PO BOX 1179 1 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Southold, NY 1 971 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 00m n on New York Mate Insuum r'I'�o Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) ^^^^^^ 112294493 " AMWINS INSURANCE BROKERAGE LLC 200 ELWOOD DAVIS ROAD M SUITE 200 LIVERPOOL NY 13088 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER INDIAN NEC' CORP. TOWN OF SOUTHOLD T/A CREATN E ENVIRONMENTAL DESIGN PO BOX 1179 PO BOX 160 SOUTHOLD NY 11971 PECONIC NY 11958 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z1318 046-8 966723 05/01/2023 TO 05/01/2024 11/20/2023 THIS IS TO CEf tTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1318 046-8, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' CO PENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW„ IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE U' ON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY,. NEW YORK STAT ANSUR NCE FUND 7 V DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NU BER:541632407 U-26.3 ORK Workers' CERTIFICATE OF INSURANCE COVERAGE STATS Compensation under the NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW Board PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use streetaddrees only) 1 b.Business Telephone Number of Insured INDIAN NECK CORP DBA CREATIVE LAND-SCAPE DESIGN. 39160 ROUTE 25 631-734-7923 1c.Federal Employer Identification Number of Insured or Social Security PECONIC NY 11956 Number Work Location of Insured 112294493 (Only required If coverage is specifically limited to certain locations in New York State,Le„Wrap-Up Policy) 2.Name and Address of Entity Requesting Proof of 3,a Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY b Policy Number of Entity Listed in Box"la" LNY-323682 U Policy effective period 01/01/2023 to 12/31/2023 4.Policy provides the following benefits: a❑A.Both disability and paid family leave benefits. ❑B.Disability benefits only. ❑C.Paid family leave benefits only. 5.Policy covers: o❑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. Date Signed 09/13/2023 E r� �)' lSi,gtiatuxo of insurance caa�rrfor°Ir atrfhtarizod repraaenlallive or NYS Licensed)Inenravace Agent orf that Inartran"carrier( Telephone Number (212)553-8074 Name and Title:Elizabeth Tello—Assistant Director,Statutory Services 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 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 56 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 B (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(9-17) 11 �����!�B-'120.10 �� �IIII IH E 1497 ' r aI N m w • _ v l — � � m F _ Qw 4 1 Twp m g \rV Q WW Lu JJJJi3 € 1 V is C iiaoo : — CTJ v t I i •� 3 ,I 11610" 319.76 cz U I lIf £ K� 0--24„CAL� I cz J Rm OAK RESIDENCE ow 270' I �L € U ._ N ; 15'X50' O N LAP POOL DRIVEWAY O T E T 16 31, C CL S _ U ^Q� GATE .� { cz 3e. DRIVEWAY T � ti k HU 7" 0 czr ` ! U T t = p } -- , co -- s N 14ro.29 e _ s T ROAD � o � � � � � 3 �� 501� 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 77 PO()L FENCE Z.4 C - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _ _ ---------------- ------------- ------------------------------- ------------------------------------- P -s --------------- ---------------------------------------------------------------------------- ----------- - > lop do P-ml I NCE 'L ,. BOO /� oCa � , ,�y, � - g Oft " V I, � ,c, C� 1 1 •:� 7U -AI < > > It - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1.1- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - U4 Ah 5CTM 1000-11ro-2-3 Revision #: Scale : Landscape Plan : 11 - 10-22 Landscape Design by: David Cichanowi z if 1 ff lut I m In Date : 8/2.r.-5/2023 10 Sweeney Crlpeative nvirol"w"him, , el"mkital PROVIDED CONTINUOUS PROVIDE PAVING TO MATCH TERRACE PROVIDE PRE-FAB POOL POURED GUNITI_ BOND OVER AUTOMATIC POOL COVER BOX WITH COPING 24" W. WITH BEAM AND HAUNCH WITH REQUIRED S.S. SUPPORTS FOR PAVING BULLNOSE EDGE AT REQUIRED REBAR AS ANCHORED INTO POOL STRUCTURE. POOL (TYP.) SHOWN 1 -1 " STONE COPING 21_711 AUTOMATIC POOL COVER. �; _ �nl - - - _ _ .----- - _ __ - - - GRADE J - - - - --- - - - RER'S ... ... .............. ...................................................................---................................................................................................................................................................................................................................................................................................................................... ._.. . SPECIFICATIONS FOR SIZE WATER LINE AND REQUIREMENTS 3" CL PROVIDE POURED STEPS INTO POOL WITH #3 @ 121, O.C. VERT. - PROVIDE CONTINUOUS POUR 5 EQUAL RISERS, TO BE POURED WITH BOND BEAM AND HAUNCH WITH � POOL STRUCTURE WITH NO COLD JOINTS. MARBLE DUST FINISH #3 @ 6„ .O.C. HORIZ - / �o / REQUIRED REBAT IN POOL MARBLE DUST FINISH Ln STRUCTURE BELOW FOR RADIUS 1211 - PAVING AS REQUIRED AT - SLOPE 4” PER FT. MARBLE DUST FINISH STONE TERRACE TO BE CONSTRUCTED AS A MONOLITHIC STRUCTURE WITH COMPACTED GRANULAR SAND POOL STRUCTURE WITH NO GUNITE POOL STRUCTURE TO BE TYPICAL FLOOR - 6" TH . DRAIN LINE FROM AUTOMATIC POOL FILL. COMPACT IN 12" LI FTS COLD JOINTS - TYPICAL CONSTRUCTED AS A CONTINUOUS SINGLE --GUNITE WITH #3 KEBABS AT 6" COVER BOX TO DRYWELL TO 95% DENSITY. FILL BOTH UNDISTURBED SUBGRADE (TYP.) SURROUND FOR POOL. STRUCTURE WITH NO COLD JOINTS. SIDES OF WALL EVENLY (TYP.) PROVIDE REBAR AS SHOWN. OC EACHWAY MIN . (TYP.) POOL SECTION A I-- -] 6' DIA. x 4' D DKYWELL FOR POOL I BAC KWAS H I I FF-::: _ � I POOL SKIMMER POOL SKIMMERI POOL SKIMMER II ' I II I II 50 I II I UNDERWATER POOL PROVIDE D( I RAIN WITH DRAIN I LIGHT SWITCHED AT SHALLOW END COVER CONNECTED TO Ln I ( SUBSURFACE DRAINAGE I RESIDENCE I I WATER LEVEL: 4.5 DEEP I I DRYWELL (TYP.) II I I I II I STEPS INTO POOL I I I I 5 RISERS I I I AUTOMATIC POOL COVER. LOCATION A I II I I POOL RETURN POOL RETURNI POOL RETURN I I II I POOL COPING (TYP.) POOL PLAN NOTE: SEE SITE PLAN FOR LOCATION OF CODE COMPLIANT FENCE AND GATE, AND POOL EQUIPMENT. ISSUES/REVISIONS CLIENT/OWNER PROJECT DRAWING No. SWEENEY -- CREATIVE 4955 Moore's Lane � ��� ENVIRONMENTAL �� ��' Robert I. Brown Cutchogue, NY o� '"rr DESIGN QAll Architect>' o. l000-11 -2-3 NEW P.C. sCTM N6 � Mme•`�, 239160 RTE 25 20 Bax Ave. Greenport NY SWIMMING "} PECONIC, NY info@ribrownarchitect.com DRAWING TITLE 7ti��'��G. 631-734-7923 631-477-9752 POOL DETAILS POOL �„_ creativeenvdesign@yahoo.com DATE IT IS A VIOLATION OF THE LAW FOR ANY PERSON,UNLESS SCALE ACTING UNDER THE DIRECTION OFA LICENSED ARCHITECT, TO ALTER ANY ITEM ON THIS DRAWING 1N ANY WAY.ANY Aug, 31, 2023 AUTHORIZED ALTERATIN MUST BE NOTED,SEALED AND 1 - Z O f DESCRIBED IN ACCORDANCE WITH THE LAW.