HomeMy WebLinkAbout48545-Z O�Dg�FfOlK 4a Town of Southold 10/18/2023
y� P.O.Box 1179
co 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44658 Date: 10/18/2023
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 2120 N Sea Dr, Southold
SCTM#: 473889 Sec/Block/Lot: 54.-5-45.4
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/30/2022 pursuant to which Building Permit No. 48545 dated 11/30/2022
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 swimming fenced to code as allied forswimmin�ool fenced to code as allied for.
The certificate is issued to Burrascano Jr,Joseph&Dona
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 48545 7/7/2023
PLUMBERS CERTIFICATION DATED
r
A or edASInature
i
' TOWN OF SOUTHOLD
��gUFfQ(
BUILDING DEPARTMENT
o �
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#: 48545 Date: 11/30/2022
i
Permission is hereby granted to:
Burrascano Jr, Joseph
2120 N Sea Dr
Southold, NY 11971
To: Construct inground swimming pool to an existing single family dwelling as applied for
per flood permit as applied for. Pool and pool equipment must maintain a minimum
setback of 15 feet from rear and side yard surveyed property lines.
At premises located at:
2120 N Sea Dr, Southold
SCTM #473889
Sec/Block/Lot# 54.-5-45.4
Pursuant to application dated 9/30/2022 and approved by the Building Inspector.
To expire on 5/31/2024.
Fees:
IN-GROUND SWIMMING POOL $250.00
Flood Permit $100.00
CO- SWIMMING POOL $50.00
Total: $400.00
Building Inspector
o��Of SOUTyDI
� o
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 Q sean.devlin(a-town.southold.ny.us
Southold,NY 11971-0959 'Q
�ylrouff 1,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Joseph Surrascano Jr.
Address: 2120 N Sea Dr City:Southold st: IVY zip: 11971
Building Permit* 48545 Section: 54 Block: 5 Lot: 45.4
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: Electrician: REP Electric License No: 3897ME
SITE DETAILS
Office Use Only
Residential ,X Indoor Basement Service
Commerical Outdoor }( 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 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
Transfer Switch UC Lights Dryer Recpt Emergency StrobeHeat Detectors
Disconnect R ! Switches 4'LED Exit Fixtures Sump Pump
R H
Other Equipment: Intermatic Pool Panel 8 Circuit/ 5 Used, 3 Lights 30OW J&J Trans. 120GFI, Heater,
Pump 220GF1, AutoCover '120GF1 w/ Keylocked Switch
Notes: Pool
Inspector Signature: Date: July 7, 2023
S. Devlin-Cert Electrical Compliance Form
OF SOUIyO� 4t S q 5 o —0 -
f # TOWN OF SOUTHOLD BUILDING DEPT.
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Cuurm 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: aaL
DATE t 2 INSPECTOR V
hO��OF SOUIyOIo V yv s I ZV No s
f # TOWN OF SOUTHOLD BUILDING DEP - CQ
631-765-1802
INSPECTION .
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
7
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
" [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)
[ ] CODE VIOLATION ] PRE C/O [ ] RENTAL
REMARKS: 1�
lAa
d
a` c-o►vo
DATE INSPECTOR
�Qt�U hO��OF SOGTyO
# # TOWN OF SOUTHOLD BUILDING DEPT.
°`ycourrn��' 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ Y(NSULATIOWCAULKING
[ ] FRAMING/STRAPPING [ ] FINAL?a,,--�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] . FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
l
DATE INSPECTOR
ho�apFSOUTyolo � �vl � e'
# # TOIN OF SOUTHOLD BUILDING DEPT.
�ycoom, 631-765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] 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: �G
DATE Z INSPECTOR
SOGIy��
# #
TOWN OF SOUTHOLD BUILDING DEPT.
cno631-765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ylfiSUL10 TA G
[ ] 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:
TV
Li
DATE INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
FOUNDATION (1ST)
------------•------------------------
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FOUNDATION (2ND)
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ROUGH FRAMING&
PLUMBING
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INSULATION PER N.Y. r
STATE ENERGY CODE
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10t-4-y p� �rav Cz
FINAL
rADDITIONAL COMMENTS
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
oy • o,� Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtoMnny gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only I-J ++
IC
.PERMIT NO. U Building Inspector:
SEP 3 0 2022 .f .
Applications and forms must be filled out in their entirety.;lncotnplete ff J
applications will'not be acce ted','Where the A' ilcant is'not the owner;an ILI71r,
P PP- Tut'' t.
Owner's:Authorization form(Page 2)shall be completed.
Date:
OWNER(S).OF PROPERTY
Name: SCTM#1000-� "—
Project Address:
Phone#: Email: m
.0
Mailing Address:
CONTACT PERSON
Name:Jennifer Del Vaglio
Mailing Address: PO Box 368 Peconic NY 11958
Phone#:631 734 7600 __._._..r.__.....__. Email: M1
DESIGN PROFESSIONAL•INFORMATION
*5 f >
Name:
Mailing Address:
Phone#: Email:
CO .NTOR,IIVFO MATION:
Name [ End Pools DBA East.End Pool__King ___ -..._ _..__.._._.._--._..____..._..._._.___... ...____- _.__... ._
Mailing Address: PO Box 368 Peconic 11958
Phone#:631.734 7600Email:cj,@eastendpoolkingcom r.._.
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair El Demolition Estimated Cost of Project:
ther (zogl, 1 Cok 3a $ 95,00O
o
Will the lot be re-graded? es El No Will excess fill be removed from premises? ❑Yes
1
:..PROPERTY
.INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes o IF YES, PROVIDE A COPY.
CheelC BOX After Reading The owner%contractor/des�gn.professional is responsible for all drainage and storm water issues as-provided by
Chapter 236 of the_Town-Code. APPLICATION IS HEREBY MADE to theWilding: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 oi;demolition as herein described.The applicant agrees to,comply with all,applicable-laws;ordinances,building code,:'•- J
;housing code and regulations and to admit authorized inspectors on premises and in buildmg(s)for necessary mspe ons.False statements mad_a herein are
punisheble•as a Class A misdemeanor pursuant to Section 210.45 of the' New York State Penal Law.
Application Submitted By(print name): ��-��\ �� authorized Agent Downer
Signature of Applicant: Date:
_..._:._...........CONNIE D. P State oNew York���_...:,....
STATE OF NEW YORK) Notary No.01 U6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,2
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract bove named,
(S)he is the
(Contractor,Agent, Corp ate 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
day of , 20 a al A
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
;qner's
Town of Southold Buildi Department for approval as described herein.
• z7 z
Signature Date
3-O5C�/4 ( u K%XA-ro fin Al A- R u 2 vc�5ch�3
Print Owner's Name
2
opo AFF°�K�o TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y� Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
Iry �� Telephone (631) 765-1802 hltps://www.southoldtownny.gov
Floodplain Development Permit Application
PROPERTY INFORMATION: Flood Zone: 46 J// I FIRM Panel: SCTM#1000-5zl
Address: '
cel o2 Q / 0ge'6 &V AF71
City: Zip: ll 7
CONTACT PERSON: Name: Phone#: —7,o
Mailing Address: 6P�
PROJECT DESCRIPTION: 0" /(0
Or
7'Gv G
SECTION A:S RUCTURAL DEVELOPMENT(CHECK ALL THAT APPLY)
Type of Structure Type of Structural Activity
Residential (1 to 4 families) New structure
❑ Residential (snore than 4 families) ❑ Demolition of existing structure
❑ Combined use ❑ Replacement of existing structure
❑Non-residential ❑ Relocation of existing structure
❑ Elevated ❑ Addition to existing structure
❑ Flood proofed(attach certification) ❑ Alteration to existing structure
❑ Manufactured Home ❑ Other:
❑ Located on individual lot
❑ Located in manufactured home park
SECTION B: OTHER DEVELOPMENT(CHECK ALL THAT APPLY)
❑ Clearing of trees,vegetation or debris ❑ Mining Grading ❑ Drilling ❑ Dredging
❑ Connection to public utilities or services ❑ Paving ❑ Placement of fill material
❑ Drainage improvement(including culvert work) ❑ Roadway or bridge construction
❑ Fence or wall construction ❑ Watercourse alteration (attach description)
❑ Excavation (not related to a structured development) ❑ Other development not listed (specify):
By signing below I agree to the terms and conditions of this permit and certify to the best of my knowledge the information contained
in this application is true and accurate. I understand that no work may start until a permit is issued.The permit may be revoked if any
false statements are made herein. If revoked,all work must cease until permit is re-issued. Development shall not be used or occupied
until a Cert.of Compliance is issued.The permit will expire if no work is commenced within one year of issuance.Other permits may be
required to fulfill regulatory requirements.Applicant gives consent to local authority or representative to make reasonable inspections
to verify compliance.
Application Submitted By(print name):
Signature of Applicant: -- Date: i2��
Slaf BUILDING DEPARTMENT-Electric 1 ector
TOWN OF SOUTHOLD JAN 18 7023
Town Hall Annex- 54375 Main Road - PED
C4 . BoU'� 20®EPT
Southold, New York 11971-0959 TowN of qnl rMOLD
t��jar �0� Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr(@-southoldtownny.gov - seanda-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: Z3
Company Name: REP Electric LLC
Electrician's Name: Robert E Paladino
License No.: 46288-ME Elec. email:REPelectric1 @gmail.com
Elec. Phone No: 631-767-6034 El I request an email copy of Certificate of Compliance
Elec. Address.: PO Box 635 Mattituck, Ny 11952
JOB SITE INFORMATION (All Information Required)
Name: _.L& M 2 5 0
Address:
Cross Street:
Phone No.:
Bldg.Permit#: �j,r�/S email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
kl[euj /10 o o
Square Footage:
Circle All That Apply:
Is job ready for inspection?: 0 YES 0 NO F�Rough In EJ Final
Do you need a Temp Certificate?: 1-1 YESF6-/] NO Issued On
Temp Information: (All information required)
1 PhF-13 Ph Size: A #Meters Old Meter#
Service Sizer-1
F-1 New Service[]Fire Reconnect[]Flood Reconnect[]Service Reconnect OUnderground00verhead
# Underground Laterals n 1 R2 H Frame Pole Work done on Service? F1 Y nN
Additional Information:
PAYMENT DUE WITH APPLICATION I Icaj 2.3 ��(�
BUILDING DEPARTMENT- El ' R- P
ectricector
�1�� LD
� TOWN OF SOUTIHOLDJAN 1 S 2023
Town Hall Annex - 54375 Main RoadBoj2 ;&I)EPT
Southold, New York 11971-0959 wiu 0Fgn1 M40«
®*4 Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr@southoldtownny.gov - seandO-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 1,11-171,23
Company Name: REP Electric LLC
Electrician's Name: Robert E Paladino
License No.: 46288-ME Elec. email:REPelectric1 @gmail.com
Elec. Phone No: 631-767-6034 211 request an email copy of Certificate of Compliance
Elec. Address.: PO Box 635 Mattituck, Ny 11952
JOB SITE INFORMATION (All Information Required)
Name:
. (.k 2.2 3 C A-zi 0
Address: ( Z c5 a je
Cross Street:
Phone No.:
Bldg.Permit#: LVI2-"V5 email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE,(Please Print Clearly):
0 0 L
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO F—]Rough In F Final
Do you need a Temp Certificate?: F-� ,YES.0 NO Issued,On
Temp Information: (All information required)
Service Size]l Ph]3-Ph Size: A # Meters Old Meter#
❑New Service[]Fire ReconnectE]Flood Reconnect[]serviceReconnectE]Underground[3Overhead
# Underground-Laterals 1 LJ2EjH.Frame .� Pole Work done on Service? ^Y IIIN
Additional Information: i
PAYMENT DUE WITH APPLICATION 1ct 2-.5 �� �r
Goll d�U' �••`w �� ��
............. ............... .......... ........... .............................---................ ..............
N SCDHS REF11 R10-170033 SURVEY OF PROPERTY
AT SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y
1000-54-05-45.4
SCALE. I= 30'
APRIL 7,2015
MAY IZ 2015(B.O.H.)
FEBRUARY 14,2017(PROP.HOUSE)
MARCH 1,2017(CERURCAWNS)
MARCH 30, 2017(REVISIONS)
AUGUST 09,2017(TOPO. &MONUMENTS)
TEST HOLE DATA SEPT. 7, 2017(REVISIONS)
.a'r—'r OCTOBER TZ 2017(STORM WATER MANAGMENT)
-q,
EL.4.7- ITROWLOAmrs-D sm 10 JANUARY 8,2016(STAKES SET)
...o5. 61 Olt FEBRUARY 27,2016(FOUNDATION LOCATION)
FAZE`BROMANE SAND SP O� NOVEMBER JO,2018(FINAL)
2' c',
Ayq
PA�BRoM FINE
TO COARSE RANO SW a. CG /FiV
NIM IOX GRAVEL9
EL.a4' 4J*
44, sP
WATER W 0
PALE�i.-E YC—SE r/
LL
mIH IDXA�l
a
NOrl WATER ENCOUNrRED 4.3'BROW WAFACF
Ow
4t;i�-
414 0, r
\ >2 / /F J� �°
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SEPTIC LOCATION �A /� / �`�� °0 4"B a� ''tp m j _ / ./ .-�-F
ST 26' 49'
LP 1 44' 61, L
LP 2 41-
62-
LP 3 J8' I 66' ti v
e
LP 4
j5, 68,
LP 5 'A
LP 6
/1
LP LP 7 � AG
LP a o S.
LP 9
07
KEY --o
REBAR
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A -STAKE 1� CERTIFIED TO-
S -TEST HOLE
6 -PIPE Al 5TEWART TITLE tN5IJRAN5CE COMPANY
TITLE NO. ADA-03089-
N -MONUMENT S, J05FPH J. DUKFA5C,
DONA DURRA5CANO AN0 JK
WILAND FLAG ""s
,C,-UTILITY POLE T.
Liz),
-HYDRANT
YAP 41
ELEVATIONS ARE REFERENCED TO NA W'88 DATUM.
,z.
I—f—Wo,elth Me STANDARDS FOR APPROVAL AND CONSTRUCTION OF
SUBSURFACE SEWAGE D15POSAL SYSTEMS FOR 9NGLE P4MIL Y RESIDDYCES
S. LIC.NO. 49618
rd,.ffl abide by the cmfitime at f�fh thook,md m the pe-If to AREA= 40,903 SO. FT PE5cc 9
17DN OR ADDITION TO THIS SURWY 15 A VOLA RON Or SECTION 7209OF THE NEW (631)765-5020 FAX(631) 765-7797
ANY tA�t P.O.Box 909
YORK STATE EDUCATION LAW EXCEPT AS PER SECTION 7209-SUBDIVISION Z ALL
CERI7RCAnONS HEREON ARE VAUD FOR THIS MAP AND CORES THEREOF ONLY IF SAID MAP OR 12JO TRAVELER STREET[15_11.9
COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR FN05E SIGNATURE APPEARS HEREON. N.Y.SOUTHOLD, N 11971
W1lhoul Base Flood Elevation(BF€)
toac A�.se=4
SPECIAL FLOOD With BFE or Depth-114-AE,40 Ar+,az,aR
r� HAZARD AREAS Regulatory Floodway
0.2%Annual Chance Flood Hazard.Areas
of 14.annual chance flood with average
depth less than one tool or with drainage
areas Of Less than one squate mile .. . .
�3 Future Conditions 1%Annual
Chance Flood Hazard:
Area with Reduced Flood Risk due to
i► OTHER AREAS OF Levee.See Notes.Ok :
FLOOD HAZARD Area with Flood Risk due to Levee_
'10 SCREErt Area of Minimal Flood Hazard
Effective LDMRs
w
OTHER AREAS Area of undetermined Flood Hazard
1
t
GENERAL -—-- Channel.Culvert,at Storm Sewer
•� ,� STRUCTURES 1 1 1 1 1 1 1 Levee,Dike.or Fioodwall
ZGflo its ;
Cross Sections w9th 1%Annual chance
(EL 1fi Feet) ZaFle�t� ,TS Water Surface Elevation
(EL'�72 Feet) _ _ _ Coastal Transect
-- Base Flood Elevation Line IBFEi
Limit Of Study
JuristticUon Boundary
L JfIFi4iE' AREA OF MINIMAL FLOOD HAZARD — — Coastal Transect Baseline
OTHER _ Profile aaseline
i Town of Southold Za`�r'x` FEATURES
HydrograpAuc Feature
r� 364813
Digital Data Available
}
36103COIS4H
No Digital Data Avalla&e
9/25/2009
Wu MAP PANELS unmapped
"J +
r
� The pin displayed on the map is an approAimate
Point r * r an authoritative propeted by ttw rtylocatiom er and does notrepreser
rr f
r Ir
This map complies with FEMANs standards for the use of
�• digital flood(naps it It is not void as described below.
The basemap shown compiles with FEMA's basemap
oil accuracy standards
The flood hazard information is derived directly from the
(EL 11 Feet) authoritative NFHL web services provtded by FEMA.This map
/ was exported on 12 1 2022 at 1119 AM and does not
reflect changes or amendments subsequent to this date and
time.The NFHL and effective information may c-flange of
become superseded by new data over time_
ZJfTt3 f�� This map Image is void If the one or more of the following map
( L 10 F.eet) elements do not appear:basemap Imagery,flood zone labels.
legend, m
scale bar.map creation date.cOn>wiity ideritirlers.
Feet �r26.45*W 4t'4'22'N FIRM panel number.and FIRM effective date.Map images tar
0 250 504 1.000 1,500 2.000 1:6,000 unmapped andun odemized areas cannot be used for
regulatorypurposes.
AC R® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY)
`� 11/18/2021
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 i
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 NCONTACT AME: Barbara Dammers
Roy H Reeve Agency,Inc. PHHONIN&fE (631)298-4700 FAX
Exth AIC,No): (631)298-3850
PO Box 54
ADDREss: bdammers@royreeve.com
13400 Main Road
INSURER(S)AFFORDING COVERAGE NAIC p
Mattituck NY 11952 INSURER A: CNA Insurance Companies
INSURED INSURER B: Continental Insurance Co. 35289
Eastern End Pools LLC,DBA:East End Pool King INSURER C: Transportation Insurance Co- 20494
P O Box 369
INSURER D:
INSURER E
Peconic NY 11958
INSURER F
COVERAGES CERTIFICATE NUMBER: CL21111815751 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE 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.
s
LTR TYPE OF INSURANCE1 p POLICY NUMBER MOLICY EFF MOLIC LIMITS
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000
CLAIMS-MADE ®OCCUR 100,000
Contractual
PREMISES(E....%,nce $
X Contractual Liability MED EXP(An one erson $ 15,000
A Y Y 6080837145 11/15/2021 11/15/2022 PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY ❑JECT 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: !
AUTOMOBILE LIABILITYCOMBI NED SINGLE LIMIT Ea $ 1,000,000
accident
ANY AUTO BODILY INJURY(Per person) S
g OWNED SCHEouLED
AUTOS ONLY AUTOS 6080837159 11/15/2021 11/15/2022 BODILY INJURY(Per accident) S
X HIRED NON-OWNED PROPER DAMAGE
AUTOS ONLY HAUTOS ONLY Per accident S
S
UMBRELLA LIAB OCCUR EACH OCCURRENCE s
EXCESS LIAR HCLAIMS-MADE AGGREGATE $
DED RETENTION$ S
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY Y/N STATUTE ERS
ANY PROPRIETOR/PARTNER/EXECUTIVE
C OFFICERIMEMBEREXCLUDED) N/A 6080837162 11/15/2021 11/15/2022 E.L.EACH ACCIDENT $ 1,000,000
(Mandatory d Ory be and E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
1
I
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
Certificate holder is included as additional insured under General Liability as per the terms and conditions of form#CNA75079XX-Blanket Additional
Insured with Products-Completed Operations Coverage Endorsement, Form CNA74705NY-Contractors GL Extension Endorsement,NY includes waiver
of subrogation&primary&non-contributory coverages as required by written contract or agreement. Additional insured under the business auto is included
under Form#CNA63359XX-Auto Contractors Extended Coverage Endorsement-Business Auto Plus.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 1179
AUTHORIZED REPRESENTATIVE
Southold NY 11971
1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Road
APPROVED AS NOTED
DATE t 3o-aa g 5 COMPLY WITH ALL CODES OF
-B.P.# NEW YORK STATE & TOWN CODES
FEE M •b'6 BY A AS REQUIRED AND CONDITIONS OF
NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE SOUTHOLD TOWN Zfla
FOLLOWING INSPECTIONS:
1. FOUNDATION-TWO REQUIRED SOUTHOLD TOM PLANNIN080AAD r
FOR POURED CONCRETE ;
2. ROUGH-FRAMING,PLUMBING, SOUTHOLD TOWN TRUSTEES
STRAPPING, ELECTRICAL&CAULKING
3. INSULATION N.Y.S.DEC r
4. FINAL-CONSTRUCTION&ELECTRICAL
MUST BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES-OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
FLOOD ZONE,.,.,
COMpLyvwTH CHAPTt146"
ELECTRICAL
INSPECTION REQUIRED FLOOD DAMAGE PREER VENTION
SOUTHOLD' TOWN CODE.
RETAIN STORM WATER RIMI ff "IMM ENCLOSE-POOL O COD
ENCLOSE- OOL TO CODE
PLASUANT TO OHAPlM UPON COMPLETION
OF THL TOWN CODE. BEFORE"WATER"
OCCUPANCY OR
USE IS UNLAWLFUL
WITHOUT CERTIFICATE
OF OCCUPANCY
-- -- -- POOL NOTES: 2020 RF51DET1TIAL ODDS OF NYS$ECI)ON itus SWIMBM1IND POOLS.SPAS AND HOTTUBS
L POOL AND PROPERTYTOCONFORM TO 2020 NTS UNIFORM FIRE PREV911WNAND BUILDING ODDE, TEMPORARTUARIERS
III OF GREENPORT CODE AND 2017 NATIONAL ELECTRIC ODE
2.POOL SHALL CONFORM TO ANSV APSP/ICC S STANDARDS RTIG3L AN OUTDOOR SWIMMING POOL.SHALL BE SURROUNDED BY ATEMPORARY BARRIER DURING DWA11AT10N OR CONSTRUCTION AND '
3.SECTION 8326.7 POOL ALARM REQUMM. SHALL REMAIN IN PUKE UNFLLAPERMANENT BARRIER IN COMPLIANCE WITH SECTION R326.4215PROVIOM
I POO.SHALL COMPLY WITH BARRIER REQUWMAENTS SECTION P02&& L THETOP OFTHE TEMPORARY BARRIER SHALL BE AT LEAST 48 INCHES 42219 MM)ABOVE GRAN MEASURED ON THE SIDE OF THE
S.POOLSHALLCOMPLYWOH2O20 ENERGY(ONSERVATIONCMSMKnDNODDEOFNIS%aM BARRIER WHICH FACES AWAY FROMTHESWIAMM POOL
840310 2.REPLACEMEBNTBYAPERMANENTBARRIER.ATEMPORMYLUUMSWOLSERFLUWBYAWO YNGPERRMNWBAPJM
POOLSANO PERMMENTSPA ENERGY CONSUMPROM(MANDATMVT WITHIN EITHEROFTHE FOLLOWING PERIODS:
SECTION FM3.10.1 HEATERS A)90DAYSG'YMDATEOFLSWANCEOFTN WM*GPUW fFORIMINSTALtAYMORCOFb7M1 MCFTHEWAMMM ..
SECTION R403"102 TMESWRCHES POOL;OR '
OFTHESINMMlIG P)0L
SECTION R403.103 COVERS 0190 DAYSOFTHE DATEOF COMMENCEMENTOF THE 66TAUATON ORCTNSiRUCNON
6 REBARSHALL SE 3'MIN.CSEARTOFARHL
7.LOCATION OF PROPOSED SSVIMMAG POOLAND POOL.EQUIPNB98YOTHERS ANDSHALLCOMPI.Y PEBMAM9TTBARIRR E328,4.2:
\ LINE OF IRACK FOR/ &AORAiLNG
UODVERSTO MEETREALL CAwMENTSOF THEVrAWMGAMFMEBLER(VGB)PODLAND LTHETOPOFTHEBMMERSNALLSENOLESSTWI48MOEES(1219MM)ABOYEGRADEMEAStWMONTNESMEOFTHEBALv"
A �� - ( A T Lp�R 9"SLOPE ATIO SURFACE 114-PER FOOTAWAYFROM POOL_ THATFACESAWAYFROM TAN21NCMINGPOOLTHEVERTICALOFARANCOFTHE 9CGMtTMTfA ESAWA0MOFT1E SM ER
IONPROPOSED I POOStt4LL WIERETRGTERTTUN21NOLEt(SIMM)MEASURWRADEIH BAMS MAYBERTGROUND LEWEL FRODUNTED ON Top
C7 VEL 30.BAQ(FILL MATERIAL TO BE FREE DINNING GRANULAR AIAi90Al(NO MYGi LARGE ROO6)- POOL WNERETNETOP Of THEP00LSTNCNREKABOVEGRANUWOFTHEPOOLMU TGFTHE E=MgVWMT310WIM
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VINYL SWIMMING POOL 12.ENf1APMENiPROTECTONREQUREDYCII[NR3265. S2.E SOLIDIR32EA'SWHICHW2NUTH
F-0NMfA003,5pD PS 13.POCRWALLSARE NOTDESGNED FOR SURCHARGE LOAAMIDIERM BYWXMU)ADSWRMN SDI(6) CONS WMRIOLSWFM DONUT NOT 00MAw wDFNfATIONSORPROTRUIIOFEF]U>3•fFOLNORMAI•
( ATE FEETOF POOLWALL FROM CONSTRUCTION EQUWMENTORAMYOIHIER WADING CONDITION IMPOSED �LSTRUC TOIFF ViCSMDTOG®MASONRYJONTS. ,
I// p ONTMEPOOLSTRUCIV EBYEXSTMORPROPOSEDADLMENT5P10K7URES 3.WHERE THE BARRIER IS COMPOSED OFHORQONTALAND VETTIMMEMBERS ANDTHEDSIANCEOERNEEN7HE70PSOFT/E
AO 288 S.F. HORMWALMEMOMISLESSTHAN4SWO4B(lU3MM),THEROMCMALMEMBER59ULLBEIDOLTEDCNTESWIMMNG '
34.NG DIVING EQUIPMEMPERMRTFD. POOLSIDEOFTREFENCE-SPACING BEPNMVERTICL MEMBERS SHALL NOT EK(EED 1-3/4 INMES(NMAT wWADTH.WHERE '
STEP 25.CONTRACTOR
SOIL FRIID" THERE ARE OECORA7NE07T0UfSWlTHR1 VERTICAL MEMBERS SPACING Wf1HWTHECUTG1135HALLNOTBE Ia"HfA7FRTiM11-3I1
36.CON PLAN IS OR CONSTRUCTION
SOL PRO PROPEIMES RTY
623CAIONTO 1PEAMfW,FOOL INCHES(44MM)NWIDT.
17.THIS PUN IS FORCONSFRUCTION ON PIlOPE10YA76UCARPDOBLSTRFPT.GRE9PORRi,N.Y.119M
F IREBAR ONLY. 4_VMEIIETHEBARRIERS(DMPOSEDOFHORQD/RALANDVERROILMEMBERSAND711ED6TANCEBE71N9YETIff7OP50FTNE
MIDOlESB18.REINfORCNGS'IEMSHALIBEINTERMEDMTEGRADEBUETSMMVAIHAMNMUMLAPOF300M HORRONTL MEMBERS IS45 INCHES 11143 MM)OR MORE,SPACING BETWEEN V901CALMEMBFISSHNLNUT DOMED41NCHES(IM
4� DIAMETERS. MM).WHM7MEREARE DECORATIVE CUTOUTS WIHHN VERTIGLMEMBFASSPAONG WRNINTHE CUIOFISSHWLN ITE)WEED 1-
CONTa000S CWCREIE 3/41NCHES(44MMw_WIDTH.
HALL(SLE DETAIL THIS S.MA)a U MESHRTRE BORFFORCHAIN INK OM VAOCH REOUEN�OSPEl BEAZ-Il"RH(ROTMORE(SIMMI)SQU UMESSTHTHAN 2-3/4 INCHES("NFENCE HASSUTSFASIBIED
BENCH SEAFINP SI(F � 64REBAR 6 WHERETHE BARRIERLSCOMPOSEO OF DLWONAL MEMBERSTHE MMMUM OPeRNG FORMED BYTHEDWAMIMEMOM
EVERYI•CC GENERAL Nl7TES• . SRUUL BE NOT GREATERTHAN I-3/4 NONS(N MM).VERTICAL 7.GATESSNALLCOMPLYWIMTHEREQUIREMENTS OF SECT"R:i26A.U7HR000HR326A28ANDWHHTNEFOIDWINGSBOT70M 1. HM ENGINEERING.P C.SHALL NOTE RESPONSIBLE FORCONSIRUCHON MEANS,METHODS, RIKKINEMENIS .
MATERIAL TECHNIQUES OR PROCEDURES UTt®ETYTNE CONTRACTOR,NOR FORTE SAFETY OFTHE 7.L ALLGATES SIMEBE SELF-Q04NG.INADDTRON,IFTHEGATESA PEDUTRWIAOWGATF,7IEGATERMLLOPMWMARD-
PORMORCONTRACTOR iEMPLOYEIES.OR FOR THE FAILURE OFTEECANIRACTORTO CARRY AWAYFROMTtEPOG.
_ OUTTHE WORK N ACCORDANCE WIM THECONIRACTOOCEHFiS 72.ALLGA7F gPU8ESEP-LATCUNG.WFTHYnIATCHHANDLELOGTMWffHINIMUJ )SUM040TATHEPOOL90E0FTH
39i - ENCLOSURQANDATLFAST40 INCHES(1016 MM)ABOVE GRADE.INADUMONIFMGtATCIHAND(EISLOGTEDIESST AN$4
it 2. SELECT GRANULAR FILL[MATERIAL SHALL REAS DEFIED NTHEREQUPEMENfS OFTHE INCHES(2372 MM)FROM GRADE,THE UTW HANDLESHALLBE LOCATEDATLEAST 3 INCHES(76MM)BElOWTHETOPOFTHECATE,
_ MUNICIPALAGENCYFWNNGAMUSOCTMAWASA&WO"PEF04EDNSECTON203OF AND NUTHOTMEGATENORTKRUIUERS)ALHMVEANYOPEMNGGAFATERnM&SwW(=YMM)V TM 1824OHS(457
N.YS.D.0 T STANDARD SPECIFlGTION%LATFSTEDMO L MM)OF THE LATCH HANDLE.
3LI"` TYPICAL WAIL DETAIL 79.ALLYHE GATES SHALL BE SECURELY LOIXEDWITH A KEY,COMWMTDN OR OTHER 09M PROOF LOCK SUR7�7YTOPREVENT
3 COMPACTION SHALL CONFORM TO THE REQUIREEOIPS OF TLEMUMCOALAGEN.YHAVING ACCESS TOTHE SWIMMING POOL THROUGH SUCK GATE WHEN THE SWIMMJNG POOL IS NOT IN USE OR SUPERVISED-
SCALE:3W 1.4Y JURISDICTION AND AS A MINIMUM DEEMED N SECTION 7WOF N.YSD.O.T.STANDARD &AWALL OR WALLSOFA DWELLING MAYSERVEAS PARTOFTHE BARRIER,PRMDED'MTTWWALLORWAUSMEErIM
SPECMCATONS,LATFSTEOwoK APPLICABLE WARIER REQUIREMENTS E SECTIONS R326A2.1THR000M FMGA26AND ONE OFTHE FOLLOWING CONDITIONS
SHALL BE MET.
t ALL FLLeBACJ(FRL SHALL BE SELECT GRANULAR MATERNAL COMPACTED TO 96%MA)OMM L.DOORSWRHDIRECfACCESSTOTHEPOOLTIflMHTHATWALLUMUtEEQUIPPETWiw ANAURMVMIWPRODUCSAM
/L DENSITY AT OPTIMUM MOISTURE.AS DETERMINED BY IMF"PROCIDRTEST,UNLESS MOME WARNING WHEN THE DOOR AND/OR ITS SCREEN,IF PRESENT,ARE OPENED"THE ALARM SIWL13E LISTED IN ACDORDANCE
POOL PLAN OTHERISENOIED. WITH UL 2017.THE AUDIBLE ALARM SMILLACTNATE WITHIN 7 SECONDS AND SOUNDCONTINUOUSI.YFOR AMNIMUMOF 30
SECONDS AFTER 114E DOOR AND/OR ITS SCREEN,IF PRESENT,ARE OPENED AND BE CAPABLE OF BEING HEARD7HROU GHOUTTHE
NOTE 6 DEBRIS SKUL NOTE BURIED ON THE SILIECTSTFE BLLLU6GTAMEMATERWL,SIR"= HOUSE DURING NORMALHOUSEHOID ACnvmm DELMMSHALLAUTOMAT7GLLYRFSETUNOERALLWNDRIONi7HEALARM
SCALE 1J4n_�t�n MATERIAL AND DEBRIS SHALL BE DEPOSED OF N ACCORDANCE WILFLLL IDCA-TOM SYSTEMSHALLSEEQUIPPWWRHAMANULMGNS,SUCHASTOUCHPADORSWM,TOMAPORNULYDEACRVATEIMLARM
THI515 A NON-DING POOL SWAQ59WLLBFARONIRR16M4lDSDI- COUNTY.STATE AND FEDERALLAWS ANOAPRICAME COONS. FOR ASNGtE OPENING.OIJICTWATION SHALL IASTFOR NOTMORETHAN 15 SECONDS;AND
CALLISSHALLUMO BE pD72D WI)SOLOUTRRCPWR.- 0.OPERABLE WNDOWSNTHE WALLOR WALLS USEDASA BARRIER SHALLHAVEA LATCHING DEVICELOGT®NOLESST A N48
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3.8ACK LLWTE OIW. THE OPENING WHENTHE WINDOW S N ITS LARGESTOPENED POSTRON:AND
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EVERY DOOR V=ORECf ACCESS TOTHE POOL;OR
2,OTHER APPROVED MEANS OF PROTECTION,SUCH AS`ELF41MNG DOORS WITH SEIF4ATCHNG DEWCS,SMALLIEACCEPrABLE
SO IDNGASTHE DEGREE OF PROTECTION AFFORDED SNOfIESSTMNTHEPROIE'CIION AFFORDEDBTTIEM 29MO ABED ABOVE.
1
&I ALARM DEACTIVATION SWITCH LOCATION.WHERE AN ALARMS
PROVIDED,THE DEACTIVATIONSYAfC MAIL BE LOCATED 54
• INCHES OR MORE ABOVE THE THRESHOLD OFTHE DOOR.N DWELLINGS REQUIRED TO BE ACCESSIBLE UNITS,TYPEAUNTM ORTYPE0
GTT JIM A,YC L UNOS,THEDFACTVATON SWITCH SHALLBE LOCATED 48 INCHES ABOVETETHRESHODOFTHEDOOR.
6 umOH RAVED AILI IMTO Yrt 9.WHWAN A8011EGROUND POOL STRUCTURE S USED ASAEARN9L OR W HERETHER AMMOMWWWONTOPOFTHEFOOL
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.iL, i®(ILVURa mM� 1mA 1 LWUCABIEBMRHRREQUIRMENTSOFSECTONSR326AIlMtROUGHIG26A2.LWHFAETHEMEMADFACCSSISAUDDOt
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rte• 8' 6' •Y-B� (4SIMM BY 5(14 MM)DRAIN GRATE OR LARGER.ORAN APPROVED CHANNELOWN SYSIEAL
3.POOLMD SPASINGIE-OR MULTPE-OURtTORaJLAMN SYSTB6SINLLBE EQUWM WI111ATMOWHWC VACUUM RELIEF
SHOULD GRATE COVERS LOCATEDTHEIE IN BECOME MISSING OR BROKEN.TDSVACUUM REUEFSYSPEMSHALLNODDEATIF/5T
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APPROVAL OF THE 916Iffit POOLAWIMS SHALLCOAIPLY WITH ASTM FnM AND SHALL BE INSTILLED,USED AND MAINTAINED NACCORDANCE WIRHTHE
MANUFACTURER'S INSTRUCTIONS AND THE SECTION.
1 LOCATIGIOF ORAIYU9E POOL TO EDETEPD/®BY OTHERS. ICi367.1 MULYFF MA11M.A POOLAARM MUST BECAPABLE OFDEMCTING ENTRY INTOTHEWATERATANYPOTTONTHE
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THIS WORK ISTHE COPYRIGHT PROPERTY OF THE ENGINEER AND IS PROTECTED UNDER SECTON 102 OF THECOPYNGHTACT, eruNoeXAWT1AE NEBE
1711S.0 ANY UNAUTHORDED USE AND/OR REPRODUCTION OF THE DRAWINGSSHAIL BE PROSECUTED UNDERINE FULL
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