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HomeMy WebLinkAbout48676-Z �o�S�fFOt,�COG. Town of Southold 10/20/2023 y� P.O.Box 1179 0 53095 Main Rd WOy�j�l �ao� � Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44679 Date: 10/20/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 260 Oak Dr,Cutchogue SCTM#: 473889 See/Block/Lot: 104.-5-27 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/29/2019 pursuant to which Building Permit No. 48676 dated 12/30/2022 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-ground swimming pool fenced to code as applied for. The certificate is issued to Bowe, Scott&Stacy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43716 6/26/2019 PLUMBERS CERTIFICATION DATED th ri d ignature TOWN OF SOUTHOLD BUILDING DEPARTMENT y x 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#: 48676 Date: 12/30/2022 Permission is hereby granted to: Bowe, Scott 17 Smith St Rockville Centre, NY 11570 To: Construct accessory in-ground swimming pool as applied for. Replaces BP #43716. At premises located at: 260 Oak Dr, Cutchogue SCTM # 473889 Sec/Block/Lot# 104.-5-27 Pursuant to application dated 1/1/1900 and approved by the Building Inspector. To expire on 6/30/2024. Fees: PERMIT RENEWAL $150.00 Total: $150.00 Building Inspector o�g11FE0(,rCo TOWN OF SOUTHOLD BUILDING DEPARTMENT C, TOWN CLERK'S OFFICE SOUTHOLD, NY , s BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 43716 Date: 5/7/2019 Permission is hereby granted to: Bowe, Scott 17 Smith St Rockville Centre, NY 11570 To: construct accessory in-ground swimming pool as applied for. At premises located at: 260 Oak Dr.,Cutchogue SCTM #473889 Sec/Block/Lot# 104.-5-27 Pursuant to application dated 4/29/2019 and approved by the Building Inspector. To expire on 11/5/2020. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building or Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: y F'' A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets, and unusual natural or topographic features. 2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9,1957)non-conforming uses,or buildings and"pre-existing"land uses: I. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00, _dditions to dwelling$50:00, Iterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 . 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. ,3^ - f New Construction: Old or Pre-existing Building: (check one) Location of Property: House No Street Hamlet Owner or Owners of Property:_ Suffolk County Tax Map No 1000, Section_ /� Block_ �— Lot_ Z7 Subdivision Filed Map. Lot: Permit No. 3� Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: y/ Request for: Temporary Certificate Final Certificate:icate: (check one) Fee Submitted: $ �U plicant Signature \N'pF SO�l�ol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road cn Fax(631)765-9502 P.O.Box 1179 G Q �. • �o roger.richert(a-town.southold.ny.us Southold,NY 11971-0959 QCOdJNT`1,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Scott Bowe Address: 260 Oak Dr City: Cutchogue St: New York Zip: 11935 Building Permit#: 43716 Section: 104 Block: 5 Lot: 27 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electric License No: 40557-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt . Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches El Twist Lock Exit Fixtures TVSS Other Equipment: In ground swimming pool to include, bonding, control panel, gas pool heater, 2-GFCI circuit breakers, 1-pool pump,salt generator Notes: Inspector Signature: Date: June 26 2019 81-Cert Electrical Compliance Form.xls 50Uryo� # TOWN OF SOUTHOLD BUILDING DEPT. ,ourm,��'' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. l [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: f DATE INSPECTOR �e l SOUTyO� --- -- --- f # TOWN OF SOUTHOLD BUILDING DEPT. courm, 631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [-J FINAL Aw�l [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATIN [ ] PF E C/O [ ] RENTAL REMARKS: 6A4ie t44 �,v r • (-;L-- L 4 DATE 0 '��! INSPECTOR SOUI,f°lo # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I SULA N/ 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: DATE kv 1 INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) • Jy ---.. .......................: 'FOUNDATION (2ND.) -� N a • a ROUGH FRAMING& y PLUMBING �- • J O INSULATION PER N.Y. y STATE ENERGY CODE tlam SW if& Io 2 C FINAL ADDITIOkkt COMMENTS - rn I N z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,_before applying? 'OWN"HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey Southoldtownny.gov PERMIT NO. ,, Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined —,20/1 Single&Separate Truss Identification Form Storm-Water Assessment Form Contact: Approved 5 ,20� Mail to: Disapproved a/c Swim King Pools Phone: 471 Reiff OA Expiration .7Z Rocky POIK NY 41778 liSi n4+- 51o2. Q4 R 2 g 2019 Buil ' pector `,,APPLICATION FOR BUILDING PERMIT ® 01F S® � , 20 INSTRUCTIONS Date /q a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months. Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code,housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. (Signature of applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premisesd�T" — (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No.-21 Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: oeo jiZ. �ryT/ orUG House Number Street Hamlet County Tax Map No. 1000 Section l� Block Lot ZZ Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and i nded use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy cel 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost �;2:5 ��� Fee � (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded? YES NO Will excess fill be removed from premises?YES NO 14. Names of Owner of remis jjP Address&o Phone Nla! I4. ( In Name of Architect 11 Address—:2,7& e No Name of Contractor ddress i-(— Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? * ES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE QUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: 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 bwner (Contractor,Agent,Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform Qf\,kaignqXormed the said work and to make and file this application; that all statements contained in this application are true to);Al�.�/l�i//k jowledge and belief; and that the work will be performed in the manner set forth in the application fili�'ti Y �� 4u: DjM16231657'•. Swo tpp�before met�j is �y = :NQuaurcouNN•? LU day of 1C1'� 20 1"1 = SUFFOMM �Xp. �,,gyp COMM. C" U" Q ��ii�s'�q•. pU g� • �• Imo_ `" Notary Public /������u1�i��i1tN1`1 Signature of Applicant Town Hall Annex 1 rt [ Telephone(631)78g65--122802 54375 Main Road G r0 eC.ClChefit 0 n.)o151t101d:11 ;US P.O.Box 1179 ,�+ Q _ Southold,NY 11971-0959 . JUN 5 2019 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION �D QUESTED BY: ��0 FAA 17% ' �l�lrC s©C Date: .. �0 3�1�pany Name: .ao' Q- 15kc,jn(d &,/'1I`ni 1 L Mme: .. RtArP.i [Or\ -ense No.: NAL, ]dress: IJAC.o r-, A\ t- oI Prov. N 1 17�-- lone No.: (0 )BSITE INFORMATION: (*Indicates-required information) lame: C.O ., ,4 . ddress: ; toss Street: A w& -e rS r-iXi hone No.. �p wrnit No.: ix-Map District: - 1000 Section:� 10 J-, Block: Lot: RIFF DESCRIPTION OF WORK (Please Print Clearly) lease Circle All That Apply) job ready for inspection: YES NO. Rough InFinal o-you need a Temp Certificate: YES (]ND mp Information (if.needed) ervice Size: 1 Phase 3Phase 100 150 200 .300 . 360 . 400 Other ew Service: Re-connect Underground Number of Meters Change of Service Overhead ditional Information:. PAYMENT DUE WITH APPLICATION Y&4 82-Request for fnspectlon Form Scout .A. R. ' .. r 7C{C�r]l�.I��J['�'AV TIER SUPERVISOR :sA� A MI N A �: OGLhTOwivHALL-P:O,.Bpg•W9 A\l��\Gr]�.I��[]���[' 59095 Maht Rbad-SOUMOLD;NW YogK. li97i :. ..:; Town 'ofSouAW CHAPTER.236 - STORMWATER.MANAGEMENT WORK SkET .( T.0-BE COMPLETED•BY THE APPLICANT.) ]DOES 1,111-IIS' PROJECT INV0LvE ;A'11Ty OF a'HE FOLI.G) WII G.- Yes Nb 40JECK ALL TRAT APPLY) Clearing; grubbing, grading or stripping.of land which affects.more han5;000 square feet Of ground .surface, Excamatiorl or filling involving-more: than 200 cubic yarns'of materia.l within any parcel-or any contiguous .area. ite pre arat.ion on s P lopes . hloh exceed 10 feet;vertical Tice. to :10.0 'feet of'horizontal.distance; .[] - D. Site preparation within 100 f- et of wetlands beach b erosion .hazard area. tuff or,coastal E� Site preparation within the. one-hundred-year floodplain.-as depicted on.FIRM Map-of any watercourse.. [] `(Instal of new or. resurfaced impervious surfaces of 1,0.00 square I feet or*more, unless prlot approval of .a Storm water M.`ana:-gement Control Plan was .received by the'Town -arid the-proposalincludes in-kind replacement of .impervious surfaces. If you'answered 1�0 to all of the questions above; 1OP! tvtimplete the Applicant.section below ,your,name, 'Slgnature,.Contact.WormatioA,.Date &Calm#Tax.Rap:Ngmber! Chapter 23.6 does not Pte apply.tQ yoty project. If you.answered"ICES to one,or more of the above, please submit 'levo copies•of a 5tormwater Managoment.Contra�I Plan and a completed:Check List Form to'the Rullding Department id&—your Building Permit Application. APPLICANT (PMQertY Ofter,besign Professtbnat Agtrit,Oonttac'tor,Other.) S'C,T.M! '�: tdoo DbtC ItNAME: u Dlstndt 3�GZ .B1ook lot I' Contact fnforroatfoh � y l " FORBUILDING DEPARTN[ENT.USE ONLY Relf*w Num;ei 1 — _ _ _ _ _ _ _ ;i Reviewed.By: _ - _ - _ _ - - 1,, Property Address/I .of Coristi iu�tion'Work _ —Date: Approved.for.processing Building Permit: i Stormwater.Management-Control-Plan.N�at Required, _ _ _ _ _ _ted LI� StormwaW Management:Contr.ol.'P;lan*is Requited. �-_--__-___..--_--_ _____ _ (ForwaM to Engineering Department for.Review.) FORM " SMCP-TOS MAY 2014 — -- IN •� - • �} `. lit � G ............. C3 rr✓✓ Ir - m OO.lb o to o tr-' Z bi ,. .zLIL n11TC' 4Y vt ! ' t t� rn I - �` W IIs'�3ci3:t� ib•- - / CTI :.r ac•S sash be na T j Ct X yO f� o VA 0 Iry ..f :t ae�nss�sllibs �y�gcifn c>r� - _. � • _ t...S Caa;"'s r- siitF�113•��� - ' ( S � - . - � 'a[tY,aieti�u�. is .� Z 3U1sD ` -� "r..:;•r xsd�'a�s sa�iracef�h Y� .. x f ,1,•ia+:fi:.r►i'S;•� �sut�a�a=n's -• - ! 5 � �,.� —.. •• � �_. � - S _. - � c -' - _ •y, •`S�it''*•a �- � ��.Y+.L+��'•i.:�1•s•��'�:F�~�"��` -t+rti•'•-: -v . ��r i=re - : �,`. �;• =<' ,° fir , , : •? Y 'E } Cslt +� t� {e�..:: O ' _ ����{.���3 .�+.5��%.�3� _��_: 1'� _. `� �:��='�.,�,� r � _ ��. _ may;''! _ - �f.: •� �-_ ,t buirolK uouniy uept.or i Labor, Licensing&Consumer Affair 1 1, HOME IMPROVEMENT LICENSE Name 4 RANDY RODECKER Business Name I FENCE KING OF ROCKY POINT INC This certifies that the bearer is duly licensed License Number H-21412 by the County of Suffolk Issued: 06/01/1992 ` Coommismmissioner Expires: 06101/2020 I r t+tw workers' 'sr°AM CompensationCERTIFICATE OF INSURANCE COVERAGE 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 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured FENCE KING OF ROCKY POINT INC.DBA SWIM KING POOLS&PATIOS 471 ROUTE 25A ROCKY POINT,NY 11778 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specificallylimited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 113008276 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 53095 Rt. 25 3b.Policy Number of Entity Listed in Box"1a" PO Box 1179 DBL37154 Southold, NY 11971 3c.Policy effective period 02/01/2019 to 01/31/2020 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. 1' { Date Signed 2/1/2019 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 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 5B 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 D8-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) �I01 piiiim1o2i0�ii1iiiii(1i0iui1i7i)ii1011� vop Wrgrltrs' CERTIFICATE OF STATE �`CDITI[ enSa ° NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a,Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Fence King of Rocky Point,Inc. 631-744-8100 DBA Swim Kings Pools&Patios 471 Route 1 a NYS Unemployment Insurance Employer Registration Number of Rocky Pointt,,NY 11778 N insured Work Location of Insured(Only required if coverage is specifically limited to 1d.Federal Employer identification Number of Insured or Social Security certafn locations in New York State,i.e.,a Wrap-Up Policy) Number 11-3008276 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Everest Indemnity Insurance Company Town of Southold 53095 Rt 25 3b.Policyy Number of Entity Listed In Box"1 a" PO Box 1179 SWSWC00205181 Southold,NY 11971 3c.Policy effective period 11/05/2018 to 11/05/2019 3d.The Proprietor,Partners or Executive Officers are X❑ included.(Only check box if all partnerstafficers Included) [] all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box 7'Insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)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 of 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 nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the Insured from the coverage Indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form Is approved by the Insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",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 may be 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. 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 the coverage as depicted on this form. Approved by: Kevin White (Print name auth 'zed r r entative.or licensed agent of insurance caller) Approved by: 11-07-18 ( n ure) (Date) UnderWr�ting Vice Prssident Title: Underwriting Assistant Telephone Number of authorized representative or licensed agent of insurance carrier: 714.371.9612 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2(947) www.wcb.ny.aov iC-f NVL ir _j ip !IL - Z ..fi.:�csnas�s'IIi���Ff�yny��i1[1'31 � - o ` � • - - - � - ••� cr:r ta'thi���" ��ba t;ra ,/ ' � - - - I - - - - t i` -:tr ru{.+tt��nodon.�i�sssu�iES�`Y�s � 'z '• _ i ,g:?i inc:iittliF� tY�a to u4€g' ' "r,.:;.rxa,i�arxs`d �a�.�t,[t � - � ,�.��_l•2hI� - IL �n�t'�•@�vEs�ssCi�b6a�sn1 .. _ � � 5�F �.. ___. .. •• � � F%fii.tst .LA�i. tbGi= TFk OF t-k •— • F - -� s. "• _ "' .- •�i,f. .-.-. t �. �•Sl�f^�1:,����=?-��I� [ix t j. :� -{'�r.?3�•+�'� -v •i� - -j' � • , . _ .:_ Hr';(iCK.�v't:d`+S'�� � (WJ .T�-+�--5�.}%�y� �����lt •y. ;:�,. +��+ T at Z. VA 0 TQAV 44- '-{ _ - t ,r _ - t^ 'a. •, �7. ��+��• .'�C 1� -• '� ' { X, 1f.rjJ;`a``�' ` .=- •r`'`�:t'•���. ' (f](.�{/jam �j��.(.y\j �j � � � _`,• .._—._„__;_�..-r.— ,r�_ t•�, -.:,. - ;�'}(J•��. . . .. j ;�..' t 1 .slFi'L •�•�. ly: �•'••'i,' _s�UtY�.rt • •• -• 'T Z.Ot L... T" `' /{ ( �jR�T�:..J�._:•J.L. _ iis }' {� Y, �'•L 4• , tp?•t- f /'�({''} `� _ Y.`Vr Yv Iff`i`•:i '•�=• 4''R••s _1}:_ •� r ' 1 , APP 0 ED AS NOTED DATE: S B p # ELECTRICAL FEE: ,66 INSPECTION REQUIRED BY: NOTIFY BUILDING DEPARTMENT AT - 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH -.FRAMIP!^ & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEV, YORK STATE. NOT RESPONSIBLE FC =. " DESIGN OR CONSTRUCTION ERRORS. RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF ZBA 1p BOARC `SBtt t6t6i9W4-T ll$—TEES a' HV`E D I A ELY'S Ny c npr. ENCLOSE POOL TO CODE F�Sti ,,Q-O.ON COMPLETION. J OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY 40' NOTES 1. NO SOIL SURCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION AT THE SHALLOW END,OR 6 FEETOF EXCAVATION ATTHE DEEP END. U l 2. THIS POOL MEETS THE REQUIREMENTS OFAN51/NSPI-5 'AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROUND SWIMMING O > POOLS"AND 1996 BOCA CODE-SECTION 421. DIVING EQUIPMENT 15 NOTALLOWED. o 5 3. SWIMMING POOL SHALL BE COMPLETELYAND CONTINUOUSLY SURROUNDED WITH A BARRIER CONSTRUCTED LAW REQUIREMENTS OF a- SECTION R326.5.3 OF THE INTERNATIONAL RESIDENTIAL CODE(2016)AND IN CONFORMITY WITH ALL SECTIONS OF THE SOUTHOLD f� TOWN CODE.ACCESS GATES SHALL COMPLY WITH SECTION R326.5.2 OF THE IRC AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY H20 H20 LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED.ALL GATES ARE TO OPEN AWAY FROM THE POOL AREA. NI co Ory 3'-6" iv 8,_0. O a 4. DURING CONSTRUCTION THE CONTRACTOR SHALL ERECTA TEMPORARY BARRIER AROUND THE EXCAVATION LAW THE CODE OF THE O r TOWN OF SOUTHOLD. d 0 S. POOL MUST BE EQUI PPEP WITH AN APPP OVED POOL ALARM CAPABLE OF DETECTING A CH ILP ENTER I NG TH E WATER ANP SOVNPING } AN AUDI BLE ALARM WH EN DETECTED THAT IS AUDI BLE AT POOL51DE AND ATANOTH ER.LOCATION ON TH E PREMISES WH ERE TH E POOL V v Z4 15 LOCATED. THE ALARM MUST BE INSTALLED,MAINTAINED AND USED IN ACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS. Z Q Z THE ALARM MUSTMEETASTM F2208 "STANDARD SPECIFICATION FOP POOLALARMS. THE DEVICE MU5170PERATE INDEPENDENT(NOT Ln I lr ATTACHED TO OR DEPENDENT ON)OF PERSONS. CONC.WALLS D. 6. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS)MUST BE PROVIDED WITH A COVER THATCONFORM5 TO ASME/ANSI B A112.19.SM ORA MINIMUM 18"x 23"DRAIN GRATE ORA CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MUST BE EQUIPPED WITH u - ATM05PHERIC VACUUM RELIEF IN THE EVENT THE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OR BROKEN. SUCH t/1 C2 VACUUM RELIEF SYSTEMS SHALL CONFORM WITH ASME A112.19.17 OR BEA GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD. PLAN POOL SHALL BE PROVIDED WITH A MINIMUM OF2 SUCTION FITTINGS OF THE ABOVE MENTIONED TYPE. THE SUCTION FITTINGS SHALL BE SEPARATED BY A MINIMUM OF 3'AND MUST BE PIPED SUCH THAT WATER 15 DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRE55UPE CLEANING FITTINGS SHALL BE IN AN ACCESSIBLE 20'VINYL COVERED CONCRETE END STEP POSITION,M INIMUM OF 6"AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENT TO THE SKIMMER/5KIMMER5. q 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF NFPA 70(NEC)PRINCIPALLYARTICLE 680 AND THE IRC SECTIONS ° 4201 THROUGH 4206.ALL ELECTRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS LABORATORIES AND BE PROTECTED BYA GROUND FAULT CURRENT INTERRUPTER(GFCU CVRRENT CARRYING ELECTRICAL CONDUCTORS EXCEPT FOR THOSE PROVI DING POWER 2'fe 4'SANDBOiTOM TO POOL LIGHTING AND POOL EQVIPMENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4203.5.ALL METAL ENCLOSURES, FENCES OR RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHARGED DUE TO CONTACT V WITH AN ELECTRICAL CIRCUITSHALL BE EFFECTIVELY GROUNDED. Ql SECTION A 8. WATER SOURCE FILLING THE POOL 5HALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE JAW NYS PLUMBING CODE 608. Ll 9. ALL PIPING 15 DIAGRAMMATIC UNLESS OTHERWISE STATED. 0 QJ TOP OF WALL WATER LINE 4' r 10. WALKS IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM POOL EDGE. 8 Z Z r 4' 12' 4' '` 11. A MEANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED IAW ANSI/N5PI-5 SECTION 6. u Q ! b 4 v 0 cn 0 of 12. CONTRACTOR TO PLACE THE POOL IAW TOWN OF 5OUTHOLD CODE SETBACKS. n QJ u o O _Z: b 13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SVBIECT PROPERTY. 15• THE DESIGN 15 BA5ED ON A DRAINAGE SOIL WITH<10%SILT. GROUND WATER SHALL NOT EXIST WITHIN THE EXCAVATION. IF GROUND WATER EXISTS WITHIN 6'-0"FROM GRADE,DEWATERING FACILITIES WILL BE REQVIRED. SECTION B 16. ALL GAS AND OIL HEATERS(IF INSTALLED)FOR THE INGROUND SWIMMING POOL SHALL BE NATIONAL APPLIANCE ENERGY 0 CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATERS SHALL BE TESTED LAW ANSI 7-21.56 AND SHALL BE INSTALLED IAW Ln MANUFACTURERS SPECIFICATIONS, OIL FIRED POOL HEATERS SHALL BE TESTED IAW UL726. POOL HEATERS SHALL BE LOCATED OR GUARDED TO PROTECTAGAI NST ACCI DENTAL CONTACT OF HOT SURFACES BY PERSONS. POOL HEATERS SHALL BE PROVIDED WITH N TEMPERATURE AND PRESSURE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPASS SYSTEM. A BYPASS LINE SHALL BE INSTALLED FROM INLET TO OUTLET TO ADJUST WATER FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE FOLLOWING ENERGY CONSERVATION MEASURES: U vl CHECK VALVE 2'-Y' 16.1 AT LEAST ONE TH ERMOSTAT SHALL BE PROVIDED FOR EACH HEATING SYSTEM. 4 FROM SKIMMER COPING AND WALKWAY 16.2 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW SHUTTING OFF THE pop PUMP F (BYOTHERS) 10" OPERATION OF THE HEATER WITHOUTADJUSTING THE THERMOSTAT SETTING AND TO ALLOW RESTARTING WITHOUT RELIGHTING THE 6CD GRADE PILOT LIGHT. WATER LINE e 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQUIREMENTARE OUTDOOR POOLS ..i DERIVING 20%OF THE ENERGY FOR HEATING FROM RENEWABLE SOURCE5 AS COMPUTED OVERAN OPERATING SEASON) 16.4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BE SETTO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN BE SET UNDISTURBED EARTH W >r�0 p a TO DI_L 5P' \ TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER INA CLEAN AND SANITARY CONDITION IAW APPLICABLE W a- DRYweLL 3500 P51 POURED CONC. a° - SANITARY CODE OF NEW YORK STATE. 3/8"REBAR.2)7YP. - \ '�° 17. THI5 DRAWING 15 FOR STRUCTURAL SHELL ONLY.ALL ACCESSORIES AND APPURTENANCES ARE DEFINED BYOTHERS. ~ s co� 3 �(}h i Lo m m a ,� VALVE R O VINYL LINER •: Z E �� d 2 n \ 18. BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS. DO NOTALLOW THE HEIGHTOF BACKFILL TO EXCEED THE HEIGHTOF THE yco z"ro a"SAND. WATER IN THE POOL BY MORE THAN 9", OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8" Lu N d u r ,G F FILTER .. u 19. PLACE CONCRETE ON SANDY TO LOAM SOIL. REMOVE ANY CLAY DEPOSITAND REPLACE W/COMPACTED CLEAN BACKFILL. 20. THERE 15 NO MAIN DRAIN IN THI5 POOL. SUCTION FOR POOL WATER CIRCULATION IS PROVIDED BY THE SKIMMERS ONLY. THIS MEETS Ci oa REQUIREMENTS OF THE IRC-SECTION 8326.6 FOR ENTRAPMENTPROTECTION. n VERTICAL 3/8"REBAR®3'O.C. ! (NOT5HOWN) 21. THE POOL WAS DESIGNED IAW THE FOLLOWING: C N y0 u 21.1. THE INTERNATIONAL RESIDENTIAL CODE(IRC)-CHAPTER 42(2016) 21.2. THE INTERNATIONAL ENERGY CONSERVATION CONSTRUCTION CODE-SECTION 8403.10(2015) WALL SECTION 21.3. THE INTERNATIONAL FUEL GAS CODE(2015) 'co TO REJRNS N.T.S. 21.4. THE NEW YORK STATE CODE SUPPLEMENT-SECTION 8326 (2017) k`� 'v t CG 21.5. THE NEW YORK STATE SANITARY CODE. Lu U.1 CHECK VALVE 21.6, AN51/N5PI-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. '• ftt 21.7. BOCA CODE-SECTION 421. 21.8. CODE OF THE TOWN OF SOUTHOLD. r s 22. ALL BACKWASH TO BE SELF-CONTAINED ON-SITE. 23. POOL TO BE EQUIPPED WITH AN AUTOMATIC POOL COVER PLUMBING SCHEMATIC PRO ESS\o�P N.T.S.