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Home My WebLink About48122-Z ��o�g11FFD1 oy Town of Southold 10/20/2023 P.O.Box 1179 co o _ 53095 Main Rd o +' Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44678 Date: 10/20/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 28100 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 18.-6-22.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/27/2022 pursuant to which Building Permit No. 48122 dated 7/27/2022 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 Smith,Andrew&Jennifer of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 22-85019 12/7/2022 PLUMBERS CERTIFICATION DATED V-h A, A thoriz Signature tF j�,co. TOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE "�y�• �o� �fi 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#: 48122 Date: 7/27/2022 Permission is hereby granted to: Smith, Andrew 26 Lefurgy Ave Hastings-on-Hudson, NY 10706 To: construct accessory in-ground swimming pool as applied for. Pool equipment must have a minimum setback of 15 feet from all lot lines. At premises located at: 28100 Route 25, Orient SCTM #473889 Sec/Block/Lot# 18.-6-22.1 Pursuant to application dated 6/27/2022 and approved by the Building Inspector. To expire on 1/26/2024. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Bu 9 Inspector Certificate of Compliance ............................................................................................................................................................................................... CERTIFIED ELECTRICAL INSPECTIONS, INC. 188 PARK AVENUE AMITYVILLE, NY 11701 P: (631) 598-5610 ............................................................................................................................................................................................... CERTIFIES THAT Upon the application of Upon premises owned by LC Electrical Contracting Smith Residence 22 Woodbine Lane 28100 Main Road East Moriches, NY 11940 Orient, NY 11957 Located at: 28100 Main Road , Orient, NY 11957 Application Number#: 22-85019 Certificate#: 22-85019 Electrical License#: ME-38043 Section: Block: Lot: Building Permit#: 48122 Described as a Residential occupancy, wherein the premises electrical system consisting of electrical devices and wiring, described below, located in/on the premises at: In-ground Swimming Pool A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed herein, was conducted in accordance with the requirements of the applicable code/or standard promulgated by the State of New York, Department of State Code Enforcement and Administration, or other authority having jurisdiction, and found to be in compliance therewith on the 7th day of December 2022 L� Name QTY 11 D J Swimming Pool Bonding 1 Pool Fixture- 15 Amp, 120V 2 UG 4 24� Pump Motor Circuit- 20 Amp, 220V 1 Switch -20 Amp, 120V 1 MNG DEPT. Ton, cr, �Og i�:t �. Pool Receptacle-20 Amp, 240V 1 Time Clock-40 Amp, 220V 1 Key Switch -20 Amp, 120V 1 Pool Panel - 100 Amp, 240V, 6 Circuit 1 Electrical Inspector: Anthony Giordano IAN L ..................bs',, ��APPROVED o s This certificate'is not valid unless raised seal is present. Certificate of Compliance _...................................................:.......................................................................................................................................... CERTIFIED ELECTRICAL INSPECTIONS, INC. 188 PARK AVENUE AMITYVILLE, NY 11701 P: (631) 598-5610 ............................................................................................................................................................................................... CERTIFIES THAT Upon the application of Upon premises owned by LC Electrical Contracting Smith Residence 22 Woodbine Lane 28100 Main Road East Moriches, NY 11940 Orient, NY 11957 Located at: 28100 Main Road , Orient, NY 11957 Application Number#: 22-85019 Certificate#: 22-85019 Electrical License#: ME-38043 Section: Block: Lot: Building Permit#: 48122 Name QTY GFCI Circuit Breaker-20 Amp, 220V 1 GFCI Circuit Breaker-20 Amp, 120V 2 GFCI Receptacle-20 Amp, 120 V 2 Pool Cover Circuit-20 Amp, 120V 1 Pool Heater Circuit- 50 Amp, 220V 1 Electrical Inspector: Anthony Giordano `APPROVED�=' This certificate is not valid unless raised seal is present. oe souTyolo } # TOWN OF SOUTHOLD BUILDING DEPT. um, 631-765-1802 - INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ �INAL T�/ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL R MARKS: 2 I �11; f s�Cv►Zc,� � oC,�SGt �= DATE INSPECTOR hO,*pF sopl,�o� TOWN OF SOUTHOLD BUILDING DEPT. coum a 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [eFINAL i�/ oel - ��yne- [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION /1 [ ] PRE C/O [ ] RENTAL REMARKS: DATE INSPECTOR Jeffrey Sands Architect September 15, 2022 ® C EDVR D Property/swimming pool location: OCT - 5 2022 Andrew Smith 28100 Main Road WELDING DEIPT. Orient NY TOWN OF SOUTHOLD RE: Swimming pool rebar inspection Attention Town of Southold Building Department: Upon inspection of swimming pool rebar and drywell at above mentioned property, I find all to have been installed to meet current building code requirements. Sincerely, ED j p,EY M.s cti� �2o n 1 � ��. 02789Q OF N E\1`I Jeffrey Sands Architect 6 Evergreen Lane, East Quogue, New York 11942 phone-631-375-5997, fax, 631-576-8916 email—Leffrey sands(Qhotmail.com FIELD INSPECTION REPORT DATE COMMENTS f �ro FOUNDATION(1ST) ..__ N � ------------------------------------ N FOUNDATION(2ND) t4 1 ' O C4 r I rA ROUGH FRAMING& y � PLUMBING J0 J r INSULATION PER N.Y. Q�3 STATE ENERGY CODE a 3 Glc � ��eo✓oC� �Gt u �. FINAL p, a3 Ole- Yoe,-,, C. O. ADDITIONAL COMMENTS $ 3 2 L Pal 300 na c l d Z ZS y! Z 4. � y rr N z s � H d ro H TOWN OF SOUTHOLD—BUILDING DEPARTMENT y2 C, s Town Hall Annex 54375 Main Road P. O. Box 1179 Southold;NY 11971-0959 �y�o• �ao� Telephone (631) 765-1802 Fax (631) 765-9502 hgps://www.southoldtonm.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only RDE C F I I WE i PERMIT NO. Building Inspector: JUN 2 7 209 Applications and fomhs'must be filled out in their entiret :Incom tete�,: BUILDING DEPTA pP Y p TOWNOFSOU'I:iUL) applications will not be accepted.. Where the Applicant'is not.the owner,an Owner's Authorization form(Page 2)shall be completed. Date: OWNER(S).OF PROPERTY: Name: AY) �e-u � 4,hSCTM#1000 Project Address: a b I DO \ Phone#: Email: Mailing Address: CONTACT PERSON: Name: Mailing Address: i/ Moiqoe vk� Phone#:(� _(`i Email: C( r DESIGN,PROFESSIONAL INFORMATION; ... ,. Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION:,` Name: t Mailing Address: '-�>O a + M ue N1411 ( °1 Phone#: 90 �-s (-Its �S .DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑D molition Estimated Cost of Project: Other CCS.S3 Sw, vncil $ I' 1 Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises?r es ❑No ' 1 ROPERTY INFORMATION. ke- Existing use of property: Intended use of property: tX�� c,� 3� V Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to Bb this property? ❑Yes o IF YES, PROVIDE A COPY. heck Box After Reading:: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by C apter 236 of the Town Code..APPLICATION IS'HEREBY MADE to the Building Department.for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk,County;New York and other applicable Laws,,Ordinances or Regulations,for:the construction of buildings; additions,alterations or for removal or demolition as herein described.The a,pplicant'agrees to comply with all applicable laws;ordinances,building code, . housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to-Section 210AS of the New York State Penal Law. Application Submitted By(print name): ,a- r Ina MtrcuA Owthorized Agent ❑Owner Signature of Applicant4rt:(ka Date: STATE OF NEW YORK) SS: COUNTY OF !�uW-p i K ) 4l V I'1')a Mew-ccwo being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the ar ontractor,Agent, Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief; and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this ,Z-TTday of�I �.)/� , 202—,9— Notary Public MICHELE A MED USKI Notary Public,state of New York PROPERTY OWNER AUTHORIZATION Reg,No.01ME6393343 (Where the applicant is not the owner) Qualified in Suffolk County Comrni6sion Expires June 17,2023 I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 ,eco o CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDD/YWY) 05/10/2022 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CONTACT Nicholas Zulkofske Brookhaven Agency,Inc. PHONE 631 941-4113 FAX 631 941-4405 100 Oakland Ave,Ste 1 E-MAIL certificates@brookhavenagency.com Port Jefferson,NY 11777 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Philadelphia Indemnity Insurance Co. INSURED INSURER B: Merchants Mutual Insurance CO. Patrick's Pools,Inc INSURER C: Wesco Insurance Co. PO Box 3024 INSURER 0: East Quogue NY 11942 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS L POLICY NUMBER D /DD x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS-MADE X❑ OCCUR DAMAGE TO RENTED $100,000 x Contractual Liability X PHPK2385555 02/28/2022 02/28/2023 MED EXP(Any oneperson) s5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 POLICY X❑ PRO JECT F1 LOC PRODUCTS-COMP/OP AGG s2,000,000 OTHER 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $500,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED XX CAP9267113 07/12/2021 07/12/2022 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per anc.dent) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ FIEXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100,000 C OFFICER/MEMBER EXCLUDED? YY N/A WWC3587728 05/13/2022 05/13/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Southold is included as additional insured per written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold,Town Hall Annex SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE <NSZ' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD L Da APPRO ED AS NOT ,) DATE: B.P.4 FEE: R f • RETAIN STORM WATER RUNOFF NOTIFY BUIL INr. :,:pgRTMENT AT PURSUANT TO CHAPTER 236 765=1802.: P.4_8 AM 1w 4 ' FOR THE OF THE TOWN CODE. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE .,2. ROUGH ,.FRANING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCT;ON MUST BE COMPLETE Fr•R G.O. ELECTRICAL ALL CONSTRUCTION HALL MEET THE REQUIREMENTS OF THE CODES OF NEW INSPECTION REOUIREC YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF Y 50 I .? � I IC IOARD ENCLOSE POOL TO CODE, UPON COMPLETION=:;i' SOUTH J DWRIRUSTEES °WATEfi NCS-2EE� `)CCUPANCY OR USE IS UNLAWFUL ` WITH�OT CERTIFI.CA p.F OCCUPANCY f it , : I i : , clgS t f , , , - _ : , I , i I -7711 "-1 I ' i , t ' I '_ i - -- ----—-1111111-'-- ---`- -- -- •-- - --- - - —------ -- -- ^- - , , ` - - — -- - - - 1 I , i � r , 1Q�1i4 �0 { I I ;- �• I I I I I i 1 1 '�` I'. j I - ----- —. :JUN 2 17 2n72 , I i • : I I � � - -- --..._..--{--- - - ----- - --. __I - --- - - --- - ---- ----- ---�' -- - - -- -- ------ -- -- ------!--- -,�`-- I "� -708 R':OF SOUE:��LD olp , I I ! • , i- Il : , I ! -- ., I I - I I QE t , t , att- ' t. -t -.• ' � - i I •i ; i i , i- I , - ! � t , I , ! i i I ' I I I I j , -=$' � Y f ' ' � i I —' � •�fl i;�! _' 1 -1 _ t— i _ I - Isc - 1 I— , , , p f r. lie- Di kn DO 1 1 1 , ! - --- -- --. ,--- -. � VV�� `� , j` I- --Q! ta—=•-.-�-2-e•-8--ac� -� i ' '(�Q` �S'9 I f.. Y� !, , ;` � �.-. i Y i / • i Ov I V^ - - - - I 1 I t I I -t �C , I 1 t a i N - t , , , i SURVEY OF PROPERTY nD N JUN 2 7 20AT ORIENT' 2 �' OF SO U�'.,�.�OLD �`O TnB(ni nD� ��EWQ,L[ SUFFOLK COUNTY, .N. Y 1000-18-06-22.1 SCALE.• 1'=30' SEPTEMBER 21, 2010 OCT. 20, 2010`lWON. FNDJ AD ASP IZ� HALT g*TON 1N APP OO "r �A 15o�__~136 � TO p052R ROAD 0f PAVEMENT NARROW FIVE f? EDGE f)�PHEAS! APRT n t N-79 20 001 E g N2a a i 58.2 i Z ro Ca� O �O 29.9' n 3�> it N t• -� O � ' SEA O SEP-PC F (P�A �j c� O O � � 2g.3' t; SCA OZ h O oo NOh V� GO tK CER TIFIED TO: ANDREW SMITH1 .��CAEN,� JENNIFER SMI TH Qp FIRST AMERICAN TITLE INSURANCE' COMPANY CI TIMOR TGAGE, ,INC., ITS SUCCESSORS OR ASSIGNSre AREA=39,773 SCS. Fr. c ■ =MONUMENT k�%J// �� -: �,� 9618 • =PIPE' ANY ALTERATION OR ADDITION TO THIS SURVEY IS A WOLA77ON CONIC (! YOR , OF SECTION 72090F THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 FAX (6 765-1797 EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CER7IFICABONS P.0. BOX 909 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF TRAVELER STREET ®_ � SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF 1230 THE SURVEYOR 1230 OLD, N. Y. 11971 WHOSE SIGNATURE APPEARS HEREON. i r SURT AT } .. .... �*: :w7CGI-fP.f77+T+t� 68Y x•6$7/�Lg'F",.,'..:..• • lz0 or PA . 0. 7 yPNRa.TEVGC iEAQ Wim" lbOF gto r o , �.M 1 0-1 X01 CER77FIED TO., ANDREW SMi T H dENNIFER SMI TH ,d dFNEW y FIRST AMERICAN 777LE INSURANCE COMPANY h •:�,,,�"i.l►i ��,c , C171MORTGAGE, ,INC, ITS SUCCESSORS OR ASSIGNS AREA=39,773 Std. Fr. s' * =MONUMENT =Pif'E' --IfJ' 616 ANY AL7ERA.77ON OR ADD17YON TO, 7MS SURVEY IS A VIOCA7700 CONIC Y©R , OF SEC170N 7209of THE NEW YORK STATE CWCAnoN LAW. (631) 765--5020 FAX 6 65-1797 EXCEPT AS PER SECTION 7209—SUBDIV190N 2. ALL CER71f7CAnONS P.0. BOX 909 HEREON ARE VALID FOR THIS MAP AND COPIES THERECr ONLY IF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL. OF THE SURVEYOR 1230 TRAVELER STREET 1. -2 MOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11,971