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HomeMy WebLinkAbout45936-Z rte.-.. OpSUFFOi��OGy� Town of Southold 8/28/2022 P.O.Box 1179 h i 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 43373 Date: 8/28/2022 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 675 Jacksons Landing,Mattituck SCTM#: 473889 See/Block/Lot: 113.-5-6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/1/2021 pursuant to which Building Permit No. 45936 dated 3/17/2021 was issued,and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in-ground swimming pool fenced to code as applied for. The certificate is issued to Nieves Jr,Jorge&Nicole of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45936 11/23/2021 PLUMBERS CERTIFICATION DATED A 1zo 'z ignature SUfFe�� TOWN OF SOUTHOLD �o�° coGy BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE "oy • o� 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#: 45936 Date: 3/17/2021 Permission is hereby granted to: Nieves Jr, Jorge 675 Jacksons Landing Mattituck, NY 11952 To: construct accessory in-ground swimming pool as applied for. At premises located at: 675 Jacksons Landing, Mattituck SCTM #473889 Sec/Block/Lot# 113.-5-6 Pursuant to application dated 3/1/2021 and approved by the Building Inspector. To expire on 9/16/2022. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector O��pF SO!/jyol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 sean.devlina-town.southold.n .us Southold,NY 11971-0959 CO y COUM,N BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Jorge Nieves Jr Address: 675 Jacksons Landing City.Mattituck st: NY zip: 11952 Building Permit* 45936 section: 113 Block: 5 Lot: 6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Island Power Electric Corp License No: 52729ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 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 2 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 2 Disconnect Switches 2 4'LED Exit Fixtures 11 Pump 2 Other Equipment: Sub Panel 8 Circuit/ 5 Used, Salt Generator, Hayward Pool Tranny, Polarir Cleaner Pump 220GFI, Pump 220GFI, Heater Notes: Pool Inspector Signature: s Date: November 23, 2021 S.Devlin-Cert Electrical Compliance Form %f so!/lyo 1 # # TOWN OF SOU THOLD BUILDING DEPT. `ycouhm ' 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 REMARKS:- T2 90 0,4V f-C, IC2 +Z4 DATE 2 INSPECTOR OP SOUTyOIo # # TOWN OF SOUTHOLD BUILDING DEPT. cou631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]VdSULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINAL Pdt---- FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: VSA ut, Sides Ak /01 *eA, m. '/ DATE INSPECTOR Irtaf s 0 TOWN OF SOUTHOLD BUILDING DEPT. co 765-1802 INSPECTION FOUNDATION 1ST [-. ] �'ROUGH PL13G. FOUNDATION 2ND [-eSAULATIOfj/CA FRAMING /STRAPPING FIN 4�� rG FIREPLACE & CHIMNEY ] 'FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLATION PRE C/O REMARKS: e4 DATE ANSPECTOR � ���� . . .. �\��l���� §�� �� . .w�) \ ��/\��\� ���� � . , � « \\�/� . <}.> ! . : ��\ . t7 � ? ���� .:N �� " 'i �i �, t�5 Y�v," Y.c. 4ss�� ��� �b �k5�?�� FIELD INSPECTION REPORT DATE COMMENTS b t� FOUNDATION(IST) �q ----- w FOUNDATION(2ND) U1 LI� ROUGH FRAMING& PLUMBING C� INSULATION PER N.Y. ` H STATE ENERGY CODE D rn••-,v y &415d —� � U FINAL A d� ADDITIONAL COMMENTS o -a3 .a G. Z ;)�D m X E� Nz � x d b y La r TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 a Telephone(631) 765-1802 Fax (631) 765-9502 haps://www.southoldtomm.gov �• �•� ff te-Received--r APPLICATION FOR BUILDING PERMIT For Office Use Only MAR - 1 2021 PERMIT NO. Building Inspector: Applications-and,forms;rriusi:.be filled out in their'entirety'.ancomplete'_'; -40plications will not be'.aceepted. Where,the Applicarit is not the:owner,_ari:; Owner's"Auth6eiiatidnLform_(Page'2)shall be compieted..' Date: - I to- 21 `QINNER(5)OF PROPERTY: ' - - • - - - - .- - _ _ ..- - - ... .. _ .. Name: '-Q(' I�►ev�5 SCTM#1000 Project Address: 6--75 - Phone#: (Q��- rl b�- ��9� Email: NteV�S�_R5@4KP L'�61'1__. Mailing Address: PERSON: _ '.CONTACT - :. Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL.INFORMATION: Name: Mailing Address: Phone#: Email: °'CONTRACTOR:INFORMATION':_``:==: , Name: Mailing Address:. . q2—q. �t- ._2-� � 11'& Plan .. W i I 17b. Phone#: �31-�}4-�]18S X- Email: DESCRIPTION'OFPROPOSED'CONSTRUCTION - ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: '54bther 1A WN0 VIhu, ' Ymy'ImiP1 �x1 $ Will the lot be re-graded? KYes El No 9� h-eh oA�j Will excess fill be removed from premises? 'WYes El No 1 PROPERTY INFORMATION Existing use of property: D�I � Intended use of property: w �/r�y►/yi�/9 41. Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes No IF YES, PROVIDE A COPY. .0 Check Box After-Reading: The owner%contractor%design professional is;responsible for all drainage and storm water issues as provided,by .Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of 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 applicant agrees to comply with all applicable laws,ordinances,building code, housing code and-regulations and to admit authorized inspectors on premises and in building(s)for necessary,,inspections:Falme statements,made herein are:: punishable as a Class A misdemeanor pursuant-to Section 210ASW the New,York State Penal'Law. t Application Submitted By(pri name): U<Ug-e- i-ed-S []Authorized Agent 'XIOwner Signature of Applicant: Date: STATE OF NEW YORK) . SS: COUNTY OF &C-FOLY, ) --Srj�u_ Mev e S being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the GVJV4_9 (Contractor,Agent,Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of his/her knowledge and belief, and that the work will be performed in the manner set forth in the application file therewith. Sworn before me this ,low day of . 2o2_1 MARGARE f A. KIDNEY Notary Public Notary Public-State of New York No. 01 K16021 I I I Qualified.in Suffolk County PROPERTY OWNER AUTHORIZATION My Commission Expires March S,202 (Where the applicant is not the owner) 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 �o�SpfFUI�-� BUILDING DEPARTMENT-Electrical Inspector d Gym TOWN OF SOUTHOLD coo Town Hall Annex-54375 Main Road - PO Box 1179 o Southold, New York 11971-0959 y�r01 �ao�' Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr southoldtownny aov- sea ndasoutholdtownny gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All.information Required) Date: 11/19/2021 Company Name: Island Power Electric Corp. Electrician's Name: License No.: ME-52729 Elec. email:islandpowerelectric@gmail.com Elec. Phone No: 631-828-4676 []I request an email copy of Certificate of Compliance Elec. Address.: P.O. Box 591, East Setauket, NY 11733 JOB SITE INFORMATION (All Information Required) . Name: Jorge Nieves Address: 675 Jackson Landing Mattituck, NY 11952 Cross Street: Phone No.: 631-764-4193 BIdg.Permit#: 45936 i email:nycnieves@gmail.com Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Circle All That Apply: Square Footage: Is job ready for Inspection?: YES [] NO F-�Rough In F-1 Final Do you need a Temp Certificate?: YESI'NO Issued On Temp information: (All information required) Service Size F1 Ph❑3 Ph Size: A #Meters Old Meter# [-]New Service0 Fire Reconnect[]Flood Reconnect[]service Reconnect[]Underground[]Overhead # Underground Laterals n 1 2 R H Frame Pole Work done on Service? F1 Y FIN Additional Information: PAYMENT DUE WITH APPLICATION OY� R,P ,f S SUFFOLX Cd- "4^-LTA NT OF IN—r9l"I STAT A" DISPOSAL WATER SUPFL Wf LI. OENICE ,, ;'°.'. � Y : ';" /- p; �'--"i .• SYSTEMS +�� T�f REEx��� OF THE t, , �, s ' Ct?l�t�rORM 0. THE DEPT. OF 14EA1,TH �ERytCE� Isl ApPLICAmT :,_ _ i 3 �ila`t9t COUNTY DEPT. OF HEAD P P � .. _g �- p p �o FOR APPROVAL;. � AN VAN �M-0 �g y do. 1 SERVICES B 3� i�.�.i` } '_,i P .. _or1STRUCT10H ONLY REF" NO. �FOLfF CO. TASK MAP 0ESlGXA `f6 ' O#E3, SECT ®L:OCIa -• t '!' ` pil�l'i1ERS ADDRESS: •� � �� � •''T �r-... _`^�. � � ���:a Yi�.e qr'.T+o'gyiQXp e�.�/'i6'� �r rB',�9..�!`��p ,�s yj�;^ -Jl,.�y°�yT � Iii♦{ 1`� t� _ err � �� # R��. 7 41 of Aa o Y�.�+, ` _ p� 7 y _�'—!_ qq�,_,'+ - •'"fib�/a� r .�:^-�v Lu -e 1 �\ ��'���rraa��•• }� �! �-• p,�g �4 .`. i`CYS.IZE F4 MAP O O ,4 � pie, :�;• ;� .,Sp g�� _ _ .. _:..�,,,,.- •- „,�,... $e�IKSE�Miu+A��'1.1r!lltl �g y 7'��zSt P -, L, so F.- a ;�'r':4.' r4t<,.•,S,�.t.. °'S+a Wig^. 4-70 { c NcwM1A � ,.F 6• is -'" �a .-yp. t �% _ -. -_._ - .._. _-....r0"t°'..i.=_e n-t +1�.`ta �!1 �u9��. 0�'-;':3sy s��.:�$� b. `5� _ .L- �F"+•�-..4m�ar.'a`°�- .,.P..� ..�� - -•-�- "� ! i�'� >.C�:. ',�'�': r, .cmr.�4AR°'�i .dp�t?eK"��`s•�s'g�yP „�� =..P�e��e ':��� � � €�3 � f '�rt3thlaMCiM1�f7��li �����•f' :1•.`'' - ,.� � ,. .....,,,—. _._. ..._,. ._.�..® .. f -.ot' aK�arr�irraiiRl�iCi�'x�fSiM " r Q�e � •, p pt's,l> e al a .., -AVII sn ` I p � •�- - �AE£1�1�+�A�' �. N�E1!!I;_SIQR,,.. * :: • 'y _ . . ��` �'max - .�:_�, '=_ ,a r ARTHUR EDWARDS POOL & SPA CENTRE 929 ROUTE 25A MILLER PLACE, NY 11764 516-744-7185 FAX-744-0174 APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD TOWN OF SOUTHOLD MAIN ROAD (P.O. BOX 1179) SOUTHOLD, NY 11971 (631) 765-1802 PAPERS ENCLOSED: (a APPLICATION FOR OUTDOOR POOL PERMIT CERTIFICATE OF WORKER'S COMPENSATION [ CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE OF DBL INSURANCE SUFFOLK COUNTY LICENSE 4 SETS OF STAMPED PLANS [� 3 SURVEYS with FILTER LOCATION [� C.O. TAX BILL $400.00 CHECK FOR PERMIT FEE xi,- CLS 10 SPIN vws IL 40 WMA �� � j til• \, Ir Mills) NYSIF199 CHURCH STREET,NEW YORK,N.Y.10007-1100 New York State Insurance Fund nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA D �... 112377925 LEVITY-FUIRST ASSOCIATES LTD 520 WHITE PLAINS ROAD,2ND FL TARRYTOWN NY 10591 � Y SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER ARTHUR J EDWARDS MASON TOWN OF SOUTHOLD CONTRACTING COMPANY INC P.O.BOX'728 929 RTE 25A SOUTHOLD NY 11971 MILLER PLACE NY 11764 POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE G 2438 491-9 308232 06/29/2020 TO 06/29/2021 06/18/2020 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2438 491-9, COVERING. THE.ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WOE RKRS' 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:/NVWW.NYSIF.COM/CERT/ CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUNDIS 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 UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES.NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 730432298 IlIlii p� I� ®I1000000000000834456925RE111 Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC PoGry-243849191 U-26.3 57 [00000000000083456925][0001-000024384919][*#G][15408-10][CerLNoP{ERT_I][01-MMI) IEW workers' CERTIFICATE OF INSURANCE COVERAGE YiM Compensation 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 1 a.Legal Name 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ARTHUR J EDWARDS MASON CONTRACTING COMPANY INC 929 ROUTE 25A 6317440174 MILLER PLACE,NY 11764 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social.Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 11-2377925 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier TOWN OFListed as the SOUTHOLD to Holder) Standard Security Life Insurance Company of.New York PO BOX 728 3b:Policy Number of Entity Listed in Box"1a" SOUTHOLD, NY 11971 Z06874-000 3c.-Policy effective:period 7/1/2020 to 6/22/2021 4. Policy provides'tfie following benefits: Q A.Both disability and paid family leave benefits: E] B.Disability benefits only. F1 C.Paid family leave benefits only. 5. Policy covers: Qi 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 employers employees: Under penalty of perjury,I certify that-1 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 des d above. Date Signed 6/23/2020 By g (Signature of insurince'carriees authorii representative or NYS Licensed Insurance Agent of that insutance cariier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY 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;4G&513 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 BY (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to Issue this form. DB-120.1 (10-17) 11111 B-120.1 (10-17)ii���� A`o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDlYY1R� 01/0512021 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(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 confer rights to the certificate holder in lieu of such endorsement(s). CbNPRODUCER NAME Gene Romano Liberty Risk Management,Inc. PHONE , (631)569-5633 FAX AM No):(631)56M636 664 Blue Point Road,Suite A ADDRESS: gene&ibertyrisk.org Holtsville,NY 11742 IN-MIR911191 AFFORDING COVERAGE NAIC r INSURERA: NIP/Greenwich. INSURED INSURER B Arthur J.Edwards Mason Contracting Company Inc. INSURER : DBA Arthur J.Edwards Pool S Spa Centre 929 Route 25A INSURER D: Miller Place,NY 11764 INSURER E: ' INSURER F COVERAGES CERTIFICATE NUMBER: 00000005.963374 REVISION NUMBER: 1 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. INSR06—LSUER POLICY EFF POLICY EXP LIMITS LTRTYPE OF INSURANCE POLICY NUMBER MM1DD DIMM A X COlrMERC1ALGENERALLIABILRY NPC-1004300-00 01/01/2021 01/0112022 EACH OCCURRENCE $ 11000,000 CLAIMS-MADE Nd OCCUR PREMISES Ea oceummoe $ 300,000 MED EXP(Any one person) 10,000 PERSONAL a ADV INJURY $ 1,000,000 GENLAGGREGATELIMRAPPLIESPEFZ GENERAL AGGREGATE $ 2000000 POLICY a jELOC PRODUCTS-COMPIOPAGG $ 2,000,000 $ OTHER COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY I.acddenl ANY AUTO BODILY INJURY(per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLYAUTOS PROPERTY DAMAGE $ HIRED NON-OWNED per accident AUTOS ONLY N AUTOS ONLY $ UMBRELLA t lAB OCCUR EACH OCCURRENCE $ EXCESS UA13 CWMS MADE AGGREGATE $ DED RETEMION$ WORI�RS COMPENSATION SSTTATUTE I I OR AND EMPLOYERS!LIABILITYYIN E.L.EACH ACCIDENT $ ANY PROPRIETOFJPARTNERIEXECUTIVE ❑ N I A OFFICERUAEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ (Mande"In NH) IfYes describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached U more apace la required) Town of Southold is included as an Additional Insured,ATIMA,as requried by written contract,subject to policy terms, conditions,and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall P.O.Box 728 AUTHORRED REPRESENTATIVE Southold,NY 11971 GGR ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Printed by GGR on January 05,2021 at 03:12PM APPR VED AS NOTED 2 DATE:3 B.P.# J FEE: l� , BY: RETAIN STORM WATER RUNOFF NOTIFY BUILDING "';=PARTMENT AT 765-1802 8 AM TO 4 PM FOR THE PURSUANT TO CHAPTER 236 FOLLOWING INSPECTIONS: OF THE TOWN CODE. 1. FOUNDATION - TWO REQUIRED FOR POURED CONI-PETE 2. ROUGH - FRAMiti'c- PLUMBING 3. INSULATION 4. FINAL - CONS-'-. MUST BE COMPLETE O, ALL CONSTRUCTi,.,I� S-;ALL MEET THF REQUIREMENTS OF THE CODES OF NEV,,' YORK STATE. NOT RESPONSIBLE FOP, DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF ELECTRICAL NEW YORK STATE & TOWN CODES INSPECTION REQUIRED AS REQUIRED AND CONDITIONS OF _ SCIJTPOtr-1 @Wb�t NNffd6 BOARD IU' RUSTEES N.Y.S.DEG, ENQLbSE POOL 1'Q:dbt `UPOPv COPAPLET165 `:",iiPEFORE "WATER OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY A— B v. tnD B B lAkvWhm To R&W Fran Rr1w a� To Mab• �To#t*xm A P,D%d WM Plan Piping . Arrangement F4 RM 42" VV _ ,Y, ,Pg p• RFi< \ Section B—B PAU Ca„cr,,, =10" 4r Typical Wall Section 043595 <C�, � Section A—A A%FESSO, SIZE A B C D E F G H AREA CAP - FEET FT FT FT FT FT FT I FT I FT SQ.FT GAL. 1 ''ry I' 15 X 30 15 30 101121 5 3 3 9 450 15,000 ��� �-•� POOL&SPA CENTRE jV11I 16 X 36 16 36 12114 6 4 4 8 576 21,600 PERMACRETE WALL SYSTEMCUT IL 18 X 36 18 36 12 14 6 4 5 8 648 24,300 929 Route 25A Miller Place NY 11764, 20 X 50 20 50 24114 8 4 5110 1000 34,000 , (631) 744-7185 FAX (631) 744-0174SL Nassau License #HI74450000 24 X 44 24 44 18 14 8 4 8 10 798 35,000 Suffolk License #4436—HI phm 24 X 48 24. 48 20 16 8 4 6 10 900 38,500