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HomeMy WebLinkAbout48612-Z o`OSUFFO� �p Town of Southold 11/29/2023 -G• y�. P.O.Box 1179 0 o - a 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44786 Date: 11/29/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Properly: 55 S.View Dr, Orient SCTM#: 473889 Sec/Block/Lot: 11-3-12.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/20/2022 pursuant to which Building Permit No. 48612 dated 12/19/2022 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 Feldman,Nancy of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48612 7/25/2023 PLUMBERS CERTIFICATION DATED L A tho ize i nature �,r�sufFilljt TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE o • FV 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 #: 48612 Date: 12/19/2022 Permission is hereby granted to: Feldman, Nancy 19 E 88th St Apt 15A New York, NY 10128 To: Construct in ground swimming pool at existing single family dwelling as applied for. Must maintain 10 foot setback to side / rear property lines for pool and equipment. 'Separate permit required for deck. At premises located at: 55 S View Dr, Orient SCTM #473889 Sec/Block/Lot# 13.-3-12.1 Pursuant to application dated 5/20/2022 and approved by the Building Inspector. To expire on 6/19/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector oF so�ryol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlin(cD-town.southold.ny.us Southold,NY 11971-0959 COUn�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Nancy Feldman Address: 55 S View Dr city.Orient st: NY zip: 11957 Building Permit#: 48612 Section: 13 Block: 3 Lot: 12.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Genovese Electric License No: 60644ME SITE DETAILS Office Use.Only Residential Indoor Basement Service Commerical Outdoor 1st Floor Pool New 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 100A A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 1 4'LED Exit Fixtures Sump Pump Other Equipment: Pentair Intellicenter 10 Circuit/ 0 Used, 100A Sub 20 Circuit/ 8 Used, Waterfill 120GI Heater 115GF1, AutoCover 120GFI, Pump 220GFI, Lights Intermatic 30OW 120GFI Notes: Pool Inspector Signature: ate: July 25, 2023 S.Devlin-Cert Electrical Compliance Form �OF SOUTy �� 5 Vie,c --- # * TOWN OF SOUTHOLD BUILDING DEPT. cou 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 VIOLATIO N [ ] PRE C/O [ ] RENTAL REMARKS: Bon v� r�144 DATE rO - a 3 INSPECTOR oFsouryo! - -- — # # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm��'' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULA ION/CAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] LECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMA S: A� n y DATE INSPECTOR hO��pF SOUTyO6 L4 &&�2, - 59 S�µ view # # TOWN OF SOUTHOLD BUILDING DEPT. cou 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: n�erl� /6—i'•Sj P 17 Alter In dk J or War n- DATE INSPECTOR OF 50U --- # TOWN OF SOUT14OLD BUILDING DEPT. 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 [ ] P E C/O [ ] RENTAL REMARKS: a DATE INSPECTOR OF 50Glyo� TOWN OF SOUTHOLD BUILDING DEPT. `yCrourm 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SUL IOWCAIULKING [ ] 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: SV�/ I�r✓I�(l ��� � DATE g INSPECTORAo V -� ® ® SHERMAN ENGINEERING&CONSULTING �`4 F 70 MAGNOLIA DUNES GIRCLE ST AUGus nNF.,FL 32080 S E 631.831.3872 'ING May 1, 2023 �r 1 Building Department JL 1 2 9 2023 Town of Southold 53095 Route 25 Rt.T,P, . G 1 T, Southold, NY 11971 ' Re: Pool steel inspection; Permit#48612 Feldman 55 S. View Drive Orient, NY SCTM 1000-13-3-12.1 Building/Zoning Official, This certification is for the foundation steel installed at the above referenced property on or about April 20, 2023. The rebar was installed in substantial compliance with the approved design with #4 bars at 10" each way throughout the bottom and #4 bars at 10" horizontal. and 5" vertical in three 8" walls with 10" beam. The fourth wall has double steel in 10" wall having a 12" beam. All steel was spaced to be in the middle of the concrete shell and beam with appropriate laps and intersections tied in accordance with acceptable building practices. This certification is limited to the installed structures and does not include, nor does it address plumbing, electrical, site placement, or any other aspect of construction. Please contact me if you have questions or require clarification for this certification. Very truly yours Sherman ine g & C sulting, P.A. pF NELyY Ov4JAA4/, 0 Matth w She , P.E. w LU O 08358A v 9°FEss10NP CIVIL ENGINEERING DESIGN SITE PLANNING PERMITTING Mejia, Evelin From: Nsfnyc <nsfnyc@gmail.com> Sent: Monday, November 20, 2023 10:18 AM "'� 2023 JJJ To: Mejia, Evelin Subject: Pool fence- 55 South view dr. Orient gulldln!1 Town of Gout'-lot Here are the photos of the pool fence and the added wood top at my home, 55 South View Dr in Orient.Please pass on to John Many thanks and have a happy thanksgiving. Nancy Feldman ATTENTION:This email came from an external source.Do not open attachments or click on links from unknown senders or unex ected emails. :t W. ry. r a 4 _ r-'IF +r xt r �.a•'G�f� �'i-tuft�'` '�t �.+�y_-� � a;���: t *��`, ` r t �, r ; •��tea. p it r•. 27: r t . j + r � . r � a1 q t J _y • -G J �lrzy,, �'• -TAP y 7 , ;IELD INSPECTION REPORT DATE COMMENTS r. FOUNDATION (1ST) H --------------- FOUNDATION (2ND) -gyp tt I ROUGH FRAMING& H PLUMBING I � INSULATION PER N.Y-. STATE ENERGY CODE ` YQJ1�Q i - li a� N 6- To 4 W FINAL y g, OKI lbb ADDITIONAL COMMENTS w o re- oq(e7 v -7 a C 6 C 5 ro z x d H i ' '�ufF TOWN OF SOUTHOLD—BUILDING DEPARTMENT " Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone(631)765-1802 Fax(631)765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. Building Inspector: WE Applications and forms must be"filled out in their entirety. Incomplete'. RDEC 1 6 2022 'ED, applications will not be accepted. Where the Applicant is not the'owner,an BUIL®INGOEPT Owner's Authorization form(Page 2)shall be completed'. TOWNOF80U1N= Date:5/18/2022 REVISED 12/14/22 OWNERS)OF,PROPERTYc. Name: Nancy Feldman SCTM#1000-13-3-12.1 Project Address: 55 S. View Drive, Orient, NY Phone#: Email: NSFNYC@gmail.com Mailing Address: 19 E. 88th St., Apt. 15A, NY, NY, 10128 .CONTACT PERSON:, Name:."Judy Card (Binder Pools, Inc.) Mailing Address: PO Box 1960, Shelter Island, NY 11964 Phone#: 631-774-9429 (cell) Email: Judy@binderpools.com DESIGN PROFESSIONAL INFORMATION:, Name: Dorsa Afshadavan Mailing Address: Phone#: 202-607-8943 - Email:dorsa@dorsacorp.com CONTRACTOR rINFORMATION: Name: Binder Pools, Inc. MailingAddress:PO BOX 1960, Shelter Island, NY 11964 Phone#: (o) 631-749-2110/ (c) 631-774-9429 Email: Judy@binderpools.com DESCRIPTION OF PROPOSED CONSTRUCTION ' ®New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: D Other 14'x48'gunite pool w/autocover,55x30"retaining wall, 192 sq.ft patio at pool $163,560.00 Will the lot be re-graded? BYes ONO Will excess fill be removed from premises? ❑Yes BNo 1 PROPERTY INFORMATUM Existing use of property: residential 1 Intended use of property:residential Zone or use district in which premises is situated: ; Are there any covenants and restrictions with respect to R-40 this property? CYes.NNo IF YES, PROVIDE A COPY. IN Ch*Lh Boa After fBeaditr ewav�etusaaKtorl profssriagal a rsepeeesFlils l�r stk eltagnf pr errs s [sveea rs vrowald�r 0WK 2"of dW TVM Cols.I MAT1oM is Wlu W MADE to tits k#uhkelp t for ow issuance ore®uWNS permit ounwnt to UW Duii ms zont ordl aw*d go roar,of sauthasd,sulfa.Cos mV fww ywh and©tbar applliabiet taws,&&mom 0 Rsi08000,rar the em"buaw"alwWRE11, ardiaertes.alaratiai+s or Ilsr atefseepl w ettommose as befem douitieL The amka+n mass w easnptq Mikan aopwads fags,ardkna ftm DWMkill ems. Roes ime ao&WA 160"M ear to Admit atatlwobw Wspaatim an PftniiiM bed In OW01111*1 Peer W0211 ep ltespsatlsns.Fable stah~b reads hsrsln we esurelsWeBeka as a Cm A neisdswsanes owsennR to seetlm 2WAS er Ohs Werra Y®tt stets pang haw. Appuca4m Submitted By(p nt name':Damn Binderi8inder Pools. Inc. ®Authad zed Agent ❑owner Signature of Applicant: Date: (q ZZ STATE OF NEW YORK) SS. COUNTY OF i PZPMI ct being truly svmm,deposes and says that[s)he is the applicant (Name of individual signing contract)above named, (S)he is the CCU - .�y (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 -day of_� ' Notary Public -- DOROTHY S. OGAR PROPER, OMAR AUTHORIZA oN� Notary Public, State of New York No.52-8200218,Suffolk Count lWhere the appileant is not the owner) ommission Expires August 31. oas I, Nancy Feldman 19 E. 88th St., NY, NY 10128 residing at do hereby authorize ®arrin Binder/Binder Pools, Inc. to apply on my behalf to the Town of Southold Building Department for approval as described herein. Ak ' 05/18/2022 Ow is Si®nature Nancy Feldman Date Print Owner's Name �Qg�FFO(�`O BUILDING DEPARTMENT- Electrical Inspector ��O Gym TOWN OF SOUTHOLD c Town Hall'Annex- 54375 Main Road -PO Box 1179 co • Za Southold, New York 11971-0959 'yjj�l �ap�f� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr _southoldtownny.gov — seandca-)southoldtownny.goy APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: ,5 31 a oa3 Company Name: ' 0V eC, l - Electrician's Name: Mcka tAe., License No.: ME—�oG' If►{ Elec. email: p &( Elec. Phone No: -1-y fj& El request an email copy of Certificate of Compliance Elec. Address.: "I JOB SITE INFORMATION (All Information Required) Name: �e(d Address: ' Cross Street: Phone No.: Bldg.Permit#: �f�(�(a email: R� Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please. Print Clearly): fdoL - Square Footage: Circle All That Apply: Is job ready for inspection?: ❑ YES ❑ NO ❑Rough In ❑ Final Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect[]Service Reconnect[—]Underground❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? M Y nN Additional Information: PAYMENT DUE WITH APPLICATION 23 '� � 000— �p Ll?I(Vf-a � cep p �—U � 20 — �OrrQ��: -�9eld� � a..� e � lC1 C� S RVEY F DESC IBED PROPERTY SITUA TE AT RIENT TOWN OF SOUTHOLD SUFFOLK COUNTY,NEW YORK vs ` S.C.T.M.DIST:1000 SEC.:13 BLK.:03 LOT: 121 15 8 0 15 30 45 60 75 90 105 120 135 SCALE. 1"=30' DATE.JANUARY 24, 2021 LOT AREA:25,021 SQ.FT. =0.574 ACRE ELEVATIONS HEREON REFER TO NAVD 1988 �s 1 \ y6opp —g0 • �"s ti°�' ,��5��o c� / �j psi,. ���O DIGITAL RELEASE ea o CERTIFIED TO.NANCYFELDMAN / SIN JOB NO.:2020-287 ,� � / �'16 /� r J _ �� -�� �� '� ���6� MAP NO.: / /' // � / FILED: �F NEW // —'.'�� -- / �' 62 s \ REVISIONS: d(/y i / /� o . ��� o/// / / ,$ ADD TOPOGRAPHY&ELEVATIONS 2125121 q, Fa a ti I o p �_41 CF 050538 LAND �� �o q 1, i � ,CON 62 Fo�FP JEFFREY W. HADERER L.S. oi� / // �0 P�\� NYS LIC.NO.:050538 I ti u.77 �ssu =Ynr ,vrW tv� AA Mn TWINFORKS n�°PF� AREF '�W" aomI M.9 57RUa92 rons: m. FROPOSEAWgAnPFORASPc W CT/�/�7��///���y//�/�/T//,t W Norlx�USEMDi CEDES S Y L l ll V V Ane"smesu¢s mscnav OF revices,nErarAna WALLS,FOOLS.PA110S P{ANnNG ME0.S.Aoanons ro8f8LO1NG5 AM1�ANY On1EN[AYSInICnON SUCCESSOR TOHANDS ONSURMNG,"TLND.HAND L.S. uvAunrowgc urmAnovoaAmnox 188 W.MONTAUK HIGHWAY, UNIT E3 ,noN"u ""° ssenox rem oPnneW raar�sufe HAMPTON BAYS,NEW YORK 11946 �� �,��;~ (V)631-369-8312-(F)631-369-8313 °"�AL07ME OPY." ° ° ° email.•twinforkslandswvey@yahoo.com _ aavro n�P�asows Favnt aen�suaver eFnnflamLs mmrwreo man seuu. fSPWTAF¢OANDONMSSEXaF ro me mLecawArry sovHiwlfENiaLAG9vcYaxO COPIES OF THIS SURVEY MAP,EITHER PAPER OR ELECTRONIC,NOT BEARING ro rHe ass+sr,>«oP'MELEnmI"G wsn. MION,fP2nFfJlnOhRAPENOirRAASFERen c THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE O"AL dr N 10.Y60RS A 5EG 9 r CONSIDERED TO BE A VALID COPY AND SHALL NOT BE USED FOR ANY PURPOSE. r i Suffolk County Dept,of Labor,Licensing&Consumer Affairs t y HOME IMIPPOVEMENT LICENSE Name DARRIN C BINDER Business Name iris ceriifics that the Dearer is duly licensed BINDER POOLS INC :)y the County of suffoM License Plumber:H-37179 Rosalie Drago Issued: 04112/2005 Comm:ssionar Expires: 04/01/2023 This license is the property of Suffolk County ` = Department of Labor,Licensing&COnsurner Affairs. l > _- ?asssssion of this licensj does net gu=rantee its valiiilty. y Additional Business Name License Category H3-Pools/Spas;H26-Pools and Spas.+Certified ,I I .. 1 I STATE OF NEW YORK WORKERS' COMPENSATION BOARD' CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia. Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured 631-749-2110 Binder Pools,Inc. 1 c.NYS Unemployment Insurance Employer Registration PO Box 1960 Number of Insured Shelter Island,NY 11964 Id.Federal Employer Identification Number of Insured or Work Location of Insured(Only required if coverage is specifically Social Security Number limited to certain locations in New York State, i.e.a Wrap-Up Policy) 11-3368250 2.Name and Address of the Entity Requesting Re uestin Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Liberty Mutual Insurance Town of Southold 3b.Policy Number of entity listed in box"la": 54375 Main Road XWA60950488 PO Box 1179 3c. Policy effective period: Southold,NY 11971 10/01/2022-10/01/2023 3d. The Proprietor,Partners or Executive Officers are: indluded. (Only check box if all partners/officers included) (X)all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "Y' insures the business referenced above in box "Ia" 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"T', The Insurance Carrier will also notes the above certificate holder 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 far 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. Please Note:Upon the 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: _James Amaden (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _ 10/4/2022 (Signature) (Date) Title: AGENCY PRINCIPAL Telephone Number of authorized representative or licensed agent of insurance carrier: 631-324-0041 Please Note:Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb/state.ny.us IWWorkers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrleil 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured BINDER POOLS INC 631-749-2110 PO BOX 1960 SHELTER ISLAND,NY 11964 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required!(coverage Is specifically limited to or Social Security Number certain locations in New York State,Le.,Wrap-Up Policy) 113368250 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 P O Box 1179 3b:Policy Number of Entity Listed in Box"1a" Southold, NY 11971 DBL397420 3c.Policy effective period 01/01/2022 to 12/31/2022 4. Policy provides the following benefits: n A.Both disability and paid family leave benefits. ® B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: 0 A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. Fj B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 1/5/2022 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 emailed to PAU@wcb.ny.gov or it can 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 413,4C or 58 have 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(Article 9 of the Workers'Compensation Law)with respect to all of their 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 (12-21) �IIIIIPDB°111°20.1°���(12�a�2�1)°IIII� Client#:23825 BINDERPO DATE(MMIDDNYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 10/04/2022 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 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 any rights to the certificate holder In lieu of such endorsement(s). PRODUCER Nc%EAt Kimberly L.Schuerlein Amaden Gay Agencies,Inc. PHONE 631 324.0041 AIc N,; 6313240671 AIC No Et 11 Gay Road E-MAIL ADDRESS: y kschuerlein amaden9 a com P.O.Box 5004 INSURER(S)AFFORDING COVERAGE NAIC� East Hampton, NY 11937 INSURER A:Valley Forge INSURED INSURER B:Continental,Insurance Company Binder Pools Inc INSURER c:American Fire and Casualty Ins.Co. 24066 PO Box 1960 Ohio Security Insurance Company 24082 INSURER D• tY P Y Shelter Island,NY 11964 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 CONTRACTOR 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. TR TYPE OF INSURANCE NSR WVD ADDLISUBR POLICY NUMBER MPOL POLICY EFF MPMOILDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY X X 5084911313 9/25/2022 09/25/202 EACH OCCURRENCE $1 000 000 CLAIMS MADE DX OCCUR PREMISES ao�WEr ante $1 OO 000 X PD Ded:1,000 MED EXP(Any one person $15 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s2,000,000 X POLICY JECOT_❑ LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: I I $ D AUTOMOBILE LIABILITY X BAS60950488 5/29/2022 05,129/202 Ea accidentSINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ AUTOS ONLY X SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident X Drive Oth Car $ B �( UMBRELLA LIAR )( OCCUR X X 5086496894 9/25/2022 09/2512023 EACH OCCURRENCE $1 GOO 000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1 OOO OOO DED I X RETENTION$10000 $ C WORKERS COMPENSATION XWA60950488 10/0112022 10101/2023 1STEA OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 000 000 OFFICERIMEMBER EXCLUDED? ® N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is an additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold, NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S75037/M75032 KLH t a v 55 SOUTH VIEW DRIVE Schematic Design Proposed Plan Enlargement - Dimensions =E- uLf i . _ _ _ . . . . ... . . .. . - _ _ y� _ _ _ _ . _ _ 7 :s2 - �' - - ` _ . - - _ _ _ - F,: �p. ,bF 6 -Y NAf �' - - Fh ' GL - 7 - - / — _ 76 i i ?. GJ / / /�' /, i. -s- - a 74 . ' - 'fin - - - 16'4Ai: 14'�4_. p - — EXISTING - / .7-60172 , STEP STONES EiOUSE - _ -_- DEN 'Z7 GARAGE O = = = _ - POOL 14 x48 - - - - %- i - i - - — — — _ . - _ = _ --=-- - 6 .p p g - - _ - -_ _ . - _ : . T - '--:-:-:-:-:- - : - : . - - � : _ : . . - : . . - _ - - _ - - - - _ _ __- _ . PE - :- - - - . . . . . . . . . -- D s io NOTE LOCATION OF EXISTING TREES ARE APPROXIMATE AND MUST SEVERIFIEO IN FIMM CM PG 9 DORSAcorporation 55 SOUTH VIEW DRIVE Schematic Design Proposed Plan SOUTH VIEW DRIVE ss = - _ ---- f - DRIVEWAY : - zt - - '\:-. - g ._._�-- :- -�: - :+� .L. --- . . :=:-:- = - - �•'- \:- - - �} - , ;::. / - i -- =. - ___.:82-:- .. .. . i✓::-:. _ _ \ - - .fir:::.:•::::::•: - - : . .. 7 - _ - -- - _BIT-: •. 76 - .y.i. _- J— •o 6 Y h.. - 7Rfe12T: _ t: - ' :{ ::: per.:.• q.•__ •GT45PS_ •- __ r�?='`r �.i`%�;5, :c//l'L - - EXISTING - :.;�`:•:' TEP TO ES HOUSE DEN .. dam; . - ..,. / ..... _ _ -70 _ - -C� = — .� -- =' ` . - r" ": - --r_ - _ - O / :- ' -: :t . i _ - :: ... . ;a: •: =: .. % - — sa •:-� : _ . PE 7 KEY _ : : .•:.-_. : _ r- — EXISTING VEGETATION i ' __ . :�: - = ::•: :. : :^ `� 0 7.5' 15 30 s /1 2 NOTE:LOCATION OF EXISTING CONDITIONS ARE APPROXIMATE AND MUST BE VERIFIED IN FIELD(VIF) PG 6 DORSAcorporation ©2022 APPROVED AS TOTED DATE '? B-R# 11i�' OCCUPANCY OR FEE ±l am- 610BY: USE IS UNLAWFUL NOIFYEPARTMENT AT 631T765-8 02 AM UILDINGTO PM FOR THE WITHOUT CERTIFICATE FOLLOWING INSPECTIONS: (� �+ 1. FOUNDATION-TWO REQUIRED OF OCCUPANCY FOR POURED CONCRETE 2. ROUGH-FRAMING&PLUMBING 3. INSULATION 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE, NOT RESPONSIBLE FOR t�++ivlDL`I WI".HALL C��DcS OF DESIGN OR CONSTRUCMN ERRORS P4F:-vv YOF K STATE &TOWN CODES AS REOUI D AND CONDITIONS OF SOUTHOLD TOWN ZBA SOUTHOLD TOWN PLANNING BOARD "IMMEDI'ATELY��r SOUTHOI.D TOWN TRUSTEES ENCLOSE POOL TO'CODE_ UPON COMPLETION N,`i'�.DEC BEFORE "WATER" RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 62CrWcLV na�n OF THE TOWN CODE. BUILD SET HOUSE AREA s 30" pool cover coping 3611x36" top step 4 LED lights 2 skimmers (3) 12" stairs 18" x 18" seat 1 autofill F-6 ft. _� 6 ft. TV 00 12 ft. 12 ft. 12 ft. 4, cl �10ryft =_ - - -- - -= ----- =- -- --8=ft 1:0,=ft --=_ _-..--«_,.�__...-_..._._._._..-_--__.-_.....-_:..'._._.:_._.__.::_•----_.e_..---=_.___-_- -..-_..�-.-_.`._^-._._�«.__..--.__-..---_-_--:...^.��:-:;.:�-:e�..��:._._v-: :__..=.::.:_.__...__war:::.:_.�-_—=e�--_-._.-_ 4q ft. 4 ft. 10 ft. 10 ft. 10 ft. 10 ft. 4 ft. 2 main drains 14" bluestone coping 5 returns 14' x 48' Gunite Pool Binder Pools, Inc. Phone:631-749-2110 Designed by: PO Box 1960 Judy Card Designed FELDMAN With auto cover Shelter Island NY 11964 Fax: 631-749-3529 12/14/2022 for: BUILD SET 1411 x 2" pool coping 3011 cover box coping 18 in. seat 5 LED lights 2 skimmers 36"X36" top step (3) 1211steps 12 ft 1 autofill 12 ft. 48 ft. =_ __ -. .__-:_.:. (V N� 36, 18u LO o 12" 9.5" 12" 9.5" - LO M 9.5" 10 28 ft. 10 ft. 2 main drains 8" Gunite shell 14' x 48' Gunite Pool Side view Binder Pools, Inc. Phone:631-749-2110 Designed by: PO Box 1960 Judy Card Designed FELDMAN Shelter Island NY 11964 Fax: 631-749-3529 12/14/2022 for: s 10.5" 12" Coping Pavers Mortar 4-" Compacted Sand 6" Tile 12" Bond Beam O Marble Dust Concrete #4 rebor (4) #4 rebor 10" o.c. throughout cdnt. through verticals 5" o.c. where bond beam water depth exceeds 5' O O 12" TO 36" Radius Compacted Soil O O Minimum specifications; Shotcrete Gunite 4,000psi minimum O Grade 40 rebor (conf to ASTM A615) All work to be in compliance with ACI-318 4" min, thick " Gravel bcse sy a' UNAUTHORIZED ALTERATION OR ADDIRON TO THIS DRAWING AND RELATED DOCUAIENiS IS A VIOLITLON OF SEC. 7209 OF THE N.Y.S EDUCARON LAW �p �83584 O-- J08r. binder 1t DATE: 4.29.22 T yp Pool ®s�E Mq�® SHE NGINEEIUNG SCALE: AS NOTED �`t &CONSULTING P.A. DRAWING NUMBER Cross Section � E C F 14 NELMAN AVENUE ►`J ST AUGUSTINE,FL 32084 2 631.831.3872 r BINDER L S DEC 16 2022RP ® ® BUDDING pEK °P�W(�0 SOU_M= Name: Feldman Residence Date:November 3, 2022 Pool Address: 55 S. View Dr., Orient Pool Size: 14'x48', 3.5'-5' depth Swimming Pool Contract Proposal Pool Includes: • 8"/10" Shell, 10"/12" beam, formed • 2 Pool Draw plans • %2"Rebar(10"c, 5"v),double steel 1 corner+ • (2)Main Drains • Rough grading • White or gray marble dust finish • Porcelain 6"x 24"the($6.95 sq.ft.) • Pre-fab cement equipment pads • High grade 2" solid PVC plumbing • (2) skimmers • StaRite Modular Media Filter(or equivalent) • (4)returns • Pentair Variable Speed Pump • Medium corner stairs • Pentair Chlorinator • Individual Suction Lines • Electrial Conduit by others • Jandy never lube valves and unions • Levlor electronic autofill • (5)12v LED Pentair MicroBrite lights Features Included. Payment Schedule: AquaSeal pool shell sealant$1,500.00 Deposit upon signing: 40% 4'x8' Dry well $2,500.00 Shell installed: 40% 14"x 2"Bluestone coping$5,760.00 Equipment installed: 10% (4)Loads of water$2,400.00(allowance) Ready for finish: 5% 400k HD Heater(Jandy or StaRite) $6,000.00 Start up: 5% Coverstar Auto Pool Cover$19,500.00(for summer use only) Pentair IChlor with IntelliChem Salt/pH Maintenance System$6,000.00 Pentair Intellicenter system for pool with in-door control and programing$5,000.00 (equipment only,installation and internet by electrician) 55 LF 8"retaining wall,3' deep footing$8,250.00(allowance)(includes returns) 66 LF 14"bluestone coping on retaining wall and returns$2,970.00 192 sq.ft.bluestone patio on cement pad$7,680.00 3' Footing for outside(1)long and short pool wall$3,500.00 Crushed stone base 1 truckload$4,000.00 additional(allowance) (3) 12"x72"bluestone tread stairs,with 4 bluestone risers$2,500.00 Patio haunch on pool shell(no charge) *Total Price: $163,560.00 (This proposal is good for 30 days from mailing date.) Does of include electr'cal contracting, stru tural staining wall ray ings, autofill aterl'ne enein railing, patio drain e removal, deb 's d p fee , propane instal[ation/1 ookup surveyor ee in er safety co er,doo ndow ala, s or fished grade.As an industry, are currert6l, dealing w'th or e Majet�re e e t due o th pandemic.The kno progress of this situat on may have an effec o o r roject prisi g and corn letio date as the face un recedented roduct rice i creases al n with a nd su 1, short es Additional Options: Fill and grading$10,000.00 allowance to be discussed Stucco on exposed pool and retaining wall surfaces additional(see email info) r—I Install 215 sq.ft.bluestone patio on cement as upper patio$8,600.00 additional an 0 a P.O.BOX 1960-30 S.CARTWRIGHT ROAD-SHELTER ISLAND,NEW YORK 11964 (631)749-2110 FAX(631)749-3529-EMAIL:HEYBINDER@OPTONLINE.NET BINDER P O O L S Name: Feldman Residence Date:November 3,2022 Pool Address: 55 S. View Dr., Orient Pool Size: 14'x48', 3.5'-5' depth While we will do our best to protect the existing environment,Binder Pools is not responsible for any damage to driveways,sidewalks,patios,sprinklers,septic systems, water wells,lighting, lawns or plantings.We are not responsible for obtaining certificates of occupancy. Initial I agree that this contract,including the General Terms and Conditions Contract and the White and Colored Pool Interior Finish Agreement,which I have read and to which I agree, constitutes the entire agreement relating to said sale,and I have received a true copy thereof. Agreed: Date: N aU a0 M a P.O. BOX 1960-30 S.CARTWRIGHT ROAD- SHELTER ISLAND,NEW YORK 11964 (631)749-2110 FAX(631)749-3529-EMAIL: HEYBINDER@OPTONLINE.NET BINDER P O O L S Name: Feldman Residence Date:November 3,2022 Pool Address: 55 S. View Dr., Orient Pool Size: 14'x48', 3.5'-5' depth Swimming Pool Contract Proposal Pool Includes: • 8"/10" Shell, 10"/12"beam, formed • 2 Pool Draw plans • %z"Rebar(10"c, 5"v),double steel 1 corner+ • (2)Main Drains • Rough grading • White or gray marble dust finish • Porcelain 6"x 24"the ($6.95 sq.ft.) • Pre-fab cement equipment pads • High grade 2"-solid PVC plumbing • (2) skimmers • StaRite Modular Media Filter(or equivalent) • (4)returns • Pentair Variable Speed Pump • Medium corner stairs • Pentair Chlorinator • Individual Suction Lines • Electrial Conduit by others • Jandy never lube valves and unions • Levlor electronic autofill • (5)12v LED Pentair MicroBrite lights Features Included: Payment Schedule: AquaSeal pool shell sealant$1,500.00 Deposit upon signing: 40% 4'x8'Dry well$2,500.00 Shell installed: 40% 14"x 2"Bluestone coping$5,760.00 Equipment installed: 10% (4)Loads of water$2,400.00(allowance) Ready for finish: 5% 400k HD Heater(Jandy or Sta.Rite) $6,000.00 Start up: 5% Coverstar Auto Pool Cover$19,500.00(for summer use only) Pentair IChlor with IntelliChem Salt/pH Maintenance System$6,000.00 Pentair Intellicenter system for pool with in-door control and programing$5,000.00 (equipment only,installation and internet by electrician) 55 LF 8"retaining wall, 3' deep footing$8,250.00(allowance)(includes returns) 66 LF 14"bluestone coping on retaining wall and returns $2,970.00 192 sq.ft.bluestone patio on cement pad$7,680.00 3' Footing for outside(1)long and short pool wall $3,500.00 Crushed stone base 1 truckload$4,000.00 additional(allowance) (3) 12"x72"bluestone tread stairs,with 4 bluestone risers$2,500.00 Patio haunch on pool shell(no charge) *Total Price: $163,560.00 (This proposal is good for 30 days from mailing date.) - S..i�J9J� �5. .: - .. `r"- S� S,.r.,',q1.: f.�a. dfLVf, f5i -'!^- I��•: .sl b i �N:'� I.' Does not��incliide a ectricalt ,contracting; structural 1,retaiiiing� yrallr;'dra�vin`g's eau afillrie;.waferline' f �I�IBi ,{�p' @ t HE ftl� �.r4#:�';1�'G".EF"1' u i 'yy eMwncing/razlinpg?_1patio drawm, tre�5e remopv�NalC�♦y;deMbnss dump fees; prgpane;gi1n�stalla:Uzson%h�o/yok�izr}C'''�yl wuYrfvpT"'or,fees' Spr fOi;$I(iA0 �' fiAYIDk. KY. a" #t'$1 {i, fl{yM1 Y�! 4�I��:�ILs�1�.t�';+�"P�k�L1 WiG 816KSi�Ffi"tip,ll,.tli{f{i.l koT winter safety c over„door/window alarms,�or finished grade.As an industry,,we are currently dealing with p'@ ; i: d1�3�`J�'� Sk�, ':t kI once Majezrr��``eventidue to thepandeinic:,T1i'e otivn progress on'of his situation may'havean�effect o # at3 l 39: t 1!v 6-id ii_ dgt- '$'i 4$ tl ka�c4 Ui 3' =N t 1;f 1 t�r5� � 5 2te9 '� , i x k our prole pr cing and,com lefion dP ate:as we»face un recedented pro,duct,;price I cruses al9ng witli�labo surNl oia es Additional Options: Fill and grading$10,000.00 allowance to be discussed Stucco on exposed pool and retaining wall surfaces additional(see email info) Install 215 sq. ft.bluestone patio on cement as upper patio$8,600.00 additional a, P.O. BOX 1960-30 S.CARTWRIGHT ROAD-SHELTER ISLAND,NEW YORK 11964 (631)749-2110 FAX(631)749-3529-EMAIL: HEYBINDER@OPTONLINE.NET