Loading...
HomeMy WebLinkAbout48287-Z g�FFU1Kc Town of Southold o G 1/27/2024 y�E) P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44911 Date: 1/27/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2540 Yennecott Dr, Southold SCTM#: 473889 Sec/Block/Lot: 55.-4-34 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 8/4/2022 pursuant to which Building Permit No. 48287 dated 9/13/2022 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 Grattan, Steven of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 48287 10/25/2022 PLUMBERS CERTIFICATION DATED c 0 Au o 'ze S nature p.zzr TOWN OF SOUTHOLD �yo gQFFD� BUILDING DEPARTMENT TOWN CLERK'S OFFICE 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#: 48287 Date: 9/13/2022 Permission is hereby granted to: Grattan, Steven 2540 Yennecott Dr Southold, NY 11971 To: construct accessory in-ground swimming pool as applied for. At premises located at: 2540 Yennecott Dr, Southold SCTM # 473889 Sec/Block/Lot# 55.-4-34 Pursuant to application dated 8/4/2022 and approved by the Building Inspector. To expire on 3/14/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector SO!/j�,ol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlinO-town.southold.nv.us Southold,NY 11971-0959 Q �y�0UNT1,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Steven Grattan Address: 2540 Yennecott Dr city:Southold st: NY zip: 11971 Building Permit#: 48287 Section: 55 Block: 4 Lot: 34 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Elec Tec Inc License No: 4814ME 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 1 Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: Intermatic Pool Panel 4 Circuit/4 Used , Salt Gene, Light AJ Tranny 120GFI, Pump 220GFI, Heater Notes: Pool Inspector Signature: Date: October 25, 2022 S.Devlin-Cert Electrical Compliance Form �O�aUFSOUTyo� 48U7 'Z5 4 V * # TOWN'OF SOUTHOLD BUILDING DEPT. �ycomm. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION: [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) = [ ] CODE VIOLATION [( ]_ PRE C/O REMARKS: �CG DATE fo 12,5-/ S�IN-iPECTOR �o�aOF SO(/lhO� -- O # f TOWN OF SOUTHOLD BUILDING DEPT. cOUNr+��' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/FINAL SULATION/CAULKING FRAMING /STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: S� Out 41tlw�b!-zl(kt�t, nvi:7-v • DATE9,111:74W?!2INSPECTOR rruuorrr 1 m mm Bull, I 1 - /u=oror�i Susumu /rrrrrrrrr Ir.U.MI 1�i� ■ /rrr/r/r/rri 1/�a4�1 'rl� J�, cwuouuo•••ate+1 i i=� .. ■■r1/rr =�wwA�\�\�Ilm� llxiii8r11�l�, ' f6=r r if" :a/r=rrrrr.3 al rrw/z ��r��ies�ir�yr� o.l�/aawww �Gressa/�IR All i gg ` [}P• . ' , s WA R 1 l rrr/ir .. Pon .'//!lfa;S►IA9C tick .�Q,� a'!,�'�, "+{trR �• .*,,. SM -4K, ViL' 31 01, 4 •.Jv 1 MY'�iYMa�.!`�.� � - i �« ( �-' r ' =� � `� '� 111yyy yF�Y�. �,� � �. . ��,, ,.�r � . � , ` �4 y { ii�. � r� � � ,�� �. � � ,� F- ~. �1. �`�� .� °�.. ` , /e,i 4 � '�f �, 1 ��: � t s ,�:.%. � t 'g h r 1�g ����' a u°�„},,,,, �,Fa'� s�A � �� M. v y ,i,"S, '.Y a.� t'h#,tea,« } d *�2+L, y h�iA��"�'M F�j�.� �LL`o S tyay��SY�r„��,XYt h Fop}�� r '+S1D�/��.. � (�'.r ��G .A' j� yC+Y•Y F v k �'�� �At y��i. ;}. .Yy FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION(IST) ►- y ------------------------------------ FOUNDATION(2ND) 4011-lim No 1s1. o rn H ROUGH FRAMING& v 1 PLUMBING t n W INSULATION PER N.Y. STATE ENERGY CODE dvy — y ? 47 FINAL 0- 6 - I/ ADDITIONAL COMMENTS as'70 4 30 / A re c" i- a co S W � tz �y m V H �osuFFui �o;� . o � TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ly =� Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ® I l r P 11 W/ PERMIT NO. 4X Building Inspector: AUG 0 4 2022 Applications and forms must be filled out in their entirety.Incomplete BUILDING DEP`I: applications will not be accepted. Where the Applicant is not the owner,an TOWN OF SOUTHOLD Owner's Authorization form(Page 2)shall be completed. Date: 3�ZZ OWNER(S)OF PROPERTY: Name: 6•TEgE1\1 T?-,%TT>:*AJ SCTM#1000- Project Address: 2�ry� YCNtiEC6T7 —Dr2, r 50U-T1kjE-�, ,,,jy /1971 Phone#: Co y�.� �5"S7 Email:63,eV,n. Mailing Address: �y� CONTACT PERSON: Name: 6762uc /k Mailing Address: U, CUrC1 k vas 3S Phone#: (�3i-ygy-yZvs Email: gCln cD o-r-+on i; DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: CAk..U14 •-7U0L5 LTl�• Mailing Address:—�00, 30X q. ,. Cv7Cf4o4 UE1 1W I J 9 3 — Phone#: &31_ ilFrg/_ yaV6- IEmail: scc ,' Li (ZO—P C)n e,+ DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other -:77/�'a `dal.. $ s-q4 ODU Will the lot be re-graded? I,�Yes El No Will excess fill be removed from premises? kYes []No 1 y { PROPERTY INFORMATION 4 Existing use of property: P Intended use of property: /�v�r r2 z2rzx�c� 3 , - /7 -5&zx rw, etc .7w -2/4 L Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to G I ���'� this propertyr uYes,iNo IF YES, PROVIDE A COPY. I Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by p 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.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210A5 of the New York State Penal Law. Application Submitted By(pri t name): Authorized Agent El Owner Signature of Applicant: Date: C'�y/�Z STATE OF NEW YORK) SS: COUNTY OF )��T7 TLk being duly sworn,deposes and says that(s)he is the applicant (Name of ind idual signing contract)above named, (S)he is the & -�rv-ky- 4 (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 tk� 20� Notary Public SABRINA M BORN Notary Public,State of New York No.01806317038 PROPERTY OWNER AUTHORIZATION Qualified in Suffolk County (Where the applicant is not the owner) Commission Expires Dec.22,20�� I, S+e-u" GP46-41% residing at 2, 9yto Yeilte,4 Jr do hereby authorize to apply on my behalf to the To n of Southold Building Department for approval as described erein. z02 Z Owner's Signature Date en 6 r4 Print Owner's Name 2 ®w�FFOL BUILDING DEPARTMENT-Electrical lnspectc�c :TOWN OF SOUTHOLD Town Hall Annex-54375 Main Road -PO Box WJ92 4 2022 -- ;' Southold, New York 11971-0959 Telephone (631) 765-1802- FAX (631) 765-9502 r - ogerr _seutheldtewnnv.Nev- seand ccD-southoldtownny gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: - � Company Name: E eC —7,CC- Electrician's Name: ' License No.: L- 1 t-f-M E Elec. email: Elec. Phone No: request an email copy of Certificate of Compliance Elec. Address.: JOB SITE INFORMATION (AII Information Required) Name: uen Cn fG r1 Address: 2S40 v Cross Street: �,v \ Phone No.: Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Cl otnon Square Footage: Circle All That Apply: Is job ready for inspection?: YES❑NO Rough In Final Do you need a Temp Certificate?: YES DDVO Issued On Temp Information: (All information required) Service Size111 Ph❑3 Ph Size: A #Meters Old Meter# ❑New Service[]Fire ReconnectOFlood Reconnect❑Service ReconnectE]Undergroundaverhead #Underground Laterals 0 1 Q2 n H Frame Pole Work done on Service?. Y N Additional Information: PAYMENT DUE WITH APPLICATION BUILDING DEPARTMENT-Electrical Inspectar : r ii TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box %J92 4 2022 Southold,fNew York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerrP_southoldtownny.gov- seand@southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: ! Company Name: F D(fC --\�C_ Electrician's Name: - ` License No.: LA M E Elec. email: 3nLP 2, cc h.1 Elec. Phone No: request an email copy of Certificate of Compliance Elec. Address.: i JOB SITE INFORMATION (All Information Required) Name: f2icoen f� r1 Address: V Cross Street: Phone No.: BIdg.Permit#: Lk&;r6­7 email: Tax Map District: 1000 Section: Block: I-{- Lot: Sq as BRIEF DESCRIPTI N OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): �C1 � Square Footage: Circle All That Apply: Is job ready for inspection?: YES®NO ❑Rough In Final Do you need a Temp Certificate?: ® YES UJ40 Issued On Temp Information: (All information,required) Service Size®1 Ph®3 Ph Size: A #Meters Old Meter# New Service®Fire Reconnect®Flood Reconnect11Service Reconnect®Underground[3Overhead #Underground Laterals 0 1 2 M H Frame Pole Work done on Service? Y MN Additional Information: PAYMENT DUE WITH APPLICATION PERMIT # Address: Switches I Outlets I GFI's Surface Sconces H H's UC Lts Fans Fridge HW Exhaust Oven W/D Smokes DW Mini Carbon Micro Generator Combo Cooktop Transfer AC AH Hood Service Amps Have Used Special: Comments f J • + - SUFFOLK CO. HEAL H DEPT. APPROVAL .. . H.S. N�X )•cl-50-4$ MAP OF M-OPE-12T ` sm"m Comm f>Eum DICPmnxm '•. 5UIZVEYID POP xm OCT 031995 B. D. FJW. # /f:SZo fhe sMWO disposal and water 1 . . �YY. lacilitiea for this 'Location �PF haRre been AT �T UMP801ted hp this dsPaWttseat and foune StATEMENT OF WTEN'T � ie be satlsft atorf.t.J . � L _ _ "i THE WATER SUPPLY AND SE'wA4t:'DISPOSAL .> SYSTEMS FOR THIS RESIDENCE WILL f 01,A/N OF UT14O D NY emer of Centel Ensineerl im CONFORM TO THE STANDARDS OF THE _ C4t+v1 RNIt SUFFOLK CO. DEPT. OF HEALTH SERVICES. APPLICANT SUFFOLK COUNTY •DEPT. OF HEALTH } SERVICES — FOR APPROVAL Of' CONSTRUCTION ONLY DATE: 0 4 2��� D H.S. KEF. NO. 1'4- S:t'�-43 ` c APPROVED: 1B ILDING DEPT: 1 F�iO ` 3�.�✓ TO iq OF SOUTH(LL) SUFFOLK CO.TAX 04AP DrESIG"T`•XM! , J DIST. SECT._ _ BLOCK PG.i.. 10 ��,f..—P.. .,c' ��►.--t ��' �= 3 : - _ t OW'NERS ADDRESS: •,_... '�� � - - �� fly• � i �. ' • ' �-- � ` � } �,..C�:t�a`€' �2C}e?� sip 0 �'�j' •. •�i. 7 ?{' ,y .4.J ���)A�� {�+}�[ � it •.yw `�a a • �$•b o l �• r=,�• ` C tii W�'�i4�a.+.►i' �lri�eNU x /, fir,:' cP. H I. DEED. L.N/A P. Y �. 4.7fi�' 1.fp �f1/i (O `o . �� '� ` FLS:6 i SL 1+itJLS T T HOLE Aw y ..tv iJnoz,thorees b:terAtwn or addttFpr< ^ to this surve-j is a viasation,04 may,�� eduge n n La . ttt®M1etY Y�State t EtsuCBii¢�7 Law. , f•.� 01 Swi,gw,,w* 7el- ,,� Coaiss of this sunrey map trot beating 1 _ .. t5.�f= the tend s�„rrevor's 1.11w seat I 1 V��"�f�. amboss®d seat 0� 1I itoz be mt+atderod =e �.a ,t 7• to be a valid true.Copt, `►W S J 1�1A,GAt�IT yn��,�}r»y/�y , yy�� lyw eaz tD blis /d�h��p� it�t _ ""`�•"" '(� to the aasigrteea of the 6Meeotl ttaQ " ``• tution.Guarantm im �!tAP +`�*E .•', ? ; wer .�wst»etsti�s.4CG.22 f o V.afCfFOY1�/4� rr?'I1LlR .. .- _.......... -- _.�..,_� __ _ ,-_'�--_ •• - _- _ ,'+9Y1 YORK Workers' 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 carrier 1a. Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured CHITUK POOLS LTD 631-484-4245 PO BOX 9 CUTCHOGUE,NY 11935 1c.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to 113306347 certain locations In New York State,i.e.,Wrap-Up Policy) 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 PO Box 1179 3b.Policy Number of Entity Listed in Box"I a" DBL614067 Southold, NY 11971 3c.Policy effective period 05/01/2022 to 04/30/2023 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. 8/4/2022 g adw, ot Date Signed Y (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent ofthat 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 4B,aC or 56 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) 11111111 1111111 CERTIFICATE OF YEW Workers' NYS WORKERS' COMPENSATION INSURANCE COVERAGE STATE Compensation Board Insured Detail la.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Chituk Pools Ltd 631-734-7665 PO Box 9 Cutchogue,NY 11935 le.NYS Unemployment Insurance Employer Registration Number of Insured ld.Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Only required if coverage is specifically limited to 113306347 certain location in New York State,i.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Company Town of Southold PO Box 1179 3b.Policy Number of entity listed in box"la": Southold,NY 11971 WWC3563869 3e.Policy effective period: l/l/2022 to l/l/2023 3d.The Proprietor,Partners or Executive Officers are: included(Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"la"for --- 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 must notify Ilse above certificate Bolder and fire 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 titan nonpayment of premiums that cancel the policy or eliminate the insured from tine 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: Matt Zender (Print name of authorized representative or licensed agent of insurance carrier) Approved By: _ 2/3/2022 (Signature) (Date) Title: SVP Workers Comp Production Management 7 ® DATE(MMIDDIYYYY) ACC>o CERTIFICATE OF LIABILITY INSURANCE 08/04/2022 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 rights to the certificate holder in lieu of such endorsement(s). CONTACT Lauren Murphy PRODUCER NAME: Roy H Reeve Agency,Inc. AICNNo Ext: (631)298 4700 A/C No: (631)298-3850 PO Box 54 E-MAIL SS: Imurphy@royreeve.com 13400 Main Road INSURER(S)AFFORDING COVERAGE NAIC# Mattituck NY 11952 INSURERA: Valley Forge Insurance Company 20508 INSURED INSURER B: Chituk Pools Ltd. INSURER C: PO BOX 9 INSURER D: INSURER E: Cutchogue NY 11935 INSURER F: COVERAGES CERTIFICATE NUMBER: CL228417514 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ X Contractual Liability MED EXP(Any one person) $ 15,000 q 6018146726 03/15/2022 03/15/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- PRODUCTS-COMPlOPAGG $ 2,000.000 POLICY JECT LOC $ OTHER: AUTOMOBILE LIABILITY Ea accidentSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ El RETENTION RETENTION$ $ WORKERS COMPENSATION PER OTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N IA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE--EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Steven Grattan,2540 Yennecott Drive,Southold,NY 11971 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 AUTHORIZED REPRESENTATIVE Southold NY 11971 __1 ©1988-2015vvvvvv��+vVCOAC000��ORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Telephone Number of authorized representative or licensed agent of insurance carrier:CarrierPhone 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(9-17) www.wcb.ny.gov Workers' Compensation Law Section 57.Restriction on issue of permits and the entering contracts unless compensation is secured. 1.The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2.The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-17)REVERSE Additional Instructions for Form 1313-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in Box 1 a for disability and/or Paid Family Leave benefits under the NYS Disability and Paid Family Leave Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage(Certificate)to the entity listed 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 cancelled 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 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 NYS disability and/or Paid Family Leave benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or Paid Family Leave benefits 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 Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. DB-120.1 (12-21) Reverse kod AP ROVED AS NOTED DATE: B.P.# g ELECTRICAL BY: INSPECTION REQUIRED FEE: NOTIFY BUILDING DEPARTMENT AT 765=1802 8 AM TO 4 PM FOR THE FOLLOWING INS PECT'.ONS: 1. FOUNDATION-- TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOP, G.O. ALL CONSTRUCTi ON SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW "e°,� � LYY'"; YORK STATE. NOT RESPONSIBLE FOR ENCLOSE POOLTO.CODE;'.. DESIGN OR CONSTRUCTION ERRORS. ; j;{-UPON COMPLETION;.;-,-1'.. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF 9eqMnT-D70WMl1WNG BOARD ,, u l N i RUSTEES JCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE -)F OCCUPANCY NOTES: 1. DIVING BOARD TO CONFORM WITH ANSI/APSP/ICC-5 SEC 6 2. NO SOIL DISCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION 3. POOL MUST BE SURROUNDED BY A CONTINUOUS BARRIER CONSTRUCTED IAW REQ.OF SEC 326.4.2.1-R326.4.2.6 OF THE NYS RESIDENTIAL CODE(2020)AND ALL SECTIONS OF THE SOUTHOLD CODE 4. WALLS MAY SERVE AS PART OF THE POOL BARRIER AS PER SEC 326.4.2.8 AND ALL WINDOWS HAVE A SELF LATCHING DEVICE 5. ACESS GATES SHALL COMPLY WITH SEC R326.5.2 OF THE NYS RESIDENTIAL CODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY LOCKED WHEN POOL IS NOT IN USE OR SUPERVISED. ALLL GATES ARE TO OPEN AWAY FROM THE POOL AREA. 6. DURING CONSTRUCTION THE CONTRACTOR SHALL ERECT A TEMPORARY BARRIER AROUND THE EXCAVATION IAW CODE OF THE TOWN OF SOUTHOLD. 7. POOL MUST BE EQUIPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING ENTRY INTO THE WATER AND SOUNDING AN AUDIBLE ALARM WHEN DETECTED THAT IS AUDIBLE AT'THE POOLSIDE AND INSIDE THE DWELLING.THE ALARM MUST BE INSTALLED,MAINTAINED AND USED IN ACCORDANCE WITH TEH MAUFACTURERS INSTRUCTIONS.THE ALARM MUST MEET ASTM F2208"STANDARD SPECIFICATION FOR POOL ALARMS".THE DEVICE MUST OPERATE INDEPENDENT(NOT ATTACHED TO OR DEPENDENT ON)OF PERSONS. 8. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIIMERS)MUST BE PROVIDED WITH A COVER THAT CONFORMS TO ASME/ANSI Al12.19.8M OR A MINIMUM 18'X23"DRAIN GRATE OR A CHANNEL DRAIN SYSTEM.POOL CIRCULATION SYSTEM MUST BE EQUIPTED WITH ATMOSPHERIC VACUUM RELEIF.SUCH VACUUM RELIEF SYSTEMS SHALL CONFORM WITH ASME Al12.19.17 OR BE A GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD.POOL SALL BE PROVIDED WITH A MINIMUM OF 2 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 IS DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS).VACUUMIPRESSURE CLEANING FITTINGS SHALL BE INACCESSIBLE POSITION,MINIMUM OF 6"AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENT TO THE SKIMMER/SKIMMERS. A REQUIRED POOL ATMOSPHERIC VACUUM RELEIF SYSTEM SHALL BE INSTALLED AS PER NYS RESIDENTIAL CODE R326.6.3(2020)AND IN ACCORDANCE TO TOW CODE 9. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF NFPA 70(NEC),PRINCIPALLY ARTICLE 680 AND THE NYS RESIDENTIAL CODE SECTION 4102 THROUGH 4106.ALL ELECTRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS LABORATORIES AND BE PROTECTED BY A GOUND FAULT CURRENT INTERRUPER(GFCI).CURRENT CARRYING ELECTRICAL CONDUCTORS EXCEPT FOR THOSE PROVIDING POWER TO POOL LIGHTING AND POOL EQUIPMENT 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 WITH AN ELECTRICAL CIRCUIT SHALL BE EFFECTIVELY GROUNDED. 10. WATER SOURCE FILLING THE POOL SHALL BE EQUIPPPED WITH A BACKFLOW PROTECTION DEVICE IAW NYS PLUMBING CODE 608. 11. ALL PIPING IS DIAGRAMMATIC UNLESS OTHERWISE STATED. 12. WALKS,IF PROVIDED SHALL BE NONSLIP AND SLOPE AWAY FROM THE POOL EDGE. 13. A MEANS OF EGRESS FROM DEEP AND SHALLOW ENDS MUST BE PROVIDED IAW ANSI/NSPI-5 SECTION 6. 14. CONTRACTOR TO PLACE THE POOL IAW TOWN OF SOUTHOLD CODE SETBACKS. 15. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SUBJECT PROPERTY. 16 THE DESIGN IS BASED ON A�RAINAGE SOIL WITH<10%SILT.GROUND WATER SHALL NOT EXIST WITHIN THE EXCAVATION. IF GROUND WATER EXISTS WITHIN 60"FROM GRADE,DEWATERING FACILITIES WILL BE REQUIRED. 17 ALL GAS AND OIL WATER HEATERS(IF INSTALLED)FOR THE IN-GROUND SWIMMING POOL SHALL BE NATIONAL APPLIANCE ENERGY CONSERVATION ACT(NAECA)COMPLIANT.POOL HEATERS SHALL BE TESTED IAW ANSI Z21.56 AND SHALL BE INSTALLED IAW MANUFACTURERS SPECIFICATIONS.OIL FIRED POOL HEATERS SHALL BE TESTED IAW UL726.POOL HEATERS SHALL BE LOCATED OR GUARDED TO PROTECT AGAINST ACCIDENTAL CONTACT OF HOT SURFACES BY PERSONS.POOL HEATERS SHALL BE PROVIDED WITH TEMPERATURE AND PRESSURE-RELIEF VALVES.A BYPASS LINE SHALL BE INSTALLED FROM THE INLET TO OUTLET TO ADJUST WATER FLOW THROUGH THE HATER.POOL HEATERS SHALL BE PROVIDED WITH THE FOLLOWING ENERGY CONSERVATION MEASURES: 17.1 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW SHUTTING OFF THE OPERATION OF THE HEATER WITHOUT ADJUSTING THE THERMOSTAT SETTING AND TO ALLOW RESTARTING WITHOUT RELIGHTING THE PILOT LIGHT. AT LEAST ONE THERMOSTAL MUST BE PROVIDED FOR EACH HEATING SYSTEM.HEATED SWIMMING POOLS SHALL BE EQUIPTED WITH A POOL COVER.(exempt FROM THIS ARE OUTDOOR POOLD)DERIVING 20%OF THE ENERGY FOR HEATING THE POOL FROM RENEWABLE SOURCES OVER AN OPERATING SEASON. E j; 11 17.2 TIME CLOCKS SHALL BE INSTALLED SO THE PUMP CAN BE SET TO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS,AND CAN BE SET TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN A AUG 0 4 2022 CLEAN AND SANITORY CONDITION IAW APPLCIABLE SANITORY CODE OF NEW YORK STATE. 18 BACKFILL WILL BE DONE WITH CLEAN EARTH FREE OF ROOTS AND DEBRIS. BACKFILL HEIGHT AND WATER LEVEL TO BE WITHIN 8"OF EACH OTHER. PLACE CONCRETE ON SANDY LOAM SOIL. CLAY TO BE REMOVED AND BUILDING DEPI: REPLACED WITH SANDY LOAM. TOWN OF s a UTH.0 LD 19 THERE ARE MAIN DRAINS IN THIS POOL.THERE ARE TWO APPROVED SUCTION OUTLETS WITH A MINIMUM OF T OF SEPARATION. THE SUCTION OUTLETS ARE PIPED SO THAT WATER IS DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM-RELEIF-PROTECTED LINE TO THE PUMP.COMP I • WITH ENTRAPMENT PROTECTION AS PER CODE. 20 THE POOL WAS DESIGNED REFERENCES AS THE FOLLOWING: 20.1 THE RESIDENTIAL BUILDING CODE OF NEW YORK STATE(2020)SEC R326 OE EPv Yv 20.2 THE ENERGY CONSERVATION CONSTRUCTION CODE OF NEW YORK STATE(2020)SEC R403.10 �- D E 20.3 THE FUEL GAS CODE OF NEW YORK STATE(2020) � •...art"`� '.:�,'fa�. r r ;:i ' o 20.4 THE NEW YORK STATE SANITORY CODE. JJ; � 20.5 ANSI/APSP/ICC-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. uFO •s, ��� POOL NOTES SCALE: NTS 20.6 BOCA CODE SECTION 421. p P JAMES DEERKOSKI, P.E. 20.7 CODE OF THE TOWN OF SOUTHOLD RoFEs 260 DEER DRIVE DATE: 101212020 MATTITUK, NEW YORK 11952 DRAWING NUMBER 2 OF 2 . :. :.. _. PODL6G� .withstep''• '/�. t.8�. - C . :6 E.' F, G'. H •K '•'L.' :.•O> �- N. BSI" . 1440 1434: .14.; .'30 -3••4 6'6• 6 _14- 6. ':4._ '4: 6•:AW $�, 12900 . .. _ .i6iQ&.� .�6�LiZ;• 16 ''2a': 3'=4r.:-6' '. -;:6.. .:.1t: .::6: :,4'..::4 •8-.' '4'-0".:'T-4`," �3200 i6#R 16 'so: i8 4";i6 6�' :%.4_ •:.8'':4;'• :4.:": 4. :,.8•' 4:0"•:T,�t` :9�00 ' : -• _ -• � 16Y30` :°' 6iA4; - '"1fi: ..30:� 3'yt". 6'�`: :.8- •:I?�•: :6 ;;4:: ;.:4.�..8-� 4-0''-:Te4`?14000 . :.'.'. • .�: -SS00 •..10iQ6';.. �.10>�0�... 1p..•"qs;.3'=4`;':;4''• .:6':. '.4.:..��:'4� ::Z:"' 2. ;,fi'::�2�• :7="4;. . _. :A, t4%�i12900 ". 1aQ6:;_- " -.•121Gi0^_ ..12. �..16[ 3'3''. 6=6' .•6': 10' :-6-- -`4.:. :�'¢: .yy��� :;�: :: i :�;• i:K:'. :.:L' .:1�: _:..'� .:•:: �. :".165¢6: . -'x,16X30;, .-.16.. :ss. '44'::6'6" =6:;. 10;' •`:65. '•4.' '=.:4 8:.;"4:b'-.T4: 13000 _ ;.r.:: a. �• a .. ° �'•�° 'I6' 7�°: :: :' 68 1b' y "12 .'4:' - !t.=: ". ... _ •.1�Q:�, 14_-. :'20: ..����. :fi, 4'-0".:T�4'"':4000 • _:1121 :,:;- :;�7�:::: 12` 3 t�` . �° B: 4 -GP : ..2g... _ �2 . ago^ rr1'.::aiaao • - . tf"►" � Z�': '3'�B`• :7�'� 1P�! ��° '6'3° -4`.•�_- ���`.: .S'� .+��TM �':6�`�•711'1?;• �..7 .:::" •.z�cii:.: �.;.2�a6::_ .za: :az �:3~•a•� :;s•. .:1a-: :�2::=:u•. `_a= :.�,..;:�z.;4~�•�:z s;:zt000' 1®c42r.. ��R ;T i6wO - `•i6(J0.,: IW.4:• :18 30 34b - : :6 :Y0 . `.SG::' 4::' :4 r+i9Fti•4_ ^4' ®� ioae' .Iwz' to= �;': 4E•=' :46 �,�:, :i' :fq:`; :. "F•Z"''G}':4'b. 7'-4`'2f00" t, q _ MiAr. ems �a •fir... g . .•�. = 3'4° 7�•1�` �1' 4=�' '4'-1N ` -11i` ':®',7.7AC' <_ `49. •.d moo: somas -leas=esRiioibae�s:.� : .. _�:: ::• •.:.:+� �.. _ , ... �: "' � 0Oo s�� � I�t �." - ...• iBa/3� pro o�e�'.+ .;- t t • en.v�au>a� saw - oB� v0000 AmN DMNG BOARD" �,� K : il&fi:�ID9ffi idslow a ,. POOL P 1�9 - apt - . . • To a TYPICAL6u�¢®� E — CORNER C®NNECF10N DETAIL Map III®9 am - cs . E`py �Q� POOL SECTION • 1 Complies.With �. - - . .. �� ,i,o•� � � ' 2020 Code Section 3032.1 303A Swimming Pools,Spas and Hot Tubs Section"R326 of theResideritial Code of New York ' =-----------=isi------------- Section 3109 of the Bdilditig'Code of New York { Section N1103-12(R403.12)Residential Pools and Permanent Residential Spas POOL ME:RECTANGLE . REV. " SCALE: :NIS- Section 31093.12--3.109 7A..Pools and Spas Gates,Barriers JA ES®EERK®5��'P•� Section G106 Entrapment Pro#ection DATE. TYPICAL EL�`�OFNER section G107 Alarms 260 DEER®RIVE Section E42U1—E4312 Electrical ConneLfioos for Pools MATWUK,NEW YORK 11952 DRAWING NUMBER OF. 1