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HomeMy WebLinkAbout48404-Z ��o�OS�FFQt'�coGy Town of Southold 2/18/2024 0 P.O.Box 1179 V' 53095 Main Rd Way o�� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45003 Date: 2/18/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 630 Nokomis Rd, Southold SCTM#: 473889 Sec/Block/Lot: 78.-3-19.2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/12/2022 pursuant to which Building Permit No. 48404 dated 10/14/2022 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 Nyren,Alexander&Rittberg,Kim of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL 1 ELECTRICAL CERTIFICATE NO. 48404 8/31/2023 PLUMBERS CERTIFICATION DATED fi A or ze 9 gnature TOWN OF SOUTHOLD y BUILDING DEPARTMENT y TOWN CLERK'S OFFICE .be X+ -V 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#: 48404 Date: 10/14/2022 Permission is hereby granted to: Nyren, Alexander & Rittberg, Kim 75 Henry St Apt 25H Brooklyn, NY 11201 To: construct accessory in-ground swimming pool as applied for. At premises located at: 630 Nokomis Rd, Southold SCTM #473889 Sec/Block/Lot# 78.-3-19.2 Pursuant to application dated 9/1/2022 and approved by the Building Inspector. To expire on 4/14/2024. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector OF SOUI��I � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q Southold,NY 11971-0959 �� • �o sean.devlin(crD_town.southold.ny.us �4Coum,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Alexander Nyren Address: 630 Nokomis Rd City:Southold st: NY zip: 11971 Building Permit#: 48404 Section: 78 Block: 3 Lot: 19.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Bethel Electric License No: 40557ME 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 X Attic Garage INVENTORY Service t 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 A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Intermatic Pool Panel 8 Circuit/6 Used, AutoCover 115GF1, Timeclock, Heater250, Salt Generator, 2 Lights 120GFI, Pump 220GFI Notes: Pool Inspector Signature: Date: August 31, 2023 S.Devlin-Cert Electrical Compliance Form OF SoUl�o �o � OF Ato # # T W OF SOUTHOLD ILDING DET. °`ycourm,N�' 631-7654 802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/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 REMARKS: OK DATE o INSPECTOR OF SOUTyo� TOWN OF SOUTHOLD. BUILDING DEPT. `yooulm,��' 631-765-1802 'INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] NSULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL Po�� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 00 ()(Vv�-�l OV v DATE Y INSPECTOR OE SOUj6 .5 0 x-r TOWN OF SOUTHOLD BUILDING DEPT. `ycou 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] 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: �4 A a o-Arl 4 a✓zIl 449�e&r DATE ��° 12-3 INSPECTOR cN" OF SOUTy�6 �'� - # # TOWN OF SOUTHOLD BUILDING DEPT. IOU ��' 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: A Ltn cc -J-\ A 1"V,A, t Ll L //I" Le 4 v(�- & DATE �� INSPECTOR laF SOGT �..(�� V / V * # .TOWN OF SOUTHOLD BUILDING DEPT. courm, 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: DATE 1 .2-3 INSPECTOR '4F' � 1 I • �` A R I i t A _ l�ls� No� )Mx(s t'd .�u+tcN � 4S4c� 1 N I E Z f . ti _� .. .� , �� � FIELD INSPECTION REPORT DATE COMMENTS ro 0 FOUNDATION (1ST) -------------------------------- FOUNDATION (2ND) z �o 0 ROUGH FRAMING& PLUMBING v � •n r s � INSULATION PER N.Y. ' STATE ENERGY CODE ✓ co*- FINAL ADDITIONAL C MMENTS o 7 �� 2-s Pat't o Olecfi- c ✓en c- o4sga - z S ' r ro y N O x x d ro gUfFO(,� TOWN OF SOUTHOLD—BUILDING DEPARTMENT �o y� h Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 oy�o ao�� Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny_ v_ Date Received APPLICATION FOR BUILDING PERMIT For Office Use OnlY PERMIT NO. r0 Building hspector: SEP 12 202 Applications and forms must be filled out in their entirety. Incomplete BUILDING DEPT. applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. TOWN OF SOUTHOLD Date: q (y ZZ OWNER(S)OF PROPERTY: Name: SCTM#1000- "� ?j •. LCr . 'Z Project Address: 3 U _c IC_G Phone#: "l l—�� �o(�� '-u_s� Email: iVh_ __ _Je•�-�i- Mailing Address: 3 p h-L a I CONTACT PERSON: Name: Mailing Address: 351y U(j`tl'_fGv,S Phone#: � � I —S�� — (3oG Email: �-l--e �(S •cic, DESIGN PROFESSIONAL INFORMATION: Name: ::� Cr vH.P 5 jGv-s 1G Mailing Address:2&U ems( _� 4al!C Phone#: CONTRA TOR INFORMATION: Name: Mailing Address: Phone#:G3 /_ Email: DESCRIPTION OF PROPOSED CONSTRUCTION ew Structur ❑Addition ❑Alteration ❑Repair ❑Demolition Estir_ted Cost of Project: ❑Otherlr-% t.� w. ; -�. $ �5 Coo, Will the lot be re-graded? ❑Ye o Will excess fill be removed from premises? es ONO- 1 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covena is and restrictions with respect to G this property? ❑Yes�Vo IF YES, PROVIDE A COPY. ❑ 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.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law. Application Submitted By(p Int ame). Authorized Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) COUNTY OF S e �Ga ►-4"Y1he,n being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the (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 6—day of 5 20 —7 Nota Public GREGORY PINTO NOTARY PUBLIC,STATE OF NEW YORK N 55 PROPERTY OWNER AUTHORIZATION QUALIFIEDD IN IN SUFFOLFFOLK COUNTY MY COMMISSION EXPIRES APRIL 14,2 Where the applicant is not the owner) I, ; m 4 residing at JG✓-��'1� do hereby authorize {�.l? h 01 / 41 to apply on my Vallf to:it; old i Department for approval as described erein. 6 2z Owner's Signat Date u a .4 Print Owner's Name 2 CONSENT TO INSPECTION �,��"" ``� e✓ the under si e signed, do(es)hereby state: Owner(s)Name(s) That the unders geed(is) (Fe)the owner(s) of the premises the T=-I f Southold, located at C> G C�Gv� ; S Q A �G v which is shown and designated on.the Suffolk County Tax Map as District 1000, Section `d 'Block 3 , Lot 19 , -Z That the undersigned(has) (have) filed, or cause to be filed, an application in the Southold Town Building Inspector's Office for the following: auk-:c- That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and'all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances,rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances, rules or regulations of the Town of Southold. Dated: 2 y 12 2 Gvv� (Signa e Kim f (Print Name) (Signature) (Print Name) �O�aSUFFptkco BUILDING DEPARTMENT- Electrical Inspector Gym TOWN OF SOUTHOLD c =` Town Hall Annex- 54375 Main Road - PO Box 1179 o s Southold, New York 11971-0959 yfj O� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerrCo)southoldtownny.gov- sea nda-southoldtownny.aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (A!!Information Required) Date: �j Company Name: Bethel Electrical Contracting, Ltd. Electrician's Name: viateur Pilon License No.: ME-40557 Elec. email: Bethelec@optonline.net Elec. Phone No: 631-750-6555 EZI I request an email copy of Certificate of Com_'Iyiap�,nce. Elec. Address.: 1337-8 Lincoln Avenue Holbrook, NY 11741 JOB SITE INFORMATION (All Information Required) Name: ALE5X a- 1<lPA NV M Address: c: r7fKl oA 564tAdA Cross Street: � , W. erVlr��- Phone No.: A)4x; 1 Bldg:Permit#:. - email: Tax Map District: 1000 Section: -'j Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Swimming Pool Wiring Square Footage: Circle All That Apply: Is job ready for inspection?: v YES ❑ NO ❑Rough In v Final Do you need a Temp Certificate?: ❑ YES ✓0 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? OY N Additional In gin: Rlease call our office wit►i an inspection date�and`"tfie�Homeowner,for;.inspection access - �Tliank', PAYMENT DUE WITH APPLICATION l b8 S1(4 23 Y--c_4 t C 5-4 0 ��S�FFp1,�co BUILDING DEPARTMENT- Electrical Inspector �y4 Gym TOWN OF SOUTHOLD z Town Hall Annex- 54375 Main Road - PO Box 1179 co ^7 Southold, New York 11971-0959 Oy,�o� 41� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerrna southoldtownnv gov'- seanda—southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: �j Company Name: Bethel Electrical Contracting, Ltd. Electrician's Name: Viateur Pilon License No.: ME-40557 Elec. email: Bethelec@optonline.net Elec. Phone No: 631-750-6555 01 request an email copy of Certificate of Compliance Elec. Address.: 1337-8 Lincoln Avenue Holbrook, NY 11741 JOB SITE INFORMATION (All Information Required) Name: At-5X. �1- 1<I►`IN M Address: G 50 011'6m c-, '50 d e M-7 Cross Street: 2jA UU f- ANto.ve, Phone No.: A)--Q-xf J Bldg.Permit#: 6- email: Tax Map District: 1000 Section: —76 Block: '2.> Lot: �a BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE.FOOTAGE (Please Print Clearly): Swimming Pool Wiring Square Footage: Circle All That Apply: Is job ready for inspection?: YES ❑ NO ❑Rough In Y 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❑Underg round❑Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: Please call our Office with an inspection date and the Homeowner for inspection access -Thank you! PAYMENT DUE WITH APPLICATION 00 sl f 4 23 r.e c- l o 4-5-4 c� y �4 ��� � 2fr� ,� r � 2�' 2 ��' �rn�4c/ �v �u�ri � �v� I �� S.C.T.M. N0. DISTRICT: 1000 SECTION: 78 BLOCK: 3 LOT(S): 19.2 _ I LAND N/F OF I BYRAN TREHARNE I U.P. I213.52' MOH. 0 E N 85059'00 3 MON. O _ w .p° p ? to O \C) d � P O rn ° O IV �17 � SHED CD Z 14.2 z w LAND N/F OF BRICK WALK � ASPHALT DRIVEWAY JOHN PECHA '8 0' 22 0. N a O N 5.0 39.3'' o F 1 w q _ 9.0'E LL v _ wooD DECK 3 �- a ` 28.5. � m m W or M o (� a7 �0 1 STY FIR J X m© DRAIN (1 n DWELLING 1.2 w � (Y _` #630: � In rj "a � 78�—m�, m v $2 �� 45.5' O LAND N/F OF DALE ELAK LP GAS �\ 5r0kE DRIVEWAY 3 l� w o�eRyFq o V_ Ll N O` P o MON. CN O z 220.60' MON. h1 S 8505910011 W $ O LAND N/F OF RICHARD HOKANSON HIAWATHA'S S ]PATH THE WATER SUPPLY, WELLS, DR YWEL L S AND CESSPOOL LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 27,661 .77 SQ.FT. or 0.64 ACRES ELEVATION DATUM: UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR'WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUfURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO. ALEXANDER P. NYREN; MAP OF: KIMBERLY R. RITTBERG; FILED: FIDELITY NATIONAL TITLE INSURANCE SERVICES, LLC; SITUATED AT:SOUTHOLD TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK a_. Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 PHONE 631 298-1588 FAX 631 298-158 8 FILE # 220-60 SCALE: 1"=30' DATE. DUNE 2. 2020 ). ( � .. .. .. ... DUNRIA CERTIFICATE OF LIABILITY INSURANCE D04/06/2022Y) 04/05/2022 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 endorsements. PRODUCER 845-783-2555 c TACT Walter Rose Agency Inc Walter Rose Agency,Inc PHONE ' 845-783-2555 FAX 845-783-2425 8 Stage Road ac No Ext: A/c No Monroe,NY 10950 E-MAIL •lisa@walterroseagency.com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Utica National of Texas 43478 INSURED INSURER B Central Mutual 20230' Dunrite Manufacturing Corp Dunrite pools INSURER C 3510 Veterans Memorial Highway Bohemia,NY 11716 INSURER 0 INSURER INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH:POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPEOFINSURANCE ADDL SUB POLICYNUMBER PLICYEFF POLICYEXP LTR O LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE �OCCUR. CLP 9791864 04/01/2022 04/01/2023 DAMAGE TO RENTED 300,000 PREMISES(Ea o MED EXP(Anyoneper-son) 51000 PERSONAL&ADV INJURY 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE .2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 idntl X ANYAUTO 4822099 12.131/2021 12/31/2022 BODILY INJURY Perperson) $ OWNED SCHEDULED AIUTOS ONLY AUTOS -BODILYBODILY INJURY Per accident $ ALTOS ONLY AUTO ONLY Pe�eccRnt AMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ WORKERS COMPENSATION PER JTE OTH- AND EMPLOYERS'LIABILITY Y/N STATL OFFICERIMEMBER EXCLUDE(CUTIVE El NIA E.L.EACH ACCIDENT (Mandatory in NH) E.L.DISEASE-EA EMPLOYE K 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) Swimming Pools -Installation,Servicing Or Repair-Below Ground CERTIFICATE HOLDER CANCELLATION SOUTH02 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. 630950 Route 25 PO Box 1179 AUTHORIZED REPRESENTATIVE Southold,NY 11971 ACORD 25(2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD m� workers'�, CERTIFICATE OF INSURANCE COVERAGE Comperssation 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 1 a.Legal Name 8 Address of Insured(use street address only) 1b.Business Telephone Number of Insured DUNRITE MANUFACTURING CORP 3510 VETERANS MEML HGHWY BOHEMIA,NY 11716 1c.Federal Employer Identification Number of Insured or Social Security Number , Work Location of Insured(Only required Ycoverageisspecfrcafty Hinted to' certain locations in New York State i.e.,wrap-up Policy) 112245133 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPolnt Life Insurance Company Town of Southold 530950 Route 25 3b.Policy Number of Entity.Listed in Box'"1a' PO Box 1179 DBL593730 Southold, NY 11971 36.Policy effective period 01/01/2021 to 12/31/2022 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,[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 12/15/2021 By lU'r (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 Bois 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 4S,4C or 55 have been checked) State of New York Workers' Compensation Board According to information maintain wit ed by the.NYS Workers'Compensation Board,the above-named employer has complied h the NYS Disability and Paid Family Leave Benefits Law(Artide 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workene Compensation Board Employee) Telephone NumberName 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. oB-120.1 (12-21) BIIIII'iiuo1A2ii0iiii1iiiiii1iei-i21)ii0l� ' ='�-`�► =U%':�r _�t\�`!f!I)'r -iii�a.-�J.;u r •�� U' r.r)'�S '." I'�•itl. r yrS, e" -' ,+^:�d=1 Ir rlyir L 1'.li'•" � _ �' S; r � ' ••c r S• s "'_�iti r•.1. �i?i t �E. is' r: nyc;-t'r a rr•.�: , ,,. .. .."'u —•.v r - $cam18i lditaicToaS� U✓. t►t► r_ - =�t� 1frrit _ ytttil Srrr `' :• fill M rI � :_ '?n � � cd°R 11 i�='>��` :•' �'t^�r`yl'� ,, f :.. ��� ."ri�'tlrri?�3n�•s:� ., /`; moc-•.m����._ ;�y/nsaG�t``::u�u'�,�y.,� �'�� �y:�uour�.;,h��"�y11 �t�i' � w y�, � .. .,'+y• <i-�t, "t'"Tt•�=A t 41."-`111 ��,'� �,.�. ,,p� •. %� ��yy �J.' t� "�'�'I,t � L1 lyi, . .':3��•Irv. „Z, (�(((�-' ` l i"-� i/L' �;u -Kr"a t' ,YI �� 'y,+r', �`�"'I,�rr`t.l�l '� "^.,1= i��;id ��X • '!(`S"ci ��'. }+'+@-�' �"�:- :'L ' ` u11„ *73.4„'Y-YL'ti'?:14!•fN71tLf26`J.(f4'4xkYdt�7NCQ;'XN:4Yf.7f.'11Q4N!/�N�/S?ii3YL(.J'd:VAt!g1TXllWd1L.'1l'f.w5tb'9LxfYt4Gl'.t'.9.lRN/.1V_Q�r:L`:d:WLffi'lN.Y. ,l - ' 1M. � '�. -:� ,�ll.�il\� �'' �� ,,,� .�. ___—_ 4?11T4"A 9„4C1Y+N':.^J6'7CelitW4S7W11='::2C[2N�f11�8W7'h1Y&:fftiYl6;'R:'U,L{<'?:{;,J•.L!Q!9t! u` In - !N.'.V'L'1.:5!WSYiJ.^.11larvnlNJr5Y1L't•U^'t! I A:Y rw� ::'/• . � I• •Rl.'E`�5•:1!...;hYJM:<C556�J.k!1k:' .tf• �' T _ Su olk Count ff .Department of Labor, Licensznn} • '.q 19ffalrs 4� Consumer U VETERANS MORTAL HIGHWAY ' �T .•:s„ ME � HAUPPAUGE,NEW YORK 11788 ATE ISSUE I 'k D D: 3/1/1977 WI" ' No. 3585-K OLK COUNTY BUFF Improvement Contractor License.moo � f� This is to certify that s' z� KE t• NNETH J BARTHMAN . do�ng-business as ]DUNRITE MANUFACTURING CORP %- having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws rules and regulations.of t1ie.County of-Suffolk, State-of New York is hereby licensed to conduct business as a HOME I ,.,�•I; IMPROVEMENT CONTRACTOR, in'the County of Suffolk. jtlt x ` =u f License Category. I �• t • 1 ` . Additional-Busiriesses Pools/Spast' '+ :� .. �--••fit.-•-�u Y' .P �' •' �'i . s L. La6oi;•'Gticensfng>8elCon'sai ier'Afifaii§• DLNRUE•PooLS I fit• ta;-... (,� • ."Halite'. S f �� � ' K. N `r(f XtE4R711tviAtJ I Y Commissioner Fhis�'eertifes''thaS:t�ie - � �• ". ieareris%duo :lic rytse'lJ f)UNRI F ?tv1AlY 1FAP.T.URING;COFtP•ABA , �y'LheiCoeinty<oVstaffatk" t icnSQ'NtlFr} er:j :35$'S• ��1,;:.�� f� � 77 120 - \`"` vi.l'• iry � a ,, 'k .. Ytroi'mrmmSnmc-' �' ^' ea•.mrr,+Tr:rn•-.•�• ,,,,��1ry ti `� Ptt ail t1.47S:>•NA1R1 UtP,Stu,1dYrS6:•Ylll/p+ 7 r Ul1P' i@ ' + \ �'�� �.�;: '!�r':rl 1�;:,�',•"�• .�/ 1� � 4t+tbn+Jr!1) UU r .,1 N1NANll 6, 1 fU{ t �.tR' tUtt \S . 71n' :+: V a,i \ �r • T `+'aS,:t.,I: "tt ++: 'rr I•g t:; y } -?�-•-".� , ,+uv>rw ut< .M.a,F,. ,uN n '•m v' ,tt N. ��p .. � ttt .:. •3 �t.y!3f% i. `' :�'»'1 v t..rr 1 I:'•' N u r N:•• 'tawr.^.ev:r rr A t -�,•- '=�'''.�ia ..rr-n•' :'i a,.,*}. E,..^!. •-. �,. _,�+���� "' .�r�, + '.¢..!.•t?'� ' :..�1 ;1 v �1 rS 1 N;::.. ��,f .,,,�� �r., �, ,r^•.•�` z�'r`�,., �•� ' ;►.:.tJ" n"1�� �f. +4't:!%.�i.ar'..�;' .. 4 � � T��' Rh• N Workers'' CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE s°ATE Compensation COVERAGE Board la.Legal Name&Address of Insured(Use street address only) 1 b.Business Telephone Number of Insured 516-543-1616 Dunrite Manufacturing Corp ; 3510 Veterans Memorial Highway 1c.NYS Unemployment Insurance Employer Bohemia,NY 11716 Registration Number of Insured Work Location of Insured (Only requlred If coverage is specifically limited to certain locations In New York State,Le.,a 1d.Federal Employer Identification Number of Insured Wrap-Up Policy) or Social Security Number 112245133 2.Name and Address of the Entity Requesting.Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Am,Trust Insurance Company of Kansas Inc Town of Southold 3b.Policy Number of entity listed in box"1 a" 530950 Route 25 KWC1223367 PO Box 1179 Southold,NY 11971 3c. Policy effective period 10/20/2021 to 1020/2022 { 3d. The Proprietor,Partners or Executive Officers are ®included.(Only check box if all partners/officers included) x all excluded or certain partners/officers excluded. i This certifies that the insurance carrier indicated above in box'"3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers'Compensation Law,(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The Insurance Carrier will also notify 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-Certifrcate 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 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: Kevin McDonough (Print name of authorized representative or licensed agent of insurance carrier) Approved by: �e d r'- 10/132021 (Signature) (Date) Title: President of Walter Rose Agency,Inc Telephone Number of authorized representative or licensed agent of insurance carrier: 845-783-2555 _ Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-17) www.wcb.state.ny.us � S 4� I APP OV�D AS N TED DATE: P.# RETAIN STORM WATER RUNOFF FEE: , . - BY: PURSUANT TO CHAPTER 236 NOTIFY--BUILDING DEPARTMENT AT OF THE TOWN CODE. .765°1802 8-AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE ELECTRICAL2. ROUGH- FRAMING & PLUMBING 3. INSULATION INSPECTION REQUIRED 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 DESIGN OR CONSTRUCTION ERRORS. 7° rILY!! ENCLOSE POOL TO CODF_,y f' °x'UPON COMPLETION, t; Er "WATE a: COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF Si T LDIOMIPIIANNING BOARD Wl li'N TRUSTEES 1-1000PANCY OR USE IS--UNLAWFU.L `WITHOUT CERTIPICA - ,)r: OCCUPANCY ,�� ►y-ti POOL SIZE WITH STEP A B C D E F G H K L M GALS FLICfdJMI 1OX16 IOX20 16 16 3-4* 4' 6 4 4 2 2 6 2'-0' 5500 RUBBp IOX28 1OX32 18 28 3-4' 6'-6" 6 12 6 4 2 6 4'-O" 12500 3/8• REINFCRCING ROD 12X24 12X28 12'-0' 24'-0' 3-4' 6-0' 6'-0' 8'-0" 6'-3" 4'-O' 4'-0" 4'-3' 4'-0' 9050 12X26 12X3O 10 26 3'-4' 6-6" 6 10 6 4 4 4 4'-0' 12900 13X26 I 13X30 0-0' 26-0' S-4" 6-0' 8'-0' 10'-0" T-3' 4'-0' 4'-0- 6'-3" 4'-0' 11600 1-1 ' 14X20 14X24 16 20 S-4' 6'-6' 4 8 4 4 4 6 4'-O" 9000 14X28 14X32 14'-0" 29-0' 3-4' &-0' 8'-0' 12'-0" 4'-3' 4'-0" 4'0' 6'-3' 4'-0' 12100 DIVING BOARD 14X30 14X34 14 30 3-4" 6'-6" 6 14 6 4 4 6 4'-0" 12900 4'A16X20 16X24 16 20 3'-4" F-6' 4 8 4 4 4 8 T-0" 9500 16X24 16X28 16'-O" 24'-O' S-4' T-O' 6'-0" 8'-0" 6'-3" 4'-O' 4'-0' 8'-3' 4'-0' 13750 ym. N O 16X26 16X30 12 26 3'-4' 6'-6' 6 10 6 4 4 8 4'-0' 13000 mw STFERATICN 00 16X28 16X32 16 28 T-4- 6'-6" 6 12 6 4 4 8 4'-0- 13200 16X30 16X34 16 30 3'-4- 6'-6' 8 12 6 4 4 8 4'-0' 14000 16X32 16X36 16'-0" 32'-0- S-4" 8'-0- 9-6- 13'-6" 6'-3- 4'-0' 4'-0" 8'-3- 4'-0' 19500 16X34 16X38 16'-0' 34'-0' 3'-4' 8'-0' 10'-6" 13'-6' 6'-3" 4'-0' 4`0' 8'-3' 4'-0' 20900 16X36 16X40 16'-0" 36'-0" 3'-4' 8'-0' 14'-0' 12'-0" 6'-0- 4'-0" 4'-0- 8'-0" W-0- 22,000 16X38 16X42 16'-0" 36'-0" 3'-4" 8'-0' 14'-0' 14'-0' 6'-0" 4'-0' 4'-0' 8'-3' 4'-0' 22000 18X30 1BX34 18 30 3-4" 6'-6' 6 10 10 4 4 10 4'-0' 16500 F� 18X38 18X42 20 38 3-4" 8' 10 12 12 4 4 10 4'-0' 18000 18X36 IBX40 18'-0" 36'-0- 3'-4' 8'-0" 10'-6" 13'-6" 8'-3" 4'-0' 4'-0" 10'-3" 4'-0" 25500 18X44 18X48 18 44 3-4" 8' 14 14 12 4 2 6 4'-0' 24000 JL-- 20X40 20X44 2O'-0" 49-0' 3-4" 8'-0' 12'-6' IS-6" 10'-3" 4'-O' 4`0' 12'-3" 4'-0" 32000 R1NP& SKARvEFt SKIMMER 2OX42 2OX46 20 42 3'-4' 8' 14 12 12 4 4 12 4'-0' 21000 SUCTION SUCTION 2OX44 20X48 14 14 S-4' 8' 14 14 12 4 4 12 4'-0' 22000 B 25X50 25X54 25'-O' 50'-0- 3-4' 8'-6' 20'-6' 13-6' 12-3' 4'-0' 4'-0'1 1T-3' 4'-0'150750 3OX60 3OX64 30'-0" 60'-0' 3'-4' 8'-6' 20'-0' 15'-0' 20'-3' 4'-6' 4'{' 21'-3' 4'-6' 79550 5/16'DUl CARRIAGE BOLTS POOL PLAN w/VA-9-ER & lNUT TOP OORPFR & FILLER 1-1/2 COF�S w1TFP i 2020 CODE SECTION 303.2.1-303.4 SWIMMIN3 PODS, SPAS, I AND FDT TUBS SECTION R326 OF THE RESIDENTIAL(X10E OF NEW YORK (XA7vID FILLER SECTION 3109 OF THE BUILDING CODE OF NEW YORK TO RELIEVE LINER C SECTION ND03.12 fR4031Z REST EN TAL POOLS AND BATED w/ 5/16"CIA PERM41ENT RESIDENTIAL SPAS CARRIAGE BOLTS SECTION 3109.3.12 - 3109.7.4 POOLS NO SPA GATES, BARRIERS O SECTION G106 ENTRAPMENT PROTECTION SECTION G107 ALARMS � SECTION E4201 - E4312 ELECTRICAL CONNECTIONS FOR i�112' T MIN. 2"THICK VERMICULITE CORNER CONNECTION DETAIL AGGREGATE PAflRED 10-32X5/8'SELF DRILLING SCREN5 O © O O SPACED 0 12"OL 03 CRETE OR WOOD DECK UP TO OWINGBY OTHERS) �--- SIDE SECTION SLOFED ANR1Y FROM POOL PANEL ALL IINlM1 CCPJM STIFFENER (BEYOND) LONG STEEL AWZLE 0 0 �N 1'LOW WELD C i 1'LONG WELDS ON % w/TYP.ALIWUMM ORATING % Vem TOOPP&BOTTOM ;OF PANEL. ° 0 miL VIM1-LINER P1EIN r0 O AS SHOWN AM COVER ; � OVER WELDS �WITH `iP`',FRAM�E BASE: O STEEL VALL PANEL DEER/( STEEL ACE 3/8"-16x1'BOLT,NUT, (2) yy (may ORIVE STAKE W O Maw WITI-L3 CU. CONCRETE SFA72T ���� y yO� �_� O © O 2"BO F°PRo END SECTION 0 DU N R ITE POOLS, INC. 18'LONG STEEL REINFORCING ROD 3510 VETERANS MEMORIAL HIGFMAY 63ll INTO UNDISTURBED EARTH THROUGH BOFE 1 63 NEW YORK ll718 UD]SRIRBED EPF71H FCLES IN BOTTOM OF PANEL 5851618 POOL TYPE, RECTAGLE REV. 9C1 E N.T.S. TYP. PANEL STI FFN E R TYPICAL WALL SECTION AT 'A' FRAME DATE �° P� MWTTITl1CtC,NEW YORK ll952 U14YM NUMBER OF