Loading...
HomeMy WebLinkAbout46866-Z ��o�OgtlEFUI�-lpGy� Town of Southold 4/25/2024 o - P.O.Box 1179 `n �. 53095 Main Rd �`yk �ao� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45145 Date: 4/25/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2890 Kerwin Blvd., Greenport SCTM#: 473889 Sec/Block/Lot:- 53.-4-44.11 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/15/2021 pursuant to which Building Permit No. 46866 dated 9/23/2021 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in ground swimming pool fenced to code as applied for. The certificate is issued to Salzberg,Fred&Dorothea of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46866 4/23/2024 PLUMBERS CERTIFICATION DATED Authori Signature �suFFot,��o TOWN OF SOUTHOLD BUILDING DEPARTMENT H x TOWN CLERK'S OFFICE 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#: 46866 Date: 9/23/2021 Permission is hereby granted to: Salzberg,.Fred 2890 Kerwin Blvd Greenport, NY 119442745 To: Construct in ground vinyl swimming pool at existing single family dwelling as applied for. At premises located at: 2890 Kerwin Blvd., Greenport SCTM #473889 Sec/Block/Lot# 53.4-44.11 Pursuant to application dated 9/15/2021 and approved by the Building Inspector. To expire on 3/26/2023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector SO!/ryol - � . o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q Southold,NY 11971-0959 �l �� sean.devlinCaD-town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Fred Salzberg Address: 2890 Kerwin Blvd city:Greenport st: NY zip: 11944 Building Permit#: 46866 Section: 53 Block: 4 Lot: 44.11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: MRJ Industries License No: 41853ME 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 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO 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: Pool Panel 8 Circuit, Pump 220GFI, Jandy Aquapure, Salt Generator, Heater, Lights 120GFI Notes: " AS BUILT NO VISUAL DEFECTS " POOL Inspector Signature: Date: April 23, 2024 S.Devlin-Cent Electrical Compliance Form OF SOUTyO� TT TOWN OF SOUTHOLD BUILDING DEPT. courm 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] WIULATIOWCAULKING [ ] FRAMING /STRAPPING [ FINAL�w---� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMA KS: 04 V X(E., JAT6 NA0C,4AZ----- fill 06) wl-oL qbA4Vi(� DATE 1,V y'L INSPECTOR "Lou/ OF SOUIyo� Li �•Lj(Q�p �� 'r l O ��V" �C — # # TOWN OF SOUTHOLD BUILDING DEPT. 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 VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Q174'�40 Gt/1 Top,,, -epoci a �l IVLCA CAV� � DATE 2 INSPECTOR - OF sooryo6 H # # TOWN OF SOUTHOLD BUILDING DEPT. �`y�OUtm� 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] 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: y L rg== hci-akm AI & J -ebo& A il\ �-aor-ilv 4-�.� ekr b oli <4 , DATE 1,gp INSPECTOR SOGTho� TOWN OF SOUTHOLD BUILDING DEPT. `ycou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [/, FINAL SULATIOWCA G FRAMING /STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: C� $( r, 0 DATE Io INSPECTOR �48It(o Swimming Pool Bonding Integrity Test Name: salzberg Date : 04/08/2024 ' Address: 2890. Kerwin Blvd. Greenport, NY 11944 Inspection of swimming pools—No certificate of compliance will be issued without a valid bonding integrity test performed by a licensed electrician and/or qualified testing agency. ' A low impedance instrument capable of measuring.01 ohm shall be used. The lead conductor used in the measurement shall be calculated and deducted from readings. A test of applicable test points such as filter motors housing, ladders,diving board,safety line eyelet, water heaters or any other associated metal components shall be performed at least twice and tabu- lated. Point of Test Readings in Ohms Point Of Test Readings in Ohms TEST 1 TEST,2 TEST 1 TEST 2 Ladder .002 .002 Handrail .002 .002 Filter Pump .001 .002 Gas Heater .001 .001 The resistance between any one points shall be low enough to eliminate any voltage gradients in the pool area as prescribed in Article 680.26 Equipotential Bonding.' Spas and Hot Tubs shall comply with the provisions of Parts I and II of Article 680 except as modified by .680.42(A) and (B), 680.43. Fountains,Signs Part V,Therapeutic Use Tubs and Pools Part VI. Test Data must-be•verified by electricians signature, license number and date. John F rguson 41853-ME 04/08/202d Ele tri is rint License Number Date 98 E. Montauk Hwy., Hampton Bay3 rrician Signat Address ail rail results to: EI rical Inspectors, c.,300 East Meadow Avenue,East Meadow,NY 11554 or Fax(516)794-5854 acv M117�Pca Swimming Pool Bonding Integrity Test Name: Salzberg Date : 04/19/2024 2890 Kerwin Blvd. Address: Greenport, NY 11944 APR 2 3 2024 Inspection of swimming Pools—No certificate of compliance will be issued without wtva(id b integrity test performed by a licensed 'electrician and/or qualified testing agency. A low impedance instrument capable of measuring.01 ohm shall be used. The lead conductor used in the measurement shall be calculated and deducted from readings. A test of applicable test points such as filter motors housing, ladders, diving board, safety line eyelet, water heaters or any other associated metal components shall be performed at least twice and tabu- lated. Point of Test Readings in Ohms Point of Test Readings in Ohms TEST I TEST 2 TEST 1 TEST 2 Ladder .002 .002 Handrail .002 .002 Filter Pump .001 .002 Water Electrode .001 .001 Electrical Pool Pane .001 .001 The resistance between any one points shall be low enough to eliminate any voltage gradients in the pool area as prescribed in Article 680.26 Equipotential Bonding. Spas and-Hot Tubs shall comply with the provisions of Parts I and 11 of Article 680 except as modified by 680.42(A) and (B), 680.43. Fountains, Signs Part V,Therapeutic Use Tubs and Pools Part V1. Test Data must be verified by electricians signature, license number and date. John Fe%us_o 41853-ME 04/19/201d Ele, nt Name License Number Date ti4rician - 98 E. Montauk Hwy., Hampton Ba Ele,rician Signature—` Address it results to: Electrical 1 ectors, 300 East Meadow Avenue,East Meadow,NY 11554 or Fax(516)794-5854 HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,W 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET September 03,2021 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of. Salzberg Residence 2890 Kerwin Blvd. Greenport,N.Y. 11944 will not require draining because the pool is constructed,with 'a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not interfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private roads. Sincerely, Zjj gineering P.C. arnika,P.E. FIELD INSPECTION REPORT 'DATE COMMENTS FOUNDATION(IST) -------------------------------- FOUNDATION(2ND) 'bt�17 .ROUGH FRAMING:& y PLUMBING . ' r INSULATION.PER N.Y. STATE ENERGY CODE 1 vv i 'n. n - 408 iq H FINAL r ADDITION,: CQMME... .S. r6 z Z2 C �.� ,- `( �eC 1:b�q:'1' 5l yZw 2 rt�a d H. ��o�ogUffO(A�oGy� TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 1 1 97 1-0959 Telephone (631) 765-1802 Fax (631) 765-9502 htq?s://www.southoldtownny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. 4 D Building Inspector: �' Applications and formsariast,be filled out in their entirety:in"complete'` S E P 1 5 2021 .,applications will,not be accepted: INhe-re the-,Applicant is-not,iFie owner;an - Owner's Authorization for`m',(Page'2)slialf be completed'." BDG DEPT. Date:9/10/2021 TOlVN OF SOUTHOLD OWNER(S) PROPERTY:' Name:Dorothea & Fr _d-,Salzberg sCTM#1000753-04744.11 ProjectAddress:2890 blvd Greenppft N Y 11944 Phone#:631-477-9733 Email:salzbf o tonline.net _. . .._ @_. I? Mailing Address:Same CONTACT. "PERSON: - Name:John J W soczanski Islandia Pools L.T.D y. . . . _.__�.....,,..,__ _ - ._._._._)__..__.—.__.._.._._._.___._..__ Mailing Address:108 Fishel Ave Riverhead NY 11901 Phone#: Email: DES16N':PROFESSI ONAL,INFORM T A ION• Name: Mailing Address: Phone#: Email: CONTRACTOR.INFORMATIONc - Name:lslandia Pools L.T.D. Mailing Address:108 fishel ave Riverhead NY 11901 Phone#:631- 27-6312 ohn Islandia ools com 7 Email DESCRIPTION OF:PRO.P:,OSED;CONSTRUCTION"`" El New Structure ❑Addition ❑Alteration ❑Repair El Demolition Estimated Cost of Project: E30therswimming pool $54,050.00 Will the lot be re-graded? ®Yes El No Will excess fill be removed from premises? RYes ❑No 1 PROPERTY INFORIVIAT,ION, Existinguse of property: Intended use of property: `? Zone or use district in which premises is situated: Are there any covenants and restrictions with expect to this property? ❑Yes Mo IF YES, PROVIDE A COPY. . ❑ Check Box After Reading: The owner/contractor/design.p'rofessional is responsible�for all,drainage-an&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 t name): GG �V ` /� � Xuthorized Agent ❑Owner Signature of Applican • ! Date: ��Zl STATE OF NEW YORK) SS: COUNTY OF ��mvv--Id U r/�f�Oc Z/�-G`J being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the jlg �/f -A7 ew"A- (Contractor,Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said or nd to make and file this application;that all statements contained in this application are true to the best of his he kn wledge and belief; and that the work will be performed in the manner set forth in the application file therewi h. Sworn before me this day of 410QT6M9eA, , 20� N tar Public DAVID FREEBORN Notary Public,State of New York; t No.01FR6137963 PROPERTY OWNER AUTHORIZATION Qualified in Suffoli:County a. , Commission Expires Dec.05, OZ (Where the applicant is not the owner) I, residing at o2 FfO166LW tA.-I (-U f) �- ,-: GROI VtDOIV)"��Y // �! do hereby authorize 1f60A) (f /�G� Z �/S'w to apply on my behalf to the Town of Southold Building Department for approval as described her in. Owners Signature . .,, Date Print Owner's Name J: 2 g�FF01 �� 1 1 NG DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD H �,N��� r Hall Annex-54375 Main Road - PO Box 1179 o • e oFs Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX(631) 765-9502 rogerrCcDsoutholdtownny.gov - sea nd(a-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail Information Required) Date: 12/16/2022 Company Name: MRJ Industries, LTD Electrician's Name: John Ferguson License No.: ME-41853 Elec. email:office@mrjindustdes.com Elec. Phone No: 516-885-7914 p I request an email copy of Certificate of Compliance Elec. Address.: 27 Quail Run, Hampton Bays, NY 11946 JOB SITE INFORMATION (AII Information Required) Name: Salzberg Address: 2890 Kerwin Blvd, Greenport, NY 11944 Cross Street: Main R Phone No.: Bldg.Permit & R GO email: Tax Map District: 'on: �� Block: Lot: 1 I BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Installation of new inground pool. Need bonding and final inspection. Square Footage: Circle All That Apply: Is job ready for inspection?: YES❑NO Rough In I✓0 Final Do you need a Temp Certificate?: ❑ YES FV�NO issued On Temp Information: (All information required) Service Size01 Ph 03 Ph Size: A #Meters Old Meter# ❑New ServiceOFire Reconnect[]Flood ReconnectOService Reconnect OUnderground❑Overhead # Underground Laterals 1 F12 M H Frame 0 Pole Work done on Service? Y MN Additional Information: PAYMENT DUE WITH APPLICATION NG DEPARTMENT-Electrical Inspector TOWN OF SOUTHOLD C* a��v�-� (m Hall Annex- 54375 Main Road - PO Box 1179 v. * 50 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(cbsoutholdtownny gov - seand southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail Information Required) Date: 12/16/2022 Company Name: MRJ Industries, LTD Electrician's Name: John Ferguson License No.: ME-41853 Elec. email:office@mrjindustries.com Elec. Phone No: 516-885-7914 El I request an email copy of Certificate of Compliance Elec. Address.: 27 Quail Run, Hampton Bays, NY 11946 JOB SITE INFORMATION (AII Information Required) Name: Salzberg Address: 2890 Kerwin Blvd, Greenport, NY 11944 Cross Street: Main_Road-_ Phone No.: BIdg.Permit email: Tax Map District: on: �� Block: Lot: f I BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Installation of new inground pool. Need bonding and final inspection. Square Footage: Circle All That Apply: Is job ready for inspection?: YES® NO ®Rough In Final Do you need a Temp Certificate?: 0 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 r # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION PERMIT# Address: Switches Outlets 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: rl Comments v �. 2/aavwZ3 m q� � MAR z z saiaLD JOB No. AUG-9 REV 9114/D1 TAX I.D. No. 1000-53-04-44.11 SEPTIC G P y s , LOT 30 LOT 2QD , R S E P 1 5 2021 KERW-IN BLVD [ 50' ] BUMD-ING DEPT. R=25.00' .WATER SERVICE S 43009'40°E 160.00!. TOWN Or, SO'UT11 Y.D L=39.27' TIE 617.00' \ LP2 LP3 0 O SEPTIC C LP1 C7Lu \ LOT 8 B 44.2 o w°< LOT 33 A 16.7 23.9 ry 31.2 36.6 2.0 1 ST N GAR a o co F, _ — 1 9 �1 5T 15. tz 'O 23.9 5.2' _ O ' O BAY 6.4 !/t O L _ CONC ENT \U N 13 DOWN IX) uJ 2 ST RAME " " N o - ING O " Uv o v Z U) SEPTIC LOCATIONS CORNER A CORNER B / SEPTIC 47' 56' / LP1 39' 69 I LP2 53' 71' LP3 62' 59' / N 43009'40"W 160.00' N%F SAG ESTATES FILE MAP No. 9107 6/3/91 Unauthorized alteration or addition to this document Is a violation of Section 7209 of the New York State Education Law. SURVEY OF:Certifications indicated hereon shall run only to the person for whom it is prepared LOT 9 and on his behalf to the Title Company,Governmental Agency and Lending Institution listed hereon,and to the assignees of the lending Institutions or M/O AUGUST ACRES SECTION 1 subsequent owners. Copies this document not bearing the professional's inked seal orembossed ARSHAM0MAQUE, TOWN OF S0UTHOLD seal shallll not be considered a valid true co The offsets[or dimensions I shown hereon from structures to the property lines are for a specific purpose and use and therefore are not Intended to guide the erection of S U F FO L K COUNTY, N E W YO R K fences,retaining walls,pools,planting areas,addition to buildings or any other construction. The eyistence f right of ways and/or easements of record,if any,not shown are not guaranteed. SURVEY DATE: 07/19/01 SCALE: 1"=50' CERTIFIED ONLY TO: FRED K. SALZBERG AND DOROTHEA T. SALZBERG DESTIN G.GRAF LAND SURVEYOR 73 Woodlawn Road Rocky Point, N.Y. 11778 By DESTIN G. GRAF N.Y.S. LIC No. 50067 631-821-3442 Y workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compens ation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ISLANDIA POOLS LTD. 108 FISHEL AVENUE 6317276312 RIVERHEAD, NY 11901 Work Location of Insured(Only required if coverage is specifically limited to 1c.Federal Employer Identification Number of Insured certain locations in New York State,i.e., Wrap-Up Policy) or Social Security Number 11-2915558 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Building Dept Standard Security Life Insurance Company of New York 53095 Main Road 3b.Policy Number of Entity Listed in Box"1a" Southold, NY 11971 69146-00 3c.Policy effective period 1/1/2014 to 9/7/2022 4. Policy provides the following benefits: 0 A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: ❑X 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 des c' d above. Date Signed 9/8/2021 By Aa�t (Signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,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 mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers' Compensation Board(Only if Box 4C or 56 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note: Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1 (10-17) 111111111t°°1°1°1°°11°°�11°!�°�!�!°!°IIIIIII Additional Instructions for Form D13-120.1 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 New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance 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 my 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 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 NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. 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. 1313-120.1 (10-17)Reverse A!`�® DATE(MM/DD/YYYY) V CERTIFICATE OF LIABILITY INSURANCE Fo9/08/2021 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). PRODUCER CONTACT Edgewood Partners Insurance Center PHONE Commercial Su ort FAX 40 Marcus Drive 3rd Floor C N Ex : (866) 414-7475 (FA/C. A/C No:(631) 390-9700 E-MAIL Melville NY 11747 ADDRESS: msmcertscm@epicbrokers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:HARTFORD FIRE & CASUALTY GROUP 00914 INSURED INSURER B:Technology Insurance Company, In 42376 Islandia Pools Ltd. INSURER C: 108 Fishel Avenue INSURERD: Riverhead NY 11901 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 316 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. INT Y R TYPE OF INSURANCE INSD WVD 'POLICY NUMBER MML EFF D MMY EXP D R LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Fx_1 S Eaoc OCCUR 12UUNOZ9731 04/25/2021 04/25/2022 DREMES curr0ence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL SADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�JE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 A ANY AUTO 12UENOZ9729 04/25/2021 04/25/2022 BODILY INJURY(Per person) $ OWNED - X SCHEDULED BODILY INJURY(Per accident) $ AUTOS 014[_Y AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR 12HHUOZ9730 04/25/2021 04/25/2022 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ B WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY Y/N TWC3961844 04/25/2021 04/25/2022 X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER N/A (M EXCLUDED? � andatory 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 S DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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 Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 AUTHORIZED REPRESENTATIVE PO Box 1179 Southold NY 11971 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1a.Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured Islandia Pools Ltd. (631) 727-6312 108 Fishel Avenue 1 c. NYS Unemployment Insurance Employer Registration Number of Riverhead NY 11901 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 112915558 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Co, Inc. Town of Southold Building Dept 3b.Policy Number of Entity Listed in Box"1 a" 53095 Main Road TWC3961844 Southold NY 11971 3c.Policy effective period 04/25/2021 to 04/25/2022 3d.The Proprietor,Partners or Executive Officers are Included.(Only check box if all partners/officers included) 0 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 1 a"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 must notify the above certificate holder and the 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 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 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: Commercial Support (Print name of authorized representative or licensed agent of insurance carrier) Approved by: GO" (Signature) (Date) Title: Leonard Scioscia Telephone Number of authorized representative or licensed agent of insurance carrier: (866) 414-7475 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.ny.gov Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into 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 OCCUPANCY OR APPROVED AS NOTED USE IS UNLAWFUL B.P. ( WITHOUT CERTIFICATE DATE ,� OF OCCUPANCY FEE: d�9.6?� BY: .,. NOTIFY BUILDING DEPAPTMEN AT 765-1802' 8AM TO 4PM FOR FOLLOWING INSPECTIONS: 1. ,FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2• ROUGH FRAMING & PLUMBING 3."INSULATION COMPLY WITH ALL CODES OF 4. FINAL -CONSTRUCTION MUST NEW YORK STATE & TOWN CODES BE COMPLETE FOR C.O. AS REQUIRED AND CONDITIONS OF .ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW SOUTHOLD TOWN ZBA YORK STATE. NOT RESPONSIBLE --:OR DESIGN OR CONSTRUCTION ERRORS. SOUTHOLD TOWN PLANNING BOARD SOUTHOLD TOWN TRUSTEES NY.S.DEC �MN�r : : : ELY. RETAIN STORM WATER RUNOFF is ENULOSE 0 CODE OF RSUANT TO CHAPTER 236 UPON C. � HTION'""; BEFORE "WATER" THE TOWN CODE. ele"MIL 11 PJWIRED POOL NOTES: 1.POOLAND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION TRACK FOR AND BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC PUMP VINYL LINER FILTER 2.,POOL SHALL CONFORM TO ANSI/APSP/ICC 5 STANDARDS R326.3.1. . SKIMMER VINYL LINER " 3:SECTION,R326:7 POOL ALARM REQUIRED: � .� '$;5" 4.P00L•SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION.R326.4. . 5.POOLSHALL'COMPLY WITH'2020 ENERGY CONSERVATION CONSTRUCTION CODE FOAM PADDING 3,500 PSI OF NYS SECTION R403,10:: \ CONCRETE POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). 4 .X 8, 4 a SECTION R403;10:1 HEATERS, i r I STEP GLASS .'a SECTION R403,10,2'-TIME SWZTCHES SECTION'R403.10.3 COVERS . I ( #4 REBAR TOP a` a, „ 6.REBAR,SHALL BE3",'MIN.CLEARTO EARTH.. RETURN PROPOSED VINYL 42 TYP: "I IIiAMING POOL & BOTTOM 7.LOCATIONOFPROPOSEDSWIMMING,PO'OL AND,POOL EQUIPMENTBYIOTHERS 3' SW 16' " a AlD SHALLCOMRLY WITH ALL LOCAL ZONING;REQUIREMENTs.. s (MIN.' 544 S.F. S.ALL,DRAIN COVERS TO MEET ALL RECjUIREMENTS OF'THE VIR6INIA GRAEME BAKER°,(VG B)P,,OOLAN D SPA.SAFETY ACT: 9 SLOPE PATIOrSURFACE 1%4"PER FOOTAWAY FROM POOL., I I 10 BACKFILL 1VATERIALTO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR DUAL,'MAIN DRAINS,NTH a " = STRAINER (VGB SAFETY !e IARGE ROCKS): .. . : ACT APRROVEO DRAINS) a 11.;S,UCTION'O.UTLETS SHALL BE'DESI6NED AND INSTALLED IN ACCORDANCE WITH „. ANSI/APSPACG,7, 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. 'i CQNTRACTOR SHALL VERIFY SOIL•BEARING LOADS PRIOR TO INSTALLATION OF r,. . TYP CAL::WALL 'DETAIL 14.::THIs PLAN IS FOR CONSTRUCTION ON PROPERTY AT 2890 KERWIN BLVD. 36 I ..- GREENPORT;N:Y:;11944 ONLY. SCALE: 3/4"•. 1'-=0" . 15.,NO`:DIVING`EQUIPMENT:PERMITTED. 16;,REINFQRCINGSTEELSHALL>3E.INTER'MEDIATE GRADE BILLET STEEL WITH A' MINIMUM LAP,OF30'BAR DIAMETERS. NOTE:. 00�P�LAN NOTES: 17.,POQL WALLS ARE NOT DESIGNED'FOR SURCHARGE LOADS'EXERTED BY WHEEL TISZS A NON-DIVING POOL ��> NOT' TO ,SCALE'' L'OADS'WITHIN SIX;(6)FEET-QF'POOL,WALL FROM CONSTRUC, ION,EQU)PMENT6. 1:1�A A4'IS SHALL BEAR ON UNDISTURBED S01L.; 2.ALL CONCRETE.SHALL BE PLACED AS A MONOLITHIC POUR., 7i'•; ANY;0THEKL6"bING CONDITION IMPOSEDtONTHE POOLSTRLICTURE;BY EXISTING „ OR PROPOSED ADJACENT STRUCTURES..IF,SITE CONDITIONS DIFFER FROM THIS PLAN;IT'.ISTHE:RESPO'NSIBILITY.OF7HECONTRACTORTO,GONTACT;HMi,;,. ENGINEERING,.P.C:;`BEFORE ANY CONSTRUCTION BEGINS 18;HM ENGINEERING,P C,SHALLNOT�BE RESP,ONSII3lE FpRCONSTRUCTION s 4", Co WALL MEANS;METHODS;TECHNIQUES;OR PROCEDURES UTILIZED BYTHE CONTRACTOR, 5'-6" `;' =` npN N&f,' R:THE;SAFETY.OF THE.PUBLIC OR CONTRACTOR'S EMPLOYEES,OR FOR;THE y31 -- d (SEE SEC FAILURE TO'CARRY OUT I HE'1NORKIN ACCORDANCE HITTHIS.BLAN1 .1/2" .TO WASTEUNDISTURBED EARTH 8, 150. ('TYP.). HAIR & LINT STRAINER PUMP a . 3" COMPACTED FILTER `AU.TO SKIMM S E P 1 5 2021 SAND POOL PR POOL�777 z�EP� POOL T w �3 SOT)aTG� .� NOT T0.'SCALE BAPI `To. POOL GENERAL,N.pTE: :. ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 RESIDENTIAL CODE OF;NYS,INCLUDINGTHE SPECIFICATIONSIN SECTION R326. 2'MAIN ,DRAINS . PREPARED FOR. vnTH'HYDROSTATIC {, . kHtMATIC PIPING ARRANGEMENT `VALVEi,,AND,, SALZBER'G`RESIDENCE : NOT To scALE COLLECTOR';TUBE 28.90,KERWIN BEND. IN GRAVEL BASE RE 'NPORT, N. �'11944 a DATE. .0 312021 /J ?; NOTE: , HM ENGINEERING, P.0 SCALE:' ASSHOTHESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERINGP.C.. 7® '1'OF;1T IZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209OFTHE 1 a • ; • P.O.BOX 914 EiAST NORTHPORT,NY 11731UNAU HOR RESIDENTIAL,CONCRETE NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILLBEPROSECUTED. Tel.(516),476-5392,Fax:(631)980-7671 Email:hmarnikar�optonline.net VINYLLERPOOL`PLANV UT RAISED SEAL AND BLUE SIGNATURE CAST IRON FRAME 8 COVER IF UNDER PAVED AREA FINISHED GRADE 8' MIN. — 12' MAX. 24• x NOTES: BRICK LEVELING COURSE ��MIN < CONCRETE COVER 1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST CONC. COLLAR 27' 6' MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND AS REQUIRED MAX BACKFILLED WITH SAND AND GRAVEL TO BOTTOM OF BASIN. PRECAST 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE REINF. CONC. SUBSTITUTED WITH APPROVAL OF THE ENGINEER. DOME 4'0 PVC 3. LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. MIN. SPER FOOT ® ® ® 910 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. INVER ® ®®0 NON-SHRINK ®®� 5. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR GROUT FULL DEPTH. 9:10 SAND 'e 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND F AN GRAVEL AND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, W COLLAR y N SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) a ALL AROUND rn PERCENT. W PRECAST REINF. > CONC. LEACHING ~ RINGS a. O W Mtn W " C wo 8' DIAMETER �w o o DRYWELL CALCULATION: a BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF) �~ DRYWELL CAPACITY = 1,263 GAL. (168.8 CF) Lai �••'�•:®'••.;;tea .• . :•o.••;..•;..••..•;!+.':•;'.•g• z 6' MIN. PENETRATION iu C3 INTO VIRGIN STRATA GROUND WATER (K OF SAND S GRAVEL DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: SALZBERG RESIDENCE 2890 KERWIN BLVD. GR NPORT, N.Y. 11944 A DATE: 09/03t2021 NOTE: ,,�` HM ENGINEERING, P.C. SCALE: NOT TO SCALE THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.UNAUTHORIZED SHEET: 1 OF 1 ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE P.O.BOX 914,EAST NORTHPORT,NY 11731 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.net DRYWELL DETAIL V ID WI RAISEDSEALANDBLUESIGNATURE