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HomeMy WebLinkAbout50576-Z ��o�ag�EF01�-cpGy Town of Southold 5/3/2024 P.O.Box 1179 0 c _ 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45157 Date: 5/3/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3705 Alvahs Ln,Cutchogue SCTM#: 473889 Sec/Block/Lot: 101.-2-24.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/26/2021 pursuant to which Building Permit No. 50576 dated 4/22/2024 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 Satur,Paulette&Mueller,Eberhard of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 46101 8/30/2021 PLUMBERS CERTIFICATION DATED Authori ed jjnature o�SUFFot,��o TOWN OF SOUTHOLD �� . .. BUILDING DEPARTMENT y, z TOWN CLERK'S OFFICE V . 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 #: 50576 Date: 4/22/2024 Permission is_hereby granted to: Satur, Paulette 3705 Alvahs Ln Cutchogue, NY 11935 To: replaces by#46101 construct accessory in-ground swimming pool as applied for. 1 At premises located at: 3705 Alvahs Ln,Cutchogue SCTM #473889 Sec/Block/Lot# 101.-2-24.5 Pursuant to application dated 3/26/2021 and approved by the Building Inspector. To expire on 10/22/2025. Fees: PERMIT RENEWAL $200.00 Total: $200.00 Building Inspector ��o�gQfFQ(,�co TOWN OF SOUTHOLD uy� BUILDING DEPARTMENT N x TOWN CLERK'S OFFICE "o • SOUTHOLD, NY y�ol � s 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#: 46101 Date: 4/19/2021 Permission is hereby granted to: Satur, Paulette 3705 Alvahs Ln Cutchogue, NY 11935 To: construct accessory in-ground swimming pool as applied for. At premises located at: 3705 Alvahs Ln., Cutchogue SCTM #473889 Sec/Block/Lot# 101.-2-24.5 Pursuant to application dated 3/26/2021 and approved by the Building Inspector. To expire on 10/19/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Bui g nspector OF SO(/T�ol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q sean.devlinCaD-town.southold.ny.us Southold,NY 11971-0959 o�yCOUM`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Paulette Satur Address: 3705 Alvahs LN city,Cutchogue St: NY zip: 11935 Building Permit#: 46101 Section: 101 Block: 2 Lot: 24.5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Retrofit Electric License No: 60131 ME SITE DETAILS Office Use Only Residential X Indoor X Basement Service Commerical Outdoor X 1 st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 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 300W UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Intermatic Pool Panel 8 Circuit/ 5 Used, Pentair Tranny w/ 12 Lights, Jandy Salt - Generator, Pump on 220GFI, Heater, Pool Cover w/ Key Locked Switch Notes: Pool Inspector Signature: - Date: August 30, 2021 N � S. Devlin-Cert Electrical Compliance Form soaryo� 1 C) # # TOWN 01 SOUTHOLD BUILDING DEPT. 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~ REMARKS: �[ y C' 1 DATE i �I INSPECTOR 1410 500Tyo� * TOWN OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [rSLATIOWCAULKING U FRAMING /STRAPPING [ NAL Pnt-,, [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS. no vro&,,� wvc�, �0✓ w Avalk DATE Z INSPECTOR g SOUTyo� TOWN OF SOUTHOLD BUILDING DEPT. `ycoU10% 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING/STRAPPING [ FINAL �q� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION .[ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: h"�4 �o at b aPa�2. qe Ok- 0, DATE •oZ o? INSPECTOR Jeffrey Sands Architect 6/18/2021 Property/swimming pool location: 3705 Alvahs Lane Cutchogue, NY 11935 RE: Swimming pool rebar inspection Attention Town of Southold Building Department: Upon inspection of swimming pool rebar at above mentioned property, I find all to have been installed and built as designed meets current building code requirements. Sincerely, D A,9 Cr J T"�'aF N Jeffrey Sands Architect MAY - 1 2024 � L: c: 1, 6 Evergreen Lane, East Quogue, New York 11942 phone-631-375-5997, fax, 631-576-8916 email—ieffCc�isa-nv.com FIELD:INSPECTION REPORT DATE CONIlVINTS 77771.17777 FOUNDATION(1ST) --------------------- --- FOUNDATION(2N)?) RQUGH FRAMING:& H Q� PLUMBING: i . H INSULATION.PER N.Y. STATE ENERGY CODE Q rn�164� uW0126 FINAL'. ' a CQ �6 Lo ADDITIONAL COMMENTS 6 S' 2 a l o 14_2 •I 4 0 c� te o 2KI zz o cat C' wilt -- . a . Ix .. Y •M TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 hM2s://www.southoldtownny.go Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. �6� Building Inspector: (� Y 2 6 ?02� Applications and forms'must be filled out in their entirety. Incomplete applications will not.be accepted. Where the Applicant is not the owner,an Pp p pp - -.v - - - Owner's Authorization form(Page'2)shall be completed. ' Date:03/08/2021 OWNER(S)OF PROPERTY: Name:Paulette Satur & Eberhard Mueller scrM#100.0-101-02-24.5 Project Address:3705 Alvah's Lane, Cutchogue, NY 11935 Phone#:631-734-4219 . Email: aulette saturfarms.com Mailing.11 Address:3705 Alvah'sw Lane,_Cutchogue, NY 11935 CONTACT PERSON: . Name:Paulette Satur Mailing Address:3705_Alvah's Lane, Cutchogue, NY 11935 _ Phone#:631-734-4219 Email: aulette saturfarms.com DESIGN PROFESSIONAL INFORMATION: Name:Sundance Pool & Spa Corp _ Mailing Address:P.O. Box 791. Westhampton, NY 11977 Phone#:631-288-0373 TF7;11.lavenderlandsc.aping.inc%u m"` CU CONTRACTOR INFORMATION: Name: 1 -JC 6C k 4N)0 Mailing Address: 1J6 _N e.. M2_ Phone#: 1— ��� 7q Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: bother Pool $88,000 Will the lot be re-graded? ®Yes El No Will excess fill be removed from premises? ®Yes ❑No 1 PROPERTY INFORMATION Existing use of property:residential/farm Intended use of property:residential/farm Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes @No IF YES, PROVIDE A COPY. @ 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 orfor 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(print name). l nUmaC , lUYlhckm @Authorizeo Agent El Owner Signature of Applicant: / f,' Date: STATE OF NEW YORK) COUNTY OF — I`( 1ymo J being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the PYQEP:� (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 1` day of ��rfG� ,20� Notary Public MICHAEL P.MALONE NOTARY PUBLIC,STATE OF NEWYORK ROPERTY OWNER AUTHORIZATIO " Regiwmion No.02MA5070712 (Where the applicant IS not the owner) ' Qualified in Suffolk County Commission Expires March l7,2023 I� Paulette Satur residing at 3705 Alvah's Lane, u c ogue, NY 11935 do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Digitally signed Paulette 03/08/2021 Paulette Satu �Date:2021.03.05 -05'011:43:500' Owner's Signature Date Paulette Satur Print Owner's Name 2 BUILD DEPARTMENT-Electrical Inspector AUG 2 A 2021 TOWN OF SOUTHOLD Town Hall Annex- 54375 Main Road - PO Box 1179 Southold New York 11971-0959 13UTT,DING DEPT. TO'l -N, �;,; r; gIephone (631) 765-1802 - FAX (631) 765-9502 rogerr(cDsoutholdtownny.gov - seand0-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORM I N (All nforma ion Required) Date: Company Name: n _ ` P Y 9LSz � z' Name: ')U License No.: rA kL-(6 t 3 ` email Phone No: Ua 1- 1 'EI request an email copy of Certificate of Compliance Address.: arc v2 G JOB SITE INFORMATION (All Information Required) Name: 5,A�u r Address: 0 S S Cross Street: Phone No.: Bldg.Permit#: email: Tax Map District: 1000 Section: Q Block: Lot: S BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: Is job ready for inspection?: [ YES ❑NO ❑Rough In ❑Final Do you need a Temp Certificate?: ❑YES ❑NO Issued On Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground [—]Overhead #Underground Laterals ❑1 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION Ca-&-eA 4`�� Electrical Inspection Form 2020.xisx C—I r) a' §VfFAC1k, 1 ''A BUILD I DEPARTMENT-Electrical Inspector AUG 2 d 2021 TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 qlepl�ctcne (631) 765-1802 - FAX (631) 765-9502 r_ogerra-southoldtownny.pov — seandO-southoldtownny.aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORM lf N (All Information Required) Date: �qoN2 Company Name: nn 6 ` p Y �.Sz Name: 75 O Y)U License No.: rl t 3 \ email: - 1 6oA Phone No: �j �-2,1 `®I request an email copy of Certificate of Compliance Address.: arc jjo2 \ JOB SITE INFORMATION (All Information Required) Name: S'A�U r Address: S M c Cross Street: Phone No.: Bldg.Permit#: (0 rQ I email: Tax Map District: 1000 Section: Q" Block: Lot: S BRIEF DESCRIPTION OF WORK (Please Print Clearly) j eA of KL.,A i (M hA t--�C.)� Check All That Apply: Is job ready for inspection?: [ YES ❑NO ❑Rough In ❑Final Do you need a Temp Certificate?: ❑YES ❑ISO Issued On Temp Information: (All information required) Service Size_01_Ph. -❑3_Ph_ Size: - A. :#.Meters - 01d Meter# . New Service ❑ Service Reconnect ❑ Underground ❑Overhead #.Underground Laterals ❑1 2 ❑H Frame❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION 4 D Electrical Inspection Form 2020.xlsx C—1r) a I V�ec9 "'1bS 7 �D PERMIT# Address: Switches Outlets G FI's Surface Sconces H H's UC Lis Fans Fridge HW Exhaust :Oven W/D Smokes DW Mini or Carton. ;:IVliero.: . ... Generat Combo Cooktop Transfer . AC Ati Hood.. Service Amps Have..:. Used:, LAComments:. Q N �lJ `ate. - . Horton, LisaMarie From: Paulette Satur <Paulette@saturfarms.com> Sent: Tuesday, October 25, 2022 1:31 PM To: Horton, LisaMarie Subject: Satur Pool Permit Extension Hello Lisa As we discussed this morning, we'd like to extend our pool permit for an additional 6 months. Please confirm. Thank you Paulette Paulette Satur Founder I CEO FARMS lA� NORTH FORK SATURILONGISLAND Main:631.734.4219 1 Fax:212.656.1624 Email:paulette@saturfarms.com Cell:516.523.2182 www.saturfarms.com I Facebook I Instasram Farm Mail:3705 Alvahs Lane I Cutchogue, NY 11935 Cold Facility&Shipping:4195 Middle Country Road Calverton, NY 11933 ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i SCIJWf3RE>< 70t42W-47--alm P The/ocaflons of WeNs and cesspools N jL1D�g7-otvk L RO shoWn hereon are from fleld obsordalions P` and or from data obtained from others, aR CONTOUR LINES AND ELEVA710N5 Ilk ` ARE REFERENCED TO THE FIVE u,' EASTERN TOWNS TOPOBRAPMC A6 MAPS "w&ole css 5115 �a° IVY I�e 1410 eL I ° 07- �od1 f'���. � , t:`,,►" pox o cP ,. st yr.r.ft�.::o~ ryr.N vi rGG�V�� dk O Od 00 SURVEY OF I&D AmEw N*Ale STAAVARas Fa?APPROVAL PROPERTY. AW�MCMtTS ,CESMSE AT CUTCHOGUE DiSPOSL SYSMl FOR coad&wY$at f"IfLYvk aw YCfS TOWN OF 50WHOLD �1y A!r eons xl faNh b}�rah and as b3a cnsh+rl SUFFOLK COUNTY, N.Y. WO- 101-02-.04. Scale:1"_501F CERT#5w Tar Feb. 27, 1997 EBER1fARf)MULL6R Ma 2G (welt.f c P.s J PAULETTE SA"MUU-M? June 26'1lmpap. Wep 8 sanitary 1 WEBSTER BANX SORI�1997 t hse's/hs'1 COAfLfONWEALT}f LAND T/TLE/NSURANCE COMPANY , 1997 f cane fourtdolfon J R1I 9T 0J59 May a/,1998 1 thal) a AREA=80,000 aq ��1rSOF Nt;p S,aaN T.Mtr�CNO�-� ANY AL 7WA77aV OR 7A7EAL�IY Y y VT T &8VEYJ9�A,gWaA 7A7K Rai sived�� * , a •SEC7ICW TP09 OF TA7E E�IRAC£fi1FAG u�y 1 'r c 4961E CEPT AS VA SFC FOR M 4WAPpD/ C yV!L ALL 3uY= Co. 1/FYiELYJ ARE YAL�FOR 71#s Lt4P AAD COPS 77ERE GMLY F i Wei°sEwrurTargrFssm sFAt of survtYae OCT 151998 PECOneC Yo t&W 765- ADDIT%r"CLY"CO MY WIT,5"U V 7TE'TfM"ALT ,f7tW Or �-�-Of s;ez:;Y;9'Ljm, P. O.BOX 9 •�� .vs��,�a'�'+O AR cST BF G6FD BY ANY ppAD ALL SLItVfYORS lrTR�at A CCYY ;• O±4Jaste»aier A I23O IRAVQ g QFANO7T-7t 6YAWARE NOT ?MWSSUCHAS*W�PEC7i�'AAp "`���� SOUT1iOLD, N. xV1DlAafr-TO.OAT£'ARE 1NDT er COAn 64 Ftt7E N7TH TtfE LAf, ., NYSI F New York State Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 I nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE a a ^"^^^ 113041142 EPIC INSURANCE BROKERS &CONSULTANTS 40 MARCUS DR 3RD FLR MELVILLE NY 11747 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER SWIMMING POOLS BY JACK ANTHONY INC SUFFOLK COUNTY 623 MEDFORD AVENUE PO BOX 6100 PATCHOGUE NY 11772 HAUPPAUGE NY 11788 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12432 495-6 299270 12/01/2020 TO 12/01/2021 3/19/2021 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2432 495-6, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:821720646 Client#: 10246 SWIMPOO1 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 3/19/2021 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Commercial Support Edgewood Partners Ins.Center A/C,N Ext:631-390-9700 FAX 631-390-9790 AIC No 40 Marcus Drive ADDRe 3rd Floor ss: certificates@cookmaran.com INSURER(S)AFFORDING COVERAGE NAIC# Melville, NY 11747 INSURERA:Hartford Fire Insurance Company 19682 INSURED INSURER B:Trumbull Insurance Company Swimming Pools By Jack Anthony,Inc 27120 623 Medford Avenue INSURER C: Patchogue,NY 11772 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY 12UUNOJ2738 02/05/2021 02/05/2022 EACH OCCURRENCE $1 000 000 PREMIS Eaoc urrrrence $300 OOO CLAIMS-MADE �X OCCUR ES MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY FX1 JECOT- LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 12UENOZ9490 02/05/2021 02/05/202 (CEOsacccidentSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person). $ AUTNOS ONLY SCHEDULED BODILY INJURY(Per accident) $ X AUTOS ONLY X NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS,COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N S ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (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) CERTIFICATE HOLDER CANCELLATION Suffolk County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P.O. BOX 6100 ACCORDANCE WITH THE POLICY PROVISIONS. Hauppauge, NY 11788 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2986596/M2912623 CCUMM voeK workers nsation CERTIFICATE OF INSURANCE COVERAGE sTnTE.: Compe 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 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured SWIMMING POOLS BY JACK ANTHONY INC 631-878-7665 623 MEDFORD AVENUE PATCHOGUE,NY 11772 1 c.Federal Employer Identification Number of Insured Work Location Of Insured(Only required if coverage Is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 113041142 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of.lnsurance Carrier (Entity,Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Suffolk County 3b.Policy Number of Entity Listed in Box"I a" P.O. Box 6100 DBL66700 Hauppauge, NY 11788 3c.Policy effective period 12/13/2020 to 12/12/2021 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. Q B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 3/19/2021 By �lyi (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B,4C or 513 is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board (Only if Box 4C or 56 of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB.120.1 (10-17) �I�IIPiuiiii1�2ii0iii1�iiiii1i0iiii1ii7Nii�lllA v .}-k.. ` , +r,, ���� .� '� ' .\ \i o ;; } • ��1' '. :�a:��'4�j : '�by• ^�i:Mbe.^r�.+ �h� - C+�i�, ,' ,i f�+�, ♦ I �'Y y • i ��♦ {�. •� .9 h NAi `p, q' •�, �, / ? ~�. .M• ♦ x k x °P .ti xd. tii �'�`s'�: y� r �'x q��4'A ° s .fat"�1 g• l �• �.f s 'f��r','a�"�+.s�iV' r �' ` � '' •,ram �' -/`lam-///yy/�//j/,� 1/1� _ a LJ�.i.i oil\' • • • {SKI~ County ExecunYe s Office of 'onsumer Affarrs r VETERANS MEMORIAL HGH IWAY *. .HAUPPAUGE, NE YORK 11788 =` >tia }.sum =tip, _1260 DATE ISSUED: -- ----- ' -- _5/1/86 _ ---- �-. No. 0-H : { # v . � SUFFOLK COUNTY Home Im .�orrement Contractor License p rat lG 'This is to certify that LENDA R SCHOECK .. . -. — SCI30ECK INC =_? = doing business as SVVIlVIMING POOLS JOEN 5x: having,furnished`the requirements set forth in accordance with and'subject to the provisions of applicable Iaws, rra= rules and regulations of the County of Suffolk, State'of New Yorlt is hereby licensed to conduct business as a HOME BOROVEMENT CONTRACTOR,in the County of Suffolk. r'•' Additional Businesses - r -• .: NOT VALID WITHOUT DEPARTMENTAL SEAL AND A CURRENT CONSUMER �. AFFAIItS ID'CARD .-. r Director .._; ' mow i yJAM, . :: l //- � !'@,. / ' r \ \ i \ �' 3 `:•> �Q a a A' 1 , -��5.,wrfl,`L s �• / $• °�'�I .� .�� y� -�'��! �y '� a f��` °h ,J+ y/�5°.a1� .�`* •'.�i\ /� �'.'� 3Y� �€F ��J C�*r`��'jpy�� s� '� +• 9 A 4 uYl • ♦ • • �'iY•�iJ+ k }�• �' + �x. Y�� - • • ;�'� • r '+/:°1 .. 4 .` _.'�''s'• .......... *'�•'�FAMS• ,;;<< '...^•.'"lit :t'',. $CQF:;SRFF8 0�` The locations of wells and cesspools tck R shown hereon are from lleld obsoroollons and or from data oblataed from others. gP J�p►�� Q� .9 CONTOU N LINES AND ELEVAT1OAls ARE REFERENCED To THE FIVE �? EASTERN TOWNS rOPOGRAPMC 0 v- MAPS. O j 4 LP s 'a s eq Q " . 60 11 5 i I G ,/ d'' e we ?ko, Az � Q bx�1. 3UFF+'F.t:t'�tt,�.:S�5'. 'T :SLYTN Vi /� �1• d 0 Od 2 01 -a.gjo\40 0* �� � �..� -,. .,�� ->:: ; •.�.:_3� off` SURVEY OF SrAna7A=FOR APPROVAL PROPERTY AW howl INA7W DF SMWACE MWAW AT CUTCHOGUE DASPW" sY%'son se! �mom, ` TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000- 101-02-IN5 Scale: 1"=50, cFRT� Ta, Feb. 27, 1997 EBERNARl1 Mt1LLER Mar 2G /ggg@ PAL4LETTB$A AN MULLER •lure 26'a T prnp. wep 8 saeltery 1 OA401WEALTH LAND TITLE AlS~CE COMPANY Ocf!!0,199T t conc. foundation 1 R14 97 0159 May 21,1998 1 Raar 1 a AREA=80,000 agft S�Poa 9T M f Q1od� gA�NY ALTER 7209 ATMN aR er &RVEY 1S jA7�U(101r{N7l7W ROi.eived l.•r .* ea FJ1 1 AS SE �72a�SLDAJI?'ulT CWA 2.AIJ ACE!! u 77�Y/S awlrol4 c nU1.y 49618 11F]WW ARE VALV FOR 7W MAP AND COPES IiEtEEp�• Y/� sAp uAr aR camas 6EAR rMEatoR—SEAL of 7PAE�^ IV6YGY4 OCT 51998 J t�lutc matt, W. N7fGA1E'&gYA7YA4E APPEARS HE•REOM f5167 Thy- r To COMPLY N77P!SAn uW 7W 7E+W ALTMO Ar• PRICK BOX 9 G!I?ear�58Ric6S 1230 TliA VEY Dg �a MUST L BY,W A�p ALL dtA4VfY t/fliII/!G A CfYY G!Ydast2faai8r Niamt.t -sy of ANa71 M StA4YEY YOBS NM. TD7ARS s d As 1K9�C11FA'AAD "'--�� SOUTHOID, N. f YROUSHr-7"AW ARE Nor Av CCMIYWIKS Wl7N 71E'us. . 87- 134 y DQ { td Z 621 - 41' 11 inc ICF system Secondary block wall 8 " 24 ' coping SK1 SK2 SK3 SK4 ——————————— ————— ----- ----------- ------ ---------- o ------------------ o ------------------- o I o I r------- ----- ------------- ---- ------ — -------- ---- ------------- --------------- I , 61 5 4 3 2i1Lg-2Lg-3Lg-4Lg-5Lg-6 I I I PROPERTY OWNER I of I I Ci -4.0' -4.0' -4.0' i v' + 1 nEl n -, ❑ El7 a 110 12 - 4 I g D MD MD MD g l I I I I I 1 2 I I I SECTION AA RJ-1 RJ-2 RJ-3 RJ-4 RJ-5 RJ-6 RJ-7 RJ-8 SECTION AA' 'LL- I I I I ---------- --------- ----------- --------- --------- ---------- --------- ---------!fR---------- ADDRESS *APPRVED AS N ED pDATE: B.P.#FLOOR PLAN FEE: BY: U J R = R e t u r jet NOT1802 B 81AMNT0 LDIGD4 PMR FOR TIIET CONTRACTOR S K — skimmer FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRE Lg = pool light FOR POURED CONCRETE Lavender Landscaping, Inc. SECONDARY BLOCK WALL M D = main drain 2. ROUGH - FRAMING & PLUMBIN 3. INSULATION PO Box 791 ICF SYSTEM 4. FINAL - CONST'�!T,'lON MUST +1.ss - Westhampton, NY 11977 BE COMPLETE '= IR :' 0. p ' --- ---- --------- CQNSTRIUTL h, .` BALL MEE T E Office: (639) 288-0373 R BIREMENTS OF THE CODES 0 NEW SK1 SK2 K3 SK4 NOT RESPONSIBLE F( IR Fax: (631) 288-23934ft 5'- 10 -2. / / well (516) 901-6153 Iavenderlandsca in inc mail.com \/\/\ p 9 -4.17 \ \ www.lavenderlandsca in .com Al \�\\ \// � / /\ , . � CONCRETE FLOOR HEATING FLOOR SYSTEM SECTION A,A' INSULATION COMPLY WITH ALL COD PROJECT GRAVEL BASE NEW YORK STATE & TOWN C D=S AS REQUIRED AND CONDITIO qS OF 11� .. 1 10 X 601CF SYSTEM POOL GENERAL SPECIFICATIONS Notes: I"�' 3 E ARD Mesurements: *The distance between the inlet INil TRt ST :S Pool,measurements = 20' x 40 / regulating valve to the pump and the y �-gC�--- SECONDARY BLOCK WALL 4'- 0 to 4'- 0 deep suction of the pump shall be not less than 10 inchh� DRAWING NAME +1.66' AMVIC ICF SYSTEM Surface area = 870 sq/ft *The equipment must be correctly �_ �� Maximum length = 63.66' 1�--�---- -- -------- ... =---------- -- -- .. positioned on light concrete bases that OCCUPANCY 0 PROPOSAL PLAN + - : . 18 Total depth = 4 ft USE IS UNLAWFUL I will keep them away from the natural soil. 4 ft �\y \y �\ �/ �j Volume = 2,400 cubic ft ' / // / ` / // //� Gallons = 17,900 gallons *The box of electrical connections for r-'5- 10 ( 2.34 \\ \\ \ � \\ \\ \ g _ _�- \ \ \ WITHOUT CERTI f AT,- �- - 17, '\�/�f� ///�//\// Construction: swimming pool lighting must be of least one OF OCCUPANCY Date: March 2021 I -- \/ \\/ foot high above the water level of the pool - --------- --------� INGOUND ICF INSULATED CONCRETE FORM POOL 1/2" steel rebar reinforced *The pool lights should be placed at a minimum CONTENT �ONCRETE FLOOR 3,000 - 3,500 PSI concrete depth of eighteen inches at the bottom of the RETAIN STORM WATER RUN F HEATING FLOOR SYSTEM Marble dust finishing and tile pool coping. PURSUANT TO CHAPTER 23 FOOTING \ INSULATION Pool coping 24 " (Type of stone coping not defined) Floor plan --- OFTHE TOWN CODE. /,, r ; ,•. ; ., GRAVEL BASE *The return jets outputs should be placed Pool Equipment: SECTION B,B to a maximum depth of 16 under the ELECTRICAL One 1.8 HP Jandy variable speed purrp bottom coping. Issued One D.E 24" 0 filter INSPECTION REQUIRED One Heater Ray-Pak 400,000 BTU Drawn And add a raypak heat pump Four Skimmers of 12" inch mouth. °4 air m�:,oliATELY � Ef�osE POOL TO CODE S 1O Lavender landscaping Inc. Seven PO01 glObrite LD light UPON COMPLETION EMMA'S PATH PROJECT Eight jet returns with adjustable output ': '_:',BEFORE"WATER" � March 2021 Scale. 1/f —— 5 �/2-1 -- , , ACI I_ MAY 1 3 2021 r'nhvx s 0 m � f 631 - 8 „ WKf ' 60 i I` Secondary block wall 8A17 Klvr " k SK1 SK2 SK3 SK4 ---------------————— __1 /------ ----------- ------------------ ------------------ ------------------ \ ' I { ' II --------- ----- ------------- ---- -------- -------- ---- ------------- _ 11 1 1 61 5 41 3 2 1 '� g-2 g-3 g-4 g-5 � g-6 1 12 13 4 5 i 6 l l I l i I I I 4 ---- - ► ' ' PROPERTY OWNER II I ' ' Paulette Satur & I0 1 I ( 1 1 41 - 411 1_ ' -4.5' -4.5' -4.5' I 1 1 1 1+ 1 1 12 15 - 8 Eberhard Muller I I I Lg-1 MD MD MD MD Lg-7 I I I 11 inc ICF syste SECTION AA' i 1 I2 s 24 ' coping SECTION A,A' ADDRESS RJ-1 RJ-2 RJ-3 RJ-4 RJ-5 RJ-6 RJ-7 RJ-8 i 1 I 3705 Alvah's Lane, Cutchogue, NY. Ii --------- --------- -- -------- --------- -- ----- ---------- --------- --- --- ----------� 11 11935 I FLOOR PLAN m J R = R e t u r jet CONTRACTOR m z . SK = skimmer 0 U W Lg = pool light Lavender Landscaping, Inc. SECONDARY BLOCK WALL I� D = main drain PO Box 791 +1.66, ICF SYSTEM Westhampton, NY 11977 -- 14;---- -------- 1 i o.o ti` 18 „ Office: (631) 288-0373 1 f SK1 SK2 SK3 SK4 :>t Fax: (631) 288-2393 6 - ; -2.8�ij \ \ \ \ \ Cell. (516) 901-6153 lavenderlandscapinglnc@gmail.com -4.67' // // // ,.... .. .. .. /:,y,.: :.:: www.lavenderlandscaping.com - --------- \ \y \ \ \y \ \y \y \ \ \y \y \ \ \y \y \� \y \� \y \� \� \� \� \y \� \� \y � \/\/ CONCRETE FLOOR PROJECT HEATING FLOOR SYSTEM SECTION AA INSULATION GRAVEL BASE 12 X 601CF SYSTEM POOL GENERAL SPECIFICATIONS Notes: Mesurements: *The distance between the inlet Pool measurements = 12' x 60 / regulating valve to the pump and the SECONDARY BLOCK WALL 4'- 6" to 4'- 6 " deep suction of the pump shall be not less than 10 inch DRAWING NAME +1.66' AMVIC ICF SYSTEM Surface area = 1000.84 sq/ft _____-____ _ Maximum length = 63.66' *The equipment must be correctly ---- --;-------- -- - ------ ------ „ positioned on light concrete bases that PROPOSAL PLAN +/ o.o {, 18 Total depth = 4.5 ft will keep them away from the natural soil. 1 4' - 6" `r/\/\/ : `,: \/\/\/ Volume _ 3,240 cubic ft Gallons 20,152 gallons 6 - 4 i _2 84, /\\/\\ \ :.; /,\\/\\/� 9 The box of electrical connections for I ---- ----- /\,�f\ :: : .. //\//\//� Construction: swimming pool lighting must be at least one , Date. r -4.67� \/\/ /\/ foot high above the water level of the pool arch 2021 INGOUND ICF INSULATED CONCRETE FORM POOL \\ \\ \\ \\ \\ \\ \ \\�\ 1/2 steel rebar reinforced The pool lights should be placed at a minimum CONTENT \//\�/\//\ \/ 3,000 - 3,500 PSI concrete depth of eighteen inches at the bottom of the �ONCRETE FLOOR Marble dust finishing and tile pool coping. HEATING FLOOR SYSTEM Pool coping 24 " (Type of stone coping not defined) Floor plan INSULATION FOOTING GRAVEL BASE The return jets outputs should be placed Pool Equipment: to a maximum depth of 16" under the q SECTION B,BI One 1 .8 HP Jandy variable speed pump bottom coping. Issued One D.E 24" 0 filter One Heater Ray-Pak 400,000 BTU Drawn � And add a raypak heat pump 9 0 . ' Four Skimmers of 12" inch mouth. 0 5 10 �F NE\11�°Q` Lavender landscaping Inc. Seven Pool globrite LD light ICF Pool system project Eight jet returns with adjustable output March 2021 Scale. 1 ►► = 4