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HomeMy WebLinkAbout50702-Z o�OS�FF� G` Town of Southold 5/21/2024 y�f 24 P.O.Box 1179 53095 Main Rd Woo? �a Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45193 Date: 5/21/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 190 Pheasant Pl, Greenport. SCTM#: 473889 See/Block/Lot: 53.4-44.36 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/17/2024 pursuant to which Building Permit No. 50702 dated 5/17/2024 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 Greenport W Holdings Inc of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45618 07/23/2021 PLUMBERS CERTIFICATION DATED A th rize, igna e SnEFot,�� TOWN OF SOUTHOLD BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE o • SOUTHOLD, NY 4,ol BUILPING 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#: 50702 Date: 5/17/2024 Permission is hereby granted to: Greenport W Holdings Inc 44 Country Club Dr Port Washington, NY 11050 To: construct an in-ground swimming pool as applied for. replaces #45618 At premises located at: 190 Pheasant PI, Greenport SCTM #473889 Sec/Block/Lot# 53.-4-44.36 Pursuant to application dated 6/17/2024 and approved by the Building Inspector. To expire on 11/16/2025. Fees: ELECTRIC $150.00 Total: $150.00 Building Inspector gUFF1111re TOWN OF SOUTHOLD BUILDING DEPARTMENT y TOWN CLERK'S OFFICE �y • SOUTHOLD, NY 0 �Jpl .� 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 #: 45618 Date: 12/29/2020 Permission is hereby granted to: Greenport W Holdings Inc 44 Country Club Dr Port Washington, NY 11050 To: construct an in-ground swimming pool as applied for. At premises located at: 190 Pheasant PI, Greenport SCTM #473889 Sec/Block/Lot# 53.-4-44.36 Pursuant to application dated 12/9/2020 and approved by the Building Inspector. To expire on 6/30/2022. Fees: SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector pF SO!/ry0l Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 117 CA- Southold, Q sean.devlinCcb-town.southold.n NY 11971-0959 .�` � �� y'us Comm,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Greenport W Holdings Inc Address: 190 Pheasant PI city:Greenport st: NY zip: 11944 Building Permit#: 45618 section: 53 Block: 4 Lot: 44.36 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: TRC Electric License No: 46689ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect 1 Switches 4'LED Exit Fixtures 11 Pump 1 Other Equipment: Hayward Omni PL 8Circuit - 4 Used, Pump 220GFI, Hayward Summit XL Heater, (2) Lights on GFI, Hayward Touch Switch Notes: Pool Inspector Signature: Date: July 23, 2021 S.Devlin-Cert Electrical Compliance Form O�aOf SOUIyO * # TOWN OF SOUTHOLD BUILDING DEPT. 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) LECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O REMARKS: DATE �r INSPECTOR pF SOUIyo� # # TOWN OF SOUTHOLD BUILDING DEPT. Quo,NF'' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST . [/IR UGH PLBG. FOUNDATION 2ND [ ULATIOWCAULKING FRAMING /STRAPPING [ AL P [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]' R FN T(AL REMARKS: (D w4a AV51- a d'u �lP� SI CiC� bqioueLu c N $ t (130 �► — v DATE a` �a'a` INSPECTOR OF SOUlyolo # TOWN OF SOUTHOLD BUILDING DEPT. `ycourrn��' 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I SULATION/CAULKING [ ] FRAMING /STRAPPING [ FINAL Pow [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 6%wRk in Fao,�v S� • DATE INSPECTOR 44t �. ;+-ja r x4 kqT ry Y { l•e''fi�' ..to,� `' f� ek ea 1 , r to r P t _H ,jr � � �r x; �. ., '. ,t .._��-fit:•� •:. -. '' ..J •� 97f •, '!L ����� �1�' `4 ~ASS/' �: •' ... '` _BIZ !/ .p.. �t���, '��rl��.;• +f� • '1t• K.'`W rr R T 1 a s 4 Ir cz • /UUIICC�:r y ` co •1- �� �. \ � i rib r 1 YA q v Vy CNJ wv 44 VIA, caCn " '''� �' DTI%Q • y �� 'i y � ✓ 04 � �� � r, N +• X' .._. ,.�.��•��• . Al f .� .� �_._ '!_; `46 A�Y.t VIP �b c .����#, �;�;; ;_;, ,,^i . - ,i t 1 � � r i"` ♦. 1 � � '.�'. s � �1 +�.r_r , 5 1�y } ,. � �' ...; 9. „' c _� � ...__ T J _`� — ` -�. s„�— -1�--' �_ rJ �.'s.^- �� �,�,`�' � ��1 ��+����_` 1`ate-_>"`� -. -- �! -� _��-s � �- � - � ,-..fie.`^ y �, �.�/: � +r �• t . r r a 1 - 1 e • • i. �•,�•�� ' \ti Wit".: �_�1. _,-+� '`'�, _• _.�, �'1r-.+�I�J�J p ws • t S 44 f � R t ti `• !.# i �1a mow( ; • i 1• f 'W Single take I c k � _ r � ( o.'r' .� Via) ., , !�' • i � r= J� 1l 11 :02 • �• 0 At AP Single take aim FFTT � II' r• ti O �' S rf a 1 e _ i jz 1 � i l , t \`mac t i R, n 1 � 4 r ryy t ^i Y i i ►r� 11 L 0 r � r • s 1 ' i InstallationDOOR ALARM • MODEL DAPT-2 SIGNALING MEETS UL 2017 N I 9DRIgure LASTED r \ A-- �. \ ►' STHRUITCHRN l Figure 1 The horn is 85d13 at 10 feet IMPORTANT AD THOROUGHLY BEFORE The product has been designed to aid in the detection of unwanteo '11110` intrusions into unsupervised areas. POOLGUARD DAPT,2 IS A SAFETY ALARM SYSTEM AND NOT A LIFE SAVING DEVICE It should be used in conjunction with the safety equipment currently in usc. -. and should not affect existing safety procedures. i w s„ it "^}�e• dip.+ 1 M1 a Q a • � �� `iliY+ A' gNsm r OA K t � 1� C 10 I • r 10 i HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET December 3,2020 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 Pagnozzi Residence 190 Pheasant Pl. 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, HM E ineering P.C. o' arnika,P.E. • r, FOUNDATION(2i ROUGH FRAMING* IMUMBING ATI • O 9 t ava add r- �► P tyreVIEW- s • r �ff0�.r(k z``� b.S� ooG TOWN OF SOUTHOLD—BUILDING DEPARTMENT z Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Way o� Telephone (631),765-1802 Fax (631) 765-95021ittL)s://,"rww.southoldtowtui..Y.gov Date Received "..-APPLICATION FOR BUILDING P.ERNIIT For office Use Only L �t�„..� jn?7 f �._..,,��_.�, L - PERMIT NO. Building Inspector: j DEC 9 2020 ';Applications'-and';forms.=must=be;#illed,put,in'th'eir'entirety:anco'' "I" e, :applications;wilhnot'beaccepted.''WheretheApolitant�is"not theowrier ,an Own e`r's-Auth'or'iiation form;,(Page 2).ahall be completed'. OLD, Date: F'PR PERTY;' ri OWNERS:0 0 .� G� t_ i .. . • vim.- ,. � �,, Name:" jk© b�f Pa no-1-OL- SCTM#1000- 3 Physical Address: Iq l. l phone#: l?— 7 `Email: C Mailing Address: . i -Y lY, ,E y_CO CT?P NTA RSON: Name: Morano Expediting Services 1S Mailing Address: 28 Edward Street NY 117-14 Phone#: �3 _5� Email: •v 'J - F SSIONAL.IN FORMAT+GNtl-P O E'DE I S R Name: Mfor Mailing Address: ,4 otophooa n Phone#:1 < L•)'� �v � � I Email:. _ :1 3 :'INFOR ATIO °CONTRACTOR. t _ _ nJ r Si - '•'t Name:... ..L 'ISI (1 -r Ruh Mailing Address: rJ. . Phone'#: ' 31. _� D Email: ! /J a A TIO'� N T UC N ` - ESC RTIO'N'.OF�RROPOSED CO S R - =D RI - _ ❑New Structure ❑Addition ❑Alteration ❑Repair []Demolition Estimated Co t f Project: IeOther inavi LA. A om 1 Will the lot be re-graded? ❑Yes Mbp Will excess fill be removed from premises? ❑Yes qN071 1 �•PROPERTIf'INF.ORMAT{ON'. Ex is ti ng use of property: l Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect.to this property? ❑Yes Go IF YES, PROVIDE A COPY. Check Box After.,Reading:,rne.owner/,contractor/design professional is responsible for all;dra'inage.aridtstorm;water'issues as£provided,by,', . =' :. Chapter.236.of,the Towri,`Code.;APPLICATION'IS REREBY.MADE;to'the:Build ng,Department forthe issuance of a Building Permit pursuant to,the Bwlduig Zones: kOrd'inance:of tfie,Towriof Southold;Suffolk,,County,New York and'other applicable°Laws;;Ordinances or Regulations;for,thcon"str"uctiori of b`uildingr,' additions,alferetions,or.'for removal o"r demolition a"s hereiri:describedr',Ttie apphcant agrees to comply with all ap'plicable_laws,ordinances,building code„" "! ;;housing'code and regulations-and to admit autfioriied:inspe`ctors o._premises;and in buildings)for necessary,inspectioFalse stafements;inade herein are"?' ,. npunishable as a Class,A'isdemeano[pursuant to,Section;210.45_of,the New York State Penal law: Application Submitted By(print e):D� � �� Authorized Agent ❑Owner Signature of Applicant: Date: `a U00 STATE OF NEW YORK) SS: COUNTY OF RGLSSGICAD) ) am)A_Ct o 1�a J being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (a q-enL (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 S�day of,Je nbe , 207D U6 Notary Public Rosemarie Edith Kilicarqlan Notaty_P-ublic--State-of.N��llti' - PROPERTY OWNER AUTHORIZATION No.01KI6360137 " (Where the applicant is not the owner) Qualified irrSuffolk Co,nt Iiity Commission E�tpiree . _ki l;a f ! "f7'Z residing at ?�. r--�. do hereby authorize NOMAD 'PV,0.P-&ii0A to apply on my behalf to the To en or approval as described herein. 5a .. ' GOv�tner Ss Ign L-Date•.. JACK GROj 3ACK GROSSMAN N Y PUBLIC;ST YORK q � I �I19(( N0. 02GR6 Print Owner's N )i�r. i 1;;�-;�::� ��:. QUALIFIED IN NAUNTY: �- - ----------- ( .. ISSION EXPIRES,2� \fie,' _r,'.�.'•:'•S.�.ti 1lyil�'� • � r SU¢ BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD 3�U1. Town Hall Annex - 54375 Main Road - PO Box 1179 ca AV�• 'D Southold, New York 11971-0959 elephone,(631) 765-1802 - FAX (631) 765-9502 rogerr(cDsoutholdtownny.gov — seand(a�southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 07/10/2021 Company Name: T.R.C. ELECTRIC CORP. Name: I "S C&l kl'te -� License No.: 46689 ME email: TRC4426@GMAIL.COM - - - Phone No: 9.1-7=709-3255 Z1. request an email copy of Certificate-of-C—oi�ipliGnce Address.: 190 PHEASANT PLACE , GREENPORT JOB SITE INFORMATION (All Information Required) Name: BOB PAGNOZZI Address: 190 PHEASANT PLACE , GREENPORT Cross Street: Phone No.: 91-7-70.9-3255 Bldg.Permit #: 45618- email:,-TRC,4426@GMAIL.COM Tax Map District: 1000 Section: 53 Block: - -- - - Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) IN GROUND POOL/ FINAL ELECTRICAL IN GROUND POOL / FI'NAL ELECTRICAL IN GROUND POOL / FINAL ELECTRICAL Check Ail That Apply: Is job ready for inspection?: ❑✓ YES ❑N ❑Rough In Final Do you need a Temp Certificate?: [::]YESNO Issued On 07/1012021 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑l ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: _..- PAYMENT DUE WITH APPLICATION A Electrical Inspection Form 2020.xlsx ����� o D OSU� � BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD U�- Town Hall Annex - 54375 Main Road - PO Box 1179 • Southold, New York 11971-0959 eephone (631) 765=1802 : FAX (631) 765-9502 rogerr(@,southoldtownny.gov -- seandCcD_southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 07/10/2021 Company Name: T.R.C. ELECTRIC CORP. Name: -B* eez s License No.: 4§.689 ME email: TRC4426@GMAIL.COM. .�.�,. .w. Phone No:-917=7GQ-3255- QI-request G,n er�ail:eopj of-Ce.rtifi of o;Co&mpii-arrce'_ LL Address.: 190 PHEASANT PLACE , GREENPORT JOB SITE INFORMATION (All Information Required) Name: BOB PAGNOZZI Address: 190 PHEASANT PLACE , GREENPORT . Cross Street: _..._... --.-Phone-No.:-91-7770.97325-5;: _ ::........ .- :`' .. .:Bldg:Permit'#:'45618>- .,.._.. ..._.._......... .....:._.,_. ...,..........._..;_..__.....-.. ema.11-..IQG442.6@GMAIWL SectTax Map District . 1000 ion: . Lot:.. BRIEF DESCRIPTION OF WORK (Please Print:Clearly) IN GROUND POOL-./.FINAL ELECTRICAL'" IN GROUND POOL / FI'NAL ELECTRICAL IN GROUND POOL / FINAL ELECTRICAL Check All That Apply: Is job ready for inspection?: ❑✓ YES ❑N ❑Rough In ❑✓ Final Do you need a Temp Certificate?: DYES NO Issued On 07/i 0/2G21 Temp Information: (All information required) Service Size 1_]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 Electrical Inspection Form 2020.xlsx ��� �oSUFFO(,4-co BUILDING DEPARTMENT- Electrical Inspector 0�0 Gym TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 o Ze - Southold, New York 11971-0959 y p� Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(a-)_southoldtownny.gov — sea nd(a�southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN" INFORMATION (All information Required) Date: Company Name: Name: License No.: email: Address: Phone No.: JOB SITE INFORMATION (All Information Required) Name: Address: Cross Street: Phone No.: Bldg.Permit#: L( �1p j� email: Tax Map District: -1000 Section: :Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print CI arly) Circle All That Apply: Is job ready for inspection?: YES / NO Rough In Final Do you need 'a Temp"Certificate?: YES PNO 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 Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work-done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION Request for Inspection Form.xls PERMIT# Address: Switches O? A U�/L Outlets GFI's Surface Sconces H H's LIC Lts Fans Fridge HW Exhaust Oven Dryer Smokes DW Service Carbon Micro Generator Combo Cooktop Transfer AC AH Mini Special: 4t Comments. \ y �_ �T:tiE��l� � :��.i�:'t;E~�: �• ... ��F'���aik:�c�iii��{ .. LEc�i���� v�ry H�=CJTr;F� LONGI-7 OP ID: DO -1cURO� CERTIFICATE OF LIABILITY INSURANCE FDATE(MM1DDm^rY) 04/07/2020 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 631-669-3434 COMEACT Brennan P.Regan Regan Agency,Inc. PHONE 631-669-3434 FAX 631-669-3035 463 Deer Park Ave A/C,No,Ext): (A/C,No): Babylon,NY 11702 E-MAIL Brennan P.Regan INSURERS AFFORDING COVERAGE NAIC# INSURER A:American Casualty Company 20427 INSUR INSURER B:State Insurance Fund 36102 Long�Viand Pool&Patio,Inc. 543 Midd Coram,�Y 11727 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 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. ILTR NSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 5099218546 12/20/2019 12/20/2020 DAMAGE TO RENTED 100,000 X PREMISES occurrence) $ MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY 0jECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY CO aBco deDtSINGLE LIMIT $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS AUTOS ONLY O OS ONLY PROPERTY accident AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY S ATU ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ 12439-791-1 04/10/2020 04/10/2021 100,000 FFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ Mandatory fn and E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Property Section 5099218546 12/20/2019 12/20/2020 -F DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate Holder is additional insured. CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD LONGI-7 OP ID: El .L1coRo° CERTIFICATE OF LIABILITY INSURANCE DATE 12/03/2020 /2020 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 631-669-3434 CONTACT Brennan P.Regan Regan Agency,Inc. PHONE 631-669-3434 FAX 631-669-3035 463 Deer Park Ave (A/C,No,Ext): (A/C,No): Babylon,NY 11702 E-MAIL -M IEss Regan Agency,Inc. INSURERS AFFORDING COVERAGE NAIC# INSURER A:American Casualty Company 20427 INSUR D INSURER B:State Insurance Fund 36102 Long Ffsland Pool&Patio,Inc. 543 Middle Country Rd. INSURER C: Coram,NY 11727 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 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 TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X] OCCUR X 5099218546 12/20/2020 12/20/2021 DAMAGE O RE(EaoNTED ccurre a 100,000 MED EXP(Any oneperson) $ 15,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ B WORKERS COMPENSATION X SEAT TE ERH AND EMPLOYERS'LIABILITY - 100,000 ANY PROPRIETORIPARTNER/EXECUTIVE Y 12439 7911 04/10/2020 04/10/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Property Section 5099218546 12120/2020 12/20/2021 BPP 150,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate Holder is additional insured. CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 Southold, NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 1 NYSIP New.York:stateinsurance:Fund 8 CORPORATE;CENTER1DR,'3Rp FLR,MELVILLE,NEW"YORK..117-07-3129 (.nysifc"om CERTIFICATE OF'WORKERS' COMPENSATION INSURANCE (RENEWEDY %..v A,A A A A A -112590$90 ;B EGAN AGENCY°INC-463,VEEKPARKAVENUE"NY 11702� SCAN.TO,VALIDATE AND SUBSCRIBE POLICYHOLI}Eft 'GERTIFICATE'H LDER LO'NGlSLAND'•Pt OL'&PAT1.0 INC' TOWN,OF'SOU.THOLD 543 MIDDLE COUNTRY.F2D 53�95`Rpl1TE 25 Ci3RAiV1.NY'•11727" SQU,.OLD• NY .1:19.71 POLICY NUMBER, CERTIFICATE,NUMBER POLICY-PERIOD, DAl"E 124,3.9 79,l4 95'1370 040,0 090 T.0 04/10/2021 3(12/2020 THIS IS''TO-CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK•STATE 10SURANCE FUND UNDER POLICY NO, 2439.791-1, .COVERING THE ENTIRE, OBLIGATION, OF THIS "POLICYHOLDER, FOR VIIORKERS' COMPENSA' ON: UNDER THE NEt' YQRI< WORKERS' .COMPENSATION: LAIN WITH RESPECT' TO ALL OPERATIONS 'iiV Ilk OF NEW. PORK, EXCEf!T AS INDICATED. BELOW, AND. WITH RESPECT TO OPERATIONS OUTSIDE' OF NEW PORK; 'TO THE POLICYHOLDER`S REGULAR NEW YORK ,STATE EMPLOYEES' ONLY. IF'Y,0 WISH:TO,RECEIV,,E'NOTIF.ICATIQNS.REGARDI.NG SAID POLICY,,INCLUDING:ANY NOTIFICATION OF CANCELLATIONS, OR.TO VALIDATE THIS CERTIFICATE,VISIT'OUR'WEBSITE AT HTTPSs%11NWW.NYSIF:GOM/GERT/CERTVAL:ASP.THE NEW YQRK°:`.STATE INSURAI!iCE.FUPFD fS.NOT L1kBLE'IN:TME_EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POl.1.GY'QOES.NOT"CtOVER::CLAiM5'OR';SUITS"THAT ARISE FR'QWBODILY'INJURY SUFPERED,BY THE'OF'IQERS op TME INSURED:CURPORAT(ON. PRESIDENT MICHAEL DOMINICI LONO ISLAND POOL,,&PATIO..INC' (ONE PERSON CORP). THIS CERTIPIGA[E IS,ISs.UEb,AS:-A ,MATTER, OF ANFORMATION,oNLY•AND"COkFERS NO RIGHTS NOR INSURANCE COVERAGE, UPON. THE GERTIFI,CATE' HQL'D,ER: THlS CERTIFICATE '44ES" NOT AMEND; EXTEND' :OR ALTER THE'C.0VERAGE -AFPORbED,tY'.Tt iE POLICY. NEW YORK STATE INSURANCE FUND �D IRECl"0 R",INSU RANCE'FUN D.UNRERWRITI NG` VALIQ#t ll NUJVIBl R:.244201077 U-20 3 ISTNE"WIK Workers' CERTIFICATE OF INSURANCE COVERAGE dTE Compensation 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) 1b.Business Telephone Number of Insured LONG ISLAND POOL&PATIO INC 543 MIDDLE COUNTRY ROAD CORAM,NY 11727 1 c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specirically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 112590890 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 53095 Route 25 3b.Policy Number of Entity Listed in Box 1a" Southold, NY 11971 DBL575672 - 3c.Policy effective period 01/01/2020 to 12/31/2021 4. Policy provides the following benefits: A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. rl C.Paid family leave benefits only. 5. Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above.Date Si ned 10/7/2020 By "0' ot 9 (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 513 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) �IIIIIP°°u�1211°�1°°(110°°17)°�II� �100 �� SURVEY OF ,x, ��, �� LOT 34 APPROVED AS NOTED MAP OF DATE: - B.P.# ta9SAUGUST ACRES, SECTION ONE FILE No. 9107 FILED JUNE 03, 1991 ��. iOTI Y BUiLuiilt: iJEt . RTMENT AT o&� .'65-1802 8 AM TO 4 FWI FOR THE SITUATE va3 i , OLLObtifING INSPECTIONS: ARSHAMOMAGUE I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE I:li 2. ROUGH - FRAMING O F S O U TO L D_& PLUMBING TOWN H 3. INsuLATION SUFFOLK COUNTY, NEW YORK 4. FINAL - CONSTRUCTION_MUST o BE COMPLETE FOR C.O. S.C. TAX No. . 1000-53-04-44.36 ALL CONSTRUCTIQN SHALL MEET THE SCALE 1 "=40' REQUIREMENTS OF THE CODES OF NEW ASP AUGUST 14, 2020 \ HALT�� , �. ® YORK STATE. NOT RESPONSIBLE FOR \ DRIVEWAY DESIGN OR CONSTRUCTION ERRORS. �•`� • � cf11 c� ry �Od'�i���� � I OF COMPLY WITH ALL CODES AREA = 42,036 sq. ft. NEW YORK STATE &TOWN CODES 0.965 ac. ,T � �' LOT 14 { AS REQUIRED A ONS OF SOUTHOLD TOWN ZBA Y OR SOUTHOLD TOW NNINGBOARD S S L���IFU L SOUTHOLD WN TRUSTEES N.tir.s. c WITHOUT CERTIFICATE . or- OCCUPANCY N 0/� Gym LOT f4 Tom0p$OUTBOLO LOT 14 r ' � ELE • `�`�' "iMEDtATELY ENCLOSIE POOL TO CODE, f. TEST HOLE UPON COMPLETION ,� I ■ CONC. MON. FOUND BEFORE"WATER" M SUBSURFACE UTIU ES AND OR E OF ANY uTiuTY POLE STRUCTURES �r WATER METER NOT READILY VISIBLE, ARE NOT CERTIFIED. S i METES AND BOUNDS SURVEYING THIS SURVEY SUBJECT TO ANY EASEMENT � OF RECORD AND ANY OTHER PERTINENT FACTS N�O�F WHICH A TITLE SEARCH MIGHT DISCLOSE AUGUST ACRES XOJItROR71VSRSC 53 PROBST DRIVE "UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND SURVEYOR'S ASSOCIATION, I1VC. 'A i SHIRLEY,_ NY 11967 SEAL IS A VIOLATION OF ARTICLE 174, SECTION i 7209, SUBDIVISION 2, OF THE NEW YORK STATE �,�. PHONE (516) 972-5812 EDUCATION LAW" ee surveydude@optonline.net "Copies from the original of this survey inup not rnurked with on original of the land LOTS: 44.36 surveyor's inked seal or his embossed seal BLOCK: 04 SECTION: 53 DISTRICT: 1000 Shull ,at be considered a valid true copy. • / O thisrsuirvey nvasIndicated preparedaiearacer.rdarice that with MAP OF: AUGUST ACRES SECTION ONE the existing Cad. of Practice for Lund Surveys / adopted by the New York Slate Association of 41t / r Professional Lund Surveyors. Said SITUATED AT: ARSHAMOMAGUE certifications shbil run only to the person for whorn-the survey is prepared, and on his TOWN OF SOUTHOLD, SUFFOLK CO., N.Y. behalf to the thin company, governmental agency and tending institution. OldQ CertiflCUU0418 are not transferable to °Q X/O�F additional institutions or subsequent owners," S cold Louts i?lLLO r' CERTIFIED RI ;.� TO JOB NO.: 20-267 DATE: AUGUST 14, 2020 i NOTES: --- AND'PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION AND BUILDING CODE,TO 14' WN 1.F= OF SO.UTHOLD CODE AND 2617 NATIONAL ELECTRIC CODE. 2.POOL;SHALL CONFORM TO AN51/APSP/ICGS STANDARDS R326.3.1. I •' " : BRACE CONTINUOUS CONCRETE 3,.SECTION R326,7 POOL ALARM REQUIRED. {., (gip.) COLLAR',(ENTIRE 4.ENTRAPMENT PROTECTION REQUIRED SECfI0N,R326.5. .. PERIMETER) SEE DETAIL 5.P.00L SHALL COMPLYWITH BARRIER REQUIREMENTS SECTION R326.4. THIS`SHEET .6.POOLSHALL COMPLY.VUITH 2O26.ENERGY CONSERVATION CONSTRUCTION CODE OF NYS SECTION R403.10: SUNDECK `..� POOLS-AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). ;SECTION`R403;10':1'HEATERS', • - t; r, ,•, SECTION R403',10.2 TIMESWITCHES .'•: .•: '•..: .: %.: .' '•• :.k. �': SECTION R403.10:3,COVERS 7.SLOPE PATIO SURFACE 1%4"PER FOOT(MIN.)AWAY FROM POOL. 8.LOCATION OF•PROPOSED;SWIMMING POOL AND POOL EQUIPMENT BY OTHERS.LOCATION TO COMPLY ;: :• ," STEPS ,` WITH LOCAL'ZONING REQUIREMENTS.• 9.EIACKFILL:MATERIAL;TO,BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR LARGE ROCKS). •'.; 10.FILL POOL-WITH WATER'PRIOR'To DACKFILLI,NG. 26' 1'1,POOL TO,REMAIN PERMANENTLY FILLED. �. .' 12.ALL O•RAIN COVERS TU`MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME BAKER(VGB)POOL AND SPA . ' PROPO>3ED VNYL ( ( sAFETY•ACT.', . 13. -i4&bIVING EQUIPMENTPERMITTED. SIAIb11N1lIlIVC `POOL 18, CONTRACrOR SHALL VERIFY S011.BEARING LOADS,PRIOR TO.INSTALLATION,OF POOL. (7" S.F.) ( I 15.THIS,PLAN 15 FOR,CONSTRUCTION ON PROPERTY AT 190 PHEASANT PL.GREENPORT,N.Y.119"ONLY. I 16 HM ENGINEERING,P.C.SHALL•NOT BE RESPONSIBLE FOR CONSTRUCTION MEANS;METHODS,TECHN.IQUES OR PROCEDURES UTILIZED BY THE'CONTRACTOR;•NOR FOR THE SAFETY OF THE PUBLIC,OR CONTRACTOR'S EMPLOYEES,OR`FOR THE FAILURE OF THE CONTRACTOR TO CARRY OUT THE WORK IN ACCORDANCE WITH ( THIS'PLAN: 17:'S0CT(ON OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH ANSI/APSP/ICC 7. 18:NO SURCHARGE ALLOWED WITHIN 4'OF SHALLOW END AND W OF DEEP END. 38' FILTER BRACE PUMP BRACE M( I 8 CAVITY.'iM1N GRAVEL E,O,.:_OL• .PLAN NOTE: :AGGREGATE OR 'NOT TO SCALE_ THIS IS ANON-DIVING POOL. ' SKIMMER(TYP.)" DUAL MAIN DRAIN MATH STMAINER,(VGB ' 3:W. T VINYL LINER: (MIN.) SAFETY AC. 3'-4" VIEW ACROSS CENTERLINE OF HOPPER APPROVED'DRAINS) —. o 8' SIMMMING POOL b' CPOSITE EL 711 2" SAND BOTTOM o., • ;;. uous ,TAMPED do ROLLED `,`;'`'', , COIlAR FILTERED-.WATER ` IIRIVE STAKE 0 R E T U R N : NUMBER OF. 14' 14' 6' 4' NOZAES:VARIES.PER, '' 4, r ',`'••' POOL;SIZE:,`;::r pooi: SEcnoN �AAIN'''DR'AI PIPING- SCHEMAl1C N'OT TO SCALE NOT,TO SCALE LEVELING BASE UNDISTURBED EARTH' NOTE: DRAWING CONFORMS TC+,ANSI/APSP-7 SUCTION WALL SECTION AND.BRAC SE_ YS1EM " GENERAL NOTES: ENTRAPMENT AVOIDANCE.CODES. 1.ALL"MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 RESIDENTIAL NOT TO SCALE CODE.O.,F NYS;INCLUDING THE SPECIFICATIONS IN SECTION R326. NOTE: 2.A'DEEP END'LADDER OR'SWIM OUTTO CODE SHALL BE PROVIDED. BACKFILL MATERIAL TO BE SAND,GRAVEL OR OTHER PREPARED FOR NON-EXPANSIVE MATERIAL. PAGNOZZI RESIDENCE 190 PHEASANT PL. GR •ENPORT, .Y: 11.94, DATE:" 12/03/2020 NOTE: ,I,�� .fir, HM ENGINEERING, P.C. SCALE: ASSHOVYN AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED / /6�'�� EAST NORTHPORT NY 11731 SHEET: 1 OF.1 THESE PLANS ARE AN INSTRUMENT OF SERVICE ,�?j/ ,j/ P.O.BOX 914,EA , ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE NEW YORK STATE L [[[ t EDUCATION LAW,INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 virwW.hmarnika@optonline.net RESIDENTIAL SWIMMIN. V ID WIT OUT RAISED SEAL AND BLUE SIGNATURE POOL PLAN