Loading...
HomeMy WebLinkAbout47757-Z �o��g�EFOt,�cpG. Town of Southold 6/8/2024 o yam , P.O.Box 1179 o _ ? 53095 Main Rd y Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45262 Date: 6/8/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 9325 Main Bayview Rd., Southold SCTM#: 473889 Sec/Block/Lot: 88.-3-20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/22/2022 pursuant to which Building Permit No. 47757 dated 4/29/2022 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in ground swimming pool fenced to code as applied for(maintain self-closing;action of all access gates). The certificate is issued to Itenberg,Isaac&Ashley of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47757 10/11/2022 PLUMBERS CERTIFICATION DATED Auto 'zed i nature �o�sufFot,��o TOWN OF SOUTHOLD ay BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE o • SOUTHOLD, NY y� 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#: 47757 Date: 4/29/2022 Permission is hereby granted to: Itenberg, Isaac 117 Beckman St New York, NY 10038 To: Construct in ground gunite swimming pool at existing single family dwelling as applied for. Maintain minimum 10 foot accessory setback from rear & side property lines as required. At premises located at: 9325 Main Bayview Rd., Southold SCTM #473889 Sec/Block/Lot# 88.-3-20 Pursuant to application dated 3/23/2022 and approved by the Building Inspector. To expire on 10/2912023. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector ho��,oF so�Tyol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �Q sean.devlinla'D.town.southold.ny.us Southold,NY 11971-0959 Q�yeDiUNTI,�� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Isaac Itenberg Address: 9325 Main Bayview Rd city:Southold st: NY zip: 11971 Building Permit#: 47757 Section: 88 Block: 3 Lot: 20 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: L&L Lighting License No: 37285ME 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 Fixture Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: Intermatic Pool Panel 8 Circuit/ 3 Used, Pump 220GFI, Salt Generator, Heater, 4 Lights AJ 100WTranny Notes: Pool Inspector Signature: Date: October 11, 2022 S.Devlin-Cert Electrical Compliance Form oe souryo� TOWN OF SOUTHOLD BUILDING DEPT. N iC courm,N�' 631-765-1802 INSPECTION [c:�] FOUNDATION 1 ST f t lgp, [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] -FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: LE60r- le, ©,X. DATE S-S —Zz INSPECTOR A 1111114, SOUTyO� rl 7 7 57 I'", # # TOWN OF SOUTHOLD BUILDINGDEPT. co 765-1802 INSPECTION . . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [' ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ CODE VIOLATION [ ] PRE C/O REMARKS: y r QLA- wh DATE INSPECTOR 4775 �OUTHOLD9-5z� N� OF S OUL M h O , -( # * TOWN OF BUILDING DEPT. cou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: POO-1, ll q A/11 A tyl)Or' 0 � DATE 7 Z INSPECTOR oe sooryolo 4 77S M, I` ��� # * TOWN O SOUTHOLD BUILDING DEPT. °ycourmN�'' 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) CA ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: Aleze DATE 0 2 INSPECTOR C laFSOUI,y�� # # TOWN OF SOUTHOLD BUILDING D PVT. V(� �ycou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: �V /2 �4, �d l fin DATE 16 22 INSPECTOR �� q SOUIyO� TOWN OF SOUTHOLD BUILDING DEPT. courm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ V(FINAL POZ [ ] FIREPLACE & CHIMNEY [ ]. FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: ke- 49lot-ce- 464-OU4,e II qqo . &eu e s� . Yl rnti w GB►�t • -be 0to a la 1,WIs . a)Xke— a.�a �2�n a lylKd 0 yJ j2e s47'Lrc�6y DATE 2'5 ANSPECTOR l OF SOUTgo� # # TOWN OF SOUTHOLD BUILDING DEPT. o�ycou �`� 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ &F' INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O ( ] RENTAL REMARKS: DATE l�_ �l a3 INSPECTOR ��� SOUTyolo # TOWN OF SOUTHOLD BUILDING DEPT. `ycou 631-765-1802 INSPECTION . [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ pj'-FiINAL f ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: DATE 49- 5 'a3 INSPECTOR i TOWN OF SOUTHOLD BUILDING DEPT. Comm 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ dFINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: 42 /n s ��— r911I5ian 0/ 6,Jii2e ,,a/ 58clo2z .e---A, � S on Sl2o�- McSA �����-�i'✓ell - GL �dT��t /Ll e,�� /�-/� Sc�Cy/2� �j ge DATE INSPECTOR hO,\\pF SOUIyo� # # TOWN OF SOUTHOLD BUILDING DEPT. `ycouur+, 631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ rSLATIOWCAULKING U FRAMING /STRAPPING [ NAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ]- RENTAL REMARKS: i � DATE ANSPECTO *Of SO!/Tb°� # * TOWN OF SOUTHOLD BUILDING DEPT. Ulm, 631-765-1802 ��- I N S P E C T IO N [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I SUL ION/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 REMAR S: v Q v-1" 01- c��• h 6&4 DATE INSPECTOR Pontino, Susan antoske4@gmail.com Tuesday, ••- 1 • ' Pontino, 9325 Main Bayview '• r 1 1, + .ff s �.� 1 . �� � �..� ,� � � •• • --�., • ? `,' � _ • r '�`. � f i_ i� �b�. r .� . � • : ���a x ' -. � �� r � � � �� 1 !r� 'f, �• �. - � , #�La -�. ;� .=� ,� - �. ' � •��yr:'. ,� � i f �� .� i •�� �► •� � ! .� ' _ ,� �. .. , , � � " f, r , � � .,� � , ..� s � 9 4 ' `` i i FIELD INSPECTION REPORT DATE COMMENTS , ..� 'j m FOUNDATION(IST) v l ..� H ------------------------------------ S-z-Lz lZErSPt� � � FOUNDATION(2ND) . W o Ul H ROUGH FRAMING& PLUMBING H 1 r INSULATION PER N.Y. H STATE ENERGY CODE Tq a-as a lacc w(� K fiz�o a re- co Coat 2k, Q"OZ a fU15 .w a.lAimgJnderto a FINAL 2t4r24l�Os S i to l w unµ. y A FlrIhAjv\ 11olf 0 kvtt4\— IM UL16 X 'H ADDITIONAL COMMENTS 5 2 - — G�i 0 C Loa-Ate iG p" 101Sql 61A&)) 6 0 b 6 � Z H X clo N � y C Wz H 1�[ d ' b H OUT 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 https://www.southold-tgAnny. oy Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only-75�7 R PERMIT NO. Building Inspector:_ MAR 2 2 2022 BUILDING DE pT Applications "y. List be fii'I6�d",`1but"ih"A"he i't"ehfir6t rnpete,"'', TOWN must OF SOUTH will 66t Ap an OLD �Dwner's Autfioriza411 form(Page'2)shall,,bo,toMoletLid 41�, Date: 3 4,;, 1r, -7-7777,- - OWN R(S 0 PERTfj It F�0R4'0 �Y: Name: Ashley Itenberg SCTM# 1000- 88-3-20 Project Address: 9325 Main Bayview Road, Southold Phone#: 512-731-3933 Email: ashleyitenberg@gmaii.com Mailing Address: 9325 Main Bayview Road, Southold, NY 11971 :CONTACT PE RSON:{' Name: Lisa Poyer,Twin Forks Permits Mailing Address: 288 E. Montauk Highway, Hampton Bays, NY 11946 Phone#: 631-644-5998 Email: lisa@twinforkspermits.com DESIGN PROFESSIO 41(iiNF ",i'A`TIO0-Name: Mir Mailing Address: V Phone#: (ON, 0Z--S--0- L--­..-­-­-- iT!L11-n-vi 0A& U CON AT ,4,-,q ,:r qQRJ! Name: Vitality Pools LLC Mailing Address: 59 Kerry Ct., Riverhead, NY 11901 Phone#: 631-833-9673 Email: vzpools@yahoo.com .......... 0.DESCRIPTION OF,,,PROPOSED,,CONST.RUCTI il' A; ®New Structure DAddition ElAlteration EIRepair El Demolition Estimated Cost of Project: 70ther $ 55,000 Will the lot be re-graded? ElYes ®No Will excess fill be removed from premises? E]Yes ENO r ' PROPERTY INFORMATION Existing use of property: Single Family Residence Intended use of property: Single Family Residence Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R-40 this property? ❑Yes 5�1\lo IF YES, PROVIDE A COPY. O Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water Issues as provided by- w` .;,Chapter 236 of the Town Code.APPLICATION IS HEREBY-MADE to the Building Department for the issuance of a Building Permit,pursuant to the Bailding:zonef-` Ordiriance of the Town'of Southold;Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the co" ructlori of bulldirigs, ;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,- punishabie as a'Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted B Ashley Itenberg pp y(print name): ❑Authorized Agent ®Owner Signature of Applicant• i `f I Date: `� J � )S �y� VL ( 2i`` l STATE OF NEW YOR....KK)) SS: COUNTY OF SU�i As )ti g`/ TTC v 6 c-2 G being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the owner (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 L day of I-) 20 ZZ Notary Public CAROLINE M MACARTHUR PROPERTY OWNER AUTHORIZATION NOTARY PUBLIC-STATE OF NEW YOF K No.01 MA6384635 (Where the applicant is not the owner) Qualified in Suffolk County rNjy Commission Expires 12-17-202 I, Ashley Itenberg residing at 9325 Main Bayview Road, Southold, NY 11971 do hereby authorize Lisa Poyer,Twin Forks Permits to apply on my b half to the Town of Southold Building Depart ent for approval as described herein. Owner's Oature Date Print wner's Name 2 OF SO!/T�QI 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 • Southold,NY 11971-0959 Q couff BUILDING DEPARTMENT TOWN OF SOUTHOLD STOP WORK ORDER TO: Isaac Itenberg 9325 Main Bayview Road Southold, New York 11971 YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: 9325 Main Bavview Road, Southold, New York TAX MAP NUMBER: 1000-88-3-20 Pursuant to Section 144-8 of the Town of Southold Code, you are hereby notified to immediately suspend all work until this order has been rescinded. BASIS OF STOP WORK ORDER: Construction without first obtaining a Building Permit CONDITIONS UNDER WHICH WORK MAY BE RESUMED: When a Building Permit has been issued. FAILURE TO REMEDY THE CONDITIONS AFORESAID AND TO COMPLY WITH THE APPLICABLE PROVISIONS OF LAW MAY CONSTITUTE AN OFFENSE PUNISHABLE BY FINE, IMPRISONMENT OR BOTH. DATE: August 22, 2022 )THI n J. rnior ui ing I spector IT SHALL BE UNLAWFUL TO REMOVO IT OUT WRITTEN CONSENT OF THE ISSUING AGENCY 7 SaFal't BUILDING DEPARTMENT- Electrical Inspector F TOWN OF SOUTHOLD o Town Hall Annex- 54375 Main Road - PO Box 1179 o • Southold, New York 11971-0959 'yfj o� Telephone (631) 765-1802 - FAX (631) 765'-9502 rogerr(aD-southoldtownny.gov - seand(cD-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ali information Required) Date: . 6 2 1202z Company Name: Z c,( G. L,i G G/ T'iN G Electrician's Name: License No.: --372,R Elec. email: p . c�ZAII:Pftz Elec. Phone No: 6'�3l-�2/-7��0❑I request an email copy of Certificate of Compliance Elec. Address.: 8 %'©wALx e-12 C-4, /VS-' 7/7 Z c5 JOB SITE INFORMATION (All Information Required) Name: Address: 9 325 scx-17;,- �,c� Al,4 97/ Cross Street: Phone No.: .5�/2. 731� Bldg.Permit#: 57,-5-'-' email: Gas f ® ezc=P Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION. OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Square Footage: Circle All That Apply: Is job ready for inspection?: 11 YES Nd 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[—]Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals .1 2 H Frame Pole Work done on Service? Y FIN Additional Information: PAYMENT DUE WITH APPLICATION ov w Southold Town Building Department P.O.Box 1179 Permit#: 47757 53095 Main Rd Southold,New York 11971 Permit Date: 4/29/2022 (631)765-1802 Expiration Date: 10/29/2023 Parcel 0: 88.-3-20 BUILDING PERMIT RENEWAL LETTER Dated: 5/3/2024 Applicant: Itenberg,Isaac Location: 9325 Main Bayview Rd., Southold Work Description: IN GROUND POOL Construct in ground gunite swimming pool at existing single family dwelling as applied for. Maintain minimum 10 foot accessory setback from rear&side property lines as required. A FEE OF$200 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: Itenberg,Isaac Address: 117 Beckman St New York,NY 1003 8 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department,P.O. Box 1179, Southold,New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. CERTIFICATE-OF INSURANCE ISSUE DATE 02/28/20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 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 INSURER(S)AFFORDING COVERAGE Northeast Agencies, Inc 8209 IBM Dr., Bldg 102 INSURER A: Mesa Underwriters Specialty Insurance Company Suite 100 Charlotte, NC 28262 INSURER B: N/A INSURED INSURER C: VITALIY POOLS LLC 59 Kerry Ct INSURER D: Riverhead, NY 11901 INSURER E: N/A COVERAGES 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. INSF TYPE OF POLICY POLICY POLICY LIMITS LTR INSURANCE NUMBER EFFECTIVE DATE EXPIRATION DATE A GENERAL LIABILITY MP0031004006476 4/26/2021 4/26/2022 GENERAL AGGREGATE 2,000,000 PRODUCTS-COM/OP AGG. 1,000,000 PERSONAL&ADV.INJURY 1,000,000 EACH OCCURRENCE 1,000,000 DAMAGE PREM RENTED TO YOU 100,000 MED EXPENSE(Any one person) 5,000 B PERSONAL LIABILITY COMBINED SINGLE LIMIT MEDICAL PAYMENTS TO OTHERS C EXCESS LIABILITY EACH OCCURRENCE AGGREGATE D E PROPERTY BUILDING CONTENTS BUSINESS INCOME THE INSURER(S) NAMED HEREIN IS (ARE)NOT LICENSED BY THE STATE OF NEW YORK, NOT SUBJECT TO ITS SUPERVISION,AND IN THE EVENT OF THE INSOLVENCY OF THE INSURER(S), NOT PROTECTED BY THE NEW YORK STATE SECURITY FUNDS. THE POLICY MAY NOT BE SUBJECT TO ALL OF THE REGULATIONS OF THE DEPARTMENT OF FINANCIAL SERVICES PERTAINING TO POLICY FORMS. DESCRIPTION OF OPERATIONS/SPECIALTY ITEMS Contractors subcontracted work-building construction,repair of one or two family dwellings,Swimming Pools installation,servicing or repair below ground Town of Southold is listed as additional insured. CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED N OF SOUTHOLD BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN TOWN MAIN RD ACCORDANCE WITH THE POLICY PROVISIONS, SOUTHOLD,NY 11971 AUTHORIZED SIGNATURE r 06,061012 NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE � p AAAAAA 871261966N SALMAN KHAN AGENCY INC ., 8807 82ND AVE GLENDALE NY 11385 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER VITALIY POOLS LLC TOWN OF SOUTHOLD 59 KERRY CT 54375 MAIN RD RIVERHEAD NY 11901 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12437 067-8 505356 02/08/2022 TO 02/08/2023 2/28/2022 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2437 067-8, 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 POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS OF A LIMITED LIABILITY COMPANY. 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. NEWYORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER: 500934921 U-26.3 STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier Ia. Legal Name and Address of Insured(Use street address only) lb.Business Telephone Number of Insured 6318339673 VITALIY POOLS LLC lc.NYS Unemployment Insurance Employer Registration 725 E AVENUE EXT 14 Number of Insured RIVERHEAD,NEW YORK,11901 Id.Federal Employer Identification Number of Insured or Social Security Number 871261966 2. Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company 3b.Policy Number of entity listed in box"Ia": TOWN OF SOUTHOLD 54375 MAIN ROAD DBL527995 SOUTHOLD, NY 11971 3c.Policy effective period: 12/10/2021 to 12/10/2022 4.Policy covers: a. 0 All of the employer's employees eligible under the New York Disability Benefits Law b. .Only the following class or classes of the 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 B ne its i surance age as described above. Date Signed 12/10/2021 By (Signature of insurance carrier's authorized represe ative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 718-626-0733 Title AGENT IMPORTANT: If box"4a"is 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"is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,New York 12207. PART 2.To be completed by NYS Workers'Compensation Board(Only if ibox"4 "of Part 1 Fhas 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 Benefits Law with respect to all of his/her employees. Date Signed BY (Signature of NYS Workers'Compensation Board Employee) Telephone Number Title Please Note:Only insurance carriers licensed to write NYS disability 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 (5-06) Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in box "Y on this form is certifying that it is insuring the business referenced i box"la"for disability benefits under the New York State Disability Benefits Law.The Insurance Carrier or its licensed agent will sen� this Certificate of Insurance to the entity listed as the certificate holder in box"2". This Certificate is valid for the earlier of one year after this forin is approved by the insurance carrier or its licensed agent,or the policy expiration date listed in box "3c". Please Note:Upon the cancellation of the disability 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 Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New Fork State Disability Benefits Law. DISABILITY BENEFIT'S LAW §220.Subd.B (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 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 for all employees has been secured as provided by this article. DB-120.1 (5-06)Reverse SCTM # 1000-88-03-20 OCCUPANCY OR USEIS UNLAWFUL AP ROVED AS NOTED JL DESCRIPTION: AREA LOT COVERAGE: EXCAVATE: FILL: `s6Qp1 ' Tf-IOUT CERTIFICATE FEE: BY: DATE: p I\� — PROPERTY: 32105 SF 0.737 ac - - O 60' 1jF OCCUPANCY NOTIFY BUILDING DEPARTMENT AT ESTIMATED AREA 10000 SF 765-1802 8 AM TO 4 PM FOR THE M C H GROUND DISTURBANCEE:: v- IONS:r' • F FOLLOWING INSPECT 1. FOUNDATION - TWO REQUIRED Design Services FOR POURED CONCRETE 2. ROUGH - FRAMING 8 PLUMBING EXISTING HOUSE 2591.4 SF 8.1 Rio ENCLOSE POOL TO CODE 3. INSULATION www.mchdesignservices.com UPON COMPLETION EXISTING PORCH 206.0 SF o.b% / \ RLFOP� „U'�aT�c Felk " 4. FINAL - CONSTRUCTION MUST phone: BE COMPLETE FOR C.O. (631)298-2250 ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW email: PROPOSED POOL 800.0 SF 2.5% 300 CY 100 CY I rOP SOIL YORK STATE, NOT RESPONSIBLE FOR michael@mchdesignservices.Com DRYWELL 8'dia 4'deep - 6 CY 2 CY LOCATION ' DESIGN OR CONSTRUCTION ERRORS. / T rn z / 48� 1z 1� / G) TOTAL: 3597.4 SF 11.2% 306 CY 102 CY r j 1 F, c-� i�'LY WITH ALL CODES )i- \ f•j!T`v%' YO K STATE & TOWN C DES METES & BOUNDS BY: NATHAN TAFT CORWIN ill / \ "S REQU RED AND CONDITIOP S OF \S!�T SOUTHOLD TOWN ZBA SURVEY DATE: 4/18/2016 / p �,� N Ro os \��� SOUTHOID TOWN PLANNIN BOARD / ORou, \ POOL EQUIPMENT TBD IN FIELD ^�� SOUTHOLDTOMTRUSTE i A MINIMUM 10' V N.Y.S.DEC / SETBAU FROM PROPERTY LINE �� � • • y cxc a"t r'*-,-- r dnrc* O W O ' CONCRETE , �Ab / WASHOUT \ Z Iw-1 r PROPOSED 8dia X 4 ' L -TA'N STORM WATER RUNOFF Q w W deep �, ,�� / o S/4 DRYWELL(LOCATION TBp/ PURSUANT TO CHAPTER 236 �+ Z OF THE TOWN CODE, Lj,1 E'—+ Pq � zo FRq N O yousF OK CL 040 / �. UTILPO SITE PLAN ELEC. LIL 2 SCALE: 1" = 20'-0" METER 600 6Q, � Ri�F ONF SA 2 2 2022 I j Q) 'IpT�� EUILDING DEPT. C �O' s TO`%,fi OF SOUTHOLD ST p /p WATER Q!�K I� METER DRAWN BY: MH ��,w�Q0, � ���,�° 3/18/2022 SCALE: SEE PLAN )9O ` �OF INEIV y DEFRt O,p'f ° SHEET NO: cc A�'°FESSI NPR. - \ M C H Design Services IN PROVIDE HOSE BIB CONNECTION(LOCATION PER OWNER) AUTO WATER FILL(PER OWNER)TO CONNECTTO HOSE BIB \ www.mchdesionservices.com 1 _ phone: / ) I — — — ' T (631)298-2250 ( 1 I I I I , , HAYWARD HAYWA ID HAYWARD I email: 1 ) i ' ; I DIR: NAL D fETURTURIRECTIN RETU RETURN) NAL DIRECTIONAL I I michael@mchdesignservices.com 1 / � 8'dia.,4'deep DRYWELL ( 8 ( I /I HAYWARD I I r — -L — 1 I 6 1 DIRECTIONAL , RETURN I I \ O 1 J I 40'-0" MINIMUM 30amp SUPPLY.CONNECT POOL EQUIPMENT I I ( z AND PROVIDE MINIMUM 2 OUTDOOR OUTLETS IN WEATHER BOXES (1 AT POOL EQUIPMENT LOCATION 2N0 LOCATION PER OWNER) PUMP TO HAVE TIMER AS REQUIRED BY CODE. FILTRATION TO BE STARITE SYSTEM 3 WITH APPLICABLE FILTER \ I I POOL EQUIPMENT I a I I PUMP TO BE PENTAIR SUPER-FLO,VAR.SPEED INSTALL PENTAIR INTELLICHLOR SALT CHLORINE GENERATOR Q O C (PUMP,FITTER,HEATER) I z I _ HEATER PER OWNER(TED) \ I I ON CONCRETE SLAB , a , O MAIN DRAIN b 3'-6" I o I v (MIN.3'SEPERATION) o SHALLOW END I — I I I I I I 1-1/2"TO WASTE -c* L — — — HAIR&LINT HAYWARD STRAINER I I I FILTER A I I 8�-O" DIRECTIONAL PUMP , w I I DEEP END RETURN AUTO SKIMMER I I I PENTAIR AUTOMATION,LED LIGHTS, p00L FILTRATION,140k ELECTRIC HEATER L - - —�BACKTO I I STEPS 1 O H4YWARD HAYWA D LED LIGHT HAYWARD L D LI HT LED LIGHT LED LIGHT O PIPING TO BE SCHEDULE80 p00L I OPTIONAL DUAL MAIN DRAIN I SCMMER M R SKIMMER i O QUICK PIPE(TYPICAL)w/ WITH HYDROSTATIC VALVE AND I _ _ _ _ _ _ — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ — _ — — , 0 POOLE EQUIPMENT (TYR)TS TO L — '6 J COLLECTOR TUBE IN GRAVEL BASE i POOL EQUIPMENT(NP.) COPING AS SELECTED PIPING SCHEMATIC BYOWNEft NOT TO SCALE W PROPOSED POOL PLAN t � '-' P A POOL NOTES: /�/� 11 — 1 11 v I � Z O 1. POOL AN)PROPERTY TO CONFORM TO CURRENT STATE AND LOCAL CODE, 8. SEE SITE PLAN(BY CONTRACTOR)FOR POOL LOCATION.SETBACKS.VARIANCES, SCALE: 3/16 1 -0 O w x ENERGY CONSERVATION(R403.10)AND ELECTRICAL CODES. AND OTHER STATE AND LOCAL REQUIREMENTS TO BE VERIFIED PRIOR TO OPTIONAL TO 2. POOL SHALL CONFORM TO ANSI/NSPI STANDARDS R326.3.1 CONSTRUCTION. AU VATIC 3. SECTION R326.7 POOL ALARMS TO BE INSTALLED AS REQUIRED BY CODE. 9. DRAIN COVERS TO MEET CODE REQUIREMENTS(VIF). POOL COVER 06, 10. POOL PATIO SURFACE TO SLOPE AWAY FROM POOL 1/4":i'-0"AND AWAY FROM In 4. INSTALL TEMPOARCONSTRUCTION. O PERIMETER BARRIERS AROUND CONSTRUCTION AREA HOUSE IF CONNECTED.PROVIDE ADDITIONAL DRAINAGE IF NECESSARY. O V j M v J DURING CONSTRUCTION.FINAL FENCING BARRIER PER R326.5.ALL GATE ACCESS � TO BE SELF-CLOSING AND SELF LATCHING/LOCKING PER CODE. 11. INSTALL CLEAN BACKFILL,FREE OF CLAY AND ORGANIC MATTER.COMPACT SOIL AS REQUIRED PRIOR TO PATIO INSTALLATION. 5. POOL AND HOT TUBS TO COMPLY WITH R403.10.1(HEATERS); R403.10.2(TIMERS);R403.10.3(COVER) 12. SUCTION OUTLETS PER ANSI/APSP-7.VERIFY IN FIELD PRIOR TO CONSTRUCTION. I? 00 6. #3 REBAR TO BE INSTALLED,3"IN,FROM BACK FILL. 13. SURCHARGE NOT PERMITTED WITHIN 4'FROM SHALLOW AND G FROM DEEP ENDS. SWIMING POOLTO BE EXCAVATED ONE FOOT OVER DESIGN ALL FILL BENEATH CONCRETE SLABS TO BE COMPACTED IN 7. SOIL CONDITIONS AND SITE MANAGEMENT TO BE RESPONSIBILITY OF 14. POOL EQUIPMENT LOCATION TO BE DETERMINED IN FIELD(MAINTAIN MINIMUM SPECIFICATIONS AND SOILTO BE LEFT ON PROPERTY.SOIL 12"LIFTS T03000 psi T095%DENSITYASTMD-689.TO BE STOCKPILED OR RUFF GRADED(AS PER OWNER)ON COMPACTION TEST REQUIRED(FEES TO BE PAID BY CONTRACTOR.PROVIDE SOIL TEST IN POOR SOIL CONDITIONS. SETBACKS AS REQUIRED). THE DAY OF EXCAVATION ONLY UNLESS SOIL IS TO BE CARTED OWNER)TESTING TO BE PERFORMED BY SOIL AWAY.SWIMING POOL STRUCTURE TO INCLUDE A MATT OF MECHANICS DRILLING,516-221-2333.GENERAL 3/8"STEEL REBAR TIED,10-ON CENTER FOR WALLS AND FLOOR, CONTRACTOR IS RESPONSIBLE FOR ARRANGING TESTING. 5"ON CENTER FOR ALLTRANSITION BREAKS AND BOND BEAM. THE POOL SHELLTO BE MADE OF 1-4 DRY GROUTGUNITE MIX SHOT INTO THE STEEL CAGE AT A THICKNESS OF NO LESS THAN 10"ON THE TOP EDGE OF THE POOL(BOND BEAM)AND NO LESS THAN 8"ON THE WALLS AND FLOOR.INTERIOR FINISH OF POOL TO BE"PEBBLE TECH"DURABLE FINISH.COLORS AS PER OWNER. POOL SECTION 101/2' COPING SCALE: 3/16" = 11-0" NOTES: %_ % MORTAR SWIMING POOL TO BE EXCAVATED ONE FOOT OVER DESIGN SPECIFICATIONS AND ti,_,:, ,• ;�,;_„. SOILTO BE LEFT ON PROPERTY.SOIL TO BE STOCKPILED OR RUFF GRADED(AS t'KG MPA TED G1 AVEk,)1 6"TILE BAND PER OWNER)ON THE DAY OF EXCAVATION ONLY UNLESS SOIL IS TO BE CARTED - ° 12"ON CENSWIMING OOOR FOR STRUCTURE TO II FLOOR,A ON T OF 3/F S ALL TRANSITION r. W O a — 12" 12" 12" 12" 12" 12" / _ ____ (WATER) Q D BREAKS AND BOND BEAM. - - MARBLE DUST ...THE POOL SHELL TO BE MADE OF 1-4 DRY GROUT GUNITE MIX SHOT INTO THE __'_--- (4)#4 REBAR(TYR) _ ° - n STEEL CAGE AT A THICKNESS OF NO LESS THAN 10"ON THE TOP EDGE OF THE „� i� - p POOL(BOND BEAM)AND NO LESS THAN 8"ON THE WALLS AND FLOOR. -_ _ _ #4 STEEL REBAR(VERTICAL) _. _ SO"OC(5"OC FOR DEPTHS °INTERIOR FINISH OF POOL TO BE"PEBBLE TECH"DURABLE FINISH.COLORS AS � -- - � � '' � '- '' EXCEEDING 5 FEET) PER OWNER. - - p p #4 STEEL REBAR */- - �� ! (HORIZONTAL) R.2"(TYP,) (COMPACTED SOIL) o p ° D o o D e Qp DRAWN BY: MH - ° < <• 12"TO 36"RADIUS , (VARIES) fA� nn - COMPLIES WITH: p Q Q'�REINFClRCED GUST€' ° SECTION R326 OF THE 2020 NYS RESIDENTIAL CODE 3500 psi FLOOR REINFORCED WITH ( I ) CONCRETE #4 REBAR AT 12"OC EACH WAY(TYP.) ( , ,_ ']/i Q/202� SECTION N1103.12(R403.12 RESIDENTIAL POOLS AND ° ° a 4 a Q 0 4 0 4 0'4 o J 1Q PERMANENT RESIDENTIAL SPAS - I 8"(MIN.) ° a °° O 4° p V° a °° O °° O ° ar. 4° a ° p SECTION R326.4 BARRIERS SECTION R326.5-R326.6.5 ENTRAPMENT AVOIDENCE o ° ' SCALE: SEE PLAN Ew Y r O SHEET NO: .y d LU A��FESSI N��