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HomeMy WebLinkAbout50343-Z o"of FOI-W-0o Town of Southold 6/8/2024 G y� P.O.Box 1179 o • 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45267 Date: 6/8/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 8095 Alvahs Ln, Cutchogue SCTM#: 473889 Sec/Block/Lot: 95.-3-12 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/15/2021 pursuant to which Building Permit No. 50343 dated 2/15/2024 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 Caspert,Laurie&Ronald of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50343 5/24/2024 PLUMBERS CERTIFICATION DATED A h riz 9 9n'ature �soFFacK�a TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE 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#: 50343 Date: 2/15/2024 Permission is hereby granted to: Caspert, Laurie 8095 Alvahs Ln Cutchogue, NY 11935 To: - Replaces by#46868 Remove existing above ground pool and construct new in-ground vinyl swimming pool at existing single family dwelling as applied for: At premises located at: 8095 Alvahs Ln, Cutchogue SCTM #473889 Sec/Block/Lot# 95.-3-12 Pursuant to application dated 9/15/2021 and approved by the Building Inspector. To expire on 8116/2025. Fees: PERMIT RENEWAL $250:00 Total: $250.00 Bui ding Inspector �o�g�fF TOWN OF SOUTHOLD ay BUILDING DEPARTMENT H z TOWN CLERK'S OFFICE oy • �� 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#: 46868 Date: 9/23/2021 Permission is hereby granted to: Caspert, Laurie 8095 Alvahs Ln \ Cutchogue, NY 11935 To: Remove existing above ground pool and construct new in-ground vinyl swimming pool at existing single family dwelling as applied for. At premises located at: 8095 Alvahs Ln., Cutchogue SCTM #473889 Sec/Block/Lot# 95.-3-12 Pursuant to application dated 9/15/2021 and approved by the Building Inspector. To expire on 3/25/2023. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 DEMOLITION $100.00 CO- SWIMMING POOL $50.00 Total: $400.00 Building Inspector SO!/T�,QI Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlina-town.southold.nv.us Southold,NY 11971-0959 QIyCOU�'�,��` BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Laurie Caspert Address: 8095 Alvahs Ln city,Cutchogue st: NY zip: 11935 Building Permit#: 46868 Section: 95 Block: 3 Lot: 12 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: MRJ Industries License No: 41853ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Pool Panel 12 Circuit/ 8 Used, Heater, Pump 220GFI, Timeclock, Salt Generator, Timeclock, (4) Lights 120GFI, Autocover 120GFI w/ Key Locked Switch Notes: " AS BUILT NO VISUAL DEFECTS " Pool Did a bond integrity test Inspector Signature: Date: May 24, 2024 S. Devlin-Cert Electrical Compliance Form �F SOUTy�� # # TOWN OF S0UTHOLD BUILDING DEPT. co 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: 144 DATE "SPECTOR ho�aOF SOUIyo� * # TOWN OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 �o-�L�lz INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATIO CAULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE /O [ ] RENTAL ) C"� REMARKS: C� AQIAp 1 _ k&4- f 'n. et 6WK-.,- - DATE INSPECTOR *F-Jfc SO 'TOWN OF SOUTHOLD BUILDING DEPT. orm��'' 631-765-1802 INSPECTION ,...; [ ] FOUNDATION"1 ST/ REBAR [ ] 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 403 PRE C/O [ ] RENTAL REMARKS: a 4j Zo n 9 �-� a-VIla a bm,� (-, o ) A I ce�, WR DATE INSPECTOR / /• o�aOF 50UlyO - --- --- --- —- ----- # # : .TOAWOF OUTHOLD BUILDING DEP . o l+,� 631-765-1802 INSPECTION [. ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] -FOUNDATION.2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE &CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION •[ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL,(FINAL) . [ ] CODE-VIOLATION ] PRE C/O [ ] RENTAL REMARKS: A-��ti r - DATE 7i INSPECTOR Swimming. Pool Bonding Integrity Test Name: Ron Caspert Date : 5/15/2024 Address: 8095 Alvahs Lane Cutchogue, NY 11935 Inspection of swimming pools—No certificate of compliance will.be issued without a valid bonding integrity test performed by a licensed electrician and/or qualified testing agency. A.low impedance instrument capable of measuring.01 ohm shall be used. The lead conductor used in the measurement shall.be.calculated_and deducted.from readings. A test-of applicable test points such as filter motors housing, ladders,diving board,safety line eyelet, water heaters or any other associated metal components shall be performed at least twice ano tabu- lated. Point of Test Readings in Ohms Point of Test 'Readings in Ohms TEST 1 TEST 2 TEST 1 TEST-2 Filter Pump .003 .00.2 Cover Spindle .001 .001 Gas Heater .002 .002 Aqua Link Panel .002 .001 Water Electrode .001 ' .002 Electrical Panel .002 .002 ool Light Transform .002 .002 Deck Box .001 :Q01 over Brackets..(x10 .001 Cover Motor .002 .001 --.over Side Rails (x2 .001 .001 The resistance between.any one points shall be low enough to eliminate any voltage gradients in the pool area as prescribed in Article 680.26 Equipotential Bonding. Spas and Hot Tubs shall comply with the provisions of Parts I and II of Article 680 except as modified by 680.42(.A)and (B),6,80.43. Fountains,Signs Part V,Therapeutic Use Tubs and Pools Part VI: Test Data must be verified by electricians signatureAiEemse cumber and date. MRJ Industries LTD. r 4 853-ME 05/15/209 El ricia, Prin N License Number Date 98 E. 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Y . ,, 1 `I: , t: n '11M,, v . �`., . , y . ?r Y' : . �' . •.j' j fib:. ;ariika P.E.. . • i FIELD INSPECTION REPORT DATE COMMENTS • FOUNDATION(1ST) ------------------------------------- FOUNDATION(2ND) ROUGH FRAMING.&' . �,� kA „� PLUMBING --- !! W r y INSULATION PER N.Y. ,. STATE ENERGY CODE 51 IA- t c CeAl'K '" {,� o✓ J '� lam- k tj FINAL i ADDITIONAL COMMENTS . 0 u� ►a ao a � :— co m tv H TOWN OF SOUTHOLD—BUILDING DEPARTMENT , Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 �y�o Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtownn�gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only � Y DD PERMIT NO. Building Inspector: S E P 1 5 2021 Applications and forms;must�be.fill'ed out,in their`entirety., ncomplete B JD G DEPTe applicationswill not beaccepted: Where.the Applicant'is„not�the,owrier,an Owner's Authorization#.orm(Page 2)shalf 6e com'pleted.'.:, TDB OF SODTIT®LD _ .5 . .. Date:9/10/2021 OWNER(S).OF PROPERTY: Name:Laurie & Ronald Caspert SCTM# 1000-95-03-12_ a Project Address:8095 Alvas Cutchogue Phone#: Email:rdas ert cast ert.Com Mailing Address:Same CONTACT PERSON: Name:John J_ W soczanski islandia Pools L.T.D. 1 Mailing Address:108 fishel ave Riverhead 11901 Phone#:631-727-6312 A _,,.... ..,__.... _.......__. _.. .._,... Email:john@islandiapools.com DESIGN'PROFESSIO,NAL.INFORMATION:" Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name:lslandia Pools Itd Mailing Address:108 Fishel ave Riverhead Ny 11901 ____.._..._ -------- Phone#: Email:john@islandiapools.com DESCR1PTION'OFrPROP"O`SED-CONSTRUCTION . ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: DOtherSwimming pool $75,000.00 FWill the lot be re-graded? ©Yes El No Will excess fill be removed from premises? ®Yes ONO 1 s' PROPERTY INFORMATION ' Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions wit respect to this property? ❑Ye 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. Fiapter 236 of the Town Code: APPLICATION IS HEREBY MADE to the Building,Department for the issuance of a Building Permit pursuant to the Building zone Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,ordinances or Regulations,for the construction of buildings, additions,alterations or for.removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building,code, housing code and regulations and.to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are punishable as a Class A misdemeanor;pursuant to Section 210.4S of the New York State PenaL.,Law. Application Submitted B name : `t/ Gt/C/sp�Z�j-lr�G � uthorized Agent ❑Owner Signature of Applica Date: � . STATE OF NEW YORK) SS: COUNTY OF ) t being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the (Contractor,Agent, Corporate Officer,etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;that all statements contained in this application are true to the best of h' /her knowledge and belief; and that the work will be performed in the manner set forth in the application file th re ith. Sworn before me this day.of 4- 4M- 2014 1 , ...,„... ., ,.. .. :, _ —I— otaryPublic �DAVID FREEBORN°a Notary Public,State of New or No.01FR6137963 ?,• Qualified in Suffu;liCount .: PRnoI �a-r`f OQ,"rr,t��R !�'�;TH' s�.1Tinr h h/Y 1 .A. YNE �7,111^ Commission Expires Dec.05,20f`t, (Where the applicant is not the owner) residing at / = c — do hereby authorize�J fLI - l/iI D 2Gi/ LZ to apply on my ehalf to the Town f Southold uilding Department for approval as described herein. Owner's S gnat re D;..Dated o�7f1vQ F-.Print-Own r's,Name , bi 2 Sc V-LA S3 �-0 1 r-%,% 11// t — SUFfDt,��, BUILDING DEPARTMENT-Ele is Inso"o2 0 2022 TOWN OF SOUTHOLD BUILDIry; LUEPT. CA =, Town Hall Annex-54375 Main Road - RY98KWD a • Southold, New York 11971-0959 y�o ao� Telepl?one (631) 765-1802- FAX(631) 765-9502 ro-gerr(@.southoldtownny.gov-- seand(@-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail Information Required) Date: 12/16/2022 Company Name: MRJ Industries, LTD Electrician's Name: John Ferguson License No.: ME-41853 Elec. email:office@mrjindustries.com Elec. Phone No: 516-885-7914 El I request an email copy of Certificate of Compliance Elec. Address.: 27 Quail Run, Hampton Bays, NY 11946 JOB SITE INFORMATION (Al Information Required) Name: Rob Caspert Address: 8095 Allvahs Lane, Cutchogue, NY 11935 Cross Street: County Road 48 Phone No.: Bldg.Permit#: 9- G email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Installation of new inground pool. Need bonding and final inspection. Square Footage: Circle All That Apply: Is job ready for inspection?: 0 YES❑NO Rough In ❑✓ Final Do you need a Temp Certificate?: 0 YES R]NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A #Meters Old Meter# ❑New ServiceOFire Reconnect[]Flood Reconnect Elservice Reconnect DUndergroundDOverhead #Underground Laterals 1 2 0 H Frame Pole Work done on Service? 0 Y N Additional Information: PAYMENT DUE WITH APPLICATION ��� 0 12\ ;.0` ZZ ?"!�C-4 103� 1 g' �h — �i1 F014, BUILDING DEPARTMENT-Elei is Inset®? 0 2022 TOWN OF SOUTH, LD BUILDviAjohPT o x Town Hall Annex- 54375 Main Road - Ifta a-c G, ® Southold, New York 11{971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(cDsoutholdtownny.gov — seand(a_�southoldtownny gov i i APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (Ail Information Required) Date: 12/16/2022 Company Name: MRJ Industries, LTD Electrician's Name: John Ferguson License No.: ME-41853 Elec. email:office@mdindustn*les.com Elec. Phone No: 516-885-7914 01 request an email copy ofJCertificate of Compliance Elec. Address.: 27 Quail Run, Hampton Bays, NY 11946 i JOB SITE INFORMATION (All Information Required) Name: Rob Caspert Address: 8095 Allvahs Lane, Cutchogue, NY 11935 Cross Street: County Road 48 Phone No.: Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: i BRIEF DESCRIPTION OF WORK; INCLUDE SQUARE FOOTAGE (Please Print Clearly): Installation of new inground pool. Need bonding and final inspection. Square Footage: Circle All That Apply: Is job ready for inspection?: a YES❑ NO ❑Rough In Final Do you need a Temp Certificate?: ❑ YES 0 NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground ElOverhead #Underground Laterals 0 1 2 H Frame Pole Work done on Service? F71 Y FIN Additional nuonnation. i I PAYMENT DUE WITH APPLICATION 12-\ 01 Z , �� 4ct�6 g CA MA. The offsets or dimensions shown from structures to the property lines are for a specific purpose and use,and therefore,are not intended to guide in the erection offences,walls,pools,patios,additions to buildings and any other constriction.Subsurface and environmental conditions were not examined or considered as a part of this survey.Easements,Rights-of-Way of record,if any,are not shown.Property corner monuments were not placed as a part of this survey.Certifications on this survey signify that the survey was prepared in accordance with the current existing Code of Practice for Land Surveys adopted by the New York State Association of Professional Land Surveyors,Inc.The certification is limited Ito persons for whom the survey is prepared,to the title company,to the governmental agency, and to the lending Institution listed on this survey.Said certifications indicated hereon are not transferable. ALVAHIS LA E i S 3362 '50" E __�5.00' c, DRIVEWAY ON-LINE ` 'I,786.97r FE II S Q Of 00 lot � � � �.II I o II I / I o I a III LAND NOW OR Z i 4 FORMERLY OF o I 3 CLARK z I� M II00 I S 33027'50" I LAND NOW OR FORMERLY OF 24 .00' I> ERNEST SCHNEIDER APPROXIMATE LOCATION OF r Z 60' WIDE STANCHION 4 "LILCO" EASEMENT / Z x M I2. -0 - /6 00 ° I W U of 3/ I I W t � <25 LAND NOW OR FORMERLY OF I oar SCHMITT � 1-1/2 I 3F75 W c?T STORY : 2° DWELLING 0 1 STORY WITH #8095 ROOF DECK(13'x31') CONC. STOOP 78.2' J °TRANS- 52.4 w iv CO NC. DRIVEWAY 1� FORMER 3 Z WALLS ON-LINE DRIVEWAY _. �_ 52.5' ON-LINE Z ELEC. WOOD I (� METER STEPS WOOD I ' p WALK & ROOF rl�l PORCH STEPS 12'x \ � � +I-Jf tl1.�C^.11 12 / SHED4 12TRUCK � IBODY ABOVE— 17.3' • ED GROUND --� SEP 1 5 2021 ;;f,�� POOL y POOL EQUIP. L.AJ .MINT! DE PT. j MI•"I OF SOUTI10-D N 31'25'20" W — — 260.16' STANCHION o , LAND NOW OR FORMERLY OF / WICKHAM LOT AREA= 113,974 SQUARE FEET OR 2.6165 ACRES Certified to: Title No.: 7404-010089 Date I Revision LAURIE RIVLIN CASPERT& RONALD MARK CASPERT FIDELITY NATIONAL TITLE INSURANCE COMPANY I • I Unauthorized alteration or addition to this survey is a violation of Section 7209,sub-division 2,New Tax Map: DISTRICT 1000 SECTION 95 BLOCK 03 LOT 12 York State Education Law. .am "y , , oF Nca� Situate: CUTCHOGUE,TOWN OF SOUTHOLD County: SUFFOLK r'rgeP" AQ e7'� .AdPINNACLE I` * �'�"+� Map of: MINOR SUBDIVISION MAP PREPARED FOR ERNEST SCHNEIDER LAj ND SURVEYORS LLP Map Lot: 2 Map Block: File Date: JANUARY 30, 2004 File No.: 11051 41 55 VETERANS HIGHWAY, SUITE 1 1 63 1 .648.9273 N-.-- Scale: 1"= 80' RONKONKOMA, NEW YORK 1 1 779 WWW.PLSLI.COM Copies of this survey map not bearing the land surveyor's embossed seal and signature shall not be considered to be a true and valid copy Date: DECEMBER 1, 2020 Project No.: 200334 © 2020 PINNACLE LAND SURVEYORS LLP ® DATE(MM/DD/YYYY) A CC CERTIFICATE OF LIABILITY INSURANCE 09/08/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. { IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Commercial Support FAX Edgewood Partners Insurance Center PHONE 40 Marcus Drive 3rd Floor (A/C.No Ext: (866) 414-7475 A/C No: (631) 390-9700 AIL Melville NY 11747 , ADDRESS: msmcertscm@epicbrokers.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:HARTFORD FIRE I& CASUALTY GROUP 00914 INSURED INSURER B:TechnologyInsurance Company, In 42376 Islandia Pools Ltd. INSURER C 108 Fishel Avenue INSURERD: Riverhead NY 11901 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 316 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDNYYD POLICYPOLICY EXP MM/ LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGE TO RENTED CLAIMS-MADE FxI OCCUR 12UUNOZ9731 04/25/2021 04/25/2022 PREM SES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY X JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO 12UENOZ9729 04/25/2021 04/25/2022 BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR 12HHUOZ9730 04/25/2021 04/25/2022 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 11 000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- B AND EMPLOYERS'LIABILITY Y/N TWC3961844 04/25/2021 04/25/2022 X STATUTE I I ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? F N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 AUTHORIZED REPRESENTATIVE PO Box 1179 Southold NY 11971 U ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I NEW Workers' STATE Compensation CERTIFICATE OF INSURANCE COVERAGE Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW i PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ISLANDIA POOLS LTD. 108 FISHEL AVENUE 6317276312 RIVERHEAD, NY 11901 Work Location of Insured(Only required if coverage is specifically limited to 1 c.Federal Employer Identification Number of Insured certain locations in New York State,i.e.,Wrap-Up Policy) or Social Security Number 11-2915558 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Town of Southold Building Dept Standard Security Life Insurance Company of New York 53095 Main Road 3b.Policy Number of Entity Listed in Box"I a" Southold, NY 11971 69146-00 3c.Policy effective period 1/1/2014 ! to 9/7/2022 4. Policy provides the following benefits: ❑X A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. ❑ C.Paid family leave benefits only. 5. Policy covers: I ❑- A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance;carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as des c' d above. Date Signed 9/8/2021 By (Signature of insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Name and Title SUPERVISOR-DBL/POLICY SERVICES IMPORTANT: If Boxes 4A and 5A are checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 46,4C or 56 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. i 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. it DB-120.1 (10-17) IIII P°°1°1°1°1°1111°°(11°0°°1°11)°IIIIII Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box"1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law. The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers' Compensation Board within 10 days IF a policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices my be sent by regular mail.) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in Box 3c,whichever is earlier This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or paid family leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract iss l ed by a certificate holder,the business must provide that certificate holder with a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE BENEFI S LAW §220. Subd. 8 (a) The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in employment as defined in this article, and not withstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand and twenty-one, the payment of family leave benefits for all employees has been secured as provided by this article. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any disability benefits to any such employee if so employed. (b)The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in employment as defined in this article and notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that the payment of disability benefits and after January first, two thousand eighteen, the payment of family leave benefits for all employees has been secured as provided by this article. I DB-120.1 (10-17) Reverse INEW Workers' CERTIFICATE OF ATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Nu ber of Insured Islandia Pools Ltd. (631) 727-6312 108 Fishel avenue 1 c.NYS Unemployment InsIrance Employer Registration Number of Riverhead NY 11901 Insured Work Location of Insured(Only required if coverage is specifically limited to 1 d. Federal Employer Identification Number of Insured or Social Security certain locations in New York State,i.e.,a Wrap-Up Policy) Number 112915558 I 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Technology Insurance Co, Inc. Town of Southold Building Dept 3b.Policy Number of Entity Listed in Box"l a" 53095 Main Road TWC3961844 Southold NY 11971 3c.Policy effective period 04/25/2021L i to 04/25/2022 3d.The Proprietor,Partners for Executive Officers are ❑ Included.(Only check box if all partners/officers included) x❑ all excluded or certain partners/officers excluded. I This certifies that the insurance carrier indicated above in box"T'insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days.IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices may be sent;by regular mail.)Otherwise,this Certificate is valid for one year after this'form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate)holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance onlywhile the underlying policy is in effect. Please Note: Upon cancellation of the workers'compensation policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Commercial Support i (Print name of authorized representative or licensed agent of insurance carrier) Approved by: G94001-� - I - (Signature) (Date) j Title: Leonard Scioscia I Telephone Number of authorized representative or licensed agent of insurance carrier: (866) I414-7475 Please Note: Only insurance carriers and their licensed agents are authorized to issue Ford C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov i I Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office auth prized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as providded by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided�by this chapter. I II �i I I i I I i i it i I I I I i I C-105.2 (9-17) REVERSE i i OCCUPANCY OR APPROVED AS NOTED USE IS UN(AIFUL DATE: I B.P. S WITHOUT CERTIFICATE FEE: '0-2) BY: OF OCCUPANCY NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION '- TWO REQUIRED FOR POURED CONCRETE 2. ROUGH •-;.FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE COMPLY WfTH ALL COE)ES O1= REQUIREMENTS OF THE CODES OF NEW NEW YORK STATE & T014 N CODES YORK STATE. NOT RESPONSIBLE FOR AS REQUIRED AND CONDITIONS OF DESIGN OR CONSTRUCTION ERRORS. SOUTHOLD SOUTHOLD TOWN PLANNING BOARD SOUTHOLD T,^,WN TRUSTECS N.Y.S.DEC "'IMMEDIATELY" ENOL08t POOL TO CODE UPON COMPLETION BEFORE"WATER" RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE, EUcMCALVi9P=0N PMucRW i i POOL NOTES: TRACK FOR 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION AND BUILDING CODE,TOWN OF SOUTHOLD CODE AND 2017 NATIONAL ELECTRIC VINYL LINER PUMP CODE. FILTER VINYL LINER 2.POOL SHALL CONFORM TO ANSI/APSP/[CC 5 STANDARDS R326.3.1. SKIMMER 8.5" 3.SECTION R326.7 POOL ALARM REQUIRED. 4.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION R326.4. (TYP•) FOAM PADDING 3,500 PSI 5.POOL SHALL COMPLY WITH 2O20 ENERGY CONSERVATION CONSTRUCTION CODE OF NYS SECTION R403.10: ' a CONCRETE POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). SECTION R403.10.1 HEATERS I I STEPS SECTION R403.10.2 TIME SWITCHES I I #4 REBAR TOP SECTION R403.10.3 COVERS I I & BOTTOM ° 42" 6.REBAR SHALL BE 3"MIN.CLEAR TO EARTH. RETURN I I PROPOSED VINYL s' a 7.LOCATION OF PROPOSED SWIMMING POOLAND POOL EQUIPMENT BY OTHERS I 3N I SWIMMING POOL I SUNLEDGE AND SHALL COMPLY WITH ALL LOCAL ZONING REQUIREMENTS. (MIN' I I 800 S.F. i ° ° . ° 8.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA GRAEME I I I 20• BAKER(VGB)O SURFACE AND SPA SAFETY ACT. 9.SLOPE PAT FAC 1/4"PER FOOT AWAY FROM POOL DUAL MAIN DRAINS WITH ° 10.BACKFILL MATERIAL TO BE FREE DRAINING GRANULAR MATERIAL(NO CLAY OR I I I STRAINER (VGEI SAFETY LARGE ROCKS). ACT APPROVED DRAINS) 0 11.SUCTION OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH I J-----L` I ANSI/APSP/ICC 7. I / I 12.ENTRAPMENT PROTECTION REQUIRED SECTION R326.5. I / 13.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO INSTALLATION OF 12.5" POOL TYPICAL WALL DETAIL 14.THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 8095 ALVAHS LANE, CUTCHOGUE,N.Y.11935 ONLY. SCALE: 3/4 = 1 —0 15.NO DIVING EQUIPMENT PERMITTED. 16.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL WITH A AUTO COVER NOTES: MINIMUM LAP OF 30 BAR DIAMETERS. VAULT POOL PLAN 1.WALLS SHALL BEAR ON UNDISTURBED SOIL 17.POOL WALLS ARE NOT DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL NOTE: 2.ALL CONCRETE SHALL BE PLACED AS A MONOLITHIC POUR. LOADS WITHIN SIX(6)FEET OF POOL WALL FROM CONSTRUCTION EQUIPMENT OR NOT TO SCALE THIS IS ANON-DIVING POOL ANY OTHER LOADING CONDITION IMPOSED ON THE POOL STRUCTURE BY EXISTING OR PROPOSED ADJACENT STRUCTURES.IF SITE CONDITIONS DIFFER FROM THIS PLAN,IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO CONTACT HM ENGINEERING,P.C. BEFORE ANY CONSTRUCTION BEGINS. 18.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR CONSTRUCTION 3'-4" MEANS,METHODS,TECHNIQUES OR PROCEDURES UTILIZED BY THE CONTRACTOR, LNOR 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 7 CONCRETE WALL THIS PLAN. (SEE SECTION THIS SHEET) _ 1 1/2" TO WASTE -D--Ec_INNS - ---- -- - - - 2' COMPACTED _- LJ SAND UNDISTURBEDDD �---6' 14' EARTH (TYP.) PUMP 4' 16' HAIR & LINT STRAINER n S E P 1 5 2021 FILTER AUTO SKIMMER POOL PROFILE P LD.R. M DF�PT. NOT TO SCALE `POOL TOWN OF SOUT HOL BACK TO POOL GENERAL NOTE: ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 PREPARED FOR: 2 MAIN DRAINS RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. WITH HYDROSTATIC CASPERT RESIDENCE SCHEMATIC PIPING ARRANGEMENT VALVE AND 8095 ALbAHS LANE NOT TO SCALE COLLECTOR TUBE IN GRAVEL BASE CUTCHOGUE, Y. 1193 DATE: 08/22/2021 NOTE: /OUT H_ M ENGINEERING, P.C. SCALE: ASSHOWN THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. vp 2-�j/ 2� SHEET: 1 OF1 UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OFTHE "((( P.O.BOX 914 EAST NORTHPORT,NY 11731 NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel.(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.net RESIDENTIAL CONCRETE OIDWITEDSEALANDBLUESIGNATURE VINYL LINER POOL PLAN CAST IRON FRAME & COVER IF UNDER PAVED AREA FINISHED GRADE 8' MIN. - 12' MAX. 4 X NOTES: BRICK LEVELING COURSE � MIN CONCRETE COVER 1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST CONC. COLLAR 27' ZD 6' MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND AS REQUIRED MAX BACKFILLED WITH SAND AND GRAVEL TO BOTTOM OF BASIN. PRECAST 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE REINF. CONC. SUBSTITUTED WITH APPROVAL OF THE ENGINEER. DOME 4'0 PVC 3. LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. MIN. SPER FOOT ® ® ®®0 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. INVER ® ®®0 NON—SHRINK ®®0 5. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR GROUT FULL DEPTH. ®O 3' MIN. SAND 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND = 0 AND GRAVEL zAND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, COLLAR W cu N SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) a ALL AROUNDUND y PERCENT. W PRECAST REINF. o > CONC. LEACHING ci~ RINGS ly .J., � a \y W ' 8' DIAMETER MO F> � W v o DRYWELL CALCULATION: zX BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF) '~" DRYWELL CAPACITY = 1,263 GAL. (168.8 CF) ce z z 6' MIN, PENETRATION Fu o INTO VIRGIN STRATA GROUND WATER w OF SAND & GRAVEL DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: CASPERT RESIDENCE 8095 ALVAHS LAN VDW:1TH ROGUE, N. 11935 DATE: 08/2212021 NOTE: HM ENGINEERING, PC. SCALE: NOT TO SCALE THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED !/ Z, SHEET: 1 OF 1 ALTERATIONS OR ADDITIONS TOTHESE DOCUMENTS ARE AVIOLATION OF SECTION 7209 OF THE NEW YORK STATE L P.O.BOX 914,EAST NORTHPORT,NY 11731 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.net DRYWELL DETAIL RAISED SEAL AND BLUE SIGNATURE