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HomeMy WebLinkAbout50286-Z �o�aS�E ly+boy Town of Southold 8/29/2024 P.O.Box 1179 W T+ 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45494 Date: 8/29/2024 THIS CERTIFIES that the building ACCESSORY Location of Property: 70 Wildberry Ln, Southold SCTM#: 473889 Sec/Block/Lot: 51.-342.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 12/28/2023 pursuant to which Building Permit No. 50286 dated 2/2/2024 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 outdoor shower as applied for. The certificate is issued to 108 Harbor Watch LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 8/26/2024 ose Reyes r 0t0 Signature �suFFot,t�, TOWN OF SOUTHOLD BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 50286 Date: 2/2/2024 Permission is hereby granted to: Head of the Harbor LLC c/o Harry F George 2631 Merrick Rd Ste 406 Bellmore, NY 11710 To: Construct an accessory outdoor shower as applied for. At premises located at: 70 Wildberry Ln SCTM #473889 Sec/Block/Lot# 51.-3-12.7 Pursuant to application dated 12/28/2023 and approved by the Building Inspector. To expire on 8/3/2025. Fees: ACCESSORY $133.00 CO-RESIDENTIAL $100.00 Total: $233.00 Building Inspector Town Hall Annex si�p�! yt'� Telephone(631)765-1802 $4375 Main Road S, P.0.Box 1179 ae Southold,NY 11971-0959 � ,y?fAl v4 `�' DBUILDING DEPARTMENT TOWN OF SOUTHOLD ; DD AUG 2 ? 2024 CERTIFICATION BUILDING DEPT. -,I-F SGUTI-901.7 , Date: Building Permit No. Owner: � t U-e— LJ (Please print) Plumber: . e �� (Please print) I certify that the solder used in the water supply system contains less than 2/10 of I%lead. (Plumbers Signature) Sworn to before me this � day of 20 SHAUN T MAS 4 -Antary Public,State New York Notary bif�4V County 1!o.02TassauNo PiabliC, ied in Nassau Co ty nva� :Ion Expires October 1 , SHAUN THOMAS Notary Public,State of Newyork No.02TH624860 Qualified in Nassau County A�?9 ommission Expires October 11 66 i OP SObTyO� TOWN OF,S.OUTHOLD-BUILDING DEPT. o � 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [- ] NSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINALW&W IS ffAt'JpL___ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT-PENETRATION . [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] .RENTAL REMARKS. p 11 mhw, )a4k Gk, O - l DATE 63 INSPECTO SOUIHp� # # TOWN.OF SOUTHOLD BUILDING DEPT. coum, 631-765-1802 6�,/"" INSPECTION [ ]. FOUNDATION 1ST [ ] ROUGH PLBG: [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION XFI ESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION TRICAL (ROUGH) [ ] ELECTRICAL (FINAL) VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: / Ln, D- I), p I 09!4 lap Wq .01 DATE ?'q INSPECTO FIELD INSPECTION REPORT DATE COMMENTS V4M d FOUNDATION (1ST) N -------------------------------------- C FOUNDATION (2ND) ,ZC40 � O Zi ROUGH FRAMING& y T PLUMBING v ' t J r INSULATION PER N.Y. STATE ENERGY CODE Vwl FINAL ADDITIONAL COMMENTS �p i� 3 3a LA) 6 -t-o z m X t� O z x �x d b y SUF TOWN OF SOTJTIIOLD-BUILDING DEPARTMENT M Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 ca Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtoMLnny.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. .�D (D Building Inspector: DEC 2 6 2021 Applications and forms must 6e filled 6ut'in their'entirety:Incomplete y_f p� applications will not b'e accepted.,Where the.Applicant is not the owner,any °` . i . Owner's Authorization form(Page 4 shall be completed. Date: OWNERS)OF PROPERTY: Name: 10k AM TiCTM#1000- s/ - 3- Z Project Address: '70 Gl)I LD 13-L?-W Sojj ��q 71 Phone#: 131 NI-3 3LI Email:. U6M L &A17 Mailing Address: . 2ol SG yp CONTACT PERSON: Name: Q / v Mailing Address: S ,� Phone#: S 4 ?3? _ Jt1 V 6 Email:UdUf f L LIM DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION. Name: F0()L. fi—ZVchf JD A7 Mailing Address: 531 ,ems 1/ ` 1-171v f f qi. be Phone#: `� 3�j Email: PC'0L.&-'G17,9 c>- /)19ic.. 4)10 DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other �J -3SA Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ONO 1 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 with respect to this property? Dyes ❑No IF YES, PROVIDE A COPY. Fdn i BoX After.Reading{ The owner/contractor/design professional is responsible for all drainage and storm water issues as'provided by'Chapter6 of the Town code. APPLICATION,IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone of the Towri of Southold,Suffolk,County,New York and other applicableLawg,Ordinances or Regulations,for the construction of buildings, lterations or for removal or demolition as herein described.Theapplicantagrees to comply with'all applicable laws,ordinances,.tiiiildingeode; e and regulations and to admit authoriedinspectors on premises and in buildings)for. ryinspectio1.ns.Falsestaementsmadeherein'are as a Class A misdemeanor pursuant to Section 210.45"of the New York State Penal Law. Application Submitted By(print name): ff I cC 6:tl 04-RnJj ❑Authorized Agent {Owner Signature of Applicant: "� Date: ��-ZO-Z3 \STATE OF NEW YORK) SS: COUNTY OF S, \ ) aP., dP4 of `n6� being duly sworn, deposes and says that(s)he is the a licant (Name of individual signing contract)above named, pp (S)he is the 0(•Vtl,?G (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 Zo day of �et_.e i,� , 20 Z3 Notary Public MIGDALIA A ROQUE NOTARY PUBLIC,STATE OF NEW YORK QUALIFIED IN SUFFOLK COUNTY PROPERTY OWNER AUTHORIZATION NO.OIR06173781 (Where the applicant is not the owner) COMMISSION EXPIRES 11/P9/2a? I' residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name 2 'j �"t-r�cd Z)lb/ *OF SO!/j W�f K Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G • Southold,NY 1 1971-0959 �Q a o it BUILDING DEPARTMENT TOWN OF SOUTHOLD STOP WORK ORDER TO: 108 Harbor Watch LLC 11 Livingston Street Bay Shore, New York 11706 YOU ARE HEREBY NOTIFIED TO SUSPEND ALL WORK AT: 70 Wildberry Lane, Southold, New York TAX MAP NUMBER: 1000-51.-3-12.7 Pursuant to Section §144-8 A(1)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: Over clearing into 50 foot undisturbed buffer. CONDITIONS UNDER WHICH WORK MAY BE RESUMED: When the Planning Board and Building Dept. have issued approvals to continue. 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: 4/9/2024 Jo n J. JVildi Se for B I sp ctor IT SHALL BE UNLAWFUL TO REMOVE ISOTI OUT WRITTEN CONSENT OF THE ISSUING AGENCY. .. __ten—OH—or.—oN—a.—_on —oH—off—OrIuH _ SURVEY OFPROPERTY OVERHEAD WIRES LOT 1 - MAP OF WILDBERRY FILEDS S42 —_,.,,—w,— Y,_w—w—w 302 w— /> EDGE OF PAVEMENT HYDRANT 7 6b', ,v- / WATER MAIN FILED:JUNE 21, 2001 -MAP NO. 10641 °sx 6a, —w—`"�w—W _ —w ss> a SITUATE 66x 62.3 —D6—eY—w—w—w—w•—w•—w,— 0S i eC es? 4x S vY—w�w w,—w,—w—w sS64B >6 @S s3gx S8.2gx w w.--w n w YV—w—w 8, SOUTHOLD, TOWN OF SOUTHOLD 69 63> 6,8 SOUND VIEW AVENUE ° ——— ---— -----—DRAIN——MARK OUT EDGE OF P,d >"-ME T —— S9 — > S?4 Y`S SUFFOLK COUNTY, N.Y. 8 TAX MAP NO.: 1000-51-3-12.7 ----------------- ecs?Qs scsa.8 LOT AREA:36,899.37 S.F. (0.847 ACRES) N71 o32'55"E 1 15.00 TEE — a DATE SURVEYED:JAN.5,2023 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES STAKE SET t� STAKED PROPERTY LINES:FEB.22,2023 APPROVAL OF CONSTRUCTED WORKS FOR STAKE SET R� v REVISED:APRIL 5,2023 ASINGLE FAMILY RESIDENCE J Sl0 FOUND.AS-BUILT:OCT.6,2023 1sTzoza R-23-036a Q O O a Date H.S Ref No ..... fY LLI O FINAL SURVEY:JUNE 25,2024 La O M N REVISED SAN.TIE:JULY 17,2024 The sewage disposal ar.d water supply facilities at this location have been O 0 Q O Ld �O xS Tc6 N inspected and/or certified try this Department or other agencies and found O LO z I— LL to be satisfactory FORA MAXIA4UM OF 6 BEDROOMS O LLI 02 N —ELEVATIONS REFER TO NAVD88 rx N _O ❑ m V W o> CRAIG KNEPPER,RE.,CHIEF O COVENANTS AND RESTRICTIONS: Office of IYlastewater Management N ELEC m STgKESET COVER ON MARCH 14,1997 THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BOARD OF REVIEW GRANTED 162.00 O O APPROVAL TO THE REQUEST FOR THE VARIANCE TO USE TEMPORARY ON-SITE WELLS SUBJ ECT TO THE O I 0 FOLLOWING CONDITIONS: 6�29 S7 1°32'55"W O 1. ALL LOTS WILL BE REQUIRED TO HAVE INDIVIDUAL TEST WELLS PRIOR TO APPROVAL TO CONSTRUCT.ANY L EouIP� o LOT WHICH DOES NOT MEET THE WATER QUALITY STANDARDS SHALL NOT BE BUILT UPON UNTIL PUBLIC 4.2X5. 1 J 2. WATER IS AVAILABLE. LIMIT SHOWER FOOL pISTLIR C BANE (3)A.C.UNITSDRY WATER MAINS AND LATERAL SERVICE LINES FOR ALL SUE301VISION 3. A COVENANACCORDINGT O A FOREACH LOT HAS BEEN FVED ILFDDUEPARTMENT NDER LIBERO7 19H35,CP 4 LTH O WHICH PROHTS SHALL BE IJBITS TRANSFER OF /. CELLAR ENS STALLED Og ANY LOT PRIOR TO INSTALLATION OF DRY WATER MAINS AND WITHOUT AN ACCEPTABLE TEST WELL \p_W..20� 38x of ❑ CEN7 D.B. I 6@T FURTHER,THE COVENANT REQUIRESTHE OWNERTO CONNECTTO PUBLJC WATER WHEN IT BECOMES ` �� OOO —�\ Z AVAILABLE,AND NOTES THAT CONNECTION COSTS WILL BE INCURRED. 37 4 S> \ I O 4. LOT 10 It 3.6 ACRES)NOTED ON THE SUBDIVISION MAP SHALL BE COVENANTED,IN LANGUAGE ACCEPTABLE N snN - r/, \ TO THE COUNTY ATTORNEY,THAT IT WILL REMAIN AS OPEN SPACE(NO AGRICULTURAL OPERATIONS)UNTIL 69 r v C.P. PUBLIC WATER IS AVAILABLETO ALL OF THE SUBDIVISION LOTS.UPON INSTALLATION OF PUBLIC WATER THE LEGEND Q' 24•7' 2 r 5� r��l e > x T c PARCEL MAYBE USED AS AN AGRICULTURAL RESERVE EASEMENT AREA.THE COVENANT SHALL ALSO NOTE J � 6,2 - O I Gt THAT LOT IO CANNOT BEFURTHER SUBDIVIDED. LIGHT POLE O ,2O 2s-�pRY q•3 F. r0, r0, tG� � c6>O s>oa ecs6>s v ® ® DRAINAGE INLETS Q FRAME - ° L�J L J L I' _ OF NEyV UTILITY POLE W/GUY WIRE z p m I rI, II D+ k 20X4o f pWELLING N z WATER METER IN GROUND D #'�O O O rLr, I�1 I O A r O �W POOL z In �l pd WATER VALVE O FIN.FLR.=64.3 W (pi I I a O I> BsMT.FLR.=55.0 W STREET TREE RIDGE EL.=93.9 p SD•O' 1'T'I Z z STAKE SET 6.3 > m O '= V,J } 60.00+ EXISTING ELEVATION C ' ro z V. r IT I o W BC660.00 BOTTOM CATCH BASIN ELEV. Z Z BBO m O GARAGE 'A VA •A' I OZ (ED ] rr TC1360.00 TOP CATCH BASIN ELEV. J LOT 1 z GAR.FL.=51.6 ? I SC60.00 BOTTOM OF CURB ELEVATION ' 42.4 /rJ�, T V(c��OSOS �99O 30 60 TC 60.00 TOP OF CURB ELEVATION ' 6�8?iL:. ` PLAT. Tel°2 C 600 x"D.>> e�s638 'V SANITARY LOCATION p '� 43 Feet OWTS I D.B. LGI LG2 I LG3 LG4 LISS LGIS r ;D,W IZ \ E SCALE: 1 INCH= 30 FEET 42.0 46.5 35.5 40.0 19.0 27.5 `i PAVER \ I V LEGAL No, • 1 6.0 26.0 20.0 29.0 29.0 35.5 WALK v Y I \ > 4 o I.COPYWGHT2 24A LAN RVEYINGPLLC ALLRGHTSRESERVED DRIVEWAY V�'rtH fiSTEEL EDGING 2UNAUTHOP.rLEDALTERATIONORADDnIONTOTHBSUMV MAPBEARINGAUCENSEDLANDSURVEYOR'SSEALISAVIOLATIONOFSECTION720. : GRAVEL SUBDIVISION 2 OF NEW YORK STATE EDUCATION LAW .O-. 3 ONLY BOUNOARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL ARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYL:R S ORIGINAL WORK AND OPINION _ N 4.CER'TrICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED IN ACCORDANCE WITH THE CURRENT ETIS"rING CODE OF PRACTICF. FOR LAND SURVEYS ADOPTED BY THE NEWYORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.INC THECERTIFICATION ISUMREDTO PERSONS I y. 00 mow, p FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED.TO THE TTLE COMPANY.TO THE GOVERNMENTALAGENCY.AND TO THE LENDINGINSTRUTION LISTED ON `D•W.I \ �w w.�w m THIS BOUNDARYSURVEY MAP. -. "-'- / G —w� WATER SERVICE 1 U 5.THE CERTIFICATIONS HEREIN ARE NOTTRANSFERABLE. QC\ \ £ •C 6.THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED,IF ANY UNDERGROUND TS EXIST ORARE SHOWN,THE TS ARE NOT COVERED By THIS SURVEY 7 TI EOFFSETS IOR DIMENSIONS,SHOWN HEREONNMOM THE STRUCTURES TO THE PROPERTY IMPROVEMENTS ARE FOR AS SPECIFIC PURPOSE AND USE AND THER FORE ' �A���r'(�A�_ GAS SE 1 BC SG,6 E ARENOTINTENDF.D TO GUIDE THE ERECTION OFFENCES.RETAINING WALLSPOOLS.PATIOS PLANTING AREAS AODITIONSTOSUILOING.S NY" }' {+,''�' ,�.+ GA$-�RGACE \ £ x$6� .Ss/2 E OF CONSTRUCTION. : 1 �� G�r s S> T .JO D 8.ONLY SURVEYS BEARING THE MAKERS EMBOSSED SEAL SHOULD BE RELIED UPON SINCE OTHER THAN EMBOSEEDSEAL COPIES MAY COr�T VELOP�� / "S Q BC 6,>O / UNAUrHORP.EDANDUNDETECTABLEMODIFICATIONS,DELETIO(IS.ADDMONS.ANOCIWG[5 l'—I ' p1NG EN �� MEtER�/ Ss// 1 D.PROPERTY CORNER MONUME14TS WERE NOT SETAS PART or THIS SURVEY UNLESS OTHERWISE NOTED gUIL �/^ GAS EtER MALL MEASUREMENTS REFER TO US SURVEY FOOT s h a 7 ^.02n, 557G27 35" covE 10,W1� In � ='1 d 1` 'v r1Al`ID,rSURVEYII�IGPLLC o s�s64� r m'&• O TAKE`SET V`I P s'S3 U ,< .:; 1.=Al I D_I;S U:RVEYI .J.":P.LAN IV I NG }.} `� �g9p .. ``:','K• .ri:l•::.1:l.I. :_yri ,F^`yn•.,"' .+.=<__ ` \ •`'"�'3 Sedgy+ >�` 8- eCSSSO a 1:53115_(.ADING:RIV-'Z� 4ANOR RD., MPNORVILLE I I<9A9 ' OWN AY 60 5 LOT s° a z.R'. L.::� Y�-;4 •_Y•i,FX _r-~.—ltP [, t-,.,'..1.-.... �" 5 \2 � 2 O Gf- '..� ^PHONi~•. 63•1.=846 P3``:' :::=Q•�, 212 1 :v.�:'-it,.'�-y""""'-- ,SAKE S� y J T Al INFO@•,E4JGL'AND§ RVEYING.COM s U ACC>R" CERTIFICATE OF LIABILITY INSURANCE r ATE(MMIDDIYYYY) 12/14/23 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 CONTANAME* JOSEPH C.TINGO THE TINGO INSURANCE AGENCY INC PHONE 631 619-4285 ac No: 631 619-4289 3771 NESCONSET HIGHWAY,SUITE 210 ADORE S• JTINGO TINGOINS.COM SOUTH SETAUKET,NY 11720 INSURERS AFFORDING COVERAGE NAIC# INSURERA: TRANSPORTATION INSURANCE COMPANY 20494 INSURED INSURER B: DOMIANO POOLS INC INSURERC: DBA POOLFECTION INSURERD: 531 RTE 111 INSURERE: HAUPPAUGE NY 11788 1 INSURERF: 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 I ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000.000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 10,000 A Y B6019985774 03/30/23 03/30/24 PERSONAL&ADV INJURY $ 1 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 X POLICY1:1 PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident)H 1 $$ i UMBRELLA LIAR r OCCUR EACH OCCURRENCE $ s EXCESS LIAR HCLAIMS-MADE AGGREGATE 11 DED RETENTION$ Is { WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN ISTATUTE I I ER I ANY PROPRIETOR/PARTNER/EXECUTIVE f OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ (Mandatory in It and er E.L.DISEASE-EA EMPLOYE $ yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ j LL I I I f I• DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Certificate holder is included as additional insured if required by written contract. t I i i f P CERTIFICATE HOLDER CANCELLATION i 108 Harbor Watch,LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 309 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Islip, NY 11751 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE f © 988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD s f NYSIF New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE "A^AA^ 113234713 TINGO INSURANCE AGENCY INC f 3771 NESCONSET HWY STE 210 SOUTH SETAUKET NY 11720 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOMIANO POOLS, INC.DBA 108 HARBOR WATCH, LLC POOL FECTION PO BOX 309 531 RTE 111 ISLIP NY 11751 HAUPPAUGE NY 11788 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12357 753-9 57935 04/14/2023 TO 04/14/2024 12/14/2023 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2357 753-9, 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 CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT JOSEPH DOMIANO v OF DOMIANO POOLS,INC.DBA P POOL FECTION(ONE PERSON CORP) 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. e ii F # NEW YORK STAT SUR NCE FUND f J � In, # vv ; # DIRECTOR,INSURANCE FUND UNDERWRITING ! S VALIDATION NUMBER:809183840 U-26.3 i STATE CompWorkers' CERTIFICATE OF WSURANCE COVERAGE STATE Compensation Board NYS DISABILITY ARID PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by NYS disability and Paid Family Leave benefits carrier or licensed insurance agent of that carrie 1a. Legal Name&Address of Insured(use street address only) 1b.Business Telephone Number of Insured DOMIANO POOLS INC DBA POOL-FECTION 531 ROUTE 111 HAUPPAUGE,NY 11788 1c.Federal Employer Identification Number of Insured Work Location of Insured(Only required if coverage is specifically limited to or Social Security Number certain locations in New York State,i.e.,Wrap-Up Policy) 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 108 Harbor Watch, LLC PO,Box 309 3b.Policy Number of Entity Listed in Box"1 a" Islip, NY 11751 DBL65302 I 3c.Policy effective period 11/03/2023 to 11/02/2024 4. Policy provides the following benefits: ® A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employer's employees: i Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 12/14/2023 By (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. t 4 If Box 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit,PO Box 5200,Binghamton, NY 13902-5200. T i PART 2.To be completed by the NYS Workers'Compensation Board (Only if Box 4B,4C or 56 have been checked) f 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(Article 9 of the Workers'Compensation Law)with respect to all of their employees. i Date Signed By e (Signature of Authorized NYS Workers'Compensation Board Employee) i 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 i r agents of those insurance carnets are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. I i D13-120.1 (12_21) �IDII'IIIIIIIIIIIII�IIDIIIIII1I2IIil2l1uli SIT I i Suffolk County Dept,of Labor,Licensing&Consumer Affairs is HONE INPROVEVENT LICENSE v Name ' JOSEPH P DONIANO JR Business Name Th:s certifies;hat the 3earer is duly licensed DOMIANO POOLS INC 08A :)y the County of suffolk License Number:H-16355 Rosalie Drago Issued: 03/0111989 Comn•:ssiorer Expires: 03/0112025 a i i • i i 6 i k t t S t s F ' F • i 4t 1, , . i i A i �� load APPROVED AS NOTED DATE:a-a-2 B.P# 5oag(o COMPLY WITH ALL CODES OF FEa 33.oa BY: NEW YORK STATE&TOWN CODES REQIJ El)AND CONDITIONS OF NOTIFY BUILDING DEPARTMENT AT SOMOLDTOWN ZM 631-765-1802 8AM TO 4PM FOR THE $000LDTOWNPONINGBOMA01 FOLLOWING INSPECTIONS: 0X0LDTOWNTAUSTEES FOUNDATION-TWO REQUIRED x N.Y.S.DEC FOR POURED CONCRETE SOUMOLD FIRM ROUGH-FRAMING&PLUMBING INSULATION SCHO FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS RETAIN STORM WATER RUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE OX •OH-__ON_—ON Survey of Property ESI ENCE- U off-_ -o"—o"E I Es X— LON W N VE HE WI ES —GN—off—OH--ON —GN --ON LOT 1 - MAP OF WILDBERRY FILEDS $ w w "— 3_ E GE F VEMENT HY NT . - w ,N-._w__w2 _w-__,H.-_w—w---._w>> W TE M IN 'J I FILED: JUNE 21, 2001 -MAP NO. 10641 3' 2 w— w--D°—w—w--w=w—w—w s s> x SITUATE 3 � $ �°w�w—IY—w--w—w— ? - $ _3 x S 2 w_-w 4w.-__w—w--w_W S UN $ VIEW VENUE $ SOUTHOLD, TOWN OF SOUTHOLD --- _-----------_ INM K LR E GE F VEMEN 3 --GAS GAS—GAS—GAS--__--.----- GAS.-- 2 S O TC$> T SUFFOLKCOUNTY, N.Y. GAB--GAB--- GAS_GAS—G ---- -----------------�----- �$>' �s AS--GAS—GAS--.—GAS--GAS—GAS-- T _——— CS? 3 G SM K UT GAS GAS---GAS--___GAS.-- __�..( — GAS — /M 3 1 LT (P GAS GAS— —GAS S?61--GAS—GAS--GAS —GAS-- TAX MAP NO.: 1000-51-3-12.7 \ GAS LOT AREA: 36,899.37 S.F. (0.847 ACRES) N71°3'2'55"E I 1� 115.00 ` TEL-1 J E DATE SURVEYED: JAN.5, 2023 0 30 60 ' STAKE SET f STAKE STAKED PROPERTY LINES: FEB.22, 2023 Feet f I I\ / ELEVATIONS REFER TO NAVD88 SCALE: 1 inch= 30 feet I \ ` J Q W N CJ(u N (IJ UQ l m > (V T ° COVENANTS AND RESTRICTIONS: o o l Q W w I `� ` Tc *$? s? o ON MARCH 14,1997 THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BOARD OF REVIEW GRANTED O ` In Z LLL In JU/ C gy$S $?$2 0 APPROVAL TO THE REQUEST FOR THE VARIANCE TO USE TEMPORARY ON-SITE WELLS SUBJECT TO THE I / UJ (7 L2 4, I > N FOLLOWING CONDITIONS: N / O 1. ALL LOTS WILL BE REQUIRED TO HAVE INDIVIDUAL TEST WELLS PRIOR TO APPROVAL TO CONSTRUCT.ANY / / / m N I ��/ �� r N LOT WHICH DOES NOT MEET THE WATER QUALITY STANDARDS SHALL NOT BE BUILT UPON UNTIL PUBLIC / ` -0 -6 � 00 00 (5 ) STAKE SET EL VE ° WATER IS AVAILABLE. ) 2.DRY WATER MAINS AND LATERAL SERVICE LINES FOR ALL SUBDIVISION LOTS SHALL BE INSTALLED I, W. I 1 162.00 ACCORDING TO A DESIGN APPROVED BY THE DEPARTMENT OF HEALTH SERVICES. / 3. A COVENANT FOR EACH LOT HAS BEEN FILED UNDER LIBER 11935,CP 475 WHICH PROHIBITS TRANSFER OF x �, - w —^ CD .2 ___ - -. - 571°32' o f d ANY LOT PRIOR TO INSTALLATION OF DRY WATER MAINS AND WITHOUT AN ACCEPTABLE TEST WELL. / ). ) O�JTDO ,. ->?OOL( )t FURTHER,THE COVENANT REQUIRES THE OWNER TO CONNECT TO PUBLIC WATER WHEN IT BECOMES I (, / I ,: ° S OWER EQUIP. / AVAILABLE,AND NOTES THAT CONNECTION COSTS WILL BE INCURRED. ( _------ F 4.LOT 10(13.6 ACRES)NOTED ON THE SUBDIVISION MAP SHALL BE COVENANTED,IN LANGUAGE ACCEPTABLE i ( / TO THE COUNTY ATTORNEY,THAT IT WILL REMAIN AS OPEN SPACE(NO AGRICULTURAL OPERATIONS)UNTIL j('I' CELLAR 1° :3� $?) CS? ) J PUBLIC WATER IS AVAILABLE TO ALL OF THE SUBDIVISION LOTS.UPON INSTALLATION OF PUBLIC WATER THE / I 58.5 _ �..I ( I/ E sEc / I f PARCEL MAY BE USED AS AN AGRICULTURAL RESERVE EASEMENT AREA.THE COVENANT SHALL ALSO NOTE / S�t WJ ) ��-llliss��-llliii l ^ THAT LOT 10 CANNOT BE FURTHER SUBDIVIDED. I _ � N LEGEN ro 21.1, �' I j ICI r� (NOT TO SCALE) J !, 5.5 LIJ LIJ �§ TEST HOLE ��(( r� r I f.> 2 $ TEST HOLE AS SHOWN ON MAP OF �fj,•"' LIGHT POLE o WILDBERRY FIELDS,FILED MAP C) / x 0 7+ C L_J L J NO.10641 ® ® DRAINAGE INLETS $o ~ O O $• 2 zU rl I rl 1 I £ < O ��.� UTILITY POLE W/GUY WIRE Z z / _ W 7 J N O �'N 0 V)^trj W I I I J O 0 I I� GRADE 0.0' 1- J d O O LL O O 3 �• 0.5' LOAM ® WATER METER I- N P� O'er 'O� L J L J I p £ z O �# LJ F- O O 5 Q CA N N J J r l r 1 I N -I W 3, SAND AND CLAY pd WATER VALVE z D_ F-Cr 0IN �m O LLLL I LL I I D:I r J r _ J SAND AND GRAVEL (J STAKE SET J �- LD L J L J 4.5' STREET TREE (n N + EXISTING ELEVATION / LL r-I ( ) PROPOSED ELEVATION Z / 'D LLLJ L J SAND AND CLAY N G GE C BOTTOM CATCH BASIN ELEV. J / L T 1 BBQ w G.FL. t-I !- / I £ J 13' TC I 3 . - -----WATER IN C BOTTOM OF CURB ELEVATION / l r \ I L3 _ ' TOP CATCH BASIN ELEV. I I TL.-,> xS ,CS < SAND AND GRAVEL _ TIC - TOP OF CURB ELEVATION i / \✓1 P t.t ) £ / ,; c 3 '>>. '3L c 19 WATER ENCOUNTERED - EXISTING CONTOUR WA K AY 13'BELOW SURFACE ' / £ E ( ) PROPOSED CONTOUR / / / £ ti$'33 IVEW Y _ / LEGAL NOTES 1.COPYRIGHT 2022 AJC LAND SURVEYING PLLC.ALL RIGHTS RESERVED 1 £ 2.UNAUTHOFILED ALTERATION OR ADDITION TO THIS SURVEY MAP BEARING A LICENSED LAND SURVEYOR'S SEAL ISAVIOIATION OF SECTION T N. — SUB-DIVISION 2.OF NEW YORK STATE EDUCATION LAW 1 G.ONLY BOUN DARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL AR E GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL WORK , �J ^q' "~i ' -- E N �.�•( V1 AND OPINK)N. W w 5 w'W TE .w VI k �0W,—`w w _'!�'�-�N £ A.CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED HI ACCORDANCE WITH THE CURRENT EXISTING CODE OF PRACTICE ,',��': i:_�-T `{I ^J ) - / \ ( )•_— / /-/J/— ' O FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS,INC.THE CERTIFICATION IS LIMITED TO PERSONS FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED.TO THE TITLE COMPANY,TO THE GOVERNMENTAL AGENCY,AND TO THE LENDING INSTITUTION LISTED ON 1 GO.O�_e \ _ THIS BOUNDARY SURVEY MAP. J `j i U 5 THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE L _ C S.THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN ANDOFTEN MUST BE ESTIMATED IFANV •^ i \ �/ �($ / / / / 1 T r, UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN.THE IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY �` ) ��-- ) �S> £ xS CS E T.THE OFFSETS(OR DIMENSIONS)SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR ASPECIFIC PURPOSEAND USE AND THEREFORE FEB - Z 202A �. \ / ( .W.) ® —L5 3S/ T -$ �2 0 AR E NOT INTENDED TO GUIDE THE ERECTION OF FENCES.RETAINING WALLS,POOLS.PATIOS PLANTING AREAS.ADDITIONS TO BUILDINGS AND ANY OTHER TYPE 1, �d• E/ EL `, ® /// $?35 /� C , j OF CONSTRUCTION t,•1 / 8.ONLY SURVEYS BEARING THE MAKERS EMBOSSED SEAL SHOULD BE RELIED UPON SINCE OTHER THAN EMSOSSEDSEAL COPIES MAV CONTAIN I G ® j ' / £•)Y DI UNAUTHORIZED AND UNDETECTABLE MODIFICATIONS.DELETIONS.ADDITIONS.AND CHANGES - uI , PROPERTY CORNER MONUMENTS WERE NOT SET AS PART OF THIS SURVEY UNLESS OTHERWISE NOTED. G� gTpKES / ,� 10 ALLMEASUREMENTS REFER TO US SURVEYFOOT. _ ® °TILITY-' l ff j S57°27 5�U8�1C, A'�,�,C,�L'a n dl Su rvey i n g n-1 I a T� RAG ems$ 7, .oM t- '' e'\. £� 3 i - � � T gipKESE ` -- :Lan.d.sSjU,py.d ins $& Plan;nin- �k U\ T� x$ 21 7 yy9µ - `� �...,�,�:, f. . . ._}� C$ $. 1 yti) 5 1 L T 2 I $ 3 1'S3LWad n Riuer..lMar or­Rd ;.Vanor�ille:.1.1949 v C NT L T 15 P,hone1631'=1846-9973. " `` "y 212' DRAINAGE CALCULATION: I °WEu e :. ^'"•'• -' ��` ~,•, `^"`'�;'_- "� • � ,,I, BTpK SET RESIDENCE:3,009 S.F.x 0.17 FT.x 1.0=512 C.F.REQUIRED m �eGnail: Info@Afc andSurveying.COm S8� PROVIDE:(4)V DIAM.x 4'DEEP DRYWELL PR EQUIV. j