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HomeMy WebLinkAbout50264-Z pG. Town of Southold 8/29/2024 z� P.O.Box 1179 0 o _ �-3 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 45495 Date: 8/29/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 70 Wildberry Ln, Southold SCTM#: 473889 Sec/Block/Lot: 51.-3-12.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated i 12/28/2023 pursuant to which Building Permit No. 50264 dated 1/26/2024 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 inground swimming pool fenced to code as applied for. I I 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 A—C"\ Au or ze gnature O�g�FFO(,�co TOWN OF SOUTHOLD Gyp BUILDING DEPARTMENT TOWN CLERK'S OFFICE �y • 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#: 50264 Date: 1/26/2024 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 inground swimming pool as applied for. Pool and pool equipment must maintain a minimum set back of 10 feet. At premises located at: 70 Wildberry Ln, Southold 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 7/27/2025. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: $400.00 jc� p Building Inspector I pF SO(/��ol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G Q Southold,NY 11971-0959 �� • �o sean.devlini'cD-town.southold.ny.us �yCOUNT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: 108 Harbor Watch LLC Address: 70 Wildberry Ln city:Southold st: NY zip: 11971 Building Permit#: 50264 Section: 51 Block: 3 Lot: 12.7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Brilliant Electric Corp License No: 40896ME 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 12ecpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt 1 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: Intermatic Pool Panel 8 Circuit/6 Used, Pump 220GFI, Heater 220GFI, Hayward Salt Gene 215, (2) Lights 120GFI Notes: Pool Inspector Signature: ate: May 20, 2024 S.Devlin-Cert Electrical Compliance Form �o��OF SOUlyolo —7 C) # # T&W UTHOLD BUILDING DEPT. r . cou�n,��' 631-765-1802 INSPECT-ION [ ] 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: fA,�nt or on f e4 DATE J �a�I�`�-P INSPECTOR SOl/jh°� # # TOWN 'OF S.OUTHOLD BUILDING DEPT. coum, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SUL =ULKING [ ] 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: � — --- (� - - - - - ---— — - -- — 0qvcv (bT• Qi �wCS� wtalk,/07 DATE g Y3 INSPECTO I I i Of SOUlyolo # # TOWN.OF SOUTHOLD BUILDING DEPT. `yComm, 631-765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG: [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING . [ ] FINAL I [ ] FIREPLACE & CHIMN.EY [ ] FIRE SAFETY INSPECTION XFI ESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION TRICAL (ROUGH) [ ] ELECTRICAL (FINAL) VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: in z 44 Ao, A0WqA- A6 I e7 (KY1 DATE INSPECTO FIELD INSPECTION REPORT I DATE COMMENTS 0 � FOUNDATION(1ST) ------------------------------------ C FOUNDATION (2ND) J z CIO 0 H ROUGH FRAMING& t� PLUMBING � J r INSULATION PER N.Y. 0J , STATE ENERGY CODE C) ex Y" wvkool � FINAL ADDIT ONAL COMMENTS o pd P) a �06� m \ ti do z x d r� b FFO(' TOWN OF SOUTHOLD—'BUILDING DEPARTMENT s= Town Hall Annex 54375 Main Road R. O. Box 1179 Southold,NY 11971-0959 oy • o�g Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownn . ov Date Received i APPLICATION FOR BUILDING PERMIT For Office Use Only 1 � ` f /_ i L/ PERMIT N0. �P ' J i 11,Building `'S ,"� DEC 2 8 2023 Applications andllorms must be filled'out in their entirety.Jncomplete. 'applications`will not be accepted. Where the Applicant is:n pit tKe'.d'ner;:ari, I"I�'�r .D �I;rEPI T, _ Owner's Authoriiation'fdtm(Page'!)shall be-completed:r' �Cgr ,,. r;Jg,ri Date: OWNERS)OF:PROPERTI(: Name: log - - SCTM#1000- Project .Address - _-.-7a _... -- ---.-1/. -�� - -- --- - Phone#: Email:, Mailing Address: CONTACT PERSON: i Name: _ Mailing Address: Phone#: - ;"pESIGMPROFESSIgNAL INFORMATION: . Name: Mailing Address: Phone#: Email: ..:CONTRACTOR".INFORMATION: Mailing Address: Phone#: Email: DESCRIPTION,OF P,ROP.OSED;CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Pr,,i?ct: Other a t)NO 4j)OL.,. Will the lot be re-graded? ❑Yes ONO Will excess fill be removed from premises? ❑Yes ❑No 1 i PROPERTY INFORMATION,:- Existing use of property: j Intended use of property: i Zone or use district in which premises is situated: ! Are there any covenants and restrictions with respect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. D.Check Box After'Reading::The owner/confractor/d'esign,professional is,resPonsitile'forall drainage-and'storm'water-issues as:prodided by; Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to tFie`Bwldnig Depeitment for the issWke.of a Building Permit pursuant to the`Building Zone ; OriJinance af,4he Town of.Southoid,Suffolk,County,'New York and otherapplicable Laws;Ordinances or Regulations;far the pristruction,q buildings,- sdditions,`alteration"s,or for,removal or demoliiion,as herein'describ`ed The applicant agrees to,comply,wifh;all applicable laws;ordinances;,building code; ` mousing code'and regulations"and to admtt authonzed`inspector"s on-premises and m 6uildirig(s)for necessary inspections.,False statementrmade Herein ale punisHable as a[lass A rrmis'demeanor pursuant to'Section:210,45 of.the-New.York State PenaLlaW. I Application Submitted By(print name): w�P�C� v ❑Authorized Agent .Owner Signature of Applicant: Date: )z IT-0 Zoz3 STATE OF NEW YORK) SS: COUNTY OF l 5n �_n�) _Mt G V��'l �r� '�' being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the ® LA-,-nMv (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 thisy`r+ ;._ 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 7-0 day of 20a-;� No��T�l�!( J�L10,STATE OF NEWYORK ALIFIED IN SUFFOLK COUNTY NO.01 R06173781 COMMISSION EXPIRES 11/291ZE77 PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) 3 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 jo WNW ItICI _Li 77 IFF9Z BUILDING DEPARTMENT- Eladrical Insp ector 4L FEB 1 6 2024 TOWN OF 5-OUT110LD Town Hall Annim - 't14375 rvl-aiiri Road - T'cj Fw:y. 1-79 Southold, Nov., York, 40 (631) .765-18,02 - FAX (631176335-9,�':012 - 'if -%61Kcdd1q-vm nv.gov -ic se 11 p APPLICATION FOR ELECTRICAL HNSPE-10-710N 14 6 20 ELECTRICIAN INFORMATION iAII !,,-fr�rTiat�:.-:- %e: Feb .24 Cr3nripany Nair zj: BrOli.anz Cf,,rp Pier Irician's. Oureshi License 40896--VIIE tier;ier;. email,mqwrny@.y.qhoo_cct'.q Eiec. Phcri_- Nic), 516,3521.2.72 1 ren,ti-am a n e rn ai I c- -c.,1)y o f C eir i i f i e, c j n i n-r,p E iec- Ad-dr-ess.: 2 1) Pi-ritt 0-v al G I. C'uive NY 11 1-542 JOB SITE INFORMATION (Ai; R,-.(�.Wrud) NLqjji,1:,:i 108 HPrty<-jr*'.,\!,-jl,dhi L L C Add-,ess- 70 'A',I.dberr­ lane ScuAhh6IdNY 'l1971 G'rcj-i.,, Street, Ph,. one, 1,4 4744.792:�"� Bldg.,Flerr-ait -' . 5br,1&_1 emailT. Tax Map-District 1000 Section: LOT: BRIEF DESCRIPTION OF VVORK III LUDEE S E 6t.mr.7ment(57.11.1 amp i 1 1 1]tj;j�jj 1_�W IU "�U IV lUt-: Alf I 4p �poni and bar b errfivionv F)ota,ge:_7 Clrc[e All That Apply, lzq jnb rn)a dy for i_spect1'rjn?: L pini" CIG you nec-A a Ternp, Clerlific.ate?.- YE "N 0 ISSUed 'On JO )o Ly Temp Fiff6rmation: IAll itlfjrrcrinn rnq ji(ccj '� p;' A 13 1;� .sosvic'12 SI/E.I%-_ .I 0,1 cl /] Ph F❑-1 h..Iew-Ser-Ace[:1 FifH 4 tinderground Late(als -1 F ra.rr e r Pole. 'S,'Vcjtrif, cone (1 q S j:: Y [__!N PAYMENT DUE WITH APPLIGATEON + f 00 PERMIT# Address: Switches I Outlets GFI's I Surface Sconces H H's UC Lts Fridge HW POOL Fans Mini Fr. WAD Panel Pump2'Z& Exhaust Oven Sump Heaters Trnsfmr Smokes DW Generator Salt Gen.Uv( Carbon Micro GrbDis Water Bond ' Lights -e)JA Heat Pucks ERV HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo Cooktop Minisplit Blower AC AH Hood Blower Service Amps Have Used Sub Amps Have Used Comments J pF SO(/r�Ql Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 G • Southold,NY 11971-0959 'Q a �y�OUNT`I,N� 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 o n J. Jars Se for Buil ing ns c or IT SHALL BE UNLAWFUL TO REMOVE T IS OTI ITH T WRITTEN CONSENT OF THE ISSUING AGENCY. 1 ® \ DATE(MMDD/YYYY) A400R o CERTIFICATE OF LIABILITY INSURANCE 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 endorsements). CONTPRODUCER NAME: JOSEPH C.TINGO THE TINGO INSURANCE AGENCY INC P"o"E 631 619-4285 nr°xC No: 631 619-4289 3771 NESCONSET HIGHWAY,SUITE 210 AADD IEss, 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 INSURER E: HAUPPAUGE NY 11788 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM DDY EFF POLICY EXP MM DD/YYYY LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR 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 POLICY PE LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY Ee aBcid.ntINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A i E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If es,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is included as additional insured if required by written contract. CERTIFICATE HOLDER CANCELLATION 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 ACCORDANCE WITH THE POLICY PROVISIONS. Islip, NY 11751 AUTHORIZED REPRESENTATIVE �• © 988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i II/�1 NYSI F New York State Insurance Fund PO Box 66699,Albany,NY 12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^AAAAA 113234713 TINGO INSURANCE AGENCY INC f 3771 NESCONSET HWY STE 210 Qi 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:/MIWW.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 OF DOMIANO POOLS,INC.DBA 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. NEW YORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:809183840 U-26.3 NEW Workers' CERTIFICATE OF INSURANCE COVERAGE STATE Compensation Board NYS DISABILITY AND 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 la. Legal Name 8 Address of Insured(use street address only) 1 b.Business Telephone Number of Insured DOMIANO POOLS INC DBA POOL-FECTION 531 ROUTE 111 HAUPPAUGE,NY 11788 1 c.Federal Employer Identification Number of Insured (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"I a" DBL65302 Islip, NY 11751 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: ❑X A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑ B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described �abbovee. Date Signed 12/14/2023 By Wig f (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Name and Title Richard White, Chief Executive Officer IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 413,4C or 513 is checked,this certificate is NOT COMPLETE for purposes of Section 220, Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be 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. PART 2.To be completed by the NYS Workers'Compensation Board (only if sox 413,4C or 5B have 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(Article 9 of the Workers'Compensation Law)with respect to all of their employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (12-21) 111111iiiiiiuiiuiimiaiiiiiiiioiiiiiiooiil�11 Additional Instructions for Form D13-120.1 By signing this form, the insurance carrier identified in Box 31on 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 NYS Disability and Paid Family Leave Benefits Law.The insurance carrier or its licensed agent will send this Certificate of Insurance Coverage (Certificate)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 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 NYS 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 issued by a certificate holder,the business must provide'that certificate holder with a new'Certificate of Insurance Coverage for NYS disability and/ or Paid Family Leave Benefits or other authorized proof that the business is complying with the mandatory coverage requirements of the NYS Disability and Paid Family Leave Benefits Law. i NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS 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. 1313-120.1 (12-21)Reverse Suffolk County Dept.of Labor,Licensing&Consumer Affairs °a FONE IMPROVEVENT LICENSE i Name ' JOSEPH P DONIIANO JR Business Name ?h:s ceriries;hat the DOMIANO POOLS INC DBA 3earer is duly licersed )y the Ccunty of sufiolk License Number:H-16355 Rosalie Drago Issued: 03/010989 Comn•.ssiorer Expires: 03/0112025 I SURVEY OF PROPERTY off OVERHEAD WIRES OH LOT 1 MAP OF WILDBERRY FILEDS SQw-w 3, EDGE OF PAVEMENT HYDRANT i 6 -W--w-.„-w-02 W-w-w i.>, FILED:JUNE 21 , 2001 -MAP NO. 10641 °Os, s3 -LY-W-w_,YwaTwRMAiN Y �a,s> a SITUATE 66� a234X --D6 -W S9 w-_ w-W-W OS.TAG w �w-w-n-evaCeSs 46 > 6S .3a* sa24x I �n'-W D4 W sO w- SOUTHOLD, TOWN OF SOUTHOLD 63> 6 s SOUND VIEW Au�NUE T x $ $ ---- DRAIN MARK OUT- . -- EDGE OF PAVEMENT s9. SUFFOLK COUNTY, N.Y. -------- - 2° ---------- _ TAX MAP NO.: 1000-51-3-12.7 ------------------------ - ems>tis ecs883 LOT AREA:36,899.37 S.F. (0.847 ACRES) - 6 s3 U N71 D32'55"E i 15.00 TELE.- a DATE SURVEYED:JAN.5,2023 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES STAKESET PEO. STAKED PROPERTY LINES:FEB.22,2023 APPROVAL OF CONSTRUCTED WORKS FOR STAKE SET R� v REVISED:APRIL 5,2023 ASINGLE FAMILY RESIDENCE J S!O m FOUND.AS-BUILT:OCT.6,2023 D Date 8/9/2024 H.S Ref NO. R-23-0368 �� 00 FINAL SURVEY:JUNE 25,2024 m D m N REVISED SAN.TIE:JULY 1 7,2024 - The sewage disposal and water supply facilities at this location have been O Q�W �� .$ TCe N Inspected and/or certified by this Department or other aoencres and found 0 to Z 1- IL TC ? eC s? _ to be satisfactory FORA MAXIMUM OF 6 BEDROOMS. O W U) LL 'W� e04?.5' $ s es?O2 N -ELEVATIONS REFER TO NAVD88 N D z CRAIG KNEPPER.PIE. CHIEF O O v Office of Wastewater Management 0 (4 STAKE SET COVER COVENANTS AND RESTRICTIONS: toELECj ON MARCH 14,1997 THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BOARD OF REVIEW GRANTED 162.00 O o AD ROVALTO THE REQUEST FOR THE VARIANCE TO USE TEMPORARY ON-SITE WELLS SUBJECTTO THE O FOLLOWING CONDITIONS: 62 S71°32'551'W O ' 1. ALL LOTS WILL BE REQUIRED TO HAVE INDIVIDUAL TEST WELLS PRIOR TO APPROVALTO CONSTRUCT.ANY LOT WHICH DOES NOT MEET THE WATER QUALITY STANDARDS SHALL NOT BE BUILT UPON UNTIL PUBLIC 4 2x5. POOL EQUIP. LIMIT OF WATER IS AVAILABLE. DISTURBANCE SHOWER (3)A.C.UNITS 01b, 2 ACCORDING TO A DESIGN APPROVED BIYTHE DEPARTMENT OFCE LINES FOR ALL DHEALTH SERVICES. ISION LL BE INSTALLED OO 9�s> xS?la eOssa) 3. A COVENANT FOR EACH LOT HAS BEEN FILED UNDER LIBER 1 1935.CP 475 WHICH PROHIBITS TRANSFER OF 7.,38 CELLAR EN_?T �- 1 cEN7 D B ANY LOT PRIOR TO INSTALLATION OF DRY WATER MAINS AND WITHOUT AN ACCEPTABLE TEST WELL x e� ❑ Z FURTHER.THE COVENANT REQUIRES THE OWNER TO CONNECT TO PUBLIC WATER WHEN IT BECOMES �, �'• .........-, 37 4 -'6tT$> 0" AVAILABLE.AND NOTES THAT CONNECTION COSTS WILL BE INCURRED. 4. LOT 10 0 3.6 ACRES)NOTED ON THE SUBDIVISION MAP SHALL BE COVENANTED,IN LANGUAGE ACCEPTABLE w TO THE COUNTY ATTORNEY,THAT]TWILL REMAIN AS OPEN SPACE(NO AGRICULTURAL OPERATIONS)UNTIL_ _ _ _ _ _ 692r -�D 'pl SAN r`�-1 r��-� p PUBLIC WATER IS AVAILABLE TO ALL OF THE SUBDIVISION LOTS.UPON INSTALLATION OF PUBLIC WATER THE LEGEND 24•7' - - in- - - PARCEL MAYBE USED AS AN AGRICULTURAL RESERVE EASEMENT AREA.THE COVENANT SHALL ALSO NOTE 6.2 THAT LOT IOCANNOT BE FURTHER SUBDIVIDED. Q F LIJ LI, 161 CH NG P C 6>O s>°2 eCs6>6 'o LIGHT POLE Q 2.0 r, rLEA U 2 STORE' 4.3 O �� GALLEYS o ® ® DRAINAGE INLETS Q ' E O I w l I A I I O CNZ v ro FRAM °� L J L J z x OC NZtV >-� UTILITY POLE W/GUY WIRE ZZ 2oxao m r LLING NW mz \ rIl-1 rlclI T-11 11 IkI azD OwOOpWE ® WATER METER N D #70 O0 POOL 5.4 FI .FLR-=64.3 L0Jiz O =55.0 O WATER VALVE BSMT.FIR. SO.O O m=939 LLSTAKE SET RIDGE EL- 6.3 O USTREETTREE 'vZ-1 1 0 r Z 7t 60.00+ EXISTING ELEVATION 0 ' I m0 I I<Z w al 1 BCB60.00 BOTTOM CATCH BASIN ELEV. 'Z BBO rn ° N .� I Z �O o GARAGE rr y TCB60.00 TOP CATCH BASIN ELEV. _J LOT 1 GAR 61.6 A I \A f J "k BC60.00 BOTTOM OF CURB ELEVATION r 6 42.4 m n I TOS U 7 G60.00 TOP OF CURB ELEVATION ' °.';v ` PLAT. x61 p2 TC b y°x > QCS638 y r S09g� > 0 30 60 0; a3 SANITARY LOCATION Vr C Feet ; Q T d - D.B. LG1 LG2 LG3 L34 LG5 LG6 I �WOO-` -O i \ E SCALE: 1 INCH= 30 FEET 1 (8 42.0 46.5 35.5 40.0 19.027.51 PAVER o LEGuruo 1 6.0 26.0 20.0 29.0 29.0 35.5 ' WALK y tt \ A< o 1.COPYRIGHT 2024 AJ LAN RVEYINGPLLC ALLP.IGHTS RESERVED \ I DRIVEWAY WITH STEEL EDGING Zm� I 2.UNAUTHORRED ALTERATION OR ADDRION TO THIS SURVEY MAP BEARINGALICENSED LAND SVRVEYOR'SSEAL ISA VIOLATION OF SECTIONT20D. \ GRAVEL < SVBDIVISION 2.OF NEW YORE:STATE EDUCATIO N LAW I \ m 3.ONLY BOUNDARY SURVEY MAPS WITFI THE SURVEYOR'S EMBOSSED SEALARE GENUINE TRUE AND CORRECT PI COMES OF'T14E SURVEYORS ORIGINAL WORK V1 -. AND OPINION �. {V� .r� f/ •'� M FOR LA DSL RVFSONTHITED BYTARY SURVEY STATEAP SSOCIIFY ATTHEMAROFE PROFESSIONAL L IN SURVEYORS.ORDANCE INC.THE CEH THE URRENTIONIS NGCODE O PERSONS FOR LAND SURVEYS ADOPTED BY THE NEW YORM1 STATE ASSOCIATION OF PROFESSIONAL LAND CURVEYORS.Iry .THE CERTIFICATION IS LIM1IITF.D TO PERSONS � � y. � W-\ FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED TO THETTLE COMPANY.TO THE GOVERNMENTALAGENCY.AND TO THE LENDING INSTITUTION LISTED ON �W NAY`' THISBDUNDARYSURVEYMAP. "" ( �� -�W- WATER SERVICE F I U 5.THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. 6.THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED.IF ANY C UNDERGROUNDIMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN.THE IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY. 7 THE OFFSETS(OR DIMENSIONS)SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR ASPECIFIC PURPOSE AND USE ANDMHEREFORE - ' (aAS�G AS SERVICE x aC Jn6(ja E AR-NOT INTENDED TO GUIDE THE ERECTION OFFENCES.REIAINING WALLS POOLS PATIOS PLANING AREAS.ADDITIONSTO BUILDINGS Nr O/ _775777111Y �,rr• 3� '4 $ s� E OFCONSTRVEYSB. {(�' � �� GAS-�Gam` \ $>3 O )-8 ONLY QJrp 2 O 9 11 NAUT UNAUTHORIZED ANEE BEARING TABLETS MODIFICATIONS.N SET PART IONS.ADDITIONS, VEY AND C OTHERWISE IJOTED MBOSSEDSeAL COPIES MAY CO VN ltt--�,J III�L,-., D ' BU1LDtN�E�P� G M��E _p� �0 aC 66 01 IO ALL MEA5UREMENTS REFER TO U S SURVEY FOOT {IlJ,1 J ,.� ELEG'T R� STAKE r' 2 7T35LL`N UpVERS 1 , \DE . f J 1?� rt S57D ? c ( U LAG 'LAD N SURVEYII`IACPLLC o ��H�°� Tom$ A-I - atii3` y Ar `.I. :L- # _ G I-t1 I� T � ^O 9 AKE SET y v P� Css a3 SLAMID;% VEY'IN; 'r&PLANNI. G , ` q �3 �� � ', Z T T *$62� - -%.a - iTT.i v�_-v Y.,1�.,i Lh;,:;-I •.:�` �t;,'.. ,rY,t�_.:•','>.f..,t"• � '.:"'b I.� ��¢- _ r'; ":1 3 VViADI'1VGsRIVE 'M'ANOR;'fRD., MAI IORI%1LLE;111A"1.0 ' � T ' Sso N .��Y�I� LOT 2 =t�,%'':,:l�fsF�:"i: _ 'Tf�.'i=ai'�;.,.�::'." •''1;:'t,.r'�.,,�„2f;,•„_.,,:. .:�i'�'' o,;,.'.-• `y h i`IE`''63,'1=846=9;9, _,,� r- { :•:L _�- ,s�' 2123t �>v�T•Y`''"�+6.++y:Yl.::V_"-'- rJ-?AKE 55f � EMAIL: INFO@AJ.isLANDSURVEYING.COM L 0 Y 10 ad APPROVED AS NOTED B.P-0 50 • .j �" DA • 1-z�a FJE ±il 7 •J NOTIFY BUILDING DEPARTMENT AT 31 831-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: J l! FOUNDATION*TWO REQUIRED - Q . FOR POURED CONCRETE • �,¢ d� ROUGH-FRAMING&PLUMBING �• a - INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. (� ALl CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW • I W A j'Q YORK STATE. NOT RESPONSIBLE FOR • Ql . , oo LL 'DESIGN OR CONSTRUCTION ERRORS 0 fl Q 0 ELECTRICAL a a INSPECTION REQUIRED d tz .� - - IMMEDIATELY '• ,-� ENCLOSE,A0OL TO CODE i UPON COMPLETION BEFORE"WATER- RETAIN STORM WATER RUNOFF • d `� PURSUANT TO CHAPTER 236 =• • 4 OF THE TOWN CODE r[l F N g -PLY WITH ALL CODES OF V NE YORK STATE&TOWN CODES REQUI ED AND CONDITIONS OF SpUi}IOLDTO zm _ SQN}IplpT01NNPLANNING6QAA0 SDUINOID TOWN TRUSTEES _l � �, � • N.Y.S.DES SOUTIi04D NPC SgHD ,r "--'-ON Survey of Property ON - OH °N ESI ENCE- oFI ,- ' w- W w -., 3'w. w � - ,.. ..., >/ E GE F VEMENT LI LIC WHY E NT� = VE HE WI ES°N ON -" -off S ° aH ._off -- DH LOT 1 - MAP OF WILDBERRY FILEDS N W -. yy ._... 2- W W W �- W..-.. V) W W.,TW_M. W- 1�.._.,Ar.._ \y .. > $ N - FILED: JUNE 21, 2001 - MAP NO. 10641 3' x a- W W W W _ W $> _ SITUATE S UN ` - W _ �" W - `" SOUTHOLD, TOWN OF SOUTHOLD 3' IN K UT7. z VIEW E GE F V S > .. VAS - - GAS - -.. _. EMENT SUFFOLK COUNTY, N.Y. GAS. -. . GAS - - _ - -- ' GAS .. x$ ..._.GAS - GAS GAS � - GAS --'GAS-...- GAS."._ C$>> C$ G S M K UT GAS - GAS. - .- GAS - .- GAS.__- GAS GAS T. ... _ _ CS>' 3 N ._ GAS - .. GAS -- GAS ...I.GAS__ -GAS ..__ _ S> M 3 TAX MAP NO.: 1000-51-3-12.7 GAS '�A$ GAS GAS GAS "'GAS GAS P Lf a � LOT AREA: 36,899.37 S.F. (0.847 ACRES) N71°32'55"E 115.00 TELE. E DATE SURVEYED:JAN. 5, 2023 0 30 60 STAKE SET a STAKE SET ..._ ���.. STAKED PROPERTY LINES: FEB. 22, 2023 Feet IS F'p > --ELEVATIONS REFER TO NAVD88 SCALE: 1 inch= 30 feet p w �� r • COVENANTS AND RESTRICTIONS: V- m >� , ' v ? � �LY w �j�m T x$> TC S a C? Z W to �U" C S $ -7 C $�S2 �•,� ON MARCH 14,1997 THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BOARD OF REVIEW GRANTED ~LL N tR C j 6 rJ APPROVAL TO THE REQUEST FOR THE VARIANCE TO USE TEMPORARY ON-SITE WELLS SUBJECT TO THE _ W � (7 > FOLLOWING CONDITIONS: N Ld •\ 1. ALL LOTS WILL BE REQUIRED TO HAVE INDIVIDUAL TEST WELLS PRIOR TO APPROVAL TO CONSTRUCT.ANY to '• _ 7 LOT WHICH DOES NOT MEET THE WATER QUALITY STANDARDS SHALL NOT BE BUILT UPON UNTIL PUBLIC ✓ ~ WATER C AVAILABLE. r- LO o2S -H. (5 -- ELEC. IF W\ STgKESET C VE 2.DRY WATER MAINS AND LATERAL SERVICE LINES FOR ALL SUBDIVISION LOTS SHALL BE INSTALLED 1 .. 162 ACCORDING TO A DESIGN APPROVED BY THE DEPARTMENT OF HEALTH SERVICES- .00 __ .-- 3. A COVENANT FOR EACH LOT HAS BEEN FILED UNDER LISER 11935,CP 475 WHICH PROHIBITS TRANSFER OF _ - _, _ S71°32' '� ANY LOT PRIOR TO INSTALLATION OF DRY WATER MAINS AND WITHOUT AN ACCEPTABLE TEST WELL. __ C, 7.' OUTDOOR - .FADE).. .. .........,.��5� � o _ FURTHER,THE COVENANT REQUIRES THE OWNER TO CONNECT TO PUBLIC WATER WHEN IT BECOMES ) SHOWER EQUIP, I AVAILABLE,AND NOTES THAT CONNECTION COSTS WILL BE INCURRED. - 4.LOT 10(13.6 ACRES)NOTED ON THE SUBDMSION MAP SHALL BE COVENANTED,IN LANGUAGE ACCEPTABLE r TO THE COUNTY ATTORNEY,THAT IT WILL REMAIN AS OPEN SPACE(NO AGRICULTURAL OPERATIONS)UNTIL - CCLi AR t S�37 PUBLIC WATER IS AVAILABLE TO ALL OF THE SUBDIVISION LOTS.UPON INSTALLATION OF PUBLIC WATER THE / ^ PARCEL MAY BE USED AS AN AGRICULTURAL RESERVE EASEMENT AREA.THE COVENANT SHALL ALSO NOTE 5g 5, ( .1)I7 E SE z _ THAT LOT 10 CANNOT BE FURTHER SUBDIVIDED. L?N 1, IjI I ✓'`j' I,l TC r TEST HOLE _ I L J $` (NOT TO SCALE) ; �>�y`.`-';`-� I = >2 L G J ) L J i, �$ > , a s'3 >': I r1 r.l r.. TEST HOLE AS SHOWN ON MAP OF LIGHT POLE Y I o y L) I j I I j WILDBERRY FIELDS,FILED MAP U „� _X O .�; _ _ 7+ C L J L J - NO.10641 _ ® ®_DRAINAGE INLETS _ - - --- - �. cw o • ;"'.�;: ~to -O •� x$. 2 ZS rl-I r 1 11 5 N v 1= Z Z OZ tee' J^ ego O u��m w� I I I jl CD '• GRADE 0.0' UTILITY POLE W/GUY WIRE - _. IT y ' • ' N N ` j n of tv _ O� ` � X O0u aN LJ LJ s� r B� 0.5' _ - LOAM ® WATER METER [U •{ O V` _ %\ 5.5 O_U) (D N j j r-� r 1 p ^u � w 3, - SAND AND CLAY pd WATER VALVE a i•: F- N�m O LL w W I r " r (: LL I I I w 11 z� ,.� SAND AND GRAVEL STREET TREE \ U STAKE SET r+,, _ J [L N coca I L J L y + EXISTING ELEVATION 1 _I to LL_ I LL I I Lq I w • 7c ( ) PROPOSED ELEVATION z -SAND AND CLAY /�', BBQ GE L J t C BOTTOM CATCH BASIN ELEV. J L T l �\ \ W' N G.FL. 1.1 L J 1 o J �. \ 13' TIC TOP CATCH BASIN ELEV. \\�• 9- - T[3 TCS F-]- ---- �--'WATER IN C BOTTOM OF CURB ELEVATION ,C W:\ \ L ! t Co> y"$ C$'3 SAND AND GRAVEL TIC TOP OF CURB ELEVATION (� f \ l.t ) ) - -ii \\ IIz 19 WATER ENCOUNTERED - EXISTING CONTOUR ✓ WA�KWAY 3 I y L�j� 13'BELOW SURFACE• ` �'l,;.C�c xS 3 SE E - ( )---- - PROPOSED CONTOUR \ s 3 IVEW Y( o 1.COPYRIGHT 2022 AJC LAND SURVEYING P C.ALL RIGHTS RESERVED' r� - 2.UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY MAP HEARING A LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209. L _ � SUB-OMSION 2.Of NEW YORK STATE EDUCATION LAW- ' �- 3.ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL ARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL WORK - -w'" .IN SE W TE VICE' ' ,' N Y T _ AND OPINION. -_-lV_... O..OW,_.....W W.t ...yT�'�.-, t F'YI CO 4.CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED IN ACCORDANCE WITH THE CURRENT EXISTING CODE OF PRACTICE \ ( ) -- _ FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND SURVEYORS.INC.THE CERTIFICATION IS LIAIRED TO PERSONS e FOR WHOM THE BOUNDARY SURVEY MAP IS PREPARED.TO THE TITLE COMPANY.TO THE GOVERNMENTAL AGENCY,AND TO THE LENDING INSTITUTION LISTED ON 50.0. ' _ _ ! _ _ THIS BOUNDARY SURVEY MAP __ - V .��i / I D 5.THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE / 6.THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN AND OFTEN MUST BE ESTIMATED IF ANY �� I^ ($)--"'--` _ TCS UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN,THE IMPROVEMENTS OR ENCROACHMENTS ARE NOT COVERED BY THIS SURVEY. -'-'" - �, f l`S> _ x^ C`5 7.THE OFFSETS tOR DIMENSIONS)SHOWN HEREON FROM TIE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ~� _ 5 7,� J E ARE NOT INTENDED TO GUIDE THE ERECTION OF FENCES.RETAINING WALLS.POOLS PATIOS PLANTING AREAS.ADDITIONS TO BUILDINGS,AND ANY OTHER TYPE E -Q__Vp O OF CONSTRUCTION ' 1- �$ 'O CS > U S.ONLY$UTNEYS BEARING THE MAKERS EMBOSSED SEAL SHOULD BE RELIED UPON SINCE OTHER THAN ENIBOSSEO-SEAL COPIES MAY CONTAIN �(yG ENv,E.�. _+ UNAUTHORIZED AND UNDETECTABLE MODIFICATIONS.DELETONS.ADDITIONS.AND CHANGES. U7 .�II((E SET /' 9.PROPERTY CORNER MONUMENTS WERE NOT BETAS PART OF THIS SURVEY UNLESS OTHERWISE NOTED I , SSW` C 10 ALL MEASURF.MENTS REFER TO US SURVEY FOOT. / _-1�^ � �3k 1,351,W 15to- OF �$ 570 ' .q�,C.n�L,a n.dR,S u rvey i n g p l,l-c�r M :Land'Suive.,..'.n v &..; Cn pl:a.Mining xl � Wallin,Riven`lyl�anor"'R`d Manorville',11'9.49� L T 2 i V C NT L T � 631''8469973y: :' ;.,yf�r -�1 DRAINAGE CALCULATION: 1soTo ELL F`.., .'•' %' - y�•�=.,.-�" .c:..r �. it .:.�`"� S STAKESET °. a RESIDENCE:3,009 S.F.x 0.17 FT.x 1.0=512 C.F.REQUIRED�. email: Info@Ajc'andSurveymg.com PROVIDE:(4)8'DIAM.x 4'DEEP DRYWELLOR EQUIV.