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HomeMy WebLinkAbout51487-Z sa TOWN OF SOUTHOLD BUILDING DEPARTMENT 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#: 51487 Date: 12/17/2024 Permission is hereby granted to: Alexander D Badanes 2275 Pine Neck Rd Southold, NY 11971 To: Demolish existing octagonal deck and construct an inground swimming pool as applied for. Pool and pool equipment must maintain minimum side and rear yard setbacks of 5 feet. Premises Located at: 2275 Pine Neck Rd, Southold, NY 11971 SCTM#70.-5-50 Pursuant to application dated 10/24/2024 and approved by the Building Inspector. To expire on 12/17/2026. Contractors: Required Inspections: Fees: DEMOLITION $217.00 SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $617.00 'Jz L__ Building Inspector TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 littr)s://www.sout�holdtowiitiy.gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only (9 RE PERMIT NO. Building inspector: 0 C T 2 4 2024 Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an RUITZINr, Owner's Authorization form(Page 2)shall be completed. TOW � ,1? IO1 Date:10/7/2024 OWNER(S)OF PROPERTY: Name:Alexander Badanes SCTM#1000-1000-070.00-05.00-050.000 Project Address:2275 Pine Neck Road, Southold, NY 11971 Phone#:704-651-9907 Email:sehayden410@gmail.com Mailing Address:2275 Pine Neck Road, Southold, NY 11971 CONTACT PERSON: Name:Justin Phillips - NYCD Group, Inc, Mailing Address:270 Spagnoli Road, suite 210, Melville, NY 11747 Phone#:516-477-6391 Email:Justin@nycdgroup.com DESIGN PROFESSIONAL INFORMATION: Name:Hrvoje Marnika, P.E. - HM Engineering, P.C. Mailing Address:P.O. Box 914, East Northport, NY 11731 Phone#:516-476-5392 Email hmarnika@hmengineeringpc.com CONTRACTOR INFORMATION: Name:Sweeney's Pool Service Inc, Mailing Address: 1740 Church Street, Holbrook, NY 11741 Phone#:631-431-0498 ]�Ell':nick@sweeneyspoolsvc.com DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other Maintain inground Swimming Pool $45,000 Will the lot be re-graded? ❑Yes igNo Will excess fill be removed from premises? MIYes ONO 1 PROPERTY INFORMATION Existing use of property:Single Family Intended use of property:Single Family Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to R40 this property? ❑Yes 10No 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 Chapter 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 210.45 of the New York State Penal Law. Application Submitted By(print arne):Justir1rhillips @Authorized Agent ❑Owner Signature of Applicant: , Date: STATE OF NEW YORK) SS: COUNTY OF <cw45 ) Justin Phillips being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the Agent (expeditor) (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 9 day of Oelebey, 20 2y 14.1 STEFANO BARRESI Notary Public Notary Public, State of New York No. 01BA6097508 )(III (III (III _ . ilk Qualified in Kings noun "" � re the applicant Is not ei� "� �m�. commission Expires August 18, i z-; owner Alexander Badanes residing at 2275 Pine Neck Road, Southold, NY 11971 ,do hereby authorize Justin Phillips to apply on my behalf t tip Ta 'n of Southold Building Department for approval as described herein. 2 Owne s Signature Date Alexander Badanes Print Owner's Name 2 ItJ18YNw 'X N°W WtlIWI Po BVNv kWaYXn II�I��IiIpIq�I I IYWo r i y 1 .,: ��W I 1NX'YW. !Y JWW%'DWVIWv;X4vp1414vpYrvArvNWI✓YddArvN ONNrtf IXXYlIi%IIX'lJd6ryX/7 'YZaJdW4V'loldYfi4lrilN 270 Spagnoli Road, Suite 210 Phone:(516)477-6391 Melville,NY 11747 Fax:(516)586-8164 Website:ivw .NYt,"'DG oq .cpm Email: info MYCa rou axoni TRANSMITTAL Via: Hand Delivery ® U.S. Mail ❑ FedEx Standard Overnight ❑ Pick Up ❑ To: Town of Southold Date: October 9, 2024 54375 Main Road Southold,NY 11971 Attention: Building Department Re: Maintain Swimming Pool Application Badanes Residence 2275 Pine Neck Road Southold,NY 11971 Project# SWEE24-04 Enclosures: uanti Date No. Description 1 10/8/2024 --- ToS Application for Building Permit 4 --- _-- Survey 1 6/27/2024 1-4738- NYS DEC No Permit Necessary Letter 05022/00001 4 5/2/2024 S-1 of 1 Proposed Plot Plan 4 3/10/2024 S-101 of 1 Proposed Swimming Pool Engineer's Plan 1 _-- 4 Pages Contractor's Insurance Certificates 1 --- 1 Page Contractor's Suffolk County License Comments: Enclosed please find the above referenced items for your department's use in review and issuance of a building permit for the proposed swimming pool at the above referenced location. Please contact our office with any questions or concerns you may have. Signed: fAld Phillips— Justin( YCI)Group.com cc: we ney's Pool Service, Inc. —w/ enclosures (via email) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Division of Environmental Permits,Region 1 SUNY 0 Stony Brook,50 Circle Road,Stony Brook,NY 11790 P;(631)444-0365 1 F:(631)444-0360 www.dec.ny.gov NO PERMIT NECESSARY: TIDAL WETLANDS ACT June 27, 2024 Alexander Badanes 2275 Pine Neck Rd Southold, NY 11971 Re Application# 1-4738-05022100001 Badanes Property — 2275 Pine Neck Rd, Southold, NY SCTM# 1000 — 70— 5 — 50 Dear Applicant: The Department of Environmental Conservation (DEC) has completed a review of your proposal to remove an existing deck and construct a new rear deck and inground pool. All proposed work is located greater than 75 feet from the Tidal Wetlands Boundary and conforms to the Tidal Wetlands Development Restrictions under 6NYCRR Part 661.6 as per the plans prepared by NYCD Group Inc, dated 5/2/24. Based on the information you submitted, DEC has determined that this type of work is listed in the Tidal Wetlands Land Use Regulations,(6NYCRR Part 661.5) as a use not requiring a permit. Therefore, no permit is required under the Tidal Wetlands Act (Article 25) of the Environmental Conservation Law. Please be advised, pursuant to the Tidal Wetlands Development Restrictions under 6NYCRR Part 661.6(a)(4), any further construction or expansion of additional structures or other impervious surfaces that exceeds an impervious lot coverage of more than 20% of the adjacent area and 3,000 square feet would require a Tidal Wetlands permit even if the work is greater than 75 feet from the Tidal Wetland Boundary,. Please contact this office if such activities are contemplated. In addition, please be advised that dewatering in excess of 45 gallons per minute would require the applicant to obtain a Long Island Well —Temporary Dewatering permit from DEC. As no permit is necessary, we have voided the check for $200 submitted by NYCD Group Inc. (#1261) on your behalf. H EWYORrt V' Da: �artment of a,Aytf f IRTUraerr Environmental Conservation Please note that this letter does not relieve you of the responsibility of obtaining any necessary permits or approvals from other agencies or local municipalities. Sincerely, Laura Star Deputy Permit Administrator cc: NYCD Group Inc. DEC Bureau of Marine Habitat Protection File DATE(MMIDDIYYYY CERTIFICATE OF LIABILITY INSURANCE 2122/2024 � 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 CERTIFICATE OF INSURANCE DONS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)a AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder'Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. REPRESENTATIVE If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on thl c rllfacet cVo1 ns r conier�>ri� Irts keav) q c rti,flcat 1141der.in iiezq p)B9ch endorsement(s), CONTACT PRODPRIM Insurance SAE ST S SECT. FAX" SSfi 35 7645 N MAIL EI L.Di DKM Insurance Agency Inc. �ItlloNl: 8 One Rabro Drive,Suite 11 @dkminsurance com Hauppauge,NY 11788 APRR9AS.,., IN $IsRERt IfiFF0ikCY9WWLn r Q71 aft ,.:. I NAIe a 1NSURERA:CONTINENTIAL CASUALTY COMPANY 1_20443 IN BURIED INSURERt3 I.F'IIBLII, R;INILIIINS�C I SHFLTERPOIRT LIFPn W 1740 CHURCH STREET �INsu SWEENEY'S POOL SERVICE INC. INSURERC UTIC SPECIALTY RISK YNS C'....W .. ... .._.S14k4 Ro. HOLBROOK, NY 11741 INSURER, ,- a .. (.,INSURER.F.. ,COVERAGES CERTIFICATE NUMBER-, REVISION NUMBER. a 0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ..... ,p4�0o. id,Y" °. _ .. WOLtlON EF � POLICY"FXP -LN�IT$, ,...... � 1'R TYPE,,,�COMMERCALOGENERALLIABILITY Y Y 7038677184 1l08/2024 4Im1/08/2025 EAC�,.O CUR .ERCE 1,I].00,I 001' i3A1w#CE app�g.w 6 � �,d„wL u i �.1'OL7CYNUMIIER MMI YYYY 41MI S�GIEt4fiE lT L �. ,_CQNTRACTUAL__,„... D I 00„0io 1 CLAIMS MADE 4bG.Gdl'I' f?kTMAGE = IX A n� ral al s 10,00 t GEN..AG _ OBNERAL r�GGRE,�GAT'E;... 1 w 2aP00,0'00. R ., LIABILITY PERSONAL A A:0V INJURY r I ^ 'L AGGREGATE LIMIT APPLIES PER: Ipp $ .,,,. . POLICY(x......� PRO- �.m.. iI.C:G; �70tIGT.:zz...{:C'',h,TI'�1R.? .fr,.4",O OTH LIABILITY �Y Y 561957 i _. '1/08/2024 1/0 __. .... AUTOMOBILEANY 8/2025 c•I��trINEc�Srr^br`IE LIMIT . .,.I ULED BODILY INJURYra II'f .�cEc+Rderzl (Par dor"i)I OWNS ONLY AUTOS HIRED NON-OWNED AUTOS ONLY X AUTOS ONLY I $ 7��Xll 000 00 Jx REE n gPC 0 _ ... _.w. _ _... I -7 1 0"P�ER r1Et NTar��N r Cbf 00 �� .�. .....�.... _ .._ _.... r� NYEMPRYERSr` �r��rE�ErI�T°Iw�E YI�..N�A � ��.�w;���� uD�I�PERC �z� 1000000 I? NSAT4ON iICER)MEMREP EFCtt.0 Yradalttry in NH) DCI li descnbeurultm CONTINOUS UNTIL C NCELLED Cqntractor's Tools � 70877164 IMM ._' DESCRIPTIO-N OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) I Certificate Holder is added as an Additional Insured. __T CANCELLATION TOWN OF SOUTHOLD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 MAIN ROAD ACCORDANCE WITH THE POLICY PROVISIONS. SOUTHOLD,NY 11971-0959 F AUTHORIZED REPRESENTATIVE la r Scu-a, ►L K, Luec,k, j ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NE O K Workers' CERTIFICATE OF ^STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a. E POOL SERVICE INC Name&Address of Insured(use street address __w.only) 1 b. Business sine498 Telephone Number ~y .. . ...... �. of Insured 1740 CHURCH STREET HOLBROOK,NY 11741 1 c.NYS Unemployment Insurance Employer Registration Number of 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 473890168 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) UTICA SPECIALTY RISK INS CO TOWN OF SOUTHOLD 54375 MAIN ROAD 3b.Policy Number of Entity Listed in Box"la" SOUTHOLD,NY 11971-0959 5619572 3c.Policy effective period .24 to 1 i08/2025 3d.The Proprietor,Partners or Executive Officers are ❑ included.(Only check box if all partners/officers included) ❑K all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"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 underljenijA 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 f°nay 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 only while 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: Sarafr1 .Lueck (Print name of authortxed epre rytative or licensed agent of insurance carrier) � Approved by: (Signature) (Date) Title:Account Manager Telephone Number of authorized representative or licensed agent of insurance carrier: 631-363-5200 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2.Insurance brokers are NOT authorized to issue it. C-105.2 (9-17) www.wcb.ny.gov 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 authorized 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 provided 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, C-105.2(9-17)REVERSE aV Workers' CERTIFICATE OF INSURANCE COVERAGE 2:��j! 1t ornpensation Bfard NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1 To completed by N YS disabilitymand Paid Family Leave benefits carrier orlicense N N ., mmg d insurance agent of that carrier 1 a.Legal Name&Address of Insured(use street address only) 1 b. Business Telephone Number of Insured SWEENEY'S POOL SERVICE INC. 631-431-0498 1740 CHURCH STREET HOLBROOK, NY 11741 1c. Federal Employer Identification Number of Insured or Social Security Number Work Location of Insured(Onlyrequired if coverage is specifically limited to certain locations in New York State,i e, Wrap-Up Policy) 473890168 2.Name and Address of Entity Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 3b. Policy Number of Entity Listed in Box"I a" 54375 MAIN STREET DBL470388 SOUTHOLD,NY 11971 3c.Policy effective period 08/08/2023 to 08/07/2025 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: Under penalty ,of perjury,I cert y that am an authorized representative or C—insed agant of the insurance carrier referenced above and ghat the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. 2/22/2024 ' Date Signed BY (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that - .. -. .. w.._ _. ��, ..... insurance carrier) Telephone Number 16-829-8100 Name and Title Richard White, Chief Executive Office) .�. x_� ,, __ IMPORTANT: If Boxes 4A and 5A are checked,and this form is signed by the insurance carriers authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE. Mail it directly to the certificate holder. If Box 4B, 4C or 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 p Binghamton,NY 13902-5200. completion to the Workers Compensation IT � y n PART 2.To be com p I:__... .,,._-..__ ..� .: have IpU Board Plans Boa rd (Onl if Box 48,4C or 56 have been checked ..Y.. .. �......�. »...�.....�...,._.... pen sat ansAcce lance Unit, PO Box I:..� .....,.�._... eted b the NYS Workers Com ensa. State of New York Workers" Compensation Board ion Board the above-named employer has complied with the r 'Com Compensation According to'information maintained by the NYS Workers' p , 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 y_ �(signato._r..- e of Authorized NYS Workers'Compensation Board Employee) Telephone Number Name and Title Please Note:Only insurance carriers licensed to write NYS disability and paiddisability 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) ! IDu� i �i� . � f Additional Instructions for Form D13-120.1 By signing this farm, the insurance carrier identified in Box 3 on this farm 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 anal/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. 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. DB-120.1 (12-21)Reverse RECEIPT SUFFOLK COUNTY GOVERNMENT DEPARTMENT OF LABOR, LICENSING,AND CONSUMER AFFAIRS COMMISSIONER WAYNE T. ROGERS P.O. BOX 6100, HAUPPAUGE, NY 11788 (631)853-4600 Today Date: 04/01/2024 Application: H-5321 1-REN02 , License#: H-53211 Application Type: Home Improvement License Renewal Receipt No. 523428 Payment Method Ref. Number Amount Paid Payment Date Cashier ID Comments Credit Card $400.00 03/27/2024 PUBLICUSER18722 ------------------------------------------------------...------------------------------------------------- Total: $400.00 Contact Info: SWEENEY'S POOL SERVICE INC KENNETH M SWEENEY 1740 CHURCH STREET HOLBROOK, NY 11741 Work Description: Suffolk County Dept.of Labor,Licensing s Consumer Affairs w HOME IMPROVEMENT LICENSE Name. KENNETH M S'WEENEY Business Name SWEENEY'S pO,OL SERVICE INC This certifies that the bearer is duty licensed License Nu 0410312i)1,411 by the County of suffotk issued- WET Rogu-Y Expires: 0410112026 Commissioner N$1°32'00"E 16 RIGHT OF WAYC.L.F. CHAW LINK OH WIRES &U.P. G.4.5N 1,;"F FENCE 0:8'W 1 J9�'I� FENCE STOCKAOE FENCE I ZN VWOOO 1.6w M D co w 4.7'W 0.2'W 16"W 6.7"W 0A" ' 33 W 0.6"W O w '/ w ° FR�`� O*D. � V j AC DE SHOWER STEP 3.0 W 0.3dE 4 GATE 56.0• GATE Z 0.4'W ^ 2 STY Z W FR RES N Z �a #2275 0.2'W Lu c 19.62' MAS WALK& STEP 0 ZL/ p � ri' M Lo i O o 49 o o O CO w } LG O co L�ku END 1,9Edm 99.10' 03N 0.7 N CM 0.8 W _ FD CM e1 BRICK 100.0' FD S 83o 31r 0 W APRON PAVEMENT EDGE OF PINE NECK ROAD MAP OF DESCRIBED PROPERTY -'T' 'NTE AT SOUTHOLD 'Znl ITH01 r)