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HomeMy WebLinkAbout50821-Z S%IFFD1k�oGy Town of Southold 9/8/2024 0 . P.O.Box 1179 N 53095 Main Rd oy o� Southold,New York 11971 �lp `a ;r CERTIFICATE OF OCCUPANCY No: 45528 Date: 9/8/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1180 August Ln, Greenport SCTM#: 473889 Sec/Block/Lot: 53.4-44.30 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/22/2021 pursuant to which Building Permit No. 50821 dated 6/14/2024 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in-ground swimming pool fenced to code as applied for. The certificate is issued to Wachter,Beth of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 50921 8/28/2024 PLUMBERS CERTIFICATION DATED A h iz ignature ufFotk� TOWN OF SOUTHOLD BUILDING DEPARTMENT y z TOW_ N CLERK'S OFFICE oy • �� SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 50821 Date: 6/14/2024 Permission is hereby granted to: Wachter, Beth 1180 August Ln Greenport, NY 11944 To: construct accessory in-ground swimming pool as applied for. Replaces BP #46067 At premises located at: 1180 August Ln, Greenport SCTM # 473889 Sec/Block/Lot# 53.-4-44.30 Pursuant to application dated 6/14/2024 and approved by the Building Inspector. To expire on 12/14/2025. Fees: PERMIT RENEWAL $150.00 ELECTRIC $125.00 Total: $275.00 Building Inspector �o�SOFFot,�� TOWN OF SOUTHOLD �y BUILDING DEPARTMENT Co TOWN CLERK'S OFFICE oy SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 46067 Date: 4/12/2021 Permission is hereby granted to: Wachter, Beth 1180 August Ln Greenport, NY 11944 To: construct accessory in-ground swimming pool as applied for. At premises located at: 1180 August Ln, Greenport SCTM #473889 Sec/Block/Lot# 63.-4-44.30 Pursuant to application dated 3/22/2021 and approved by the Building Inspector. To expire on 10/12/2022. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Bui ing nspector oF so�ryol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 iQ Jamesh@southoldtownny.gov Southold,NY 1 1 97 1-0959 O �ycoUNT`l,0cty� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Beth Wachter Address: 1180 August Lane city:Greenport st: New York zip: 11944 Building Permit#: 50821 section: 53 Block: 4 Lot: 44.3 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: MRJ Industry Electrician: John Ferguson License No: 41853-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures 11 Sump Pump Other Equipment: 1 pool panel, 1 240v pool pump, 1 salt gen., 1 pool light, 1 auto cover and switch, 1 time clock with fireman switch for heater Notes: POOL Inspector Signature: Date: August 28, 2024 1180 august In f 16 06/ r ► G u ,a-���sv �-•n �o�aOF'SOUIyo� `( ` # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 1� C,o lle S� r � v a, c-A - i GC►� — V A DATE INSPECTOR oFso�T -l�o Col < < �o PLk j w # # TOWN. OF SOUTHOLD BUILDING DEPT. coutm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/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: po p e eAz l V1, okevt oco fi DATE �-�© y a INSPECTOR f - ho�*UF SOpT�°lo # TOWN OF SOUTHOLD BUILDING DEPT. WN, 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] ASULATIOWCAULKING [ ] FRAMING /STRAPPING iv�FINAL?Nk� [ ] FIREPLACE & CHIMNEY [ ] ,FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] 'FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: n_ �RsTr�� DATE INSPECTO OF SOUI Av v � # .TOWN O LOUTHOLD BUILDING DEP 631-765-1802 INSPECTION [ ] FOUNDATION 1 ST/ REBAR - [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ . ] -INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] ` FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [. ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS:41;A ALMA is or yooll ,\j 04 JO ,r cl- 4 ®v�� I vn G�/a - g-42 4v �6 wai 19. DATE It INSPECTOR �. OF SOUjyOI � o # # TOWN OF SOUTHOLD B ILDING DEPT.' coo 631-765-1802 INSPECTION [ ] FOUNDATION.1 ST/ REBAR [ ] ROUGH PLBG.- [ . ] FOUNDATION 2ND [ ] .INSULATION/CAULKING [ ] FRAMING/STRAPPING [ ] .FINAL [ ] FIREPLACE'& CHIMNEY [ ] _FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS:- Poo( POO( t L5 Ao� w dlo h'� e DATE ?l 13 INSPECTOR INSPECTION 1 1 r M 4 t A 4 mA4 i J 4 1 4 11 � k MMi MARK& �►� for A . : r c-f w IWr r r+ ► � t .a- ka { � "� ` l y. • s ._ �'•� `'+T �, � � ..-..k'Y� �i��` t�!• 1 �� y �S}a` to �• .. .fir ����>� • a.. t ���� ,•,tit ��, � � � � �t .,ar l .t� -��y y✓ HM ENGINEERING P.C. P.O.BOX 914 EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET March 14,2021 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of- Wachter Residence 1180 August Road Greenport,N.Y. 11944 will not require draining because the pool is constructed with a vinyl liner. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash will be piped to a drywell located on the subject lot and will not interfere with the public water supply system, existing sanitary facilities, adjoining property owners, public highways or private roads. Sincerely, HM E gineering P.C. � w of arnika, P.E. COMMENTS FIELD:INSPECTION REPORT DATE77 FOUNDATION(IST) -----------------------------. -- -- v� FOUNDATION'(2ND) ROUGH FRAMING: PLUMBING: tJ' � d INSULATION.PER N.Y. y STATE-ENERGY CODE ct FINAL. IL ADDITION'• • C.UIVIMMEiTS' z 2 TOWN OF SOUTHOLD-BUILDING DEPARTMENT y. Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 https://www.southoldtgmLnny..Rov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only L PERMIT NO. Building Inspector: Li M A R 2 2 2021 Applications and fdrrns-rri`ustb4:filled out'in their,e: ,app acc epted� Where the Aoolicalif'!,sL-,hot,,th.L,-- , licationswill-n4be, owner;an OwneriA6'thoriz6tioh ibrm(PageshM[66eorn Iq da Date:03/22/21 WN ER(S),OF PROPERTY:., Name: Beth Wachter SCTM# 1000-53-04-44.30 Project Address:1 180 AupstLqRp,_qreeQp Phone#:(!917) 513-0419 Email:bethwachter@ gD�qLfl.,qqrn Mailing Address:1180 August.Lppq,-qpqnport NY 11944---,-, CONTACT PERSON,; Name: John Wysoczanski (Islandia Pools Ltd.) Mailing Address: 108 FiShel Ave., Riverhead NY 11901 Phone#: (631)727-6312 Email:john@ islandiap —99.1s.corn INFORIVIATIO r 'DESId'N4"ROFE$- Name: Mailing Address: Phone#: Email: CONTRACTOR;lN'F.ORMATIOIV: Name:John Wvsoczanski (Islandia Pools Ltd.) Mailing Address: 108 FiShel Ave., Riverhead NY 11901 Phone#: M11727-6312 iohn@islandiar)ools.com D8t'R:IPTIoN'Oi.PR6POSED CONSTRUCTION:ONSTRUCTIO " El New Structure EAddition ElAlteration EIRepair ElDemolition Estimated Cost of Project: El Other New Swimming Pool $38,950.00 Will the lot be re-graded? ©Yes El No Will excess fillr be removed from premises? E]Yes ®No incensed use of property, -Zone or use4istrict in which premises.is situated: Are there any covenants and.restrlctions with respect.to this property? GYesXNo IF YES,PROVIDE A COPY. - per, •�;> w ._ _ ._. ...- t k,{i O "i" "•+n q xAiter:R'ad 3 e � ,,.,;'11ie,a�r;tr co ,c0oi'';leaj". -:f ..!� .1,- ,�=piofeaata"eiai is r"esporWble:foratl aniais�j°andi_ =; ; a:,. _i� Stoflthw8tei?•tlse[eiaspfipYlilEit;�y;• RtEr236_gfttreToaiii.cade:°IiPPUGA'IION LS HEREBY NIARB'to`. dep�rt�ne�Gtortfiets3va� te`ot�ieuDdinrPeriiiit -totlfe:eu Zoae;� �O�at►�a of tl�e'1'ativti of SoYu�oti�Sallolk;:Coyitily'NewYoik-irid"ottiera "it~re" :".'^._" ^t,� �tri�° .x. ��,y ,�.,,Ap b1e�Caiws;:Ondta"uncesorRegiitist�niit;fgi'tfueoai�strueWnofbuUd :;?ioisstnQtodeaiui` `laWiiisanai.to�adi»tisuttio tie,d.,7tie�p'ptipnzagreest000enply:!i�ritf+'_aq:apptlgt�tetaws;ardtnanorJ„tiult'd'tng_coite;�.;- �, taspenors,4r%premis�? `-°:!'�' ,._ riled snd;tntwitdti�(ajfo'.ne�rYtnsPeulonsiFatse'sfaLe�rieii4.iri�detie+eli;a'e� tae a Cxs A!!�. tftto.5ititidn.230:?i5 npuntshab °ass trdemeanar urava : .,{-• ,,.�;,:,,;.y-, ,a Application:Submitted B e : ` 1i _ ....._: `V^J _. Autha ized.Ager�t� ❑owner Signature of Applicant: . ... ..... .Date: STATE OF NEW YORK) SS: COUNTY OF USG `M Ur-1 M-0' ;tt4.42)Z 1 being duly sworn,deposes'and says:that;(s)he is the applicant (Name of-individual,signing contract)above named, (S)he is the e1h { ntractor,Agent,Corporate Officer,etc.) of said,owner:or owners,and is duly authorized to perform or have performedahe sa wo and to make and.file,this application;that all stateinents.contained in this'application are true to'the.best of his e' k owledge and belief;and that the work will be performed In the manner set forth in the application file therewit . Sworn before-me'this ,.LZ day cif I"YA&Z ,20_�;L DAVID FREEBORN Notary Public,State of New York '�"," No.01FR6137963 Qualified in Suffolk County PROPERTY OWNER AUTHORIZATION Commission Expires Dec.05, 0� >• 1Nhere the apolicant is not the owner I, (�. ./11J residing at r"C'�► S t' do hereby authorize o to apply on my behalf to the Town ofSouthald Building Department for approval as described herein. Owner's.Signature Date �)C WOLCla Print Owner's Name 2 Z'g�FFUj��; BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 00 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rocierr(@southoldtownnv.aov — seand -southoldtownny aov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 03/22/21 Company Name: MRJ Industry Name:John Ferguson License No.: 41853-ME email: johnf2b@opgtonline.net Phone No: (516)887-7914 ❑✓ I request an email copy of Certificate of Compliance Address.: 1180 August Lane, Greenport NY 11944 JOB SITE INFORMATION (All Information Required) Name: John Ferguson Address: 1180 August Lane, Greenport NY 11944 Cross Street: Phone No.: (516)887-7914 Bldg.Permit#: -- 5� . . _ email: johnf2b@opgtonline.net Tax Map District: 1000 Section: 3 yb0 ) Block: 04 Lot: 44.30 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Pool Service 220V Pool Service 220V Pool Service 220V Check All That Apply: Is job ready for inspection?: DYES IgNO ❑Rough In ❑Final Do you need a Temp Certificate?: DYES 'LZN0 Issued On 03/22/21 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect [] Underground [:]Overhead # Underground Laterals 01 02 ❑H Frame ❑Pole Work done on Service? Y N Additional Information. ❑ ❑Install pool service on new pool construction Install pool service on new pool construction Install pool service on new pool construction PAYMENT DUE WITH APPLICATION PIL " Electrical Inspection Form 2020.xlsx )/�' yl2A( &/ BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD y x Town Hall Annex - 54375 Main Road - PO Box 1179 " Southold, New York 11971-0959 o4,, Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(d)southoldtownny.gov - seanda-southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 03/22/21 Company Name:'MRJ Industry Name:John Ferguson License No.: 41853-ME email: johnf2b@opgtonline.net Phone No: (516)887-7914 ❑✓ I request an email copy of Certificate of Compliance Address...: 1180 August Lane, Greenport NY 11944 JOB SITE INFORMATION (All Information Required) Name: John Ferguson tAiN W"+te Address: 1180 August Lane, Greenport NY 11944 Cross Street: Phone No.: (516)887-7914 Bldg.Permit#: 5Q �c re` �'Ced --gaV email: johnf2b@opgtonline.net Tax Map District: 1000 Se ion:53 Block: 04 Lot: 44.30 BRIEF DESCRIPTION OF WORK (Please Print Clearly) Pool Service 220V Pool Service 220V Pool Service 220V Check Al That Apply: Is job ready for inspection?: DYES -ENO ❑Rough In ❑Final Do you need a Temp Certificate?: ❑YES10 Issued On 03/22/21 Temp Information: (All information required) Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter# ❑New Service ❑ Service Reconnect ❑ Underground ❑Overhead # Underground Laterals ❑1 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: Install pool service on new pool construction Install pool service on new pool construction Install pool service on new pool construction PAYMENT DUE WITH APPLICATION Electrical Inspection Form 2020.xlsx �2 /y/ PERMIT# Address: Switches Outlets GFI's Surface Sconces H H's A� Ll UC Lts Fridge HW POOL k"7ee- Fans Mini Fr. WAD Panel /--C L( — Pump z`p j '� Exhaust Oven Sump Heater J Trnsfmr Smokes DW Generator Salt Gen) 0-A4 /010 Carbon Micro GrbDis Water Bond / Lights 1410 v Heat Pucks ERV I HOT TUB/SPA Inst Hot J DeHum Transfer Disc Combo Cooktop Minisplit Blower AC AH Hood Blower Service Amps Have Used Sub Amps Have Used Comments 321 Certificate of NYS Workers'Compensation Insurance Coverage WOPICQ'FSy CERTIFICATE OF <Y10.RK7�, NYS WORKERS'COMPENSATION INSURANCE COVERAGE TE Gom,pensa#ion 8oafd Insured Detail la.Legal Name and address of Insured(Use street address only) IN Business Telephone Number of Insured Islandis Pools Ltd 631-727-6312 108 Fishel Avenue Riverhead,NY 11901 lc.NYS Unemployment Insurance Employer Registration Number of Insured Id.Federal Employer Identification Number of Insured Work Location of Insured 0 required i caves a is 2.Name and Address of the.Entity Requesting Proof of Coverage 3a.Name of Insurance Carder (Entity.Being Listed as the Certifleate Holder)Town of Southold Technology Insurance Company,Inc. Building Dept 3b.Policy Number of entity listed In box"la":53095 Main Road cy tY Southold,NY.11971 TWC3961844 3c.Policy effective period: 4/25/2021 to 4/25/2022 3d.The Proprietor,Partners or Executive Officers are: Included(Only check box if all partners/officers included) all excluded or certain partners/officers excluded This certifies that the insurance carrier indicated above in box 113"insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box 112". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mai&)Otherwise,this Certi,jicate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the pollcy 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: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance carrier) Approved By: 3/3/2021 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent of insurance carrier:CartierPhone Please Note:Only insurance carriers and their licensed agents are authorized to issue the G105.2 form.Insurance brokers are NOT authorized to issue it hfps://wc.amtrustgroup.com/ANAWC/PolicyNYCertificateOfWclns.aspx7lndexld=329590&Instanceld=ddda018f-80bbAcc2-9a63-d722398ee00e 1/2 3/3/2021 Certificate of NYS Workers'Compensation Insurance Coverage C-105.2(9-17) wwwwcb.nygov Workers' Compensation Law Section 57.Restriction on issue of permits and the entering 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=1,7)REVERSE https.//wc.amtrustgroup.com/ANAWC/PolicyNYCertificateOfWclns.aspx?lndexld=329590&lnstanceld=ddda0l8f-80bb-4cc2-9a63-d722398ee00e 212 Client#: 4647 ISLAP002 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 3/03/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME; Edgewood Partners Insurance Ce Edgewood Partners Insurance Center a/c°Nro'Et:631 390-9700 FAX No: 631 390-9700 40 Marcus Drive . E-MAIL certificates@cookmaran.com 3rd Floor INSURER(S)AFFORDING COVERAGE NAIC# Melville, NY 11747 INSURER A:Philadelphia Indemnity Insurance Co 18058 INSURED INSURER B:Technology Insurance Company,Inc. 42376 Islandia-Pools Ltd. INSURER C: 108 Fishel Avenue INSURER D: Riverhead, NY 11901 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEKISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 LTR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2127301 4/25/2020 04/25/2021 EACH OCCURRENCE $1,000 000 CLAIMS-MADE OCCUR PREMISES Fa occurrOence $100 OOO MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000. POLICY JECOT FX LOC -PRODUCTS-COMP/OP AGG s2,000,000 OTHER: $ A AUTOMOBILE LIABILITY PHPK2127301 4/25/2020 04/25/2021 COMBINED SINGLE LIMIT 1 00O 000 Ea accident) $ f ANY AUTO BODILY INJURY(Per person). $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ $ A X UMBRELLA LIAB X OCCUR PHUB720492 4/25/2020 04/25/2021 EACH OCCURRENCE $1 000 000 EXCESS LIAB CLAIMS MADE AGGREGATE $1 00O 000 DED . X I RETENTION$1O 000 $ B WORKERS COMPENSATION TWC3875091 4/25/2020 04/25/2021 PER OT H- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEYIN E.L.EACH ACCIDENT $1000000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB s1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Town Of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Main Road ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2971731/M2722583 KPEAR the paa!ment of disaDiuty Deneras ana aver January ulat, wwU tIIVu0a11.. ll efnployees has been secured as,provided by this article. k1lVire° 54 CERTIFICATE OF INSURANCE COVERAGE - rat = DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured ISLANDIA POOLS LTD. 108 FISHEL AVENUE 6317276312 RIVERHEAD, NY 11901 Work Location.of Insured.(Only required lfcoverage Is specifically limited to ---Ac_.Federal Employer Identification N.umber.of.1nsured._ .. certain.locations In New York State,i.e.,Wrap-Up Policy) N - r o nt-Ify Requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity Bein Listed as the Certificate Holder) Town of Riverhead . Standard Security Life Insurance Company of New York 1295•PUI6Ski Street 3b.Policy Number of Entity Listed in Box"I a" Riverhead,,NYA 1901 69146-00. 3c.Policy effective period 1/1/2014 to 3/15/2022 4: Policy provides the following benefits: ©.A.Both disability and paid family leave benefits. 0 B:Disability benefts only. 0 C.Paid.family leave benefits only. 5. Policy-covers: 0 A.All of thb employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. E. 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 desc' d above. Date Signed 3/16/2021 By •c' �"(Q� (Signature of Insurance carrier's authoriz d representative or NYS Licensed Insurance Agent of that Insurance carrier) Telephone Number (212) 355-4141 NameandTitle SUPERVISOR-DBL/POLICY SERVICES 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 mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit, PO Box 5200, Binghamton, NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(only if Box 4c or 5B of Part 1 has been checked) State of New York . Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family.Leave Benefits Law with respect to all of his/her employees. 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 (10-17) IIIIIII�!°°111°1°1°�111°!�1°0�a�17)°011111 Additional Instructions for Form D13-120.1 By signing this form,the insurance carrier identified in Box 3 on this form is certifying that it is insuring the business referenced in box 1 a"for disability and/or paid family leave benefits under the New York State Disability and Paid Family Leave Benefits Law.The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box 2. The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a . policy is cancelled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from coverage indicated on this Certificate. (These notices my be sent by regular mail.).Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in'Box 3c,whichever is earlier This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed, nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Disability and/or Paid Family Leave Benefits contract of insurance only while the underlying policy is in effect. Please Note: Upon the cancellation of the disability and/or. paid family leave benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder,the business must provide that certificate holder with,a new Certificate of NYS Disability and/or Paid Family Leave Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability and Paid.Family Leave Benefits Law. DISABILITY AND PAID FAMILY LEAVE 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 �Mai:trji n-ridnced in a forra:satisfactory to.the.chair;.that 6a APPR VED AS NOT IID^^ DATE: B.P.# L(�(X P FEE: NOTIFY BUILDING '�.ARTME AT . 765-1802. 8 AM i c 4 PM FOR THE FOLLOWING INSPECTIONS: RETAIN STORM WATER RUNOFF 1. FOUNDATION - TWO REQUIRED PURSUANT TO CHAPTER 236 FOR POURED CONCRETE OF THE TOWN CODE. 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRUC''ION MUST BE COMPLETE r': .-.0. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. ELECTRICAL aNSPECTION REQUIRED COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED .AND CONDITIONS OF Sir iT ' n m N ZBA ' BOARD Mui490-TeWN-TRUSTEES �tliAA Mi EDIATELY". ENCLOSE POOL TO.0 D� UPON COMPLETi OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY POOL NOTES: 1.POOL AND PROPERTY TO CONFORM TO 2020 NYS UNIFORM FIRE PREVENTION TRACK FOR, AND BUILDING CODE,TOWN OF SOUTHOLD'CODE AND 2017 NATIONAL ELECTRIC PUMP VINYL -LINER CODE: ' FILTER 2.POOL:SHALL CONFORM TO ANSI%APSP/,ICC 5 STANDARDS R326.3.1. SKIMMER VINYL LINER "' 3.SECTION R326.7 POOL ALARM REQUIRED. Typ SHALL 4.POOL COMPLY WITH BARRIER RE QUIREMENTSSECTION R326:4. FOAM PADDING 3,500 ,PSI S.,pOOLSHALL'COMPLY WITH 2020 ENERGY CONSERVATION CONSTRUCTION CODE CONCRETE OF NYS SECTION•R403:10: POOLS AND.PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). I a a SECTION:'R463.10."1 HEATERS . 'SECTIpN.'R40.10.2 TIME SWITCHES I ° SECTION R403,10.3 ,COVERS, PROPOSED VIN.,YL #¢ REBAR TOP a o s.REBARSHALL'BE3"MIN,.CLEARTOEARTH. RETURN & BOTTOM 42" 7.LOCATION OF PROPOSED SWIMMING POOLANO.POOL ECIUIPMENT BY OTHERS I SWIMMING POOL a AND.SHAI.LCOMPLYWITHALLLOCALZONINGREQUIREMENTS., 3' 648 S.F. 18' B.ALL DRAIN,COVERS-TO MEET ALL REQUIREMENTS'OF THE VIRGINIA GRAEME MIN:) :'� ° a BAKER,(VGf3);POOL-AND SPR SAO Y,ACT. .. DUAL MAIN DRAINS . I wITH,,sTRAINER<'(Yc6 9.SLOPE PATIO,SURFACE'1/4"PER FOOTAWAY FROM POOL SAFETY ACT APPROVED 10.BAGKFILL MATERIAL TO BE FFEE.DRAINING GRANULAI�•MATERIAL(NO CLAY OR DRAINS) I ° a LARGE ROCKS). " STEPS 0 11:SUCTION.OUTLETS SHALL BE DESIGNED AND INSTALLED IN ACCORDANCE WITH , ANSI/APSP/ICC 7,, 12.ENTRAPMENT PROTECTION,REQUIRED SECTION R326.5. 13.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIORTO INSTALLATION OF ti 3g' 12 5" POOL ; TYP�C'A WALL. .DETAIL 14.>THIS PLAN IS F6R,CON5T9UCTI0N ON PROPERTY AT 1180 AUGUST ROAD GREEN,P.ORT;N Y:11944 ONLY. ' SCALE: 3%4" 1�+0;� ` 15.NOpIVING EQUIPMENT PERfVI1TTE0. 15.REINFORCING STEEL SHALL B.E-INTERMEDIATE GRADE BILLET STEEL WITH'A MINIMUMi4p.&30 BAR'DIAMETERS.„ . NOTESi 17:'POQ(WALLS_ARE NOT:DESIGNED FOR SURCHARGE LOADS EXERTED BY WHEEL NOTE: 1 WWALLS-SHALL BEAR ON UNDISTURBED SOIL THPS IS'A NON-DIVING POOL. POOL PLAN 2.ALL CONCRETE SHALL BE PLACED A5A MONOLITHIC POUR. LOADS WITHIN SIX`{6)FEET OF POOL,WALL FROM CONSTRUCTION EQUIPMENT.,OR ■. ANY,OTHER LOADING CONDITION IMPOSED ON 711 E PQOLSTRUCTU<tI;BY'EXISTING._ ; NOT TO SCALE oR`PROPOSED ADJACENTSTRUCTURES.IFSITE CONDITIONS DIFFER EROIVI THIS PLAN;IT:fSTHE RESPON$IBILITY;OF.THE CONTRACTQR,TGCONTACT HM ENGINEERING,P.0 . .BEFORE ANY CONSTRUCTION BEGINS.' 18:;HN1 ENGINEERING,P..CSHALL;NOT BE_RESPC+NSISLE FOR CONSTRUCTION,, " CONCRETE WALL MEANS;,IVIETHODS,TECHNIQUES OR PROCEDURESUTILIZED.BY.THE CONTRACTOR, $_¢ NOR�FOR THE SAFETY OF THE PUBLIC OR CONTRACTOR'S EMPLOYEES,C R;FOR THE ' -0" (SEE_:SEC nON FAILURE OF THE CONTRACTOR TO CARRY OUT THE 1NORK IN ACCORDANCE WITIi -- 3"—' -- �`- RF THIS SHEET) THIS PLAN. 1 1%2"• TO WASTE UNDISTURBED, (TYP.) HAIR & LINT STRAINER 4' 6' 14'. 12' PUMP " AUTO SKIMMER 3 COMPACTED SAND FILTER PooLo NOT'TO SCALE POOL BACK TO GENERAL NOTE: POOL ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2020 RESIDENTIAL CODE OF NYS,INCLUDING THE SPECIFICATIONS IN SECTION R326. PREPARED FOR:. 2,MAIN DRAINS r SCHEMATIC PIPING ARRANGEMENT 'WITH HYDROSTATIC WAC;HTER RESIDENCE VALVE:,AND, NOT TO SCALE -COLLECTOR,TUBE 116 , AUGUST R ,. ,,"D IN .GRAvEL,BASE ;GRNPORT`i . , '11944 DATE:" :03114I2p21 74 NOTE ,✓� HM ENGINEERING, P.C. SCALE: AS SHQINN SHEET: 1,AF;1 THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C.. 1 � P.O.BOX 914 FAST NORTHPORT,NY 11731 UNAUTHORIZED ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS AREA VIOLATION OF SECTION 7209 OF THE G Tel:(516)476-5392 Fax:(631)980-1671 Email:hmarnika@optonline.net RESIDENTIAL CONCRETE NEW YORK STATE EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. T.RAISED SEgI AND BLUE SIGNATURE VINYL LINER POOL PLAN , CAST IRON FRAME & COVER IF UNDER PAVED AREA FINISHED GRADE 8' MIN. — 12' MAX. 24• NOTES: BRICK LEVELING COURSE MIN CONCRETE COVER 1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL PRECAST CONC. COLLAR 27' r`Oi 6' MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND AS REQUIRED MAX BACKFILLED WITH SAND AND GRAVEL TO BOTTOM OF BASIN. PRECAST 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE REINF. CONC. SUBSTITUTED WITH APPROVAL OF THE ENGINEER. DOME 3. LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. 4'0 PVC MIN. S PER FOOT ® ® ®®� 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. INVER ® ®9111 NON—SHRINK ®®❑ 5. FULL 5. R IS DEPTH. NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR GROUT ®O x 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND AND GRAVEL AND GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, a COLLAR (TYP) o w ALL AROUND 0 a SILT AND CLAY. SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) a rn PERCENT. > PRECAST REINF. CONC, LEACHING I— RINGS W c� W L6 I A W J W 8' DIAMETER as a "C DRYWELL CALCULATION: Za ° ° BACKWASH FROM POOL 70 GPM @ 5 MIN. = 350 GAL. (47 CF) �~ DRYWELL CAPACITY = 1,263 GAL. (168.8 CF) / z 6' MIN, PENETRATION Fu o INTO VIRGIN STRATA cz OF SAND & GRAVEL GROUND WATER DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: WACHTER RESIDENCE 1180 AUGUST ROAD ;WIUT PORT, .Y. 119 DATE: 03/14/2021 NOTE: HM ENGINEERING, P.C. SCALE: NOT TO SCALE THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED D 3f (�� P.O.BOX 914,EAST NORTHPORT,NY 11731SHEET: 1 OF 1 ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORKSTATEEDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516)476-5392 Fax:(631)980-7671 Email:hmamika@optonline.netDRYWELL DETAIL RAISED SEAL AND BLUE SIGNATURE s Islandia Pools, Ltd. Sales Order 108 Fishel Avenue u Riverhead, NY 11901 Salesperson 1: John Wysoczanski Phone: 631-727-6312 ® a Fax: 631-727-8419 Email:john@islandiapools.com Sales Type: Inground Vinyl Pool °; Web:www.islandiapools.com Revenue Center. Sales inground poo Invoice 74028 *nn7An7Q* Created: 3/9/2021 5:11:32 PM Completed: 3/11/2021 3:25:36 PM Customer Id: 8479 Register. JOHN *nQA7n* BETH WACHTER H: C:917-513-0419 1180 AUGUST LANE W: F: AUGUST ACRES COMMUNITY Email: BETHWACHTER@GMAIL.COM GREENPORT, NY 119" Qty Part Number Description Price Discount Amount 1 18X36 VINYL POOL 18X36 2/26/21 45,750.00 45,750.00— (WACHTER) 3500 P.S.1 poured concrete with steel reinforcing pool construction with limited lifetime guarantee(non-prorated)20 gauge virgin vinyl liner, automatic skimmer, 2 hydro returns, all 801b pressure pipe and all necessary plumbing, quick disconnect unions on all plumbing lines -Excavation •Dirt removal&rough grading up to 4' round •Boxed extrusion •Stainless steel ladder -Fine washed sand for base -Vacuum set see below -Personalized training in maintenance of pool -Starter chemicals up to$100.00 -Rigid PVC pipe 2" -CARTRIDGE FILTER -VARIABLE SPEED PUMP 1 JDY-45-1500 JANDY POWER CENTER,FOR PLC1400 34 23240 BIOGUARD MINERAL SPRING. BEGINNINGS 27.9LB Chemicals are non returnable due to safety reasons. 3 HAY-25-1644 WALL FITTING INLET SP1411 2 HAY-25-1527 SKIMMER VINYL WIDEMOUTH 1 SRS-35-1266 LADDER SS COPING MOUNT 3 CYCOLAC TREAD 1 PER-35-770 LADDER JIG 20"CENTER ALUMINUM 1 LOOP LOC LINER LOOP LOC 18X36 STANDARD. 18X36 STANDARD Liners that have been opened are not returnable. Please make sure the liner you purchased is the right size by measuring your pool diameter and height before you open the box. 12 CAR-811-030 EXTRUSION TM ALUM 8'X 3"WIDE 1 GAD-60-6169 WALL FOAM ROLL1/41N X 421N X 125'2LB 8 GAD-801-6169 SPRAY ADHESIVE SUPER 72 Invoice: 74028 BETH WACHTER Monday,March 22,2021 Page 1 of 5 1 HAY-30-682 NICHE FOR VINYL SP607U 1 AMP-30-644 LIGHT POOL 50OW 120V 100'CORD AMERLITE 1 GEP-57-6263 CONDUIT SWEEP ELBOW 11N 1 GEC-30-2010 CONDUIT PVC 11N X 10FT UL SCH40 2 GEP-57-349 CONDUIT COULPING 11N PVC 1 TLD-10-2072 DANDY EPUMP VARIABLE W/SVRS DEVICE 1 TLD-05-117 JANDY 460SQFT SERIES CARTRIDGE FILTER 1 PVU-37-303 EQUIPMENT PAD 36 X 36 X 2 BLACK PLASTIC 2 AAA-37-5052 PORTLAND GRAY CEMENT 94 LB TYPE 1 1 AMG-40-2218 ROPE&FLOAT KIT 18FT 2 AMG40-2226 ROPE STRAP ANCHOR ALUM 11 AAA-56-4137 PVC PIPE 21N X 20FT SCH 40 25 LAS-56-0602 ELBOW 90 21N SWEEP 4 LAS-56-4056 TEE 21N SOC X SOC X SOC 7 LAS-564090 MALE ADAPTER 21N MPT X SOC 25 LAS-56-4080 COUPLING 21N SLIP X SLIP 3 LAS-56-4599 STREET ELBOW 45 2" 3 LAS-56-4595 UNION AN SOCKET SCH 80 1 UEL-60-5040 PRIMER CLEAR PVC 1 QUART 1 UEL-60-5259 CEMENT CLEAR PVC QUART 1 HAY-25-1031 MAIN DRAIN VINYL 21N W/AV COVER 2 PAK 2 JDY-56-4055 JANDY VALVE 3 WAY 21N -2.51N 2 HAY-25-1546 EYEBALL 3/4"OPENING WHITE 1 AMG-60-5034 DUCT TAPE 21N X 180FT STD 1 PBM-40-2079 ALARM IN-GRD W/REMO POOLGUARD 1 START UP START UP CHEMICALS FOR NEW POOL CHEMICALS FOR NEW POOL Chemicals are non returnable due to safety reasons. 1 HAY40-2158 VAC HEAD W/WEIGHTS DELUXE HAYW 1 HAY-25-1538 SKIM VAC SP1106 1 PSL-40-9540 VAC HOSE 1.5X40FT "Non-Taxable Items "Consists of both Taxable and Non-Taxable amounts Sub Total $45,750.00 Total $45,750.00 State Tax $0.00 City/County Tax $0.00 Amount Due $45,750.00 Amount Paid $18,298.00 Balance $27,452.00 Payments Type Approval Code Id Numbers Amount Date of Trans Type Reference# Date Received Employee Name Check $18,298.00 3/9/2021 P 1365 3/9/2021 Dave Freeborn Special Comments: Invoice: 74028 BETH WACHTER Monday,March 22,2021 Page 2 of 5 18X36 VINYL POOL WITH STEPS IN CORNER ,400W LIGHT,ROUGH GRADING 4FT AROUND POOL,DRY WELL AS PER TOWN CODE,JANDY ZODIAC VARIABLE SPEED PUMP(YOU GET A REBATE BACK FROM PSAG OF $450.),JANDY CARTRIDGE PRO FILTERAND POOL ALARM,MINERIAL SPRINS SALT SYSTEM AND ELECTRIC WORK UP TO 60 FT AFTER 60 FT IT WILL $21.50 PER FT EXTRA EXTRAS IF WANTED: ELECTRIC COVER ADD-------------------------------------------------------- $14,900.00 ELECTRIC WORK UP TO 60 FT ADD-------------------------------------$INCLUDED AFTER 60 FEET ADD PER FOOT-------------------------------------------- $ 21.50 LED LIGHTS INSTEAD OF REGULER LIGHT ADD---------------------- $ 2,895.00 MINERIAL SPRINGS SALT SYSTEM ADD---------------------------------- INCLUDED PROPANE HEATER ADD------------------------------------------ ------ $ 4,595.00 PROPANE LINER TO BE DONE BY PROPANE DEALER NOT ISLANDIA AGREEMENT OF SALE: Contract between(Seller)hereinafter called the corporation and Purchaser hereinafter called the customer(Owner)hereby orders from Seller subject to all terms,conditions and agreements contained hererin,and the ADDITIONAL PROVISIONS printed on the bottom of this page hereof. Entrance to property to be determined by Customer. Customer Sign X TERM OF PAYMENT TOTAL DEPOSIT 40% EXCAVATION 30% INSTALLATION OF WALLS 25% INSTALLATION OF LINER 4% START UP BALANCE NOTE:This is subject to the written acceptance of an authorized officer of the Corporation. Purchaser's deposit will be returned if not accepted. ACCEPTED BY SELLER: NAME DATE ALL CHANGES TO THIS CONTRACT MUST BE MADE IN WRITING. COMPLETE COVERAGE ON WORKMENS COMPENSTATION AND PUBLIC LIABILITY INSURANCE: Licensed and Insured#16641-HI Seller is responsible to obtain a permit for the pool up to cost of$250.00.Purchaser is responsible for all costs for surveys,inspections and other items necessary to obtain said permit or Certificate of Occupancy or varriance. Purchaser is responsible to apply for and obtain the Certificate of Occupancy for the pool as items such as fencing,self-latching doors and electrical certificates may be required but are outside the scope for the contract. SIGN X I HAVE READ AND FULLY UNDERSTAND THE PAYMENT SCHEDULE: SIGN X ISLANDIA POOLS LTD. IS NOT RESPONSIBLE FOR DAMAGE TO ANY SIDEWALKS,CURBS, PATIOS,DRIVEWAYS,TREES, SHRUBS,FENCES, SPRINKLERS OR OTHER ITEMS THAT INTERFERE WITH INGRESS AND EGRESS OF ANY TRUCK OR EQUIPMENT THAT IS USED BY SELLER OR ITS AGENTS IN PERFORMING ANY ACT REQUIRED TO COMPLETE SELLERS OBLIGATION UNDER THIS CONTRACT. Invoice: 74028 BETH WACHTER Monday,March 22,2021 Page 3 of 5 SIGN'X CUSTOMER HAS THE RIGHT TO CANCEL THIS CONTRACT WITHTIN THREE(3)BUSINESS DAYS OF THE SIGNING OF SAID CONTRACT.ALL PAYMENTS WILL BE PROGRESSED PAYMENTS IN ACCORDANCE WITH THE LIEN LAW.NO PAYMENT WILL BE HELD IN ESCROW. SIGN X DEWATERIZATION EXTRA CHARGE IF NEEDED.ANY DIRT LEFT ON PROPERTY BY CUSTOMERS REQUEST WILL NOT BE REMOVED WITHOUT AN ADDITIONAL CHARGE. SIGN X ADDITIONAL PROVISIONS The owner,contracting with Islandia Pools Ltd.agrees to direct the pool location on his property and to be responsible therefor,all measurements are approximate. The pool site shall be accessible for excavating equipment and trucks,site preparation shall be the responsibility of the owner. The ground to be excavated shall be free of rock and/or obstructions;any extra cost incurred by reason of foreign matter shall be paid for by the owner,this includes a hight water table which will increase the cost of installation. There shall be no responsibility by seller for damge to lawn,shrubs,trees,curbs,sidewalks,etc;there shall be no obligation for restoration of landscaping or grounds by seller. Seller shall work with all possible speed but shall not be liable for delay caused by strikes,weather conditions or acts of God and the same shall not be grounds for owners violation of this contract. Warranty, Islandia Pools Ltd.warrants all materials used in the installation will be new,of best quality,and the work done in a competent and workmanlike manner. The assemblies or units(such as heaters,pumps,motors,etc.)and standard fittings or accessories furnished are subject to manufacturers guarantee and any recourse for defective materials shall be against the manufacturers only. The buyer agrees that any recourse against the seller for defective/negligent installation is limited only to repair and/or replacement of the defectively installed assembly or unit and does not cover any consequential damages. This warranty is the only warranty applicable to this contract and is expressly in lieu of any warranty or conditions otherwise implied by law, including but not limited to implied warranties of merchantability or fitness for a particular purpose. The remedies under this warranty shall be the only remedies available to the buyer or any other person and neither the seller or any authorized agent of the seller assumes any other obligation or repsonsibility to the condition of the purchased item,and neither assumes or authorizes anyone to assume for the seller,any additional liability. Any work stoppage caused by owner shall be paid for by owner at the rate of$200 per day. Owner agrees to waive trial by jury. He shall give promptly all necessary information to secure financing whenever required and indicated in the contract;his failure to do so will be a breach of contract on his part. If owner should refuse to pay for additional cost incurred,or to be incurred; by reason of presence of rocks,obstructions etc.,then seller shall have the right to forthwith discontinue work and immediately remove his equipment,and have no further liability to owner. Seller responsibility is to obtain permit from a municipal authority to construct the swimming pool. Owner responsibility is to have the pool inspected and passed as to proper construction by the proper authority. Title to the filter and all other removable equipment shall remain in Seller until payment in full of the contract price. Seller shall have no duty or responsibility for any other inspections or certificate of occupancy. Owner agrees to pay seller balance of contract price in full on START UP. Fencing,electrical work,retaining walls,deviation of existing water drainage flow,dry wells, heater gas connection,etc.,and any and all other work necessary;not contained in the above contract,shall be the sole responsibility of the owner. The pool warranty is not valid until final payment of the pool installation is paid and this warranty is signed by an officer of this corporation. Where electrical,fencing,dry well,retaining walls,and etc.are included therein,the seller responsibility is limited to recommending a contractor for such work and the payment of his fees once received from purchaser. Fees included herein for such work are estimates only and any excess cost determined from vouched invoices shall be paid by purchaser/owner. Contractor once accepted by owner/purchaser are contractors of purchaser/owner. Purchaser represents and warrants that he is the owner of the real property on which the pool is to be constructed or that he is other wise authorized on behalf of the owners to enter into this agreement. Purchaser/owner agrees to obtain at his own cost and expense any and all special licenses,variances,and/or permits in excess of$50.00 of cost for the installation of said pool from any and every regulatory authority state,county,town or municipal,having jurisdiction thereof. .Purchaser agrees to provide ingress and egress to and around the ground area of the pool site for necessary vehicles and equipment. He shall pay the expense of the site preparation including removal or protection of trees and other vegetation,removal or change in piping, wires,drains or any other type of obstruction,underground or otherwise. Purchaser agrees to hold Seller harmless from any and all claims arising while Seller,its agents,servants,and/or employees are on or not present on the site. Purchaser agrees that,if for any reason whatsoever,any Town,City,County,State or other municipal board having jurisdiction of the installation shall require the installation of a dry well or other water waste facilities,etc.,or additional construction such as fences,retaining walls,etc.,either before or after the costruction of the pool, Purchaser will hold Seller harmless from cost or responsibility therefor. ALL GUARANTEES AND WARRANTIES ARE NULL AND VOID UNTIL BALANCE ON POOL IS PAID IN FULL. This agreement constitutes the entire agreement between the parties,and may not be altered or amended except in writing executed by the parties hereto,and shall be binding upon the executors,heirs,successors and assigns of the parties hereto. It is understood that all liners are not 100%wrinkle free. Cosmetic defects in the liner are not the responsibility of the Seller. Purchaser agrees that if Islandia Pools Ltd.institutes action to collect the sums due,any and all attorney's fees shall be added to the Invoice: 74028 BETH WACHTER Monday,March 22,2021 Page 4 of 5 amount due. SELLER PURCHASER PURCHASER Invoice: 74028 BETH WACHTER Monday,March 22,2021 Page 5 of 5