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HomeMy WebLinkAbout51157-Z of souryo`o Town of Southold * * P.O. Box 1179 ,0 53095 Main Rd COUNTM Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 45707 Date: 10/30/2024 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1665 Glenn Rd Southold, NY 11971 Sec/Block/Lot: 78.-1-25 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 08/16/2024 Pursuant to which Building Permit No. 51157 and dated: 09/10/2024 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: 1665 Glenn LLC Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 51157 09/12/2024 PLUMBERS CERTIFICATION: V- %, "— uth riz ignature ho4*0 soy Tyo�c 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#: 51157 Date: 09/10/2024 Permission is hereby granted to: 1665 Glenn LLC 3 Sandie Ln Manorville, NY To: construct accessory in-ground swimming pool as applied for. Pool equipment must be located a minimum of 10 feet from lot lines in the rear yard. Premises Located at: 1665 Glenn Rd, Southold, NY 11971 SCTIVI#78.4-25 Pursuant to application dated 08/16/2024 and approved by the Building Inspector. To expire on 03/12/2026. Contractors: Required Inspections: FOOTING/REBAR, ELECTRICAL- ROUGH, ELECTRICAL-FINAL, DRAINAGE, FINAL, Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO-SWIMMING POOL $100.00 Total $400.00 r ---- --- -------------------- Building Inspector ho��pF SO!/jyOlo Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 �o sean.devlinl'a-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: 1665 Glenn LLC Address: 1665 Glenn Rd city:Southold st: NY zip: 11971 Building Permit#: 51 157 Section: 78 Block: 1 Lot: 25 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: Big Bear Electric License No: 43841 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 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors Disconnect Switches 4'LED Exit Fixtures Sump Pump Other Equipment: Intermatic Pool Panel 8 Circuit/ 3 Used, Pump 220GFI, Salt Gene, (2) Lights 120GFI Waterbond is Light Notes: Pool Inspector Signature: ILDate: September 12, 2024 1665GIen n Rd Pool Electric 1 OE SOUlyO� # * ' TOWN OF SOUTHOLD,BUILDING DEPT.. "cou 631-765-1802 INSPECTION [ ] FOUNDATION 1ST/.REBAR [ ] ROUGH PLBG. [ ] -FOUNDATION 2ND [ ] SUL IOIN/CAIULKING [ ] FRAMING /STRAPPING [ FINAL tom/ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE-RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMAR I : 1 Co,,�( 1-7 DATE ANSPECTOR (� y4�. r��...17 �• J v�a t M _ 1 La M 4 I"'J�'� .�-✓� ��^!'_'.=' s,. fi5c ti r,wt '•.,s, ,(� ga`�o+,r•��;�rptr (�* - Ic a %,�.,��.. ..r'�=�,�c,r_r+� ,�" —. 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Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax(631) 765-9502 https://www.southoldto=..gov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only .AEG � 6 2024 PERMIT NO. -5115� Building Inspector: Applications and forms must be filled out in their entirety.Incomplete 'w BUS applications will not be accepted. Where the Applicant is not the owner,an Jr s® ®a Owner's Authorization form(Page 2)shall be completed. Date: S 115- 1 :)0,9Z/ OWNER(S OF PROPERTY: Name: __ ( SCTM#1000- Project Address: Phone#: r Email: Mailing Address: CONTACT PERSON: Name: 4 /1 � __ Mailing Address: � ��� (&__Ag �,�� — Q� �Q�`�' Phone#: EmaiLd( -ks- p?s DESIGN PROFESSIONAL INFORMATION: Name: Lob Mailing Address:Phone#: LpEmail: CONTRACTOR INFORMATION: ;� Name: _ =�C `— IJI-ek( -_ __I- Mailing Address: l( -- e - - � - - - -t- - 3- Phone#: ff^ /!� Email �� — DESCRIPTION OF PROPOSED CONSTRUCTION ❑N Structure ❑Addition ❑Alteration ❑Repair Demolition Estimated Cost ooff Project: Other t i f1C $ 1 � l S Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? es ❑NO 1 d r PROPERTY INFORMATION Existing use of property., a Intended use of property: S a lb Fawi Hame l am, H0,�1 Zone-or use district ih which premises is situated: Are there any covenants and restrictions with respect to this property?.-❑Yes 546 IF YES, PROVIDE A COPY. oe Check BOX After.Reading: 'The owner/contractor/design professional 1.s responsible for all drainage and storm water issues as provided,by . Chapter 236'ofthe Town Code.APPLICATION IS HEREBY MADE to the Building Department for the issuance of a BuildingPermit 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 name): I��t' SCE �thorized Agent ❑Owner Signature of Applicant:Id Date: STATE OF NEW YORK) SS: COUNTYOF S46Y,. ) 0.) e. r Spef_M— being duly sworn, deposes and says that(s)h,e is the applicant (Name of individual signing contract)above named, (S)he is the roo1mcl� (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 day of UC'T` . 20-ZA Notary'Public Christina Dianne Parise Notary Public;State of New York . No.OIPA6415578 PROPERTY OWNER AUTHORIZATION QwMed in Suffolk CMAY (Where the applicant is not the owner) I, Ul residing at do hereby authorize le C 1/1T to apply on my behalf to the own of Southold Building Department for approval as described herein. w er's ignat a Date Print Owner's Name 2 FE oti�SUF;fl �C� �T Electrical Inspector 2 5 2024 +, BUILDING DEPARTMENT- TOWN OF SOUTHOLD `o ` Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 hold Telephone (631) 765-1802 - FAX (631) 765-9502 jamesh _southoldtownny.gov - seand(crbsoutholdtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: /0 2.9- Company Name: J f J I Electrician's Name: w L License No.: �/3 g y I M C Elec. email: G /C� /' G✓el �I Elec. Phone No: 17&0 - ❑I request an email copy of ertificate of Compliance Elec. Address.: JOB SITE INFORMATION (All Information Required) Name: (ash L G Address: Cross Street: Phone No.: 4, Bldg.Permit#: , J IS 7 email: Tax Map District: 1000 Section: Block: 1 Lot: 5� BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 0 Square Footage: Circle All That Apply: Is job ready for inspection?: VJ YES ❑ NO ❑Rough In n Final Do you need a Temp Certificate?: ❑ YES 2 NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire Reconnect Flood Reconnect❑Service Reconnect❑Underground❑Overhead # Underground Laterals D 1 R2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION BUILDING DEPARTMENT - Elec'tricgj InspecApr" TOWN OF SOUTHOLD _ J ?�nrn Hall .Annex - 54375 Main Road - PO B 179: ., .' ox 1 New York 11971-ri'+a9 y C� ti�f'r , 8[)4 i A.X 1631 o 6)5 950L `k' ic'3(rE'$r11J501_li��D±rli�t^ )"il,',j IJ',r �n �Lit1",U1C1.�'v' j ; APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Requ;red, Date: 03/28/2024 Company (Name: Big Bear Electrical Contracting Electrician's Name: Paul DeLucia I.l:.ense !�lo.: ME-43841 er ; ; office@bigbearelec.com Elec. Phone No: 631.760.1997� Ell request an email copy of Certificate of Compliance z Elec. Address.: 45 Ramsey Rd, Unit 5, Shirley NY 11967 JOB SITIE INFORMATION (All information Required) Name: 1665 Glenn LLC, David Robers, Member Address: 1665 Glenn Rd, Southold, NY 11971 Cross Street: Main Bayview Phone No.: 631.905.4789�-��������~� SIdg.Permit TJ �.�� email. david@djcustomhomes.com Tax Map District: 1000 Section: 78.00 Block. 01 Lot: 025.00 BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): w construction, e�vttec� r Square Footage: 3900 Circle All That Apply: ,s jvU r acy iv iii5)7�i t �; e . L_J II�• 1 l_J LFJFinal Do you need a Temp Certificate?: Fy—(] YES ❑ NO Issued On!! Temp Information: (Ail informatior required; Service SizeFv_(11 Ph❑3 Ph Size: 200 A # Meters 1 Old Meter# 0 RV New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑✓ Underground❑Overhead # Underground Laterals 2 0 H Frame ❑ Pole `dVork done on Service? Y ZN Additional Information: t PAYMENT DUE WITH APP I— TION JIM LA vd7 C9a WNe \ C ome. C., -�-® $�17 173,1 lL I�.N PERMIT# Address: Switches �Jvl Outlets G F I's Surface Sconces HH's' F[Heater UC Lts Fridge HW baA Fans Mini Fr. W/DExhaust Oven 9 � Sump Trnsfmr Smokes DWG Generator Salt Gen.Z2,0 Carbon Micro GrbDis Water Bond J, f Lights 2 Heat Pucks ERV HOT TUB/SPA Inst Hot DeHum Transfer Disc Combo C Cooktop Minisplit Blower AC AH Hood C Blower Service Amps Have Used Sub Amps Have Used Comments � ,� LA M HOU OR MRl=Y OF EDfTtdin J 7PAU19ttltV JR LL1.PQxIF70D�d S 700090300E 106.00 S 1P1V' Q rB .s�vX �x � 1.6'N roo ar goons ' C'� �a YORK XWD. 0811911983 MAP No. sere S.C.T.M. l�v. ,iQ00-78-01-25 LOT W LOT APYA Z4826I+�AP88�DATUM ATIONS PER EnmG LOT CppER�ICE = 0X TOT CLURINO = 82 S.P. ' l re��� SURFACE WATER IS LOS THAN 300' b CCL. �� � td. � svcT �� � tip' oDeD''` VAPPLICANT. 2Q tES7 OORNV4 .1• 9.3 PROP. 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I e 80' DATE. l0/a/2028 i NYSIF Now York state Insurance Fund i PO Box 66699,Albany,NY'12206 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) 0 0 A A^A"^ 010648957 1 t INNOVATIVE RISK CONCEPTS,INC. 179 SOUTH MAPLE AVENUE ' RIDGEWOOD NJ 07450 SCAN TO VALIDATE AND SUBSCRIBE .POL-ICYHOL-DER CERTIFICATE HOLDER SPECHT-TACULAR POOLS INC TOWN OF SOUTHOLD BUILDING 265 BROOKFIELD AVENUE DEPARTMENT MAIN ST'I CENTER MORICHES NY 11934 TOWN HALL, SOUTHOLD NY 11971 POLICY,NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE Z2557 589-5 157094 02/28/2024 TO 02/28/�025 7/29/20�4 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSU ONCE FUND UNDER POLICY NO. 2557 589-5, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDERI FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION ilj W 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 WESSITE AT HTTPS://VWYW.NYSIF.COM/CEAT/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 O THE INSURED CORPORATION. PRESIDENT DIETER SPECHT SPECHT-TACULAR POOLS INC 1 OF 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS I O RIGHTS NOR INSUF�ANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ///LTER THE COVERAGE AFFORDED BY THE POLICY. i l 1 NEW YORK STATE INSURANCE FUND DIRECTOR INSURANCE FUND UNDERV RITING VALIDATION NUMBER:764788639 U-26.3 I lm ,acoRU CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 09/29/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME: Matthew Ruperto Liberty Risk Management, Inc. PHONE FAX 2333 Route 112 (A/C.N Elf• (631)569-5633 ac No:(631)569-5636 ADnREss: matthew@libertyrisk.org Medford, NY 11763 INSURERS AFFORDING COVERAGE i NAIC# INSURER A: Hartford Fire Insurance Company !19682 INSURED INSURER B: Merchants Insurance Company '23329 Specht-tacular Pools Inc INSURERC: Federal Insurance Company 265 Brookfield Avenue INSURER D: Center Moriches, NY 11934-1001 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 00000072-1518641 REVISION NUMBER: 75 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 A DL S BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE lus-121 YM POLICY NUMBER MM/DD MM/DD LIMITS , A X COMMERCIAL GENERAL LIABILITY Y 12 UUN OZ8606 09118/2023 09/18/2024 EACH OCCURRENCE $ 1 000 000 -BA—MAGE TO CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ i 1000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 00O 000 �( POLICY❑JECT LOC PRODUCTS-COMPlOP AGG $ 2 OOO OOO OTHER: $ B AUTOMOBILE LIABILITY CAP1068516 0312712023 03127/2024 Ea acccidentsINGLE LIMIT $ 1 00O 000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ XIAURED NON,OWNED TOS ONLY X AUTOS ONLY PROPERTY DAMAGE $ IPer accident UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Inland Marine 45470320 09/18/2023 09/18/2024 Any One Occur 507,436 C Inland Marine 45470320 09/18/2023 09/18/2024 Newly Acq Equip 100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Town of Southold is included as additional insured,ATIMA,as required by written contract,subject to policy terms,conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ' Building Department ACCORDANCE WITH THE POLICY PROVISIONS. Main Street,Town Hall Southold, NY 11971 AUTHORIZED REPRESENTATIVE 4L"-- I MJR ©1988-2015 ACORD CORPORATION. All right's reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by MJR on 09/29/20231at 02:34PM STA E Compensation CERTIFICATE OF INSURANCE COVERAGE 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 thai came 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured SPECHT-TACULAR POOLS INC. 631-696-3900 265 BROOKFIELD AVENUE CENTER MORICHES,NY 11934 1c.Federal Employer Identification Number of Insured I or Social Security Number Work Location of l nsured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,wrap-up Policy) 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) ShelterPoint Life Insurance Company Town of Southold Building Department 3b.Policy Number of Entity Listed in Box la Main Street,Town Hall DBL152822 Southold, NY 11971 3c.Policy effective period 09/26/2022 to 09/25/2024 4. Policy provides the following benefits: ® A.Both disability and paid family leave benefits. B.Disability benefits only. C.Paid family leave benefits only. 5. Policy covers: ® A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. B.Only the following class or classes of employer's employees: I i Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 9/25/2023 By "d 4f (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 4B,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law. It must be emailed to PAU@wcb.ny.gov or it can be mailed for completion to the Workers'Compensation Board, Plans Acceptance Unit,PO Box 5200,Binghamton,NY 139025200. PART 2.To be completed by the NYS Workers'Compensation Board (only if sox 413,4C or 56 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)wiih 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) BI IIIPiuiiii1i2ii01li1i2ia2i1)ii101�1 ) Fig TELN r%E*' -0 c:'C,CLOSE 7 1 CODE 10 0 FLETI 36' god NOTES '(jpoN c EFORE AT z 1. NO 501L SURCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION ATTHE SHALLOW END,OR 6 FEET OF EXCAVATION AT THE DEEP END. V) COMPLY WITH ALL CODES OF 2. THIS POOL MEETS THE REQUIREMENTS OFAN51/APSP/ICC-5"AMERICAN NATIONAL5TANPARD FOP.RESIDENTIAL INGROUND SWIMMING POOLS'ANP1996 BOCA CODE-SECTION 421.DIVING EQUIPMENT 15 NOTALLOWEP. SWIMMING POOL SHALL BE COMPLETELY AND CONTINUOUSLY SUP ROUNDED WITH A BAR RIER CONSTRUCTED IAW P EaUIREENT5 OF NEW YORK STATE & TOWN CODES 3. SECTION P326.4.2.1 THROUGH P,326.4,2.6 OF THE NEW YORK STATE RESIDENTIAL CODE(2020)AND INCONFORMITY WITH ALML SECTIONS A H20 H20 OF THE SOUTHOLD TOWN CODE.DWELLING WALL(5)MAY SERVE AS PARTOF THE POOL BAkRIERAS PEP,SECTION R326.4.2.8 AND AS REQUIRED AND CO IDITIONS Of c_/ 3, CONDITION(1)ARE MET.OPERABLE WINDOWS IN THE WALLCS)USED ASA BARIZIEP SHALL HAVE A 5ELF LATCHING DEVICE.ACCESS GATES 8"OLD WN ZBA SHALL COMPLY WITH 5ECT10N R326.5.2 OF THE NYS RESIDENTIAL CODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECURELY LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED.ALL GATES ARE TO OPEN AWAY FROM THE POOL AP EA. TOWN PLANNING BOAA 4. DURING CONSTRUCTION THE CONTRACTOR SHALL E?ECTA TEMPORARY BARRIER AROVND THE EXCAVATION LAW THE CODE OF THE TOWN OF SOUTHOLD. Z swo LD TOWN TRUSTEES I I L 1 5. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING ENTRY INTO THE WATER AND SOUNDING AN AUDIBLE ALARM UPON DETECTION THAT 15 AVDIBLEAT POOLSIDE AND INSIDE THE DWELLING. THE ALARM MUST BE INSTALLED, MTO DEC C.NC T." UTNOLD Hn MAINTAI NEI)AND USED IN ACCOP DANCE WITH THE MANUFACTURERS INSTRUCTIONS. THE ALARM MUST MEETASTM F2208 "STANDARD SPECIFICAT10N FOP,POOL ALARMS,THE DEVICE MUST OPERATE IND EPEN PENT(NOTATTACH ED To OR DEPENDENT ON)OF PLAN PERSONS. LLJ N.T.S. xw 6. POOL SUCTION FITTINGS(EXCEPT FOP,SURFACE SKIMMERS)MUST BE PROVI PED WITH A COVEP THAT CONFORMS TO A5M E/ANSI V, I A112.19.8M OR MINIMUM 18"x 23'DRAIN GRATE OP A CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MUST BE EQUIPPED WITH N u 20'VINYL COVERED ATMOSPHERIC VACUUM RELIEF IN THE EVENT THE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OR BROKEN.SUCH CONCRETE STEPS VACUUM RELIEF SYSTEMS SHALL CONFORM M WITH ASME A112.19.17 OP BE A GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD. POOL SHALL BE PROVIDE[)WITH A MINIMUM OF 2 SUCTION FITTINGS OF THE ABOVE MENTIONED TYPE.THE SUCTION FITTINGS SHALL BE u SEPARATED BYA MINIMUM OF3'ANP MUST BE PIPED SUCH THAT WATER 15 DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCE551BLE POSITION,MINIMUM OF6'AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENTTO 2'TO4"5ANDBOTTON� THE SKIMMER/SKIMMERS.A REQUIRED POOL ATMOSPHERIC VACUUM RELIEF SYSTEM SHALL BE INSTALLED AS PER NYS RESIDENTIAL CODE R326.6.3(2020)AND IN ACCORDANCE WITH TOWN CODE. CZ/ APPROl ED AS NOTED 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIP EMENTS OF NFPA 70(NEC)PRINCIPALLY ARTICLE 680 AND THE NY5 lAl SECTION A MSHEP c� RESIDENTIAL CODE SECTIONS 4201 THROUGH 4206.ALL ELECTRICAL DEVICES MUST BEAPPROVED BY UNDERWRITERS LABORATORIES AND _j BE PP OTECTEP BY A GROUN DFAULT CURRENT INTERRUPTER(GFC0 CURP ENT CARRYI NG ELECTP ICAL CON DUCTORS EXCEPT FOP.THOSE 4-C. PROVIDING POWER TO POOL LIGHTING AND POOL EQUIPMENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4203.5.ALL N.T.S. c V 9 METAL ENCLOSURES,FENCES OR RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY CHARGED TOP OF WALL "ITE PVE TO CONTACT WITH AN ELECTRICAL CIIZCU17 SHALL BE EFFECTIVELY GROUN DEP-. -6 Norm AT S. WATER SOURCE FILLING THE POOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE LAW NY5 PLUMBING COPE608. L 20 631- TO 4M MR THE - Ln a 9. ALL PIPING 15 DIAGRAMMATIC UNLESS OTHERWISE STATED. 0 "o Z 10. WALK5IFPkOVIDEP5HALLBE NONSLIP P AND SLOPE AWAY FROM POOLEDGE.I cFl& N-TWO REQUIRED 0 1 F04LIN A Z.VNMAM 11. A MEANS OF EGRESS FOR,DEEP AND SHALLOW ENDS MUST BE PROVIDE[)LAW AN5I/APSP/ICC-5 SECTION 6. 0 N v FOR PIOU ED CONCRETE 2 �R 0 Dog 12. CONTRACTOR.TO PLACE THE POOL IAW TOWN OF SOUTHOLD CODE SETBACK S.KS 2. ROUGH- NG&PLUMBING INSU SECTION B 3. ALL DRAINAGE FROM THE POOL SHALL BE MAI NTAINED ON THE SUBJECT PROPERTY. N.T.S. CLEA F M��BE 4. FIN&- NSTRUMMMM Nl 115. THE DE51GN 15 BASED ON A DRAINAGE SOIL WrrH,ID%SILT. GROUND WATER SHALL NOT EXIST WITHIN THE EXCAVATION. IFGROUNP 0 BE COMP ETE FOR C-0. WATER EXISTS WITHIN 6'-O-FROM GRAPE,PEWATERING FACILITIES WILL BE REQUIRID. ONSTR ION SHALL MEET WE LEACHING POOL 16. ALLGA5ANP OIL HEATERS(IFINSTALLED)FORTHE INGPOUND SWIMMING POOLSHALLBE NATIONAL APPLIANCE ENERGY ALL C CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATEP,5SHALL BETE5TEI)IAWAN51 Z21.56ANI)SHALL BE INSTALLED IAW DISTRIBUTION P05L MANUFACTURERS SPECIFICATIONS.OIL FIRED POOL HEATERS SHALL BE TESTED LAW UL726. POOL HEATERS SHALL BE LOCATED OP. REQUIRE-ME S OF THE CODES OF NEW OCCUPANCY OF-4 FLUSH I N LET LEACH I N G BA51 N GUARDED TO PROTECT AGAI N5TACCIPENTAL CONTACT OF HOT SURFACES BY PERSONS. POOL HEATERS SHALL BE PROVIDED WITH YORK STATE. NOT RESPONSIBLE FOR TEMPERATURE AND PRESSURE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPASS SYSTEM.A BYPA55 LINE SHALL BE INSTALLED FROM INLETTO OUTIETTO ADJUST FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE DESIGN OR NSTRUCTON ERRORS USE IS UNLAWFUL It DRAINAGE CALCULATIONS FOLLOWING ENERGY CONSEPWATION MEASURES: 00 00 STORAGEPWV]DED 16.1 AT LEASTONE THERM05TATSHALL BE PROVIDED FOR EACH HEATING SYSTEM. a) WITHOUT CERTIFICAT, ffl6'0.5'�EEPI­L- 16.2 ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF5WITCH MOUNTED FOR EASYACCESS TO ALLOW SHUTTING OFFTHE r OPERATION OFTHE HEATER WITHOUTADJUSTING THE THERMOSTAT SETTING AND TO ALLOW RESTARTING WITHOUT RELIGHTING THE r .-00 0 PILOTILIGHT. , 1, 0 OF OCCUPANC IV 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM TH15 REQUIREMENTARE OUTDOOR POOLS -25'b 6 .2 a) 0 N CHECK VALVE DERIVING 20%OF THE ENERGY FOP,HEATING FROM RENEWABLE EWABLE SOURCES AS COMPUTED OVER AN OPERATING SEASON) >>-co Z-2' r < 3: 0 0 16.4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BESETTO RUN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN BESET - w FROM SKIMMER COPING AND WALKWAY 10, 1 B s za) Pump (BY OTHERS)WALKWAY TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN CLEAN AND SANITARY CONDITION LAWAPPLICABLE 0 WATERLINE GRAPE SANITARY CODE OF NEW YORK STATE. • g cc! @ )_1 ELECMIC AL r a; E ?. 0 0 2 co a JD 17. THIS DRAWING 15 FOP,STRUCTURAL SHELL ONLY.ALL ACCESSORIES AND APPURTENANCES ARE PEFIN ED BY OTHERS. uj ",, , r -'r 0 cl) co 6 _j 0 NSPECT10N RE QUIRED VISIDISTURBEP EARTH 18. BACKFILL WITH CLEAN EARTH,FREEOF ROOT5ANP DEBRIS. DO NOTALLOW THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHT OF THE 0 ISPOSAU L 1POYWEL 3500 PSI POUR-EDCONC WATER IN THE POOL BY MORE THAN 8", OP,THE WATER TO EXCEED BACKFILL BY MORE THAN 8' 5/8*REBAR.3)TYP. 19. PLACE CONCRETE ON SANDY TO LOAM SOIL. REMOVE ANY CLAY DEPOSITAND REPLACE W/COMPACTED CLEAN BACKFILL. 0 DIVERTE VINYL LINER VALVE R 0 20. THERE 15 NO MAIN DRAIN IN THIS POOL.SUCTION FOP,POOL WATER CIRCULATION 15 PROVIDED BY THE SKIMMERS ONLY.THIS MEETS olm 2'TO4'SAND--,, REQUIREMENTS OF THE NYS P ESIPENTIAL CODE-SECTION P.326.5 FOR ENTRAPMENTPPOTECTION. ___r�10 F � , FILTER 21. THE POOL WAS DESIGNED LAW THE FOLLOWING: 21.1. THE NEW YORK517ATE R.ESIPENTIALCODE-SECTION P,326(2020) c THE NEW STATE ENERGY CONSERVATION CONSTRUCTION TkUCTION CODE-SECTION R403.10(2020) 21.3 THE NEW YORK STATE FUEL GAS CODE(2020) VERTICAL 518'MAPOYOC 21,4'. THE NEW YORK STATE SANITARY CODE. U L (NOTSHOWN) rr7 Cr vi TO RETURNS 21.5. AN5I/AP5P/ICZ-5 STANDARD FOP.RESIDENTIAL IN-GROUND SWIMMING POOLS. CHECK VALVE 21.6. BOCA CODE-SECTION 421. 21.7. CODE OF THE TOWN OF SOUTHOLD. RUNOFF PLUMBING SCHEMATIC WALL SECTION 22. ALL BACKWASH TO BE SELF-CONTAINED ON-SITE. 088 IMIN STORM W rP N.T.S. It, - PURSUANT TO CH T10,120"Il N.T.S. ssl DF THE TOWN CO