Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
48693-Z
�oyaof Sou Tyo`o Town of Southold * P.O. Box 1179 �0 53095 Main Rd CouNV Southold, New York 11971 - CERTIFICATE OF OCCUPANCY No: 45925 Date: 02/01/2025 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 355 Willis Creek Dr Mattituck, NY 11952 Sec/Block/Lot: 115.-17-17.16 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 11/14/2022 Pursuant to which Building Permit No. 48693 and dated: 01/05/2023 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: Rebecca O'Brien Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 48693 06/13/2023 PLUMBERS CERTIFICATION: A4oriQd Signature TOWN OF SOUTHOLD oy BUILDING DEPARTMENT x 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#: 48693 Date: 1/5/2023 Permission is hereby granted to: O'Brien, Rebecca 355 Willis Creek Dr Mattituck, NY 11952 To: Construct in-ground gunite swimming pool at existing single family dwelling as applied for. Must maintain 15 feet minimum to pool and equipment,from side and rear property lines. J At premises located at: 355 Willis Creek Dr, Mattituck SCTM #473889 Sec/Block/Lot# 115.-17-17.16 Pursuant to application dated 11/14/2022 and approved by the Building Inspector. To expire on 7/6/2024. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO- SWIMMING POOL $50.00 Total: $300.00 Building Inspector so�jyol 0 Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlin(Q-town.south old.ny.us Southold,NY 11971-0959Q �yCOUMV,N BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Rebecca O'Brien Address: 355 Willis Creek Dr city:Mattituck st: NY zip: 11952 Building Permit#: 48693 Section: 115 Block: 17 Lot: 17.16 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Electrician: LC Electric License No: 38043ME 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 Surrey 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 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 Sump Pump 11 Other Equipment: Intermatic Pool Panel 8 Circuits / 6 Used w/Timeclock, Pump 220GFI, Salt Generato 2 Lights 120GFI, Auto Cover w/ Key Locked Switch, Heater 250 Notes: Pool Inspector Signature: Date: June 13, 2023 S.Devlin-Cert Electrical Compliance Form ho�aOF SOGIyO� f # TOWN OF SOUTHOLD BUILDING DEPT. 631-765-1802 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 [ ] RENTAL REMARKS: o G T Cf DATE 3 Z INSPECTOR OF SOpTyo� --- # # TOWN OF SOUTHOLD BUILDING DEPT. �o • �o `ycourm, 631-765-1802 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) 6ELECTRICAL (FINAL) [ ] CODE VIOLATION ] PRE C/O [ ] RENTAL REMARKS: �a'� DATE I '� INSPECTOR -- # # TOWN OF SOUTHOLD BUILDING DEPT. cou 631-765-1802 INSPECT[ON ' [ ] FOUNDATION'1ST/ REBAR " [ ] ROUGH PLBG. [. ] FOUNDATION 2ND [ ]-INSULATI ULKING [ ]' FRAMING/STRAPPING [ �INAL [ ] FIREPLACE.& CHIMNEY - .. [ ] -FIRE:SAFETY INSPECTION [ ] FIRE RESISTANT.CONSTRUCTION [ ] FIRE RESISTANT PENETRATION - [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)' [ ] CODE VIOLATION . [ ] PRE C/O [ ] RENTAL �tl D106le- Mt&1\A1 tREMARKS. ��- 15 l/l - f A 61 �L 0�- od a�� S- DATE �a' a INSPECTOR f 'S .Of I(X-3011 fJ r +i �F _e.�:.�5�,��• 1. „11s�.w ry ti' 9`j s •`�- �y'ti�,%{�� l ''�+ �' •pS a16. t V.. t�•�`'�.��'�3 MOk"�.4i f�^4;q.1��ILL�f�'��a�r •��f�.,La f` ��tiYs h�;r. �/������i �s __��'`►��rii���'s` ",r�' �A..�, II 4�i,`- - i �.r' ♦. ,s � ���'► e Q � �q ��(���s���,���I�� r� � of �, ` r; �'�!i °�•�� $'� .a! t wu., .r ''tea S/'1�/>'s�j�asd�/r� J i,f's,{i•, r, � . art��1 +,a�s ���C`r: w-`t"!�_ t ��� � `�:,_off\�'-'�'�� r'wj I�Cy: Ir.•�' ) 't; t•-�/ h��r��lh'tf 'y�'eM•. �U Art1.4 • s.. C,��,t: Mol.F+.'�"r�'� 'r! rt..��� ��',`,�* �§�3► t �., t* ta,�i 1 ,.s 'eQ a h; �,�� t�. '�� g��ti v ��.es Y (�,,•M ,�,'\ r ,�y��,t. �.`t '` ` � �t�,.pt' EIS . "� �..t-� #k i.r��'X� Pa.��\\�.�'-' Ii7� •�1 s a`�"+,�"''t� ^.,l7rS:i�t '��.', �Li �O.- '.1 A� �% t.. I :4�r11:3 `t!`�' �: .li'�:S y:.jt s�ti' t .' ti_ �... J, ?.:`1. t _ • r:'i :t` U1:1�AAb�2vr ���y d L�■: Ji^.y���`4�� .rr ,tJr. �� i. '§T,. � fy� - {. �,. , w N }. � .�,► vvmwf Am -low wt $y FA, 41 INK ��''JJ'�� '+� �- '�`e� . �' '.�.*,+• �� *ate �l''' ' � �s -sue'-+•1�',4� 'a `� '� r _ I 1 xx ! i � v � ���r. �� a � yf.,Sf •. � � r,w 2Z�., :SLAW�i'. +"�♦ Jeffrey Sands Architect Jan 21 th, 2023 LF iv/ l�' Property/swimming pool location: _ I�AI 7f19? 355 Willis Creek Drive SUILowGoEPT Mattituck, NY l��F�O�1FJpLD RE: Swimming pool rebar and drywell inspection Attention Town of Southold Building Department: Upon inspection of swimming pool rebar and drywell at above mentioned property, I find all to have been installed to meet current building code requirements. Sincerely, D Aqc \G, PEY M.S /� a 027B9' yp2 �F NE`N Jeffrey Sands Architect 6 Evergreen Lane, East Quogue, New York 11942 phone-631-375-5997, fax, 631-576-8916 email—Jeffrey sands Whotmail.com FIELD INSPECTION REPORT DATE COMMENTS b FOUNDATION (IST) ►= w y -------------------------------------- FOUNDATION (2ND) LA W O ROUGH FRAMING&z PLUMBING y '� INSULATION PER N.Y-. �y STATE ENERGY CODE (p dt OC � FINAL ADDITIONAL COMMENTS 3 � � �of 00 le ,e O�g�1-�- 5 Z JA .4 y � X NC) 0 x E� H x d b y f F04 S �o�y TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 ems://www.southoldtonm.gov_ Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only ® �� PERMIT NO. Building Inspector: NOV 1 4 2022 Applications and forms must be filled out in their entirety.Incomplete applications,wlll not be accepted` Where,the Apphcant'is not the owner,an B1,MDI ?G DE, T. Droner s AuthoraatIon.form(Page 2)shall be-completed. TG"j, OF SOUTTIO D Date: I I y OWNER(S),OF,PROPERTY r Name: R &-,e—h SCTM# 1000- I15-_ 11 Project Address: kl , \M, Ma-Phi-ocAL Phone#:34-n_ 3_ Email: be���dbV Mailing Address: CONTACT PERSON Name: P Mailing Address: Phone#: W3) _ S _ �dcy Email: ` I DESIGN;PFtOFESSIONAL:INFORMATION 14 Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION Name: 'Pa rh C— Mailing Address: bS+ a Ny I)qL Phone#: (031_ _ , Email:%\es � %, C(5 DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demblitio.n Estimated Cost of Project: "they_ N ar} _:r`,� =-°� v c�� C �� . ►v�m6n� $ (-1 Will the lot be re-graded? ❑Yes PO Will excess frill be removed from premises?,Wes El No 1 `PROPERTY INFORMATION Existing use of property: Tw ''`( �' Intended use of propert :TWA S S,Oi ww Zone or use district in which premises is si uated: Are there any covenants and restrictions with respect to An this property? ❑Yes o IF YES, PROVIDE A COPY. eck Box After Reading The ow professional ner%contractor/design profesnal is responsible for all drainage and storm water issu �Ch es as pvided Chapter 236 of the Town Code.APPLICATION 15;HEREBY=MADE to the:Buildiri Department for tM Issuance of a'Building;Perm' ro 1t pursuant to•the Buiiding`Zone Ordinance of.the Town of Southold,Suffolk,County,Newyork and other applicable Law;;ordinances or Regulations,for the.construction ofyb"uildings, additions,alterations-o -for.removal ortlemolitiorras herein described:The applicantagrees to comply witfi'ail"applicable laws,ordinances,building code, housing code and regulations and to admit authorized inspectors on premises and in buildmg(sj fob necessary inspections Faise statements made harem are- punishable ara Class'A_:misdemeanor pursuant to Section 210 45 of the_New York,SEate,Penal4law.` Application Submitted By(p int name): � ){�6( Y 1 f-V L UA KA uthorized Agent ❑Owner r Signature of Applicant: Date: 1 I 1 `Ll I STATE OF NEW YORK) S COUNTY OF ) Afl, me being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the A (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 ' +� nI 1"l day of " "t7\re m�d 20 2Z— /&N_ 4�d LNotary G STRITTMATTER c-Sta 2 of New York1ST6137451 PROPERTY OWNER AUTHORIZATION �Expires Mayik u12,20nty (Where the applicant is not the owner) I, residing at do hereby authorize to apply on my behalf to the Town of Southold Building Department-for approval as described herein. Owner's Signature Date Print Owner's Name 2 Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) l Rebecca O'Brien residing at 355 Willis Creek Drive,Mattituck NY (Print property owner's name) (Mailing Address) do hereby authorize Katrina Mercurio (Agent) of Patrick's Pools to apply on my behalf to the Southold Building Department. For the purposes of a pool permit. (Owner's Signature) (bate) (Print Owner's Name) BUILDING DEPARTMENT- Elec E nspector I TOWN OF SOUTH FEB 2 4 2023 La Town Hall Annex - 54375 Main Road - POAaaGQPT A. Southold, New York 11971-09MVNOFSOUTHOLD V. ~ Telephone (631) 765-1802 - FAX (631) 765-9502 ' w rogerr southoldtownny.gov - seand southoldtownnv.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/16/2023 Company Name: LC Electrical Contracting Inc Electrician's Name: LC Electrical License No.: ME 38043 Elec. email:office@ Icelectricalcontracti ng.com Elec. Phone No: 631-874-0485 211 request an email copy of Certificate of Compliance Elec. Address.: 22 Woodbine Lane, East Moriches, NY 11940 JOB SITE INFORMATION (All Information Required) Name: O'Brien Address: 355 Willis Creek Dr., Mattituck Cross Street: Phone No.: 'Bldg.Permit#: 48693 email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Swimming Pool Square Footage: Circle All That Apply: !s;ob ready for inspection?: ❑ YES RI NO LF]R.ough In ® Final Do you need a Temp Certificate?: ❑ YES FV-] 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 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION a oZ-t _d,3 q>"aL j 16C)s �'e- ci 1 b 3 g-7 L( Ora c01 lb 0 fP `FF BUILDING DEPARTMENT- Elec E nspector TOWN OF SOUTH FEB 2 4 2023 Town Hall Annex - 54375 Main Road-PO ,px 1177PT -' - pay Southold, New York 1.1971-09&DVN0FS0ii7H0LD Telephone (631) 765-1802 - FAX (631) 765-9502 t, ra err southoldtownn (a) g c� y.gov � wand southoldtavvnnv. ov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: 2/16/2023 Company Name: LC Electrical Contracting Inc Electrician's Name: LC Electrical License No.: ME 38043 Elec. email:office @ Icelectricalcontracting.com Elec. Phone No: 631-874-0485 I request an email copy of Certificate of Compliance Elec. Address.: 22 Woodbine Lane, East Moriches, NY 11940 JOB SITE INFORMATION (All Information Required) Name: O'Brien Address: 355 Willis Creek Dr., Mattituck Cross Street: Phone No.: 'Bldg.Permit#: 48693 email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): Swimming Pool Square Footage: Circle All That Apply: I Is job ready for inspec#ion?: ® YES ,�® NO ❑Rough fn ❑ Final Do you need a Temp Certificate?: ❑ YES NO Issued On Temp Information: (All information required) Service Size❑1 Ph❑3 Ph Size: A # Meters Old Meter# ❑New Service[]Fire Reconnect[—] ctFlood Reconnect❑Service Reconnect[]Underground❑Overhead # Underground Laterals jr-1 - Framei c r Pole f'voin, doi E onService? yy Additional Information: PAYMENT DUE WITH APPLICATION � 7?01aL ,re, GO- c�/ REF. NO. S1000,,'115-17-17.016' 7ME SURVEY D IE I C WE I �• Do* eF40y NOV 1 4 2022 444Z- 120 W i -a N W15'10'£ 150.00 O . 0 0�„ - N N a b s 121 jig 4y A£P 4 maw Qft F: a . U 2 a1m N rmn S BB'15'10'W � 265.00 �\ CER77FIED To: TI71£No. L770901 NO. DATE TENSION OLD REPUBLIC NA77ONAL TM-E.INSURANCE COMPANY NAP OF PR7OPtERTT,Y'SMA47M IN LANDMARK THE AGENCY INC. CO N yy0 MA//If LJCK JPMOR&A GCHAS£, N.A., 1SAOA/A77MA . R£B£CGI G. 0$81 �+o PF SUTFOLK COUNTY,N.Y. sf TAX DIST. 1000 TAX SECT.: 115 TAX BLOCK.•17 TAX LOT(S): 17.016 LOT 19 ON r iNA o Empire State Land Surveyor,AC P OF HARBOR VIEWAT.MATO)UCK' � � F "° rr FILED AUGUST 21, 1987 AS MAP IBJ77 2 °s°ane ai FranKl.GaBrEao Projeslfonal Land Snrveyor rnYnMWm A[rEWaGi AVIV Ada mlNS SFn IW A!@®END FIgOOT54I[6 AIp.RpIQYCID1I TdD?lK�D 10d•1U� m o is m 60 120 <AND SV�, RemrdfojAMmA.Bl co mnmrEac�ata and sorer ry rm awa ocuw srAoOa wim aeams�O sx awE wr e•meaeOmaA wo nu mw: St hen J.Refd-M.'B amanmisemarm radar sxrt sw arm rx reawrarea>xsaxra�rwrm.nc imc aawxe ae oAwiwrcu.mcr,uo nc raoew eP erry Carman-G.W.Havfland r¢nrtnmrrarmmrra smnaw.mmc®saarOr rRwsmscm.mrmx emrmoms,vorto s�mrna aDc�m¢ars[rs amrarma: Vandmater&Lapp.RobertE.CarNn-WdUm J.Daly . om+DiOaaws w aaa eacv smrAa.we rsr sore.msrr rr sNSAnq ne caserams a REEo2D rm saw a va smerue nor admen mars Aw mmrm�a rn811Aa I A sees--,M e9 aZ rmr m a—0 m rxatw a"Am114e1 saaDaiS ores a aDm YDanwrrs GRAPHIC SC41E 1-TO' 1005 Glen CovaAvenue,Glen Head,NP,I1545 OaaD Au suns iesxem 571RYE1iO AUCUS7 iS 2�0 empiresunny(a]aOLcom (51;106901 REF. NO. S 1000 ' 115 17-17.01 s TITLE SURVEY 1774-1 . NF N . 120 MON. N 88'15'10` E 150.00 . MON. 0.ION AT CORNER O ELECTRIC O METER PANEL O� STONE CURB �F `'o sy0 65 o �, -('T L? o v 121 Cb ( t9 ' j ' ' S7£ Lj 84.8 Ur CoiVc l- s 4� w Z SSE CURB " ) J MON. CE MON. �. HELD wp �-fB ON LINE N/S S 88015,100 W ! 26J�' .00 o2oE J1B NO. DATE REVISION CERTIFIED TO: TITLE NO. LT70901 OLD REPUBLIC NARONAL TITLE INSURANCE COMPANY OF N . MAP OF PROPERTY SITUATED IN LANDMARK TITLE AGENCY INC. JPMORGAN CHASE, N.A., ISAOA/ATIMA c��P �o MATTI TUCK REBECCA G. O'BRIEN �0 �� SUFFOLK COUNTY, N.Y. x� TAX DIST 1000 TAX SECT.: 115 TAX BLOCK. 17 TAX LOT(S): 17.016 LOT 19 ON "MAP OF HARBOR VIEW AT MATTITUCK» o Empire State Land Surveyor, P.C. FILED AUGUST 21, 1987 AS MAP 18377 OS0088 t� Frank L Galluzzo Professional Land Surveyor s0 0 15 a0 s0 120 AND S �J Records o Albert A.Bianco UNAUTHORIZED ALTERATIONS AND/OR ADDITIONS TO THIS SURVEY BEARING A LICENSED LAND SURVEYORS SAIL /S A VOCATION OF SECAON 7209 OF THE NEW YORK SfA1E C v of Albert LAW. COPIES OF THLS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED OR EMBOSSED SEAL SHALL NOT BE CONSIDERED 70 BE A VALID TRUE COPYij� Stephen J.Reid-M.Berry Carman-G. W.Haviland COMFICA7/ONS INDICATED HEREON S7Wl RUN ONLY 70 THE PERSON FOR WHOM THE SURVEY CS PREPARED, 7HE TITLE COMPANY, THE GOVERNMENTAL AGENCY AND THE LENDING MMMUDON USTED ON 7MS SURVEY AMP. CL7MRf7C TOO ARE NOT TRANSFERABLE 70 ADWM4L. INSTITUTIONS AND/OR SUB=UENT OWNERS FENCE OFfSVS TAKEN AT POSTS Vandewater&Lapp-Robert E. Carlin-WYlliam J Daly ENCRCI4CHMENiS OR VALKTS BELOW SURFACE ARE NOT SHOWN. RIGHT OF WAYS AND/OR FASMEW OF RECORD NOT SHOWN ON 7MS SURVEY ARE NOT CERWED GRAPHIC SCALE 1=30' I005 Glen Cove Avenue, Glen Head,1VY, 11545 OfF%7S AND DIMENSIONS HEREON ARE FOR A SPECIFIC PURPOSE AND ARE NOT 70 BE USED IN 7HE ERECAON OF ADDIWA14L S7RLICWI? FENCES OR OTHER IMPROVEMEN>S SURVEYED: AUGUST 15, 2020 em iresurve oLcom 51 a 240- , 01 11 ®2020 ALL RIGHTS RESERVED P y� � ( )- AC * CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmmr) 05/10/2022 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 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 CONTACTNAM Nicholas Zulkofske Brookhaven Agency,Inc. IAIG No PHONE 631 941-4113 FAx 631 941-4405 100 Oakland Ave,Ste 1 EMAIL ADDRESS- certificates@brookhavenagency.com Port Jefferson,NY 11777 INSURERS AFFORDING COVERAGE NAIC# INSURERA: Philadelphia Indemnity Insurance Co. INSURED INSURER B: Merchants Mutual Insurance Co. Patrick's Pools,Inc INSURER C: Wesco Insurance Co. PO BOX 3024 INSURER D: East Quogue NY 11942 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LT POLICY NUMBER DD/YYYY1 (MM/DD8MYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1 00O 000 A CLAIMS-MADE ,X OCCUR DAMAGE TO RENTED $100,000 x Contractual Liability X PHPK2386555 02/28/2022 02/28/2023 MED EXP(Any oneperson) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 JE� LOC PRODUCTS-COMP/OP AGG $2,000,000 POLICY� OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Fa accident) $500,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED X X. 'CAP9267113 07/12/2021 07/12/2022 BODILY INJURY(Per accident $ AUTOS AUTOS ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Par anniciprit) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED RETENTION $ WORKERS COMPENSATION X PER IITF OTH- AND EMPLOYERS'LIABILITY y/N STAT ER ANY PROPRIETOR/PARTNER/EXC OFFICER/MEMBER ER EXCLUDED?ECUTIVE� N/A E.L.EACH ACCIDENT $100,000 (Mandatory in NH) WWC3587728 05/13/2022 05/13/2023 E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Southold is included as additional insured per written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold,Town Hall Annex SHOULD ANY OF•THF ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 54375 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Southold,NY 11971 AUTHORIZED REPRESENTATIVE <NSZ> ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD OCCUPANCY OR " APPROVED AS NOTED ' `' DAT • - -a3 B.P.# ��93 USE IS UNLAWFUL ;3=: FEO30D.OD BY �-- WITHOUT CERTIFICATE NOTIFY BUILDING DEPARTMENT AT OF OCCUPANCY 631=768.1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 2. ROUGH-FRAMING&PLUMBING S. INSULATION COMPLY WITH ALL CODES O� 4. FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. NEW PORK STATE & TOWN CODES ALL CONSTRUCTION SHALL MEET THE AS REQUIRED AND CONDITIONS OF REQUIREMENTS OFTHE CODES OF NEW SOUTHOLD TOWN ZBA YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTON ERRORS SOUTHOLD TOWN PLANNING BOARD SOUTHOLD TOWN TRUSTEES N.Y.S.DEC "IM�EDIATELY"- ENCLO$I= POOL UPON CO PLE lON ; Bl FOREe-';.WAfiE RETAIN ST ORM WATER RUNOFF PURSUANT TO CHAPTER 230 OF THE TOWN CODE. D 4— „ .. ....`"..r,` .- ...ra .x ,. .... ., ,.-,� ..e a: ,£�aa::-a� ,r,,•t,. ..aai,_., ..�......�.. y _-„ +N s a. c<r a ,. +�;: xiFv... _.., � -, s . .. ,�Sr3.. �y :. sue-�. . S:h°4'�•�a 6. _ ,.. m 4.. .._ '�C .. ,� Y.... #- ";=i�'wx.... ..r .�y.. .t$-T - �... ..., -.. •� a...:�..- ,a .7•'`i����,"',. .. 7,vrp.�,r ...�r .,=S .�`�..-tk _.-. . r.., - �,.... .. _,., � t�a��ra: e.'v 'y. t...e 5,..,.�.a.. -..,.,. .���f��«�Fm �SSi="c.+...:^r ��.;.,:,�.t....� � �...+......... ....�,>„ 3R..as...�.��sm.,>.n�^- t x.K.._. �`"✓.:a�`�,"�'.°^t'�:..,. x .:�- ..�a�a. ,.'�.u..c.* _ .:n:�".G";i' ..�2^ �e�; - ...._._ .,..., .n.:..... a..,..��.. ..,ti-t,.•-...sri:.. .. :'�`.,, n.. � ..E.3:.^' �..�.: Y:''J'F e. yii_:- ,e_ �r A'y"+> �ay _ T rr I � ;r��� tV IMcEV1k r-,�-- 5 . in— qov ?'rtJill es, ,, � ,., .. -., .._. „ .. . -., .,-. .. .... u a k .- .. . ., .,,.. ,. .`a- r ...,r-+• X :. ..: K .,�..... awl. "�,.. de.,e�. � v F� � 1' .¢. 4 �;w+s.. .at t,,a,!. ._�,,...,..,•.:„s; .r,.:?{�c;<,� ,+.<:-s..,..,:'w,,rt,..,...... r . ....- .. ��,.`"'-� ,. ., ,.�..:,,. .:�x .,i.:!k:"�, �,.: tr..d-.�cea3....�.. :v,��i ., I r.Is.� tip. a IV f ate(