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Home My WebLink About45359-Z of souryolo Town of Southold * * P.O. Box 1179 0 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 46002 Date: 02/28/2025 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 5920 Indian Neck Ln Peconic,NY 11958 Sec/Block/Lot: 98.-5-17.4 Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 10/13/2020 Pursuant to which Building Permit No. 45359 and dated: 10/21/2020 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: Francis Lupinacci,Jennifer Lupinacci Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 45359 05/13/2021 PLUMBERS CERTIFICATION: utho zed i ature � TOWN OF SOUTHOLD O�g11FF0(,�co BUILDING DEPARTMENT y TOWN CLERK'S OFFICE "oy o� �3ti 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#: 45359 Date: 10/21/2020 Permission is hereby granted to: Bernhardt, Nicholas PO BOX 441 Peconic, NY 11958 To: construct accessory in-ground.swimming pool as applied for. At premises located at: 5920 Indian Neck Ln, Peconic SCTM # 473889 Sec/Block/Lot# 98.-5-17.4 Pursuant to application dated 10/13/2020 and approved by the Building Inspector. To expire on 4/22/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE.ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Buildi c or oF so�ryol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 c o sean.devlin(a-D-town.southold.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Francis Lupinacci Address: 5920 Indian Neck Ln city:Peconic st: NY zip: 11958 Building Permit#: 45359 Section: 98 Block: 5 Lot: 17.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: LC Electrical Contr License No: 45359ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor 1 st Floor Pool X New 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 CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Other Equipment: Pentair Pool Panel 8 Circuit- 3 Used, Pump 220GFI , Heater, Salt Generator- on 120GFI, Lights 120GFI Notes: Pool Inspector Signature: Date: May 13, 2021 S.Devlin-Cent Electrical Compliance Form.xls gf souryolo `4 511-TOWN SUTHOLD BUILDING DEPT. `y�ouxnN�' 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) �MELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: Coo A c�l�J-e s l too DATE > INSPECTOR - '1 ho��Of SOOlyo6 # TOWN OF SOUTHOLD BUILDING DEPT. e 765-1802 INSPECTION [ ] FOUNDATION 1ST [ - ] 'ROUGH PL13G. [ ] FOUNDATION 2ND j :] SULATION/CAULKING [ ] FRAMING/STRAPPING -[ FINAL-?,,L,-- [ ] FIREPLACE & CHIMNEY [ ] FIRE,SAFETYj-INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 60\/ i US -1/pr, el DATE INS-PECTORkA%v4,/ ho�aOF 50U1y�� ll # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm, 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] I SULAT N/ AULKI G [ ] 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: DATE °� INSPECTOR q53 5 9 Jeffrey Sands Architect June 19 2021 AUG 2 0 2021 Lupinacci Residence BUILDING I3t;PTe 5920 Indian Neck TOWN OF SM7HOLD Peconic, NY 11958 RE: Swimming pool rebar inspection Attention Town of Southold Building Department: Upon inspecting swimming pool rebar at the above mentioned property I find all to have been installed to meet current building code requirements. Sincerely, D Agcti Q� o a p CF NE`Ny Jeffrey Sands Architect 6 Evergreen Lane, East Quogue, New York 11942 phone-631-375-5997, fax, 631-576-8916 email—ieffrey sands6d-)hotmail.com • 1 • ----------------------- ROUGH 1 I/ �LUMBVG 7-77 ---- --- 1 • • ! rimer lam_: Iwo;'��":�i - TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631)765-1802 Planning Board approval FAX: (631)765-9502 Survey Southoldtownny.-gov , PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees i C.O.Application Flood Permit Examined 20 0�6 Single&Separate Truss Identification Form i Storm-Water Assessment Form ' Contact: Nkr- L_ Approved 07 1 20 c Mail to: Peke I Disapproved a/c °f�od:pC�t 2��-C, 0{ 11 Phone: l��'J r-Expir 120 rJ 6 lit w Ckvk I 1� Buildin ector OCT 3 2020 APPLICATION FOR BUILDING PERMIT DU w- (( 1 - . Date 6 �� , 20 �-� la DI NG DUPlr. INSTRUCTIONS l �rO1,� „r..}•�. T I.G. a.This application MUST be completely filled in by typewriter or in ink and'submitted to the Building Inspector with 4 sets of plans,accurate.plot plan to scale.'Fee according to schedule. b. Plot plan-showing location of lot and of buildings on-premises, relationship to adjoining premises or public streets or ,areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant.Such a permit . shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire'if the work authorized has not commenced within 1.2 months after the date of issuance or ha's not been completed within 18 months from such date. If no zoning"amendments or other regulations affecting the property" have-been en acted in the inter6;the Building Inspector may authorize din writing;the•ezfension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or 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 for necessary inspections. A�, (Signature of ap7alyof name,if a corporation) sP� �s 814 J\jy 1t��. (Mailing address of applicant) State wheter appli an i caner, )es ee, agent, architect, engineer, general contractor, electrician,plumber or builder J� Name of owner of premises (As on the tax ro r latest deed) If ppl'�ca t is a c ,rporati'ori; ignatiire'of duly authorized officer —, fib• .: Name nd title.of corporate,officer) Builders License No.,' Plumbers License No. Electricians License No. 3 �� Other Trade's License No. 1. Location of land on which proposed work ill e done: House Number Street Hamlet County Tax Map No. 1000 Section , Block �� Lot Ly Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy U41<__ � r � b. Intended use and occupancy ova 1 J � S w P� A, 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work S(,u"m uo (Descript on) 4. Estimated Cost 5, D�0 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business,.commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories `A.. Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories' 8. Dimensions of entire new construction: Front Rear Depth;; Height Number of Stories 9. Size of lot: Front Rear Depth ''f y-r 10. Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 13. Will lot be re-graded? YES Will excess fill be removed from premises? YES Y*'NO 14.Names of Owner of premises V ^n_ �'�P �� Address 5 Vm d n�.�•�lllr��l—LnPhone No. Vj( ' $ Name of Architect Address 6 l~v" au, /n 1IRqPhone No Name of Contractor � Address ( Q Phone No. 6 S `t s7 a 9. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE,REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey,to scale,.with,accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on sur ey. 18. Are there any covenants and restricti6ns with respect to this property? * YES NO * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COU TY OF ) n ' "" being duly sworn,deposes an86% g6(gl fib tpe applicant (Name of individual§Igning contract)above named, �v t Notary Public,State of New York (S)He is the No:01 BU6185050 SuffolkV Qualified on Count (Contractor,Agent,Corporate Officer;etc.) commission Expires April 14,2 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 knowledge'and belief,land that the work will be performed in the manner set forth in the application filed therewith. G Sworn to b fore me thWA&I- .20�O.' day of Notary Public Sign Orte of Apiticant Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) C 1 5 6siding at I (Print property owner's name (Mailing Address) do hereby authorize �� r'I'L f aa./j�' (Agent) to apply on my behalf to the Southold Building Department. Zwner's, Signature (Date) v �C. ✓) C, Gi r C_ (Print Owner's Name) s BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 rogerr(D-southoldtownny.gov - seand as southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Lc g z f£c r-fe CGyt/T�r i,—c, L,—t Name: e4 eLicense No.:No.: 391043 mail: FAc 6 �o�rK,4� .rr Phone No: -3 -e7 —Ulfg5 request an email copy of Certificate of Compiiance- Address.: a- wow ,61,vq 1wolef4 f-S JOB SITE INFORMATION (All Information Required) Name: �„ N P u Address: a0 N_c j-40 Pie-o.-v r e Cross Street: Phone No.: Bldg.Permit#: if5-3 fl email: Tax Map District: . 1000 Section: qg Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: Is job ready for inspection?: I,YES ❑NO ❑Rough In ❑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 ❑ Service Reconnect ❑ Underground [:]Overhead # Underground Laterals ❑1 ❑2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N Additional Information: PAYMENT DUE WITH APPLICATION ell� �® Electrical Inspection Form 2020.xlsx g BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD >r Town Hall Annex - 54375 Main Road - PO Box 1179 k " Southold, New York 11971-0959 , + Telephone (631) 765-1802 - FAX (631) 765-9502 ,_.. , =` rogerr(a�southoldtownny.gov seand(a�southoldtownnLgov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: . Le ?ice 7-a,, C&,r2 G 1"C_ LAe Name: - - License No.: /LL 3$01*3 mail: ��, te Fe _re fo c �� Phone No - request an email co of Certificate Com Rance - 3 -a�? n�� 9 py P Address.: wow�BirvE L, ,vg ,E�,-sa�2 �S ftl N�� JOB SITE INFORMATION (All Information Required) Name: Address: a0 N N 2✓-w�.�, ��.�,�r Cross Street: Phone No.:. Bldg.Permit#: 45-3�n email: Tax Map District: . 1000 Section: qg Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Check All That Apply: Is job ready for inspection?: ,YES ❑NO ❑Rough In ❑Final Do you need a Temp Certificate?: [—]YES ❑NO Issued On Temp Information: (All information required) Service Size 01 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: PAYMENT DUE WITH APPLICATION �� o® Electrical Inspection Form 2020.xlsx �C PERMIT# Address: Switches Outlets Sconces Ws U.C.Lt5 .. Fans-. Fridge HW Ex#faust .' OyEn. Dryer SXrratte5;: '[)1i. Service Cor�nba .. , ...;. : : ...: •- Coal�top .�� . , . .�.- � �'�arrsfer... . AC AH -Specia{: Commehtss T 2 (2) /' 1k) �✓1 G Gl�/�G(J I e�IL� Scott A. Russell �°SUS �"� STcO�] '{ �1CWA\T]EIK SUPERVISOR y I��1[A\lam (G�]EI��IC]E N T SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971Q� Town f Southold i - CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEE ( TO BE COMPLETED BY THE APPLICANT ) i FLOES THIS PROJECT INVOLVE ANY OF THE ;;OLL d,VING: Yes N o T iCH[CI( ALL THAT APPLY) ❑ A:-Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ElB. Excavation or filling involving more than 200 cubic yards of mate I ial within any parcel or any contiguous area. i ❑1W C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑ D. Site preparation within 100 feet of wetlands, beach, bluff f or coastal erosion hazard area. El i E. Site preparation within the one-hundred-year f loodplaiT as depicted on FIRM Map of any watercourse. ❑ F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Ma agement II Control Plan was received by the Town and the proposal includes ii in-kind replacement of impervious surfaces. If you an NO to all of the questions above, STOP! Complete the Applicant section below vith your Name,Signature, Contact Information, Date & County Tax Map.Number! Chapter 236 does not apply to your project. If you answered YES to one or.more of the above, please submit Two copies of a Stormwater Mai iagement Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner,Design Professional,Agent,C ntractor,Other) S.C.T.M. te: 1000 I Date: � W�e �District NAME Q0�/ a lock Lor _ •N ts t— f FOR BUILDING DEPAR"T'IYII IT USE ONLY *Contact Information: — — — — — — Reviewed By: i Property Address/Location of Construction Work: _ _ _ _ Date_ ® Approved for processing Building Permit. — Stormwater Management Con tr of Plan Not Required. Stormwater Management Conn of Plan is Required! (Forward to Engineering Depaiti nent for Review.) FORM SMCP-TOS MAY 2014 i Uniiam Adnwde nmt 1:Y V. "I'I F Ark, \ D F 1 4 E NEW YOR T TF k 'ss. State of New York,County of ,ss: -n the year 2020, before me, On the day of in the year ,before me, ared the undersigned,personally appeared ria Bernhardt ' or proved to me on the basis of personally known to me or proved to me on the basis of `be the individual(s) whose name(s) is satisfactory evidence to be the individual(s) whose name(s) is within instrument and acknowledged to (are) subscribed to the within instrument and acknowledged to executed the same in his/her/their me that he/shelthey executed the same in his/her/their ihal by his/hedtheir signature(s) on the eapacity(ies), and that by his/her/their signature(s) on the I ridividual(s),or the person upon behalf of which instrument,the individual(s),or the person upon behalf of which sI acted,cxecu the instrument, the individual(s)acted,executed the instrument. 1 .v: in ividual taking proof) (signature and office of individual taking proof) Kenneth 8.Zahlar Notary Public New York Sutiotk No.01 ZP,a517618 Expires Feb-28.2023 TO 1313 USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE i State(or District of Columbia,Territory,or Foreign Country)of ss: i On the day of in the year ,before me,the undersigned,personally appeared personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s)whose name(s)is(are)subscribed to the within instrument and acknowledged to me that he/she/they executed the same in hisAter/their capacity(ics),and that by his/her/their signatures)on the instrument,the individual(s),or the person upon behalf of which the individual(s)acted,executed the instrument,and that such individual made such appearance before the undersigned in the (insert the city or other political subdivision and the state or country or other place the acknowledgment was taken) (signature and office of individual taking acknowledgment) I i BARGAIN AND SALE DEED'WITH DISTRICT: 1004 COVENANT AGAINST GRANTOR'S ACTS SEC170N: 098.00 BLOCK: 05.00 TITLE NO.:Abstracts,Inc.#563-S-15010 LOT: 017.004 PREMISES:5920 Indian Neck Lane,Peconic,NY 11958 COUNTY: Suffolk Nicholas Bernhardt and Maria Bernhardt TO Francis E.Lupinacci and Jennifer Lupinacci RECORD AND RETURN TO: ADVANTAGE TITLE 201 Old Country Road, Suite 200.Melville,NY 11747 631.424.6100 • 800.285.1551 • Fax: 631.424.6049 RICHARD VANDENBURGH ESQ. 245 Park Avenue,New York,NY 10167 - 212.672.1960 42155 Main Road ' Peconic,New York 11958 vr►vw.advantagetitle.com TN C AwAinAtr dour:AWAhUU Tani-AWAMUir roan OM AWNIAU 114n•AYIXNaW SErn040•YOMW ANAWAW YORK Workers' CERTIFICATE OF STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE Board 1 a.Legal Name&Address of Insured(usC street address only) 1 b.Business Telephone Number of Insured 631-9964687 Patricks Pools Inc PO Box 3024 East Quogue NY 11942 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to id.Federal Employer Identification Number of Insured or Social Security . certain locations in New York State,i.e.,a Wrap-Up Policy) Number 262929943 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Co Town of Southold 3b.Policy Number of Entity Listed in Box"1 a" 54375 Main Rd WWC3465462 PO Box 1179 SoutholdNY 11971 3c.Policy effective period 05/13/2020 to 05/13/2021 3d.The Proprietor,Partners or Executive Officers are Included.(Only check box if all partnersloffioers Included) QX all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed 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"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or , eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form Is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a 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 1 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: Nicholas Zulkofske (Print name of authorized representative or licensed agent of insurance carrier) Approved by: _� /7/ZV (signatur (Date) Title:Authorized Agent Telephone Number of authorized representative or licensed agent of insurance carrier:631-941-4113 Please Note:Only insurance carriers and their licensed agents are authorized to issue Form C-106.2.Insurance brokers are NOT authorized to issue it. C-106.2(9-17) www.wcb.ny.gov DATE (MMID A 0 CERTIFICATE OF LIABILITY INSURANCE 10711312020 D THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY ORNEGATIVELY 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 CONTACT Brookhaven Agency,Inc. PHONE 631 941-4113 Fax 631 941-0405 100 Oakland Ave,Ste 1 ongE . certificates brookhavena enc .com Pont Jefferson,NY 11777 - INSURERS AFFORDING COVERAGE NAIC8 INSURER •Philadelphia Indemnity Insurance Co. INSURED INSURERB.Wesco Insurance Co. Patrick's Pools,Inc INSURER C•Merchants Mutual Insurance Co. PO BOX 3024 INSURER D East Quogue,NY 11942 INSURER F: 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. l TYPE OF INSURANCE DL UB POLICY NUMBER POLICY EFF POLICY EXP LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A CLAIMS MADE a OCCUR DAMAGE TO RENTED $1 OO 000 X X PHPK2103006 02128/2020 02/28/2021 MED EXP(Anyoneperson) S6,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2 000 000 X POLICY JECT LOC PRODUCTS-COMPlOP AGG S 2 OO OOO O AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $60O OOO C IX ANY AUTO BODILY INJURY(Per person) S AUTOS ALL OWNED SSCCHHEEDULED X X CAP9267113 07112/2020 07/12/2021 BODILY INJURY(Per accident) S AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE g AUTOS S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAJMS-MADE AGGREGATE S S WORKERS COMPENSATION X I PER JTE OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100 000 B OFFICER/MEMBEREXCLUOE09 Y NIA WWC3465462 05/1312020 05/1312021 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 100 OOO H s.desaibe unno or pERATIONS below E.L.DISEASE-POLICY LIMIT I S 600 OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if Mora apace is required) Town of Southold is included as additional insured CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 64376 Main Rd. ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE <CC> 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD APPROVED AS NOTED DATE: A B.P.# FEE: ' Is7� BY: NOTIFY BUILDING DEPAR ENT AT 765--1802, '8 AM TO 4 PM FOR THE ELECTRICAL FOLLOWING INSPECTIONS: 1: FOUNDATION - TWO REQUIRED INSPECTION REQUIRED FOR POURED CONCRETE 2.,ROUGH"-:FRAMING & PLUMBING 8::INSULATION 4: "FINAL,- CONSTRUCTION MUST BE COMPLETE POR C.O. ALL.;CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 1= E;CQSE POOL TO CODE COMPLY WITH ALL CODES OF ,X, PON COMPLETION NEW YORK STATE & TOWN CODES vi ">_ BEFORE "WATER" AS REQUIRED AND CONDITIONS OF `�6�FFf8L-B-T6',�Z-BAD BOARD SOMMOITTOWMSTEES L OCCUPANCY OR RETAIN STORM WATER RUNOFF USE IS UNLAWFUL PURSUANT TO CHAPTER 236 OF THE TOWN CODE. WITHOUT CERTIFICATE OFOCCUPANCY fi I •1 1 t f t }� 1 c 1 , I , 1 q , v i• � ; _.». �w-.d�,_.•�.s® •..r..;.....:-.... ... a<,.u�o•-r.+e:n�-.rp:-�-:s...::.�..spa,. Tom:-.^�>•..i.� xea�ry�rvxr,.:,c��..ss.�xaww.e..�-,+ ..�.�._:.su*�m-�*�s zc anx-r:....s.mty+.�waa,•ii^nun+�� ... ._ : ., _ r 1F a S,' S 1 � w < 777, , • s' _i '!_ V� 10 _ dro IPOO IAA , t , Ok N SURVEY OF PROPERTY A T PECONIC TO WN OF SOUTHOLD SUFFOLK COUNTY, N. Y 1000-98--05 17.4 SCALE: 13=40 JUL Y 7, 2020 ( r + I SCTM# 1 00-86-6- 7 VACANT SCTM# i �2� 1000-86-6-16 DWELLING I PUBLIC WATER j � Za•2. SCTM# SCTM# 1000-86-6-14DWELLING r 1000--86-6-13 r PUBLIC ATER r ' r op`p ` ' 16 N tvGK , NAIL SET ,Np1P wl*� 55 127 6 JOS 5•22 Ed's 0v BRICK !. PIER O w \ BRICK r !� CMF 0 PIERro n� \ \ 12 tp- Q '0 \ o� SCTM 'Z► \ jn0 N n �G•c\ N 1000-98-5-17.6 \` Q ` 00 CB � a' �� a DWELLING SCTM# \ cv- y d ti WELL 1000-98-5-14.2 Q \ �i 125 SQ FT. FR. SHED O \ Z° WOOD L \ RAMP 0 ` c�� ` . o CONC. ` \ WELL �A�cr OR • 's \ •� 2 ' PAVER ` FLAG STONE NO �$� WALK ` \ PA110 ON DIRT 1 ` R/O STONE PORCH CHIM. \ \ STONE STEP ACD '� 69 \ , \ _ GENERATOR--'d ON CONC. \ \ ice\ 1 STY. FR. HOUSE SLAG, ` & GARAGE FF=25.4' W000 Q� ✓` PROPANE CMF \ DECK __ \a� TANK AREA ` I OFF i ` SEPTIC SCTM# \ 1000-98-5-17.2 DWELLING \PUBLIC WATERck- ` \ \ x rrAJ \\,, col 5. 1 \ SCTM# \ 1000-98-5-14.3 ,\ \\ MAIL SET oNEIG� 1� EW 56 S�cTM# SET1000-98-5-17.5 \ \ ` N/O/F PHYLLIS & SAMUEL D \ CONSTAN �\ DWELLING PUBLIC WATER SCTM # 1000-98-5-14.4 KEY Q = REBAR ® = WELL CERTIFIED TO: ® = STAKE FRANCIS LUPINACCI & JENNIFER LUPINACCI ® = TEST HOLE CITIBANK N.A. ABSTRACTS INCORPORATED ® = NAIL 13 = MONUMENT 4 = WETLAND FLAG c-CL = U11L1 TY POLE LIC. NO. 49618 P C lC SURVE MWP.C. ANY AL7ERA77ON OR ADDITION 70 77-IIS SURVEY IS A V10LA77ON OF SEC77ON 7209 OF 7HE NEW YORK STATE EDUCA770N LAW. AREA= L878 ACRES (631) 765-5020 FAX (631) 765--1797 EXCEPT AS PER SEC77ON 7209-SUBDIVISION 2. ALL CER77FICA77ONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF P.O. BOX 909 ONLY /F SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. 1230 TRA VELER STREET `t 20 t,�-0 �J OUTHOLD, N. Y. 11971 c.� i