HomeMy WebLinkAbout50559-Z of so Town Town of Southold
* P.O. Box 1179
io 53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 46005 Date: 02/28/2025
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 725 Lands End Rd Orient,NY 11957
See/Block/Lot: 15.-9-1.16
Conforms substantially to the Application for Building Permit heretofore, filed in this office dated: 02/14/2022
Pursuant to which Building Permit No. 50559 and dated: 04/16/2024
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: George Alissandratos , Gerasimos Alissandratos
Of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL:
ELECTRICAL CERTIFICATE: 47563 06/28/2022
PLUMBERS CERTIFICATION:
Auth rize ignature
SUFFOl� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y, TOWN CLERK'S OFFICE
SOUTHOLD, NY
col,� ya
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#: 50559 Date: 4/16/2024
Permission is hereby granted to:
Alissandratos, George
3 Sidehill Ln
Yonkers, NY 10710
To: Construct in-ground gunite swimming pool at existing single family dwelling.
Must maintain 20 foot setback from sanitary system.
Minimum 20 foot setback required from rear and side property lines for pool and
equipment. Replaces BP#47563
At premises located at:
726 Lands End Rd, Orient
SCTM #473889
Sec/Block/Lot# 15.-9-1.16
Pursuant to application dated 2/14/2022 and approved by the Building Inspector.
To expire on 10/16/2025.
Fees:
PERMIT RENEWAL $200.00
Total: $200.00
Building Inspector
�o�SUFFn,,t . TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x TOWN CLERK'S OFFICE
"o • 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#: 47563 Date: 3/17/2022
Permission is hereby granted to:
Alissandratos, George
3 Sidehill Ln
Yonkers, NY 10710
To: Construct in-ground gunite swimming pool at existing single family dwelling.
Must maintain 20 foot setback from sanitary system.
Minimum 20 foot setback required from rear and side property lines for pool and
equipment.
At premises located at:
725 Lands End Rd., Orient
SCTM # 473889
Sec/Block/Lot# 15.-9-1.16
Pursuant to application dated 2/14/2022 and approved by the Building Inspector.
To expire on 9/16/2023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
Building Inspector
OF 50(/T�QI
� o
Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 sean.devline-town.southold.ny.us
Southold,NY 11971-0959 Q �,
�yCOUNT`I,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: George Alissandratos
Address: 725 Lands End Rd city:Orient st: NY zip: 11957
Building Permit* 47563 Section: 15 Block: 9 Lot: 1.16
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Home Owner License No:
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 CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks [12
Disconnect Switches 4'LED Exit Fixtures Pump
Other Equipment: Intermatic Pool Panel 8 Circuit/6 Used, Cleaner Pump &Pump 220GFI, Salt Gene,
3 Lights 120GFI
Notes: Pool
Inspector Signature: Date: June 28, 2022
S.Devlin-Cert Electrical Compliance Form
oe souryo!
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: C�11
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DATE INSPECTOR
OF SOUIyO� L4 C & / -72,G7 1,4 i✓l," -
* # TOWN OF SOUTHOLD BUILDING DEPT.
courm, 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:
DATE INSPECTOR
V SOUIyo�
TOWN OF SOUTHOLD BUILDING DEPT.
courm,��' 631-765-1802
-INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [vf'FINAL -P"7(
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT.CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS: o2R-.ec11- Awat o-64 G�-�-
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DATE �'/k-a� INSPECTOR
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TOWN"OF SOUTHOLU BUILDING DEPT.
°ycou �i� 631-765-1802
1 NSPECTION
[ .]. FOUNDATION 1ST/ REBAR [ ] _ROUGH PLBG.
[ ] . FOUNDATION 2ND [ ] INSULATIOWCAULKING
[ ] FRAMING /STRAPPING [ v]IFINAL VqV7'�9
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
] FIRE-RESISTANT CONSTRUCTION [ ] 'FIRE RESISTANT PENETRATION
[ .] ELECTRICAL.(ROUGH) [ ] ELECTRICAL (FINAL)
[ } CODE VIOLATION [ ] .PRE C/O [ ] RENTAL
REMARKS:
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S�FFOIK :.
o� eoo : . TOWN OF.SOUTHOLD-BUILDING.DEPARTMENT
_? s Town Hall:Anriex 543:75 Main:Road P. O.'Box 1179:Southold;NY 11971'0959:.: '- "
Tele hone 631 765-1.80:2 Fax.(f31 765=95:02 htt s/lwwwsoutholdtowrin . ov
p.. (. ) P y.�: ..
.. ... :.. Da.. � to. Receive..
APPLICATION FOR-WILDING PERMIT Ic rFor OfficeUse'Only �] "
-PERM IT Building' _ �.... B
inspector:' 6
FEB:.1 202.2: .
Applications:and forms must be filled out in their entirety.Incomplete DEPT.: BUILDING
applications will not be accepted. Where'the Applicant is not the owner,an TOWN OF SOUTHOLD
:.. .. .... .. .... .. .... .. .... .. ..
Owner's Authorization form(Page 2)shall be:completed; : .
:Date:: pq
. . -: 1. -
OWNER(S)OF PROPERTY: .... .: .... .: .... .. ....
Name:
Al ISCTM"##.1000 `
.. .. ..
Physical Address:
s
:. Phone#::.
..
:Mailing'Address::.. .-::
CONTACT PERSON:
Name: ..0
Mailing Address: .. ....
vet obb
.Phone#:
S T
Email:
.DESIGN PROFESSIONAL INFOR M4'ATION' :.: p :. ....
Name: a.
Mailing Address: :.. ..:: :.. ..::
:.Phone#.:: .. : .
: .. Email:
: ..:CONTRACT:OR INFORMATION-'::' :. ..>=
Name'. �U�....
Mailing Address:
Phone#:
b15Email: " 106 6 ieoj Q �.
.DESCRIPTION OF PROPOSED:CONSTRUCTIONsa
"
:.. ..::
❑New:Structure:❑Addition. ❑Alteration ❑Repair_El Demolition Estimated Cost of:Project:
Other
Will the lot be re-graded? *es'El No :: Will excess fill be removed from premises? s ❑No
PROPERTY INFORMATION
Existing use of property: es t clQ��c-e Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
-e % t CQ-L-"4—z this property? I]Yes\tA-lo IF YES,PROVIDE A COPY.
LQQheck Box After Reading: The owner/contractor/deslgn professional Is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code.APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and In building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the Now York State Penal Law.
Application Submitted By(print name): i4o?o'-� Authorized Agent ❑Owner
Signature of Applicant: cL CONNIE D.BUNCH Date: f �J�/Lp22
otary Public,State of New York
STATE OF NEW YORK) No.01 BU6186050
SS:nn Qualified in Suffolk County
COUNTY OF6Qt -- t'�p��L ) Commission Expires April 14,2 as
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(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 20
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, (>a'CZsI V►1CIS ✓411
"I I S��re yIsiidinng at �� � Y1 ASC�t �
ion to r,cL Coo 1&are�r�
)c�- do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
q��4 Q- 2/11/22
Owner's Signature Date
Gerasimos Alissandratos
Print Owner's Name
2
P
OS%3FF91/( ( BUILDING DEPARTMENT- Electrical Inspector
Gy
D l!� N OF SOUTHOLD
i'�1nrn Hall Ann - 4375 Main Road - PO Box 1179
co 'x �H{�� 3 I ?Q,9-buthq d� New York 11971-0959
suRelppbone (631-) 765-1802 - FAX (631) 765-9502
rogJ�{W�s�8l�fh0ldtownny.gov - seand(cD-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: CD000
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: I To s
Address: 2 ,s
Cross Street:
Phone No.: 68 3
Bldg.Permit#: 47jr4 r113 email: <aEgr�s��tosAr;i 4�� �z4s GMdI Coo
Tax Map District: 1000 Section: 167 -
Block: 9 Lot: I AG
G
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: ❑ YES E�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[-]Fire Reconnect[]Flood Reconnect[:]Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 0 H Frame 0 Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
'�✓ uFFO(A, � `i � BUILDING DEPARTMENT
N OF SOUTHOLDaI Inspector
+, y� Town Hall Ann b4375 Main Road - PO Box 1179
A Q . 208outhold New York 11971-0959
ZIP
suT�elgpbone (631 j 765-1802 - FAX (631) 765-9502
rog I-lthbldtownny.gov — seand(aD-southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: - I.- ZZ
Company Name:
re—
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street: L AT14/�,KA L-&Q
Phone No.: ( '58 .3 ( 7
Bldg.Permit email: �Er�r�si�tosat.►yQ�� �7os G�rAi coM
Tax Map District: 1000 Section: Block: Lot: 1 . l G
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle 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❑1 Ph❑3 Ph Size: A # Meters Old Meter#
El New.Service[—]Fire Reconnect[:]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals , 1 02 0 H Frame Pole Work done.on Service? Y N
Additional Information:
PAYMENT DUE'WITH APPLICATION f1 I
PERMIT# Address:
Switches
Outlets
GFI's .
Surface
Sconces
H H's
UC Lts
Fans Fridge HW
Exhaust Oven Dryer
Smokes DW Service
Carbon . Micro: Generator.
Combo.. Cookto Transfer
AC A Mini
y
Special:
Comments:
�J/
A�&
I
1 -
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i
DATE(MMIDDIYYYY)
ACC) " CERTIFICATE OF LIABILITY INSURANCE
os/osi2o21
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 tertificaW holder is an:ADDITIONAL INSURED,the:policy(ies.1must have ADDITIONAL INSURED provisions or be endorsed.
if:SUBROGATION.IS WAIVED;;;subject to the terms'and:conditions.of-the policy,certain pol(cies:may require an endorsement. A•statement on
this certificate does'not confer rights,to the'certificate holdeYin'lieu of.such endorsement s
.. . .. .. .: CONTACT .. .: ... -
PRODUCER' MorstamGeneral Agency NAME:
P O Box.9006. HONK 631 578=0890 AAA roo: 631 582-1412
New Hyde.Park, NY 11040 aooaesS.
INSURERS AFFORDINGCOVERAGE NAIC#'
iNSURER'A:'C.entU Surety COm .an :36951
INSURED Long Island-Pool.Care,Corp:G INSURER•B:
PO BOX;1.690 INSURER C
INSURER D-
.SOuthOld NY 1:1971 (INSURER E:
INSURER F:'
COVERAGES CERTIFICATE.NUMBER- REVISION NUMBER:'
THI-9,IS TO CERTIFY THAT THE P.OL'ICIES OF:'JNSURANCE LISTED BELOW.HAVE BEEN-ISSUED.TO THE INSURED NAMED ABOVE-FOR',THE POLICY PERIOD
INDICATED:. NOTWITHSTANDING ANY REQUIREMENT.'TERM OR:CONDITION OF'ANY.CONTRAGT 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.
EXGLUSIONS`AND CONDITIONS'OF SUCH POLICIES..LIMITS'.SH..OWN.MAY HAVE.BEEN REDUCED BY PAID;CLAIMSs
INSR ADD S BR POLICY EFF POLICY P
LTR_ TYPE OF INSURANCE POLICYNUMBER- MM1DD MMIDD LIMITS
)f .COMMERCUILCIENERALLIABILITY
. EACH OCCURRENCE $ 1,000;000
CLAIMS-MADE' ^ I.OCCUR PREMISES Ea.o�hce $ 1001-000'
A w CCP970688 a 04/30/21: 04/30/22. Mm W(A. ,ore person) . :S 5,000
PERSONAL a Aw,iNJURY;, $ 1;400,000
GENERLJGREGAT ;Q00.GN'LAGGREGATE.UMITAPPLIE9:PER; Z0
PRO- ..
POLICY.❑ a
PRODUCTS COMP/OP AGG .$ toOA
JECT LOC 1000
,OTHER: S
AUTOMOBILE LIABILITY. ,. COMBINED SINGLE LIMIT $
Ea accident
ANY'AUTO 'BODILY.INJURY(Per person) $
OWNED SCHEDULED.
AUTOSONLY AUTOS. BODILY INJURY(Pecaocident) $
HIRED NOWOWNED PROPERTY DAMAGE' $
AUTOS ONLY AUrOS'ONLY Per acddenl
UMBRELLALIAB OCCUR EACHOCCURRENCE $.
E)ICESSIiABH.CLAIMS-MADE AGGREGATE. $
.DED RETENTION $
WORxERSCOMPENSATION PER OTH-
ANOEMPLOYERS'646iLITY YIN N STATUTE `ER .
ANYPROPRIETORIPARTNER(EXECUTIVE ❑.NIA E.L.EACH ACCIDENT $
OFFICERIM EMBEREXCLUDED?
(Mandatory inNH)- E.L.DISEASE-EAEMPLOYEE $
I►yyeess desaihe under "
DESCRIPTION OF OPERATIONS below E.L.DISEASE r POLICY LIMIT $
DESCRIPTIONOF OPERATIONS.I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may.he-attached.ifmora,spaceIs:required)
SUBJEC.TTO COMPANY TERMS,CONDITIONS AND EXCLUSIONS
CERTIFICATE HOLDER CANCELLATION
Town of Southold
Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE D VERED IN
PO Boxx 1179 • OV
Town Annex ACCORDANCE WITH THE POLICY PR N
Southold,NY 11971 AUTHORIZED REPRESENTATIVE
01988-2015 ACORD C TION'. is reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
NeRK w workers' CERTIFICATE OF INSURANCE COVERAGE
STA E Compensation
Board 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
1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured
LONG ISLAND POOL CARE CORP 631-765-8285
50000 MAIN ROAD
SOUTHOLD,NY 11971..
1c.Federal Employer Identification Number of.lnsured
or Social Security Number
Work Location of Insured(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
3b.Policy Number of Entity.Listed in Box^1a"
Building Department-Town Hall Annex
P.O. Box 1.1:79
DBL357404
Southold NY 11971 3c.Policy effective period
.04/19/2021 to,
04/18/2022.
4. Policy provides.the following"benefits:
A.Both disability and-paid.family leave benefits. .
.B.Dlsab'ility:ben efits only
C.:Paid family leave benefits only.
5: Policy,`covers:- ,
W. ...All,of the employer's employees eligible under the NYS Disability and,Paid Family Leave Benefits Law.
Q,B.Only the following:class or;classes'of employer's employees;
Under penalty of.perl'ury,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 6/9/2021 By
.(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 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 513 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.
D13-120.1 (10-17) 11111111°°°1°1°1°1°°1°11°111°11°111°IIIIIII
AC Rosn4reo21® . CERTIFICATE OF LIABILITY INSURANCE rATE(MMDDIYYYY)4I2021
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 endomement(s).
PRODUCER CONTACT Laura Fauteux
NAME:
McMann Price Agency,Inc. PHONE (631)477-1680AIr
No: (631)477-6930
828 Front Street ADDRESS: laura@mcmannprice.com
PO Box 2065 INSURERS AFFORDING COVERAGE NAIC a
Greenport NY 11944-0876 INSURERA: Wesoo Insurance Co.
INSURED INSURER B
Long Island Pool Care Corp INSURER C:
50000 Main Rd INSURER D
INSURER E'
Southold NY 11971 INSURERF:
COVERAGES CERTIFICATE NUMBER: CL2161403146 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES'6P INSURANCE LISTED BELOW RAW BEEN ISSUED TO THE INSURED NAMED"ABOVETOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY.REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND'CONDITIONS.OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS.
INSRTR wffl�TYPE OF INSURANCE. POLICY NUMBER' t MIOR UICY EFF" MMID IYYY LIMITS „..
COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE S
CLAIMS-MADE Q OCCUR: PREMISES Ea omurrenee S
MED EXP(Amc one person) S
PERSONAL&ADV INJURY S•
GEN'LAGGREGATEUM"'APPUES'P,ER GENERAL AGGREGATE S
�POLICY❑'EC Q:.,LOC PRODUCTS COMPIOPAGG S
;_O*Eh:' S
AUTOMOBILEUABILITY- COMBINEOSINGLE,LIMIT
a eoeitlem
ANYAUTO BODILY INJURY(Per peison) ' S
OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) S
HIRED NON OWNED PROPERTY DAMAGE' S
AUTOS ONLY AUTOS ONLY Pabaeddant
S
UMBRELLA LUAB HOCCUR EACH OCCURRENCE S
EXCESS LIAR CLAIMS-MADE AGGREGATE S
DED I I RETENTION$ S
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER
ANY PROPRIETORIPARTNERIEXECUTIVE YIN 500.000
A NIA WWC3521424 04119/2021 04119i2022 E.LFJACHACCIDENT S
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L DISEASE-EA EMPLOYEE S 500.000
if yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500.000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Town of Southold Building Department ACCORDANCE WITH THE POLICY PROVISIONS.
Town Hall Annex
PO Box 1179 AUTHORIZED REPRE A
Southold NY 11971
61988-2015 ACORD C T10N. A11 rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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KURT WERBER a MARY ELLEN WERBER SEPT IO, 1986
LOT 16 "MAP OF LAND'S END" M AY 14, 1986
JULY 23,1985
AT ORIENT POINT DATE: JULY 11, 1985
-TOWN OF SOUTHOLD SCALE: I" =50'
SUFFOLK COUNTY, NEW YORK NO. 85-559
N UNAUTHORIZED ALTERATION OR ADDITION TO THIS
SURVEY M A VIOLATION OF SECTION 7209 OF THE
NEW YORK STATE EDUCATION LAW
*COPIES Of THIS SURVEY HOT BEARING THE LAND ���E QF lV��
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL - A
IIOGUANANTEESOINDICATED TOD HEREON!SHALL RUN ONLYTO �P�D Hf' d �P
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PERSON FOR WHOM THE SURVEY IS PREPARED A�
AND ON HIS BEHALF TO THE TITLE COMPANY,GOVERN- ti
N NEAREST WATER MAIM—..MI. *SOURCE OF WATER' PRIATE_.',FUALIC_ MENTAL AGENCY AND LENDING INSTITUTION LISTED
N SUFF CO. TAX MAP DIST 1000,SECTION nit BLOCK_02—LOT 1.ia HEREON,AND TO THE ASSIGNEES OF THE LENDING
*THERE AMC NO DWELLINN WITHIN 100 FEET OF THIS PROPERTY INSTITUTION. GUARANTEES ARE HOT TRANSFERABLE
OTHER TNAM THOSE SHOWN HEREON. TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT
N THE WATER SUPPLY AND SEWAGE 01610011AL SYSTEM FOR THIS RESIDENCE OWNERS
WILL CONFORM TO THE STANDARDS Of THE SUFFOLK COUNTY DEPARTMENT *DISTANCES SHOWN HEREON FROM PROPERTY LINES
Of HEALTH BLRVICES. TOEXISTING STRUCTURES ARE FOR A SPECIFIC
AP►LICANTf PURPOSE AND ARE NOT TO BE USED TO ESTABLISH Q�
PROPERTY LINES OR FOR THE ERECTION OF FENCES 44 D S1tRd��v
ADDRESS
OSTRADER
YOUNG 8k YOUNG RIIVVERHEADsNEW YORKE
NOTES; ■=MONUMENT AREA=55,439S.F. ALDEN W.YOUNG PROFESSIONAL ENGINEER
SUBDIVISION MAP FILED IN THE OFFICE OF THE CLERK OF
SUFFOLK COUNTY ON MAY 3,1973 AS FILE NO.5909 AND LAND SURVEYOR N.Y.S.UCENSE NO.12845
HOWARD W.YOUNG, LAND SURVEYOR
*TIM LOCATION OFWELL(W),SEPTIC TANK(ST)&CESSPOOLS(CPI SHOWN HEREON N.Y.S.LICENSE NO.45893
ARE FROM FIELD OABERVATIONS AND OR DATA OBTAINED FROM OTHERS
BRANDIS Ni SONS INC. 1046
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LOT 16 "MAP OF LANDS'END" MAY"2 T 1' 985 986
JULY 3
AT ."...ORIENT POINT... DATE: JULY.11'.1985
:TOWN OF:SO SCALE 1"=50': -' UTHOLO:: ... .
SUFFOLK•COUNTY,NEW YORK No. 95=559•
«am6li (MIEEo ALTERATION OR ADDITION TD:THIS
SURVEY I!A VIOLATION or SECTION TIOB OF THE
M[W YORR STATE[OYCAT ION LAW
«CO►IES OF THIS SURVEY NOT BEARNG THE LAND �p4EOF ryI-�y
.. .- SURVEYOR's HIRED BEAL OR EMBOSSED SEAL$HALL
. - MOUAR�NTLLSOINOICAT90 MERfOD TO Of A M DSHALLL�UN.ONLY TO •IICOPY �pD W'h Off*
TII FERSOM FOR WHOM THE SURVEY 1/PREPARED O O
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT T G
.. ... .. ANO.OM'HIS uIULFTo.T1lEmlecoNFANr,Govwx- �M •.
. .M MAEESTWqp���AIM�MI.S 4SOURCE OF WTATIRI,FIHW►TE _FUSLIC_.. MENTAL AOfNCY,AND LENDING INSTITUTION LISTED. p ...
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:NTMIR AIR MD MELLDMB WITMINAGO FEET OF VMIS.PRO►ERTY 'INSTITUTION.GUARANTTEES ARE NOT TN117![IIIWASLE.
orNER IMAM THOSE SHOWN HEREON, - -TO ADDITIONAL tNSTITUT10Nt OR aUSSEOUEMT
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• •AIFYCAMT•-• - '' -• ,PRO►ERTY LIMp.DA FOR THE ERECTION OF FENCES SOS'Ei�
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YOUNG AYYOUNG RIIVVERHEADN EW YORKE
NOTES, ■•MONUMENT AREA-55,4390.F. ALOEN ' '
SUBDIVISION MAP'ALED IN THE OFFICE OF THE CLER 'W.YOUNOT PROFESSIONAL ENGINEER
K OF
SUFFOLK COUNTY-ON MAY 3,19T3 AS FILE N0:5908. AND:LAND SURVEYOR N,Y.S.UCENSEWO:12845
La HOWARD W.YOUNG;LAND SURVEYOR
.*TN[LOOLTOMaF W ILUW),@ERIe'rAMNUTIBCESY00LS101 SHOWN HMO" N.Y.&LICENSE,NO.45893
ARE FROM FIELD 0089NATMS moan DATA OSTAIN@o FROM OTHER@
' SIIAN01$A'/GINS INC.WN
APPROVED AS NOTED COMPLY WITH ALL CODES OF _
NEW YORK STATE & TOWN CODES
:
DATE: S.O B P r 3 AS REQUIRED AND CONDITIONS OF:
E E:'s 3v'D•�7 BY: - SOUTHQb TOWN ZBA ,
10TIFY BUILDING DEPARTMENT AT SOUTHOLD TOWN PLANNINOIDARD.
-35-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS: SOUTHOID TOWN TRUSTEES-
1. FOUNDATION - TWO REQUIRED N;Y.S:DEC
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
aLL CONSTRUCTION SHALL MEET THE CY OCCUPAN OR
REQUIREMENTS OF THE CODES OF NEW II
PORK STATE. NOT RESPONSIBLE FOR USE IS UNLAWFUL
DESIGN OR ,CONSTRUCTION ERRORS.
WITHOUT CERTIFICATr
OF OCCUPANCY
M:Vg�ipO�o TELY
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UPON.CO(VIPLETION
BEFORE"WATER" RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
OF THE TOWN CODE.
82CMCAL INVOOM
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NOTES -
10" 50' 10° V
1. NO SOIL SURCHARGE PERMITTED WITHIN 4 FEET OF EXCAVATION AT THE SHALLOW END,OR FEET OFEXCAVATION ATTHE DEEP END.
J
B 2. THIS POOL MEETS THE PEOVIREMENT5 OF AN5I/APSP/ICC-5'AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROUND SWIMMING O
POOLS"AND 1996 BOCA CODE-SECTION 421.DIVING EQUIPMENT15 NOTALLOWED. O
o 3. SWIMMING POOL SHALL BE COMPLETELY AND CONTINUOUSLY SURROUNDED WITH A BARRIER CONSTRUCTED LAW REQUIREMENTS OF
SECTION R326.4.2.1 THROUGH R326.4.2.6 OF THE NEW YORK STATE RESIDENTIAL CODE(2020)AND IN CONFORMITY WITH ALL SECTIONS
OF THE SOUTHOLD TOWN COPE.DWELLING WALL(5)MAY 5ERVE AS PART OF THE POOL BARRI ER AS PEP SECTION R326.4.2.8 AND Q
CONDITION(1)ARE MET.OPERABLE WINDOWS IN THE WALL(S)USED AS A BARRIER SHALL HAVE A SELF LATCHING DEVICE.ACCESS GATES
SHALL COMPLY WITH SECTION R326.5.2 OF THE NYS RESIDENTIAL CODE(2020)AND BE SELF CLOSING,SELF LATCHING AND BE SECVRELY z
LOCKED WHEN POOL 15 NOT IN USE OR SUPERVISED.ALL GATES ARE TO OPEN AWAY FROM THE POOLAREA. e
T
w 4. DUPING CONSTRUCTION THE ZONTPACTOR SHALL ERECTA TEMPORARY BAPPIEKAROUND THE EXCAVAT10N LAW THE COPE OFTHIE � �
A H o H o TOWN OF SOUTHOLD. V) N Z
'^ W5
5. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING ENTRY INTO THE WATER AND SOVNDINGAN ( �
AVDIBLEALARM UPON DETECTION THAT 15 A;DIBLEAT POOLSIDE AND INSIDE THE DWELLING. THE ALARM MUST BE INSTALLED, V Q �
MAINTAINED AND USED IN ACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS.THEALAIRM MUSTMEETA5TM F2208 Z 0' O
"STANDARD 5PECIFICATION FOR POOLALARMS THE DEVICE MUSTOPERATE INDEPENDENT(NOTfATTACHED TO OR DEPENDENTON)OF O
PERSONS. O O O
v
0
6. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS)MU5T BE PROVIDED WITH A COVER THATCONFORM5 TO ASMUANSI '-� L
A112.19.SMO2A MINIMUM I6'x23"DRAIN GRATE ORA CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MUST BE EQUIPPED WITH
ATMOSPHERIC VACUUM RELIEF IN THE EVENT THE GRATE COVERS LOCATED WITHIN THE POOL BECOME MISSING OIR BROKEN. SUCH
VACUUM RELIEF SYSTEMS SHALL CONFORM WITH ASME A112.19.17 OR BE A GRAVITY SYSTEM APPROVED BY THE TOWN OF SOUTHOLD.
PLAN POOL SHALL 3E PROVIDED WITH A MINIMUM CF 2 SUCTION FITTINGS OF THE ABOVE MENTIONED HYPE.THE SUCTION FITTINGS 5HAILL BE
SEPARATED BY A MINIMUM OF 3'AND MUST BE PIPED SUCH THAT WATER 15 DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A
N.T.S. VACUUM RELIEF-PROTECTED LINE TO THE PUMP(OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCESSIBLE
POURED CONCRETE WALLAND STEPS POSITION,MINIMUM OF 6"AND NO GREATER THAN 12"BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENITTO Q)
THE SKIMMER/5KIMMERS.A REQUIRED POOL ATMOSPHERIC VACUUM RELIEF SYSTEM SHALL BE INSTALLED AS PER NYS RESIDENTIAL CODE u
} R326.6.3(2020)AND IN ACCORDANCE WITH TOWN CODE.
o
v 7. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENT50F NFPA70(NEC)PRINCIPALLY ARTICLE 680 AND THE NYS "lT
RESIDENTIAL CODE SECTIONS 4201 THROUGH 4206.ALL ELECTRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS LABORATORIES,AND
Ql
2'TO 4"SAND BOTTOM R BE PROTECTED BY A GROUND FAULT CURRENT NTERRUPTER(GFC0 CURRENT CARRYING ELECTR[CAL CONDUCTORS EXCEPT FOR THOSE
PROVIDING POWER TO POOL LIGHTING AND POOL EQUI PM ENT 5 HALL MEET THE 5 EPA RATION REQUIREMENTS OF TABLE E4203.5.ALL Ln
METAL ENCLOSURES,FENCES 0R RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECITRICALLY CHARGED �
DUE TO CONTACT WITH AN EECTRICALCLRCUITSHALL BE EFFECTIVELY GPOUNDED. f'S
i _1111
5 ECTI ON A S. WATER SOURCE FILLING THE FOOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICE LAW NYS PLUMBING CODE 608. '( Ln
o r7 Ol
N.T.S. 9. ALL PIPING 15 DIAGRAMMATIC UNLESS OTHERWISE STATED. C" �n w}
TOP OF WALL _u 'tT Z
WATERLINE 10. WALKS IF PROVIDED SHALL BENON5LIPAND SLOPE AWAY FROM POOL EDGE.
4' 12' 4' ` 11. A MEANS OF EGRESS FOR DEEP AND SHALLOW END5 MUST BE PROVIDED LAW ANSI/APSP/ICC-5 SECTION 6. 0 0 -� N
a d CL
m 0 12. CONTRACTOR TO PLACE THE POOL LAW TOWN OF 5OUTHOLD CODE SETBACKS.
n
13. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SUBJECT PROPERTY.
N
N
15. THE DESIGN 15 BASED ON A DRAINAGE SOIL WI-H(10%SILT. GROUND WATER SHALL NOT EXIST WITHIN THE EXCAVATION. IFGROU'ND
WATER EXISTS WITHIN 6'-O"FLOM GRADE,DEWATERING FACILITIES WILL BE REQUIRED.
SECTION.B N
16. ALL GAS AND OICHEATERS([FINSTALLED)FORTHEINGROVNDSWIMMINGPOOLSHALLBENATIONALAPPLIANCEENERGY
N.T.S. CONSERVATION ACT(NAECA)COMPLIANT. POOL HEATERS SHALL BE TESTED LAW ANSI 721.56 AN D SHALL BE INSTALLED LAW
MANUFACTURERS SPECIFICATIONS. OIL FIRED POOL HEATERS SHALL BE TESTED IAW VL726. POOL HEATERS SHALL BE LOCATED OR
GUARDED TO PROTECTAGAIN517ACCIDENTAL CONTACT OF HOT SURFACES BY PERSONS. POOL HEATERS SHALL BE PROVIDED WITH
2'2" TEMPERATUREAND PRESSURE-RELIEF VALVES. FOR HEATERS NOT PROVIDED WITH AN INTEGRAL BYPASS SYSTEM.A BYPASS LINE SHALL BE
INSTALLED FROM INLET TO OVTLETTO ADIUSTWATER FLOW THROUGH THE HEATER. POOL HEATERS SHALL BE PROVIDED WITH THE W IT
CHECK VALVE COPING AND WALKWAY 10" FOLLOW[NG EN ERGY CONSERVATION MEASURES: +� o
(BY OTHERS) v lt
PUMP FROM SKIMMER GRADE 0
WATERLINE 16.1 ATLFASTONETHERMOSTgTSHALLBEPROVIDEDFORFACHHFA�TING5Y5TEM.
`v 16.2 ALL POOL HEATERS SHALL BE=QUIPPED WITH AN ON-OFF SWITCH MOUNTED FOUR EASYACCE55 TO ALLOW SHUTTING OFF THE
a' OPERATION OF THE HEATER WITHOUTAD)U5TING THE THERMOSTAT SETTING AND TO ALLOW RESTARTING WITHOUT PELIGHTING 7HE
To DISPosAU .. PILOT LIGHT. W n r N a
DRYWELL UNDISTURBED EARTH 16.3 HEATED SWIMMING POOLS SHALL BE EQUIPPED WITH A POOL COVER(EXEMPTED FROM THIS REQUIREMENTARE OUTDOOR POOLS W Q}T 00 co m y
VBESETis CZG{i D
/ 3500 PSI POVRED CONC. DERIVING20%OFTHEENERG FOR HEATINGFROM RENEWABLE 50UPCE5 AS COMPUTED OVER AN OPERATING SEASON) Z iO
DIVERTERJ 3/8"REBAR.2)TYP. 16.4 TIME CLOCKS SHALL BE INSTALLED 50 THE PUMP CAN BE SET TO 2UN DURING OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN ��tt11 :iC n n e ce
VALVE O TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN A CLEAN AND SANITARY CONDITION IAWAPPLICABLE V�y E^^e a
VINYL LINER •d SANITARY CODE OF NEW YORK STALE.• z _ Ud
co X
2'T04`5AND N G tDV X LL^
FILTER 17. THIS DRAWING IS FORSTRVCTURALSHELLONLf. ALLACCESSORIESANDAPPURTENANCESAREDEIFINEDBYOTHERS. Yy; u
18. BACKFILL WITH CLEAN EARTH,FREE OF ROOTSAND DEBRIS. DO NOTALLOW THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHT OFIIHE
WATER IN THE POOL BY MORE THAN 8", OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8"
FNE
TO RETURNS 19. PLACE CONCRETE ON SANDY TO LOAM SOIL, REMOVE ANY CLAY DEPOSITAND REPLACE W/COMPACTED CLEAN BACKFILL. V ��O y O
CHECK VALVE VERTICAL REBAR03'O.0 20. THERE I5 NOMAIN DRAIN IN THIS POOL.SUCTION FOR POOL WATER CIRCVLATION IS PROVIDED BY THE SKIMMERS ONLY.THIS MEETS 3 `P DER THQ
PLUMBING SCHEMATIC (NOT SHOWN)
' woe
REQUIREMENTS OFTHE NYS RESIDENTIAL CODE-SECTION R3265 FOR ENTRAPMENT PROTECTION.
N.TS,
WALL SECTION 21. THE POOL WAS DESIGNED LAW THE FOLLOWING: hAc`
N.T.S. 21.1. THE NEW YORK STATE RESID=NTIALCODE-SECTION R326(2020) r = I N,. D W
21.2. THE NEW YORK STATE ENERGY CONSERVATION CONSTRUCTION CODE-SECTIONI R403.10(2020) n U s` m
LJ
21.3. THE NEW YORKSTATE FVELGAS CODE(2020) �I�I '„'
21.4. THE NEW Y•ORKSTATE SANITARY CODE. ® V �T' `
21.5. ANSI/AP5P/ICC-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS. ^� '
21.6. BOCACODE-5ECTION421. ��� p ^o^n �J p� 088476
21.7. CODE OF THE TOWN OF SOUTHOLD. I L LL
O ESS10
22. ALL BACKWASH TO BE SELF-CONTAINED ON-SITE. Im
BUILDING DEPT.
TOWN OF SOUTHOLD