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HomeMy WebLinkAbout50671-Z F SOUryO!° Town of Southold * * P.O. Box 1179 �0 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 45987 Date: 02/20/2025 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 540 The Greenway East Marion, NY 11939 S ecBlock/Lot: 30.-2-43 Conforms substantially to the Application for Building Permit heretofore,filed in this office dated: 04/02/2024 Pursuant to which Building Permit No. 50671 and dated: 05/14/2024 Was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: In-ground swimming pool fenced to code as applied for. The certificate is issued to: Greenway LI LLC Of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL: ELECTRICAL CERTIFICATE: 24-96964 11/31/2024 PLUMBERS CERTIFICATION: r tho ' d ignature �sufFetK�o TOWN OF SOUTHOLD BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE o � SOUTHOLD, NY 1,43 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#: 50671 Date: 5/14/2024 Permission is hereby granted to: Greenway LI LLC 11 Livingston St Bayshore, NY 11706 To: Construct an in ground swimming pool accessory to an existing single-family dwelling as applied for. Pool and pool equipment must maintain a minimum side and rear yard setback of 10 feet. At premises located at: 540 The Greenway, East Marion SCTM #473889 Sec/Block/Lot# 30.-2-43 Pursuant to application dated 4/2/2024 and approved by the Building Inspector. To expire on 11/13/2025. Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: $400.00 Building Inspector " Certificate of Compliance' . ' _ - - .. 1 I! -i! -, I I CERTIFIED;ELECTRICAL INSPECTIONS, II, _ - _ A88t PARK AVENUE . AMITYVILn t NY-1170.1 ; ` P (6& 598 5610 J CERTIFIES THAT' . , Upon the application of` Upon premises owned by - Bnll'iant Electric ,, Greenway LI LLC/Laurie 20 Pratt Oval Klee ;J (,. , A 540 The"Greenway �, " , t Glen Cove:, NY 11542 ! h t , Marion NY 11939 .i i 4,`x a , s,.fi , ,,it t r' LocatedJat: 540 The Gr'-eenway East „ r East Ma'non, NY`11939 °', i _ 4 - fi ti Application Number#`24 96964 +Certificate# 24,W964 Y �.` 1 Y, yl ..-� - ! t ! J ! 5 -, 4 v !1 4 t ,i Y,II.j,�. f Electrical License# 40896ME 1 , y ' t s ! t t. '� d t Y w� ( ' 't t ,x ._. n -� , — ,I 1 4 } ,J t — , t. Lot Building Penmrt# 50320/50324 / Section 30 k Blo ? ,;4 71 ; r ck 1 3 '., -, } A i J 111 J' , 1. _ -I ' r_. - r I 1'1. . f l }�(, i`...L. t yt-,J +, f 3 I 4.1 r' , n a ' t yl r ,.,r 1 t ii t .+ . { tit t { _-�F Name' QTY r,' 4 , . - Meter 200 Arne, 240V ,' ` I t i 4 J. . ` t t t ,' e v ( F { Meter'' 200 Amp; 240V t , , 11 , r{ '�a �' ✓ ,- r .r '{ k `tn .' r v•"1 ! t4 :r R t ., ;,, ` ! T I -, Y - Pool Receptacle°20 Arnp,;240V 1 Y Power Panel 200 Amp, 240V r 1 I J :a i '.' L ReaesSed'Fixtur'e 15 Arnp, 120V; I157 " f r P! U Y y i t Service Disconnect 200 Amp, 240-:i� �1 rt - 1t ,. _ 4� `' Service,Dsconnect '200 Amp, 2,.,V 1 t t !t t J t f t -i 4 f t ry _ -,4: } ` l — 1 - h Seance Feeders 200 Amp;, ,., , ; : t _ 1'! ' rs ' , s Smoke Detector `15 Amp,'120U , 7 ` ' , S , Swimming Pool�Bondmg , ti 'a1 a w , r ) I ': ' R t , TI , f ST 1.1-- s r Sviiitcti 15 Amp, 1f20y t` , ,1 F ', , i c , ! fit . `' :;} . ectricaf,lnspector Anthony Grordano a j 11 `11 ?; ;,7 ,.; I' a f i yt � '', . \auu1w111 ' ; •'- ,, x 1 r 1 y. t, { `ro ! ,.. i 1 e�e. E� l t . '^ — iAPPROVED=o - - �y, �„ ' {tit , _ . {. -_ i' { - l �-//pIIII II111\\\\\ a s. , , ',i:, i t _ j _ _ _ —i ' , ., .,, _ , „ - ,t t_,. n ,�, ..-. y << -t -C.I t - j' - ' ' - . ., Certificate;of Compliance .............. ....... .................. . CERTIFIED ELECTRICAL INSP,ECTIONS,'INC. 188.PARK"AVENUE V AMITYVILLE, NY 11701 P (631) 598 5610' �p2 :................................................ .... ..... ...... :` ... CERTIFIES THAT Upon the,application of . Upon premises owner Greenway 11 LLC / Laurie �� Brilliant Electric'_ 20 Pratt Oval 540 The;Greenway: . Glen Cove`, NY 11542 East.Manon,',NY 11,939 Located a't: 540'The Greenway, East Mari6n,1 .11939. f App icati_o,'n Number#: 24 96964 Certificate# ,24=96964; Electrical-License# 40896ME Lot Building Permit# 50320 /50321 '/ ., • '-. . Section:;3q ,, Block 2 Described as a.,Residential occupancy;:wherein t-,e;premises`electrical•"system consisting,of„ electrical devices_and wiring, described below, th located in/on e premises at. New Single Familypwelling w/.Rear Deck/HVAC/ Detached Accessory'Garage Apartment w/ Attached Per ola/Coyere otio/''Inground Swimiming'Pool A visual inspection,of the premises electrical system, limited to electrical devices and>wir ng_to the extent detailed herein, was conducted-in'.ac;6' ance with•the:require'ments-of the;applicable code/o'%standard'promulgafed by_the State of New York, Department of Stafie'Code Enforcement aril Administration, orother.,a'dt"hority having lur".isdiction, ar d`•found:to be'in compliance therewith on the 30th day°o ovember 2024' Name Power Panel 2'OO-Amp, 240V" 1 ARC Fault 20 Amp, 120V 15 AC_Condenser 30 Amp, 220V 2 - Motion Light Fixture 15 Arnp, 120V :1 GFI Receptacle 1.5'Amp, 120 V 16 Feet Tape Lighting :15/2 Amp, 12Q712 V 16 Pobl Panel 60:Am 240V, 1 Electrical,Inspector Anthony Giordano ; .\.LC Nz Salo IAPPROVED o= ,. i.,.. -. -.. - _, ' Cerfifi_eate-,of Compliance = ...... J , ,. . CERTIFIED;ELECTRICAL INSPECTIONS, fNC 188 PARK AVENU,E,.. _ AMIVVILLE, NY 11' - _ , P (631)'S98 5610 .Yf CERTIFIES THAT 'S' t.. a; f,. .;. _ ; Upon the application of" lJpon premises owned tby f t r r t , Greenway LI LLC/.,,I e ' -r Brilliant Electric r1,, Klei {t, "" I Y 20 Pratt Oval tl 5405 The Greeriway{', ,f" A Glen Cove', NY 11542 East'Manon;NY 11:939 ',r ' t 4: � y �. 4 !� y s t, 2 r. , I li 1 A-! 4tt ` '' ' t ;` d Gated at 540 The Greenwa , 5 i , '' h U { LO y b East Marion, NY°11939• ;, {7 _ , ' . ` f A `lication Number# 24 96964 ,`Certificatef# 24'96964 �' {' a f` Electrical.License# 40896ME ,•r ;; 'i x y 4 .. ,t� l I a r r ` t v '4. r r•+ ' zl . " , c t,,s , r . x ; ' Lots Burldmg Permit# 50320'%50321{/ Section. 30 x _ tt 06 ' r Block 2 r a 7 _ f r, r� '1. �7 ,; ,, ,r, iJ dF ,t �;t ;,,' ii 1 r, 43 71 4 •-t 1>`ti Y fy s 7 -w. : ,c ( z, r} ! t I �..', , l y t f:, , J ' <i S.J 'f w pn. f t t 6, ) t -t t r �I �„ , Name 1 �� `` ,t QTY a A { AC,Blower �15 Amp,=220V; ;^wr • ' , } `,AFZC'Fault 15,Amp, 120V 20 N r ," •A Combo Sinoke & Ctacbon Detector 15 Amp, 120V 3 -i { f , p t - 1 p f5_ kJ (�- r' '•• iFr + , / _ ! 1 Dishwasher Circuit 20 Amp,t 120V r 1, x r Duplex Receptacle ;15 Amp;V120V 1' __ , , 'r 1 Duplex Receptacle ,l15 Amp„J120V �' r :,� , r S » r ti+, li t t G `+ Y, a' a 4 1} r 1 IrF 11� r {r, _ � Ezji' ui ,Fan° 15 Amp, r w ' �' ' , � r ( �� , t 1 , Y ;, Exhaust,Hood 15,Am , 120V t P J 1; , ?! Furnace/Motor,(.4 Circuit ,20 Amp, 120V',s 1' 'i GFI Circuit Breaker 20 Amp, 220V ' t s } a y , k`' 1 t j < e r, a 1. LV Lighting Transforrn`er ,,,Amp, 1_20/12 V , 2 ,r, , ' '. g "y J P f Y - I ` Electrical Ilnspector Anthony Giordano 71 '_._ `t' n E 5. t t' , st l '.. t i t N,\U15111111I7/!// S T 7 r c S + ,t t I y 4 r r .,.,- 1^) N 1 '-Yt i i„ ", .I o c �^, f_sw a , I i APPROVEI- _ w fyr i,,' , , ` , ,� r - ` _ _ s ., je t:.. l " j .V I ' +} , - -.t�i jam,). .S r5. .rt , t t ..` t u' T - - , Cer.:.tificate'of Compliance .......................................................... .... .......... ........................................................... CERTIFIED ELECTRICAL INSPECTIONS, INC." 188-PARK AVENUE AMITYVILLE, NY 11701 'P: (63.1)'598=5610 .................................................................................... ..........CERTIFIES THAT.... t Qpon'the.application of 'Upon,premises owned by. Greenway L1'LLC / L'aune Brilliant Electric Klee 20 Fratt Oval 540 The Greenway Glen Cove;,NY 11542 East Marion, NY 11939, Located 6t.t,54Q The Greenway, -- East Marion;,NY`11939 Application Nuniber.#,: 24 96964 ;Certifcate#:.24 96964 = Electrical License# 40896ME Y; Lot Building,hermit'.# 50320 /50321 / Section:-.30 Block: 2 43 50671 s E Name QW Switch 1'5 Arnp, 120V 24 UG Seruice 17eeder="200Arnp,,240V 1' Electrical"Inspector Antho Gi ny ordano . sA� \`, wuunur i - pE SOUIyo� TOWN .OF.SOUTHOLD BUILDING DEPT. o rm,N 631-765-1802 1NSPECTI-ON [ ] FOUNDATION 1ST/ REBAR [ ]- ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SUL ION/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 INSPECTORXL1 4*1 FIELD INSPECTION REPORT DATE COMMENTS O FOUNDATION (IST) H ------------------------------------ �C FOUNDATION (2ND) 71 z QAo a ROUGH FRAMING& PLUMBING l� r INSULATION PER N.Y. H STATE ENERGY CODE 3 FINAL ADDITION C MMENTS `\ 1 �°. z t rd" L O x H x d � y o�soFFntr�o TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 oy • o� Telephone(631) 765-1802 Fax (631) 765-9502 hgps://www.southoldtowm.gov Date Received APPLICATION FOR BUILDING PERMIT E II __-7 For Office Use Only to PERMIT NO. 5 Q I I Building Inspector: APR 2 2024 Applications and forms must be filled oufintheir entirety. Incomplete applicatioris,will not be accepted.. Where-the Applicant is not the owner,an Owner''-s Authdrii6tiomf6rin(Page,2)'shall be completed. T+w��¢3P otatl?ait .I Date: OWNER(5)OF PROPERTY Name: 464AIM/ . Ll _.LLC_ SCTM #1000- - pv —_O.z, Oct-_-0V�3. 000 Project Address: Phone#: .3/' Email:/�(JS1f - -.�-• �A/G l.�7 . Mailing Address: ev 60K ._ S-4 'CONTACT-PERSON Name: Ali Mailing Address: Phone#: I 5-�(o .3g, 3 Email: /.(/ DESIGN-.PROFESSIONAL-INFORMATION Name: Mailing Address: Phone#: Email: CONTRACTOR"INFORMATION: Name: Mailing Address: .._..... � - -,�-u e . _ Phone#: Email: ._. /-_- W -PD- - - _ - -U - - DESCRIPTION OF:PROPOSED,CONSTRUCTION, ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ❑Other IAI &e Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ❑No 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ❑No IF YES, PROVIDE A COPY. 11 Check Box After Reading: The owner/contractor/design professional is responsible-for all drainage and"storm water issues as provided by chapter 236ofthe Town Code. APPLICATION IS,HEREBY MADE to ihe'Building Department fo'r"the issuarice`'of a'Building O'er mitpursuant to the Building zone Ordinance of the Town'of Southold,Suffolk,County,,New York and other applicable Caws,Ordinances or��Regulations;for the,construction,of buildings, additions,alterations or forremaval or demolition as herein iJescribeil:fhe 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(o)for necessary inspections.False statements made herein are ` punishable,as a Class Amisdemeanor pursuant to Section 2i0:45 of the New York3fate P,enaltaw. Application Submitted By(print name): AE L MEL 4ti\ )v ❑Authorized Agent Xfowner Signature of Applicant: Date: 0 0Z Z� STATE OF NEW YORK) COUNTY OF!j ) being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)he is the M ou&6e. u'C— (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 hot r day of a� 20� /1WC&'10ak_ Notary Public MOBAGNIESMA LECNOWSKK- - PROPERTY OWNER AUTHORIZATIO Notary Pub York Qualified in Suffolk County (Where the applicant is not the owner) My Comm. Expires Jan. 10, 2028 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 Suffolk County Dept.of 1 t> = Labor,Licensing&Consumer Affairs f+ONE INPROVENENT LICENSE l �3' • Name s: JOSEPH P DOMANO JR ; Business Name Th:s cerifies:hat the )earer is duly licensed DOt�11A10 POOLS INC DBA ,y the Ccunty of suffA License Number:H-16355 Rosalie Drago Issued: 03/01/1969 i Comn•:ssiorer Expires: 03/01i2025 A��® 74/1/2024 (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 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: JOSEPH C.TINGO THE TINGO INSURANCE AGENCY INC PHONE 631 619-4285 aixc No): 631 619-4289 3771 NESCONSET HIGHWAY,SUITE 210 ADDRESS: JTINGO TINGOINS.COM SOUTH SETAUKET,NY 11720 INSURERS AFFORDING COVERAGE NAIC# INSURER A: TRANSPORTATION INSURANCE COMPANY 20494 INSURED INSURER B: DOMIANO POOLS INC INSURERC: DBA POOLFECTION INSURER D: 531 RTE 111 INSURER E: HAUPPAUGE NY 11788 INSURERF: 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 SUER POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGES( RENTED PREMISES Ea occurrence) $ 300,000 X CONTRACTUAL LIABILITY MED EXP(Any one person) $ 10,000 A Y 6019985774 3/30/2024 3130/2025 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JECTO- F7 LOC PRODUCTS-COMP/OP AGG $ 2 000 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident r $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I JER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Project: 540 The Greenway, East Marion NY 11939 Rush Builders Inc.is included as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Rush Builders Inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 11 Livingston St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bay Shore, NY 11706 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - 988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD NYSI F New York State Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 0. .-7r .0 AAAAAA 113234713 TINGO INSURANCE AGENCY INC . 3771 NESCONSET HWY STE 210 . j SOUTH SETAUKET NY 11720 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOMIANO POOLS, INC.DBA RUSH BUILDERS INC POOL FECTION 11 LIVINGSTON ST 531 RTE 111 BAY SHORE NY 11706 HAUPPAUGE NY 11788 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12357 753-9 299524 04/14/2023 TO 04/14/2024 4/l/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2357 753-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW 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 WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/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 OF THE INSURED CORPORATION. PRESIDENT JOSEPH DOMIANO OF DOMIANO POOLS, INC.DBA POOL FECTION(ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STAT SUR NCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:366462666 11_7a Q /70%*N4- NYSI F New York state Insurance Fund PO Box 66699,Albany,NY 12206 1 nysif.com CERTIFICATE OF WORKERS' COMPENSATION INSURANCE (RENEWED) M. '"� .0 ^AAAAA 1132347/3 TINGO INSURANCE AGENCY INC 3771 NESCONSET HWY STE 210 .. SOUTH SETAUKET NY 11720 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER DOMIANO POOLS, INC.DBA RUSH BUILDERS INC POOL FECTION 11 LIVINGSTON ST 531 RTE 111 BAY SHORE NY 11706 HAUPPAUGE NY 11788 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12357 753-9 346423 04/14/2024 TO 04/14/2025 4/1/2024 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2357 753-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW 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 WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/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 OF THE INSURED CORPORATION. PRESIDENT JOSEPH DOMIANO OF DOMIANO POOLS, INC.DBA POOL FECTION(ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATrSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:903090612 CA od APPROVED AS NOTED OF DATE:5-1 4' 4 s.P# 5 0(vl _ COMPLY WITH ALL CODES NEW YORK STATE&TOWN CODES FE D , OU B AS RED RED AND CONDITIONS OF St?lfi{OLDIOWNZBIt NOTIFY BUILDING DEPARTMENT AT 80=700110M BOARD 631-765-1802 8AM TO 4PM FOR THE FOLLOWING INSPECTIONS: v M=T=pAw FOUNDATION-TWO REQUIRED FOR POURED CONCRETE 5 NPG ROUGH-FRAMING&PLUMBING $ INSULATION FINAL-CONSTRUCTION MUST BE COMPLETE FOR C.O. ELECTRICAL ALL CONSTRUCTION SHALL MEET THE INSPECTION REQUIRED REQUIREMENTS OF THE CODES OF NEW YORK STATE NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS RETAIN STORM WATERAUNOFF PURSUANT TO CHAPTER 236 OF THE TOWN CODE "IMMEPIATEILI" ENCLOSE.POOL TO GODS UPON COMPLETION BEFORE"WAT-EEr 1 �� , -F-or��,n .� . _ �Wit• © • - P�aDn1NG' • g•rE?5 V 1t�lYL"LtU�2, 'TY 3��faQS 3/4-aa1=�� P440 tAlO06.E per::AQ•:�'--.... vie t/8"n 1LC� •� Qt�MVD, ---- —_�• i3 � lbw . . � U U D\S"R.�• 3�� �AIZ"I' of .Pc►�U t ul V M l�T 8`-Cam" . FOUNDATION STAKEOUT LOT 105- MAP OF PEBBLE BEACH FARMS, SHEET 2 FILED: JUNE 11, 1975- MAP NO.6266 SITUATE EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. TAX MAP NO.: 1000-030.00-02.00-043.000 a LOT AREA:22,396.80 S.F. (0.514 ACRES) DATE SURVEYED: JUNE 16, 2023 m PROPERTY STAKES:DECEMBER 11,2023 ELEVATIONS REFER TO NAVD88 0 0 --ZONING:R40 a --NO WETLANDS OR SURFACE WATERS WITHIN 300' -NO WELLS WITHIN 150'OF SUBJECT PROPERTY m r LAND N/F CHERYL & ROBERT SCHEIDET a z RESIDENCE - PUBLIC WATER m o N z 0 r L T1 z i 1 n m o.s'N N66o28'1O"E q'METALFENCE / // 290.88 W 1 0.3'N M I Stake Set p / / / 40 MON.FND. y� a -4 -{ I J 9 / O / /� I oWl m 3 C t o POOL 32.0 / / NI Z I O EQUIPMENT o J_ ® EL.42.0 / EL.41.0 m INGROUND / 4R.@0/ / i ��t -q m W In I / .- EX. 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S ) LEGAL NOTES SURVEY MAP BEARING A LICENSED LAN SURVEYORS SEAL ISAVIOLATION OF SECTION T2M. n .•� ^-"^�- 2.UNAUTHORIZED ALTERATION OR ADDITION TO THIS SUR D N �'/ �`J`l.rrLand-Surve in '"� SUB-DIVISION DARYSURVEYMASWTHTHESUNLAW. O V ly�'/�1II/'��s-`- I ]ONLY BOUNDARY SURVEYMAPS WITH THE SURVEYOR'S EMBOSSED SEAL ARE GENUINE TRUE At1000RRECT COPIES OF THE GURVEYOR'S ORIGINAL WORK G ./ �-,!:'" _v:,� ANDOPI ON. CERTIFICATIONS ON THIS BOUNDARY SURVEY MAP SIGNIFY THAT THE MAP WAS PREPARED IN ACCO.RDANCEMTHTHECURRENTEMTIIIGCOOEOFPRACTICE J FORLANDSURVEYS ADOPTED BY THE NEWYORK STATE ASSOCIATION OF PROFESSIONAL"NO SURVEYORS.INC THECERTIFICATIONISLIMREDTOPERSONS () LandSurveyrn•g.& Plann' ng� L TH98MOM THE BOUNDARY 0UNOARYSURVEYMMURVEV MAP IS PREPARED.TO THE TITLE COMPANY TO THE GOVERNMENTAL AGENCY,AND TO THE LENDING INSTITUTION LISTED ON Q � ^ 5.THE CERTIFICATIONS HEREIN ARE NOT TRANSFERABLE. B THE LOCATION OF UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS ARE NOT ALWAYS KNOWN ANDOFTEN MUST BEESTUTATED IF.WY x' 153'VVacling Rider Manor Rd_.;-Manorvllle :1�.57Y� JSs UNDERGROUND IMPROVEMENTS OR ENCROACHMENTS EXIST OR ARE SHOWN,THE IMPROVEMENTS OP.ENCROACHMENTSME NOT COVERED BY THIS SURVEY D 30 60 O _/l:-....�.,-�^^ T THE OFFSETS OR DIMENSIONS)SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR ASPECIFO PURPOSEAIID USE AND THEREFORE 631 QAC ����], S ME NOT INTENDED TO GUIDE THE ERECTION OFFENCES,RETAINING WALLB FOOLS PATIOS P PLANTING PREAS.ADDITIONS TO BUILOWGS.PNDPNY OTHER TYPE Phone 4 ' VF'Y'CJ f L�f 4y -' OF CONSTRUCTION. Feet L L i��"'-�- ^^'\. �•-`tc lr L di.: B.ONLY SURVEYS BEARING THE MAKERS EMBOSSED SEAL SHOULD BE RELIED UPON SINCE OTHER THAN EMBOSSMSEA.COPIES MAY CONTAIN N emal: Info @&clan d S u rveyin g.co m UNAUTHORIZED AND UNDETECTABLE MODIFICATIONS,DELETIONS.ADDITIONS.MD CHANGES. SCALE: 1 inch= 30 feet - 9.PROPERTY CORNER MONUMENTS WERE NOT SET AS PART OF THIS SUR-VEY UNLESS OTHERWSE NOTED 7 .k �..i ID.ALL MEASUREMENTS REFER TO U.S.SURVEY FOOT 0