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HomeMy WebLinkAbout33493-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33226 Date: 08/15/08 THIS CERTIFIES that the building Location Of Property: 22642 MAIN RD ORIENT (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 18 Block 5 Lot 9.2 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated OCTOBER 16, 2007 pursuant to which Building Permit No. 33493-Z dated OCTOBER 24, 2007 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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to DAVID & GERALDINE CHADICK (OWNER) of the aforesaid building. SIIFFOL& COUNT7C DEPARTIffi~TP OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 8134 01/26/08 PLDUffiERS CERTIFICATION DATED N/A uth ized Signature Rev. 1/81 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT ' 5 TOWN HALL 765-1802 (i t APPLICATION FOR CERTIFICATE OF OCCUPANCY- T --- - ~ ____,I This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). Q Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1 % lead. 5. Commercial building, industrial building, multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy -New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy -Residential $15.00, Commercial $15.00 Date. ~ Q New Construction:~u' ~n,n~'"~ ~r'~ ~ Old or Pre-existing Building. (chec one) Location of Property: ~ a b `f o1 House No. Owner or Owners of Property: CLI~O ~OQ~ (~C'tPn•~ Street ~,a ~ r~~-, ~~~~~ l~<< Hamlet Suffolk County Tax Map No 1000, Section U ~ S Block OQ O ~ Lot Ql~c!• 0(702 Subdivision Permit No. J 3l'{ l 3 Z.. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ "~ ~ " O v p. Z ~.=e ~ 33 ~ ~? ~ / ~~~~ Filed Map. Lot: Date of Permit. 1 D~J Applicant: ~(Qr,rd f lI't'r 1 CHs3 1C Underwriters Approval: Final Certificate: ~ (check one) ~ Applicant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO_ 33493 Z Date OCTOBER 24, 2007 Permission is hereby granted to: DAVID & ORS CHADICK 415 EAST 37TH ST APT 8J NEW YORK,NY 10016 for CONSTRUCTION OF AN IN-GROUND SWIMMING POOL AS APPLIED FOR IN THE REQUIRED REAR YARD. at premises located at 22842 MAIN RD ORIENT County Tax Map No. 473889 Section 018 Block 0005 Lot No. 009.002 pursuant to application dated OCTOBER 16, 2007 and approved by the Building Inspector to expi Fee $ 250.00 ORIGINAL Rev. 5/8/02 ~ h~ a~1 Co nc~ln ~ b W how ~ I C~ ~ou .ale-Q5e 5~ 1~-e C~r~L~i~.Je, o-F CXc~~ano~ ~Cn~, ~~ `C1~e pooh ~}-o Luc- ~-~w~e IIC,,td,^, dress ~ ,~ 1 Npw ~,~I-,.IC C L-16.~ ~-S,n n c-e l/v'~ ~ D J1 t71 ~ f /"~ L ~ CL-7 C 1 1'~- o'1,a-fir ~ Z addreSr ~ n c~ ~ ~n~- . Q, l l u~~ ~r ~-a ~ I ~ s -~~ war~d~ d -b ~a~~d-r ~i Chad,~E ~--~ ~ 5 ~ a S} 3~ T'' S~ e~- ~~ f ~ ~ ~1PW ~f~-k C~-~ ~ ~~~ . ~uo~ to CcSSlS-fence , 8l~sl~ a ~ ~ of ~- Gam-; Gh.o~el tcl~ S' -~ fih ~s t s a ~ro bl~n Gov cs~ Ccr~-}acr} N•.¢ min ,µ~-~, C$6L t~ ~ 11- ~~~ S- l~~-7 TOWN OF SOUTAOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Examined ,20 Approved 20 Disapproved a/c I~r~'s ~~~~ i w 'i~ ~ cc. 16 lJ U I `.___ -.J t~LD , DEPT. T lNN ~ F S^_TNOLD Do you have or need the following, before applying ? Boazd of Health 3 sets of Bu~ g Plans ~ Survey Check' aZ.5,3 Septic Form N.Y.S.D.E.C. Trustees PERMIT NO. 3 3~{ ~ 3 ~ Mail to: Building Inspecl~ Phone: y- 71 g$ APPLICATION FOR BUILDING PERMIT Date_ ~-- ~ ~ , 20QZ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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 a Certificate of Occupancy is issued by the Building Inspector. 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 cock and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. ~ ~ ~ , ~ (Signa`[Gre of app~ant or name, if a corporation) ~~ t,~5zt- J~ltll~ Ply ,~/ 1/717 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (as on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. ~~31o-HT Plumbers License No. Electricians License Other Trade's License N 1. Location of land on whic 228 2 27{0- Mt; proposed work will be done: House Number Street Contact: Hamlet' Yiw i~ County Tax Map No. 1000 Section l g Block S ;; , . Lot ''Q • 2 - Subdivision Filed Map No. " "Ldif' (Name) BUILDING PERMIT APPLICATION CHECKLIST 2. State existing use and occupancy of premises a. Existing use and occupancy intended use and occupancy of proposed construction: b. Intended use and occupancy ~CStt>QnMfi~. ~tl, fY1A1 ~Ng YY~L, 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work~~~w,m~t,nta, Dc. (Description) 4. Estimated Cost ~1~' 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 50' Reaz 50 ' Depth fig' Height Number of Stories I Dimensions of same structure with alterations or additions: Front .Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front l~ai•~ `f0' Depth 3~~z--~ 8 ~ ~Glf Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises aze situated 12. Does proposed construction violate any zoning law, ordinance or regulation: N O 13. Will lot be re-graded ~"~- ~~ ~l~ Will excess fill be removed from premises: ES NO 14. Names of Name of Name of No. 323-01OP No Sys-Oy(ll> 15. Is this property within 100 feet of a tidal wetland? *YES NO • IF YES, SOUTHOLD TOWN TRUSTEES 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 survey. STATE OF NEW YORK) SS: COUNTY OF ) ~DWAL05 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the (f1MY/1~7bR- (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 knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Swom to before me this ~5`t" d__ay of _nn~ , /' 20Q~ I~PI~ Lt- K.I~Qe/ Notary Public Signa of Applicant MARGARET A. KIDNEY Notary Public -State of New Yodt No. 01 KI6021 I Yl f~ualHied in SulloNc County MY Canmissbn Expires hl9rch 8, 2011 ~3S'~i3~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INS ION [ ]FRAMING /STRAPPING [ . FINAL [ ]FIREPLACE 8~ CHIMNEY [ ]FIRE RESISTANT [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT PENETRATION REMARKS: 33~g3~ ~~~ ~~w a~~ ~, TOWN OF SOUTHOLD BUILDING DEPT. ~~i~ir 765-1802 ~,~ fJ, ,~~ 1 NSPECTION s,~~ ~~t [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING /STRAPPING [ ]FIREPLACE & CHIMNEY [ ]ROUGH PLBG. [ ] 1 CATION [ FINAL [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION REMARKS uN~ DATE ~0~~ 5~`~' ~ INSPECTOR G,/ FIELD INSPECTION REPORT DATE ~ COMMENTS ~ ~ i!' t~ ~~ FOUNDATION (1ST) W ~ f~~ ~ FOUNDATION 2ND V U m ( ) z 0 ~~ IJ '~ ~ ~ ROUGH FRAMING & PLUMBING „ ,~ 'r ~ -- - J F- ___.__ ____-.__ J x i __.__ _ a ~yy ~Z - - .+ {s7 ' INSULATION PER N. Y. STATE ENERGY CODE -7 /3 'ir/a ~? ~, - ~. z i ~ s . ~`' ~~ FINAL u.( ADDITIONAL COMMENTS 5, n r O n ~ Z m n c 2 y .`3-~ O z Z- ~r y x c b y SUFFOIK IBUREAUoi I N S P (: C i 0 R S, n C. 40 Nottingham Drive, Middle Island, NY 11953 Telephone: 631 495 8136 Fax: 631 980 6455 E-Mail: SBEIGS~gmail.com CERTIFICATE OF ELECTRICAL COMPLIANCE Applicant: Raymond Electrical Certificate No.: 8134 Rough In Inspection Date: ]anuary 26 ,2008 Final Inspection Date: January 26 ,2008 Application No.: 8134 Building Permit No.: Suffolk County Tax Map No.: _. _ ---_ - This Certificate of Electrical Compliance is limited to the inspection and compliance of electrical equipment and/or work described below, installed by the applicant named above, located at the premise of and not after the final inspection date above: Owner: David Chadick Site Location: 22842, Main Road, Orient, NY 11957 Owner's Address (if different): ^~ Residential ^~ Indoor ^ Basement ~ Service ^ Shed Commercial ~ Outdoor ~ First Floor ^ Pool ~ Hottub ^ New ~ Renovation ~ Second Floor 0 Attic ^ Garage ^Addition Survey Other: INVENTORY Single Phase 200A. Heat t-gas Duplex Recpt Ceiling Fbdure HID FiMUres Three Phase Hot Water GFCI Recpt 1 Wall Future Smoke Main Panel 40ckt AC Contl Single Reept Recessetl FlxWre CO Detect Sub Panel 1-8ck AC Bkxver Range Recpt Flourescent pumps 2 Transformer Appliances Dryer Recpt Fm n area cY Time clock 2 Disconnect Switches 1 Twist Lock 2 Fait Fizlurea NSS GFCI Breaker Hea[ Pump Electric Heat Pool Luminaire t Exhaust Fan ONer Equipment: Aulo Chbrinator The electrical work and/or equipment described above were inspected and appear to be in compliance with local, state and national electrical code requirements and this office. Applicant: Raymond Electrical License No.: 5141ME Inspected By: Gene Surdi Date Of Certificate: Feb 03 , 2008 Signature: FORM N0. 4 Ciro ~ f41tt trnii.Y ItI~ORi~AiIQN TOGIN OF SOIITHOLD BUILDING DHPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-30384 Filed Map No. Lot No. IBIS CB&TIFIES that the building ALTHRATION Location of Property: 22642 MAIN RD ORIENT (HOUSE N0.) (STREET) (HAMLET) Couaty Tax Map No. 473889 Section 18 Block 5 Lot 9.2 Subdivision conforms substantially to the Application for Building Permit heretofore filed is this office dated DECEMBER 11, 2003 pursuant to which Building Permit No. 29985-Z dated JANUARY 2, 2004 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 ALTERATION TO CONVERT EXISTING ATTACHED GARAGE INTO A DEN IN SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued t0 DAVID & GERALDINE CHADICX (owNERI of the aforesaid building. SDPFOLR: CO[IDTTT7i DEPARTMENT OP HEALTH APPROVAL ELECTRICAL CSRTIPICATE NO- PLDMIDER.S CffitTIFICATION DATED ReV. 1/Bl Date: 08 27/04 1192490 02/18/04 N/A c ~i or' ed ignature C~FY FCR YuJ~ FORM N0.4 O~~o~ii~~I i~+~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..?13120......... Date .......... JarIPaFY• .9..........., 19$`~ . THIS CERTIFIES that the building -raacessnr'y. bui lding ....................... . Location of Property ...S 5 .................... V k 1].age . ?+dne ............... oz >_~Rt House No. Street Hamlet County Tax Map No. 1000 Section .. ~1$......Block ... OS.........Lot .. oQ9,~........ . Subdivision .. ?C ...........................Filed Map No. X ......Lot No. .?{.......... . conforms substantially to the Application for Building Permit heretofore filed in this office dated ..>zeci=tuber. 2Q ...... , 19 $ 3. pursuant to which Building Permit No. ..12$2.2 . Z.......... . dated ....?al~.uazY. !# ............. 19 $4. ,was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this cert~cate is issued is ........ . ...... an,acc@~FarY.~torage building.• ...................................... The certificate is issued to .....>r It>;AF+kzI~It .G.. & .JA~F7~'f . S -. TABOi; , , , , , , , , , , , , , , , , , , , (owner, leatee-orterrantl of the aforesaid building. Suffolk County Department of Health Approval ... N/.I? .................................. . UNDERWRITERS CERTIFICATE NO........... N/R,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Building Inspector nw. 1/81 FORM N0.4 TOWN OF SOUTHOLD NOI1dWNO1Nl BUILDING DEPARTMENT apps ypl AdO~ Office of the Building Inspector Town Hall Southold, N.Y. Certificate OF Occupancy No. .. Z]A.fi60........ Date ......S.eptemher..1.1 ............. 198.1. THIS CERTIFIES that the building ............................................... . Location of Property . A....0...W... off..Main .Road, ....Ocien.t, . Nadi .York .......... . Houma No. Street Hamlet County Tax Map No. 1000 Section ... 01$.....Block ........ 95.....Lot .. Q9.9-~........ . Subdivision ...............................Filed Map No. ........Lot No. ............ . conforms substantially to the Application for Building Permit heretofore filed in this office dated ...Apri,1 .1 .......... , 19.8lpursuant to which Building Permit No. .....1 JA.QO. 2....... . dated ..........April . Z .......... t 9.81, 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 ........ . ,.. .,.„Priyate,One,Family, Dwelling,,,,,,,,,,,,,,,,,, ............... The certificate is issued to ......Jane,t A. Tabor ......... ~owneiG7~eWr7fdWDxJc .................... . of the aforesaid building. Suffolk County Department of Health Approval .. , 11-SO-17 ~ 9/10/81 ~ R . A. Villa P.F.. UNDERWRITERS CERTIFICATE NO......?i.5,?9}03,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ~ ~ 1 J,,~! / i ''/' L' Bu(il/dmg Inspector Rw. t/91 ..y .'I 3 r~ ~,r,,, _ i~ - .~ - 9.2 TOWN OF SOUTHOLD PROPERTY ,~~ORD CARD ,~ .:._ b~.:~ y; OWNER . ~ STREET ~ VILLAGE DIST. SUB. LOT ~I/lC.1~ ChQd~(~t ~0`~S ~ /"lCal N ,~i lr' ~D~YC`~'~ G °iL'IV ~ ~. ~~s'C7`~'' ~4 (J FORMER OW ER ~r''e T4 '~ 'Zgrze ~l, ~ tAl.Tal~,. N E 'j3. Sch,-iev~~- ACR. o.Pt' o ~~ rle~ ~ ~Jr~r g ~/~/ ~ TYPE OF BUILDII~jG' to f ' . " ' I / G A I ~ OGj l ¢ ~ / l ~ ~ '-i ~' ~- f" ~ ~ ~1.-. S l ~ 11.1' G Y Y ° ;ES. ~x ~ r SEAS. VL. FARM COMM. CB. MICS. Mkt. Value LAND IMP. TOTAL DATE REMARKS 3e~ A-PF. 3~ l9/~ ~ 7 7 S~1il ,~iC'~ Irk rA~a~'vANO lAM sc2 :>cr REd. Sv0 ~-/~i9/'°9 ./P ,; I ~L.DC~. ~:: t~~'~~lk ~~=' ~~~ ~45c~o,°'v' 70 ' -, ~©oo ~ ~ oo ' S y.` `~ / / B ~~ 'x i 2 s~z A~ l~l ~G ~-f c~ o5oe J '~ 200 4400 l/' to l0 2004 2 - I I ~ _: - ~~C~~ ~ pn~_`S+n`i-f' ~ 5 0 - 1Z25y /~9-Za~zeclf,` Gq0 ~ /C(~~/ •'~~- BP a 8 rs -L 1 z.z 3 l -~b~N fo GC~~ck ~OYS 3E0,~, "illabie FRONTAGE ON WATER Noodland FRONTAGE ON ROAD ,Aeadowland DEPTH louse Plot BULKHEAD "otal :' f I OR TRIM I zM 3 9 i X 18-5-9.2 10/04 g a Bld M _ ~ z ~~ : . x i = a 9 3. a5 3a f '~. "~"~- F ctension ° ' ~ _ ~ I~ ~ Z x i ~ = 3a o ~i•50 ~ Extension Extension Foundation ice. ~ Both ~ Dinette -Porch Basement ~,,~~ Floors , ~ ~ K, ~ r~ ~ x ~U o~ ~ Ext. Walls qs~. Interior Finish S~ LR. Breezeway v-~ 3 p° ~ p Fire Place ---- Heot I~,W, i~M~ DR. Garage I~ K~,o =~g~ O Type Roof Ga~3Li= Rooms 1st Floor BR. Z Patio Recreation Room Rooms 2nd Floor FIN. B O. B. ~'O Dormer Driveway Total ~~ ~'~y~ '~ ,. COLOR TR I AA ---._....e..++a..Pa_y Suffolk County ExecutzvesOtfice of ConsumerAffazrs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 7/1/78 SUFFOLK COUNTY No. 4436-H ~Ior~e ._I.~pro velnl~nt Contractor License This is to certifythat _ __ _ _ART_HUR JEDWARDS __ _ doing business as _ _ A,'2THUTc EDWARDS MASON CONTRACTING INC - --- - ---------- _a~ing fil! ~d.i.e~ ±~+•= recllii~emenls set. iortl~ r. acco, dance wzlii and subject to the provisions of applicable laws, relics ar' ; eg~aiauc;~u O_`"?3C Coun - of Suffolk, State of New York is hereby licensed to conduct business as a HOME I2~II'ROVEMENT CONTRACTOR, in the County ofSuffolk. THIS Oefflfle5 (flat ffM hearer 5 duly licensed by the County of Suffdk L~ SUFFOLK COUNTY EXECUTNE'S OFFICE OF CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR LICENSE ARTHUR J EDWARDS ~®® ARTHUR EDWAR0.5 MASON caNTRACnNO iNc 4436-H o~rov~s~s °°"'"'°'°"'~ o~rofrzoos Additional Businesses Duector Suffolk County Executive s Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 5/1/80 No. 2740-ME SUFFOLK COUNTY Master Electrician License This is to certify that EDWARD S REIFF doing business as UNDERGROUND SPECIALTIES INC having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. This certifies that the bearer is duty licensed by the County of Suffdk ~4wGa ,F. Cjw~Lro. a,a.. SUFFOLK COUNTY EJCECUTNE'S OFFICE OF CONSUMER AFFAIRS MASTER ELECTRICIAN «.~ EDWARD S REIFF ~~ UNDERGROUND SPECIALTIES INC uw w..., 2740-ME macaw os~ovfsso °P°"1pNp"'~ OS/01/200t3 Additional Businesses L~itector ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID T DATE (MMIDD/YYYY) PRODUCER ARTHU-1 Ol 08 07 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Bagatta Associates Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE , . 823 W Jericho Turnpike Ste lA ALO ~ HE E Smithtown NY 11787 TER THE COVERAGE AFFORDED 8 T POLIC ES BELOW. Phone: 631-864-1111 Fax: 631-864-8274 INSURERS AFFORDING COVERA INSURED GE NAIC # Arthu J Ed INSURER A: poccasaor inaursnw Cwop~ny C47 r wards DBA: INSUR Arthur J. Edwards Pool 5 Spa ER B: Center Contracting Inc. 929 Route 25A INSURER C: Miller Place NY 11764-2700 INSURER O: COVERAGES INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICA ANV REQUIREME TED NOTWITH NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAV PERTAIN . STANDING MAY BE ISSUED OR , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAV HAVE BEEN REDUCED BV PAID CLAIMS. LTR NSR TYPE OFINSURANCE POLICY NUMBER GATE MMIDD/YY DATE MNVDD I LIMB S GENERAL LIABILITY A X COMMERpALGENERALLIASILITY EACH OCCURRENCE E 1 OOO OOO MPABG0912 01/01/07 Ol/Ol/OB CLAIMS MADE OCCUR PREMISES Eaoccurence E 50 000 A X ContractualLi b ~ MED EXP(Any one person) ES, OOO a A X Blanket Addtl In PERSONALS ADV INJURY ES,000,OOO s GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE E2 OOO,OOO POLICY D CO- LOC PRODUCTS-COMP/OP AGG E 2 OOO OOO E AUT OMOBILE LIABILITY ANV AUTO EOM B I N ED SINGLE LIMIT E a K J O ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY E (Par person) HIRED AUTOS NON-0WNED AUTOS BODILY INJURY E (Par axJOen!) PROPERTY DAMAGE E (Per acdoenl) ' GARAGE LIABILITY ANV AUTO AUTO ONLY-EA ACCIDENT E OTHER THAN EA ACC E AUTO ONLY: AGG E E%CESSNMBRELIA LUVSILITY OCCUR ~ CLAIMS MADE FACH OCCURRENCE E AGGREGATE E DEDUCTIBLE E RETENTION E E WORKERS COMPENSATION AND f EMPLOVERS'LIABIUTY TORY LIMITS ER ANV PROPRIETOR/PARTNER/E%ECUTIVE OFFICER/MEMBER EXCLUDEDP ' E.L. EACH ACCIDENT q If yas, Oeapiba un0er SPECIAL PROVISIONS Eelow E.L. DISEASE-EA EMPLOYEE E OTHER E.L. DISEASE-POLICY LIMIT E A Property MPA8G0912 01/01/07 01/Ol/OB A I l Building 919 000 n and Marine MPA8G0912 ~ 01/01/07 01/01/08 DESCRI D d , PTION OF OPERATIONS I LOCATION8l VEHICLES I EXCLUSKNB ADDED BV ENDORSEMENT /SPECIAL PROWSK)NS e 1 000 CERTIFICATE HOLDER ,,,,,,,~, , ,~,_„ Town o£ Southold Town Hall P.O. Box 728 Southold NY 19971 OOOOOOO SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO BO SMALL IMPOEE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE INSURER ITS AGENTS OR (<w uuo/ 1988 7'hlx atri8cata is an orit{inal. STATE OF NF.w YORK WORKERS' COMPENSATION BOARD CERTIFICATE OI•' I'.AJR.TICIPATION IN WORKERS' CO1bIPIrNSATION GROUP SI~I~I+'-INSURANCE la. R.etlal Nana xW Addma of BuNam Partklpntloa Io Groop td. Boebecg Tebphoao Nvmpor of 8oaaere referaced n tax "ln^ aei6toxaraaee (Uaa atrxet Addreaa Onlvl Arthur J. Eduwrtla Mason Contrpdar, Ina 16317447185 DBA; Arthur Edwards Pool & Spa Centre 929 Route 25 A MYler Piece, NY 11764 le. NY$ Uncmpisytment raeorance tmployer Re`4variea Nanbor of 9oatneas nkrnad is Box "la". 1h. Bffeetire Daq ofMembenhln M the firaap OA12d12nn~ 2410871 S tine Date 6!30/2007 6:piratlon Date _6/24/2008 1L Bedcral fimplover rdexlmcalMn Namher ofBrulapr ]a The Propridor. Partners or 6xxativo 06cora arc 'ef"'"xad h Box "ra" !~' iseloded (ONy check pox rcall parmorrtoakon acladetl) 111277925 ^ all exdaded or certain wrrnerNOdlan exladed. 1 Name and Apdrypt of the Btltiry Ragataea` Ptootof Coratagc J. Name n~ Addrcn at f-la rv fSntav acraa I.hkd u Grtlfrate Roidar) Towrl tN fioutholtl Spedal Trades, Gontwcting And ConstrucUOn Tnlet Tpwn Hap 6260 South Bay Road PO Box 728 PO Box 3380 Southold, New York 11971 Syraouae, NY 13220 Polley: W521504 This cetdfles drat tho business raforolwed abovo in box "I a" {s oomptying with the mandatory coverage reglriremems of the New York State Workors' Componsadon Law as a participating member of the Group Self-Insurer tasted above in box "3" and Participation in auoh group self-insurance is still in force. The Group Seif-Insurer's Administrator will seadthis Certificate of Participation to the entity liaxd above as the certificate holder in box'Z". The Group Solf-insurer's Administrator will notify the above certificate holder within I4 days IF the tnambership of the Participant listed in box " la" is terminated. ([')tese tlotieea may be sent by regutar.mail.) Otherwise, this Certificate is valid for a maximum of one year tfom the date certified by the group sel€insurer. !f this cdrtt, ficate is no longer valid according to the abovd guiddlines and the business referenced in box "1 a " continues to be named on a permit, license or contract issued by the certifIcare holder, the business must provide the cert~cate holder either with a new eert(ltcate or other authorized proof the business is complying with the mandatory coverage requirements of the Certified by: Delvld Certified by: Title: 6/30!2007 ~~ Telephone Number: (315) 699-8476 (3SI-105.2 (2-02) WORKERS' cOMPBNSATION t.vw WORKERS' COMPENSAT][ON LAW Section 57 Restriction on issue of permits cad the entering into contracts unless compensation is secured. 1. The head ofa state or municipal department, board, commission ar office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this ohapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duty subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for a[I employees has been secured as provided by this chapter. Nothing herein, however, shall ba constnzed es creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation tp any such employee ifso employed. 2. The head of a state or municipal department, board, commission or' office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defned by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance oarrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Please Noto: Thlp CertMcats Is valid only through the policy dates Indlaated above, OR a maximum of one year utter this foml is approved by the authorized ropresentativvea of the Group belt-Insurer, At the expirption of those dates, if the business continuos to be named on a pemtlt or contract issued by the above govamment entity, the lwainess muet provide that government entky with a new CertMoate. The buslneas must also provide a new Certifleate upon notice of oanoellatlon or change In status of the policy. 4S1-105.2 (2-02) Reverse A~ E F 8 Section B-B /l/~.'~/'(~rte.. a wnp To by -Te RMV,r (Gy iM OptYaQ Piping Arrangement FEET Ff F T F T F T Ff F T F f F T SQ Ff GAI ~ . . . . . . . . . . .. ~ 16z92' IB' 32' 8' 14' 6' 4' 4' 8' 512 19,000 ~~$~(~uQ,j~_ Hama 185Gi6' 18' 38' 12' 14' 6' 4' 4' 8' 576 21,800 POOL & SPA CEPT['RS PERMACRETE WALL SYSTEM 8' ' ' ' ' ' ' ' ' ' 1 z38 18 38 12 14 8 4 5 8 648 24,300 929 Route 25A Miller Place NY 11764 20'z4D' 20' 40' IB' 14' 6' 4' 6' 8' 800 30,000 (631) 744-7185 FAX (631) 744-0174 ( ) ~ 24'z44' 24' 44' 18' 14' B' 4' B' 10' 798 30,000 Suffolk License #4436-HI 24'z48' 24' 48' 20' 16' 8' 4' 6' 10' 900 30 000 Nassau License #HI74450000 Section A-A Typical Wall Section Erosion, Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM Yes No. EXEMPTIONS:. A. Does this project meet the minimum standazds for classification as an Agricultural Project. _ _ Note: If you. answered. Yes to any of the. above, aStorm-water,. Grading, Drainage & Erosion Control Plan is not required. ------------------------------------------------------------------- ACTIONS. REOUHtINGTHE. SUBMISSION OF A STORM-WATER GRADING DRAINAGE & EROSION CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL Ty THE STATE OF NEW YORK.. Item Number:. (A Check Mark (/) for each question is required for complete application) Yes No. 1. Will this. project retain all Storm-Water Run-off generated on Site? (This will include all run-off created by site clearing and/or construction activities. as well as all Sit I d h / e mprovements an t e permanent creation of impervious, surfaces.) ^ 2. Will this. project require any land filling, grading or excavation where. there. is a change to the natural existing grade. involving more than 200 cubic yazds of material within any pazcel? ^ 3. Will this application require land disturbing activities. encompassing an area f f e s o iv thou and (5,000) square feet of ground surface or more? ^ 4. Is there a Natural Water course running through the site or is this project within One hundred (100) feet of wetlands or a beach? ^ 5. Will there be site preparation on slopes which exceed fifteen (15) feet of vertical rise to One hundred (100). feet of horizontal distanceT 6. Will driveways,. pazking areas or other impervious. surfaces. direct Storm-Water Run-off into and/or in the di ti f T Ri h W f ? / / rec on o a own g t-o -- ay ^ 7. _ Will this application require the placement of material, removal of vegetation and/or the construction of any item within the Town Right-of--Way or road shoulder azea? ^ (This. item. does not include the installation. of driveway. aprons.). 8. Will there be site preparation within the one hundred (100) year floodplain of any watercourse? Note: If any answer to questions one through. eight is answered with. a check mark in the Box, aStorm-water Grad ing , Drainage & Erosion. Control. Plan is required. and must be submitted for review prlorto issuance. of any build , ing. permit. ------------------------------------------------------------------- STATE OF NEW YORK; COIJN'I'YOF.....r__ ................_..................... ss That I . ............~-ll fvi, ~,:, ~p.h/,tFaCAS,,,,,,...... _......... being duly sworn, deposes and says that he/she is the applicant for Peanit, (Name of individual signing Document) ~} And that He/She is the ...................................1,;('Jn17Y!Yt' !?X ; ......................................................................................................... (Owner, Contractor, Agent, Corporate Officer, etc.) Owner and/or representative of the Owner or Owner's, 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 tme to the best of his knowledge and belier; and that the work sill be performed in the manner set forth in the application filed herewith. Sworn to before me this; ...................I`~~...........day of ...~~..................... 200'.7.. Notary Public:....t~-t Q ~4t{. ~R(3ARET A. KIONEY Nogry PubRa -State of New 1brK ........... ........ .......................... No. O I KI6021 1 Yl (Signatur f Applicant) t]uaUfied in Suffolk County My Commission Expires March 8, 2011„ y" ~~v~ ~v v~` ~EA=34, 064 RV ~M.NP Q~ ~6 MONUMENT ~S'(P\NSN~~~~ p ~ =PIPE QURS~~~~wNG ~~' OF ~N 146. 11 ~SOQC,CUi7~P UNLAW R L ~'`~?THO~'~ C~ QF OCC1.E!=xN~;Y N/0/F BEATRICE & EDMUND LOUIS PAPANTONfO S' 6~ S9< p„ ~. \ E. //tea O- /~ \X~. 0~ ~e ~~ O\ 2~ N/0/F WILLIAM W. SCWRIEVER UNDERWRIPEQ~RED ~F1CP~ 2;' ~~ ANY ALTERATION OR ADDITION TO TH/S SURVEY lS A VIOLATION OF SECTION 72Q90F THE NEW YORK STATE EDUCATION LAW. EXCEPT AS PER SEC770N 7209-SUED/VlS/ON 2. ALL CERTlF7CA7)ONS HEREON ARE VALID FOR THIS .~lIAP AND COPIES THEREOF ONLY lF SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. Q J N W 5 O 2 (631) 765-5020 FAX P. O. BOX 909 1230 TRA I/ELER STREET SOUTHOLD, N. Y. 71971 7 h'~.4D SURVEY OF PR(7PERT Y 5" ~ AT ORIEl\TT s ~ I 7'O~N OF SOUTHOLD N ~ ~ SUFFOLK CO UN7`Y, N. Y. I CER nF/EO T0: 1000-18-05'-9.,2 ~ ~ l nAV/D cNADICIC SCALE.• 1'=30' p ~ / GERALD/NE CHAOICK SEPTEMBER 17, 2003 '~ I ~ l THEODORE CHAD/CK F/RST AMER/CAN TITLE INSURANCE COMPANY ~ I OF NEW YORK ' I-lOMfBR/DGE MORTGAGE BANKERS I ~ ~ „~ r M-V-~Dlg7-~ t y„ ENCLOSE P N/0/F ARTHUR SPANGEL UPON C~~ OpLEOpN DE BEFpRE.WATER^ i ,...~ ,,.. <~ ~ 294.61' I k 1 ~~ ~ 8L16" "~ - ~ STOCKADE FEN - - - - - - - - -. cV o.z's 2/3.45' ~ i o's ~ i~ o.f•w ''' "~ AP R VED AS NOTED m . ry' ~ DATE: b `f P.# ~~12i~i ~ ~ l~RC~ O FeN' FE ~ ~ ~v. ASPHA(T 28.8 ~1 fl ~ h Off. rv NOTI G~UE`SOt.~V (/~ 1 "f ~ ~iq~ BUILDING D_PA MENT AT ~ ~ 785-1802 8 AM 70 4 PM FOR THE .a a '~ J~' 0;~ F FOLLOWING INSPECTIONS: ~ ~ ~ ~ ~ " •- ~ : T 7. FOUNDATION - T~/'`~0 REOUIRED _ FOR POURED CONCRETE ~ ~ ~ 2. ROUGH -FRAMING & PLUMBING ~~ y~ ~ P.rs ' 3. INSULATION r'" ~ ~ ~ '~-y ~ FR. Y{~~- 3YfED q{ 4. FINAL -CON"T4UCTION MUST ~ I ~9' ' I 40' ^ BE COMPLETE FOR C 0 ~ zs.o' ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW o YORK STATE. NOT RESPONSIBLE FOR N ~ ~ DESIGN OR CONSTRUCTION ERRORS. N MGN. 0.4'W S88'20'40 W 329.36' / N/O/F RICHARD J. GILLOOLY I Nl0/F RACHEL &