The URL can be used to link to this page

Home My WebLink About34405-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPA=qTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33552 ~ate: 02/18/09 THIS ~TIFIES that the building ACCESSORY I~Dcatlon of P~perty: 1325 KI~BERLY LA SOUTHOLD (HOUSE NO.) (STREET) (HAMLET) Cottnty Tax Map No. 473889 Section 70 Block 13 I~t 20.8 Subdivision Filed Map NO. __ Lot No. __ conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 30, 2009 pursuant to which Building Perat~t No. 34405-Z dated J~/~UARY 30, 2009 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 SWIPING POOL WITH FENCE TO CODE AS APPLIED FOR. · ~ne certificate is issued to DENNIS & ANN HENCHY (OWNER) of the aforesaid building. SUFFOLK CO~3NTYDBPARTMENTOFHEALTHA~pRovAL N/A ELECT~ICAL c~KTIFICATE NO. 64152C 09/16/04 PLUMBERS C~TIFICATION DATED N/A yAut~ized S~gnature Rev. 1/81 BUILDING DEPARTMENT 765-1802 /w ~l [EB i 8 2~_~ APPLICATION FOR CERTIFICATE OF OCC~CY 8~. D~. application must be ~lled in by t~ew~ter or i~ ~d submitted to the Buil~ng D~ent wi~ the follow.g: 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). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Swora 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 prope~y 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 New Construction: Old or Pre-existing Building: (check one) LocationofProperty: /3~~5~ A//mO~/q,t'/ /A~ .--,cvt~r/~o~-~. ,~/,~J_ House No. Owner or Ownem of Property: 2)c'-,,~/jq/J Suffolk County Tax Map No 1000, Section Subdivision Street Hamlet 0 70 Block 00/3 Lot o~.~. 0o8 Filed Map.. Lot: Underwriters Approval: PermitNo. ,J'/yo,>~-- 2., DateofPermit.,7;~. -~v .2oo~ Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ,2 ~ ~ ~ Final Certificate: / (check one) Issue Date 9/16/04 Electrical Inspection Certificate Electrical Inspection Service, Inc. Application 375 Dunton Avenue 64152C East Patchogue, New York 11772 (631) 286-6642 Issued To: Henchy Street: 1325 Kimberly Lane Village: Southold Section: Block: Contractor: USI Electric (L) Zip: Lot: 11971 Town: Southold Lic. # 2740-E Was examined and found to be in compliance with the National Electrical Code. [] Commercial [] NVDefects [] Pool [] lstFIoor [] Indoor [] Basement [] HotTub [] Residential [] Det. Garage [] Attic [] 2nd Floor [] Outdoor [] Addition [] Survey Switches Receptacles Fixtures GFI Heato~ 2 2 2 1 Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves Fumace Oil Gas C/mu/atom Smoke Detector Bell Transformer Meter Amps Phase UG/OH Jacuzzi / T~e~sion CODetector Bldg. PermS: Other Equipment I-Motor I-Pool Panel I-Time Clock I-Gas Heater Hugo 3. Surdi President Inspector: Ed Scavelli Rnal Inspection: 10/01/2002 Inspector: Ed Scavelli This certificate must not be altered in any manner. Inspectors may be identified by their c. mdentials. FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34405 Z Date JANUARY 30, 2009 Permission is hereby granted to: DENNIS & ANN HENCHY 22 PEMBROKE DR NORTH MASSAPEQUA, NY 11758 for : CONSTRUCTION OF AN IN GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACE 31430. at premises located at County Tax Map No. 473889 Section 070 pursuant to application dated JANUARY Building Inspector to expire on JULY 1325 KIMBERLY LA SOUTHOLD Block 0013 Lot No. 020.008 30, 2009 and approved by the 30, 2010. Fee $ 150.00 / Authorized Signature ORIGINAL Rev. 5/8/02 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. 31~4~0 Z Date SEPTEMBER 6, 2005 Permission is hereby granted to: DENNIS & ANN HENCHY 22 PEMBROKE DR NORTH MASSAPEQUA,NY 11758 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. THIS PERMIT REPLACES BP 28050. at premises located at County Tax Map No. 473889 Section 070 pursuant to application dated SEPTEMBER Building Inspector to expire on MARCH 1325 KIMBERLY LA SOUTHOLD Block 0013 Lot No. 020.008 6, 2005 and approved by the 6, 2007. Fee $ 150.00 Signature Rev. 5/8/02 . ORIGINAL 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 OMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 'Z~k~0 Z ~0 Date JAiqUARY 29, 2002 Permission is hereby granted to: DENNIS & ANN HENCHY 22 PEMBROKE DR NORTH MASSAPEQUA,NY 11758 for : CONSTRUCTION OF AN IN-GROUND SWIMMING POOL AS APPLIED FOR WITH FLOOD PERMIT at premises located at 1325 KIMBERLY LA SOUTHOLD County Tax Map No. 473889 Section 070 Block 0013 Lot No. 020.008 pursuant to application dated JAIqUARY 28, 2002 and approved by the Building Inspector. Fee $ 250.00 /~ ..).e< Signature Rev. 2/19/98 ORIGINAL II RONALD C. HANNA ARCHITECT Suite 15 761 Coates Avenue Holbrook, New York 11741 (631) 285-7870 August 15, 2005 Town of Southold Building Deparhnent Main Street Southold, N.Y. 11971 Re: Henchy Residence 1325 Kimberly Lane Southold, N.Y. Gentlemen: This is to certify that I have inspected the swimming pool reinforcing steel installation for the subject project and to the best of my professional judgement ail work was completed in accordance with the approved permit drawing and code requirements. TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] ROUGH PLBG. [ ] IN/S~LATION [~FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION [ ]FOUNDATIONIST [ ]FOUNDATION2ND []FRAMING/STRAPPING []FIREPLACE&CHIMNEY[ [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: ~~ DATE INSPECTOR 765-t 802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING [ ] FIREPLACE & CHIMNEY [ [ ] ROUGH PLBG. [ ] INS~JL4~iON [/,~F~NAL ] FIRE SAFETY INSPECTION REMARKS: /'~ ~~ ~'~ ~-~-~ DATE INSPECTOR 765-~.802 BUILDING DEPT. SPECTION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY DATE~INSPE~~~,~ FO~DATION (2ND) [ ~ % ~ ROUG~ F~G & ' PL~B~G ~ ~ ~S~ATION PER N.Y. ~ STATE ENERGY CODE ~ ~DITION~ CO~ENTS 5 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 ., ,20 ¢',~ ,20._~.~ L TO'g/fi PERMIT BUILDING PERMIT APPLICATION CHECKLIgq B q q D~ D°Y°uhaw °rncedthc f°ll°vang' b~f°re applying 3 scm of Bmqa~,g Plans Survex NO Check S~pfic Form N,Y.S.D.E.C, Trustees Con*a~t: ~ tO: APPLICATION FOR BUlL,DING PERM1T Date INSTRUCTIONS ,2O a. Th/s application MUST be completely filled in by typewriter or in ink a~t s~Zm~itted to the BuKlfling Iuspector with 3 sets of plans, accurate plot plan to scale. F~ according to schedule. b. Plot plan showing location of lot and of buildings on pr~kse~, rdatio-~hip to adjoining premises or pubhc streets or areas, and waterways. c. The work covered by this application may not be comraea~ced before is~an*e of Building F=,,-it. d. Upon approval of this application, the Building Inspector will issue a Building Pla-mit toth~ applicant. Such a pentax shall be kept on the premises available for inspection throughout the work. e. No building ~halfbe occupied or used in whole or in part for any purpose what-so-ever urrtil a Ccu'tificate of Occupanc is issued by the Building Inspector. APPLICATION IS ~Y MADE to the Building Deperunant for the i~suance of a Building Perant pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, Hew York aud otl~ applicable Laws, Ora;nances or Regulations. for the consunction of buildings, additions, or alteratious or for removal or d~aolition as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code, housing code, ~a r~gulations, and to admit authorized inspectors on pr~mises and in building for necessary inspections. (Sx~dn~ of applicant or,,~,~e, if a corporation) State whether applicant is owne~, lessee, agent, architect, engineer, general corm-actor, electrician, plumber or builder Name of owner of premises (as o~ the tax roll or latest deed) If apphcant ~ a ~t?. oration, signature of^d_uly authorized officer (Name and rifle of c~rporate officer) Builders License No. Plumbers License No. E!ectncians License No. Z74o-E. Other Trade's License No. Location of land 9n which propos.~ work will be done: I<l lS_ve q LA, House Number Str~ Haml~ County Tax Map No, 1000 Sc~tion 7~ Block Subdivision]2>gt?.~llkq~.. [k~ T}-~ fiSOo Ffled Map No. (Name) I f Lot Lot 3 · * · ' ' ~ eduse and oc an of' sed construction: 2~ Stateerastingusemd,occupmcyofpmnnsesandmend cup cy propo a. Exis~ug use md oCCUpancY b. Intended use md occupancy ~uHHI~(,I~M~,,, 3. Nature o£work (check which applicable): New Repair Removal Demolition Addition Alteration OtherWork IId~-)~,q oB Ak Estimated Cost If dwelling, number of dwelling utfits If garage, number of cars Fee (to ke paid on filing thi~ a~plic.a,t~o,n) Number of dwelling umts on each floor If business, commercial or mixed occupancy, specify nature and extent of eacli type of use. ~//fi. Dimensions of exi~i~ stmctm-es, if any: Front ~ ? ! Rear O F / Depth Height ~/1/~ - Number of Stories 2 .//'Z .~'/-Z)~-/~--~' Dimensions of same structure with alterations or additions: Front Rear 9.. S~eoflot:F~ont ·/~o ' R~ r6~'Z v~th , 10. Date of Purchase Name of Former Owner.. I 1. Zone or use district in'whiCh premises are situated Number of Stodes Depth Height Dflnensious of entire new construction: Front Rear Depth Height Number of Stories .3~/' 12. Does proposed construction violate any zoning law, ordiusnce or regulation: /~ 0 13. Will lot be rergraded · Will excess fill be removed.from premi.qes: YE(._.~i~ 14. Names of Owner of m'emises Name.of Architect' ~0M Name of Contractor ~ ~/&~leg -5~o/~t, ma ~oa/5 15. Is this property withln 100feetofatidalwetland? YES F' NO · IF YES, SOLrI~OLD TOWN TRUSTEES PER_MITS 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. 7>copr-~, /<~ &,~//,~--z~- STATE o~ ~w YOmO / SS: COUNTY OF ) -- ~ f~//'4Ar"~t ~ .... n being duly sworn, deposes and says that (s)he is the applicant (Name of individual si?~ng contract) above n~med, (Con~'actor, Agent, Corporate Officer. etc.) of said owner or owners, and i~ duly anthorized to perform or have performed the said work and to make and file this application; that all stat:ernents co~.~ined ~ at~licatioa are true to the best of his knowledge ami belief; and that the work will be Sworn t.q b~/ // O)f dayof~Z~-Jc~dS~. 200.,~ .. , (_~otm, h~oti~ / si~ of~,licm ANNMARIE PSOTTA Notary Public, State of New Yo~ No. 01PS5036312 Qualified in Suffo k Courlt~ Commisson Expires 11/21/ i/Z.- TOWN OF SOUTHOLD APPLICATION FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I: GENERAL PROVISIONS (APPLICANT to read a_nd sign): L No work may start until a permit is issued. 2. Thc permit may be revoked if any fane statement~ are made herein. 3. If revoked, all work must cease until permit ix re-issued. 4. Development shall not be ttsed or occupied until a Certificate of Compliance is kssucd. 5. Thc permit will expire ff no work is commenced within six montb-s of issuance. 6. Applicant ix hereby informed that other permits may be reqinxed to fulfill local, state and federal regulatory requirements. 7. Applicant hereby giv~ consent to the Local Administrator or hi~/her representative to make /easonable ktspections required to verify compliance. 8. I, THE APPLICANT, CERTIFY THAT ALL STATEMENTS HEREIN AND IN ATTACHMENTS TO . THIS APPLICATION ARE, TO TI~E BEST OF MY KlqOWLEDGE, TRUE AND ACCURATE. SECTION 2: PROPQSED D~LOPMENT (Th bc completed by APPLICA/xW} TELEP,HONE - To avoid delay in processing thc application, ple~e provide enough information to ea.nily idcutdy the project location. Provide the street address, lot number or legal dezcdption (attach) tud, outside urban are. a.% the distance to the nearest intersecting road or well-known landmark A sketch attached to this application showing the projecl location would be helpful. FDP(931 AP PLICA. T] O N ~ PAGE 2 OF 4 DESCRIPTION OF WORK (Check all applicable boxcs): STRUCTURAL DEVELOPMENT AGTIVITY ~TR UC~I'U R E TYT'E U] New Structure [] Residential (1~ Family) [] Addition O Residential (More than 4 Family) [] Alteration [] Non-residential (Floodproofmg? [] Yes) [] Relocation [] Combined Usc (Residential & Commercial) [] Demolition ~' [] Manufactured (Mobile) Home (In Manu- C] Replacement factured Home Park? [] Yes) IIqSrgO.~"~o~3 oF h 2.0XqO ~ ~wo~16 ~u~lf; ESTIMATED COST OF PROJECT 5~ B. OTHER DEVELOPMENT ACI'IVITIES: [] Fill ID Mining ID Drillbg [] Gradbg [] Excavation (Except for Structural Development Checked Above) · [] Watercourse Alteration (Including Dredging and Channel Modifications) [] Drainage lmprovemen~ (Including Culvert Work) [] Road, Street or~lge Construction ID Subdivision (New or Expansion) [] Individual Wi~ter or Sever System After co4~t~Jg ~EOc~I~ OI ~N'{'~ 3~t~ s~h~m~it e~'rmO~t° r~cal'"~dmtmstr;°r'f°r re[qew. ~;ECTION 3: FLOODPLAIN DETERMINATION (To be completed bv LOCAL ADblINISTRATOR) The proposed development is located on FIRM Panel No .... Dated The Proposed Development: [] L~ NOT located in a Special Flood H.?ard A~ca (iqotify thc applicant that the application review b complete and NO FLOODPLAIN DEVELOPMENT pERMIT IS REQUIRED). [] I~ located in a Special Flood Hazard Area. FIR. M zone de.4gnatlon is tOO-Year flood elevation at the site b: Ft. NGVD (MSL) UI Unavailable [] Thc proposed development is located in a floodway FBFM Panel No. Dated [] See Section 4 for additional instructions· SIGNED DATE APPLICATION PAGE 3 OF 4 SECTION 4: ADDITIQNAL INFORMATION REQUIRED £To hollered bv LOCAL ADMINISTRATOR] Thc apphcam must submit thc documents checked below before the apphcafon can be processed: [] A site plan showing thc location of all cristmg structures, water bodies, adiaccnt roads, lot dimensioms and proposed development [] Development plans, drawn to scale, and spccificatiorm, including where applicable: details for a~choring structures, proposed elevation of lowest floor (induding basement), types of water resistant materials used below the lust floor, details of floodproo£mg of utilities located below the first floor and details of andosures below thc lust floor. Also, [] Subdivision or other development plans (If the subdivision or other development exceeds 50 lots or 5 acs-es, whichever is the lesser, the applicant must provide tOO-year flood elevations if they are trot otherw/se available). [3 Plans showing the extent of watercourse relocation ~rtd/or landform alterations. [] Top of new l-all elevation Ft. NGVD (MSL). [] FIo~.~dproof-mg protection level (non-residential o~aly) Ft.' NGV'D (MSL). For flo<~a~-~i-oofed structures, applicant must attach certification from registered engineer or architect. [] CertificatiOn from a regSstered engineer that the proposed activity in a regulatory lloodway will not result in ~ increaSe in the height of the loo-year flood. A copy of Mi data and calculations supporting.~..his £mding must also be submitted. [] Other: SECTION 5: PERMIT DETERMINATION (To be coml~leted lpg LQGAL ADMINI~'TRATQR) I have determined that the proposed activity:. A. ID Is B. U] Is not in conformance with provisions of Local Law ~ , 19__ attached to and made part of thl, permit. · The permit is issued subject to thc conditions SIGNED , D~.TE f.~BOX A is checked, the Local Administrator may i~sue a Development Permit upon payment of designated If~.BQX B i~ checked, thc Local Administrator will provide a written summary of deficiencies. Applicator may revise and resubmit an application to the Local Administrator or may request a bearing from the Board of Appeals. APPE2KL3 Appealed to Board of Appeals? [] Yes [] No Hc~mg date: Appeals Board Decision --- Approved? [~ Yes ConcLitioas E~ No APPLICATION PAGE ,~ OF ,~ S_E~'TION 6: AS-BUILT ELEVATIONS (To be submiued by APPLICANT before Certific2te of Compliance is issued) The following information mttst be provided for project structures. This section must be completed by a registered professional engineer or a licensed land surveyor (or attach a c~rtilication to ttd~ application). Complete 1 or 2 below. 1. Actual (A~-Built) Elevation of the top of the lowest floor, indudlng basement (in Coastal High Hazard A.rea% bottom of lowest structural member of the lowest floor, excluding piling a.nd colnmns) is: FT. NGVD (MSL). 2. Actual (As-Built) Elevation of floodproo£mg protection Lq FT. NGVD (MSL). NOTE: Any work performed prior to submittal of the above information is at the risk of the Applicant. SECTION 7: COMPLIANCE ACTION (To be completed by LOCAL ADMINISTRATOR) The LOCAL ADMINISTRATOR will compl~t~ this section as applicable based on is~spection of the project to ensure compiianc~ with the community's local law for flood damage prevention. INSP.'.'ECTIONS: DATE BY DEFICIENCIES7 ID YES Fl NO DATE BY DEFICIENCIES? [] YES [] NO DATE BY DEFICIENCIES7 [] YES [] NO SECTION 8: CERTIFICATE OF COMPLIANCE(To bc comnleted by LOCAL ADMINISTRATOR) Certificate of Compliance issued: DATE: BY: Attachment B SAMPLE CERTIFICATE OF COMPLIANCE for Development in a Special Flood Hazard Area TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD ~ AREA (OVVNER MUST RETAIN THIS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: [3 NEW BUILDING [3 EXISTING BUILDING [3 VACMCr LAND THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: COMPLIANCE IS HEREBY CERTIFIED 'WITH THE REQUIREMENTS OF LOCAL LAW # , 19 SIGNED: DATED: COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19__, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/Cf93) Suffolk County Executive's Office of Consumer Affairs VETERANS ME/vlOI:IL~,L HIGHWAY · HAUPPAUGE. NEW YORK 11788 DATE ISSUED : .,?p,.z.k .lo..19.83. No. 83.9.L-rHI ....... SUFFOLK COUNTY This is to certify that ....... ~.o.~..a,..Q%~BONS doing business as ............ .R.O.N. GIBBONS SWIMMING PDOkS %NC having furnished the requirements set forth in accordance with and subiect to the provisions of applicable laws, roles and regulations of the County of Suffolk. State of New York, is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk THIS LICENSE EXPIRES...AP R II... 1 s ~ ......... NOT VALID WITHOUT DEPARTMENTAL SEAL l)irector ACORD.CERTIFICATE OF LIABILITY INSURANCP G i DATHIMM,DD , 01/21/02 PRODUCER Coverage Associates, Inc. 2941 Sunrise Highway Islip Terrace NY 11752 Phone:631-277-5700 Fax:631-277-5941 INSURED Ron Gibbons Swimming Pools Inc., etal 2995 Sunrise Hwy Islip Terrace N~ 11752 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 POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Colony Insurance Co. INSURERB: Mount Vernon Fire Ins. Co. INSURERC: Interstate Indemnity Insurance ~NSURERD: State Insurance Fund ~NSURERE: First Rehabilitation COVERAGES THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATHD. NO'P~ITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATH 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 POUCIES, AGGREGATH UMITH SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POUCY EXPIRATION GE~NERAL LIABILITY EACH OCCURRENCE 5 i, 000,000 A X COMMERCIALGENERALMABILITY G'r.645668 12/15/01 12/15/02 FIREDAMAGE(Anyoneflre) 550r000 I CLAIMSMADE ~ OCCUR MEDExP(Anyoneperson) 51,000 __X BI/PD Ded. $250 PERSONAL&ADVINJURY 51,000,000 __ GENERAL AGGREGATH 5 2,000,000 POUcy I LOC -- COMBINED SINGLE LIMIT 5 i ,. 000 ~ 000 C ANY AUTO BA29029007 08/15/01 08/15/02 EXCESS LIABILITY EACH OCCURRENCE 5 I f 000 ~ 000 B X~OCCUR [~ CLAIMS MADE CUP2010379 12/15/01 12/15/02 AGOREGATH 51,000,000 $ RETHNTION 510 r 000 $ WORKERSCOMPENEATIONAND I TOR~L'~'THI I ER D 785065-4 06/29/01 06/29/02 E.L. EACRACClDENT $ CERT TO E.L. DISEASE-EAEMPLOYEI $ FOLLOW E.LmSEARE-POUCYL~S~T 5 FROM SIF E Disability Benefit DBL108165 01/01/98 Statutory NY Certificate holder is included as additional insured aima under the General Liability CERTIFICATE HOLDER I Y I ADDITIONAL INSURED: INSURER LETTER: A__._ CANCELLATION Town of Southold P.O. Box 1179 Southold NY 11971 ACORD25~(~97) SOUTHOL SHOULD ANY OF 1HE ABOVE DESCRIBED POLICIES DE CANCELLED BEFORE THE EXPIRATION DATH THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAiL ~~' ~" ACORD CORPORATION'1988 ACORD. CERTIFICATE OF LIABILITY INSURANCP G i DATE(MM,DDt, 01/21/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Coverage Associates, Inc. 2941 Sunrise Highway Islip Terrace NY 11752 Phone: 631-277-5700 Fax:631-277-5941 INSURED Ron Gibbons Swimming Pools Inc., etal 2995 Sunrise Hwy Islip Terrace N~ 11752 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Colony Insurance Co. ~HSURERD: Mount Vernon Fire Ins. Co. INSURERC: Interstate Indemnity Insurance INSURERD: State Insurance Fund INSURERE: First ~h~bilitation COVERAGES THE POUCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTINITESTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT I~ITH RESPECT TO WHICH THIS CERTIFICATE MAY RE ISSUED OR MAY P ERTAIN~ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY =rr=~. HVE POUCY EXPIRATION G E~NERAL LIABIUTY EACH OCCURRENCE S i, 000,000 A X COMMERCIALGENERALLIABILIT~~ ~ GL645668 12/15/01 12/15/02 , FIREOAMAGE(Anyoneflm) $ 50,000 I CLAIMS MADE ~J OCCUR MEDEXP (Any one pemon) $ 1,000 ~ BI/PD Ded. $250 PERSONAL&ADVINJURY $ 1,000r000 __ GENERAL AGGREGATE s 2,000,000 COMBINED SINGLE UMIT $ 1,000,000 C ANY AUTO BA29029007 08/15/01 08/15/02 (Ea accident) EXCESS LIABIM1Y EACH OCCURRENCE $ 1 ~ 000,000 B X~OCCUR ~]CLAIMSMADE CUP2010379 12/15/01 12/15/02 AGGREGATE $1,000;000 $ RETENTION $ 10 r 000 $ EMPLOYERS' LIABILITY D 785065-4 06/29/01 06/29/02 E.L. EACH ACCIDENT $CERT TO E.L. DISEAEE-EAEMPLOYEI $ FOI&TaOT~ ~L DISEASE - POUCY UMIT ~O~J SIF OTHER E Disability Benefit DBL108165 01/01/98 Statutory NY Swimming Pools, installation, servicing or repair-below ground incl. products &/or completed operations. CERTIFICATE HOLDER I N r ADDITIONAL INSURED; INSURER LETTER: CANCELLATION Dennis Henchy 1352 Kimberly Lane Southold NY 11971 ACOKu25~(~97) HENCH~D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WiLL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, RUT FAILURE TO DO SO SHALl. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSDRE.~ ITS AGENTS O R~P~ j~.I~R ES E N TA TI V ES. ~ ~ " ACORD CORPORATION t 988 PINE NECK N 84' 22'20" E t 4BOX ROAD pi ~ 361.97' ~_l/~ STOBI ~ ~ ~R^ME .ouSE f ~ ~ ~ LOT(i', LOT® o ~ ~ 282.44' · S 84'22 W J SURVEY OF LOT 8 MAP OF ?ARADL~ ]3Y THE BAY FILE No. 646-9 rILED NOVEMBER 4, lg75 SITUA TED A T SOUTHOLD TO~N OF SOUTHOLD SUFFOL~ COUNTY, NE~ YORK S.C. TAX No. ~000-70-~3-20.8 SCALE ~ "=50' AREA = 47,426.24 sq. ff. (TO T~E LINE) 1.089 ac. CERTIFIED TO: DENNIS HENCHY COMMONWEALTH LAND TITLE INSURANCE COMPANY OF NEW YORK Joseph A. Ingegno Land Surveyor N.Y.S, Lic. NO. 4966B PHONE (631)727-20g0 row (651)727-~727 99-381G J FO~ECTIOHS: ~ , : , ~ ~" CODES. NOT RE~II~ FOR t NALO C. HANNA ' W. BABYLON, N.Y. 11704 ' 516' 376- 0784. ,