HomeMy WebLinkAbout36813-ZTown of Somhold Annex
P.O. Box 1179
54375 Main Road
Somhold, New York 11971
7/9/2012
CERTIFICATE OF OCCUPANCY
No: 35805
Date: 7/9/2012
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
IN GROUND POOL
505 Soundview Ave, Mattituck,
Sec/Block/Lot: 94.-1-3
Filed Map No.
conforms substantially to the Application for Building Permit heretofore
10/27/2011 pursuant to which Building Permit No.
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 with fence to code as applied for.
Lot No.
filed in this officed dated
36813 dated 11/14/2011
The certificate is issued to
Soundview Isles LLC
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36813 4/17/12
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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 #: 36813 Date: 11/14/2011
Permission is hereby granted to:
Soundview Isles LLC
_c/~.._Saynour
109 Monterey Dr
New Hyde Park, NY 11040
To:
construct an inground swimming pool, fenced to code as applied for
At premises located at:
505 Soundview Ave, Mattituck
SCTM # 473889
Sec/Block/Lot # 94.-1-3
Pursuant to application dated
To expire on 5/15/2013.
Fees:
10/27/2011 and approved by the Building Inspector.
SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE
CO - SWIMMING POOL
Total:
$250.00
$50.00
$300.00
Building Inspector
TOWN OF $OU~HOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF occUPANcy
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 aceUrate'location of all buildings, property lines, streets, and unusual natural, or
topographic features.
2. Final Approval from Health D~pt. of water supply and sewerage-disposal (8-9 form).
3-. Approval of electrical installation froro Board 0f Fire Underwriters.
4. 'Sw. om statement from plurobor certifying that tho solder used in systero contains less than 2/10 of 1% lead.
5. Comm°rc, ial building, irtdustrial building, rotiltiple residence~ and similar buildings and installations, a cestificate
of code Coropliance'froro architect or engineer responsible for the building..
.6. 8ubroit planning Board Approval of coroplcted site plan requirements.
B. For existing buildings (prior to April 9, 1957) fion-conforming uses, or buildings and "pre-existing" land uses."
1. Accurate survey of property showing all property lines,'streets, building and. unusufil naturai or topographic
features. ' '
2. A properly c~mpleted pphcat~on and consent to respect stgned by the applicant. Ifa 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
, Swimroing pool $50.00, Accessory bui ding $50.00, Additions to accessory building $50.00, Businesses $50.00,
2. Cbrtifieat¢ 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:
Location of Property: '~
House No.
Owner or Owners o~Property: ~ [.).L/v~/I,~ (J/C~.~
Suffolk Copnty Tax Map No 1000, Secti0n -:Cf
Subdivision
Old or Pre-existing Building: '
Street
Pe~mitl',Io, ~ ~/_~ DateofPermit.
Date.
Block
H~alth Dept. Approval:
Planning Board Approval:
(check one)
Hamlet
C.c C.
/' ·
Lot:
Underwriteri; Approval:
Request for: Temporary Certificate
Fee Submi~/ed: $
Final Certificate: (cheek one)
Applicant Signature
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631 ) 765-1802
Fax (631) 765-9502
ro.qer, dchert~,town.southold.n¥.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: Torkelsen Builders
Address: 505 Soundview Ave City: Mattituck St: NY Zip: 11952
3uilding Permit#: 36813 Section: 94 Block: 1 Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Raymond Electrical License No: 5141 -me
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ Basement ~ Service Only ~
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 3 ph Hot Water GFCI Recpt
Main Panel NC Condenser Single Recpt
Sub Panel A/C Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment:
Ceiling Fixtures [~ HID Fixtures
Wall Fixtures ~_~ Smoke Detectors
Recessed Fixtures ].~ CO Detectors
Fluorescent Fixture [~ Pumps
Emergency Fixtures~ Time Clocks
Exit Fixtures L___J TVSS
in ground swimming pool to include, bondin9, 1 pool light, I GFCI circuit breaker
1 control panel, I pool pump, 1 heat pump
Notes:
Inspector Signature:
Date: April 17 2012
81-Cert Electrical Compliance Form.xls
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I/I/NSULATIO/~I
[ ] FRAMING/STRAPPING [~/]'FINA~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) I ] ELECTRICAL (FINAL}
REMARKS:
INSPECTOR ~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] ROUGH PLBG.
[ ]INSULATION
~X~ FINAL ~ ]
[ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (FINAL)
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] RRE RESISTANT CONSTRUCTION
[ ] ELECTRICAL (ROUGH)
REMARKS:
DATE ~- -~ .2/,2._
BUILDING DEPARTMENT
TOWN HALL
SOUTHOI_,J), NY 11971
TEL: (,.G31) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
~×~mined r ~11'(20 II
Disapproved a/c
Expiration ~ I I DE 20 1,5
BLD(]
PE IT NO. ¢ 3
Building Inspector
Do you have or need the following, before applying?
Board of Health
3 sets of Building Plans
Plarming Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
.clwim King Pools
Phone:471 Route 25A
Rocky Poini, NY 11778,
631-744-81 O0
PPLICATION FOR BUILDING PER3/IIT
Date OcT-off d"?l
INSTRUCTIONS
~( ,20//
TO',/h ,)F 50IjTd0LB
a. Thi~ ~qJFlicmidn fv[USY be coz pletely filled in by typewriter or in i~ and sub~tted to the Building h~spector 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 premses, 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 Pemt.
d. Upon approval of this application, the Building ~spector will issue a Building Pe~t to the applicant. Such a pe~it
shall be kept on the presses available for inspection t~oughout the work.
e. No building shall be occupied or used in whole or in pa~ for any pu¢ose what so ever until the Building ~spector
issues a Ce~ificate of Occupancy.
f. Eve~ building pe~t shall expire if the work authorized has not cemented wit~n 12 months a~er the date of
issuance or has not been completed witMn 18 months from such date. If no zoning amendments or other re~lations affecting the
prope~y have been enacted in the interim, the Building ~spector may authorize, in writing, the extension of the pemt for an
addition six mon&s. Therea~er, a new pemt shall be required.
~PLICATION IS HE,BY M~E to the B~lding Department for the issuance of a Building Pe~t pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~d other applicable Laws, Ordinates or
Re~lations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with ali applicable laws, ordinances, building code, housing code, ~d re~lations, and to admit
authorized inspectors on presses and in building for necessaw inspections.
'"'"""'~'~'~T"lU~n'"~'" ,,.,
¢... ,c, UN~WFUL ~na~re of applicant ornme, ifa co.oration)
ENOLOSE POOL TO 6~ .... , ~
UPON COmPLeTION "::: '.it CERTIFIC~ ~% ~5 ~ ~cJ~ ¢~
BEFORE WATER*d'~? ~' (~t'~! ID~!~V(Mailing address of appliCant) ~ ' ,
State
whetheE
apphcant ts owner, lessee, agent, architect, engine¢~~, electrician, plumber or builder
~. C . APPROVED aS NOTED
Name of owner of premises
If apolicant is a corporation, signature of duly authorized officer
(Nm~e and title of corporate officer)
Builders License No. c/37o£- /4
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street
County Tax Map No. 1000 Section
Subdivision
(Name)
(As on the tax roll or latest dl~__ ,~ST).B¥.~4~
765-18~ 8~ TO 4 PM FOR THE
FOLLO~NG INSPECTIoNs:
1. FQUN~TION. ~ REQUIRED
F~ ~URED CONCRETE
2. R~. F~ING, PLUMD~4G
STRAPPING, ELECTRicAL ~ CAULKING
3. INSU~TION
4. FINAL. CONSTRUCTIO~ & E~ECTqr2~L
MUST BE COMPLETE FOR C O
ALL CONSTRUCTION SHALL MFr-
REQUIREMENTS OF TH~ CODEs ~r .~&~,,
· ~URSUANT T0 ~H,~PTER 236
S~ook ~ ( ' T~tT-~.
~iled ~ap ~o. ELECTORAL
INSPECTION R
State existing use and occupancy of premises and intended use and oqcupantqy of prop,osed construction:
a. Existing use and occupancy ..~4~/4_ ~ /r ~
b. Intended use and occupancy
Nature of work (check which applicable): New Building
Repair Removal Demolition
Estimated Cost I ~> / I~U>C>
;. If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Work ,~)~,c> I'
I (Description)
Fee
(To be paid on filing this application)
Number of dwelling units on each floor
If business, commercial or mixed occupancy, specify nature and extent of each type of use.
Dimensions of existing structures, if any: Front Rear Depth
Height Number of Stories
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
Dimensions of entire new construction: Front
Height Number of Stories
Rear .Depth
Size of lot: Front Rear Depth
Rear
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO J
13. Will lot be re-graded? YES __ NO J Will excess fill be removed from premises? YES __ NO ~'/
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
NameofContractor ~"O.J)dl)'7-_ ~d~'~diddress4-'TJ ~'/'~ ~,Z~- ehoneNo.
15 a Is this property within 100 feet of a tidal wetland or a freshw~ter~et~a~?' *YES ~3( N?
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRE .
b. Is this property within 300 feet of a tidal wetland? * YES ~ NO__
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17 If elevation at ~ny. pqiat,ol~ p~OpeTty is at 10 feet or below, must provide topographical data on survey.
OF
COUNTY OF
'"~ ~5 f~"'~'"'d~;~6~ i'~(¢' .,t~J'' being duly sworn, deposes and says that (s)he is the applicant
(Name of individuat'qJ~/n~,¢t~/ract) above named
(S) e is the
: ' "~'i (G°~tract°~C°rp°rate 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 contaiued in this application are tree 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 thi3~,.
cO~b-(4~ day Ol~ 20 ! ]
Notary Public
CONNIE D. BUNCH
Notary Public, State of New York
No. 01BU6185050
Qualified in Suffolk County .-./...
...~,~ ~ ~ Commtaalon Expires April 14, 2_(..~
Signature of Applicant
Jill M. Doherty, President
Bob Ghosio, Jr., Vice-President
James F. King
Dave Bergen
John Bredemeyer
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
June 2,2011
BOARD OFTOWNTRUSTEES
TOWN OFSOUTHOLD
Mr. Robert E. Herrmann
En-Consultants, Inc.
1319 North Sea Rd.
Southampton, NY 11968
RE:
SOUNDVIEW ISLES, LLC
505 SOUNDVIEW AVE., MATTITUCK
SCTM~94-1-3
Dear Mr. Hem,ann:
The Board of Trustees reviewed the survey prepared by Nathan Taft Corwin III dated March 7,
2011 and determined the proposed demolition of an existing single-family dwelling and
swimming pool and construction of a new dwelling and swimming pool to be out of the Wetland
jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code.
Please be advised that the proposed location of the pool fence will require a further
review by this office.
Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal
Erosion Hazard Area (Chapter 111 ) no permit is required. Please be advised, however, that no
construction, sedimentation, or disturbance of any kind may take place seaward of the tidal
and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard
area as indicated above, or within 100' landward from the top of the bluff and/or wetlands
jurisdictional boundary, without further authorization from the Southold Town Board of Trustees
pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to
ensure that all necessary best management practices are taken to prevent any sedimentation or
other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands
jurisdiction and Coastal Erosion I-~rd Ama, which may result from your project.
This determination is not a determination from any other agency.
If you have any further questions, please do not hesitate to call.
Sincafel"Y' ~M.
Jill F~herty, P?~l~nt
Boa~l of Trustees
New york State Department of Environmental Conservation
Division of Environmental Permits, Region 1
SUNY @ Stony Brook
50 Circle Road, Stony Brook, NY 11790-3409
Phone: (631) 444-0365 · Fax: (631) ~.~.~.-0360
LETTER OF NO. JURISDICTION
'TIDAL WETLANDS ACT
Joe Maffens
Commissioner
May25, 2011
Soundview Isles, LLC
109 Monterey Ddve
New Hyde Park, N.Y. 11040 '
Attn: Mr. Robert Sayour, Managing Member
Re:
UPA #1-4738-00823/00003
Facility: 505 Soundview Avenue, Mattituck, N.Y.
SCTM#1000-94-1-3
Dear Mr. Sayour:
Based on the information you have submitted the Department of Environmental ConservatiOn (DEC)
has determined that the property landward of the "top of bluff" line, as shown on the'survey prepared
by Nathan Taft Corwin III dated 12/16/10, last revised 3/7/11,.is beyond Tidal Wetlands Act (Article
25) jurisdiction. Therefore, in accordance with the current Tidal Wetlands Land Use Regulations
(6NYCRR Part 661 ) no pen"nit is required.
Be adviSed no construction,-sedimentation, or disturbance of any kind may take place
seaward of the tidal wetlands Jurisdictional boundary, as indicated above, without a permit. It is
your responsibility to ensure that all precautions are taken to prevent any sedimentation or other
alteration or disturbance to the ground surface or vegetation within Article 25 'jurisdiction which may
result from your Project. Such precautions may include maintaining adequate work area between the
tidal wetland jUrisdictional boundary and your project (i.e. a 15" to 20' wide construct, ion area) or
· erecting a tempora~ fe ~.~:;eTb=,~r.~r hale bay berm. ' -
Please note that~l~s.letter does not reli~e you of the responsibility of obtaining any necessary
p~rm~s or app~vals from other agencies~r local municipalities.
cc: Eh-COnsultants, Inc., Habitat-TW, file
Tow~ IB
54~5 M~
P.O. !~
Tdepbme (6~1) 765-1802
REQUESTED BY:
Company Name:
Name:
License No.:
Address:
Phone No.:
*Name:.
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
BUILDING DEP~
TOWN OF ~OUTHOLD
APPLICATION FOR ;j ~CTRICAL INSPECTIOI"
Lot:
JOBSITE INFORMATION: (*Indicates required information)
("q ~"~,-') q-'lq - ,;::~00-'7
1000 SecUon: ~z-tL BIook.'
~BRIEF DE$CFUPTION OF WORK (Ple~ss PNnI CleaN¥)
In
(Please Circle All That Apply)
*Is job ready for Inspection:
.*Do you need a Temp Certificate:
Temp'lnformation (ff noeded}.
~ Size: 1 Phase 3Phase
*New Service:.Re-~onnect
Additional Information:
(~t NO
100 150 200
Underground Number of Metem
Rough In Final
PAYMENT OUr: WITH APPLICATIOH
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold~ NY 11971-0959
Telephone (631) 765-1802
Fax (631) 765-9502
BUILDING DEPARTMENT
TOWN OF SOUTI-IOLD
July 6, 2012
Soundview Isles LLC
C/o Saynour
109 Monterey Dr
New Hyde Park, NY 11040
Re: 505 Soundview Ave, Mattituck
TO WHOM IT MAY CONCERN:
The Following Items Are Needed To Complete Your Certificate of Occupancy:
'/Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate. (contact your electrician)
A fee of $50.00.
__ Final Health Department Approval.
Plumbers Solder Certificate. (All permits involving plumbing after 4/1184)
__ Trustees Certificate of Compliance. (Town Trustees # 765-1892)
__ Final Planning Board Approval. (Planning # 765-1938)
__ Final Fire Inspection from Fire Marshall.
__ Final Landmark Preservation approval.
BUILDING PERMIT: 36813 - Swimming Pool
STATE OF NEW yoRK
woRKER'S coMPENSATiON BOARD
GE UNDER THE NYS DISABILITY BENEFITS LAW
ANCE COX/ERA ~r
· T F cATE OF INSUR ~ ~-~ ~nsurance A9ento ....... ,
cER ~ .... . ....... ~t~ ¢,arr er or Llcensuu ................. -
~ nisability Bene.~= .~a
PART 1 .To be completed u~ ~ lb Business Telephone Number of ~nsured
1 a. Legal N~me and Address of b~sured (Use street address on~y) 1 c. NYS unemployment ~nsurance Employer Registration
Number of insured
RANDY T. RoDECKER, iNC. DBA sW~M KING
471 ROUTE 25A
ROCKY pOiNT, NY 11778
1716110
Id. Federal Employer ~dentification Number
or SoCiat Security Number
11
ddreSs of the Entity requesting
LNamea~dA. _~ , the Certif cate Holder)
ToWn of S0uthold
55095 Route ~5 pO Box 1179
Southold, IqY 11971
· Coverage
Name of insurance Cam(
The First Rehabilitation Life insurance
company of AmenCa ......
3b policy Number of Entity Hsted m box la.
DBL37154
3c. policy effective period:
0~/01/2011
0113112012
the New york Disability Benefits LaW
~. policy covers: ~ em~lO:,,er.s employees eligible under .
e. ~J All of the w
b. ~ Only the fo~owlng class or classes of the employer's employees
· o¢ licensed agent of the insurance carrier referenced
...... n authOriZed re?.re~er~.a-t~v~e~e cover age as described ab°Ye'
.... of ,~er. jury. I certCy rna, ~a~isability Beneftts insu,~-c ~-,
6/2112011 · _-.- By .... %~;~7~-&~s authorized represent~
Date Signed ................. (S~gnature o, ,.-- Chie~Off~¢r
itmustbe~dedf°r omp (O~ if bOX 4b of part 1 has been ch~
2. To be completed by NYS Worker'S compensatiOn Board
PART State of NeW
Worker s Compensation Board
Date Signed _
pleas, i , horized to issue Form
those insurance csmers art, aut "
DisabditY Benefits insurance poticies end NYS Lice
.120.1. insurance brokers are NOT authorized to issue this f rm.
DB-120A (5-06)
STATE OF NEW YORK
WORKERS' COMPENSATION BOARD
CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE
la. Legal Name & Address of Insured (Use street address only)
Randy T. Rodecker, Inc.
471 Route 25A
Rocky Point, NY 11778-8985
Work Location of Insured (Only required if coverage is
specifically limited to certain locations in New York State, i.e., a
Wrap-Up Policy)
2. Name and Address of the Entity Requesting Proof of
Coverage (Entity Being Listed as the Certificate Holder)
Town of Southold
53095 Route 25 PO Box 1179
Southold, NY 11971
lb. Business Telephone Number of Insured
(631)744-8100
lc. NYS Unemployment Insurance Employer
Registration Number of Insured
ld. Federal Employer Identification Number of Insured
or Social Security Number
113092960
3a. Name of Insurance Carrier
Valley Forge Insurance Co.
3b. Policy Number of entity listed in box "la"
2094735086
3e. Policy effective period
09/01/2011 - 09/01/2012
3d. The Proprietor, Partners or Executive Officers are
X included. (Only check box lfall partners/officers included)
[] all excluded or certain partners/officers excluded.
This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for worken
compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under
Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed
agent will send this Certificate oflnsurance to the entity listed above as the certificate holder in box "2".
The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of
premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured
from the coverage indicated on this Certificate. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for
one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box
"3c'; .whichever is earlier.
Please Note: Upon the cancellation of the workers' compensation policy indicated on this form, if the business continues to be
named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a
new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the
mandatory coverage requirements of the New York State Workers' Compensation Law.
Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced
above and that the named insured has the coverage as depicted on this form.
Approved by: Thomas P. Terry, CPCU
(Print name of authorized representative or licensed agent of insurance carrier)
Approved by:
August 29, 2011
(Signature) (Date)
Title: Authorized Representative
Telephone Number of authorized representative or licensed agent of insurance carrier: (631) 283-8000
Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105~2. Insurance brokers are NOT
authorized to issue it.
C-105.2 (9-07) www.wcb.state.ny.us
~z~u
PLUNBING SCHENATIC
NOT TO SC~E
21X40 ML
SCALE: 1/8" = 1'-0"
WALLS AND STEPS .
2" to 4" SAND BOSOM ~a O
G AND W~AY- ~ N~TE~ '
~ 1. ~L CONSTRUCT]ON IS TO BE IN ACCORD~CE W~H THE R~SIDENTI~ CODE OF N~W Z
YORK STATE- 2010 ~D THE ~SI/NSPI-~3 ST~D~DS FOR RESIDENTI~ INGROUNO
G~DE 2 STRUCTURE ms DESIGNED FOR USE BELOW G~E ~D ONLY IN ~ ~E~ THE
~~ ~ ~~ 3. BACKFILLWITHCLE~E~TH, FREEOFROOTS~D~EBRIS. DONOT~LOWTHEHEIGHT
OF BACKFILL TO EXCEED THE HEIGHT OF THE WATER IN THE P~L BY M~E TH~ 8", OR
TOP OF W~l.~ THE WATER TO EXCEED BAC~I~ BY MORE TH~ 8"
WATER LINE
' ~~ ~ -~2~~r~M i1~- ~ ~~~ j~ ~~ 4. P~CE CONCRETE ON SANDY TO LO~ SOIL. REMOVE ~Y C~Y DEPOSIT ~D ~PACT
4' 'VARIES 4' CLE~ BAC~ILL.
' ~ ' ~ 5 W~S TO BE SMOOTH, NON SKID TYPE, SLOPED AWAY FROM ~.
SE ION B
· ..ou~.o~ ~.~.~.,o~ o~ oo.~.u~,o, o~..~ ~w,~,.~.~, o. ~.~,~ ~.~ 1 O-24-2Oll
¥odSp
SURVEY OF PROPERTY
SITLL4 TE
lvi~ i TITUCL
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-94-01-05
SCALE 1"=,50'
DECEMBER 16, 2010
MARCH 7, 2011 ADDED PROPOSED HOUSE
AREA = 39,456 sq, ft.
(TO TIE UNE) 0.906 mc.
BUILDING AREA DATA
LOT AREA LANDWARD OF CZM LINE=25,674 ~q fl
)POSED HOU-~
PROPOSED POOL
AREA
NOTES
DRAINAGE SYSTEM CALCULATIONS
LLOYD$ LANE
Nathan Taft Corwln III
Land Surveyor
Successor To S±anJey J Isoksen, Jr LS Joseph A Ingegno L S
\
\
leaching po~l required
,,
N Y S LIC NO 50467
.%
CERTIFIED TO.
ROBERT SAYOUR
STEPHANIE SAYOUR
SOUNDVIEW ISLES, LLC.
BARRISTER LAND, LLC.
TEST HOLE DATA
UNAUTHORIZED ALTERATION OR A~DI~ION
TO THIS SURVEy IS A VIOLATION OF
SECTION 7209 OF T~E NE~ YO~K $~ATE