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Home My WebLink About36951-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 2/6/2012 CERTIFICATE OF OCCUPANCY No: 35431 Date: 2/6/2012 THIS CERTIFIES that the building 1N GROUND POOL Location of Property: 355 LESLIE RD CUTCHOGUE, SCTM #: 473889 Sec/Block/Lot: 97.-4-16 Subdivision: Filed Map No. conforms substantially to thc Application for Building Permit heretofore Lot No. filed in this officed dated 6/18/2009 pursuant to which Building Permit No. 36951 dated 1/27/2012 was issued, and conforms to all of the requirements of thc 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. The certificate is issued to RICHARD & REBECCA ORLOWSKI (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 129878C 8/28/09 u~,~ed S~atul~' 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 #: 36951 Permission is hereby granted to: RICHARD & REBECCA ORLOWSKI 355 LESLIE ROAD CUTCHOGUE, NY 11935 Date: 1/27/2012 To: CONSTRUCTION OF AN INGROUND SWIMMING POOL AS APPLIED FOR, FENCED TO CODE. REPLACES EXPIRED B.P. # 34815 At premises located at: 355 LESLIE RD CUTCHOGUE SCTM # 473889 Sec/Block/Lot # 97.-4-16 Pursuant to application dated To expire on 7127/2013. Fees: 6/18/2009 and approved by the Building Inspector. PERMIT RENEWAL $125.00 CO - SWIMMING POOL $50.00 $175.00 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. 34815 Z Date JUNE 26, 2009 Permission is hereby granted to: RICH/LRD H ORLOWSKI 355 LESLIE RD CUTCHOGUE,NY 11935 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL AS APPLIED FOR, FENCED TO CODE at premises located at 355 LESLIE RD CUTCHOGUE County Tax Map No. 473889 Section 097 Block 0004 Lot No. 016 pursuant to application dated JUNE 18, 2009 and approved by the Building Inspector to expire on DECEMBER 26, 2010. Fee $ 250.00 Authorized Signature ORIGINAL Rev. 5/8/02 Forln No. 6 TOWN OF SOUTHOLD 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 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. 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 Plamfing 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: I. Accurate survey of property showing all property lines, streets, building and unusuat natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. [fa Certificate of Occupancy is denied, the Building Inspector shall state lhe reasons therefor in writiug to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimmiug pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, 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 Occnpancy - Residential $15.00, Commercial $15.00 Date~. ~ New Construction: Location of Property.'~ House No. Owner or Owners of Prope~XY~/ Suffolk County Tax Map No 1000, Section SuSdivision Pe m tNo. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~-'"~ , Old or Pre-existing Building: (check one) Street Block L.,/' Lot Filed Map. Lot: ate of Permit. / ~2 '~ - / ~2, Applicant: Haq~t Underwriters Approval: Final Certificate: / (check one) ~'" ~' Applicant Signature Date Electrical Inspection Certificate Electrical Irtspectlon SMvice, Inc. Application Number 375 Ounton Avenue 129878C Ea,~t Pet~hogue, NewYor~ t1772 (e,11) ~.,(44z Issued To:Richard Orlow6ki Street: 355 Leslie Rd Village: Cutchogue Section: Block: Zip: 11935 Lot: Town: Southold Contractor: US1 Electric (L) LI;. # 2740-E w~s examined and found to tm In compiiance with the NaUo~al Electrtcal Cede. Commercial [] NVDefects ~ Pool ~ lstFIoor [] IndOor [~ Basement L-~ HntTub [--[ DeL Garage gl AttiG [] 2nd Floor [] Outdoor (~} Addt~lon ~.~ Survey Receptacles Fixtures GFI Heaters AIC Fans 1 Washer/Amps Dryer/Amps Oven Range~Amps MIcrowaves [] Residential Dl~hw~she~ Furnace Oil Gao Circutetem Smoke Dot.tot Bell Transformer Meter Ampa Phase UG/OH Jacuzzi Television CO Detecter / Bldg. Permit: 34815 Other Equipment ~pool Lt/2-20 amp Spec. Outlets/1-Rt, ubpanel/1-Time Clock Hugo S. Surdi President This ~e~llficate must not be altered In any rrmnne~. Inspec~om may be identified by their credeNZas. TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT PENETRATION DATE 7--/7..-o? INSPECTOR~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU~.A-?ION [ ] FRAMING / STRAPPING [//,]"FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ REMARKS: ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) / DATE ~INSPECTOR ~/~ F~L~) INSpeCTION REPORT I DATE I COMMENTS FO~ATION (2ND) .~ m ROUGH ~G & ~ ~ PL~G ~ ~S~ATION P~ N.Y. q STATE E~R~ CODE ~DITION~ COUNTS ~ TOWN OF SOIJTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined Approved Disapproved a/c Expiration JUN 1~ L.'J III. DC. DEPT. TOWN OF $OUTHOLD · This appilcanon MULl be compl PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying'? Board of Health 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Tmstees Flood Permit Storm-Water Assessment Form Contact: Mail to: Phone: ~B~uilding Inspector LICATION FOR BUILDING PERMIT Date ¢-I] ' ,200q INSTRUCTIONS ~tely filled in by typewriter or in ink and submitted to the Building Inspector with 4 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 the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced with/n 12 months after the date of issuance or has not been completed within 18 months froxn such date. If no zoning amenchnents or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. 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 co¢~, and reg¢lations, and to admit authorized inspectors on premises and in building for necessary inspections. ccc,. ,, * (Signature of appfiq/ant or name, ifa corporation) "IMMEDIATELY USEIS UNLAWFUL ,, ENCLOSE POOL TO CODE UPON cOMPLETIONWITH: "IT CERTIFICATE /(( ( ai i[ 'g addr re2 'o; :ppli a t7 BEFORE "WATER" r' '": .v r't.y State whether applicant is ow'l'f~r' ~essee, agent, ~bhi~ect, engineer, general contractor, electrician, plumber or builder Name of owner of premises If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. J'P4 ~ ~9 Plumbers License No. APPROVED AS NOTED DATE: B:P. # [,LOh~ICt ri': ,~gO ' ,,. (As on the tax roll or late~7 ';- '~~ ~ ~ ~ ':'M FOR THE ~WRITER$ CERTIFICATE ,.,REQUIRED Electricians License No. ~'TqO Other Trade's License No. CONSTi " ALL :~ ,:,-._L MFFT THE REOUZ/::: i:,']., OF THEALL CO '*~ '.' :S OF NEW CODES OF NFw r,J Z STATE. REQUIREM£N~$ 1. Location of]and on which proposed wo~ will be done: YO~< STATE. NOT RESPONSIBLE FOR House Number S~ect Ha~Ai~ U 10RM WATER SUI,0r , :. , ~qA;: ¢,AMPURSUANT T0 CHAPTER 23~ County T~ Map No. lOOO Section ~ ¢~'~"..'BIoe~ ~, '~,r;OFTHET~CODE¢~ Subdivision lot 2. State existing use and occupancy of premises and intende~ use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy Nature of work (check which applicable): New Building_ Repair Removal Demolition Estimated Cost l'/~j/~q0- If dwelling, number of dwelling units If garage, number of cars Fee Other Work "~_M4.63Jao V~/c (Description) (To be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 6 ~ Rear Height Number of Stories I Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front ~2C) Rear 20 Depth Height Number of Stories ,, 9. Size orlot: Front ]~ Rear )~-0 Depth /D~O 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 fee,0.4 13. Will lot be re-graded? YES gt NO Will excess fill be removed from premises? YES / NO__ 14. Names of Owner Name of Architect'_M0w Name of ContractorJ0~ Address'~ ~ 0'~P~'oneNo. ~.ddress /-{ ~Y-e~/~t cScaWhoneNo ~]~q-7i=~'5 Address 6}2:} /{~- )%A T°~Phone No. -/qq~-Tlo 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland. YES __ NO L/ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this within 300 feet of a tidal wetland'? * YES NO %// property * 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 any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO ~/ · IF YES, PROVIDE A COPY. ]~"F~ ~. ~)~¢_.0..~ being duly sworn, d~oses and says that (s)he is the applic~t (Name of individml si~ing contract).above named, (S)He is the ~~ (Contractor, Agent, Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are 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. Sworn to before me this---~ 200q MARGARET A. KIDNEY · ..._ ~, ublm - State c No. 01 K16021111 Qualified in Suffolk Courtly · S~'~gnature of Cplicant Tow____ n o_ f Southold Erosion, Sedimentation & Storm-Water Run-off ASSES8MENT FORM PROPERTY LOCATION: $,C,T,M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE 8UBMIESION OF A to=o - .. % District Section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE ~TATE OF NEW YORK, .Item Number: 1 2 3 4 (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Will this Project Retain All Starm-Waler Run-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all run.off created by site clearing and/or construction activities as well as a~l Site Improvements and the permanenl creation of impervious surfaces.) Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and Slopes Controlling Surface Wated=low! Will this Project Require any Land Filling, Grading or Excavation where there is a change ID the Natural Existing Grade Involving more than 200 Cubic Yards of Matedal within any P'arcal? Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Surface? 5 6 Is there a Natural Wa[er Course Running through the Site? Is Ibis Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? Will there be Site preparation on Ex/sling Grade Slopes which Exceed Fifteen ifS) feet of Vertical Rise to One Hundred (100') of Horizontal Distance? 7 Will Driveways, Parking Areas or other Impervious Sudaces be Sloped to Direct Sierra-Water Run-Off into and/or in the direction of a Town right-of-way? 8 9 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item Within the Town R ghbof-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse? Yes No E-IZ El/ NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark in the Box, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit! EXEMPTION: Ye~s N_..E Does this project meet the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosibn Control Plan is NOT Requiredl __ __ STATE OF NEW YORK, j /,COUNTY OF.'"~'7' '[';~'i}'"; ' "" ~)d{:~, ,~ SS That[ g ~/~.. ~ ....... '" ~.-~'..~.~..Q..l~..s~.../~:.,.'.'.'.".'-". being dui, s,, o m, de'po ses m~d says fl~at he/s he is the applicant for Penmt, (Name of ~ndividu al signing Document) ~d d~at he/she is dm (Owner, Comract~r, Agenh Co~orate Olficef Owner and/or representative of tim Owner of Om~er's, ~d is duly authorized to perform or have performed ~e s~d work ~d to m~e ~d file tiffs application; ~at ~1 smtemenU con.ned in ~s application are ~e to ~e best of ~s ~owledge ~d beliefi ~d · at tim work will be pe~ormed in fl~e m~ner set forfl~ in tim applicaQon filed hereud~, Sworn to before me ~is; .................... ..................... FORM - 06107 ARTHUR EDWARDS POOl & SPA CENTRE 929 ROUTE 25A MILLER PLACE, NY 11764 516-744-7185 FAX-744-0174 APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD TOWN OF SOUTHOLD MAIN ROAD (P.O. BOX 1179) SOUTHOLD, NY 11971 (631) 765-1802 PAPERS ENCLOSED: APPLICATION FOR OUTDOOR POOL PERMIT EROSION SEDIMENTATION & WATER RUN ASSESSMENT FORM CERTIFICATE OF WORKER'S COMPENSATION CERTIFICATE OF LIABILITY INSURANCE SUFFOLK COUNTY LICENSE SUFFOLK COUNTY PLUMBER LICENSE SUFFOLK COUNTY ELECTRICIAN LICENSE 4 SETS OF PLANS - (3 STAMPED) 3 SURVEYS [ ] TAX BILL [~ $250.00 CHECK FOR PERMIT FEE PLEASE CALL OUR OFFICE IF THERE ARE ANY QUESTIONS REGARDING THIS APPLICATION. Southold Town Building Department 54375 Main Road Southold, New York 11971 (631) 765-1802 Parcel ID: 97.-4-16 Permit #: 34815 Permit Date: 6/26/2009 Expiration Date: 12/26/2010 BUILDING PERMIT RENEWAL LETTER Dated: 10/31/2011 Applicant: RICHARD & REBECCA ORLOWSKI Location: 355 LESLIE RD CUTCHOGUE Work Description: IN GROUND POOL CONSTRUCTION OF AN INGROUND SWIMM1NG POOL AS APPLIED FOR, FENCED TO CODE A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Address: RICHARD & REBECCA ORLOWSKI 355 LESLIE ROAD CUTCHOGUE, NY 11935 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. No work is permitted or authorized beyond the expiration date. THANK YOU, SOUTHOLD TOWN BUILDING DEPT. /o~o - 77-¥-/~ TOWN OF $OUTHOLD P~OPERTY RECORD CAI~D~I VILLAGE DISTRICT ACREAGE SUB. LOT W i' ~ TYPE OF BUILDING 1ND. C MIS F~cZ: la O. YIg/c~ SEAS. VL. FARM LAND IMP. TOTAL DATE ~t O0 Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushland House Plot Tota I COMM. REMARKS Extension Extension Extension Breezewa~ Garage Foundation Basement Ext. Walls Fire Place Porch Porch ~_ ~ Bath J~ubb Floors Interior Finish Attic Rooms Ist Floor Patio Rooms 2nd Floor Driveway ACORD. CERTIFICATE OF LIABILITY INSURANCE OP,D == ARTHI~- 1 01/14/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE Bagatta ~ssociates, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 823 W Jericho Turnpike Ste ZA ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. smithtown NY 11787 Phone: 631-864-1111 Fax: 631-864-8274 INSURERS AFFORDING COVERAGE NAIC# ~rthur J Edwards Mason ~URERB Contracting Co Inc DBA Arthur Ec~ards Pool & Spa Center ~NSURE~C 929 Route 25A ~NSURERD Miller Place NY 11764 COVERAGES 6EN~RAL LIABILrrY EACH OCCURRENCE $1000000 A X COMMERC~LGEkERALUABIL[TY bYEASG0912 01/01/09 01/01/10 u~= ~u~.,~u $ 100000 m C~,MS~ ~ ooou~ MED E~ (~ O~ person) sSO00 PERSO~ & ~V r~Y $ ZOO0000 ~ ~T ~DITIO~ GENE~AG~E~ $ ~000000 CERTIFICATE HOLDER CANCELLATION 0000000 Town of Southold Town Hall P.O. Box 728 Southold NY 19971 ACORO 25 (2001108) @ ACORD CORPORATION 1988 This certificate is an original. State of New York Worker's Compensation Board CERTIFICATE OF PARTICIPATION IN WORKER'S COMPENSATION GROUP SELF INSURANCE la. Legal Name and Address of Buslness Participating In Group Self-Insurance (Use Street Address Only) Arthur J. Edwards Mason Contractor, Inc. DBA: Arthur Edwards Pool & Spa Centre 929 Route 25 A Miller Place, NY 11764 lb. Effective Date of Membership in the Group 4/24/2002 Issue Date 6/17/2009 6/16/2010 Expiration Date (631) 744-7185 le. NYS Unemployment Insurance Employer Registration Number of Business Registered in Box "la". 24108715 If. Federal Employer Identification Number of Business Referenced in Box ] Included. (Only check if all partners / officers inluded. 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as Certificate Holder). Town of Southold Town Hall PO Box 728 Southold, New York 11971 111277925 3. Name and Address of Group Self Insurer. Special Trades, Contracting And Construction Trust 6250 South Bay Road Syracuse, NY 13039 Policy: W521504 This certifies that the business referenced above in box "la" is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law as a participating member of the Group Self-Insurer listed above in box "3" and Participation in such group self-insurance is still in force. The Group Self-Insurer's Administrator will send this Certificate of Participation to the entity listed above as the certificate holder in box "2". The Group Self-insurer's Administrator will notify the above certificate holder within 10 days IF the membership of the Participant listed in box" la" is terminated. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year from the date certified by the group self-insurer.'. If this certificate is no longer valid according to the above guidelines and the business referenced in box "Ia" continues to be named on a permit, license or contract issued by the certificate holder, the business must provide the certificate holder either with a new certificate or other authorized proof 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 of the Group Self-insurer referenced above and that the business referenced in box "la" has the coverage as depicted on this form. Certified By: Certified By: Title: David France}, ~,/~/ '/ (Signamre) (Date) Trust Admirasxrator Telephone Number: (315) 699-8475 GSI-105.2 (2-02) Worker's Compensation Law Worker's Compensation Law Section 57 Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any pen'nit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance cartier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board, commission or office to pay any compensation to any such employee if so 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 defined by this chapter, notwithstanding any general or special statute requiting or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. please Note:This Certificate is valid only through the policy dates indicated above, OR a maximum of one year after this form is approved by the authorized representatives of the Group Self-insurer. At the expiration of those dates, if the business continues to be named on a permit or contract issued by the above government entity, the business must provide that government entity with a new Certificate. The business must also provide a new Certificate upon notice of cancellation or change in status of the policy. GSI- 105.2 (2-02) Reverse 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 satisfactou 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, SUFFOLK COUNTY EXECUTIVE'S OFFICE OF CONSUMER AFFAIRS Additional Busillesses MASTER ELECTRICIAN This certifies that the bearer is duly licensed by the County of Suffolk EDWARD S REIFF 2740-ME ~'~'~" ~'~ 05/0112010 Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGttWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 7/1/78 No. 4436-H SUFFOLK COUNTY _t-Ion ~ e [~pro veto en t Con tractor License This is to certify that ARTHUR J EDWARDS doing business as . __AR_TH UR EDWARD_~ MASON CONTR.~.CT1NG INC h~x, in8 fio__,~,~l~c~ ,, e ? ~emem:~ sel ~o~ ~ ~ ip, accordance w~th attd subject to the provisions of applicable laws, ~q,.,c~ and t.g~ a ~o.s -,? ,~hc CounL; of Suffolk, State of New York is hereby hcensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. $ ~at ~he bearer is duly Ik:er~ed by the County of Suffolk SUFFOLK COUNTY EXECUTIVE'S OFFICE OF CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR LICENSE ARTHUR J EDWARDS 4436-H /1978 ~'~" ~"~ 07/01/'2010 Additional Businesses Director Plan Section B-B Section A-A Typical Piping SIZE A B C D E F G H AREA CAP. FEET FT. FT. Fr. FT. FT. FT. FT. FT. Sq. FT. GAL 15x3~.' 1§' 32' 8' 14' 6' 4' 4' 8' 51~. 19,000 15'x36' 16' 36' 12' 14' 6' 4' 4' 8' 576 21,600 18'zf16' 18' 38' 12' 14' 6' 4' 5' 8' 648 ~4,300 ~0'x40' ~0' 40' 15' 14' 6' 4' 6' 8' 800 ~,000 24'x44' 24' 44' 18' 14' 8' 4' 6' 10' 24'x48' 24' 48' 20' 16' 8' 4' 6' 10' PERMACRETE WAT.I. SYSTEM 929 Route 25A Miller Place NY 11764 (631) 744-7185 FAX (631) 744-0174 Suffolk License #4436-HI Nassau License #HI74450000 Wall Section Arrangement NOTE~ I,m:MONUMENT SUFFOLK COUNTY TAX MAP ~ST.~OOO SEC~O.,.,9.7 BL.O4 LOT~ TOTAL AREA=22620S.E SURVEY FOR WALTER P. HENNESSEY MARIANNE A. FONTANA AT CUTCHOGUE TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK DATE: AUG. 9, P985 SCALE: I" : 30' NO. 85 ' 649 GUARANTEED T~ YOUNG & YOUNG RIVERHEAD~ NEW YORK ALDEN W. YOUNG, PROFESSIONAL ENGINEER AND LAND SURVEYOR N,Y.S. UCENSE N0.12845 HOWARD W, YOUNG~ LANO SURVEYOR NH.S, LIC~NSE'NO.45895