Loading...
HomeMy WebLinkAbout36454-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 6/21/2012 No: 35760 Date: 6/21/2012 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 700 Orchard St, Orient, SCTM #: 473889 Sec/Block/Lot: 25.-4-11.7 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 5/31/2011 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 Lot No. filed in this officed dated 36454 dated 6/7/2011 which this certificate is issued is: accessory in ~'ound swimming pool with fence to code as applied for. The certificate is issued to Morton, Keith (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 36454 /~Sl(or~Sigl~ure 6/4/12 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 #: 36454 Date: 6/7/2011 Permission is hereby granted to: Morton, Keith 108 E 91st St New York, NY 10128 To: construct an Inground Pool, fenced to code as applied for At premises located at: 700 Orchard St, Orient SCTM # 473889 Sec/Block/Lot # 25.-4-11.7 Pursuant to application dated To expire on 12/6/2012. Fees: 5/31/2011 and approved by the Building Inspector. SWIMM1NG POOLS - IN-GROUND WITH FENCE ENCLOSURE CO - SWIMMING POOL Total: $250.00 $50.00 $300.00 Building Inspector Form No. 6 TOV~N 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 thc 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00~ 2. Ce[tificate 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 $ l 5.00 New Construction: Old or Pre-existing Building: (check one) Location of Property: House No. Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Pegmit No. '~o t./~',~ Health Dept. Approval: Planning Board Approval: DateofPermit. ~ - 7- t[ Block q Filed Map. Applicant: Underwriters Approval: Hamlet Lot //,? Request for: Temporary Certificate Fee Submitted: $ /~C) t ~) (..~ Final Certificate: × ne) 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, richert~town southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Keith Morton Address: 700 Orchard St City: Orient St: NY Zip: 11957 Building Permit #: 36454 Section: Block: Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: B J Electric LicenseNo: 2670-me SITE DETAILS Office Use Only Residential [~ Indoor ~] Basement [~ Service Only [~ Corn merical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ Service 3 ph Hot Water GFCl Recpt Main Panel A/C Condenser Single Recpt Sub Panel A/C Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: motor Notes: Ceiling Fixtures [~ HID Fixtures [~] Wall Fixtures ~ Smoke Detectors Recessed Fixtures J.~ CO Detectors Fluorescent Fixture ~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures L~ TVSS in ground swimming pool to include, bonding, 2 pool lights, gas pool heater, cover Inspector Signature: Date: June 4 2012 81-Cert Electrical Compliance Form.xls TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUG~LBG. [ ] FOUNDATION 2ND [ ] ~ULATION [ ] FRAMING/STRAPPING [~:INAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCl'ION I ] FIRE RESISTANT PENETRATION [ ]ELECTRICA~UGH) [ ]ELECTRICAL (FINAL) REMARKS: '"'~/~,,'d a~ &,~ ~ ~ ~ ~ DATE INSPE~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS~ULATION [ ] FRAMING/STRAPPING [~/J'FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTAHT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL.. SOUTHOLD, NY 11971 TEL: (6.;!) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork. net Examined ~'~/7,20 ( [ Approved ~/~7~, 20 l/ Disapproved a'c _ 2011 BI )~ ;;,EPT. PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board ol' Health 4 sets of Building Plans . Planning Board approval fiurve; Check Septic Form NY.S.D.E.C, Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to:¢tAc/~ ?~) [,'s [ Building Inspector PLICATION FOR BUILDING PERMIT 22) .2o i1 ;letely filled in by tspewriter or in ink and submitted to the Building Inspector with 4 sets of flans, accurate plot plau to scale. Fee according to schedule. b. Plot plau shox~ lug location of' lot and of buildings on premises, relationship to adjoining premises or public streets or areas, aud xx aterways. 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 kepl 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. fi Ever3 buitdiug permit shall expire if the work authorized has not commenced within 12 mouths after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the properl3 have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an additkm six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Deparhnent fbr the issuance cfa Building Permit pursuant to the Building Zone Ordinauce of'the Toxin 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 compl3 with all applicable laws, ordinances, building code. housing code. and regulations, and to admit authorized inspectors on premises and in building for necessaD inspections. OCCUPANCY OR USE IS tJl",l!.AWn7 (Signature of applicant or name, ifa corporation) .... ',,,-;" 39 t, fl? , ~': , ....... ~f i~m i L2 .ENCLOSE POOLTO COP-~. , (Ma/lin~-a~dr~ss of applicant) - ff / ,~/~/~/~ ..... (As o~n the ta' x roll or It' a p_.~,~t~ rporation, sign atu re of duly au th orized officer Plumbers License No. Oi: OCCUPANCY u~,ON COMPLETION BEFORE "WATER" State ahethcr applicant is owner ..... lessee agent architect engineer general ct>ntrj~tl~c~on~ltj~beT or builder ]~'~[~u~NG DEPARTMENT AT ~ AM rO a PM FOR THE FOLLO~NG INSPECTIONS: I. ~OUNDATION. T~ REQUIRED FOR POURED CONCRETE 2 ROUGH-F~gMING, PLUMBING, STRAPPING: ELECTRICAL $ CAULKING 3 ~NSU~TION 4 FINAL- CONSTRUCTION $ ELECTRICAL Electricians License No. MUST 8E COUPLET6 FOR CO Other l'rade's Eiccnse No. ~ ALL CONSTrucTION SHALL MEETTHE 18~ .... REOUIREMENTS OF THE CODES OF NEW REQUIRED vor~ STATE NOr RESPONSIBLE FOR . 1. I.ocation~ of land on ~hich~)proposed work~will be done: ,,*~~/~ ~m~ ~ESIGN O~T~. ................. ~, ~,,~U' ~orF llouse Number - ' Sire~t .... Hamlc~UHbU~I~I IU bM~KICM ~00 OF THE TOWN CODE Count} Tax Map No. 1000 Section 2 '~ Block q Lot H, O0 ~ ~ ubdlxlsmn Filed Map Nu. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy' b. Intended use and occupancy Nature of u, ork (check which applicable): Ne,,', Building .......... Repair Removal .... Demolition 4. Estimated Cost ¢'fft0'~0r~) 5. Fee If d,aelling, number oI'dv~elling units If garage, number of cars Addition , Alteration OtherWork ~,/ lAS~ff~,~ iDescription) ('Fo be paid on filing this application) Number of dwelling units on each floor 6. If business, commercial or mixed occupancy, specil}' nature and extent of each type of use. Dimensions of existing structures, if any: Front ............... Rear Height_ Number of Stories Depth Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Rear 8. Dimensinns of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated · ~ NO/~ 1 2. l)ocs proposed construction xiolate any' zoning la~. ordinance or regular on. YES___ 13. Will lot be re-graded? YES NO.~9 Will excess fill be removed from premises'? YES NO 14. NamesofOwnerol'premises~t~5. ~ Address ftc Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this propert5 v, ithin 100 feet ora tidal wetland or a fresh'dater u, etland? *YES NO * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMH'S MAY BE REQUIRED. b. Is this property within 30(I feet ora 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 hines. 17. If elevation al any poinl on property' is al 10 feet or below, must provide topographical data on surYey. 18. Are there any covenants and restrictions vdth respect to this property? * YES NO .~ · IF YES. PROVIDE A COPY. S I'A I-E ()F NEW YORK) SS: ¢'()t/NTY OF ) "~ ~.~_~-~ ce_ ~:>~o, x~/~ ~r~ t beiug duly sworn, deposes and says that ts)he is the applicant -(lqame of indMdual signin'~g contraS) above named. (S te isthe ,4 6r.4r5, (Contractor, Agent, , Corporate Officer. cie . ) of said ox~uer or ou, uers. and is dub authorized lo perJbrm or ba,,c perlbrmed the said u, ork and to make aud file Ibis application: that all statements contained in this applicalion are true Io the best of his knovdedge and belief: and that the v, ork u, ill be pcrlbrmed iu ll~e manner set ['orth in the application filed therewith. S~orn It) before me this ¢:~ (o da5 of_..~,afx~:~_ x~ Notary Public Ikllmy Public, State of New Yodl No. 01R06141351 Corn Qualifies1. in Suffolk County mission t. xpires February, 21,~9_l~ L~re of' Apl)licant Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: $.C.T~. #: THE FOLLOWING ACTIONS MAY REQUIRE 13gE SUBMI~810N OF A ~L~ ~lock ~.~ S¥okM-wJ'r ER, GRAI)ING, DRAINAGE AND EROSION CONTROL PLAN also,ct S,ctio~ CERTIFIED BY A DESIGN PROFEUlONAL IN THE .%-rATE OF NEW YORK. SCOPE OF WORK - PROPOSF~D CONSTRUCTION ITEM# / WORKASSESSIvIENT I Yes No a. What is the Total A~ea of the Project Paroels? (Include Total Area of all Parcels located within ~.~/./ J Will this Pm.h~ct Retain A~I Storm.Water Run-Off the Scope of Wo,'k fo~' Proposed Consb-uctlon) ,~qO i-q} Germrated by a Two (2") Inch Raiofall o~ Site? (S.F./~,~s) (This item will indede air mn-off created by site ',z~ ii b, What is the Total Area of Land Clearing clearing and/or constmctico astJvities as well as all -- and/or Ground Disturbance for the proposed construction acflvi'~,? ~(~) ~ Site Iroprovements and the permanent creation of PRO3vTDE BPJ[][F PRO.~BC~ ]:)F.~CP~'~ON {~de~t~,~Pag.,~N~,~,~t 2 DoestheSitePlanandlorSurveyShowAIIProposed r'~ Drainage Structures Indicating Size & Location? This Item shall include all Proposed Grade Changes and IA)'~'~'~'~ ~F /--~c:~r-~) ~/'~iFE SlopusControllingSuffacaWaterFIow. ~ uJ~ ~',~l~Jb ~24~)Z.- 3 OoestheSita PlanandlorSurveydeschbetheerosion r~ and sediment control pmc~ces that will be used to X control site erosion and storm water discharges. This item must be maintained throughout the Entire Construct~n Pefind. 4Will this Project Require any Land Filling, Grading or Excavation where thera is a change to the Natural ['"'1 Exis~ng Grade InvoMng more than 200 Cubic Yards of Matedal within any Parcel? ~ Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? 6 Is there a Natural Water Course Running through the Site? Is this Project within th~ Trostees jurisdiction General D~C SWPPP Reeulremen~: or within One Hundred (100') fe~ of a Wetland or Submission of a SWPPP is required thr ail Const rdction activities invc~ving scSI Beach? d~sturhences of one (1) or mom acres; including disturbances of less than one acre that 7 Will there be Site preparalJon On E~ds~r~g Grade Slopes ~ are part of a larger common plan that will ~tJmately disturb ese or more acres of land; which Exceed Fifteen (15) teat of Vertical Rise to I I v~ 00') of Horizontal Distance? the DEC ~ determined that a SPOES p~-mlt is required for storm water ~scha~e~. 1. The SWPPP shall be ~'~pared i:)do~ to the submlnal of the NOI. The NO] shetl be into and/or in the dlmc~on of a Town Hght-of-way? required, post-construction storm water managem~t practices that w~ll he used and/or Removal of Vegetation and/or the Construction of any constru(Aed to redu~ the poflutonto in storm water disd~arges and to assure rcem Widhin the Town Right-of-Way or Road Shoulder 5'TATE OF NEW YORK, o ~'X' -, ,,., ,, COUN'I'Y OF ........... ~ ........... .~ .......... SS That ! .......~.~.~.L..~.~......._-r:..~.../~..~X.t,~.. ........... be n[ th y sworn, deposes and says that he/she is the applicant for Permit, And that he/she is the ...... ~..~ .......... O,4~er md/or representative of the Owner or O~Jers, mid is duly authorized to perfon~a or have performed the said work and to make ~utd file this application; that all statemenh conta.~led in this applicadotl, are true to the~ best ofl~ lmowledge mid belief; md that the work will be performed in the maturer set forth in the application filed herewith. / j~ ~. N0t~P, blic StatedNew, ~ [( Qualified in Suffolk Counl i <S~r~t.. of` Town Hall Knnex 5437,5 Main Road P.O. Box 1179 Sout~old, 1~t 119714g$9 REQUESTED BY: Company Name: Name: License No.: Address: Telephone (631) 7~5-1802 iN ~q/~j I~ 44 ~TOWN OF SOUTHO'.I~ - ..~' ,~A~PLICATION FOR ELECTRICAL INSPECTION Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Address: *Cross Street: *Phone No.: Pe~it No.: TaxMap Dist~ct: 1000 Section: Block: Date: Lot: *BRIEF DESCRIPTION OF WORK (Please Pdnt Cleady~ ' ' (Please Circle All That Apply) *Is job ready for inspection: *Do.you need a Temp Certificate: Temp Information (If needed) *Service Size: 1 Phase 3Phase ~New Service: Re-connect Additienal Information: 100 Underground (~O Rough In ~ 150 200 300 350 400 Number of Meters Change of Service PAYMENT DUE WITH APPLICATION Other Overhead 82-Request for Inspection Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 l) 765-9502 May 8, 2012 BUILDING DEPARTMENT TOWN OF SOUTHOLD Keith Morton 108 E 91st St NewYork, NY 10128 Re: 700 Orchard St., Orient 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 4/1/84) __ 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: 36454 - In-Ground Swimming Pool Suffolk County Department of Consumer Affairs VETERANS MEMORIAL t-tlGIIWAY * ttAUPPAI (J[:. NEW YORK 11788 I)AT[i ISSUED: 5~7/2009 NO. 46207- H SUFFOLK COUNTY Home Improvement Contractor License Ihls is t, ccnifx that .lAMES M OBRIEN doillg htlsillcss as PELICAN POOLS IN(: lux ing ILtrnished Ibc requirements scl lbrlh in accordance aith alld stlbjecl hi Iht prm ~sions of applicable laxvs, rulc~ alld I'CgtlJaliolt~ of Ibc ('mint} {>t SufMk. Stale ol New York is hcreb) Jicdlscd to colldtlcl htlSillCSs as a I I()MI: IMPRIIVI'M[N 1' L'()N I'R:X(* Ii)IL in lhc ('OUlll~ ol Suflk)lk NO! ~, Al,Il} Wl'ftl()lJ I' DEPARTMENTAL SEAl &ND ~X (I!RREN'f ('ONNI'~MER AFFAIRS ID CARD Pools/Spas ACORD CERTIFICATE OF LIABILITY INSURANCE ~ 4/12/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE'FWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Maran Corporate Risk Associates, Inc. 300 Hampton Road Sou thampto~ NY 11968 INSURED Pelican Pools Inc. 509 County Rd 39 Southampton NY 11968 CONTACT NA~: C!rnth~a Boumnaia, AAI PHONE (631) 283-8000 ! FAX EA~aDARI~ ~ $: cboumnaia@ mcrain sur ance. eom PRODUCER INSURERIS) AFFORDING COVERAGE I NAIC ~ ~NSURERA:Hartford Casualty Ins Co 129424 !NSgR_~s:H~RTFORD Insurance Group * i00914 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:GL Aut:o Omb 11-12 ~C REVISION NUMBER: INSR IADDLISUBR LTR TYpE OF INSURANCE INER WVD POLICY NUMBER GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE iNSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W1TH RESPECT TO WH[CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS I POLICY EFP POLICY EXP i PERSONAL & ADV INJURY $ 1,000,00( COMB]NED SINGLE L~MIT $ 1,000,000 EACH OCCURRENCE $ i, 000,000 AGGREGATE $ i, 000,000 GENL AGGREGATE LIMIT APPLIES PER X POLICY J~CT LOC AUTOMOBILE LIABILITY X ANY AUTO EACH ACCIDENT $ 500 r 000 DISEASE - EA EMPLOYEE $ 500 , 000 DISEASE - POLICY L~MIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold 53095 Route 25 PO Box 1179 Southold, NY 11971 ACORD 25 (2009109) INS025 (200909) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ·errs, c~cu, m~/s~ ~:~~~ © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P~OL AND PROP~/'Y ~D ~ TO N.Y. STATE RESIDENTIAL COOE APPEZ~)IX G 20~ EDITION POOL TO ~ TO ANSI/NSPI STANDARDS AGI03.1 ~A A~ 0 0 0 MAIN RESIDENCE jl O O ~ O 0 , 00000 0 0 0 0 0 0 0000000 PROPOSED PoOL FENCING O POOL