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HomeMy WebLinkAbout36679-ZTown of Somhold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 7/19/2012 CERTIFICATE OF OCCUPANCY No: 35827 Date: 7/19/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: 1N GROUND POOL 565 PARK AVENUE SOUTHOLD, Sec/Block/Lot: 56.-1-2.3 Filed Map No. conforms substantially to the Application for Building Permit heretofore pursuant to which Building Permit No. 36679 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 ~round swimming pool with fence to code as applied for. Lot No. filed in this officed dated dated 9/9/2011 The certificate is issued to DAVID & KELLY HUNSTEIN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 4149 12/28/06 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 #: 36679 Date: 9/9/2011 Permission is hereby granted to: DAVID & KELLY HUNSTEIN 565 PARK AVENUE SOUTHOLD, NY 11971 To: CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD, FENCED TO CODE. REPLACES EXPIRED B.P. # 32541 At premises located at: 565 PARK AVENUE SOUTHOLD SCTM # 473889 Sec/Block/Lot # 56.-1-2.3 Pursuant to application dated To expire on 319/2013. Fees: 10/2012006 and approved by the Building Inspector. PERMIT RENEWAL Total: $125.00 $125.00 Building Inspector 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. -9~! Z Date OCTOBER 25, 2006 Permission is hereby granted to: D & K HUNSTEIN 565 PARK AVE SOUTHOLD,NY 11971 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD, FENCED TO CODE at premises located at County Tax Map No. 473889 Section 056 pursuant to application dated OCTOBER Building Inspector to expire on APRIL 565 PARK AVE SOUTHOLD Block 0001 Lot No. 002.003 20, 2006 and approved by the 25, 2008. Fee $ 150.00 Authofi zed Signature COPY 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. 32451 Z Date OCTOBER 25, 2006 Permission is hereby granted to: D & K HUNSTEIN 565 PARK AVE SOUTHOLD,NY 11971 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD, FENCED TO CODE at premises located at County Tax Map No. 473889 Section 056 pursuant to application dated OCTOBER Building Inspector to expire on APRIL 565 PARK AVE SOUTHOLD Block 0001 Lot No. 002.003 20, 2006 and approved by the 25, 2008. Fee $ i50.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form 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 Depamnent with the follo~ving: 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 D.opt. of water supply and sewerage-disposal (S-9 form). 3.. Approval of electrical installation from Board 6fFire Underwriters. 4. 'Sw. om statement from plumber ca,drying that the solder used in system contains less than 2/10 of 1% lead.. 5. Comm~a'oiat building, industrial building, multiple residences and similar buildings and installations, a certificate of Code ComPlia~tce'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) ~ion-conforming uses, or buildings and "Pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets, building and tmusu/fl natumi or topographic features. 2. A properly Qogmpleted application and cOnsent to inspect signed by the applicant. If a Certificate of OccuFancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. C. ertifica{c of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, ~ Swinunitig pool $50.00, Aecessory building $50.00, Additions to accessory building $50.00, Businesses $50.0(~. 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 Coustmction: Location of Property: Hous~ No. o crs of Property: , ' I d Suffolk ~ty T= Map No 1000, S~tion ' ~ Su~sion Health Dept. Approval: ~lanning Board Approval: mest for: Temporary Certificate 'ubmitted: $ ~0, OO Old or Pm-existing Building: Da~ofPermit. Date. ¥ (check one) Street Hamlet I Lot c~, 3 Fried Map. Lot: Underwriters Approval: Final Certificate: X/ (check one) AplSlica t/,~S ignat ure SUFFOLK BUREAU or iNSP E CTORS, Jnc 40 Nottingham Drive, Middle ~sland, NY 11953 Telephone: 631 495 8136 · Fax: 631 980 6455 · E-Maih SBE~GSOgmail.com canB OF ErEC IC L COl Applicant: LEO'S Electric Rough in Inspection Date: 12/28/2006 Final Inspection Date: 12/28/2006 NO: Certificate N°: 4149 i Application 4149 Suffolk County Tax Map N°: Building Permit N°: 3:2451 i.! and/or work described below, installed by the applicant named above, located at the premise of and not .i. after the final inspecUon date above: iiiil local, state and naUonal electrical code requirements and th,s office, iii!i ::ii - . ia iii : :~ .......... Electric License No. 21D3 ...E [iiii ~:~:~P, ppllCarlc LI=U ~ iil Owner: Hunstein iiAddress: 566 Park Ave, Southold, NY 11971 Address of ]Inspection Site: 566 Park Ave, Southold, NY 11971 X Residential X Indoom Basement Service Shed Commercial Outdoom Ist Floor X Pool Other: Addition Survey Attic Garage iiii Znventory iiii Service 30 I Time Clock :2 Switches Wall Fix Smoke Der ~:~: 4 Ckt Sub- Panel GFC/I~eaker :2 Single Recpt Fluorescent Fix 2 Pump !iii Disconnects Dryer Recpt Range Recpt A/C Blower Emergency !iii Transformers Exhaust Fan Appliance A/C Cond Exit Fix Twist Lock TVSS Heat Pump Electric Heat I Pool Luminaire TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION [ ] ROUGH PLBG. [ ] INSULATION ['~ FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FRAMING/STRAPPING [W] FIliAL ~ ~_~// [ ]FIREPLACE & CHIMNEY [ ] FIRr~S~Erf INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [~j ELECTRICAL (FINAL) REMAI~KS:~ DATE ~ INSPECTOR FIELD INSPECTION REPORT I DATE i COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) - ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE EIN~ ~/,,'L~ ~-..~~_~ _ - '" '/-- ~-?)~7'~'~~ ADDI:N~~ ~ '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL ° SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.netYSouthold/ Examined IO/°?~~)/0~[$ 20 Ob Approved [V? , Disapproved a/c Expiration ,20 0 ~ PERMIT NO. Building Inspector BUILD1NG 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. Trustees Contact: Mail to: Phone: APPLICATION FOR BUILDING PERMIT Date _ INSTRUCTIONS a. This application MUST be completely 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 within 12 months 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 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 code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. [~11[ RS ~I~'['[~[~A'['~ (Sig/~re-a~ a corporate'on) 'IMMEDIATELY" ALL¢~I~CTIONSt..~4 ~r 02F7~ ~NCLOSE ? )OLTO CODE UPON COMPLETION ML~' THE REQU!P%IENTS OF THE (Mailing address of applicant) BEFORE "WATER' CODES OF NE,5 ~ :4 gTATc State whether applicant is owner, lessee, agent, architect, engineer, ~ner~l contractor, electrician, plumber or builder Name of owner of premises~ffJlt/~f5 C~ ~e/{? h¢/%-~c/~ A?P?'?VED, AS (As on the tax roll ~s~.. ~ orlat ed V , "- '- If applicant is a corporation, signature of duly authorized officer FEE ~ ~'0 ' (Name andtitle°fc°rp°rate°ff{~{~CUPANCY OR NO'hFY BUiL[. -',"'E~? AT 765-1802 SA" FOR THE rISE IS UNLAWFUL ..... ' Builders License No. - FOiLC, ,t.G ,h Plumbers License No. , It t r=l"LI/'h I ~T r'~:I::ITIFICATE ~' ~' '." ,,~,,.'r~or_... Electricians License No. ~.~L~-O- ]U(~ ~ v,..'~ , ~,,,,- .... Fu~ ~ ,~URE~., ,,h~..TE 2. ROU'3H - FE,'.L ,, , PLUN',5,!'4G Other Trade's License No. OF OCCUPANCY INSULA}ION 3. 1. Location of land on which prccosed work will be done: ,5 5 dive_. House Number Street CountyTax MapNo. 1000 Section ~(¢ Block J Subdivision f~a0 0¢ L~ Qo~ ~ Filed Map No.__ ,(Name)' 4. FINAL - CC ,~:,r~ U:'":?",~ MLST'I BE COi~i; ~:_ : ...... *r ~E FOR BESI6N OR CONSTRU&TI~ ERRORS. Lot ~, ~ State existing use and occupancy of premises, and intended use and occupancy of proposed constr~,ction: a. Existing use and occupancy f-,E~l~- · b. Intended use and occupancy '~x~.S '~ ~ I,J'x'l~ '<O¥~'~t~j~v'C) ~,aOC. 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition 4. Estimated Cost I'~l 0C)0 - 5. If dwelling, number of dwelling units If garage, number of cars Addition Other Work Fee Alteration (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 (~0' Rear Height Number of Stories ~ Depth Dimensions of same structure with alterations or additions: Front Depth Heigh[ Number of Stories 8. Oimensions of entire new construction: &U~r o~-' -R--~'r~ 42' Depth Height Number of Stories Rear 9. Size of lot: Front 2~Y Rear 2,~'0' Depth 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 v~ 13. Will lot be re-graded? YES J' NO__Will excess fill be removed from pr~rnises? YES ~'/ NO 14. Names of Owner of premises ['~luV~o ~ell~ tka~s~;~ Address SI,5 ~)~ p~,~,~aox-ao.o Phone No. Name ofArchitect"~m¢~ h ~lJJq [OiS' Address~/ ~zt'c Z.~ ~)mr~n'~PhoneNo Name ofContractor~Cc-a~,~t~~',.~-s Address t~2~ ~ ~ Phone No. 15 a. Is ~is prope~y within 100 feet of a tidal wetl~d or a ~eshwater wetl~d? *YES NO ~ * IF YES, SOUTHOLD TO~ TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this prope~y within 300 feet of a tidal wetl~d? * YES NO ~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide su~ey, to scale, with accurate foundation plan and distances to prope~y lines. 17. If elevation at ~y point on prope~y is at 10 feet or below must provide topo~aphical diff.0n s¢~ey. STATE OF NEW YORK) SS: COUNTY OF ) ~JEr~3c ~, ~l~hm'cu 05 being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the c//Ok4t'LOEtO'~- (Contractor, Agent, Corporate Officer, etc.) of said owner or owners and is duly authorized to perform or ha¥~'parformed the said work and to make and file this application that all statements contained in this apphcat~on are true to the best of iris knowledge and behef; and that the work will be performed in the manner set forth in the applicabon filed therewith. Sworn to,before me this ~-, I~x~- dayof (.,)~'I'~{~~-- 20L,~9 MARGARET A. BANNWARTH Notary Public, State of New York No. 01BA6021111 Qualified in Suffolk County Commission Expires March 8, 200~ 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 (516) 765-1802 PAPERS ENCLOSED: [] APPLICATION FOR OUTDOOR POOL PERMIT CERTIFICATE OF WORKER'S COMPENSATION CERTIFICATE OF LIABILITY INSURANCE SUFFOLK COUNTY LICENSE SUFFOLK COUNTY PLUMBER LICENSE SUFFOLK COUNTY ELECTRICIAN LICENSE 3 SETS OF PLANS 3 SURVEYS C.O. TAX BILL $150.00 CHECK FOR PERMIT FEE PLEASE CALL OUR OFFICE IF THERE ARE ANY QUESTIONS REGARDING THIS APPLICATION. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 TeLephone (631 ) 765-1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLD ~une 30th, 2009 David & Kelly Hunstein 565 Park Avenue 5outhold, N.Y. 11971 RE: 565 Park Avenue (In-Ground Pool W/Fence) 5CTAA: # 1000-56.-1-2.3 bear Mr. & Mrs. Hunstein, Please be advised that your Building Permit # 32451 issued October 25th, 2006 has expired. According to the Code of the Town of 5outhold, a Certificate of Occupancy must be issued before the use of the structure. Please be aware To renew your Building Permit please submit a fee of $250.00; at that time we can Schedule an inspection by one of our Building Inspector's. Please read enclosed docqment regarding swimmino oool codes. If you have any questions, please call us at 765-1802. Respectfully, 5OUTHOLD TOWN BUILDING DEPT Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765- 1802 Fax (631 ) 765-95{)2 BUILDING DEPARTMENT TOWN OF SOUTHOLD September 20,2011 David & Kelly Hunstein 565 Park Ave Southold, NY 11971 TO WHOM IT MAY CONCERN: The Following Item(s) Are Needed To Complete Your Certificate of Occupancy: ~/ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. Alee of $50.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1184) __ Trustees Certificate of Compliance. (Town Trustees #765-1892) Final Planning Board Approval. __ Final Fire Inspection from Fire Marshall. - Bob Fisher __ Final Landmark Preservation approval. BUILDING PERMIT: 36679 - In-Ground Swimming Pool Town Hall Annex 54375 Main Road P.O. Box I 179 Southold, NY 11971 0959 Telephone (63 t) 765-1802 Fax (631) 765-9502 May 8, 2012 David & Kelly Hunstein 565 Park Ave Southold, NY 11971 BUILDING DEPARTMENT TOWN OF SOUTHOLD xbTO WHOM IT MAY CONCERN: .,q&The Following Items Are Needed To Complete Your Certificate of Occupancy: /hi// ~ ~ Application for Certificate of Occupancy. (Enclosed) -x~ Electrical Underwriters Certificate. (contact your electrician) / --' Afeeof$s0.00. __ 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: 36679 - In-Ground Swimming Pool ~0~©_5.~?~.I_~o~ TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET.,.,, ~, ~ ,~,,,~7~ ( VILLAGE DIST. SUB. LOT FOYER OWNER ~ il9 ~ H~S~ N E ACR. ~ND IMP. TOTAL DATE R~RKS · illable FRONTAGE ON WATER W~land FRONTAGE ON ROAD Meadowland DEPTH ~otal 56-1-2.3 10/00 Extension Ext. Wails '~~', Interior Finish Extension Fire Place ~ Heat Porch _'~x i~ = 70 > I~b '~0 ~ 5 Pool Attic Deck Patio Rooms 1st Floor Breezeway Driv~ay Rooms 2nd Floor o.a. ~. Suffolk Coun~ £xecudve ~s Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 7/1/78 No. 4436-H SUFFOLK COUNTY I-Iota e .hnlaro vezn en t Contra ctor License This is to certify that ARTHLrR ~ EDWARDS doing business as ARTHUR EDWARDS MASON CONTRACTING INC b¢l ~o~ m m accordance with and subject to the provisions of apphcable laws, and ,~gu'.auons of fl~_c Coun~' of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. This certifies that the bearer is duly licensed by the County of Suffolk SUFFOLK COUNTY EXECUTES O~'FICE O~ CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR LICENSE ARTHUR J EDWARDS 4436-H /1978 e~,~. ~,~ 07~t/2008 Additional Businesses Director Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORLAL HIGHWAY * HAUPPAUGE, NEW YORK 11 ?$$ 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 SPE_C_L~L_TIES INC ...... having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. SUFFOLK COUNTY EXECUTIVE'S OFFICE OF CONSUMER AFFAIRS Additional Businesses MASTER ELECTRICIAN This certifies that the beare~ is duly licensed by the County of Suffolk EDWARD S REIFF UNDERGROUND SPECIALTIES INC 2740-ME ACORD. CERTIFICATE OF LIABILITY INSURANCE OP D GATE M , ~T~o-1 I 01/05/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bagatta Associates, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 823 W Jericho Turnpike Ste lA ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Smithtown NY 11787 Phone: 631-864-1111 Fax: 631-864-8274 INSURERS AFFORDING COVERAGE NAIC # Arthur J Edwards dba INSURERB: Arthur J. Edwards Pool & Spa Center Contracting Inc. INSURERC: 929 Route 25A INSURERO: Miller Place NY 11764-2700 COVERAGES THE POCICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDI~ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH 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. AGGREGATE LIM~S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. GENERAL L~BILFFY EACH OCCURRENCE $ I, 000,000 A X COMMERC~LGENERALUABILITY M~A8G0912 01/01/06 01/01/07 u^u^~u~="'=u $50r000 PREMISES (Ma o~mn~) I CLAIMS MADE ~ OCCUR MED EXP (Any one pe~on) $ 5 f 0 0 0 A X Contractual Lia~ PERSONAL&ADVINJURY $1~000f000 GENERAL AGGREGATE $ 2 ~ 000 ~ 000 GEN.L AGGREGATE LIMIT APPLIES PER: ! PRODUCTE - COMPIOP AGG $2F000f000 AUTOMOBILE UABIL~ COMBINED SINGLE LIMIT $ (Per $ A ! Propert~ MPA8G0912 01/01/06 01/01/07 Building 919,000 A Tnl~nd Marine MPASG0912 01/01/06 01/01/07 Ded lr000 CERTIFICATE HOLDER CANCELLATION Town of Southold Town Hall P.O. Box 728 Southold NY 19971 0000000 SHOULD ANY OF THE ABOVE DESCFUBED POUCIES BE CANCELLED BEFORE THE EXPIRA~OI DATE THEREOF, THE tSSUING INSURER ~LL ENDEAVOR TO M~JL 1~ DAYS WR~'~N NO~CE TO THE CER~FICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGA~ON OR EABIUTY OF ANY KIND UPON THE INSURER, ~S AGENTS OR REPRESENTA~VES. ACORD 25 (2001108) © ACORD CORPORATION 198u This certificate is an original. STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF PARTICIPATION IN WORKERS* COMPENSATION GROUP SELF-INSURANCE la. Legal Name and Addre~ of Business Participating In Group Self-Insurance (U~e Street Address Onlv~ Arthur J. Edwards Mason Contractor, Inc. 929 Route 25 A Miller Place, NY 11764 lb. Effective Date of Membership in the Group 04/24/2002 ld. Business Telephone Number of Business reisrnced in box "la" 1-631-744-7185 lc. NYS Unemploytment Insurance Employer Registration Number of Business refernced in Box "la". 24108715 Issue Date 6/5F2006 Expiration Date ~/4/2007 lc. The Proprietor, Partners or Executive Officers are [~ includetL (Only check box if all partners/officers included) [] all excluded or certain Imrtnerx/officers excluded. 2. Name and Address of the EntiB/Requesting Proof of Coverage (Entity Bein~ I~tod as Cerfifcato Holder) Town of Southold Town Hall PO Box 728 Southold, New York 11971 1L Federal Employer Identification Number of Business 111277925 3. Name and Address of Group Self-insurer Special Trades, Contracting And Construction Trust 6250 South Bay Road PO Box 3580 Syracuse, NY 13220 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-lnsurer listed above in box "3" and Participation in such group self-insurance is still in force. The Group Self-Insurers 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 "la" 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 Ce~ified by: Certified by: Title: TelephoneNumber: (315) 699-6475 GS-105.2 (2-02) WORKERS' COMPENSATION LAW WORKERS' 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 permit 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 carrier 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 requiring 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 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. GS-105.2 (2-02) Reverse 'qO' Notes: 1, Elevations are in assUmed datum. 2. There is public water and electric in the street. 50,0 ~0,0 Map of Lot 15 "Subdivision Map of Long Pond Estates, Sec. 1" Filed: December 27, 1985 Situated at Southold Town of Southold, Suffolk Co., New York District 1000 Section 56 Block 1 Lot 2.3 Certified To: David C. Hunstein Kelly J. Hunstein Bank of New York Sunrise Abstract Co: ANTHONY ABRUZZO R.L.S. REGISTERED LAND SURVEYOR 775 Mill Creek Drive Southold, New York 11971 (631)-765-6242 SURVEYED: May 18, 1999 F~nal Surve · March 4, 2000 / / Scale: 1"~ Fil~. 2226 A B Plan a-- Piping Arrangement Section B-B ___// r~,~ ~-- Section A-A Typical Wall Section 16~' 16' ~' 8' 14' 6' 4' 4' 8' 512 19,~ ~~~ i6'~' 16' ~' 1~' 14' 6' 4' 4' B' 576 ~i,~ ~ C~ ~ PER.CRETE W~{,{. SYSTEU 18'~' lB' ~' 12' 14' 6' 4' 5' 8' ~ ~,~ 929 Route 25A Miller Place ~ 11764 ~ ~ ~'x~' ~' ~' lB' i4' 8' 4' 6' 10' ~ ~,~ S~fo~ ~cense ~36-~ ~'x~' ~' ~' ~' 16' 8' 4' 6' 10' ~ ~,~ Nassau ~cense ~7~50000