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HomeMy WebLinkAbout36639-ZTown of Southoid Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 7/25/2012 No: 35842 Date: 7/25/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: IN GROUND POOL 2855 Laurel Trail, Laurel, Sec/Block/Lot: 125.-4-24.9 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 8/19/2011 pursuant to which Building Permit No. 36639 dated 8/19/2011 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 per ZBA #6457, dated 4/20/11. The certificate is issued to Mowdy, James & Karen (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIHCATION DATED 36639 11/30/11 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 #: 36639 Permission is hereby granted to: Mowdy, James & Mowdy, Karen PO BOX 1357 Jamesport, NY 11947 To: Date: 8/19/2011 construct an inground swimming pool per ZBA dec. #6457, fenced to code At premises located at: 2855 Laurel Trail SCTM # 473889 Sec/Block/Lot # 125.-4-24.9 Pursuant to application dated To expire on 2/17/2013. Fees: 8/19/2011 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 Form No. 6 TOWN OF SOUTIIOLD 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 tbrm). 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 Planning Board Approval of completed site plan requirements. 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. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Telnporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: Owner or Owners of Property: ~,~ ~ l,~ j~dO Suffolk County Tax Map No 1000, Section / Old or Pre-existing Building: House No. Street Subdivision Permit No. Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Date of Permit. (check one) Hamlet Block q Filed Map. Applicant: Underwriters Approval: Lot Lot: Final Certificate: (check one) Applicaut ~ Town Hall Annex 54375 Main Road P.O. Box 1179 Soulhold, NY 11971 0959 Telephone (631 ) 765-1802 Fax (631) 765 9502 rofler, richert~,town southo d ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Mowdy Address: 2855 Laurel Trail City: Laurel St: NY Zip: 11948 Building Permit #: 36639 Section: 125 Block: 4 Lot: 24,.c WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electrical Cent LicenseNo: 2880-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 GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel NC 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 Fixtun~J Pumps Emergency Fixture Time Clocks Exit Fixtures [__~ TVSS in ground swimming pool to include, bonding, 1 GFCI circuit breaker, 1 20a pump- recpticle, 1 control panel, 1 heat pump, 2 pool lights Notes: Inspector Signature: Date: Nov 30 2011 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 // INSPECTION ~ //~[,/] FOUNDATION 1ST [ ] ROUGH PLBG. ~')/~[ ] ;O URAMNi::~I:TN 2NRAi~ iDNG [[ ]] IFI~I::LLAT I 0 N []FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION []FIRE RESISTANT CONSTRUCTION [] FIRE RESISTANT PENETRATION []ELECTRICAL (ROUGH) [] ELECTRICAL (FINAL) REMARKS: ~) ~ ~ ~ DATE INSPECTOR INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING ] FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL iROUGH) [¥~.~L_ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR<~~ TOWN OF SOUTHoLD BUiLDiNG DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING/STRAPPING [ ]FIREPLACE & CHIMNEY [ [ ] ROUGH PLBG. [ ] INSULATION ~INAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) DATE 7- ~-'-~/,~,q-- INSPECTOR .. ~-~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] IN~,.~ILATION [ ]FRAMING/STRAPPING [,vi FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~ ] ELECTRICAL (FINAL) REMARKS: ~~ ~ / / TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 ,~ SoutholdTown.Nort hFork.net 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 Check Septic Form Examined ~/} ¢}, 20 II Flood Permit Contact: mlto: Disapproved a/c ; Building l~ctor APPLICATION FOR BUILDING PERMIT INSTRUCTIONS /; ,201 ~) 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 phm showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or aeas, 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 budding pormit shall expire if the work authorized has not commenced within 12 months a~er die date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the proper~ have been ~nacted in the interim, the BuilcYmg Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be reqinred. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Building 7~-~ 0 ;'_~--~ .,- .~! Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ,,~ o~~, ~ ..~e million, l~¢~h e [~ ~ of buildings, adthfions, or alterations or for removal or demolition ~ herein described. The ~pl~~ ~1~ all applicable laws, ordinances, building code, housing code, and regulations, and to admit UI]LhVVFUL I"-" [ IIglIVll~l~l/All~L'g'-l] (Signatureofapplicantorname, ifacorporapon) ENCLOSE POOL TO CO ' ' IT TI UPON COMPLETIONI~ '_/'t~/ ~Or~C~!04']"~ r-'~d.. ma'te"w~el~ alpplicant is ow.er, lessee, agent, archll~ct, engineer, general contractor, electl:~l:~r 'l Nameofownerofpmmises ~.,..] (_l ZY)~,~ .~ ./V[ U U~_~J L~ ,,~ . // .'1. -- on the roll o ate t deemEE: BY If applicant is a corporation, signature &duly authorized officer NOT[FY BUILDING D~PARTMENT AT FO~ (Name and title of colporate omcer).~ t ~-]-e£ TUE Builders License No. -~ ~.~ '7 ~ ! ~ -- tt~ 1. FOUNDATION. TWO REQUII~D ' Plumbers License No. ~ FO~ POURED CONCRETE i ' Electricians License No. 2. ROCGH. FRAMING PLUMBING, , STRAPPING, FLFCTRICAL & CAULKING Other Trade s Licanse No. ~ . 3 INSULATION 1. Loc~:ti.l~n of land on which proposed work will be done: · .~ _ __ -- ~ 4 FINAL - CONSTRUCTION & ELECTRICAL House Number Street , HamlctALL CONSTRUCTION SIdALL MEET THE sCuO~Tis~n_~Map. N,o.. fi 000... '/~ J'V/) D4 -~Secti°n0~ ,.~"~6/{,1/~°//~' Block. 'IL-/ ¥~31~IcI~~REQUIREME'~OF6~HE CODES OF NEW_' I 'FOR ELECTRICAL INSPECTION REQUIRED 2. State existing use und oceupuncy o f premises and imen, ded use and oceup~.ncy o fpfoposed construction: a. Existinguseundoceupancy ~lC~]~_j '/-~'11~ ~}l.~ b. lntendeduse~ndocet~ancy / ,~ FD L/ ['~[ ~L) / DQIhO I FX, O 3. Nature of work (check which applicable): New Building_ Repair Removal Demolition 4. Estimated Cost //~,, ~90 '-- 5. If dwelling, number of dwelling units [ If garage, number of mrs Fee Addition 'b''~b~/ Alteration Other Work /D~ I-DLI I~t:5[- D/gF3 I .J (Descril~tion) ' (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 o f existing structures, if any: Front Rear _Depth Height Number of Stories Dimensions of same structure with alterations or additions: Froat Depth. .Height Number of Stories Rear 8. Dimensions of entire new construction: Front Rear Height Number of Stories 9. Size of lot: Front Rear _Depth _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 13. Will lot be re-graded? YES__ NO Will excess fill be removed from premises? YES NO 14. NamesofOwneroforemises~.~///)lL~t~U~ Address ~q ~ ~/2rr' / 7~(~}~une No. ~ ~ Name of Architect ~ P/~f) ~_ Address Phone No Name of Contractor qO?tnh4 -T&fLI//Yr ]g~O/SAddress .'2,/~//j / ]-t/P/~b/av~Jlone No. , 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO ~ * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED. b. Is this proporty within 300 feet of a tidal wetland? * YES NOw`/ * 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 uny point on pmporty is at l0 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this properly? * YES__ NO ~ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) CO.TVs: ~'~/C ~C'/~ ~:~ (~ t~ ~7- being duly swom, deposes aad says that (s)he is the applicant (N~e of ~dividu~ si~ing ~n~a~) ~ve nme~ (Con~ctor, AgenL Co~mte Offi~r, etc.) of s~d om~ or om~, ~d is duly au~o~d to ~o~ or have ~fo~ed ~e s~d wo~ ~d to m~e ~d ~e ~s application; · at ~I s~ ~n~ned in ~is applicon ~e ~e to ~e ~st of his ~owle~e ~o~ed in ~e m~ s~ fo~ m ~e ~lic~on filed ~emwi~. fom me ~i~ ~t day of ~20/~ MAUREEN A. BRODEUR Notary PuBlic, State o* New York No. 01BR606[ 871 Oualified in Suffolk County Expires 1 ~, 20 ~ Fe~. ~d/~.~ BOARD MEMBERS V/Leslie Kanes Weisman, Chairperson James Dinizio, Jr. Gerard P. Goehringer George Homing Ken Schneider Southold Town Hall 53095 Main Road · P.O. Box 1179 Southold, NY 11971-0959 Office Location: Town Annex/First Floor, Capital One Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 http://southoldtown.northfork.net ZONING BOARD OF APPEALS TOWN OF SOUTHOLD Tel. (631) 765-1809 · Fax (631) 765-9064 4GS, DELIBERATIONS AND DETERMINATION MEETING OF APRIL 20, 2011 ZBA FILE # 6457 NAME OF APPLICANT: James and Karen Mowdy PROPERTY LOCATION: 2855 Laurel Trail Laurel, NY SCTM# 1000-125-4-24.9 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without further steps under SEQRA. PROPERTY FACTS/DESCRIPTION: Subject parcel is improved with a one-story framed house with attached garage. It contains 28,325 sq. ft. and has 137.34' of frontage on Laurel Trail, 191.17' along the north east property line, 176.64' along the rear property line and 180.00' on the south west property line as shown on the survey prepared by Peconic Surveyors last dated Feb. 9, 2011. BASIS OF APPLICATION: - Request for Variance from Art. XXIII Code Section 280-124 and the Building Inspector's December 16, 2010 Notice of Disapproval based on an application for building permit to construct accessory in-ground swimming pool and pool house at; lot coverage of more than the code required 20%. RELIEF REQUESTED: The applicant proposes to construct an in-ground swimming pool and accessory pool house in conforming locations requiring relief from lot coverage of 23.4% where 20% is permitted per code. ADDITIONAL INFORMATION: At the Public Hearing the Board asked the architect for the applicant to submit a survey showing the proposed location of a drywell and mechanical equipment for the pool and a determination from the Building Department indicating if the equipment would increase the proposed lot coverage or not. In a letter dated April 18,2011 the agent states that they spoke with the building department's Chief Inspector and that if the pool mechanical equipment was to be enclosed in a structure that it would increase the amount of non- conforming lot coverage. The applicant submitted an alternative design shown on a plan to reduce the noise without increasing the proposed non-conforming lot coverage date stamped received April 18, 2011 and in a location that would be the most suitable. Also submitted was a survey altered by Mark Schwartz, Architect dated stamped received April 18, 2011 showing the location of the pool mechanicals and the drywell. FINDINGS OF FACT/REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on April 7, 2011, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant and makes the following findings: Page 2 - April 20, 2011 ZBA File#6457 CTM: 1000-1254-24.9 I. Town Law §267-b(3)(b)(1). Grant of the variance of will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The neighborhood consists of similar sized single-family homes. In-ground swimming pools and accessory pool houses are customary structures in residential areas. 2. Town Law §267-b(3)(b)(2). The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. The house was constructed in accordance with standards required by a declaration of covenants and restrictions which measure the size of the structure differently from what is required in the town code. 3. Town Law §267-b(3)(b)(3). The variance granted herein i~ substantial representing a 17% increase in the permitted lot coverage of 20%. However, the square footage of the house was dictated by the minimum size requirements set forth in the covenants and restrictions which do not include unheated spaces such as the garage and decks. These restrictions coupled with the relatively small size of the building lots leave little room for customary accessory structures such as sheds and swimming pools. 4. Town Law §267-b(3)(b)(4) No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The neighborhood consists of large homes all built according to the same restrictions. The impact to the environment will be minimal due mainly to the fact that the development is surrounded by a golf course 5. Town Law §267-b(3)(b)(5) The difficulty has not been self-created but is a direct result of the covenants and restrictions of the development. 6. Town Law 1~267-b. Grant of this variance is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a swimming pool and pool house_while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering alt of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Dinizio, seconded by Member Goehringer, and duly carried, to; GRANT~ the variance as applied for, and shown on the Survey prepared 02/09/2011 by Peconic Surveyors and the survey altered by Mark Schwartz, Architect dated stamped received April 18, 2011 showing the location of the pool mechanicals and the drywell. Any deviation from the survey, site plan and/or architectural drawings cited in this decision will result in delays and/or a possible denial by the Building Department of a building permit, and may require a new application and public hearing before the Zoning Board of Appeals. Any deviation from the variance given such as extensions, or demolitions which are not shown on the applicant's diagrams or survey site maps, are not authorized under this application when involving nonconformities under the zoning code. This action does not authorize or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. The Board reserves the right to substitute a similar design that is de minimis in nature for an alteration that does not increase the degree of nonconformity. Vote of the Board: Ayes: Members I~eisman (Chairperson), Horning, Goehringer, Dinizio, Schneider. Approved for filing /~Z-/0~/ /2011 . TOWn of Southold .Erosion, SedimentatiOn & S,torm-Water Run.Off ASSESSMENT FOR? PROPERTY LOCAT~N: S.C.T.M./h. THE FOLLOWING ADTIONS MAY REQUIRE THE SUBMISSIDH OF R STORM-WATER~ GRADING, DRAINAGE AND EROSION COHTRO~. PLM! GF.k ~ .?:ED BY A DESIGN pRQFESSiONAL IN THE STATE OF NEW YO.__~ SCOPE OFWORK . PROPO$1//) CONSTRUCYION (Indude Total Ama d all ~ located wlb,.~ b. What is the Total A~ea of Land C~ conslmcaon e~ rrm{ # / worK '~ W~ thl~ Project Retain Ail Sten~Waler Run. Off ~ mxYor const~ ac~ as well as a# . ~~&~?~ ~ G~e In~Mng of Mate~al ~ln any 5 ~11 ~ ~i~Uon R~uire Land Di;turblng A~ En~p~ an~ah ~s °f ~ ~ (5,~ S.F,) Square Feet of Gr~ Su~? 6 Is ~e a ~ml Water Site? Is ~ls ~j~ ~in ~ ~ ~e Hun~ (1 ~a~? 7 W~t ~ be Site ~pam~n ~ E~s~ ~e Si~ ~ ~1~ ~ R~een (15) bet °f Ve~l ~ ~ O~ Hundred (100') of H0~i Dis~qm? 8 WUI ~, Pa~ ~ mo~ ~o ~ ~ ~e di~ ~ a T~ ~t~ 9 ~ ~ ~ R~uim.~ ~~ STATEOFNEW'YORK, <:~,, r/~, ,, COUNTY OF ..~Z.~..~.~./..tg~. ......... SS That I, ..-.....~.-.2 ~· ...... - ' Owner and/or rcpre~nla~ of ~e Owner or O~na--~, and ~ dul~ aull~orized to perform or ha~ performed ~¢ ~aid ~rk and to m~ke ~nd fie ~ applicon; ~.al ~1 ~tement~ comain~ i~ ~ spplical/on ar~ ~,ue to the be.~t ofhi~ knowled~ and ~ ma FORM - 06110 MAUREEN A. - ....... Notary Public, State of New York No. 01BR6065871 Qualified in Suffolk County Commission Expires Feb. 11,20 L~ To~n [-Iall Annex .~1375 Main Road P.O..Box 1179 . Sou&old, NY ! 1971-09.~J Te!epb~me (631) 765-1802 er ri-- -"'~= (631) 7~,950~ ro~ . cnen(mlown,soumola.n¥.u,~ BUII,I~IING DEPAR~ TOWN OF $OO'l~IO~.n APPLIOAT~ON FOR ELECTRICAL iNSPECTiON REQUESTED BY: Company Name: Name: License No.: Address: Phone No.: Date: *Name: *Address: *Cross Street: *Phone No.: Permit No.: JOBSITE INFORMATION: (*IndiCates requ red information) Tax Map District: *BRIEF DESCRIPTION OF WORK (Please P~tnt. clearly) 1000 Section: ./2..5' Block: O'/.~. Lot: ©or) I (Pleas~e ,Circle Ali That Apply) *mJob , .dx xEs/ ~ ~u n~ a Te~ Centre: YES/~O~ ~emp'ln~a0on {If needed}- *Se~ see: I ~ase 100 150 200 *New Se~: R~nnect Number of Metem AddEIonal Info~ation: 3Phase Underground Rpugh In Final 300: 350 400 Other Change of Service Overhead PAYMENT DUE WITH APPLICATION ~ e. ~ f3 l~,Co 82-Reauest for Inst~-:~Jon Form STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured (Use street address only) SPECHT-TACULAR POOLS INC. 3661 HORSEBLOCK ROAD MEDFORD, NY 11763 2. Name and Address of the Entity requesting Proof of Coverage (Entity being listed as the Certificate Holder) TOWN OF OF SOUTHOLD 54375 MAIN ROAD SOUTHOLD, NEW YORK 11971 lb. Business Telephone Number of Insured 631-696-390O lc. NYS Unemployment Insurance Employer Registration Number of Insured ld. Federal Employer Identification Number of Insured or Social Security Number 010648957 The First Rehabilitation Life Insurance Company of America 3b. Policy Number of Entity listed in box "la": D152822 3¢. Policy effective period: 9/26/2010 to 09/26/2011 4. Policy covers: a. [] All of the employer's employees eligible under the New York Disability Benefits Law b. [] Only the followingclassorclassesoftheernployer'sernployees: Telephone Number 516-829-8100 Title Sr. Vice President PART 2. To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part I has been checked) State of New York Worker's Compensation Board Date Signed. Telephone Number Title Please Note: Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form, DB-120.1 (5-06) 8TAII/OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NY$ WORKERS' COMPENSATION INSURANCE COVERAGE lo. Legal Name & Addre.~ of I~ured (Uae street ~[dress only) Specht-Tacular Pools Inc. 3661 Horseblock Road, Unit R Medford, NY 11763 Work I~caOon of Inmred (Only required i f c~n,erage is al~eci fieally limited to c~n ~ca~ans in N~' l~rk ~t~, L~, a ~ 2. Nome and Addrtas ef~he Entity Reqursti~g Proof of Coverage (Emity lt~tng Li~ted ss the Certificate Holder) Town of Southold 54375 Main Rd. Southhold, NY 11971 I.b~ Business Telephone Number of Imm'ed 631-924-3482 lc. 1~'$ IT~employmer~ lmura~e Employer Regist~.atiou Number of Iastlred 4613877 Id. Federal Emplo~r Idontffi~ etlon Number of Imur*d nr 8oclal Security. Number 010648957 New Hampshire Insurance Company .lb. PolLy Number of entity listed In box WC 009774071 ~c. Policy effeettve period 09126/2010 to 09126/2011 3d. The Proprietor, Par~ners~or Executive Officers are [] aH excluded or certain portnersJoffice].s excluded. This ca-titles that tho inmranoe coercer indicated above in box "3' m~u~es the business referenced above m box "la" fe~ work. rs' cernp~tion tmd~r theNew Ymtc State Workers' (::ompematton La~ (To usetht~ form,New York 0xPt) mmtbe Ilst*d underltem 3A on the INFOlt.MATION'PAGE of the workers' core,motion ~.sur~nce policy). Th* Im~ ~Ls C~ of ~u~e to fix* enfi~' ~ed above os ~e c~cate hold~ m box"2". ~ Im*o'a~; Ca;;~ r will also no~.. ~a &m,~ ca~ficat; hol~r wi~m 10 d~ ~. IF a polio, is canc~ l*d ~te to hoop.'meat of pt~mo~* or ~tn ~0 &O~ IF thet~ a~* ;va~ns ot~r than nont,~m~l of j,~h~.~ thttt c~cel the poh*>' or e l~ma~ ~e tn~t;v{~ ~e c~;rage tn~ca~d ~ ~is C;~Ofi~te. ~;~ .o~c~s mc~' b; sent ~.' reg~dar mail.) Othe~,~e, ~ C~fie~ ~ tnlid for one )~ar afler this farm ~ a~m,ed ~' ~e ~nmn~ ~mer or tts ~censed ageng or ungl thepolio' ~imgon ~te P~se Note: U~n ~e ;~cell~on of the ~orkem' ~om~n~on ~li~' Indica~d ~med on a ~ Iken~ ur e~a~ i~md ~v n ce~ffie~* bolder, ~e ~im~ mu~ provide ~at co.cate ~lder w~ a new Ceffiflcm~ of Worke~' Compe~fion Cover~e or ~r a~riz~ p~ ~ ~* bmin*~ ia oomph'lng with tbe man~tor~ coverage req~men~ ~ the New York ~nte Wo~em' Com~ma~on tinder ~ml~ of ~rJno', I ;crafty t~t I om an a~horized re~e~b'e or Ii;~m~ a~nt of above and t~t the mm~d~red has the coverage ~ ~epl~ed on this fora. Telephone 0f representative or licensed agent c~ imurance cartier: ~" Please Not~: On~.' n~trance cartiere and their licensed agents are mrtho~xed to J*s;te Fo/~ C-105.2. ]n,vnr~mce bt*ketx are NOT C-105.2 (9-07) www.wcb, state.ny.us Workers' Compensation Law ,~'tiola .67. Restriction o1~ issue of permits and the e~erh~g into contracts anle~s compensation ts aacur~O. I. The head efa s'~te or raunicipal department, Ix~ard, comm~asioa or office aa thorized or reo/uh'ed by ]aw to i~us any permit for or in aormec~oll wifl't any work involv k~g tl~ gillpleymellt of eql~ployee.s i, a hazardous ~mploym~nt defined by' this chapt~x, and notwithstanding any ganewal or sp~i~l statut~ r~ quiri~g or authoriziag the issu~ of ax;ch permits, shall not issue st~eh permit ~mless proof duly .~bac~ibM by an msurame can'ler ts produced in a form s~tisfa etcty ~o atio chair, that eOmF~nSatioa for all employ e~ has b~a ~ttted as provided by flai's chapter Nothing h~¢in, howewr, shall b~ cons~-u~d ss ~anff, an.-,' liabili~- on lib., pa~t of ~x~h stat~ or municipal department, board, corn mis~ian o~ office to pay any oompens~ti, oa to any such Oml~loy,:¢ il' so omploy~d. The head of e state ormum¢ipal departmant, board, eommi,~mon or office ~[zed ~ m~u~ad by t~w to ~t~ mm a~ ~aet c~n~c~ wi~ ~y w~k m~oh,~ fl~ omplo~an~ of ea~pl~'e~s m a h~a~dous ~mpl~'m~t d~ft~d by aris ~ap~r. ~' g~l ~ ~bl s~mte re~ or au~ori=lg ~y such con,ack shah not ~ter ~o any su~ c~ct unle~ proof ~ly an fi~a~ c~i~ is ~oduced in a fo~ $atmfacto~ to ~e ~, ~at com~ fion for afl ~ ployees ~3as ~en ~cumd as prov~ed by ~s c~p~. C-105.2 (9-0'/) R~verse This certifies that the bearer is duly licensed by the County of Suffotk SUFFOLK GOUN~-¥' DEPARTiviENT OF CONSUMER AFFAIRS HOME iMPROVEMENT CONTRACTOR LICENSE DIETER SPECHT SPECHT-TACULAR POOLS INC 27415-H 08/20/lg99 ~'"'~°" ~'~ 08/01/2011 Suffolk County ExecutiVe's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 8/20/1999 No. 27415-H SUFFOLK COUNTY Home Improvement Contractor License This is to certify that DIETER SPECHT doing business as SPECHT-TACULAR POOLS INC having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk,_ State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT coNTRAcToR, in the County of Suffolk. Additional Businesses NOT VALH~ DEPARTMENTAL SEAL CONSVMXR ID CARD Director SURVEY OF PROPERTY A T MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK 1000-125-04-24.9 SCAI.E: 1"=30' JAN. 2#, 20O2 FEB. 22, 2002 (CERTIFtCA ?7ON) JUNE 17, 2002 (PROP. HSE.) SEPT. 18, 2002 (PROP HSE.) DEC. 9, 2002 (FOUNDATION) DEC. 15, 2002 (CERT/F/CA T/ON) NO~A 21, 200J (FINAL) CERTIFIED TO: JAMES IdOWD Y KAREN MOWDY FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK JPMORGAN CHASE BANK I am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES nd wi[( ~olde by the conditions set forth therein and on the permit to construct The location o¢ wells and cesspools shown hereon are from ~teld observations and or data obtained from others Elevations are referenced to an assdmea datum AREA=BS,3B5 $,F, SCDHS ReL # R10-02-115 LOT NUIffBERS REFER TO 'NAP OF LAUREL LINKS' FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON NOV P3, Pill AS FILE ~0. ll]T1B. L=13Z34 ' TRAIL P~CONIC SU~'~EYORS, PC, (631) 765 - 5080 FAX:(631) 765-1797 ~ O. BOX 909 1230 TRAVELER STREET $OUTHOL~ N.Y 11971 Jot-sO0 A T MA TTITUCK TOWN OF SO UTHOLD SUFFOLK COUNTY, NEW YORK 1000-125-04-24.9 SCALE: 1"=30' JAN. 24, 2002 FEB. 22, 2002 (CERTIFICA T.ION) JUNE 17, 2002 (PROP. HSE.) SEPT. 18, 2002 (PROP HSE.) DEC. 9, 2002 (FOUNDA TfON) DEC. 13, 2002 (CERflFICA TION) .NOV. 21, 2003 (FINAL) Dec. 13, 2010 dot coverage) Yon. 31, 2011 (POOL & POOL HOUSE STAKEOUT] Feb. 9, 2011 (LOT COVERAG£) CERTIFIED TO: JAMES MOIkDY KAREN MOWDY FIRST AMERICAN TITLE INSURANCE COMPANY OF NEW YORK JPMORGAN CHASE BANK LOT COVERAGE HOUSE~ DECKS & STOOPS = 5305 sqofL 5505/28325 = IF~.7% POOL & POOL HOUSE = 1516 sq, fL 6621 sq. fl. 6621128325 = 25.4% x = LATH [ om familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SE~/AGE DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES and wit[ abide by the conditions set Forth therein and on the permit to construct, The location of we[[s and cesspools shown hereon ore From Fle[d observations and or data obtained From others, Elevations ore referenced to an assumed datum, AREA=B8,325 $,F, OPEN SPACE pARCEL A PLA TIC LOT NL{~BUR.C RFF-FR .... 4AP CF t t',UREI L[NK.~' FILED IN THE ~UFFOL,: ::UNTY CLERK '$ OFF[CE ~EON 4RE VALIB FOR TH~$ ~ ANB COoIE$ ~EF~.OF O~ ~ Bm L = 116 I sT~. FR. HSE. ~ GAR. RECEIVED APR I 8 ZOll BOARD OFAPPEAI~ R NETER V/~LVE 0 5.5 ~ -~ ~ ' L~uI~L B UN~ER CONSTRUCTION ROA ~ pUBLIC ~ I~ b~c~o~,:~ ~ O. BOX 9~9 T~IL ':F"; ~ ~ (631) 765 - 5080.: '- F~ 765-2 797 PENTAIR 2 HP '¢JISPER F LO~(,~ POOL PUMP SIGNATURE SERIES AQUACOMFORT HEAT PUMP ULTRALITE EQUIPMENT PAD (OR EQUAL) CONCRETE SURFACE '~JITH VIBRATION ABSORBING POLYSTYRENE CORE REAR ELEVATI'ON SCALE: 1/8" = 1' LEFT ELEVATION SCALE: 1/8"= 1' FLOOR PLAN SCALE: 1/8" = I' FRONT ELEVATION .SCALE: 1/8"= 1' RIGHT ELEVATION SCALE: 1/8" = 1' REVISIONS: 40' RETURN ROPE AND FLOAFS REQUIRED 12 INCHES FROM SLOPE CHANGE RETURN RD' RD' CONCRETE STEP B[NATIQN PUMP SKIMMER AND VACUUM LINE D!VR BOARD LIGHT ViEW ACROSS CENTER LINE OF HOPPER CONCRETE (T'rr) '1 SECTION N1 5 DiVE BOARD OETAIL END ViEW NOTFS; 1 NOTES: 1 NO SPOIL SURCHARGE PERMIr rEP WITHIN 4 FEET OF EXCAVAIlON AT THE SHALLOW END, OR 6 FEET OF EXCAVATION AT THE DEEP END, 2 THIS POOL MI-ETS THE REQUIREMENTS OF ANSI/NSPI 5 "AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROUND SWIMMING POOL S" AND 1996 BOCA COPE SECT[ON 421, DIV]NG EQUIPMENT IS ALLOWED 3 THE PNEUMATICALLY APPLIED CONCRETE (GUNITE) SHALL BE A 14 M]X WITH A MAXIMUM OF ~1/2 GALLONS OF WAFER PER ONE SACK OF CEMENT, 4. THE REINFORCING STEEL SHALL BE iNTERMEDIATE GRADE STEEL WitiI MINIMUM LAP OF ~0 BAR DIAMETERS 5. SWIMMING POOL AND POOL EQUIPMENT SHALL BE COMPLETELY SURROUNDED BY AN ENCLOSURE FH~F COMPLIES WITH THE CODE OF THE FOWN OF SOU FHOLD SECTIONS OF THE ENCLOBURB THA~AREC~MPRISED~FAFENCE~~~ALLB~GREATERTHENB~ANDLESST~~EN6~~NHE[GH~AN~BEN~NCL~MBABLE ALL GATESINTNE FENCE SltALL BE SELF CLOSING AND SELF LATCltiNG AND BE SECURED WITI I A I OOK OPENABLE FROM THE OUTSIDE ONLY FiN[SI ZD SIDE OF FENCES SI IALL BE LOCATED ON THE OUTSIDE OF THE REQUIRED FENCE. TFIE RESUI TING CONS] RUCTION SHALL COMPLY WiTH CLAUSES 310941 THROUGH 31094,3 OF THE NEW YORK STATE BUILDING CODE CHAPTER 31 AND THE NEW YORK STALE REBIDEN1 IAL CODE APPENDIX G 6 DURING CONSTRUCTION THE CONTRACTCR SHALL ERECT A FEMPORARY BARRIER AROUND THE EXCAVATION lAW TNE CODE OF TI IE TOWN OF SOUTHOLD 7 POOL MUST BE EQUIPPED WiTH AN APPROVED POOL ALARM CAPABLE OF DETECTING A CHILD ENTERING THE WAIER AND SOUNDING AN AUDIBLE ALARM WltEN DETECTED TltAl IS AUDIBI E AT POOLS]DE AND AT ANOTHER LOCATION ON THC PREMISES WHERE TBE POOL IS LOCATED. THE Al ARM MUST BE INSTAl LED. MAINTAINED AND USED iN ACCORDANCE WITH THE MANUFACTURERS INSTRUCTIONS. THE ALARM MUS f MEET ASTM F2205 "STANDARD SPECIF/CA1 ION FOR POOL ALARMS THE DEVICE MUST OPERATE iNDEPENDENT (NOr ATTACHED TO OR DEPENDENT ON) OF PERSONS. b POOL SUCTION FITTINGS (EXCEPT FOR SURFACE SKIMMERS) MUST BE pROVIDED WiTH A COVER THAT CONFORMS FO ASME/ANSI AI1219.8M OR A MINIMUM 12"X12" DRA~N GRATE OR A CHANNEL DRAIN SYSTEM. POOL CIRCULATION SYSTEM MUST BE EQUIPPED WiTH ~FMOSPHERIC VACUUM RELIEF IN THE EVENT THE GRATE COVERS LOCAl ED WITHIN THE POOL BECOME MISSING OR BROKEN SUCH VACUUM RELIEF SYSTEMS SHALL CONFORM WiTH ASME AI12.19.17 OR BI- A GRAVITY SYSTEM APPROVED BY Tile TOWN OF BOUTI-IOLD POOL SHALL BE PROVIDED WlTl-I A MINIMUM OF 2 SUCq iON Flaa [NGS OF Tile ABOVE MENTIONED TYPE, THE SUCTION FITTINGS SHALL BE SEPARATED BY A MINIMUM OR 3' AND MUSF BB PIPED SUClt THAT WATER iS DRAWN THROUGH THEM SiMUL rANEOUSLY THROUGH A VACUUM RELIEF PROTECTED LINE TO THE PUMP (OR PUMPS) VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN AN ACCESSIBLE POSITION, MiNiMUM OF B" AND NO GREATER THEN 12" BELOW THE MINIMUM OPERATIONAL WATER LEVEL OR BE AN ATTACHMENT TO THE SKIMMER/SKiMMERS. 9, ALL ELECTRICAL WORK SHALL COMPLY WiTlt PblE REQUIREMENTS OF NFPA 70 (NEC; PRINCIPALLY ARTICLE 680 AND THE NYS RESIDENT]AL CODE SBCTION 4102 THROUGlt 4106. ALL ELEt-rRICAL DEVICES MUST BE APPROVED BY UNDERWRITERS I ABORATORIES AND BE pROTECTED BY A GROUND FAULT CURRENT INTERRUPTER (GFC[). CURRENT CARRYING ELECTRICAL CONDUCTORS EXCEPT FOR THOSE PROVIDING POWER TO POOl_ L[GblTING AND POOL EQU]PMENT SHALL MEEr THE BEPARAT]ON REQUIREMENTS OF TABI E F4103B ALL METAL ENCI OSURES, FENCES OR RAILINGS NEAR OR ADJACENT TO THC SWIMMING POOL THAT MAY BECOME ELEOTR]CALLY CHARGED DUE TO CONTACT Will I AN ELECTRICAl CIRCUIT SHALL BE EFFECTIVELY GROUNDED JO. WATER SQURCB FiLLiNG THE POOL SMALL BE EQUIPPED WItH A BACKFLOW PRO FECq ION DEVICE ]AW NYS FI UMBiNG CODE BOB I1. ALL PiPiNG IS DIAGRAMMATIC UNLESS OTHERWISE STATED. 12 WALKS, IF PROVIDED SHALL BE NONS[IP AND SLOPE AWAY I--ROM POOl_ EDGE 13 A MEANS OF EGRESS FOR DEE P AND SHALLOW ENDS MUSP BE PROVIDED/AW ANSI/NSP[ 5 SECTION 6 14. CONTRACTOR FO PLACE THE POOL ]AW 1 OWN OF SOUTI IOLD CODE SETBACKS 15 ALL DCA]MACE FROM THE POOL SHALL BE MAINFA]NED ON THE SUBJECT PROPERTY 16 POOL AREA 88~BQFT, PERIMETER 125' VOLUME ,~0,~00 GALLONS. 1% THE DESIGN IS BASED ON A DRAINAGE SOIL W/TH <10% SILT, GROUND WATER SHALL NOT EX, ST WITHIN Tile EXCAVATION. if GROUND W~FER EXISTS W]I H]N 60" FROM GRADF~ DEWATERING FACILITIES W[II BE REQUIRED 18 ALL GAS AND OIL WATER HEATERS (IF INSTALLED) FOR THE IN.ROUND SWIMMING POOl SHALL BE NATIONAL APPLIANCE ENERGY CONSERVAIiON ACT (NAECA) COMPLIANT, POOL HEATERS SHALL BE TESTED lAW ANSi Z2156 AND SHALL BE INSTALLED ]AW MANUFACq URERS SPECIFICATIONS. OiL FIRED POOl NEA~ ERS SltALL BE TESTED lAW UL726. POOL HEATERSS~~ALLBEL~CATED~R~UARDEDT~PROTEOTAGA~NSTACCI~ENTALC~NTACTOFH~rSURFAC~SBYPERS~NS POOL HEATERS SltALL BB PROVIDBD WITN TEMPERATURE AND PRESSURE-RELiEF VALVES FOR HEAl ERS NOT PROVIDED WiTbl AN iNTEGRAL BYPASS SYSTEM, A BYPASS LiNE SI IAI I BE INSTALLED FROM iNLET TO OUTLET TO ADJUST WATER FLOW THROUGN THC HBATBR. POOL HEATERS SHALL BE PROV]DBD WITN THE TOLl OWING ENERGY CONSERVATION MEASURES: 181. ALL POOL HEATERS SHALL BE EQUIPPED WlTlt AN ON OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW SblU~F[NG OFF THE OPERATION OF 11tE blEATER WITHOUt ADJUSTING THE THERMOSTAT SET TING AND TO ALLOW REDa ACTING WITHOUT REL]GHT]NG PHC PILOT LiGNT, 182 I rEAT ED SWIMMING POOLS SMALL BE EQUIPPED WlTlt A POOL COVER (EXEMPTED FROM Tills REQUIREMENT ARE OUFDOOR POOLS DERIVING 20?, OF THE ENERGY FOR HEATING, FROM RENEWABLE SOURCES. AS COMPUTED OVER AN OPERATING SEASON) 18.3. TIME CLOCKS SHALL BE INSTALLED SO THE PUMP CAN BE SET TO RUN DURING OFF-PEAK El ECTRICAL DEMAND PERIODS, AND CAN BE SET TO RUN THE IvlINIMUM TIME NIECESSARY TO MAINTAIN THE POOL WATER IN A CLEAN AND SANITARY CONDiTiON IAW APPLICABLE SANITARY CODE OF NEW YORK STATE. THIS DP. AWIi~9 IS FOR STRUCTURAL SHELL ONLY ALL ACCESSORIES AND APPURTENANCES ARE DEFINED BY OTHERS 19. qO. TBE POOL WAS DESIGNED lAW 1 HE FOIJ OWliSh: CONCRETE SHALL qAVR A MINIMUM COMPRESSIVE STRENGTH OF 3,500 PS1 MiN. OVERHANG POOL TYPE I MAX DIVING BOARD LENGTH VINYL LINER 3/8" REBAR UNDISTURBED EARTH CONCRETE MINIM Uivl 3500PS[ VERTICAL 3/8" PLACED 3'0.C. WASTE HAIR & LINT CATCHER RET URN TO INLET WATER LINE PIPING SCHEMATIC 2" BOTTOM It I. a ~tolollon of New Ymk State Iow for any p~on, unle., they are acting under tl~e direction of a licensed profem.ionol engineer, to alter lhl. drawing In any way. WALL CROSS SECTION NTB STANDARD DETAILS- CONC. WALL POOL 3/16": 1'-0" I **^*~'~" CdP 2010-09-29I **w** 0 MOWI2Y 2855 LAUREL TRAIL MATT/TUCK, NY PEDro Engineenno Solutions 173N. Main Street ~ 118 SPECHT-TACULAR POOLS 3661HORSEBLOCK ROAD BUILDING R MEDFORD, NY 11763 (631) 636-3900 Sayvllle~ NY 11782 (631) 472 -3600 PAGE 1 OF 1