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HomeMy WebLinkAbout37239-ZTown of Southold Annex 12/14/2012 P.O. .ox i179 54375 Main Road Southoi, New lI CERTIFICATE OF OCCUPANCY No: 36083 Date: 12/14/2012 THIS CERTIFIES that the building 1N GROUND POOL Location of Property: 2605 Orchard St, Orient, SCTM #: 473889 Sec/Block/Lot: 27.-1-4 Subdivision: Filed Map No. conforms substantially to the Application for Building Permit heretofore 5/18/2012 pursuant to which Building Permit No. Lot No. filed in this officed dated 37239 dated 5/23/2012 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: inground swimming pool fenced to code as applied for. The certificate is issued to Higgins, Lawrence & de la Vega, Frederick (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37239 7/24/12 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 #: 37239 Date: 5/23/2012 Permission is hereby granted to: Higgins, Lawrence & de la Vega, Frederick 344 W 23rd St New York, NY 10011 To: construct an Inground swimming pool fenced to code as applied for At premises located at: 2605 Orchard St, Orient SCTM # 473889 Sec/Block/Lot # 27.-1-4 Pursuant to application dated To expire on 11/22/2013. Fees: 5/18/2012 and approved bythe 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 O17 $OUTHOLD 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. Fina~ survey ~f property with aceurate~~~cati~n ~f a~~ bui~dings~ property ~ines~ streets~ and unnsua~ natural~ ~r topographic features. 2.Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3..Approval of electrical instalIation from Board 0fFire Underwriters. 4.'Sw. orn 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. 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 linch, streets, building and unusual naturai or topographic features. 2. A properly c~mp]eted 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 I. Certificaie 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[tifieate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy- $_25 4_ Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: House orOw ers of Proporty: Old or Pre-existing Building: Street Suffolk Copnty Tax Map No 1000, Section. Subdivision P itNo. (check one) Hamlet Date of Permit. ~' ~73- Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ~-tr). ~ Bilk 'k. ~ O1 Lot Filed Map. Lot: Applicant: Underwritem Approval: Final Certificate: ~ (check one) Applicant Signature Town Hall Annex 54375 Main Road P.O. Box I 179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (63 l) 765-9502 rofler, richert~town.southold.n¥.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Fred Delavega Address: 2605 Orchard St City: Orient St: NY Zip: 11957 Building Permit #: 37239 Section: Block: Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE 3ontractor: DBA: Sweet Hollow II Inc LicenseNo: 4300-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY 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: Ceiling Fixtures ~[~[~ HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures CO Detectors Fluorescent Fixtun ~ Pumps Emergency Fixture Time Clocks Exit Fixtures I I TVSS in ground swimming pool to include, bonding, 2-pool lights, 1-control panel, 1-pum gas heater, 2-GFCI circuit breakers Notes: Inspector Signature: Date: July 24 2012 81-Cert Electrical Compliance Form.xls TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [~]~FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~:~ .~=~r/~/~ ~---~ ~,~~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ [ ] ELECTRICAL (ROUGH) REMARKS: [ ] ROUGH PLBG. [ ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ~rJ. ECI'RICAL (FINAL) DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSU~LATION [ ] FRAMING/STRAPPING [/.,.,]"FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH} L] ELEctS(FINAL) REMARKS: ~,~, vi ~.,,~ ~.~/? DATE INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] IN~II~?~ [ ~J'~l N~L f~.~ ,,~ [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] FIR~SPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: ~, ~-~ -~/~,~ ~/~'//Z-.- INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROU~PI~BG. [ ] FOUNDATION 2ND [ ]~I~ULATiON [ ] FRAMING/STRAPPING [//]~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRIC)~.AI~,(FINAL) REMARKS: DATE ,~/~P'~///~ ?'~ INSPECTOR ~~ 7/P~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork. net Examined Approved Disapproved Wc Bt I)G DEPI. 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. Trustees C.C. Application Flood Permit Single & Separate Storm-Water Assessment Form Contact: Mail to: · Building Inspector PLICAT1ON FOR BUILDING PERMIT INSTRUCTIONS Date ~/////0 , 20/2, am This application MUST be completely filled in by typewriter or ill ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Pict plan showing location of lot and of buildings ou premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this applicatiou 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 tile premises available for inspection throtmghout the work. e. No building shall be occupied or used io whole or in pa~ for any purpose what so ever until the Building Inspector issues a Ce~ificate of Occupancy. f. Every building pem'mit shall expire if the work authorized has not comnmenced within 12 months after the date of issuance or has not been comnpleted within 18 moaths from stmch date. If no zoning amendments or other regulations affecting the proper~ have beeu enacted in the interim, the Buildiug Inspector may authorize, in writing, the extension of the pe~it for an addition six months. Thereafter. a new pem'mit shall be required. APPLICATION [S HEREBY MADE to the Building Depa~ment for the issuance cfa Building Permit pursuant to the Building Zone Ordiuance of the Fown of Southold, SuflBlk County, New York, and other applicable Laws, Ordinances or Regulations, for the constm'tmctiou of btmildings, additions, or alterations or for removal or demolition as heroin described. The applicant agrees to comply with all applicable laws, ordinauces, building code, housiug code, and regulations, and to admit authorized inspectors on premises and in btmilding for necessa~ iuspections. ~ , .. ' (Signature of applicant or name, ifa corporation) "IMMEU A,FELV; , ,, mvvr%l ENOLOS~ ~ COL TO C~D~ ':".' ;~...- ' ' cou. r ~7pUicant) ' ' -', : ~,i ~ gener~,~~n,~l~b~or~_. State whether applicant is oxvner, lessee, agent, arch~ect, engineer. builder ~ · , NO~ ~;~ ~PA~ AT ..... -. '~ (As on th~ roll o}.1~~- ~ REQ~ It app~cor~~ o~¢ut~fi, cer ~, ,, ~~N~Y~ (Name and t tie of corporate officer) 3. INSU~TION Builders License No. ~ ~5'~. ~ / I, FINAL. 00NSTRUOTION ~ E~OT~OAL Plumbers License No. ~T ~ O~ ~ Electrici~s License No. ELECTRICAL &t Other Trade's License No. INO~OT}ON ~UI~D v~. 1. Location of laud on which proposed ~ork will be done: House Number -' -Street - ' - gHWl~ 0[ lHa County Tax Map No. 1000 Sedion ~ Block ~{ Lot Subdivision Filed Map No. Lot State existing use and occupancy of premises,and intended use and a. Existing use and occupancy ~-b',c'~er~\~,~ 4. Estimated Cost ~/(<::2Of--) 5. If dwelling, number of dwelling units_ If garage, number of cars b. Intended use and occupancy ~r~,~.n.~ ~--,Q~. Nature of work (check which applicable): New Building Repair Removal Demolition occupancy of proposed construction: Fee Addition & Alteration Other Work I .c~:5 7 ~ ~ ~ ~ (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 Height Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height_ Number of Stories Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear .Depth 9. Size of lot: Front Rear Depth 10. Date of Purchase ~/// /';lO Name of Former Owner ' / ' l 1. Zone or use district in which premises are situated tr'~C% '\ 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO__ 13. Will lot be re-graded? YES NO W' Will excess fill be removed from premises? YES/NO__ 14. NamesofOwnerofpremises ~.,-r~ t'~/~r~-'OqAddress /',~'/. ~ff- PhoneNo. Nme of Architect ~( ~ IOAddress I~O ~7~ ~ ~~ (~/ Name ofContractor~a. ~k (;~ ~Address ~Phone No. (3/~TY-~ 15 a. Is this prope~y within 100 feet of a tidal wetland or a freshwater wetland? * 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 wetland.'? * YES~ NO / · IF YES, D.E.C. PERMITS MAY BE REQUIRED. 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. Sworn to before r~e this 2 ,, '. ~ ~ Notary Public Signature of Applicant 17. If elevation at any point on property is at 1 0 feet or below, must provide topographica~ data on survey. 18. Are there any covenants anti'restrictions with respect to this property? * YES N ,:&,. :. :j · IF YES, PROVIDE A CQPY.. STATE OF NEW YORK) ~ ......... .~" ~ ~9.~' ', Q/'~ k ...... ,~ be,ng duly swor,,, deposes and says that (s)he is the applicant 'mame ofihdi~idda. G~ih~9~)}~ba<e named, OONN]~ D. BDNGH (S)He ~s the Nota~ Publ~, State ..... ~ t ;-~aclor,,Agen}, Corporate Officer, etc.) Qualifl~ In ~olk C~n~ .~,, of smd owner or o~.~d~;aut~o' perform or have performed the smd work and to make and file this apphcat~on, that all statem~a~ ~Ahhi~,~h~g~;Fue to the best of Ins knowledge aud behef: and that the work will bc perfo~ed m the ~ ~ ~~filed therew,th. NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION Facility DEC ID 1-4738-00835 PERMIT Under the Environmental .Conservation Law (ECL) Permittee and Facility Information Permit Issued To: FREDERICK DELAVEGA 344 W23RD ST #PHB NEW YORK, NY 10011 (2i2) 353-2200 LAWRENCE HIGGINS 344 W23RD ST #PHB NEW YORK, NY 10011 (212) 353-2200 Facility: DELAVEGA & HIGGINS PROPERTY 15437 MAIN RDISCTM# 1000-23-1-6.1 EAST MARION, NY 11939 Facility Application Contact: EN-CONSULTANTS INC 1319 NORTH SEA RD SOUTHAMPTON, NY 11968 (631) 283-6360 Facility Location: in SOUTHOLD in SUFFOLK COUNTY Village: EAST MARION Facility Principal Reference Point: NYTM-E: NYTM-N: Latitude: Longitude: Authorized Activity: Construct a pool, patio, and retaining wall, and install stepping stones and a fence, all as shown on the attach plans prepared by Stacy Marshall Paetzel, dated 12/19/11, stamped "NYSDEC Approved" on 2/23/12. Permit Authorizations Tidal Wetlands - Under Article 25 Permit ID 1-4738-00835/00003 New Permit Effective Date: 2/23/2012 Expiration Date: 2/23/2017 Page 1 of 6 ) Town of Southold - Chapter 236 - Stormwater Management SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION:.~ Requested Information is Required for a Complete Application) APPUCAI~T HA.ME: t Owner. Ag.,~nt - C~nsultant -_ on~.~ Other (Circle One) P~pe r ty OWNE~ (If E~iffe rent ~an Appl;cant) i S~ai~l;~on BMP;, ~'o~ct Scope ancot Will this Project Dlsturbe five (5) or More Acres at [--] ~ Any One Time During the Proposed Development ? Yes No a. Does the Applicant have a Qualified Inspector On ~ r-~ Staff To Conduct the Required Inspections ? Yes No Inspections will Occur and for What Perfed of Time ? Yes No c. Does the SWPPP Adequately Identify All Temporary ~ ~ and/or Permanent Soil Stabalizafion Measures ? Yes No d. Does the SWPPP Adequately Identify a Complete ~ ~ Project Phasing Plan ? Yes No e. Does the SWPPP Indicate Additional Site Specific ~ ~ status of Impacted Waterbody: {ag. TMDL, 303(d) Usted, Impaired.,.) Practices that Wil be Utiized 0 Protect Water Quality ? Yes No Of Intent and SWPPP Acceptance Form for Review ~ ~ by the Town of Southold ? Yes No 5~I'AqT~OFN~VV¥ORK, J ~_~. h ~- CONNIED. BUNCH C~)UNq_'Y OF ....~L.,~.-L'~.., ~...... $$ Notary Public, State of New York /'~ --~ - ~/ , [ ~ ' No. 01BU6185050 2u-~d that he/she ]$ d~¢ [ ) (Ovule. C~nb'aclor. ~gent. Corp~ate Officer, etc.] ........................................... Owner ~md/or represent, dye o£ ~ Owner m- Owners, a~d [s duly author, ed to pcffon~ or have performed the s~d work ~d to make and file this application; that a~! statements conb~ned in this application ~ true to the best o£ ~s k~owledgc ~md ~Jle£; and that the work w~JJ bc performed in the m~Lqner set £orLh [n the application filed he~-ewith. Sworn to b¢£ore me d~s; Notary .................................... ................ SWPPP Assessment FORM: 03-12 Towa l-hlh~Ju~ex 54375 ~ ~ P.O. Bo~ 1179 Somhold, NY 119714)959 Telephoae (631) ro~ er. richet~)~.n¥. L_,q B[m ~ING DEPARTMENT TOWN OF 8OUTHOLD APPLICATION FOR ELECTRICAL INSPECTION *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax.Map District: JOBSITE INFORMATION: (*Indicates required information) 1~0 Se~ion: Bbck: Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) 5'0 ~ ~ C--~_eh~s ~ f'u,,,~? ~ t ~ ktea.~.r (Please Circle Ali That .~ply) *Is job ready for inspection: *Do you need a Temp Certificate: ~'NO Rough In ~ YES / NO Tamp Information (If. needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 .400 *New Service: Re-~onnect Underground Number of Meters Change of Service Additienal Information: PAYMENT DUE WITH APPLICATION for Insped. Jon Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (631 ) 765-9502 November 7, 2012 BUILDING DEPARTMENT TOWN OF' SOUTI-IOLD Lawrence Higgins Frederick DelaVega 344 W 23rd St NewYork, NY 10011 Re: 2605 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 $50.00. __ Final Health Department Approval. APlumbers Solder Certificate. (All permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT: 37239- Swimming Pool To: From: Rita@titoloagency.com 5/29/2012 12:45:30 PM (Page 1 of 4) · Titolo Agency To: Company: Fax number: 16317659502 From: Company: Fax number: Business phone: Home phone: Address: Rita@titoloagency.com Titolo Agency 631-585-3171 N/A N/A Date _Time: Pages: Re: 5/29/2012, 12:45:30 PM 4 Imperial Gunite To: From: Rita@titoloagency.com 5/2912012 12:45:30 PM (Page 3 of 4) ~ IMPER-I OP ID: R CERTIFICATE OF LIABILI INSU NCE THIS CER~FICATE IS ISSUED AS A MA~ER OF INFORMA~ON ONLY AND CONFERS NO RIGH~ UPON THE CERTIFICATE HOLDER. THiS CER~FICATE DOES NOT AFFIRMA~VELY OR NEGA~VELY AMEND, ~TEND OR ALTER ~E COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS~TE A CONTRACT BE~EEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA~VE OR PRO~CER, AND THE CER~FICATE HOLDER. IMPORTANT: If the ceffifl~te holder Is an ADDmONAL INSURED, the pollcy0es) must be endorsed. If SUBROGA~ON I$ WAIVED, subject to the terms and conditions of the policy, ce~aln polkles may require an e~orsement. A stateme~ on this c~lflcate do~ not confer rlgMs tothe cerUacate holder In lieu of s~h endorsement(s~. PRODUCER 866~65( CO~C~ NAME: All United Insurance Agency ~AX 9716-B Rea Road ~ 23 866-362-~0i Char DEe, NC 28277 E-HAmE All United Instance Agency Co ADDRESS: INSURER(~ AFFORDING COVE~GE NAIC msu~R A: Ha~ord Insurance ~459 INSURED Imperial Gunite Inc ~NSU~BR ~O Barbara Heller 8t Commercial Avenue INSURER C: Oakdale, NY 11769 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 8ELOW 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 WITH RESPECT TO WHICH 'I~IS 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. A ~ C/)MMFRCIAL GENENA~ LIAE~ILIIY 72UENQY2427P4 06114/11 06/t4112 DAMA~-E TrJ R[:NTFD 300,00C Contr. Liability PER'~DN AL ~, ADV INJLIRy $ 1,000,00C C-ENE~AL AGGPEGATE $ AUTOMOBILE LIABILITY COMDINED SINGLE LIMIT (Ea acclde./I $ 1,000,00{~ A ANI AIJ]O 12UENQY2427P4 06/14/11 06/14112 I~oDI[ Y INJIJRY (Per pert 'ri) -- UMBRELLA LIAB ~OCCU~ ~A¢, OCCURPENCE EXCESs LIAEI ~ CL AIM~MADEi AGGREGATE $ ANY PROPRIETOR/PARTNFRFF)~FCI)TIVE [ ~ I E L EACH ACCIDENT I CERTIFICATE HOLDER CANCELLATION TOWNSH2 Town of Southold PO Box 1179 53095 Route 25 Southold, NY 11971 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ~14E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE To: From: Rita@titoloagency.com 5/29/2012 12:45:30 PM (Page 4 of 4) ~ IMPER-I OP ID: RB ACORD' DA~ CERTIFICATE OF LIABILITY INSURANCE 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 CONS'~.ITE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CER'I1FICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 endorsementtsI. PRODUCER 866-484-8656 CONTACT NAME; All United Insurance Agency FAX 9716-B Rea Road, ~ 23 866-362-9807 IA~C, No, Ext):PHONE J (A~C, No): Charlotte, NC 28277 E-MAIL John M THolo ADDRESS: INEURER(~ AFFORDING COVERAGE ~ NAIC # ~NSURER A: Chartis Insurance ~.SUREO Imperial Gunite Inc ~NSU~R S: CIo Barbara Holler 205 West Crest Road ~NSURER C: Wilmington, DE '19803 ~NSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, '~IE 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, ~R ~UUL ~U~ POLICY EFF POLICY EXP LTR ~(PE OF INSURANCE N~R ~ POLICY NUMBER IMMIDD~YYYYI MMIDD~YYY~ LIMITS I CLAIM~MADE [] OCCUR t4EDE)4P(Anyoneperson) PERSONAL & ADV INJURY $ GENERAL AC*GFZEG ATE __ (Ea a¢¢iden{} $ I $ EXCESS LIABUMBRELLA LIAB O~L~ CUR EACH ODCUR~bNCb $ DEDI [ PFTEN liON $ WORKERS COMF~NSATION ITORY LIMITS I , ER AI~) EMPLOYERS' LIABILITY Y I N ANYPRORRIFTDRIPARTNERIEXEC~JT,VF ~ ~NC007124251 04/18/12 04/18/13 EL EACH ACCIE, ENT $ 100,00(~ (M~nd~tor,/In NH) E L DISEASE. EA EMRL©YEE $ 100,00(~ CERTIFICATE HOLDER CANCELLATION TOWNSH2 Town of Sou~old PO Box 1 t 79 53095 Route 25 Southold, NY 11971 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL nE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATFVE II.CONIC ~ P,O. BpX 909 AREA ~ 1.5000 ac to tie lin~m Elevations referenced to N.G.¥.D. SURVEY OF PROPERTY AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY , N.Y. ~C,U~: ( l) THIS DESIGN 15 t~ASEP ON A PKAINA~E 50IL WITH LES5 THAN IOZ 5IL T. ~KOLINPWA TEK 5HALL NOT ~IST ~ITHIN THE LIMIT5 OF THE EXCAKATIO~ IF ~KOUNP~ATEK POE5 ~IST · ITHIN 5IX FEET DELOW ~KAPE, 5~ECIAL PE~A TEK/NC FACILITIES WILL ~E KE~MIKEP. WA TEK DISPOSAL 15 LIMITED TO THE O~NEK'5 ~KO~EKTY. (2) NO 5UKCHAK~E ~ILL ~E ALLOWED ~ITHIN FEET OF SHALLO~ ENP AND ~ FEET F~OM PEE~ END. (~) THE ~NEUMA TIC Y A~LIEP CONC~ETE,(~UNITE), 5HALL DE A MINIMUM MIX OF 1:5 ~ITH A M~IMUM OF & 5 ~ALLON5 OF ~OTA~LE WA TE~ ~E~ ~ LD5 0F CEMENT. (4) ~EINFO~CEMENT STEEL 5HALL ~E I~E~MEPlA TE ~PE ~ILLET STEEL WITH A MINIMUM LA~ OF 50 ~A~ DIAMETEr5. (D) ~OOL WATEK 5E~L Y~YOWNE~5 ~AgREN HOSE, FILL 5~OUT OK AUTOMA TlC FEEREK. (~) ~UMF CA~ACITY I5 TO DE 5UFFICIE~ TO EM~OOL IN24 HOEg5. ~OOL 15 TO ~E KE~ ~LL RUglN~ FgEEZIN~ W~ THEK, (7) OETROOK FOOL5 SHOULD ~E ~OTECTEP DYA FENCE, WALL OK DUILPlN~ IN ACCOKPANCE TO THE N, ~5. DEILRIN~ COPE, (~) INSTALLATION 15 TO ~E PONE IN ACCOKPANCE WITH ALL FEPEKAL, 5TA TE AND LOCAL ~UILRIN~ COPE5 A5 WELL A5 SUggESTED 5TANRAKR50 LOCATION OF OFEKHEAR WIKE5 TO MEET KE~UIKEMENT5 OF N, ~5, DOAgP OF FIgE ENREK~KITEK5 IMPERIAL GUNITE CORP HALF-. AND rUMP HOT WATER TO TOP' ~ .SKIMMER TILE DESIGN DATA FILTER TYPE: CARTRIDGE NO BACI<,WASH REO, UIRED TURNOVER RATE --12 HRS PUMP CAPACITY-- IOOGPM FILTER RATE--88GPM/50,FT FILTER AREA: 300 50.FT. HEATER, 400,O00[STU GA5 HOT WATEF, TO DEEP RETUF-.NS COVERVAULT ~O0' AUTO COVER MOTOR WATERLINE UNDER COPING COVER TRACK STEEL R I~APlU5 KAI~IES: 5HALLOW EIVP --6" TO Z4 " MATCHING 5TONE COVER BRACKET5 ROLLED COVER ~/10/II,~L ~,CALE, 1"= - L. O.A ~ '~ ' W. O.A. '3~~ FREE AREA 720. sq, ft. VOLUME:[; 2 8,000 gals. WA TER DEPTH: 3.5' TO 8' A VERA GE DEPTH: 6'[3 MAXIMUM 5LOPE ALLOWED. (3: 1) Peep heaters I I o9. TNor p_so,' 3' BROWN SANDY SILT BROWN FiNE TO COARSE SAND WITH 10% GRAVEL ..,, PROPOSED SWIMMING POOL PLAN WATER IN BROWN FINE TO COARSE s~.~w~'~o~w~ DE LA VEGA / HIGGINS RESIDENCE 17' 2605 Orchard Street, Orient, New YorR marshall SITE DATA: m p a landscape, o~ architecture, pc LotArea: 20,920 8F S t U ~ J O 8CTM ~ 1000-27-01-04 lanascape architecture ph 631-209-2410 S e a I 0 10 20 ~. fixistin~ condition~ b~se map as per su~ey prepared by John T. ~ Metz~er, k.8. dated D~eember 30,200~. seo~, ~"=~o' 2. This dmwin~ i~ for tho purpose of obt, inino p~rmits. ~OT FOR ~ ~ ~ ~ ~ ~F NE~ SHEET