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HomeMy WebLinkAbout32198-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 11/29/2012 No: 36067 Date: 11/29/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: IN GROUND POOL 725 MAPLE LA ORIENT, Sec/Block/Lot: 17.-2-14 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 7/11/2006 pursuant to which Building Permit No. 32198 dated 7/11/2006 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. The certificate is issued to BARRY M & RONA SMITH (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 32198 10/23/12 ed)~i~nat~re 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. 32198 Z Date JULY 11, 2006 Permission is hereby granted to: BARRY M & RONA SMITH 331 MADISON AVE 3RD FLR NEW YORK,NY 10017 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL WITH FENCE TO CODE IN THE REQUIRED REAR YARD AS APPLIED FOR. THIS PERMIT REPLACES BP 29503. at premises located at 725 County Tax Map No. 473889 Section 017 pursuant to application dated JULY Building Inspector to expire on JANUARY MAPLE LA ORIENT Block 0002 Lot No. 014 11, 2006 and approved by the 11, 2008. Fee $ 150.00 ORIGINAL Rev. 5/8/02 F~RM 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. 29503 Z Date JUNE 19, 2003 Permission is hereby granted to: BARRY M & RONA SMITH 331 MADISON AVE 3RD FLR NEW YORK,NY 10017 for : CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at 725 MAPLE LA County Tax Map No. 473889 Section 017 Block pursuant to application dated MAY 12, 2003 Building Inspector to expire on DECEMBER 19, ORIENT 0002 Lot No. 014 and approved by the 2004. Fee $ 150.00 ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate ]ucation of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water snpply and sewerage-disposal (S-9 form). 3. Approval of electrical installation fi'om 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 fi'om architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. Bo For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and "pre-existing" land uses: I. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. Ifa Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees I. 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. ~-." Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporat3r Certificate ofOccup~ cy - Residentia[ $15.00, Commercial $15.00 / New Construction: .... Old or Pre-existing Building: (check one) Location of Property: 7c~5 /_d~4ff-"~4. House No. Street Owner or Owners of Property: ~ ~_ ~_._,L/I~_ Suffolk County Tax Map No 1000, Section /7 Subd;~ ision Pern,itNo.~--~4~? ~_ DateofPermit.'7-//- ~~, Health Dept. Approvai: ....... Underwriters Approval: P!anniug Board Approval: f~.equest for: 'femporary Cellificme ~"nu.I (.crtdlcate:' ' ~ .... J (check one) Block ~'~ Lot /q Filed Map. . _ l.ot: Appliuant: ........... Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 l) 765-9502 roger.richert~,town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Barry Smith Address: 725 Maple Lane City: Odent St: NY Zip: 11957 Building Permit #: 32198 Section: 17 Block: 2 Lot: lZ WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: C-Cat Co License No: 953-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 Service 3 ph Hot Water GFCI Recpt Main Panel A/C Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures ~[E~ HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures CO Detectors Fluorescent Vixtur(~ Pumps Emergency Fixture Time Clocks Exit Fixtures I I TVSS in ground swimming pool to include, 4-pool lights, pool bomding, 1-time clock Notes: Inspector Signature: Date: Oct 23 2012 81-Cert Electrical Compliance Form.xls TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ [ ] FOUNDATION 2ND [ [ ] FRAMING / STRAPPING [ ] ROUGH PLBG. ] INSULATION ] FINAL ] FIRE SAFETY INSPECTION TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING ROUGH PLBG. ]~SULATION FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATE '~/'~ ~/~7 INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-t 802 INSPECTION [ ] ROUGH PLBG. [ ] INSULATION [~FINAL [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE ~''*~- ~ *~ 6 '~ _ INSPECTOR ' TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INS~~ [ ] FRAMING / STRAPPING [ ,'~FIN~ ~_.~ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION [ ] FIRE RESISTANT CONSTRUCTION [ REMARKS: DATE -~ ~'~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ [ ] FRAMING / STRAPPING [~'~ FI~ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REM~ DATE ~///~'~/~)'~ INSPECTOR~/~ FIELD INSPECTION REPORT ! DATE I COMMENTS t FOUNDATION (1ST) FOUNDATION (2ND) i / ,~ou~.F~IN~ / ~SULATION PER N.Y. ~ STATE ENERGY CODE F~ ADD[TION~ COMMENTS / TOWN OF SOUTHOLD BUILDING~DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 www. northfork.net/Southold/ Approved ~ / t t ,20 '~ Disapproved a/c [/ Expiration ,/ Z./ /7 , 20~/~ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 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 ~_...5 ~ ' __j Date ~ ~ [ ~- ,20 O.~ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 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. (Signature of applicant or name, if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. ~ Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which proposed work will be done: House Number Street Hamlet County Tax Map No. 1000 Section I "1 Block 0 '2- Subdivision ~T ~ L-o~.(r~C.. \~( ~\\~ Filed Map No. (Name) (_a2o Lot .Y~ ,,,' Lot ' IO State existing use and occupancy of premises and intended use and occupancy of propose_d constructi6n: . a. Existinguseandoccupancy ~)~<~,~,~Jv~._ '~ - O~c~po.~,ecl ~to. dt ~d2~,'vhlj , b. Intended use and occupancy --~7~ Nature of work (check which applicable): New Building Repair Removal Demolition Addition J Alteration Other Work %~,~,~ ~ [&'.~ ~O ' (Description) Fee ~ ~'O. OD (To be paid on filing this application) Number of dwelling units on each floor 4. Estimated Cost ~,, OOo- cO 5. If dwelling, number of dwelling units If garage, number of cars I¢ 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 Humber of Stories Rear .Depth Dimensions of same structure with alterations or additions: Front Depth Height Number of Stodes 8. Dimensions of entire new construction: ~ / d~ ' ~ .5 ~ ' .Depth Height Humber of Stories Rear 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 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO ,~' 13. Will lot be re-graded? YES X' NO__Will excess fill be removed from premises? YES ,~' 14. Names of Owner of pramises ~a¥, R~ Su,'~ Name of Architect Name of Contractor~u~,.,,~,~- God,b- NO Address lq.~j,~'~ /ozs-- PhoneNo. a~a- q~'q-Sq~~/ Address Phone No Address 8~ ¢o~-u~o-¢,;v~ ~o~_Phone No. (,at- oqq - c~o~3 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 property within 300 feet of a tidal wetland? * YES NO )~ * IF YES, D.E.C. PERMITS MAY BE REQUIRED. .~ ~ ~ ~ '3 ~ 16. Provide survey, to scale, with accurate foundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. STATE OF Ni~W YORK) co=Yo] C ' (Name of individual signing contract) above named, (S)Ue is the (Contractor, Agent, Corporate Officer, etc.) being duly sworn, deposes and says that (s)he is the applicant of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are tree to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. ( ~ Not~l~b,ic ( ) No. ~-4E03968, SC ;folk County Term Expires M~mh 30, ~k.~.'~- Signature of Applicant Town Hall Annex 54375 Main Ro~d P.O. Box 1179 Southold, NY 119714)959 Telephone (631) 765.-1802 Bt.qLDING DEPARTMENT , TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Company Name: Name: ..... _ _ - MattitUck, NY 11952 License No.: Date: Address: Phone No.: (.o'~\- JOBSITE INFORMATION: (*Indicates required information)~ *Name: *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: luuu Sect~n: -1 "7 Block: *BRIEF DESCRIPTION OF WORK (Please Pdnt Cleady) *Is job ma,dy for inspection: *Do you need a Temp Certificate: Temp Information (If needed] *Service Size: I Phase *New Service: Re-connect Additional Information: (~NO YES (~ Lot: Rough In 3Phase 100 150 200 Underground Number of Meters 82-l~equest for Inspection Form 300 350 400 Other Change of Service Overhead PAYMENT DUE WITH APPLICATION 'NER TOWN OF SOUTHOL~ PROPERTY RECORD CARD VILLAGE E W VL FARM cOMM. CB. MISC. Mkt. Value AND IMP. TOTAL DATE 1 ~ ~ o ~ ~ o o ~ ~ ~a ~//~/~ ~ e O AgR. I TYPE OF BUILDING ~RM Xcre Valde Per ! SCalue able 2 ~mpland FRONTAGE ON WATER use Plot / ~ >~ ,, ~ ~ ~ ~ /~ ~ ~ ~ 3 ~ BULKH~D ~. Bldg. ~ ~' ~= /~0~ ~teo~ion .~ .~ ~ _ ~ension ~X ~ ~ ~t. Wolls ~D 5~.,~,~;~Jnterior Finish ,~_ LR. ~tension ~ ~ ~ $~ Fire Pl~ce ~ Heot DR. ? ~ ' ~; : /~) ~eation R~m Rooms 2nd Flor FIN. B. ~orch ~ r~ .: ~V/~ ~ ~ . , ~ewa Y ~lO: ~O ~ ,2~ ~ Driveway ~arage O.B.~'~'~41 ~ Total ~ ~ Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971-0959 Fax (631 ) 765-9502 Telephone (631) 765-1802 BUILDING DEPARTMENT TOWN OF SOUTHOLD June 5th, 2006 Barry M. Smith 331 Madison Avenue 3rd FI. New York, N.Y. 10017 RE: 725 Maple Lane SCTM #017 0002 014 Dear Mr. Smith, Please be advised that your Building Permit # 29503 issued June 19th, 2003 has expired. According to the Code of the Town of Southold, a Certificate of Occupancy must be issued prior to use of the structure. To rene~v your Building Permit, please submit a fee of $150.00 at that time we can schedule an inspection by one of our Building Inspector's. If you have any questions, please call us at 631-765-1802. Respectfully, SOUTHOLD TOWN BUILDING DEPT. Jun 03 03 ll:5~a RHCI ~12 ~83 085~ p.1 Barry Smith 331 Madison Avenue, 3rd Floor New York, NY 10017 Tet: (212)856-9060 Fax: (212)983-0859 Via facsimile 631-765-9502 June 3, 2003 Michael Venity Director, Buildings Depaftment Town of Southold Main Road Southold, New York RE 325 Maple Lane Orient, N.Y./pool permit Dear Mr. Verrity, The following information is intended to clarify the situation with regard to our pending application for a pool permit at our property located at 325 Maple Lane in Orient. While a casual reading of the survey of our proparty has led your examiner to conclude that our property is subject to zoning regulations pcrtaimng to three f~ont yards, the supporting details contained in our deed and title descriptions do not support this interpretation. Attached is a copy of the relevant portion of the legal description which is attached to our deed of purchase There are no rights of egress and ingress to our property fi.om North Lane. In fact our property rights specifically terminate on thc South side of North lane. Reference to the Ticor Title Insurance Company's legal description of our property supports this fact. See paragraph two of the attached description which reads as follows: "Beginning at a point on the easter',y side of Sound Lane (a right of way) whom the same is intersected by the southwesterly comer of the hereinafter described premises and the Northwesterly c ~mer of land now or fomrerly of Mary B. Tuthill." The description cominues, in paragraph ncmbered '4' to indicate our property's northern temfinus, as ,follows: ".. ,to thc Southerly side of North La~e." Jun 03 03 11:55a RHCI 212 583 0859 p.~ On the following page of this legal description of our property where fights of egress and ingress are specified, the description reads as follows: "Together with ingress and egress over Maple Lane, Sound Lane and Dexter Lane to State Rte. 25 (Main Road). Since the legal description includes no fights of ingress or egress over North Lmae, this cannot be considered a front yard since it has no road frontage that would allow right of passage on the North side of the property. Since the front yard definition requires such right, this catmot be considered a 'front yard' and the pool permitted should be granted on the site as applied for. Please call Rona if you have any questions at 212-784-9488 or 646-824-8969 © Very truly yours Bar~ Smith ' BMS:Is .Jun 03 0:9 11~55a RHCI 21~ 883 0859 p.4 P.~ T~le Number: 13o0-ooo59 TIOOR TITLE GUARANTEE COMPANY LEGAL DESCRIPTION (Continued) TOt~rz'~H WTT~ INGRESS AND ECR~SS OV~ MAPLE LAN~, SOUND LA~TS AND D~L~T~R LANE TO ST. RTE. 2~ (MA~N ROAD). FOR IN~I~MATION ONLY: DISTRICT 1000 SECTION 017.00 BLOCK 02.00 LOT 014.000 PAHCEL II; ALL T~AT CEI~TAIN PLOT, PIECe, OR PARCEL OF LAND, SITUA~, LYLN~, A~ BEiNG IN ~ TOWN OF SOUTHOLD, COUNTY OF SUFFOLK AND STATE OF NEW YORK ~I~NG KNOWN AND DESiGNATeD AS LOT NO. 3 ON A CERTAIN MAP ENTITLED, "M~ OF NA~N~ HIL~'S" AND FILED IN THE OFFICE OF THE ~ OF 'Z~ COUNTY OP SUFFOLK ON 11/29/1921 AS MAP NO. ?6S ~EZNG MORE ~ARTICULARLY ROUNO~D A~D DE~CRTRED A~ ~OLLOWS; ~EGINNING AT A POINT ON TH~ NOH~$T~RLY T~RR~NUS OP MON~ ~ AT TH~ 9OUTH W~ST CORN~I~ OF THE H~ELN DESCRiBeD FP~HISF~ WHB]t~ ~ S~ I~ INTERSeCTeD BY THE ~ASTE~LY SiDE OF LAND NOW Oa F0~/~KLY OF DUCROT~ RUNNIN(~ THENCE ~OM SAID POINT O~ ~LAC~ OF BEGINNING ALONG LAND NOW Ol~ FORMERLY OF I~UC~OT, NORTH 6 D~GP. SSS 44 Mi~u'&'~$ 00 SECONDS EAST $3.36 FEET TO TEE MEAN HIGH WkTI~ MAP. K OF THE I&~i'G ISLAND SOi~D~ T}I~C~ ALONG TH~ APPARENT HIGH WATER MARK OF LONG ISLAND ~O~ID, ALONG 2 TI~ LZ~S AS POLLOWS: 2. NQ~TH 82 DI~C~.SE,~ 07 MI~'H~ 33 $~CONDS EAST 81.42 FEET; Tm~CB ALONG SAID LAST HE~Ti0~ LAND, SOUTH 0 ~G~SSS 53 NINU'~$ 00 SECONDS EAS9 81.02 FEET TO LAND NOW OK FORMERLY OF K..~RDWSLLi TO~THEI~ WITH INC. R~SE AND E~SS O~-ER MUNN LANE TH~ CIRCLE, MAPLE LANE AND LANE TO ST. RT~. 3S (MAIN ROAD). FOR I-NFOR/~ATION ONLy: D~STRI~T 1000 SECTION 01'7.00 BLOCK 02.00 ~ 011.000 RHCI p.3 P. ~,?. TICOR TII'I.E INSURAHCE COMPANY LEGAL DESCRIPTION Tige Number: :1200-00059 TAX LOT 0:14.000: ALL THaT C~'RTAIN VLOT, VL'~CE, OR VARCBL OF IAND, $~'TU.~.TE, I,YIN~, AND SSZNG AT ORTENT, TOWN OF $OOTHOLD, CO~%F~Y OF SUFFOLK AND STATE OF NEW YORE BS'~N~ PARTZ~LAHL¥ BOU~D~D AND D~SCR~B~D ~B FO~OWS: RU~NING THENCE ALONG ~'~u~ ~ASTERAY SID~ OF SO~HD LANE TH~ FOLLOWIN~ 4 COURSES AND DISTA~CES: 1. NORTH 03 DE(}~$ ~ MINUTES 00 SECONDS ~AST 11.01 FEET TO A MONUM~/~T; 2. /~0N(} T~]~ /%RC OF A CU~V~ BSAR~N~ TO TH~ R~C4~T }IAV~ A R~IUS OF 194.~ F~'T A DISTANCE ALON~ SAID CURVE OF 113.43 ~-&' TO A MONUMENT; 3. NORTH 3~ D~K]~E$ 43 MIN~$ ~$ECONDS EAST 170,08 ~ET; 4, NORTH 26 DEGREES 35 N~I'F.,S 40 S~COEDS ~AST ~0.00 ~EET TO TH~ S0~'~'~RL¥ $IDB OF NORTH LANE; THENCE ~ASTER~¥ ALON~ T~U~ SOUTHBRLY SiD~ OF NORT~ LANE ALONG AN ARC OF A CURVS BEARING TO TH~ RIGHT HAVING A RADIUS OF 620.00 FE~T A DZST~NC~ OF 290.~4 FE~TI TH~C~ SO~&'~ 28 DE~R~SS ~? MINUTS-~ 00 SEC0~DS WBST A DIST~CE OF 2.43 FE~T~ T~CE SOUTH 03 DE~S 12 NI~gU~ 11'S]~C~ ~$T /~ ~ NOW OH ~NCY p. KA/~DW~LL 313.11 FE~T TO T~ NDHTI~y SIDE OF T~ CIHCL~; ~ 90~ 54 D~]~S 32 MINUTES 00 S;Cn~S ~AST ALON~ ~ WESTERLY OF TH~ CIRCLE 19.81 PEST; T~Eb~2E EJ%S~ERLy AL~ 'i'..H~ 90~&'~u~RLY SIDS OF MUNN LAN~ ';,'~:~.~ FOLLOWING 2 COURSES A~ DI STANCES .~ 1. ALONG AN A~C OF A CURVE ~FJ~IN~ TO Th'~ LEFT HAvIN~ A RADIUS OF $00,00 FE~T A DISTANCE O~ 84.~,2 F~ET; 2, A~ONG AN A~C OF A CURVE BFJ~RING TO T~ LE~T ~AVIN~ A RADIUS 0~ 113.82 F~T A DISTANCE OF 20.7~ FEET TO LAND NOW OR F0~RLY REATRI~ DU~ROT~ B~ATR~CE DUCROT 126.46 FEET TO L~ND NOW OR FORM~RLY LAWRENCE R, DORMAN; ~T; '~'~C~ NORTH 84 DE(]P.~S 26 MZ~T0'T~S $0 ~EC01~S WEST ALONG ~ NOW OR DORMAN AND ALONG LAND NOW OR iKIEMEHL¥ OF M~¥ B. %VA'~:LL, SAi.~a PRET TO THE FJ~STSRLY SZD~ 0F SO~r~&~ LAN~ TO T~ ~0~NT OR ~L~CE 0~ Jun 18 03 11:35a 8HCI 21~ 983 0859 p.1 FACSIMILE COVER SHEET DATE: TO: FAX NUMBER: June 18, 2003 MichaeIVerrity (631)765-9502 TOTAL NO. OF PAGES (INCLUDING COVER PAGE): FROM: Barry M. Smith Affordable Housing Concepts, Inc. 331 Madison Avenue New York, New York 10017 (212) 856-9060 (212) 983-0859 FAX RE: 325 Maple Lane Pool Permit COMMENTS: Dear Mr. Verrity, Pursuant to our conversation, attached is the letter we discussed on my legal stationery. I will put the original in the mail. / THIS TELECOPY CONTAINS CONFIDENTIAL INFORMATION INTENDED ONLY FOR THE PER~,ON(S) NAMED ABOVE. ANY OTHER DISTRIBUTION, COPYING, OR DISCLOSURE IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS TELECOPY IN ERROR, PLEASE NOTIFY US IMMEDIATELY BY TELEPHONE, AND RETURN THE ORIGINAL TRANSMISSION TO US BY MAiL WITHOUT MAKING A COPY. IF YOU DO NOT RECEIVE ALL MATERIALS BEING TRANSMI'I-FED, CALL US AT (2'[2) 856-9060 AS SOON AS POSSIBLE~ 3un 18 03 11:36a RHCI ~1~ 583 085e po2 (212) $55-9060 BAR. R.Y M. SMITH A'I-['OR. NEY AT LAW 331 MADISON AVENUE NEW YO!KK~ N.Y. 10017 FAX; (2t2) 963-08,59 Via facsimile 631-765-9502 June 18, 2003 Michael Verrity Director, Buildings Department Town of Southold PO Box 1179 Southold, New York 11971 RE 325 Maple Lane Orient, N.Y. / pool permit Dear Mr. Verrity, The following information is intended to clarify the situation with regard to our pending application for a pool permit at our property located at 325 Maple Lane in Orient. While a casual reading of the survey of our property has led your examiner to conclude that our property is subject to zoning regulations pertaining to three front yards, the supporting details contained in our deed and title descriptions do not support this interpretation, Attached is a copy of the relevant portion of the legal description which is attached to our deed of purchase. There are no dghts of egress and ingress to our property from North Lane. In fact our property rights specifically terminate on the South side of North lane. Reference to the Ticor Title Insurance Company's legal description of our property supports this fact. See paragraph two of the attached description which reads as follows: "Beginning at a point on the easterly side of Sound Lane (a right of way) where the same is intersected by the southwesterly corner of the hereinafter described premises and the Northwesterly corner of land now or formerly of Mary B. Tuthill," The description continues, in paragraph numbered '4' to indicate our property's northern terminus, as follows: Jun 18 03 11:36a RHCI 212 583 0859 p.3 "...to the Southerly side of North Lane." On the following page of this legal description of our property where rights of egress and ingress are specified, the description reads as follows: "Together with ingress and egress over Maple Lane, Sound Lane and Dexter Lane to State Rte. 25 (Main Road). Since the legal description includes no rights of ingress or egress over North Lane, this cannot be considered a front yard since it has no road frontage that would allow right of passage on the North side of the property. Since the front yard definition requires such right, this cannot be considered affront yard' and the pool permitted should be granted on the site as applied for. If you have any questions, please call. Very truly yours, .]un 18 03 11:35a JAN-I~-2BB1 83: 81 AHCI ~1~ 883 TICOR TITLE INSURANCE COMPANY LEGAL DESCRIPTION 0859 p.4 Title Numbs: 12ao-ooo5~, ALL THAT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SIT~ATE, TYING, A~D BEING AT ORIENT, TOWN OF SOUTHOLD, COL%iTY OF S~'~OLK AND ~TATE OF NEW YOKK SBING MOF. E PARTICULARLY BOUNDED AND D~CRIEED AS FOLLOWS: BEGINNING AT A POINT ON '£~ EASTERLY SIDE OF SOUND [JkNE (A HIGHT OF WAY) TH]/ SAME iS TNT~SECTED BY THE SOUTHWESTEP. LY CORNER OF TH~ H~REINAFTER nESCRISED PREMISES AND THE NORTHWESTJ~RLY CORNER OF LAND NOW OR FO~//I~RL¥. OF MARY B. TUTHILL; R%"NNING THENCE ALOND THE EASTERLY SID~ OF SOUND LAJ~E TNB FOLLOWING 4 COURSES DISTANCES: 1 · NORTH 03 DEGREES ~ MINUTES 00 SECONDS EAST 11.01 ~RT TO A MO~; 2. ALON~ THE ARC OF A CU~V~ B~ARING TO THE RIGHT HAVING A P, ADIUS OP lg4.39 FE~ A DISTANCE ALONG SAID CURVE OF 113.43 FE~T TO A MONUMENT; 3. NORTH 33 DEGEF. E$ 43 MINUTS~ ~ SECOND~ EAST 170.08 ~EET; NORTH 26 DEG]EEES 35 MINUTES 40 SECONI~S EAST ~0.00 FEET TO THE SOUTHERLY SIDE OF NORTH LANE; THENC~ ~J%STER.Ly A~NG TH~ ~OUTHERLY SID~, OF NORTH L~ ALONG AN ARC OF A CURVE BEA~TI~G ~ ~ ~IG~ ]{AVING A RADIUS OF 620.(]0 F~t/'k A DISTANCE 0F 290.84 FEETI T~NCE EOUTH 28 DEGREES 5"7 MINUTES 00 SECONDS WEST A DISTANCE OF 2.42 FEETI THENCE SO~"~'~ 03 D~REES 12 MINUTES 11 SECONDS W~ST ALONG LAND NOW OH 19-ANCY p. KAI~DWELL 313.11 FF~T TO '~'M~ NO£T~RLY SII~E OF ~ CIHCL~ SOUTH 54 DE~R~ES 23 MINUTES 00 S~.C:,NDS ~AST ALONG THE WESTFA~LY TERMZ~JS CIRCLE 18.61 FEBTI THENCE F. ASTERL¥ ALONQ TH~ nO[F~RLy SIDE OF MUNN LA~ THE FOLLOWI~ 2 ~Ob'RSES AND DISTANCES: 1. ~'Q ~ ARC OF A C~J~V~ BEARI~/G TO T~ ~EFT HAVING A ~ADIUS OF ~00.00 F~ A DISTANCE OP 84.12 FEET; 2. ~-LONG AN ARC OF A CtTRVE ~EARING TO TH~ L~FT HAVING A RADIUS OF 113.82 FEET A DISTANCE OF 20.7° FEET TO LAND NOW OR ~0SRERLY E~ATRICE DUCKOTi THENCE SOUTh{ 05 DEGR~SS 28 MINUTES O0 SECONDS BAST ALONG LAND NOW OR FOP.~ERLY B~J%TRICE DUCROT 126.46 FEET ~ LAND NOW OR FORJ4~¥ LAWRF~CE B. DORMANt FEET; DORMAN AND ALONG LAND NOW OR FO~2/~RL¥ OF MA~Y B. TUTHILL, 541.~ FEET TO TH~ EASTERLY SIDE OF EOU~D LAN~ TO TH~ POINT OR ~',[~C~ OF ~INNIN~. ,]un 18 03 11: 36a ~e Numbe~ 1Z00-00039 8HCI 212 883 TICOR TITLE GUARANTEE COMPANY LEGAL DESCRIPTION (Continued) 0858 p.5 TOGET~IER WITH IN~.ESE AND EG~SS OVE~R MA~Z~ L~/T~, SOUND LANE A~ DEXTER LANE TO ST, RT~. 2~ (~A~N ROAD). FOR ZNFOI~4ATION ONLY: DISTRICT 1000 S~CTION 017.00 E~OCK 02.00 LOT 014.000 PAKCEL II: WITH A~ UNDIVIDED INTEREST IN TH~ FOLLOWING PARCEL. A~L T~AT u~TA_TN ~LOT, ~IE~IE, OR PA~C~L OF LA~, SITUATE, LYINg, AND BEING IN THE TOWN OF SOUTHOLD, COUNTY 0F SUFFOLK AND STATR OF NEW YORK ~ZZNG KNOWN AND DESIGNATED AS LOT N0, 3 ON A CERTAIN MA~ ~NTITLED, "MAP O~ MANTALEXN~ HZLL~ AND FILED IN THE OFFICE OF THE CLERK O~ 'l'k~ COONTY OF SUFFOLK ON 11/29/1921 AS MAP NO. ~65 B~.ZNG MO~E PARTICULARLY 2ODND~D AND DE~C~IRED BEGINt~ING AT A POLNT O~ TH~ NOKT~iWEST~L¥ T~$LINUS OF MUNN LAN~ A~ THE SO~H W~ST CORNER OF T,U.~ H~HEIN DESCribeD I~EMISES WH~.~ -&?~.u EAMTM IS ZNT~RSZCT~D BY THE EAST~LY SIDE OF LAND NOW OR FORMERLY OF DUCROTi RUNNING THENCE ~ROM SAID ~OINT ON ~IACEOP EEGI~TRZNGA~ON~ LAND ~W OR FO~Y 0F ~OT, NOR~ 6 ~S 44 M~U~ 00 S~S ~T 53,36 ~ ~ T~ HIgH WAT~ ~K O~ ~ ~G IS~ T~C~- ALONG TH~ AP~AP~D~T HZ~ ~9~u~ MA~K OF LOnG ISlAnD SOUND, ALONG 2 TIE LZN~S AS FOLLOWS: 1. NORTH 88 D~C~ES 00 MINUTE 4~ SECONDS EAST 81.42 NORTH 82 DEG~.EES 07 MINUTES 23 S~ONDS EAST 8Z.42 FEET; THENCE ALONG SAID LAST ~qTIO~D LAND, SOUTH 0 D~RE~S 53 MINUTES 00 SECONDS EAST 81.02 FEET TO LAND NOW OR FORMErLy OF KARDW~LL; THENCE ALONG SAID .LAST MENTIONED IJU~D AND ALONG T~ NORTH~L¥ TEI~4INUS O1· MUnN I,~N~, ~R~ 85 DEG~ 1~ M~E~ O0 SE~B ~T 170.10 FEET ~ *T~ ~ OR ~ OF BEGZ~Z~. WITH INGE~S~ ~ EG~S~ OVEH MUN~ LANE TH~ CIRCLE, MA~E LAN~ AND LAN~ TO ST. RTE. 2~ [MAIN ROAD). FOR INFORMATION ONLy: DISTRIUT 1000 SECTION 01~.00 BLOCK 02.00 LOT 011.000 2 3 (212) 856-9060 B^R.R.Y M. SMITH ATTOFLNEY AT LAW 331 MADISON AVENUE NEW YORK, N.Y. 10017 FAX: (212) 983-0859 Via facsimile 631-765-9502 June 18, 2003 Michael Verrity Director, Buildings Depa .rtment Town of Southold PO Box 1179 Southold, New York 11971 RE 325 Maple Lane Orient, N.Y. / pool permit Dear Mr. Verrity, The following information is intended to clarify the situation with regard to our pending application for a pool permit at our property located at 325 Maple Lane in Orient. While a casual reading of the survey of our property has led your examiner to conclude that our property is subject to zoning regulations pertaining to three front yards, the supporting details contained in our deed and title descriptions do not support this interpretation. Attached is a copy of the relevant portion of the legal description which is attached to our deed of purchase. There are no rights of egress and ingress to our property from North Lane. In fact our property rights specifically terminate on the South side of North lane. Reference to the Ticor Title Insurance Company's legal description of our property supports this fact. See paragraph two of the attached description which reads as follows: "Beginning at a point on the easterly side of Sound Lane (a right of way) where the same is intersected by the southwesterly corner of the hereinafter described premises and the Northwesterly corner of land now or formerly of Mary B. Tuthill." The description continues, in paragraph numbered '4' to indicate our property's northern terminus, as follows: "...to the Southerly side of North Lane." On the following page of this legal description of our property where rights of egress and ingress are specified, the description reads as follows: "Together with ingress and egress over Maple Lane, Sound Lane and Dexter Lane to State Rte. 25 (Main Road). Since the legal description includes no rights of ingress or egress over North Lane, this cannot be considered a front yard since it has no road frontage that would allow right of passage on the North side of the property. Since the front yard definition requires such right, this cannot be considered a 'front yard' and the pool permitted should be granted on the site as applied for. If you have any questions, please call. Very truly yours, Title Number: 12oo-ooo59 TICOR TITLE INSURANCE COMPANY LEGAL DESCRIPTION P. 02 LOT 014.000= ALL THAT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SITUATE, LYING, AND BEINO AT ORIENT, TOWN OF SOUTHOLD, COUNTY OF SUFFOLK AND STATE OF NEW YORK BEING MORE PARTICITLARLY BOUNDED AND DESCRIBED AS FOLLOWS: BEGINNING AT A POINT ON ='~u~ EASTERLY SIDE OF SOUND LAN~ {A RIG~{TOF WAY) WHERE THE SAM~ IS I~'r~SECTED EY THIS SOUTHWESTERLY CORNER OF THE HEREINAFTER DESCRISED PREMISES AND THE NORTHWESTERLy CORNER OF LAND Now OR FORF~P~LY OF MARY E. TUTHILL; RUNNING THENCE JtLONG THE ~J%STERLY SIDE OF SOON~ ~ THE FOLLOWING 4 COURSES AND DISTANCES: 1. NORTH 03 DEGREES~MINUTES DO SECONDS EAST 11.01 FEET TO A MONUMENT; 2. ALONG THE ARC OF A CURVE BEARING TO THE RIGHT HAVING A RADIUS OF 194.39 FEET A DISTANCE ALONG SAID CURVE OF 113.43 FEET TO A MONUMENT; 3. NORTH 33 DEGEEES 43 MINUTES ~$ECONDS EAST 170,08 FEET; 4. NORTH 26 DEGREES 3S MINUTES 40 SECONDS EAST 50.00 FEET TO THE SOUTHERLY SIDE OF NORTH LANE; THENCE ~ASTERLY ALONG THE SOUTHERLY SIDE OF NORTH LANE ALONG AN ARC OF A CURVE BEARING TO THE RIGHT HAVING A RADiUS OF $20.00 FEET A DISTANCE OF 290.84 FEET; THENCE SOu'£~ 28 DEGREES ~7 MINUTES 00 SECONDS WEST A DISTANCE OF 2.43 FEET; THENCE SOUTH 03 DEGREES 12 MINUTES 11 SECONDS W-EST ALONG LAND NOW OR FORMERLY Arfl/~CY p. KARDWELL 313.11 FEET TO T~E NORTHERLY SIDE OF T~ CIRCLe; THENCE SOUT~ 54 DEGREES ~2 MINUTES 00 SECONDS EAST ALONG THE WESTERLY TERMINUS OF THE CIRCLE 1~.81 FEET; THENCE EASTERLY ALON~ THE SOUT~{~RLY SIDE OF MUNN LANE THE FOLLOWIN= 2 COURSES AND DISTANCES: 1. ,;~ONG ~ ARC OF A CURVE BEARING TO THE LEFT HAVING A RADIUS OF ~00.00 FEET A DISTANCE OF 84.12 FEET; 2, ALONG AN ARC OF A CURVE BEARING TO T~ LEFT HAVING A RADIUS OF 113.82 F~ET A DISTANCE OF 20.70 FEET TO LAND NOW OR FORMERLY ~EATRICE DUCROT; THENCE SOU~ 05 DEC, ES 28 MINUTES 00 SECONDS EAST ALON~ L~ NOW OR FORMERLY BEATRICE DUCROT 126.46 FEET TO LAND NOW OR FORb~RLY LAWRENCE E. DOR~; 'ra~NCE NORTH 84 DEGREES 28 MINUTES SO SECONDS WEST ;%LONG LA~D NOW OR ~ORMERLY OF DORMANAND ALON~ LAND NOW OR FORMeRLy OF MARY E. TUTHILL, $41.48 FEET TO EASTERLY SID~ OF SOUND LAN~ TO T~ POINT OR PLACE OF EEGINNI~. -~2~ZNDED LEC~ DESCRIPTION- J~M-f2-2~l DE: 02 T'~.le Number; 12o0-ooo5~ TICOR TITLE GUARANTEE COMPANY LEGAL DESCRIPTION (Continued) TOGETN~R WI%~{ INGRESS ~ EGRESS OVER MAPLE LA~, SOUi~ LANE ~ DEXTER LANE TO ST. RTE. 25 (MAIN ROAD). FOR INFORMATION ONLY: DISTRICT 1000 SECTION 017.00 BLOCK 02.00 LOT 014.000 PAKCEL II: TOGETHER WITH AN UNDIVIDED INTEREST IN T~E FOLLOWING PARCEL. ALL T~AT CERTAIN PLOT, PIECE, OR PARCEL OF LAND, SITUATE, LYING, AND BEING iN THE TOWN OF SOUTHOLD, COUNTY OF SUFFOLK AND STATE OF NEW YORK EEING KNOWN AND DESIGNATED AS LOT NO. 3 ON A CERTAIN MAP ENTITLED, "MAP OF MANTALKING HILLS" AND FILED IN THE OFFICE OF THE CLERK OF THE COUNTY OF SUFFOLK ON 11/29/1921 AS MAP NO. ?65 EEING MORE PARTICULARLY BOUNDED AND DESCRIBED AS FOLLOWS: BEGINNING AT A POINT ON THE NORTHWESTERLY TERMINUS OF MUNN LANE AT TEE SOUTH WEST CORNER OF THE HEREIN DESCRIBED PREMISES WHERE THE SAME IS INTERSECTED BY T~LE EASTERLY SIDE OF LA~D NOW OR FORMERLY OF DUCROT; RUNNING THENCE FROM SAID POINT OR PLACE OF BEGINNING ALONG L;tND NOW OR FOP. M~RLY OF DUCROT, NORTH 6 DEGREES 44 MINUTES 00 SECONDS EAST S3.36 FEET TO T~E M~J%N HIGH WATER MARK OF THE LONG ISLAND SOUND; THIn, CE ALONG THE APPARENT HIGH WATERMARK OF LONG ISLAND SOUND, ALONG 2 TIE LZNES AS FOLLOWS: 1. NORTH 88 DE~R~ 00 MINUTES 49 SECONDS EAST 81.42 FEET; 2. NORTH 82 DEGREES 07 MINUTES 23 SECONDS F-J%ST 81.42 FEET; THENCE ALONG SAID LAST MENTIONED LAND, SOUTH 0 DEGREES 53 MINUTES 00 SECONDS EAST 81.02 FEET TO LAND NOW 0E FORMERLY OF KARDWELL; THENCE ALONG SAID LAST MENTIONED LAND AND ALONG THE NORTHERLY TEHMINUS OF MUNN LANE, NORTH 85 DEGREES 16 MINUTES 00 SECONDS WEST 1~0.10 FEET TO -T~E POINT OR PLACE OF BEGINNINg. TOGETHER WITH INGRESS AND EGRESS OVER MUNN LANE THE CIRCLE, MAPLE LJtNE AND DEXTER LANE TO ST. RTE. 25 (MAIN ROAD). FOR INFORMATION ONLY: DISTRICT 1000 SECTION 017.00 BLOCK 02.00 LOT 0!1.000 631-323-1245 BARRY M. SMITH PO Box 404 ORIENT, NY I 195'7 July 5, 2006 FAX631-323-0131 Building Department Town of Southold Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971-0959 RE: 725 Maple Lane SCTM # 017 0002 014 Southold Town Building Department, Enclosed is our check for $150.00 and a copy of your letter indicating the need to renew the Building Permit # 29503. We would like to schedule the inspection. Evidentially the pool company never followed up with the final inspection. BMS/rm Enclosures 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 O1' SOUTHOLD June 9, 2009 Barry or Rona Smith PO Box 404 Orient, NY 11957 RE: 725 Maple Lane, 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. ""q A fee of $25.00 Final Health Department approval. Plumbers solder certificate (all permits involving plumbing after 4/1/84.) Trustees Certificate of Compliance. (765-1892 Town Trustees) Final Planning Board Approval. Final Fire Inspection from Fire Marshal. Final inspection from the Building Department. Final Landmark Preservation approval. Building Permit: 29503-Z swimming pool Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (63 l) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLD November 2, 2012 Barry Smith PO Box 404 Orient, NY 11957-0404 RE: 725 Maple Lane, 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 $50.00 (check is not signed) Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1184) __ Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept. BUILDING PERMIT: 32198-Z swimming pool STAT£ OF N~.W YORK WO;~E~.$' COMr;ENSATION BOARD CER~FICATE OF NYS WOR~RS' COMPENSATION INSURANCE COgE~GE 3d. The Proprietor** e~d~de4 ~r cern }nflno~officc~ exclude, ~ Include~ ~hc ~e~ liSt~ a~vc ~ ~lc CC~ hold~ in bm "2". b~,ic~ on rh~r Ctmfi~c, ~hr=e a~n'ccz may be xe,~t ~v ~ulttr mtdZ) Oth~n,i.~, rhi~. Orti~eit va~4 foe a m~v~ of u'e ~ur 773 -- SS/'-- g~77 STATE OF NEW YORK THiS AGENCY EMPLOYS AND SERVES WORKERS' COMPENSATION BOARD PEOPLEWITH DISABILITIES WITHOUT DISCRIMINATION EMPLOYER'S APPLICATION FOR CERTIFICATE OF COMPLIANCE WITH DISABILITY BENEFITS LAW INSTRUCTIONS TO EMPLOYER: Complete PART 1 ONLY and have your Disability Benefits Insurance Carrier complete Part 2. PART 1. TO BE COMPL~*[Eu BY EMPLOYER EMPLOYER'S NAME AND ADDRESS (Home or Main Office) IMPERIAL GUNITE INC 81 COMMERCIAL ,4 VENUE OAKDALE , NY 11769 RE: POLICY# E65560-000 NAME UNDER WHICH BUSINESS IS CONDUCTED, IF DIFFERENT FROM ABOVE DISABILITY BENEFITS CARRIER (If mom than one, list all) STANDARD SECURITY L. IFE INSURANCE CO., OF NEW YORK LOCATION OF OPERATIONS OPERATIONS?r~a.-~ TO BEGIN ~-~,,r'" ~.~ x on,~ ' '-~ -~1, OR A~:~ ~/~/ Application is hamby made to the CARRIER for a Certificate of Compliance with the Disability Benefits Law. oat, s~,~ -~-':~-<"=~'', D., ~. L. ~t ToLNo:.~ G~-o~a,'~ov"L~ Th,, 'J. ~. PART 2. TO BE COMPLETED BY DISABILITY BENEFITS CARRIER CERTIFICATE OF COMPLIANCE WITH DISABILITY BENEFITS LAW STANDARD SECURITY LIFE INSURANCE CO., OF NEW YORK This ia to ce dihJ that the abova employer is insured with. and that the policy covers: * a. ~/ALL of the EMPLOYER'S employes eligible undm' the New York Oisabiti~ e~mfl~s Law. · b.~-I ONLY the foitowing class or classes of the EMPLOYER'S employees: 2)2 October 7, 2002 355-4141 BY~flle with D-B Bureau)) SUPERVISOR-DBL/POLICY SERVICES TiUa 'IMPORTANT: ff 8ox "a' is ~ecked, this oandicata is COMPLETE. Mail it directly to the employer. If Sox "b" is checked, this certificate ia NOT COMPLETE for purposes of Section 220, subd. 8 of the Disability Benefits Law. It musl be mailed for compledon to the Workers' Compensation Board, Disability Ba~efit$ Bureau, 100 Broadway Menanda, Albany, NY 12241-0005. PART 3. TO BE COMPLETED BY WORKERS' COMPENSATION BOARD (Only if box "b" of Part 2 has ba~n checked) STATE OF NEW YORK WORKERS' COMPENSATION BOARD There is on tile with the wodalrs' Compensation Board, Certificate of Insurance indicating that the abovemamed emplo~ has compl~d with the DIsability Benefits Date Signed By. DISABILITY BENEFITS BUREAU Tel. NO:. ( ) T~e DB-120.1 (4-99) 8. (a) (b) DISABILITY BENEFITS LAW Section 220 Penalties 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 employment as defined in this article, 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 chairman, that the payment of disability benefits for all employees has been secured as provided by this article. 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 disability benefits to any such employee if so employed. 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 employment as defined in this article, and 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 carder is produced in a form satisfactory to the chairman, that the payment of disability benefits for all employees has been secured as provided by this article. DB-120.1 (4-99) Reverse SC. HEN1A~IC' PiPllqG A,q,P,,A, NGF-:-ME_N.._.~T.T UNDER~FFERS CERtiFICATE lmF~r~k[ ouniTe Cot 32 Wo°dlawn Avenu~ Oakdale, NY. 11760 f NOTIFY BUILDING 7~5-1~0~ I.Mi~ TO 4PM FOR POURED CONCRETE 2. ROUG~ - FRAMING & 3. 14SIJLATION 4. FINAL - CONSTRUCTIO~ BE COMPLETE FOR C.O. ~ CONSTRUCTION ,SHALL REQUIREMENTS OI YORK STATE. N~.T A USE iS UNLAWFUL PL/x,M REQUIRED ~.~ ~.,,,~^,. ' ~ ,...,,..,~. WITHOUT CERTIFICATE ~-' ~,":1- / '~ '.~ , / ~ ',,x j . . ~/"' ~/ /j _Su~,~u~u~, ~ ~ ,.' ME~ THE REQUIREMENTS OF THE UPoN COMPLETION 'U BEFORE "WATER" SECTION GUNiTE SW!MMII'g'G POOL DETAILS FOR: FOUND Lot (~ k ~or (~ LOT STORy FRA~4E HOUSE I 322.00' P/O £o/' Q 54 _,y/o/,~ 17 SURVEY OF PROPERTY SITUA TED A T ORIENT TOWN OF SOUTHOLD ,~ SUFFOLK COUNTY, NEW YORK 'f · S.C. !AX No.'1000-17-02:-1¢., ~. SCALE 1 .30 ..: NOVEMBER' 14, 2000 AREA = 141,607.55 sq, fi. $,251 ac. CERTIFIED TO:' CHICAGO TITLE INSURANCE COMPANY PNC-MORTGAGE CORPORATION OF AMERICA, ITS SUCCESSORS AND/OI} SSiGNS, · BARRY SMITH . ~' ,, RONA SMITH' NOTE: LOT NUMBERS SHOWN THUS: MAP OF BUNGALOW SITES MA'NTALOKING HILLS' FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON SEPTEMBER 19, 1908 AS FILE No. 620, N.Y.S, LIc, No. 49668 Ai' Ingegno Joseph Land .SUrveyor PHONE (St 6)727-2090 OFFICES LOCATED AT One Union Square Aquet~gue, New York 11931 rifle SurYe~ - Sul~,/lsions - $~i~ Plent~ -- CortefrucGon Loyou! ';rr' Fax (516)722-50cJ3