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HomeMy WebLinkAbout38244-Z .n~~ ,ps~~fpt4, Town of Southold Annex 8/27/2013 3~' P.O. Box 1179 54375 Main Road 'Z.~/~ ~ S~ Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36467 Date: 8/27/2013 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 28547 Route 25, Orient, 2 SCTM 473889 Sec/B1ocWLot: 18.-6-24.1 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this ofiiced dated 3/7/2011 pursuant to which Buildmg Permit No. 38244 dated 8/9/2013 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in ¢round swimmine pool with fence to code as applied for per ZBA #6436 dated 2/16/11 The certificate is issued to Lois Abramchik & Barbara Cavallo _ (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 36240 5/16/11 PLUMBERS CERTIFICATION DATED - 1 ut rued ignatut`e =.~ffoi~;--.__ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE 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 38244 Date: 8/9/2013 Permission is hereby granted to: LOIS ABRAMCHIK & BARBARA CAVALLO _ P.O. BOX 582 ORIENT, NY 11957 To: CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL PER ZBA DECISION # 6436,FENCED TO CODE. C/O HAS BEEN PAID. REPLACES EXPIRED B.P. # 36240 At premises located at: 28547 ROUTE 25, ORIENT SCTM # 473889 Sec/Block/Lot # 18.-6-24.1 Pursuant to application dated 3/7/2011 and approved by the Building Inspector. To expire on 2/9/2015. Fees: PERMIT RENEWAL $125.00 Total: $125.00 - Building Inspector 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 36240 Date: 3/16/2011 Permission is hereby granted to: Abramchik, Lois & Cavallo, Barbara PO BOX 582 Orient, NY 11957 To: construction of an accesso in round swimmin ry g g pool per ZBA decision #6436, fenced to code At premises located at: 28547 Route 25, Orient SCTM # 473889 Sec/Block/Lot # 18.-6-24.1 Pursuant to application dated 3/7/2011 and approved by the Building Inspector. To expire on 9/14/2012. Fees: SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE $250.00 CO -SWIMMING POOL $50.00 Total: $300.00 Building Inspector i i , ~ ~ ~ ~ ~ r°~,» N°. 6 i~ I" AUG 2 2 2013; TOWN OF SOUTHOLD BUILDING DEPARTMENT ! I "TOWN f1ALL I 765-1802 ~'~~-,n~,D APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/] 0 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 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 [o the applicant. C. Fees 1. Certificate of Occupancy -New dwelling $50.00, Additions [o 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. Temporary Certificate of Occupancy -Residential $15.00, Commercial $ I5. 0 ` / Date. I ~ _ New Construction: Old or re-existing Buil 'ng: (check one) Location of Property:r~~~ ~ ~l ~ ~ ~ ~ r~P ~ Q/~ House No. ff Street Hamlet Owner or Owners of Property: W ~N ~ I I ~ i ~ ~ ~~(C~ Suffolk County Tax Map No 1000, Section f ~ Block Lot-- Subdivision Filed Map. Lot: c ~n Permit N Date of Permit U / ~ Applicant: L a 1 S t~'1"t`C ~ r ~ U Health ept Apr~al: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ ~~a ,Oq ~(y Applicant Signature ~ ~O~~OF SO!/lyolo Town Hall Annex ~ ~ Telephone (631) 765-1802 54375 Main Road N ~ Fax (631) 765-9502 P.O. Box 1179 ~ Q Southold, New York 11971-09.59 ~ roger. richert(a)town.southold.nv.us ~~~OOUNTV BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Cavallo/Abramchik Address: 28547 Main Rd City: Orient St: NY Zip: 11957 Building Permit#: 36240 Section: 18 Block: 6 Lot: 24.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: USI Electric License No: 2740-e SITE DETAILS OfFce Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 2 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 1 Disconnect Switches 2 Twist Lock Exit Fixtures TVSS otner Equipment: in ground pool including bonding 1 pool light 1 heat pump 1 GFCI circuit breaker 1 chlorine generator Notes: Inspector Signature: ,Pit Date: May 16 2011 61-Cert Electrical Compliance Form 1 ~o~~,OF SO~l~6 +IM ®f TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 NSPECTION [ FOUNDATION 1ST ( ]ROUGH PLBG. [ J FOUNDATION 2ND [ ]INSULATION [ J FRAMING /STRAPPING [ ]FINAL [ ] FIREPLACE ~ CFIIMNEY [ ]FlRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRIlC110N [ ]FlRE RESISTANT PENETRATION REMARKS: ~C ~ ~ G~/~-' ~ - -7 DATE G ~ ~ INSPECTOR 't'`/~ ~o~.1,OF SOUTy06 n~~ OWN OF SOUTHOLD BUILDING DEPT. 765.1802 1 NSPECTION [ ]FOUNDATION 1ST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ]FRAMING /STRAPPING [ ]FINAL [ ]FIREPLACE & CNIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR ~ ~ ,roe souryo* TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH P BG. [ ]FOUNDATION 2ND [ ] I CATION [ ]FRAMING /STRAPPING [ FINAL [ ]FIREPLACE & CHIMNEY [ ]FIRE SAFETY INSPECTION [ ]FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL) REMARKS: G~ DATE l1` INSPECTOR FDELD ON REPORT DATE COMMINTS f~ b FOUNDATION (1ST) ~ ~ ...__._.T........_____~__ • FOUNDATION (2ND) x t_; c V., s ROUGH FRAMING & ~ PLUMBIlVG i i~ W INSULATION PER N. Y. STATE ENERGY CODE 1 r._` , I FINAL ADDITIONAL COMMENTS ~ ~ ~ ia-- ~ ~ ~tilvlL - - m~< /6 / ~~pZ ~ 0 z m ~~'z O } z " d TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following, before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. 3~p ~ 7 t' Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined ) ~ 20~ Storm-W ater Assessment Force Contact: Approved ~ /~',20~ Mail to: V1Cti9 IOW~/~V Disapproved a/c Phone: ~~~~5(/p(p~ Expiration- '1~/ 20~ L~ uilding Inspector APPLICATION FOR BUILDING PERMIT Date ~Al,'~~ ~ , 20 ~ ~ INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agree pI a ,ordinances, building code, housing code, and regulations, and to admit authorized insp p i a~d b ' g necessary inspections. MAR 2 2011 (Signature of applicant or name, if a corporetion) BLDG. DEPT. TOWN OF SOUTHOLD (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ~~Q `.~~j(.~e-/ Name of owner of premises ~ bra /M~ i - Ca ?e~ l IO (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. I . Location of land on which pr/o~posed work will be done: A/1~4.1 /COrr-dC ~Yc~ House Number Street Hamlet County Tax Map No. 1000 Section ~ Block G Lot ~ r- Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and interl5~ed use and occupancy of proposed construction: a. Existing use and occupancy S~ ?~l~ ~tl ~n r'eSioC~!a2Gc_- b. Intended use and occupancy , j'a21x wi'>~ ~Ba 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work BcC~,Hnrvii~ P~ (D ri tion) 4. Estimated Cost ~'I`/'~, Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front ~ Rear ~ ~ Depth ~(o ~ Height Number of Stories S Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front a ~ Rear a ~ ~ Depth `~o Height Number of Stories 9. Size of lot: Front ~ 3 ~ Rear a ~ % Depth 3.3'7 ~ 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 NO_Will excess fill be removed from premises? YES_ NO!~ 14. Names of Owner of premises f{bra,~~% ddress 0'"~ e Phone No. Name of Architect -3 O'.p/a-~ Address n Phone No Name of Contractor Lvr Ewa rc~5 Address l~ is-e-~-- Phone 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 property 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. 17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? *YES NO * IF YES, PROVIDE A COPY. 21?J~ GL~-- STATE OF NEW YORK) SS: COUNTY OF,~,~ )A,y~ cvl , D7Ny-Gf being duly sworn, deposes and says that (s)he is the applicant (Name of individual igning c ntract) above named, yr CONNIE D. BUNCH (S)He is the /y~'iy.-/ Notary public,_Stet s~ YOrk (Contractor, Age ,Corporate Officer, etc.) OualNied in SufloNc CeuniY Commissron Expires April 14, ~Q/~- ofsaid 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 aze true to the best of his knowledge and belief; and that the work will be perfonmed in the manner set forth in the application filed therewith. Sworn to efore me this " t _~i day of ~ 1 GYl 20~ \ ~ f~ ~ ~ ~ e. Notary Public Signa u e of Applic,^ nt FORM NO. 3 NOTICE OF DISAPPROVAL DATE: August 16,2010 TO: Arthur Edwards Inc. for B Cavallo & L Abramchik 929 Route 25A Miller Place, NY 11764 Please take notice that your application dated August 5, 2010 For a permit for an accessory inground swimming pool at Location ofproperty: 28547 Main Road, Orient County Tax Map No. 1000 -Section 18 Block 6 Lot 24.1 Is returned herewith and disapproved on the following grounds: The proposed accessory ineround swimmingpool is not permitted pursuant to Article III, 280-15 which states: "In the case AC District & Low Density Residential R80, ...Districts, accessory buildings & structures or other accessoryuses shall be located in the required rear yard, subject to The site plan indicates the proposed accessory ineround swimmingpool is located in a front yard. ~ Authorized Signature \ ABOARD MEMBERS ~pF SOply Southold Town Hall Leslie Kanes Weisman, Chairperson Oho 53095 Main Road • P.O. Box l 179 Southold, NY 11971-0959 James Dinizio #t ~ Office Location: Gerard P. Goehringer G Q Town Attnex /First Floor, Capital One Bank George Horning ~0 ~ ,,pig 54375 Main Road (at Youngs Avenue) Ken Schneider ~y~OUNi'1,~~ Southold, NY 11971 http://southold[own. northfork. net ZONING BOARD OF APPEALS D ~ ~ ] , TOWN OF SOUTHOLD Tel. (631) 765-1809 • Fax (631) 765-9064 F E ~ ~ ~ FINDINGS, DELIBERATIONS AND DETERMIN IO MEETING OF FEBRUARY 16, 2011 - - E,:~.~_ , T^" ' )F SUUlHGLC' ZBA FILE # 6436 - NAME OF APPLICANT: Lois Abramchik and Barbara Cavallo SCTM#1000-18-6-24.1 PROPERTY LOCATION: 28547 Main Rd. (SR 25) and Brown's Hill Rd (Private Rd), Orient, NY. SEORA 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. SUFFOLK COUNTY ADMINISTRATIVE CODE: This application was referred as required under the Suffolk County Administrative Code Sections A 14-14 to 23, and the Suffolk County Department of Planning issued its reply dated Nov. 9, 2010 stating that this application is considered a matter for local determination as there appears to be no significant county-wide or inter-community impact. LWRP: This application is not subject to review under Chapter 268 because the variance relief requested does not involve features that relate to a regulated natural feature or a bulkhead or other shoreline. PROPERTY FACTS/DESCRIPTION: Subject property contains 1.934 acres with a 25 foot right of way access from Main Rd. (NYS Rt. 25), 337.80 feet on the southern property line, 243.91 feet on Brown's Hill Rd. (which is a private Rd., no access), 441.00 feet along the northern property line and 219.72 feet on the eastern property line. It is improved with a framed house and a framed cottage as shown on the survey dated February 2, 2011 prepared by Peconic Surveyors, PC. BASIS OF APPLICATION: Request for Variance from Code Section 280-15 and the Building Inspector's August 16, 2010 Notice of Disapproval based on an application for building permit to construct an accessory in-ground swimming pool at; a location other than the code required rear yard, at: 28547 Main Rd. (SR 25) and Brown's Hill Rd (Private Rd), Orient, NY. RELIEF REQUESTED: The applicant proposes to install a 20 ft. by 40 fr. in-ground swimming pool in a side yard as shown on the survey prepared by John T. Metzger, L.S., dated Nov. 3, 2010. AMENDED APPLICATION: During the January 6, 2011Public Hearing, the applicant was asked to bring the plan i~ into more conformity with the code. The applicant on the February 3, 2011 Public Hearing submitted a plan increasing the front yard setback to 88 feet (a 20 foot increase) and increasing the side yard setback to 134 feet, (a 9 foot increase), bringing the plan into more conformiTy with the code. ADDITIONAL INFORMATION: The subject parcel's western property boundary (street line) adjoins a private road named Browns Hill Road. The subject parcel has no legal access rights to this private road over this street line. Therefore, by Code, this street line shall not be considered to be a front yard, and any accessory structure Pagc2-February l6, 2011 ZBA Filek6436 - AbramchiWCavallo CTM: 1(Y00-IS-6-24.1 placed in such yard shall comply with the applicable side yard setbacks for the zoning district within which it is located. The subject parcel is accessed from the Main Road (NYS RTE. 25) via a 25 foot wide easement through the adjoining parcel to the south. This is presently the only legal access to the subject parcel. This access easement enters/adjoins the subject parcel, at its southeasterly most location, through/along its 219.72 foot eastern property boundary for a width of 25 feet as shown on the survey of the subject parcel prepared by John Metzger, L.S. revision dated Feb. 2, 201 I. At both public hearings, the applicants agreed to repair any damage to this easement/R.O.W. that may be caused by heavy equipment during the construction of their proposed swimming pool FINDINGS OF FACT/ REASONS FOR BOARD ACTION: The Zoning Board of Appeals held a public hearing on this application on January 6, 2011 and February 3, 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 fmdings: l . Town Law &267-b(3)(b)(1). Granting of the requested variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. An in-ground swimming pool is a common accessory to residential dwellings in this neighborhood. 2. Town Law &267-b(3)(b)(2). The benefit sought by the applicant can be achieved by some method, feasible for the applicant to pursue, other than an area variance. The applicant could locate the proposed in-ground swimming pool in the conforming rear yard. However, the additional expense of the removal and relocation of an existing underground propane tank, and the removal of existing mature trees and vegetation, represents a financial hardship to the applicant. 3. Town Law &267-b(3)(b)(3). The variance granted herein is substantial insofar as it is a request for an accessory structure in a side yard, however the substantiality is mitigated by the proposed setbacks from all property boundaries exceeding the code requirements of principal structures. 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 mechanical equipment for the pool is proposed in a utility shed that will mitigate noise disturbance. 5. Town Law &267-b(3)(b)(5). The difficulty has been self-created. The applicant purchased the parcel afrer the Zoning Code was in effect and it is presumed that the applicant had actual or constructive knowledge of the limitations on the use of the parcel under the Zoning Code in effect prior to or at the time of purchase. 6. Town Law &267-b. Grant of the requested relief, is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of an in-ground swimming pool in a side yard, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Weisman (Chairperson), seconded by Member Goehringer, and duly carried, to GRANT. the variance as shown on the drawing entitled "Site", Abramchik-Cavallo Residence Proposed Pool, prepared by Nancy Dwyer, Design Consulting, Inc., dated 2.3.2011. ~ Page 3 - Februar}r 16, 2011 ZBA Filedb436 - Abramchik/Cavallo CTM: IlIb0-18-6-24.1 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 heazing before the Zoning Board of Appeals . Any deviation from the vaziance given such as extensions, or demolitions which are not shown on the applicant's diagrams or survey site maps, aze not authorized under this application when involving nonconfotmities 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. Vate of the Board.' Ayes: Members Weisman (Chairperson), Dinizio, Goehringer. (Absent was: Member Schneider) (Member Harping by tefephone,~ no votang]ri~ght) This Resofutton was duty adop(ed (3-O). l.r' n.vi Leslie Kanes Weisman, Chairperson Approved for filing a / / 7 /2011 ~~k~ Town of Southold Erosion, Sedimentation 8e Storm-Water Run-off ASSESSMENT FORM ~ ~ PROPNaTV LoGAnoN: S.C.TAl R THE FOLLOWING ACTIONS STAY REgDIRE THE SOSMIS810N OF A /073 / (p ~ ~ / STO ATER, GRADING, DRAINAGE A!H! EROSN)N CONTROL PL11N ~61v cf- ~g-n '~IoTc Tot CERTIFIED BY A OESION PROFESSIONAL IN THE ATE O NEW YORK. SCOPE OFWORK -PROPOSED CONSTRUCTION TTEM # /WORK ASSESSMENT Yes No a. What is the Total Area of Ne Project Parcels? Will this (Indude Total Area of all Parcels located wNhin 'i Projed Retain Afl Storm-Water Run-OtF ~ + j ~ ~ Generated b)/ a Two (2") Inch Rainfall on Site4 ~ ? the Scope W Wark Tor P ) / (This Nam will Mdude alt nn-off created by sae b. What is Me Tohdl Anna of Lantl Cteedn8 deadng and/or censWdion activities as waN as all andJOr Ground Disturbance for tlee proposed ~ O Site Improvements and the permanent rfeation of cnnsWdion actlvity? impervious surfaces.) (SF. /.Wee) ' PROVIDE BRIEF 1'RO,TECI' DES(,'RIPTION rPe.ns.aa~d 2 Does the Site Plan and/or Survey Show PJI Proposed - P'0Y ° Nidi°) Drainage Stmdures Indicating Size & LOCatlon? This Item stroll indude all Proposed Gade Changes erM ' ~L(/. M/7Al~~Oa / y SfB~-t- Slopes Controlling Surface Water Flow. ~ JJ 3 Does the Site Plan endlar Suryey desaibe the erosion r~f~~ O Sr/YYC?{ti/.~- and sedimem control practices that wN be used to ik; i control site erosion end stone water dlsdtarges. This 7 - 1 hem must be maintained Mroughout the Entie Constructlon Pedotl. 4 WIN this Projed Requre any Land Riling, Grad'mg or, Excavation where there is a change m tfte Nelurel Existing Grade Invdving more than 200 CuMC Yards _ _ I of Material wNhin any Paroel7 rj Will this Application F?equ(re Land Disturbing AdlNties Encompassing an Araa in Excess of Rve ThousarW (5,000 S.F.) Square Feet of Ground Surface? s Is dtere a Natural Water Course Running Through the a I Sita7 Is this Projed within Me Trustees jutlsdiction oarrerel tTEC SWPPP tteaWreervlb: or within One Hrmdred (100') feet M a Wetland a 'i Srbmiseion of a SWPPP is requbed na aq Corretna.1bn actwtiea invdNrg Sul 8eadl9 1 i dbtarbences d ore {1) v nnre eves; iriduding dblerbenWS of less Man arre eve Met 7 Will drere be Sk@ preparedon on 6dsdng Grade Sbpas are pen of a Iwger common plan Mat will rdNmatey tlbWb one or more eves W bed; Whfdl Exceed Fifteen (15) feet d Vertical RLa9 to (x". irrJudirig Constrealon actlvitbs ervdving soil6stubarrcea of leas Men one (7J eve where One Hundred 10 a Me DEC has debmdrred oral a SPDE3 pemar b requbed fv alarm water 6aG10rgee. ( 0') of Hodzontai DlStanCe9 ~ ( SWPPP'a ShMI meet dro 19nknum Raqulraeiama of the SPDES Oanerel Pomdt $ Will DflYewaya, Pafldreg Area9 Or other Impervious for Swrrrr water Disehsryy ham Ceasbercaon aetlWry • PermN No. GP.a-1a-0o1.) Surfaces be Sloped to Dired Stone-Water Run-Oil 1, The SWPPP anYl be prepared pdv m MB wbmebl W the NOI. The NOI anew be into 8fldfOf In the dlrectlon of a Town rgM-of-wayl subndlbd to the Oq/anmem pdv to the mmnancemem of wrraWCtlon eetlvlty. ~ z. Tea SWPPP aheY deacdbe pte erosion and wdlrnent control precdces aM wham 9 Wll this Project Require the Placement of Material, ` ' required. poNMOmMxxipn storm wabr management prectlces Met wal6a used ardbr Removal of Vegetatbn arN1/or ih0 Construction O<any j~ mresauded ro radars Me polubnts b storm actor dbcnargae and ro aswre Item Witltin the Tawn R' fN~of-W or Raad ShouWar / _ , vxnplbrpe weft dr tame arr6 conrafiana of tnb permit b adtlelon, too awQPP snail ~ a I identlly polentlel sources U polutlon whldl may raewrubly ce eJgrecled to aaM Me Areal Per mm wen Norrnwe. nw arrurwr of amew.y wwom,) quality oFalorm water dsciterpea NOTE: aAry Anawr to Queatlvr one Mrough NlrobAnn,end wehaehsdrMrk 3. Ae SWFPPa Mpt regrare Me poslyxxrebuNOn 6tOlm Wabr management pmcMce N a eos end Me COrbbrCaOn ales ®elraberlC! is batweN e,OaDSF.6 f Ave rn area, ~ cemponem efb/!b prepared by a OudiNed Design Proreemoral Licensed In New York a SbnrraNaM, (rramrrg, bralnegs i emalon Oormul %M is Rpuin;d aY Via Town of Mat b krawivlgeebb in the pdndpbs and Practlces of 3bm Water Managemem. eoomeld end Nus1 be auhrnRNd br ReMew Pdar to leaumce of Arq 9uatlina Permk MOTE= AUad~abe(./) end/orAmav bresrh 0unapnb ReVUeed fare ltraaleMAONkeean) I S1A1'E OF NEW YORK, NotDry pW~ g18(O d NDw YOIk CO~UNjTYOF..~.~.~~.......SS No. O1BU818s6n0A610~ q i That I . ............_/.~;~:,~.cz~ ...1.?../N.}'..~.:................ being duty sworn, depuse~Od1 top gp~lir-t1[TOr P i (NamedbdvM Isigrang ) j Md that he/she is the .................................~Q S 1, ~ ( ~Camaav, Agent, Caporete OMcer, eM-) Owner and/or representative of the Owner or Owners, azhd is duly authorized to perform or have performed the said work and to i make and file this application; that all statement concealed in this applicaton are true t4 the beat of his lutowledge and belief; and that the work will be performed in the manner set fortlt in the application filed herew4dt. Sworn to before e dus; Zy~C~ ..da of...\1..... 20_~.~ r , / / ~ Notary Public: ....`.}.-:.Z.`.:.n.Y..:^..~.....:}'..:....AF::.S!.~%~..f...4~ C........ ( of ) FORM - 06M0 TOWN OF SOUTHOLD PttOPERTY RECORD CARD ~ _ ~ doe --tV +o~ OWNER STREET a 5 { VILLAGE DIST. SUB. LOT a 5 ramGh~ Qf OQ ~Y'er ~ ~ ~ 1-f4 FORMER OWNER N, ~ . „ ~ E ACR. 1 4 ~ n r f 'mss j 1'~lo rro ' k~ ~(eD77-~Y~L~t ~~o+^^~~~ ,,.~fwis II / W TYRE OF BUfLDI/NpG 1. ii°.' k+SL`~, ~rC~ ~`YFI Y-I~ Uf ~ F1S 3 a ~ /V~ ~v6 . .RES. 2 f p ° SEAS.. - VL. FARM COMM. CB. MICS. Mkt. Value ,!t// ~L/ g - LAND IMP. TOTAL DATE REMARKS 7~ Q/,rPa, ' ~ DY Ui/Qo~adQf~ It, ~C. /,Z Cr10 0 d O I o~ v o (a O v ` ~ 7 a'-~/' ~ ~ ^ ~ , yDUP~ s~ ~JF p °3298 ~ !I % i I / ~ Qf1N , 5 _ C r C?~7 I _>•s/~,~r - Yf ~s 7~ oa J iy;caw fo dE„e //..vim C-.c.~~~i; arc l `IO C`~ / O GO . , ^ -err--'-- i F . ~ 5~ Y Y .C _2__.f DO f 3b t. ' Op Z = - ! r - ~ - ,,,'r, ~ 41.~~a 1nC©~ l3 300 1.5,20© to .S t% ~ - a~5on ,p 1 rr1 ~c,n0._~34G -man i jeZ3d0 3 IL 49 ~t3, 5 9700 ~ s~ - - k _ AGE j BUlLD1NG CONDITION ~ ~ i NEW ~ NOR/v1AL I BELOW ABOVE FARM Acre ~ Value Per Value ~ i Acre ~iElabie• ~ ~ 9 ~ ~ ~fj ~j I FRONTAGE ON WATER , i Woodland I FRONTAGE ON ROAD Meadowland ~ ~ DEPTH House~Plot ~ ~ ~ 'B~U~LKHEAD Totol ~E~~-~---CK _ _ _ DOLOR V JC N C 7V - _ TRIFiT ~~L r ~ _ - f _ _ + - h. - _ _ - _ . . } ~ - - - b ] - - _ _ _ _ _ . I - y ~ [ s. a _ i ~ , ~ - - - ~ _ ~ 1 X ~ _ ~ i..... - - _ 3 _ ~ -i nn.BFdg. 1~ xZ .4! 21 ~sO 2~{,'''_ _ - 19x. 7= 7 - _ _ _ ? Exte Sion 23X2 C SS ~ _ _ /s -ti X3'715/3. /Sy1 ~S ~ i I ~ I i Extension RD ~ Faundotion - ~ 7f''Q~t l`'~ Bafh - ~ Dinette _ _ Porch X 2 s- , j ~ ! ~ Basement ~ _ Floors - - - 7 Parch ~ I F~c#~ Walls S f ~ IntetiorFinish Shee LR. i~ / .l T_ _ Breezeway Fire Place ~ Heat ~ Garage- _ _ Type Roof '1 ! Y DR. yf.~ Rooiiis' TSt Floor ` g~, Patio i I Recreat,an Room - Rooms 2nd FEaor 2 _ _ FIN, B t f~ c~ ao Ca`~ .Dormer l3riveway r r - Total _ _ - ~ - - i - \ j ARTHUR EDWARDS POOL & SPA CENTRE 929 ROUTE 25A MILLER PLACE, NY 11764 516-744-7185 FAX-744-0174 APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD TOWN OF SOUTHOLD MAIN ROAD (P.O. BOX 1179) SOUTHOLD, NY 11971 (631)765-1802 PAPERS ENCLOSED: APPLICATION FOR OUTDOOR POOL PERMIT ~Q EROSION SEDIMENTATION & WATER RUN ASSESSMENT FORM l[~ CERTIFICATE OF WORKER'S COMPENSATION CERTIFICATE OF LIABILITY INSURANCE SUFFOLK COUNTY LICENSE SUFFOLK COUNTY PLUMBER LICENSE SUFFOLK COUNTY ELECTRICIAN LICENSE 4 SETS OF PLANS - (3 STAMPED) 3SURVEYS TJI~ APPLICATION FOR ELECTRICAL INSPECTION WITH $100 CHECK [ ] C.O. P~ TAX BILL 9~ $250.00 CHECK FOR PERMIT FEE PLEASE BALL OUR OFFICE IF THERE ARE ANY QUESTIONS REGARDING THIS APPLICATION. •:•n = Southold Town Building Department ~''_~9~FF~'tC ~ P.O. Box 1179 Permit 36240 54375 Main Road ~ Southold, New York 11971 Permit Date: 3/16/2011 (631) 765-1802 ~ Expiration Date: 9/14/2012 .r,.r Parcel ID: 18.-6-24.1 BUILDING PERMIT RENEWAL LETTER Dated: 8/2/2013 Applicant: LOIS ABRAMCHIK & BARBARA CAVALLO Location: 28547 ROUTE 25, ORIENT Work Description: IN GROUND POOL CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL PER ZBA DECISION # 6436,FENCED TO CODE. A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: LOIS ABRAMCHIK & BARBARA CAVALLO Address: P.O. BOX 582 ORIENT, NY 11957 The permit listed above has expired. Please contact our office as soon as possible to begin the renewal process. All work on the project must stop on the expiration date. No work is permitted or authorized beyond the expiration date. THANK YOU, SOUTHOLD TOWN BUILDING DEPT. ^~~~pF SOpTo ~~o Town Hall Annex yy Telephone (631) 765-1802 54375 Main Koad ~ T~ Fax (631) 765-9502 P.O. Box 1179 G Q Southold, NY 11971-0959 ~ ~ ~1y00UNTV 0 BUILDING DEPARTMENT TOWN OF SOUTHOLD August 13, 2013 Lois Abramchik Barbara Cavallo PO Box 582 Orient, NY 11957 Re: 28547 Route 25, Orient TO WHOM IT MAY CONCERN: The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. (contact your electrician) A fee of $50.00. Final Health Department Approval. Plumbers Solder Certificate. (Ail permits involving plumbing after 4J1/84) Trustees Certificate of Compliance. (town trustees u ass-tssz) Final Planning Board Approval. (Planning # 7s5-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept BUILDING PERMIT: 36240 - In-Ground Swimming Pool Suffolk County Executive s Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 7/1/78 No. 4436-H - _ _ SUFFOLK COUNTY ~Ion~~~ f~npro~e~nent Contractor License This is to certify that ARTHUR J EDWARDS doing business as ARTHUR EDWARDS MASON CONTRACTING INC _ L av;n~; `u! iiFhc,x 1'r re,,~li~emern:, sei foi t'n in accordance with and subject to the provisions of applicable laws, rnics and ~g~l.iatio~ts of the Coun ~ of Suffolk, State of New York is hereby licensed to conduct business as a IIOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. SUFFOLK COUNTY DEPARTMENT AddlhOrld)_ $llS1IleS52S OF CONSUMER AFFAIRS HOM€IMPROVEMENT CONTRACTOR ARTHUR J EDWARDS This c That the i~Hler IS duly ARTHUR EDWARDe MASON ~ ~ /S ~ IICen68ft by the CONTRACTING INC OBA ~l /~LtiV- _1~IGJ Q- County©iSUffolk - 4436-H 07io7/19~a Duector Denis McE1liRott °°".."e, o~rotrzotz i a'eAinr qv o!!~ pi"~! p~l~ a?a vi l2 £8V ~""'My! ~/v v,; ys •xnn~nr~/~ ~ Ur•o ~ yli °at'y4a ;'fit G~~~'°'4 ~ v c` vyr~N c ra a n~"~A" nk, - ~ x r ~ "a"+S' ~ wF1.a o P I r~r ~"hiAVa"~ aI fT 4 q h, f w- a~ a1> .~.,~~a v ~z a5 kir ~°y y 3. ',~y/i,° F ~ ! E i ~~r V y N:. j`~.. r~ as`. " x < 3~~~~- Suffolk County Executive s Office of Consumer Affairs . rl ` ; s.." VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 _ DATE ISSUED; 5/1/80 No. 2740-ME ~ SUFFOLK COUNTY = Master Electrician License =.r =s~- ~ This is to certify that EDWARD S REIFF , . doing business as iINDERGROtiND SPECIALTIES INC havin even satisfacto evidence of com eten g g~ ry p cy, is hereby licensed as MASTER ELECTRICIAN in 3 - m accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York. :ms's ~ yr _ Y. - SUFFOLH COUNTY DEFARYMENT Additional BuSiIIeSSES ~ ~ OF CONSUh1ER AFFAIRS r ,z IIAA-STER v3 r`~€-fi;~l ELECTRICIAN ~si~~/ ~ wr EDWAR6 S REIFF ~ }`.,Y,3. 4 pUW1CgMN6 ~ UNbERGRWNG:SAEClq Ll1fi31lIG 'I This certifies that the ~ Q ~ A ~ I>~rerredu IiceRSed ~ ( -0~~"="~=V?.C/L s ~~i H o,..~» - ~ by the County of Suffolk 2740-ME os~atn~ao irctcn i l~alaeA. g, osrotnotz ' l~ ?2 - r ~s`b e N ! ~ i bt v W i4 P Y ° ~ rt ll i! - ~ ~ _ • ~ i n ~v~^ day ~ v~'-~ v~ ~~T,v~`: `~.W flr r ~~e .G``uY a,' h~ry„ v sa' tel. ~~.~~v ~Ft . ' r ~ t E , ~ / ~ ~ ~ t gCOR,~7' CERTIFICATE OF LIABILITY INSURANCE °AFLTtN l ol~oa~lo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bagatta Associates, inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR . 823 W Jericho Turnpike Ste 1A ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. Smithtown NY 11787 ~ Phone: 631-869-1111 Fax:631-864-8274 II INSURERS AFFORDING COVERAGE NAIC# INSURED ' MSURERA Romest~c xvucanc. conpanJ 26182 Arthur J Edwaxds Mason INSURERS. Contracting Co Inc DBA Arthur ~ wsuRERc Edwards Pool & Spa Center MilletuPlaceANY 11769 INSURER D INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HOVE BEEN ISSLED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTwrtHGTANDMG ANY REOUIREMEM. TERM OR CONDITION OF qNY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OP MAY PERTAIN, THE MSURPNCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS MJD CONDITONS 0- POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIp CLAIMS POLICY NUMBER DATE (MMIDDIYYYY) DATE IMMIDDIYYYYI LIMBS LTR NSR TYPE OF INSURANCE EACHOauRRENw $ 1000000 GENERAL LIABILRY A I X COMMERCIAL GENERAL UA8ILITY MPA8G0912 01/01/10 O1/O1/11 PREM SES IEacoccurenw) $100000 CLAIMS MODE ~ OCCUR MED ExP 14ny one person) $ 5DDD PERSONAL c tw wduRr a 1000000 X BLANKET ADDITIONA GENERAL AGGREGATE E20O0000 PROwrT~-coMProP AGG 52000000 ' GENL AGGREGATE LIMIT PPPLIEG PER PR4 LOC POLICY JECT AUTOMOBILE LLABILRV ~^MBUVEC SINGLE LIMIT $ Ea amnenL ANY AUTO PLL OWNED PUTOS BODILY INJURY $ IPer per5onl SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ IPer acmtlent) NO&OVJNED ANDS PROPERTY DAMAGE $ (Per ecmtlanq GARAGE LIABILITY AUTO ONL`~-EA ACCIDEM E Ally q~O OTHER THWJ Eq ACC E AUTO On,U' AGG S FACH OCCURRENCE b E%CESSI UMBRELLA LIABILffV OCCUR ~ CLAIMS MADE AGGPEGATE 8 DEDUCTIBLE 8 RETEMION $ ~o WORKERS COMPENSATION TORS LIMITS ER AND EMPLOYERS' LIABILfTV Y I N PNY PROPRIETORIPPRTNERIEXECUTIVE ~ E L EACH ACCIDEM 8 OFFICERIMEMBER EXCWDEp4 E._ DISFr".SE-EA EMPLOYEE $ (Mentletory In NH) IYyes, tlescnbe untler EL OI~EASE-POLICY LIMIT E SPECIAL PROVISIONS below ' OTHER DESCRIPTION OF OPERAT10N5/LOCATIONBI VEHIOLES/EXOLUSIONB ADDED BY ENDORSEMENT; SPEOIAI PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE E%PIRATION DDOOOOO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ZS DAUB WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO BO SHALL IMPOSE NO OBLIGATION OR LLABILIN OF ANY KIND UPON THE INSURER, fi5 AGENT6 OR Town OF Southold REPRESEMATIYES. Tcwn Kall gUiHOREPD ~ AT~~._ P.O. Box 728 /~"TJ~~ outhold NY 19971 ACORD 25 ~2009V01} ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD This certificate is an original. State of New York Worker's Compensation Board CERTIFICATE OF PARTICIPATION IN WORKER'S COMPENSATION GROUP SELF INSURANCE la. Legal Naroe and Address o(Business Participating In Group ]d. Business Telephone Number of Business Referenced in "la". Self-Insurance (Use Street Address Only) (631)744-7185 Arthur J. Edwards Mason Contractor, Inc. DBA: Arthur Edwards Pool & Spa Centre 929 ROUte 25 A le. NYS Unemployment Insurance Employer Registration Number of Business Miller Place, NY 11764 Registered in Box "la". lb. Effective Date of Membership in the Group 4/24/2002 24108715 Issue Date 7/27/201p Expiration Date 7/26/2011 lt. Federal Employer IdentificaBon Number of Business Referenced in Box lc. The Proprietor, Partners, or Executive Officers are la ' ® locluded. (Only check if all partners / otlicers inluded• 111277925 All excluded or certain partners / oliicera excluded. 2. Name and Address of the Entity Requesting Proof of Coverage 3. Name and Address of Group Self Insurer. (Entity Being Listed as Certificate Holder). Town of Southold Special Trades, Contracting And Construction Trust Town Hall 6250 South Bay Road PO Box 728 Syracuse, NY 13039 Southold, New York 11971 Policy: W521504 This certifies that the business referenced above in box "1 a" is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law as a participating member of the Group Self-Insurer listed above in box "3" and Participation in such group self-insurance is still in force. The Group Self-Insurer's Administrator will send this Certificate of Participation to the entity listed above as the certificate holder in box " 2". The Group Self-insurer's Administrator will notify the above certificate holder within 10 days IF the membership of the Participant listed in box " la" is terminated. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year from the date certified by the group self-insurer.'. If this certiftcate is no longer valid according to the above guidelines and the business referenced in box "la"continues to be named on a permit, license or contract issued by the certificate holder, the business must provide the certificate holder either with a new certificate or other authorized proof the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative of the Group Self-insurer referenced above and that the business referenced in box "la" has the coverage as depicted on this form. Certified By: David France nn[ name of authorized representative of the Group Self-insurer) Certified By: 7/27/2010 (Signemre) (Data) Title: TrustAdmi ra[or Telephone Number: (3151699-8475 GSI-105.2 (2-02) Worker's Compensation Law Worker's Compensation Law Section 57 Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or'special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board; commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, boazd, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. please Note:This Certificate is valid only through the policy dates indicated above, OR a maximum of one year after this form is approved by the authorized representatives of the Group Self-insurer. At the expiration of those dates, if the business continues to be named on a permit or contract issued by the above government entity, the business must provide that government entity with ~a new Certificate. The business must also provide a new Certificate upon notice of cancellation or change in status of the policy. GSI-105.2 (2-02) Reverse ' "MAP OF HILL CREST ESTATES SECTION ONE'S SUFF. CO. MAP N0. 7218 I \ LOT 4 I L07 3 ~ LOT 2 - ro.TB°34'40"E. ~ aal.oo' _ RECEIVED FEB 3 2011 2 D ~ J ~ O p E W O ~ J J J BOARD OF APPEALS ~ '~o ~ ~ ~ ~ ~ O O O, 4 : N A~.i 3.00 J $ ~ ~ ~ dean L3J . 2__ v u 3 a. QO Z O 1~ ~ ~ ~ W ~n Q ~ < ~ F0. 3K1UIE i ~ J!~' 1 2i.5 _ W 11 ~ N.7' - _ i P c ~ a'~ - . h rowan 'O ~ y, Q 1 aUaT¢t$ ~ t~ r.o~ ce cicr' I ~ Naye • O O 9 Z O ~ ~ <-r~l -`-~P°rd' ~ roc. i i w0.L N z. 1 , ^ ~ o O u, ~ I- I - ~ ~ rs.°' ~ y ~ SURVEY OF PROPERTY o I m W O O D E D ~ is' a. o. w. _ ' i"• 5°.°' _ ~ AT ORIENT AREA = 1.934 Acres ~O S .78°34'40" W. ~ 337.80' _ TOWN OF SOUTHOLD N/0/F~NATO 8 M. REGINA ~ ~ SUFFOLK COUNTY , N.Y. _ Nu Poop 1000 - OIS - 06 - 24.1 N I N qt~s~ SCALE I " = 60 ' Am"°x' ~ounoN OCT 20, 1986 # p DEC . I S 1 9 8 6 ~j~ V * JULY 8 , 1987 ~ NOV. 3, 2010 (prop. pool ~-'"a - / ~ - - FEB. 2, 2011 ladARonc) ~ F4 FG7P1 f+qn ~l , 496/8 MAIN ROAD ANY AIiERATWN oR ADOITKka TO iRIS SURVEY IS A vrouTKNI S ~'--~I~ r (N.Y.S. RTE. 25) OF SELiDN 7209 OF T3E MEY YORK STATE EOUCATDN LAW. PECONlC SURE ;~..p!+i~~ ExcEPr As PER sECrDR 7209-sue03vls1oR 2. ALL cERnFlcnrlo3r # NOISIJ30 33S (63%) 765-5020 FAX f63N 76'5-1797 nEREOR ARE vALD FOR tlas MAP AIO COPES T}EREOF ORLV P.O. BOX 909 IF SAD MAP OR COPES BEAR Thk" MPRESSED SEAL Of THE ~ dVW lVNi3 V9Z 1230 TRAVELER STREET suRVEYOR wMDSE slcNan3RE APPEARS HEREON. SOUTHOLD N. Y. l/97l 8 6- 5 9 7 - ~~M AP OF - HILL CREST ESTA TES , SECTION ONE SUFF. CO. MAP N0. 7218 'L07 4 I LOT 3 I LOT 2 N.TB'84~40"E. I 441.00 - - 75.00.` i~ ~ ° ~ 0 h c 2 c -A r» No ~ ~ m ~ : O ~ Q !Z ovo°~ N decK Z i 111' ia3' ~ a 0 Q /sfy ~ ,sr o a v~ fr. lase. m M o: a v ~ri a m ' o!d ~ 22. i - 3 ¢ ' O Q .-p ~ Wo ~ - 48 ~ ~ ~ r on ~ sea y z._s x m r .P n roc - W Prepared in accordance with the minimu ~ , D ~ o covernT ~6a~ sc` ~ f Hoye m standarda for thle w tot established b v ( 6~" a ~.K,oa ca'st' I O ~ ^'eY F V` G~ pef`^ ns. ~ I N o the L. I. A. L S. and .approved and ado to O, 1 ~ I ~ Z for wdi use by The Nsw York State la ~ ~ ~Q~O N l i a l N THb Association.. o n ~b o M i sel Ib X25 R'OW SURVEY OF PROPERTY a ~K i - 50.0- ~ AT ORIENT AREA = I. ~ 3 4 ACRES ' ~ ~ S.78°3440" W. s l 337.80 sfk TOWN OF ~©UTHOLD N Q y~o tAM°T ~q~ SUFFOLK COUNTY , N.Y. U q.~ ~ N/0/F HOWARD L- YOUNG IOOO 018 - O6 - P/O 24 t"2~ ~~P N - ~ ~ N 9 BARBARA A. YOUNG SCALE I° = 60~ ocr. 20, I98s DEC . 18 i 986 ~ CERTI TIED TO FO, .Y. S. LIC. N0. 4961$ JULY 8 , 1987 FIRST AMERICAN TITLE INS, PECONiC SUftV£YQRS 8 ENGINEERS P-C _ COMPANY OF NEW YORf<. ' c51s) ~s5 - solo MAIN. ROAD REM ABSTRACT P. O. 80X 909 MAY WATSON MAIN ROAD (N.Y.S. Rr. 25 ) SOUTHOLD, , N.Y. 11971 RF - ~ a ~ A sanu,wn Rawr,r / NuNnum B E F B To FYter Flom Jr/~y(1 i9hr ! Puny MY~ RWIW Wa0 F Plan A Piping Arrangement wyi H rt.ev _ 42" , Section B-B z. ~ P~ , , ~ n~ H / i~ ~ w~ ~ 10" ~ /1~ Section A-A Typical Wall Section SIZE A B C D E F G H AREA CAP. FEET FT. FT. FT. FT. FT. FT. FT. FT. SQ.FT. GAL 18z32' 18' 32' 8' 14' 8' 4' 4' B' 512 19,000 ~tt/~iL~'~iceatd~ IB'z3B' 16' 36' 12' 14' 6' 4' 4' B' 576 21,600 POOL & SPA CENTRE .am... PERMACRETE WALL SYSTEM le'z96' 18' 36' i2' 14' 6' 4' 5' e' 648 24,909 929 Route 25A Miller Place NY 11764 8tste 20'z40' 20' 90' 18' 14' 8' 4' 6' 8' 800 30,000 (631) 744-7185 FAX (831) 744-0174 ~ ~ ream 24'z44' 24' 44' 18' 14' 8' 4' 8' 10' 798 90,000 Suffolk License #4438-HI 24'a48' 24' 48' 20' 18' 8' 4' 6' 10' 900 90000 Nassau License #HI7445OOOO