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HomeMy WebLinkAbout37551-Z `y61!l Town of Southold Annex 4/4/2014 P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 36847 Date: 4/4/2014 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 900 N Sea Dr, Orient, SCTM 473889 See/Block/Lot: 15.-3-39 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 9/20/2012 pursuant to which Building Permit No. 37551 dated 9/28/2012 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: IN-GROUND SWIMMING POOL FENCED TO CODE AS APPLIED FOR The certificate is issued to Brudie, Donald & Brodie, Barbara (OWN ER1 of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37551 03-26-2014 PLUMBERS CERTIFICATION DATED A ignat e TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE a ~n 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 37551 Date: 9/28/2012 Permission is hereby granted to: Brudie, Donald & Brudie, Barbara 5 Cathedal Ave Garden City, NY 11530 To: construct an InGround Swimming Pool fenced to code as applied for At premises located at: 900 N Sea Dr SCTM # 473889 Sec/Block/Lot # 15.-3-39 Pursuant to application dated 9/20/2012 and approved by the Building Inspector. To expire on 3/30/2014. Fees: SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector ~a4~t,c)~,yy Form No. 6 ! y TOWN OF SOUTHOLD c , BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings, property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 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 2/10 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 lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied, the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, 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 $15.00 Date. ` l 2 New Construction: Old or Pre-existing Building: (check one) Location of Property: 9(nlp Nnr±N 5 ma, "b ri %;e o r House No. n Street Hamlet Owner or Owners of Property: sr i'L Suffolk County Tax Map No 1000, Section Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. - Z $ - /Z Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ 9-0 4"L - Applicant Signature pF SO!/lyOlo Town Hall Annex y Telephone (631) 765-1802 54375 Main Road T Fax (631) 765-9502 P.O. Box 1179 rog Southold, NY 11971-0959 er.richert(a)town.southold.ny.us coum, BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Brodie Address: 900 North Sea Dr City: Orient St: NY Zip: 11957 Building Permit 37551 Section: 15 Block: 3 Lot: 39 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Bethel Electrical Cont. License No: 2880-me SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 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 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect Switches 1 Twist Lock Exit Fixtures TVSS Other Equipment: AS BUILT-in ground swimming pool to include-bonding, pool lights Notes: Inspector Signature: Date: March 26 2014 81-Cert Electrical Compliance Form.xls TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/ STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] RRE RESISTANT CONSTRI TION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (RO GH) [ ] ELE ICAL-( INAL) REMARKS: - DATE ~~l INSPECTOR 3~~( pFSOtm' TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] I LATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ j FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: S Ax~ Get,,-DATE INSPECTOR 7rr/~ 2~ ~o~y OF SOUly~6 F©f TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] RO H PLUMBING [ ] FOUNDATION 2ND [ ] 1 SUL N [ ] FRAMING/ STRAPPING [ FINA gJ [ ] FIREPLACE & CHIMNEY [ ] FIRE S INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: ca~ DATE C7ZINSPECTOR,,~ I FD&LD N REPORT DATE CO 8 7 !~a ro ` J FOUNDATION (IST) U~ FOUNDATION (2ND) 'p ~9 0 d ' d `y . ROUGH FRAMINCF & rt-k PLUMBING y d INSULATION PER N. Y. 3 STATE ENERGY CODE /Ae Ji Ile R WC G FINAL C_ W ITIONAL COMMENTS 644 m k A.-~ ~0 q fe( "10`7 C m 0 - o ~z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following, before applying? TOWN HALL Board of Health SOUTHOLD, NY41971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. 755 ( Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined, 20Storm-Water Assessment Form Contact: Approved 20 Mail to: Disapproved a/c / Phon(j L7b?-3s~ 7 Expiration 201f ,Building Inspector APPLICATION FOR BUILDING PERMIT Date 1 7 201 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations; for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on tri~i' ildin for necessary inspections. i --,IIII)I occ 2 0 2012 U { J,~ I (Signature of applicant or name, if a corporation) I SEP Est art t~1% olPi t i licant) T6 aowr: of su, Irlo~o , I State wh he is owner, lessee, agent, architect, engineer, genes? c~3 builder FEE: _BY~L44~-- r r 765-1802 8 AIv1 TO 4 PM FUR ins Name of owner of premises Qr t1k t FOLLOWING INSPECTIONS (As on the tax roll or11a€~O 11 7777-0T If ap h is a corporation, signature of duly authorized officer rvr2 1 0 n" e}Nar c)~v~~r~ p 2 STRAPPING ELL Ell + u'_!N ; (Nam and title of corporate officer Y 3 INSULATION NCI p„= P00L TO CODE UP,:Y :)IvIhLETION 4, FINAL • CJNSTRU' ' $ E E T .AL Builders License No. 0-271. 5--y BEFCr,E `VyAIER" MUST BE COM 1_c?E C r'. Plumbers License No. ALL CONSTRUCTION SH4,.L MEET THE Electricians License No. 0? 80a REQUIREMENTS OF THE NCOOES OF SIKE FOR NEW YORK STATE. NOT RESPONS181.E fOR Other Trade's License No. DESIGN OR CONSTRUCTION ERRORS. a RED 1. Location of land on which roposed work will be done: 9a~~Sea Hamlet Location House Number Street H is 39 County Tax Map No. 1000 Section 0 Block_ Lot~~00 7 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy SPAP•°.1 b. Intended use and occupancy S. i I r ©tz. Gr/i 3. Nature of work (check which applicable): New Building Addition Alter tion Repair Removal Demolition 1,7 Other Work 'K3119 Ik14 90 (Descrilion) 4. Estimated Cost ~7.7a S 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 Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 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_ NO Will excess fill be removed from premises? YES- NO_ 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO Z * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE RfQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO t/ * 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,prorperty 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 1 * IF YES, PROVIDE A COPY: STATE OF NEW YORK) SS: COUNTY OF- being duly sworn, deposes and says that (s)he is the applicant (Name of in ividual signing contract) above nam"df .3C~ . (S)He is the _ _~wcc-~° P Contractor, A orporate Officer, etc.) of said owner 9f,gxy5ers, and.? {11i~ Yto perform or have performed the said work and to make and file this application; that all stateme~d> ;re true to the best of his knowledge and belief, and that the work will be performed in the manner set ort m the app ica ion filed therewith. Sworn to before me this 1 44otary of tGrNnCI' 20J 9- VA.4 JENNIFER GUASTELLO blic LIC-STATE OF NEW YORK Signature of Applicant No. O1 GU6185268 Qualified In Suffolk County MY Commission Expires April 14,ap-do ~o~aaF s Town Hall Annex 4 4 Telephone (631) 765-1802 54375 Main Road 66~~..yy55pp~~ P.O. Box 1179 G Q rocler.richertCouvn.105616.ny.us Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: Date:-3131,q Company Name: Name: UWA If.V PALY) License No.: 09-11 WE Address: X331- g I-AreoO hi-c IIMDX- KH O'll Phone No.: ~p -31 - -ID- cJr~ JOBSITE INFORMATION: (*Indicates required information) *Name: -bona1d. -&Ud~e, *Address: 9(70 N. Se0.'p(Z- l~Y\~ 1~0\nt 11Q51 *Cross Street: HWY. *Phone No.: Silo' 3W-0301q Permit No.: Tax Map District: 1000 Section: 15 Block: Lot: 3q *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ~wlmmino) fool r~oyc~-t-\~ Gtx~. w~hn~ (Please Circle All That Apply) *is job ready for inspection: C~ NO Rough in Final *Do you need a Temp Certificate: YES NO Temp Information (If needed) *Service Size: 1 Phase 3Phase 1.00 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of cqr Overhead ( 1 Additional Information: PAYMENT DUE WITH APPLIOA' I ~I \S V.,dS Wj"j in JvLl b13 ~ ~ ~ ,i MAR 16 2014 Lt m I r 82=Request for Inspection Form 31 10 I I, r O `Q a Town of Southold - Chapter 236 - Stormwater Management SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION: (AH Requested Information is Required for a Complete Application) APPLICANT NAYS: On -ASwt-Conershnr Orraeaar other (prel.or.I Pm~ oMx+Ma«Apyawq /1~ Tv Addmc Of e T roil 6 ° 6 -.I to 3/ F e631 6 -31 1 Goy i wev~ E BnefDeseeiprioaofCao,ancdonnctnq.noposedliencaalBAftSod S.C.TAI.k ~,o O~O° . asmpe sod/or segamce ofcmumnrfim Acfivay 'ia M"la~ Aw.Nwdq aa i NnnoarCQWMdw miler Carded Pereeelhepr-4re/orYplesenYa erswpm. is? ~_-(1 _ ~t)Q.Sd1__Akv~fOl7tal_AtI.¢ _ _ 3 XT IM OIV n-31 b - Mrne arPerean anya°0le for attetterwwafa°e6nC°Yd prrJleK r 6 3 oa ° s E 30~® sCo~ L: - TOMAMOFM AM LWW on" PPMoal Paces: arderf/oud DlMUEra+z pr.rAUa PAIA.4 Protest owes= Eat ~ (AMCbabtl) Dale: i - pe-eraaraYVO~p _ _ VM this Project DYhab N« (S) or More Acres it Any OMThree During theProposed Dewbpnent? « I VVEk Pbr As WAFOSOeded a. Does Vie Appllcard hwe a aYnied YuparJOr On C J Sb>fToColydadtileRequired anpedbns7 e No wrap7- b. Dow Me SWPPP indicate How Frequently ttb Sib I rowdy hr4moYdwaYrandmam§wwoa°def andfor w area Inspections will Occur and for VWW Period otTtos? Y« Ic. Does do SWPPP Adequately lda-ft AN Tooporary ~ Q Parma salt Sri Slabalhebn M«Yses? « No d. oesthe eSWWPgPPPAAdequately ldsdNy a Compleb aeelusorenP.a.d .owTOM, m(n sWiffida e. Does tie sWPPP bdbale Adatiael Site sped6c O O PracOcn tlbt 1M1 be tAYaed b Prober Wader Oua*y? Yes No f. Has the Appkant Submitted a Comrgatad DEC Notice Of InW and SVVPPP Aaeplarce Form for Review O Type ar enaeelea WAftW reek e.y, Pond. SowA Poeeeee Vftd-w-) by the Town of Sadtrold? Yes No ST AIM OF NF YOK COlMIOF SS That I, being duly sworn, deposes and says "~'8 a for Permit, qqL (Naaeor ~D1oaromd) And dig he/she is the ......tld ! CaSG _ Notary Public, State of New York _ _Ni3"l7IEt7tST88090_.. i. ( - M. Agmt.C.pWaMOMw.wc) Owner and/or represeatative of the Owner or Owners, Y authorized to D 4~! and to make and file this application; that all statements contained in this application are hv~ bd Me ef; and that the work will be performed in the manner set forth in the application filed herewith. Sworn to before me this, Notary Public: da__ (slrwreeaAppf~q SYrPPP Assessment FORM: 0342 9/11/2012 14:42 5165046400 5165046400 0 2/3 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la. Legal Name and Address of Insured (Use street address only) tb. Business Telephone Number of Insured SPECHT-TACULAR POOLS INC. 631-696-3900 3661 HORSEBLOCK ROAD BUILDING R Number ofInsured MlnsumneeEmployerRegistratidn MEDFORD, NY 11763 1d. Federal Employer Identification Number of Insured or Social Security Number 010648957 2. Name and Address of the Entity requesting Proof of Coverage 3a. Name of Insurance Carrier (Entity being listed as the Certificate Holder) The First Rehabilitation Life Insurance TOWN OF SOUTHOLD Company of America 3b. Policy Number of Entity listed in box "la": 54375 MAIN ROAD DBL152822 SOUTHOLD, NY 11971 3c. Policy effective period: 09/26/2011 to 09/25/2013 4. Policy covers: a. All of the employer's employees eligible under the New York Disability Benefits Law b. ] Only the following class or classes of the employer's employees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 9/11/2012 BY i - (Slgnawm of Inwranca amiw's mAhorind mpmsentative m NYS Licensed Insmanca Ag@M of that inwmnea nrrier) Telephone Number 516-829-8100 Title Chief Executive Officer IMPORTANT: If box "W" is checked, and this form is signed by the inwrarce carrier's authorized representative or NYS Licensed Insurance Agent of thatwrier, this artifiram is COMPLETE. Mail it directlyto the certificate holder. If box "b" is chwksd, this certificate is NOT COMPLETE for the purposes of Section 22% Subd.0 of the Disability Benefits Law. It must be mailed for completion to the Worker's Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, NY 12207. PART 2. To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Componsstion Board, the above-nomad employer has compiled with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Worker's Compensation Bard Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS Disabi I ily Benefits insurance pol icies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form 138-120.1. Insurance brokers are NOT authorized to issue this form 9/11/2012 14:42 5165046400 5165046400 ? 3/3 Additional Instructions for Form DB-120.1 By signing this form, the insurance carrier identified in Box 1" on this form Is certifying that it is insuring the business referenced in Box "1a" for disability benefits under the New York State Disability Benefits Law. The insurance carrier or its licensed agent will send this Certificate of Insurance to the entity listed as the certificate holder in Box "2". This certificate is valid for the earlier of one year after this form Is approved by the insurance carrier or its licensed agent, or the policy expiration date listed in Box "3c". Please Note. Upon the cancellation of the disability benefits policy indicated on this form, if the business continues to be named on a permit, license or contract issued by a certificate holder, the business must provide that certificate holder with a new Certificate of NYS Disability Benefits Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Disability Benefits Law. DISABILITY BENEFITS LAW Section 220. Subd. 8 (a) The head of 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 chair, 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. (b) The head of 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 carrier is produced in a form satisfactory to the chair, that the payment of disability benefits for all employees has been secured as provided by this article. New York State Insurance Fund Workers' Compensation A Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR. 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phwe: (631) 7564300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 10648957 SPECHT-TACULAR POOLS INC 3661 HORSEBLOCK RD UNIT R MEDFORD NY 11763 POLICYHOLDER CERTIFICATE HOLDER SPECHT-TACULAR POOLS INC TOWN OF SOUTHOLD 3661 HORSEBLOCK RD UNIT R 54375 MAIN ROAD MEDFORD NY 11763 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 1 2163 665-9 202628 09/26/2012 TO 09/26/2013 9/11/2012 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2163665-9 UNTIL 091262013, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 0926/2013 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. DIETER SPECHT, FIRES OF SPECHT-TACULAR POOLS INC (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND ~Jz,,e DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.comtcerUcertval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 68332291 U-26.3 !'1 AC4~R0" OP lo: vM CERTIFICATE OF LIABILITY INSURANCE D"'E"41112"" 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 CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is III ADDITIONAL INSURED, the polley(les) must be endorsed. N SUBROGATION IS WANED, subJect to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certltkate does not confer rights to the cardlicate holder In lieu of such endorsement s PRODUCER 831-064_1111 NAME: 92 JericchhomTa~rnWluStelA 6314164-8274 Smithtown, NY 11787 NO) Bagatfa Associates, Inc. ADDRESS: CU11TO RlocSPECC 1 NSLRED Specht Tacular Pools NSV AFFORDINGCOVERAGE MAICr , Inc. INSURER A; Worcester Insurance Company 26182 3661 Horseblock Road, Unit R Medford, NY 11763 INaReRe:Tower Group Companies 300 tt$UgDT c: INSURER D: INSURER E INNAiHt F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE 111 11 11:11 S OF INSURANCE LISPED BELOW HAVE BEE Y CONT N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN G ANY REQUIREMENT, TERM OR CONDITION OF ANRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. GENERAL LNall7Y M LMR8 FAUTO YPE OF 14SUtANCE POLICY RI MINI EACH OCCURRENCE $ 1,000, ERCIAL GENERAL LIABILITY MPAOOODD024836J 0327/12 0327H3 PREMISES Eaaawwo 5 100,00 LAIMS-MADE ~ OCCUR NED EIF we person) f 5,00 tractuel ket Addti lrre PERSawAL a ADV IN uRr t 1,000,00 GENERAL AGGREGATE S 2,000,0 REGATE LIMIT APPLIES PH7: Y PRO- LOC PRODUCTS-COMP/OP AGG f 1,000,0 aE LMHLRY f COMBIN®SINGIE LIMIT $ 5~, Y UTO 0000573200 03/27%2 0327/13 IEasadmq WNEDAUTOf BODILr N.A1RY (Parparson) S UIID AUTOS BODILY INURY (Par wa dwo S AUTOS PROPERTYDAMAGE (Par eaMwd) S WNEDA/TOS t t WBRB1A LMe OCCUR E%CESS EACH OCCURRENCE t LNB CLAMSATAOE AGGREGATE S DEDUCTIBLE f RETENTION f WORom LbHPB/ I= f AND IMPLOYERS' LAOLrFY WC ATLL OTH- ANYN70PRIETORIPARTNErLE7ECUTIVE YIN TQU UNITS ER OFRICERAEMBER AFRr DICLUDED? NIA E.L. EACH ACCIDENT S dwy In III rAmPeny be uRd E.L. CISFABE-EA EMPLOYEE $ 5DC N OF OPERATIONS bebw PAOOODOe21816J E.L. pSEASE-POLICY O MIT t BPP 17,5 Ded L9RA710JB/LOCATIONS/VBOCUMIAaaeh ACORDNH,A*M9 Rmmks to Insured's operations. CERTIFICATE HOLDER CANCELLATION SOUTH03 SHOULD ANY OF THE ABOVE DESCRIBED POUC1E8 BE CANCELLED BEFORE THE EVRATION DATE THEREOF. NOTICE WILL BE DELR/ERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 54375 Main Rd. Southold, NY 11971 AUrH0R1=KEI'RESBITA7NE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD - - 'z- <<~, T•-_ COT 25 Y ~ ORIENT-BY-Ti-IE-SEA SECT. 1 rY N . •~A L0 ` 10 , SUFF. CO. FILE Ne 2fTr J~ : 0 0` S9• O' E. ma it15.. y' N h~ I a~ 9£ 1` II? J e 40 4.. ~ S•Ln ' w I . ~'s+, a MAP OF. LOT 76. C I ~vaw•e lwusetq '`V O u -j ORIENT-BY=TuE-SEA" kt O = O ao SECTI.O'N' TWO O o SUFFOLK Cd. FI.Lr= MAP N_ 344.4 SURVEYED P09 GOB LP- A4P DUE WEST .150.0 I _ BLS . . L. AA QGUEQ~tT!'-' 0 t4ORTH SEA DRIVE ORIENT,N.Y a, tOeIW~VUweR®-T &AU Or Aso" " GUARANTEED TO THE : ' SKMH Sas OF Alf mw im RAW CHICAGO TITLE INSURANCE CoMpAala('AI~Lp"_;% ' A70NUW• THE SOUT14OLD SAVIN'Gs,I3&KK.`rp-'-%= woes OF sNti URM sw AT sureo SURVEYED, :JUi* L °~r:. TO N A VMS "M CM. TI I scaLE 40'=I"' MSSmamvRw . RUM16K 'VAN*.- TOY[' kT MONUMENT OWAIU~ •.euau MUSae aun 00 ~c• 011f IO,rE MUCH eae WIYM1 111 WOW O =IRON PIPE sweurewrmersnnwlonK mes eeet ris : ' ...r : ' . ` WU CC we?ewewWnr. ao.GWV WMwrmis AWN" _'::,y:`..".~. ENSEDLAN Shc -•N v z CHECK VALVE NOTES NOTES FROM SKIMMER PUMP 1, NO SPOIL SUA 1, NO SPOIL SURCHARGE PERMITTED WITHIN 4 FEETOF EKCAVATION ATTHE SHALLOW END, OR6 FEETOF PACAVAEON ATTHE DEEPEND O 2. THIS POOL MI POOLS"AND' 2. THIS POOL MEETS THE REQUIREMENTS OFAN51/NSPI-5"AMERICAN NATIONAL STANDARD FOR RESIDENTIAL INGROUNDSWIMMING O POOL5"AND 1996 BOCA CODE-5ECTION 421, DIVING EQUIPMENTS NOTALLOWED N1 3. SWIMMING P( E 3. SWIMMING POOL SHALL BE YAND CO R OED WITH KEQUIREMENTSOF RESI LCODE F NYS 2 AND IN CONFORMITY AND IN CONFORMMITY ITY WITH ALL SECTION OFTH0US TOWN CODE ACCESS CATER S r TO DISPOSAV SKAG105 OF TI FWMHALL ALL COMPLY WITH SECTION SECTION N A005 AG1O52 OF OF THE NYS RESIDENTIAL CODE AND BE5ELFSELFC W5I SINGE NGANDSELFELF L -ATCHINGAND OPEN AWAY Q J VRVWELL GATES SHALL( FARM THE PO, FRDMT THE POOLAREA r\' O C) 4 DURINCGON 4 DURING CONSTRUCTION THE CONTRACTOR SHALL ERECTA TEMPORARY BARRIERAROUND THE EXCAVATIONIAW THE CODE OFTHE V y O TOWN OF 501. DIVERTER C] VALVE 5. POOL MUST BI TOWN OF 501,7T0LD, 1~1 'i Q H2O O H30 S. POOL M UST BE EQUI P P ED WITH AN APPROVED POO L A LARM CAPA BLE OF DETECT NO ACH I LE ENTERI NO TH E WATERAN D SCUM DI NG AN I~ O W -LI AUDIBLE ALARM W HEN 0ELECTED THAT 15 AUDI BEE AT POO LSI PE AND ATANOTH ER LOCATION ON THE PREMISES W HERE THE POOL IS ERB LOCATED, TH E ALARM MUST BE I PETALLED, MAI NTAI N ED AN D USED I N ACCORDANCE WITH TH E MANUFACTURERS I FRTRUCTIONS TH E W Z O 3=4" 11-0" AVDIBLEALA LOCATED, TH FILTER ALARM MUST ATTACHED TC A LARM MUST M EET A57M F2209 5TA N DARE SPEC I FICATIO N FO P. POOL ALARM5 TH E DEVICE MUSTOPERATE I N DEPEN DENT (NOT T LY V ~ ATTAC H ED TO O R D EPEN D ENTOW OF PERSONS •..L Qz U Sp0 6, P00L5VCPO ;d. OR A MIPIIML b, POOL IMU FITTI TUGS TRHPCEPT HO R. AIN GRATE SURFACE SKI MM EAS) MUST BE PROWITH COVER PLATOON FORMS TOASME/ANSI A11219 8M p W r J ORA MIx0.ACHANHANNE L TRAIN SYSTEM PWOOLCWII RULAnO OLBEMMVSFBE SSINCOPED VITN Q. 'DE CW ATMOSPHERIC RELIEF IN ENTH COVERS LOCATEDWITHINTHEPOOLBYTHRBPOICEN SUCH Ln M/b A VACUUM REL POOL SHALLI LL BE MTRAIN GRATE POOL TMOSPHERIC VACUUM G VACUVM BELI EF SYSTEMS SHALL CONFORM WITH SUCTION FITTINGS OR BOA H A EM IO ABOVE MNROVEDVEE BYTHETOWNOF SON S55HA SEPARA PROVIDED OF AS ASM2 C TTINGS 15 E DRAWN NEDTYPE THESUCTION BE SEPARATED B' SEPARATED ED BY A MINIMUM CF OF3 D M MUSTOFUST PIPED SUCH FIED SUCH THAT WATER IS DRAWN THROUGH ITEM TAIREC EOVSLY ACCOVGH A VACUUM R F6EDLINE TO RPUMPS) VACUUM/ PRESSURE CLEAN ING FITT MOB SHALL BE AN N ACCESSIBLE CONIC WALLS VACUUM REL POSITION, MI POSITION, INIMUM O 'APIA NO NO CREATERM GREATERTHA THAN 2' BELOW THE MINIMUM OPERATIONAL WATER ER LEVE LEVELOR ORBBAN ATTACHMENTTO B THESICIMMER THE SICIMMMMERIMVM OF 6E0./SICIMMERS 7. ALL ELECTRIC 7. ALL ELECTRICAL WORK 5HALL COMPLY WITH THE REQUIREMENTS OF NFPA 70 (NEC) PRINCIPALLYARTICLE690AND THE NYS RESIDENTIAL TO RETURNS CODE SECTI0f BYAGROVND CODE SECTION 4102 THROUGH 41O6. ALL ELECTRICAL DEVICES MUST REAPPROVED BV UNDERW BITERS LABORATOKIESAND BE PROTECTED BYAOROUNDFAULTCVRRENTINTERRUPTER(CFCN CURRENTCARRYINGELECTRICALCONDUCMMR CEPTFORTH05EPROVIDING CFIECK VALVE POWER TO PO POWER TO POOL LI SHTI NO AND POOL EQUIPMENTSHALL MEETTHE SEPARATION REQUIREMENTS OF TABLE EVO35 ALL METAL ENCLOSURES, CONTACT W Il ENCLOSURES, FENCES OR RAILINGS N EAR OR AP)ACENTTO THE SW IMMI NG POOLTHATMAY BECOME ELECTRICALLYCHARGED DUETO CO NTACT WITH AN ELECTRICAL Cl RCUIT SHALL BE EFFECTIVELY GROUP! FEE 0 PLAN e wATEasopR 9 WATER SOURCE FI LLI NO THE POOL SHALL BE EQUIPPED WITH A BACKFLOW PROTECTION DEVICEIAW NYS PLVMBINGCGDE 601 9. ALL PIPING 15 DIAGRAMMATIC UNLESSOTHERWISE51]ATED U 9. ALL PIPING 15 Q PLUMBING SCHEMATIC 10. WALKS IF Pk( 10. WALES IF PROVIDED SHALL BE NON5LIPAND SLOPEAWAY FROM POOL EDGE En V It A MEANS0F QJ m 11.A MEANS OF EGRESS FOR DEEP AND SHALLOW ENDS MUST BE PROVIDED LAW AN51/NSPI-S SECPONb 40 LJ Of N T.S. 12. CONTRACTO NATHCONCRETE 12. CONTRACTOR TO PLACE THE POOL IAWTOWN OF SOUTHOLD CODE SETBACKS N WALISAMNC 19 ALL DW I 19 ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE 51JBIECTPROPERTY - 0S 15. THE DESIGN I EXI 15 BASED ONA DRWINAGE5 PEWATiIT GROUND WATER SHALL NOT E%ISTWITHIN THE IXCAVATION IFGRDUND 15. THE EDESIGN WATER EXIST WATER EXISTS WITHIN 6'-0'FRDM GRADE, E, DEWATERINCNGF FACILITIES WILL BE REQUIRED. z V 16. ALL GAS AN[ N 0 M UFACTO 16. ALL CAR A OIL HEATERS (IF I INSTALFOR THE INCROUND SWIMMING POOL BE NATIONI CONSERVATION AW M AC ECA) COMPLIANT POOLHEATEKS SHALL LL BE TESTED M.56 AND SHALL B IAW UFACPECAFGA) GUARDS ECTAIC OIL FIRED POOL HEATLLRETESTED PO OLHEATER55 TERSSHALINSTALLED ALLBELO d 0- Cn z• to a• SANG B7ilom GUARDED TO GUARDED T NR TEMPERD DFTO TO PRO PROTECTAGAINSTA DENTAL OT F PROVIDED ES RYWITHPERSIAWWANSIV926 UV36 NS POOL HPATERSSHALL BE PROWPEDSS WIT ITH VALVE. FOR HEATERS HOT SURFACES PROVIN INTEGRAL EU Y4 PASS LINE SHALL BE T INSTALLED RELIEF FA INSTALLED INSTALLEDFROM FROM MLETT LETTOOUTLETTOADIVST WATER FLOW THROUGH THE WITH AN HEATER POOL OL HEATERS SHALL BE PROV PPQVIDED WITH THE FOOLLO LLOWINNG FOLLOW I NC ENEROYCONSERVATONVATON MEASURES 161 ALL POOL4 y_2 OPERATION 161 ALL POOL HEATER55HALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOKEA5YACCL55TOALLOWSHUTINGOFFTHE N OPERATION OF THE HEATER WITHOUFADI USTING THE THERM05TATSETTING AND MALLOW RESTARTING WITHOUT RELIGHTINGTHE I PI LOT LIGHT PI LOT LIGHT 162 HEATED SWIMMI NO POOLS SHALL BE EQUIPPED WITH A POOL COVER (EXEMPTED FROM THIS RWUIREMENTARE OUTDOOR FOGIES t DERIVING 20, OF THE ENERGY FOR HEATI NO FROM RENEWABLE 5CU0.CESA5 COMPUTED OVERAN OPERATINGSEASON) SECTION A GPINGANpWALICWAY p 62 HEATEDSV (BY DERIVING: THERS) GRADE 163 TIMECLCLOCI 163 TIME CLOCKS SHALL BE I NSTALLED 5Q THE PUMP CAN BE 5ETTO RUN PURI NO OFF-PEAK ELECTRICAL DEMAND PERIODS AND CAN BE SET WATER LINE TO RUN 1111 ~t y SANITARYC TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN TH E POOL WATER IN A CLEAN AND SANITARYCONDFLON IAW APPLICABLE SANITARY CODE OF NEW YORK5TATE IT THIS )RAWIP UNDISTURBED EARTH - / IT TH15 DRAWING 15 FORSTRUCTURALSHELL ONLY ALLACCE55ORI BAND APPURTENANCESARE DEFINED BYOTHER5 r 1 iB. BACI(FILL WI 19, BACKFILL WITH CLEAN EARTH, FREE OF ROOTS AND DEBRIS DONOTALLOWTHEHEIOHTOFBACICFILLMaCEEDTHEHEIGHTOFTHE V 3500 P51 POURED CONC .e! WATER IN T4 WATER IN TH E POOL BY MORE THAN B', OR TH E WATER TO ERCEED BACICFILL BY MORETHAPI B" Y -pp \ 19. PLACE CONIC TOP OF WALL WATERLINE 3/0"REBAR 3)TP 19. PLACECONCRETE ON 5ANDYTO LOAM SOIL REMOVEANYCLAVDEPOSITANDCOMPACTCLFANBACKFILL w g V VINYL LINER 21 THERE ISN0 21 THEREISMENA DRAININ THISPOOL SUCTION POPWL WATER CIRCULATION 15 PROVIDED BYTHE514MMEP50NLV THISMEETS i REO/REMEf 2'-0" 4 2'TO4"5AN • REQUIREMENTSO OF RC- SECTON AG106F0K0. ENTRAPMENTNTNROTECPON '-y 22 THE POOL WAS DESIGNED IAWTHE FOLLOWING jj F 1A 22, THE P00LW n 1. THE BUILD 221. THE BUILDINGCODEOF NEW YORKSTATE(2MO) J12. THE ENER( 223 THE FUEL 222 THE ENERCYCONSERVATION CONSTRUCTIONCODEOFNEWYORK5TATE(2010) g 223 THE FUEL GAS CODE OF NEW YORK 5TATE(20TO) 3O 22A. THE RESI DI 22A. THE RE51 DENTIAL CODE OF NEW YORKSTATE (2010) W 22.5. THENEW' 226. ANSI/NSP 22.5. THE NEW YORK STATE SANITARYCODE O 226. ANSI/NSPI-5 STANDARD FOR RESIDENTIATN-OROUNDSWIMMINGPOOL5 o VERTICAL3/0"REBARPTO.C 227 BOCACOC 227 BOCACODE-5ECTION421. SECTION B (NOTSHOWN) 228 CODEOFI 229, CODE OF THE TOWN OF SOUTHOLD. Q) 0 U P Oo m f0' m m WALL SECTION J . NT5 sate 4 w N 2 LL ¢ ~ Q _ o ~bfsiy ae ~S+ll N5