Loading...
HomeMy WebLinkAbout37536-ZNo: 37121 Town of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 631-765-1981 CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building IN GROUND POOL Location of Property: 8310 SOUNDVIEW AVENUE SOUTHOLD, Date: 2/5/2015 2/5/2015 SCTM #: 473889 See/Block/Lot: 59.-7-29.6 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/1/2010 pursuant to which Building Permit No. 37536 dated 9/21/2012 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: accessory in ground swimming pool with fence to code as applied for. The certificate is issued to ROBERT & ROSEMARIE WAGNER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37536 11/19/2013 Au e igna re TOWN OF SOUTHOLD F ". BUILDING DEPARTMENT TOWN CLERK'S OFFICE '� . SOUTHOLD, NY =�,' , ,�ao'''' 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 #: 37536 Date: 9/21/2012 Permission is hereby granted to: ROBERT & ROSEMARIE WAGNER P.O. BOX 20541 FLORAL PARK, NY 11002 To: CONSTRUCTION OF AN INGROUND SWIMMING POOL FENCED TO CODE AS APPLIED FOR. REPLACES EXPIRED B.P. # 35468 At premises located at: 8310 SOUNDVIEW AVENUE SOUTHOLD SCTM # 473889 Sec/Block/Lot # 59.-7-29.6 Pursuant to application dated To expire on 3/21/2014. Fees: 4/1/2010 and approved by the Building Inspector. PERMIT RENEWAL $125.00 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. 35468 Z Date APRIL 13, 2010 Permission is hereby granted to: R WAGNER 8310 SOUNDVIEW AVE SOUTHOLD,NY 11971 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL FENCED TO CODE AS APPLIED FOR at premises located at 8310 SOUNDVIEW AVE SOUTHOLD County Tax Map No. 473889 Section 059 Block 0007 Lot No. 029.006 pursuant to application dated APRIL 1, 2010 and approved by the Building Inspector to expire on OCTOBER 13, 2011. Fee $ 250.00 ORIGINAL Rev. 5/8/02 Authoifized Signature Form No. 6 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 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 $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00, Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. Z New Construction: Old or Pre-existing Building: (check one) Location of Property: Q _1z ova �r � u L_1 > House No. ,,�Street ` Hamlet Owner or Owners of Property: �iSd-W'i /T K./�jC� l / gL J' ! gYL— Suffolk County Tax Map No 1000, Section _S9 Block -7 Lot -2- Subdivision Subdivision Filed Map. Lot: Permit No. 3 1 `���o Date of Permit. Applicant: Robec—, � PrG d'J&42_ Health Dept. Approval: Underwriters Approval: Plannin&Board Approval: Request for: Temporary Certificate cr0 Fee Submitted: $ Final Certificate: � (check one) Applicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD Telephone (631) 765-1802 Fax (631) 765-9502 roger.richert(aD_town.southold.ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Wagner Address: 8310 Soundview Ave City: Southold St: NY Zip: 11971 Building Permit #: '?)-7 5alp X4468 Secti rj9 Block: 7 Lot: 29.6 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: as built DBA: License No: 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 Attic Garage IIJU/y"Ihrilrl1A Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 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 3 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 2 Disconnect Switches 1 Twist Lock Exit Fixtures [I TVSS Other Equipment: in ground swimming pool to include, bonding, 1 -heat pump, 4 -pool lights, 1 -cover motor, 1 -control panel Notes: Inspector Signature: Date: Nov 19 2013 81 -Cert Electrical Compliance Form.xls OF SOUIyo� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION FRAMING/ STRAPPING [ FINAL /�KLl� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: DATE INSPECTOR '��OUNiV, TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTIONG FOUN ]FOUNDATION 2ND [ ]INSULATION [ ] FRAMING / STRAPPING [ ] FIREPLACE A CHIMNEY [ ] FINAL [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: t - DATE -INSPECTOR ,��►OF SOUI,�,O� � TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING/ STRAPPING [ ] FIREPLACE A CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION FIRE RE8ISTAlR CONSTRUCTION [ ] FIRE RESISTANT PENETRATION `N ELECTRICAL (ROUGH) I l ELECTRICAL (FINAL) DATE � � � INSPECTOR Y" � ] TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTI [ ] FOUNDATION IST [ [ ] FOUNDATION 2ND [ [ ] FRAMING/ STRAPPING [ [ ] FIREPLACE A CHIMNEY [ [ ] FIRE RESISTANT CONSTRUCTION [ [ ] ELECTRICAL (ROUGH) [ [ ] CODE VIOLATION [ REMARKS: ] RN PLUMBING ] SOLATION FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION ] ELECTRICAL (FINAL) ] CAULKING DATEINSPECTOR pF SO31 Ury� 3 G Q TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION IST ] FOUNDATION 2ND ] FRAMING/ STRAPPING ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION ] ELECTRICAL (ROUGH) ] CODE VIOLATION REMARKS: [ ]ROU PLUMBING t ]� IN &Q/ i / ) [ F [ ] FlRE [ ] FIRE RESISTANT PENETRATION I ] ELECTRICAL (FINAL) [ ]CAULKING DATE / j INSPECTOR L ✓� TOWN OF SOUTHOLD BUILDING DEPARTMENT TO )VN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.North Fork.n et Examined 20 Approved 120 Disapproved a/c Expiration , 20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 4 sets of Building Plans Planning Board approval PERMIT NO. �, X Survey Check Septic Form N.Y.S.D.E.C. Flood Permit Storm -Water Assessment Form Contact: Mail to: Phone: (� E � n n E Building Inspector DLC U ICATION FOR BUILDING PERMIT APP 1 2n� DateVd 20 /O INSTRUCTIONS a'TlitS^ JeF, tely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plan �t,,according to schedule. nd 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) 24yy x6L A" � ;q-1em scl (ter (Mailing address of applic State whether applicant is owner, lessee, agent, architect, engin 1general contrac r, electrician, plumber or builder Name of owner of premises (As on the tax roll or latest deed) If appli t is a corporation, signature of duly authorized officer —� (Name and title of corporate officer)) Builders License No. 31g' T7 Plumbers License No. Electricians License No. Other Trade's License 1. Location of land on which proposed work will �e done: House Number Street County Tax Map No. 1000 Section_ Block -7- Lot oc t Subdivision Filed Map No. Lot 2. State existing use and occupancy of premijes and i�ntenped use and occupancy of proposed construction: a. Existing use and occupancy�- b. Intended use and occupancy 3. Nature of work (check which applicable): New BuildingAddition Alteration Repair Removal Demolition Other Work ^':M&,4,rL su rri (Description) 4. Estimated Cost 410. vats Fee 2 S`a & C� (To be paid on filing this appli anon) 5. If dwelling, number of dwelling units/Number of dwelling units on each floor If garage, number of cars 4444 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 /v Rear Depth Height Number of Stories 9. Size of lot: Front ( A Rear /l b 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� remises A/ VA- Address n10 Siiur►clyie.J Phone No. Name of Architect //en� AWE Address 7«CewJS hy*4- Phone No 613! Z jr- Name of Contractor _ 11z Address gm j2*,,hL(- Aw2 Phone No. d3 1 'R:� Qr,rSL 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NOk_ * 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. STATE OF NEW YORK) c SS: COUNTY OFSY ik -) AW -A L,0 &OAMAg— being duly swom, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the .4 --Z:i(4611> (Contra(5tor, Agent, Corporate Officer, etc.) 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 true 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. Sworn to before me this j 5T day of /L! L 201_Q__ r. G !bl AN NOT rU C. ST TE OF NEW RK NO.rOIMC4981492 - NASSAU COUNTY MY COMMISSION EXPIRES June 9. 201,Q_ ignature of Applicant 0-o UGI-� t-11S- 19 Tetepl* t (631) 7654802 M$er. che.___S�rt�r is'%U '%.nym ....'�._ BLUING DEPAR'T'MENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION lREQUESTED Sr. Date: _ Company Name: Ace- C ec�-y, e Name: License No.: Address: Phone No.: 6 'S 2-:1 JOBSITE INFORMATION: (*Indicates required information) Name:" *A dress: *Cross Street: "phone No.: Permit No.: " Tax Map District: 1000 Section: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ....._ Lot:2cr. c (Please Circle All That Apply) *Is. job ready for inspection: YES / Rough in Final *Do you need a Tamp Certificate: YES /CO Temp -Information 79-ded) *Service Size: 1 Phase) 313hase 100 150 200 300 350 400 Other *New Service: Re -connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION 82 -Request for Inspection Fort Z /Z # I 6LZ6£5L ! H: W Ol-LZ-50 -:•_�> _ Southold Town Building Department tFBt'�cp P.O. Box 1179 54375 Main Road • { * Southold, New York 11971 (631) 765-1802 -'' Parcel ID: 59.-7-29.6 Permit #: 35468 Permit Date: 4/13/2010 Expiration Date: 10/13/2011 BUILDING PERMIT RENEWAL LETTER Dated: 5/30/2012 Applicant: ROBERT & ROSEMARIE WAGNER Location: 8310 SOUNDVIEW AVENUE SOUTHOLD Work Description: HISTORICAL CONSTRUCTION OF AN INGROUND SWIMMING POOL FENCED TO CODE AS APPLIED FOR A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: ROBERT & ROSEMARIE WAGNER Address: 72 CYPRESS STREET FLORAL PARK, NY 11001 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. : r ; Southold Town Building Department �,gufFOl,�C© P.O. Box 1179 54375 Main Road Permit #: 35468 W Southold, New York 11971 Permit Date: 4/13/2010 y� 4 `' (631) 765-1802 al Expiration Date: 10/13/2011 Parcel ID: 59.-7-29.6 BUILDING PERMIT RENEWAL LETTER FINAL NOTICE Dated: 8/27/2012 Applicant: ROBERT & ROSEMARIE WAGNER Location: 8310 5OUNDVIEW AVENUE SOUTHOLD Work Description: IN GROUND POOL CONSTRUCTION OF AN INGROUND SWIMMING POOL FENCED TO CODE AS APPLIED FOR. A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: ROBERT & ROSEMARIE WAGNER Address: 72 CYPRESS STREET FLORAL PARK, NY 11001 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. THANK YOU, SOUTHOLD TOWN BUILDING DEPT. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 January 20, 2015 kpF SOUr�o� N% BUILDING DEPARTMENT TOWN OF SOUTHOLD Robert & Rosemarie Wagner 72 Cypress St Floral Park NY 11001 Re: 8310 Soundview Ave, Southold TO WHOM IT MAY CONCERN: FFollng Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: pplication for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $50.00. Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 411184) Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Punning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by Building Dept. Final Storm Water Runoff Approval from Town Engineer BUILDING PERMIT — 37536 — Swimming Pool Telephone (631) 765-1802 Fax(631)765-9502 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE KEEVILY,SPERO-WHITELAW INC. 500 MAMARONECK AVENUE HARRISON NY 10528 POLICYHOLDER ALL -ISLAND IRRIGATION INC T/A ALL ISLAND GUNITE POOLS 200 CENTRAL AVENUE FARMINGDALE NY 11735 CERTIFICATE HOLDER TOWN OF SOUTHHOLD BUILDING DEPARTMENT 53095 ROUTE 25 SOUTHHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 634 961-7 24766 05/01/2009 TO 05/01/2011 3/29/2010 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 634 961-7 UNTIL 05/01/2011, 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. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 05/01/2011 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 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 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 DIRECTOR, INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 865955717 U-26.3 . CCWT616 CERTIFICATE OF LIABILITY INSURANCE DATE o ' 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 an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER FARM FAMILY CASUALTY 859 CONNETQUOT AVENUE ISLIP TERRACE, NY 11752 631-277-7770 CCAONNTACT A/CC. No Ext), FVC No): ADDRESS: PR U ER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED ALL ISLAND IRRIGATION INC. T/A ALL ISLAND GUNITE POOLS 200 CENTRAL AVENUE FARMINGDALE, NY 11735 INSURERA: FARM FAMILY CASUALTY 13803 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 100666 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IANSR WVD POLICY NUMBER MMYDD EFF MMIUDO LIMBS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR 3152X1234 09-07-09 09-07-10 EACH OCCURRENCE $ 1,000,000 NTED DAMA E REPREMISE Ea occurrence 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: X POLICY JE T LOC PRODUCTS -COMP/OPAGG $ 1,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS X SCHEDULED AUTOS X HIRED AUTOS X NON-OWNEDAUTOS 315204198 09-07-09 09-07-10 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) X $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 3152E2303 09-07-09 09-07-10 EACH OCCURRENCE S 5,000,000 AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SOUTHOLD BUILDING DEPARTMENT 53095 ROUTE 25 SOUTHHOLD NY 11971 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE RVA--� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo arereistered marks of ACORD PDF created with FinePrint pdfFactory trial version http:/rwww.fineDrint.com STATE OF NEW YORK WORKERS' 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 Ia. Legal Name and Address of Insured (Use street address only) lb. Business Telephone Number of Insured All -Island Irrigation Inc (631) 753-0003 x 200 Central Avenue l c. NYS Unemployment Insurance Employer Registration Farmingdale, NY 11735 Number of Insured 78-10789-4 1 d. Federal Employer Identification Number of Insured or Social Security Number 11-2499557 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage (Entity Being Listed as the Certificate Holder) STANDARD SECURITY LIFE INSURANCE CO., OF NY Town of Southhold 3b. Policy Number of entity listed in box "la": D98008-000 Building Department 53095 Route. 25 3c, Policy effective period: Southhold, NY 11971 4/1/2009 to . 4/1/2010 4. Policy covers: a. 0 All of the employer's employees eligible under the New York Disability Benefits Law b. M 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 Benefi nsu nce cove a as de bed above. r Date Signed 3/29/2010 By (Signature ofillsurance carriers thorized reprilsentative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number (212) 355-4141 Title SUPERVISORIPOLICY SERVICES IMPORTANT: If box '4a" is checked, and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier, this certificate is COMPLETE. Mail it directly to the certificate holder. if box "4b" is checked, this certificate is NOT COMPLETE for purposes of Section 220, Subd. 8 of the Disability Benefits Law. It must be mailed for completion to the Workers' Compensation Board, DB Plans Acceptance Unit, 20 Park Street, Albany, New York 12207. PART 2. To be completed by NYS Workere Compensation Boar (Only If ox "4b" of Part 1 has been checked) State Of New York Workers' Compensation Board According to information maintained by the NYS Workers' Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers' Compensation Board Employee) Telephone Number Title Please Note: Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB -120.1. Insurance brokers are NOT authorized to issue this form. DB -120.1(5-06) Additional Instructions for Form DB -120.1 By signing this form, the insurance carrier identified in box "3" on this form is certifying that it is insuring the business referenced in box "I a" 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 vaild 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 bax " 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 §220. Subd. 8 (a) 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 not withstanding 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 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 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. DB -120.1(5-06) Reverse W Q W Z 7 N Story Frame 949.33 Driveway ------—---------- ; � � 1 N 20x45 POOL I I I 19 1 > V�-- PO* EQUIP. O 1 1 1 DRYWELL I n�4' High Fence as per J I Sec AG 105 Of NYS Code � 1 � I N SCALE 1"=60' H date: 25 MAR 10 All—Island Gunite Pools 200 Central Avenue Farmingdale, New York 11735 tel: 631-753-0004 WAGNER RESIDENCE 8310 Soundview Ave, Southhold NY Site Plan r - f VI VwwV1 / 11 1%0 1 - t- � co{1�G i•tr.E. fACKZ, MJZJAOG i1+'1f a 0 APPROVED AS NOTED DAT,Er���3 �� B.P. # FEE: 00 BY: NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL CONSTRUCTION MUST BE COMPLETE FOR -C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. CONIPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AN e6N&PFIG)NI2 OF D TOWN Z 7SOUTHOLD� LANNING BOARD Lim, WN TRUSC teA UNDERWRITERS CERTIFICATE -Q,t 0jU* t/AtO.* G" To s4 • ,uA Loy✓ eAI ALL CONSTRUCTION SHALL ON THE REQUIREMENTS OF THE �,S OF IdUV YORK STATE. 0 0 0 6ECj►Ot-A eecp Ot-1 li�.`resrits PtiflcL . ,rte . =[r.x_W M "=,k� cmm rikf-D /•; jJl 1 eATr CL. T 7 O urCAA To G�ow9f.��.Tt� C0171 n1A,r-1 1�, $fe :''e►t�rt. skp4t, iv M Lasr`t PAA-. 1,i Sv Pew °l'rVi• ^f,&Ar d vcIeP c.�f2-)A 1Tw' 1 PcPtNG OCHI=MATlG s G\S�ERED AIP?,n �P%,p C. /Y FC,� r "o. O 11� A�6 �� , ENTRAPMENT PROTECTION FOR SWIMMING POOL AND SPA SUCTION OUTLETS AG106.1 General. Suction outlets shall be desiped to pro- duce circtdiation throughout the pooi or spa_ Singic outiet szs- t ems. such as autotnaric vacuum cleans systems. or other wch multiple suction outlets whether isolated by valves or other- wise shall be protected against user entrapment. AG106.2 Suction Httings. All Pool and Spa suction outlets shaallbepro%ridedwithacoverthatconformswith ANSUASME AI 12.19-9A4. or a 12" x 12' drain mate or larger. or an ap- proved charnel drain system. Exception_ Surface ekimmers AG 1063 :atmospheric vacuum relief system required. All pa)l and spa singie or multiple outlet circulation systems ,hall be equipped with amwospheric N•acuum reiief .should grate cov- e:-% located therein becotrte missing or broken. Such vwjum re- Ect systt ms shat include at least one approved or en ineered method of the type specified herein, as follows: 1. Safety %=uum release ns;_m conforr_ttng to ASME Al 12.19.17, or An approved gravity drainage system AG106ADual drain separation. Single or muicipie pump cir- culationsystems sh:111 be provided with a minimiun of two (2) melon mticts of the approved type- A minimum horizontal or vertical distance of three (3) feet shldlI separate such outlets. :'hese suction, cutteu shall br, piped so that water is drawn through them simultaneously through a vaccurn relict - protected line to the pump or pumps. AG IOU Pool cleaner tittingt. where Fnwided- •..��-uurt or Ixessu-ecleaner fitting(s) shall belocared in an accessible posi- nomc) u least (6) iwhei ew mot ereme: than rw:ly- .i-. imiles below the minimem opmzx>nal warer'.evei or. as an at - '**! mks to the skinioms). _Aster. >;y!.� 1f 1-r_,AT1, olL4, lASG. - _ ,too GlauT A1. ,AVXo,- Yj -- f11�+�-LGA-t.�i� 0--6 RQNALD C. HANNA' IOv0c. Na 761 COATES AVE. SUITE 15 140LBROOK. N.Y. 11741 631 285 - 7870 ARCHITECT, POOL ALARM THIS POOL SHALL BE EQUIPPED WITH AN ALARM SYSTEM AS FOLLOWS: IS CAPABLE OF DECTECTING A CHILD ENTERING TTIE WATER AND GIVING AN AUDIBLE ALARM WHEN 1T DEC"IECTS A CHILD ENTERING WATER IS AUDIBLE POOLSIDE AND AT ANOTHER LOCATION ON THE PREMISES. IS INSTALLED, USED AND MAINTAINED IN ACCORDANCE WITH MANUFACTURERS INSTRUCTIONS. IS CLASSIFIED BY UNDERWRITERS LABORATORY, INC. (OR OTHER APPROVED INDEPENDENT TESTING LAB.) TO REFERENCE STANDARD ASTM F2208, ENTITLED "STANDARD SPECIFICATIONS FOR POOL ALARMS-., AS ADOPTED IN 2002 AND EDITORIALLY CORRECTED IN JUNE 2005, PUBLISHED BY ASTM INTERNATIONAL, 100 BARR HARBOR DRIVE, CONSHOHOCKEN, PA. 19428. IS NOT AN ALARM DEVICE WHICH IS LOCATED ON PERSONS OR WHICH IS DEPENDENT ON DEVICES ON PERSONS FOR ITS PROPER OPERATION. THE POOL ALARM MUST BE CAPABLE OF DECTECTING ENTRY INTO THE WATER AT ANY POINT ON THE SURFACE OF THE POOL. IF NECESSARY TO PROVIDE DETECTION AT EVERY POINT, MORE THAN ONE ALARM SHALL BE INSTALLED. POOL ALARM SHALL BE POOL GUARD MODEL PGRM-2 OR EQUAL AND COMPLIES WITH N.Y.S. BUILDING CODE TITLE 19 SECTION 1221.3 MEETING ASTM F2208. GENERAL NOTES: THE DESIGN IS BASED ON A DRAINAGE SOIL WITH LESS THAN 10°x, SILT. GROUND WATER SHALL NOT EXIST WITHIN LIMITS OF EXCAVATION. IF GROUND WATER EXISTS WITHIN 6' — 0" BELOW GRADE, SPECIAL DEWATERING FACILITIES WILL BE REQUIRED. NO SURCHARGE ALLOWED WITHIN 4' — 0" OF SHALLOW END AND 6' — 0" OF DEEP END. THE PNEUMATICALLY APPLIED CONCRETE (GUNTPE) SHALL. BE 1t4 MIX WITH A MAX11MUM OF 3 AND 112 GALLONS OF WATER PER SACK OF CEMENT. BILLET REINFORCING STEEL SHALL BE INTEMEDIATE GRADE 60, STEEL WITH A NI LNIUM LAP OF 30 BAR DIAMETERS. POOL WATER BY OWNERS FILL SPOUT. POOL TO BE KEPT FULL DURING FREEZING WEATHER. PUMP CAPACITY TO BE SUFFICIENT TO EMPTY POOL IN 24 FOURS. FILL SPOUT TO BE 314 INCH GOOSE NECK. WITH A 12" AIR GAP BETWEEN SPOUT AND POOL WATER LINE.. 3 q LtuE. • � -R.c t�tu�} V�tE.�� - -2 y tf as nrx P isty. WA4i-P 0ETArL 1")l and ;pa singie or multiple outlet circ uiation systems hall I cc{)aX, be equipped with atmospheric %mcuum relief should grate cov- ttcL.rZ . VE4(-r-• Cot 14" oC 11' aC 14.8C G•OG 1?" oG FACri 1+..'AL� method of the tyFe ,peri ted hemin, as follows: 1. Safety vacuum release sti-rem conforming to ASME A112.19.17, or ` ra erust� %L%avoc.-t,tS- AGI06.4 Dual drain separation. Sinele or mui►ip;e cir- puma culation systems shall be provided with aurin- rn of two (2) snrion outlets of the approved trpe. A minimum horizontal or vertical distance of three (3) feet shill separate such otniets. zj ►,r,,v CrwMDs ► These suction outlets shall N� piped so that water is drawn through them simultaneous v through a vacuum reliet- procected line to the pump orpumps. a� aG106.5 Pool cleaner fittings- Where provided- %,m uum or ffessum cle.=nerfitting(s) shall be located in an accessible Dasi- 1' t� �t • Got O -� b'�30 _�+�,1.�..'�1J 1�leSi. �1 � - X00 G>�U�.I, .�/>�✓• -- ?3 l --p- :.4f_s'i�'1 �C!,&L, �+� ?4.�ii -�p���}o�!''�I. RONALD i"� O {'.,ALD Loa /�-- H A t� t �I A a,�%c,. !.s O• A=— -'-CT P;CAM AU, f�•��CM 761 COATES AVE SUITE 15 cr st,:j Q_-e-F_0t,>4-41 q LtuE. • � -R.c t�tu�} V�tE.�� - -2 y tf as nrx P isty. WA4i-P 0ETArL o MSG S 0C.1?WE1A-j of-t%we , CkfAcliv 80 GlM fuuf x 01•4111. % A 0 CA t.. aAqra►.M H x & t(oco Get,. C1I'&CITtl ",V. cfT npi.a, e3nf p') t 1. 0_ cr F� x lot DP. = 16 oto cAt,- 2. 6 Gr ,Qf x. 9 -le -Pt- •= 1142 CAI, - I �J • I V.0- 9'x 'i C. GAI, f�_-je_ t_CCAt- .k_' IqJJOLVkf R1v4 FLX.t., Gam, TY gxl.�wsltx eel Tr> tc. fhb-u=F� -re> Cel w1f11;0 A. F1 KI -V TIS- (ITUC01 �'f JF, CA C-0 E-&TKx09 t9D>< T� [�c3 4Li Old-; lkF". • '44 `r e,, cZ-Ctyla_, 4Lo log 10WEr-- . • �� xrtfD- V"W at., -L ° L °- l o CSECjrO!-t 6ECT1ot-A 1�."srxm7k t' L"A- �� CC <aq • E�sEQ-G� God Cc�.+,pt,t�..lG�: • - ttCAS>-. tb 0--u TO CC -4 1;9ofA,!, N77C�Q C81�fi ENTRAPMENT PROTEC71ON FOR SVAMMING POOL AND SPA SUCTION OUTLETS MA"'`1 A<&W rp-_ °i1MX.4. AGIO6.1 General. Suction outlets shall be desigped to pm- �+~ C¢`.t'tPLtf-•tTT� •juc- circ xIation tiros u' t ih- S' 'C' Wu poor or spa. tngte outlet szs- terns. such as autoznatic vacuum cleaner systems. or other such rnuitiple suction outlets whether isolated by valves or other- wise shall be protected against user entrapment. AG106.2 Suction Ht&.gs. All Pool and Spa suction outlets sh"" "be provided with a cover that conforms wit}: ANSPASN4E AI 12.19.8A4. or a 12" x 1 drain gate or larger or an ap- proved charnel drain system. ntiAs,-4 S v jpo- °J'nsu,E• Exception: Surface skimmers Air Z VCS C40Mfl-;A- jY AG 1063 Atmospheric vacutaim relief systern required All R PIPING OGHEMAIiC .,10 ^?GtLt.- 1")l and ;pa singie or multiple outlet circ uiation systems hall be equipped with atmospheric %mcuum relief should grate cov- ttcL.rZ . VE4(-r-• Cot 14" oC 11' aC 14.8C G•OG 1?" oG FACri 1+..'AL� o MSG S 0C.1?WE1A-j of-t%we , CkfAcliv 80 GlM fuuf x 01•4111. % A 0 CA t.. aAqra►.M H x & t(oco Get,. C1I'&CITtl ",V. cfT npi.a, e3nf p') t 1. 0_ cr F� x lot DP. = 16 oto cAt,- 2. 6 Gr ,Qf x. 9 -le -Pt- •= 1142 CAI, - I �J • I V.0- 9'x 'i C. GAI, f�_-je_ t_CCAt- .k_' IqJJOLVkf R1v4 FLX.t., Gam, TY gxl.�wsltx eel Tr> tc. fhb-u=F� -re> Cel w1f11;0 A. F1 KI -V TIS- (ITUC01 �'f JF, CA C-0 E-&TKx09 t9D>< T� [�c3 4Li Old-; lkF". • '44 `r e,, cZ-Ctyla_, 4Lo log 10WEr-- . • �� xrtfD- V"W at., -L ° L °- l o CSECjrO!-t 6ECT1ot-A 1�."srxm7k t' L"A- �� CC <aq • E�sEQ-G� God Cc�.+,pt,t�..lG�: • - ttCAS>-. tb 0--u TO CC -4 1;9ofA,!, N77C�Q C81�fi ENTRAPMENT PROTEC71ON FOR SVAMMING POOL AND SPA SUCTION OUTLETS MA"'`1 A<&W rp-_ °i1MX.4. AGIO6.1 General. Suction outlets shall be desigped to pm- �+~ C¢`.t'tPLtf-•tTT� •juc- circ xIation tiros u' t ih- S' 'C' Wu poor or spa. tngte outlet szs- terns. such as autoznatic vacuum cleaner systems. or other such rnuitiple suction outlets whether isolated by valves or other- wise shall be protected against user entrapment. AG106.2 Suction Ht&.gs. All Pool and Spa suction outlets sh"" "be provided with a cover that conforms wit}: ANSPASN4E AI 12.19.8A4. or a 12" x 1 drain gate or larger or an ap- proved charnel drain system. ntiAs,-4 S v jpo- °J'nsu,E• Exception: Surface skimmers Air Z VCS C40Mfl-;A- jY AG 1063 Atmospheric vacutaim relief systern required All R PIPING OGHEMAIiC .,10 ^?GtLt.- HOLB R OO KS M.Y. 11741 631 285 - 7870 SW1MM1 NG POOL Ota-TAIL015 1")l and ;pa singie or multiple outlet circ uiation systems hall be equipped with atmospheric %mcuum relief should grate cov- ert located therein become missing or broken Such va jam re - he: systems shall Include at lest one approved or enoneered method of the tyFe ,peri ted hemin, as follows: 1. Safety vacuum release sti-rem conforming to ASME A112.19.17, or ` An vppmved grdviry drainage system erust� %L%avoc.-t,tS- AGI06.4 Dual drain separation. Sinele or mui►ip;e cir- puma culation systems shall be provided with aurin- rn of two (2) snrion outlets of the approved trpe. A minimum horizontal or vertical distance of three (3) feet shill separate such otniets. zj ►,r,,v CrwMDs ► These suction outlets shall N� piped so that water is drawn through them simultaneous v through a vacuum reliet- procected line to the pump orpumps. a� aG106.5 Pool cleaner fittings- Where provided- %,m uum or ffessum cle.=nerfitting(s) shall be located in an accessible Dasi- porltc) X least (61 niches ime m. grease_r than twdlve i i= 'echos below the minimum ope--wonal watcr'.eve' or as an at- tachment to the skiminen s ). -� b'�30 _�+�,1.�..'�1J 1�leSi. J��^�s - - -- � - X00 G>�U�.I, .�/>�✓• -- ?3 l --p- :.4f_s'i�'1 �C!,&L, �+� ?4.�ii -�p���}o�!''�I. RONALD i"� O {'.,ALD Loa /�-- H A t� t �I A a,�%c,. !.s O• A=— -'-CT 761 COATES AVE SUITE 15 cr HOLB R OO KS M.Y. 11741 631 285 - 7870 SW1MM1 NG POOL Ota-TAIL015