HomeMy WebLinkAbout39148-ZSUFppt�.c Town of Southold
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 37420 Date:
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 1000 Fanning Rd, New Suffolk,
SCTM #: 473889 See/Block/Lot: 117.-6-34
3/30/2015
3/30/2015
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this 6ffice dated
8/21/2014 pursuant to which Building Permit No. 39148 dated 9/3/2014
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 AS APPLIED FOR
The certificate is issued to Meyers, Kevin
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
39148 03-24-2015
ori d Si ature
Town of Southold
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
4/14/2015
No: 37509 Date: 4/14/2015
THIS CERTIFIES that the building ACCESSORY
Location of Property: 1000 Fanning Rd, New Suffolk
SCTM #: 473889 Sec/Block/Lot: 117.-6-34
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
8/21/2014 pursuant to which Building Permit No. 39148 dated 9/3/2014
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 TRELLIS AS APPLIED FOR
The certificate is issued to Meyers, Kevin
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
39148 03-24-2015
A� o ed gnatu e
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 39148 Date: 9/3/2014
Permission is hereby granted to:
Ruckel, Frank & Ruckel, Frank
139 Pembrook Dr a
Yonkers, NY 10710 .
To: construct an accessory inground swimming pool fenced to code as applied for
At premises located at:
1000 Fanning Rd, New Suffolk
SCTM # 473889
Sec/Block/Lot # 117.-6-34
Pursuant to application dated
To expire on 3/4/2016.
Fees:
8/21/2014
and approved by the Building Inspector.
SWIMMING POOLS - IN -GROUND WITH FENCE ENCLOSURE
CO - SWIMMING POOL
Total:
L
Building Inspector
$250.00
$50.00
$300.00
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
B
TOWN CLERK'S OFFICE
5 •
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 #: 39148 Date: 9/3/2014
Permission is hereby granted to:
Ruckel, Frank & Ruckel, Frank
139 Pembrook Dr a
Yonkers, NY 10710 .
To: construct an accessory inground swimming pool fenced to code as applied for
At premises located at:
1000 Fanning Rd, New Suffolk
SCTM # 473889
Sec/Block/Lot # 117.-6-34
Pursuant to application dated
To expire on 3/4/2016.
Fees:
8/21/2014
and approved by the Building Inspector.
SWIMMING POOLS - IN -GROUND WITH FENCE ENCLOSURE
CO - SWIMMING POOL
Total:
L
Building Inspector
$250.00
$50.00
$300.00
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 I% 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
Da 6 a / (
New Construction: Old or Pre-existing Building: (check one)
.lli0 C t Location of Property.✓1 I v` F,j6
House No. kjwtK
Stre Hamlet
Owner or Owners of Proper i 0�y� Pss
Suffolk County Tax Map No 1000, Section Block Lot ?
Subdivision Filed Map. Lot:
Permit No. Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ \
V
Applica ignature
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(at-town.southold.ny.us
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Kevin Meyers
Address: 1000 Fanning Road City: New Suffolk St: New York Zip: 11956
Building Permit #: 39148 Section: 1 1 7 Block: 6 Lot: 34
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Lunas Electrical 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
INVENTORY
Service 1 ph Heat Duplec Recpt 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
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other Equipment: In Ground Swimming Pool to Include, Bonding, Gas Pool Heater, 2- Pool Lights,
1- Pump, 1- Control Panel, 1- GFCI Recepticle, 1- GFCI Circuit Breaker
Notes:
Inspector Signature: Date: March 24, 2015
Electrical Compliance Form.xls
[40 f4f s
co
TOWN. OFSOUTHOLD BUILDING-DEPTi
765-1802
INSPECTION'
VI �FOUN'DATION I -ST ROUGH PLUMBING
FOUNDATION 2ND INSULATION
FRAMING/ STRAPPING FINAL
FIREPLACE& CHIMNEY FIRE SAFETY INSPECTION
FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION
ELECTRICAL (ROUGH) ]ELECTRICAL (FINAL)
CODE VIOLATJ9N ] CAULKING.
REMARKS:
Q
DATE —INSPECTOR
souryo�
couNiV,N
TOWN OF SOUTHOLD BUILDING DEPT. -
765 -1802
INSPECTION.I.,...w.
[ ] FOUNDATION IST [ ] ROUGH MBING
[ ] FOUNDATION 2ND [ ] 1 AT -ION "
[ ]
FRAMING/ STRAPPING [ FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY-. INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] CAULKING
REMARKS: �,re-.$ d C'tf 2_2� ✓
DATE r ;' �� INSPECTOR
OF SOUlyolo .
COUM`I,
TOWWOF SOUTHOLD -BUILDING DEPT.
765-1802
INSPECTION'——
[ ]FOUNDATION iST [ ] ROUG UMBING
[ ]FOUNDATION 2ND [ ] 1 ULATION .
[ ]FRAMING /STRAPPING [ FINAL
[. ]
FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ]
FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL)
[ ]CODE VIOLATION [ ]CAULKING
REMARKS: � 9
S�
DATE INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
South oldTown.NorthFork.net PERMIT NO.
Examined 20J
Approved , 20
Disapproved a/c
Expiration I& , 20_/�
I�
IIU
AUG 21 2014
BLDG. DEPT.
N OF SOUTF
BUILDING PERMIT APPLICATION CHECKLIST
Building Inspector
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O. Application
Flood Permit
Single & Separate
Storm -Water Assessment Form
Contact:
Mail to:
Phone:i �? �� +� jI l
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
Date
0 la( , 20_L�_
!---ter.-Thi-s-&.-plic-91on X4tTSTbe 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 premises and in building for necessary inspections.
aL,i/-A!,,�J� (A Zl_
iC4 d d B k o (Signature of applicant me, if a corporation)
�J 10
.^
I CAT E ' 1: - 40— (Mailing ress of applicant)
f
i h �
State whether applicant is ownery, lessee, agct%t,arChte�t ykiineer, general contractor`electrician, plumber or builder
FEE
Name _,'• �3'r .�'
Name of owner of premises %o—1/;Vti .,,,1111 -. n., -Th Ii h
(As on the tax'roll or
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate ofd '
Builders License No. s� EDIATEL
Plumbers License No. t=N6L0eS F braL TO E
pee r+EWDt CTION
Electricians License No. , RI= -FORE "WAT'"
Other Trade's License No. ".9111
1. Location of land on which
House Number U
County Tax Map No. 1000 Section
work will be
M-9euVP S ANI TO 4 PNi FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING, PLUMBING,
STRAPPING, ELECTRICAL & CAULKING
3. INSULATION
4. FINAL - CONSTRUCTION & ELECTRICAL
MUST BE COMPLETE FOR C.O.
ALL CONISTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
Y(§ 1MTE. NOT RESPONSIBLE FOR
HairiTet .
ETAIBlock (3jjpON Sl IA TOTrt RMbW�A�7ERoU
OF THE TOWN CODE.
2
a
Subdivision
Filed Map No.
Lot
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b.
�nended use and occupanc_ 0c4IJ 15WwtnW. vto. Poo
Nature of work (check which applicable): New Building � Addition Alteration_
Repair Removal_ Demolition Other Work
(Description)
4. Estimated Cost
Fee
(To be paid on filing this application)
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 "4
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 ':.'`' `' " DJP=
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 , . 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.
STATE OF NEW YORK)
SS:
COUNTY OF
/n Y - l �c/� S being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named, CONNIE D. BUNCH
Notary Public, State of Now York
(S)He is the No. 015116165050
afe-Ofcer,,`etc.} • Qualified in u o (Contractor Agent, Cor o'I
? Commission Expir®s April 14, 2
of said owner or owners, and is duly, authorized to perform oraye'performed,the_said work and to make and file this application;
that all statements contained in this application are true to the besf-_6fhis 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
�� day of 20A
Nbiary-Piblie V: is
Si ture of Ap 'ant
Scott A. Russell ��-°� JL )[WAT]EIE,
SUPERVISOR MAANA\(G IEMIENT
SOUTHOLD TOWN HALL - P. O. Box 1179 p
53095 Main Road- SOUTHOLD,NEWYORK 11971 �' � 'own of Southold
CHAPTER 236 - STORN WATER MANAGEMENT -WORK SHEET
( TO BE COMPLETED BY THE APPLICANT)
` DOES 'a'I:iIS PROJECT INVF'fi�ICL�35�Il�it�
(CHECK ALL THAT APPLY)
Yes No
i
[j �A. Clearing, grubbing, grading or stripping of land which affects more
t _
than 5,000 square feet of ground surface. t
Excavation or f illing involving more than 200 cubic yards -of material
within any parcel or any contiguous area.
t
E �,/C. Site preparation on slopes which exceed 10 feet vertical rise to .
L�
10.0 feet of horizontal distance.
t M/6 -Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
! Q E11L Site preparation within the one -hundred -year floodplain as depicted
on FIRM Map of any watercourse.
I Installation- of -new-or-resurfaced-impervioussurfaces of 1,00Q quare
' feet or more, unless prior approval of a Stormwater Management
t
Contro-1 Plan was received by the Town and the proposal includes
in-kind replacement of impervious surfaces.
- _-- --1 .
- If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name,
Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project
If you answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan
and a romnleted Check List Form to the Building Department with your Building Permit Application.
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
NAME.-
Contact
AMEContact lnformatiort
[rdrynmc Nwnecd
Prjop
e
�/frty Address / Location of Construction Work:
Ne Sc. �g_- Oy, I1 5
FORM - SMCP - TOS MAY 2014
S.0-T.M- 1000 Date: j
G� � /
Section Bock Lot
'FOR BUIL.DINNG DEPARTMENT USE 0;
Reviewed By: YUP
Date
Approved for processing Building Permit_ — — —
Stormwater Management Control Plan Not Required.
Stormwater Management Control Plan is Required.
(Forward to Engineering Department for Review.)
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 1197I-0959
S�(/jyO
y
y�4UiVi'I,�
Telephone (631) 765-1802
. 12
roaer.richert(0, (631) od.nv us
BUILDING DEPARTMENT
TOWN OF SOUTHOILD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY:
M �
�S #or-nc
oWne�)Date:
Company Name:
_ _L.AZL_CL FE
/e�:c� (
.�� c .
No.:
JOBSITE fNFORMATION: (*Indicates required information)
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax -Map District:
9000 Section:
Block: Lot:... 3y
*BRIEF DESCRIPTION OF WORKS ((Please Print Clearly) �l.- c � (mac. dr;
�PooE C_M_feteW ih lieV o101q �&! Se_ lvtiQ
kbrk
Gko4ic- LA,,
(Please Circle All That Apply)
*ls job .ready for inspection: NO Rough In Final
*Do -you need a Temp Certificate: YES ! O5_�)
Temp Information (if. needed)
*Service Size: 1 Phase 3Phase 100 950 200 300 350 .400 Other
*New Service: Re -connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
.82 -Request for Inspection Form 12p—C_ 1_2s f
/(;.o 0 /? TOWN OF SOUTHOLD
PROPERTY
RECORD CARD ,
I
OWNER
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IMP.
TOTAL
DATE
REMARKS
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FRONTAGE ON WATER
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FRONTAGE ON ROAD.13d
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DEPTH
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5URVEY OF PROPERTY
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SITUATE: NEW SUFFOLK
TOWN: 50UTHOLE)
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5UFFOLK COUNTY, NY
5URVEYED 07-21-2014
S
5UFFOLK COUNTY TAX F
1000- I I7 -G-34
-
CERTIFIED T0:
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KEVIN J.MEYERS
FIRST' AMERICAN TITLE INSURANCE COMPANY
FANNING
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CHARLES M. THOMAS
ARCHITECT
Offices At: 206 Lincoln St.
Riverhead, NY 11901
Mailing: PO. Box 877
Jamesport, NY 11947
A� O CERTIFICATE OF LIABILITY INSURANCE
8/19/22014
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
Brazier Insurance Agency
1745 Montauk Highway
Bellport NY 11713
CO CT Debra Ferraro
PONE (631) 286-1400 FAX . (631)286-1406
E brazier-debra@optonline.net
INSURERS AFFORDING COVERAGE NAIC #
INSURERA:National Fire Insurance Company
INSURED
Island Gunite Swimming Pools, Inc.
P.O. Box 1595
ISag Harbor NY 11963
INSURER B:CNA COnneCt
INSURER C:
INSURER D:
INSURER E:
1 INSURER F:
rnVr.PA _Fc r;:PnF1rATF NlIMRFR:CL1481905275 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR
TYPEOFINSURANCE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town Of Southold
POLICY NUMBER
MMMrLDIDD1YYEFY
mmfon;YYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
Kevin Braz' /KEVIN
3 4029374585
/23/2014
/23/2015
EACH OCCURRENCE $ 1,000,000
DGE ToRENTED
PREMISES Ea occurrence $ 50,000
MED EXP (Any one person) S 10,000
PERSONAL 8 ADV INJURY S 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER:
Fx_1 POLICY PRO LOC
PRODUCTS - COMPYOP AGG S 2,000,000
$
AUTOMOBILE LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
NON -OWNED
HIRED AUTOS AUTOS
COM131NO SINGLE l
e accident
BODILY INJURY (Per person) S
BODILY INJURY (Per accident) $
PROPERTY DAMAGE y
eracdden
$
UMBRELLA UTAB
EXCESS LUAB
OCCUR
CLAIMSMADE
EACH OCCURRENCE S
AGGREGATE S
DED I RETENTIONS
S
B
WORKERSCOMPENSATION
AND EMPLOYERS LIABILTTY Y I N
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
Mdescribe under
RIFTION OF OPERATIONS below
NIA
C 4 31039084
/26/2013
/26/2014
I WCSTA U- I_EROTH.
E.L. EACH ACCIDENT $ 500,000
EL. DISEASE -EAEMPLOYEE $ 500,000
EL. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, K more space Is required)
SWIMMING POOL INSTALLATION
CERTIFICATE HOLDER. CANCELLATION
ACUKD 25 (2070105) @ 1988-;R10,0kC0RD CORPORA'110N. All rights reserved.
INS025 potom).ot The ACORD name and logo are reglstereJVrJFrsof ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town Of Southold
ACCORDANCE WITH THE POLIC
53095 Route 25
AUTHORIZED REP ATIVE loberto
a Breda
Southold, NY 11971
Kevin Braz' /KEVIN
ACUKD 25 (2070105) @ 1988-;R10,0kC0RD CORPORA'110N. All rights reserved.
INS025 potom).ot The ACORD name and logo are reglstereJVrJFrsof ACORD
ReceiptCopy
SUFFOLK COUNTY DEPT OF LABOR,
LICENSING & CONSUMER AFFAIRS
PAYMENT RECEIPT
RECEIPT NO. 283214
Page 3 of 3
ISLAND GUNITE SWIMMING POOLS INC
PO BOX 1595
SAG HARBOR NY
11963
Rec'd From:
D/B/A:
Date: .
M FORD
ISLAND GUNITE SWIMMING POOLS INC _ .
03/12/20141,
Payment Type:
No:
Drawn On:
CHECK
10012
CAPITAL ONE BANK
Category
Service Fee Violation
Slip No Remarks
5 - H.I. Contractor
C - Lic. Renew. $400.00
RECD BY:
License# / Registration#:
LA
39944
TOTAL:
$400.00
Remarks:
ATTENTION HOME IMPROVEMENT CONTRACTORS Suffolk County Code. Chapter 563-17 (D)
states: All advertising for Home Improvement contracting shall contain the number of the Home
Improvement license.
Customer copy
http://suffolkca/receiptcopy.aspx?ID=283214 3/12/2014
H. ROY JAFFE, P.E.
82 EAGLE CHASE, WOODBURY, N.Y. 11797
'S 16.364-0.148
FAX 516-364-0158
Aug 14 2014
Village of Southold
Dear Sir:
This is to certify that the drainage facilities to be used
exclusively for the construction of a swimming pool on the
premises. of:
Meyers
1000 Fanning St
New Suffolk, NY
will not require draining because the -pool is of gunite
construction. The pool water will be continuously
recirculated through the filter- and will be reused from
year to year. The drainage from the filter backwash is
nominal'an'd will not interfere with the public water supply,
the existing sanitary facilities or public highways.
Very truly yours,
pF NF�0
h�' O��T S0 �✓
H. Roy Jaffe, P.E. vj
,A
047470
F�P9�fESSIO�Q�'��
jt ROY, JMTE,'P E
82'EAGLE CHASE`, ,
WOODBURY; NY `11797
FIN4L G AOE'
T;0 -MDE- w1TH COT ZRo1I
�JNDEA PAYED ARS � i
LAZ'rtl.A.PIPEN. -Z
11N,.S,L0PE PER GT.
voTc .4' gal: z4'n1N,
4 T07'h1AX,'Mb':,30" `1N-
. I .I
NOTE I DE514N RATE 15
4rH4 $AKD 4 GRAN EL STRATA
EF.FECTIV`L bEPTµ
SOLID bOMEi "
J ":✓S � MAX
0
V1
J
J
07
Q '
Q ,
(Y '
1 '
7:
o
3'NIN 3'nIN,
Z4 TA. -D W1 WT
49
* COLLAR MATERIAL
t' "k%
(rd.+C,r, 0»�
QATEAEILE S -01L
ubif>MRLY1144 S^xD 4 C.XAVEL 6114 YA
*NOTES CAPACITY 1.263 GALLONS -(169 CU.FT.)
1. COLLAR IS NOT.REQUIRED-WHEN'RATEABLE MATERIAL EXISTS FOR FULL DEPTH,
2. THE MATERIAL USED",FOR;;'C lIL-A,RING.- SHALL .BE COMPRISED OF SAND & GRAVEL
FILTER MBT'ERIAL'CONTAINI'NG: LESS THAN FIFTEEN (15) PERCENT FINE SAND.
SILT & CLAY (SILT; &; CLAY,t' FRACTIONS ARE NOT TO 'EXCEED
TYPICAL DETAILDIFFUSION WELL ��®F NF
ROYGfir
BACKWASH FROM POOL 70''GPM @""_5' MIN = 350' GAL.CO
Meyers'
1000 Fanning St
New Suffolk, NY ¢
w
tr�LJ'�O Q4747U
�ROFESSIONP�
cr-
Fo-t
m
CHARLES M. THOMAS
ARCHITECT
Offices At: 206 Unco'In St.
Riverhead, NY 11901
Mailing: P.O. q9x-6.. '
Jamesport,
r
Pie
13 7
/3
ca,,ve gf-a-Ijos 0�1 cdt, "2'jj1j
ax
CHARLES M. THOMAS
ARCHITECT
Offtes At: 206 Lincoln St.
Riverhead, NY 11901
Mailing: P 0. Box 877
Jamesport, Nyllj-k4=,
D A
7-0 M.
40
V
PCOL AND PROPERTY 16 OCHFORM TO N.Y_ SATE RESIDENTIAL
OCOE APPEND:�X G 200 EDITION
POOL 'Ib OCNFO M 'PO ANSI/NSPI STANDARDS AG103.1
C D E I F hRtl [Ap.
O - -
141 J
-A i
SECTION 6106
EI1I'mmmT PRt7TDCTION REQuiRFE
SDMCN G107
POOL ALARM REQUIRED
r � — J// • .F •-�ti�A p �tN u��z►t M�cveCiTa
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uam .r•rT�„�
MAIN,
DRAINS, srP 1N -
n
-'rec
- pooL P LAN
CCHrERAL NOTESs -
—
`.i
t-
�•�
L Tbt£ D[SICJI a sAxC ON A DRAINAGE SOIL WITH <q'f_ SILT_..
CROVND WATCR SMALL NOT EXIST WITHIN TMC LIMITS OF THC
'
]cfAqb4
GI Trit
EXCAVATION- W 9PI"O MATER LXIST3 WITHIN /�-O 1ELDW
-
GP -QC SIECIAL-05WATEXING rACR_JTIES WILL K RCOWREG.
•�l.Cev�1.4,•��p[m
Atl- ?T LtG►
WA3'u.Ot3TOl'iAL IS LIMITED TO OWKR-3 rROrMVWr
Z NO 7t1lC ZINE ALLD VED-WfTMN 4'-0- Of SHALLOW END
' _
sc •
AND 4 r O - OI DCCT. [MO.
�-`
> tw
i- THC PMMJ AATICALLT A" LXQ CONCRETE CCVHIT E) SMALL
d
1
K A.0,4 HIX WITH AMAXIMUMt OFA•GALLONS OF
W $ 85M,
, -'
—
DI+►f
WATER MR SACK OF CEMENT_
i
-
�
S- RC3MrORCtX6 STEEL SMALL &C INTCRMEDIATE CRADC
+s
. - /euET STEEL 11TTN A MIINIYVM Lwr OF 30.4t1t,
: -.
.
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Cc/ No pop PW OW
TOOL *AT Ca iVrfL7.BY OWNER 3 GARDCN HOSE_
;
Tltlyq "f it )r"1
46L Or"
Pool_ To AC KEPT ruL,L OVRING FRCramr. wrATHER_
'Wei i1 G
rVMf►'CAPACITY TO INC 3tWFICICNT TO EMPTY TOOL
nl �
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u
ra�tC �j f PinP'.
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IN 24 WURS. rFic-AL vcA
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.. IIf•A1 fl►NV'LsitT
' Meyers " REVISED C3/14 H. .ROY-JAFFE, P. E..
1000.Fanning St
New Suffolk, NY
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