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HomeMy WebLinkAbout31556-ZTown of Southold P.O. BOX 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37588 Date: THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1910 BAY AVE MATTITUCK 6/3/2015 6/3/2015 SCTM #: 473889 See/Block/Lot: 144.-3-40.4 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/24/2005 pursuant to which Building Permit No. 31556 dated 10/26/2005 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 HSA HOLDINGS LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 31556 5-26-2015 Auth ed Signature (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 31556 Date: 10/26/2005 Permission is hereby granted to: HSA HOLDINGS II LLC 108 REMINGTON RD MANHASSET, NY 11030 To: CONSTRUCTION OF AN IN -GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR At premises located at: 1910 BAY AVE MATTITUCK SCTM # 473889 Sec/Block/Lot # 144.-3-40.4 Pursuant to application dated To expire on 4/26/2007. Fees: 10/24/2005 and approved by the Building Inspector. NEW DWELLING/ADDITION/ALTER. CO - SWIMMING POOL Total: Building Inspecto $150.00 $50.00 $100.00 $300.00 TOWN OF SOUTHOLD BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE o . 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 #: 31556 Date: 10/26/2005 Permission is hereby granted to: HSA HOLDINGS II LLC 108 REMINGTON RD MANHASSET, NY 11030 To: CONSTRUCTION OF AN IN -GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR At premises located at: 1910 BAY AVE MATTITUCK SCTM # 473889 Sec/Block/Lot # 144.-3-40.4 Pursuant to application dated To expire on 4/26/2007. Fees: 10/24/2005 and approved by the Building Inspector. NEW DWELLING/ADDITION/ALTER. CO - SWIMMING POOL Total: Building Inspecto $150.00 $50.00 $100.00 $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 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. 5 —2_? -1< New Construction: !/ Old or Pre-existing Building: (check one) Location of Property: 1/0 &e_ M fi- r-/ -ru C% House No. V /�,Street Hamlet Owner or Owners of Property: �5 A I l 0 w t �,, Suffolk County Tax Map No 1000, Section %�}�7 Block J Lot �y 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: $ 0 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. richertO-town.southold. ny. us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Peters ( HSA Holdings) Address: 1910 Bay Ave City: Mattituck St: New York Zip: 11952 Building Permit #: 31556 Section: 144 Block: 3 Lot: 40.4 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 X Addition Survey X 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 Appliances2 Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures 11 TVSS Other Equipment: AS BUILT - ELECTICAL SURVEY- NO VISUAL DEFECTS - Notes: In Ground Swimming Pool and Hot Tub To Include - Bonding, 4- Pump Motors, 1- Pool Cleaning Pump, 4- Pool Lights, 2- Gas Pool Heati 1- Spa Blower, Control Panel, 1- Jandy Panel, 1- GFCI Circuit Breaker. Inspector Signature: Date: May 26, 2015 Electrical 81 Compliance Form.xls oF so�ryo`� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION KFOUNDATION IST [ ]ROUGH PLBG. [ ]FOUNDATION 2ND [ ]INSULATION [ ] FRAMING/ STRAPPING [ ] FINAL [ '] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION REMARKS: — A 1 ,d p &r� eA- DATE /—lk-o�—INSPECTOR ";%r' e le TOWN OF SOUTHOLD BUILDINGDEPT. 765-1802 INSPECTION. ] FOUNDATION IST ] FOUNDATION 2ND ] FRAMING/ STRAPPING ] FIREPLACE & CHIMNEY ] FIRE RESISTANT CONSTRUCTION ] ELECTRICAL (ROUGH) ] CODE VIOLATION [ ]ROUGH PLUMBING [ ]INSULATION [ ]FINAL [ ] FIRE SAFETY INSPECTION [ ]FIRE RESISTANT PENETRATION ELECTRICAL (FINAL) [ ]CAULKING REMARKS: sot DATE t� INSPECTOR� „1 FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (IST) UJ j ------------------------------------ FOUNDATION (2ND) �Q m -gyp C9 z ROUGH FRAMING & PLUMBING 0 y OD INSULATION PER N. Y. STATE ENERGY CODE FINAL T ADDITIONAL COMMENTS L141 L (V -1515a ✓ a b e� ri _ r a o �Z rn P o � z H d .. b H TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN 1L -LL SO UTHOLD, N=Y 11971 TEL: 765-1862 Exanuned /0 Approved Disapproved a/e 20 20_ bU1LUINU 1'LKMII xYYLll,xituly 1 Do you have or need the following, before applying Board of Health 3 sets of Building Plans Suryey PERNUT NO, Check Septic Form N.Y.S.D.E.C. Trustees Contact:. Mail to: Phone: a 77 f 7 .4 ual g Ins• for APPLICATION FOR BUILDING PERMIT �. �,� , OST �2-'Q. � � , ,-J� • • -- `, Date INSTRUCTIONS ?0 a. This application UST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3 M 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 corp manced'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 shallbe occupied or used in whole or in part for any purpose what -so -ever until a Certificate of Occupanc is issued by the Building Inspector, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York,, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or. alterations or for removal or demolition as herein described, The applicant agrees to comply with all applicable laws, ordinances, building code; housing code, and regulations, and to admit authorized inspectors, on premises and in building for necessary -inspections. (Signature of applicant or name, if a corporation) (Mailing address apphct) /�/� J/732 - State whether applicant is owner, lessee; agent, architect, engineer, general contractor, 611p rician, plumber or.builder Name of owner of premises (as on the, tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer ame an 'title corporate officer) Builders License, No. a -3 177f , Plumbers License No. Electricians License No Other Trade's License No. 1. Location of land on which proposed work will be done: P Street rl-71elz— Hamlet Block �:... •Lot �4 County Tax Map No. 1000 Section Subdivision Filed Map No. Lot • tr3 u, ray (Name) 2. State existing use acid occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy/ b. Intended use and occupancy 3. Nature of work. (check which applicable): New Building _ drlitinn Alteration R Removal Demolition Other Work ,��/!� //V-6rOreN� Repair :VKlAff (Descnption)i )6e-- . 4. Estimated Costc �Ji Fee (to be paid on filing this a plication) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars _ commercial or mixed occupancy, specify nature and extent of each type of use_ 6. If business, commer x P .. 7. Dimensions of existing structures, if any: Front Rear L%,5" Depth 30 Height / Number of Storms • �k��% i�v^6�ueU0 �vNs�r°�c�►sM�s,° Dimensions of same structure with alterations or additions: ccnt Rear �oo�f Depth Height Number of Stories 8. Dimensions of entire nein construction: Front Rear Depth Height 19 Number of Stories 9. Size of lot: Front %;FBeat �V5 Depths---- 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: Al 0- 13. Will lot be re -graded /V o Will excess fill be removed.from premises: YES NO 14. Names of Owner of premisesaS' Address I AMz'?J'.!G Phone No -623/-mfg 133 Name. of Architect'aywe Adfdress �`i Phone No spa% -X 55--7070 Name of Contractor4A(gS(,,o;Ain r(&ai�4ddress ' , Phone No.(t 3/-&0/-Z5 -2�� AM9 /175� 15. Is this property withi-6 100 feet of a tidal wetland? *YES • NO f/ • IF YES, SOTTIHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED t 6. Pro�ide survey, to scale, with accurate foundation plan and distances to property lines. 17. if elevation at any point on property is at 10 feet or below; must provide topographical data on survey. STATE OF NEW YORK) SS: .�OUNTY OF ) ea S being duly sworn, deposes. and says that (s)he is the applicant ame of individual signing contract) above named, S)He is the (Contractor, Agent, Corporate Officer, etc.) )f said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; hat all statements contained in this application are true to the best of his knowledge and belief, and that the work will be )erformed in the manner set forth in the application filed therewith. )worn to)� re me this _ day, of 200 i r otary Public \ KELLIE A. STAMM Notary Public, State of New York No.01ST6035196 Qualified in Suffolk County Commission Expires December 27, 2005 114 , Signature o A�'p hcant ���OF SOUTy�P o Town Hail Annex J fK Telephone (631) 765-1802 54375 Main Road C13 � ax (63.11765 - 5 2 P.O. Box 1179 G� Q roger.richert(downsout�iold ny us Southold, NY 11971-0959 a BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL .INSPECTION REQUESTED BY: A yrs' Date: s Company Name: oer, - Name: License No.: Address: j2f Phone -No.: JOBSITE INFORMATION-. (*Indicates required information) *Name: Address: s %D �' tir9 �TUc /9Sz- *Cross Street: *Phone No.:a. is — O5 yU Permit No.: 3 /,SS6 Tax Map District: 1000 Section:�oL1 Block:_ *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: *Do=you need a Temp Certificate: YES / NO. Rough In Final YES / NO Temp Information. (if needed) *Service Size: 1 Phase Whase 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 Foam 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. 31556 Z Date OCTOBER 26, 2005 Permission is hereby granted to: SEAN PETERS 350 W 51ST ST i(� NEW YORK,NY 10010 for CONSTRUCTION OF AN IN -GROUND SWIMMING POOL IN THE REQUIRED REAR YARD AS APPLIED FOR at premises located at 1910 BAY AVE MATTITUCK County Tax Map No. 473889 Section 144 Block 0003 Lot No. 040.004 pursuant to application dated OCTOBER 24, 2005 and approved by the Building Inspector to expire o Fee $ 150.00 ORIGINAL Rev. 5/8/02 RON GIBBONS SWIMMING POOLS, Inc 2995 Sunrise Highway Islip Terrace, NY 11752 "Three Generations of Experience" 0#: 631-581-8258 Fax #: 631-581-8273 www.rongibbons.com RE: Sean Peters 191OBay Ave Mattituck, New York SCTM No. 1000 144 3 40.4 Swimming Pool Permit Applicati Enclosed is our complete application for an in -ground gunite swimming pool pen -nit. The following documentation has been included: Two applications, three surveys, three sets of stamped plans, insurance certificates, our Suffolk County License and the permit fee of $150. Th' ou for your cooperation or 0 for Construction Coordinator GENESIS_` Tho As5o,,Vation of r 'bof & Spa l"ro6cssionafs" M EM 0 E B Internationar assonUff ION October 19, 2005 Town of Southold A Building Department S 53095 Main Road AP e., PO Box 1179 Southold, New 6&`1-191 L JJ RE: Sean Peters 191OBay Ave Mattituck, New York SCTM No. 1000 144 3 40.4 Swimming Pool Permit Applicati Enclosed is our complete application for an in -ground gunite swimming pool pen -nit. The following documentation has been included: Two applications, three surveys, three sets of stamped plans, insurance certificates, our Suffolk County License and the permit fee of $150. Th' ou for your cooperation or 0 for Construction Coordinator GENESIS_` Tho As5o,,Vation of r 'bof & Spa l"ro6cssionafs" M EM 0 E B Internationar assonUff ION Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 February 5, 2009 Sean Peters 350 W 51 st St, Apt H New York, NY 10010 BUILDING DEPARTMENT TOWN OF SOUTHOLD Telephone (631) 765-1802 Fax(631)765-9502 . • 1910 Bay Avenue, Mattituck NOTE: our Building Permit for the swimming pool expired on 10/26/07. Please a fee of $150.00 for the renewal. TO WHOM IT MAY CONCERN: The following items are needed to complete your Certificate of Occupancy: v Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of $25.00 Final Health Department approval. Plumbers solder certificate (all permits involving plumbing after 4/1/84.) Trustees Certificate of Compliance. Final Planning Board Approval. Final Fire Inspection from Fire Marshal. Final inspection from the Building Department. Final Landmark Preservation approval. Building Permit: 31556-Z swimming pool Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 October 26, 2011 Sean Peters 108 Remington Rd Manhasset, NY 10010 BUILDING DEPARTMENT TOWN OF SOUTHOLD Re: 1910 Bay Ave., Mattituck TO WHOM IT MAY CONCERN: The Following Item(s) Are Needed To Complete Your Certificate of Occupancy: �. Application for Certificate of Occupancy. Enclosed � anc . pp p Y Electrical Underwriters Certificate. /A fee of $25.00. Final Health Department Approval. Telephone (631) 765-1802 Fax (631) 765-9502 Plumbers Solder Certificate. (All permits involving plumbing after 411184) Trustees Certificate of Compliance. (Town Trustees #765-1892) Final Planning. Board Approval. Final Fire Inspection from Fire Marshall. — Bob Fisher Final Landmark Preservation approval. BUILDING PERMIT: 31556 — Swimming Pool Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 May 1, 2012 BUILDING DEPARTMENT TOWN OF SOUTHOLD Sean Peters 108 Remington Rd Manhasset, NY 10010 Re: 1910 Bay Ave, Mattituck TO WHOM IT MAY CONCERN: The Fo llowing Items Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) V_11/ Electrical Underwriters Certificate. (contact your electrician) A fee of $25.00. Telephone (631) 765-1802 Fax (631) .765-9502 Final Health Department Approval. Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees # 765-1892). Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. BUILDING PERMIT: 31556 — Swimming Pool Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 January 16, 2015 HSA Holdings 108 Remington Rd Manhasset NY 10010 BUILDING DEPARTMENT TOWN OF SOUTHOLD Re: 1910 Bay Ave, Mattituck TO WHOM IT MAY CONCERN: I5 The Fo owing Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: S �a o /Application for Certificate of Occupancy. (Enclosed) V Electrical Underwriters Certificate. 07� �a A fee of $50.00. Final Health Department Approval. Plumbers Solder Certificate. (AII permits involving plumbing after 4/1/84) Trustees Certificate of Compliance. (Town Trustees # 765-1892) Final Planning Board Approval. (Planning # 765-1938) Final Fire Inspection from Fire Marshall. Final Landmark Preservation approval. Final inspection by:Building Dept. Final Storm Water Runoff Approval from Town Engineer BUILDING PERMIT — 31556 :- Swimming Pool Telephone (631) 765-1802 Fax (631) 765-9502 �. { •�n�r$.�y�iw7ray'M��?upn���'�� CONTRACTOR �q.�'tvti,��,�X ��n�5tr NAME RON A GIBBONS BUSINESS NAME RON GIBBONS SWIMMING POOL INC lw.n.r—b.r 8391-H Da ;uta 04!01!1983 EXPIRATION DATE 04101!2007 ��iS�tr�,�: ryj•4 kV .. n n ,� T b by a e h,. D.— I ........... his certifies that the Barer is duly licensed the County of Suffolk 7&- -/. Ca,tGrcr (or SUFFOLK COUNTY EXECUTIVE'S OFFICE OF CONSUMER AFFAIRS HOMEIMPROVEMENT ' CONTRACTOR LICENSE NAME RON A GIBBONS BUSINESS NAME RON GIBBONS SWIMMING POOL INC lw.n.r—b.r 8391-H Da ;uta 04!01!1983 EXPIRATION DATE 04101!2007 Suffolk County Executive's Office of Consumer Affairs airs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 1 788 DATE ISSUED: 4/1/1983 No. 8391-H SUFFOLK COUNTY Doyne Improvement Contractor License This is to certify that RON A GIBBONS _ doing business as RON GIBBONS SWIMMING POOL INC having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. NOT VALID WITHOUT DEPARTMENTAL SEAL AND A CURRENT CONSUMER AFFAIRS ID CARD Additional Businesses Director M1 New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 199 CHURCH STREET, NEW YORK, N.Y. 10007-1100 Phone: (888) 9973863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE RON GIBBONS SWIMMING POOLS INC 2995 SUNRISE HWY ISLIP TERRACE NY 11752 POLICYHOLDER CERTIFICATE HOLDER RON GIBBONS SWIMMING POOLS INC TOWN OF SOUTHOLD 2995 SUNRISE HWY — - - P. O. BO 1179 - ISLIP TERRACE NY 11752 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER I PERIOD COVERED BY THIS CERTIFICATE DATE G 785 065-4 248202 06/29/2005 TO 06/29/2007 8/10/2005 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 7850654 UNTIL 0612912007, 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 06/29/2007 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. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. 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 hdps:/Iwww.nysif.comtcert/certval.asp or by calling (888) 875-5790 U-26.3 VALIDATION NUMBER: 1008495734 OP ID C ACORD CERTIFICATE OF LIABILITY' INSURANCE RONGI-1 DATE (MMIDDIYYYY) 08/09/05 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION LTR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Coverage Associates Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 100 Comac Street, Ste 2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. LIMITS Ronkonkoma NY 11779 Phone: 631-277-5700 Fax: 631-277-5941 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Lexington Inauranee company 19437 INSURER B: Merchants Mutual Insurance Co 204 Ron Gibbons Swimming Pools Inc., etal, 2995 Sunrise Hwy Islip Terrace NY 11752 INSURERC: Scottsdale IrisuraIICe CO. INSURER D: State Insurance Fund INSURER E: First Rehabilitation Insurance 41LX64379121 COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYY) DATE (MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 0 0 A X COMMERCIAL GENERAL LIABILITY 41LX64379121 06/24/05 06/24/06 ISREMi's ES(Eao�cc rrence) $ 100,000 CLAIMS MADE Fi�r OCCUR MED EXP (Any one person) $ Excluded X,$2,500 PD DED. PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 , 00.0 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG s2,000,000 POLICY rX7 PEC 7 LOC B AUTOMOBILE X LIABILITY ANY AUTO CAP9256058 08/15/04 08/15/05 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) BODILY INJURY Per person) $ X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) X X HIRED AUTOS NON -OWNED AUTOS PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $1,000,000 C X OCCUR F—I CLAIMSMADE UNS0018045 06/24/05 06/24/06 AGGREGATE $ 1,000,000 $ DEDUCTIBLE X RETENTION $3.0,000 $ D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE 785065-04 06/29/05 06/29/06 TORY LIMITS ER E.L. EACH ACCIDENT $CERT TO E.L. DISEASE - EA EMPLOYEE $ FOLLOW OFFICER/MEMBER EXCLUDED? It yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ FROM SIF OTHER E Disability Benefit DBL108165 01/01/98 Satutory NY DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION TOMOF S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Town of Southold IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Town Hall Southold NY 11971 REPRESENTATIVES. ACORD 25 (2001108) / / / / O ACORD CORPORATION ✓F SURVEY OF FROPERTY q i LAnii rtJRG E�`p`ER R SITUATE: MATTITUCK j TOWN OF SOUTHOLD SUFFOLK COUNTY, NY n SURVEYED OI / 05 / q5 / AMENDED OI / 20 / q8 N FOUND. LOG. 04 / 22 1115 AMENDED 04 /:q8 / q8 —DyNR . �,`�Np, Jj D{RT DRIVE 6 FINAL Oq-24—q8 yiEOR. ) E ' + 5UFFOLK COUNTY TAX MAP LPND ,,HP tpyiELL Z 1000 144 5 40.4 s ii� CERTIFIED TO: _.G AS'l.a4a /_.,o, ,�mmtyY.°er� O t 11 I JOHN FRIZEMAN w47� r'2f RM L�2Dwtc. p. p �4 bJ• !.5Z M 66. GRAP14C SCALE 1" = 50' I _� :• � __,.".:_., ti - _``_ =:ter i +'mac �. � '�cn. -,. _-� -_ -�. • ' ua =:-� �- - -:,Z eo�.s to i,yr,�.,�1':rrtc::rd"N�RswatxNL-ugeracct ■ MONUMENT FOUND p STAKE WOODEN FENCE .--.. WIRE FENCE AREA = 55,11q S.P. OR 1.55 ACRES wammnzeo aueretmn qr .ea,t,gn !q . s Ne„ rvn state Ed—t— Ll. mr� [q n, m1 er,wnal qa !nn eg +e(naa r,q,nq] q v lane s cco.:y 1211 ;nev ee ca^veerae ro oer.ai:el�re. Ler:, l,ca[+gne , O regn s+p^+!v [nae tn:e g Cgee o e�—0 rrLanleSur.eis^aq[e:ee 5tetc[e ,at+vn o nal Lanea� Sa,e cert l',cet,an! •na]lar Onl. enelgim.... [ ,tle [q cal aglnc _a�r'SemVug ,na t,lul+gn 1,611. —.c. ane V S. LIC. 140• 50202 1 REFERENCE H 97-0109 It JC2 0 4 FT CHAIN LINK FENCE TO NYS CODE WITH SELF CLOSING AND LATCHING GATES POOL N 10110 cn J V� .-� 'j f 1 PROPOSD 20 X 40 �. SWIMMING POOL —Ali . • or �4 sits Q -T.) A b c o e F c �f-A up. 1 11/1�aoo 20x40 20 40 10 20 to V/2 b bco --- rt;A+4 t � s ?stl r Q 3 - a 4 t•&-9 r, f -A ,{ JE LL I R c I . 9tG7mr o,G . t QA p �v'i VA [lil> \ G' Tb 'rt' 1 r U--, t'k-�C L:JP a..1 t-. P- C. VIAL,-, OETA! lj o�wo 01 F44 lj�,X L 0- I rV'AI .,reg .t.1're A P P R 0 7V D P".W,4T`T 51D ODATE: "0:2K B. P. # R_ NOTfFY BUILDING L ` „PTMENT AT 765-1802 8 AM TO 4 PMI FOR THE L FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUII= ED FOR POURED CCNCRETE - .uvaJ 2. ROUGH - FRAMING & PLUMBING 3. INSULATION 4. FINAL - CO^'FT�1,1-! ;TION MUST BE COMPLE? r '70n C.O. ALL CONSTRUCTION SHALL MEET THE O REQUIREMENTS OF THE CODES OF NE YORK STATE. NOT RESPONSIBLE FOR _ DESIGN OR CONSTRUCTION ERRORS. - COMPLY WITH ALL CODES OF 5E lot -1 NEW YORK STATE & T0W[', kCODE .^JS O ASRE", D � t1t,J I tt i rATT /r,,•1i N.Y.Q. DEC { C wA- wf T Id- 0111y fit PLW f 4 © mitl. .4 co GA t., C.Acx-r;A� Ac 4 1Goo Cst. C.I{tiltY f-fe D �T1cx Uit, r31 Tf1v I t., U. cY ! x 1d 0. or 11, oo c-. t,- 2. y5,- "Of • x I'141 aA t. - �.10'-d"'¢�x titcr�. . I'14G GSL GAr`A44 T`f OF o1U -> rv� fr-, c", - h n cwt., G1eq 40 w� ntZA11r C-Cl� >, c act. c, --� - ' v � s w, nom. %# m -sy O st s i I�.. 4,: as rid- ! —Z M.• "e-wJ OC UPghL� USE IS UNLAWFUL WITHOUT CERTIFICATEI�,; OF OCCUPANCY PIPWG 5CHEMAnG ye) ? AC1L ALL CONSTRUCTION SK.�'. MEc - --'1i "RFMENTS OF T L CODES,,. STATE. cle,�-cq ccoe- fpr-v,G1✓ C-Ae)�� Cf - COLI f tE-t x161 Gnu-fXt Av ; I- F -.f -r,4 W '7C -r,. Fes¢ . T11,04 r; c 4 . c KCAL so1�Ec> I. ME Cr-* -4j N N-,�ce GJ A, sVjwvrr— �A Fx4w M fRui Vt£ to o Tr; qr fccA1lxrKxJ • %F G[czi>d Y-4 Tyll F1 r1r;fi x.7'!'ML3 6t OF Ct`u?s? �� YO f1`rCJ�Yi Fit cm Ty -V wm, Q• e�P vGtpt!tt"THV3-41-o'crg • �6iw1 rL 'fir i'�.L tL A I. 4-n r V) rd 1k ..V,. CfVo&AX,AAumy". � K� f c�.,t, G.�4t2i Ftl E-1 silt �,t•�f �• f1c,r01-m rpw/ dna,, U t 4 tiaaG7 . • iFI LL Ifs' to te, s e in A 1#2' !'t G'lr !ttn,�ll l� 'i�Dur (rILO(i 14.7►fi UvL M A T-rn T J G1C. , r-41 Y. RONALD C. HANNA G 1f�J'j 0t-17 PQN..x>0 "c- ?99� �vr�.4a� Hwy N/G. "o- ARCHITECTI i 761 COATES AVE. SUITE 1S 16r- 1 HOLBROOK. K.Y. 11741 931 265 • 7970 to-�- 05 5Yr)NStYSING POOt� O�TA�� �uF • nQi�1 r�lgcc 11, be >�,. o'fAj-- r;.crr1 rat M•ac G•Oc 19 • oc E,&c rt V. k j C wA- wf T Id- 0111y fit PLW f 4 © mitl. .4 co GA t., C.Acx-r;A� Ac 4 1Goo Cst. C.I{tiltY f-fe D �T1cx Uit, r31 Tf1v I t., U. cY ! x 1d 0. or 11, oo c-. t,- 2. y5,- "Of • x I'141 aA t. - �.10'-d"'¢�x titcr�. . I'14G GSL GAr`A44 T`f OF o1U -> rv� fr-, c", - h n cwt., G1eq 40 w� ntZA11r C-Cl� >, c act. c, --� - ' v � s w, nom. %# m -sy O st s i I�.. 4,: as rid- ! —Z M.• "e-wJ OC UPghL� USE IS UNLAWFUL WITHOUT CERTIFICATEI�,; OF OCCUPANCY PIPWG 5CHEMAnG ye) ? AC1L ALL CONSTRUCTION SK.�'. MEc - --'1i "RFMENTS OF T L CODES,,. STATE. cle,�-cq ccoe- fpr-v,G1✓ C-Ae)�� Cf - COLI f tE-t x161 Gnu-fXt Av ; I- F -.f -r,4 W '7C -r,. Fes¢ . T11,04 r; c 4 . c KCAL so1�Ec> I. ME Cr-* -4j N N-,�ce GJ A, sVjwvrr— �A Fx4w M fRui Vt£ to o Tr; qr fccA1lxrKxJ • %F G[czi>d Y-4 Tyll F1 r1r;fi x.7'!'ML3 6t OF Ct`u?s? �� YO f1`rCJ�Yi Fit cm Ty -V wm, Q• e�P vGtpt!tt"THV3-41-o'crg • �6iw1 rL 'fir i'�.L tL A I. 4-n r V) rd 1k ..V,. CfVo&AX,AAumy". � K� f c�.,t, G.�4t2i Ftl E-1 silt �,t•�f �• f1c,r01-m rpw/ dna,, U t 4 tiaaG7 . • iFI LL Ifs' to te, s e in A 1#2' !'t G'lr !ttn,�ll l� 'i�Dur (rILO(i 14.7►fi UvL M A T-rn T J G1C. , r-41 Y. RONALD C. HANNA G 1f�J'j 0t-17 PQN..x>0 "c- ?99� �vr�.4a� Hwy N/G. "o- ARCHITECTI i 761 COATES AVE. SUITE 1S 16r- 1 HOLBROOK. K.Y. 11741 931 265 • 7970 to-�- 05 5Yr)NStYSING POOt� O�TA��