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Home My WebLink About39250-ZTown of Southold P.O. Box 1179 53095 Main Rd Southold, New York 11971 CERTIFICATE OF OCCUPANCY No: 37629 Date: THIS CERTIFIES that the building IN GROUND POOL Location of Property: SCTM #: 473889 Subdivision: 4445 Hallock Ln, Mattituck Sec/Block/Lot: 112.-1-3.1 Filed Map No. 6/26/2015 6/26/2015 Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/25/2014 pursuant to which Building Permit No. 39250 dated 10/6/2014 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 Peix, J Douglas & Paoli, Robert of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 39250 06-23-2015 Au o ped gnature g�FFO( TOWN OF SOUTHOLD BUILDING DEPARTMENT y 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 #: 39250 Date: 10/6/2014 Permission is hereby granted to: Peix, J Douglas & Paoli, Robert 227 E 57th St Apt 3A New York. NY 10022 To: Construct an inground swimming pool, fenced to code as applied for At premises located at: 4445 Hallock Ln. Mattituck SCTM # 473889 Sec/Block/Lot # 112.-1-3.1 Pursuant to application dated To expire on 4/6/2016. Fees: 9/25/2014 and approved by the Building Inspector. SWIMMING POOLS - IN -GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector 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. New Construction: Old or Pre-existing Building: (check one) (� Location of Property: 41 q s twocg, ( MA41 (/V � House No. Street Hamlet Owner or Owners of Property: o uil f A S Suffolk County Tax Map No 1000, Section t ( 2- Block Lot t Subdivision 2 Filed Map. Lot: Permit No. 3 9 25S Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �� `� --1 -I -� i App a Si re Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 OF SOUj�,� �CDUNTI BUILDING DEPARTMENT TOWN OF SOUTHOLD Telephone (631) 765-1802 Fax (631) 765-9502 roger. riche rt(aD-town.southold.ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: -Douglas Peix Address: 4445 Hallock Lane City: Mattituck St: New York Zip: 11952 Building Permit* 39250 Section: 112 Block: 1 Lot: 3.1 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: VMD Tremat Corp. License No: 4684-E SITE DETAILS Office Use Only Residential X Indoor Basement Commerical Outdoor X 1st Floor New Renovation 2nd Floor Addition Survey Attic INVENTORY Service Only Pool X Hot Tub Garage Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 Twist Lock Exit Fixtures TVSS Other Equipment: In Ground Swimming Pool To Include Bonding, 4- Pool Lights, 1- Salt Generator, 1 -Electric Pool Heater, 1-20A GFCI Circiut Breaker Notes: 'Inspector Signature: Date: June 23, 2015 Electrical 81 Compliance Form.xls rjF SOpr�,�lo . couffm TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTIO [ ]FOUNDATION -1ST. [ ] ROUG LUMBING [ ]FOUNDATION 2ND [ ] 1 LATIAN [ ]FRAMING /STRAPPING [ FINAL � � [ ] FlREPLACE &CHIMNEY [ ]FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ]FIRE RESISTANT PENETRATION [ ]ELECTRICAL (ROUGH) [ ]ELECTRICAL (FINAL) [ ]CODE VIOLATION [ ]CAULKING el�IAO VQ. r DATE � � INSPECTOR OF SO(/jyolo Outm,� OF SOUTHOLD BUILDING DEPT. TOWN 765-1802 INSPECTION.'....-. [ ] FOUNDATION IST`' [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION- ]FRAMING/ NSULATION- ]FRAMING/ STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ , ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [J ELECTRICAL (FINAL) [ ] CODE VIOLATION '[ \] CAULKING REMARKS: . - .. . DATE INSPECTOR FIELD IIVSPEC'a' ON REPORT DATE COMMENTS FOUNDATION (IST) ------.....�,..;....-------- ' FOUNDATION (2ND) t4 �rA ROUGH FRAAl1NQ & y PLUMBING INSULATION PER N. Y. y STATE ENERGY CODE d see Ik `I FINAL _ . ADDI T IOM tlC0RMNfS - z rn -�}' z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWNfMALL 9OUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown.NorthFork.net Examined 20. Approved 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. R D C SEP 2 5 2014 BLDG. DEPT. TON!l�I OF SOUTHOLD Building Inspector Septic Form N.Y.S.D.E.C. C.O. Application ✓ Flood Permit Single & Separate Storm -Water Assessment Form . Mail toA 8 W stn kn ,1 v f- 1FCLM— Wi\ N I113v Phone:�g3 k 5 q " oic%D r' �I f' Ve U3 1 44s- 7LO3Ln APPLICATION FOR BUILDING PERMIT Date 4 I , 20 )J INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale -Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the,date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim, the Building Inspector may authorize, in writing, the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. CUpjc�s ICY 'bq-)L0-vgoojs , Inc. _ULVrya (Signature of applicant or name, f a corporation) %�� g 4 1� ailing address of applicant) T aF•- ,�• `��;.4' [)A !�- ip B.P. # State whether applicant is owner,lessee�Eagenf, arci�ec t3 Cengmeer, general contractor, electrician, p tuber or builder I y ., " F . ;,. BY _ ,,- -'',,-PARTMENT AT Name of owner of premises Ou �a fs;��S��r'r""T-11r5 � �� 4=��r��!�� ' i:'.,� AM TO 4 PM FOR THE r�i� 52. As on the tax roll or latest deed) i "'y ` t ; - N S: Ifapplica c o tion y authorized officer 1. FOUL,AItON - Ti V,)0 REQUIRED FOR POURED CONCRETE (N an tle of corporate officer) �a ; x ^0,, 2. ROUGH - FRAMING, PLUMBING, Bui ers cense o. 27822-44 IeEe E -P00 T O CO STRAPPING, ELECTRICAL & CAULKING ^GC�L TO CODE Plu be License No. 3. INSULATION Electricians License No. PIIPLETION 4. FINAL - CONSTRUCTION & ELECTRICAL Other Trade's License No.BEF WATER MUST BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE 1. Location of land on which proposed work will be done: REQUIREMENTS OF THE CODES OF NEW '- 4Lf S 110C.K Icwie �1a-bh +w CA( YGRK STATE NOT RESPONSIBLE FOR House Number Street Hamlet DESIGN OR CONSTRUCTION ERROR,) County Tax Map No. 1000 Section 2. Block Lot 3 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 91 — TeGfingLe (e) yu'r%_j Poo 1 3. Nature of work (check which applicable): New Building J� Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost Loi 51 00 0 Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Height Number of Stories Depth Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated _ �_' W 0 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. o Address 4445 -Ha (lacl_ Ju-vLC Phone No. ()qU u0ggt� Name of Architect i Address Phone No Name of Contractorb ox,lLofi k ?0615 , I n L Address 4rWy.- Phone No. V0 l tfL%S — - fa3 L.P Easfi I I% Ny 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetlans? *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 S-t FV f d �I0 R I- GV_- being duly sworn, deposes and says that (s)he is the applicant (Name of individual signink contract) above named, (S)He is the Cove k'rA (,Lcv�' (Contractor, 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. 1-7 Swom to efore me thi day of � 4 ,.' 20 Public dNew Yo*( /v /,Aignat 6 of pplic Na 01"118299986 Cwmflulon WuMo n aL John M. Bredemeyer III, President Michael J. Domino, Vice -President James F. King, Trustee Dave Bergen, Trustee Charles J. Sanders, Trustee September 11, 2014 Mr. J. Douglas Peix PO Box 1444 Mattituck, NY 11952 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD RE: J: DOUGLAS PEIX 4445 HALLOCK LANE, MATTITUCK SCTM# 112-1-3.1 Dear Mr. Peix: Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 R E C E 0 V E F- - SEP 2 5 2014 BLDG. DEPT. TOWN OF SOUTHOLD The Southold Town Board of Trustees reviewed the survey last dated May 14, 2014, and determined the proposed swimming pool is out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and Chapter 111 of the Town Code. Therefore, in accordance with the current Wetlands Code (Chapter 275) and the Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, or within 160 -landward from the top of the bluff, without further authorization from the Southold Town Board of Trustees pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such precautions may include maintaining. adequate work area between the tidal wetland jurisdictional boundary and the coastal erosion hazard area and your project or erecting a temporary fence, barrier, or hay bale berm. This determination is not a determination from any other agency. 0) If you have any further questions, please do not hesitate to call. Sincerely, John M. Bredemeyer III, President Board of Trustees JMB:amn Scott A. Russell ,��°suF� SUPERVISOR ca SOL7THOLD TOWN HALL - P. O. Box 1179 1b 53095 Main Road - SOUTHOLD, NEW YORK 11971O��eOr 55TO][ IM[WA\TlEIK MAIN-4NAG]EAMI ENT Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET Yes I No ( TO BE COMPLETED BY THE APPLICANT) DOES THIS PROJECT 11WO]LVE, ANY OF THE FOLLOWING: (CHECK .ALL THAT APPLY) Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. Site preparation within the one -hundred -year floodplain as depicted on FIRM Map of any watercourse. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tag 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 completed Check List Form to the Building Department with your Building Permit Application. APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) r NAME: 7/ '' ``�'RI Contact Informatio - U I ` f `t ` lY 3lP tEEJ) V �'I Mlph N..b.)/ — — — — — — — — — — — — — — — — Property Address / Location of Construction Work: 4LI 45 'N4 11 a 52 FORM # SMCP - TOS MAY 2014 T.M. #: 1000 Date: District 117— 1 3.1 9� 2eY 1 Section Block Lot **** FOR BUILDING EPARTM USE ONLY **** Reviewed By. Da e: - Approvedfor processing Building Permit. Stormwater Management Control Plan Not Required. riStormwater Management Control Plan is Required (Forward to Engineering Department for Review.) Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 `o ny usOrogerrichertw BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: 111iVCL-W7— /14��5 Company Name: VIVI 4-:3 Name: IM i Z4 ' i� / IJ V No.:. (/0 3 /— 7 k7_ ? 2. ? JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone: No.: . Permit No.: Tax -Map District: Date: /o/ a,2 - / - 4 u� VC y -tuuu Section: // r Z *BRIEF DESCRIPTION OF WORK (Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: *Do -you need a Temp Certificate: Temp Information (If needed) *Service Size: 1 Phase *New Service: Re -connect Additional Information: 3Phase 100 Underground Number of Meters Change of Service PAYMENT DUE WITH APPLICATION //2 Block: -- Lot: YES NO Rough In Final YES NO 150 200 300 350 400 Other Overhead .82=Request for lnspec6on Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 June 15, 2015 J. Douglas Peix 227 E 57" St, Apt 3A New York NY 10022 BUILDING DEPARTMENT TOWN OF SOUTHOLD Re: 4445 Hallock Lane, Mattituck TO WHOM IT MAY CONCERN: Telephone (631) 765-1802 Fax (631) 765-9502 The Following Items (if Checked) Are Needed To Complete Your Certificate of Occupancy: Application 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 4/1/84) lr--trrustees 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 — 39250 — Swimming Pool TOWS ::LD. � : ; . 0PET--.DECD CARS r. OWNER STREET ;°<�'r� �!� VILLAGE DISTRICT SUB. LOT Da 2Ix FGRN1tR OtirNk N L_ .SO U 6 d E ACE J Ii�?i i�j �I1rYr`irJi� S Vel TYPE OF BUILDING i-IGYCi�a pa i., 1,]tE Z a RES. SEAS. VL. FARM COMM. I IND. C13, I MISC. j LAND �t�l I IMP. j TOTAL DATE REMARKS v o V1 Z11 D .7h, Z 1741 $d L D 41c' 6 a �?.�1�f ✓-�4 -7,/ ? ! !1 �✓'t S �[ { 'r •_`7i5 i i \ . L� r iG� irk /_':rra Cl; ..�' f.;;7 • ' ' �. -�, -: �� 1 LJ B.�SI I C Dl� f� �y X11 95 ,-•;t.a,/,�.a; arm�� cre 4 �( ue er re kake 'jam `rt 4e '` Til [able 1 0" Tilldble 2 Tillable, 3 Mlcc-d land j -- LP Pa 0 ! 47 Swampland __. `• Q 3 P 30 31 win doves Oars 0 Brushiand House Plot. . v- - = -=U : ✓SGC. To ±c t 6 ell M. Bldg. e7 Ile . _o = G ^ v o „� t! o 'f I' ,Foundation Bath Extension I Basement Floors " Extension / t. Walls WOOD interior Finish f■■■iH■iH■i■■H�■■ / IH■■■■iHi■■■i■ Fire FINK �� t�l� Heat 9 _ �G/� �� PbKcn N■HHN■ Attic Porch Rooms ] st Floor ■■■■i1■■■N■■'r■■■iN MESE [MEN Patio \ HH■■H■ Garage /.�� X � �.�'� J MKIN"=MENNOMMIN � � D Driveway � ME Ii■i■Hi�t■■■HSI ■NJ��i■�■ �ia�■■■tiHl ■■■N0L"M..�■�®■■w M. Bldg. e7 Ile . _o = G ^ v o „� t! o 'f I' ,Foundation Bath Extension I Basement Floors " Extension / t. Walls WOOD interior Finish t / Extension Fire FINK �� t�l� Heat 9 _ �G/� �� PbKcn Attic Porch Rooms ] st Floor J Breezetivoyl Patio \ Rooms grid Floor Garage /.�� X � �.�'� J i � � � D Driveway � 0. B. 3..� mit--��i—'- i�■■■!! ��? lc=a"� Jr. t� aii I l ��,�j1 �'�� k i l.' �■■!■ ■!�. gig f ■■!!!!! t a ■■NllOK■ IMMINIMINKM ` ■■■■..■ m New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300. CERTIFICATE OF WORKERS' COMPENSATION INSURANCE A "AAAA 010647086 DAKOTA POOLS INC 48 WANTAGH AVENUE EAST ISLIP NY 11730 POLICYHOLDER DAKOTA POOLS INC 48 WANTAGH AVENUE EAST ISLIP NY 11730 CERTIFICATE HOLDER TOWN OF SOUTHOLD 54375 MAIN ROAD PO BOX 1171 SOUTHOLD NY 11971 POI 1382 NUMBER CERTIFICATE 655 NUMBER I PERIOD OCOOVE 094 TO 04 HI01/2015S 19/2D3 T14 E THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1382 932-0 UNTIL 04/01/2015, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 04/01/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. EXECUTIVE EXCLUSION STEVEN YONICK PRESIDENT DAKOTA POOLS INC 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 hftps://www.nysif.com/cert/certval.asp or by calling (888) 875-5790 VALIDATION NUMBER: 546803580 U-26.3 Akr�OVT'll 1- I Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 11/10/98 No. 27822-H SUFFOLK COUNTY Dome Improvement Contractor License This is to certify that STEVEN C YONICK doing business as DAKOTA POOLS 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 DEI'ARTMEN 'Al, ,SEAL AND A CURRENT CON-5kryIER AFFAIRS 1D CARD Additiorial Businesses Director SOLi� I �jD rJl �l lER _ ISLAND ff lam' LONG \2g.85� N�s•59'�9"E rE "` SURVEY OF PROPERTY AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-112-01-3.1 .,� SCALE, 1'-30' Botta' °F APRIL 8, 2014 MAY 14, 2014 (Revisions) N � - 0. i VBJ FF s>avf w� 0. t� I Q, - z �R K i• • S,LB o y' c i% S +i BNA T oxelk' N , r 0 -:A GRAVEL v or- SEP - 9 2014 AREA -84,841 SO. FT. EXCEPT AS PER SEC7701V 7209-SUBDIWSION 2. ALL CEHMIUAIIUVJ P.O. BOX 909 TO TIE LINE HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF 1230 TRAVELER STREET=06 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR SOUTHOLD, N.Y. 11971 WHOSE SIGNATURE APPEARS HEREON. sKED syj F � Q �lr F oa, V. �L .4• J� JN\ t ` ` wa i m GARP ` zp5 J� J� Pay ' - \ SSS m- V,c. gSP ssao E by jPaJs NPRgE i N'� � � • ANY AL?7_, i9no()c SURVEYR ADD1770M TO THIS 774p NEW YORK STA EDUCAHON L W.ON H PECO (631) 71 SEP - 9 2014 AREA -84,841 SO. FT. EXCEPT AS PER SEC7701V 7209-SUBDIWSION 2. ALL CEHMIUAIIUVJ P.O. BOX 909 TO TIE LINE HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF 1230 TRAVELER STREET=06 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR SOUTHOLD, N.Y. 11971 WHOSE SIGNATURE APPEARS HEREON. H. ROY JAFFE, P.E. 82 EAGLE CHASE, WOODBURY, kY. 11797 516-364-0148 FAX 516-364-0158 Sept. 19, 2014 .-. __._Town.._.of S.ou_thold_. _.._.._. _ .........._......_._ Dear sir: I : o.: This 'is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of Peix 4445 Hallock Lane Mattituck, NY 11952 .will not require draining because the pool is constructed with a vinyl liner. 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 and will not interfere with the public water supply, 'the'existing sanitary facilities or public highways. The-' proposed pool• measures 70 The soil disturbance will be about 3 kg Ir square feet. Since this less than 5,000 square feet,as outlined in your Storm Water Management code,:,no drywell,is required. Very truly yours, -F NFA, y H: Roy Jaffe, P.E. 0474'70 C�= ��pAOFESSIONA�'�� pu'CnVoVS concRET'E RaivRvd \ Of- 3 :coli AR caws srge .4.uccF p'' K - )RAl*{S. E -2p M1L MIN. too SLOPE DEaVTERRAI AWAY 1'Ftl�i POOL GLS OC^4r PLAN VIEW O(�- POOL "�^ _ STEEL ANGLE - GnS1P.R AT 900LrE-VtfE 4Z n•2 r - ' l o �-- _ o N L0N'-0TU0tNA !-SECTiON CO - uvo✓rrrvEv E.uQrx� � � 047470 :3/47-SIST PIPE _ AT EVERY STRAiGar-PANEL � PAM - TH'D RUD Peix- � 4445 Hallock ,lane 80nj ENDS Mattituck, ,NY 11952 ba,X >R TE COLLARL t-+�K_ 2-4'4t 6" SEP 2 5:2014]"--,_ BLDG. DEPT. liORlZ- BRACE TOWN OF SOUTHOLD I.5- X 2t x 27' ~A~ FRAME DETAIL STAKE !-5 X 1. 5; X 24 - 14 CA. REV 1 5 E D &J33 I i_ N O Y J A F F E, P_ E_ C90L AND PROPERTY TO ca4fF c f j To N_ Y- STATE RESZDENt� SDCTION Gi06 NDE APPaUD( G 2010 EDITION ENTRAPMENT PRCf=ION RDQUIRED POOL TO OQgOF� 'm 1vZSi/Nspl STANDARDS AG103.1 SFSGTION 6107 POOL ALARM REQUIRED _