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Home My WebLink About39209-Z�$,"c�u�F�4�c Town of Southold P.O. Box 1179 53095 Main Rd ,gjn� ` � Southold, New York 11971 7/23/2015 No: 37676 hate: 7/23/2015 THIS CERTIFIES that the building IN GROUND POOL Location of Property: SCTM #: 473889 Subdivision: 2405 Arbor Ln, Mattituck Sec/Block/Lot: 113.-7-24 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 9/11/2014 pursuant to which Building Permit No. 39209 dated 9/24/2014 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 of the aforesaid building. Granshaw, Edward & Granshaw, Mary ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 39209 07-14-2015 Aut6/fzed Vgnaturi (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 39209 Date: 9/24/2014 Permission is hereby granted to: Edward & Granshaw, 2405 Arbor Ln 7 Mattituck, NY 11952 construct an accessory essoi, ,gfoui1d swimming ;Fool, fenced to code At premises located at: 2405 Arbor Ln. Mattituck SCTM # 473669 Sec/Block/Lot # 111-7-24 Pursuant to application dated 9/11/2014 To expire on Fees: 3/25/20160 and approved by the Building Inspector. SWIMMING POOLS - IN -GROUND WITH FENCE ENCLOSURE CO - SWIMMING POOL Total: Building Inspector $250.00 $50.00 $300.00 Foran 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 - $10000 - - - --- 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. —7-03-15 New Construction. LCD? Old or Pre-existing Building: (check one) Location of Property: Z/017 Xd40®,-e 64AWe 1,fti y'/ TIZ6 House No. Street Hamlet Owner or Owners of Property: C-11 110SNI, Suffolk County Tax Map No 1000, Section , / Block % Lot a 4 Subdivision Filed Map. Lot: Permit No. ?)9 0 Date of Permit. Applicant: Health Dept. Approval Underwriters Approval: Planning Board Approval. Request for- Temporary Certificate Final Certificate: (check one) Fee Submitted $ ApKicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 Fax (631) 765-9502 roger. richert@town.southoId.ny.us CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: M & E Granshaw Address: 2405 Arbor Lane City: Mattituck St: New York Zip: 11952 Building Permit #: 39209 Section: 113 Block: 7 Lot: 24 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Raymond Electric License No: 5141 -ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 Twist Lock Exit Fixtures 11 TVSS Other Equipment: In Ground Swimming Pool To Include, Bonding, 1-GFCI Circuit Breaker, 1- Salt Generator, 1- Pool Light Notes: Inspector Signature: 7.1 Date: July 14, 2015 Electrical 81 Compliance Form.xls oF so�ryo� ��co►►nm 0�� TOWN OF SOUTHOLD- BUILDING'DEPT. 765-1802 Ilk �Lo* �l ] 1 T6WN OF ,�OUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 Southolffown.Northl+ork.net PERMIT NO. 3qc;u9 Examined 7rc , 20 Approved , 20 Disapproved a/c. Expiration 20/A BUILDING PERMIT APPLICATION CHECKLIS` E C E� V E SEP 1 1 2014 BLDG. DEPT. TOWN OF SOUTHOLD A - Building Inspector Do you have or need the following, before applying' 13Q�rd of liealth tea..= 4 sets of Building Plans--- ,,'Planning lans_','Planning Board approval '—Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm -Water Assessment Form Contact: ��!!�� , Mail t� ) Y)"" 4-7), Phone: ° // 1 1 4177 7Z APPLICATION FOR BUILDING PERMIT Da �� , 2A___ 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 th. 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 pen -nit 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. 0—r t�� 91V«.� i (Signature of applicant or name, if a corporation) g� 6� rT�fM1fiti��fwa1-1ktUT CERTIFICATE J n F= ,n Ny It/ (Mailin addr seg s y�f �ppl' �n i l 1 � j"' � State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .?PRO 'ED AS NOTED Name of owner of premises If applicant is a corporation, signature of duly authorized officer 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS - 1 FOUNDATION - TWO REQUIRED (Name and title of corporate offf�, A x 79 Poll FOR POURED CONCRETE �'� - 1— U 2. ROUGH - FRAMING, PLUMBING, 5NCi_ 0 r (A-, L 'd O CODS Builders License No. STRAPPING, ELECTRICAL &CAULKING $��®l��°i��"' 3 INSULATION Plumbers License No. s_ 4 FINAL - CONSTRUCTION & ELECTRICAL Electricians License No. MUST BE COMPLETE FOR C 0 Other Trade's License No. of land on will be done: _ ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW HWORIJSTTE. NOT RE PON 1LE BFOR R CONSTRUC I House Number Street Hamlet County Tax Map No. 1000 Section Block �� Lot , ,.i - -1 r X__ 'XT- T .nt 2. State existing use and occupancy of premises and intended Uge and OCCUPECy Of pTOpOSCd COIlStrUCti0Y1: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Repair Removal Demolition Other Work In Estimated Cost (To be paid on filing this application) Number of dwelling units on each floor Fee Alteration (Description) 5. If dwelling, number of dwelling units 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 AG 12. Does proposed construction violate any zoning law, ordinance or regulation? YES N 13. Will lot be re -graded? YESNO 14. Names of Name of Name of Will excess fill be removed from premises? YES NO~�. No. ® 7` No a3T —2 No.I C�121_ 15 a. 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 BFk, 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 eing duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He is the �� D,¢/ (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. Sworn,ty before me thi +OF AW VW day of Notary Public Signature of Applicant Scott A. Russell SUPERVISOR SOUTHOLD TOWN HALL - P. O. Box, 1179 53095 Main Road - SOUTHOLD, NEW YORK 11971 CHAPTER 236 STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED .BY THE APPLICANT) )DOLES 'rH[IS PROJECT 'INVOLVE ANY OF THE FOLLOWING: (CHECIC ALL THAT .APPLY) 0 A. Clearing, grubbing,gradin or stripping of land. which affects more. than 5;000 square feet .of ground surface. ❑[, B. Excavation or filling involving'more: than 200 cubic yards of material within any, parcel or .any contiguous :area. a C. Site preparation on slopes which exceed 10 feet vertical rise to: 100 feet of horizontal -distance, ®� D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ®� E. Site preparation within the one -hundred -year floodplain as depicted on FIRM Map of any watercourse. ❑ F. Installation of new or resurfaced .im.pervious surfaces o ' 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 witir.ydar 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 completed .Check List Form to the Building. Department wit i -your Building Permit Application. APPLICANT: (Property. Owner. Destgn Professional„ Agent, Contractor, Other) �I;S;ME: (Prim i5igmt rd Caformation �� -rd,phe. Nu bh , I I ) II Property Address / Location of Construction Work: 1 FORM 4 SMCP -TO MAY 2014 S.C.T.M. *: 1000 Date: lQ� St Section Blockk Cot FOR BUILDING DEPARTMENTUSE ONLY **** i4 l Reviewed By: c -----Date—e---- — —— 1� Approvedfor processing Building Permit. Stormwater Management Control Plan Not Required. Stormwater Management Control Plan is. Requii°ed. (Forward to Engineering Deoai•tment for Review) Town Nall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765-1802 rocer.rlchertdfoxw(6n ltg76utn95oig.ny.gs *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ' 1� uald S(1Jimm- (Please Circle All That Apply) *Is job ready for inspecti®n: YES NO Rough In Final *Do -you need a Temp Certificate: YES N® *Service Size: I Phase 3Phase 100 150 200 300 350 400 Other iNew Service: Re -connect =Underground b:r of Meters Additional InforTnation: PAYMENT DUE WITH APPLICATION B2®Request fbr Inspectlon Form JOBSITE INFORMATION: (*Indicates required information) *Name: M&ry 'i EcL C r ar shamL *Address: a4dg ArVb -- Lip ,- LjCLWaf►, c k N y *Cross Street: erg Agelf So ve. � *Phone No.: to 31 2 5 — 240 Permit No.: aoq Tax -Map District: 9000 . Section: Block: 0 *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ' 1� uald S(1Jimm- (Please Circle All That Apply) *Is job ready for inspecti®n: YES NO Rough In Final *Do -you need a Temp Certificate: YES N® *Service Size: I Phase 3Phase 100 150 200 300 350 400 Other iNew Service: Re -connect =Underground b:r of Meters Additional InforTnation: PAYMENT DUE WITH APPLICATION B2®Request fbr Inspectlon Form Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 July 21, 2015 Edward Granshaw 2405 Anchor Lane Mattituck NY 11952 TO WHOM IT MAY CONCERN: Telephone (631) 765-1802 Fax (631) 765-9502 The Foll 'ng 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) 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 — 392709— Swimming Pool OWNER --- ----- ----- STREET 7 VILLAGE DIST. SUB LOT r�xy- ACR. 5,c)( REMARKS TYPE OF BLD. PROP. CLASS It 21�- 10 LAND IMP. TOTAL� DATE 19 7 34 A, f<. e v q o c, C, 11ba-loo-an FRONTAGE ON WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL �� ,� i(ti��i��, , Client#: 39819 RANDT ACORD, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/04/2014 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(les) 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 Southampton Commercial Cook Maran & Associates 300 Hampton Road NAMCONTACT Cook Maran & Associates A/CNNo Ext:631 283-8000 ac No): 631 287-2207 ADDRESS: cboumnaia@cookmaran.com INSURERS) AFFORDING COVERAGE NAIC # Southampton, NY 11968 INSURERA: Transportation Insurance Co. 20494 INSURED Fence King of Rocky Point, Inc. dba Swim King Pools & Patios INSURER B: Rochdale Insurance Co. 12491 INSURER C: Continental Insurance Company 35289 INSURER D: 471 Route 25A INSURER E - Rocky Point, NY 11778-8985 INSURER F : COVEROC;FR PCOTI IMP^ TL . - -- -- -- --- - • — •--...__• •• KCV ISIUN Numtst:K: 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 CONTRACTOR 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. INSR ADDLSUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDY EFF MMIDDY EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITYENTED 2094735072 0910112014 09/01/2015 EACH OCCURRENCE $1.000.000 WARMERa occurrence $100,000 MED EXP (Any one person) $6,000 CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX JECT X LOC PRODUCTS - COMP/OP AGG $2,000,000 C AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 2094735069 9/01/2014 09/01/201 EOMaBcINdEeD SINGLE LIMIT $1000'000 BODILY INJURY (Per person) $ BODILY IN(Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ B DED RETENTION $ WORKERS EMPLOY RS' LI A ILITION ANDEMPLOYERS' LIABILITY OFFICERIMEMBER EXCLUDED, ECUTIVE� Mandatory in If yes, describe under N / A RWC3342508 9/01/2014 09/01/201 X WC STATU- OTH- E.L. EACH ACCIDENT $110001000 E.L. DISEASE - EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CFRTIFICATC ue%l nro Town of Southold 53095 Route 25 PO Box 1179 Southold, NY 11971 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 W IVtst%-ZU1U ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S625497/M625431 MH1 Certificate of NYS Workers' Compensation Insurance Coverage Page 1 of 2 STATE OF NEW YORK ^ NVQ COMPENSATION BOARD CRRTIFI\ .�ry ATF. , 1F IV VC Wn1DW1W1DCt �n1%X1DL'1lLTQ A TTIIAT TXTOTTTI A AT9`11- /'1/1f ]TT • s-ry --_ - la. Legal Name and address of Insured (Use street address only) -- a..v V L'l�t'1lSY� Ib. Business Telephone Number of Insured Randy T Rodecker, Inc. 631-744-8100 471 Route 25A RockyPoint, NY 11778 lc. NYS Unemployment Insurance Employer DBA: Swim King Pools Registration Number of Insured Id. Federal Employer Indentification Number of Insured or Social Security Number 113092960 Work Location of Insured (Only required if coverage is specifically limited to certain location in New York State, i.e. a Wrap- Up Policy) 2. Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Rochdale Insurance Company Town of Southold 50395 Route 25 PO Box 1179 3b. Poll Number of entity listed in box "la": � ty Southold, NY 11971 RWC3342508 3c. Policy effective period: 9/1/2014 to 9/1/2015 3d. The Proprietor, Partners or Executive Officers are: °tom included (Only check box if all partners/officers included) all excluded or certain partners/offlcers excluded i iris ceruues ulat me msurance carver indicated above in box "3" insures the business referenced above in box " la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York (NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certification of Insurance to the entity listed above as the certificate holder in box "2". The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment ofpremiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate (These notices may be sent by regular mail) Otherwise, this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c" whichever is earlier. Please Note: Upon the cancellation of the workers' compensation 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 Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. 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 the coverage as depicted on this form. Approved By: Henry C.Sible (Print name of authorized representative or licensed agent of insurance carrier) Approved By 7 9/4/2014 (Signature) (Date) Title: Underwriting Manager Telephone Number of authorized representative or licensed agent ofinsurence carrier. Card erPhone Please Note: Only insurance carriers and their licensed agents are authorized to issue the C-105.2 form . Insurance brokers are NOT authorized to issue it. C-105.2 (9-07) https://ao.amtrustgroup.comlanawelPolicyNYCertificateOf Wchis.aspx?IndexId=87991 &Ins... 9/4/2014 'r r �o M PUUKF P (-UN(-KL I t WALLS AND STEPS 2" Eo 4" SAND BOTTOM SECTION A PLAN 24 x 42 Rolling Lake SECTION B COPING AND (BY OTHERS) WATER LINE ROLLED FOAM BETWEEN LINER AND CONCRETE FORM TIES 3500 PSI POURED CONC. 2" RETURN LINE VINYL LINER 2" TO 4° SAN D 10° WALL SECTION LHtLF PUMP DRY.WI DIVER' VALVE FI LTER TO TURNS CHECK VALVE �PLUMBINGSC'HEMATIC NOT TO SCALE t�! RETAIN STORK! WATER RUNOFF �° 017 t. PURSUANT TO CHAPTER 236 NOTES � OF � z.r OF THE TOWN CODE. 1. ALLCONSTRVCTION 15 TO BE IN ACCORDANCE WITH THE RESIDENTIAL CODE OF NEW YORK --- -• STATE -2010 AND THE AN5I/NSPI-5-03 STANDARDS FOR RESIDENTIAL INGROUNDSWIMMING " " "' =t - - - •- .POOLS FORA TYPE II POOL, 2. STRUCTURE 15 DESIGNED FOR USE BELOW GRADE AND ONLY IN AREAS WHERE THE GROVND WATER TABLE IS A MI NIMVM OF 4'-8" BELOW THE PROPOSED FINISHED GRADE. 3, BACKFILL WITH CLEAN EARTH, FREE OF P0075AND DEBRIS. DO NOTALLOW THE HEIGHTOF BACKFILLTO EXCEED THE HEIGHT OFTHE WATER IN THE POOL BY MORE THAN V, ORTHE WATER TO EXCEED BACKFILL BY MORE THAN 8 4. PLACE CONCRETE ON SANDY TO LOAM SOIL. REMOVE ANY CLAY DEPOSIT AND COMPACT CLEAN BACKFILL. S. WALKS TO BE SMOOTH, NON SKID TYPE, SLOPED AWAY FROM POOL. 6. WATER DISPOSAL SHALL BE LIMITED TO OWNERS PROPERTY IN ACCORDANCE WITH LOCAL REGULATIONS. 7 PROPERTY OWNER 15 RESPONSIBLE TO INSTALL PERMANENT FENCE AROUND POOL IN ACCORDANCE WITH THE NYS BUILDING CODE, APPENDIX G, SECTION AG105. PERMANENT ENCL05VRE MVSTBE COMPLETED WITHIN NINETY DAYS AFTER THE DATE OF COMMENCEMENT OF CONSTRUCTION. B. THERE 15 NO MAIN DRAIN IN THIS POOL. SUCTION FOR POOL WATER CIRCULATION 15 PROVIDED BY THE SKIMMERS ONLY TH15 MEETS REQUIREMENTS OF RC-5ECTIONAG106 FOP, ENTRAPM ENT PROTECTION. 9 THI5 POOL SHALL BE EQUIPPED WITH AN APPROVED POOL ALARM WHICH 15 CLASSIFIED BY VNDERWITERS LABORATORY, INC TO REFERENCE STANDARD A5TM 2208 ENTITLED "STANDARD SPECIFICATION FOR POOLALARMS,"AS ADOPTEDIN 2008. 10, A TEMPORARY ENCLOSURE, OR4 FT FENCE SHALL BE INSTALLED AND REMAIN IN PLACE THROUGHOUT THE PERIOD OF CONSTRUCTION OF THE SWIMMING POOL OR UNTIL THE COMPLETION OF A PERMANENT ENCLOSURE, 11. POOL SHALL BEAR ON UNDISTURBED SOIL FREE OF PEAT, MUCK OR OTHER DELETERIOU5 MATERIALOFANY SIGN IFICANTAMOUNT 12. THE PRESUMPTIVE SOIL LOAD-BEARING PRESSURE 15 ASSUMED TO AS 2,000 POUNDS PER SQUARE FOOT, IN ACCORDANCE WITH TABLE R401.4.1, RCNYS. 13. THE MINIMUM COMPRESSIVE STRENGTH OF CONCRETE USED FOR WALL AND OTHER COMPONENTS OF THIS PRO) ECT SHALL BE 3,500 POUNDS PEP, SQUARE INCH. CONCRETESHALL BE AIR ENTRAINED, WITH TOTAL AIR CONTENT CPERCENT BY VOLUME OF CONCRETE) SHALL BE NOT LE55 THAN 5 PERCENTOR MORE THAN 7 PERCENT IN ACCORDANCE WITH TABLE R4022, RCNYS. 14. STEPS OR LADDERS SHALL BE PROVIDED AT EACH END OF POOL PER CODE. 15. IF THE SLOPE FROM SHALLOW END TO DEEP END 15 MORE THAN 1:7, A SAFETY ROPE SHALL BE PROVIDED WHEN REQUIRED. to O � LU U } VW z Z 0 Z Lno N n. W } QZ 00 Cf1 oC cl- cL W INA W % N�Z GVWZO ZLLIQ�N 1 = = � LLJ C4 W M OL.:W We- Q�J�� Q�r4 r Q CL. 1 9-3-2014 1 SURVEY OF LOT 8 FINAL PLA T THORNTON SMITH SECTION 2 FILE No. 10006 FILED MAY 23, 1997 SI T UA TED A T MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-113-07-24 SCALE 1 "=60' OCTOBER 29, 1998 APRIL 5, 1999 FOUNDATION LOCATION JULY 26, 1999 FINAL SURVEY AREA = 218,039.57 sq. ft. 5.005 ac. S.C.D.H.S. No. — R10-98-0165 4L TITLE INSURANCE COMPANY OF NEW YORK , Inc. JSHAW IAW UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK iIATE EDUCATION LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAT SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY, CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITI E COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI-- TUTION CERTIFICATIONS ARE NOT TRANSFERABLE. THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. —5640 56 ti��$ � p /110 app Zul St. sem,, R\G��51 1, �0) pr\ \gym°. � / WELL�y/ / „____ 8°• __"'. / ale' / / / / / / 2,253.95' s s� 'mss, F , , / / / 16g`'i / , 1819' / / s s s' 0s. F � Fo�00 S�P� 0 o O co 4�_ w m N m v 6'�o mo rn Q 0O X FOUND �9s�J�9�G2o WOOD STAKE F ~TF y FpppO n, y�0 •�FY FS's�\G -E� SURVEY OF LOT 8 FINAL PLA T THORNTON SMITH SECTION 2 FILE No. 10006 FILED MAY 23, 1997 SITUATE MATTITU C K TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-113-07-24 SCALE 1 "=60' OCTOBER 29, 1998 APRIL 5, 1999 FOUNDATION LOCATION JULY 26, 1999 FINAL SURVEY MAY 13, 2015 FINAL SURVEY ON POOL CER TIFIED TO: FIDELITY NATIONAL TITLE STG ASSOCIATES, Inc. EDWARD T. GRANSHAW MARY E. GRANSHAW UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. AREA = 218,040 sq. ft. 5.005 ac. S.C.D.H.S. No. - R10-98-0165 INSURANCE COMPANY OF NEW YORK CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. ,�p'4' ®" z ; .Y.S. Lic. No. 50467 —584 / 2,253.95' s s� 'mss, F , , / / / 16g`'i / , 1819' / / s s s' 0s. F � Fo�00 S�P� 0 o O co 4�_ w m N m v 6'�o mo rn Q 0O X FOUND �9s�J�9�G2o WOOD STAKE F ~TF y FpppO n, y�0 •�FY FS's�\G -E� SURVEY OF LOT 8 FINAL PLA T THORNTON SMITH SECTION 2 FILE No. 10006 FILED MAY 23, 1997 SITUATE MATTITU C K TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-113-07-24 SCALE 1 "=60' OCTOBER 29, 1998 APRIL 5, 1999 FOUNDATION LOCATION JULY 26, 1999 FINAL SURVEY MAY 13, 2015 FINAL SURVEY ON POOL CER TIFIED TO: FIDELITY NATIONAL TITLE STG ASSOCIATES, Inc. EDWARD T. GRANSHAW MARY E. GRANSHAW UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. AREA = 218,040 sq. ft. 5.005 ac. S.C.D.H.S. No. - R10-98-0165 INSURANCE COMPANY OF NEW YORK CERTIFICATIONS INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE THE EXISTENCE OF RIGHT OF WAYS AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED BY THE L.I.A.L.S. AND APPROVED AND ADOPTED FOR SUCH USE BY THE NEW YORK STATE LAND TITLE ASSOCIATION. ,�p'4' ®" z ; .Y.S. Lic. No. 50467 —584