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,�0 S : Town of Southold 9/2/2015 - : t% ` P.O.Box 1179 cf.,Go a 53095 Main Rd X401 -19 ° Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37759 Date: 9/2/2015 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1905 Fairway Dr, Cutchogue SCTM#: 473889 Sec/Block/Lot: 109.-5-14.20 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 4/3/2015 pursuant to which Building Permit No. 39659 dated 4/8/2015 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is: accessory in ground swimming pool with fence to code as applied for. The certificate is issued to Weber Jr, Robert&Weber,Patricia of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39659 5/27/2015 PLUMBERS CERTIFICATION DATED r f Au ,'o i d Signatu TOWN OF SOUTHOLD /NS, BUILDING DEPARTMENT zeze; TOWN CLERK'S OFFICE o eg 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#: 39659 Date: 4/8/2015 Permission is hereby granted to: Weber Jr, Robert &Weber, Patricia 24 Sunset Dr Manhasset, NY 11030 To: Construction of in-ground swimming pool as applied for. At premises located at: 1905 Fairway Dr, Cutchogue SCTM # 473889 Sec/Block/Lot# 109.-5-14.20 Pursuant to application dated 4/3/2015 and approved by the Building Inspector. To expire on 10/7/2016. Fees: IN-GROUND SWIMMING POOL $250.00 CO - SWIMMING POOL $50.00 ELECTRIC $100.00 NibTotal: $400.00 Building Inspec 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 cqmpleted 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 r Pre-existi Building: V (check one) Location of Property: l 90 S' /rIA-//4f/lJv� a/JO- yam= House No. / Street Hamlet Owner or Owners of Property: r,her F a 474 c4- Suffolk County Tax Map No 1000, Section l£q Block Lot / 4 • g° 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: $ ff(/ (//4 Applicant Signature �ii�*®F SO14,, I Town Hall Annex �� l® : Telephone(631)765-1802 ,� 54375 Main Road i * 41 Z Fax(631)765-9502 P.O.Box 1179 ; c z � roger.richert@town.southold.ny.us Southold,NY 11971-0959 : .c' �® �� - cour,� �'''� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Robert Weber Address: 1905 Fairway Drive City: Cutchogue St: New York Zip: 11935 Building Permit#• 39659 Section. 109 Block: 5 Lot• 14.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Kel-Rob Electric License No: 37725-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 Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: In Ground Swimming Pool To Include - Bonding, 1- Control Panel, 2-GFCI Circuit Breakers,Gas Pool Heater,2-Pool Lights, Pool Cover Motor Notes: ,,,qInspector Signature: i, C -' Date: May 27, 2015 Electrical 81 Compliance Form.xls � p SO( �o ,, ,`o3 to ; G `Q i COUtiO 0'1TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 , r / iNSPECTION FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE.SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: c)v._*zAicr4 DATE INSPECTOR /i39' 50--vi 2_ (C%\ * *1 Pe'I v TOWN OF SOUTHOLD BUILDING DEPT. ' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 4<--4"L___ co Etea, _ Gi . DATE OP INSPECTOR FIELD 319.64C7XeNIMORT DATEC01vIl12I�PS3 . FOUNDATION(1ST) 1MINIIIMMIll 1 • cA FOUNDATION(2N • D) - . •� • — ° ' c4 ROUGE!FRIG& ' . ill —P.(j\ y PLUIYIBXNG '‘'.7 . • • INSULATION bEIt N.?, - • H STATE ENERGY COVE • . . A I _ . , MIIIPPF- • VAIN / . .� "' : '' • ' : . . . ,. , . / I .. ,• .JY l' ' FINAL ' • 7 1. . . • . . •• INN . ' 1 afire '''•ry. 471:ti-.Ts . r. an-0 i 1111 iC.. . X . • f 2O, • 1 ' . .. ., .. .' .. ... . ' Ci '2 . 1 g • . . • . , ... .:. .. . . ._ . . . . . . .., . ..1 .. . ____.i4 • . • • . . . . . G---0 . . . .. . . • z . .• .., ." . . . . . .. . . • • ___ ____ f 1. .I BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO.`�jq6 2 Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined ,20 Single&Separate I Storm-Water Assessment Form Contact: Approved ,20 ( Mail to: Disapproved a/c Phone: 5I!o 7 a-9 -- jg Y 7 Expiration /0 .F.-- ,20 /� � . 1... .... h......_ Building Insp1 cto A:`,4 ©2 •'fill'PL ' ION FOR BUILDING ' . ' IT Gf DG DEPT _ Date (/ / d , 20 [0 /N OP _OEmO D 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,hous. code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. 6e./4.2 (Signature of applicant or name,if a corporation) fy cc„,,G/,),. ii 4tr1c-/ NY, (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder Name of owner of premises o h1L We L A ;z4 k/att. (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer Builders License No. 26 L 9D--1-f 14 o/J.u6.r/12 Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land which proposed work will be done: 90 5 /-a r f� CJc—h f House Number 'Street Hamlet County Tax Man No. 1000 Section /0, Block S T,ot `q, j-CJ 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 P0,6 / /A/ifA--///f'�/oic/ 3. Nature of work(check which applicable): New Building Addition Alte ti n Repair Removal Demolition Other Work ,0 f /f/I"/-/d r/ 1' (Description) 4. Estimated Cost S Do0 - 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 Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front 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 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 Pb o Address Ataktvoi ,tie Phone No. 3/- 5-kr—Pi 2 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 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. CYNTHIA A WORSDALE STATE OF NEW YORK) Notary Public-State of Now York No.01WO8301872 : Qualified Ib SIk County COUNTY ' S 1Vly Com ion ,Apra al,2018 ' /}�4- 6416g-- being duly sworn, deposes and says that 62)e e is the applicant (Name of individual signing contract)above named, e,is the On.,/u e_r (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 to before me this /S-1- day of pvvf 20 / S Y', '� suifcL� . ST(0)RM[WAT)ER - Scott A. Russell ��,oj�� 4 � SUPERVISOR z t M[ANA(G!]EM[JEN T SOUTHOLD TOWN HALL-P.O.Box 1179 a - ' Town of Southold 53095 Main Road-SOUTHOLD,NEW YORK 11971 L�'��0.14,-p � Jfi� ���'t''�� CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: Yes NO (CHECK ALL THAT APPLY) i ❑Ign A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑El B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. , ❑ C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. . ❑II D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑[4E. Site preparation within the one-hundred-year floodplain as depicted - 1 d- - ori FIRM-Map=of-a-ny-watercourse.-- ---❑ F. 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 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 with your Building Permit Application. ' APPLICANT: (P rty Owner,Design••,••fessio.al,Age t,Contractor,Other) S.C.T.M. #: I OOO Date District NAME_ �' L `:� r�iO /o% S /L-A-0/-P Li-2-/5' Section Block Lot `" FOR BUILDING DEPARTMENT USE ONLY -_ " Contact Information 94 reie,�,on��umeer, - Reviewed By: Date: 1(4-1 1 Property Address / Location o Construction Work: fy'' r' Approved for processing Building Permit. / / OS- J /1-41/CA-4i7 / — /t'S --Stormwater Management Control Plan Not Required. e“I e-Ao LcLJ / ` 7�r ❑ Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review.) FORM # SMCP-TOS MAY 2014 +,}'�,o��OF S j,, - ' . O Town Hall Annex SIP - * Telephone(631)765-1802 54375 Main Road ; co ,, ,a� 7�.� QQ22 P.O.Box 1179 Q �+ rOger.richertdtown S1) 0 5.ny.US Southold,NY 11971-0959 oc"O X11 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: 6.1, 6ral te Date: 5/ 121, Company Name: 14 e. I- Rob e (I- Name: B1/4,6- 1) i(-r ,c9 r a • License No.: .3-1�a _ Nes.' Address: (915i QCSwns-k 1'kwj -1OQ 3 �r(s�1LJy l/1616 • Phone,No.: . G.�I - (-1 I - JOBSITE INFORMATION: -(*Indicates required information) *Name: ( e (f- lid doer _ *Address: 1q°S Fwi(way 1- (i YC. I CL4c),0 Ut - /Nit 11 93 *Cross Street: e'.e a d-s 1? 'Phone No.: 6-al- 4'41-1- $LI1 y permit No.: (,5'Gj Fax-Map District: 1000 Section: l 09 - Block: 5 Lot: J 4. BRIEF DESCRIPTION OF WORK(Please Print Clearly) - SLA-li'mmi e0 j Please Circle Alf That Apply) Is job ready for inspection: y(0/ NO Rough In Fin Do.you need a Temp Certificate: YES! 1,0 - - emp.Information (If needed) Service Size: 1_Phase 3Phase 100 150 200 300 350 400 Other New Service: Re-connect Underground Number of Meters Change of Service Overhead ►dditional Information: - ` PAYMENT DUE WITH APPLICATION 82-Re uest for! e a "- 6? q nsp cfion Form STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la.Legal Name and Address of Insured(Use streetaddress only) lb.BuslnessTeiephone N umber of Insured KEL-ROB ELECTRIC INC 631-981-1889 1c NYS Unemployment Insurance Employer Registration Number of Insured 2188 NESCONSET HIGHW AY#109 STONYBROOK, NY 11790 id.Federal Employer identification Number of Insured or Sodal Security Number 421589586 2 Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being listed asthe Certificate Holder) ShelterPoint Life Insurance Company Town of Southold 3b.Policy Number of Entity listed in box"fa": 54375 Main Road DBL288401 PO Box 1179 3c Policy effective period: Southold, NY 11971-0959 12/14/2014 to 12/13/2015 4.Policy covers: a. El All of the employer's employees eligible under the New York Disability Benefits Law b.® Only the following dassorclassesof the employer'semployees 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 N YS Disability Benefits Insurance coverage as desixi bed above. Date Signed 4/1/2015 By (Signature of insurance carrier's authorized,representative or NYS Licensed I nsurance Agent of that insurance carrier) Telephone N umber 51.6-829-8100 Title Chief Executive Officer I NI PORTANT:If box"4a lsthedced,and thief orm assigned by the insurance carrier'sauthorized representative or NYS Licensed Insurance Agent of that carrier,thisoertif irate is COM PLETE M ail it directly to the certificate holder. If box"4b"isdtedced,this certificate is N OT COM PLETE for the purposes of Section 22D,Subd.8 of the Disability Benet its Law. It mus be mailed for completion to the Worker's Compensation Board,DB PlansAcceptano:Unit,328 State Street,Schenectady,NY 12305. PART 2.To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board,the above-named employer hascomplied with the N YS Disability Benefits Law with respect to all of hi eller employees Date Signed By (Signature of NYS Worker's Compensation Board Employee) Telephone N umber Title Please Note:Only I nsurance carriers licensed to write NYS Disability Benefits insurance poi ides and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form D B-120.1.I nsuranoe brokers are NOT authorized to issue this form. DB-120.1(12-13) STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1a Legal Name and Address of Insured(Use streetaddress only) lb.Business Telephone Number of Insured KEL-ROB ELECTRIC INC 631-981-1889 1a NYS Unemployment Insurance.Employer Registration N umber of Insured 2188 NESCONSET HIGHW AY#109 STONYBROOK, NY 11790 ld.Federal Employer Identification Number of Insured or Social Security N umber 421589586 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being listed as the Certificate Holder) ShelterPoint Life Insurance Company Historic Details, Inc. 3b.Policy N umber of Entity listed in box"1a": 87 North Monroe Avenue DBL288401 Lindenhurst, NY 11757 3a Policy effective period: 12/14/2014 to 12/13/2015 4.Policy covers: a El All of the employer's employeesellgibleunder the New York Disability Benef its Law b.® Only the following dass or dassesof the employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the Insurance carrier referenced above and that the named insured has N YS Disability Benefits insurance coverage asdesaibed above. Date Signed 4/1/2015 By /i%� (Signature of insurance carrier's authorized representative or NYS Licensed InsuranceAgentofthatinsurancecarrier) Telephone N umber 516-829-8100 Title Chief Executive Officer i M PORTANT:If box"4a"is checked,and thisform is signed by the insurance<arrier'sauthorized representative or NYS Lioansed Insurance Agent of that carrier,this certif irate Is COM PLErE Mall it directly to the certificate holder. If box"4b"ischecked,this certificate is N OT COM PLETE for the purposesof Section 220,Subd.8 of the Disability Benef its Law. It must be mailed for completion to the Worker's Compensation Board,DB PlansAooeptance Unit,328 State Street,Schenectady,NY 12305. PART 2.To be completed by NYS Worker's Compensation Board (Only if box"4b" of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of hischer employees Date Signed _ By (Signature of NYS Worker's Compensation Board Employee) Telephone Number Title Please Note:Only Insurance carriers licensed to write NYS D Isabl l Ity Benefits insurance pol id es and NYS Licensed I nsurance Agents of those Insurance carriers are authorized to Issue Form D B-120.1.Insurance brokers are NOT authorized to Issue this form. DB-120.1(12-13) A D° CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YVYV) 04/01/2015 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 CONTACT NAME: Remco Agency PHONE FAX 14 Front St Ste 102 (A/c,No,Ext): (877)234-4420 (A/C,No): (877)234-4421 Hempstead, NY 11550-3602 E-MAIL ADDRESS: PRODUCER (516)488-3040 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA Continental Indemnity Co. 28258 INSURER B: Kel-Rob, Inc. INSURER C: 2188 Nesconset Hwy Ste 109 Stony Brook, NY 11790-3503 INSURER D: INSURER E: CTL 1273 1003960 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED OCCUR PREMISES(Fa occurrence) $ CLAIMS MADE MED EXP(any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRO PRODUCTS-COMP/OP AGG $ POLICY FJECT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE ' (Per acadenU NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- , AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE 11 N/A 4 6-8 5 3 6 01-01-0 3 06/15/2014 06/15/2015 E.L EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED9 i (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 1O1,Addltlonal Remarks Schedule,if morespace is requIre CERTIFICATE HOLDER CANCELLATION Historic Details, inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED, 87 oe Aeenue BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED:; Lindenhurst, NY 11757 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNEoe — -- "�""' PC937411 A CERTIFICATE OF LIABILITY INSURANCE _ Diioi o5 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 pollcy(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 CONTACT NAME: Remo°, Agency PHONE 877 234-4420 FAX 14 Front St Ste 102 (a/c,No,EM): ( ) (A/C,No): (877)234-4421 E-MAIL Hempstead, NY 11550-3602 ADDRESS: PRODUCER (516)488-3040 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC A INSURED INSURERA. Continental Indemnity Co,. 28258 INSURER B: Kel-Rob, Inc. 2188 Nesconset Hwy Ste 109 INSURER C: Stony Brook, NY 11790-3503 INSURER D: INSURER E: CTL 1273 1003962 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD " POLICY NUMBER (MM/DD/YYYY1 (MM/DDNYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $ CLAIMS MADE OCCUR MED EXP(any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. PR — PRODUCTS-COMP/OP AGG $ O I POLICY JECT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident)' $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE HIRED AUTOS (Per accident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N x TORY I IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE ly N/A 4 6—8 5 3 6 0 1-0 1-0 3 06/15/2014 06/15/2015 E L EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED'? I�+ (Mandatory in NH) E L DISEASE-EA EMPLOYEE $ 100,000 It yes,describe under SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $ 5 00,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Addltional Remarks Schedule,B more space Is required) , CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Ma'in Road BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 54375 M PO Box ain IN ACCORDANCE WITH THE POLICY PROVISIONS. Southold, NY 11971-0959 AUTHORIZED REPRESENTATIVE asoree PC937411 , � Tae Association of '/- � Pool&Spa Professiotols® 2111 Eisenhower Avenue,Alexandria,VA 22314•www.APSP.org { 703.838.0083.703.549.0493 fax•ci@APSP.org • Stephen Smith,CBP r Member ID: 15552119, Expires: 12/31/2016 • CB,P.'CERTIFIFD'BUILDINO PROFESSI;ONA'L®1-,,,i ` I _ I;', j1.'0 11,'ci4-'!Y'.V•,,':,,1,,,r'q:"i-T7,,N.:1'.t'"4 I SUFFOLK COUNTY DEPT OF LABOR, .";.ri,V=')e �'���''" ' LICENSING&CONSUMER AFFAIRS M ryr• HOME IMPROVEMENT i_' 1` 'I "1' CONTRACTOR ;} ..„ `1 n .; , ' \ i BUSINESS NAME This certifies that the pOOL CARE INC bearer is duly Date h,u•, licensed by the 04/09/1998 County of Suffolk 26690-H r5�v n�p.../.(?4, 'p ExPIBATON DATE 04101/2016 ComMssloner �1 OP ID: KH ^ %RO® CERTIFICATE OF LIABILITY INSURANCE °A'E`"'°"'°°'"'"") 03/31/2015 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). PRODUCERCONTACT HARTT INSURANCE AGENCY,INC. PHONE 45 MAIN STREET (A/C.NoEm): (NC.No): NORTHPORT,NY 11768 E-MAIL ss: HARTT INSURANCE AGENCY INC CUSTOMER RERIDs:POOLC-1 INSURER(S)AFFORDING COVERAGE NAIC# INSURED POOL CARE INC INSURER A:Harleysville Worcester Ins Co. 26182 Steve Smith(Owner) INSURER B:Rochdale Ins Co 12491 140 Raynor Avenue INsuRERc:Standard Security Life Ins Co 69078 Ronkonkoma,NY 11779 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR MAX SUBR POUCY EFF POUCY EXP LTR 7YPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDTYYYY) IMMI)DIYYYY) LIMITS GENERAL UABILnY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY X MPA00000028960J 04/01/2014 04/01/2016 DAMAGE TO RENTED PREMISES(Ea oxunerwe) $ 100,000 CLAIMS-MADE n OCCUR MED EXP(Any one person) $ 5,000 X Contractual Liab PERSONAL A ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEM.AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 4,000,000 n POLICY n 12% n LOC $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accIdent) $ SCHEDULED AUTOS PROPERTY HIRED AUTOS (PER A C DENNTT)) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ — DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'UABILITY Y/N X TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVERWC3364701 03/29/2015 03/29/2016 E L EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? n N I A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POUCY LIMIT $ 500,000 C DISABILITY 65097-00 01/01/2015 12/31/2015 STATUTORY LIMITS DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,AddlBrnul Ramalce Schedule If man apace Is required) Town of Southold is included as additional insured as required by written contractor agreement. CERTIFICATE HOLDER CANCELLATION TOWNSEC 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 POLICY PROVISIONS. PO Box 1179 53095 Route 25 AUTHORD D REPRESENTATIVE Southold,NY 11971 �// 0.213r 1 .ice ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured 631-585-1112 Pool Care Inc. 140 Raynor Avenue lc.NYS Unemployment Insurance Employer Ronkonkoma,NY 11779 Registration Number of Insured Work Location of Insured (Only required if coverage is specifically limited to certain locations in New York State,Le., a ld.Federal Employer Identification Number of Insured Wrap-Up Policy) or Social Security Number 113363633 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Rochdale Insurance Company Town of Southold 3b.Policy Number of entity listed in box"la" 53095 Route 25 RWC3364701 PO Box 1179 Southold,NY 11971 3c. Policy effective period 3/29/15 to 3/29/16 3d. The Proprietor,Partners or Executive Officers are ❑ included. (Only check box if all partners/officers included) ❑ all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "l a" 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 Certificate 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 IFa 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 iadd blanket addl insd endtnsured has the coverage as depicted on this form. Approved by: William F.O'Shea III (Print name of authorized represeenr.ttaatifie or licensed age of ce carrier) by: ���a Gt (/- - :l ..e 3/31/15 (Signature) (Date) Title: President Telephone Number of authorized representative or licensed agent of insurance carrier: 631-261-6300 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it: STATE OF NEW YORK WORKERS'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la.Legal Name and Address of Insured(Use street address only) lb.Business Telephone Number of Insured Pool Care Inc. 631-585-1112 140 Raynor Avenue Ic.NYS Unemployment Insurance Employer Registration Ronkonkoma,NY 11779 Number of Insured Id.Federal Employer Identification Number of Insured or Social Security Number 113363633 2. Name and Address of the Entity Requesting Proof of 3a.Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Standard Security Life Insurance Company Town of Southold 3b.PolicyNumber of entitylisted in box"la": PO Box 1179 53095 Route 25 65097-00 Southold,NY 11971 3c.Policy effective period: 1/1/15 to 12/31/15 4.Policy covers: a.Q All of the employer's employees eligible under the New York Disability Benefits Law b. Only the following class or classes of the employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insu ce coverage as des ibed aski - . Date Signed 3/31/15 By G/`�- , (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 631-261-6300 Title President IMPORTANT: if box"4a"is checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that tamer,this certificate is COMPLETE. Mail it directly to die certificate holder. If box"4b"is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion to the Workers'Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,New York 12207. PART 2.To be completed by NYS Workers'Compensation Board(Only if box"4b"of Part 1 has been checked) State Of New York Workers'Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Workers'Compensation Board Employee) Telephone Number Title Please Note:Only insurance carriers licensed to write NYS disability benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. DB-120.1(5-06) C _; . ue i O9.e :::, ,_•.f ALL LL CODES OF r>,‘, NE��?'WT '(' I iK STATE ArE & TOWN CODES AS REQUIRED /;v- CW` ,' 1. OF SQ T , SO,T_ it & , 'KING BOARD s •a ES oq EDIATELY" 1 ENCLOSE POOL TO CODE i ' S m i�. .b `� UPON C©MPL TION B.P. ��� �- BEFORE"W TER° DRTE• ,?,,,LS:::- 2�� B _ FEE: — T DEPARTMENT AT NOT E( BUILDING D 765-1862 8 AM TO 4 Pi,A FOR THE `� 'CUPANCY OR c TIONS: 4'-1 c n FOLLQV`lING INSPECTIONS: REQUIRED I. FOUNDATION CONCRET - US !S UNLAWFULRETAIN STORM WATER RL; OFF F FOR POURED WITHOUT CERTIFICATE PURSUANT TO CHAPTER 236 2. ROUGH - FRAMING & PLUMBING OF THE TOWN CODE. 3. INSULATION OF OCCUPANCY a• FINAL - CONSTRUCTION OR MUST BE COMPLETE FN SHALL MEET THE ALL CONSTRUCTION REQUIREMENT G THE CODES OF NEl'V YORK STATE.NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. G106 G ° 'SECTION 1 r N G1 PROTECTION REQUIRED POOL P ) PROPER'T'Y TO OONFORM TO N.Y. STATE RESIDENTIAL S �' •ION G107 CODE APPENDIX G 20fa` EDITION 'POOL. ALARM REQUIRED 'POOL TO OONF ! TO ANSI/NSPI =WARDS AG103.1 • 512E(FT) A 0 C D E F o At1t.A CAP. ( . ✓ GRA'. aJll„ . . -' 7-1; !-I° .. . . _ ..lk .E. IWb: : R !NM AiTtri4 - _ • Past . _ . . __ - - . I—,-- .� fa TAP-OM A+M.ur�) I 11.: , Jw►trktW a.aiblit► IHRiAN*41 (2) VALVD At415 c*LuEQ•otL timet lk A • 3 mv • A °r1'� 3E Li/d11 ( LIL� -1-UB \N 1Aq GRAVEL .S1= , •N��. . O © IIIIIIIIIIIIII Rt,1-14' 4ti 1 ` A :�UUlllilntl 'J ntunntn .1u..ta• 6 . . • c-tiL'.v:4. s tiMP c-'14Tot ' I • tsO .� O , . peoL P LAN . tt • 341 � -�' Ito N GEttERAL MOTET: .••,...:. ~• • • LNJE F P L THl DESIGN a tASCD ON A DRAINAGE SOIL, WITH t10`Y.S1LT. :- •..••fir ' \,4Gtxtl IV. �` NU + tNg t•UKt Qt1L1 EA • r GROUND WATER S,LALL NOT EXIST MYTNIN TiltLIaItTs Of THE ON'ti = FI'WI'o1 EXCAVATION.If CHN.10o wATCR EXISTS wITHII f.-O-IICLOW ,GRcr•DMVIM :,: S I lkst$4 LAID •.CRADC SrECcAL-O(�wATERNHG FACR.ITWE3 wK1.SE REQUIRED. •' + r�� 'r -s * 41 }{� . YATCR..DISffrOS_AL U UMITCO TO OwtCR'S PROPCJITY. 71• 7'i"NG• . ' R IPPt L NO 7UI�iAR'GC ALLOYED wITHif 4-0r OF SHALLOW ENO . }� MUT' • . *Lim C' OF Dt[P EMO. "` f.• H ttYOOSTATIC. 3.• c hCU1ATICALLY APPLIED CONCRETE canal Cl SHALL b $ I)( • l jf co..LECT{it b -rvYsE z I k I K O+RAY EL pgAiE RC A Y4 t4IX WITH A HAXIIdUY Of.3k.GALLON3 OF I WATER rat SACC Cr CCNENT. • • �3 S' •.•. '•. - —f181-,11MAIMS �+T h G H e P1 f.T!Ce r t-•U riDING • fY:tl Er 141- 4. RUNfORCING STEEL SHALL DE INTERMEDIATE GRADE +a -_ , Wars vrV+lss SMUT STEEL WITH A MINIMUM LAP OF so..AR. i '? .t?-11'I't'rod 4140ri2 YV DLAMCTERS. . . • • I ¢q kr M Dir{ow �(� -AE, S. POOL NATER SUPPLY DY OWNERS GARDCk HOSE. .r' TN Ni/tI•Pdl. '�•• • !_ v3 -01PEL O ,%�� -"�a m��r4 POOL TO K KEPT FULL OURING t REELING WEATHER-• YAM* G To 01 ..'.7' r- ' t'�CM451e, >�d G ay- ... q • PUMP'CA,AGTY•TO •C SUFFICIENT TO EMPTY POOL ` tli lrlutl • ' ! it a1,`, to �-.'- Ncr12. yt'ii it i•a 1 !� IN 24 MOORS. tit i 71'PIGh L • Ti YLhT. 12'1 (dal. ' E ^_'E g4 j`' . HALL .05G-�•to t4 n.qc 17ak wd wr,rt ��. ut ^n _ , tti�H M+uWltxT a�^ r fir; Weber REVISED `/�+-: H. ROY JAFFE, P.E. ' 1905 Fairway Dr -.--. +�' /' Cutchogue, NY :',,nti ::._': ,/2 /� . H. ROY JAFFE, P.E. 82 EAGLE CHASE,WOODBURY,N.Y. 11797 516-364-0148 FAX 516-364-0158 March 26 2015 ---Town-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 Weber 1905 Fairway Dr Cutchogue, NY . 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 46005(7E7' . The soil disturbance will be about 111 -76 square feet. Since this less than 5 , 000 square feet as outlined in your Storm Water Management code, no drywall is required. Very truly yours, 4of e 44% Sh r9°) H Roy Jaffe, P.E. T { �\;4 fie;/' ,47A1• oPRoFEsso H.ROY JAFFE,P.E. 82 EAGLE CHASE WOODBURY,HY 11797 FINAL GRADE. I i 70 GRADE wit%C4sT L2oli L' izr M11.1• ' 1 FRAnt -AuD COVER' IF ' 24"MAX. �r UNDER PAVED AREA I I A 1 H uo TO 4 D=24 MIH j 4'70 7'MAX.':D-3°" H' I r FD -SIGHT•JOINTS I� C11H.SLOPE %g PER GT. . IIOTE: DE51411 RATE.15 L7t(G SANDS GRAVEL STRATA EF.FSCTIVE b EPTH • (SOLID DOME) NSA' . J O h -1 J Co Q d (y . I 0 7 -.o— 3`NINr—. 0-311Ii� « I r 8 Z4+"It►N- D 1AP}E7fi R CSI 0114 TER COLLAR MATERIAL 6 �IK (PcncTrol:on) RATEABLE SOIL 1 UNDERLy%NG 51•0x3o d C.RAI,et. STRA'PA * NOTES CAPACITY — 1263 GALLONS (169 CU.FT. ) 1. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR FULL DEPTH. 2. THE MATERIAL USED FOR CCLLARING SHALL BE COMPRISED OF SAND & GRAVEL FILTER MATERIAL CONTAINING LESS THAN FIFTEEN ( 15 ) PERCENT FINE SAND SILT & CLAY (SILT & CLAY FRACTIONS ARE NOT TO EXCEED ( 5 ) PERCENT) . TYPICAL DETAIL — DIFFUSION WELL BACKWASH FROM POOL 70 GPM C 5 c•i1N = 350' GAL. @k1 ®Y Weber I 1905 Fairway Dr ' Cutchogue, NY 047410 • - A UFESS14 1/2 s N89°12' 10"W 200'00 STORM WATER MANAGEMENT DESIGN CALCULATIONS — — — — \ — — — — — — — — —® — — — — — — — — — — — — — — - Town of Southold 5' Pratnage basement A5 Shown on Filed Map Requires capacity for 2 inches of rainfall. r --- - _ __-- - Rear Yard 10' SETBACK J 0 I 0Patio,steps,wall= 2425 sq.ft. 2425 x.167/12 x 1.0=405 cu.ft.required JilliW AO I PROVIDE: ® ® ® 1-10'dia.x 6'drywell= 410.52 Cu.ft. R / ■ ,� 1-10'dia.x 1'-6"shallow Dome Cover=54 cu.ft. ` Total Capacity 464.52 cu.ft. ® �� .�. ® I Front Yard 1 ) , ► I Existing Driveway=3334 sq.ft. ® Proposed Driveway=3523 Proposed Walkway= 126 .1111EI � �� �� , Total Proposed sq.ft.=3639 ■ra— ■r�— ■., o �- ■■�- ■■�-�■� ® Additional sq.ft.=305 I4 . ii 1 I in ;■I a +98'-6" +T,C.99'.0" ■I \ :■ CONC. COVER 1111P...01 II Topsoil Stockpile 1' MIN. I lik 1■■.. j!I Concrete Paver Patio Area 200 ds I 2' MAX --- Pool ■■ I y I rill /7/76" ri rill 'MEW' =. INLET IiI �� � -01 PIPE 1/8" PER DFOOT 20„I LAWN-- -�, •' I PIPE SIZE,TYPE AND PITCH AS PER PLAN. 1 ����� Pod gm m 7nlzywE I p®®®F • , ■. ��6' II \ // Old® • v // ii _ I _ I D 3' MIN SAND Prtiwell 8'x4' for Pall — — — �I m I I // ' ' GRAVE)COLLAR. 13ackwa5h aid Overflow �:.■■.--m.■ n--:■■■n--:■■ 4-98'��� 12Surface �� IIIIIp // PRECAST REINF. AL IAROUND —\ ` " r■■w■ ■■Er ■■■� ■■, 11 r/�• p • CONC. LEACHIN� > / _ Prams with 6 _ �■ ■P■ ■�! ■�■ m 131uestane \ ■� '■� •,� -) nraln e Pipe N o RINGS <, m?iHir N pail fence&Gate to ■■: ■ • ■■: p - . o 0 eanforn,to NYS code for I 111 I ���■���I■,��.■'�;■�I I.andwq& stepN a o s ce pG�Erldosues I I■■�••■i•9■��•■, m 5- O5EK N tali I CD w DIAMETER AS PER PLANtA I \ , 4-51-P 2MN ////// �o \z a- +� ' 6' MIM. PENETRATION INTO .j' �_ ° _ = o- _ 4tea, I � Nle �_.�• ..4,//// VIRGIN STRATA OF SAND & GRAVEL. kk��3 AG ` "❑` OM ����'� .S' lllll,� �. err -rose? .O // ❑ +98'8" ' �• ,� •• MIN. TO GROUND WATER. -- \.‘ le 111 tisio II © GROUND WATER. 5�- '' 2-16 �,���w�QO ,tea;,■•1 1•; °°°[ r�° �i 5_II3p © I DRAINAGE LEACHING POOL DETAIL (LP) 2'x2' Steppinglar `�j-' 4 ■L it -] ■ ► ■ - FIrepit Area with Stale Walkway /a : ��'�� .�CO ® �'1i�-■Li/__ `iii'.■�■��O�il I M R■■, 441 �■`, A, . Seatwall 24" tall & 1) ALL DRAINAGE PIPES MUST �� O j'� "`� ■ ■� II © BE PROVIDED WITH A MINIMUM Exlstl I N �i,....:� , ;��■!■�■�■�■!■�`�., r rier5 30 tall0 2'- 0" COVER. 11 lifilli nq O .. .. 0©❑❑❑❑❑■vim.�■:� �.}��� i��^'C Q Y� 111 /.' - ____ItALIIM11117111 '2� . .511 Litm .■___. ■ - . B•� IV"X IS" © I2) UNSUITABLE MATERIAL SHALL BE Vrlvew Line _ -�. ©©I I'm REMOV6D UNDER LEACHING POOL ,�► ■■:■��■� �' 1 � UNT1L 6' MIN. PENETRATION .4L .�. J� • �-�■ ■, .� INTO VIRGIN STRATA SAND AND I I ❑ �� -J Z ��� 3-I6 1 © GRAVEL AND BACKFILLED WITH SAND I ►I porJll `v` & I C3luestone I AND GRAVEL TO BOTTOM OF BASIN. 1 I I❑ •i quipment rood Par Landing& Step L_ Waver WIRE�+cc nn..14 irz ° encs PERSPECTIVE VIEW route,MAX.c ME xq 1 �, 51►7�NC� screened ® 30 . t ® I❑ .. POSTS.K MCC .►, GA12P�GE 5CPL1 : I' 10''0" I'aeh / ` WweNW■emxzn4lnrA►«e.,ru,e I° .cToc ...____ I 7 UNDISTURBED GROUND J/�� ❑ � e sr�araG1 Wim rsme a.orn wee CR 6'NAI2 Fri I00',00 �y2 PRCAERKATm 9 LT 1eON. ■,1' MM A C GRIXM7 owvee 0� Covered O CCyy*tltl�`�'yy I GEOM. 20MM., 4 INN I 4111 0 N I ,..\ 4i-- milliillifimmumm Illigilill ---i-1 / *$ OIWID rum CLOTH M■.anrrocwuw nx. gMillanin'1PJiI!■ ` ■ �►iXil rr�lll5PILle5tale Porch 1 Z ��tni1� II ® VW '■ 0 0 0 - CONSTRUCTION NOTES FOR FABRICATED SILT FENCE �/ 1 \ Prlvewaq \ M •ID. 1. WOVEN WIRE FENCE TO BE FASTENED SECURELY POSTS: STEEL EITHER T OR U O -- O TO FENCE POSTS WITH WIRE TIES OR STAPLES. TYPE OR 2" HARDWOOD V 1 _ I - _ _ ,�; © I 2. FILTER CLOTH TO BE FASTENED SECURELY TO FENCE: WOVEN WIRE, 14 1/2 GA. WOVEN WIRE FENCE WITH TIES SPACED 6" MAX. MESH OPENING \ \ ■ ,1 - EVERY 24" AT TOP AND MID SECTION. .4 op �e 3. WHEN TWO SECTIONS OF FILTER CLOTH FILTER CLOTH: FILTER X, \ +99.A 1 'A�' ADJOIN EACH OTHER THEY SHALL BE OVER- MIRAFI 100X, STABI- \ /IWI\ LAYYIV LAPPED BY SIX INCHES AND FOLDED. LINKAEQUAL T14ON OR APPROVED 1 \ 4. MAINTENANCE SHALL BE PERFORMED AS PREFABRICATED UNIT: GEOFAB, 1 \—`—____ \ I NEEDED AND MATERIAL REMOVED WHEN ENV ROFENCE, OR APPROVED 1X. _ "BULGES" DEVELOP IN THE SILT FENCE. EQUAL \ I +98,x„ -- _ _ �_ SILT FENCE DETAIL N N 8 NTS I n.. \ 1 f Existing �_ 17riveway L Inc \N \\ I I LAM \\ \\ ® PLANA-UST 1 �\ \ OCDE QTY LAT N NAME COMMON NAME SIM ). Rear Yard 4' \ , AG 3 Abilia gra:Eloa Glossy Abelia 3 gal. I e e 1 �� BS 6 BuxLs Wntergreen Boxwood 18-24" I ® CL 5 Clethra drlifdoa Sumn ersweet 3-3.5 • I b, Ai" I / HAR 6 Hydrangea artcorescene Annabelle Hydrangea 3 c„pt. I e IBP 5 Ilex rresene Blue Princess Holly 2.5-3' 1jir. // ICC 5 Ilex crerata contiexa Compact Japanese Holly .18-24" r / 1 IG 5 Ilex labra Inkberry 2-25 b.It- 1 — — +98'-2" / +98'-2 1 APCT 1 Prunus cerasifera Purple Leaf Plum 2-2.5'cal. - - 588°38'20"E 175.01' — — — — — — }_ — — • PER 30 Perennials Assorted Perennials 1-2 gal. / 1 PL 5 Prunus laurocerasis Cherry Laurel 18-24" Temporary / 1 R-I 5 Riododerxiron hybrid Rhododendren 2-2.5' • J • Construction // ROSED 5 Rcsa x Clift series Rose 2 cal. Entrance i 1 SDLP 4 Spiree japonica Little Princess Spiree 3 gal. FAIONAY npIV . 5C : III - 1010" 1.ANIP5CAPt �I�lV ©� T«e Inc.,1k ,spaa /nateprepardbylsoffikezGNEIZ 'KdasahbmtafeaNe,,dored lXGNNn12A-1 : 9-17—IqLan sea ePBfrm a* 5e, f to tie ENcE a� ;X1511NG TM5MVISIONS; II-21-14 T 1E wE I: ER " SI ada aeds Technes eta,*coal*.t 1 dsasowts prepared by onto,etc.)pipet!hes we to be staled ak by a lardsrape fel:114es Inc.shell)Trott le teed limed before ori ceetnetel6a s, G i by /dataOiiY75,hdldllgay xr eEd«Mk{I I. ■CtQ7�QIAtO,Er .a 1 5 ro I3I 905 FAI{?WAY I2pIV� byrarat�nstothtspryatfacalpletrelby I III , IZ�Mov�n n�51GN PULP. 51T� MM1f�IvI�N1' �,Nspatofti,esedxattettsrta�be 141 OLD CEDAR SWAMP ROAD. rEluCliO,NY 11753 C U1'CNOG UE a;h all fart by all realsatiavi"Amto" :1 field" fealties 6. PHONE(516)681-5732 FAX(516)681-1596 E-MAIL LAND141QAOL COM Lasicape NY Tax # 1000-109-5-14-20 e ^�^ reateayaesbef�e