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HomeMy WebLinkAbout39181-Z Town of Southold 10/21/2015 P.O.Box 1179 cf.„}W 53095 Main Rd ���1 �d Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 37846 Date: 10/21/2015 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 350 Stirling Woods Ln, Southold SCTM#: 473889 Sec/Block/Lot: 88.-2-15.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore Med in this office dated 9/3/2014 pursuant to which Building Permit No. 39181 dated 9/15/2014 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, FENCED TO CODE, AS APPLIED FOR The certificate is issued to Cornell,Craig&Cornell,Laryssa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39181 10-19-2015 PLUMBERS CERTIFICATION DATED A ize Signature TOWN OF SOUTHOLD ,cpsif iCt„�; BUILDING DEPARTMENT ' 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#: 39181 Date: 9/15/2014 Permission is hereby granted to: Cornell, Craig & Cornell, Laryssa 350 Sterling Woods Ln Southold, NY 11971 To: Construct an accessory Inground Swimming Pool, fenced to code At premises located at: 350 Stirling Woods Ln, Southold SCTM # 473889 Sec/Block/Lot# 88.-2-15.3 Pursuant to application dated 9/3/2014 and approved by the Building Inspector. To expire on 3/16/2016. Fees: - IN-GROUND SWIMMING POOL $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 rCt*Lut-c- ' ?,0C-. Building Inspector ,r. Form No.6 TOWN OF SOU T,:OLD BUILDING DEPARTMENT TOWN HALL 765-1302 APPLITCATION 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 Certifaoate of Occupancy-$25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 Date. /�/ — /6 r/`' New Construction: J Old or Pre-existing,Building: (check one), Location of Property: .1 -�I t/ ,ea/#.5�i/ 1fO4:��I [OId House No. Street , Q Hamlet Owner or Owners of Property: rr.t 1 Suffolk County Tax Map No 1000,Section 86 Block a Lot /5-'7-13 Subdivision A..i 60 ✓1 L, Filed Map. Lot: Permit No. 3° l p I ate of Permit. Applicant: Health Dept.Approval: ' Underwriters Approval: Planning Board Approval: , Request for: Temporary Certificate Final Certificate: ✓ (check one) �o .00 Feee Submitted:$ Ap licant SignPture ��,�%OF SO!/lyo Town Hall AnnexAili �, ' e• . Telephone(631)765-1802 54375 Main Road ; Alig Fax(631)765-9502 P.O.Box 1179 \. , Southold,NY11971-0959 ly -OQ,��� roger.richertCa�town.southold.ny.us i BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Craig Cornell Address: 350 Stirling Wood Lane City: Southold St: New York Zip: 11971 Building Permit#: 39181 Section. 88 Block' 2 Lot: 15.3 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: EECO Electric Corp. License No: 2816-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 2 Wall Fixtures Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 1 NC Blower Range Recpt Fluorescent Fixture Pumps 2 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches Twist Lock 2 Exit Fixtures TVSS Other Equipment: In Ground Swimming Pool To Include, Bonding,1-Gas Pool Heater,1-Control Panel, 1-Pool Cover Motor,3-Pool Lights,5-GFCI Circuit Breakers. Notes: Inspector Signature: .;0 Date: October 19, 2015 Electrical 81 Compliance Form.xls Tor' - S 0 •,* * TOWN OF- SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION /466--,--)[ 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 VIOLATI •• [ ] CAULKING REMARKS: if--a--64-L. ae. DATE /c#77 INSPECTOR 2 z. 4*pF�+. SOUjya- :* 0€ i Se9 l =°!y00urm,�t i�''� ./.12./.� 0 -- TOWN OF SOUTHOLD BUILDING-DEPT. 765-1802, I,.NSPECTION, ,:- [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION 4'i ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 'r ' ciLtrt, 6- DATE. / ZC f' INSPECTOR ` 3 718 / �O� OF SOUl�olo\` 4o,,, �y�ouHr+,�'. TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION : , [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ]'1 LATION [ ] FRAMING /STRAPPING [ FINAL ��--e [ ] FIREPLACE ,& CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 7- -44 /� /24 ,fc fid-, { DATE (70/21-1( INSPECTOR i4- I - 37 jj8 ��,,%pF SOpT9p'; iii (Ceil -t.,0 ---Y-Couri .01 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION "1ST [ ] RO H PLUMBING [ ] FOUNDATION 2ND [ ] SOLATION [ ] FRAMING /STRAPPING [ ] FINAL [- ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION . ' [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL"(ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: ee-c, . , / - /7 r d/,, L. , DATE INSPECTOR ,46lo *i CLC:\ , 4,7* --Y-couri,voo TOWN OF SOUTHOLD BUILDING DEPT: 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ISS1 ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: rcf — Poo DATE /O/// l c INSPECTOR` � - ' • FIELD IlV•SPECTIQN RESORT DATE , _'' _ OIVINIENTS ' ' ...c' p..09-Ae.- rre A ' 'QUNDATIOPI(1ST) r FOUNDATION(2ND) ►A • • • ROUGH FRAMING.& li PLUMBING - • • d 1E1 1.4 INSULATION PER N.Y. • .. �H STATE ENERGY CODE . . , • - (..,,,,Y) i t r42, V'-'--‹ 4 _ . • . ,. • , , & . . . FINAL . • • -ii . • AD$ TTOIT4Ltb•• 1 'i I Tr 'Y '' • ` - R i, . 1b - 6 --1 , O rn . • l -- TOWN OF SO'ITTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you lave or need the following,before applying? TOWN BALL Board of Health ' SOUTHOLD,NY 11973g Plans 4 sets of Building TEL:(631)765-1562 Planting Board approval FAX:(631)765-9502Survey Sot thoki T own.Nort ork.net PERMIT NO. _/ c1? I Check Septic Form , N.Y.S D.E.C. Trustees C.O.Application Flood Permit Examined V,20 1 S:ng`le&Separate Storm-Water Assessmer't Form 11II I� Corr:act: Approved i� 11 Mail to: Disapproved e% Phone. 2 e Expiration ( ) 0 J� Building Inspector APPLICATION ION FOR.BUILDENG li ERM TT Date ,20 INSTRUCT IONS a.This application MUST be completely filled in by typewriter or in irk 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 buildbigs 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 penult shall be kept on the premises available for inspection throughout the work. e.No building chall be occupied or used in whole or in part far any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. £Every buildi g permit shall expire if the work authorized has not commenced wrthRr 12 moths after the date of issuance or has not been completed within IS months from such date.if no zoning amendments or other regulations affecting the property have been enacted in the interim,the Buildit g Irsoector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required, APPLICATION ION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Orrirance.of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for tine construction of buildings,additions,or alterations or for removal or demolition as herein described The applicant agrees to comply with all applicable laws,andirsar oes,.building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necess ins_oections. � ,�h$h�`° C_ ,e-7 r r L�'' 1 r" 1 (Si 4mrre of applicant or n rte,if a corporation) ENC'-C FOCI_TO COD v,1�' irz 1.,'•:,1. 'WFUL UPG'. COMPLETION .p `="' `` r�¢ 3 0 3(\ 0 Sa,) s\%\ BEFORE"WATgR° vi, ; 1_,1%,1 rr I. I l l e 1 Imo. f''-"` —. 8.- ' '1 61 i �y State whether applicant,isaoc nen;Jesse"e,agent, rc:e1t'1 engineer,get�r�l r�tu r e� ,ici ,,gr lumbcr o_ builda;r, - -;46 .1 :Y %/�!_� - Name of owner of,prernises CS'c . n A, L . s�„ F 8Ud =.e •e_ 'FOR , .T (As on the 'ill fat eek AMTG4PMFORTHE If applicant is a corporation,signature of duly authorized officer FOLLOWING INSPECTIONS {Name and tleof rpqrateoffcer) 1 FOUNDATION -TWO REQUIRED Builder License No. N-1501--x-1 FOR POURED CONCRETE Plumbers License No. 2 ROUGH-FRAMING,PLUMBING, Electrician�sLicenseNo. STRAPPING, ELECTRICAL&CAULKING OtherTrade'sLicenseNo. 3. INSULATION 4 FINAL-CONSTRUCTION &ELECTRICAL 1. Location of land on which proposed work:will he done: MUST BE COMPLETE FOR C 0. House Number Street REQ r NTS OF TH 4 g OF NEW 's YO•�1•TATE. NOiTc 2ESP�,, S►B( FOR UtS OR CONSTRUC ION ERRORS. County Tax Map No. 1&30 Section $$ Bloc RETAIN STORM WATER RUNOFFL C T CAL PURSUANT TO CHAPTER 236,. SPECTI1 `N 0 PIP_(?f�ro . OF THE TOWN CODE. craigeornelll -Yahoo Mail Page 1 of 1 Home Mail News Sports Finance Weather Games Groups Answers Screen Fhckr Mobile I More permit app.PDF I 2 of S Search Mail Search Web Home ®crag a C Subdivision Filed Map No Lot j Compose 2 State existing use and occupancy of premises and intended an,..ccupancy of p......construction: m a. Existing use and occupancy i} . . a .,.A, Inbox Drafts b. Intended use and occupancy S w' l 4').4.1) iad-d / JVJ n.-V;\ Sent 3 Nature of work(check which applicable).New Building Addition temtion Repair Removal Demolition Other Work '• 'v., Spam(71) (Description) ~' Trash 4. Estimated CA b Li 0 61co.WID Fee (To be paid on filing this application) > Folders 5. If dwelling,number of dwelling units, ' Number of dwelling units on each floor > Recent If garage,number of tars .^, 6. If business,comn41 or mixed occupancy,specify nature and extent of each type of use. 1 Sponsored 7 Dimensions of existing structures,if any: rent Rear Depth Ilh% F ir!ill .,- Height Number of Stories J Dimensions of same structure alterations or additions Front Rear 1 -.- Depth - eight Number of Stones LendingTree 8 Dimensions of entire new construction'Front Rear Depth , .,,.. Height Nu�er of Stones t—„a. Mortgage Rate �y C� 9. Size of lot Front fes,7 (5!1 ARM) / • '95 Rear ty0.22. 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,onlmance or regulation?YES NO •_ . ��.N" 13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES_NO .-. 14.Names of Owner of promises Address Phone Na. i TY, ' Name of Architect Address Phone No e A Name ofContractorSp�" Address Hi1 (A1 ` hone No.(Q'2,!)s1 1( SiNACK; 15 a.Is this property within 100 feet of a tidal wetland ora freshwater wetland?•YES_NO FUN •IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE REQUIRED ED IN t 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. 17.1f 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 rnhrnrrvn£ ) er_CC (DT Yt e/�( being duly sworn,deposes and says that(s)he is the applicant (Name of ' dual signing contract)above named, (S)Ile is the /11�C,�i���"e�✓J (Contractor,Agent,Corporate Officer,e ) of said owner or owners,and is duly authorized to perform or have performed the said work and to male and file this appticahow that all statements contained in this application arc true to the best of his knowledge and bebeE and that the work will be performed in the manner set forth in the application filed therewith. SRyo to before me this v 20 I .t �y 1 � ci...._;.....„......._,..,...__Q.... uak.X CI 4J V'- Notary`ic Signature of Apphcant DANIELLE GRATHWOHL Notary Public, ob 01 GR6208717W York Qualified in Suffo County Commission Expires l to,20 Available on iOS and Android Text me a link r' https://us-mg4.mail.yahoo.coin/neo/launch?.rand=at44jpmo ltjnh 8/27/2014 e ScottA. usseli ,,.•••'tea° STORMWATEJ . - Nts SUPERVISOR MANGENT zz, SOUTHOLDTOWN HALL-P_0.Box 1179 ` O �♦, Town of Southold 53095 Main Road-SOUTHOLD,NEIN YORK 11971 9 44,04 •♦ CHAPTER 236 -- STOIRMWATER M NAGEMENT•WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOL OFTFIE--FOLLOWING: (CHECK ALL THAT APPLY) Yes No ❑[rA. Clearing, grubbing, grading or stripping of land which affects more t I than 5,000 square feet of ground surface. 0 . Excavation or filling involving more than 200 cubic yards-of material within any parcel or any contiguous area. ❑DK. Site preparation on slopes which exceed 10 feet vertical rise to . 100 feet of horizontal distance. • . 0�-A �-'. 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. D 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. - -- --— -- = ---- -- -- S.C.T.M_ '1: 1000 Date: APPLICANT_ (Property+Owner,Design Profesional,Agent,Contracto,Other) !ofl DistrictLNAME td1 d _ —Block Lot �.GC4�7 4( Aefs: }vasti, FOR BUILDING DEPARTMENT USE ONLY Contact informattort - (T kphmr Numec.l • o • Reviewed By: ,4',j° , w II Date: /G- 3- Property Address / Location of Construction Work:3 — ' Approved for processing Building Permit_ 50y ' IA Stormwater Management Control Plan Not Required. -50U•- (Ti. I l Stormwater Management Control Plan is Required. I (Forward to Engineering Department for Review) FORM - SMCP -TOS MAY 2014 H. ROY JAFFE, P.E. 82 EAGLE CHASE,WOODBURY, N.Y. 1 1797 516-364-0148 FAX 516-364.0158 Aug 29 2014 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: Cornell 350 Sterling Woods La Southold, NY will not require draining because the,•pool is of gunite construction. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash is nominal an'd will not interfere with the public water supply, the existing sanitary facilities or public highways. Very truly yours, --� 1, ®F NE* H. Roy Jaffe, P.E. i �` i , � * • t CC``� CA e�V�O u47W7V \v�� X75 Annex Hall Telephone(631)765-1802g� P.O.Box 1179 G ,+ r�i (631}7UCh 1 Southold,NY 11971-4959 �` �O i+� roger riche On.t 0 .nv.us '-- y - :_ • eeUlii'I, BUILDING DEPARTMENT • TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION • : REQUESTED BY: Ay,, a s t,eS Date: It]1 14_01 Company Name: rE co e(e+G-4Y I.c Corp .- • - {- . Name: C,1;-r-vt-d eve nQ-1 1 - License No.: Z$ 1 to -m e. Address: SCVSU C'oi.c jj t ' decon:., tom`/ t 1r►`c • -Phone No.: - (o 3 I - -7&5 - 54-1K JOBSITE INFORMATION: (*Indicates required information) - •*Name: C ra.;9 CO *Address: 3 S O -jthe-.-(11 e-11 AWOQcQS L ez.---2, s0 -12h0 id *Cross Street: r N Ct;n ei o� ✓i'w Rdt i, *Phone No.: • (P3l - -7c.60 — gt --td - Permit No.: Cl'O Tax-Map District: - 1000 . Section: - Block: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) • �n SwiMmi/lqJ V'fa0,� • . {Please Circle All That Apply) *Is job ready for inspection: . YES/ 45Rough In Final • *Do.you need a Temp Certificate: - YES/ NO - • , Temp 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 - . Additional Information: PAYMENT DUE WITH APPLICATION b.-) 0 .-rf . 0dL kctit'•1 - B24Regtcest for Inspection Form f /lily, Client#:36213 SWIMP001 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)2/03/2014 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(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: Southampton Commercial PHONE631 324-1440 FAX Cook Maran&AssociatesE-MAILo,Ext): (AIC,No): ADDRESS: 300 Hampton Road INSURER(S)AFFORDING COVERAGE NAIC# Southampton,NY 11968 INSURER A:Valley Forge Insurance Company 20508 INSURED INSURER B:Rochdale Insurance Co. Swimming Pools By Jack Anthony,Inc INSURER C•Continental Insurance Company 35289 378 Main Street Center Moriches,NY 11934 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. UBR L• TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DDIYYYY) (MM/DD/YYYY) A GENERAL LIABILITY 5084912171 02/05/2014 02/05/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA E S l RENTED PRREMI E Ea occurrence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $2,000,000 POLICY n.7a n LOC $ C AUTOMOBILE LIABILITY 5090892726 02/05/2014 02/05/2015 {ECOMaacadent)BINED SINGLE LIMIT A1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ _ _ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) _ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION RWC3314330 12/01/2013 12/01/2014 XWCSTATU- OTH- AND EMPLOYERS'UABIUTY TORY LIMITS _ER OFFICELUEDPROPRIETOR/PARTNER/EXECUTIVE YN N/A E L EACH ACCIDENT $1,000,000 (Mandatory In NH) E L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If mom space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold Building Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Hall Annex Building ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 53095 Route 25 AUTHORIZED REPRESENTATIVE Southold,NY 11971 ;�� o O Lz r tlfa i& ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S535605/M535543 CM4 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 Swimming Pools By Jack Anthony,Inc 631-878-7665 378 Main Street lc.NYS Unemployment Insurance Employer Center Moriches,NY 11934 Registration Number of Insured Work Location of Insured (Only required if coverage is ld.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, Le., a or Social Security Number Wrap-Up Policy) 113041142 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 Co. Town of Southold Building Dept 3b.Policy Number of entity listed in box"la" Town Hall Annex Building RWC3314330 53095 Route 25 3c. Policy effective period PO Box 1179 12/01/2013 to12/01/2014 Southold, NY 11971 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 "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 Certificate of Insurance to the entity listed above as the certificate holder in box"2". The Insurance Carrier will also notes the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums 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: Leonard Scioscia (Pnnt name of authonzed representative or licensed agent of insurance camer) Approved by: 12/06/2013 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier:(631)324-1440 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. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law Section 57. Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse ��, %c SOM, , �O to , Town Hall Annex 1 : Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box1179 G Q %� Southold,NY 11971-0959 `. - -• •I olyc®UIVT�,�' 'toe September 16, 2015 BUILDING DEPARTMENT TOWN OF SOUTHOLD Craig Cornell 350 Stirling Woods Lane Southold NY 11971 TO WHOM IT MAY CONCERN: The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy: pplication 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 — 39181 —Swimming Pool . 0 u it v.G r (it' F.teul-/Eh'TY- A T BA YVIEW i. f4=2o.oo' ss�y TOWN OF SOUTHOLD • 473 c-20.47' ,0,..,• �4�r SUFFOLK COUNTY, ;N. Y. A 4\51 1-4'..s."''''' gcgN1 1000-88-02— 15, 3 �h° 4• , ,-,,,i, s�� T SCALE: 1'=40 y• �° O <A }sem �. ,, AN. 27, 2009 4v f SEPTIC SYSTEM C�'�� �' ,.4) , (441, BEDROOMS) Cr" ,-.... / \ l- 1000 GAL. PRECAST SEPTIC TANK /1„/ �a .� O !�,"igi C 2- LEACHING POOLS 8'ox 6.5' DEEP ��� k WITH 3' SAND COLLAR (SWI BOTTOM 0 , yd. TO BE 3' MIN. ABOVE GROUND WATER • C./ ‘-- 2- y ...b.. fe - �• 7 1\ - q„ S ti 7 •s• s.,7 41' , 4.1 . e *il 644 7 .--'\„,..,.... , _ k i Ned. \ actql .44 . SA. ,,ZAC)(S' s''''''...../C. 47. .* ? ,,�10 o �M 9 9 Ate/ �'� ©es� R^25.00 �Q� �0'� L=39.32 J0 / it I ELEVATIONS ARE REFERENCED TO ANASSUMED DATUM ,ss I am familiar with the STANDARDS FOR APPROVAL • `p AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAM/L Y RESIDENCES ' and will abide by the conditions set forth therein and on the permit to construct. The location of we/Is and cesspools shown hereon are from field observations and or from data obtained from others. _ ' ti ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLA710N i /_ �! .• )t S. Ll OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. ^N C.- NO. 49611 EXCEPT AS PER SECTION 7209—SUBDIVISION 2.) ALL CERTIFICATIONS AREA-42,499 �(�. T. "ECOIVIC S- �l/ YOBS; P.C. HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF ; (63/), 7t;S-5020 SAX (631) 765-1797 ,� SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR LOT NUMBERS REFER TO j'FINAL PLAT STANDARD P.O. B X 90.9-'. u WHOSE SIGNATURE APPEARS HEREON. Q SUBDIVISION FOR STERLING HARBOR INC" 1230 TRAVELER STREET ��f „� SOUTHOLD, N. Y. 11971 ��-�42 - pool, AND -pici5ERTY '10 OCNEORM TO N.Y. STATE RESIDENTIAL SECTION G106 CODE APPEND) C G 2O J EDITION - E NTRAPt4E Tr PROTECTION REQUIRED • POOL 'TO CONFORM TO ANSI/NSPI STANDARDS AG103.1 SECTION G107 POOL ALARM REQUIRED 51:E(FT) A G C D E i O Aft Vs CAP. Ca ff. alu.. ' • - 2a TO . . . _ . ' '.. 8'. V.00: Mord% wan Rmlla past _ +run /1111111111 DSA 1K Inti n%urn% M • - rO 1111111111' V/�YL` AHD G1L6�0� A Al 'TVB� \N GRAYEL $�S6 ��%���, MEi © siis lllllllr. MAIN • DRAINS -4) " - • - •�nnnuulr - - na - co • Poo tr P t.�N r�.�������� ��///// �_ G I� O I - a _Ij . :�.. f e �Y 110 N CCIIERAL MOTES: • • =::,-1,..w-:-...... ' S -ps '-, • fl1�tA PSP L THE DCSIGN tS SAstD ON A ORAIHACE SOIL WITH<1)s+LT- . --.--r- �_r �- �Gtjed txt po •i . Witt 4ii4 oVituitA . • ' F7kt�1 GROUND WATER SHALL MOT EXIST WfTWH THE L!>+tTZ Or TMC :����� - _ _ EXCAVATION.W CfOtA , • . GRAO.E WATCA[R1STS '1THIN 6.-O DELAv .(.A4j:ONIPDf�l '.��-_ s a - tom I)IG-- iitl. titT[R.�DtT�frOS���[.tL LJMiTCD TO OIM�CR'S Mpf'(Jt•E MOUIRCf!_ TTS'��I-aG► I 4 V�ragw121 Tr yt 6 i -2- z. Z A10 IJ10L71A71GC AL1CWZD AMAX i-O-Of.SHALLOW[NO 4.E51, - - - rY.r► DO - . AND srd or OCEP[H0. •_ 3_THC t, 1KAT/CALLY APPLIED CONCRETE tWHtT C1 SHALL d :$ '. VALVE Nib ��£ co.-LCCTt\t DC A 1'4 ittX WTT11 A HAXIM A or 32•I�LLOHS Or I • K 6RAYP1 SASE YATEA PER SACK of CCHENT. - - I $ '' .- - — n a+t h G H e r1 f.T!G /r 1-V 111,Na -Af iMVlNG1 ar!�N 1 <- RtJNf1,IlG1lIt1 iTCEL SHALL d[ IHT[RY[OIAT[ CRAOC 41i'n- �mm ` _ P$L CT STEEL WITH MINIMUM LAI Or 30.SAR. • *'. "L .0-A�C. %N.fGrp • DwKT[R3.- . : - E 811216, M - eV My rP w1 Mr MD �� E he A. POOL WATER SO 1.1..T Irt OwHCR 3 GARDEN HOSE_ - ' - f - 13 -,tat. ftif-r o - - - ���'O��T or/ �L POOL TO oC I[CPT rLLt WRING ►REE211IG WEATHER.•• YAMS G W/t ''- t mot <54 >L�i� . •� �4` •'f l''. T . . PVYP'CAPACITY•TO SC Surr,GICNT TO DIP TT POOL ` tIN �' IN 24 MOORS. I f - t• 6r,'>a. 1 Titicr_71A_ LL G-f to r1 , fly • 17.RA Pod CtS - - - • <4# tifisl Fwlfwcsst J'® .J, 747 - • - ' Cornell REVISED 9/14 H. ROY JAFFE, P.E. / '�`�QFfSSiO�A\' ' 350 Sterling Woods La - T/ 7-114'��- _ - 'j Southold, NY • 1 H.ROY JAFFE,:P.E, 82 EAGLE CHASE • WOODBURY,NY 11797 Pisa!GRADE I 'i ' ITO GRADE-wITHC4sT iRoN L�_ _---� ' IL' MI►�. RART,•_.A4D covER - 1F I I I Z4"MAX, F LNDER PAVED AREA i I I •,F{' uoTO 4�' �D 7 24 "14' 14 10 VmAX,'•�,-30•'MIm. 94 QtA.PIPE L2±0 "„4. , 1 1ZIGNTJ011475 "DJ IMEMtar 1 C11H,SI-LPE ve PER CT. I NOTE DES14HRAI'SIS I/.2 TMA'T.AP.fNE.VnDE3L_ .. y 1,7114G SATO t GRAVEL,STRATA �� EFFECTIVE 'DEPTH • (SOLID DOME) J 'LS MAK. 0 o d JPI � 4.i ' I 3 o r 8 -DIAMETER 21-'''/) IL_42..1bMi....... (i'S it * COLLAR MATERIAL (..' -- — ftceeTrnY:oa) . RwTEAEABLE SOIL• _ 1 VItiDUAL: 4G Sw>lD 4 47..AVEL STRATA * NOTES • CAPACITY - 1263 GALLONS ( 169 CU.FT. ) 1 . COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR FULL DEPTH , 2. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND & GRAVEL FILTER M8T•ERIAL 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 @ "_5 MIN = 350' GAL. '��� ®��I RO ��® � Cornell • ,' .,z. , 14`..„,13---, �r- 350 Sterling Woods La. iE Yein,,,,,i,'' '�Southold, NY % c' . ` i cc, • A �04747U * _ ' �� / 17 .7 6-l 4;/''';p19®FFSSI00-