Loading...
HomeMy WebLinkAbout39584-Z SUF',,O� Fetp.4oG: Town of Southold 12/3/2015 tot , P.O.Box 1179 o '' 53095 Main Rd z,fod �° `la'o,� Southold,New York 11971 ti CERTIFICATE OF OCCUPANCY No: 37944 Date: 12/3/2015 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1850 Indian Neck Ln,Peconic SCTM#: 473889 Sec/Block/Lot: 86.-4-6.3 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 3/6/2015 pursuant to which Building Permit No. 39584 dated 3/13/2015 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 AS APPLIED FOR The certificate is issued to Albano,John&Albano, Susan of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39584 06-09-2015 PLUMBERS CERTIFICATION DATED j(497ed ignature PSUF tic TOWN OF SOUTHOLD sod °�y� BUILDING DEPARTMENT z TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS f" UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 39584 Date: 3/13/2015 Permission is hereby granted to: Albano, John &Albano, Susan 416 Washington St Apt 4F New York, NY 10013 To: construct an accessory Inground Swimming pool, fenced to code At premises located at: 1850 Indian Neck Ln, Peconic SCTM # 473889 Sec/Block/Lot# 86.-4-6.3 Pursuant to application dated 3/6/2015 and approved by the Building Inspector. To expire on 9/11/2016. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 .0 Building Inspector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines,streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957)non-conforming uses,or buildings and "pre-existing" land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool $50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00,Commercial$15.00 / Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: /Bev 'd3/0/ A�zIL L House No. Street Hamlet Owner or Owners of Property: 701/ 'Lfl 0 Suffolk County Tax Map No 1000, Section Block 0 / Lot 6 3 Subdivision Filed Map. Lot: (If Permit No. ,g Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ ✓U AppliA' nt Signature Town Hall Annex �i : Telephone(631)765-1802 54375 Main Road % t Fax(631)765-9502 P.O.Box 1179 ; ,`� roger.richertc town.southold.ny.us Southold,NY 11971-0959 : .® 1i `- COUNTI,* ''' er_... ,l' BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: John Albano Address: 1850 Indian Neck Lane City: Peconic St: New York Zip: 11958 Building Permit# 39584 Section* 86 Block* 4 Lot 6 3 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: C-CAT Electric License No: 953-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 X Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel NC Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel NC Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment' In Ground Swimming Pool To Include, Bonding, Chlorine Generator, 1- Pool Light, 1-Pool Heater. Notes: Self Contained Hot Tub,2-GFCI Protected Circuit Breakers For Power To Hot Tub '7...r. Inspector Signature: Date: June 9, 2015 Electrical 81 Compliance Form xls .1c1 ((c-- - ------------- sc. SOIo\, TOWN OF SOUTHOLD BUILDING 'DEPT. 765-1802 NSPECTION 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: GZa DATE if INSPECTOR a7 0 61 -181 )".Z -- .��r 0SOUr4o.. 01..' ' cf.. 4\ ao'p TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ' [ ] FOUNDATION 1ST [ ] ROUGH P BING [ ] FOUNDATION 2ND [ ] INS TION • [ ] FRAMING / STRAPPING [ INAL ` [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATI •dia, [ ] CAULKING "' REMARKS: �% - � � � _ 4,-EJ-- /�' LCA 0 ()r-ior.t. c,-)c- IY6(-c-e-l-a- &4 o r g.... • e_ / � ze.` 4'9c. ._ 0---ti,,,_ 4,31_ / --e— -Z -tea 0 rkJ' AP / j� loci-,--.4J kijlee:. 4JC.eael.glite f i DATE ) X2/// ' INSPECTOR 7 , ,- • FIELD IlelSPEf}N 2�E ORT DATA COI IDENTS --,• int.. 1- _ — — . ' 14'1'0 , i ik k'OUNDA XON(1sT) , . FOUNDATION(2ND) • •--�txi • 09 P ROUGH FRAM�NC�•& H PLUMBING . • , , , • • • INSULATION PER N.Y. v • . • '; • H STATE ENERGY CODE , . • -cam Gir ,7 FINAL y /1 F 'tom A — .._ • i • g41:° ,49 1161-4—- ,-77—Al . ... ,,, ic,,k , . . . . � . _ t....,....._ AD iii:, :- o ilfs,.�. 1- . . . .1 ' ' ,,,' g 6- )63—cc ) bG a, — , . ( ' , /. . t G ._s 2 . . . . .. . . . . . , _ . . .. . „ , . .. . . , ) . . , . . . , . . . , - 7-- . r r, f' ti . TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? c. 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. Check Septic Form N Y S D.E.0 n Trustees E E C.O.Application i S Flood Permit Examined 3/I-5,20 niSingle&Separate l I MAR® 6 pyo Storm-Water Assessment Form MAR ® 2015 Contact: �J Approved ,311‘ 20 Mail to: /�C ✓✓ y. Disapproved a/c BLDG DEPT —> 1 4009/ ®3// / ,S7741$1,0.11 `!,'Y' P'�1 //f6" TOWN OF SOUTHOLD Phone. 52(f7 3( /. ' Expiration 11 0,20 Mali �i°(mi� Building Inspector APPLICATION FOR BUILDING PERMIT Date 2/2-C ,20 INSTRUCTIONS a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date.If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold,Suffolk County,New York,and other applicable Laws,Ordinances or Regulations,for the construction of buildings,additions,or alterations or for removal or demolition as herein described The applicant agrees to comply with all applicable laws,ordinances,building code,housing code,and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. q (Signature of applicant or name,if a corporation) 1ENCLOSE?OOL TO CO9 cal/AU UPON COMPLETION -7, -cf-miir //764 BEFORE„WATEFIn (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder 4E/177/ADL a 7-,4 Name of owner of premises JW4 /71,04 (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. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done. �gS© �',t�Oit/NEc,'&f4' House Number Street Hamlet NOTED Tax Map No. 1000 Section g& Block I t;,tPPR S NOTED DATE ,3/05-BP # TO ,.: "t 1(I, p sln FEE !,'-TV BY..1:26.0 ,,./L - °�y Ga�9�� NOTIFY BUILDING DE ARTMENT AT /1(4:I'_: i"; 3 II V g 765-1802 8 AM TO 4 PM FOR THE 's` " Xit pV5 � � „ �, FOLLOWING INSPECTIONS. 11'1 J J, i E a I 1 FOUNDATION-TWO REQUIRED I FOR POURED CONCRETE f`'%%g 2 ROUGH-FRAMING,PLUMBING, STRAPPING, ELECTRICAL&CAULKING 3 INSULATION 4 FINAL-CONSTRUCTION &ELECTRICAL FEL ' TPICAL MUST BE COMPLETE FOR C.0 ON P c "lu-.d RET! L '' 1 ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy -5:721,4-m- , .zzp' Avad-,w6 b. Intended use and occupancy S S fE 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work S✓z-Np znr6 (Description) 4. Estimated Cost �J/OOO 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 FormerOwner 11.Zone or use district in which premises are situated_ /`►C,, 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 Address Phone No. 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�tEQUIRED. 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 L/9/(14/4.7146e being duly sworn,deposes and says that(s)he is the applicant Mame of individual signingnicontract)above named, (S)He is the ��/ j AZ 694614A (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 o wore me this day of MaCch 20 15 3naou, CNotary Publi 'ignature of Applicant TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 ; 1' QUALIFIED IN$UFFOLK COUNTY;' COMMISSION.EJ(PIRES JUNE 30,Y , .•�'''�.°Suk�' ST(0)R.MWAT]ER. Scott A. Russell SUPERVISOR MA. T SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 %% Town of Southold 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) ❑['A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑[I/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. ❑[�D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. 012(E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. O 121 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 witIyour Building Permit Application. APPLICANT (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. '`: 1000 Date //gy�pp //�� �/a/. 06 District NAME 1 /,? 6orfaO& / 4x.� oq 6.3 3/45//3- ffff Section Block Lot i **"*FOR BUILDING DEPARTMENT USE ONLY**** Contact Information _ 34? 30'1672/ 4Tr1.pMne{ Mr) . __ ./i Reviewed By: , t.J./j iyU/t{..'l- Property Address/ Location of Construction Work: — ZA�r/f/t�/1��e'i�C////t,-- Date: /3-6- /5 • �o�Gc�l(, Approved for processing Building Permit. Stormwater Management Control Plan Not Required. Stormwater Management Control Plan is Required. (Forward to Engineering Department for Review) FORM ' SMCP-TOS MAY 2014 - r • H. ROY JAFFE, P.E. • • 82 EAGLE CHASE,WOODBURY, N.Y, 11797 516-364-0148 FAX 516.364-0158 • Jan 31, 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: Albano 1850 Indian Neck Lane Peconic, 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 and will not interfere with the public water supply, the existing sanitary facilities or public highways. The proposed pool measures 720 scuctrece4 . The soil disturbance will be about Y2J-1--8 square feet . Since this less than 5 , 000 square feet as outlined in your Storm Water P:anagement code, no drywell is required . Very truly yours , ,- H. Roy Jaffe, P. E. • {,la:, ; cu ''r, F4d' 047A1V fl . FESSk.:�`'�`y • n' ,e 0,o��OF SO�l�o ++ � <o , Town Hall Annex /NgTelephone(631)765-1802 54375 Main Road (631) 5�Q50g P.O.Box 1179 roAer.richert(aowns76o o d.nv.us Southold,NY 11971-0959 '+� • BUILDING DEPARTMENT - TOWN OF SOUTHOLD • APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: i �� 1 �J Date: 6ff 21/5"- Company Name: 0,_CAT— L- 2 LC ---Name: - - - -- r.O chi. ONitIc - - -- - - - - -- License No.: Address: Po gcyc .? P147r7 , /1/41Y t?s2 Phone No.: ?7,9( JOBSITE INFORMATION: (*indicates required information) - *Name: QPLk NI 4! _24ND *Address: ' Igr) /lL1OI4 1 ,_ d r-L� *Cross Street jet *Phone No.: Permit No.: ci 5 Tax Map District 1000 Section: Block:_4 Lot ,3 • *BRIEF DESCRIPTION OF WORK(Please Print Clearly) / a beo(Ad) top-tui)( L ,4 0.6 - (Please Circle All That Apply) --Is job ready for inspection: YE NO Rough In Cr*Do you need a Temp Certificate: S O. -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 82-Request for Inspection Form 1°) --1 S� 1 ,IIA se •�1r 1 Y• y, ` },f �: t, , - ulllunll } ��'�}}}\fff; ,\\il. r.� ,a,_S4�,,• }}y7j�y 7��� {t(� 111 1111 'rl%� 1111111H111111/ 11111111111 /11111111 111111111 111111/11 I•/" 7t' fry (� r(' ' "1 11111/ C J t1`11 111/..`NI g 111.1 .NN . i !IIIb •.1111 Illll/lr .0. 1111/11,' IN1111 „11c.1/1 � '.11111.,,, 1/ .,,.11/4 •111111111111111111_4, 11111111111111111/11//, 11111111,111.,., /1/I, 11111111111HIN/l 4, .111 1. twc tdef lliEi t l !11111111111 it,flfffl ill IIIIIlss111111111111111111111111,II111111111111111111111111I111H11111111111111111111 Illlllllllllllllll1111111I111111111111IIIII 111111111111111 IIIIIIIIIIIIIIIIIIIIIIIII Illi Ilflllllllf IIf111f1 Illlllllllllflll IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIHIIIIIIIIIII/III is 1111111 Ilflllllllllllllllllllllllll 111./to; -• - .� . ..„. , ,. (,01; _ "` ...,....„--------------,,.„..„,.„„,,,,,,,n,..,.„,....,,,,,...__i,,,..........w.,...„,.,„„„„„„,.,„„,„„„,.„,„„„„ _.r-- , ONI%N �!r/N%z`Il/ %irUIMi,i:!f�����wriMiv r Orre'L I 7, •r f i • � t 'Iii�i� �{ _ ...tip,. 1 / 1 A tP. • : i I` ' . , ,! •.,1 y . _ — `_ E. '`lam}%$ E. �'� _ - 7 � i� i�JtLyI+lti�Z ly�l rli nl/ifi1/X = I :..ar II 4 - .— `�l^ = This----I--s- rt-certtliat^�-- �I►ri�y►J0 : P. _ ir` P; • �. - - - - — , i _ ' �, i _ -�� •-_� vim_ I 1 (!�)C�7•\ . /] !iilt J_ _ t �mR; ; '1Wr 1 111 iii -tarv reInent Se-t rt• • _` — • ,.2 r. ,; �- �� :sserdance-with-and-sub. ��t: ::�:r-• i��rr.�f�nn�tic�bler . •.s r t- = ; ..' - - -----and r-eg:ilationf-0:41:___________74-fr----'.te-, • - .. • I ' e-re• ' - me • . •. • iU 'nes , "WWJI'I ? ,,,,-.1.- .,*,„ .. .�!, , rt: —��- � �I`i1[�►� '�• rJs iii1_e • : WOO: I - 1,t.".:,--7::::: 1 t �� —ter r---_ --v— _ _\, 1Wy ? E - --�__��1� i.��_r ---_� T ICEASB-Cit or -a?`vl NT AL D-W4TH_A�--- �_ �rdditionral-Bttsinesses-- ! _1- •!els •a _ -` ; ,• �1.. I ,-J- D T>��R � Ate., _ �� 1� s4 • I [= ,J' ,rpt_–v�__s-- ----_—�--- 1~ '\0 ,= r, r<f, as •;} 'fir 1 ''_- �-'',� nUl 11:/ Va_A�1 �� r�� =uOINIMINIONIIIINIOIP i rr/= i : Y '! E. r�—jam '1 .••• I a �!T' • l •y'+ :. 111m1010111.11111110/11 aw•-Jd'''' M 'Lill -mi ----.rv_ ilei ��Mr 1 = 1 �,;� (; .: v41 1. ---_____ 'x" �i;--o oo o f 11 11 1 'Y'1 H 1 11111 11 1111 ANA,1111 III III II H'fffl�l'f Yf if�ff�f'flfl �l"i'fl"1111111 I I 111111 111 III II IIIHIII Il 111 oil iii iii 111111111111 1 1111 IIII 111 II 11 111111 11 111111 1,1, I„�1,k1.1,11••1,11,1,1) . ;_,� . .,j 1 a J• t U .•..•U„.,.1.,�. .,..11.� �,.,lIflt t,.. X'11.1.1f,1 ) 1 ,...,..,a,.,,,ai l i J1.U.......,,l.,dAa! l l.,l•.,..,,U,.,IH.,l1,.,.U11� lU. (7,,!;•1:411,;__,,..0041:),41\11,41 I P• ISP N��y -1 F 1._ .�.f r 1 It `/ y -,It �1 • ~�% 1: n �s � ::;�11o/' ' �j ,. 1 �� r ��,�I �yl(((� r�. 6 y .. (I�� :%1�'•� (�� d��l � !I q. .. 1 . x'1111 +III1111.//I � 111\•!IIII . 1� 111 IIIA�e5. IN•+III E.�� I,,•/II� IN 0,,, ->-'1111�•r �Y�//11 . 4•}11111w., 'a.t e :a,, ,.44%,°0 Inunr,u la # L',,'00,,,,Ig1111111 -t,,,.!1,11011111111,,1 I12.,nplmin111H1 -taN,•, IIIINH1111111N ,,R,',,,,.'",n0,11 IIII„,,,,,,1. h11111ppHHll1 IIINlllllll l lllH .};I-,.l 11 II 11111111 II IH . },'� al,,lnn,l nl isr.Y 11111111p 1111111 I•(.. Ipllllh P,1e1..IA: . '/! l.. `I• b - !f r ttv/pI -3 �. Ir ♦ Lr,R ..��p__'q�77"(. ` 'q,.t. ' • tT. 1 ♦ •rr1 1. r oma. lal,1. ♦. f•.. •ppY1,1(1yh11. ` AN`I'•S?>,' J 4 -.IOS'"�..,� i �j. 1q �,�r. '.�p�1�S(4.♦� i�rj tiff l,\ ���OS+�1/1ti` iy��PlSrllllq\` / d✓ppS�f1�11J� ���1}/l��l>,�” 'ij�f��l.�l�l: (•11,, . i�. .II;7v i' L, 1,1 v l�ia, pt ♦ i `• . 1 , • 10• \,•l \ ry/J� 1`��'\ . {'i.\\ \. / \ �I 1\. iii/ 4 8 `\�\\ •♦ J# It\\ . ' \ /J ` \ I ` Certificate of NYS Workers' Compensation Insurance Coverage Page 12 of 19 STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Pelican Pools Inc 631-287-5135 509 County Road 39 Southampton,NY 11968 lc.NYS Unemployment p yment Insurance Employer Registration Number of Insured ld.Federal Employer Indentification Number of Insured Work Location of Insured(Only required if coverage rs specifically limited or Social Security Number to certain location in New York State,Le.a Wrap-Up Policy) 112973725 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 53095 Route 25 3b.PolicyNumber of entitylisted in box"la": PO Box 1179 Southold,NY 11971 RWC3345593 3c.Policy effective period: 11/1/2014 to 11/1/2015 3d.The Proprietor,Partners or Executive Officers are: EA included(Only check box if all partners/officers included) P.a 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 Certification 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 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.Sibley (Print name of authorized representative or licensed agent of insurance carrier) f'•I�id. rf.1 Approved By 1/7/2015 (Signature) (Date) Title Underwriting Manager Telephone Number of authonzed representative or licensed agent of insurance earner CamerPhone 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.com/anawc/Po]i cyNYCerti ficateOf Wclns.aspx?IndexId=-1&Instanc... 1/7/2015 Client#:40417 PELIPOOI DATE(MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1/07/2015 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). PRODUCER CONTACT NAME: Southampton Commercial PHONE 631 324-1440 FAX (A/C,No,Ext). (NC,No): Cook Maran&Associates E-MAIL ADDRESS: 300 Hampton Road INSURER(S)AFFORDING COVERAGE NAIC# Southampton,NY 11968 INSURER A.Valley Forge Insurance Company 20508 INSURED INSURER B•Continental Casualty Co. 20443 Pelican Pools Inc. • INSURER C Rochdale Insurance Co. 509 County Rd 39 INSURER D: Southampton,NY 11968 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. INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A GENERAL LIABILITY 5099189209 01/01/2015 01/01/2016 EACHOCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES IpEa occurrrence) $100,000 CLAIMS-MADE X OCCUR • MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $2,000,000 —I POLICY PRO- JECT B AUTOMOBILE LIABILITY 5099189243 01/01/2015 01/01/2016Ea COMBaccidINEDSI ent) � r rNGLELIMIT 1 000 000 ( X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS XNON-OWNED PROPERTY DAMAGE $ _ AUTOS (Per accident) X Drive Oth Car $ B X UMBRELLA LIAB X OCCUR 5099189212 01/01/2015 01/01/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $1,000,000 DED X RETENTION$10000 $ C WORKERS COMPENSATION RWC3345593 11/01/201411/01/2015 T,ORYTLIMITS 24" - AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (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 more space Is required) CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN _ 53095 Route 25 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE G410-716/11 carlimt'a al ©1988-2010 ACORD CORPORATION.All rights reserved. ' ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S674511/M673895 CM4 i SURVEY ' OF L i0L '� 3 , FILE No. 9331 FILED MARCH 9, 1993 SITUMAP ATEDOF AT WI ?ECONICDOATS TOWN OF SOUTHOLD 0 o \ SUFFOLK COUNTY, NEW YORK 250' \ v• \' \ S.C. TAX No. 1000-86-04-6.3 4. \ SCALE 1 "=40' °° •P \ o JULY 30, 2001 - o, m20 0 \O SEPTEMBER 25, 2001 REVISED PROPOSED HOUSE 1,OT \pwN e o 0 NOVEMBER 19, 2001 FOUNDATION LOCATION NCE EGGS° LP \ 1pva� OCTOBER 22, 2002 FINAL SURVEY F2as AI /— ^ P�\p'SNop�N C. FEBRUARY 21, 2015 ADD PROPOSED POOL ,eii a I� ��p6o PS AREA = 39,998.00 sq. ft. �sN�S `� \ 3 E Fac Sp��P• Q <t• 0.91 8 a c. OF OJ��GROjirik 02 000 i \ �Py�03 ; c o 0 co 56 Ey0N \ c7- ,.e,,\ 0 N�o i O 6 0 0`0' ��\\ �2 NDN qc. �//// Poop'\NG L0� tv \\ \\,, i3 N 6 it \ t\\NG n 0 \ \ .5&s N.eo \tea f POO\' \ , 7� J ...- -4t,, .« PUMP o ` ° \ c� C7‘ o\� ME o °o o� to. `` ��O3 2 PS9E0" P� �• P\G a ° \\ �� 0 , 9 5S <J 5 SPNK ° ° e I \ o , �.- 5 ° c °° ° 4 ° a ° \\ i•,* O� . t^t� GRON ° °GRAVEL DRIVEWAY° ° O� 000 ` ` ! �0 Ni °°° ° i\ 5(EPS i 0 / A \ ° ° a< ° e' /3 -4. ° ° ° o° ° �r 4. L y \ gOj�// T`��A1N V 9 15 ° cn r. I') (P l41 t• �••� .-- i • PpS��G'G • 4 ° 4 122 5 ' i - ' \ Lrn �'z - . / PpOL� : -cas\\c o, __ — MON - . . • N •2� .a o 3a3 25' WIDE VENT_ � 1 PREPARED IN ACCORDANCE WITH THE MINIMUM STANDARDS FOR TITLE SURVEYS AS ESTABLISHED 9Z�9 • O �`i ,it��`\ 416)5 DR�WAj- 125 '. 1 \ BY THE L I A L S. AND APPROVED AND ADOPTED J oc POyE� \� O00 10 N S _ - C\O, \i FOR SUCH USE BY THE NEW YORK STATE LAND tel • .. 6\ y.. -PV-P0�� SjEPs \ r-- ' ZcJQ TITLE ASSOCIATION. 0 .2,0:8 ___ 0. • Z G\P-„.------, J 247.41' �., Ci 125'U���V' I • C4 P\pdg(ING OED / PSQ\'8' \� -0 (In .. rt=S�7o EA Z v� - WE\l S 7$• r�T-1Y�0 LOT in m o 070�p-p� -S- cA •s01 4" rmo�o N.Y S. Lic No 50467 o C-C1170—\m" 30iS\73511-3 UNAUTHORIZED ALTERATION OR ADDITION Nathan Taft Corwin I I I 7p�� lnrn TO THIS SURVEY IS A VIOLATION OF �y ��� 4 SECTION 7209 OF THE NEW YORK STATE =C -�t1\ EDUCATION LAW ' -r 7c111 COPIES OF THIS SURVEY MAP NOT BEARING Land Surveyor =C\7. . THE LAND SURVEYOR'S INKED SEAL OR Ls-% Zr \ 'O TO EMBBE SA DVALID LTRUELCOPYiv " c33 L NOT BE CONSIDERED �'\-rn �� CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To. Stanley J Isaksen, Jr. L S. d��\`=j\ �, ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S �p-it'll IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys — Subdivisions — Site Plans — Construction Layout LENDING INSTITUTION LISTED HEREON, AND r TO THE ASSIGNEES OF THE LENDING INSTI- r TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727 THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P 0 Box 16 ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947 35-03 i • !„i F�RAPNiF'NmatApN G106T PROTECTION REQUIRED POOL AND PROPERTY '10 QONPORri 10 N.Y. STATE RESIDENTIAL • ON G107 ' QODE APPENDIX G 2-0(' EDITION I�'0�� AI.AFtM REQUIRED 'POOL 10 (MOM T O ANSI/NSPI STANDARDS AG103.1 - 61;ti(FT) A G C P E F 0 AMA CAP. S uN D GS • r 3 M. 4At.. ' • H 51 b - . 4• ""t ,`;. - - - DW�IN S ``' riiisi► t3 �SCFi M�,�or_ "MI5 U' bcfc � N �2� 9��".urr,. iiiiii1 Apmftmor • O ,Illlllllllllt ::. P ! �� ' . . . ,;_r„..5 '•.Hnnnnr 00001110111117111111.111111111 • • poop r I o o GENERAL NOTES �- - -- ''- • f L Txt Of.St6X tS SASLQ OK A ORAIHAGE SON_br*TH<gxLLL._ .i-.- .f -- )ce �ltFpa� - . - i / Stir i� - b1/420411 • t:ROUNO 'KAT SHALL MOT CXt2T VATHISt Tic own:Of THC :(,)1,�rYS -`• L - --_ EwCAwITION-tf C UH0 WATCR[xtSTS 1ratitrt t;•-O-L£LOMI .4A{i.iktct f1 :' s �•J r - I' Ott— - cRADC SeCCZ(AL-O4 WATCRYNG FitCtc.tTIES -;LL SC REOtuRE4nglfz . r • �yy� • IrAT A_IxSPOS.��A_t_IS LJ mTCO To O 1&R' priory TY_ s - Z. MO suf�tS•fIICE ALUJJMrCO MTntWN 4---0-Or iHALLAw Eu0 'c - Ot(�( i AK x0 4.-t-a" of DCCT tMD- -`- >-"• is vJ�tKYUoSTRTtc, VE s 3_TfATKat LT APtuEO COftCRCTE(Gt1NIT CI SHALL ti: g t x_ . :-C .co.��c-rdst TV>�f !C A *4 NIX WtTX A wuw AXtuOf 32ctiL3' • O.th of - i iH 6RAY1� �« xATER PER SACK Of CEMENT_ . ' K 8 6�5- ;-. - .'- — —FiSI-} �"r h G t j 6 r1 AT r 2 r-u11 vrN G ,- i F N Er- I;N-t- s- pox FORC:WS STEEL SHALL be INTCRA MEDIATC GRD( -� - t'AtMK Wol•-• 4. •u 1 CT STEEL watt A wINIwUY LAP OF 30 eAR- Y-. Y -q-O'/r'n,4tl414+ry OLAMCTCRl. - T - c9��r .M v:cr FHP 1 POOL_ wATCR suft'LY WY OWN CR'S cARDEx NOSE. . 1 34l •f ►rtt 1 13 ( t p. o w �' �� ------- ��� Pool Tq RC Kiri' rocs_ OURiNG FREEZING WCATH£R_,' AN51' G V If - - >'-. t` kpKtg <Sr1 GYO �`A. _'�4� ; �� e ,® ruwr C.A/AGIT1S TO SC Su(FICICNT TO CJ/PTY root_ �•.- Nava. dti Q -,a--• 9° `'�� '1i I �' t4' 1S'se-a. � � t � -n IN :, MOORS. r ',YAPI _.L - - •r• rt•nL if At. a.... MOW- ,,,-Y iti..'1' - � `-;ate.. :,� t �'t--vt ,LL-. f-G1 ,orr n.,o?s iraAftil&,� e,. [,� ;,. c I of ti /-..lfwtfRT . -Z-,:-, 14.; : Albano REVISED 8/Et H. ROY JAFFE, P. E_ 047470 3. �`i 1850 Indian Neck Lane 4®FESSIOP\/` Peconic, NY - .-— -- , 13 �!5-'