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HomeMy WebLinkAbout39384-Z �o�S�EFOt,�co Town of Southold 11/4/2016 P.O.Box 1179 a' 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38642 Date: 11/4/2016 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3825 Rocky Point Rd, East Marion SCTM#: 473889 Sec/Block/Lot: 21.-6-2 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/13/2014 pursuant to which Building Permit No. 39384 dated 11/25/2014 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 Owens,Thomas&Owens,Lisa of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 39384 06-16-2015 PLUMBERS CERTIFICATION DATED ovorized Signature g�fFatK TOWN OF SOUTHOLD 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#: 39384 Date: 11/25/2014 Permission is hereby granted to: Owens, Thomas & Owens, Lisa 1083 Steele Blvd Baldwin Harbor, NY 11510 To: Construction of an in-ground swimming pool as applied for. At premises located at: 3825 Rocky Point Rd, East Marion SCTM #473889 Sec/Block/Lot#21.-6-2 Pursuant to application dated 11/13/2014 and approved by the Building Inspector. To expire on 5/26/2016. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building ns 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 I%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. ////,?41` New Construction: Old or Pre-existing Building: (check one) Location of Property: ,313 QS_ /R r-k Y PU 0 J T R!� ASi MA12fo� House No. Street Hamlet Owner or Owners of Property: ;r//6m,4 S 01-JEP-S 4- .4 154 d zAks Suffolk County Tax Map No 1000, Section l Block Lot 2- 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: $ O Applicant Signature pF SO�j�®l Town Hall Annex Telephone(631)765-1802 54375 Main Road coy Fax(631)765-9502 P.O.Box 1179 G., ® �� roper.riche rt(a)-town.southoId.ny.us Southold,NY 11971-0959 ®l�c®u0,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Thomas Owens Address: 3825 Rocky Point Road City: East Marion St: New York Zip: 11939 Building Permit#: 39384 Section: 21 Block: 6 Lot. 2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: C G Edwards License No: 3552 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 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 2 Disconnect Switches Twist Lock Exit Fixtures 11 TVSS Other Equipment: In Ground Swimming Pool to Include, Bonding, 1- Heat Pump, 1- Chlorine Generator 1-Control Panel,2-GFI Circuit Breakers,2-Pool Lights,Circuit for Cover Pump Motor Notes. Inspector Signature: Date: July 16, 2015 Electrical 81 Compliance Form.xls cou TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION, [Vf'-FOUNDATION IST ROUGH PLUMBING FOUNDATION 2ND INSULATION FRAMING / STRAPPING FINAL FIREPLACE & CHIMNEY FIRE SAFETY INSPECTION FIRE RESISTANT CONSTRUCTION FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) ELECTRICAL (FINAL) CODE VIOLAT"N CAULKING REMARKS: DATE INSPECTOR ho��OF SOpr�olo cOUNi`t,� TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION , ' [ ] FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: ATE INSPECTOR �a0f SOUlyol �0 0 UNT TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] WSULA ION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL FINAL) REMARKS: � `, vav�O �L' DATE l INSPECTOR FIELD INSPEMON REPORT DATE CONM.NTS oUND,� o ST) FOUNDATION(2ND) 30 ISN ROUGH FRAMINQ& - PLU-MING INSULATION PER N.Y. - STATE ENERGY CODE Q Y FINAL CD -. ADDXT` NAS"C�f1V1�YIENTS o a •�° - z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST 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 3°I3�( ' Survey SoutholdTown.NorthFork.net PERMIT NO. l `� Check Septic Form NYSDEC Trustees C O Application IFlood Permit Examined 20( Single&Separate Storm-Water Assessment Form Contact: IA0664r 164^4k/ Approved ZJ 20 r-1 Mail to /8 A-(.EcJ &0- Disapproved a/c /=,4f2,, J6)>,1 CC tJY 117-1 one ?93-ayfo Expiration]DE C E W Building Inspec or PPLICATION FOR BUILDING PERMIT NOV 13 2014 5 Date / ,20t� INSTRUCTIONS a M(ii I>°dation MUST be co pletely filled in by typewriter or in ink and submitted to the Building Inspector with 4 1�I�� sets of 9cc late by lan to scal ee 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 A(Pog- QLAL sc�i .�1 i�G ncr lL ('a` lh1C_'. (Signature of applicant or name,if a corporation) lf3 ��cc�� i3�vA,l'A�Ml,J6�)4c/,0y 11735 (Mailing addre s of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises 7-Po M-S d S A 0 iJ E ct)5 (As on the tax roll or latest deed) If ap 'ca!,P a co orat��signature of duly�pthorized of t V. � 1 If (Name and title of corporate officer) Builders License No. Plumbers License No. 1 Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 355 ZS !Zoay POt,J7` 121 . 9ST' tMIUO-Al House Number Street Hamlet County Tax Map No. 1000 Section c2/ Block 1p Lot Z 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 S i cj&j�- IrA^Z'V /ZS/dl%a)cC b. Intended use and occupancy S/e�Y�lr -'q/✓1rLY ,2 Qr/����ec 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other WorkS�/jltnI4 . ��i (Description) 4. Estimated Cost_ "Y3 8_ux, 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 alterationior additions: Front Rear Depth Height Number of Stories i f 8. Dimensions of entire new construction:Front Rear Depth J6 Height o Number of Stories o 9. Size of lot:Front /&. Rear /6/_ 6_� Depth 33.3, 60/ 10.Date of Purchase (0,/z /4/ Name of Former Owner 7-16114-C &)E66,$ 4 TF" JN L e^{ 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES_NO I' 13.Will lot be re-graded?YES P NO VWill excess fill be removed from premises?YES V"'NO 14.Names of Owner of premises pert+-LSA ewLzS Address 60t m4iiv�J ray Phone No. 376 Name of Architect d. 1'2ay YA rN r Addresses ,`•.y.�e Phone No S%(, 3G y—u/�{ Name of ContractorAQ,,4-oL4i. St.Nn'W"J(y Address /,14-aI' gcuD. Phone No. 3/ x,793,�35 ylp laic �,. r=,gtM��kalv9cC� �y � 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. STATE OF NEW YORK) SS COUNTY OF ) /l nA 17)z )L4 ml lj SK/ being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the Co-)T-AZAC-16 a (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. Swo� before me is r\ 'q d of FV�VQ 01 LU Notary Public Signature of Applicant PAULA L"RADO NOTARY PUBLIC-STATE OF NEW YORK No. O1 LA6265296 Qualified in Nassau County My Comrrifssion Expires July 09, i f„� Scott A. Russell ' 'Zis ,tq) ST01R.MWA\TIER. SUPERVIS®RAWA\�A\GIEMIEN T SOUTHOLD TOWN HALL-P.O.Box 1179 1 53095 Main Road-SOUTHOLD,NEWYORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES 'E IIS PROJECT µINVOLVE A-N' ' OF THE FOLLO'A'11\!G: (CHECK ALL TIIAT APPLY) Ye:, No ❑ff A. Clearing, grubbing, grading or stripping of land which affects more '! than 5,000 square feet of ground surface. ❑ v❑/B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. �I ❑orc. Site preparation on slopes 'which exceed 1.0 feet vertical rise to # 100 feet of horizontal distance, ❑E�D, Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ❑el]. Site preparation within the,one-hundred-year f loodplain as depicted on FIRM Map .of any watercourse, I ❑dF. 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. _.__._ __-.-___ 1' W. _ _. _.__ 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 r tPropertti Ownei,Design Professional.Agent,Contractor.Other)€ S.C.T.IVI. #: 1000 Date y Dr>trict NAME Ro a>-Z r K4 M ra <i : , 021 I/ t & rrno Section Block Lot i FOR BUILDING= DEPAR"I'MI '�T USE ONLY Contact info,mat,on. 4�/ dl / VST 0 � ?MMne tinmbrr ( ��I r (f - - - - - - - - - - ' Reviewed By. ; Date. Property Address I Location of Construction Work: ! E X31 — — — — — — — — — — — — — — — j ppioved for piocessing Building Permit. iE Stormwater Management Control Plan Not Required. � j — — - - — — — — — — — — — — — — — . 1 ❑ Stormwatei Management Control Plan is Regwied. I h } } � (Forward to Engineering Depaitment for Review.) !� ;1 FORM Sl\/1CP-' TOS MAY 2014 S0�/ryDl 0 Town Hall Annex T e h ne�`{631)7,6511$02, 54375 Main Road 42 _ P.O.Box 1179 G Q ro er.nchert n.sounfil.n .us F Southold,NX 11971-0959 �O JUL 15 2015 : v BUILDING DEPARTMENT ro ,FIT, 11,77 — G ;:OUiNQI� TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL-]NSPECTION REQUESTED BY: Date: Company Name: Name: �r License No.: �F Address: Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: *Cross Street: *Phone No.: 576, 36 9 f&- Permit No.: Tax-Map District: 1000 Sectio •-,,�:/_ Block: ` Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clead ce C_ (Please Circle All That Apply) *Is job ready for inspection: YEA- 0 Rough In Final *Do you need a Temp Certificate: YES ! NO Temp Information (if needed) 'Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other _ 'New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: PAYMENT DUE WITH APPLICATION -711 82-Request for Inspection Form I V tC r Ilk 49 06 •, i j \. +-'� �� yyam�} .�•'. r1. t.: 'K=t • 1. �J r ,air t i f 1� Hai p'F AL � .._. � ,• 1 �',`$'. �� � ,:'° ♦ � i ii'i) ��1 Yt • rpt:r� #"' _ AL AP ,tri r yy�,, �� � - q,• ,,4 :, ., F' N r _,.� _.. f �#.l is - I�' � rt...6• �'@F�,��• •r•` ^('iy ,— ,�, �iJr► }.'/Y. • e J � 1 • � � `�:� �.?� i �• 11 :� • T + Ar 1-4 L Alp" - . • *., � f �� � ..-. � ��: - _lam\•,��[ _ +fes. _/ • • '+/ _,: +- � � t RM , .F + °'-••_.>• ` ; 'fr _ � / � �!. _ - •r .- \ ems. (' rlA - .4i �� I 4.:�?' ^ I t �r f ;4" 1 ,�, j• } �; 1 ''� � >...w°. RIR � �� - i. �•-�,r r _ � � +.�' 'b.. J'�+.:�T� tr„7� _ ,,,�1�M`. Vit•. �ra�. 09 / 22 / 201-611dOp 441 4w. .•s ••d*+_,••K �I ->'�Y --` .�+ ter SRT - ¢' IF ,,,i, AQUAQ-1 OP ID:JB ,�►`oRa� CERTIFICATE OF LIABILITY INSURANCE D0911 /2014Y) 09/19/2014 PRODUCER Phone:516-938-3737 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION John E.Komara Jr.,Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 675 Broadway Mall HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Hicksville,NY 11801 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED Aqua Qual Swimming Pool Co Inc INSURER Nw Mutual Insurance Company 23787 18 Allen Blvd Farmingdale,NY 11735 INSURER B INSURER C INSURER D INSURER E COVERAGES 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 AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICYEFFECTIVE POLICY EXPIRATION R INSRD TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED AX COMMERCIAL GENERAL LIABILITY ACP GLO 5425340076 02/01/2014 02!0112015 PREMISES Ea occurence $ 100,000 CLAIMS MADE FRI OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1,000,000 JECT X POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY A X SCHEDULED AUTOS ACP BA 5425340076 02/01/2014 02/01/2015 (PER PERSON) $ X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (PER ACCIDENT) $ PROPERTY DAMAGE $ (PER ACCIDENT) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO NIA EA ACC $ OTHER THAN AUTO ONLY AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 1,000,000 A X OCCUR CLAIMS MADE ACP CAF 5425340076 02/01/2014 02/01/2015 AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS I I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A OFFICER/MEMBER EXCLUDED E L EACH ACCIDENT $ (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ OTHER NIA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Swimming Pool Installation and Service. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Town of Southold NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE YO DO SO SHALL Town Hall Main Road IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR PO Box 1179 REPRESENTATIVES Southold,NY 11971 AUTHORIZED REPRESENTATIVE ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD New Fork State Insurance Fund s Workers'Compensation&Disability Benefits Specialists Since 1914 199 CHURCH STREET,NEW YORK,N Y 10007-1100 Phone (888)997-3863 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE AAAAAA 112034409 LOVELL SAFETY MGMT CO,LLC 110 WILLIAM STREET 12TH FLR NEW YORK NY 10038 POLICYHOLDER CERTIFICATE HOLDER AQUA-QUAL SWIMMING POOL INC TOWN OF SOUTHOLD 18 ALLEN BLVD MAIN ROAD-BOX 1179 FARMINGDALE NY 11735 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE G 1409 032-8 2243 04/01/2013 TO 04/01/2015 2/21/2014 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1409 032-8 UNTIL 04/01/2015, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED,OR CHANGED PRIOR TO 04/01/2015 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https://www.nysif.com/cert/certval asp or by calling(888)875-5790 VALIDATION NUMBER:987615136 U-26 3 JOB No. 01-62 - - - car TAX I.D.No. 1000-2i-M-02 LOT B IAT 3 f N 13005'6(M 164.58' i N �►- 556' -----+� �T " ♦>r 2S CC1A6►!dN QlZNirWAY j Q LOT 7 E LOT x a 1 e d fff To[33VAIZ 29 w �-- I wW`L t ROCKY POINT tR' a 49.5" ] s 8.WS&E 465 W - i TAXLOT y TA) LOT'S 6 MIO 5 TAX LOT t THE LOCATION OF WELLS,WATER ATER SERVICE LIMES, SEPTIC TANKS AND CESSPOOLS SHOWN HEREON AAE SELD OBSUWA• TIONS AND OR DATA OBTAINED FROM OTHERS. i ME MAP No. 8759 W/89 I uno�o�o.sw..�onar.�ie0 +ava4@M#W*w to W oftoamomrias .r.,.�rr►Yas,lw. i.a► SURVEY OF: LOT 2 coma " >MIr011 MM m ayr*$"/Uf w Its a11aR i Is p"wo 1{ owe**Now*$*"ftc + .r ►•wt«+arfo MAP OF CAST MARION WOODS • Yrlirflorr"�Wifrw"n4 IMtbt�w e aw�ew"dtlM ley " t'"—sop %awwwrs"ad"Wrwou"d FEAST MARION, TOWN OF SOUTHOLD �.r.ar�.m�aae.+aww oov �r ��ws t awwa�>�r1�oArw b lw.,�o«er ea.o w °` SUFFOLK COUNTY, NEW YORK , Irww •.r�ra"+a wb+�r�......wwr�a�+.�.,...�r.rn► «YMw�twet�lu+ysaeM�►w"�rdsa�nao���tw�r.�Ma+�+�a" SURVEY DATE: 07IM2 SCALE: 1"=50 j CE_ nV IED ONLY TO. _ Tis WELLS DESTlN G. C3RAF OF NEW YORK LAND SURVEYOR 704_ _ WELLS FARGO HOW MORTGAGE,INC.- _ V- PQM Irtiooky PoiK ""Yolk 117M - - -- - - - -------- ._ r 831-821-3442 t 5-y DEsm G.GRAF N.Y.S.UC NO.6M7 i N 13 05'50"W 164.58' APPROVED NOTED DATE: I RfL� .P. �� MOTIF A� BUILDING RTMENT� AST OCCUPANCY 58-8 765-1802 8 FOLLOVINGINSP O TIO IS:FOR THE USE I LA U 1. FOUNDATION - SQUIRED FOR POURED CONCRETE WITHOUT CERTIFY ATE 16' ONC 2. ROUGH - FRAMING & PLUMBIN3 OF OCCUPANCY Pool Equipmer t 3. INSULATION 4. FINAL - CONSTRUCTI N MUST BE COMPLETE FOR G.O. 4'Fence to NYS Code ALL CONSTRUCTION SHALL MEE THE REQUIREMENTS OF THE CODES OF NEW 119'-10" YORK STATE. NOT RE PONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. Propo d 18'x3 ' Z RETAIN'STORM WATER RUNOFF 001 PUR UN TO CHAPTER 236 16' .W OF Tilt TOWN CODE. m N W W W DO _ O Existing Residence Driveway cra o ® K -® � �� ��. .0 COMELY WITH ALL CODES OF ��yo NEW YORK STATE & TOWN CODES �✓� ���e O�Qv��� AS REQUIRED A F " SO 4 l PD — S01W;��'h Tf1tA1't t,t«TEES S 8 59'50"E165.00' ROCKY POINT ROAD XY�sia l��ia�. ric>r2�i2ci�, .`Jool 18 Allen Boulevard, Farmingdale, New York 11735 T(631)293-8540 F(631)293-9181 Email mfo rDaquaqual coin OWENS RESIDENCE-SITE PLAN 3825 Rocky Point Road East Marlon,NY Section 21 Block 6 Lot.2 Scale V=40' 11/10/14 / NOTE:All existing site information is taken from survey done by Destin G.Graf Land Surveyor,dated-7/2/02 H. ROY JAFFE, P.E. ' 82 EAGLE CHASE,WOODBURY, N.Y, 1 1797 516-364-0148 FAX 516-364-0158 Nov 7 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: Owen 3825 Rocky Point Rd East Marion, 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. Very truly yours, OFN��� �EqT RO},J O H. Roy Jaffe, P.E. crj T 1 J' U47471i �®p9oFfSSIONP�'�� ATE RESIDENTIAL `SECTION-G106 .... •, POOL ASID-PROPERTY TU N:Y. ST ` FNrR1 pmEar PRC7rEC' w REQU•IREE CODE APPEDIDxX G 204 EDITION _ POOL TO CONFORM TO ANSI/NSPI STANNkRDS AG103.1 SECTION G107 POOL ALARM REQUIRED. 61;E(FT) Il o C v F o A1%9A CAP. - A � A V/OttAW49A t7 �►4ve pKD cn taCrov, - 4 MAIN - DRAINS - - root P LAN T 1=o N -= • =• a Lh* f�R1t L TMs= PSP S Cs - 1+uft jPSPWATMV;SPAA� Otcu is s�sc0 009w ORwtNacw ��.E soft TNs+lT_ - CAWIt0 WATCR SMALL NOT EXIST WITHIN THC LlutTS Of TNI:EXCAVATUM.tr CAO"WATER CXtSTS VMTtMN S'-O'SCLOW PW S Lc, 7C tWtTtA TO OMH[A� tRprmK MOutRtOT1a� 1t �1GtwdL No* `W- ALLCwEO wTTNtN 4=O�Of ittAL.LAw ENO • AMD 4--Cr Or DCCt KNO. VALVE P-ub �� '. a•a' �M YppsT�4z-ic, 3_THE: P►M(WAAT)CALLY Ar LWO CONCRETE CCVk TEa SMALL to. 'g ct>.-LCcilR-rune RC A 1-4 Nix wtTX A UAXLUt U Of.4-CALLOM.S Of .r r f 'WATER r" WC or Ct.•£NT_ i 9 i3Y�S - h�i r(�P'1 h T j 'r p U I7 DIN G, -m BANGS r-rl i�N-r 4- ItCj#IMRCWG STEEL SMALL BE INTEltsAMATE c"oc -- NaLET I(TECL WtTN A tWNuruw LAP or 3o.tAR•' i.• !V. W �� OLAHETERS. t► ;T - t9�+'�wP �"vitt sHo ® h _ Y S_ POOL WATER SurrL7 OY CwNER 3 CAROCN Hose_ TH ifPlrsl• v -ymu �Y p POOL TO K KIIT PULL OVRING FREEZING WCATNCR., Y/WLS t✓�+>� +-r_ t--- Y AZ > PvWP'cArwuTY TO BE wrriCIENT TO EMPTY Pool ptlryLatry -`�-: -• ' z ° . Mavz. �, tr..a aw :, HOUR:. I -�YPIC-A I. =1.- nAT. W fc w.- 5 - ttfre( f+ufJ'LSMT �'��. U4741u- � Owen REVISED 'j/i H. ROY JAFFE, P.E. �'4090FESSV��°�'�v 3825 Rocky Point Rd East Marion, NY