Loading...
HomeMy WebLinkAbout40163-Z ����S11FfOt,fcD�y� Town of Southold 6/15/2017 M P.O.Box 1179 0 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39018 Date: 6/15/2017 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3585 Great Peconic Bay Blvd, Laurel SCTM#: 473889 Sec/Block/Lot: 128.-3-12.5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/2/2015 pursuant to which Building Permit No. 40163 dated 10/9/2015 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,FENCED TO CODE, AS APPLIED FOR The certificate is issued to Doyle,Marialice of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40163 03-23-2017 PLUMBERS CERTIFICATION DATED A t o ' ed Signature TOWN OF SOUTHOLD �O�gUFEO(pCO - ' ay BUILDING DEPARTMENT y a 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#: 40163 Date: 10/9/2015 Permission is hereby granted to: Doyle, Marialice 1035 N 7th St New Hyde Park, NY 11040 To: Construct accessory in-ground swimming pool as applied for. At premises located at: 3585 Great Peconic Bay Blvd, Laurel SCTM # 473889 Sec/Block/Lot# 128.-3-12.5 Pursuant to application dated 10/2/2015 and approved by the Building Inspector. To expire on 4/9/2017. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 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 I Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: 3 S85- 12 e_-Cel , C- k rr,,4ve• L. A v u-e— ► -/ I i ry House No. Streef Hamlet Owner or Owners of Property: Kky i/}-(..l e�P Suffolk County Tax Map No 1000, Section Block Lot 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: $ �j� To �—o pplicant Signature SOU��®lo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 ® roger.rich erKD—town.southold.ny.us Southold,NY 11971-0959 Q l�c®UNT`l,�c`� BUELDI NG DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Doyle Address: 3585 Peconic Bay Blvd. City: Laurel St: New York Zip: 11948 Building Permit#: 40163 Section: 128 Block: 3 Lot: 12.5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Main Breaker Electric License No: 5150- SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 2 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 2 Disconnect Switches r 2 Twist Lock Exit Fixtures 11 TVSS Other Equipment: Inground Swimming Pool to Include: Bonding, Pool Light, Control Panel, 2 GFCI Circuit Breakers. Notes: Inspector Signature: Date: March 23, 2017 0-Cert Electrical Compliance FormAs SO(/jy� h0 �O H O i TOWN 'OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] NSULATION [ ] FRAMING / STRAPPING [ FINAL POP'_ [ ] FIREPLACE & CHIMNEY, [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: 1 N&' —Fe*siok' ow VOA ;vf-o,- 14I, IS pUl�� G c ► n f sov, C�A_6A si�ul --Sure f�tQk'�'.�- � - is v►� - DATE 313,612V 9-- ANSPECTOR SOUIyo`o ✓� ��'�OOUNi'I,a TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: DATE INSPECTOR so�Tyo N O i coulm act TOWN OF SOUTHOLD BUILDING DEPT. 765-16®2 INSPECTION [ ] FOUNDATION.1 ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATI N [ ] FRAMING /STRAPPING [ ] FINAL PW [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS. 6 n — 7b DATE41-:Vf7wi INSPECTOR qotV 3 Qk SOUTyo! � o �y00UNi TOWN OF SOUTHOLD BUILDING DEPT. 76518®2 INSPECTION [ ] FOUNDATION 1ST [ ] R _UGH PLRG. [ ] FOUNDATION 2ND [ ] I LATI [ ] FRAMING / STRAPPING [ FINAL 0,( [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL FINAL) REMARKS: OK 4 DATE INSPECTOR i I•A iNaTiL.ATION PEA N,Y. STATE • rr - i ol EVA"0 gig mw AMOL/11AIM i FIN AM onto wIN 1� • �S I i. I i i I r �i.� ,I�_ _ • 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 Budding Plans TEL:(631)765-1802 Planning Board approval FAX: 631 765-9502 Surve SoutholdTownNorthForkxet PERMIT NO. V Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined 20 Single&Separate Storm-Water Assessment Form l� Contact: Approved 20 h✓ Mail to:-� Disapproved a/c 5ga,4 G✓'y S 7-,+e- 1 -,+e- Phone: z 3 5/-7D 2 3 Expiration20 17 Build pector I ' APPLICATION FOR BUILDING PERMIT �J 2 2015 �I Date 20 OCTQCT INSTRUCTIONS a.This_ap icatio MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 __ �Lsgts 9fp(ans,accurate plot Ian to scale.Fee according to schedule. �b,Tl'ot plan sho ' g location of lot and of buildings on premises,relationship to adjoining premises or public streets or an 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. U (Signature of applicant or name,if a corporation) / 2oa 13� de,4 b uvIn P-A. �S C✓1v�a(i cJ9 Y-,-1 (Mailing address of applicant) t 1 y State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber r builder St-A cR.V, ,JkC p�nt_5 �voc _ Name of owner of premises MW A L-< <C OV L t (As on the tax roll or latest deed) If ap licant is a co o�-ry�ti'on,,signature of duly authorized officer i (Name and title of corporate officer) B ilders License No. Plumbers License No. Electricians License No. S/.Sy IV)E Other Trade's License No.Qoa,- C.,- 1. .c1. Location of land on which proposed work will be done: a House Number Street Hamlet County Tax Map No. 1000 Section Block 3 Lot 12, a 1 Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of pro po§ed construction: a. Existing use and occupancy SissJla t a �.¢w w>✓l/` 44 b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work_Flyr&e,,—' fR�riC (Description) 4. Estimated Cost_ _z.�r 5-ye 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 1 5-3 ` Rear. S Depth GZ 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES NO Will excess fill be removed from premises?YES 'ANO 14.Names of Owner of premises MOV c"A�(ic•e 6&dd e Address LA �v� Phone No. T�6 -6 Name of Architect4.i-2,r'K Address LAA—e,( wrr Phone No 574-36V-.0 1 y$ Name of Contractor jAm ti S w r6F-L 4, i Address2coatv b Phone No.6�/-2 3 y >a 2 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES—Nd—' *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- LW-k IC COUNTY OF ) II 1 -:�'A"M CS ► T 2� ` being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, j [d 0(S)He is the ML x G actor gent,Corporate Officer,etc.) P p of said owner or owners,and is duly authorized to perform or have performed the said work and to make and file this application; Lt that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be •� 1peIrformed in the manner set forth in the application filed therewith. before me this day of �e ern6e.2o I5 Notary Public Signature of Applicant 06/0-5/2015 0P':57 6317659064 MNINGED01 APPEAL-S PAGE 01/07 Scott A. Russell �°��` `� STORMWA-7CIER SUPERVISOR hVIIANAGIENCENT SOt:TIIOLD TOWN IIALL-P.O.Box 1171 1 Southold y 53035 Mail,Rd),4-SQiJ7'>` QO ,NEW YORK 11971 �� ,n�• Town of So uth o T01 BE COMPLETED BY THE APPLICANT) DOES 'THIS PROJECIr INVOLVE ANY OF TME. 1I10LL0'VV3NG: -_. -- UIECK ALL THAT APPLY' - IC�IT`iq �Y Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. C . Excavation or filling involving more than 200 cubic yards of material � ,vvithm any parcel or any contiguous area. 001 C:. Siteprepara,tion on dopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. Site preparation within 100;'feet of wetlands, beach bluff or coastal tZ erosion hazard area. E. Site preparation within the one-hundred-year floodplain as depicted on FIRM N/Jap of any water colors,~_ Cj[]IF. Installation of view or resurfaced impervious surfaces of 1,000 square l feet or more, unle:.is prior approval of a Storm-water 1Ulanagernent Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. if you answered N1 0 to all of the,questions above, STOP! Complete the Applicant section below with your NRme, Siguature, Comart Information, Date & County Tax Neap lEtumhsr! Chapter 236 hoes not apply to your project. ~y If you answered xr.s to one or more of the above, please submit Two Copies of a Wrinwatsr Warageinut Control Plan �a ad R completed Chock List Form to the Didlding Depaitmcnt tw;lh your Build;ng Permit 4pplication. Troperty Owner,Dcaign Prof CGS[one],Agent,Contractor.Q!heel S.C.TN. 1000 Date Dia ilei I 7 fo, sectIon 131pck f,pt 631-z3 ba I.V* FIUI1 DINT; =v,taco Inru r�n „- 3 73A Ruvjcwcd B3 , DaLC �10_'Z t'r nil Ly Adrirt ss�' Lo;:ailart o1 �'t�ll l I t,zl loll �yr�riti:_ crsiommmu - - - - - - - - - - - -- -1 - - - pr3ro"c-i for DI-neo,s•n,; ! o��oF SQUIyo D LE � Town Hall Annex 3D one(63F1�,76 -1802 54375 Main Road P�g�2� ! P.O.Box 1179 G� . Q f0 er.richert townSOUIhOlC1.n 20s7 Southold,NY 11971-0959 �O ! lyCoubm,� BUILDING DEPT. TOWN OF SOUTHOLD j BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION ! REQUESTED BY: ` Date: Company Name: 2 ! Name: G �- License No.: 5r o (Y1C Address: 8 (� ��� LJ c j Phone No.: - 63� — q�Z—B.Zo/ JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: L"41• *Cross Street: *Phone No.: % A _651_ 3o go Permit No.: LY U 1 b 3 Tax-Map District: 1000 - Section: 12A Block: ,v3, Lot: 12.•� *BRIEF DESCRIPTION OF WORK(Please Print Clearly) (Please Circle All That Apply) *Is job ready for inspection: ( Y9/ NO Rough in Final *Do-you need a Temp Certificate: ES NO I 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 0' 82=Request for Inspection Form I H. ROY JAFFE, P.E. 82 EAGLE CHASE,WOOMURY,N.Y. 11797 516-364-0148 • FAX 516-364-0158 Sept 18 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 Doyle 3585 Peconic Bay Blvd Laurel, NY 11948 will, not require draining because the pool is constructed with a vinyl liner. The' pool water will be continuously recirculated through the filter and will be. reused from year to year. The drainage from the filter backwash is nominal and will not interfere with the public water supply , the existing sanitary facilities or public highways . Very truly yours, OF N ' H. Roy Jaffe, P.E. 5 SCTM # „ X000 - � '- ����.� TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET �'�� VILLAGE DIST.1 SUB. LOT% Z - CR. � � �' REMARK TYPE OF BLD. 6VI n` 5 2du m� PROP. CLASS a. A LAND IMP. TOTAL DATE 1060 :3 qO(20 012,711 FRONTAGE ON WATER HOUSE/LOT BULKHEAD TOTAL TOWN OF S.OUTHOLD PROPERTY RECORD.CARD -f' Z-0 � (,(S STREET VILLAGE DIST. SUB. 'LOT aayin�✓�J�. t S-j po t l.L a�t ,r 6 n ��« wY�' .0 ? ` �t Fi. �if�tom' r [r14 •� e r=1 FORME OWNER N , E ACR. , I 'sem" otrr i )S 0'. rJ+::- 4: - ��- OCAnq ors. S "��`-� W TYPE OF BUILDING ' fiw(f<�( RES.- ,�(o SEAS. VL. FARM v COMM. LAND IMP. OTAL DATE REMARKS is CI I~,`% 4` ��r i z✓. � - L I b l u� $ 8 p a�9c-7• �i'` "paw � c�e�tc�r�, - le__ ��'. )cf5 `s I 40 � ',r.` > r Q / L. I UZ70,01(o6- V a t) t7r"� 4o Pa U (' �1 000 3 000 o o o ,l 2,1 2-�1/ a a s S �.. 12,11 4 4 -/L-C2.Fo° ' 3oq ( c� - Z.o urn 5 5'6t y 12C l' t5i"s�e; t ti St eC^e $ r^1 rNit� 14 X t r1 C FRONTAGE ON,WATER TILLABLE FRONTAGE ON ROAD WOODLAND DEPTH MEADOWLAND BULKHEAD HOUSE/LOT TOTAL 9 COLOR IT 3a �� I fTRIM , /-m5-"Bldg. Foundation Extso /dnj Bath a Dinette eni Z Basement FUAWL Floors Kit. SLAB Extension Ext. Walls Interior Finish L.R. Extension Fire Place Heat D.R. Patio Woodstove BR. � 3 Porch Sx � 5 _ �7S /-5-7 S Dormer Fin. B. Deck Attic Breezeway Rooms 1st Floor Li�.tr• Gar NY NY P 4h5 ' Driveway Rooms 2nd Floor 14r Y S o.B. Pool LOT AREA = 20,922 SQ. FT. 14--270 PROPOSED DWELL 2,878 SQ. FT, W/4 BEDROOMS 15-02 SANITARY SYSTEM 1000 GALLON SEPTIC TANK, 1 LEACHING POOL 8'DIA, X 12' DEEP 15"-69 ( ) ELEVATIONS NOTE DATUM NAVD 1988 t NOW OR FORMERLY MYRON YOUNG 0 �7 FD WO k 0 ��' MO ^, O Xwood lawn omorm nt allN 28'37'00"E 100.00' — K > 1>4 MON ) cA ' IV GI p wd landing r- p and step6 N fr enclaSU'e i x4' X (� Z —I Z x 4.5'x3 5'to O C_ 21 CD C p 54 9' n�/ k x k x rTi rn Q] W —45 2' N 2 SN FR 45 0' c >< Ar x x x DWELL g© �✓' GAR 26.2' 14.6' m` 27' 22 0' - 23 5' F43' m � L' 3 ' covered 3.5porch , CI L n I I C? �` V R=55 48' N O 1_=45 90 7' Q 7 MON 122.56 S 28'37'00"W 15,300' --- - PECONI(: .RAX BOULEVARD r'j�+- existr_i of right of ways and or easer eno N record, it any, not shown are not guaranteed NOTE. CESSPOOL, SEPTIC TANK Ar WATER SERVICE LOCATIONS BY OTHERS 5-6-2015 FINAL SURVEY 1-6-2n15 LOCATED FOUNDATION 12-2-2014 SNAKED BUILDING 11-4-2014 REVISED PROPOSED DWELLING THE OFFSETS (OR DIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE PROPERTY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THEREFORE ARE NOT JOB Na 14- 130 FILE No. 959 F INTENDED TO GUIDE THINNC E ERECTION OF FENCES, RETAWALLS, POOLS, PATIOS. PLANTING AREAS, ADOMON TO BUILDINGS OR ANY OTHER CONSTRUCTION UNAUSURVEYED FOR 72M OF THE ALTNEW YORK A ADDITION UCAT To THIS suRVEY Is A VIOLAT1oN OF sErnoN KNOWN AS LOT NUMBER 2 MINOR SUBDIVISION 7ZOA OF THE NEW YDRK STATE EDUCATION LAW INDICATEDGUARWTW MAP FOR CECIL r YOUNG TES'r HOLE BY McDONALD GEOSCIENCE S_ PREPARED, AND ONN MS MSBEHALFTONLY TH�rx�ANY. GOVERFOR NMENT& SITUATED AT LAUREL INSTITUTION HEREON, ELEV=22 6 7-10-2014 LENDING NSTMnIONGUARANTEES �NOT TRANSFERABLE TO ADDITIONAL INSiT(UTIONS OR SUBSEQUENT OWNERS TOWN OF SOUTHOL.D, SUFFOI I{ COUNTY, N.Y 0' COPIES OF THIS SURVEY NAP NOT BEARING THE LAND .SURVEYOR'S INKED SEAL OR SCALE 1" - 40' DATE 7-8-2014 DARK BROWN LOAM OL EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY 1 - FILED MAP No, DATE BROWN SILTY SAND SM CERTIFIED ONLY TO: TAX MAP No (REF ONLY) 1000--X128-3-12.5 DISK 2014 2 5' - F-I I S-r/' ")ERICAN 71 II'1SURANC E COC1PAtJy PALE BROWN FINE SAND SP AFICRiUN0 LAND INC_ HAROLD F. TRANCHON JR. P.C. MP,R ALICE 11a,ATi?IrI6-, a--)-(L.E LAND SURVEYOR 17' P.O BOX 616 -T- T _ 1866 WADING RIVER-MANOR RD. WADING RIVER, NO WATER ENCOUNTERCO 1 NAIC No 048192 NEW YORK, 11792 HAROLD F. TRANCHON JR. PENN. LIC. No. 2115-E 631-929-4695 Koa4 - cou-c r.,uou5 cotACRETE :Cot-.1-AR LONL S1� AAKLEo MA N )RPI�{5 3 I>< -2p rill-t�1N, NOTESLOPE DEaVVERRAIN Srexi--.wcc y ETM POOL aFr `� ' • I - • rcn�. �.�Et cct aa••r i c PLAN VIEW OF POOL_ nAss• _ STEEL fa,NGL _ :Z,+ r G c04CEMAf � 00L Mvli -=tea= - of R0 LoNGiTU0iNAL-'SEC130M ' uvossrrvEo E�aRTN—+ ` - i4' � � U47�e1� ST-5T PIPE AT EVERY STRAIGar-PANEL It ' PAM Doyle 5�8' TH'D RUD , 3585 Peconic Bay Blvd Laurel, NY 11948 BOTH ENDS %ALT�tZt�(A�EPjj0RjZ- BRACE , l_5 X 2` X Zf - 14 CA- -A- FAME DETAIL � STAKE _ 1.5 X 1.!57 X 24 - 14 CA ENOL AND PROPERTY T'0 CptlFpFrii 1 TO N_Y. STATE RESIDENTLAI, SECTION G106 RFV 1 5 F.D &./ 33 11- ROY J A F F E, P. E_ CODE APPaUIX G 2010 EDITION ENTRAPMENT PROTECTION REQUIRED POOL TO COR.- TO A1151/NSP1 STANDARDS AG103.1 SIXrTION G107 POOL ALARM REOUTRED _ i 'STATE,OF NEW YORK WORKER'S'COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Legal Name and Address of Insured(Use street address only) 1b.Business Telephone Number of Insured SEA CRYSTAL POOLS, INC. 631-757-9465 ' k 1c.NYS Unemployment Insurance Employer Registration Number of Insured 200 BLYDENBURGH ROAD SUITE #4 653600 ISLANDIA, NY 1 1749 1d.Federal Employer Identification Number of Insured or Social Security Number 030486684 2.Name and Address of the Entity requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity being I isted as the Certificate Holder) ShelterPoint Life Insurance Company 3b.Policy Number of Entity listed in box"1a". DBL188483 3c.Policy effective period: 10/17/2014 to 10/16/2015 I f 4.Policy covers: ! a. Z All of the employer's employees eligible under the New York Disability Benefits Law f b. R Only the following class or classes of the employer's employees. j i r I i I k Under penalty of pegury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. Date Signed 10/22/2014 By �lYi I (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) s l Telephone Number 516-829-8100Title Chief Executive Officer IMPORTANT:If box"4a"is checked,and this form is signed by the insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,this certificate is COMPLETE.Mail it directly to the certificate holder. I If box"41b"is checked,this certificate is NOT COMPLETE forthe purposes of Section 220,Subd 8 of the Disability Benefits Law ` It must be mailed for completion to the Worker's Compensation Board,DB Plans Acceptance Unit,20 Park Street,Albany,NY 12207. I' PART 2. To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked) ( , State of New York ; Worker's Compensation Board I I According to information maintained by the NYS Worker's Compensation Board,the-above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees i Date Signed By (Signature of NYS Worker's Compensation Board Employee) i Telephone Number Title Please Note:Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents of those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form. I DB-120.1 (5-06) c r I , - k , New York State Insurance Fund g { Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 Phone (631)7561300 c CERTIFICATE OF WORKERS'COMPENSATION INSURANCE A A A A A A 030486684 SEA CRYSTAL POOLS INC 200 BLYDENBURGH ROAD STE#4 ISLANDIA NY 11749 POLICYHOLDER CERTIFICATE HOLDER SEA CRYSTAL POOLS INC TOWN OF SOUTHOLD 200 BLYDENBURGH ROAD STE#4 53095 MAIN ROAD ISLANDIA NY 11749 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 1 1336880-8 316562 10/19/2012 TO 10/19/2015 1 10/24/2014 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO 1336880-8 UNTIL 10/19/2015, 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 10/19/2015 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 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 U DIRECTOR,IN SURANCE 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:363971934 U-26 3 SEACT-1 OP ID:VM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDnYYY, 09/11/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subJ ct 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 CNAMEc Bagatta Associates, Inc. Bagatta Associates,Inc. PHONE F 823 W Jericho Turnpike Ste 1A A1C No Ext•631-864-1111 Arc No' 631-864-8274 Smithtown, NY 11787 E-MAIL Bagatta Associates,Inc. ADDRESS. INSURER(S)AFFORDING COVERAGE NAIC 9 INSURERA Wesco Insurance Company 25011 INSURED Sea Crystal Pools Inc INSURER James Vitelli INSURER C. 200 Blydenburgh Rd. Islandia,NY 11749 INSURER 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS IR TYPE OF INSURANCE p POLICY NUMBER POLICY MMIDDIYYYY LT,RLIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PP119706301 09110!2015 09!10/2016 PREMISES AMAGE ToEa occurrence $ 100,00 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT F1 LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident) $ 1,000,000 A ANY AUTO WPP119706301 09/10/2015 09/10/2016 BODILY INJURY(Perperson) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETORIPARTNERIEXECUTIVEE L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I EL DISEASE.POLICY LIMIT $ A Property Section WPP119706301 091,10!2015 09/10/2016 Bldg 41,82 E: DED:$1,000 Bus Inc 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF SOUTHOLD ACCORDANCE WITH THE POLICY PROVISIONS. 53095 MAIN ROAD SOUTHOLD, NY 11971 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD SUFFOLK COUNTY DEPT OF LABOR LICENSING&CONSUMER AFFAIRS HOME IMPROVEMENT �` fa CONTRACTOR P �4 NAME JAMES E VITELLI _ This certifies that the BUSINESS NAME bearer is duly SEA CRYSTAL POOLS INC licensed by the County of Suffolk 36633-H 02/22/2005 Ac[In0 ccmml.d°�.. I EXPIR nON DATE 02101/2017 r i Ta".e;3.-,of 3: __. ,`SUFFOLK-_COUNTY-_DEPT-OF, LABOR, :LIGE,NSING & C,®NSUI�IER AFFAIRS ; PAYMENT`RECEIPT �~RECEIPT:NO.: =296998± -SEA;CRYSTAL POOLS INC = . ~200'BLYDENBURGH:RD STE 4 :ISLANDIA;;';fVY Rec'd.From: D/B/A:'; - Date: - - `VITELLI' SEWCRYSTAL INC` "`- 2/27/201'5;` Payment Type: No:''` :r Drawn On'­",, CHECK 7811,,, n BANK OF AMERICA, Category Service- Fee. : : Violation. Slip No : ._Remarks 5=H.L.Contractor C -'U6-_Renew. $400.00' _ REC'&BY:, License#/ Registiation#: DL = 6633 r " OTAL: (. r Rerriarks:; $400.00 ATTENTION'HOME-IMPROVEMENT CONTRACTO,RS"Suffolk.,County,Code Chap,e„5 states:,Ail'advertising for Home,lmprovement_contracting shall contaim_the number of�the.Home- ; Improvement license., ; _ Customerb?py. „ http://suffolkca/receiptcopy.aspx?ID=296998 2/27/2015 R151 I �:l,:�l-:'�;u- _.,moi iu.'.�A.'.Jfrsrsx.,_. ,4 rvM-.�-+,v,..�.rvr�•+y '-"�y.KKPo'C 21�f .6Y "' s�•Sc .tn`4L'y - __�'v`=^'� _ _ _ _ ,, all .E!'� - - _ ,'�.•. "-Y-, ~,,1.'' _ _ `�4'-r-." [r:` `f� t:: J'C�.^'�,tkx-�'.a3�i.�{ .fes._yt•%Y`�-� ,�:,'' ` �\r�'�.-,��i.�, __ •l, •:,;, \��f, -• •,�,-.. r 1.- ,/�_♦�,:c'c.f•i.�_�L'r"�•E-r�+r T '�`�; _ Suffolk County EXecirtl-v&s`0tfice,- of C'onrrrrier_ � { rs �� ~ VETERANS MEMORIAL HIGHWAY * HAUPPAUGE;/NEW YORK- 1178$:. DATE ISSUED: 2/22/2005 _ ::N6.. • �f 36631'. ` 1,'-SUFFOLK"COUNTY:' 'r): r/-' •, _ _ -, t'\�.rl::'i ..S"- ii. J._��.4'3�✓�`S � W `i•^ - „ _ - lir '� ?`✓: `• .:.� ��•,- `�• '''','1 ,�\��F-)`\� y'� - ; I�®me_Improver , en, Co itractor- ice-se _ _ - `� �,. -�'• - :-��-_!', ._� tip•= , ,~.-;� �*�'� _ :r ,,�,� fh�-i,�'-�•,• :e'-;:%n:s �c�'`.3�s�-'-,C`2. =Yr. -.,'i.is�, •\"f'��`'� '-��'-!-'1 �✓�.�'•�.'�.ji•��c�'••!%f`4_'l.`•'`;==/:=.s�=ly�:\-"rr4' �y _T_ his is to certify that `, -"y' :�: :.TAIVIES EVTTE�.I: <�• `'�'� :� ?:�� 'a;_. �.°;r` <,:- ,� ,:��••"•'t _ _ \,.'y,�•t�;{r R .�.. /, \ x,,.'.?'y �l yt�."'.\t%;:�1.-{7G a„'. :. 44_V"�� ` ,= doing business as -- — _' POOLS;IN b -- . -�'c.•1F-.-�;-%r. ,`,":i�! 't srG`'ter:\�t„s^:=•'�`•�`.�y� � ?'t fT.._•Jf,.'f'r s � -'c^'O• •"h°'� - g mished the requirements set_f ffl6h accordancewitTi=ani°subject to ne; r appheable-taQvs, : �^),r✓�, ` ••j �� �.�. �,�r.\ ♦ r. '.� :n;. f=n_:.C.t'�•S.,,Y�. `C:�;nr-`=tel�V• �' %`"�+� > :rules an the-Coon �o S��LL�(1�o StaoIew-Y'oiis= e�i�licenseto 'busmen's•- a a �-.�'+1 ,\.. •i•Z%:-•-`••= •- _ :Ai1'� i 'JIl ♦i{ r.g GY'r�1ty ^1 •�7 �� ' - HOMEIiVIPROVEMEN'T COTRCTOR,�m tie Count ;6 <Suffol�C. ��y'�� � � " -J�•4'�^,- - - :' -t`r': �:J:•�`v\T;,..\`�;�i-s^\\�;,:i'!1�fC'•t��i��\'s ,a � .,���.r_1� y � W� _{q:-5•,i7��1�i1s1neS' r i1-�'�•`''�ic.•�h+�!s _ �•_. \-v, SY y �,. - - - � -_:�' _- - - r,i_,�\- - �` _ - ��\_:%i-_\\ ��h�i.�'�e i`;1t..\:•.x-r'i-:�'�};,yid%fr�`���r(}p sr , NOT VALID WITHOUT .. �` �: y', r�•',� :� �t!r '^ DEPAR ENTAL - TA CURRENT AND - `= '- - - .,f,--�,;,✓���-••r.-. ,'/ . .��``/.....,::.��,,s� f til, i / \ '!'~1-4 ` ''``T 4•ryf.-�,Y \ CONSUMER AFFAIRS. % Yr-:7 ID CARD ` _ - � - - ,r ;`�r.,� C:\-"�i\,\�-'!_,rte,' -• ;'\'\ "�1♦�_C:/,�_.\�_• r / ., - �'moi-,•`'\�t\..'%r. �'! - � ,Oi+. ��/'�.''� i � V ,,'1'Z• ''lw'ryT� 'O �'''�' I,`''{yMJ,� � rti ♦ • ` r� � , rti � ti �Y. H.ROY JAFFE,.P.E 82 EAGLE CHASE WOODBURY,NY 11797 ' FIHgL G AO � TO GRADE—WITH CAST ZRo>aL_I— — — i-0 Hltj• F`RANY_-A4D CdvER - IF I Zy"MAX. JJ N D EA P AV ED ARF1i , I I s�DW.PIPE 2�I� M11J, I Z iGNT JOigTs D — CIIH,•SLDPE. '/g PER PT. I NOTE I DES14N RA-. IS '/.y,T1{AT.AFc]NE.VNDER_ ► 471kG SAND t GRAVEL STRATA EFP6c-rI`1E U6P7H • (Soup DornE) 0 N J J I I a • of I x � 3`NIN 3'niN, V IA E-f E GR v O COLLAR MATERIAL V (tt+cTroT: r, • QwTEASLE&OIL _ v _ ' L STkxs I DIDmvL'f1NG 5j-o0 1► G) EA t * NOTES CAPACITY — 1263 GALLONS ( 169 CU. FT. ) 1 . COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR FULL DEPTH . 2 . THE MATERIAL USED FOR CCLLARINC• SHALL BE COMPRISED OF SAND & GRAVEL FILTER MATERIAL CONTAINING LESS THAN FIFTEEN ( 15 ) PERCENT FINE SAND SILT & CLAY (SILT & CLAY FRACTIONS ARE NOT TO' EXCEED TYPICAL DETAIL - DIFFUSION WELL �!�®F NE BACKWASH FROM POOL 70 GPM @ 5 MIN = 350' GAL. A�' �st4� 9fl Doyle _ rn t � 3585 Peconic Bay Blvd Laurel, NY 11948 '474TJ ���iOgnF�s�E