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HomeMy WebLinkAbout40792-Z � S�EFOI�ca� Town of Southold 6/15/2017 0 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39017 Date: 6/15/2017 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 2432 Bridge Ln, Cutchogue SCTM#: 473889 Sec/Block/Lot: 85.-2-32 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/21/2016 pursuant to which Building Permit No. 40792 dated 6/23/2016 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 Bridge Lane I LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40792 09-06-2016 PLUMBERS CERTIFICATION DATED �VL an AL 0- 0 t ed Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT y s TOWN CLERK'S OFFICE 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#: 40792 Date: 6/23/2016 Permission is hereby granted to: Bridge Lane I LLC PO BOX 467 Cutchogue, NY 11935 To: construct accessory in-ground swimming pool as applied for. At premises located at: 2432 Bridge Ln, Cutchogue SCTM # 473889 Sec/Block/Lot# 85.-2-32 Pursuant to application dated 6/21/2016 and approved by the Building Inspector. To expire on 12/23/2017. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 'n Ins JUN/22/2016/WED '10: 37 AM FAX No, P, 001 06f22l2016 09:22 6917656641 SOUTHOLD TRUSTEES PAGE 91/01 Perin No.G TOWN OF SOUTHOLD BUILDIN6 DVPARTWNT TOWN HALL 765-1<802 APPLICATION FOR CFRTIFICAT1i:OF OCCUPANCY This apptica,tion must be filled in by typewriter or ink and submitted to the Building bepartment with the following: A. Ver 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 suppty and smweragcAisposal(8-9 form). 3. Approval of electrical installation from Board of Fire Underwriters, 4, Swom statement from plumber certifying that the solder used In systam contains less than 2/10 of l%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 Flaming Board Approval of completed site plan requirements. 13. For existing buildings;(pr•ior to April 9, 1957)non-conforming irses,or buildings and"pre-existing"land uses: I. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and convent to inspect signed by the applicant.If a Certificate of Oocupanoy is denied,the-l3uilditlg Inspector shall state the reasons therefor in writing,to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling.$50.40,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- $100-00 3. , Copy of CeatiFicate;of0ecupancy-$,25 4. Updated CeAffiicatp,of Occupancy- $50.00 5. Temporary' Certificate of Occupancy-Residential $15.00.Commercial$15.00 . . . _., ._.., . _.�,.�.----_.�.� —_.._�-----...�..... - •_..,..,.. . .bate. New conshvOtion.. , >C Old or Pre-existing Building: (check one) Location.of Property: "Z4 3 Z t4� House No, n Street Hamlet Owner or Owners of Property; �.� "ii PLA�L V ri✓'' Suffolk County Tax Map No,1000,Section 9� 'Block. � Lot 01–Z SvUdxvisivtt tiled Map. Lot: Permit No. 'f01 I Date of Permit-_ Applicant; Health Dcpt.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: "' (check one) �A Fee Submitted:$ �� licant Signature OF SO!/j�,®! � o Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 CA P.O.Box 1179 ® �Q roger.riche rt(-town.southoId.ny.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Bridge Lane 1 LLC Address: 2432 Bridge Lane City: Cutchogue St: New York Zip: 11935 Building Permit P 40792 Section: 85 Block: 2 Lot: 32 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Pinti Electric Inc. License No: 33025-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 2 Twist Lock Exit Fixtures 11 TVSS Other Equipment: Inground Swimming Pool to Include: Bonding, 2- Pool Lights, Sub Panel, Salt Generator, 1-GFCI Circuit Breakers. Notes: Inspector Signature: Date: September 6, 2016 OOElectncal 81 Compliance Form.xls SOUryo`o V � • �o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLRG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ,[V]---LECTRICAL (FINAL) REMARKS: DATE " l ' INSPECTOR so hod olo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] I ULATION [ ] FRAMING / STRAPPING [ FINAL 7 [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: [ 6�rf' LAA !S DATE ANSPECTOR qv so dol � o • o �ycOUNi`1,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] I SULAT N [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECT ICAL (FINAL) REMARKS: 6A- ' ldA& 0 DATE �' INSPECTOR i .L • I • r: t ; i fINOLATION STATE RNEROY •D IN �/Qj:' ;_ ' • iii - _ .., /.�l �W19A=A WW%IFlIf0,1 - - w • u n i TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following;before applying? TOWN HALL Board of Health t-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.C. Trustees Flood Permit Examined 20 Storm-Water Assessment Form 2 Contact: Approved J 20 Mail to:T o Q �A l 1-1 `4 Disapproved a/c V Expiration 20 7 Phone: Sag-, 16 Building Inspector APPLICATION FOR BUILDING PERMIT Date y J ,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 Pe d.Upon approval of this application,the'Building Inspector will issue a Building Permit to the applid9l=EUVE shall be kept on the premises available for inspection throughout the work. D e.No building shall be occupied or used in whole or in part for any purpose what so ever until theg Inspector issues a Certificate of Occupancy. e„i A M;14 f.Every building permit shall expire if the work authorized has not commenced within 12 months after the dat PN V 2W6 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. IMBING DEM APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit p 131F SOUMOLI 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. (Signature ofappNsant or name,if a co' oration) r ' (Mailing adc1r9ss of appl ant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises L AL&R P"L_Iesl (As on the tax roll or latest deed) If a ltc nt is aV on,s' nature of duly authorized officer RE'S e and title of corporate of icer) Builders'License No. 35O 5 1A Plumbers License No. Electricians License No. AoS57 we Other Trade's License No. 1. Location of land on which proposed work will be done: 2432 c31z\V&19: LA.WE House Number Street 485- -Hamlet 2 County Tax Map No. 1000 Section Block VPf Lot 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 RG5Def'3T t L b. Intended use and occupancy 2 C-5.l IJ c r.)-%-L f %- 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work:q&bD ., 4. Estimated Cost 2 col MFee 3 6 0 � (Description)o (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. 't0gT h t_L_. U x 3b SI,-� ou.w� v t*�ti` S u)VAt 1AA� e�oL. 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 34-3 Rear Depth Zq 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_G 13.Will lot be re-graded?YES_NO-7c-Will excess fill be removed from premises?YES-' NO 14.Names of Owner of premise L.A Q L Address 2. t•QUW4, Phone No. 19_ tS49 Name of ArchitectJAM8,4_1 R!leS!!0 Address ffi41T~No 2- I& •Z LL Name of Contractor_olko ,,my po tA Address W16 J)"14 iib yb- "$'• I(0-� 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_)C *IF YES,PROVIDE A COPY. STATE OF NEW YORK) COUNTY OF�. being duly swom,deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)He is the. C'p�?—pQ k-{ !m -01--pko5ff (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 t fore me this day of 201rIP PETER BOOTH Notary Public Notary Public,State Of Ne ature of Applicant No,01 806092004,Suffolk Cou ty Term Expires MaY 12,20 4 _ rg SQUl�®� _ o Town Hall Annex tfi Telephone(631)765-1802 54375 Main Road631) 5Q P.O.Box 1179 ro-ler.richerfC&oy4n s)o7u 5ol6.nY.uS Southold,NY 11971-0959 BUILDING DEPARTMEi+i'I' TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY. 1 f/AJ�� Pl�/ Date: Company Name: pi7'( 9L�R i e /de, Name: E N P, License No.: 3 3 p�5- ME Address: �40 I)ew*pp\ VE i4u tnrisTo1✓ h74-3 Phone No.: OFF(C-6f1 -720 JOESITE INFORMATION: (*indicates required information) *Name: �l i!Se 115,.Z.��' - 11 *Address: 3� e /93,E *Cross Street: C tR—r- � *Phone No.: 7-21o9 Permit No.: `t D-; - a- Tax Map District: 1000 Section:__S 5- Block: 1;1 Lot: 3 2 *BRIEF DESCRIPTION OF WORK(Pleas Print Cleady) ��ec co-Z (Please Circle All That Apply) *Is job ready for inspection: YES/ NO Rough In Final *Do you need a Temp Certificate: YES! NO °Ternp 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 017 D...,..nol fnr Inennrfinn Fnrm upi- Scott_ A. Russell ~1C'(0)�E�I�1[\� A-TIER SUPERVISOR _ J MANAGEMENT SOUTHOLD TOWN HALL-P.O_Box 1179 �� 53095 MainRoud-SOUTGOLD,NEWYORK 11971 �iL fifi 11�� .1 ovvn of Southold CHAPTER 236 - ST0)E MWATER MANAGEMENT WORMS SHE,Ff ( TO BE COMPLETED BY THE APPLICANT ) IJ®I S 7CI�I lPlf�®y1GC�7C INVOLVE, OF THE k'OLI,OWING: (CHECK ALL THAT APPLY) Yes No ❑Vf A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑G�B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. ❑E[ C_ Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance_ ❑U D. Site preparation within 100 feet of wetlands, beach, bluff or coastal i erosion hazard area. ❑ . Site preparation within the one-hundl-ed-year floodplain as depicted WE. L -..... en,FIRl-ap-of•a'ny wate-rceuar-se-:-.........,..... --- ..........._. _.. ! 000 square : ❑ '. Installation of new or resurf aced�impervious surfaces of 1, . 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 & Couuty'Tax Map Number! Chapter 236 does not apply to your project. If you answered 'YES to one or more or the above, please submit Two copies of a Stormwater Management Control plan and a completed Check Lis(Form to tho Building Department with your Building Permit Application. ou,e S.C.T.M. 4. 1000 `� Dote. APPLICANT: (Property Owner,Pesl;o Profcss,onal,A;en ontrame, g9 D�strlcl 3 NAME tftt Section Block FOR BUILDING DEPARTMENT USE ONLY"t Coawct luronn�twn, 3<to iM odea X1585-1 b tip 'r""""' °°•`, Reviewed By: 60—cli— Property Address/ Location of Construction Work: — — — — — — — '- — — — — _ — — — Approved for proceasmg Building Permit. Storrnwaicr Managatnent Control Plan Not Required. y Cu.\C_tk'o 6-U-15— 1-4• �'�Jj Stormwater Nlunagemcnl Control Plan is Required. El (Forward to Eligirieering 0epartment for Review.) FORM ° SMCP -'FOS MAY 2014 ZO/10 39vd S'lv3ddvd0Q99NINOZ 1790699!TE9 8Z:TT 9TOZ/5T/90 m r TOWN OF St}UTHOLD PROPERTY RECORD CARD a OWNER STREET 2,,Li VILLAGE I D[SfJ sue, LOT Lv) r LLC- C� S ACR. 2 RE �iKS to P5 o:07, i'lg TYPE OF BLD. 12-131 10 z a�-713 pun lese 1,�, &I dW �n rJ 1c, U, � �" 1 1wy t��4(1t(154pRop- c;"b on LAD IMP. TOTAL DATE Lo cn w o, f ( 1 � co t 3300 3 d O U Lo m 2 Lr) Lo c+7 ,.o N FRONTAGE ON WATER HOUSE/LOT m 00 m m N m BULKHEAD m TOTAL c1v iu.f N _ TOWN OF SOUTHOLD PROPERTY RECORD CARD a —_ --� ��------ - STREET -� - - -- -VILLAGE --- — DIST. SUB.- ~ LOT OWNER _ �- r JA,1 t rir S� i/ tlYt �, ACR. ��g +� RE A is +� f ' l'fes f - TYPE OF BLD. f 730 '5 r q - 9K PROP. GLASS 3 !r S It �r + /100 r + f 17.3 o r ? ► lr rI 1 ri w LAND IMP. TOTAL DATE cn cn A f [�C1 c� �• � 3 f [ _f ✓ j ` - i - : ;r �tad. - �-• 1 � � �' �t �'SC'r j J�' t� c¢f '�`E �,�_ 9 n P 3aa3 Le- t Lk LD m in Lo m Lo N FRONTAGE ON WATER HLLABL . ' m - FRONTAGE ON ROAD - EF� 00 m DEPTH MEADOWLAND o' w BULKHEAD HOUSE/LOT �400 -- TOTAL --� :�W :: : �:d ��rii■il�Mririisfiriiiiilirfiiliiiill�ai�ida� . Ali ._."I E ' - ■■i■■■■!i■■■i■■■iii■■■■■■i■ _ _ . ■ice!■i■■�■iii�1■■■■i■!i■■■t■� Mims _.. . _ [NEEMMMMEMMM■■E■■E■■■E■MM■■■ ■■MM■■■M■MM■■E MME■M■■■■■■■■ ■■EM■■ME■!M■MN■EM■i■■■ME■■■ ■■MM■■■■■■M■■■M■1■■■i■MEM■■ ■MMM■■M■MEM■■■M■EM■M■■■MM■■ ■MMM■■M■MMMM■■■MMEMMMEMEi■■ f • 7 • r / IM,- Ext. Walls Interior FF,= Rooms 2nd Floor �,Me.-Im I fFOP,1111101 STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1. To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier Ia. Legal Name and Address of Insured(Use street address only) Ib.Business Telephone Number of Insured Dunrite Manufacturing Corp 631-588-1300 Dunrite Pools 3510 Veterans Memorial Highway lc.NYS Unemployment Insurance Employer Registration Number of Insured Bohemia,NY 11716 0592920-5 Id.Federal Employer Identification Number of Insured or Social Security Number _ 112245133 2. Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) National Benefit Life Insurance Company 3b. Policy Number of entity listed in box"1 a": Town of Southold 8-910-0403697 Main Street Southold,NY 11971 3c. Policy effective period: 01/01/14 to-01/01/15- 4. o01/01/IS4.Policy covers: a.® All of the employer's employees eligible under the New York Disability Benefits Law b.❑ Only the following class or classes of the employer's employees: I I Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above. I Date 03/18/2014 By _6)_ l� (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) I - Telephone Number_845-783-2555 Title President IMPORTANT: If box 44a"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. If box"4b"is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the Disability Benefits Law.It must be mailed for completion to the Workers'Compensation Board DB Plans Acceptance Unit,20 Park Street Albany,New York 12207. PART 2. To be completed by NYS Workers' Compensation Board (Only if box"4b" of Part 1 has been checked State Of New York Workers' Compensation Board I According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability Benefits Law with respect to all of his/her employees. I Date Signed By (Signature of NYS Workers'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 tlris form. DB-120.1 (5-06) DUNRIA OP ID: LC ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDlYYYY)03/08/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME* Walter Rose Agency Inc Walter Rose Agency,Inc PHONE FAX 8 Stage Road AIC No .,1:845-783-2555 A/C No):845-783-2425 Monroe,NY 10950 ADDRIEss:lisa@walterroseagency.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:TWin City Fire Ins Co 347 INSURED Dunrite Manufacturing Corp INSURER B: Dunrite pools 3510 Veterans Memorial Highway INSURERC: Bohemia,NY 11716 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY YtYYW MOLICYEXP/YYYY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 01UENOJ2632 04/01/2016 04101/2017 DAMAGE TO REN PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 2,000,00 X POLICY 1 PRO- F-1LOCPRODUCTS-COMP/OP AGG $ 2,000,000 OTHER* $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑N/A E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E L DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more SP20e Is required) Swimming Pool Installation Service or Repair CERTIFICATE HOLDER CANCELLATION SOUTH-7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. Main Street AUTHORIZED REPRESENTATIVE Southold,NY 11971 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured Dunrite Manufacturing Corp 631-588-1300 Dunrite pools 3510 Veterans Memorial Highway lc._NY5 Unemployment Insurance Employer Bohemia,NY 11716 Registration Number of Insured 0592920-5 ld.Federal Employer Identification Number of Insured Work Location of Insured (Only required if coverage is or Social Security Number specifically limited to certain locations in New,York State, i.e., a 112245133 Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Hartford Town of Southold 3b.Policy Number of entity listed in box"la" Main Street 01WECKU5003 Southold,New York 11971 3c. Policy effective period 03/27/16_to_03/27/17 3d. The Proprietor,Partners or Executive Officers are included. (Only check box If all partners/officers Included) x all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box "3" insures the business referenced above in box "la" for workers' compensation under the New York State Workers' Compensation Law. (To use this form, New York(NY) must be listed under Item 3A on the INFORMATION PAGE of the workers' compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as'the certificate holder in box The Insurance Carrier will also notify the above certificate holder within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate. (These notices maybe 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: _KevinMcDonough (Print name of authorized representative or licensed agent of insurance carer) Approved by: fe d� 2-28-16_ (Signature) (Date) Title: President of Walter Rose Agency,Inc Telephone Number of authorized representative or licensed agent of insurance carrier: 845-783- 2555 Please Note: Only insurance carriers and their licensed agents are authorized to issue Form C-105.2. Insurance brokers are NOT authorized to issue it. C-105.2(9-07) www.wcb.state.ny.us Workers' Compensation Law �'�4p �� :l•• ,(k� �� '�•J.�A_. y � 55 {�,' �d� �dFY,� �'�� �7 � \..�✓ '� �� fig' ``` _ ^{�� if ;�ll /iyf4WCn.s:..fMil,{�� 9\tkt J��dulunwahu' P elL �w.^icuw.auY:s� t �1 � •Ud/tlu�w ,_"ti !1,��. Sia, ,3(14ri —.,." �� i� �,�4 t v��.'; �Y iLry'Y��Tt•..,y__—_" 'YfG 1dA7Y'6P_^�'S° _�'3'�`•_`�s� '•�_�� ��_.__�'-.__�_`__-.•--_____...._.-._ CFff1N7�...', ___..___"_______�'-t-na--______�`--_.�_.� _,___._._ __ ' FI 8 Suf bilk County Department of Labor, Licensing & } a , ConsumerAffairs VETERANS MEMORIAL HIG14WAY HA.UPPAUGE NEW YORK 11788 F DATE ISSUED: 3/1/1977 No, 3585-H +' SUFFOLK COUNTY 5 4 ` F II®me Improvement Contractor License This is to certify that KENNETH J BARTHMAN "F doing business as DUNRITE MANUFACTURING CORPi ' Y a having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws,rules and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. a � License Category ` NOT VALID WITHOUT Additional Businesses Pools/Spas DEPARTMENTAL SEAL s' AND A CURRENT DUNRITEpOOLS � r CONSUMER AFFAIRS ID CARD SUFFOLK COUNTY DEPT OF LABOR, LICENSING B,CONSUMEN AFPENTAIRs Commissioner d HOMEIMPROVEM ' CONTRACTOR HApE }` KENNETH J BARTHMAN ThIS Certlfles that the eusmasruwE ? bearer is duly DUNRITE MANUFACTURING CORP licensed b ^ ythe County of Suffolk rT �iDote iaesiva } �.(.+ # '•' � f •TAMA�//.n..�a�� 35i 5-H o3/dvlsn 4 M AcW9 D"Mftftw I "PMT10"DATE — IL.r_ 03/01/2017 BRIDGE LANE UTIL PgLE N 42'30'20"W TIE TO MAIN ROAD = 2,545 51' S 42'30'20" 1 121 68' CM 40 00' ;I I I +I I I I I i+ I O I 1 I I I I + I I I I RALPH AND PATRICIA PUGLIESE MI I I I ; I I IT i 3 DRIVEWAY WITHIN RIGHT OF WAY I rn UNDER CONSTRUCTION , ;N PUGLIESE VINEYARDS LLC WI1 I`t' 1 fel 1 \j Zj 1 /i I I TI I I I S 42°51 ' E 10" I M ' 298.56, + 2' 1- li\\\ CONC. coec + \ \\ BLOCK N 0) 1 - \ p BLDG APRON N\ \\ REENHOUS nru 1 \ lflll \ �1 1 1 \ 1 d- W v LOT 3 1 X111 �1 to 7 ' o _o Z + \ 2' \ b• R S. _ CESSP - 1 \ { 1 \ + SEPTIC + \ TANK \ z (COYER NOT VISIBLE) (n R-25'_57' / 1 5 44'03'00'E 2567 '/ N 44°03'00" .iW 226 18' 25. - _ N 4557'00 1 25.5 7'EI - - - ---- -- - - - - 1 �I ' -- - - - -- -- - - -- — `\-N 44'03'00" W-� CM N 44'03'00" W k 97 45' ell ir) N ' SURVEY OF r LOT 2 IN A MINOR SUBDIVISON FOR RALPH AND PATRICAI PUGLIESE SITUATE CUTCHOGUE, TOWN OF SOUTHOLD NOTE SANITARY LOCATION AS PER OTHERS SUFFOLK COUNTY, NEW YORK SURVEYED FOR: LARRY PUGLIESE TM# 1000- - 1 GUARANTEED TO v d- S SURVEYED 23 MAY 2002 LARRY PUGLIESE neo STALE 1'= 100' AREA = 87,120 S.F OR 2 000 ACRES GUARANTEES INDICATED HERE ON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE"COMPANY, GOVERNMENTAL AGENCY, SURVEYED BY LENDING INSTITUTION, IF LISTED HEREON, AND TO UNE ASSIGNEES OF THE LENDING INSTITUTION STANLEY J. ISAI�SEN, JR GUARANTEES ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS P 0. BOX 294 UN4UTHORIZ£D ALTERATION OR ADDITIOTJ TO THIS NEW SU FOLIA. N.Y 11956 SURVEY IS A VIOLATION OF SECTION 7209 OF 6,31 -7 4-5835 7H£ NEN' YORK STATE EDUCATION LAW I i l COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE - - LII t SED LAN(h 'S VEYOR COP), . IYS Lic No. 49 73 03C12'47-2A 30 APRIL 09 FINAL SURVEY e - APPROVED AS NOTED DATE: s e.P.# ELECTRICAL INSPECTION REQUIRE® FEE• - � �' •- NOTIFY BUILDING DErARTM AT 765-1802 8.AV TO 4 Pf.4 FOR THE FOLLOWING RETAIN STORM WATER RUNOFF 1. FOUNDAJ'KXll REQUIRED 1�'r'• FOR POURS PURSUANT TO CHAPTER 236 2. ROUGH - FRAICN: u PLUMBING OF THE TOWN CODE. 3. INSULATION 4. FINAL - CO^. 7")!q MUST BE COMPL E- r _,C. ALL CONSTRUC-l'CN S)HA L MEET THE REQUIREMENT3 OP i HE CODES OF NEW YORK STATE. N01- RESPODNSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF WCUPANCY OR USE IS UN`,W-1 WITHOUT ER-TIF ,CATE OF OCCUPANCY I POOL SIZE POOL SIZE WITH STEP A B C I D E F I G H K L M N GALLONS I_ p I 12X24 12X28 12'-0" 24'-0" 3'-4"16'-W' 6'-0" 8'-0" 6'-3" 4'-0" 4'-0" 4'-3" 4'-0" 6'-3-118" 9,050 16X24 16X28 16'-0" 24'-0" T-6" T-0" 6'-0" 8'-0" 6'-3" 4'-0" 4'-0" 8'-3" 4'-0" 6'-3-118" 13,750 16x32 16X36 16'-0" 32'-0" TA" 8'-0" 8'-6" 13'-6" 6'-3" 4'-0" 4'-0" 8'-3" 4'-0" 7'4" 19,500 18X36 18X40 18'4" 36'-0" 3'-4" 8'-0" 10'-6" 13'-6" 8'-3" 4'-0" 4'-0" 10'-3" 4'-0"1 7'4" 25,500 20X40 20X44 20'-0" 40'-0" 3'-4" 8'-0" 12'-6" 13'-6" 10'-3" 4'-0" 4'-0" 12'-3" 4'-0" 7'4" 32,000 16X34 16X38 16'-0" 34'-0" 3'-4" 8'-0" 10'-6" 13'-6" 6'-3" 4'-0" 4'-0" 8'-3" 4'-0" 7'4" 20,900 """ SU=N 25 X50 25X54 25'-0" 50'-0" 3'-4" 8-6" 20'-6" 13'-6" 12'-3" 4'-0" 4'-0" 17'-3" 4'-0" 7'-75116" 58,750 30X60 30X64 30'-0" 60'-0" 3'-4" 8-6" 20'-0" 15'-0" 20'-3" 4'-6" 4'-6" 21'-3" 4'-6" 8'-2-318" 79,550 S // 14X28 14X32 14'-0" 28'-0" 3'-4" 6'-0" 8'-0" 12'-0" 4'-3" 4'-0" 4'-0" 6'-3" 4'-0" 6-3-1116" 12,100 - 13 X26 12X30 13 26 3'-0" 6'-0" 8W' 10'-0" 4'-3" 4'-0" 4'-0' 6'-3" 4'-0" 6'-3-1116" 11,600 <..... \</ A /� , DrvlNcaoaxD v /// \\ � L 16X38 16X42 16 38 3'-4" 8'-0" 14'-0" 14'-0" 6'-0" 4'-0" 4'4" 8'-3" 4'-0" 7'4" 22,000 10-=SW SEIF DRILLING SCREIIH SPACED°D•o.C. CONCRETE OR WOOD DECK UP To COPING f54 owmz ILF %cpw APIA SFFWM POOL.PANEL ALUMINUM COPING rcw LONG STEEL.ANGLE 00 N LONG WELD A W TTP.AWMIN11M COATING •ImnP // \` � I ENTRAPMENT PROTECTION IN RETURN U N I� ° w nll VINYL LINER COMPLIANCE WITH SECTION AG106 W STEEL WALL PANEL ....'"> / STEEL ANGLE _31W.bd•BOLT.NO fL WASKERS B J °RIVE STAKE I �� MOUNDW ° POOL PLAN l G.FL CONCRETE SNORT STFB ° AtiGL6 ]'71UCK WAMIED SAND BOTfDM 9/16'DIA.CARRIAGE BoLT5 p W WAGNER•NUT Top CORNER C - 'Ilrlll=111 II=1112III=III=1�=nl=nl �1_II—n1=n=nl=ul—Iti= .vERnenL�yga —�IL31L= IML=111gIL=III JIL-II L=111=111=IIMu III- '0-111=III IE1112110-UISUL=1n=U1= -Urj=111 =1IL I-V �1�1�!C .J1 ic1 =C-II��Z7 I_IIIdTt=11'�_l17 IS'LONG STFFl REINIORCWG ROD IRlDlelllf]Bm EARTH INTO UNDISNRHED EARTH THROUGH D 1•p I jI I I IIIII��'111=111= HOLES IN BOTTOM OP PANEL au=_ —Olin=1111=311 _UI-1=111=r - III =11x1112111=III=III=III=111=1=III=III-` �ED FILLER L I�III�IL=III�IL--IIIJII_IIIJII=ILL— To REL.IEvE LINER =IcUi=11L-Ur111211EIUEiUf_'lll_IIL= BOLTEDW SAt6'DIA, � TYPICAL WALL SECTION AT "A" FRAME _E I.17 H G F E CORNER CONNECTION DETAIL POOL SECTION Wm®TDP•Lwrta+ -------------- --------------- Ae�ANO QF C W Y A VDNOW1'1D°GOA.Id I I P ).DEFT, 1 RUBBER FULCRUM as RBNFpR(1]l�ROp POD L ARRY P�•`I E S _ . % L4-• Dunrite Pools, Inc ' 1 3510 Veterans Memorial Highw 1 DIVING BOARD `„ AR0F Q� N.T.s. Bohemia New York 11718 \`ESS ------------- ------------- POOL TYPE: RECTANGLE REV. SCALE: NTS Pool Complies With ANSI 514,2010 RCNYS, JAMES DEERKOSKI, P.E. DATE: TYPICAL PANEL STIFFNER Appendix G,Design in Acceptable for ALL 260 DEER DRIVE COMMON SOIL CONDITIONS MATTITUK, NEW YORK 11952 DRAWING NUMBER 1 OF 1 ol�