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HomeMy WebLinkAbout41809-Z �pSUF 'f Town of Southold 7/17/2017 O G 0 P.O.Box 1179 53095 Main Rd o �� oo�g Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39055 Date: 7/17/2017 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 3950 Pequash Ave.,Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.-14-5 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated �- 7/10/2017 pursuant to which Building Permit No. 41809 dated 7/12/2017 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 Brown, Stanley of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37552 05-21-2013 PLUMBERS CERTIFICATION DATED o ' d Signature �FFnt� TOWN OF SOUTHOLD BUILDING DEPARTMENT a 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#: 41809 Date: 7/12/2017 Permission is hereby granted to: Brown, Stanley 100 Riverside Blvd 19G New York, NY 10069 To: Construct an InGround Swimming Pool fenced to code as applied for. Replaces BP# 37552 At premises located at: 3950 Pequash Ave.,Cutchogue SCTM # 473889 Sec/Block/Lot# 103.-14-5 Pursuant to application dated 7/10/2017 and approved by the Building Inspector. To expire on 1/11/2019. Fees: PERMIT RENEWAL $125.00 Total: $125.00 Building nspector TOWN OF SOUTHOLD � FFOt,y� BUILDING DEPARTMENT TOWN CLERK'S OFFICE 101 91. by 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#: 37552 Date: 9/28/2012 Permission is hereby granted to: Brown, Stanley & Brown, Susan 100 Riverside Blvd New York, NY 10069 To: construct an InGround Swimming Pool fenced to code as applied for At premises located at: 3950 Pequash Ave, Cutchogue SCTM # 473889 Sec/Block/Lot# 103.-14-5 Pursuant to application dated 9/21/2012 and approved by the Building Inspector. To expire on 3/30/2014. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL Total: $300.00 rtnzV) las,d o Building Inspector Form No.6 TOWN OF SOUTHOLD _ BUILDING DEPARTMENT TOWN HALL 765-1802 Le APPLICATION FOR CERTIFICATE OF OCCUPA-NCY This application must be filled in by typewriter or ink and submitted to the Building Departmentwith 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 2110 of 1% lead. 5_ Commercial building,industrial building,multiple residences and similar buildings and installations,a certificate of Code Compliance-from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings(prior to April 9, 1957) non-conforming uses,or buildings and "pre-existing" land uses 1. Accurate survey of property showing all property lines,streets,building.and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool $50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3.. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy -Residential $15-00,Commercial$15.00 Date. elf — / z NewConstructionOld or Pre-existing Building: Q (check one) . Location of Property: -atj As, / /�/Ea`",�a C v rC KOGy&,6F House No. Street Hamlet Owner or Owners of Property: .::5t'nNLE y jUSFI� �b2deJ ti Suffolk County Tax Map No 1000, Section /U 3 Block I-/ Lot 5 Subdivision Filed Map. Lot: Permit No. '7 55' Date of Permit. q. LES -I L Applicant: Health Dept.Approval:_ Underwriters Approval: Planning Board Approval: Request for. Temporary Certificate Final Certificate: check one Fee Submitted: $ �8•�� Applica SUFFot,��, Town Hall Annex Telephone(631)765-1802 54375 Main Road c Fax(631) 765-9502 Zft P.O. Box 1179 0 • Southold, NY 11971-0959 roper.richert(c)-town.southold.ny.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Brown Address: 3950 Pequash Ave City: Cutchogue St: NY Zip: 11935 Building Permit#: 37552 Section: 103 Block: 14 Lot: 5 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Sirs Electrical Contracting License No: 47125-me SITE DETAILS Office Use Only Residential x Indoor Basement Service Only Commerical Outdoor x 1 st Floor Pool x New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat gas Duplec Recpt Ceiling Fixtures HID Fixtures Service ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 1 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 TVSS Other Equipment: in ground swimming pool to include, bonding, 1-pool light, 1-control panel 4-GFCI circuit breakers Notes: Inspector Signature: Date: May 21 2013 Electrical Certificate.xis n 't OE SO�Tyo� . G � co ` TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ' . .' . [ ] FOUNDATION, I ST- [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION- [ ] FRAMING/STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION 9ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE ��/ INSPECTOR OF SO(/lyp� /4-j �� TOWN OF SOUTHOLD BUILDING DEPT. 4 765-16®2 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 OL,' soulti �o� olo �o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] RO H PLEIG. [ ] FOUNDATION 2ND [ ] SULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: I i DATE INSPECTOR so �o 0 courm TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUG G. [ ] FOUNDATION 2ND [ ] I LAT [ ] FRAMING /STRAPPING [ FIN [ ] FIREPLACE & CHIMNEY [ ] FI PECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ,ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: a' ' /d<44- DATE 11 INSPECTOR uI OF SOUIyo N o UOUNTI,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] I ULATION ( ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: _ DATE 13 INSPECTOR FIELD IlVSPECTZON REPORT DATE COMMENTS 1 r FOUNDATION(1ST) � FOUNDATION(2ND) b • � o rA • a ROUGH FRAMINCT& y PLUMBING m` L INSULATION PER N.Y. � H STATE ENERGY CODE d Q§ FINAL / Atl ADDITIONAL COMMENTS 11,001, M zb e TOWN OF SOUTHOLD s' BUILDING PERMIT APPLICATION CHECKLIST 'BUILDING DEPARTMENT Do you have or need the following,before applying? R TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 Planning Board approval FAX:(631)765-9502 / Survey SoutholdTown.NorthForknet PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees 01NFlood Permit Examined 20� Storm-Water Assessment Form Contact: Approved 020 I Mail to:37,q OU S�' Disapproved a/c C- Wl N.LI• Phone. (y; 2y—Z(o�5 Expiration 20 _$ AUL Building Inspector APPLICATION FOR BUILDING PERMIT (� Date / jC/ ,20 Z INSTRUCTIONS a This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans,accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant Such a permit shall be kept on the premises available for inspection throughout the work e No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy £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. (Signature of applicant or name,if a corporati ) 3-� o &t,n 5Gni. 5/ (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder /V) Name of owner of premises nq w ^ APPROWD AS NOTED (As on the tax roll or latest deed) If applicant is a corporation,si ature of duly authorized officer �� DATE` 8.v (Name aff tttle of corporate officer) Builders License No. y 1' ( BY NOTIFY BUILDING DEPARTMENT AT Plumbers License No_ /' Electricians License No. 765=1602 6 AM TO 4 FM FOR THE ��' Other Trade's License No. / FOLLOWING INUPECTIONG; 1 FOUNDATION a TWO REQUIRED 1. Location of land on which proposed work will be done: FOR POURED CONCRETE 3 S.rQ 10 2 P06 6 Ac J I tL--- O!T y U ROUGH-FRAMINrl PLUMBING, House Number Str6f Hamlet Q STRAPPING,ELECTRICAL&CAULKING County Tax Map No.1000 Section 1 G BlockLot3 I%y I®N UTI®N RLEDTRICAL ` Subdivision E Ce 5'� oC 5 Filed Map No. Z/D 91 ���FUN U 8 ALL CONSTRUCTION 61 AGS Vtf THI . ELECTRICAL RLOUiRFMLN 10P i Hk C r,f'X6 eF NSW INSPECTION REQUIRED VORK STATE NOT RE-SVIF_ R!E POR DIGIGN OR DONSTRUDTIUN LKPIORS 1WEVIATELT"" RETAIN STORM WATER RUNOFF ENCLOSE POPL TO,CODE PURSUANT TO CHAPTER 236 upd ,co�°WATE�-mntrAOly 01#FOROF THE TOWN CODE. I'ACUPAMY OR ,JSP IS UNLAWFUL 1T"OUT CERTIFICATE 0F 0CC11-1ir AN1C� i 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy D kvQ 1c n� b. Intended use and occupancy 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work � 'r � r✓h 1^1 u p/ (Descrip on) 4. Estimated Cost G 91--=� /< 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 a Tont Rear Depth Height PI tuber of Stories d Dimensions of same structure ' alterations or additions:Front Rear Depth eight Number of Stories 8. Dimensions of entire ne constructionz- wnt- Height Number of Stories 9. Size of lot:Front Rear / Depth � 2r9v"7 10.Date of Purchase Name of Former Owner s Q n y 11.Zone or use district in which premises are situated 4- . 12.Does proposed construction violate any zoning law,ordinance or regulation?YES NO 13.Will lot be re-graded?YES_NO Will excess fill be removed from premises?YES_NO 14.Names of Owner of premises brow, Address!: i f y ���J PtiAfile No.� 9-7 62 6 6 Name of Architect Address Phone No Name of Contractor Address Phone No. 15 a.Is this property within 100 feet of a tidal wetland or a freshwater wetland?*YES NO *IF YES,SOUTHOLD TOWN TRUSTEES&D.E.C.PERMITS MAY BE 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�� �AJ(&'`'f C./ "" being duly swom,deposes and says that(s)he is the applicant 'Name of individual signing_contract)above named, (S)He is the (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. wom before me 's XS/-�►�3 day o 20 lr�-n Notary Public SignatureA plic CONNIE D. BUNCH Notary Public,State of New York No.01 BU6155050 Qualified in Suffolk County Commission Expires April 14,2b/(® S13FFQ4- Town of Southold - Chapter 236 - Stormwater Management z 0ior � SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION: (All Requested Information is Required for a Complete Application) ! APP ME: pwrie-r-_6ge�nt- C tororOther (Circle One) PropertyOWNEFt (flDifferent than licant) { ell Address~ 2 i , id - �„✓ Telephone Fax#: Telephone#: h 6 Fax# ; I E-Malh `G E-Mal:14 ! r I I Property Address: Brief Description of Construction Activity,Proposed Structural BM N Sort ! s.C.T.M.#. 1 OOU1 - q Staba)ization BMPs,Project Scope and/or Sequence of Construction Activity Dbiriet seenon Blodr Lot ProvideAdAlialalPageaa3Needed) ' Name of Cglt; ctor aC Contact Persort Responsible for implementation of sWPPP: dr V ABr )n w! / /� -- - d==�= --- ---------- ------------- Telep n --/n_. ? _-?6�J�Fax111 /^' ----------- --- ---------- -- - --^----- ; E-Mail: (/r! G!� ----- - - --- ------------ ----------- ( , I i Name of Persons Responsible for ins tion b �Intenance o Eros) Control Practice: -------------------------------------------- ------------------- -- i Address: Telephone 3l Fax#. ------------- --_-- E-Mail: l --------------------------------------------- Total Areal of Al! ------------------------- ® 2 TotaiAreaofLandgearing ------------------- Project Parcels: and/or Ground Disturbance- -�� (s .IAoes) isF IA—)Disturbance- ------------------------------ -------------- is Start End " (Anticipated)- Date: Date: (Number Calera rDays) ------_--_-----___ Will this Project Disturbe five(5)or More Acres at F__1 -------------------------------------------- Any One Time During the Proposed Development? Yes No ------------------------- If YES:Please Answer theFollowingl Re "-,-,_____--- ------ ------------- i a- Does the Applicant have a Qualified Inspector On Staff To Conduct the Required Inspections? Yeess No _ - i b. Does the SWPPPJndicate How Frequently the Site List the NAMES or description of all Potentially Impacted Waterbodies and/or Wetlands: i Inspections will Occur and for What Period of Time? Yes NO c. Does the SWPPP Adequately Identify All Temporary = � ---------------'- ------ ------- , ---------- and/or Permanent Sol Stabalization Measures? Yes No -------------- -------------------------------- d. Does t e S PPP Adequately Identify aComplete ------- - --------------- . i --------------•------•--- Project Phasing Plan? Yes No e. Does the SWPPP Indicate Additional Site Specific C� IZ status of Im cued Walerbody:tell. (d)Listed,Impaired-) Practices that Will be Utilized to Protect Water Quality? Yes No f. Has the Applicant Submitted a Completed DEC Notice - --`-----'--""------- ---- ------------ j Of Intent and SWPPP Acceptance Form for Review L—J Type of Impacted Walerbody: reek,Bay.Pond,sound,Freshwater Wetland-) by the Town of Southold? Yes o I S7 ATE OF NEW YORK, t III COUNTYOF...........................................SS f prat I, .��_. v.... ping duly swo ,deposes and says that he/she is the applicant for Permit, .. »(risme of dNai signing Doaimenlj• Jc jlTr ! /7 _ f-I -C, �hCZ�J And that she is the _..............»......................... 1 Agent,Corpaafe officer.eta) ....... ..... l I Owner and/or representative of the Owner or Owners,and is duly authorized toI ' 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 kno dge and belief;and that the work will be performed in the manner set forth in the application filed herewith. I f ! ! Sworn to before me this; ` - fl I Notary Public: .. ......... -_--_-•..................... �/l� .............................. ......_..........._._ -•--••. i CONNIE D. BUNCH (Si re of Applicant) ••-• SWPPP Assessment FORM: 03-12Notary Public,State of New York No.01 BU6185050 Qualified in Suffolk County !! Commission Expires April 14,2 Southold Town Building Department �O�OguEFO(��oG P.O.Box 1179 Permit#: 37552 53095 Main Rd Cx Permit Date: 9/28/2012 o ` Southold,New York 11971 4,y # �a (631)765-1802 Expiration Date: 3/30/2014 Parcel ID: 103.-14-5 BUILDING PERMIT RENEWAL LETTER Dated: 4/23/2015 Applicant: Swimming Pools by Jack Anthony Location: 3950 Pequash Ave, Cutchogue Work Description: IN GROUND POOL construct an InGround Swimming Pool fenced to code as applied for A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT. Owner: Brown, Stanley&Brown, Susan Address: 100 Riverside Blvd New York,NY 10069 The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building Department, P.O. Box 1179, Southold,New York 11971 THANK YOU, SOUTHOLD TOWN BUILDING DEPT. SO!/r�o �o Town Hall Annex Telephone(631)765-1802 54375 Main Roadg P.O.Box 1179 Q roaer.richertCa�town soUthOlv 5.nY us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: o S, , Date: Company Name: �;� ,�� C& �� r Name: License No.: Address: 6 a G.-r,�.�v r✓ �/�o� ��' ��G � �i�s� Phone No.: G JOBSITE INFORMATION: (*Indicates required information) *Name: e fir SQ t. *Address �S® .��� e u c/aq <1 *Cross Street: A/�/�©�d *Phone No.: Permit No.: Tax Map District: 1000 Section: Block: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) ,, J A)e � po / Steil �7 ir— fru s ��� (Please Circle All That Apply) *Is job ready for inspection: YES / NO 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 82-Request for Inspection Form SCDHS REF.. # RIO-07-0116 I am familiar with the STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE N DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES ���Ty�Y ®1�' �y�®D�DrTa�T and will abide by the conditions set forth therein, and on the VV lr' PROPERTY ll�1 permit to construct. AT FLEETS NECK The locations of wells and cesspools TOWN OF SOUTHOLD shown hereon are from field observations and or from 'data obtained from others. SUFFOLK COUNTY, N. Y. 1000-103-14-05 HSE SCALE: 1 x=30' FIN FLR FEBRUARY 6, 2007 EL 16 • __� Feb. 14, 2007 (rebor sett EL 14.5 FIN. GRADE EL 14' % (Pr,0P. •NSE) Fl;P-11 200 �Q Feb. 12, 2008 (rain runoff) lE a2 lE G F� NOV. 13, 2008 (fouAddtfon °lb`calfonl' ST lE lE 9. I Q �jNO S/. 26, 2608 (ADDITIONS)to.5 Aug. 19? 2009 (final Jan. 14, 2011(certifications) SEPT. 11, 2012 (POOL STAKES) GROUND WATER EL 3 : SEPTIC SYSTEM CROSS SEC TION l- 1000 GAL. SEPTIC TANK �G' 2- 8'0 x 6.5' DEEP LEACHING POOLS 'T , WITH 3' SAND (SWI COLLAR BOTTOM 10 OF LEACHING POOLS TO BE 3' ABOVE - 2 GROUND WATER RAIN RUNOFF CALCULATIONS 2" RAINFALL HSE 8 GARAGE = 2219 sq. ft. '� lg;, 6F1 q� p� J 2219 x 0.17 x I ==377cu.ft. �P PROVIDE 2 DRY WELLS 8'0 x 5' DEEP \G OO r R °F q F ����� <�, SLOPES GREATER THAN 10%= ti 0.0 sq.ft. ®� ' O ® 6 ` a � • 9 <11v 0 � ,� O sae• � . _� �`' ®�� "oo \a 41b v P G N �0 `O40 ��` 236 FLOOD ZONE X FIRM * 36103CO163 GX05 � � \ CERTIFIED TOf STANLEY J. BROWN SUSAN BROWN Y EL EVA TION REFERENCED TO AN N� ,�\ �� FIRST AMERICAN TITLE INSURANCE ASSUMED DA TUM. �(� COMPANY �0 �y�P WELLS FA ?,,,,)t q TGA GE O. ,v V`Q J G, AREA=20,250 S0. F F . LOT NUMBERS REFER TO MAP OF EASTWOOD ESTA fES SECTION TWO" FILED IN THE SUFFOLK COUNTY CLERK'S 4-7 OFFICE ON NOVEMBER 30, 1964 AS FILE NO. 4210. 'LIC. NO. 49618 ANY ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION ECONIC V ERS;-P.C. OF SECTION 7209OF THE NEW YORK STATE EDUCATION LAW. (631) 765-5020 FAX (631) 765-1797 EXCEPT AS PER SECTION 7209—SUBDIVISION 2. ALL CERTIFICATIONS ® = STAKE P.O. BOX 909 HEREON ARE VALID FOR 1N/5 MAP AND COPIES THEREOF ONLY IF MONUMENT 1230 TRAVELER STREET SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR — 0�-114 WHOSE SIGNATURE APPEARS HEREON. • =PIPE SOUTHOLD, N. Y. 11971 1 y t SUFFOLK COUNTY DEPARTMENT OF CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR NAteE MICHAEL R INZERILLO This certifies that the Eug"E88 N"E bearer Is duly SWIMMING POOLS BY JACK ANTHONY INC C licensed by the County of Suffolk """"""n°" Eric A.K000 24507-H 03/07/1997 ` CONNN9BIONER I Em11�7gN DAh l 03/01/2013 I i STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE Ia.Legal Name and address of Insured(Use street address only) lb.Business Telephone Number of Insured Swimming Pools by Jack Anthony,Inc. 631-462-0046 378 Main Street Center Moriches,NY 11934 lc.NYS Unemployment Insurance Employer Registration Number of Insured Id.Federal Employer Indentification Number of Insured Work Location of Insured(Only required f coverage is specifically limited to or Social Security Number 113041142 certain location in New York State,r.e.a Wrap-Up Policy) 2.Name and Address of the Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Rochdale Insurance Company Town of Southold Building Dept Town Hall Annex Building,54375 Route 25 3b.Policy Number of entity listed in box"la": PO Box 1179 RWC3255583 Southold,NY 11971 3c.Policy effective period: 12/1/2011 to 12IV2012 3d.The Proprietor,Partners or Executive Officers are: F included(Only check box if all partners/officers included) F all excluded or certain partnerstofficers excluded This certifies that the insurance carver indicated above in box"3"insures the business referenced above in box"la"for workers'compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under Item 3A on the INFORMATION PAGE of the workers'compensation insurance policy).The Insurance Carrier or its licensed agent will send this Certification of Insurance to the entity listed above as the certificate holder in box"T'. 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 flus Certificate(These notices may be sent by regular mail)'Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c';whichever is earlier. Please Note:Upon the cancellation of the workers'compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved By: Henry C.Sibley (Print name of authorized representative or licensed agent of insurance carrier) Approved By: 9/19/2012 (Signature) ODate) Title: Underwriting Manager Telephone Number of authonzed representative or licensed agent of insurance carrier CarrierPhone Please Note:Only insurance tamers and their licensed agents are authorized to issue the C-105.2 form.Insra'ance brokers are NOT authorized to issue it C-105.2(9-07) Workers' Compensation Law Section 57.Restriction on issue of permits and the entering contracts unless compensation is secured. 1.The head of a state or municipal department,board,commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter,and notwithstanding any general or special statute requiring or authorizing the issue of such permits,shall not issue such permit unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter.Nothing herein,however,shall be construed as creating any liability on the part of such state or municipal department,board,commission or office to pay any compensation to any such employee if so employed. 2.The head of a state or municipal department,board,commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiring or authorizing any such contract,shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair,that compensation for all employees has been secured as provided by this chapter. C-105.2(9-07)Reverse A� CERTIFICATE OF LIABILITY INSURANCE 9/19/2012, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTANAME:C Cynthia Botunnaia, AAI Maran Corporate Risk Associates, Inc. PHONE (631)283-8000 FAX AI N.Y(631)287-22 07 300 Hampton Road EMAIL_AMgESS.ebounmaia@mcrainsurance.com INSURERS AFFORDING COVERAGE NAIC# Southampton NY 11968 INSURERA:Hartford IIIc Co of the Midwest 37478 INSURED INSURERB:Rochdale Ins CO 18910 Swimming Pools By Jack Anthony, Inc. INSURER C: 378 Main Street INSURER D: INSURER E: Center Moriches NY 11934 INSURER F: COVERAGES CERTIFICATE NUMBER:12-13 All Lines 11-12 WC 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 AUVL SUBR POLICY EF POLICY EXP LTR TYPE OF INSURANCE INSR Vinin POLICY NUMBER MIDNYY'Al (MMtDDffYyy1LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 In COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE ®OCCUR 2UENQS9193 /5/2012 /5/2013 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- 7JECT LOC $ AUTOMOBILE LIABILITY COMBINED SING LIMIT_(Ea11000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 2UENQS9193 /5/2012 /5/2013 AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOSPPIP-Addltlonal NON-OWNED P DAMAGE AUTOS Per accident $ _ $ 100,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC STATU OTH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNERIEXECUTWE E L EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) WC3255583 2/1/2011 2/1/2012 If yes,describe under E L.DISEASE-EA EMPLOYEE $ 100 000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedul%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 Building Dept ACCORDANCE WITH THE POLICY PROVISIONS. Town Hall Annex Building 53095 Route 25 AUTHORIZED REPRESENTATIVE - PO.Box 117.9 Y Southold, NY 11971 T Terry, CPCU, AAI/CO ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. " WS025(zOioo5i o1 The ACORD name and logo are registered marks of ACORD oa?O W:ex$sjJvn)v FXO=59wx->V" _? a y89f a ?aex#< r=_°X>VA7rgo I A1=n> ,4goj°xI v I--O>r-LY#r° n?, �X969w 9A�FS=_xvxg59wy4?�+ax0� 1 =<►q *# �a�8f?52w{��°�a=> (> ( =y1L Y(�>x�►• ° V L►XY8IfJ©L56wa& @-L 0- 10- 10• STEL WALL POOL SYSTEM 15' x 45' RECTANGLE - WR n D%VG#t:GS 5699 1 DATE:9/20/2012 1REV:- PAOE 2 OF p c AREA(Sq R):675 1 PERIMETER: 120' I ESS'.VOLUME: US GAL: i 45'-0" 4=6" Sr-0601CR 2{3PiL5} sT�oz ST-3030 ST�9602i sr-�6�t sT-s6ou sr-soya sr-96azi J J 3 T-W 57-9602 � ST�5502 9'-0" r sT,e4oi i 3 ST-4800 Sf 2 ST-72015a ST-%02 .9502 S 502SCL Si 2470L ST-10WM7D e i TURNBUCKLE BRACE ! ! siatrco�wcl 3'_4. rrraucat 4,-0„ 3'-4" a•n>� i aYlrra curt _ F'°Tn riot PATE 29'-ID"„ .. WS -rtn 4' r 7 V 'V0” J i J srno< - i '� SOS 000)IEY S FCO.ILUSnIATA'EF.FOd�QYLY ! 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