Loading...
HomeMy WebLinkAbout40794-Z Town of Southold 7/21/2017 G 0 P.O.Box 1179 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39070 Date: 7/21/2017 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1020 Bridle Ln., Cutchogue SCTM#: 473889 Sec/Block/Lot: 102.-8-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/24/2016 pursuant to which Building Permit No. 40794 dated 6/24/2016 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 Krasner,Robin of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 37212 06-28-2012 PLUMBERS CERTIFICATION DATED ft (\ (� U81L 0 riz d Signature, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy • SOUTHOLD, NY ?rpl � ,�aops 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#: 40794 Date: 6/24/2016 . Permission is hereby granted to: Krasner, Robin 1020 Bridle Ln Cutchogue, NY 11935 To: Construct an inground swimming pool, fenced to code as applied for: replaces BP#39011 At premises located at: 1020 Bridle Ln., Cutchogue SCTM # 473889 Sec/Block/Lot# 102.-8-15 Pursuant'to application dated 6/24/2016 and approved by the Building Inspector. To expire on 12/24/2017. Fees: PERMIT RENEWAL $125.00 Total: $125.00 spector o�SUFFot,��oTOWN OF SOUTHOLD BUILDING DEPARTMENT y 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 #: 39011 Date: 7/7/2014 Permission is hereby granted to: Krasner, Robin 1020 Bridle Ln Cutchogue, NY 11935 To: construct an inground swimming pool, fenced to code as applied for: replaces BP#37212 At premises located at: 1020 Bridle Ln, Cutchogue SCTM # 473889 Sec/Block/Lot# 102.-8-15 Pursuant to application dated 7/7/2014 and approved by the Building Inspector. To expire on 1/6/2016. Fees: PERMIT RENEWAL $125.00 Total: $125.00 Quild ng °�SUFEot,r�oTOWN OF SOUTHOLD BUILDING DEPARTMENT N x 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#: 37212 Date: 5/11/2012 Permission is hereby granted to: Robin Krasner 1020 Bridle Ln Cutchogue, NY 11935 To: construct an in round swimming g pool, fenced to code as applied for At premises located at: 1020 Birdie Lane, Cutchogue SCTM # 473889 Sec/Block/Lot# 102.-8-15 Pursuant to application dated 5/8/2012 and'approved by the Building Inspector. To expire on 11/10/2013. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building Inspector ®F SO!/Tyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q rimer.riche rt(aD-town.southoId.ny.us Southold,NY 11971-0959 • a0 cou BUILDING'DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Robin Krasner Address: 1020 Bridle Lane City: Cutchogue St: NY Zip: 11935 Building Permit#: 37212 Section: Block. Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: Raymond Electrical Corp License No: 5141-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 F1 Exit Fixtures 11 TVSS Other Equipment: in ground swimming pool to include, bonding, 1-heat pump, 1-salt generator 1-GFCI cirut breaker,pool lights Notes- Inspector Signature: Date: June 28 2012 81-Cert Electrical Compliance Form.xls pF SOcoutm, (/T�olo TOWN OF SOUTHOLD BUILDING DEPT:. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING/STRAPPING [ ] FINAL . [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: Yl DATE INSPECTORS 0 1 � OE SOUlyolo • yo o�'YCOUplry,O� TOWN OF SOUTHOLD BUILDING- DEPT:. 765-1802 INSPECTION . - * [ ] FOUNDATION i ST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND =LATION FRAMING /STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: r C DATE03/2-2.-//5 INSPECTOR SOl/Tyo o�'Y�OUMV,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]XSIULATION [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKSfinbilb 40&- 6V "M S vi v DATE INSPECTOR SOUlyol � o w O i TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] NSUL 10 [ ] FRAMING / STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRI L (FINAL) REMARKS: Ohl/, OCAVVY& o �J✓t�'�►�Ci l�� �� Off- - . UK -V/ U� DATE INSPECTOR _ 1' 1 1 • � • li • 1 1. -- i • 1 • � cv� f PLUMBING ,a INSUL ATION PER N.Y. STATE ENERGY • 1 /. i luom-wmnw.,d FITaur► �'?i�Y�L��►1��` _ ` i�� �• r f. ' ON 41 ml -�i TOWN OF SOl1�'THOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502 Suryey www. northfork.net/Southold/ PERMIT NO. 37J-Q- Check Septic Form N.Y.S.D.E.C. � Trustees Examined 5 ,20Contact: Approved Olt 20_/,,.- ail to: Disapproved a/c Phone: Expiration ,/// ,2013 ®t NWt/`� Opplan p Building Inspector V EICATION FOR BUILDING PERMIT 2012 Date 20INSTRUCTIONS T.aSQA y filled in by typewriter or in ink and submitted to the Building Inspector with 3 sets of pl , to scale.Fee according to schedule., b.Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or areas,and waterways. c.The work covered by this application may not be commenced before issuance of Building Permit. d.Upon approval of this application,the Building Inspector will issue a Building Permit to the applicant. Such a permit shall be kept on the premises available for inspection throughout the work. e.No building shall be occupied or used in whole or in part for any purpose what so ever until the Building Inspector issues a Certificate of Occupancy. f.Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize,in writing,the extension of the permit for an addition six months.Thereafter,a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations,for the construction of buildings, additions,or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws,ordinances,building code,ho sing code, and regulations,and to admit authorized inspectors on premises and in building for necessary inspections. OCCUPANCY OR A 4 ° 4Q ' r 11 f (Signa aJofpgiic nt or name,if orporation) 9NCLOSE,P bL TQ�. U U I 'a t!' 'tai© f tFOR WIT1 & Mailingaddress of applica t) State whether applicant is owneY', lessee, agent, architect, engineer, gener 1 contractor, a ectrician, plumber or.U41der jon Name of owner ofremises ��JI• pjwYi-e� ,v.p _ (As on the tax roll or latest deeA)TIt--y v,i,b'tN D:t�,,k� =,,Jr AT If applicant is a corporation, signature of duly authorized officer Q 1 pv 4 i�M Fon Trig FOt_LoWfoia (Name and title of corporate officer) t) UNDATION -TWO REUU(RED<, r'OR POURED CONCRETE p " 1 I "OUGH-FRAMING,PLUM&Nu, Builders License NA -2 STRAPPING,ELECTRICAL 6 CAULKING`' Plumbers License No. R0CA s 3 INSULATION R Electricians License No. 4 FINAL-CONSTRUCTION 8 ELECTRICAL Other Trade's License No. MUST BE COMPLETE FOR C 0 ALL CONSTRUCTION SHALL MEET THE 1. ocation of la n whi h ro os d work will be don . REQUIREMENTS OF THE CODES OF NEW 1 p p Y EOR. TA . TES 0 L �- UC I N House Number Street HajQifit RETAIN STOIPTER MTER RUNbFp County Tax Map No. 1000 Section16 Block PURSINUT 36 Subdivision J Filed Map No. E fI(:ODE- am �� 2. State existing use and occupancy of premises andintended use and occup n of proposed construction: a. Existing use and occupancy L b. Intended use and occupancy ✓0 a 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work o (Description) 4. Estimated Cost 2u ,���s Fee (To be paid on filing this application) 5. If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10.Date of Purchase Name of Former Owner 11.Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation?YES N O 13. Will lot be re-graded?YES NWill excess fill be removed from premises?YES NO 14.Names of Owner of remises YWddrress C!��L-C, Phone No �� �_ '�� Name of Architect Address P��- .) . FP- Phone No - j®S Name of Contractor `, _�cQ� Address �h1�Phone No. 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO Y� * 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. STATE OF NEW YORK) COUNTY OFM ) ��s being duly sworn,deposes and says that(s)he is the applicant (Name of in ividual signing contract)ab ve named, (S)He is the a-:�'lq+rCkC i�7 l— (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 to before me tl s- day of " I� 20_0_ 6��.VW"I Notary Public Si tore o ,Applicant NOTIFYA7 J t tII,DIP " z i Town Hall Annex 54375 Maui Road 41 1) 5-162 ll U P.O.Box 1179 COR er.rlChert 1�ou old.n .us .souffiow,IVY 11971-0959 c�. e' JUN 2 6 2012 BLDG DEPT. BT�TG I�EPA�It'1'1lNT TOWN OF SOUTHOLD TOWN OF SOUTSOLO APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: R �a,Ly Date: (o �°� `F-'12 Company Name: I � Name: ' License No.: I Address: �j 14L N 0in Phone No.: I (o "� CA JOSSITE INFORMATION: (*Indicates required information) *Name:. iCe5n-c-r *Address: Zp i el G GZn *Cross Street: � a.rt CE *Phone No.: Permit No.: -IX Tax Map District: 1000Section: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) round 1SW n11 C1 r-i o 61 (Please Circle All That Apply) *Isjob ready for inspection: YES NO Rough In Final Do you need a Temp Certificate: YDS CO Temp-information(if needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *News Service: Re4corinect Underground Number of Meters Change of Service Overhead Additional Infbr'mation: AYMENT DUE WITH APP . LIGATION 'V �3, 11T'� b� Town of Southold -,Chapter 236 - Stormwater Management N � _ old SWPPP - Storm Water Pollution Prevention Plan Assessment Form GENERAL INFORMATION:'(All Requested-Information is Required for a Complete Application) APPLICANT AME: Owne - g n sul -Contra for or O er(Circle One) P rtyNER`(If Dit7e nt an licant Address: fiddreYsf , J Telephone#;1 Fax# Telephone#: Fax#: E-Mail- E-Mail: Property Address: Brief Description of Construction Activity,Proposed Structural BMPs,,Soil S.C.T.M.#: 1000 (T Stabalization BMPs,Project Scope and/or Sequence of Construction Activity District Section Block Lot (Provide Addmonal Pages as Needed) Name of Contractor and/or Contact Person Responsible for Implementation of SWPPP: l Address: Telephone#: Fax#: ----_---------------------------.__.„___,..______ i E-Mail: _____ Name of Persons Responsible for Installation&Maintenance of Erosion Control Practice: W Address: „• •M N t Telephone#: Fax#: E-Mail: Total Area of AlI Total Area of Land Clearing ------. v _M-_ _ _ Project Parcels and/or Ground Disturbance: is F/Av ) (S F IA—) Project Duration: Start nd ri (Nu er of Caleate.• �, "lf���p -_._ --.,-„.-„_.._ (Anticipated) Date: ndr Days) , Will this Project Disturbe five(5)or More Acres at Any One Time During the Proposed Development? 0 No - - --_.__.__.__.„..__, _______,__,__.._.__ _____,_.,_ If YES:Please Answer the Followingl a. Does the Applicant have a Qualified Inspector On Q Q Staff To Conduct the Required Inspections? Yes No b. Does the SWPPP Indicate How Frequently the Site O O List the NAMES or description of all Potentially Impacted Waterbodies and/or Wetlands: Inspections will Occur and for What Period of Time? Yes No c. Does the SWPPP Adequately Identify All Temporary Q Q and/or Permanent Soil Stabalization Measures? Yes No -- d. Does the SWPPP Adequately.Identify a Complete Project Phasing Plan? Yes No Status of Impacted Waterbody:(eq.TMDL,303(d)Listed,Impaired..) e. Does the SWPPP Indicate Additional Site Specific ' Q Q Practices that Will be Utilized to Protect Water Quality? Yes No ! f. Has the Applicant Submitted a Completed DEC Notice Type of Impacted Waterbody:(eg.Lake,Creek,Bay,Pond,Sound,Freshwater Wetland...) Of Intent and SWPPP Acceptance Form for Review O by the Town of Southold? Yes No i 1 STATE OF NF.W YORK, COUNTY OF............. ..........................SS That I,...a 1 ... �� ing duly sworn,deposes and says that he/she is the applicant for Permit, i' (Name of mdivi uarsigning Document) And that he/she is the .................................................... ` i.. ................................... (Owner, r,Agent,Corporate cer,elc.) ! Owner and/or representative of the 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 best of his knowledge and belief;and that the work will be performed in thp rrlanner set forth in the application filed he with. i Sworn to Nfore methus- .............. ........ '......dayf I 'fig 1 Notary Public: .............. . ... ... .. ....... .. .. ........... ....... S a re f Ap licant) SWPPP Assessment FORM: 03-12 Lcoil May 10,2012 Towof Southold Building Department Robin Krasner 1020 Bridle Lane Cutchogue This proposed swimming pool will have a cartridge filter and doesn't require the pool to be backwashed. The cesspool location is indicated on the survey. Thank you, Swim King Pools 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 RANDY T. RODECKER, INC. DBA SWIM KING POOLS (631)744-8100 471 ROUTE 25A 1c.NYS Unemployment Insurance Employer Registration ROCKY POINT, NY 11778 Number of 1716Insured 6110 1d.Federal Employer Identification Number of Insured or Social Security Number 113092960 2.Name and Address of the Entity requesting Proof of coverage (Entity being listed as the Certificate Holder) 3a.Name of Insurance Carrier Town of Southold The First Rehabilitation Life Insurance Company of America 530995 Route 25 PO Box 1179 3b.Policy Number of Entity listed in box"1a": DBL37154 Southold, NY 11971 3c.Policy effective period: 02/01/2011 to 01/31/2013 4.Policy covers: a• 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: Under penalty of pe jury,1 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 8/31/2011 114 By (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 516-829-8100 Title 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. If box"4b"Is checked,this certificate Is NOT COMPLETE for the purposes of Section 220,Subd.B 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. 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 According to Information maintained by the NYS Worker's Compensation Board,the above-named employer has compiled with the NYS Disability Benefits Law with respect to all of his/her employees. Date Signed By (Signature of NYS Worker's Compensation Board Employee) 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. D13-120.1 (5-06) 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 Randy T.Rodecker,Inc. (631)744-8100 471 Route 25A lc.NYS Unemployment Insurance Employer, Rocky Point,NY 11778-8985 Registration Number of Insured Work Location of Insured (Only required if coverage is ld.Federal Employer Identification Number of Insured specifically limited to certain locations in New York State, i.e., a or Social Security Number Wrap-Up Policy) 113092960 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Valley Forge Insurance Co. Town of Southold 53095 Route 25 PO Box 1179 3b.Policy Number of entity listed in box°°la" Southold,NY 11971 2094735086 ' 3c. Policy effective period 09/01/2011'-09/01/2012 3d. The Proprietor,Partners or Executive Officers are X included. (Only check box if all partners/officers included) ❑ 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"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 this Certificate. ('These notices may be sent by regular mail.) Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent, or until the policy expiration date listed in box "3c",whichever is earlier. Please Note: Upon the cancellation of the workers' compensation policy indicated on this form,if the business continues to be named on a permit,license or contract issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers' Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Thomas P.Terry,CPCU (Print name of authorized representative or licensed agent of insurance carrier) Approved by: , August 29,2011 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carrier: 631 283-8000 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 SUFFOL..K CO. HEW 7,H 00,-1. AAPPR6VAL _ H. S. NO. 112 Ey r # � `` STAj_t__MENT OF INTEPUB �I'� , THE WATER SUOPLY AND SEA -,W IGE-01SP WAL ` 2c. ,4 ,.i' f i� .�` SYSTEMS FOR THIS, RESIDENCE WDLL , 9 CONFORM - TO THE S•TANDAf2O3 „AF THE, � .f r�' . 4 ,Y SUFFOLK CO. MPT. OF HEAL 1"H SER�70E . } ,-, -fSi APPL,C- I" SUFFOLK COUNTY DEPT. OF HEALTH SERVICES -FOR APPROVAL OF CONSTRUCTION ONLY [ - SUFFOLK COUNTY f-IEA DEPARTMENT • H. REF. No.. � �0 AP OVED: f SINGLE FAMILY EL iV4 ONLY H.D. REF. NO. y_ FFOLK CO. TAX MAP DESIGNA fJA{ N: Idl ! TANK IST. SECT. BLOCK PCL. ' DAT �� its. 09. ERS ADDRESS: ,THE SEWAGE AISP L AND WATER SUPPLY FACILITIES F TIS � r - _ r0ZFEk. t*A.. '#.UCA'1'10M HA EN INSPECTED BY TITS DEPARTMEN ND i r �-� Ir-4UNIJ TO H� '�ISFAC�yt4R/�+',-•�-- r e. L . Chief:, f Wastewater Management Section S A9!Q DE D: L. TEST HOLE S''TAMP !i4 �� N 5 1 E ` ,_ to this surced alterationIs a oraddition ����,��, � _.._.�._.__r — —_ _-•,-1-- - n of Section 7209 of the Now York State lrt/• c 25.2 C', F j L��,� 'education lava. + — - Conies of this survey mop mart bowing the lend surveyor's Inked 66111 or J embossed seal shall nrA be C271*16f0d !, to be a valid true copy. Guarantees indicated h6100n 911811 tttr! r ` f i s a only to the epa ed,and on w b0ldif to the \,A��A iT , ` � .—` title company,governntSMIM6"Mymrd f o` `� 3 :3E l��1 ! I I� '— `E;✓ _ — lending institution listed baroon and '''�: Z� to the assi r•.eos of the iondin®instl- P tution.Guarantow are not trditdsrebie ' 10 additional institutions or subsNuent owners. LA_ � r I SI`A� t LD TE 5 'AS �SUPZVF� SUI= ., CO.<-L!F..t�`a OFI+11..E A5 HAS' N .6 5 ?. Rt3D IG • - — - SR #C 11rA.'si T,�YL, P.C. _ LIOI_itil-IS,EW LAND.` VVEYOR'S OREENP0,RT NEW YORK I 40' 10" v`11 1 FROM SKIMMER V PUMP O O F � �O B Co LLJ TO DISPOSAL/ U Z ORYWELL V W Z p Z VALVE E O DEEP WATER RETURNS `' 0 Q _ V I— y O VINYL COVERED—-, } W } CONCRETE STEPS FILTER Z CHECK VALVE N o V) cY CZ oC - N ' 4' 9' 7' 20' TO RETURNS A PLUMBING SCHEMATIC NOT TO SCALE � 0 Al eo PLAN CONC.WALLS • fes '` � � 20 x 40 RectangleICY I ®yN �® NOTES OF ELECTRIC POOL COVER WATER LINE 1. ALL CONSTRUCTION IS TO BE IN ACCORDANCE WITH THE RESIDENTIAL CODE OF NEW YORK STATE-2010 AND THE ANSI/NSPI-5-03 STANDARDS FOR —III— — RESIDENTIAL INGROUND SWIMMING POOLS FOR A TYPE II POOL. COIJ' L—J1 J' M 2. STRUCTURE IS DESIGNED FOR USE BELOW GRADE AND ONLY IN AREAS WHERE -11 fT I' THE GROUNDWATER TABLE IS A MINIMUM OF 4'-B"BELOW THE PROPOSED y FINISHED GRADE. Q rY N LL. N 2"to 4"SAND BOTTOM .__1 - } COPING AND WALKWAY 3. BACKFILL WITH CLEAN EARTH,FREE OF ROOTS AND DEBRIS. DO NOT ALLOW (BY OTHERS) THE HEIGHT OF BACKFILL TO EXCEED THE HEIGHT OF THE WATER IN THE POOL 0 m v z C) Q FORMED CONCRETE STEPS BY MORE THAN 8", OR THE WATER TO EXCEED BACKFILL BY MORE THAN 8" SECTION A WATER LINE 10" GRADE 4. PLACE CONCRETE ON SANDY TO LOAM SOIL. REMOVE ANY CLAY DEPOSIT AND p Z:m p SCALE:1/8"=11-0" COMPACT CLEAN BACKFILL. W O `v 5. WALKS TO BE SMOOTH,NON SKID TYPE,SLOPED AWAY FROM POOL. � CJ ROLLED FOAM BETWEEN Q. LINER AND CONCRETE TOP OWALL WATELINE 6. WATER DISPOSAL SHALL BE LIMITED TO OWNERS PROPERTY IN ACCORDANCE F R / D/ FORM TIES \\\� WITH LOCAL REGULATIONS. p 3500 PSI POURED CONC. 4, G 4' 12' 4' 7. PROPERTY OWNER IS RESPONSIBLE TO INSTALL PERMANENT FENCE AROUND 2"RETURN LINE �/ POOL IN ACCORDANCE WITH THE NYS BUILDING CODE,APPENDIX G,SECTION 9 n VINYL LINER O j\\% AG105. PERMANENT ENCLOSURE MUST BE COMPLETED WITHIN NINETY DAYS Z Z Z /\ AFTER THE DATE OF COMMENCEMENT OF CONSTRUCTION. 2"TO 4"SAND o4 4 8. THERE IS NO MAIN DRAIN IN THIS POOL. SUCTION FOR POOL WATER V)V j Z O ///\ CIRCULATION IS PROVIDED BY THE SKIMMERS ONLY. THIS MEETS z Q `a c i REQUIREMENTS OF RC-SECTION AG106 FOR ENTRAPMENT PROTECTION. __ Lw i7, SECTION B 9. THIS POOL SHALL BE EQUIPPED WITH AN APPROVED POOL ALARM WHICH IS O SCALE:1/81,=1'-0" CLASSIFIED BY UNDERWITERS LABORATORY, INC TO REFERENCE STANDARD ASTM 2208 ENTITLED "STANDARD SPECIFICATION FOR POOL ALARMS,"AS --J Q °C ADOPTEDIN 2008. 1- C)C1. 10. A TEMPORARY ENCLOSURE,OR 4 FT FENCE SHALL BE INSTALLED AND 5-2-2012 WALL SECTION REMAIN IN PLACE THROUGHOUT THE PERIOD OF CONSTRUCTION OF THE SWIMMING POOL, OR UNTIL THE COMPLETION OF A PERMANENT ENCLOSURE. a - - �, I RM M Select � "ry'PentairWater � — rs. mT • :aai;t� I:I�I:t,�Ii1���IE.;1 s,:;t .. ..,a;;ta�la,i,��"#l�d�l it ,. mssjjj IN ,r,ia4 Crystal clear water the easy way Clean&Clear°Plus cartridge filter combines top-end filter ®Cartridges are easy to remove and rinse. performance with low maintenance.This dependable aesign ©Clamp ring allows easy access to cartridges and internal parts uses special filter elements to strip tiny particles from your pool to speed service routines water.. particles as small as 30 microns.(An average grain of beach sand is 1,000 microns!) Our four-cartridge design provides ° I%z"drain is easy to access and located to ensure complete draining during winterization. maximum filter surface area to capture more dirt and extends time between cleaning And cleaning is a snap.Open the top, ®Fiberglass-reinforced polypropylene tank is strong and remove the cartridges,hose them off,and Clean&Clear Plus is corrosion resistant for extra long life. ready to go again. An Eco Select TM rand ProductWe've maximized cartridge surface consistency to block and trap the maximum amount of solids,plus we use the most The Eco Select' brand identifies our"greenest"and most efficient equipment choices Water flows very efficientlydurable materials to extend cartridge life Clean&Clear Plus delivers commercial-grade performance that keeps pools clean through the Clean &Clear Plus filters,often allowing the use of and sparkling,day in and day out smaller pumps or lower pump speeds to minimize energy use. And when you rinse cartridges rather than backwash,you can o Four-cartridge design traps more dirt and extends time significantly reduce water use,too. between cleanings. 4 _ ® r ® ® 1 i — — • • • Model Filter Vertical* Filter Flour Rate GPM Turnover Capacity-Iles.(Gallons) Number /area Sq.Ft. Clearance Diameter Res,** Com. 8 hrs. 10 hrs. 12 hrs. CCP240 240 56" 21.5" 90 90 43,200 54,000 64,800 CCP320' 320 62" 21.5" 120 120 57,600 72,000 86,400 CCP420' 420 68" 21.5" 150 150 72,000 90,000 108,000 CCP520' 520 74" 21.5" 150 150 72,000 90,000 108,000 'NSF Listed. Four cartridges in a compact design *Required clearance to remove filter elements H �J *Maximum flow rate Clean&Clear°Plus cartridge filters contain four polyester cartridges that hold enormous amounts of dirt,yet are easy to clean.The fiberglass-reinforced tank halves are secured with an innovative clamp ring—just loosen the ring and remove the top Available from: half for easy cartridge access and rinsing.Filter maintenance doesn't get any easier. ®Continuous internal air bleed prevents air build-up to keep the -- filter operating at peak performance. o Single-piece base and body for strength,stability and years of dependable service. ©One-year limited warranty. See warranty for details. f. Because reliability matters most° wwwpentairpool.com Phone:800-831-7133 pumps/filters/heaters/heat pumps/automation/lighting/cleaners I sanitizers/water features/maintenance products 4/10 Part#PI-131 N ©2010 PentairWater Pool and Spa,Inc All rights reserved �sm