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HomeMy WebLinkAbout42392-Z ��4�guFFtlt�D Town of Southold 10/11/2018 0 P.O.Box 1179 W M 53095 Main Rd p'y K Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39959 Date: 10/11/2018 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 4525 Breakwater Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 99.-2-17 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 2/7/2018 pursuant to which Building Permit No. 42392 dated 2/16/2018 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 Lewis,Herbert of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42392 06-25-2018 PLUMBERS CERTIFICATION DATED 0 Ohoed Signature ���So�oc�coG TOWN OF SOUTHOLD BUILDING DEPARTMENT 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#: 42392 Date: 2/16/2018 Permission is hereby granted to: Lewis, Herbert 14 Horatio St Apt 12G New York, NY 100141660 To: construct accessory in-ground swimming pool as applied for. At premises located at: 4525 Breakwater Rd., Mattituck SCTM # 473889 Sec/Block/Lot# 99.-2-17 Pursuant to application dated 2/7/2018 and approved by the Building Inspector. To expire on 8/18/2019. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Building pector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets, and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal (S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building, industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957)non-conforming uses,or buildings and"pre-existing"land uses: 1. Accurate survey of property showing all property lines, streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses$50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00 Date. ' New Construction: Sic !/�, r Pre-existing Building: /j (check one)) Location of Property: House No. Street Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Block Z Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (che k one) Fee Submitted: $ - c ApOca Si nature pF SOUryolo Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 �Q roger.richert(a-town.southold.ny.us Southold,NY 11971-0959 couffm BUILDING DEPARTMENT TOWN OF SOUMOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Herbert Lewis Address: 4525 Breakwater Road city:Mattituck st: New York zip: 11952 Building Permit* 42392 Section: 99 Block: 2 Lot: 17 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: MRJ Industries LTD License No: 41853-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 2 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 Twist Lock Exit Fixtures TVSS Other Equipment: Inground Swimming Pool to Include: Bonding, Control Panel, 1 GFCI Circuit Breaker, 1 Pool Light, 1- Pool Heat Pump, Salt Generator. Notes: Inspector Signature: Date: June 25, 2018 0-Cert Electrical Compliance FormAs OF SOI/T�° TOWN OF SOUTHOLD BUILDING DEPT. s �o °`ycourm,N�'' 765-1802 INSPECTION, [JA/FOUNDATION 1ST WWI, [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: n /7 A DATE INSPECTOR OF SOUTy�� TOWN OF SOUTHOLD BUILDING DEPT. courm��' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. 7-7L`�z; [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [�/J ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: 0 MA Al DATE INSPECTO 1 � 50UTyO� # TOWN OF SOUTHOLD BUILDING DEPT. °`ycourm, 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ Y SULAT Ot,._N [ ] FRAMING /STRAPPING FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: OVAA DATE ®A INSPECTOR FIELD INSPECTION REPORT PATE COMME •S Inv Tqrw FOUNDATION (1ST) y -------------------------------------- FOUNDATION (2ND) tr�j z Nj ROUGH FRAMING& PLUMBING V vH INSULATION PER N.Y. H STATE ENERGY CODE 3 FINAL ADDITIONAL COMMENTS 2 I t (ta-cu6b M, �rn c � d TOWN OF SOUTHOLD z 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 Survey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined r� - -,20—a Single&Separate Dc3 Truss Identification Form D Storm-Water Assessment Form FEB _ 7 2018 contact: Approved ,20(� Mail to:: SWAtl,ja�A I S Disapproved a/c BUY-10U4G,D tPT— )Vil"J:7l 5'1P 1A\r111N.f Al hq N� 11901 TOWN OF SO ®� Phone: C#,�I --72-0 —UL?-21 Expiration ,20 1 Buil ector APPLICATION FOR BUILDING PERMIT -Date b q-- , 20_t 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. f. Every building permit shall expire if the work authorized has not commenced within 12 months after the date of issuance or has not been completed within 18 months from such date. If no zoning amendments'or other regulations affecting the property have been enacted in the interim,the Building Inspector may authorize, in writing,the extension of the permit for an addition six months. Thereafter, a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary ' spectio (SIM Si ature of a 'cant o name, if a co oration) o � P /wr (Mailing a5tfdress of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder (1,on-tya C1wr Name of owner of premises J ON's IroZ•J r)5S (IV on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Buil'd'ers License No. J LQ U 4 J •- J4 Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed wo.4 �be�dono:,ii st ,�1'e�o:!{fit �t PIT iltl=;s+ltta�,F i `�l��F %� n\� House Number Street Hamlet County Tax Map No­,1000 Section -Block ('�� Lot / - Subdivision Filed Map No. r Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy SW 4 po—p 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work` I h(lMj t)q l ( escription) 4. Estimated Cost t�1 p ou Fee —1 -,I---, —paid on filing this application) 5. If dwelling, number of dwelling units ;`" lurriber'af dwellinguniton each floor If garage, number of cars U 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 i Depth Height Number of Stories-11'��-A'.a 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 NO 13. Will lot be re-graded? YES Y NO' Will excess fill be removed from premises? YES ✓NO ed 14. Names of Owner of premises`T !W I05prt JL-fa,Address462<,- &YeQt'4t-a46yPhone No.Q(.-J. MDy LJCD_ Name of Architect Address Phone No Name of ContractorT..SIGt lld l0.�iru I s l.7-D Address 1�x -�-►sh o I j$(f, 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 ) i7 CZ7tA-j,E being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, (S)He is the ac, xi� g*e-,-� d 12 (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.._ _ �t DONNA LA�MARCA Sw n o(before me thi NOTARY PUBLIC.S1:aTE,OF NEW Y, K h day of o. 20 0 LRegistration NumlF#-pICA_391� Qu ifi�Sutlbll�Cou C mission _ IZCom/ Notary Public ature of plicant \ co%A_ A. Russell 0.1 Q> sT(O��E���J[\�v-A�C'�E)C� SUPERVISOR � z MA\,N A\G]EIMI]ENT 53095 ain Road -OSOUTHOI.D,NEW YORK 911971 'llylO �c3' Town of,Sou th o l d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS PROJECT INVOLVE ANY OF THE FOLLOWING: (CHECK ALL THAT APPLY Yes No ❑EgA. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. ❑ . Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area_ [� C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. ❑�D_ Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. ` ❑ E_ Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. ❑ : Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, —.signature,r6ontaet-InfomationTDate-&-Countj-Tax-Map-Number!—Chapter-236-does-not-appl to-3�ouT-pro}ect If you answered YES to one or more of the above,please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. S.C.T.M. �`: 1000 Date _ss APPLICANT: (Property Owner,Design Profe ) ria. gent,Contractor,Other) Di�trm NAME 'ft/df- jo f Z-t /—L w a Se U.. Block Lot 4 Contact for ation < r v 14) Tc1}dae�wnDc.• Reviewed By: — — — — — — — — — — Date: Property Address / Location of- COnstruclJOn Work- — — — — — — — — — — — — — -- - — Approved for proce�sing Building Permit !� Stormwater Management Control Plan Not Required. ���< �� ❑ Siormwater Management Control Plan a Required (Forward to Engineering Depaiiment for Review) FORM ` SMCP- TOS MAY 2014 FQLK BUILDING DEPARTMENT- Electrical Inspector g11F TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 • p`fi Telephone (631) 765-1802 - FAX (631) 765-9502 roger.richert(c_town.southoId.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY:-- - -- - - ---------- ------ --- ------ - - - - -- - - - -- - Date: - Company Name: Name: License No.: _M C' email: o�,� ®� � ,�e•''e t Address: Phone No.: JOB SITE INFORMATION: (All Information Required) Name: c�-�C G2 A � Address: C l C ttir S Cross Street: _ Phone No.: J Bldg.Permit#: Ya- 3 g email: Fax Map District: 1000 Section: Block: Lot: -41 BRIEF DESCRIPTION OF V�(ORK (Please Print Clearly) �ery - o L Circle All That Apply: Is job ready for inspection?: ES / NO Rough In Final Do you need a Temp Certificate?: YES /� Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Si A #Meters Old Meter# New Service- Fire Recon - lood Reconnect- Service Reconnected - Underground - Overhead # Underground erals 1 2 H Frame Pole Work done on Service? Y N Additional-Information: PAYMENT DUE WITH-APPLICATION N\d3 ` A\ Request for Inspection FormAs �(1�✓ ��C �` J HM ENGINEERING P.C. 3 CHERRYWOOD DRIVE EAST NORTHPORT,NY 11731 TEL:516-476-5392 EMAIL:HMARNIKA@OPTONLINE.NET December 09,2017 Town of Southold Building Department Town Hall Southold,N.Y. 11971 Dear Sir/Madam: This is to certify that the drainage facilities to be used exclusively for the construction of a swimming pool on the premises of- Lewis fLewis&Tomlinson Residence 4525 Breakwater Road Mattituck,N.Y. 11952 will not require draining because the pool is of gunite construction. The pool water will be continuously recirculated through the filter and will be reused from year to year. The drainage from the filter backwash is nominal and will not interfere with the public water supply, the existing sanitary facilities or public highways. Sincerely, HM En ineering P.C. 4�Ww' Hrvoj Marnika P.E. i - CAST IRON FRAME & COVER IF UNDER PAVED AREA FINISHED GRADE NOTES: s 8' MIN. - 12' MAX. � � 24' p��`�} BRICK LEVELING COURSE—�L�MIN�'�'� 1. UNSUITABLE MATERIAL SHALL BE REMOVED UNDER LEACHING POOL UNTIL 6' CONCRETE COVER I MINIMUM PENETRATION INTO VIRGIN STRATA SAND AND GRAVEL AND BACKFILLED PRECAST CONC. COLLAR .)• `o WITH SAND AND GRAVEL TO BOTTOM OF BASIN. AS REQUIRED MAXX 2. AS AN ALTERNATIVE TO THE DOME TOP, A FLAT SLAB CAN BE SUBSTITUTED WITH PRECAST APPROVAL OF THE ENGINEER. REINF. CONC. DOME 3• LOCATION OF DRAINAGE POOL TO BE DETERMINED BY OTHERS. 4'0 PVC 4. ALL DRAINAGE PIPES MUST BE PROVIDED WITH A MINIMUM 2'-0" COVER. MIN, SLOPE ER FOOT ® ®to 0 INVER ® a 5. COLLAR IS NOT REQUIRED WHEN RATEABLE MATERIAL EXISTS FOR FULL DEPTH. NON-SHRINK 0 6. THE MATERIAL USED FOR COLLARING SHALL BE COMPRISED OF SAND AND GROUT a GRAVEL CONTAINING LESS THAN FIFTEEN (15) PERCENT FINE SAND, SILT AND CLAY. 3' MIN. SAND SILT AND CLAY FRACTIONS ARE NOT TO EXCEED (5) PERCENT. = AND GRAVEL n~. COLLAR (TYP) o w ALL AROUND W a W PRECAST REINF. C3 > CONC. LEACHING DRYWELL CALCULATION J W RINGS W REQUIRED: y � XBACKWASH AT 70 GPM X 5 MIN. = 350 GAL. W PROVIDED: DRYWELL CAPACITY = 1,263 GAL. (169 CF) Ld-1� :4. 8' DIAMETER ra o �W • Ho o v ••�•' a .e. Z 6' MIN, PENETRATION a o INTO VIRGIN STRATA GROUND WATER OF SAND & GRAVEL DRAINAGE POOL DETAIL NOT TO SCALE PREPARED FOR: LEWIS & TOMLINSON RESIDENCE 4525 BREAKWATER ROAD MATTITUCK; N.Y. 11952 DATE: 12/09/2017 NOTE: THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED '7 HM ENGINEERING, P.C. SCALE: ASSHOWNSHEET: 2 OF 2 ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE / 3 CHERRYWOOD DRIVE EAST NORTHPORT,NY 11731 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. VOID WITHOUT RAISED SEAL AND BLUE SIGNATURE Tel:(516)476-5392 Fax:(631)980-7671 www.hmarnika@optonline.net DRYWELL DETAIL - I Y R Workers' CERTIFICATE-OF STATE Com NYS WORKERS' COMPENSATION INSURANCE COVERAGE la.Legal Name&Address of Insured(Use street address only) lb.Business Telephone Number of Insured Islandia Pools Ltd. - 108 Fishel Avenue 631727-6312 Riverhead,NY 11901 lc.NYS Unemployment Insurance Employer Work Location of Insured (Only required if coverage is Registration Number of Insured specykally limited to certain locations in New York State, La,a- ld.Federal Employer Identification'Number of Insured Wrap-Up Policy) or Social Security Number 112915558 2.Name and Address of the Entity Requesting Proof of 3a. Name of Insurance Carrier Coverage(Entity Being Listed as the Certificate Holder) Property 8i Casualty Ins Co of Hartford 3b.Policy Number of entity listed in box"la" Town of Southold Building Department 12WEGJY2946 53095 Route 25 3c. Policy effective period PO Box 1179 04/25/2017 to 04/25/2018 Southold,NY 11971 3d. The Proprietor,Partners or Executive Officers are ❑ 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"2". Will the carrier notify the certificate holder within 10 days of a policy being cancelled for non-payment of premium or within 30 days if cancelled for any other reason or if the insured is otherwise eliminated from the coverage indicated on this certificate prior to the end of the policy effective period? 0 YES ® NO This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect 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,1 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: - Leonard Scioscia (Print name of authorized representative or licensed agent of insurance carrier) Approved by:by_ 11/21/17 (Signature) (Date) Title: Authorized Representative Telephone Number of authorized representative or licensed agent of insurance carver: 631 324-1440 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(9-15) www.wcb.ny.gov Client#:4647 ISLAP002 ACORD. CERTIFICATE-OF LIABILITY INSURANCE DATE(MMJDD/YYYA� ,: r;. .. 1;1,!,21/2017 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 WANED,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 endomement(s). PRODUCERCONTACT Southampton Commercial PHONE 631 324-1440 E-MAIL F Cook Maran AIC L arc,No: 300 Hampton Road ADDRESS: Southampton,NY 11968 INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:H-ft d Rte Insurance Company 19682 islandia Pools Ltd. INSURER B:HartrordCasuatlyhrsur -Com 29424 108 Fishel Avenue INSURER C:Property&casualtyIns ofRan 34690 Riverhead,NY 11901 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADD SUB/NSR NN EFF AMM"LIDY EXP LIMITS YVI/D POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY 12UUNQY2985 0412512017 0412512018 EACH OCCURRENCE $1,000.000 CLAIMS MADE ❑X OCCUR PREMISES Fao ED $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT El LOC PRODUCTS-COMPIOPAGG $2,000,000 OTHER, $ B AUTOMOBILE LIABILITY 12UUNQY2985 0412512017 04/25/201 CD a1de�SINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Peracddent) $ X HIRED AUTOS X AUTOSWNED PROPERTY DAMAGE $ Peraccident B X UMBRELLA LIAB X OCCUR 12HHUQY2781 4/25/2017 04/25/201 EACH OCCURRENCE $1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $1.000.000 DED I X RETENTIONS70000 $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY 12VVEGJY2946 D412612017 04/25/201 PTR 1 11 ANNIy PROPR ETOR/PgqRT7NNEERfEXCCLJTIVE YI" E.L EACH ACCIDENT $500,000 OFFICEWM�MBEREXCLUDED? NIA (Mandatory In and E.L DISEASE-EA EMPLOYEE $500,000 If yes,descnhe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional RemaArs Schedule,may be attached K more space is required) CERTIFICATE HOLDER CANCELLATION Town of Southold Building Dept SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 Route 25 ACCORDANCE WITH THE-POLICY PROVISIONS. PO Box 1179 Southold,NY 11971-0000 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) 1 of 1 The ACORD name and logo aie'registered marks of ACORD #51219995/M61670 LJACO 1 (1)UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW (2)DISTANCES SHOWN HEREON FROM PROPERTY LINES TO EXISTING STRUCTURES ARE FOR A SPECIFIC PURPOSE AND ARE NOT TO BE USED TO ESTABUSH PROPERTY LINES OR FOR ERECTION OF FENCES(3)COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY (4)CERTIFICATION INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY.GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON.AND TO THE ASSIGNEES OF THE LENDING INSTITUTION CERTIFICATIONS ARE NOT TRANSFERABLE TO ADDITIONAL INSTITUTIONS OR SUBSEQUENT OWNERS (5)THE LOCATION OF WELLS(W).SEPTIC TANKS(ST)&CESSPOOLS(CP)SHOWN HEREON ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS I -_ 400 Ostrander Avenue,Riverhead,New York 11901 I SANITARY MEASUREMENTS -�- tel.651.'72-72505 303 Pax.631.,2,.0144 admin®youngengineertng.com A B N owt� 4 �4 � I 5T 44.5' 441[1 Howard W.Young,land Surveyor Thomas G.Nlolpert,Professional Engineer LF 6.1.5' 7.7.5' Douglas E.Adams,Professional Engineer �*E Lot 2 Robert G.Toot,Architect I Subdivision - eLvca I 11 SITE DATA ` eLur✓a � Viola D � Ily�tlliam F. D File No. g4"i"1 Poej--M 0 LOt 100 ► guff. GO AREA =1.5461 ACRES OR 6"1,434 50. FT. ID s gubdivtsion - I -x '' tq►n IGidd �5tates I r I SUBJECT PARCEL IS IN ZONE X-SEE FLOOD INSURANCE RATE MAP 16�2 ut PANEL NO.361030.0143 H LAST DATED SEPT.25,200-R. GI IIGgp CO. ile NO• a s 5uff. I YV�,SIRE 33"1.I'i' e I I ° E 7- Ng3 40'00 j HEALTH DEPARTMENT USE eo y'looD5NOR - - os --- IU� O o Ob'W I ft0 W0oD f�K — — ' ----------------- It --------------- - Z I _ _ • — _ipas-------------- O w __ _------ -----------BUND ELECTRIC rn I O E ac 2o0 ww 159' --�\\ 3 LOt 101 N - - STORY T+ SaRr2`10f1+ 1[p ST- IL. I TRIG i gubdivtslon - O - w 2141E HoSu ,=°°M to idd estates" o Fes' K R to 11ilk Ggp In File 1(6"12 _ O°R 20-11A N SURVEYOR'S CERTIFICATION-- Co. 5uff. NO \ '1 _ O I •WE HEREBY CERTIFY TO JON T O M LYN <N•& H ER S, ' �-1 LEWIS THAT THIS SURVEY WAS PREP Ifl`AG�RDANGE°WIT 1` THE CODE OF PRACTICE FOR l I YORK STATE ASSOCIATION OF�� w IO;�AI:l� 'NwvE 00RS 7K � y/yY /T 6" O II`w•�1 l�1 1 LL'q E O , r � I O � I 1 N 1 1� 1 , N ttI A J(-- 1S ti 9 J Z 112.29' ' "� 1 W �j rs�O O P -4 Cj t 102 "' n LO O ; ; I' ` rn HOWARD W.YOUNG,N.YS.L.S.No.45843 q N C4 II Qib K1ad n _-- -- ^_ STONE DRIVEWAY t 11 t 1 �5ta e5 ` Capt File No 16,2 �� i � _ �-� I I �pvy SURVEY FOR 5uff. GO• Wooer ` JON TOML I NSON 33-r.1-r' 4 HERB LEAIS n 1.0%yt 583 4 g LINK�.IGe �l � ; � Z at Mattituw ck, Ton of Southold CHAIN 1 11-4 w 8 � I 106 Suffolk County, New York L In ot o l I 5ub�ivision - ONO BUILDING PERMIT SURVEY I I II Iain Fstotes b o I I Lot 103 Gap �ptdle No. 16-12 O County Tax Map District 1000 section 41[41 Block 02 Lot 17 I LOt 104 I 5ubdivisio�states° 5uff.. GO'f FIELD SURVEY COMPLETED FEB.23,ton Lot 103 guL dot 1 4 - d II MAP PREPARED FEB.24,201-7 11 I Il/_ilptgln Kid 16-12 I Record of Revisions I V f./1 gvbdlviston - I IlGgptain Kidd Estates File NO L_ _ - — �5tate5" 16'12 ► ff. GO _ — RECORD of REvlsloNs DATE �'Ggptaln Kidd 10-12 Stiff. GO• File NO• l I _ _ ADAL DED SURVEY OCT-DEC, A 201 i c File 1�0' l I ADDED BUILDING PERMIT DATA . IQ ZOn 5uff. Go l o I o - I I ! R=25.00' _ - m so 0 25 50 150 o I a I I SGa1e: 1" = 50' r,. JOB NO.2016-0138 I I EA,�T POAI> DM.2016-0138-bp-pool or O = MONUMENT SET ■= MONUMENT FOUND Q= STAKE SET A= STAKE FOUND AP7, b D AS NOTED ELECTRICAL INSPECTION REQUIRED DATE: B.P;# v2 - FEE:; BY: NOTIFY BUILDING DEPAR ENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION-- TWO REQUIRED FOR POURED CONCRETE RETAIN STORM WATER RUNOFF 2.--ROUGH = F=RAMING & PLUMBING PURSUANT TO CHAPTER 236 -4.-INSULATION OF THE TOWN CODE. 4. 'FINAL - CONSTRUCTION MUST 'BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS.OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. HAM ENCLOSE FOOL TO CODE UPON C6MPLETION BEFORE "WATER" COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF S "` 'BOARD SES OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERMF;CAT1 OF OCCUPANCY - I POOL NOTES: 1.POOL AND PROPERTY TO CONFORM TO 2017 NYS UNIFORM CODE,THE PUMP ALL CORNERS FORMED, POOL DECK TO 12' 2015 IRC,2 nd PRINTING,AS AMENDED BY THE 2017 NYS UNIFORM CODE FILTER SLOPE_AWAY FROM WATER LEVEL 3" SUPPLEMENT,2017 SUPPLEMENT TO THE NYS ENERGY CONSERVATION OL SKIMMER BY INTERSECTION OF POOL 29b MIN. SKIMMER WALLS AND FLOOR OOPLLNGSE DOWN FROM TOP OF CONSTRUCTION CODE,TOWN OF SOUTHOLD CODE AND 2014 NATIONAL z: SHALL BE ROUNDED ELECTRIC CODE. ,' +•`,• 2.POOL SHALL CONFORM TO ANSI/NSPI STANDARDS R326.3.1. (3) g3 BARS ' ,"e' 6" FROST PROOF TILE BAND 3.SECTION 11326.7 POOL ALARM REQUIRED. CONTINUOUSGRADE +' 4.ENTRAPMENT PROTECTION REQUIRED SECTION R326.6. BEAM ALL AROUND 12 5.POOL SHALL COMPLY WITH BARRIER REQUIREMENTS SECTION 11326.5. O TIES " O.C. +' PNEUMATICALLY APPLIED CONCRETE - � a. 6.POOL SHALL COMPLY WITH INTERNATIONAL ENERGY CONSERVATION $wm&*m y3 BARS ®12" O.C. a A. CODE SECTION R403.10: VERTICAL AND HORIZONTAL •+ +;' POOLS AND PERMANENT SPA ENERGY CONSUMPTION(MANDATORY). RETURN MIHTE MAF�LE DUrgT -- '•, DIRECTIONAL INLET 2,5' SECTION 11403.10.1 HEATERS 3.0' THROUGHOUT � SECTION R403.10.2 TIME SWITCHES WALL THICKNESS ,••, (MIN.) 480 SF. 15' VARIES 6" TO 8" . SECTION R403.10.3 COVERS 6,"(MIN.) + . ..+ wH11E MARBLE DUST FINISH 7.THE DESIGN IS BASED ON A DRAINAGE SOIL WITH<10%SILT.GROUND DUAL MAIN DRAIN WITH WATER SHALL NOT EXIST WITHIN LIMITS OF THE EXCAVATION.IF GROUND STRAINER (VGB SAFETY STAIRS SHALL ; . RADIUS VARIES ACT APPROVED BE OF NON—SLIP ! +. •'• t' RADIUS ROUNDED CORNERS WATER EXISTS WITHIN 6 BELOW GRADE SPECIAL DEWATERING FACILITIES DRAINS)' " , (SHALLOW END) WILL BE REQUIRED,WATER DISPOSAL IS LIMITED TO OWNER'S PROPERTY. DESIGN 1}3 BARS ®6 O.C. IN RADIUS 5.5 (MAX) RADIUS ROUNDED ' AND VERTICAL WHEN WALL , * :• . 8.NO SURCHARGE ALLOWED WITHIN 4 OF SHALLOW END AND 6 OF HEIGHT EXCEEDS 5' +•••! CORNERS (DEEP END) DEEP END. (ALTERNATE BARS) ,,, 1}13 KEBABS - 12" ON, 9, THE PNEUMATICALLY APPLIED CONCRETE(GUNITE)SHALL BE 4,000 PSI g CENTER EACH WAY Lla 28 DAYS. + .• , + 10.REINFORCING STEEL SHALL BE INTERMEDIATE GRADE BILLET STEEL ' WITH A MINIMUM LAP OF 30 BAR DIAMETERS. 11.REBAR SHALL BE 3"MIN.CLEAR TO EARTH. NOTE: 12.POOL WATER SUPPLY BY OWNERS GARDEN HOSE.POOL TO BE KEPT POOL PLAN THIS IS A NON-DIVING POOL. i 6.5'' FULL DURING FREEZING WEATHER.PUMP CAPACITYTO BE SUFFICIENTTO NOT TO SCALE 6.�SLAB EMPTY POOL IN 24 HOURS. 13.LOCATION OF PROPOSED SWIMMING POOL AND POOL EQUIPMENT IMICAL WALL SEC110N BY OTHERS AND SHALL COMPLY WITH ALL LOCAL ZONING NOT TO SCALE REQUIREMENTS. FILL SPOUT AS 14.ALL DRAIN COVERS TO MEET ALL REQUIREMENTS OF THE VIRGINIA REQUIRED GRAEME BAKER(VGB)POOL AND SPA SAFETY ACT. SKIMMER INLET 15. NO DIVING EQUIPMENT PERMITTED. BULLNOSE COPING (TYP-) (TYP.) PROVIDE SEALING 16.CONTRACTOR SHALL VERIFY SOIL BEARING LOADS PRIOR TO AT DECK COPING INSTALLATION OF POOL. (�') LADDER WATER LEVEL (TYP-) 17.SLOPE PATIO SURFACE 1/4"PER FOOTAWAY FROM POOL. 18. THIS PLAN IS FOR CONSTRUCTION ON PROPERTY AT 4525 ort--- ------- - - - BREAKWATER ROAD,MATTITUCK,N.Y.11952 ONLY. O �. O 19.HM ENGINEERING,P.C.SHALL NOT BE RESPONSIBLE FOR GRADE BEAM CONSTRUCTION MEANS,METHODS,TECHNIQUES OR PROCEDURES UNDERWATER 6 (TYP.) UTILIZED BY THE CONTRACTOR,NOR FOR THE SAFETY OF THE PUBLIC OR LIGHT CONTRACTOR'S EMPLOYEES,OR,FOR THE,FAILURE OF THE CONTRACTOR (OPTIONAL) TO CARRY OUT THE WORK IN ACCORDANCE WITH THIS PLAN. 6" THICK CONCRETE (TYP.) 32' 1 1/2- TO WASTE 0.50' L 0.50' HAIR LINT STRAINER DUAL MAIN DRAIN WITH FOR POOLS CONSTRUCTED ON VIRGIN PUMP HYDROSTATIC VALVE AND SOIL, COMPACT BASE TO 95% MODIFIED' PLT AUTO SKIMMER COLLECTOR TUBE IN PROCTOR. FOR POOLS CONSTRUCTED ON GRAVEL BASEPOOL PROFILE BACKFILL MATERIAL, POOL CONTRACTOR TO INSTALL 6" COMPACTED GRAVEL BASE DUAL MAIN DRAIN NOT TO SCALE POOL WITH HYDROSTATIC VALVE AND PREPARED FOR: POOL TO COLLECTOR TUBE IN GRAVEL BASE LEWIS &TOMLINSON RESIDENCE 4525 BREAKWATER ROAD SCHEMATIC PIPING ARRANGEMENT MATTITPCKI;N:Y. 11952 NOT TO SCALE DATE: 1210912017 NOTE: / C� / HM ENGINEERING, P.C. SCALE: AS SHOWN THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF HM ENGINEERING P.C..UNAUTHORIZED 6�`S/ ALTERATIONS OR ADDITIONS TO THESE DOCUMENTS ARE A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE' 3 CH 6-5392 OD DRIVE EAST 1 www.hNORTHmarnika@optonline.net NY 11731 SHEET: 1 OF 2 EDUCATION LAW.INFRINGEMENTS WILL BE PROSECUTED. Tel:(516}476-5392 Fax:(631)980-7671 wWw.hmarnika@optonline.net REIMMI N PO GUNITE VOID WITHOUT RAISED SEAL AND BLUE SIGNATURE SWIMMING POOL PLAN - f