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Town of Southold 12/7/2018 P.O. Box 1179 53095 Main Rd V1 00" Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40088 Date: 12/7/2018 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 660 Town Harbor Ln., Southold SCTM#: 473889 Sec/Block/Lot: 62.-342 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 6/25/2018 pursuant to which Building Permit No. 42836 dated 7/5/2018 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 Clerici,Joseph&Dune of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 42836 09-04-2018 PLUMBERS CERTIFICATION DATED ho u Signature TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY .AIX 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#: 42836 Date: 7/5/2018 Permission is hereby granted to: Clerici, Joseph 3839 Wesley St Seaford, NY 11783 To: construct accessory in-ground swimming pool as applied for. At premises located at: 660 Town Harbor Ln., Southold SCTM #473889 Sec/Block/Lot# 62.-3-42 Pursuant to application dated 6/25/2018 and approved by the Building Inspector. To expire on 1/4/2020. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 Buil nspector Form No.6 TOWN OF SOUTHOLD D 19CROVE BUILDING DEPARTMENT TOWN HALL D 765-1802 1 APPLICATION FOR CERTIFICATE OF OCCUPANCY JUL7 2018 This application must be filled in by typewriter or ink and submitted to the Building Department;IRMWO PT TOWN OF SOUTHOLD 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: YppL Old or Pre-existing Building/I: ,n, (check one) r Location of Property: C9 D Tmh f�&rbo( l� j'`Q 0((�, House No. Street Hamlet Owner or Owners of Property: Jf �iGt_/l Q C lc r( L( l— �j Suffolk County Tax Map No 1000, Section �Q Z" Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ �5 V Applicant Signature pF SO�jyolo Town Hall Annex Telephone(631)765-1802 54375 Main Road y Fax(631)765-9502 P.O.Box 1179 �., roger.richert(d-)town.Southold.ny.us Southold,NY 11971-0959 Q OOUNT`I BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To. Joseph Clerici Address: 660 Town Harbor Lane city Southold st: New York zip: 11971 Building Permit#- 42836 Section: 62 Block: 3 Lot: 42 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: TRC Electric License No. 46689-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 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 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures �] TVSS Other Equipment: In Ground Swimming Pool to Include: Bonding, Control Panel, 1- GFCI Circuit Breake Salt Generator, Gas Pool Heater, 1- Pool Light. Notes: Inspector Signature: Date: September 4, 2018 0-Cert Electrical Compliance Form.xls OF SOUTyo6 * # TOWN OF SOUTHOLD BUILDING DEPT. `"�ovxn 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] 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: DATE �� INSPECTOR / SOF so * # TOWN OF SOUTHOLD BUILDING DEPT. 76S-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] IN ULATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: I DATE nA 142, INSPECTOR 1A A �o��,oF souryo6 # # TOWN OF SOUTHOLD BUILDING DEPT. "�ovxn 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSUL 46� om FRAMING /STRAPPING /FINAL [ ] [vT [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: Y--:�R DATE / INSPECTORY "400� Mr. Faucet Service Co. SEP 18 2016 201 Northwest Drive, Suite 1 Farmingdale, NY 11735 BUILDING DEff. Phone -516-752-1000 TOWN OF SOUTHOLD Fax -516-752-5000 September 12, 2018 Town of Southold Town of Southold 53095 Route 25 PO Box 1179 South Hold, NY 11971 Re: Permit# 42836 Property Address: 660 Town Harbor Lane, Southold To Whom It May Concern: This is to certify that I, Paul E. Muhs, am a licensed plumber, licensed to practice in the State of New York under license#M000310. I further certify that an installer from my company installed & pressure tested the gas line to the pool heater on 4 psi for(1) hour, as part of the scope of work included under the above referenced application and have determined that the work stated complies with the Residential Construction Code of New York State, the Town of Southold codes and all other rules and regulations applicable to this work. I make this statement under penalty of law knowing that the Town of Southold will rely on this information to determine compliance with the applicable Codes. Signs ure Sworn to before me J ,p On this ;10( day,J 2W . Therm A.0®w®I Notary Public,State of New York No.01GA6082617 C Qualified in:Nassau County Commission expires:October 28,2018 r FIELD INSPECTION REPORT7 DATE COMMENTS .N FOUNDATION (IST) ------------------------------------ (n cn •FOUNDATION (2ND) � O d ROUGH FRAMING& d' PLUMBING y 1 INSULATION PER N.Y: , 3 STATE ENERGY CODE • vJ 07 FINAL ADDITIONAL COMMENTS no CAz rn W0 Oz d b H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying`' TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval FAX: (631) 765-9502Survey _ SoutholdTown.NorthForkxet PERMIT NO. `-� Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined � ,20 D V Single& Separate D Stonn-Water Assessment Form JUN 2 5 2018 Contact: �ji D l, Approved 20� Mail to: n� � 0 1 ?alit Disapproved a/c BUILDING DEPT. 3 )'d orGvy) TOWN OF OLD Phone Expiration71 20 BLliw--,Y,rllxctor APPLICATION FOR BUILDING PERMIT ( C Date `(' t� _, 20 0 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 inspections. (SI« ture f applicant or name, if a corporation) 3&3q �v Qsl eu SA . Sia(o r� 1 (Mai mg address of applicant) State whether applicant is wt lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises �(,�, �� )Q nQ. ic (As on the tax roll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate offic r) Builders License No. -7C7— Plumbers License No. g � Electricians License No. , Other Trade's License No. 1. Location of land on which pro osed ok will be done: 62 TD( un n O r 6�rc L'a lel C Soy -Fns cQ House Number Street 3vytp nn .x County Tax Map No. 1000 Section No dv Block t�?►a �:rc W Lot Subdivision Filed Ma) 'leo., - '`��'T '` Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 5 IZ b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work I am j u000 � (I3 scription) 4. Estimated Cost 01717 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 2 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 ��" (o Rear 114 Depth 10. Date of Purchase 112W Name of Former Owner f Vl� ✓�h��° !t ' 1�I �L'I r�� 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO V 13. Will lot be re-graded? YES NO 1 Will excess fill be removed from premises? YES NO sca�r'd 14. Names of Owner of premises,�,��PDI/1 �P (�j Address S� Phone No.CJ 1 D" 5 Name of Architect Eyvlirve m Addressl0 0 121-112 PJ S 111' Phone No (oil Name of Contractor IFG01 r Q 4 1 Address Phone No. 31- 6 61 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO V * 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 v * 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 * W YES, PROVIDE A COPY. STATE OF NEW YORK) SS. COUNTY ON ,01 k a' Ige 06 C, C I r ( being duly sworn, deposes and says that(s)he is the applicant (Name ofnndivi`d�uaall signing contract)above named, (S)He is the 0 Wr IJP Vr (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 this I day of NA rle 201 WVMMOiFAR1'�J9LiC,Fdrt'a= Notary AAlic ,���� Signature of Applicant Scott A. Russell ST01KNIWATER, SUPERVISOR IMIA NAGIEMIENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold 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 E][j] A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. EIM B. 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 i erosion hazard area. El El E. Site preparation within the one-hundred-year floodplain as depicted on FIRM Map of any watercourse. F. 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, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. 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. A,- APPLICANT: (Property Owner,Design Professional(A:--�,,t� S.C.T.M. 1000 Date. ontractor,Other) District I-0 NAME: "- awe PSection Block Lot FOR BUILDING DEPARTMENT ISE ONLY Contact Information: rd<pn N...t.,! Reviewed By: Property Address Location of Construction Work: Date: _d�S dAppFoved for processing Building Permit. -b r\ Stormwater Management Control Plan Not Required. L) T _ 4L_40�1 ,t ) - - - - - - - - - - - - - - - - - �n �ho Irk �oJ () Stormwater Management Control Plan is Required. El (Forward to Engineering Department for Review.) FORM 4 SMCP-TOS MAY 2014 yac,r BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 765-9502 roger.richertta").town.southold.ny.us APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: I kow" Fs CR+(v( —uLS Date: ,2j Company Name: z�- Name: 044-5 License No.: 41 ccq w�L'- email:'1'g,C y yLG Q� MA�1 .c�w Address: A4,vS /-,f- Kc- tzovc= Phone No.: 43 /- 6 Yg-7t S 8 JOB SITE INFORMATION: (All Information Required) Name: Address: 6 6 p 7ovjRJ 11 f7/ Cross Street: Phone No.: S"/6 - S-/0 5-6 r7 Bldg.Permit#: yZ 83 G email: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please Print Clearly) Circle All That Apply: Isjob ready for inspection?: YE / NO Rough In Fin Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Underground -Overhead #Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: 20vti p004 PAYMENT DUE WITH APPLICATION 82-Request for Inspection Form As �� / 0" A. SURVEY OF PROPERTY <r, �op AT TOWN OF SOUTHOLD ' 'N '' to ' 35� '� �O SUFFOLK COUNTY N . Y. [000 - 062 - 03 - 4 2 / 6 h ' �o s s� � • SCALE I"= 30' 6 Wary MAY 2 6 , 19 8 7 / �'?• Yr, '��?;F .; � � � �. � �. �d, ' '`• � SLS •1`` ,\ CERTIFIED TO op V AMERICAN TITLE INSURANCE COMPANY LONG ISLAND MORTGAGE CORP. o P- d STANLEY M . RICHARDS O; ' MINNIE A . RICHARDS ��LANl3 SG \,�� A. o O r ,<O ,�• 5$2a No Pared i 3 crocordana with the minimum p .' dards for title sur»yr as established b 4960�y0� �-t V, "a S the L•1,A,L S. and approved and adopted Op N��! N.Y. S . LIC. N0. 49668 �. R �► ` i t �bfOr twch u» by The Mew Talc State land oc 96 ;PECONIC SURVEYORS 6 ENGINEERS , P. C . Asocrat,oe• ( 516 ) 765 -• 5020 LOT NUMBERS REFER TO • " M>; r SHOWING ALTERATION AND. P. O. 60X 909 A00iTION TO FOUNDERS ESTA-ES" FILED MAR. 25 , 1935 MAIN ROAD IN THE OFFICE OF THE SUFFOLK COUNTY CLERK SOUTHOLD , N.Y. 11971 AS MAP NO. 1178 t y SUFFOLK COUNTY DEPT OF LABOR, LICENSING d CONSUMER AFFAIRS MASTER PLUMBER NAASh GERARD JAARON This certifies that the $L"fift"`w bearer is duly MR FAUCET SERVICE COMPANY INC licensed by the County of Suffolk 32128-MP 10108/2002 '"n Tn QA" 10/01J2018 New York State Insurance Fund Ww*ffs'Cm pma&n B DhaNky BeneJlls Spedalfsls Since 1914 199 CHURCH STREET,NEW YORK N.Y.10007-1100 CERTIFICATE OF WORKERS'COMPENSATION INSURANCE(RENEWED) a � a AAAAAA 112851548 , KEEVILY,SPERO-WHITELAW INC. 3' 500 MAMARONECK AVENUE 0 � HARRISON NY 10528 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER MR.FAUCET SERVICE CO.,INC. TOWN OF SOUTHOLD DBA INSTALLGAS.COM 53095 ROUTE 25 201 NORTHWEST DRIVE,SUITE#1 PO BOX 1179 FARMINGDALE NY 11735 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE G1149 296-4 601217 05/012018 TO 05/018019 4/1612018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 1149 296.4, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:IMWW.NYSIF.COWCERT/CERTVALASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUND J'�'e,'- DIRECTOR.INSURANCE FUND UNDERWRITING VALIDATION NUMBER:601423067 U-U.3 WO&er' CERTIFICATE OF INSURANCE COVERAGE Compensation Board DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW PART L To be congdeted by DhebMW and Pak!Family Leave BeneAts Carrier or Ucensed Insurance Agent of that Carrier IL Legal Name S Address of Insured(use aired address or* 1b.Business Tclephone Number of insured MR.FAUCET SERVICE COMPANY INC OBA INSTALLGAS.COM 516-752-1234 a PAUL =L MUMS 201 NORTHWEST DRIVE SUITE 1 FARMINGDALE,NY 11735 1e,Federal Employer idarditleation Number of Insured or Social Security Number Work Location d insured(0*m *wrcoM q@ b spoeplealpr llmired b 112851548 c0 1 1 1+1s0 (ft Now Yolk SfalRLa.W apJ*Po8.7d 2.Name and Address of Entity Requesting Proof of Coverage 3a Name of Insurance Carder (Felly Being usled as the ceddlleds Holder) ShelterpoInt Life Insurance Company Town of Southold 3b.Policy Number of Erft Listed In Sox 01 or 53095 Route 25 DBL338240 PO Box 1179 3a Policy&%CN e period Southold,NY 11971 04130/2017 to 04/29/2019 4. pdq►provides the f &AV beneflis: ® A.Both dfsWW and paid family leave bendis. ('I S.DisabgRy benefits only. IUB C.Paid family leave benefits only. 5. PORV covers: ® A.A(of"anploya's employees eligible oder tide NYS Disability and Paid Faintly Leave Benteflis Law. S.only the Naft class or classes of employers employees: under that I am an autimbied rexesenigMor&MOOggaffof ft kMmmcarrier above the rwned Insured has NYS Mabli ly andfor Palo Family LAM SeneAts Insurance Coverage 88 desalbed abuft Dale Signed 41118=18 By ueffj� Ismun:of hwj mnw=r&s audwemd rotuWW41 hro or NYS crarood INWS a AM*d thattn WW=curler) Telephone Number ,516429-MOO Name and'nue Richard White Chief Executive Officer IMPORTANT: If Bruises 4A and 5A are c hecited,and thh fort is dgned by the insurance carriers authoftild representative or NYS Licenaed Ir=W%ce Agent of that carrier,this Certificate Is COMPLETE.Mail it directly to the trertlfrCMA holder. If Box 4B,4C or 58 Is dwdced,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Dbabttlty and Paid Famiy,Leave Benefits Law.It must be mailed for completion to the Workers'Cominnsafbn Board,Plans Acceptance Unit,PO Boot 5200,Binghamton,NY 13902-5200. PART L To be completed by the NYS Workers'Compensation Board(only If aux 4e or 5B of Part 1 has been dtedted) State of New York Workers'Compensation Board Aceording to informadw maintained by the NYS Workers'Compensation Board,the above-rmmed employer has compered with the NYS Dis W ty and Paid Family Leave Benefits Law wb respecK to all of his1hw employees. Date Signed By (Slaa�dae of Authorlrad NYS walous'Oompaenation 9oud EnePMY�) T&OWne Number Name and Title MW we Noce:0*bwwance conion Iicrosed b wife NYS da&W sed paid 1br*mve bwmft Insurance policies and NYS Agee wd insurance agaMs offtse bnurance d;errfera are and w*od to!sacs Fona DS-12(X1.ku w co brokers are Norautlrorfiad to bsve lila fbrrrr. M120.1(10-17) D13-120-1 (10-� 01� ACo d CERTIFICATE OF LIABILITY INSURANCE 16,� THM1 CERTIPICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIMMY OR ME13ATP41LY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INBURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE MMUG UNIBURERM AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTAUT, Nth*oerdlcMe hoidar ts an ADDITIONAL INSURED,the poltay(tes)must have ADDITIONALMURED provisions orb*endorsed. If SUBROGATION M WAIVED,subject to the teems and COndltlons of the poBq,certain policies may require an endorsomsrtL A ststsmod on this c Mic-ee does not confer rights to the oeltllCate holder In Leu of such b PROODGE tCONTACT Nag"Insurance 8rakor mgs of New Yak hr. (831)278.4812 (831)273 90 175 Oval awe APraRowaa>~raw1R MAtc. hdar dla NY 11749 q A; NNadmnts Mublal ln.urom Co 23329 ONWEED ED el.tR181e a t Mr.Faucet SeMoe Company Inc D c: DBA tnsla9gascom 3 Paul E Muhs D D: 2D7 Northwest awe D R Farad vMe NY 117354= p. COVERAGES CERTIFICATE NUMBER: 18.10 Mosier REYIMON NUMBER: THIS ISTO CI3tTW IMT THE POLICIES OF MS A*4CE LISTED BELOW WAVE SEEN ISSUED TO THE 04URED NAMED ABOVE FOR THE POLICY PERIOD MICATED NOTWITHSTANDING ANY REOIARIEME r.MW OR CONOMON OF ANY CONTRACT OR OTM DOCUMENT VNTH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURMICE AFKF4M BY THE POLICIES DESCRIBED K OM IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SWM MAY HAVE BEEN REDUCED D BY PAID CLAIMS. Lowl 1PYPROFe1SURANCE POUCYIAICeHPR Lam 1C COMIGNOA1 GROtALLMLITY EIICHOOCURRENCE . 1.0006000 CUYM3 MAM ©00MM NI . 500aoo MEDWWffirwom, 15.000 A BOPI KMS 05101/20/8 05101/!me PRRBONAI aADVeLAIRY : tnch►dad GENLAGGIN ATE POpUpM�MAPPLIESPER: GENERAL TE . $000.000 LICY a jpfg ❑LAC PnOCUCT$-COMP/OPAGG s 2.000.000 anwLs AU10MOBLE UASOM LOW" a ANYALITO 900R.Y1NJURYFWpwn0 S A{IONLY AUMB AUTOSONLY ALIFOSOPLY ABHez:M&MAM EAt71000UIWENCE . SXCMLIAR AOIOREtIATE e DED I RBTEMr". e 110N A R AND UPARM Till ANY ERITUX EMM N 1 A E L aACH AOCIOENT a NNom�s,,�aFO �IesfBQ E.LOISRM-EAEYPLOYEF ele�rlON OFOPERATtaq blot P1.ONEAae-POKY Lair e 091GRIPnaI OF OPBRAIMMi I LOCAInONS I VHBCLl8(AGGRO 101.AdiNwAI Rsasub Schoduk mybe atbdwe aom span b nqubsdl The CerMcNe Holder isLnduded os addRbnel insured A.T.I.MA wUh respad to General LbWMy os required by wMen m*adWfn Wmnertt per ft podw terns.condw"ar d eaduslons. CERTIFICATE HOLDER TION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TIS,NOTICE VALL BE DELIVERED IN Town of SoudwW ACCORDANCE WITH THE POLICY PROVISIOUL 53095 Route 26 PO Box 1179 AIIf11oA�R1TA1rVF Scuax+Id NY 11971JfGo•<.►.�� ®1988,2018 ACORD CORPORATION. AI rlgMs reserved. ACORD 26(2018103) The ACORD nano and logo are registered marks of ACORD New York State Insurance Fund Workers'Compensation&Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ^^^^^ 270918601 ft�r;j* , SCHAEFER AGENCY INC 201 EAST MAIN ST PO BOX 688 SMITHTOWN NY 11787 Scan to Validate POLICYHOLDER CERTIFICATE HOLDER TRC ELECTRIC CORP TOWN OF SOUTHOLD 16 VIVIAN LANE 53095 ROUTE 25 LAKE GROVE NY 11755 PO BOX 1179 SOUTHOLD NY 11971 POLICY NUMBERCERTIFICATE NUMBER POLICY PERIOD DATE 12219263-7 T 106840 07/09/2017 TO 07/09/2018 12/14/2017 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSUREDWITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2219263 COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING VALIDATION NUMBER:664650748 V% Workers, CERTIFICATE OF INSURANCE COVERAGE l � Compensation Board UNDER THE NYS DISABILITY BENEFITS LAW PART 1.T0 be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier 1a.Leo Nameand Addm7nof Insured(Usestradaddressonly) 1b.Bud neesTelephoneNumber of Insured T.R.C. ELECTRIC CORP 631-648-7958 1G N YS Unemployment Insurance Employer Registration Number of Insured 16 VIVIAN LANE LAKE GROVE, NY 11755 1d.Federal Employer Identification Number of Insured or Social Security Number 270918601 2 Name and Address of the Entity requesting Proof of Coverage 3a.Name of I neurance Carrier (Entity being listed a$theCWUflcdo Holder) ShelterPoint Life Insurance Company TOWN OF SOUTHOLD 53095 ROUTE 25 31'Policy Numberof Entity listed in box"is": DBL342305 P.O. BOX 1179 3m Policy effective period: SOUTHOLD, NY 11971 07/09/2017 to 07/08/2018 4.Pol Its►covers` IL ® All of the employer'semployesseligible under theNew York Disability Benefits Law b. Only the following clamor dasseeofthe empioyar'$employees: 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 N YS D isabil Ity Bandits Insurance Coverage as described above. Date Signed 12/14/2017 l�jj%l BY AW/ (Signatureof Insurencecarder'sauthorized represededvear NYS Liueo@ed lnsurenoeAgent of that inwranca carrier) Telephone N umber 516-829-8100 Title Chief Executive Officer I M PORTANTaf boot"4a"18 checked,and thisform is signed by the Insurance carrier'@ authorized representative or N YS Licensed Insurance Agent of that carrier,thiscetificste Is COM PLETE Mall It directly to the certificate holder. If box",b"Isdadred,thiscentifioste is NOT COMPLETE for the purposesor Section 2206 Subd.8 o the Disability Benefits Law. It must be mal led for eomplation to the Worker's Compensation Board,DB PlansAcceptance Unit,328 State Streetr Schenectady,NY 12305. 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 N YS Worke's Compensation Board,the abovwnamed employer hascompiled with the NYS Disability B"Itel sw with raspect to dl of hia7ar employees D ate Signed BY (Signatursof NYSWorker'aCompensation Board Employee) Telephone N umber Title Please Note:Only Insurance carriere Ileensed to write NYS Disability Benefits Insurance pol Ides and N YS Liosnsed Insurance Agents of those Insurance carriers are authorized to issue Form D&120.1.1 naurance brokers are NOT authorized to issue thleform. D&120.1(9-15) CE , RTIFICATE OF LIABILITY INSURANCE DOES NOT AFFIRMATIVELY OR NEF3� �IMMIDD/YYYY► 11'11$CERTIFICATE IS ISSUED AS A MATTER OF CERTIFICATEINFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS B1017 THIS ,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLJCIES BELOW. THIS CERTIFICATE OF IGATIVELY AMEND NSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. It the certificate holder k an ADDITIONAL INSURED,the II ies must havo ADDITIONAL INSURED provisions or be endoresd. H SUBROGATION IS WAIVED,subject to the terms and conditions of theopop ,certain policies may this certificate does not confer rights to the certiflcab holder in Ilea of such endorsemerrt(s). y require an endorsement A statement on PRODUCER The SchaeferAgency,Inc. ;ADDRESS: E: CharleneAckerly 201 E.Main Street NE (631)979-7474 Charlene 9 cy No: (631)979-7485 P.O.Box 888 ®schaefera en net Smithtown NY 11787INSUR S FO AFRDING COVERAGE NAIL S INSURED INSURERA: Merchants Mutual Insurance Co. T.R.C.Electric Corp INSURER 0: 18 Vivian Lane INSURER C: INSURER D: Lake Grove INSURER E: NY 11755 INSURER F: COVERAGES CERTIFICATE NUMBER: CL1712603463 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABEEE��— OVE gFOR THE PO CRY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, MR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY POLICY NUMBER AN29T=ANIRROM uMrrs CLAIMS-MADE ®OCCUR EACH OCCURRENCE 5 1,000,000 PREMISES $ 500,000 A BOP1059298 MED EXP(An one S 15,000 09/18/2017 09/18/2018 $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 3ADV INJURY POLICY❑JECT LDC GENERALAGGREGATE $ 2,000,000 OTHER: PRODUCTS-COMPIOPAGG S 2,000,000 AUTOMOBILE LIABILITY S ANY AUTO ecc tl LI I 5 AUTOS ONLY AUTOS BODILY INJURY(Per person) S HIRED NON'70 ED BODILY INJURY(Per accident) $ AUTOS ONLY AUT08 ONLY P accident $ uMB LI A LIAO OCCUR $ EXC�LIAR CLAIMS-MADE EACH OCCURRENCE S DED RETENTIONS AGGREGATE S WORIQERRB COMPENSATION = AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTrvE YIN STATUTE ER OFflCERIMEMBER EXCLUDED? NIA E. EACH ACCIDENT I FF! bny In NH) S H yes,de TION udder EL DISEASE-EA EMPLOYEE i DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY UMIT $ I-�-�—J DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addidonal Remake Schedule,may be attached S Moro apace Is required) TOWN OF SOUTHOLD,Is named as additional Insured with respects to the work performed by the above named insured if required by written contract and/or agreement,subject to the policy terms and conditions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF SOUTHOLD THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 53095 ROUTE 25 P.O.BOX 1179 AUTHORIZED REPRESENTATIVE SOUTHOLD NY 11971 ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 5 ACORD CORPORATION. All rights reserved. e x.�. 11�f1Y I�FPTT P e �aRs ELECTRICIAN Ralf D CHALMERS g Via. T R C UMTRO ti�rNor SUFFOUC COUNTY DEPT OF LABOR, UCENSING&CONSUMER AFFAIRS HOME IMPROVEMENT CONTRACTOR N� MICHAEL J DOMINICI jC8ftM6%MS that the NAME bMfef IS duty LONG ISLAND POOL 3 PATIO INC IiWsed by the County Of Suffolk to—M-'~ o.,,,..d • �/.,��r, 45707-H 0122rzoo9 e"nunw wnc 01/01/2019 I New York State Insurance Fund Workers'Compm&ton A Dbobll V Bas#ft Spaclolbb Since 1914 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEW YORK 11747-3129 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE Q D \A A A A A 112590890 �. REGAN AGENCY INC f 483 DEER PARK AVENUE 0 BABYLON NY 11702 SCAN TO VALIDATE AND SUBSCRIBE POLICYHOLDER CERTIFICATE HOLDER LONG ISLAND POOL&PATIO INC TOWN OF SOUTHOLD 543 MIDDLE COUNTRY RD 53095 ROUTE 25 CORAM NY 11727 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE 12439 791-1 582375 04HOJ2018 TO 04/10/2019 4/10/2018 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2439 791-1, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS:NWWYW.NYSIF.COMI'CERTICERTVALASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. PRESIDENT MICHAEL DOMINICI LONG ISLAND POOL 8 PATIO INC (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUNI job ' DIRECTOKINSURANCE FUND UNDERWRITING VALIDATION NUMBER:892973049 �w�z �NpEWpS workers' CERTIFICATE OF INSURANCE COVERAGE TATE Compensation under the NYS DISABILITY AND PAID FAMILY LEAVE BENEFITS LAW Board ART 1.To be completed by Disability and Paid Family Leave Benefits Carrier or Licensed Insurance Agent of that Carrier la.Legal Name and Address of Insured(Use street address only) lb.Business Telephone Number Of LONG ISLAND POOL&PATIO INC Insured 543 MIDDLE COUNTRY ROAD lc.Federal Employer Identification CORAM,NY 11727 Number of Insured Or Work Location Of Insured(Only required If coverage Is specifically limited To certain locations In Social Security Number New York State,i.e.,a Wrap-Up Policy) 11-2590890 2.Name and Address of the Entity Requesting Proof 3a.Name of Insurance Carrier of Coverage(Entity Being Listed as the Certificate Holder) THE TOWN OF SOUTHOLD WESCO INSURANCECOMPANY 53095 ROUTE 25 SOUTHOLD,NY 11971 3b.Policy Number of entity listed in box "la.": 0222285 3c.Policy effective period: 12/29/2017 to 12/31/2018 4.Policy provides the following benefits: ®A.Both disability and paid family leave benefits. ❑ B.Disability benefits only. ❑ C.Paid family leave benefits only. 5.Policy covers: ®A.All of the employer's employees eligible under the NYS Disability and Paid Family Leave Benefits Law. ❑B.Only the following class or classes of employer's employees: Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability and/or Paid Family Leave Benefits insurance coverage as described above. Date Signed 12/29/2017 By &&,& (Signature of insurance carrier's authorized representative or NYS Licensed Insurance Agent of that insurance carrier) Telephone Number 800-535-2711 Title Vice President IM PORTANT: If Boxes 4A and 5A are 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,4C or 5B is checked,this certificate is NOT COMPLETE for purposes of Section 220,Subd.8 of the NYS Disability and Paid Family Leave Benefits Law.It must be mailed for completion to the Workers'Compensation Board,Plans Acceptance Unit,PO Box 5200,Binghamton,NY 13902-5200. PART 2.To be completed by the NYS Workers'Compensation Board(Only if Box 4C or 5B of Part 1 has been checked) State of New York Workers' Compensation Board According to information maintained by the NYS Workers'Compensation Board,the above-named employer has complied with the NYS Disability and Paid Family Leave Benefits Law with respect to all of his/her employees. Date Signed By (Signature of Authorized NYS Workers'Compensation Board Employee) Telephone Number Title Please Note:Only insurance carriers licensed to write NYS disability and paid family leave benefits insurance policies and NYS licensed insurance agents of those insurance carriers are authorized to issue Form 1313-120.1.Insurance brokers are NOT authorized to issue this form. DB-120.1 (9-17) ��'II'�I �II 111111I1i"20.1 'f15-1?'Igl�l LONGI-7OP Q ACORO DATE(MWDMWYY) CERTIFICATE OF LIABILITY INSURANCE F12/14/2017 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(les)must have ADDITIONAL INSURED provisions or 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 631-669-3434 Acr Brennan P. Regan Regan Agency,Inc. PHONE 463 Deer Park Ave ( Nc, ,631-669-3434 �,No):631-669-3035 Babylon,NY 11702 E_ Brennan P.Regan INSURER(S)AFFORDING COVERAGE NAIC 0 INSURERA:American Casualty Company 20427 INSURED Long Island Pool&Patio,Inc. 543 Middle Country Rd. INSURER B:Twin City Fire Insurance Co. 28459 Coram,NY 11727 INSURER C; INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE [X]OCCUR Y 5099218546 12//20/2017 12202018 DAMAGE SE.TO RENTED $ 100,000 _REMMED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑jP& EILOC 2,000,000 PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT c $ ANY AUTO OWNED SCHEDULED BODILY INJURY Per arson $ AUTOS ONLY AUTOS yyNBODILY INJURY Per accident $ AU S ONLY AUTOS ONLYEp 0P.E dent AMAGE $ UMBRELLA LIAR JOCCUR EXCESS LIMB CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ --rDED7 I RETENTION$ B WORKERS COMPENSATION PER AND EMPLOYERS'LIABILI Y X OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE $ Y/N 12 WEC RT2436 04/10/2017 04/10/2018 �FF,1,J MEM EXCLUDED? N/A E.L.EACH ACCIDENT100,000 MandataryFln100 000 H describe under E.L.DISEASE-EA EMPLOYE $ 3 RIPTION F OPERATIONS bekw E.L.DISEASE-POLICY LIMIT 500,000 A Property Section 5099218546 12/202017 12/20/2018 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) Certificate Holder is additional insured. CERTIFICATE HOLDER CANCELLATION SOUTHOL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route 25 Southold,NY 11971 AUTHORIZED REPRESENTATIVE I fw ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD oa APPROVED AS NOTED ELECTRICAL DATE: S B.P.9 34 -Z- INSPECTION REOUIREJ? FEE:�Q,-ONY; NOTIFY BUILDING DEPART —AT- 765-1802 SAM TO 4 PM FOR THE FOLLOWING INSPECTIONS: I. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH - FRAMING & PLUMBING s:• + 1, 3. INSULATION 4. FINAL - CONSTRUCTION MUST ENCLOSE POOL TO CODE BE COMPLETE FOR C.O. UPON.COMPLETION ALL CONSTRUCTION SHALL MEET THE BEFORE;'WATER" REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF AMTGA ARD `36tlfitit�i�Ilt�S�EES �ur nrr OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERTIFICA7 OF OCCUPANCY ILTERED WATER RETURN NUMBER FI R OF NOZZLES VARIES PER POOL SIZE f] COMPOSITE WALL POOL SYSTEM w 16' X 32' RECTANGLE - 2'R DWG#I:CM-1008 I DATE' 10rn12M I REV:A I PAGE 2 OF 2KIMMER PUIION BRACE 32'0" SPOOL—SN UAL MAIN �-0" 3'-0*M MIN DRAIN w/ as CU-24000R(4 PLC) -�W CT O. .SPAIN G STRAINE V1 r T-4" •NCa 161w[NT 2'0(TYP) Z • loot CLw _ S STSs" w a 4'-0" 32'-3" A51bt C-360 -240 od rPam 33-41/4' 3S'-9 3/Ir IRGINIA GRAEME BAKER S ACT APPROVED DRAINS 8'0 16'0' C-720L 1-_0" FS-9604S8W'" NOTE: Pits DRAWING CONFORMS TO ANSI/APSP-7 SUCTION ENTRAPMENT COMPLIM BRACE AVOIDANCE CODES. MAIN DRAIN PIPING SCHEMATIC r (NOT TO SCALE) e °fa "P°• C-360 C-240 CODE COMPLIANCE NOTES: ^ §4 �5 9 e•a ssxt 4-0 IN ADDITION TO THE 2016 UNIFORM BUILDING CODE } 9 toot SUPPLEMENT,SECTION R326 REFERENCED AT THE Z " BOTTOM OF THIS DRAWING,ALSO REFER TO: o c �$ pli su•ar „t,« 2015 INTERNATIONAL RESIDENTIAL CODE -ni s n I STSR" SECTION N1103.10(R403.10)-POOLS AND Ca PERMANENT SPA ENERGY CONSUMPTION 0- oil �t ■ rPm BRACES&DECK SUPPOR C-480 C-720 c-72a CC-720 C-720 SECTION N1103.10.1-HEATERS am 4Y tw: AT PANEL JOINTS AS SHOWN SECTION N1103.10.2-TIME SWITCHES ; a m n nR� SECTION N1103.10.3-COVERS r !!1 CL r•e sr a p -FRAMI CO ° 5 LL f 4� I CO'oa yei a: 3'4" 3'-4• GENERAL NOTES: �i q 8 ALL WATER EITHER OVERFLOWING OR EMPTYING = 8'-0" FROM THE POOL SHALL BE DISPOSED OF ON THE �"'a OWNERS LAND,AND PLANS SUBMITTED SHALL a SHOW PROVISIONS MADE FOR SUCH WATER FROM FLOWING ON THE LAND OF ANY ADJOINING C F Ijn PROPERTY OWNER OR INTO ANY ABUTTING score I STREET ; 4'-0"-"tom—6'-0" •�• " 1 . 14'-0 8'-0" SUCTION OUTLETS SHALL BE DESIGNED AND 40 E1 INSTALLED IN ACCORDANCE WITH ANSI/APSP-7. 1311 Y N.S.P.I. TYPE 2 g¢� _ NO DIVINGSO THIS for Mg.NT IS FOR ILLl15 Own reE PURPOSES ONLY. , DANBEIC OIYNIG MAT Trwecwr My tnc 111a11la tush moss raleasenratiorts wird,are stated H its wrlioen warranty.Any aha reprtleris,statements a contracts made M me deder/coot0lacaor to me custornla regardng sny DrodlAcad by Trlvedar M/g ,:wu. tarsg Isfand PROTECTIVE BARRIER NOTE: KMT Is�ERNIFf Enc.are andbteaeb b the dadw/contra=ash.The deata or cano-acsor who sells or rutalla sour pod r an rdgwidW contractor and is not as agent or enpbyee d Triwdlx Mg.Irc.The construction rtruwds NoWaoed here are styyrt m O � �;,� DURING CONSTRUCTION OF THE POOL,A Ld W 1 11T IN BEATN, and appy ash to nonmt ground aw4tio c Thea may be addidwi at pramam and/or metltoda of cros t dJwL The raponetrey is me aonwacv M-A sefay One,sAm tewys,Is to be plerwweay attadwd V-Cr to me Allow Ade of the pdre TEMPORARY BARRIER SHALL BE INSTALLED WITH Z O Signage must be PWMnent1y attached around the d Rrst dope dtange.-Wlferetc rnemods and precaotlom maybe dictated by wwWa grwwd mtamxls.Tns is tabs tYtrmtted by and It the respon oft of the rorwadcr who is not an agent or me twdamea of me mmpoew pub. d A MINIMUM HEIGHT OF 4'-0'. U PON COMPLETION Q � -Installation is to be done In atsnrdenot wind al fedaak state and oral bt"q codes,as wall o A.H514NS.P.L stgpemed standard.-00MM SK12FIGTIDNS MUST MEET OR EXIMeD A.N L14kS.P.I./A.PS.P.RECOMMEMM STANDARDS I� Pffheter Of the pool. TSO OPMG BOW mlrst be parrwwnh atUdted to the ante pa**wof me pati.Sae bsbvc bans wah e.94mg -tT IS NOT RECCMMENOEO TO USe OriM ANO/OR SLMIMG EQUZPMENTON ROMENTL4L POOH OF POOL INSTALLATION,OWNER SHALL INSTALL A J Cn CL< PERMANENT BARRIER,MINIMUM HEIGHT OF 4'-0', WITHIN 90 DAYS. 0 Z N _ n UM Z -jz- ENGINEER'S SEAL J 2 p ICLc0i Z OF Nk Gov �� ¢e'O N G. �yt'� :D N7 O OW) 0V) o n 1 w �w 141 as N/A 052 '1 tG� CTC 0�SS10' P" sGN JUNE 140 2018 AS NOTED ALL MANUFACTURED ITEMS AND CONSTRUCTION SHALL COMPLY WITH THE 2016&2017 NEW YORK STATE UNIFORM BUILDING CODE SUPPLEMENT,INCLUDING THE SPECIFICATIONS IN SECTION R326-SEE SHEET 2 OF 2 1 0 F 2 SECTION R326.3-SWIMMING POOLS,SECTION R326.4-SPA&HOT TUBS,SECTION R326.5-BARRIER REQUIREMENTS,SECTION R326.6-ENTRAPMENT PROTECTION FOR SWIMMING POOL&SPA SUCTION OUTLETS;SECTION R326.7-SWIMMING POOL&SPA ALARMS SECTION 326 SWIMMING POOLS,SPAS,AND HOT TUBS i R326.1 GENERAL 2.Openings in the barrier shall not allow passage of a 4-inch-diameter 10.1.The ladder or steps shall be capable of being secured,locked or R326.8 STANDARDS R326.1 The provisions of this section shall control the design and (102 mm)sphere. removed to prevent access;or A326.8.1 General construction of swimming pools,spas and hot tubs installed in or on the m lot of a one-or two-family dwelling. 3.Solid barriers which do not have openings,such as a masonry or 10.2.The ladder or steps shall be surrounded by a barrier which meets the ANSI-American National Standards Institute stone wall,shall not contain indentations or protrusions except for requirements of R326.5.2,Items 1 through 9.When the ladder or steps are R326.3 SWIMMING POOLS normal construction tolerances and tooled masonry joints. secured,locked or removed,any opening created shall not allow the ANSUAPSP 7-13-Standard for Suction Entrapment Avoidance in R326.3.1 In-ground pools.In-ground pools shall be designed and passage of a 4-inch-diameter(102 mm)sphere. Swimming Pools,Wading Pools,Spas,Hot Tubs,and Catch Basins constructed in conformance with ANSI/NSPI-5. 4.Where the barrier is composed of horizontal and vertical members (R326.6.1) and the distance between the tops of the horizontal members is less R326.5.4 Indoor Swimming Pool.Walls surrounding an indoor swimming rn R326.3.2 Above-ground and on-ground pools.Above-ground and than 45 inches(1143 mm),the horizontal members shall be located on pool shall comply with Section R326.5.2,Item 9. ANSI/NSPI-3-99-Standard for Permanently Installed Residential Spas 0 on-ground pools shall be designed and constructed in conformance the swimming pool side of the fence.Spacing between vertical (R326.4.1) with ANSI/NSPI-4. members shall not exceed 1-3/4 inches(44 mm)in width.Where there R326.5.5 Prohibited locations.Barriers shall be located to prohibit are decorative cutouts within vertical members,spacing within the permanent structures,equipment or similar objects from being used to ANSI/NSPI-4-99-Standard for Above-ground/On-ground Residential R326.4 SPAS AND HOT TUBS cutouts shall not exceed 1-3/4 inches(44 mm)in width. climb them. Swimming Pools (R326.3.2) R326.4.1 Permanently installed spas and hot tubs.Permanently installed spas and hot tubs shall be designed and constricted in 5.Where the barrier is composed of horizontal and vertical members R326.5.6 Barrier Exceptions.Spas or hot tubs with a safety cover which ANSI/NSPI-5-03-Standard for Residential In-ground Swimming Pools conformance with ANSI/NSPI-3 as listed in Section 326.8. and the distance between the tops of the horizontal members is 45 complies with ASTM F 1346 shall be exempt from the provisions of this (R326.3.1) inches(1143 mm)or more,spacing between vertical members shall not appendix. R326.4.2 Portable spas and hot tubs.Portable spas and hot tubs exceed 4 inches(102 mm).Where there are decorative cutouts within ANSI/NSPI-&99-Standard for Residential Portable Spas shall be designed and constructed in conformance with ANSI/NSPI-6. vertical members,spacing within the cutouts shall not exceed 1-3/4 R326.6 ENTRAPMENT PROTECTION FOR SWIMMING POOL (R326.4.2) inches(44 mm)in width. AND SPA SUCTION OUTLETS R326.5 BARRIER REQUIREMENTS R326.6.1 General.Suction outlets shall be designed to produce circulation ANSI/ASME Al 12.19.8M-(1987,R-1996)Suction Fittings for Use in R326.5.1 Application.The provisions of this section shall control the 6.Maximum mesh size for chain link fences shall be a 2-1/4-inch(57 throughout the pool or spa.Single-outlet systems,such as automatic Swimming Pools,Wading Pools,Spas,Hot Tubs and Whirlpool Bathing design of barriers for residential swimming pools,spas and hot tubs. mm)square unless the fence has slats fastened at the top or the vacuum cleaner systems,or multiple suction outlets,whether isolated by Appliances (R326.6.2) n hi d These design controls are intended to provide protection against bottom which reduce the openings to not more than 1-3/4 inches(44 valves or otherwise,shall be protected against user entrapment. potential drownings and near-drownings by restricting access to mm). APSP-Association of Pool and Spa Professionals Zat € swimming pools,spas and hot tubs. R326.6.1.1 Compliance alternative.Suction outlets may be designed and �J 51 7.Where the barrier is composed of diagonal members,such as a installed in accordance with ANSI/APSP-7 ANSI/APSP-7-13 Standard for Suction Entrapment Avoidance in Swimming o 0 R326.5.2 Temporary barriers.An outdoor swimming pool,including an lattice fence,the maximum opening formed by the diagonal members Pools,Wading Pools,Spas,Hot Tubs,&Catch Basins co " at in-ground,above-ground or on-ground pool,hot tub or spa shall be shall not be more than 1-3/4 inches(44 mm). R326.6.2 Suction fittings.Pool and spa suction outlets shall have a cover (R326.6.1) c c k �f surrounded by a temporary barrier during installation or construction that conforms to ANSI/ASME Al 12.19.8M,or an 18 inch'23 inch(457 mm E m f and shall remain in place until a permanent barrier in compliance with 8.Gates shall comply with the requirements of Section R326.5.2,Items by 584 mm)drain grate or larger,or an approved channel drain system. ASME-American Society of Mechanical Engineers u mR Section R326.5.3 is provided. 1 through 7,and with the following requirements: p6 R326.6.3 Atmospheric vacuum relief system required.Pool and spa ANSUASME All 12.19.8 2007-Suction Fittings for Use in Swimming Pools, a M 9 f5t Exceptions: 8.1 All gates shall be self-closing.In addition,if the gate is a pedestrian single-or multiple-outlet circulation systems shall be equipped with Wading Pools,Spas,Hot Tubs,and Whirlpool Bathing Appliances 1 Above-ground or on-ground pools where the pool structure is the access gate,the gate shall open outward,away from the pool. atmospheric vacuum relief should grate covers located therein become (R326.6.2) barrier in compliance with R326.5.3. missing or broken.This cauum relief system shall include at least one m LL I Id 2.Spas or hot tubs with a safe cover which complies with ASTM F 8.2.All gates shall be self-latching,with the latch handle located within approved or engineered method of the q' f p safety p g g, g' type specified herein,as follows: ASTM-ASTM International m'o �5r e 1346 provided that such safety cover is in place during the period of the enclosure(Le,on the pool side of the enclosure)and at least 40 1 Stafety vacuum release system conforming to ASME Al 12.19.17;or N R I I" installation or construction of such hot tub or spa.The temporary inches(1016 mm)above grade.In addition,if the latch handle is 2.An approved gravity drainage system. ASTM F 1346-91(1996)Performance Specification for Safety Covers and co removal of a safety cover as required to facilitate the installation or located less than 54 inches(1372 mm)from the bottom of the gate,the Labeling Requirements for All Covers for Swimming Pools,Spas and Hot if constriction of a hot tub or spa during periods when at least one person latch handle shall be located at least 3 inches(76 mm)below the top of Exception:Surface skimmers Tubs 12- engaged in the installation or construction is present is permitted. the gate,and neither the gate nor the barrier shall have any opening (R326.5.2;R326.5.3;R326.5.6;R326.7 1) o c Er �� greater than 0.5 inch(12.7 mm)within 18 inches(457 mm)of the latch R326.8.4 Dual drain separation.Single or multiple circulation systems R326.5.2.1 Height.The top of the temporary barrier shall be at least 48 handle. have a minimum of two suction outlets of the approved type.A minimum ASTM F2208-2008-Standard Specification for Pool Alarms inches(1219 mm)above grade measured on the side of the barrier horizontal or vertical distance of 3 feet(914 mm)shall separate the outlets. (R326.7.1) e which faces away from the swimming pool. 8.3.All gates shall be securely locked with a key,combination or other These suction outlets shall be piped so the water is drawn through them tr child proof lock sufficient to prevent access to the swimming pool simultaneously though a vacuum-relief-protected line to the pump or NSPI-National Spa and Pool Institute R326.5.2.2 Replacement by a permanent barrier.A temporary barrier through such gate when the swimming pool is not in use or supervised. pumps. t5 shall be replaced by a complying permanent barrier within either of the ANSI/NSPI-3-99-Standard for Permanently Installed Residential Spas dl following periods: 9.Where a wall of a dwelling serves as part of the barrier,one of the R326.6.5 Pool cleaner fittings.Where provided,vacuum or pressure (R326.4.1) $§ t 11 1 90 days of the date of issuance of the building permit for the following conditions shall be met: cleaner fitting(s)shall be located in an accessible position(s)at least 6 installation or construction of the swimming pool;or inches(152 mm)and not more than 12 inches(305 mm)below the ANSI/NSPI-4-99-Standard for Above-ground/On-ground Residential 2.90 days of the date of commencement of the installation or 9.1.The pool shall be equipped with a powered safety cover in minimum operational water level or as an attachment to the skimmer(s). Swimming Pools LLI construction of the swimming pool. compliance with ASTM F 1346;or (R326.3.2) Z O R326.7 SWIMMING POOL AND SPA ALARMS Q F Q R326.5.2.2.1 Replacement extension.Subject to the approval of the 9.2.Doors with direct access to the pool through that wall shall be R326.7.1 Applicability.A swimming pool or spa installed,constructed or ANSI/NSPI-5-03-Standard for Residential In-ground Swimming Pools J d< code enforcement official,the time period for completion of the equipped with an alarm which produces an audible warning when the substantially modified after December 14,2006,shall be equipped with an (R326.3.1) ow permanent barrier may be extended for good cause,including,but not door and/or its screen,if present,are opened.The alarm shall be listed approved pool alarm. Q Q} limited to,adverse weather conditions delaying construction. in accordance with UL 2017 The audible alarm shall activate within 7 Exceptions: ANSI/NSPI-6-99-Standard for Residential Portable Spas m >_ seconds and sound continuously for a minimum of 30 seconds after the 1 A hot tub or spa equipped with a safety cover which complies with ASTM (R326.4.2) UZ OJ Z} R326.5.3 Permanent Barriers.An outdoor swimming pool,including door and/or its screen,if present,are opened and be capable of being F1346. Of Q O O z an in round,above round or on round I,hot tub or shall be heard throughout the house during normal household activities.The 2.A swimming pool other than a hot tub or equipped with an UL-Underwriters Laboratories,Inc. ENGINEER'S SEAL �2 Q -9 9 -9 P� Pa 9 9 9 P ( Pa)eq PPed J surrounded by a barrier which shall comply with the following: alarm shall automatically reset under all conditions.The alar system automatic power safety cover which complies with ASTM F1346. U Z O Z o a shall be equipped with a manual means,such as touch pad or switch. UL2017-2000-Standard for General-purpose V N� = <H 1.The top of the barrier shall be at least 48 inches(1219 mm)above to temporarily deactivate the alar for a single opening.Deactivation Pool alarms shall comply with ASTM F2208,and shall be installed,used, Signaling Devices and Systems with Revisions !_ N 2 v grade measured on the side of the barrier which faces away from the shall last for not more than 15 seconds.The deactivation switch(es) and maintained in accordance with the manufacturer's instructions and this through June 20041*0 swimming pool.The maximum vertical clearance between grade and shall be located at least 54 inches(1372 mm)above the threshold of section. (R326.5.3) �� �` ~ Q Z 10 the bottom of the barrier shall be 2 inches(51 mm)measured on the the door,or IL. 1 O (/) O side of the barrier which faces away from the swimming pool.Where R326.7.2 Multiple Alarms.A pool alarm must be capable of detecting 'The NSPI documents are available 7b -r the top of the pool structure is above grade,such as an above-ground 9.3.Other means of protection,such as self-losing doors with entry into the water at any point on the surface of the swimming pool.If through APSP pool,the barrier may be at ground level,such as the pool structure,or self-latching devices,shall be acceptable so long as the degree of necessary to provide detection capability at every point on the surface of '. l mounted on top of the pool structure.Where the barrier is mounted on protection afforded is not less than the protection afforded by Item 9.1 the swimming pool,more that one pool alar shall be provided. top of the pool structure,the maximum vertical clearance between the or 9.2 described above. NIA S C� top of the pool structure and the bottom of the barrier shall be 4 inches R326.7.3 Alarm Activation.Pool alarms shall activate upon detecting FQ 6Q52`'e/ 4crc (102 mm). 10.Where an above-ground pool structure is used as a barrier or where entry into the water and shall sound poolside and inside dwellling. R p'y scH the barrier is mounted on top of the pool structure,and the means of � `S$1� JUNE 14 2018 access is a ladder or steps: R326.7.4 Prohibited Alarms.The use of personal immersion alarms shall AS NOTED not be construed as compliance with this section. 2OF2 AYWARRY �w- Universal H-Series Pool and Spa Gas Heaters ------..... -71 u JUN 2 5 2018 BUMDING DEPT. SOU=OLD TOWNOF '47 _ Ay '$M _ Y H. Front-panel-only access provides easy service and maintenance, avoiding the problems and costs associated with front- and-back-panel access heaters .......... ... ........... ......................... ........ ................ Universal junction boxes on left and right sides make electrical and automation installation simple and convenient .................................................... ..I........... ................ Intuitive control pad with protective cover is always easy to read and operate H400FD ............ . ..... ........ ....... ................ ...........................................I....... ............ Universal H-Series heaters provide reliable, long-lasting comfort. .. ............... ..... . ........ ... ..... .......... . ...... . .......................... ......I............ ..... DURABILITY COMES STANDARD Built with a durable cupro nickel heat exchanger, Universal H-Series heaters offer exceptional protection against corrosion and premature failure caused by unbalanced water chemistry, ensuring you get season after season of premium heating performance FAST,EFFICIENT PERFORMANCE Universal H-Series heaters boas: industry-leading hydraulic performance coupled with lightning-fast speed-to-heat capability In fact,the powerful 500,000 BTU model is the fastest in its class, giving you less time to wait and more time in the water EASY ON THE ENVIRONMENT Designed with "totally managed"water flow, Universal H-Series heaters save energy(and money)by reducing pump run time Their low NOx emissions meet air quality standards ;r all tow-NOx areas,so you can rest easy knowing their environmental impact is low PREMIUM QUALITY WITHOUT THE PREMIUM PRICE. While other manufacturers make you spend hundreds of dollars to upgrade to the performance and reliability of a cupro nickel heat exchanger, Universal H-Series heaters include them at no extra charge— giving you total peace of mind without any added costs. TRYIT WITH ............... .. .......................................... ... . .... .... ............. . ........................................ ....... Double your comfort by pairing your Universal H-Series heater with Ageafluesao AquaRite®900—the longest-last-ng version of the world's best-selling salt chlorination system AquaRite 900 creates luxuriously soft water without harsh chemicals, and with a Universal H-Series heater,you'll get to enjoy �� y+ incomparable water quality all year long. ... ..... ...... ... ........... ................................................ ................: F SELECTING THE CORRECT SIZE UNIVERSAL H-SERIES HEATER 1.Determine your pool's surface area in square feet: 1 Determine your spa capacity in gallons(surface area x average depth x 7.51. 2. In the table below,locate the column with the spa/tub size in A B R L gallons that is closest to yours. L W 3 Select the desired time to raise the spa/hot tub temperature 30°F,read to the left and select the appropriate Universal H-Series model. AREA=(A+BJ x L x 45 AREA=RxRx3.14 AREA=LxW SPA/TUB SIZE IN GALLONS" 2. Select the model that corresponds with a surface area that 200 ` 300 ! 400 i 500 ' 600 : 700800 900 1,000 is equal to,or just greater than,your pool's surface area.For MODEL Time in Minutes to Raise Spa/Tub Temperature 30°F*** indoor pool installations,divide the pool's surface area by 3. H500 7 11 14 18 22 25 29 32 35 H400 9 i 14 18 23 27 32 36 _41 ; 45 H350 10 16 _ 21 26 31 36 41 46. 52 MODEL* H500 ' H400 ' H350 ' H300 , H250 H2O0 ` H150 H300 12 18 24 ' 30 36 42 48 54 60 H25055._.. 122 29 36 43 51_., 58 ... 5 .W_72 SURFACE . _.. .._._.._..._..._,.._..._._.._...._. ._.__. ._...__.._.._._._...,..--.---.-._-.-' AREA 1,500 1,200 1 1.050 900 750 600 450 H2O0 18 27 36 ' 45 54 63 72 81 9 ...... H150 24 36 48 60 72 84 96 108 120 SPECIFICATIONS AND H500FO ' H400FO ' H350FD H300FO H250FD ' H2O0FD H150FD DIMENSIONS BTU/hr 500,000 399,900 350,000 300,000 250,000 ' 199,900 150,000 Thermal efficiency 83% 84% 83% 82.7% 83% - ; _.. .__......83% ' 82.7°!° _._.._.. Width(inches) 41" 36" 33" _........_.._. ._ .._.._. ._..... _ --- _..._.. .._. _.. _. Depth(inches) _.__. _._.._..._..._...._.. _. _.._. --_.._.-_._ ... 291/2" 291/2" 2 i 30 • I 91/z" 2 291/i 91/z" 291/2' 9,/z" Height(inches) 24„ __i.._._...._...___.._.._. _...-.-- _._. .._. _.._._..—._.._..___._. 24 4" ; 24" ; 24" Water connections 2"x 21/2" ' 2"x 21/2' '2__...2'/2_.._.__... _ ..__.2'/2..__.._..__ ._._'/.—.__..._...___._..__.._._._.__._..._ ._.__...._...._..__..._..__._ _.._..___.._. "x 2"x _ 21/i __. ._..._.:.._..._.._..._._ .__._ __ .._..._.._.__.--.-..--- 2"x 2 z" 2"x 2"x 21/2" Heat exchanger Cupro Nickel I Cupro Nickel 1 Cupro Nickel 1 Cupro Nickel Cupro Nickel Cupro Nickel ; Cupro Nickel Indoor vent pipe diameter(inches) " _._.._..._.._.____..._._.._._._... natural gas 6 i b:. 8" 8" 4:. b 6.• Indoor vent pipe diameter(inches) _ - - -- -— propane gas 8 8" g" 8" 6" 6" 6" Heater weight(lbs) -_--.._.._...._..._:...._..._ _..__.__. 9 223 160 1158 145 134 123 110 Gas connection at heater 1" 3/4" 3 -'/` /4 3/4' 3/�" 3/�" 3 " H-Series heaters are available in a comprehensive range of BTU sizes for natural or propane gas.All units are certified by the Canad;an Standards Association and carry the exclusive Hayward"warranty 'Model recommendation is based on a 30°F temperature rise,3'/2 mph average wind velocity and elevation of up to 2,000 feet above sea level. **Heat lost and/or absorbed by spa walls or othe-objects will add to the time it takes the spa to heat up. `Basec on an insulated and covered spa gg hayward.com » 1-888-HAYWARD Pumps » Filters N Heaters » Cleaners n Sanitization » Automation >> Lighting > Water Features - White Goods Hayward and AquaRiteHayward are registered trademarks s Hayward Industries,Inc.is not i Hayward Industries,Inc.All other trademarks not owned by Hayward are the property of their respective owners.Hayward is not in any way affiliated with or endorsed by those third parties. 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