HomeMy WebLinkAbout41520-Z �p '1 � Town of Southold 2/21/2019
P.O. Box 1179
53095 Main Rd
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
No: 40221 Date: 2/21/2019
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 500 Center St., Mattituck
SCTM#: 473889 Sec/Block/Lot: 123.-2-19
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
4/4/2017 pursuant to which Building Permit No. 41520 dated 4/11/2017
was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for
which this certificate is issued is:
ACCESSORY IN-GROUND SWIMMING POOL, FENCED TO CODE, AS APPLIED FOR
The certificate is issued to HSA Holdings LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41520 02-14-2019
PLUMBERS CERTIFICATION DATED
u ho ' Signature
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
( Qui
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#: 41520 Date: 4/11/2017
Permission is hereby granted to:
Windy Bays LLC
1981 Duncan Dr
Scotch Plains, NJ 07076
To: constrct an inground swimming pool as applied for.
At premises located at:
500 Center St., Mattituck
SCTM # 473889
Sec/Block/Lot# 123.-2-19
Pursuant to application dated 4/4/2017 and approved by the Building Inspector.
To expire on 10/11/2018.
Fees:
SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Building Inspector
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.
S. 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$15.00
Date.
New Construction: k w,rHtv, Old or Pre-existing Building: (check one)
vv:_
Location of Property: S Ct7tr1�9Z -Sy?• M.�»i��ca(
House No. Street Hamlet
Owner or Owners of Property: :J Y rdE7�'yZ5
Suffolk County Tax Map No 1000, Section /Z3 Block A Z- Lot /9
Subdivision Filed Map. Lot:
Permit No. ��5� Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: '� (check one)
Fee Submitted:$
Z�/
pelican Signature
pF SO!/ryQl
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179 • i0� roger.richert(cb-town.southold ny.us
Southold,NY 11971-0959 Q
���OUNTY,N�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To. HSA Holdings
Address 500 Center St City- Mattituck St: New York Zip 11952
Building Permit#- 41520 Section. 123 Block: 2 Lot: 19
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA. Sabat Electric License No- 4204-ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor X 1 st Floor Pool X
New X 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 1 Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 2
Disconnect Switches 1 Twist Lock Exit Fixtures TVSS
Other Equipment: In ground swimming pool to include, bonding, control panel, gas pool heater,
1-GFCI circuit breaker,salt generator,pool lights
Notes:
Inspector Signature: - Date: February 14 2019
81-Cert Electrical Compliance Form.xls
Of So
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TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] SU AT40N
[ ] FRAMING / STRAPPING [ FINAL v
( ] FIREPLACE & CHIMNEY [ ] FIRESAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: ( `til f'IAWJDA��h/ m +
LIA� u -1 LJAL�A
DATE �� INSPECTOR
r 1
"
FIELD INSPECTION REPORT DATE COMMENTS
O
FOUNDATION(1ST) �
x
---------------------------------
FOUNDATION
-------------------------------FOUNDATION(2ND)
z
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w
ROUGH FRAMING& y
PLUMBING
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INSULATION PER N.Y.
y
STATE ENERGY CODE
(t/ lS
f4ver •
FINAL
ADDITIONAL COMMENTS
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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 V11,
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. :tyIrac, Z-1 Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,20 (����M� Single&Separate
D 9 V 4444g! D Storm-Water Assessment Forme
- 4 2011 Contact:
Approved ,20 ApR d �"
Disapproved a/c
,DING D •
OF SO LD ^7Z-
Expiration ,20
But mg Inspe o
APPLICATION FOR BUILD I'<RMIT
Date , 20�
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale.Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises,relationship to adjoining premises or public streets or
areas, and waterways.
c. The work covered by this application may not be commenced before issuance of Building 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.
ami
(Signature of applicant or name, if a corporation)
<--/Dc) c ox 9 . � L,6_ ,yy 1/935-
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Gc��y7�2�u2.
Name of owner of premises SC/,7-,V `�ETEiZS
(As on the tax roll or latest deed)
If applica is a corpo i n, si nat a of duly authorized officer
ame an title of corporate officer)
Builders License No. /S-/6 2 ,y
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
�®o /�c' �rr��2 .S0-1-F7 /CI.4t-7;1-i ;P ue__J1<
House Number Street Hamlet
County Tax Map No. 1000 Section /Z 3 Block lj Z Lot /9
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancyvX.y
b. Intended use and occupancy wl;ri4 ZA> �fMi,yC, 94w4_
3. Nature of work(check which applicable): New Building Addit' n Alteration
Repair Removal _DemolitionO er Wor u�?cx�itln
_ (Description)
4. Estimated Cost 0/ -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
,6.1 If business, commercial or mixed occupancy, specify nature and potent of each type of use.
7. Dimensions of existing structures, if any: Front '�e ' Rear .,�� Depth�7'
Height /�'' Number of Stories /
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front //fy' Rear %00 ' ' Depth Z33 '
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated5`yt�cr�igL
1 . Does proposed construction violate any zoning low, ordinance or regulation?YES NO
13. Will lot be re-graded? YES JC NO Will excess fill be removed from premises?YES NO Y
1 . Names of Owner of premises �.Qx)�vreR 5- Address.-
GL-xns? -4,-/7,e , Phone No. 9��-zgz-,65-00
Name of Architect Address �'�'�`�K Phone No'
Name of Contractoi�/x_#, .zxx5 4,-,z>L _ Address�G�x 7 G�aH�� Phone No. 73-766-5-
1 a. Is this property within 100 feet of a tidal wetiaAd or a freshwater wetland? *YES NO Y
IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C.PELTS MAY BE REQUIRED.
b. Is this property within 300 feet of a aV
tidal ka4d? *Yl✓S NO
IF YES, D.E.C. PERMITS MAYBE REQUIRED.
1 . Provide survey, to scale, with accurate foundation plan and distances to property lines.
1 . 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.
S ATE OF NEW YORE{
C UN TY OF
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the
(Contractor,Agent, Corporate Officer,etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application;
th it 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 t
day of 20�
Notary Publicignat of ppli ant
CYNDA M.RUDDER
Notary Public,State of New York
No.01 RU6020932
Qualified in Suffolk county
r.,
Commission F.XgrHa Uarrb R W �
O°SUFFgfr �T(0�)C� AWAT)E K
Scott A. Russell
SUPERVISOR
SOUTHOLD TOWN HALL-P.O.Box 1179
53095 Main Road-SOUTHOLD,NEW YORK 11971 'ky/O Town of,Southold
CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT)
-- --------------------)DOES---THIS---PROJECT—INITO F+TETE--FOTLOWIN(-i-
Yes No (CHECK ALL THAT APPLY)
❑[B"A. Clearing, grubbing, grading or stripping of land which affects more
than 5,000 square feet of ground surface.
❑[]B. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑13-1c. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
E�D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
❑[3"'E. Site preparation within the one-hundred-year floodplain as depicted
on FIRM Map of any watercourse.
❑[j 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.
;k 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.
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. ': 1000 Date:
D�trict
NAME. C1�CLZ(J� %X>UG 3 L /Z� O Z /7
��"
wSection Block Lot
F'OR KILDING DEPARTNI N L 0\1-LY
Contact Informotiorr. ���^7.j���
10 k
r.kJr,r\vnr.y'
Reviewed By `
— — — — — — — — — — — — — — — — — — Date: � /
17
Property Address / Location of Construction Work — — — — — — — — — — — — — — — —
Approved for processing Building Permit
PStormwater Management Control Plan Not Required.
Stormwater Manager;ent Control Plan iJ Rcqui ed—
U (Forward to Engineering Department for Re"tew)
FORM ' SMCP - TOS MAY 2014
..
UILDING DEPARTMENT-Electrical Inspector
U v D
TOWN OF SOUTHOLD
E6
13 2019 Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
qPu�0� ^+°. Telephone (631) 765
-1802 - FAX (631) 765-9502
IBVV
02TOS F SOgOLD roger richert aC?town.southold.ny_us
APPLICATION FOR ELECTRICAL INSPECTION
Date:
REQUESTED BY:
Company Name: AZ k
Name: V__V,
�►
email: �a r� C aw,
License No.: 42-04 �� o(�
Address: S IA-T n
Phone No.: " S�
JOB SITE INFORMATION: (All Information Required)
Name: c o t S
Address: Q-
Cross Street: 0 0.
Phone No.: S
email:
Bldg.Permit#: Block: Lot:
Tax Map District: 1000 Section:
BRIEF DESCRIPTION OF WORK(Please Print Clearly) I
Circle All That Apply: 6E)/ NO Rough In Final
Is job ready for inspection?:
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:
PAYMENT DUE WITH APPLICATION
82-Request for Inspection FormAs
CERTIFIED TO.HSA HOLDINGS III LLC
SURVEY OF WESTCOR LAND TITLE INSURANCE CO.
DESCRIBED PROPERTY
SITUATE AT OB NO.:201 T-f 19
MATTI TUCK MAP NO.:
TOWN OF SOUTHOLD FILED.
SUFFOLK COUNTY, NEW YORK REVISIONS:
S.C.T.M. DIST. 1000 SEC. 123 BLK. 02 LOT19
20 10 0 Z0 40 60 80 100 120 140 160 180
SCALE 1"=40' FEBRUARY 13, 2017
LOT AREA:23,300 SQ.FT. =0.535 ACRE
NOTE:GROUND WAS SNOW COVERED AT TIME OF SURVEY
LICENSE NO. 050363
HANDS ON SURVEYING
26 SILVER BROOK DRIVE "
FLANDERS, NEW YORK " E
� 11901
TEL:(631)-369-8312-FAX•(631)-369-8313
MARTIN D.HAND L.S
COPIES OF THIS SURVEY MAP,EITHER PAPER OR ELECTRONIC,NOT BEARING
THE LAND SURVEYORS INKED SEAL OR EMBOSSED SEAL SHALL NOT BE
CONSIDERED TO BEA VALID COPY AND SHALL NOT BE USED FOR ANY PURPOSE.
CENTER STREET
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POOL SIZE
tiITN STEP A B C D E F G H K L M N GAINS
12X24 121128 12'-0" 24' 3CC1 6'-0" 6'-0" b'-0" 4'-0" 41-0" 4'-3"I 4'-0" 6'-3-116" a
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16X24 18X28 16'.0' 24'-0r' 3'�8" 7'-0" 6'-0" 8'-0" r'•3" 4'-0" 4,4r r-r 4'-0" 6'7-x" 13Y. 0
18X36 16 32'-0" 3'-4' b'-0" 8'$' 13'-6 6'-3" 4'4" 4'-0" 6'S C-®r T�a i�
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18X38 1s= 1b' 3b` 3'-4" r'-0" 10 13'•8" 8'-3" 4'-0" 4'-0'' 10' 4'-0" T�1"
20X40 20X44 20'-0" 40' 3rd" b'-0" 1Z' 13 10 4'• VW 12' 4'-0` T�" 32.00p r-- "".a
18X34 18X36 16'-0" 34' 3'-4' b'�" 10 1 '� 12r 4'-0" 4'- 4'
y6p 25X54 25'40'' 50'•0" 3'-4" 79450
3004 3'-4" 20 15' 20 4'46" 4'4" 4'�" 8'-2-31b"
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2016 NYS Uniform Code Supplement Sec 8326 6 Middlethon Ave. ZJ'�.
R326.33 in Ground Pools Shall Be in Conformance with ANSreIlNSPI-5 O 0 7
R3263 Barrier requirements:Temp Pence must be installed at time of Manorville, NY 11949 AR SSS NPy
Pool construction,and Permanent fencing is the homeowners responsibility
' R326.6 ntrapment Protection installed SCALE: NTS
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- - - --- R3263 Swimming Pool and Spa Alarms must be installed POOL TYPE: RECTANGLE REV.
2015>ECC JAMES DEERKOSKI, P.E. DATE:
Sec R 403.10.2 T ne switches or other control methods that can run 260 DEER DRIVE
automatically turn off and on tom t�schedule shall be DRAWIN NUMBER
TYPICAL PANEL STIFFNER
installed far heater and pump motors. Heaters and pump motes that MATTITUK, NEW YORK 11952 1
have built in time switches shall be in compliance with Sec R 403.10.2 1 OF