HomeMy WebLinkAbout38150-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
t! TOWN CLERK'S OFFICE
Ei� U_4 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#: 38150 Date: 7/2/2013
Permission is hereby granted to:
Mandelbaum, Jay & Gordon, Lauren
1107 Fifth Ave
New York, NY 10128
To: construct an accessory inground hot tub as applied for
At premises located at:
825 Kimberly Ln, Southold
SCTM # 473889 9
Sec/Block/Lot# 70.-13-20.5
Pursuant to application dated 6/26/2013 and approved by the Building Inspector.
To expire on 1/1/2015.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
ELECTRIC $100.00
Total: $400.00
Building Inspector
Form No-6
TOWN OF SOUTHOLD ��)
BUILDING DEPARTMENT `kf
TOWN HALL �j
765-1802 1l
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 2110 of I% 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- 350.00
5. Temporary Certificate of Occupancy -Residential $15.00, Commercial $15.00
�N�ii/n Date. J e/NL Z- , ®)
New Construction:V f!4 TV. Old or re-existing Building: (check one)
Location of Property: b 21r P;%bGrly LA P,e_ go;-N,5 10(
House No. ""�� "" Street Hamlet
Owner or Owners of Property: J Gl�y/ MA�d( t I.40Wwt OW14 L-A vel 6101brl
Suffolk County Tax Map No 1000, Section' �® Block 0 ' Lot *21'10 s
Subdivision k✓a o(eS L 13T�e lB V - Filed Map. (V 6 3 Lot:
PerNo. ��61 `� (�s� Date of Permit. �'1 Applicant: J A y M0tr►(LI L0*W�
Health Dept.Approval- Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ ��•®�
Applicant Signature
FIELD INSPR N REPORT DATE CONIlVIENTS
• FoUNDAMN(IST)
�YY�oYYYYYYYMYgO*NOMYM W YYYYY�YY
FOUNDATION(2ND) �
Ut
ROUGH�CF&
PLUNMING
7D
IMULATION PL12 N.Y.
STATE ENERGY CbDE
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. V
FINAL
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDINrG,DEPARTMENT Do you have or need the following,before applying?
TOWN BALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans
TEL: (631) 765-1802 Planning oar'd approval
FAX: (631) 765-9502 Survey
SoutholdTown.NorthFork.net PERMIT NO. 0 / Check
Septic Form
N.Y.S.D.E.C.'
Trustees
C.O.Application
Flood Permit
Examined V,201 Single&Separate
` Storm-Water Assessment Form
Contact:
Approved 1/20 ` Mail to:
Disapproved a/c v r
Phone: 7
Expiration 120-"5'
E C f� E Buil �i
L� ng Inspector
Q PLICATION FOR BUILDING PERMIT
Date tJ re— 20 0,3
aLoc DEPT INSTRUCTIONS
TONIN OF SOUTHOLD
-a-4%i ica ion UST 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.
(Sitr ature of applicant or name if a corporation
110 �i f Ave,�v+e�
Neu- ye) k, NY 10) zg
=a ;, : _._�,• (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general co idCO ,i'�i�ct`r"ic�i "n; plumber or builder
® wh Pi or DATE _B P. #_ _
�17E�EE BY _
Name of owner of premises J®l M OlW ACA adVK OLVId
(As on the tax roll or e Po 'I-
r�aLtt � NSPECTIONS.
If applicant is a corporation, signature of duly authorized officer 1 FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
(Name and title of corporate officer) 2 ROUGH-FRAMING,PLUMBING,
STRAPPING, ELECTRICAL&CAULKING
Builders License No. '' 3 INSULATION
Plumbers License No. 4 FINAL-CONSTRUCTION &ELECTRICAL
Electricians License No. MUST BE COMPLETE FOR C 0
Other Trade's License No. ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEbN
1. Location of land on"which ro osed work will be done: YORK STATE. NOT RESPONSIBLE FOR
S l<± bpm,%4 �1.VA 4f- D�I�GN�ON�.TJUCTION ERRORS.
House Number Street Hamlet
County Tax Map No. 1000 Section 0 Block 1 Lot 2 0 s
Subdivision PA radl is.& Th,l 13 o,y Filed Map No. 6'i 6 3 Lot 500
4 •
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .S1'/► L I j1 come- WI' 06o I h dKS�
��1rly LL
b. Intended use and occupancy SW me.- ; ;re- v"li w 1,4--'0 a
p e&44#sus.
3. Nature of work, (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work Derm i4 fj q 11 of
' (Description) WW.
4. Estimated Cost—$ Z S-1 o®o Fee- o•d
u i (To be paid on filing this application)
5. If dwelling, number of dwelling units ��N'umbeq of d ell` g units-on each floor
If garage, number of cars
6. If business, commercial or mixed occupaitcy"'specify-nature and"6xtent of each type of use.
P
7. Dimensions of existing structures, if any'�,Ffont::));? j• Rear ��,�' r Depth. P
Height 2 O ® Number of Stories'-
Dimensions
tories Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
P8"+Jt TV.6 IUS r' e_0 I �asvv /`1 r�ra�u+lIs+� �cd�t� a� X
8. Dimensions of entire new construction: Front 0 Rear Depth
Height Number of Stories WA-
9. Size of lot: Front I L'6 ZT Rear I 1 S4'
4i Depth 6 s•��'
10. Date of PurchaseJ v I Name of Former Owner j osq,4 Goma G��1•ot
11. Zone or use district in which premises are situated ���d PiL��0. 1� q-®
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO V Will excess fill be removed from premises? YES NO
14. Naives of Owner of premises LAV—ret- &b-40r► AddressPhone No.l
Name of Architect W-A- Address Phone No
Name of Contractor P I i e u h P&a IS,, Idn C • Address SO 1 vo%� �d llPhone No. 63( -2$'�_ S''13 C-
&Ary G-ftS �w So R ,ay 11161
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO /'00
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BF 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
IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
S:
COUNTY OF NeV4yo ,L+
Ot G>�^ --l;,�rr��.; being duly sworn deposes and says that she is the applicant
(Name of Individual signing cont'ract)'"a'bove named,
iJ /I -
(S)He is the - . ''''_'.`' `' 0 �� ne
(Con1F,aictor�'Agent, Corporate Officer, etc.)
,r „_u1";,,
s1,, �,,r.:, 'Ail
of said owner or owners, and is.diily,autho ized,to perform or have performed the said work and to make and file this application;
that all statements contained in this,appligation are true to the best of his knowleFNotary
.: h,,�,.�t� +A+
�Fi e
performed in the manner set,forth-iii theiap'plication filed therewith. LERAI MEEK
Public-State of New York
N0. 01 ME6202198
Sworn to before me this =i�'�' `'l�k'��i`" Qualified in Bronx County
day of� l Ul�e 20 ommission Expires o3 0� �d1�
Notary Public Signature of Applicant
New York State Department of Environmental Conservation
Division of Environmental Permits
Rm 121, Building 40-SUNY AM
Stony Brook, New York 11790-2356
Telephone (516) 444-0365
Facsimile (516) 444-0360
John P. Cahill
Commissioner
)LETTER OF NON-JURISDICTION
Laurie Gordon and Jay Mandelbaum
40 East 89th Street
Apartment 14D
New York, N.Y. 10128
Date: August 26, 1999
Re: 1-4738-02389/00001
Gordon and Mandelbaum Property
825 Kimberly Lane
Southold, N.Y. 11971
SCTM # 1000-70-13-20 . 5
' r4
Dear Ms . Gordon and Mr. Mandelbaum: `l
Based on the information you have submitted, the New York State Department of
Environmental Conservation has determined that:
The property landward of ;'the topographic crest of the bank, shown as the l�3
foot contour interval on the survey prepared by Joseph A. Ingegno on 7/14/ -9,
is beyond the jurisdiction of Article 25 (Tidal Wetlands) .
Therefore, in accordance with the current Tidal- Wetlands Land Use Regulatiions
(6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please
be advised, however, that no construction, sedimentation, or disturbance of any
kind may take place seaward of the tidal wetlands jurisdictional boundary, as
indicated above, without "a permit. It is your responsibility to ensure that
all necessary precautions are taken to prevent any sedimentation or other
alteration or disturbance to the ground surface or vegetation within Tidal
Wetlands jurisdiction which may result from your project. Such precautions may
include maintaining adequate work area between the tidal wetland jurisdictional
boundary and your project (i .e. a 15' to 20' wide construction area) or
erecting a temporary fence, barrier, or hay bale berm.
Please be further advised that this letter does not relieve you of the
responsibility of obtaining any necessary permits or approvals from other
agencies .
Very truly you ,f
,t- L L
J hn A. Wieland
eputy Permit Administrator
CC: Samuels & Steelman
BMHP
File
d
i!
Town of Southold - Chapter 236 - Stormwater Management
SWPPP - Storm Water Pollution Prevention Plan Assessment Form
GENERAL INFORMATION: (All Requested Information is Required for a Complete Application)
APPLICANT NAME: Owner-Agent-Consultant-Contractor or Other(CireleOne) Property OWNER.,(If Different than Applicant)
J A M PJ� "M
Address: y� r�L L4W E sr K f I Address:
Telephone r.+- 7_O prpy Fax - , t Telephone ff FaXf3
-1 0 i�P
E-Mau: ' tlhA h/C@ 16 rX e— E-Mau:
Property Address: b a S ,� Sd✓I�t Brief Description of Construction Activity,Proposed Structural BMPs,Soil
S.C.T.M.#: 100D V y V, St&Azation BMPs,Project Scope and/or Sequence of Construction Activity
District 6edron Bbtk Lot (P//O�]��,l��5 as N�ed)�lfrilementinfSWPPNazne fCoractorandforCo ��l(,
_ _r�,i�1(/�lg✓
_ _pi Y�OIS' �4 IFY CrV'eS4491 ) -
n
Telephon�fF� 2-8 11. -�13 Fax ✓ y
E-Marl: �� =LQL��(l(%ll_ r/il'1v� 7NLi� Wllf
(ICrlin 001S'Mfi•L®ytqy-2�� -: _i_/ f;._______
Name of ersops Responsible for Installation&Maintenance of Erosion Control Pragtice: • -/ -----
Pit i card f7oalS' `���!vlL"4-c-(-w�t.$'f_�!
r ,, ,
Address, ------------
��t.tne at �t. cz
ova ------------- -------------$�-__
Telephone#: Fax --------------------------------------------
9-Mail:
------__ -----------------E-Mail: Total Area of Land gearing P ---------------------------------------------
Total Area of Ali Q f- -'-------------------------------------------
!^�J�
Project Parcels: /� u
and/or GrowdDisturbama --------------------------------------------
(SRIAa ) (S.filAaes)
ProjectDuration: IStart End --------------------------------------------
(Anticipated) 6® Date: lit '3 Date: `0�l3
/ . -----------------------------------------
(radon ser or Calender Dani
-----------------
.---------------------------
Will this Project Disturbs five(5)or More Acres at r""7 1771
Any One Time During the Proposed Development? Yes No --------------------------------------------
IfYES:Please Answer the Following! -.--.-_._--_--_.__-_-..__.._-.----___-----.--_------
a. Does the Applicant have a Qualified Inspector On Q
Staff To Conduct the Required Inspections? Yes No
b. Does the SWPPP Indicate How Frequently the Site = = List the NAMES or description of all Potentially Impacted Water6odies andfor Wetlands:
Inspections will Occur and for What Period of Time? Yes No
c. Does the SWPPP Adequately Identify All Temporary Q Q
and/or Permanent Soil Stabalization Measures? Yes No
d. Does the SWPPP Adequately Identify a Complete = = --"""---__. __.__...____._-,. -_'-------_-_----__________
Project Phasing Plan? Yest_._.J
�� Status of Impacted Waterbody:(eq.TMOL,303(d)Listed,Impaired_)
e. Does the SWPPP Indicate Additional Site Specific t=
Practices that Will be Utilized to Protect Water Quality? Yes No _
f. Has the Applicant Submitted a Completed DEC Notice Type of a-ed -at oc t:(e e, ek B ,Pond,Sound,FreshwaterWedand«)
Of Intent and SWPPP Acceptance Form for Review = Q
by the Town of Southold? Yes No LERAI MEEK
STATE.OF NEW YORK,
N0. 01 ME6202198
COiJN1'YOF...... ��,\. SS Qualified,in Bronx County
..... ........................�being Y
My Commission Expires 03 0 2U17
That I,... .. Y�jlfifii'lGC-e 1/�J dui sworn, eposes an says a ie is ie Ic r Permit,
Name of indMdual signing Document) (� y� ,/
And that he/she is the ...........................................`�'w!..1e .. ..... ..............................................................
........ . ... ........................
(Omer,ContraMr,Agent,Corporate Officer.etc.)
Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed the said work and to
make and file this application;that all statements contained in this application are 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 herewith.
Sworn to before e this;
................................. ..........day of. .L4 n�.-------•---------- ,20:15
NotaryPublic: ..A .Q. ............................................. .. ......... ....................................................
(Signature of Applicant)
SVVPP Assessment FORM: 03-12
1i
16D =t4
SOF S0
Town Hall Annex J Telephone(631)765-1802
54375 Main Road g p
P.O.Box 1179 Q rc enriched o ns' 016.nV.us
Southold,NY 11971-0959
JPUMDING DEPARTMENT
TOWN OF SOUTHO]LD
APPLICATION!FOR ELECTRICAL INSPECTION
It
REQUESTED BY: -J � Date: , (3
Company Name:
Name: .1 OIL, A—CA +Add6vnll
License No.: all A�
Address:
. Pat
Phone No.: ( —6 6
a
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Address: !I
*Cross Street: P t I,,.e vet �
*Phone No.:
Permit No.: I
Tax-Map District: 1000 Section: Block:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
E
u
t
a j
(Please Circle All That Apply)
*Is job ready for inspection:
YES/ NO Rough in Fina!
*Do-you need a Temp Certificate: YES! NO
i
Ternp Information(if needed)
'Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
i
82-Request for Inspection Form t
al
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PROVIDE 6" MIN. FROST
PROOF TILE UNDER COPING PIPING SCHEMATIC
lb
SCAT SPA DESIGN
W4 C
GIJNITE ODNSIRUCfICN:
POOL FLOOR - 121 x 12-,ON MAX. SPACING 1 3/8` DIA. STEEL BARS
POOL SIDES - 6" x 6' ON Wk)(. SPACING J
POOL INTERIOR WIIN LIGhr CDLOR MARBLE DUST
MINLI-H 6- COVE RADIUS BETWEEN FLOOR AND VZ' . 6�
Mandelbaum -
-�rrc HYDROSTATIC VALVES 825 Kimberly Lane
5 COLLECTOR TUBES Southold, NY
OVER GRAVEL BASE
H. ROY JAFFE, P.E.
82 EAGLE CHASE,WOODBURY, N.Y. 11797
516-364-0148
FAX 516-364-0158
June 12, 2013
Village of Southold
Dear Sir:
This is to certify that the drainage facilities to be used
exclusively for the construction of apool on the
premises of:
Mandelbaum
825 Kimberly Lane
Southold, NY
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.
Very truly yours,
H. Roy Jaffe, P.E.
e
PINE NECK ROAD
SURVEY OF
LOT 5
MAP OF
PARADISE BY THE BAY
FILE No. 6463 FILED NOVEMBER 4, 1976
SITUATED AT
SOUTHOLD
TOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW YORK
S.C. TAX No. 1000-70-13-20.5
SCALE 1 "=20'
JULY 14, 1999
DECEMBER 17, 1999 UNDER CONSTRUCTION SURVEY
JUNE 21 , 2000 REVISED PROPOSED POOL & POOL HOUSE
JULY 2, 2001 FINAL SURVEY
AREA = 66,240.30 sq. ft.
(TO TIE LINE) 1.521 CIC.
CV
S.C.D.H.S. REFERENCE No. R10-99-0172
LOT
•4
" • - 465.97'
•. W
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SET
d- ® METAL POST---.,,
SET NAIL
N g ELECTRIC METER WOOD STAKE
:.:.:. •�.:.:.:.. . . .. : .
107.83'
::::::-:: 90.00
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a METER BOX / ` I .. 1' p
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WOOD PENCE AR UND . rn .... . ..... :.. ...........
o OUTDOOR SH ER N :::::ROW----- -------------TREES,':. ::: :::::::::::.::
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/ 21' SLATE WALK 1O SLATE WALL 0.0 N Z
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0 CERTIFIED TO:
0. PREPARED NCE WITH THE MINIMUM
JAY MANDELBAUM STANDARDS IFOR TITLE ASURVEYS AS ESTABLISHED
LAURIE GORDON BY THE L.I.A.LS. AND APPROVED AND ADOPTED
FOR SUCH USE BY THE NEW YORK STATE LAND
TITLE ASSOCIATION.
of fr-
61
t,LY.S. Lic. No. 50467
UNAUTHORIZED ALTERATION ADDITION Nathan Taft Corwin 111
TO THIS SURVEY IS A VIOLATION OF
SECTION 7209 OF THE NEW YORK STATE
EDUCATION LAW. Land Surveyor
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.
CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J. Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A. Ingegno L.S.
IS PREPARED, AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys — Subdivisions — Site Plans — Construction Layout
LENDING INSTITUTION LISTED HEREON, AND
TO THE ASSIGNEES OF THE LENDING INSTI- PHONE (631)727-2090 FOX (631)727-1727
TUTION. CERTIFICATIONS ARE NOT TRANSFERABLE.
THE EXISTENCE OF RIGHT OF WAYS OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P.O. Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947
99-454F