HomeMy WebLinkAbout42867-Z SN�S�F l�c Town of Southold 11/13/2019
o P.O.Box 1179
53095 Main Rd
1i4 �ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 40849 Date: 11/13/2019
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 475 Rambler Rd, Southold
SCTM#: 473889 Sec/Block/Lot: 88.-5132
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
7/10/2018 pursuant to which Building Permit No. - 42867 dated 7/17/2018
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 Cvikevich,Peter&Nobuko Tange
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 42867 07-09-2019
PLUMBERS CERTIFICATION DATED
ho e Signature
o�sv o� taco TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
• SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 42867 Date: 7/17/2018
Permission is hereby granted to:
Cvikevich, Peter& Nobuko Tange
519 Borden Ave Apt 11J
Long Island City, NY 11101
To:
construct accessory in-ground swimming pool as applied for.
At premises located at:
475 Rambler Rd, Southold
SCTM #473889
Sec/Block/Lot# 88.-5-32
Pursuant to application dated 7/10/2018 and approved by the Building Inspector.
To expire on 1/16/2020.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Buil nspector
Form No.6
'ro\NN OrSOUTHOLD
BUILDING DEPARTMENT
TOWN BALL
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•aew 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 Certiicafe of Occupancy-x:25'
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
Date.
New Construction:JJ O �• Old or Pre-existing Building: (check one)
1 n 11
Location of Property: o4�5 jqp�kA61,er—
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section (98 Block. Lot
Subdivision Filed Map. Lot:
Permit No. Date of Permit., Applicant:J�,JO -For-9 RDC CA
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
SOU��®!
0
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 , Q roger.rich ert(a)_town.southold.ny.us
Southold,NY 11971-0959 Q
eouffNi
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Peter Cvikevich
Address: 475 Rambler Road city.Southold st: New York zip: 11971
Building Permit#: 42$67 Section: $$ Block: 5 Lot: 32
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Harrison Electric License No: 35534-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
Disconnect Switches Twist Lock Exit Fixtures �] TVSS
Other Equipment: Inground Swimming Pool to Include: Bonding, Control Panel, 2- GFCI Circuit
Breakers, Salt Generator, Gas Pool Heater, 1- Pool Pump, Low Voltage Pool Lights,
Notes: Cover Motor.
Inspector Signature: lvala Date: July 9, 2019
0-Cert Electrical Compliance Form.xls
Of SOUIy��
* f TOWN OF SOUTHOLD BUILDING DEPT.
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 r7 INSPECTOR
-
,`o !p
# # TOWN OF SOUTHOLD BUILDING DEPT."
765-1802
INSPECTION ':
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
{ ] FOUNDATION 2ND [�"] SULAT ON/CAULKING
[ ] FRAMING /STRAPPING [ FINAL
= [ ] FIREPLACE &-CHIMNEY [ ] FIRE=SAFETY INSPECTION
[ _] FIRE RESISTANT CONSTRUCTION" [ ] FIRE RESISTANT-PENETRATION
[ ] ELECTRICAL (ROUGH) [ ""] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
-- v bud
W
DATE INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
b
M
FOUNDATION (IST) Jc,
--------------------------------------
'FOUNDATION (2ND)
O Li
'� cn
ROUGH FRAMING&
PLUMBING
INSULATION PER N.Y.
STATE ENERGY CODE
000r
y
FINAL
ADDITIONAL COMMENTS
'7 d 4- 13 ci
RYUM o C Z
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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
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 / —f Survey
SoutholdTown.NorthFork.net PERMIT NO. (� ( Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined ,209 Single&Separate
Storm-Water Assessment Form
01 Contact: `
Approved f ,201Mail to: q77co imi
Disapproved a/c Q Q
Phone: o
CIA
Expiration ,20 /
1� DAPPLICATION FOR BUILDING PERMIT
JUL 1 0 2010 Date ) 20/R
INSTRUCTIONS
ING DFIPT.
a. T�'i e completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of pl ,�u e p of 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 dateAf 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
Reph flns, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applic r o I a ' ble laws,ordinances,building code,housing code,and regulations,and to admit
author n c �er?fis n ilding for necessary inspections.
JUL 1 0 2010 r44, cK C:_ C
(Signature of applicant or name,cif a®corpJoJrattiion) �j
BUMDING DEPT. `��' �g 1,jJ RJ M lq�(`1T y c(
T07-V OF S'7OLD (Mailing address of applicant) 1 1y 'I qSC�
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Cer: r F4J Lxio ►�
Name of owner of premises Pe trr uI Qu/ct-\ -�- 1 V l7 6 V�_V, tD �-
(As on the tax roll or latest deed)
If applicant i orporation i nature of duly authorized office
(Nam(/and title•-ofcorporate`officer)
Builders License No:
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on Which proposed wor will be done:
Rcwhler- Ra filt
House 1,4umber Street Hamlet
County Tax Map No. 1000 Section $C� Block Lot
Subdivision Filed Map No. of
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work(check which applicable): New Building Alter tion
Repair Removal Demolition ther Work
(Description) ®��
4. Estimated Cost Fee r
(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 us,.
7. Dimensions of existing structures, if any: Front c>'?(� Depth
Height Number of Stories _
Dimensions of same structure with alterations or additions: Front /year
Depth Height Number'of Si'o'ri� s
8. Dimensions of entire new construction: Front Rear .. tDeh
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated "
12. Does proposed construction violate any zoning law, ordinance or regulation?YES OX ,
13. Will lot be re-graded? YES NOAWill excess fill be removed from premises? YE -,)—(—NO
14. Names of Owner of premises r cu,k2V( -Address ar O)-Phone No. 54_a(Q '06a28
Name of Architect Address 5 Phone o
Name of Contractor ter vr_ f,1/�eAddress Z Phone o.(�__I -1+q( — 01J4
�JY CI�Q
15 a. Is this property within 100 feet of'a tidal wetland or a freshwater wetland? *YES T40
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAYE REgU RI;p
-, �, r fN
b. Is this property within 300 feet of a tidal wetland? * YES NO _ if f- t °�I'' "}� , a ;
* IF YES, D.E.C. PERMITS MAY BE REQUIRED. i, 4 3
16. Provide survey, to scale, with accurate foundation plan and distances to property-lmes.?e;7'
17. If elevation at any point on property is at 10 feet or below, must provide topographical,da a 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
Jo: 30 RAT's being duly sworn, deposes and'isays that(s)his the applicant
(Name of individual signing contract)above named, CONNIE D. UNCI
Notary Public,Stat of New York
(S)He is the No.01BU6185050
(Contractor,Agent, orporate Office etc.) Commission ExpiresApril 14,2�a
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 andl belief, and th t the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me this
P a day of 20 - 4D
Notary Public Signa't'ure ofApplic nt
1
Scott�--� A. Russell '
SUPERVISOR t MANA\GIEMIENT
SOUPHOLD TOWN HALL-P-O-Box 1179 a Town
(� ¢]� ]�]
53095 Main Road-SOLITHOLD,NEW YORK .11971 C O/r � �f 1Jf�uL/��Glit
enAPTER 236 - STORMWATER MANAGEMENT WORK SHEET
BY THE APPLICANT)
( TO BE COMPLETER•_.__ _
_ - - IDOFTRIS pRoj1ECI' Jlv®I�VE ANY OF 'TM , FOLLOWING:
OWING: t
(CHECK ALL THAT APPLE
Yes No
❑( A., CIearing, grubbing, grading or stripping of land which affects•more
than 5,000 square feet of ground surface.
$. Excavation or filling involving more than 200 cubic yards of material
within any parcel or any contiguous area.
❑ C. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
El D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area. `
❑ E. Site preparation within the one-hundred year floodplain as depicted
on FIRM Map of any watercourse. ,
❑ .F. Installation of new or resurfaced impervious surfaces of 1,000 square
roval of-a Stormwater Management
a
feet or more, unless prior pp
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,
igbalur�6ontaet�Iu#'oxmataora,-Data&-Count-y-T.�Map-�TumbeF!_—Chapie�-23&-doesuot.appl��;^u�pta}ect-----
If you answered YES to one or more of the above,please submit Two copies of a Stormwater Management Control Plan
and a completed Check List Form to the Building Department with your Building Permit Application.
S.C.TN. - 1000 Date:
APPLICANT_ (Property owner,Design Professional,Agent,Contractor,other) District
NAME Section Block Lot
" FOR Btl1LDl\G DEPAR]:�:(EN"I"USC ONLY.'.a"4
Contact informatiorc b�l
VReviewed By � !� i_e�
-- — — — — — — = — — — — — — — — — —
Property Address'/ Location of Construction work: — Approved for processing Building Permit. _ —
(�, ® Stormwater Management Control Plan Not Required.
❑ Stormwater Management Control Plan is Required.
(Forward to EngineenngDeparimeni for Review.)
FORM SMCP-TOS MAY 2014
E
FD)
rrot K
B I ING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
C JUN 2 7 T"o1wn Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
TOWN�� �� phone (631) 765-1802 - FAX (631) 765-9502
roger rich ert(a-town.southoId.n .us
APPLICATION FOR ELECTRICAL INSPECTION
J Date: ?
REQUESTED BY: p
Company Name:
Name:
License No.: �S 3 email: o, r/'/S a � —���� � 7� ,✓-� .
Address: j J Il
Phone No.:
JOB SITE INFORMATION: (AII Information Req fired)
Mame:
Address:
Cross Street:
Phone No.:
� email:
B[dg.Permii � 8 Block: Lot: 3a2
Tax Map District: '(000 Section: ��
BRIEF DESCRIPTION OF WORK(Please Print Clearly)
Circle All That App y- Ro Rough I n
� tv ��
Is job ready for inspection?: YES / NO gib
VL
Do you need a Temp Certificate?: YES / NO Issued On
Temp Information: (Ali information required)
Service Size
1 Ph 3 Ph Size: = Meters (d Meter#
New Service - Fire Reconnect- Flood Reconnect- Service Reconnected - Undergound-Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Servic '?
Additional Information:
PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form As
- V
��vatfF0(�-c
ELIZABETH A. NEVILLE, MMC hyo oGy Town Hall,53095 Main Road
TOWN CLERK P.O.Box 1179
CIO Z Southold,New York 11971
REGISTRAR OF VITAL STATISTICSp Fax(631)765-6145
MARRIAGE OFFICER 'f' o�� Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �0,( , `�►� www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
July 22, 2019
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
RECEIVED loo
John Harrison J U L 2 6 2019
Harrison Electric
530 Corwin Street
Riverhead,NY 11901 Southold Town Clerk
- T'kQkS AA-t_6 a
Dear Sir: Aca
The bank returned your check no. 1240 in the amount of$100.00 due to
insufficient funds. The check was payment to the Southold Town Southold Building
Department. This office is required to collect the money for the check and a$20.00
returned check charge for each check. Payment must be cash, money order, or certified
check. The total amount due is $120.00 ($120.00 +20.00). Payment must be
received be close of business on July 31,2019.
Failure to pay this amount within the specified time will result in the referral to
the Town Attorney's office for collection and the permit will be voided.
Thank you for your anticipated cooperation.
Sincerely,
l 'A\
Lynda M Rudder
Deputy Town Clerk
encs
S.C.T.N.NO. DISTRICT.1000 SECTION:ee BLOM s LOl(S):32 LOT 21 t
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W.LOT 20 CERTIFIED TO: PETER CVIKEVICH•
op TERRY WATERS j2901 N08UKO TANGS THE SECUR T=
R nEu DEC 29, 1958 GUARANTEE CORPORATION OF BALTMIOR
CASILEROCK LAND SERVICESINC.
gP1" SIUATM Ar.SOUTHOLO
WM or:SOUTHOLD XMINM M ROMIM LAND SURV6YLL1c, ME
SUFFOLK COUNTY, NEW YORK Profeadonel lmd B4OfaFlns m4 Poolp
M, p.D.De: 153 Aquebacue,Now Turk 11031
UPDATE SURVEY 04-20-17 RtE +5a5<lagan-Lw ryc(at)lr-ur
27-104 ST•.�&1'-20'OAm-SEPT. 2. 2007 ars t�xn w=2 .+,+re r....a. wa a 5� a rte..a To++
1 road
4A� RIRVED AS NOTED
,DATE: B.P.,4 RETAIN STORM WATER RUNOFF
PURSUANT TO CHAPTER 236
DE OF THE TOWN CODE.
''NOTIFY, BUILDING DEPAR AT
765-'4,802; .8 AM TO 4 PM FOR THE
'FOLL'OVI�ING INSPECTIONS:
-t FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2.-ROUGH=-'FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCITION MUST ELECTRICAL
BE COMPLETE FOR C.O. INSPECTION REQUIRED
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEN
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
ENCLOSE POOL TO CODE
COMPLY WITH ALL CODES OF UPON,COMPLETION
NEW YORK STATE& TOWN CODE FI
AS REQUIRED AND CONDITIONS OF
-�fl�Bl-B T9�Dl 7R�
S
OCCUPANCY OR
USE IS UNLAWFUL
WITHOUT CERTIF IC/-111-
OF OCCUPANCY
P.tiI•R NAME; / , ,l k �l Ji/ IlRix-r—
DATE..
■• •i Iwo
�.. SIZE:
SHAPE:
._ 80ADER PATTERN:
WALL PAr(FJq
FLOOR PATTERN:
- I
CORNERS,: (
• t
BUNG OVERLAP (drds one) .
20 GAUGE 27 GAUGE (drds one)
PI)Dt
. �
�,Jy l(q 50?
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