HomeMy WebLinkAbout44238-Z Zr Z--t -
�og�FFol�oy Town of Southold 8/11/2020
P.O.Box 1179
o - 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41340 Date: 8/11/2020
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 1745 Aldrich Ln,Laurel
SCTM#: 473889 Sec/Block/Lot: 125.-2-1.19
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/23/2019 pursuant to which Building Permit No. 44238 dated 9/30/2019
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:
Construct an accessory in-ground swimming pool fenced to code as applied for.
The certificate is issued to Leiblein,Gary&Lorraine
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 44238 07/29/2020
PLUMBERS CERTIFICATION DATED 1%
Au h i d Signature
�g�FFO TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y x TOWN CLERK'S OFFICE
o . 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#: 44238 Date: 9/30/2019
Permission is hereby granted to:
Leiblein, Gary
PO BOX 632
Laurel, NY 11948
To: demolish existing swimming pool and construct a new accessory in-ground swimming
pool as applied for. Must maintain 25' side yard setbacks.
At premises located at:
1745 Aldrich Ln, Laurel
SCTM # 473889
Sec/Block/Lot# 125.-2-1-.19
Pursuant to application dated , 9/23/2019 and approved by the Building Inspector.
To expire on 3/31/2021.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Bui t nspector
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
This application must be filled in by typewriter or ink and submitted to the Building Department with the following:
A. For new building or new use:
1. Final survey of property with accurate location of all buildings,property lines,streets, and unusual natural or
topographic features.
2. Final Approval from Health Dept.of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead.
5. Commercial`building, industrial building,multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings(prior to April 9, 1957) non-conforming uses,or buildings and"pre-existing"land uses:
1. Accurate survey of property showing all property lines,streets,building.and unusual natural or topographic
features.
2. A properly completed application and consent to inspect signed by the applicant. If a Certificate of Occupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy-New dwelling$50.00, Additions to dwelling$50.00,Alterations to dwelling $50.00,
Swimming pool $50.00,Accessory building$50.00, Additions to accessory building$50.00, Businesses$50.00.
2- Certificate of Occupancy on Pre-existing Building- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00, Commercial$15.00
Date. gjal 1 q
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 1 q 4S_ ALM,►Ck b4 &�,eL
House No. Street Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section 12s �. (
Block a Lot 4
Subdivision CV%"o croo Filed Map. 1 Lot:
Permit No. `4 l ��D Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ ��
Applicant Signature
pE SOVry®l
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 • �� sean.devline_town.southold.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To Gary Leiblein
Address: 1745 Aldrich Ln city.Laurel st: NY zip. 11948
Building Permit* 44238 Section: 125 Block- 2 Lot: 1.19
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Laurel Lighting License No: 4718ME
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service
Commerical Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt 2 Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceding Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks 1
Disconnect Switches 2 4'LED Exit Fixtures Pump 2
Other Equipment. Pump on 220GFCI Breaker, Booster Pump on 220GFCI Breaker, Salt Generator
Notes* Pool
Inspector Signature: Date: July 29, 2020
S.Devlin-Cert Electrical Compliance Form.xls
# TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] SULATIOWCAULKING
[ ] FRAMING/STRAPPING [ FINAL
[ ] FIREPLACE-& CHIMNEY _ [ -] 'FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[_ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
RE KS: ( yxt; cc,
DATE INSPECTORX61�
souryo� 1 I rlLl S A L, et cq
# * TOWN OF SOUTHOLD ILDING DEPT.
`ycou765-1802 (L-t ib I
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]- FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL)12OO
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
DATE Sq/ u INSPECTOR 27�
J
FIELD INSPECTICiN REPORT -DATE COMMENTS
b
FOUNDATION (IST)
--------------------------------
FOUNDATION
------------------------------FOUNDATION (2ND) el�i
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ROUGH FRAMING&
PLUMBING y
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INSULATION PER N.Y. y
STATE ENERGY CODE
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FINAL
ADDITIONAL COMMENTS (b
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TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPfARTMENT• 'Do you' yo
- u have,o;need the following,before applying?
TOWN HALL Board of Health
'"SOUTHOLD,NY 11971
3 sets of Building Plans
7654802'
PERMIT NSurvey
O: �-/ Check
Septic Form
N.Y.S.D.E.C.
Trustees.
Examined ,20 Contact:
Approved ,20 Mail to:. �zg ���_
Disapproved a/c
—
Phone:
L.
BuiWmWf6pector
�• � --
Sr 3 2019, � ':
APPLICATION FOR=BUILDING PERMIT
Date 201Q
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter onin ink and submitted to the Building Inspector with 3
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 a Certificate of Occupancy
is issued by the Building Inspector.
APPLICATION,IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone'Ordinance,ofthe Town-of+Southold;^Suffolk?County,New1York,and other applicable Laws;"Ordinances or
Regulations,for the construction of buildings,additions,or alterations or for removal or dem ' 'on as herein described.The
applicant agrees to comply withA applicable laws,ordinances;cbui�lding code,housing cc d regulations,-'and,to admit
authorized"inspectors on premises,andtin building for necessary inspections.
(SignWe of applicarddr name;if&corporation)
, /I,,
(Mailing,address of applicant),
State whether applicant is owner,lessee, agent, architect, engineer,,general contractor, electrician,plumber.or.builder
Name of owner of premises �� ��1�l l rN
a
(as on the tax roll or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate,officer)
Builders License No. ,fib- 4T
Plumbers License No. �
Electricians License No. Me
Other Trade's License No.
1. Location of land on which proposed work will be done:
A 1741- & Lir e�
a House Number Street Hamlet .r, ;
ur '.N@Vl 10 9161a—oil 11A natoM
County Tax Map No. 1000 Section 25 Block ►OI.�'
Subdivision LR 6l to ftw Filed Map No. 7gti7Su�./r 411u i
,. ,��a�n9.cc(�yFu1
(Name) _u' �nJ,-
2. State existing use and occupancy of premises and intended use and occupancy of proposed"construction:
a. Existing use and occupancy oewe
b. Intended use and occupancy_ A-e5Nwr..ft Lw%mmIAfA
3. Nature of work(check which applicable): New-Building. Addition Alteration
Repair Removal- Demolition Other Work_ lt�Jgn�„urs V►r�c Jwl/nn,rvc
4. Estimated Cost Lj, Ooo- Fee (Description)
(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.
J I
NP�4•
7. Dimensions of existing structures, if any: Front Rear = Depth l
Height Number of Stories ” ; I
Dimensions of same structure with"-61t6ratio ns or�additions: f=ront )8x 32- P�0'6!k-: Rear
Depth Height' Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height - Number of Stories
9. Size of lot: Front _____Rear I"�O) Depth 5Bb
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: No
13. Will lot be re-graded f ODC Af,0A 00Will.excessfill be removed.from premises: YES NO
I`7+S A,.oc►el, La
14. Names of Owner of premises Le-0o 1-e I n Address_ J Ajp , iw, 1i9.R Phone No. 31-7b�F770
Name of Architect Address - PhoneNo
Name of Contractor F-WAcM c Address 42g et z:,A Phone No. --7 I pr"
15. Is thisproperty,within 100-feet of a tidalvetland? *YES NO
s IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE
Q
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.
STATE OF NEW YORK)
SS:
COUNTY OFFf�Xk
c
JE6hJAGraS being duly sworn,deposes and says that(s)he is the applicant
(Name of indivi ual signing contract)above named,
(S)He is the LMA�e_
(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
f day of 20 !qi
4NO Public Signaturot Applicant
o MARGARET A. KIDNEY
Notary Public-State of New York
No. 01 K1602111 I
Qualified in Suffolk County
My Commission Expires March 8.20_Z
Scott A. Mussell
f§UP))��
� - STO�]E�.I��1 WAT E K
SUPERVISOR
l��l[A\1�A\�G�]EI��1[]E1N'7C'
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 F'OI LOWIING:
Yes No (CHECK ALL THAT APPLY)
®[YA. Clearing, grubbing, grading or stripping of land which affects more
�/ than 5,000 square feet of ground surface.
®[ E. Excavation or filling involving more than 200 cubic yards of material
®� within any parcel or any contiguous area.
. Site preparation on slopes which exceed 10 feet vertical rise to
100 feet of horizontal distance.
®�D. Site preparation within 100 feet of wetlands, beach, bluff or coastal
®[� erosion hazard area.
E. Site preparation within the one-hundred-year f loodplain as depicted
on FIRM Map of any watercourse.
®E3"'1F. 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.
APPLICANT. (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. #: 1000 Date.
District
NAME: -el Y- 2 7 Q
Section Block Lot
� c p **** FOR BUILDING DEPARTMENT USE ONLY
n ****
Contact Information. ��1��w —0 I ?Q
(Telephone Numbed
Reviewed By:
_
_
Property Address/Location of Construction Work _ Date
— — _ _ _ _ _ _ — _ _ _ _
Approved for processing Building Permit.
W. Stormwater Management Control Plan Not Required,
LA,W.e�- (9�`� Stormwater Management Control Plan is Required
(Forward to Engineering Department for Review.)
FORM # SMCP-TOS MAY 2014
Town Hall Annex ' Telephone(631)765-1802
54375 Main Road felUWl$O1)goP.O.Box 1179 rOger.rlChe8.nV
.US
-- ----—Southold;lVY 11971-0959--- -------- - - -'! - ----- -
'
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date: q 1 q j1
Company Name: f aj � LjA-b_rj
Name: �eN
loense No.:
Address: Q'7r] M,,(,,(, ko Lawc- W 1 I qq,6
Phone No.: 3 - c57-33b
JOBSITE INFORMATION: (*Indicates required information)
*Name~ CAR,/ Lel b t c n
*Address: 174S vim, Lr\/ J_ PY 1q -?,.
*Cross Street: -r , nic a wyj l,e_ Ro
*Phone No.: 6,31- S- 8r7
Permit No.: Z-�; -
Tax Map District: 1000 Section: . 12-5 dock: a Lot: I 19
*BRIEF DESCRIPTION OF WORK(Please Arint-Clearly)
►�P�C�i
lax 32 InQ ruLi Vinyu (�h/lrn(MOV g PWc.
(Please Circle All That Apply)
*is job ready for inspection: YES NO Rough In Final
*Do you'need a Temp,Certificate: YE / NO
Ternp-information (If needed)
*Service Size: 1 Phase 312hase 100 150 200 300 350 400 Other
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
dit[6-wgI-Infb-rm-atl0r: YMEN1`DUE-WITH APPLICA-TION
c
82-Request for Inspection Forth
PERMIT# Address:
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New York State Insurance Fund
199 CHURCH STREET,NEW YORK,N.Y. 10007-1100
, CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
AAAAAA 112377925 � ❑
LEVITT-FUIRST ASSOCIATES LTD
520 WHITE PLAINS ROAD,2ND FL
TARRYTOWN NY 10591
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
ARTHUR J EDWARDS MASON TOWN OF SOUTHOLD
CONTRACTING COMPANY INC P.O.BOX 728
929 RTE 25A SOUTHOLD NY 11971
MILLER PLACE NY 11764
POLICY NUMBER CERTIFICATE NUMBER POLICY PERIOD DATE
G 2438 491-9 53244 06/29/2019 TO 06/29/2020 06/21/2019
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2438 491-9, 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://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: 506150454
I000R00000100007717667724 O011EII
Form WC-CERT-NOPRINT Version 2(0229/2016)[WC Policy-24384919] U-26.3
40 1000000000000716724001[0001-0000243849191[01GII15159-06nCe�NoP.CERT 1][01-00001]
4`i'
Suffolk County Department of Labor, Licensing &
Consumer Affairs
VETERANS MEMORIAL HIGHWAY HAUPPAUGE, NEW YORK 11788
DATE ISSUED: 0701/1978 No. H-4436
Suffolk County
R-
Home Improvement Contractor License
This is to certify that ARTMTR J- RDWARM
doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA(1 SUPP)
having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules
and regulations of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME
IMPROVEMENT CONTRACTOR, in the County of Suffolk.
0
o — 1 hhh License Category
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OCCUPANCY
ENCLOSE POOL TO CODE USE- 10" UNLAMRX
UPON COMPLETION
BEFORE V ATE19" WITHOUT
ag���'yyjq��{/��lq`_ @��gp$[$p��q?T7}:p�.��gjNn
PROVED AS NOTED
DATE:r� - B.P.# Kan
FEE:oc B`r
NOTIFY BUILDING rEPARTMENT AT RETAIN STORM WATER RUNOFF
765-1802 8 AM TC - PM FOR THE PURSUANT TO CHAPTER 236
FOLLOWING INSPECTIONS: OF THE TOWN CODE.
1. FOUNDATION - '"P10 REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3 INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEVA'
YORK STATE. NOT RESPONSIBLE FOR ELECTRICAL
DESIGN OR CONSTRUCTION ERRORS.
INSPECTION REQUIRED
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODES
AS REQUIRED AND CONDITIONS OF
--nIaLiitfBtB�B�V�I-Z�-�=-�
ENCLOSE POOL TO C068
�'F t PQ1V COMPLETION
OCCUPANCY OR #k Mqj n+a, f
USE IS UNLAWFUL CERTIFICA7 251S' d� yitrd-
WITHOUT
OF OCCUPANCY se-loke-I-
A
Fabuno
NIT.RFW
�® T®
ft cow
Plan ' Piping . Arrangement
42w
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Section A—A Typical Wall Section �Fss►oNPA-��G.
SIZE A B C D E F G H AREA CAP
FEET FT FT FT FT FT FT FT FT SQ.FT GAL.
14 X 28 '14 28 8 10 7 3 3 8 392 12,000
16 X 32 16 32 8 14 6 4 4 8 512 19,5001
POOL SPA
CKNM
��� ����� � SYSTEM -- - ��
18 X 32 18 32 8 14 6 4 5 8 576 21,600 ,.929 Route 25A Viler Place NY 11764
20 X 40 20 40 14 14 6 4 5 10 800 33,000 (631) 744-7165 M (631) 744-0174
24 X 44 24 44 18 14 8 4 8 10 798 35,000 Suffolk incense # 6—M
24 X 48 24 48 20 16 8 4 6 10 900 38,500 , Nassau Uceffise # 0000