HomeMy WebLinkAbout41041-Z �SUFFotK�oTOWN OF SOUTHOLD
aoo �y BUILDING DEPARTMENT
a TOWN CLERK'S OFFICE
SOUTHOLD
y z
, 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#: 41041 Date: 9/29/2016
Permission is hereby granted to:
Jemcap SD LLC
360 Madison Ave Ste 1902
New York, NY 10017
To: construct an above ground swimming pool as applied for.
At premises located at:
270 Illinois Ave, Mattituck
SCTM # 473889
Sec/Block/Lot# 113.-11-18.1
Pursuant to application dated 9/20/2016 and approved by the Building Inspector.
�1 To expire on 3/31/2018.
} Fees:
SWIMMING POOLS -ABOVE-GROUND WITH REQUIRED FENCING $250.00
I
CO - SWIMMING POOL $50.00
otal: $300.00
ilding 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:
I. 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$15.00
- - -----------
-- - - - Date. - - - — - -- ------- -
New Construction: Old or Pre-existing Building: (check one)
Location of Property: �.�
House No. Street Hamlet
Owner or Owners of Property: a5g�nL„`e, "0
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision , r` y,✓� l Filed Map. Lot:
`i"
Permit No._ 1 -I J Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$ 50
At kLgatur2
SOU��®l
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 G ® Q roger.riche rt(a)-town.southoId.ny.us
Southold,NY 11971-0959 �
®ly&UuNTY,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To- Jemcap SC LLC
Address: 270 Illinois Avenue City: Mattituck St: New York Zip: 11952
Building Permit#: 41041 Section. 113 Block 11 Lot: 18.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Custom Lighting of Suffolk License No:
SITE DETAILS
Office Use Only
Residential X Indoor Basement Service Only
Commerical Outdoor X 1st Floor Pool X
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceding 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 Fixtures Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other equipment: Supply GFCI Protected Power to Above Ground Pool to Include Bonding.
Notes:
Inspector Signature: Date: October 12, 2016
0-81-Cert-Electrical Compliance Form.xls
-01
soulyO6
# # TOWN OF SOUTHOLD, BUILDING DEPT.
co 765-1802
765-1802
lNSPECTION-
I
FOUNDATION 1ST [ ] ROUGH PLBG.
[
]- FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE-SAFETY INSPECTION
[ ] FIRE SISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ CODE VIOLATION r � [ ] PRE C/O
REMARKS: � _ L %PPM/ -� �✓1�!
f� v A i A
DATE INSPECTOR
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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 //��' Survey
SoutholdTown.NorthFork.net PERMIT NO. (J W T Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 171 20 Single&Separate
Storm-Water Assessment Form
2 ` Contact:
Approved ,20/ Mail to:
Disapproved a/c
Phone:
Expiration 120
CT=a9! 'V[R
Building I p cto(GPERMIT
aPPLIC ATION FOR BU D
SEP 2 0 2016 ;Zoe
INSTRUCTIONS
a. 1 Tie completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of p11�ia n o 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,hou o code, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
r
Name of owner of premises ,2
(As on the tax roll or latest deed)
If applicant is a corporation,,-signature of duly authorized officer
(Name and title,,o'f corporate officer)
Builders License No:
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Locattiiyon off land on which proposed work will be done:
House Number Street _ Hamlet
County Tax Map No. 1000 Section r Block c ( Lot ��i
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and inten ed use and occupancy of proposed construction:
a. Existing use and occupancy c e
b. Intended use and occupancy er& A-4a!' 4 C g���
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Worktee,
(Description)
4. Estimated Cost 0 S��r Fee
p (To be paid on filing this application)
5. If dwelling, number of dwelling units V 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 0 Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Slos �umw •r_-� ���,
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front Rear Depth
10. Date of Purchase Name of Former Owner :
• 'F'.viSQ14.'�
11. Zone or use district in which premises are situated
12. Does proposed construction violate anyzoninglaw, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO 1c Will excess fill be removed from premises? YES NO
14.Names of Owner of premise§:k 6, Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* 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
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
r
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)
SS:
COUNTY OrF5,jr� 1
l:5kelfi1 being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
CONNIE D. BUNCH
(S)He is theNotary No 01 i3 tate of New
York
(Contractor,Agent, Corporate Officer, etc.) Qualified in Suffolk County
Commission Expires April 14,2 Nl-o
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
240-1)^ day of AA�20"JU
Notary Public Signature of pplicant
»�r;r
Scott A. RussellA\`�C'JEJE�
IMA NA\(G(1EN11ENT
SUPERVISOR
SOUTHOLD TOWN HALL-P.O.Box 1179 �� rJs Town of Southold
53095 Main Road-SOUTHOLD,NEW YORK 11971 7
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CHASTER 236 - STORMWA.TER MANAGEMENT WORK SHEET
( TO BE COMPLETED BY THE APPLICANT )
DOES THIS PROJECT INVOLVE ANY OF THE E FOLLOWING:
(CHECK ALL THAT APPLY)
Yes No
❑ 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.
❑�. Site preparation on slopes which exceed 10 feet vertical rise to
t 100 feet of horizontal distance-
i ❑[Z[4 Site preparation within 100 feet of wetlands, beach, bluff or coastal
erosion hazard area.
i ❑D E. Site preparation within the one-hundred-year floodplain as depicted
❑ 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.
S.0-T.M. ": 1000 Date
APPLICANT: (Property Owner,Design Professional,Agent,Contractor,Other) District
NAME Section Bock Lot
FCR BUILDING DEP ARTNIENT USE 0JN-Y. "•
Convect tnforrtutiom
Reviewed By: v"
- - - - - - - - - - - - - - - - - — Date: �✓�!+" O
Property Address / Location of Construction Work: —��-- — — — — — — — — —
N-1�/1 Approved for processing Building Permit. — — —
Stormwater Management Control Plan Not Required.
jj Stormwater Management Co�urol Plan is Required.
Ll (Forward to Engineering Department for Review-)
FORM " SMCP -TOS MAY 2014
i
o��OF SO�jly�`
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Toxin Hall Annex ] Telephone(631)765-1802
54375 Main Road y ,,aaxx(631)765- 5p
P.O.Box 1179 G @ roaer.richert LOWn.Sout9015 nv 1!S
Southold,NY 11971-0959 �O !
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY:
Q Date:
Company Name: {-
Name:
License No.:
Address: _ C
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: L C
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
i
(Please Circle All That Apply)
*Is job ready for inspection: YE O Rough In Final'
*Do you need a Temp Certificate: 5
YE ! NO -
Temp 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
82-Request for Inspection Form 1 LJ�_c' I
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Patio,Lawn&Garden>Pools,Hot Tubs&Supplies>Swimming Pools FOR POURED CONCRETE
2-ROUGH—ERAING & PLUMBING
You purchased this item on September 6,2016. 3. INSULATION
Size 12-Feet Diameter by 484nch Deep l View this order 4. FINAL - CONSTRUCTION MUST
-- BE-G0MP-LETE-FOR C.0__
eel 12-ft Round 48-ini(QOWNSTRUC�lli%! SHALL MEET THE
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Blue
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`{ Easy-Oto-Use 12-inSandFilter System with 1/2�P•P m HOUT C E t TI A I CATCH
s�m.�•-^" Sturdy A-Frame Ladder OCCUPANCY• includes fully functional skimmer 0 ut�0,�--R611
• Pool size 12 feet RD 48-inch
• Easy to clean and maintain
• Easy to install and It comes with complete installation
Instructions
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Report incorrect product information UPON COMPLETION
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You purchased this Item on August 30,2016 y
Color Taupe I View this order
NE115T Neptune A-Frame Share
Bm for Above Ground Pool, aty 1 v
Add to Cart
36 customer reviews
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• Exclusive snap together interlock assembly +$4144 shipping
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Total price-$418.62 Storage Device for
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0 This item:Blue Wave NE115T Neptune A-Frame Entry System for Above Ground Pool,Taupe$388 63 - - - -
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0 Hydro Tools 87956 Protective Pool Ladder Mat and Pool Step Pad,36-Inch by 36-Inch$29 99
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Color-Taupe
The best features of a pool step and ladder combine for safe,easy use of your pool in the Neptune A-Frame Entry System.This super-strong
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Product Information
Color Taupe
Product Dimensions 52 x 21 x 86 Inches Warranty&Support
Item Weight 739 pounds Manufacturer's warranty can be requested from customer service Click here to
make a request to customer service
Shipping Weight 73.9 pounds(View shipping rates
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Item model number NE115T
Customer Reviews 36 customer
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Technical Details
Color Taupe
Item Dimensions 86 x 21 x 52 inches
Model Number NE115T
Shipping Weight 73 9 pounds