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Home My WebLink About44440-Z ��o�SuffOi,f y Town of Southold 10/9/2021 i} P.O.Box 1179 y 53095 Main Rd o +`� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 42422 Date: 10/9/2021 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 27840 Route 25, Orient SCTM#: 473889 Sec/Block/Lot: 18.-6-21.7 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 11/12/2019 pursuant to which Building Permit No. 44440 dated 11/20/2019 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: accessory in-ground swimming pool fenced to code as applied for. The certificate is issued to Fargo,Linda of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 44440 1/26/2021 PLUMBERS CERTIFICATION DATED J 1^1 . WOA� A h riz 0 ignature o�SUFEnt,r�o+ TOWN OF SOUTHOLD BUILDING DEPARTMENT z 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#: 44440 ' Date: 11/20/2019 Permission is hereby granted to: Fargo, Linda 14 Sutton PI Apt 10D New York, NY 10022 To: construct accessory in-ground swimming pool as applied for. r At premises located at: 27840 Route 25, Orient SCTM # 473889 Sec/Block/Lot# 18.-6-21.7 Pursuant to application dated 11/12/2019 and approved by the Building Inspector. To expire on 5/21/2021. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 jotalotal: $300.00 Bui specto 1 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$15..00 C Date. zl� New Construction: Old or Pre-existing Building: _ (check one) Location of Property: `�� House No. 11 ` Street Hamlet Owner or Owners of Property: l�`�/� C FCT Suffolk County Tax Map No 1000, Section I Block 6 Lot c� Subdivision Filed Map. Lot: Permit No. a Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary /r°XJificate Final Certificate: UecK ) Fee Submitted:$ Applica gnatu e I Building Department Application �J AUTHORIZATION (Where the Applicant is not the Owner) residing at `� (Print property owner name) (Mailing Address) do hereby authorize (Agent) to apply on my behalf to the Southold Building Department. 2— 1 (Owner's Signature) (Date) D (Print Owner's Nam(,-),/ of So Town Hall Annex .,>;Y a ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 '� �� roger.riche rt(a_town.so utho Id.ny.us COU6 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To Fargo Address: 27840 Route 25 City- Orient St: New York Zip: 11957 Budding Permit* 44440 Section: 18 Block: 6 Lot: 21.7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: REP Electric License No: 46288-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st 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 Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment, In ground swimming pool to include, bonding, control panel, 1-pool pump (220), gas pool heater(240-V),4-pool lights, 1-GFCI circuit breaker, 1-GFCI recpticle, 1-time clock Notes, Inspector Signature: Date: January 26 2021 81-Cert Electrical Compliance Form As OF 50(/l�o� # f TOWN OF SOUTHOLD BUILDING DEPT. �yco 765-1802 D INSPECTION (Aq [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE'RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE INSPECTOR - 1 OE SOUIyO� - - t # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 - INSPECTIO=N, [ ] FOUNDATION IST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] SULATION/CAULKING [ ] FRAMING/STRAPPING [ FINAL�oot� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY-INSPECTION [ ] fIRE RESISTANT CONSTRUCTION - [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 0 1411W - I " LL11--_ C/ ga oe: I VM�AW//i �W4000XA t 1/- v � DATE SOY( INSPECTOR el aIOH.Lno s 3O NMOL 1d34 ONldllfl8 Izoi Q z d3s Cl k = r-.,s ` r 1 !M � \ t 4`< QZ l r � F 1 1 pp7'+ f � � Jeffrey Sands Architect August 6, 2021 Fargo Residence 27840 Main Road Orient, NY 11957 RE: Swimming pool rebar inspection 141D9W%�ILI-LL— Attention Town of Southold Building Department: Upon inspecting swimming pool rebar and drywell at the above mentioned property I find all to have been installed to meet current building code requirements. Sincerely, ED R �� 2N C7 J� 0,0789 q �OQ� OF N E\N Jeffrey Sands Architect 6 Evergreen Lane, East Quogue, New York 11942 phone-631-375-5997, fax, 631-576-8916 email—ieffrey sands@hotmail.com �s>>INSPECTION REPORT I DATE COMMENTS iL FOUNDATION (IST) -------------------------------------- FOUNDATION (2ND) � ® cn ROUGH FRAMING& �y . PLUMBING - a INSULATION PER N.Y. y STATE ENERGY CODE MIA act W Q'L, ., I/ oeqQW foow FINAL ADDITIONAL COMMENTS C UA-1— ° g z N � I y O z ,may 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 q�6 Survey Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application �) ff Flood Permit_ _ Examined20 Single&Separate Truss Identification Form w"t t 4�.�. ; ', Storm-Water Assessment Form ht�a Contact: \ \� Approved v 20 L , t Mail to: PIA C 1G—��11 f_ 1 Q Disapproved a/c �,a ��v 1 5 � J Dcn�1,.r ManOpJl�l2-�J _ a �' Phone: 631- Expiration 2 rz;,,:t B nspector APPLICATION FOR BUILDING PERMIT oc )�P_Muj 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. ' '. 1 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 HEREBYMADE 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. (Signa re Vf applicant or name,if a corporation) (Mailing address of applicant) State whether a lIC4 tisDoner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 7Nam=e off owner of premises As on the tax roll or latest deed) n lica i a cor oration signature of duly authorized officer -- (%'et- A1w40, 6F (Namefand title of corporate officer) Builders License No. Plumbers License No. Electricians License No. b-X13 Other Trade's License No. 1. Location of land on which proposed work wil be done: House Number Street Hamlet Ma No. 1000 1=skl7;t:rCl _ s :► tp r � .County Tax p Section ,, Blyoc ,�,w yy,,:+,c,,� ,. -^,Lot ➢`.'1{,_.l;`�7'is :'Sr w°I(1_:'.'�i&Py�_•- Subdivision Filed Map No. Lot 2. State existing use and occupancy of premiss and 'ntended use and occupancy of propose construction: a. Existing use and occupancy S c-� .�Mr-e- 5��7 b. Intended use and occupancy S°`''�� ' M� 730\ 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work\f [N)10AP �r . 00 (Description) 4. Estimated Cost� E ,�� Fee (To be paid on filing this application) If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars If business, commercial or mixed occupancy, specify re and extent of each type of use. �1P Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 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 11. Zone or use district in which premises are situated D l� 12. Does proposed construction violate any zoning law, ordinance or regulation?YES NO 13. Will lot be re-graded? YES NO 2!�Will excess fill be removed from premises?YES NO 14.Names of Owner of premises 1,tn� Address 2T$L% AM\4't�k Phone No. Name of Architect F Address et,`L✓ � bone No 431 T-75 S Name of Contractor � �eA SAddress V�Iky-04 hone No. L5( S90i--65 9 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. 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: V COUNTY OF �I �`C 0 NA "��i-� J(, being duly sworn,deposes and says that(s)he is the applicant (Name of individual si ning contract)above named, (S)He is the (Contractor,(Agent, orporate 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 day of 0Vt W 20-B— 0 Notary Public L. DWYER Sign of Applicant OTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2 Da Scott A. Russell ��'°SuIFIXk1G STO]KI�MIWAT]E]k SUPERVISOR - MANAGEMENT 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 ) DOLES THIS II'II8OJECT INVOLVE ANY OF THE IFOI,WWi[NG: Yes No (CHECK ALL THAT APPLY) 00"'A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 Square feet of ground surface. ❑[a/B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. E3[.3/ 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. EIM E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. ❑ 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. APPLICANT (Piopetty Ownei,Design Profes>to al,Agent,Conti actor,Other) S.C.T.M. *: 1000 Date NA`1E t�/{� J G ",avs Diwict —6 ^tt Section Block Lot- ****FOR BUILDING DEPAR"I•MEN'r USE ONLY**** Contact Information �o1�ft�L— W reQphnrc\umkn Reviewed By Property Address/Location of Construction Work: — — — — — — —Datc:— — — — — — — — DM �� ll 5� Apptoved foi processing Building Pet mit Stormwatei Management Control Plan Not Required Storm\Later Management Control Plan is Required. (Forwatd to Engineering Department foi Review.) FORM * ,SMCP'-TOS MAY 2014 o�oco fFOZA- i DVlk[DG DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD y� 6EP 8 Mn Hall Annex - 54375 Main Road - PO Box 1179 CD o - Southold, New York 11971-0959 y or BU11,DWG WLphone (631) 765-1802 - FAX (631) 765-9502 rogerr(cD-southold town ny.gov – sea nd(a-�southoldtownny.gov APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INF " MATION (All Info do Re irted) Date: MZ_0 z0 Company Name: % L 1 /V Name: ! G 1 �=- L*C� L L,�=— 2iP Plf-C-f/ License No.: q62 �� V► email: Address:, _Sov"6' a: �L - -- - ---- ----- -------- --- - - -- - - - - Phone No.- G s' JOB SITE INFORMATION (All Information Required) Name: E - Address: b Cross Street: P Phone No.: 3 ) 6 7 6 Bldg.Permit#: q /1/0 email: 12 F /�c ` �d i' AIL- , co,� Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) Circle All That Apply: Is job ready for inspection?: 01\10 Rough In Final Do you need a Temp Certificate?: YES /� Issue 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: In 00 U d /0Z) PAYMENT DUE WITH APPLICATION �I�g n^ n UU Request for Inspection Form As 'D SUR\/EY OF PROPERTY 51TUATE: ORIENT TOWN: 5OUTHOLD N ' 5U1+FOLK COUNTY, NY SURVEYED 06-28-2019 W E SUFFOLK COUNTY TAX # "T 1000 - IS - 6 - 21.-1 S GERTIFIED TO: Lisa Fargo First American Title Go. Santander Bank, NA C N , Qo yy op y � T i ra \ •_c�O 1 . v o 'Po o 710 \ i 01, 011 p� �CA i �r%-*weld to—umw dolowio A' "a wYork Lot NOTES: ` " ao.r. a r� Ir MONUMENT FOUND r n�ra tiime�rr O PIPE FOUND �`� LAND S�. Top a .- o�oo.�r IMCI r r.ru. i Area = 85,638 50 FT OR 220 ACRE5 JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LTC.NO.50202 GRAPHIC SGALE I"= 50' RIVERHEAD,N.Y.11901 631-369-8288 REF.C:\UsusUo1d\Docameut9\My Dropbox\19\19-139A.pro rORK Workers' CERTIFICATE OF Board STATE Compensation NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1 a.Legal Name&Address of Insured(use street address only) 1 b.Business Telephone Number of Insured Patricks Pools Inc 631-996-4687 PO Box 3024 _ East Quogue NY 11942 1c.NYS Unemployment Insurance Employer Registration Number of Insured Work Location of Insured(Only required if coverage is specifically limited to certain locations in New York State,i.e.,a Wrap-Up Policy) 1 d.Federal Employer Identification Number of Insured or Social Security Number 262929943 2.Name and Address of Entity Requesting Proof of Coverage 3a.Name of Insurance Carrier (Entity Being Listed as the Certificate Holder) Wesco Insurance Co Town of Southold 3b.Policy Number of Entity Listed In Box"l a" 54375 Main Rd. WWC3419103 PO Box 1179 Southold,NY 11971 3c.Policy effective period 05/1312019 to 05/13/2020 3d.The Proprietor,Partners or Executive Officers are E] included.(Only check box d all partners/officers included) QX all excluded or certain partners/officers excluded. This certifies that the insurance carrier indicated above in box"3"insures the business referenced above in box"1 a"for workers' compensation under the New York State Workers'Compensation Law.(To use this form,New York(NY)must be listed under item 3A on the INFORMATION PAGE of the workers'compensation insurance policy). The Insurance Carrier or its licensed agent will send this Certificate of Insurance to the entity listed above as the certificate holder in box"2". The insurance carrier must notify the above certificate holder and the Workers'Compensation Board within 10 days IF a policy is canceled due to nonpayment of premiums or within 30 days IF there are reasons other than nonpayment of premiums that cancel the policy or eliminate the insured from the coverage indicated on this Certificate.(These notices may be sent by regular mail.)Otherwise,this Certificate is valid for one year after this form is approved by the insurance carrier or its licensed agent,or until the policy expiration date listed in box"3c",whichever is earlier. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.This certificate does not amend, extend or alter the coverage afforded by the policy listed,nor does it confer any rights or responsibilities beyond those contained in the referenced policy. This certificate may be used as evidence of a Workers'Compensation contract of insurance only while the underlying policy is in effect. Please Note:Upon cancellation of the workers'compensation policy Indicated on this form,if the business continues to be named on a permit,license or contract Issued by a certificate holder,the business must provide that certificate holder with a new Certificate of Workers'Compensation Coverage or other authorized proof that the business is complying with the mandatory coverage requirements of the New York State Workers'Compensation Law. Under penalty of perjury,I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Nicholas Zulkofske (Pont name of authonzed representative or licensed agent of insura�n/co tarn/ar Approved by: ZO��1 (Signature) (Date) Title:Authorized Agent Telephone Number of authorized representative or licensed agent of insurance carrier. 631-941-4113 Please Note:Only insurance carrier-and their licensed agents are authorized to issue Form C-106.2.Insurance brokers are NQI authorized to Issue it. C-105.2(9-17) www.web.ny.gov k2APPRO ED AS NOTED DATE4FEE: BY: RETAIN STORM WATER RUNOFF NOTIFY BUILDING DEPARTMENT AT PURSUANT TO CHAPTER 236 765-1802 8 AM TO 4 PM FOR THE OF THE TOWN CODE. FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO 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 NEW 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 SOUTHOLD TOWN ZBA SB�r16taT6vtlN NNIpJGBOARD `'sroa MileM HA` ELY" EtVCLOSE POOL TO CODE cSQUTWO�STEES �''UPON COMPLETION OCCUPANCY OR USE IS UNLAWFUL WITHOUT CERT IFICATi OF OCCUPANCY _.. .. A Ao t� � J t � �"` W 4x..� r 1 _.,.._+.........,........�......+w.......m...�.+.-.rx�...�,...�..ww�rnrwurw...,�......«w.a,�., ,.z„..r.�.«a......v.......r_... � 1 i 4 11 � • 3 y y f ARC Cr' APSPx S TM waoervttas N • ` C �' g� . 3 EOF !� o�bkk Keeaey CDP ��