HomeMy WebLinkAbout46207-Z TOWN OF SOUTHOLD
��o�guFPodK�oGy . BUILDING DEPARTMENT
ca 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#: 46207 Date: 5/10/2021
Permission is hereby granted to:
Burns, William
24975 Main Rd
Cutchogue, NY 11935
To: Construct in-ground vinyl swimming pool as applied for.
At premises located at: � I�-� o f o �
770 Elijahs Ln., Mattituck V
SCTM #473889 DO L N D'r ( �S j f$ LLQ
Sec/Block/Lot# 108.-3-5.9 �- �J J
Pursuant to application dated 4/20/2021 and approved by the Building Inspector.
To expire on 11/9/2022.
Fees:
CO- SWIMMING POOL $50.00
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
Total: $300.00
Building Inspector
1
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TOWN OF SOUTHOLD BUILDING DEPT.
�`ycOUMV��' 631-765-1802
INSPECTION
[ ] "FOUNDATION IST [ ] ROUGH PLBG.
[ .] FOUNDATION 2ND [ ] NSULATIION/CAULKING
[ ] FRAMING /STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL
REMARKS:
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y
DATE "talJl/ INSPECTOR
COIV MNTS
FIELD.INSPECTION REPORT DATE
FOUNDATION(18T) H
FOUNDATION OR)
J
ROUGH FRAMING:&
PLUMBING:
INSULATION.PER N.Y. _
STATE ENERGY CODE
FINAL. .
ADDITION CdN11V1ENT8"
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z
ARTHUR EDWARDS POOL & SPA CENTRE
929 ROUTE 25A
MILLER PLACE, NY 11764
516-744-7185
FAX-744-0174
APPLICATION .FOR A SWIMMING POOL PERMIT: SOUTHOLD
TOWN OF SOUTHOLD
MAIN. ROAD (P.O. BOX 1179)
SOUTHOLD, NY 11971
(631) 765-1802
PAPERS ENCLOSED:
[ APPLICATION FOR OUTDOOR POOL PERMIT
[ CERTIFICATE OF WORKER'S COMPENSATION
[ I CERTIFICATE OF LIABILITY INSURANCE
[ CERTIFICATE OF DBL INSURANCE
[ SUFFOLK COUNTY LICENSE
4 SETS OF STAMPED PLANS
[ 3 SURVEYS with FILTER LOCATION
C.O.
[� TAX BILL
[
$400.00'CHECK FOR PERMIT FEE
g�FFO(
=oma° �co4 TOWN OF SOUTHOLD—BUILDING DEPARTMENT
w Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
oy�o ao� Telephone (631) 765-1802 Fax (631) 765-9502hltps://www.southoldtowm.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT N0. (J Building Inspector:
Applications and forms-must be filled out in their entirety. Incomplete
•rti 5";i`A�
a lications will,not be accepted.. Where.the Applicant is not the owner,ani
pp- p PP
.Owner's Authorizatiori.•form(Page 2)shall be completed.
Date: 15-2
OWNER($)OF PROPERTY:
Name: `Itq rn ��N S SCTM#1000-
Project Address: r?e7()
Phone#: 631-
Mailing
3i.Mailing Address: R 0 , 60X 1 �9,52
CONTACT PERSON: . 0
Name: Ac`t ,x- ijArw On is
MailingAddress: q29 f&- ZS Pr _�lll(.e�- P10 ky
Phone#: (031-7c{4 -11K X- 11 Email: 6PFie e6)fleeG3)S , CZ)m
DESIGN PROFESSIONAL INFORMATION,:
Name:
Mailing Address: t''• I � �>> �fv
Phone#: Email: + 6 1 1 C .aM1
CONTRACTOR INFORMATION: ' yi;,} f:Qic2irnfifgt3'�;,�
Name:
Mailing Address: Z'�-A -
Phone#: e e q
.DESCRIPTION OPPROPOSEWCONSTRUCTION'
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
mother lYl�MJNQ VIA& &JtMMJW9 Pte ) $ do,
Will the lot be re-graded? S�Yes ❑No Pool AfA Only Will excess fill be removed from premises? Xyes E]No
1
PROPERTY INFORMATION
Existing use of property: Pe5-x, dek Intended use of property: Resjeilee
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes XNo IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance-of a Building Permit pursuant to the Building2one
Ordinance of;the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the.construction of buildings,
additions,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(s)for necessary.inspections.False statements made,herein are
punishable as a Class A misdemeanor pursuant.to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): ONLsAlan171e-nS ❑Authorized Agent Kowner
Signature of Applicant: - -�---_ ,� Date: 1q-15-2�
STATE OF NEW YORK)
SS:
COUNTYOF
(Na5 han &''cN S being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the O Nom'
(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/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of AxIl , 20�2 1
Notary Public
MARGARE-F A. KIDNEY
Notary Public—State of New York
No. 01 K1602 I I I
Qualified.in Suffolk County PROPERTY OWNER AUTHORIZATION
4y'Commission Expires March S,2=1 (Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
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---------------------
NYSIF199 CHURCH STREET,NEW YORK,N.Y.10007-1100
Now York State Insurance Fund I nysif.co[n
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
® ...
^^^^^^ 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 I CERTIFICATE NUMBER POLICY PERIOD DATE
G 2438 491-9 308232 06/29/2020 TO 06/29/2021 06/18/2020
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: 730432298
IlmiIll000000000000834516925gillilIII
Form WC-CERT-NOPRINT Version 3(08/29/2019)[WC Policy-24384919] U-26.3
57 [ONNOO0000083456925][0001-000024384919][##G][35408-10][Cen—NoP-CEKr-1][01-MI]
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MAIN ROAD
N.Y. S. /?/ 2,5
SuFrou 001rnTY 11RA ,TR DRTARTAIEft SURVEY FOR
6REEl�BR/A�R HOAfES,INC. OCr. 24, /979
DATE H. D. IMF. �'' LOT m?. S G#EENBR/AR ACRES AUG. 27, /979
Tho9 Igqq� '�'`"s o "s AT MATT/TUCK DATE= JUNE 5, 1,079
ae AF't .j. dj:;P(). tl trirl cpll-ell Sun-ply TOWN (* SOUM01-rD SCALE' / " = 40
faciz; �.ta•T f n,' tt,I;, le,;;�- ;ei2 112 ve been NO. 79 - 316
In"3p,cct.ccl h,r f,tq ate- SUFFtILK COUNTY, NEW YORK
to ho SEtc :s�'rlctoTy, t ?"DID fjlv`tz) fo
/"� *UNAUT;HORIZ.ED ALTERAtION OR ADDITION TO THIS GUARANTEED TO
SURVEY,ISA VIOLATION 0#SECTION 7200 OF THE
' � ! NEW YORK S: ATIL EOUCATI N LAW M4t1FET/TLE/A(5MRANCECOJVP.4NYOF
Chief of C'a�,Cr�tl T:t2l;i��e®rip *COPIE�9 OFF THIS SURVEY!NOT BEARING THE LAND NEW YORK
($ SURVEYOR''* INKED SEAL OR EMBOSSED SEAL SHALL SWrHOLD SAV/NGS BANK
Services NOT St jL0 IDERED TO BE A VAL10 TRUE COPY
*GUAR , T S INOIWED HEREON SHALL RUN ONLY TO JOHNJ.Q BLANCHER.6/OVANELL/
HEALTH DEPARTMENT-DATA FOR APPROVAL TO CONSTRUCT THE PESO FOR WAOM THE SURVEY IS PREPARED
AND ON;HISREHAO TO TIDE TITLE COMPANY,GOVERN-
*NEAREST WATER SAINd-MI.t *SOURCE,OF WATER• PRI%AtTEZIPUBLIC_ MENTAL'AGINCY AND LENDING INSTITUTION LISTED i� OF Nor
*SUFF CO. TAXMAP DIST/?A�SECTIONBLACK—..LOT 02.2 HEREON ANO TO THE ASSIGNEES OF THE LENDING SSP
*THERE ARE NO DWELLINGS WITHIN 100 FEET OF THIS PROPERTY Q pTU X0W GUARANTETEARE
A ORNOT TRANSFERABLE D r0�
OTHER THAN THOSE SHOWN HEREON TO AQOOWNCRS
* ENT
THE WATER SUPPLY AND SEWAGE DISPOSAL SYS EM FOR THIS R IDENCE- *D1STA(ICES SHOWN HERION FROM PROPERTY LINES
WILL CONFORM TO THE STANDARDS 0 THE SUFF LK COUNTY7-wo' 'A
MENT TO EX IS INGF STRUCTURES ARE FOR A SPECIFIC
OF HEALTH SERVICES 0)
PURPOSE AND ARE NOT j0 BE USED TO ESTABLISH
APPLI ANT' / PROPERTY LINES OR FOR THE ERECTION OF FENCES
tilt airmists
854. Rebin • �� �I� � ENUE
BaidVAR, Now York 11%9TEL -223_,566 YO U N G a YO U N G
SUYORK
ND R`L`'
NOTE ALDON W.YOUNG,PROFESSIONAL ENGINEER
SUBD/VISION MAP FILED/N rW OF#WEOFTHECLERK AND LAND SURVEYOR N YS UCENSE NO.12845
OF SUFFOLK COUNTY ON OCT. 7, /977 AS MAPNO.6609 ;
HOWARD W.YOUNG, LAND SURVEYOR
iE THE LOCATION OF WELL(W),SEPTIC TANK(St)b CESSPOOLS(CP)SHOWN HEREONN.Y.S'LICENSE NO.45893
ARE FROM FfELO OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS
TOY POST 1"d-24
JL. ...H ! 4 L .. ;2..f t.II.I..a4 i..,Ila
9—o ,� ,
AS NOTED
�:OCCUPANCY OR
APPROVEDI.SE IS UNLAWFUL
DATE: 5-7A B.P.
FEE: BY: n KOUT CERTIFICATE
NOTIFY BUILDING DEPARTMENT AT -X OCCUPANCY
765-1802 8AM TO �)U FOR THE
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
:FOR POURED CONCRETE
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTiON MUSS �o
BE COMPLETE FOR :,.0. �M�EsD�'A�T��-x„
ENtLM- tt P60L To;c(,DDE
ALL CONSTRUCTION .S"Al-L MEET THE UPON CC3moLtho ,
t
REQUIREMENTS OF THE�7DES OF NEW BEFORE""WAVER",
YORK STATE. NOT RESPONSIBLE FOR `
DESIGN OR CONSTRUCTION ERRORS.
COMPLY'WITH ALL COMES OF
NEW YORK STATE & TOW'v CODES
AS REQUIRE AND CONDITIONS OF -
SOUTHOLD TOWN?�A
SOUTHOLD TOWN PLANNING-BOARD
SOUTHOIDTOWNTRUSTEES RETAIN STORM WATER RUNOFF
N.Y.S.DEC PURSUANT TO CHAPTER 236
OF THE TOWN CODE.
A
B
Skimmers Returns
D
B µ0 B _ Aluminum
E- -F / ..
To Filter From Filter
Filter& Pump
To Waste To Returns
(Dry Well Optinal)
Rolled Wall Foo
Plan A Piping Arrangement
Wall Section
Vinyl Una r /4 Rebar
of NEW yo
42" `�' O.
Section L—L 3500 P.S.I. Concrete y l W
2• San 7� ,
0
�
10" s
FES_-- i
Section A—A Typical Wall Section
SIZE A B C D E F G H AREA CAP.
FEET FT. FT. FT. FT. FT. FT. FT. FT. SQ.FT. GAL. Purchases
15x30' 15' 30' 8' 12' 6' 4' 4' 7' 450 16,000 ARTHUR.EDWARD► ��� G�I �e��s Lr�
POOL&SPA CENTRE. Address l�
6 x36 M6 36 1 ' 4' 6'- 4' 8' 76 21,600
PERMACRETE .WALL .SYSTEM �t �I-E��CIC State
18'x36' 18' 36' 12' 14' 6' 4' 5' 8' 648 24,300 929 Route 25A 'Mi_ller.- Place NY 11764
20'x40' 20' 40' 16' 14' 6' 4' 6' 8' 800 30,000 (631)' 744-7165 FAX:(631) •744-0174 Phone Zip ase 1195
24'x44' 24' 44' 18' 14' 8' 4' 6' 10' 798 30,000 Suffolk License #4436-HI
Nassau License H174450000
24'x48' 24 48 20 16 8 4 6 10 900 30,000 #