HomeMy WebLinkAbout28495-Z FORM NO. 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 28495 Z Date JUNE 25, 2002
Permission is hereby granted to:
CAROLYN SERBES
640 N BAYVIEW RD
SOUTHOLD,NY 11971
for
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR
YARD AS APPLIED FOR
at premises located at 640 NORTH BAYVIEW RD EXT SOUTHOLD
County Tax Map No. 473889 Section 078 Block 0009 Lot No. 042
pursuant to application dated JUNE 24 , 2002 and approved by the
Building Inspector to expire on DECEMBER 25, 2003 .
Fee $ 150 . 00
Z
th ri Signature
COPY
Rev. 5/8/02
FIELD INSPECTION REPORT DATE COMIVIL+NTS
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FOUNDATION (IST) y
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FOUNDATION(2ND)
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ROUGH FRAMING& S
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PLUMBING
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INSULATION PER N.Y.
STATE ENERGY CODE
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FINAL
ADDMONAL C0M1'l1 M
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BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: vS'!2(1`/02
APPLICANT: CAKxt�o t5E�s DATE SUBMITTED: es /,x/02
SCTM#DISTRICT: 1,000, SECTION: BLOCK: LOT:
AV
STREET ADDRESS:-��b /�'� ��'��� ;����°`'� CITY: _c�nyQzn
SUBDIVISION: 149
PROJECT DESCRIPTION: .��p
ESTIMATED PROJECT COST: ARCHITECT/ENGINEER: A114 FAST TRACK?
SINGLE & SEPARATE CERTIFICATION-REQUIRED? NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREAT''EE/D before June 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/.
ZONING DISTRICT: �'7d CONFORMING? ('
REQ. LOT SIZE: ova ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV
REQ. FRONT 1'-' PROP. FRONT --REQ SIDE ACT. SIDE
REQ. REAR PROP. REAR REQ. HEIGHT �, PROP. HEIGHT
WATER FRONT? 410 DESCRIPTION:
PANEL #: -- 9, FLOOD ZONE: ,
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTH T: YES , , O BED#): DTE: / / PERMIT#:R10-
TOWN SEPTIC RECEIPT: Y
NEW YORK STATE DEC: P c 9/1/75 YES of 1)
SOUTHOLD TOWN TRUSTEES: YESor
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES or
TOWN HISTORICAL PRE (SPLIA): YES r
NYS ENERGY: YES OR NO
EGRESS (18 H min.?4 sq total) VENT(SQ. FT. x 45LIGHT(SQ. FT. x 8%)
BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- ,
HAVE PRE CO'S : Y OR N BP -Z/C/0 Z- ,
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
1. ( SF)-( SF)= SFX$ =$ +$ +$ = $ I'
2. ( SF)- ( _SF)= SFX$ =$ +$ +$ = $
TOWN'01' SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING.DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11971 3 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
PERMIT NO.�8�� �� Check
Septic Form
N.Y.S.D.E.C.
2
Examined /,�
,20 Contact:Trustees
Approved r S 1202--' Mail to:
Disapproved a/c
Phone: - W3 3
Expiration ,20
f Buildi g Inspector
I JUN 2 4 2002 Li
A LICATION FOR BUILDING PERMIT
. Lo J U 1110, z( �Z
Date 20
INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Buildg 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 pr 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,housing code,and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
NMI 00AL
(Signature of applicant or name, corporation)
(o? Y) 0V
(Mailing address of applicant (( 7
State whether applicant is owner, lessee, agent chitect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises
(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.� - �s — H T-
Plumbers License No.
Electricians License No. 5 0 7? E
Other Trade's License No.
1. Location of land on which proposed wrk will be done:
O N.
House Number Street Hamlet
County Tax Map No. 1000 Section j Block O Lot y
Subdivision Filed Map No. Lot
(Name)
i
2. State existing Use and occupancy of premises and intended use and occupancy of proposed constructio
a. Existing use and occupancy j +
b. Intended use and occupancy_
3. Nature of work(check which applicable): New Building Addition
Repair Alteration
Removal Demolition Other Work
4. Estimated Cost i3 ppQ. °° Fee (Description)
5. If dwelling, number of dwelling units Number of dwelling units be
each floor filing
this application)
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 Number of Stories
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front /5L• 2 Z Rear NO Or 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 NO 1,
13. Will lot be re-graded? YES J NO Will excess fill be removed from premises? YES ,✓ NO
4 0 N 6w v��w 64.
14. Names of Owner of premises Ca/-01 n SQr�zs Address Sov}1,01 Phone No. 63/-
Name of Architect Address Phone No
Name of Contracto i YN Address `"'f�`,it, °` Phone No. 43/ k 7 y 4k3-3-
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO 7C
* IF YES, SOt.THOLD 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.
STATE OF NEW YORK)
SS:
COUNTY OF )
Name of individual signing contract)above named,being duly sworn, deposes and says that(s)he is the applicant
(
(S)He is the
(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
5 t day of y KJ, 20�
L6
Notary Public Signature of Appli t
EILEEN MUSARRA
Notary Public-State of New York
NO.01 MU6057891
Qualified in Suffolk county
My commission Expires Apr 30,2 d
DE TAI L A
WALL BRACE ASSEMBLY DETAIL
/ 1 1/z' .143 s i I AGA.
GAL41& ANGLE
1- — — —
14
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I I' _( I STEEL�WAALL PANE
I I L Q�6.I ( 42- Cn7gE LMIOISTUROEO EARTH
I I WALL BRACE ASSEMBLY
I I i
2• BOTTOM MATERIAL PLATE
4 TE a 12-
BFANNC
C�,J PA i C g E t 3/8' REGAR
UNDERWRITERS CERTIFICATE '
REQUIRED : , 1 1/2• . 2a- . 1s GA.
" ,� a',: 3 r CAI vN�IzEo ANGLE
s �, %j$ E S s '4 i L NOTE:BACKFILL TO BE SAND. GRAVEL.
APPROVED AS� �;`' OR OTHER NOW EXPAWSNE MATERIAL
tif OCCUPANCY
I 13=. ;�DETNL A q
NOTIFY 13UILDING D \ —T-
O 4 PM FOR TME 1 T K
FOLLOWING INSPECTIONS: `
1 1:011 �W�O—R�iREW ----- - - - - _ � G - - - - - - - - - �—
FO!?P')URED C
" 1UH - FR MING & PL
a 114SULATION
4. FINAL - COh STRUCTIONDMUST 1 E F �'LJJ— F
� �LU��1 L MEET
�'t�
"IMMEDIATELY"
P 4►N F G H J K L ENCLOSE POOL TO CODE
12 1 6 2-6- 7 3-6- 16-10- UPON COMPLETION
14 6 6 2 6 9 3'6— 29'5 3/8 BEFORE "WATER"
16 x 2 16 2 4 8 4 8 36 59 1 4
16 x36 16 36 12 14 6 4 8 4 8 36 39434
18 x 1 6 12 14 8 4 4 '° 6 40 3 CARDINAL SYSTEMS
20' x -40 0 40 14 14 8 4 8 4 12 3 6 44 8 5 8
NOTE-
20111 20B s R 41 (717) 1*1-4733
CAROwL SYSTEMS IS NOT RESPONSIBLE FOR T14E WTEWOR OIG SPED ATIONS ILLUSTRATED ON SCIN1riXR1 lNVE71. PA. (717) 365-13/6 FAX.
TMS ORMOIIG. TNEV SHOUI.O BE VERIFIED BY THE UKR wwXACTURER TO K s BOARDS IF OWC ° 2-18-99 7 ` 6" R. CORNERS
H.S P.1 AND A."A STANDARDS-
OR SLICES ,TLE TO K MC WITH CONKL •S WSTRU 10d R ECTAN GI.E
RDS
AND THE NATIONAL SPA AND POOL INSTITUTES MINIMUM STANOAROS PRIOR TO NMING ING N N
BOAOR SAES ON THESE POOLS. FOR WOMMTeII CONCERNING NSM wMMUM STANDARDS. MR: _1_ ppm. n f\ nu Now! Plrn"rr-%M %
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