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HomeMy WebLinkAbout49354-Z �o�g�EFnt,��pGy Town of Southold 7/22/2023 P.O.Box 1179 o _ .1 53095 Main Rd o +' Southold,New York 11971. y,fro a�fr CERTIFICATE OF OCCUPANCY No: 44353 Date: 7/22/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 630 N Sea Dr, Southold SCTM#: 473889 Sec/Block/Lot: 54.-5-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/19/2020 pursuant to which Building Permit No. 49354 dated 6/9/2023 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 Leo,Peter of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 45383 4/22/2021 PLUMBERS CERTIFICATION DATED A iz gnature ��o�S�FFQ �o TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY poi as., 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#: 49354 Date: 6/9/2023 Permission is hereby granted to: Leo, Peter 114 Radcliff Dr East Norwich, NY 11732 To: (Replaces BP#45383) construct accessory in-ground swimming pool as applied for with flood permit. At premises located at: 630 N Sea Dr, Southold SCTM #473889, Sec/Block/Lot# 54.-5-16 Pursuant to application dated 10/19/2020 and approved by the Building Inspector. To expire on 12/8/2024. Fees: PERMIT RENEWAL $200.00 Total: $200.00 Building Inspector �soFFnc,��, TOWN OF SOUTHOLD 41 BUILDING DEPARTMENT TOWN CLERK'S OFFICE o . SOUTHOLD, NY 0 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#: 45383 Date: 10/27/2020 Permission is hereby granted to: Leo, Peter 114 Radcliff Dr East Norwich, NY 11732 To: construct accessory in-ground swimming pool as applied for with flood permit. At premises located at: 630 N Sea Dr, Southold SCTM # 473889 Sec/Block/Lot# 54.-5-16 Pursuant to application dated 10/19/2020 and approved by the Building Inspector. To expire on 4/28/2022. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 lood Permit $100.00 Total: $400.00 'Iding I spector 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. N New Construction: Old or Pre-existing Building: (check one) Location of Property: 3 6 / lor-k J c, _5—C't'L House No. Street Hamlet Owner or Owners of Property: + /e_&r L-16 Suffolk County Tax Map No 1000, Section y Block 05- Lot Subdivision Filed Map. Lot: Permit No.-In Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: / Request for. Temporary Certificate Final Certificate: (/ (check one) Fee Submitted: $ LJp Applicant Signature pF SO�ryol Town Hall Annex ~ Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 c Q sean.deviinCaD-town.southold.n us Southold,NY 11971-0959 y' COUNT`I,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Peter Leo Address: 630 N Sea Dr city:Swouthold st: NY zip: 11971 Building Permit#: 45383 Section: 54 Block: 5 Lot: 16 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: LC Electric License No: 38043ME SITE DETAILS Office Use Only Residential X Indoor Basement Service 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 Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer 300W UC Lights Dryer Recpt Emergency FixtureTime Clocks Disconnect Switches 4'LED Exit Fixtures Pump 1 Other Equipment: Intermatic Pool Panel, Pump on 220GFI, Lights 120GFI, Pool Cover 120GFI w/ Key Pad, 30OW Tranny, Intellichlor Salt Generator, Heater, Water Bond Notes: Pool Inspector Signature: �� Date: April 22, 2021 S.Devlin-Cert Electrical Compliance Form.xls OF 50GTy0� I"� -5383 YJ '30 M G me # # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 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)- [ ] CODE VIOLATION [ ] PRE C/O REMARKS: DATE l 2 INSPECTOR OF SOUIyo� I N,` EE - * # -TOWN OF SOUTHOLD BUILDING DEPT. co765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION/CAULKING [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE'SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) n2T ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARKS: 72S CA/ cf l� DATE ''1i `LI INSPECTOR �^' �J OF SOUTyO{o # # TOWN OF SOUTHOLD BUILDING DEPT. °ycouffo", 631-765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULA N/C ULKING [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ CODE VIOLATI N [ ] PRE C/O [ ] ,R/(ENTAL REMARKS: �'°� � Yff� VI✓4, rti t 9 ova �i� ~ 0 w Frz)puj� CPJ\A zs�o V� 5 k--J�d ,�LA,6t� DATE Y INSPECTOR OF SOUTyO� v11 f # TOWN OF SOUTHOLD BUILDING DEPT. `ycourm,��' 631.765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2NDXFINALA SULION/ AULKING FRAMING /STRAPPING [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O [ ] RENTAL REMARKS: l!/ G� ✓�P/l, . h11(/4� I�j� �� DATE 'Y INSPECTO Pontino, Susan From: Paul Kaplan <pkaplan@nhos.com> Sent: Monday,July 3, 2023 3:21 PM To: Pontino, Susan Subject: [SPAM] - Fwd: 630 North sea drive Sent from my iPhone 1 Begin forwarded message: From: Paul Kaplan<pkaplan@nhos.com> Date:July 2, 2023 at 10:34:58 AM EDT To:connieb@southoldtownny.gov Subject:630 North sea drive Fence has been replaced on deck, 10 wire from disconnect in basement ceiling fixed and combo smoke replaced in basement. Please send a copy of sign off. Thanks Sent from my iPhone ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i '3 S , t. a r ti r • 1. T 1 1 i JIM kN r- 4FV40 . • r �f,�rr' k i' Y3�. is r 4L l l: i j LR FOUND. • ----------- ROUGH"FRAMING& MUMBING • • DIM WME.1 A I CA tol C t MW �A ST,In d,MIR 11m. , T, ' -� o AL 111 da r� _ QT r�� I i 0 N 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 Southoldtownny.gov PERMIT NO. Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined � 20_ Single&Separate Truss Identification Form Storm-Water Assessment Form ` II'' Approved Contact: ,20 Mail to: 5 JQ5�(I1S U Disapproved a/c ToBny f 33I ar,Ir, 4 A CX4�S 14101: 1Vt-1 l lcl`I(c, Expiration 20 3 a y -_7€4`-i `V, j 1 Building Inspector OC-T- 19 2020 APPLICATION FOR BUILDING PERMIT q !a I`'T a,.' :�';: o Date / Z 20 Z V r��I ,ID 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. 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. (Signature of applicant or name,i a co ration (Mailing addresd of applicant) State whether Applicant is owner, lessee, adren_t, areb tett, engineer, general contractor, electrician,plumber or bailder Name of owner of premises - (As-on the tax roll or-latest-deed) If applicant is a corporation, s'gnature of dul uthorized officer (Na and title corporate officer) Builders License No. f {� Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will e done: 6'-,p 0 House Number Street Hamlet County Tax Map No. 1000 Section -s!/ Block or Lot J� Y Subdivision Filed Map No. Lot 2. State existing use and occupancy of premise and intended use and occupancy of proposed'construction: a. Existing use and occupancy An -� b. Intended use and occupancy fes,4&J,of 3. Nature of work(check which applicable):New Building Addition Altt radon Repair Removal Demolition Other Work Sim, 'n , c I escription) 4. Estimated Cost _7Z 000 Fee (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. 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 Rear 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 13. Will lot be re-graded?YES NO Will excess fill be removed from premises?YES NO f� 14.Names of Owner of premises paw- Lem Address 63D &A r' ., fel Phone No. sl Name of Architect Address Phone No Name of ContractorP""N r All Address)°P Asp 133-1 a.¢Phone No. A-Y I-7 2J' v r( 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NOy * 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) SS: COUNTY OF_S 6�— ._-"wN(1(-�.Qn-5 - __ •.--bein ,dul •sworn,de oses and sa s that s he is the a 1icant S� g Y P Y ( ) PP (Name of individual signing contract)above named, (S)He is the - J 'n-t J (Contractor,Agent,Corporate Officer, etc.) of said owner or owners, and is duly authorized to perform&*lgye performed the said work and to make and file this application; that all statements contained in this application are $` �J� Q►yis knowledge and belief; and that the work will be performed in the manner set forth in the applicatialt J rey ri • Sw to before me thi day of a Q_j 01otary Public 6�''•a, ..+�' Signature of Applicant Building Department Application AUTHORIZATION (Where the Applicant is not the Owner) tec) residing at t v k (Print property owner's name) (Mailing Address) SbU4i0kd ,�� L��, do hereby authorize Jr.rvP, --rte-►rn enf (Agent) "a M C--- to apply on my behalf to the Southold Building Department. 9 oVjqbx6 (Own 's Signature) (Date) 1ptff,lel l CID (Print Owner's Name) CONSENT TO INSPECTION V1 �e � �� ,the undersigned, do(es) hereby state: Owner(s)Name(s) That the undersigned(is) (are)the owner(s) of the premises in the Town of Southold, located at !� Dl'% VC, , which is shown and designated on the Suffolk County Tax Map as District 1000, Section 54 ,Block�, Lot k& That the undersigned(has) (have) filed, or cause to be filed_, an applip�' in the SoutholdTownBuilding Inspector's Office-or the following: Z_?,r a o T 11f it Y1 'FLA-, ✓r, oD That the undersigned do(es)hereby give consent to the Building Inspectors of the Town of Southold to enter upon the above described property, including any and all buildings located thereon,to conduct such inspections as they may deem necessary with respect to the aforesaid application, including inspections to determine that said premises comply with all of the laws, ordinances,rules and regulations of the Town of Southold. The undersigned, in consenting to such inspections, do(es) so with the knowledge and understanding that any information obtained in the conduct of such inspections may be used in subsequent prosecutions for violations of the laws, ordinances,rules or regulations of the Town of Southold. Dated: (Signature) TCA-e-C r-eID Print Name) ignature) (Print Name) ;j � I � _ �� 'y � "fu,•n 11��11. S.11)US A•la�i► ' W-r'H T. TERRY S Yi f.O- In,, 1 17h ) OWN CLERK" �`•,': � Snuihnl(l. Nc%. Turk 1 ILEG15fRA!i OF VITAL STAT1511CS Fox (5 101 765.lRi `'-,�^ (� O1- n4ARRIACF OFF ICIM - Tcicphonc (5 16 1 76.5. ) RECORDS MANAGEMENT OF ICEIi r�01 �� .1 FREEDOM OF INFORMATION OFFICER 0FI'ICE OF THE TOWN CLERIC TOWN OF SOUTHOLD THIS IS TO CERTIFY THAT THE FOLLOWING RESOLUTION WAS ADOPTED BY THE SOUTHOLD TOWN BOARD AT A REGULAR MEETING HELD ON AUGUST 24, 1993 : RESOLVED that the Town Board of the Town of Southold hereby adopts two (2) new forms to be used under the Flood Damage Prevent. regulations of, the Code of the Town of Southold: "Floodplain Development. Permit / • I I !(pplication" ( FDP(93) ) , and "Certificate of Compliance fir Develc%pment in Special Flood Hazard Area (C/C(93)] . TOV%:;4 OF SOU TOLD /Ju�i"th T . Terry Southold Town Clerk August 25 , 1993 q APPLICATION f PAGE I of a TOWN OF SOUTHOLD FLOODPLAIN DEVELOPMENT PERMIT APPLICATION This form is to be filled out in duplicate. SECTION I GENERAL PROVISIONS (APPLICANT to read and sir�nl 1. No work may start until a permit is issued. 2 The permit may be revoked if any false statements arc made hcrcin- 3. If revoked, all work must cease until permit is re-issued. 4. Development shall not be used or occupied until a Certificate of Compliance is issued. S. The permit will expire if iio work is commenced within six months of issuance. 6. Applicant is hereby informed that other permits may be required to fulfill local,state and federal regulatory requirements. 7. Applicant hereby gives consent to the Local Admiaistrator-or his/her representative to make reasonable inspections required to verify compliance. 8. T,THE APPLICANT,CERTIFY THAT ALL STATEMENTS HEREIN AND W ATTACHMENT S TO _ THIS APPLICATION ARE,TO THE BEST OF MY KNOWLEDGE,TRUE AND ACCURATE. (APPLICANTS SIGNATURE) ���� .,/-� A, -�� DATE /V glz° SECTION 2: PROPOSED DEYEI opL ENT (Tn-- c completed by APPLICAB'D NAME ADDRESS TELEPH NE AP P LI CANT --��--�� /f 1f QQ // / \JOtJ'a n �rnrenrirr 32y //D� I6rr J �,dPrl a3�� ,z8-x'"66%' BUILDERr 2 p��6f 1�s111 I l IdQz ?Z tr 0-pr4--c-, 64 91 - ENGINEER —�^ A0. htfrki PROJECT LOCATION: To avoid delay io processing the applicatioa, please provide enough information to easily identify the project location_ Provide the street address, lot number or legal description (attach) and, outside urban areas, the distance to the nearest intersecting road or well-known Iandmark. A sketch-attached to this application showing the project location would be helpful. /� P ✓ D 464 ✓Poi decd �1., -1C:7- 1/7 31 CE&? S' U FDP(93) ti i 1 I rlr I , 7 r s , r I APPLICATION- PAGE2OF4 DESCRIPTION OF WORK (Check all applicable boxes): A. STRUCTURAL'DEVELOPMENT IACTIV[TY STRUCTURE TYPE O New Structure 2 Residential (1-4 Family) O Addition O Residential (More than 4 Family) O Alteration ❑ Noo-residential (FloodprooFiag? O Yes) ❑ Relocation ❑ Combined Use (Resideut-W & Commercial) O Demolition' • ❑ Manufactured (Mobile) Home (In Ma-nu- 0 Replacement factured Home Park?. O Yes) ESTIMA'1--r-D COST OF PROJECT S 7 C,U u B. OTHER DEVELOPMENT ACTIVITIES: O Fill O Mining O Drilling O Grading O Excavation (Except for Structural Development Checked Above) O Watercourse Alteration (Including Dredging and Channel Modifications) O Drainage. Improvements (Including Culvert Work). O Roafr4 Street or Bridge Construction � ❑ SuFkEvision (New or Expansion) / / / ❑11 In�dual Water or Sewer System l // [3 Other (Please Specify) -rpo I After completing SECTION 2, APPLICAffsh d submit form to Local Administrator for review. SECTION 3 FLOODPLAIN DETERMINATION (To be completed by LOCAL ADhfIMSTRATOk) The proposcd development is located on FIRM Pancl No. . Dated The Proposed Development: O Is LIQT located in a Special Flood Hazard Arca (Notify the applicant that the application review is complete and NO FLOODPL UN DEVELOPMENT PERMIT IS REQUIRED). O Ts located in a Special )~food Hazard Arca. FIRM zone desipation is loo-Year flood elevation al the site k:' ' Ft. NGVD (MSL) ❑ Uoavailablc ❑ The proposed development is located io a floodway. FBFM Pancl No, Datcd O Scc Scclion 4 (or additional ioslruclioos. SIGNED DATE t APPLICATION # PAGE ] OF 4 SECTION 4: ADDITI NAL INFORMATION REQUIRED To he completed by L CALADMTNIS-rRATOR The applicant must submit the documents checked below before the app6cadon can be processed: ❑ A site plan showing the location of all existing structures, water bodies, adjacent roads, lot dimensions and proposed development. ❑ Dcvclopmcnt plans,drawn to scale, and specifications,including where applicable: details for anchoring structures, proposed elevation of lowest floor(including basement), types of water resistant materials used below the firs(floor, details of floodproofing of utilities located below the first floor and details of enclosures below the first floor. Also O Subdivision or other development plans(If the subdivision or other development exceeds 50 lots or 5 acres,whichever is the lesser, the applicant must provide 100-year flood elevations if they are not otherwise available). ❑ Plans showing the extent of watercourse relocation and/or landform alterations_ ❑ Top of new fill elevation Ft. NGVD (MSL). Ft:NGVD (MSL). For ❑ Floodproofing protection level (non-residential only) ( ) floodproofcd structures, applicant must attach certification from r-gistered engaincer or architect. / ❑ Certification from a'registered engineer that the proposed activit�in a regulatory Qoodway will no( result inany increase in the height of the 1t0o-year flood. A copy of all data and calculations supporting this finding must also be submitted. ❑ Other. E 1 5: PERMIT DETERMINATION e completed L 'AL ADMIN[ RAT R I have determined that the proposed activity: A. ❑ Is B. ❑ Is not in conformance with provisions of Local Law'?F , 19_. The permit is issued subject to the conditions attached to and made part of(his permit. SIGNED DATE If BOX A i5 checked, the Local Administrator may issue a Dcvclopmcnt Permit upon payment of d•esigraled fee. if BOX B is checked, the Local Administrator will provide a written summary of deficiencies. Applicant may revise and resubmit an application to the Local Administrator or may request a bearing from (be Board of Appeals. • APPLICATION d' PAGE 4OF4 APPF_LLS: Appealed to Board of Appeals? O Ycs O No Hearing date: Ppea --- Appioved? El Yes 9 NO Coaditioos SECTION 6:. AS BUILT ELEVATIONS (To be submitted by APPLICANT before Certificate of Compliance is issued The following information must be provided for project structures. This section must be completed by a registered profcssion.al engineer or a licensed land surveyor (or attach a ccrtificaeion [o this application). Complete I or 2 below. 1. Actual (As-Built) Elevation of the top of the lowest floor, including basement(in Coastal High Haza Areasbottom of lowest structural member of the lowest floor, excluding piling and columns) is: Fr. NGVD (MSL). L Actual (As-Built) Elevation of floodproofmg protection is FT. NGVD (MSL). NOT'1: Any work performed prior to submittal�of the above information is at the risk of the Appl,:cant. � f J SECTION 7 COMPLIANCE ACTION (To be completed by LOCM ADMINISTRATORI The LOCAL ADNIINISTRATOR will complete this section as applicable, based on inspection of the project to ensure compliance with the communitys local law for flood damage prevention. INSPEC'T'IONS: DATE BY DEFICIENCIES? ❑ YES ❑ NO DATE BY DEFICIENCIES? O YES ❑ NO DATE BY DEFICIENCIES? ❑ YES O NO SECTION 8 CERTIFICATE OF CQMPLIANCECTo be completed by LOCAL ADNTINISTRATQR) Certif-icatc of Compliance issued: DATE: BY: Attachment B i 6AMP;LE CERTIFICATE %JF COMPLIANCE I / ec . al Flood Hazard Area for Development in a Sp ,r iR e 'r TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE FOR DEVELOPMENT IN A SPECIAL FLOOD HA ARD ARIA (n3Agn,Mn MIIST DETAIN 'IEITS CERTIFICATE) PREMISES LOCATED AT: PERMIT NO. PERMIT DATE OWNERS NAME AND ADDRESS: CHECK ONE: 0 NEW BUILDING O EXIS'T'ING BU[LDING Cl VACANT LAND ' THE LOCAL ADMINISTRATOR IS TO COMPLETE A. OR B. BELOW: A. COMPLIANCE IS HEREBY CERTIFIED WITH THE REQUIREMENTS OF LOCAL LAW # , 19_. SIGNED: DATED: B. COMPLIANCE IS HEREBY CERTIFIED WITH TIF R-EQUIREMENTS OF LOCAL LAW # , 19_, AS MODIFIED BY VARIANCE # , DATED SIGNED: DATED: C/C ( 93 ) "BUILDING DEPARTMENTElectrical Inspector TOWN OF.SOUTHOLD. $ PN 2 g 202 Town;Hall,Annex - 54375 Main Road= PO Box 1179 y; Southold, New. York.11971-0959 .: �. . ,-`.:,T'lephone (631) 765-1802..=;FAX--(631)r 765=9502 "to' `err southoldtdw' 'n ov..;�seandosoutholdtownn ov APP:LICAT10N FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION(AII-Informatiori Required) Date: Company Name:,: .. Name: License No:: _ email! . ..li't G � Sed� '� ®r-�te.�� L C,F_/fej✓�e-A-�C,��,�-2.raaTe.=.�,,.C'o:,y: .; Address: ��. ie�uv�.. vv� �► �__ �✓asTn. -5.../!l_ Phone.No:: 6 3 — 87 y —O L 96- JOB SITE INFORMATION (Ail information Required) Address: 12.o _. _ .. . _ ... _. .. ,.. Cross-Stfeet: Phone No.:. B.Idg.Perrriit#: 1. email: = aX Map,District: 1Q00 ..,.,.T BRIEF DESCRIPTION.OF VVORK-(Please Print`Clearly) Pool a v /k,. 7L CIrcle:Aft That Apply: Is job ready for inspection?`. YES / Rough In Final Do you need a Temp Certifiicate?': YES / Issued.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; PAYMENT_QUE WITH.APPLICATION. 'Request for Inspeetion form.As 'J BU `. G';ta I�a�1N: 'EPART � ENT:'. t' ctrlc itis S� s,., •9I �`'t; t[y ,� �owiv�: , UTH:OLD:. u fr df;202 M - r 2 g Town4 Hall;Artnex54375 Main F` PO=Box1 Z93 - y¢ Souholc'; New:-Y i f1 •,'? n,° x� kt'c. x'11�t1„C . '.+gip;-"AC•• : ..; w hone: fi3=fi_ 70,5=3 8'02 '1 :63:1 ::766=9;5"0` :,-��s`..w,ix's,a ;s '%`,:x 'sr�:' ;i„�� .^r>> v'. X err sou akltov i*. 6m w-.seand' o aOod ,.4�„�ti�,,�� „.Ji'1'” •�'`� ..ta."::t.q,`..F:.:.:.:.^�.u,e&:;.rx:!'.Yw"s'x>_a•,ai,. ”S:Gr6'.-'^'kp7.,:..s,a+n•Y.'a`:z�n-kwr:.at.e•:'r,ru t:i:a.;::,u _ _ - .m»:..:::5�:.-:%„`c..F:)-CY9 P� ? C : N F;O`R''EZETFI:C'AL IIV. P'EC°TLJJ . ECT =.' IAN I(tIFOM • T:0. 1r A'iifoiriiation: e`ui{Ea' bae "ry lQl'�Sa; 'Fvion4':4g�rV_. �► !£_:.. _ Dom 017Q : , - -M1 ••„ :::._'si::;%>sW::'Jai.^.E:."m.:.:.:w.:a.v:A.w�.:,w,.w`xu"s:':3:K'F..Axw:.::..:n].:«c..:.w.ski.<Yn-:^:'�:_S:.Y.,w.•:..:^5;f..`::s;:-4,.nv�.:.w ,��' 1 _, .V- IRII IifaTmetioii.f fired �E sjf ,,..a.w. .. r' '�.S::v.3i•Fa'%^?fYrk3.a",:w:Praw"wv. .. -4 O,Ss: us� - , ,a?e "'it Gill s -_ PR- . " '...i 'a D st t: .DSC :)OCTions t�3lock;' i r...._ ,. �.......•w«�:>r.1.��.vrrwre+u.xne_r.,.rrn.n-..-.-'"--'•r-•--.-'"'.r........ .[>.,.,,�, ..... ..�:.^:..._�...__�_..=>»..e_�v^: ��......__...............sj-au'YYexaexs..•rr_.e« :x`.C-.:�u:..a�a:,c:.�.,_. .. _ .. ., •a-as•w : __. fs o ad fo 'inks} e:fio ?£: YES I.. Rough; n TFi- a oybu':lee8 a,TOO P`' ei#cae'?SE J �" : .. I:ssraecl��On Temp§linfoiinat�on: ¢All information required} etvice`S� e� 1 • 3 Ph Size: _Ae. :Me es :OlcixMefer =-. New�Seivitw� Fir:.e;Rir>yorii ect Flood R--'connect,-.Servic,,e. orinecte.cf-.lJndergrrournd-' Uvetti80M #.Udergonc3taterals. i '2n H Fume _Pole Woi-'R done�on'`Ser+rice? Y N Additionalnformat�on:- PLYMENT`DU.E iTH;:APPLICA7ION. -%'F:'�v,;isx•::^::^N:.:rcufi:'a5i'x:::.:A;:-,:,�K:';:�:.�.'r-�.;;:.«:::'..'...:.��.,v."..:.'�i•-:A'�, -:ssaa.s:.:..-r.sv�:'; {���^J /'� Aequest'f-6i 1690,' io�•Foriii:zls PERMIT# Address: Switches Outlets GFI's Surface Sconces ` HH's UCLts _.__.. ... __,._...__a,_.._........ . 'HW"' Fans r. _ ,..... ..... .. _ Fridge Exhaust Oven Dryer r Smokes DV1/... _... ._.._ __._._...... ..._.._. _... eroice Carbon - -Micro Combo Cooktop ��•:�:• Transfer AC Special:. .. . Comments: JN' SURVEY UPROPERTY SITUATE' .NORTH SEA ROAD HOLD TOWN' OFTSOUTHOLD \ / SUFFOLK COUNTY, N.Y. X39 24'00" E SURVEYED: SEPTEMBER 21. 2020 583.48' 00"00' I I rA 1 1 O O f � p I 1 rn I I _ 0 II o " I 1 � 1 I 1 I �I 1 i 1 a 1 I � d ' z — 1 ; a � y f / 1\ / I � I .o p � Y IlbX3b \ ` CIO co co 52.16 - SQ" 48.35 W 1 4'30" W 3 3401o•30'N/F S ,33 0 N, HYAb1S N/f JAC[)9t1EU"E ANN R7CRARD i TOMN OF SOU't'tiOLD AlD t•AIfIiENCE F LENY HYAkHS z` NBRZOO WIES: t. PROPBHTY KNOWN AS'TAK P!01000-054-06-016A N . z LDT AREA-40.408 s0F 3. 1!"(.ssa ACRE(s)) 3 THIS SURVEY MILS PREPARED USING A TR)Y81E S3 RO�TFC TOTAL STATpN. 4 4.PROPERTY CORNER UONUYflH15 WERE NOT SET AS S PARE OF THIS StHRVEY. � Y QAN➢N�HffTFS• i . COM1¢Ort]aw wual.noa5 tM0 SU%x]pp y x' ��axOWgx On MOl.py to nv5 Safi'(YW ELNIC COf ES OF pus SUNY uM MOx tIf RB tHE L O SUFN. WS wK D SUfxxsln fNm Gt2Mt9 x']t r.•Hh,loi a'srxtd>ID], 017 CYIq$SC0 YA SHALL MOT OCCONS'DERm 10 Q A VA110 Copy. .Y •OM9t.�].tl 161,Vtgt SxN[[DUG1q W 1 Oa♦onaoar 614.n rws Rm.nr vaMtnOnS pW0;5Ep SGL MICHAEL K. Wlcxs r I aAtcruoxs o.ms aaacwl.svx•c.v su,.r r nc wa ' 4 NIIPAil11 N ACW�V<f�d NC tWYui xnlxeN tIIt O LAND SURVEYING sio nl nne ea.aN..,ra xr<raawWe.ea,�,nn Io tom. uAnNc wsnnna tmtn a i»s an>.oNn o-N•a.».. 16 FROWRIN ROAD- SWE EX •E CEIVPER MORICHES. NL7 YORK 11034 VOICE` 631.874.0166 - FAX., 631.008.sa4d g YF4tKYCllrs w D[M]KIR]Iis rnV w r:.o.r.nc 71/IDItA 70HDT:•4I6 .aoa.l.n w uatux.on wet xox aotun w t»,va sr RdCORDS OP RICXARI)n!.— na Olfyr Ira oanxe.or3 s�nw.lxul xtmn xfl s+nno.xa N K w,ran urm Aas ra,�(x,rc n»<.a uo utt Nm ouoac SCALE: SURVEYED BY: DPA1YtJ BY: SHEET: MR Wr Mtxp[n ti 0xp M[RCnO�Of fDtiy•�i'xMSC twLt ✓x roue. i q.ui no Nl/S pix0[x!t RwWOi+No I,n Mlle xme or eersmioo.. MICHAEL b ACRS, ALS. /60J80 -.,M. ALM. JA T OF 1 li / N P� / �o O SURVEY FOR C. and C. ASSOCIA TES t \ SOUO TOWNTHOLD �<c• SUFFOLK C40UN�Y,111 Y. Scale: 1"=50' Mar. 15 1994 op o COW" nt Caruvr ^b \ Q tar dme woos r- AM& L=Na 49WO and aid. / PECO�A1 -SfrRY oRA P.0 . r fir rean �a ax,909 AREA•40,400.¢n ww ROAD .i/.ya� .v..�v�♦wa ins SOUTIIOLA 14 Y. 11971 94 - 131 In i i i i I i `^1 i 50 r `�. SURVEY FOR C: and CASSOCIA TES AT TOWN OF SOUTHOLD fi. - SUFFOLK 00 TY Y. X94 CFR11�tl±ri M CWAW 77FLE_/W-WAACE COMPANY94M - 00M �d Not, P► arl;i i# oto wf'ft ``/l A4Y.'S. CIG.NCL 49NO a far;@k fsrw as �sJaAhsd PlEcomtSYdRt�EY7�R'S, P a b C L:LA. by and�a �d s soh iat by t� Yark s1a� .. L516J:R6:f -30120 Amo ARS 4 s 40,409 Sqh : �9� �f�./�s. meaty pa�:e�a:�•;f SOVTMXD, AY. 11971 94 - 131 (//(�✓] /Q gJ�'tJ/� ((\}�^ „ jj/j /f ///)j/\l(/(/•�/f I� j/f/f) -qp��} /./j�/t /t ! i! VICTFEN-01 DGIORDANO .4coRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/26/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#BR-876726 CONTACT NAMEffi Execu Ins Broker Fin Ser Inc PHONE FAX 515 Johnson Avenue vc,No,Ext:(631)563-8433 (a/c,No:(631)563-7706 Bohemia,NY 11716 E-MDR A' .certificates@eifsonline.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:TWIn City Ins Co. Hartford 29459 INSURED INSURER B:Merchants Mutual 23329 Victorian Fence Inc. INSURERC: 2559 Middle Country Road INSURER D: Centereach,NY 11720 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, \ EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDINSp SUBR WVDPOLICY NUMBER PO/DCY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [X] OCCUR X 12SBMAA3785 5/4/2021 5/4/2022 DAMAGE TSESO R ONTED $ 1,000,000 X Contractual Liabilit MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY j�T F LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER:EBL$1,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident) ANY AUTO BODILY INJURY Per erson $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY AUTOpWNED PROPERTY DAMAGE S ONLY Per acc dent $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE CUP0002463 5/4/2021 5/4/2022 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Town of Southold Is included as additional insured with respects to general liability per the Business Liability Coverage Form SS0008 04105 attached to policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Townof Southold THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Route h ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 1179 Southold,NY 11971 AUTHORIZED REPRESENTATIVE *1 ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Suffolk Courity Degt,.bf` Labor i - ,,Licgnsi6g`&ConAm&Affairs HO MEIMP ROVEMENTLICENSE . r r fir: ,.' • cr � JOSEPH S FISCHER Business.Name This reAif_s tlizFthie - bearer is duly licensed VICTORIAN FENCE INC by the.County bf Suffolk License_Number:-HA2319, r ,Rosalie Drago . Issued: -03129/-2007 ' . Commissioner Expires,* 03101.12023, 1' 1 f APPROV D AS NOT D 39- DATE: a7 o�B.P.# FEE: "6 e 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 5LIEC'TRICAL REQUIREMENTS OF THE CODES OF NEW INSPECTION IREQUIRED YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. COMPLY WITH ALL CODES OF NEW YORK STATE & TOWN CODES AS REQUIRED AND CONDITIONS OF ; - ;` " SEPOOL TO CODE r, N COMPLETION RD ' ' `FORE.°WATER" SOUTHOLD TOWN TRUSTEES OCCUPANCY OR FLOOD ZONE OWLY wim USE IS UNLAWFUL ADAM-4tif- =r-IVIN Nps WITHOUT CERTIFIC ,T� OF'OCCUPANCY 4 Bonding Wire connected to all hardware SUCTION SUC ON WASTE FILTER HAIR& PUMP z SKIMMER WATER LINE MAIN 2"RETURN TO INLET DRAIN MIN Lj 3'APART PIPING SCHEMATIC kHTER 1 ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIREMENTS OF 2015 IECC I RETURN R RN R RN R RN HORIZONTAL 4/8" 2 POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE DETECTING A CHILD . I H ENTERING THE WATER AND SOUNDING AN ALARM AUDIABLE AT POOLSIDE AND AT ANOTHER REBAR 4 PLACES a LOCATION ON THE PREMISES WHERE THE POOL IS LOCATED.THE ALARM MUST BE INSTALLED, 10 aq. UNDISTURBED EARTH MAINTAINED AND USED IN ACCORDANCE WITH MANUFACTIRER'S INSTRUCTIONS.THE ALARM . 45" MUST MEET ASTM F2208'STANDARD SPECIFICATION FOR POOL ALARMS'.THE DEVICE MUST OPERATE INDEPENDENT(NOT ATTACHED TO OR DEPENDENT ON)OF PERSON. VINYL Yy= CONC.MIN.3500 PSI 32' LINER Y" y ' ;;ry�+ VERTICAL 1/2"REBAR "F r 3 WATER SOURCE FILLING THE POOLSHALL BE EQUIPPED WITH A BACKFLOW PROTECTION SYSTEM. � WP►LL CROSS SECTION 4. ALL PIPING IS DIAGRAMMATIC UNLESS OTHERWISE STATED.ALL PIPING TO BE POLYETHELYNE. NTS 5 POOL SHALL BE GREATER THAN 10 MEASURED HORIZONTALLY FROM ALL OVERHEAD WIRING. 4' I 1010' 12' POOL DESIGN INCLUDING DRAINS WILL MEET ALL 2017 CODES. SOF NEW �Q DEER,C0 i 2 Jasons Pools Complies With '?' "" 9 2020 Code Section 303.2.1—303A Swimming Pools,Spas and Hot Tubs ��t�0 Y.Lp 'AiF630 North Sea Rd. Section R326 of the Residential COdpt6keW York �ORp S �O�P _ Southold,NY Section 3109 of the Building Code of-New York Section N1103.12(11403.12)Residential Pools and Permanent Residential Spas Section 3109.3.1.2—3109.7.4 Pools and Spas Gates,Barriers POOL TYPE: Rectangle REV SCALE: NTS Section G106 Entrapment Protection JAMES DEERKOSKI, P.E. Section G107 Alarms DATE: 10/13/2020 Section E4201—E4312 Electrical Connections for Pools 260 DEER DRIVE MATTITUK, NEW YORK 11952 DRAWING NUMBER - 1 OF 1