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HomeMy WebLinkAbout47392-Z t'fcoGy Town of Southold 8/14/2023 o P.O.Box 1179 53095 Main Rd 40 Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 44434 Date: 8/14/2023 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1435 Mill Rd.,Mattituck SCTM#: 473889 Sec/Block/Lot: 106.-9-8.2 Subdivision: Filed Map No. .Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/27/2022 pursuant to which Building Permit No. 47392 dated 1/27/2022 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 Kilgore,Zachary of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 47392 4/5/2022 PLUMBERS CERTIFICATION DATED A t ri ed Signature S,afFill Ire,, TOWN OF SOUTHOLD ay BUILDING DEPARTMENT y x TOWN CLERK'S OFFICE Way • 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#: 47392 Date: 1/27/2022 Permission is hereby granted to: Kilgore, Zachary 182 Ainslie St#1 Brooklyn, NY 11211 To: CONSTRUCTION OF AN INGROUND SWIMMING POOL, FENCED TO CODE AS APPLIED FOR. Replaces BP # 35850 At premises located at: 1435 Mill Rd:, Mattituck SCTM # 473889 Sec/Block/Lot# 106.-9-8.2 Pursuant to application dated 1/27/2022 and approved by the Building Inspector. To expire on 7/29/2023. Fees: PERMIT RENEWAL $175.00 Total: $175.00 Building Inspector 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. 35850 Z Date SEPTEMBER 10, 2010 Permission is hereby granted to: MICHAEL PSYLLOS 1435 MILL RD MATTITUCK,NY 11952 for CONSTRUCTION OF AN INGROUND SWIMMING POOL, FENCED TO CODE AS APPLIED FOR at premises located at 1435 MILL RD MATTITUCK County Tax Map No. 473889 Section 106 Block 0009 Lot No. 008 . 002 pursuant to application dated AUGUST 25, 2010 and approved by the Building Inspector to expire on MARCH 10, 2012 . Fee $ 250 . 00 -� 50 .00 C/a fob -oo r Authorized Signature ORIGINAL Rev. 5/8/02 OF SOUryol � o Town Hall Annex Telephone(631)765-1802 54375 Main Road P.O.Box 1179 sean.devlin(cD-town.southold.ny.us Southold,NY 11971-0959 Q couffm BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE SITE LOCATION Issued To: Zachary Kilgore Address: 1435 Mill Rd City,Mattituck st: NY zip: 11952 Building Permit#: 47392 Section: 106 Block: 8 Lot: 8.2 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: AS BUILT License No: SITE DETAILS Office Use Only Residential X Indoor Basement Service Commerical Outdoor X 1 st Floor Pool X New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan Service 3 ph Hot Water GFCI Recpt 5 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors Sub Panel X A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks Disconnect Switches 4'LED Exit Fixtures Pump Ed Other Equipment: Intermatic Pool Panel , Heater 250GFI, Pump 220GFI, 2 Lights 120GFI, 2-Lamp Posts w/ Built in GFI Outlets Notes: " AS BUILT NO VISUAL DEFECTS " POOL Inspector Signature: Date: April 5, 2022 S.Devlin-Cert Electrical Compliance Form J pF SOUryO� Am • �o TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 / INSPECTION JV [/FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: !J&L I 4- /L, �f DATE i �� � � INSPECTOR OF SObTyolo TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 o 0 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) moo REMARKS: �a-� DATE o /v 10 INSPECTOR OE SOUIyo� i , I. , , L } TOW OF SOUTHOLD B-�JILD.NG `ycou765-1802 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) tLECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O REMARK_ S- r F - 7 s /1 - 0 2+ � r ✓1 DATE /,S76, � INSPECTOR . aqf SOb yo # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATIOWCAULKING [ ] FRAMING/STRAPPING [ FINAL POOL, [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ - ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] PRE C/O Qpkl YZ REMARKS: Lal-tW s 44-epl Igo Ix GtOcn^/ - �►s' cirz � ) A-A i Sit o►'t c� e cc- btlm-ell S 1� ✓r � Gfiry( Y� im,ka— OjtAcd:% DATE 3 �l X22 INSPECTOR Xk1tlZ---- oF soulyolo # # TOWN OF SOUTHOLD BUILDING DEPT. °ycouuivN�'' 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULATIOWCAULKING - [ ] FRAMING/STRAPPING [ FINAL �ML, [ ] FIREPLACE,& CHIMNEY -[ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ PRE C/O REM RKS: lgAkc-' M A'-.A/ AV DATE 3/ INSPECTOR a0F S0 /5w /��3`�2 ILI /�l�l 2j # # 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 ]-P/RE C/O REMARKS: DATE Z INSPECTOR Nigel Robert Williamson Architect P.O. Box 1758 Southold, NY 11971 Phone 631.834.9740 April 4, 2022 Mr. John J. Jarski, Senior Bldg. Inspector Town of Southold Bldg. &Zoning Division 54375 Main Road P.O. Box 1179 Southold,NY 11971 Re: Kilgore residence 1435 Mill Road Mattituck S.C.T.M. 1000-9-8-2 Permit#47392 Dear Mr. Jarski: I observed the inground swimming pool at the above address on the 28th of July, 2021. To the best of my knowledge and believe the rebar which is install is the swimming pool complies with the code in affect at the time of the original building permit number 35850 dated September 10,2010. There were no visible signs of cracking in the structure of the pool. I trust that everything is in order. If additional information is required please do not hesitate to contact me. I thank you for your assistance in this matter. Your's faithfully, Nig Robert Williamson R.A. lu I DOM il 1 0 . • im M,FOUNDATION(IST) • 1 1 �-_ r.TA ROUGH FRAMING PLUMING INSULATION PER N.Y. STATE ENERGY • 1 ra _ � ,LJ�,rs ��'�� 7 GLi ADDITIONAL COMMENTS o TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPART INTENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 1,.4 sets of Building Plans TEL: (631) 765-1802 Planning Board approval- FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check 2.7o.�° Septic Form N.Y.S.D.E.C. Trustees Flood Permit Examined (0 ,20 ,ea Storm-Water Assessment Form Contact: Approved (O ,20/0 Mail to: Disapproved a/c t•D Phone: �� 2 , Expirat E 20 AUG 25 2010 Building Inspector A PLICATION FOR BUILDING PERMIT BLDG.DEPT. TOWN OF SOUTHOLD ' Date � �f� , 20' 10 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 ppo//npp premises and in building" for necessary insapections. 02- rN,CLOSE POOL,TO CODEUSE p�y ��e �rr UPON COMPLETION UNLAWFUL V V�q.1 i� (Signa re of applicant n e,if a corporation) BEFORE"WATER" IT�I )lUI T ("ERTIF I LL P b M j4 M17�CK UNDERWRITERS CERTIFICATE OF C' � 9I' NCYY (Mailing address of applicant) U QUI REq I State whether applEiRMIR rs owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder APPROVED AS NOTED . B.P. # _ Name of owner of premises M1 �� � - (As on the tax roll or latest deed) NOTIFY BUILDING DEPARTMENT AT If applicant is a corporation, signature of duly authorized officer 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: (Name and title of corporate officer) 1. FOUNDATION-TWO REQUIRED I L FOR POURED CONCRETE `7�,5��C-(� '� Z STRAPPING,PINGELECTRICAL I&CAULKING Builders License No. G Plumbers License No. 3. INSULATION Electricians License No. 4. FINAL-CONSTRUCTI.ON&ELECTRICAL MUST BE COMPLETE FOR C.O. Other Trade's License No. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW 1. Location of land on which proposed work)will be done: p� K`_ .I nYOO$R�K NSTnARTE. NOT RESPONSIBLE RESPONSIBLE FOR 14 4 dC�r AJC& !—�• (I•`.11 `Y svf�B�'.th"f�l'MT1�2���A �k F House Number Street -Hamlet PURSUANT TO CHAPTER_ 236 County Tax Map No. 1000 Section /d{v Block 9 O o HE Te N ODE. Subdivision Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy erz e .3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work qZ „t,,,,,..;�� �ao ( escription) 4. Estimated Cost a6foo o 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 th� •i� ! Height Number of StoriesLIH ' Dimensions of same structure with alterations or additions: Front Rear { Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear �l5'epth- Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Fonner Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO 2 `' , 13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES i NO 14. Naives of Owner of premises Address Phone No. Name of Architect Address Phone No Name of Contractor �.,.�; .,v, nrr,((' L.1 , 10 cAddress eo&o Xf lam, Phone No. 9,,y, i,5U'APY1-1 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 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—e< * IF YES, PROVIDE A COPY. STATE OF NEW YORK) COUNTY F,;. - being duly sworn, deposes and says that (s)he is the applicant (Name,•f.iridiviaual ig."n contract) above named, CONNIE D.BUNCH ;nr%I Notary Public State of New York �. ;_ ,"^Q No.O1bU6185050 ( He is_the';:';; : �6�� iffieff in Suffolk Gnnnfu / n (Contractor, Agent, Corporate Officer, etc.) ommission Expires April 14, 0_ 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 iri this application are true to the best of his knowledge and belief, and that the work will be performed;in the,manrier set'forth iri"the application filed therewith. Swornto be-fore'-me this' day of 201 Notary Public Signatur fAp nt pF SOUTyo ti0 l0 Telephone(631)765-1802 Town Hall Annex ax(631)765..-g512 54375 Main Road � � roger richert a( -own.so od.ny.us P.O.Box 1179 G Southold,NY 11971-0959O`�,C� UNT1, r BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUEST-BY: 4k J Date: A) /c� Company Name: Name: S License No.: 5 7- 3 0 --Ak f - -Address: �x Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: ��NAec �S� *Address: j 3 UJEST M r CC- ,>° s *Cross Street: C Qy- �J c CK - *Phone No.: - ,S f -5 — Permit No.: L--2 s , i; ; � 1 q Tax Map District: 1000 Section: )06, Block: _ Lot: �. *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ^- (� L SUR PA (Please Circle All That Apply) , *Is job ready for inspection: GJ i C- CALL YES NO Rough In d Final *Do you need a Temp Certificate: YES NO Temp Information (If needed) *Service Size: =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 o 82-Request for Inspection Form o��pF SO(/l�ol � o Town Hall Annex JL l�( Telephone(631)765-1802 Q ax(631)765- 51 54375 Main Road 2 roger richert(a�town.soutfi0 d.nv.us P.O.Box 1179 • �O Southold,NY 11971-0959 \ BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED.BY .. �CK WI- Date:, f p /i] Company Name: '5-Coc C Name: . License No.: 5 Z 3 0 lAc� 65 Address: ��x 13 -T -' I`-� �� Phone No.: JOBSITE INFORMATION: (*Indicates required information) *Name: NAC--L *Address: 1 q3 UjS',- r L P,p *Cross Street: OAC bV C *Phone No.: Permit No.: 6 t--> 7,39 a Tax Map District:. 1000 Section: )0(,, Block: Lot: _ *BRIEF DESCRIPTION OF WORK (Please.Print.Clearly) Oco L w k/I,- I -- !� �pbeoL SUR CJA�1 �Z (Please.Circle All That Apply) *Is job ready for inspection: LL YES kNO Rough In d Final.. *Do you need a Temp Certificate: YES _ NO Temp Information (if ne d.ed) *Service Size: 1 Phase 313hase 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 PERMIT# Address:' Switches t Outlets G FI's Surface Sconces H H's 2 . ... UIC Us Fans : ,•Fridge HW' Exhaust Oven W/D Smokes DW Mini CrbcSn :,...,..,. .......... Generator: Comkso.,.," Cooktop :.... ..... ....._..., .. . ,.. Tr_ans fer ; AC- AH Hood Service Amps HaveUsed Special:-...: . _. ._.,..._n.��......_......... : .. .. ........ ......._. .._.- ........ .. .."... .. . _ .. .. .... .:._..... Comments: y,.f ,V C� K i �J F ' igY � .4s �•y. N. f, HAROLDCE W. KLINE &ALICE A D. KLINE (DE_ UHER 10327 PAGE 90) I y I Y S 72'24'00'' E '$ .�' 653.82' n� �,� d� "l OC�••} gi $ � � � .ill e iY' 1 ' �� •�� -TP,rA -Mn'.�,ILfJrJA-.._..- /,)1 ----------------- , --_----_ yy N I �^��• .aw usAc ,. til N�'-M , Co ASANN.r oAx.q Der parr. - • f..� N 7 I i , I I T � ; N Z� y. f . .000 ao 133.7' ' �$ N 72'24'00" W 650.66' . � ggI N�0 IF p ` WILLIAM A. VILLANO EILEEN VILLANO j " CEORCE W, KLINE d ALICE D. KLINE SUFFOLK COUNTY DEPARUIENf OF HEALTH SERVICES (DEED LIBER 11./86 PAGE 37) ATIROVALOFCONMUCTEDWGIMImR A SINGLE FAMILY IDENCE Dail% ~00 SURVEY OF PROPERTY Them►+sedislxmllmdwliwnpptyfeenidaotthtslo.JG.-Ite " SITUATED.AT inspected"or Cati6ed by this Depub m or Ther agencies mtd f to be aatisfaelory I7OR OP 8 R MS i . MATTITUCK TOWN OF SOUTHOLD St A.CoftPa.Cwq SUFFOLK COUNTY, NEW YORK Offiiworwataand wutmaterMe4gemnu PWP•RW w.r< .NN THE NANIW STANDARDS TOR MU SAYEY3ESTAWSkE& R '"�MS�S.C. TAX No. 1000-106-09-8.2 New STATE TO1 SCALE 1"=60' MAY 30. 1997 '' �pLA1 APRIL 4, 1998 PLOT PLAN W(TH S.C.D.H.S. DATAOCT 0BER DECEMBER22. 2 986. 1 UNDER CONSTR 998 REVISED CTI NL PLOTPLAN JUNE 29. 1999 FINAL SURVEY. '.'' ' i '' LvT L, - C Q AREA a 114.089.11 sq. It. 2.619 AC, N.Y.S.Lie.No.49666 IAW/1MORRCD ALTEL TION OR NoWI N ':'•,�£�!'J�: N" 1 To 1N6 SURYEI 6 A YKIun*'or SECTION 720e or D2 Taw YORK S1ATC N {� r' LOP2S a lig SUR n,�Ao,TaMUG h A. ingegno •.-+(F Q%1 „+:.,�yl.' TWE VAO SWaYCR'S 6X EEK OR w. TO BE ""`5N"`'M `°"50"'M and Surveyor CERTIFIED'T0, To ie A MAuo T*VC CMY. C.D.H.S. REFERENCE No. RTO-98-0094 SHQ.L RW o1NY l0 T12 PERSON 0'="C 1NE STM SUfFOLK`COU A IONAL'>;BANK .... 6 PraP.REo..w oN u eENus TO ra WILLIAM;iURNER mu COMPANY.COARNNENia AGENCY AND Tick Survey-S"'visions - SAe Pons � Cmstm ion Lobo' A`..• iINONC s6TmligN L57M"Flo"' AND OLGA TURNER :« �' TO M ASE p C[S Or 112 UADNO NyT- ?:k.:. T s`:.:.., TVMN.ClamGwTaNS ARC NX TRAWERNILE. PHONE 5i ` ( 6)727-2090 Fm(5t6)722-5093 .y'�`: a>;�•..'•,^'.:• THE EXISTENCE OF RIGHT 0(MAYS OF'FOMS LOCATED AT AWCDK.AWRaV MY.N EASEMENTS O!NOT GUA.li- ._y MY.N07 SHOWN ARE NOT GUANAi/ICED. One Union SqukIR — tr/JI '&+ Aquebogile,New Yoh 11931 I.W.NmNoo,Tyr. u 3 ^"-'-•- a! Y Town of Southold Co Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY LOCATION: S.C.T.M.#; THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A of Y ' �� C-- Z . STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL VaN -b sTtrrict Section mock` Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within (✓ the Scope of Work for Proposed Construction) Generated by a Two(2")Inch Rainfall on Site? ) (This item will include all run-off created by site b. What is the Total Area of Land Clearing (S.F./Acr — clearing and/or construction activities as well as all and/or Ground Disturbance for the proposed Site Improvements Iand the permanent creation of construction activity? �© impervious surfaces.) (S.F.I ) PROVIDE BRIEF PROJECT DESCRIPTION (PmvldeAdditionalPages asNeeded) 2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location?This — Item shall Include all Proposed Grade Changes and c7irr' . (9 0- C Slopes Controlling Surface Water Flow. 0 $ Does the Site Plan and/or Survey describe the erosion /El n,�VE � ,.�,.,;,, and sediment control practices that will be used to control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Period. / 4 Will this Project Require.any Land Filling,Grading or / Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? �. rj Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F.)Square Feet of Ground Surface? El 6 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction �L General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one(1)or more acres; including disturbances of less than one acre that 7 Wilt there be Site preparation on Existing Grade Slopes / are part of a larger_common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to / including Construction activities involving soil disturbances of less than one(1)acre where One Hundred(100')of Horizontal Distance? JJtrr the DEC has determined that a SPDES permit is required for storm water discharges. (SWPP.P's Shall greet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious / for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct Storm-Water Run-Off ✓_ 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of--way*7 submitted to the Department prior to the commencement of constriction activity. 2.The SWPPP shall describe the erosion and.sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the terms and conditions of this permit.In addition,the SWPPP shall identify potential sources of pollution which may reasonably be expected to affect the Area?(Thla Item will NOT Include the Installation otDdvewayAprona) quality of storm Water discharges. NOTE: If Any Answer to Questions One through Nine is Answered with a Check Mark 3.All SWPPPs that require the post-construction storm water management practice In a Box and the construction site disturbance is between 5,000 S.F.81 Acre In area, component shall be'prepared by a qualified Design Professional Licensed in New York a Storrs-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that is kngwledgeable in the principles and practices of Stomp Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building PermiL (NOTE: A Cherie Mark(./)and/or Answer for each Question Is Required for a Complete Application) STATE OF NEW YORK, Notary Public State of New York COUNTY OF.- V-R ..........SS No.01L16185050 """ Qualified in Suffolk Count Commission Expires April 14, 0 That I,...XA .1 J K 1-.......... ..�,:� .....being duly sworn,deposes and says that he/she is the applicant for Permit, (Name of individual signing Document) Andthat he/she is the ...............................�.I ��. ...................................................................................................... (owner,Contractor,Agent,Corporate Officer,eta) Owner and/or representative of the 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 herewith. Sworn to before me this; ...... J�........ �. ...........day of... .. ..... ..... .... ..................20.0 Notary Public: (Signature of Appli t) FORM - 06/10 08/25/2010 10:39 FAX 6317280695 MALONEY&MALONEY 0]001/002 PHONE:631.728.0400 FAX-631-728-0695 MALONEY & MALONEY, INC. INSURANCE-SURETY BONDS 108 WEST MONTAUK HIGHWAY-P.O.BOX 1024 HAMPTON BAYS,NEW YORK 11946 Fax Cover Sheet Date: August 25, 2010 To: Company: Town of Southold Phone: Fax: (631)765-9502 From: Jennifer A Karadeniz E-MAIL: ikaradeniz(cD-maloney-maloney.com #OF PAGES:1 2 TOTAL Re: Insured: Hampton Brickworks Pool & Spa, LLC Certificate of General Liability To Whom it May Concern: At the request of our Insured,attached please find the above Certificate of Insurance. Should you have any questions please do not hesitate to contact our office. Thank you. A-nnilar J J%laradeniz Jennifer A Karadeniz Account Representative �l o b � nt hl I m� 08/25/2010 10:39 FAX 6317280695 11 fALONEY&MALONEY x¢]002/002 '4� CERTIFICATE OF LIABILITY INSURANCE DA i2ot" 10 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorse a. PRODUCER NAME: Joan DiFaloo Maloney and Maloney Inc. PHONE (631)728-0400 JJFZ. (631)728-0695 108 West Montauk Highway WitLS . P.O. Box 1024 PRODtlCER 0000591 ton Bas NY 11946 INSURERS AFFORDING COVERAGE MAIC I INSURED INSURER A:Hari aville Insurance Co. INSURER 8: Bampton Brickworks Pool 6 Spa, LLC IisuReN c 53 Channing Cross ImURER D: INSURER E: Hampton Bays NY 11946 SUR COVERAGES CERTIFICATE NUMBER:CL1082502961 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. M POLICY EFF POLICY EXP LIT TYPE OF INSURANCE POLICY NUMBS( (UMDNYYYI tMMIDI3IYYML.RIITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE O D IS s S 100,000 A CLAIMS-MADE3 OCCUR GL9JBO56 /26/2010 /26/2011 MED EXP(Any one ermn) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICYF-1 JECT El PRO LOC S AUTOMOSILE LIADILRY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per aaddent) $ SCHEDULED AUTOS PROPERTY DAMAGE S HIRED AUTOS (Per accident) DOWNED AUTOS $ $ UMBRELLALIMB OCCUR EACH OCCURRENCE $ EXCESS LU10 HCLAIM94AADE AGGREGATE $ DEDUCTIBLE $ RETENTION S S WORKERS COMPENSATION VdC STA1U- Oil+ AND EMPLOYERS'LIABILITY YIN EEL ANY PROPRIETORIPARTNE.RIEXECUTIVE 0 E.L EACH ACCIDENT S OFMCENIIMEMBER EXCLUDED? NIA (mmosom In NH) E.L DISEASE-EA EMPLOYE $ MOMdescribe under 6F (�tI M OF OPERATIONS below E.L.DISEASE.POIJCY LIMRT I S DESCMPnoN OF OPERATIONS I LOCATIONS I VEHICLES(Atl M ACORD I(H,A"dwal Remarks Sahedulo,I more apace to required) CERTIFICATE HOLDER .-,,,; y �' CANCELLATION AUGq0�o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE G v 2 THE EXPIRATION DATE THEREOF,- NOTICE WILL BE DELIVERED IN Town of Southold ACCORDANCE WITH THE POLICY PROVISIONS. 53095 Route "25A Y:_--------�o..,r----- P.O. Box 1179 AUTHORIZED REPRESENTATIVE Southold, NY 11971 a '�C��� ACORD 25(2009109) ®1988.2009 ACORD CORPORATION. All rights reserved. 1a1Q11�1a....:......... TI... __J__L A^^"m 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. 35850 Z Date SEPTEMBER 10, 2010 Permission is hereby granted to: MICHAEL PSYLLOS 1435 MILL RD MATTITUCK,NY 11952 for CONSTRUCTION OF- AN INGROUND SWIMMING POOL, FENCED TO CODE AS APPLIED FOR at premises located at 1435 MILL RD MATTITUCK County Tax Map No. ' 473889 Section 106 Block 0009 Lot No. 008 . 002 pursuant to application dated AUGUST 25, 2010 and approved by the Building Inspector to expire on MARCH 10, 2012 . Fee $ 250 . 00 Authorized Signature COPY Rev. 5/8/02 ��,A o I Z, LII COUNTY DEPART1 jEN T OF CONSUMER AFFAIRS � - HOMEIMPROVEMENT CONTRACTOR LICENSE �./t q�'✓ NAME �4 —J ANDREW J REGO This certifies that the BUSINESS NAME bearer is duly licensed ISLANDSCAPES LANDSCAPING CORP DBA by the County of Suffolk�£� License NumOzr Orte IzzuzC ZI-d' tt 46569-H 08/20/2009 COMMISSIONER E%PIRA,.N DA,E 08/01/2011 (I)MIS DESIGN IS 9ASED ONA DRAINAGE 40.0' 5011W/THLESSTHANIO%SILT DE51GN DATA GROUNDWATER5HALLNOTEXISTWITHIN „",:_:, ., •,:,:,,,::v.::::::.:...:.!:::, ,-,.:s:.,::":d r::u•:,,::,. ,: ra:,...,: ::::;.:a::,,:e::..:a,+I:W., !:,:! , :!,: THEL/M/TOOFTHEEXCAVATION.IF t FILTERTYPE: CARTRIDGE CiROUNOWATERD0E5EX15TW1TH1N5/X NO BACKWASH REQUIRED FEETOELOWGRADE,5rEC1AL ' ifli. TURNDVER.RATE--12 HRS DEWATEKINO FACILITIES WILL BE ,:• {,, REQUIRED.WA TER DISPOSAL IS LIMITED _. ._„" PUMP CAPACITY--1000PM TO THE 0WNERSPROPERTY. �i <;'. {;n, FILTER RATE--88GPM/SQFT (2)NO5UKCHAROEWILL BE ALLOWED FILTER AREA: 300 BQ.FT. WITH/N4 FEETOFSHALLOWENDAND6 'I``• l 1 t It FEET FROMDEEF END. j (3)THEPNEUMATICYAPPLIED 22,0' M `� / { I ! iu; 20.0' CONCRETEA011NITE),SHALL DEA MINIMUM M/XOFh5THAMAXIMUMOF3.5 1 j L,O.A 36' 0ALLONSOFPOTAOLEWATERPE996 W.O.A. 16' LVSOFCEMENT FREE AREA 5709 q,ft. (4)RE/NFORCEMENTOrEELSHALL 05 VOLUME:❑ 26,000ga1s. TE INTERMEDIAORADEOILLET STEEL WITH `I AMINIMUMLAPOF300ARDIAMETERS, I \ / / •-`i i ui WATER DEPTH: 3.5'TO 8' (5)POOL WATER SUPMYBYOWNERSt AVERAGE DEPTH: 5.5" OARDENHOSE,FILL SPOUTO9AUTOMATIC :.u.,.!c�a<t!;":, :u.,,.:;t,! :.;.;.,;:rw,m„"_ r ,.:,,,!:,{! r::!!:.::'._;;p;!,n!„{,! '!i"1 9:1!ugP.x!:y FEEDER. (6 PUMPCAPAC/TYISTOBE5UFFIC/ENT SWIMOUT TO EMPTYPOOL W24 HOURS,POOL 19 TO 46.0' OEKEPTFULL DURINGFREEZINO Thisppool conforms to the latest WEATHER. NOUTDOOK PO0 SHOULD OE ,Y.S And Riverhead Town safety MOTECTEDOYAFENCE,WALL OR 3.5 mandates.Namely; OVILD/NGINACCORDANCETOTHEN Y,S. (1)One"Aqua Guard"dieltal pool alarm OUILD/NOCODE and pool side remotes. (0)INS TALLAT/ON Is TO OE DONE IN with in house p ACCORDANCE WITHALLFEDERAL,.STATE AND LOCAL OWLDINOCOVES AS WELL AS N5PI SUGGESTED 5'TANDARDSn LOCAT/ONOFOVERHEAD WIRES TO MEET r REQUIREMENTS OFN.Y.S.BOARDOFF/RE !n: OPT SOLAR UNDERWRITERS ARRAY �_ HORIZONTAL STEEL REINFORCEMENTS _-.-_ '!'I HAIK AND .21,ON TERLINT P tlµ l�':�i "awt.•; SKIMMER 1D'112"VEAM }i�,Itli'r.r'tt 0"SLATETILE6— WATERLINE PUMP _ HOT WATER TO TOP KX,URN9 VER ICAL STEEL ,u"!.; ! ` l 4 RODS IN ?'r'•z'' U; BOND BEAM HOT WATER TO DEEP RETURNS h!' REINFORCEMENTS, , . ! s'•: _a 12"ON CENTER<5' sa ` 6”ON CENTER>5' GUNITE DETAILS FOR: WHITE MAR13LEDUST ` .t F5YLLO5 RE91DENCE 1435 WE5T MILL ROAD MATTITUCK, NEW YOLK ® Skimmers 'lights eturn5 Auto feeder Vacuum line ® Main drain 0 Oeep heater EXP. JOINT 1'—O° POOL TERRACE POOL COPING TO BE 2° THICK ALL BLUE THERMAL FINISH W/ p A' a n BULLNOSE EDGE ON INSIDE e 6 P.C. SLAB 3 ° .- •� d oc #4 REBAR AS p SHOWN FOR BEAM ;' J doc °.. .• y #4 REBAR 10° O.C. BOTHWAYS ° - d o ° d' DETAIL OF POOL BEAM (TYPICAL SCALE: N.T.S. r V A