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HomeMy WebLinkAbout27299-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-28046 Date: 11/01/01 THIS CERTIFIES that the building ACCESSORY Location of Property: 940 LAURELWOOD DR LAUREL (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 127 Block 7 Lot 8 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated FEBRUARY 8, 2001 pursuant to which Building Permit No. 27299-Z dated MAY 8, 2001 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 CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to ROBERT J FOX & LISA A REYER (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 2137 06/18/01 PLUMBERS CERTIFICATION DATED N/A u or' ed Signature Rev. 1/81 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. 27299 Z Date MAY 8, 2001 Permission is hereby granted to : ROBERT J FOX 940 LAURELWOOD DR LAUREL,NY 11948 for CONSTRUCTION OF INGROUND SWIMMING POOL AS APPLIED FOR. at premises located at 940 LAURELWOOD DR LAUREL County Tax Map No. 473889 Section 127 Block 0007 Lot No. 008 pursuant to application dated FEBRUARY 8, 2001 and approved by the Building Inspector. Fee $ 150 . 00 Authori d Signature ORIGINAL Rev. 2/19/98 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT a TOWN HALL 765-1802 I L APPLICATION FOR,CERTIFICATE OF OCCUPANCY ptpG,CVPT. TOM CIF SOUTHOLD A. This application must be filled in by typewriter OR ink and submitted to the building inspector with the following: 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 use 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 a 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 $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00. Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certificate of Occupancy - 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New Construction. . ... . . . . Old Or Pre-ex st nig Building.2/�m' � ,PM/. Location of Property. .!C:.b. :/Y�:'!�� G�_YX) J:•. • . F:; . • • • . . . . . • • . . . . . . . . . . . . . • . . . House No. Street Hamlet Onwer or Owners of Property�0 2. . . . . . . `;. .LS�f} . . .. , . . . . . . . . . . . . . . • County Tax Map�o$891000, Section. . Xc7:7 . . . . . .Block. PqQ. . . . . . . . .Lot. . .�0.& . . . . . . . . . . . Subdivision. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fi��led Map. . . . . . . . . . .Lot. . . . . . . . . . . . . . . . . . . . Permit No ?� �. . ./.,z • •Date Of Permit. , , . .Applicant./�'f� . . . . . . . . . . . . . . . . . Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . ..Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . . Planning Board Approval. . . . . . . . . . . . . . . . . . . . . . . . Request for: Temporary Certificate. . . . . . . . . . . Final Certicate x . . . . . . . . Fee Submitted: $. .��.a��.°:'. . . . . . . . . . . . . . . . . . . . .7�. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . eTDI vT r1Arrr Nassau Suffolk Electrical Inspections, Inc. 5A Canal Street• Center Moriches,New York 11934 • Tel:631-878-3500 • Fax: 631-878-3764 Application No: 2137 Date:6/18/01 Issued to: Fox Address: 940 Laurelwood Dr Village : Laurel Zip: 11948 Township: Southold Introduced By: Bethel Electric License#:2880-E was examined and found to be in compliance with the National Electrical Code Attic 1st Floor Residertid o Pod o Dd.Garage Baserriert 2nd floor Con rTwdal Hot Tub tW Defects Switches Receptacles Fixtures G.F.I. Heaters Air Conditioners 2 3 1-50OW att 1 Fans Dishwasher Washer/Amps Dryer/Amps Oven Carbon Range/Amps Monoxide Furnace Oil Gas Circulators Smoke Bell Detectors Transformers Other Meter Amps Phase Motors Equipment Inground Pool 1-11/2.3/4 H 1-20A Tim eclock Out,Res This certificate must not be altered in any manner Section: 127 Block: 7 Lot:8 THE STATE INSURANCE FUND 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ARTHUR J. EDWARDS MASON CONTRACTING POLICY NUMBER INC I 838 155-0 929 ROUTE 25 A DATE MILLER PLACE NY 11764 8/14/2000 CERTIFICATE NUMBER 240-050 PERIOD COVERED BY THIS CERTIFICATE 4/24/1998 TO 4/24/2002 POLICYHOLDER CERTIFICATE HOLDER ARTHUR J. EDWARDS MASON CONTRACTING TOWN OF SOUTHOLD INC TOWN HALL 929 ROUTE 25 A PO BOX 728 MILLER PLACE NY 11764 SOUTHOLD NY 19971 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE INSURANCE FUND UNDER POLICY NO. 838 155-0 UNTIL 4/24/2002 , COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORK- ERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 4/24/2002 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 30 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THIS CERTIFICATE DOES NOT APPLY TO BUILDING DEMOLITION. ZZIN ATE ANCE U-26.3 A.TAVERNA DIRECTOR, INSURANCE FUND UNDERWRITING PAYMENT RECEIPT SUFFOLK COUNTY OFFICE OF CONSUMER AFFAIRS NO. 100290 Redd From: D/B/A: Date: ARTHUR EDWARDS ARTHUR EDWARDS MASON CONTRACTING INC 07/13/2000,8:00 AM Cash © Check No: Drawn On: Money Order 10196 EAB Cate Service Fee Remarks 5 C Home Improvement Contractor License Renewal $200.00 0- None $0.00 0- None $0.00 0- None $0,00 0- None $0.00 RECD BY MP DIVISION VIOLATION# COSTS ASSESSED Bureau of ComplaintsEJ m $0.00 License#: 4436-HI Bureau of Licensing 39 $0.00 License#: Bureau of Weights 4t Measures 0 40 $0.00 Restitution Fund El so $0.00 Remarks: TOTAL $200.00 Ue CUSTOMER COPY 04? f i t j t ACORDCERTIFICATE OF LIABILITY INSURANCkTH DATE(MM/DD/YY) THU-1 01/29/01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bagatta Associates, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2067 Jericho Turnpike ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Commack NY 11725 INSURERS AFFORDING COVERAGE Phone: 631-864-1111 Fax:631-864-8274 INSURED Arthur J Edwards Mason INSURER A: Nationwide Insurance Co. Contracting, Inc. Dba Arthur Edwards Pool & INSURER B: S a Center Contracting, Inc. ETAL INSURER C: P O BOX 929 INSURER D: Miller Place NY 11764 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INR TYPE OF INSURANCE POLICY NUMBER P LI Y EFFE TIVE POLI Y EXPIRATION LTR DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY 66PR5796513001 01/01/01 01/01/02 FIRE DAMAGE(Any one fire) $50,000 CLAIMS MADE FX OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) A X HIRED AUTOS 66PR5796513001 01/01/01 01/01/02 BODILY INJURY AX NON-OWNED AUTOS 66PR5796513001 01/01/01 01/01/02 (Per accident) $ PROPERTY DAMAGE $ Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE E S DEDUCTIBLE $ RETENTION $ $ Wt;5TATU- I JOIN- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT E E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER N I ADDITIONAL INSURED;INSURER LETTER: CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN Hall NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town Ha Town Southold IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P.O. BOX 728 REPRESENTATIVES. Southold NY 19971 lBagatta Associates Inc. ACORD 25-S(7/97) ©ACORD CORPORATION 1988 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ;;SION [ ] FRAMING [ NAL [ ] FIREPLACE & CRIMNEY REMARKS: 9 DATE OBJ" INSPECTOR SVT, 8U2 BUILDIN DE INSPECTION [ FOUNDATIONIST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ ] FIREPLACE & CHIMNEY exo^- REMARKS: DATE lal 00 INSPECTOR I •Y FIELD INSPECTION REPORT DATE L COMMENTS H FOUNDATION ( IST) if I FOUNDATION (2ND) SI u if � II ROUGH FRAME II if o PLUMBING 11 ij nif II II II II u INSULATION P ER N. Y. A--- ii STATE ENERGY li ij H CODE �-----j' uif II Q r C=7 II -- I� 1 FINAL II © 11 7y sasasaassaasaxs=xss=saga=�_ssso-sss�asass=== - ssa�'===--aasssaas alas_ss. sa=asaas csss ' l~ 0 ADDITIONAL COMMENTS: H C� H z r a� r� ro H $ . . . . . . . . . . . . . . . FORM NO. 1 -3 SETS OF PLANS . . . . TOWN OF SOUTHOLD ✓,SURVEY . . . . . . . . . . . . . . . . .. . . . . . . BUILDING DEPARTMENT CHECK . . . . . . . . . . . . . . . . . . . . . . . . . TOWN HALL . . . . . . . . . . . . . . . . . . . SOUTHOLD, N.Y. 11971 TEL: 765-1802 NOTIFY: CALL . . . . . . . . . . . . . . . . . . Examined... 19.... MAIL TO: . . . . . . . . . . . . . . . . . . . . ry �G ........, .W ` Permit No. .. 'C.; r ..` ..........................a........ Approved_.-?4 Disapproveda/c .................................. ................................... ...................................... �j(�Building' I tor) APPLICATION FOR.BUILDING PERMIT Date. . . . . . . . ...f INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi 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 or public streets or areas, and giving a detailed description of layout of property mist be drawn on the diagram which is part of this application. c. The work covered by this application may not be comenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such 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 whatever until a Certificate of. Occupancy shall have been granted by the Building Inspector. 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 Regulatibns, 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, ordi building code, housing code, and regulations, and to admit authorized inspectors on premises and in build' for neves in tions. .... . (Signature of a 'cant, .or name, if a corporation) ........... . (Mailing addressofapplicant) State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ............................ UI( :.......................................................................... Name of owner of premiises4. ...��m......��........................................................... premises ...C-4. . 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. ... �.�+.'....-..... Plumbers License No. ......................... Electricians License No. ... o :. ...... Other Trade's License No. .................... I. Location of land on which proposed work will be done.............................................................. ........ 4.��.......................: ..Fl... ..wood..... -..........................L 44L........................ house Nuaber Street Hamlet County Tax_Map No. 1000 Section ........ Block .....7......... Lot ....6......... Subdivision ...................................... Filed Map No. �Paj"aI,I&P. Lot ... (Name) SNRT 5 2. State existing use and occupancy of premises and intended use and occurfjqqpk,Qlf pf.ppo - t pion: *In 1 1�:Y fG�1 yp;x S 41 a. Existing use and occupancy ..... ����1�.•............... •:•fry .0 ........... . inikJ�j...AJ� .ti: ° .............................r b. Intended use and ocampancy .. .. • 3. Hature of work (check which applicable): New Building Addition ..,:Alteration•::•. . Repair ............ Removal .......... Demolition ............ Other Work 4;,,,,, ........ 1�j!•!w: ..... (description) 4. Csti►reted Cost ... fee ........................................ • (to be paid on filing this application) 5. If rhrelling, nuiixer of dwelling units ............ thmber of rhaelling units on ead► floor ................ Ifgarage, minber of cars ....................................... i 6. If business, commercial or mixed occupancy, specify nature and extent of eadh type of use...................... 7. Dimensions of existing structures, if any: Front....... ...... Rear ............... Depth ................. ileig}ht ... .................... timber of Stories ..... ................ Dimensions of same structure with alterations or additions: Front ............... Rear ....... Depth .................... Height .................... Nunber of Stories ............... 8. Dimensions of entire new construction: Front ....G�©........ Rear �.,,,,,,,, Depth Height ....................ii..... Number of Stories ................... 9. Size of lot: Front ......N Q......... Rear ....Jq 0........... Depth .Cj%40............ 10. Date of Purchase ..................... tare of Former Owner ........................................ 11. Zone or use district in which premises are situated .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................ 13. Will lot be regraded ....4�6........... Will excess fill be removed fran premises: YFS ND 14. Names of Owner of 'se 1 k°L (A,,,, n © � L �premi s !z `.?.....^ ?.. ....... Address }ay LAueeL,l�(fl04 , .... Phone No. o? q�l77 None of Architect dl ..QC ........... Address 7�:�7-QL.�I`�;�:'. �qTT1�Ihohe No. Name of Contractor li .�. :. 1y �$....Ol ,,, �1 Address ,;?...l.."�� .. f!J hone No. �7 15. Is this property within 300 feet of a tidal wetland? * YES .......... NO ,,✓.,,,,, *IF YES, SOUllUD MM -S PERIL T MAY BE RE JIB. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block rnmber or description according to deed, and show street names and indicate whether interior or corner lot. 5rNIE OP "ZWC ("July Or ...��r(�C•}C... .. SS ,•e- duly swor • � p!`�............being n, deposes and sa s that he is the applicant y pp (Nam of individual signing contract) above rowed, Ileis Ole .......................�QIUT�L11 .T0 ;.................................._........................ (Contractor, agent, corporate officer., etc.) of; said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the rmanner set forth in the application filed therewith. Sworn to before me this 1-i(`�1� .clay of �� .... P.�ZQOD Notary Public ., Yl............ ... oe MARGARET A. BANNWARTH (Signature of• licant) .• Notary Public,State of New York No. 01 BA6021111 Qualified in Suffolk County Commission Expires March 8,20C, • �'7-tdi� E^rte':i-..; Tai ttii ZI� ahaft.^r�: • 1 Fi: .71, APPROVED AS NOTED f DATE:42ja3le,1 B.P. 7 FEE: /SAO _BYNOT ! LDING DEPARTIVANT AT 765-19FY 1 1802 AM TO 4 PM FOR THE / f FOLLOWING INSPECTIONS: 1 FOUNDATION - TWO REQUIRED I FOR POURED CONCRETE 2. ROUGI - FRAMING & PLUMBING & INSULAITION 4. FINAL CONSTRUCTION MUST I x 90' LETE FOR C.O. R) �1 c� Plice 40 () CON11,67 jfiUCTiON SI��►LL MEET HE REQnREMENTS Of THE N.Y. STATE CI,STRUGTIOW,$L ENERGY CODES. RESPON-SIBLE FOR I �J DESIGN I,CONSTFfUCTON ERRORS J � J O t ' tto v- N R 5- 6'sa'ip . � j ' LAWFUL s -b - '; "tMN'IEDlJLI 7'!Co Y" � U CERT�� �� _1� ENCLOSE POODE UPON COM��AV /" AP OF Pf�UPc;�;'-y- BEFORE "W U T i O; "'1 • gr: tr:C�IZ.� c.'c;•I.,_,.•.:<n�ot:oy Eli �_�_ ��••-�- ! _� d= _T •-� r-- _ lf7O/tq suT:r:T I: R •. ..:r.;H of .� ��i�r_ - __--i__..y!'-_. L��•� 'i I._1 -- :�.F 3XTIC�' _... :1-.'-, STATE i El^;-_::._-. � '.-..�__-:L: �:�:o WrV 'J,`'SC(i;'7-/0: t aaua 6 0';:=r /// / LIM._Tr!:At-'-. -'•,•'�' J?'�-- �(. �;, . �i Ll�f r';Y rT�c':3•� fo �:e �W r-T�:� .z•;;y !=r r�-� e. ✓��')Ut'j7�ivr`�' 1'�� CfYj� t�r C7`C7 C7 AKtr;rir ?rr Tt1. ;r?�!1t't^.►::F :��rrf 'zr'u `� /•--�" _.� ^' 1/ �S- ��r�/:•C�';..•E� .!-C-f. lye %�:�%. e7s `, 9� Liccns�c/ Lcyn�.�crriEyay '� %x'' /'`��• ( (!— — lig=? I Mry w.Y oadr) gar.a wau Plan A Piping arrangement _I I V-YI — c t SBC pion P-3 _ mo nz" » Section A–A Typical Wall Section 3= A E C 7) E F G H Q :AP. ARTHUR ED Tf-4PD E rr.. '. . M '. FT. FT. FT. sa� '. GAL POOL cR' SP-4 CENTRE 16'rw 32' 8' 14' 8' 4' 8' 512 19,000 PER3L4Cr,-, -.- WALL SYSTF.-�M 16 6' 16' 36' 12' 14' 8' 4' 4' 8' 576 21,600 929 Route 25A Miller Place NY 11764 c� state 1B' 6' 18' 36' IT 14' 6' 4' 5' 8' 648 24300 (516) 744-7185 FAX (516) 74..4-0174 Suffolk Lic�..r.se X4436—� 20`t40' 20' 40' 14' 14' 8' 4' 6' 8' 800 30.000 Nassau Lice— a X14450000