HomeMy WebLinkAbout29313-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y_
CERTIFICATE OF OCCUPANCY
No: 2-30012 Date: 03/08/04
THIS CERTIFIES that the building ACCESSORY
.Location of Property: 72.5 GRANGE RD SOUTHOLD
(HOUSE NO.) (STREET) (HAMLET)
`County Tax Map No. 473889 Section 75 Block 4 Lot 18
. :Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 18, 2003 pursuant to which
Building Permit No. 29313-Z dated APRIL 21, 2003
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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to JEFFERY T & LAUREN M STANDISH
(OWNER)
of the aforesaid building.
SUFFOLK. COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO_ 75224C 05/14/03
PLUMBERS CERTIFICATION DATED N/A
Authorized Signat e
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. 29313 Z Date APRIL 21, 2003
Permission is hereby granted to:
JEFFERY T STANDISH
725 GRANGE ROAD
SOUTHOLD,NY 11971
for
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL AS APPLIED FOR
at premises located at 725 GRANGE RD SOUTH/PEC
County Tax Map No. 473889 Section 075 Block 0004 ]Lot No. 018
pursuant to application dated APRIL 18, 2003 and approved by the
Building Inspector to expire on OCTOBER 21, 200
Fee $ 150 . 00
rizedd Signature
ORIGINAL
Rev. 5/8/02
nn tt 7y�(
rl L^J Form No.6
i'�'N
lS TOWN OF SOUTHOLD
d BUILDING DEPARTMENT
81 OG D-` TOWN HALL
T l C7 ^+ T t D
—�- 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 installations from Board of Fire Underwriters.
4. Swam stafetuent from plumber certifying that the solder used in system contains less than 2110 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-enisting"land uses:
1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic
a 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-$25.00
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00,Commercial$15.00
Date. Q�f h I 1 rl of)q
New.Construction: ✓ Old or Pre-existing Building: (check one)
Location of Property: °
House No. Street Hamlet
Owner or Owners of Property: �Q4e)f q <k L('_l -0(l
Suffolk County Tax Map Not 000, Section J Block Lot
Subdivision Filed Map. Lot:
Permit No. g 3) 3 Date of Permit. Applicant: J e- 4 "1 I S+a..rYi5h
Health Dept.Approval: ' Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: ✓ (check one)
Fee Submitted: $
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1slectrcallnspection Certificate
1.
Issue Date
Electrical,Inspection Service,Inc Application Number . „
1 —
av 05/14/2003 375.Dunton Avenue 75224C
East Patchogue,New York 11772
(631)2W-6642 ^ '
- issued To: Jeff&Lauren Standish -
;' z _ Street: 725-Grange Road -
Wage: Southold Zip: 1:1971 Town: Southold '
Section: 75 Block:4 Lot: 18
G Contractor: T. Raynor Electric Lic.# 1805.-E
Was examined and found to be in compliance with,the National Electrical Code: -
❑ Commercial ❑ NYDefects O-Pool ❑ 1stFloor El Indoor ❑ Basement ❑ HotTub
X❑ Residential ❑ Det Garage ❑ Attic ❑ 2nd Floor (] Outdoor ❑ Addition ❑ Survey —
= switches Receptacles Fixtures GFI Heaters A/C Fans
N 2 1 1 1 1 r
Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
Meter Amps Phase UG/OH Jacuzzi Television CO Detector '
w Bldg. Permit-
Other
ermitOther Equipment
1-Pool Panel
1-Time Clock
1-Motor Hu90 S. Surdi
President
Rough Inspection: 05/13/2003 .
..
- Inspector Ed Scavelli =� '
". Final Inspection:. 05/13/2003 _
Inspector. Ed Scavelli
This certificate must not be altered in any manner. Inspectors may be identified by their credentials. '
'" St Ilia11 + I�IY ; 1�1� !9N !Iigll'9iu !Iry •.Ililll
Al 11'nu ' 1 IYit. .px1 .iN� 1�1, - IIY — l,�p� q�Yi - I eP mN, .c-:.••
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y�+a,• x .:titu vx. .1:.;�;'�'w uN• b 1. tk l t... a dye b't {fr� �,w:^ �l•-•`:[
:$+:;,ay.'re.C,f.•.'S',�.R}�'i4y,SY`'J�/�.SiF }�•'xti<3 .:YS• .SyF •.:11! 4{:.i�y'•:Ye:� ..n �'•�-$./Yf:2�*'•u,�{��ry :•.e}:+:i{.r?h.'i� fs,RJ' is?1,.,r a.: 'Sry...�.:er.
NEW YORK STATE INSURANCE FUND
199 CHURCH STREET N^W ;YORK N.Y. 10007-1100
i-$�8-997.-386'3
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
$WIN TECH POOL SERVICE INC POLICY NUMBER
.461 MILLER PLACE RD Z 868 072-0
MILLER PLACE NY 11764 DATE
12/10/2042
CERTIFICATE NUMBER
80-277
PERtf3b CCJitERED SY t191S C K Alf
2{2 :fJ99
POLICYHOLDER, CERTIFICATE HOLDER
SWIM TECH POOL SERVICE INC TOWN OF SOUTHOLD
467 MILLER PLACE RD BUILDING DEPARTMENT
MILLER PLACE NY 11764 TOWN HALL
SOUTHOLD NY 11971
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE STATE
INSURANCE FUND UNDER POLICY NO. 868 072-0 UNTIL 2/28/2004 , 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.
IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 2/28/2004 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.
ME STATE /INSURANCE FUND
U-26.3 DIRECTOR, INSURANCE FUND UNDERWRITING
�a�
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
i
[ ] FOUNDATION 2ND [ ] INSULATION
a
[ ] FRAMING [ ] F AL
] FIREPLACE & CHIMNEY [ IRE SAFETY INSPECTION
REMARKS. �
l2 �
DATE C INSPECT
765.1802
BUILDING DEPT.
INSPECTION
k [ ] FOUNDATION IST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] [NSU IOM
FRAMING [ AL
FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
REMARKS:
l
Iq 1
i
DATES INSPECT
77i
'w
FIELD INSPECTION REPORT DATE I COMMENTS
C3i
FOUNDATION(1ST)
FOUNDATION(2ND) �
" 1
ROUGE[FRAMING&
PLUMBING y
a
r ;
INSULATION PER N.Y. "3
STATE ENERGY CODE
FINAL
t
CA
i
ADDITIONAL COMMENTS
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TOWN OtiOUT11OLD BUILDING PERNIIT APPLICATION CHEMIST
BUILDING DEPAI�,TMENT Do you have.or need the following,before applying?
TOWN HALL Board of Health:
SOUTHOLD,NY 11971 3 sets ofBuiilding Plans
TEL: (631) '765-1802 Planning Board approval
FAX: (6311)765-9502 Survey
PERMIT NO. ( �_ Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined ` � 20 Contact:
Approved,20 Mail to:
Disapproved a c
l.m .
t
_ Phone:
Expiration 20
Buildi pector
APPLICATION FOR BUILDING PERMIT
Date 4 t Q(t I ) �O 2003
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building 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 or public streets or
ureas, 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 tocomply 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,if a corporation)
(Mailing address of applicant)
5LAD tm 'lcc-py maltwp(ate 6% t 7(g Y
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Lameo
ner of premiseoe1)a A L�U �'G Yl �a art d L S h•
(As on the tax roll or latest deed)
is a corporation, signatLRof duly autho ' ed officer
�
aerie and title of corporate officer)
uilders License No.
lumbers License No.
lectricians License No.-i-S 0 e t:
ther Trade's License No.
Location of land on which proed work will be done:
7.z5 Crna — l-Dc� � 1C�
House Number J Street L t� Hamlet
County Tax Map No. 1000 Section -75 Block—'L4 Lot
Subdivision Filed Map No. Lot
(Name)
ry
2. ,tafe existmguse'and occupancy ofp�n�ses and inter ded use'and occupancy of proposed construction:,
a. Existing use and occupancy
b. Intended use and occupancy
3. Nature of work:(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Worker t tYlrrt¢, Pg c(
escr'pfion)
4. Estimated Costq ),OGc - co 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
jDimensions 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__X
13. Will lot be re graded?YES NO_Will excess fill be removed from premises?YES Y NO_
14.Names of Owner of premises_� •S_10l.Gi is h Address Phone No. 7Co,5
Name of Architect Address Phone No
Name of Contractor5�in�-Tr 6�U Address -t -) Ntwl r" Phone No.C12
mawrPI NY
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 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)
S:
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
(Name of in dual signing contract)above named,
(S)He is the Y�LG�GjI
(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.
S orn to before me '
day of f i I 20 C
Notary Public ' Signature of Applicant
TINA M.WOOD s
Notary Public-State of NeW York
No.01W05077029
Qualified in Suffolk County
My Commission Expires tj�X/�-A
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APMAIIED AS
DATE: S.P.ar Z I
FEE: I BY:
NOTIlly BUILDING DEPARTMENT T
7857802 SAM TO 4 P FORTH " 1 !--"--- --- -- EI-F PRILLIN,:- 3cP-ads
FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE \, ASO I -_ _f'AWFL aTI FFGNC T��Ri FP.YUf•6 G+'>
2. ROUGH - FRAMING APL
3. INSULATION
4. FINAL - CONSTRUCTION MUST -n ����s I L�>n.IG�6J .L�J I�I�ALLIN11Nt>CM %
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF N I VINYL LINC.r2 ----�I-C .I..Ak�I.LT; F�ASE: PLATE
YORK STATE. NOT RESPONSIBLE FOR I
DESIGN OR CONSTRUCTION ERR RS.
FLOOD ZONE
—
COMPLY
COMPLY WITHCHAPER'4G" I_��o I _____ — STEELANGLG !'.°F�"IVG ST,A1,^,
FLOOD DAMAGE PREVENTION ___ %L' EL WALL PANtL y
SOUTHOLD TOWN CODE. G
SAND &4ZVF-KHICLI1, ITfa NIv�JNI' tr CotICRE1"E:.
OCCUPANCY OR AC1c11zEc1ArE mIX
USE IS UNLAWFUL PLAN
ffo
WITHOUT CERTIFICATE PO'll" T�' "�' L-E 111 ti T III _Ilu._rll _ 11=ou=i i_ju Im=I r 1n=0
I SIII 1—D- I IF
- gun
OF OCCUPANCY uN�IsruRP>EP �ARTrI - -
TII
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UNDERWRITERS CERTIFICATE 1811 r ILII
IG�INPd(LGII�II-I 11op =�1 -
RVEQmr;o II. ESE LowFoIZ FLAT-FWE.N7' bRIVE IhlTr��H GF:tn.IF.l1� =.1j -_
or DIV INC, NT&AIxp MANDATOpLY Rope rI,0A'f
�12" FROM jkAN�>Irl hl -- 5II0I2-T51-EI LAFI r-LF
Wit
aG6l-n
ALL CONSTRUCTION SHALL `
121' lil�,ul IW
MEET THE REQUIREMENTS 0 HE" I lilt,1II
CODES OF NEW YORKSTA� '- 11_11 PI
\ �:�� JII_IT 1111111
IIII
"IMMEDIATELY"
ENCLOSE POOL TO CODE
UPON COMPLETION q�_G�� _ Iro,-3"
BEFORE "WATER"
6
COMPLY WITH ALL CODES OF �
NEW YORK STATE &TOWN CODES OW I GE.
I
AS RE UIRED AND CONDITIONS OF
,VL,SOUTHOLDTOWN ZSA
S 8 4 ra'
r /1 SOUTHOLD��TgqWNPLANNING BOARD rim3 _ ON + 3" Nt3rE.s
SO'JTHOL WNTAUSTEES �-
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SCALEtAe HvC,rit,D APPROVED BY: DRAWN BY We'114
DATE: REVISED IY
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DRAWING NUMBER