HomeMy WebLinkAbout51492-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
OR
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#: 51492 Date: 12/18/2024
Permission is hereby granted to:
William Nystrom
79 Pine St
Dover, MA 02037
To:
construct accessory in-ground swimming pool as applied for. Pool equipment must be located in the
rear yard with a minimum 15' setback to lot lines.
Premises Located at:
1815 King St, Orient, NY 11957
SCTM# 26.-2-43.6
Pursuant to application dated 10/28/2024 and approved by the Building Inspector.
To expire on 12/18/2026.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
wilding Inspector
� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt ,s:Y/www,sotitlioldtowiln .(Inv
Date Received
PERMITAPPLICATION FOR BUILDING
r
6 f L
For Office Use Only
PERMIT NO. Building Inspector:
0(
4
Applications and forms must be filled out in their entirety. Incomplete ,
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: I D lag
OWNER(S)OF PROPERTY:
Name: SCTM# 1000- _
Project Address: I&S,
Phone#: Email:
Mailing Address: 9s- .
CONTACT PERSON:
Name: w w)a
Mailing Address:
Phone#: (� _ Email: o
U3� - 53 '� Kam
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: -Paiyl `
Mailing Address: 4
Phone#: U ` 0-3 —1 S Email: Gt�-n
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[�bther Ncv w � :4 �I
$ A
Will the lot be re-graded? ❑Yes&O Will excess fill be removed from premises?\,;?Jes ❑No
1
PROPERTY INFORMATION
�, Sty — yyU
Existing use of property: RaLL'y Intended use of property:
an P= Ct -Pox4L) i VV k
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes Po IF YES, PROVIDE A COPY.
ihaheck Box Aftelr Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
nter 236 of the Town Code. 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,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(s)for necessary Inspections.False statements made herein are
punishable as a pass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): mevC-Urrl b *uthorized Agent ❑Owner
Signature of Applicant: Date: ID)ab)SL4
STATE OF NEW YORK)
COUNTY OF
z ,r t being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor,Agent, orporate 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/her knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
-. i 1 r
2,jrdayo
f C �
Notary Public
=Public-
FERREMI
tate of New York
PROPERTY OWNER AUTFIORIZATiON
6430360uffolk County(Where the applicant is not the owner) pires Mar 14, 2026
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
L --- 2
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
,p
lW,111 If 44 6 kill */residing at
(Print property owner's na e) (Mailing Address)
do hereby authorize /e 41,(_ -s
(Agent)
Katrina Mercurio to apply on my behalf to the
Southold Building Department.
Uiew
(Owner's S gnature)—4k� (Date)
(Print Owner's Name
---------------------------
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PROPOSED SANITARY SYSTEM
sill°.msrum��ca i�Mnu1 wmrenuim:...:; mr res N'm'.tMui�ruu 1,000 GAL SEPTIC TANK... ,�
or I .��..,i i..m�r�r1,mww ii[u r T P,mm^R10' TKNw
rwgiAa B'DIA.x4'DEEP POOL«.. ,,„„- "«�-"•�,- „r„ + SITE DATA
S,jixF,,,, TA
" $i� `'`• , AREA=49,414 SQ.FT,
O, IA/OVVTS "�)" +wv ` r1°" "
S ^•^� � " �"°'^« "VERTICAL DATUM =NAVD(1988)
Mama uMt a..ID ry b*r m,., "� "de Cy °�
., ... „ .. . � "*. •DEPTH TO GROUNDWATER =60 FT
m^
6
GRASS � "NUMBER OF BEDROOMS(DESIGN EQUIVALENT) °5
IRa 7 c ,�» + « "MINIMUM REQUIRED LA OWTS CAPACITY =550 GAL
J ,+" ' A "PROVIDED I/A OWTS CAPACITY =700 GAL
grew PROPOSED 2 =400 SFSWA
STORY BARN "LEACHING SYSTEM REQUIRED
y, FFEL=16.0 •LEACHING SYSTEM PROVIDED =400 SFSWA
TEST HOLE PROPOSED
(SCDHS REF.NO.BB-SO-74) ny" POOL.FENCE cpypi'
O0'
EL=16.5 0.0' �tl 9 r
BROWN b
as PR a)POSED
SILTY LOAM
PROPOSED*
GRASS WELL
APPROX sOF 1.3' 2STORY *6M
av ADDITION PROPOSED R
BROWN LOAMY WATER
(a) ® A ,nM SERVICE + ENGINEER'S CERTIFICATION
8.0' Ot R a�1 rv�, w EXISTING VIER E TO BER ,'•d � M
} I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL
BROWN `'^� �' �'.' "V� i ABANDONED EXIS.�G wl- DIRECTSYSTEION.BASED UPON PROJECTS)FOR THIS CAREFUL D THOR0116H S R 1�R MY
COARSE
W%GRAVEL 'S d rir y a WELL FOR , Si'iE ANO&RT7N,lNOWA'N",R,CadNY% I S«ALL FA
SP A C � IRRIGATION CONFORM TO THE SUFFOLK COUNTY DEPAR TIJ EP3F S3O
( ) ONLY CONSTRUCTION STANDARDS 11I EFFECT AS OF O
GWE1:2.3 WATER]:N 142' � n, .,,,«✓� i ° h,M� r1t.�� gyp' S ,/'" �D PROPOSED r` �O " �M1 ; , LSD
BRO
COARSE AND �'t Iti.21R a,' '�'^ ,i / PROPOSED WATER
SERVICE � � s '
10%GRAVELISTORY
(SP) ADDITION
17.01 � s "Y ffi ' HOWARDW.YOUNG,N,YS.LS.NO.
4 ,Asn
HIGHEST EXPECTED 1H'. � THOMAS C.WOLPERT,N.Y.S.P.E.NO.61483
GROUND WATER EL-2,3 tl4 ` +¢ O ;P. i 7{d;t '+1 DOUGLAS E,ADAMS,N.Y.S.P.E.NO.80897
y a� SURVEYOR'S CERTIFICATI
NOTES n,� WE HEREBY CERTIFY TO8UZANNE NY1ST
L THE OWTS SHALL BE MODEL CEN•7 MANUFACTURED BY ka b WAS PREPARED IN ACCORDANCE WITH THE CODE
FUJICLEAN USA. ,. '+ 1+1M Q $ SURVEYS ADOPTED BY THE NEW YORK STATE AS
PROFESSIONAL LAND SURVEYORS. Or
2.THE DESIGN ENGINEER,FVJICLEAN USA REPRESENTATIVE,
AND SCDHS REPRESENTATIVES SHALL OBSERVE THE �"+' �i(j� r,
INSTALLATION OF THE OWTS AND LEACHING SYSTEM. w, »r HEALTH rEPANVtiE�NT USE
k APPROVAL FROM ALL THREE PRIOR TO BACKFIIL \ � To
3.THE SYSTEM START UP WILL BE COMPLETED UNDER THE �
DIRECT SUPERVISION OF A FUJICLEAN USA REPRESENTATIVE. 9;X.AY r 9 rye P p D N IEL W.WEAVER.
,N ,S, NOi
BETWEEN THE MAINTENANCE PROVIDER AND PROPERTY OWNER ,� IA/OWTS Fu j II C e a 1'p DAN'IEL A.NfEAVER,N. L.S,NO. 1
PROPOSED SANITARY ` ,* N O SURVEY FOR
HMUST BE EALTH SERVICES SUBMITTED
PRI SUFFOLK C OV+L RENT OF 4.AN EXECUTED OPERATION AND MAINTENANCE CONTRACTTe.ae+ � ncIUTAIW.aF
SYSTEM(ETdnsl9avlSaRGlary egaXLDC.OisdR %wuFFou.oc Coknq7v IDu IFAI re FN F f NrALTua SE IRVICLS
wv
ot
OWTS aEGIS'T1IATION BY THE SCDHs IN ACCORDANCE WITH System to be O F'ER ma FolR Au m:mvm F CONS RW-, OIN FoR A
ARTICLE 19 OF THE SUFFOLK COUNTY SANITARY CODE. &Na E Fm111 M R imiI.ry w4cF,AND SUZANNE NYSTROM
Accessary Barn(0 Bedrooms)
NOTES FOR , H„S,REF..�O I9 2a-0s7B at Orient,Town of Southold
SANITARY STRUCTURES � DATE eT 1S2024 � Suffolk County,New York
ABANDONMENT OF SA
r ABANDONMENTSNSTEMSIN-PLACE
H_AEL BE ABANDONED BY REMOVING ALL RESIDUAL SEWAGE �� -"#c. EXPIRES THREE YEARS FROM SIDATE OFAPPROVVAL. BUILDING PERMIT SURVEY
WASTES BY A LICENSED WASTE HAULER,REMOVINS THE TOP OF THE \
4 5.MUCTURB(S)BACOMAING WrTH,$UITA"SAND AND GRAVEL MATtWAL,AND LEGEND � � County Tax Map aiwta 1000 s-u- 26 BIoak 02 roe 43.6
COMPACTING. epees .
'.... BY REMOVAL CH =CHIMNEY FIELD SURVEY COMPLETED DEC.O ,2023
ABANDONMENT
MAP PREPARED DEC,it,2023
PROPERLNY MS MAY ALSO BE ABANDONED BYREMOVn,16 ALL RESIDUAL CMF -CONCRETE MONUMENT FOUNDffS
SEWAGE
WA TES BY A LICENSED HAU(.ER.REMOVING 7HE'EN�NTIRE'STRUCTURE(S), CM5 -CONCRETE MONUMENT SET \ ° '�^' ^�^.... Record Of Revisions .
WITH SUITABLE SAND AND GRAVEL MATERIAL,AND PROPERLY EOP =EDGE OF PAVEMENT tRP Rt P I(tNBi!'.1T11IAY 7H7iB c1M 1 M,1FtiD. REVISIAN DATE
COAMPACTING. OF SEWER PIPIN+NG V IFPF =FUTURE EXPANSION POOL IRON PIPE FOUNDRL1. .. .4!lN'. 1 e44 »», D TA 2 2024
AB NDONMENT _ �N 63I R52 S1ga qTM on
A '. ''SHALL BE OJT AND CAPPED AS A MEANS OF
OL ON PROPERTY LINE
ABBANDONMENT'.THE DEPARTMENT SHOULD BE CONTACTED FOR FURTHER OS -OUTDOOR SHOWER POST RAIL FENCE advance to schedWe NIBBp ionic).
AANDONMENT REQUIREMENTS,IF FUTURE CONSTRUCTION IS CONTEMPLATED
IN THE AREA OF THE ABANDONED SEPTIC SYSTEM. RO =ROOF OVER .. dw
SPF =SPIKE FOUND h'M
SPS =SPIKE SETav
✓'`
TWA,
MAND JCNONM R T O Ex" TING 5twnot DISPOSAL SYSTEMS,EITHER WIF =WIRE FENCE
'EN•PLACE,OR BY MUST BE CM17FIED BY EIT?ER A LICENSED DESIGN WSF =WOOD STAKE FOUND �� v 40 0 !D 4D BO 100
mawwwoomw
PROFESSIONAL OR LICENSED AS tNDI 1'eb By THE DEPAR T
ON THE PERMIT
TO CONSTRUCT.FOR PROJECTS SERVED BY MUNICIPAL SEWER ® _ =WOOD STAKEVLE tR .:� Scale:1"= 40'
gyp UTILITY POLE
DISTRICTS,THE APPROPRIATE MUNICIPAL AGENCY WITH JURISDICTION
• END OF DIRECTIOWDISTANCE 10 JOB.20O. 227_7 I OF 2
DWG.2023;Q227,,,E(w