HomeMy WebLinkAbout51751-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 51751 Date: 03/18/2025
Permission is hereby granted to:
Ronald B Shelton
222 E 80th St Apt 2
New York, NY 10021
To:
construct accessory in-ground swimming pool as applied for.
Premises Located at:
1050 S Harbor Rd, Southold, NY 11971
SCTM#75.-3-14
Pursuant to application dated 02/10/2025 and approved by the Building Inspector.
To expire on 03/18/2027.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total S400.00
` uilding Inspector �
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 https://wwwsouttioldtownny.aoy
Date Received
APPLICATION I IPERMIT
For Office Use Only
PERMIT NO. 1 Building Inspector; .
APpllcat�gns and fgrrrrs must be filled out in ttfei�enre �rtcomPl, te
a s��ca i►�� 1r � p,red Where#lie SAP i n#, of the uWrier,;en OePRrtment
OwnQr's Aithoriz #ipn form(Pagi'2r shall 6e completed;, B�u11d1n
Ton of Southold
Date:
OWNER(S�C1F PR�E►ERT�f
Name: �� ���L- SCTM #1000- r75_ 3 _ I
Project Address: )050 &J'-ry �Ubo,c R0 c
Phone#: �0��-5�1- 3��a Email: yn R— . 'i o 5�2 �t1 �Ma� •['�tirn
Mailing Address: 222 �_ 20-l" 6keef 2E Ne f YOLK, QVy ��QZI v
CCN'�A 'I PARSON;
Name:
Mailing Address:
Phone#: Email:
DESI,,GN'PROFESSIONAL INFORMATION:
Name:
7777?f A
Mailing Address: ,� i-*tjv,8 _ _Adilq V1fi1OV,,
Phone#: Email: R ai l"el 1 y ' y
CONTRACTOR INFORMATION: -. w ` 's't 1
Name: jr✓q,GOs
Mailing Address: z�,� (�{?� �01Aco 176V
Phone#: W5— Email: 0FFlC2 A-e (,$ , e3m
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition DAlteration ❑Repair ❑Demolition Estimated Cost of Project:
lZ
Other VinV, ,,J,rrim rry Ax
Will the lot be re-graded? XYes ❑No VoXA ea dnj Will excess fill be removed from premises? XYes El No
1
Pa a ry 1NOIDRnrla`n
Existing use of property„ � �=Intendecl use of property: /
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? [:]Yes,[ o IF YES, PROVIDE A COPY.
h—
e
ed boxAfter Readi ,
n►t t 1« f t11 : +a tn, n. t r t a o� a aY AbE t�t e a r r i �w rt eawt t I+ � s rt t r �w t+ 4 1 r«x
C rd It 0* f� ',' d pl quo � ��a �s'r 0
1�� ( rst1 �f , f ' �'1t tdr�r1' �fic1 � r�kifdifw
uirTcP scant,,
Application Submitted By(print name): []Authorized Agent `Owner
Signature of Applicant: Date: .2-5-2-5-
STATE OF NEW YORK)
SS:
COUNTY OFFf%U�
Ro�►Q`o � � � being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the 0 WNep_
(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/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
day of 20 2S— Q
MARGARE'T A. KIDNEY Notary Public
Notary Public-State of New York
No. 01 K16021 111
Oualified in Suffolk County PROPERTY OWNER AUTHORIZATION
My Commission Expires March 8,20&'L (Where the applicant is not the owner)
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
2
!!? rre�r 18�r
NY'S I F PO Box 66699,Albany,NY 12206
New York State Insurance Fund I nySIf.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
A A A A A A 112377925 *..
LEVITT-FUIRST ASSOCIATES LTD
520 WHITE PLAINS ROAD,2ND FL `
TARRYTOWN NY 10591
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
ARTHUR J.EDWARDS POOL&SPA CENTRE TOWN OF SOUTHOLD
ARTHUR J.EDWARDS TOWN HALL
929 RTE 25A P.O.BO 1179
MILLER PLACE NY 11764 SOUTHOLD NY 11971-0959
POLICY NUMBER I CERTIFICATE NUMBER POLICY PERIOD DATE
G 2438 491-9 881298 06/29/2024 TO 06/29/2025 06/26/2024
THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUND UNDER POLICY NO. 2438 491-9, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS'
COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE
STATE OF NEW YORK, EXCEPT AS INDICATED BELOW.
IF YOU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY, INCLUDING ANY NOTIFICATION OF
CANCELLATIONS, OR TO VALIDATE THIS CERTIFICATE, VISIT OUR WEBSITE AT HTTP$://WWW.NYSIF.COM/CERT/
CERTVAL.ASP.THE NEW YORK STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH
NOTIFICATIONS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE
AFFORDED BY THE POLICY.
NEW YORK STATE INSURANCE FUND
(S,UiRAN�
4DIRECTOR,IE FUND UNDERWRITING
VALIDATION NUMBER: 633467799
ISIN
111r00000 O000 0 129 18 1 511111
Form WC-CERT-NOPAINr Version 3(08/29/2019)[WC Policy-24384919] U-263
7 [00000UD0000129018175][0001-M24384919][A#G][1641MS][CerL-ND'{0RT 1][01-00001]
\ �\
�"
-
zgggpqt
\ \
v\ \ gag-
• may `
Suffo
� � e ��t eat �� twr, eensng
ti
Consumer Affairs
-_ vy
a VETERANS MEMORIAL HIGHWAY * HAUPPAUOE, NEW YORK 11788
DATE ISSUED: 07/01/1978 No. H-4436 vy
SUFF01r,K COL,NTY �,
e Improvement Contractor License \ AD
\ R'�`\
This is to certify that ARTHUR J EDWARDS
o
doing business as ARTHUR J EDWARDS MASON CONTRACTING CO INC DBA (1 SUPP)
having furnished the requirements set forth in accordance with and subject to the provisions of applicable
laws, axles and regulations of the County of Suffolk, State of New York is hereby licensed to conduct
business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk.
s \\�'
NOT VALID WITHOUT Restrictions Additional Businesses 1
DEPARTMENTAL SEAL HI-GC; ARTHUR J EDWARDS POOL&SPA CENTRE
v �
AND A CURRENT �\
H26-Pools and Spas/Certified;
CONSUMER AFFAIRS H3-Pools/Spas
tE ID CARD Suffolk County Dept.of v
mayv
- labor,Licensing 8,Consumer Affairs
I; \
HOME IMPROVEMENT LICENSE
Name
ARTHUR J EDWARDS
v Business Name v
ARTHUR J EDWARDS MASON
c
v� This certifies that the CONTRACTING CO INC DBA(1 SUPP) ` v
Rosalie Dragon
v bearer is duly licensed v v
by the County of suffolk License Number H-4436
t Commissioner Issued: 07/01/1978
Wa y T Expires: 07/01/2026
Commissioner
x
SURVEY OF:
PROPERTY LOCATED AT SOUTHOLD
TOWN OF SOUTHOLD ROAD
SUFFOLK COUNTY. NEW YORK �A
� 25)
S.C.T.M. n 1000-75-3-14
AREA = 1
SCALE: 1'=30'
NOTE: THE EXISTENCE OF RIGHT OF WAYS. LAND N/F o
WETLANDS AND/OR EASEMENTS OF RECORD
IF ANY. NOT SHOWN ARE NOT GUARANTEED. DORA RODRIGUEZ SECAIDA 9
OSCAR R SECAIDA
ELEVATIONS REFER TO 1988 NAVO L/l
ELEVATIONS SHOWN THUS *++
PENCN 79.3 '30.E H
209.40,
VBK
3zis
I FENCE
FENCE - L7'/S VEL pµNENAY N
B.R- 0 SMEO - AT't. ON/R.R.TIE.o O
CON., y
MON. 1y �'L ��. i O W FM
(P W
O
rn
A O
UP
ACOP
UNIT
Ln u:
-o IDOL
LAND N/F f
CAROL SMITH _
}; FENCE 1
&4'/S
26,50"W
h Rµl FENCE S 72p9.38.
SURVEYED BY:
FENCE
at/s LAND N/F PAUL BARYLSKI LAND SURVEYING
ONMnSMS)ALTERATMN OR MHEN
VALE "TSN ET 6"' L"Tm" DAVID MGTAGGART 9
CRFFSCOF INS MWEt NAAPP MR BATMS TIDE LAND Sl Ef=MW JOCELYN BELL MCTAGGART PATCHOGUE NY 11772
M OROSSM BEW WALL NW M IM®EDTO E A VALAME CITY. PHONE 631-294-6985
oNRANIUM O CEUVICATMS SATES MFIE=WU RIM OaT TO
THE FENENFWIM THE SLIM IS"NR"RmN CHHSBDV&F'° FAX 631-627-3186
THE TRIE COVANF.GDW ME fAL AGENCY AM IF70O RSTRunEN
LEM WOW ANDTO THE AOROEM O'THE Looms Diffnur II PAULBARYLSKIa YAHOO.COM
MIA WREFS OI C0"*'=IMS ARE OR TRANSFOW IE M Am TMW.L
e6nTums OR SUMMM RIREIB.
JANUARY 20. 2025
6065
r. !
A 'P VED AS NOTED
DjA •� B.P .
B �
NOTIFY BUILDING DEPA MENT AT `RETAIN STORM WATER RUNOFF
631 765-1802 8AM TO 4PM FOR THE PURSUANT TO CHAPTER 236
FOLLOWING INSPECTIONS: OF THE TOWN CODE.
1. FOUNDATION-TWO NF`')''?��n
FOR POURED r 0lNJ ;P_
2. ROUGH- FRAMING&
3. INSULATION
4 FINAL-CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTON ERRORS
COMPLY WITH ALL CODE'S OF
NEW YORK STATE &TOWN CODES
AS REQUIRED AND COEMI " S OF INSPEC71014 REQUIRED
PLANNINGSOUTHOLD OWN BOARD
OWX ,
HPC
SCH7
OSE `,"'00L TO CODE.
SE ORE VAT
USE IS l.
WITHOUT CERTIFICA7
.. .. ............ _._...
" "
-.
BENCH
__...w...... ., „s
w
c�
0
46 DEEP '6' DEEPw v
e
e 16 w z
m
... V'I'I
4
_ ,.._2 _4 _ _ em u ll_u'_ . w v
n A r 4A'
a
_...
�a
,Q"b` .... _�nnvr ra,�mrwiianr
.....,._ ..w_
4
O
ap �nrr,
jptl y
Plan " Piping Arrangement
uV«aa c M... kF
Section B—B
K
Section A—A Typical ball Sectt � „„
_.......�.,
_5 . _
2E 8 w.,,...,.,,_.,.___ .._m.� ................._...„,.,.,,,.,.___�_,..,_.._.._.._.,_....,.,
as ::
.m.,,....v....,..,..,..... .x :.„-m:.:„_,:.:. .^.
FEET 'WFT FT FT FT FT FT FT FT 54 Fi GAL^
16 X 32 S6 32 B 14 6 4 4 � Q r}/ Ronald&Mary Shelton
„„, 8 512 23100
us x 21. na s a �� rERMACRM
OL Sr,SPA CePPM
1. a s a s 8 648 26.7as WALL SYSTEM 1050 South Harbor Rd
18 x 36 18 s 1z 1 w .�_. _w_w—.,g2g Route 25A Miller Place NY 11764
20 x 40 20 „40 16�14 6 4 S N30 800 33,000. (631) 744-7185 FAX (031) 744-0174 Southold, NY 11971
z4x44 za 44 18 14 8 a 8 10 79e 35,000 Suffolk License F443e—M
2a X 48 24 48 20 16 8 4 6 10 900
.....,._..,�,w_,_.,_..__..0 Liacase �FHI74460000
_ ..w _ 98,500 aBB9.m____..W_...,�,.._._,.�.,�..,�..