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Home My WebLink About32165-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY Date: 06/05/07 No: Z-32387 THIS CERTIFIES that the building INGROUND SWIMMING POOL Location of Property: 6645 (HOUSE NO.) County Tax Map No. 473889 Section 126 GREAT PECONIC BAY BLVD (STREET) Block 10 LAUREL (HAMLET) Lot 20 Subdivision Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JUNE 19, 2006 pursuant to which Building Permit No. 32165-Z dated JUNE 28, 2006 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 IN THE REQUIRED REAR YARD WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to GREGORY & DARLENE OLSEN (OWNER) of the aforesaid building. N/A SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 3014794 11/15/06 N/A PLUMBERS CERTIFICATION DATED ~ ~,~- Autnorized Signature Rev. 1/81 , Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 -~ <,,-;" \i'. ',.. \ ,\{ - APPLICATION FOR CERTIFICATE OF OCCUPANCY. ,J~ ..' '.. ..--J ,-,'"::'~ " , ",' - ,;;.;.-.::--- This application must be filled in by typewriter or ink and submitted to the Building Department\with1ne fol~o~ing:--- \->'.- I 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 installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/1 0 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-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 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 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 Date. mar 2 J I tl 7 New Construction: ~ Old or Pre-existing Building: (check one) Location of Property: t?/;; 'IS- ~Ct!J/J/{2 ~~ E/vd- House No. S eet Owner or Owners of Property: Gn:::JIJ rf +- J)a,rl1'!/11". c2I ~ Suffolk County Tax Map No 1000, Section / d). {p Block 10 but~/ Hamlet Lot ;( 0 Subdivision Filed Map. Permit No. 3d) ~5 '-7 Date of Permit. ajaR' /0(/ Applicant: Health Dept. Approval: . Underwriters Approval: .;f 30/'1 /;/ec. ) Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ d s-: (fJ c> Final Certificate: /" ( check one) ~~ ~. 7.;<6 .5 0 e.o--2. 3073 ~ 7 @] 1!.1 ~ BY THIS CERTIFICATE OF COMPLIANCE THE ~ ~ NEW YORK BOARD OF FIRE UNDERWRITERS ~ ~ BUREAU OF ELECTRICITY 1:2/ _ / _ 2.0 ~ ~ 40 FULTON STREET - NEW YORK, NY 10038 10. D ; ~ CERTIFIES THAT ~ ~ ~ ~ Upon the application of upon premises owned by ~ ~ ~ ~ GREGORY OLSEN GREGORY OLSEN ~ ~~ PO BOX 158 6645 PECONIC BAY BLVD ~~ii!l LAUREL, NY 11948 LAUREL NY 11948 ~ '~ ~ Located at 6645 PECONIC BAY BLVD LAUREL, NY 11948 ~ ~ ~ ~ Application Number: 3014794 Certificate Number: 3014794 ~ I Section, Block, Lot Building perm;:, ~/IAC- BDC, ns11 I ~ Described as a occupancy, wherein the prem;ses elew'te'al system consisting of ~ ~ electrical devices and wiring, described below, located in/on the premises at: ~ ~ Basement, pool & generator, Outside, PooVSpa, ~ ~ A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed ~ ~ herein, was conducted in accordance with the requirements of the applicable code and/or standard ~ ~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~ ~ authority having jurisdiction, and found to be in compliance therewith on the 15th Day of November, 2006. ~ ~ Name OTY Rate Rating Circuit TYm1 ~ ~ Alarm and Emergency Equipment ~ ~ Generator Permanent Installati 1 0 ~ ~ Transfer Switch 1 0 100 amp ~ ~ Appliances and Accessories ~ ~ Time Clock/Switch 1 0 ~ lID Pool/ Spa Bonding 1 0 Iil ~ Panels 1 30 5 ~ ~ 1 m 10 ~ ~ Wiring and Devices ~ ~ GFCI Circuit Breaker 3 0 20 amp PooV Spa ~ ~ GFCI Circuit Breaker 2 0 15 amp PooV Spa ~ ~ Receptacle 1 0 General Purpose ~ ~ Fixture 1 0 PooV Spa ~ ~ Receptacle 2 0 20 amp PooV Spa ~ ~ ~I ~ ~ ~ ~ 1 of 1 ~ ~ ~ ~ This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. ~ ~ I~ @] @] 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. 32165 Z Date JUNE 28, 2006 Permission is hereby granted to: GREGORY & DARLENE OLSEN PO BOX 158 LAUREL,NY 11948 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REAR YARD, FENCED TO CODE at premises located at 6645 GREAT PECONIC BAY BLVD LAUREL County Tax Map No. 473889 Section 126 Block 0010 Lot No. 020 pursuant to application dated JUNE 19, 2006 and approved by the Building Inspector to expire on DECEMBER 28, 2007. Fee $ 150.00 ~~ I Authorized Signature ORIGINAL Rev. 5/8/02 3 ~I fos:z- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING I STRAPPING [XfFINAL ~ ; [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRAnON REMARKS: f me r r;-~- a/LfL Orr:: 17 r::~ ~ ~ Vf:;-. --.... DATE S-;l-S -() 7 INSPECTOR ~~ .... ,...~. ...... . 3;}-/~S2- TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING /STRAPPING ~FINAL [ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION ] FIRE RESISTANT PENETRATION ~ , DATE /-11-07 INSPECTOR ~~ ./ fFlELD INSPECTION REPORT . DATE COMMENTS U;;g FOUNDATION (1ST) q)~ ....... .... .(;'" ~ V\=li: ------------------------------------ - (}e FOUNDATION (2ND) -D~ ,Z ~ . : f9 .:" .' , .- j;.; ~ ROUGH FRAMING & \/\ ~ t;l;l PLUMBING ..,;j " ~- .- I. " (r. r ~I (' \P~ ~ t"' INSULATION PER N. Y. ,-.. 'L ~ STATE ENERGY CODE - (J:0 -'-Z . ;L 1- (I/b 7 r(}-lli /A ",JI .J ~~ AI:Hi .-.. f) gJ -t;~./A-l r L--- Ai JJIl ~-,,-7p ~ / ~ .........., ;..- - <.. .# ( 5~~ ,. 07 F~ J..l.. - L.v 75K ~r.// ~ 'OC~' FINAL ' ~ '-- ~ ADDITIONAL COMMENTS 0 - ~ ". ,./ 0 CD~ ~ m., u :::0 C:: ~ , C? --, ( - . '-, V' a , . ~ .... ~ t>(', ~ II .... 0 0 .J z ..' ["C;;a r--~ - i-P~ , ~ . ~ . :,,~,.;' , JlIi; .' 'f\I 0\ I I 1 I I I i I , ! , i ! ! I I \ I I / I j I. :~' "':1"\", . POLlJ\K', ' 100..00 8 ci to N \ ~'\. ~ I .' ',..:,:; >;, .f 8 d 111 N w -0 ~ o 'r,. , " ~ :J ..., (j ~, f'" ...- .. .~;t'" .~) $' . ..:.: :'''~ . 'L.f~.{} , .... " '.' /P:3' I'" -8 '" .... ..;".' '! i. '; :~ MAP~"OF-'PQOPERTY' SUR.\lEYED.. f012.>. . .~._.. FlOQENCE C,.~lLE)f~~; -1 ,', , "'".". , ,", -- ~. ' . , .' " '" ' ' " ',;;' . ," . '" ,.-..;.. . . . . .. ,. ~! f - rf\J~ B^l" r-y' 'In~;'.-' L...UG L t 'l~. .r\ Lt. .~ J f'('o'" AT - lG\U tiEL TO . Mr-(~'e/'\UT"LtQ'L:'D '::t\I .,. WJ..,l:;'iim.~~ 1 n .. _ " Ph'J',; ., -'.. :;:.. ... ~';.: ~ Q -oJ W u.. -J o :r: .~ , ~ 17',,14' .. ,;.' ":'.~ ':-> ;. ;."~ .....t: :..;... //'" . . ...f , '~'''',' "I--.. . . 331t - ~ ""l >- t- I STORY FR.. MO. s - I -01 _ -I 611t o'ai I z ; 5:48 ZS'SO"W ,; 100. '-- DECON! C 8^"" 1:\'""" I) C\ 'A rID n 1 u"_'\"" 1....'-. v,.. K. '... r-.'-A.' .C' 4QJ.O',_I:j "',- . L ' - I' , ,"-' . .1.-.' '. : /' Fi : rvrnN [ J 1V!r= 'i- i...... ,.., ,-' ;~i l GUAQAt'lTE!::;:J TO THE SC.(;THOLD5AYINGS 8AN~ "'c:: '::' in' '--"/r=~ OC'..t'Z7 m7' ~ . r\-I __.,-"K..'v c: . r-V "-. ~ ' ",;7 '-. \/A\\i TII\(I -SO-',N' ,I JI V _ j I i I , IC....MS.ED ' ^N..... C:11r"l\l~" _I, ,l:~,' . .~':,.'&.if~J<w;Y"~'T:'.~ ':;R.E.E.NWO~r IN:f. I.' A E / A1umfnum Sldmnws Rftlma To FIIllIr 2' (?fFlllllr .. Pump To ~TO RIiIIlrN (!lIy WeI 0plInaI) RD-.cI WaI fi Plan A Piping Arrangement WaI SeclIon VInyl 42" Section B-B 3500 P.5.L Concnte ~HJ ~o" Section A-A Typical Wall Section SIZE ABC D E F G H AREA CAP. FEET Fr. Fr. Fr. Fr. Fr. Fr. Fr. Fr. SQ.Fr. GAL. 16x32' 16' 32' a' 14' 6' 4' 4' a' 512 19,000 16'x36' 16' 36' 12' 14' 6' 4' 4' a' 576 21,600 la'x36' la' 36' 12' 14' 6' 4' 5' a' 648 24,300 2O'x4O' 20' 40' 16' 14' 6' 4' 6' a' aoo 30,000 24'x44' 24' 44' la' 14' a' 4' 6' 10' 798 30,000 24'x48' 24' 48' 20' 16' a' 4' 6' 10' 900 30 000 ;(I,f:/Iuu,l}IlU4u/A...... PooL &. SPA CENTRE PERMACRETE WALL SYSTEM 929 Route 25A Miller Place NY 11764 (631) 744-7185 FAX (631) 744-0174 U Suffolk License #4436-HI Nassau License #HI74450000 Purchue Addn. state , DATE (MMIDDIYYYV) ACORDN CERTIFICATE OF LIABILITY INSURANCE OP 10 K~ ARTHU-1 01/05/06 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 823 W Jericho Turnpike Ste 1A ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Smithtown NY 11787 Phone: 631-864-1111 Fax: 631-864-8274 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: 647 Worcester Insurance Company Arthur J Edwards dba INSURER B: Arthur J. Edwards Pool & Spa INSURER C: Center Contracting Inc. 929 Route 25A INSURER 0: Miller Place NY 11764-2700 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 MAYBE 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. LTR NSR[ TYPE OF INSURANCE POLICY NUMBER "D<i';!~ ;MM/DDIYY 1P8kTE MM/DDIYY LIMITS ~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A ~ COMMERCIAL GENERAL LIABILITY MPA8G0912 01/01/06 01/01/07 PR~M;SES lEa occurence 1 $ 50,000 f-- :=J CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $ 5,000 A ~ Contractual Liab PERSONAL & ADV INJURY $1,000.000 GENERAL AGGREGATE $ 2,000,000 f-- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 h POLICY n ~fc?i n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f-- $ ANY AUTO (Ea accident) I-- f-- ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) f-- HIRED AUTOS BODILY INJURY I-- $ NON-OWNED AUTOS (Per accident) I-- I-- PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO OTHER THAN EA ACC $ AUTO ONLY; AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ tJ OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND I TORY LIMITS I IUIN- ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETORlPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S ~~~MLpi~O~IS1~NS below E.L. DISEASE - POLICY LIMIT $ OTHER A Property MPA8G0912 01/01/06 01/01/07 Building 919,000 A Inland Marine MPA8G0912 01/01/06 01/01/07 Ded 1.000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Town of Southold Town Hall P.O. Box 728 Southold NY 19971 CANCELLATION 0000000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRA TlO DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. A @ ACORD CORPORATION 1988 CERTIFICATE HOLDER ACORD 25 (2001/08) This QOrtifiQatc is lID originll. STATE OF NEW YORK WORKERS' COMPENSATION BOARD CERTIFICATE OF PARTICIPATION IN WORKERS' COMPENSATION GROUP SELF-INSURANCE I.. IApI Nlae lid Address orB.-iDeM PanieipatiDlID Grollp Self.I....rI..e ruse StfteI Adclrels OeM Arthur J. Edwards Msson Contractor, Inc. 929 Route 25 A Miller PlaC8, NY 11764 lei. BulDeII Telepllolle Namber ofBvlaess referated In box "1a" 1-631-744-7185 Ie. N\'S UDemploytmnf IIInnaee Employer Reprra60D Nllmber otBull.... ref.raced II 101 "b". \b. Elrec1lve Dice 01 Melllbcnllip iu tbe Groap 04/24/2002 lnae Date 6/5/20oe EsDJrltioll Dire: 6/412007 24108715 Ie. The Pro,ritlOr. Plr1IIen Or Esceatin omcers are (;ii illCladed. COnly clleck box IhD _menlofnun iaeluded) o allncladed or eenat. ,.maers/omcer. adaded. 1(. Fedenl Employer Idealifteatioa Namber oflu'.", referaeed ill Boa "ta" 111277925 Special Trade.. Contracting And Construction Tr\lst 8250 South Bay Roal.'l PO Box 3580 Syracuse, NY 1 ~220 Policy: W521504 This certifies that the business referenced above in box 111 a" js c:omplyina with the mandatoty coverage requirements of the New York State Workers' Compensation Law as a participating member of the Group Self-Insurer listed above in box "3" and Participation in such group self.insurance is still in foroe. The Group Self-Insurer's Administrator will send this Certificate of Participation to the entity listed above as the certificate holder in box "2". 2. N.... ad Addrcu or tile latit)' Reqllesdq Proor of Cm-erap (blilY BellI! LIsfecll. Certlrc:.tt HoldEr} Town of Southold Town Hall PO Box 728 Southold. New York 11971 3. Nlme lid Addms 01 Groll\) Stll-iaturcr The Group Self.insurer's Administrator will notify the above certificate holder within 10 days IF the membership of the Participant listed in box'I la" is terminated. (These notices may be sent by regular maiL) Otherwise, Ibis Certificate is valid for a maximum of one year from the date certified by the group self-insurer. qrhis cerliflco.te is no longer valid acco1'ding to the above guidelines and the bU$iness referenced in box "] a " continues to be named on a permit, license or contract Issued by the certi/icate holder, lhe business must provide the certificate holdeI' either with a new ce71iftcate or other QUthol'ized proof the business is complying with the mandatory coverage requirements of rhe Certified by: II&DlC of IUdIori:aId .....a.ai~ of1bt Group SoIt-wurcr) 81512006 (Dare) Certified by: Title: Telephone Number: (315) 899-6475 08-105.2 (2-02) WORKERS' COMPENSATION LAW WORKERS' COMPENSATION LAW Section 57 Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any pennit for or in connection with any work involvina the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or special statute requiring or authorizing the issue of such permits, shall not issue such pennit unless proof duly subscribed by an insurance carrier is produced in a fonn satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department; board, commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in oonnection with any work involving the employment of employees in a hazardous employment defined by this chapter. notwithstanding any general or special statute requiring or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been Pi.... Note: This Certificate is valid only through the policy dates indicated above, OR II max/mum of one year after this form is approved by the authorized representatives of the Group Self-insurer. At the expil'8t1on of those dates, if the business continues to be named on a permit or contl'8ct issued by the above government entity, the business must provide that government entity With a new Certificate. The business must also provide a new Certificate upon notice of cancellation or change in status of the policy. OS-10S.2 (2-02) Reverse TOWN OF SOUTHOLD&itOPERTY RECORD CARD .......:5 )1- y LAND IMP. &~O / 3 00 ')--)CJ 0 ,o50e 00 Ii 1.) 0 I I {) 0 3-Lt C\O \ OC 2.Qot::) ~.e:v 4 '000 Y'AC'L NORMAL Farm Acre Tillable 1 fjllable 2 fjllable. 3 Noodland )wampland 3rushla",-, -louse Plot rota I STREET/' ..f, /I.. "'.< 00 i-./ $vi ~ cvt-L SR. '"\. J:)"'"" <j ~ C--() J1 /C- /..J ~ y J:t/fA , FARM COMM. TOTAL DATE /9(){) 3300 Value Per Acre Value ~ VILLAGE DISTRICT LOT 1-tu~ E-- !/J..J/:. . , -l_f /.)'t 1/" 'f~ Ide 1-. ~ w, L /1 ACREAGE ,&0 TYPE OF BUILDING FRONTAGE ON ROAD /0 0 'X BULKHEAD ~ d-~~~ I \lJ-/~~ .. K 6 It-D 100 Fire Place .> zYC) .,;1 Xl r Porch '4.j S ;,(f.2'"t/l~rch Patio /'1 -.I ," --. '<:::w v\. Bldg. "2---).- Y 3.r--: :xtension :xtension I Ext. Walls :xtension 3 reezeway 3arage v" ..., J/ /.. J. B. " ,.", -.... 2-S"\2... . , .... - ..-.. I ! ~ ~ i ! ~ "4 r-~ ]; 'Ii? , v i I I~ I J ! I 1 t ; ~.. I i ! # ~ r.r f r I i I ; , ~ i i i i I i : I I I I I I I I I ! , ! ! I I I I I i I I I ~-! i I I I i I i I I ! , I ! I ! ! I I I I I I I I , I I Bath Floors r:,; Interior Finish Heat Roof Type Rooms 1 st Floor Rooms 2nd Floor Dormer ..... W H, i--e ~- Gr-e e $) 1Y't ~ .. c OWNER LAND IMP. ---~ ';1~:.~:"";,', . ~.. ~~ ~.,...",.... TOWN OF SOUTHOLD PROPERTY RECORD CARD --- ....- STREET VILLAGE ... DIST. ACR. REMARKS TYPE OF BLD. PROP. CLASS TOTAL DATE FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BUI,.KHEAD ~ .....-.. ...... e-- SUB. - - LOT TILLABLE WOODLAND , ) MEADOWLAND HOUSE/LOT TOTAL 126.10.20 2/04 'i"o. "V , " S ~- '1'",. i I~- - - .... Ii> 1'6<< *' ..... - - ..... . I 1 'r 2,! - ~ I .. .1. C!J ~~ ~\~ ':";;~",,':;:;,~:;.~..,,",",;o,,; M. Bldg. &K ~i~ - 1Qo Extension ~'< \\ ~ ~~ 7xn~ \~ ~n \C 1q " ~c H~,,~6J .:- 4"; Deck Breezeway Garage \2 'f..- ~4"', l\o8 O.B. Pool Foundation Bath Dinette Basement Floors ~,,~ Kit. Ext. Walls Interior Finish S,P. L.R. Fire Place Heat '{es D.R. Wood stove BR. \~ 1.\S- Dormer Fin. B. Attic Rooms 1 st Floor ~,~~ \ ~Q,- 1) SfioT Driveway Rooms 2nd Floor lo~ ~ -~.. - z~ iJr:1 L - TOWN bF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 3 J..-I ".5""' ~ BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying? Board of Health 3 sets of Building Plans Survey Cheek Septic Form N.Y.S.D.E.C. Trustees Contact: PERMIT NO. tlvt ,20...QL Approved I tp /)1/, 20~ I Disapproved ale . ~~;; ~ /f)4fv 7 I Examined Mail to: Phone: ,-,,1 !~ I Building Inspector ~ 0 \\ \ \\\ j\j',; \;) :I >' ~".. ',.Ai>>PL CATION FOR BUILDING PERMIT ~OU{"0l0 Date~UNe.. 17 INSTRUCTIONS ,20~ 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 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 a Certificate of Occupancy is issued 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 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 on premises and in building for necessary inspections. If applicant is a corporation, signature of duly authorized officer ALL CONSTRUCTION SHALL MEET THE PEQUIREMENTS 0 (Signature ofappl' COPES OF NEW YORK STATE. ~ it cJ:;ft MlkL 110& //70'1 RETAIN-STORM W~TER RUNO. (Mailing address of applicant) PURSUANTTO SECTION 45-10C State whether applicant is owner, lessec)fitihIE ~~neer, general contractor, electrician, plumber or builder &Y11'iOd. ~ - (!, ~tlfNe..- {jLf:eN (as on the tax roll or latest ~"ft!: tI FEE: /57J BY: NOTIFY BUILDING DEP. RTMENT AT 765.1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED FOR POURED CONCRETE 2. ROUGH. rRAMING & PLUMBING 3. INSULATION 4. FINAL - CONSTRU':TIOK MUST BE COMPLETE FOR c.o.. ALL CONSTRUCTION SHAtlllEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR - DESIGN OR CONSTRUCTION ERRORS. iAue~A~ - . Haml~t "IMMEDIATELY" ENCLOSE POOL. TO CODE UPON COMPLETION BeFORE "WA~. Name of owner of premises (Name and title of corporate officer) UMDERWRfJERSCERTIFlCAlE >"" lI.Q\ftQ.. -: .." ...-/(.-''"^ tf430-I-f ( Builders License No. Plumbers License No. R UL IFICA TE 1. Location of Ian a on w 'ch proposed vlcMi'6Oe\!IPANCY Lj.~ (\} e. 6~ - BlVD House Number Street ()7L/O me Electricians License No. Other Trade's License No. .~", . County Tax Map No. 1000 Section Subdivision \2l.p Block ) 0 Filed Map No. LfrJ3~q Lot Zo Lot (Name) ~. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · < '.. a. Existing use and occupancy R.{61 ~1'Ic:e.. ' b. Intended use and occupancy k.es'QeN1Y1l. bw1fllmlwq PaJL 3. Nature of work (check which applicable): New Building Repair Removal Demolition Addition Other Work Alteration 6J\mrnlN ~ RJJ, (Description) 12, coo- Fee 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars (to be paid on filing this application) Number of dwelling units on each floor 6. Ifbusiness, commercial or mixed occupancy, specify nature and extent of each type of use. 7. Dimensions of existing structures, if any: Front 53 \ Height Number of Stories Rear ~' Depth 8'lI ' Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories 8. Dimensions of entire new construction: Front 12' Height 311-"'") B' ~ Number of Stories 9. Size of lot: Front I OJ l Rear I ctJ ' Rear 20 l Depth 3/ Depth 260) 15rt IL~~ 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: No 13. Will lot be re-graded ~L ~ C1JL"\ Will excess fill be removed from premises: ~ NO ~/t\( (L. ~(LL(III-l. LNw. 14. Names of Owner of premises OL~'" Address (plJ+5" {I~\e (k; BI\IO Phone No. ~{n-51~'7 ' Name of Architect Iho(l\fll<s. ~ ({e,\l\( oft Address Jt &Ul.. J..N ~~ Phone No 52/y-OIQJ. Name of Contractor Address Phone No. 15.IsthispropertywithinlOOfeetofatidalw~t1and?":>iiYES:": ,...."J' '~O;; ~._, s::r""'l""""'ll ,,~'\ · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRE.ii:.~ .:.., ~.:': "'~:~~ ~t, ~ , :1<_)..,:"". ..... ~.~'.,... ,. '~~~",Jt'.../ ~'._ AOn ;,;U '11..t:)) v" 16. Provide survey, to scale, with accurate fo~~i~~"~~,-dM~~~ ~RA'f~ lines.'G:r!'i'W" 3~'~(:;.j:':s . . ",',. ~ '''J'' " T .f\l r,:;q'lJi" 17. If elevation at any point on property is at 1 0 feet or'below ~. Jius~ pr~:vid~iop~~aphical data on survey. STATE OF NEW YORK) SS: ) &\1tV<.- 1 t::ohlaws being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, ~e1O'-, (Contractor, Agent, CO!,OJ.1Ue Offi~er,etc.) of said owner or owners, and is du1y authorized to perform or h~~'~rmed 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." ,'" "" '..r 11 COUNTY OF (S)He is the '." swornt~fO~a~~f~UtJl 20~ ...it,,! ^;v ;.,.:,.:,..' ~A-~ ': ,A~)~l:Ttl"}' . ~ .' .......! " . No Public \'..'" i ,I'.' MARGARET A. BANNWARTH Notary Public, State of New York No. 01 BA6021111 Qualified in Suffolk County Commission Expires March 8. 20J22