HomeMy WebLinkAbout33101-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
NO: Z-33082
Date: 06/09/08
THIS CERTIFIES that the building ACCESSORY
Location of Property: 275
(HOUSE NO.)
County Tax Map No. 473889 Section 70
CLEARVIEW AVE
(STREET)
Block L-
SOUTHOLD
(HAMLET)
Lot 39
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MAY 22, 2007 pursuant to which
Building Permit No. 33101-Z
dated
JUNE 4, 2007
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 HOWARD W SAWICKI
(OWNER)
of the aforesaid building.
SUFFOLK COtJlIITY DEPARTMEIIIT OF HEALTH APPROVAL
N/A
ELECTRICAL CERTIFICATE liIO.
07-4365
12/19/07
PLOMBERS CERTIFICATION DATED
N/A
~/fi:,~a<"".
Rev. 1/81
\- l'
Form No.6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
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 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 I % 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 nses, 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
L 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.
New Construction: ( (~:r~~:isti~~tding: (teck one)
Location of Property: '-.75 \)v-t .\~
Str~ Hamlet
Owner or Owners of Property: fN- !/C-,.l:/i/-
Suffolk County Tax Map No 1000, Section 7tJ Block cI Lot JJ
Subdivision
Filed Map.
Lot:
Health Dept Approval:
Planning Board Approval:
Request for: Temporary Certificate
.rvo
Fee Submitte1: $ l.
<:':'10-2: 330~d-
(ZaG 1'i'-f3~
Date of Permit cf- f/-o7 Applicant: .//I<.t/1'~ 0.-J/t /,
Underwriters Approval:
Permit No. JJ/()/
.
pplicant Signature
1. ELECTRICAL INSPECTORS, INC. is not responsible for the existing conditions at the subject premises.
2. ELECTRICAL INSPECTORS, INC. is not responsible for corrections. upgrading or replacement of existing
electrical violations at the subject premises. Any corrective work shall be solely the responsibility of the property
owner. ELECTRICAL INSPECTORS, INC. DOES NOT WARRANTY OR UNDERWRITE THE
ELECTRICAL CONDITIONS AT THE PREMISES.
3. ELECTRICAL INSPECTORS, INC. only recognizes the National Electric Code, the Building Codes of
New York State all volumes and Local Municipal Codes, as Authorized by The Department of State
Codes Division, via Village, Town or City Board Resolution.
4. AN ELECTRICAL SURVEY consists of a visual examination of the premises ONLY: Electrical Inspectors
Inc. will comply with the requirements ofNFPA 73, latest edition Chapter I, Section I-I, 1-2.lfviolations exist, a
Notice of Violation (NOV) will be issued requiring correction by a licensed electrical contractor. After the
violation has been corrected, a re-inspection will be conducted and if approved a certificate shall be issued.
5. A SURVEY CERTIFICATE does not examine the actual wiring or devices unless all walls are opened and
wires and devices are exposed prior to the survey being conducted.
6. A CERTIFICATE is non-transferable.
7. AN ELECTRICAL INSPECTION consists of an examination of wiring and installations during the rough
stages of construction. After completion of the construction a final inspection will be conducted at which time a
certificate will be issued provided no violation exist. In the event no inspection is requested during the rough stages
of construction ELECTRICAL INSPECTORS, INC. will perform a CLOSED WALL SURVEY that
consists of a visual inspection of the wiring and installations only. Since access is limited, ELECTRICAL
INSPECTORS, INC. shall bear no responsibility for any defects or violations at the premises.
8. ELECTRICAL INSPECTORS, INC. shall not be responsible to remove any walls in order to conduct an
electrical inspection.
9. ELECTRICAL INSPECTORS, INC. will only release information, certificates and reports to the applicant
after payment for services rendered have been paid in full.
10. ELECTRICAL INSPECTORS, INC. assumes no liability for the results of its inspections.
11. The agreement may not be changed orally.
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.
33101 Z
Date JUNE
4, 2007
permission is hereby granted to:
HOWARD SAWICKI
275 CLEARVIEW AVE
SOUTHOLD,NY 11971
for :
CONSTRUCTION OF AN ACCESSORY SWIMMING POOL, FENCED TO CODE
at premises located at
275 CLEARVIEW AVE
SOUTHOLD
County Tax Map No. 473889 Section 070
Block 0008
Lot No. 039
pursuant to application dated MAY 22, 2007 and approved by the
Building Inspector to expire on DECEMBER 4, 2008.
Fee $
250.00
/1 - U
/~ ?L
Authorized Signature
ORIGINAL
Rev. 5/8/02
?/?/ol Z:;
TOWN OF SOUTH OLD BUILDING DEPT.
765.1802
INSPECTION
] FOUNDATION 1 ST [ ] ROUGH PLBG.
] FOUNDATION 2ND [ ] INSULATION
] FRAMING/STRAPPING [~NAL~~';-~E':)
] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: () f:- zr:, c. {) .
DATE or;lo, ft8
I /
INSPECTOR ~/~~i-
. ,
?;3/0/Z
TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] ~LATION
[ ] FRAMING I STRAPPING [8INAL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRucnON [ ] FIRE RESISTANT PENETRATION
REMARKS: ~?"ff!__ ~~~-=-r-
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DATE tJs-js- ~8
I /
INSPECTOR~k-:f
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
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DIST.
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TYPE OF BUILDING
E
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RES. L- 10
LAND
FARM
COMM. CB. MISe. Mkt. Value
IMP.
TOTAL
DATE
REMARKS
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House Plot
FRONTAGE ON WATER
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DEPTH
BULKHEAD
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Brushland
Total
DOCK
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COLOR
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Extension Basement putt.. Floors K.
-
Extension Ext. Walls "<<..A-~!( ;",,,,-<:,"1 Interior Finish LR.
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Extension Fire Place 'fDJ../ Heat DR.
Type Roof ~ Rooms 1 st Floor BR.
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Porch Recreation Room Rooms 2nd Floor FIN. B.
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FIELD INSPECTION REPORT DATE I
COMMENTS
FOUNDATION (1ST)
-------------------------------------
FOUNDATION (2ND)
ROUGH FRAMING &
PLUMBING
----,
_ ------ ---------------
INSULATIONPERN.Y. 1--------
STATE ENERGY CODE
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ADDITIONAL COMMENTS
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MAP OF
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seCTION No. I
flU NO', 3.!S& FR(O ,aUaUST 9, a$1
SrrUArED AT
SOUTHOW
TOWN OF SOUTHOLD
SUFfOLK COUNTY, NEW YORK
S.C. TAX No. 1000-70-08-39
SCALE '"=20'
JANUARY 21. 1999
AREA " N.200.00 'q, It
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"""'~<GIl INfJI<(W""""J~1I*lO
Joseph A. Ingegno
Land Surveyor
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printed: 4/30/07 14: 16 :44
11111111111111111111111111111
000071705
SVCCAT09V4
SERVICE LIST SCHEDULE
JW
Schedule- D
Svc Date- TUESDAY 5/01/07
List#- 717-05
WHITE GLOVE POOL INSTAllATIONS, INC.
SITE SURVEY DRAWING GRID
ORDER NO: 02-09-00075
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Customer Copy
Erosion. Sedimentation and Storm-water Run-off Control Plan ASSESSMENT FORM
Yes No
EXEMPTIONS: ......... J
A. Does this project meet the minimum standards for classification as an Agricultural Project. _ ~
Note: If you answered Yes to any of the above, a Storm-water, Grading, Drainage & Erosion Control Plan is not required.
-------------------------------------------------------------------
ACTIONS REOUlRING THE SUBMISSION OF A STORM-WATER. GRADING. DRAINAGE &. EROSION
CONTROL PLAN CERTIFIED BY A DESIGN PROFESSIONAL IN THE. STATE OF NEW YORK.
Item Number: (A Check Mark (J) for each question is required for complete application)
Yes No
I.
Will this project retain all Storm-Water Run-off generated on Site?
(This will include all run-off created by site clearing and/or coristruction activities as well as all
Site Improvements and the permanent creation of impervious surfaces.)
Will this project require any land filling, grading or excavation where there is a change to the
natural existing grade involving more than 200 cubic yards of material within any parcel?
B
[d~
g~
(dL
b))'
EI'X
(dY
[dY
'><
2.
3.
Will this application require land disturbing activities encompassing an area
of five thousand (5,000) square feet of ground surface or more?
4.
Is there a Natural Water course running through the site or is this project within
One hundred (100) feet of wetlands or a beach?
5.
Will there be site preparation on slopes which exceed fifteen (15) feet of vertical rise to
One hundred (100) feet of horizontal distance?
6.
Will driveways, parking areas or other impervious surfaces direct Storm-Water Run-off
into and/or in the direction of a Town Right-of-Way?
7.
Will this application require the placement of material, removal of vegetation and/or the
.construction of any item within the Town Right-of-Way or road shoulder area?
(This item does not include the Installation of driveway aprons.)
8.
Will there be site preparation within the one hundred (100) year floodplain of any watercourse?
Note: If any answer to questions one through eight is answered with a check mark In the Box, a Storm-water, Grading,
Drainage & Erosion Control Plan is required and must be submitted for review prior to issuance of any building permn.
-------------------------------------------------------------------
STATE OF ~~~Fn~<-nn'n'.nn ss
That!, n...W.\n.\.L.~n.nn:=.nn:.nnn.I..~J~.. . being duly sworn, deposes and says that helshe is the applicant forPennit,
(Name of individual signing Document)
And that He/~e ..nn.O.u)~.
(Owner, CvuD.a,-,tvl, .\1;(-1.(, Cv11^'1<U,", 0fD.uu., ute.)
Owner and/or representative of the Owner or Owner's, 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 belier; and that the
work sill be performed in the manner set forth in the application filed herewith.
Sworn to before me this;
~ ~--rt'l.
.........,.............. ............dayof ...
. ............. ..............20Q.1--
Notary Public: . .....
.... ............ANRRUDDE ....... ..................
MR8AR,.A State olllew Yorll
lIotal'! pub IC. 4855805
auel"i:doi~~~~~~P~lm~D
Commill1on ~r
TOWN OF SOUTHOLD
" BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www.northfork.net/SoutholdJ
PERMIT NO.
g3ro 10-
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying?
Board of Health
4 sets of Building Plans
Planning Board approval
Survey
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
~~:~~~j
Examined
Approved
Disapproved ale
Mail to:
Phone: 76)' 1. q 'II
Expiration
1.?/~,20~
/~
Building Inspector
\-\1\1 'L 2
"
APPLICATION FOR BUILDING PERMIT
Date
s: '2. 2.
2007
'-
....-'
-~
INSTRUCTIONS
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
a. 'ms-application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of/ot 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 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.
APPLICA nON 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
apphcant agrees to comply with all applicable laws, ordmances, building COd~? code, and regulations, and to admit
authorized inspectors on premi~s and in building for necessary inspectio~ ~/--
"IMMEDIA TEL Y" ~ OCCUPANCY OR <',-., ',,"M"" -, ". 00",,",00)
ENS~g~El~LL~~fg~OE IS UNt,AWFUl &~) /tfJ't j;:ll/{ ~v //111
BEFORE "WATER" USE LI'\ (Maifutg address ofapphcant!
.' WITHOUT CERTIFICATE
State whether apPlican~s5l=aC1eClJ'FYA'Nefneer, general conmAO~O~eBber or builder
. DATE: ~/~l! B.P. # ~ ;.{ c
Name of owner of premises ;/v;/J.& (JJ /tv) c-/(; - ~~~IFY~~DING ~~:PARTMENT';,r
roll or71liddllOae~M TO 4 PM
If applicant is a corporation signMEi1M~(tma& THE FOLLOWING INSPECTIONS:
, COS6$OFNEWYORKSTATE. 1. FOUNDATION. TWO REQUIRED
. . ". FOR POURED CONCRETE
(Name and tItle of corporate office,5~DERWRITERS CERT1~ll 2. ROUGH. FRAMING & PLUMBING
REOUII\ED 3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C,O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YO~' K TATE. NOT RESPONSIBLE FOR
(DE)) N pR CONSTRUCTION ER~'j
/ ptJ tfold }./" Ij'(
Hamlet
I. Location ofland on ~ich proposed wor will be done:
'27:; (e:4--u/tftJ I./C'
House Number Street
County Tax Map No. 1000 Section
Subdivision
70
Block d r
Filed Map No. Y f ?t?
Lot
Lot
J7
/7
(Name)
".
b. Intended use and occupancy
2. State existing use and occupancy of premises and,'l}ten
a. Existing use and occupancy '\/l" E:
3. Nature of work (check which applicable): New Building
Repair Removal Demolition
Addition
Other Work
fo,L
Alteration
(Description)
4. Estimated Cost
Fee
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
Height Number of Stories
Rear
Depth
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
Rear
Depth
9. Size oflot: 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 ~
13. Will lot be re-graded? YES_NO ~ Will excess fill be removed from premises? YES ~ NO_
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
IS a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES _NO L
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY E\E 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 anddis.tatt~sitbJf1&&Y lines.
,! ,WA HAll ';II -." i" '
17. If elevation at any point on property is at 1 0 feet ortJeloW, m~pt6vlde td!'JO~aphical data €m survey.
." l'<Yl TR 3:)cl.'OH TIW
18. Are there any covenants and restrictions with respect tq, t~ii}onr~n;;;..,;(YES",-- NO X
* IF YES, PROVIDE A COPY. . ' ,IV:7-I Uv': j -1(::;
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STATE OF NEW YORK)
G::ffi SS:
'COUNTY } Y
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being duly sworn..+J.!VI~*OO's that (s)he is the applicant
(Nameofindividualsi gcontract) above named, .r~-:.' _.
~Heisthe OWV\€~.
(Contractor, Agent, Corporate Officer, etc.)
lvn )(1'
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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.
l'" ""ore = fu',
~lr~~ :O::::RAANN RUDDER
Notary Public Notary Public, State of New
No. 4855805
Qualified In Suffolk County..., '" 0
Commission expires AprIl14,~