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HomeMy WebLinkAbout34855-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-33845 Date: 07/23/09 THIS CERTIFIES that the building SWIMMING POOL Location of Prc~erty: 480 KOUROS RD NEW SUFFOLK (HOUSE NO.) (STREET) (HAMLET) County Tax Map No. 473889 Section 117 Block 6 Lot 19.3 subdivision Filed Map NO. __ Lot No. -- conforms substantially to the Application for Building Permit heretofore filed in this office dated JULY 13, 2009 pursuant to which Building Pel~nit No. 34855-Z dated JULY 13, 2009 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 IN GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. ·"ne certificate is issued to ERIKA SHAPIRO of the aforesaid building. (OWNER) S~FPT)LK CO~DEPAR~ OFBF~%LTHAPPRO%5%L N/A BI~C'~RIC3%L C~RTIFICATH NO. 7532 04/09/07 ~BEP~ c~KTIFICATION DA'r~u3 N/A Rev. 1/81 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 for~n). 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 2/10 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. New Construction: Location of Property: House No. Owner or Owners of Property: Suflblk County Tax Map No 1000, Section Subdivision Permit No. '-~ Health Dept. Approval: Old or Pre-existing Building: (check one) Street , Filed Map. Date of Permit. Applicant: Underwriters Approval: Hamlet Lot I~.~ Lot: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ t~, O'~ Final Certificate: (check one) Applicant Signature FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. (THIS BUILDING PERMIT PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 34855 Z Date JULY 13, 2009 Permission is hereby granted to: GIL & ERIKA SHAPIRO 113 WEST 77TR STREET APT 3 NEW YORK, NY 10024 for : CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN REQUIRED REAR YARD FENCED TO CODE. REPLACES EXPIRED BP # 32576 at premises located at 480 KOUROS RD County Tax Map No. 473889 Section 117 purs,,~nt to application dated JULY Building Inspector to expire on JANUARY NEW SUFFOLK Block 0006 Lot No. 019.003 13, 2009 a~d approved by the 13, 2011. Fee $ 150.00 /~ u~zed S~i ~r.~at ufe ORIGINAL Rev. 5/8/02 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. 32576 Z Date DECEMBER 15, 2006 Permission is hereby granted to: GIL SHAPIRO 480 KOUROS ROAD NEW SUFFOLK,NY 11956 for : CONSTRUCTION OF AN INGROUND SWIMMING POOL IN THE REQUIRED REAR YARD FENCED TO CODE at premises located at County Tax Map No. 473889 Section 117 pursuant to application dated DECEMBER Building Inspector to expire on JT/NE 480 KOUROS RD NEW SUFFOLK Block 0006 Lot No. 019.003 7, 2006 and approved by the 15, 2008. Fee $ 150.00 hori z~d Signature ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ]FIRE RESISTANT CONSTRUCTION REMARKS: [ ] ROUGH PLBG. [ ] INSULATION ~X~FINAL ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION DATE INSPECTOR -/~r-. ~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FIRE RESISTANT CONSTRUCTION [ [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ]INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION REMARKS: DATE , , , __ , ~ FO~ATION (1ST) ~ ~O~A~ON (2~) ~ ~ . ROUGH ~G & q PL~G 8TA~ ~R~ ~ODE ~D~ION~ COUNTS ~ " ~ BUILDING DEPARTMENT TOWN HALL ~[~ SOUTH, pLD, NY 11971 TEL:. 705-1802 Approved /4// ~ 90 ~ Disapproved a/c PERMIT NO. ~ ~- 26 ~ ~UmDLNU P~KIVlIi AYPLiCAflUN CHECK%IS Do you have or need the following, before applying Board of Health 3 sets of Building Plans Survey Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT INSTRUCTIONS ,2001o 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 en'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 throughogt'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 Occupan is issued by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance cfa Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuffolklCo{~nty, New York, and other applicable Laws, Ordinances or Regulations, for the cbnstmction of buildings, additions, or alterations or for removal or demolition as herein described. The applicant agrees to coinply with all applicable laws, ordinan6?, building code, housing code, and regulations, and to admit authorized inspectors on premises and in building for necessary inspections. "IMMEDIATELY" ENCLOSE POOL TO CODE UPON COMPLETION BEFORE "WATER" {~EoO[~ED . x~"~i ture o. ffapplicant off name, if a corporation) MEE~ THE REQUIFIEMENTS OF TFTff"v' "-'; J" ' """ v' ' ' : - (M'ailing'a~dr'ss of'pplicanti't''J - ~' CODES OF NEW YORK STATE. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of pi'emises - ~a~ on [l~e tax roll or latest d~'~l~"--~':~~-'~' ' If n, signature ofd~y authorized o.f~c, er t: .....['; '--[ I : : :: : :: ~ ; T'~::I~T AT L --~e%d ~of OCCUPA OR co~orate office~) 1. FOUNDATION - TWO REQUIRED USE FOR POURED CONCRETE Builders License No. ~~ IS UN WFUL 2. ROUGH-FRAbIING & PLUMBING P .mb rs WlTHOOT CERTIFICATe; FINAL - CONSIRUCTION MUSI Elec~cians LicenseNo. ~ - ~4~LL MEET THE ' REQUIREMEr 3'0 OF THE CODES OF NEW Otbc~ ~adc's LJccosc No. . YORK STATE, NOT RESPOHSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. l. LocaiEn of land o~ w~ich proposed work ~i]l be dooc: House Number Street coont s p o.]ooo soo, o, 117 , . lo k Lot Iq.3 Subdivision Filed Map No. Lot !. State existing use and °ccupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy. ~ ,~>~-~.D./~-~.1..o~ b. Intended use and occupancy I. Nature of work (check which applicable): New Building Addition Alteration Repair _ Removal Demolition Other Work'~--to6~u.t.~ I{~) (Description) L Estimated Cost ' ~ Fee (to be paid on filing this application) ; If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use. Dimensions of existing structures, if any: Front Rear Depth Height_ Number of Stories Dimensions of same structure with alterations or additions: Front Depth Height_ Dimensions of entire new construction: Front Height Size of lot: Front 0. Date of Purchase Number of Stories Rear Name of Former Owner Number of Stories Rear Depth. Depth. Rear 1. Zone or use district in which premises are situated 2. Does proposed construction violate any zoning law, ordinance or regulation: 3. Will lot be re-graded L~.~ . Will excess fill be removed fi.om premises'~'~-~ NO 4 Names of Owner ,-' . ~' -- .t,, .~ 13 'Na ..... ?~em~s~t~ Ad&ess~~ ~, Ph~eSo. 917- me o~ ~cm~ecr ~ 11~ Ad~ess~ ~ ~'~ne No Name ofContractor~ ~ *~ -,. ,~ -, ~.~ _ 5. Is this prope~y within 100 feet of a tidal wetl~d? *YES ~ ~ ' NO · · YES, SOUTHOLD TO~ TRUSTEES PE~ITS MKY BB~Q~D ~'' 6. Provide su~ey, to scale, with accurate foundation pl~ and distancesr~ prope~y lines. 7. If eIevation at any point on propeay is at 10 feet or below, must provide topo~aphical data on su~ey. ~L .~J~ being duly sworn, deposes and says that (s)he is the applicant ~ame of individua] si~{ng con~a;;)~ve named, ¢)He is the (Con,actor, Agent, CO~orate OTficer, etc/J ~ ' smd o~er or owmers, and is duly authorized to ~o~ or have Perfo~ ~c, said work and to ~ke and file this application; mt all statements contained in this application ~E ~ to the b~st of his ~oWledge and belief; and that the work will be erfomed in the manner set fo~h in the applica~iofi fi]ed therewith. worn Core me this day of ~ Signature of Appli}~ant PETER BOOTH Notary Public, State of New York No. 01BO6092004, Suffolk County Term E>'r)i~'o-~ ,Ma' ~2 2007 'C TOWN OF SOUTHOLD PROPERTY RECORD CARD ~-//7- ~ -/~.~3 OWNER STREET ~7/~' !~,~ VILLAGE U!ST__~.------------SUB' FORMER O~NE~.~b b~ . E ACR. J rES. ~ ~ O S~S. VL. FARM CO~. CB. MICS. Mkt. Value ~ND IMP. TOTAL DATE R~RKS 'illoble FRONTAGE ON WATER f~land FRONTAGE ON ROAD %odowl~d DEPTH louse Plot BU LKH~D oral COLOR TRIM Xtension 3 F~' Z---- /3 Foundation Ext. Wails Fire Place Type Roof Recreation Room Dorrll~e r Bath Floors Interior Finish Heot Rooms 1st Floor Rooms 2nd Floor Driveway Dinette LR. DR. BR. FIN. B ~_/~,? OF SOUTHOLD PROPERTY RECORD CARD .-~..~ OWNER STREET VILLAGE DIST. SUB. LOT ~ ACR. FOYER OWNER N ~,,, s Z/ E U~ ~;C ~ S W ~PE OF BUILDING RES. ~// S~S. VL. ~ FARM CO~. CB. MICS. Mkt. Value ~ND IMP. TOTAL DATE RE~RKS / · Tillable FRONTAGE ON WATER N~land FRONTAGE ON ROAD ~eodowlond DEPTH ~ouse Plot BULKH~D :otol COLOR TRIM M. Bldg: Extension Extension Extension Porch Porch Breezeway Garage Foundation Basement Ext. Walls Fire Place Bath Floors Interior Finish Heat Type Roof Dine~e LR. DR. Rooms 1st Floor Patio Recreation Room O.B. Dormer Driveway Total Rooms 2nd Floor BR. STATB OF NEW YOBI( ~rOI:LKBRS' COMPENSATION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE 1% LegalName and address of Insured (Use Wet address only) Dunrite Manufacturing Corp 3510 Veterans Memorial Highway Bohemia, NY 11716 Work Location of Insured (Only required if coverage is specificalky limited to certain locations in New York State, i.e. a Wrap-Up Policy) 2. Name and Address of the l~nfity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Southold Building Dept Main Street Southold NY 11971 lb. Business Telephone Number of Imured 631-588-1300 1 ¢. NYS Unemployment Iramrimc e Employer Registration Number of Insured 0592920-5 Id. Federal Employer Identification Number of In,,ma~d 11-2245133 3a. Name of Iasurauce Carrier American International Co 3b. Po]icy Number of entity lis ted in box "1 a": WC1883215 3c. Policy ~ffective p erio d: 04/01/06 to 04/01/07 3d. TheProprietor, Parthass or Executive Officers are: ~] iaclu/l~l. (ody ~h~k~oxlf~llp~dot~m i~eluded) ~ all excluded or certai~ parthevs/officers excluded. 3e. Demolition is: (Definition of Demolitlon on Reverse) [~ i'n dufled. [] excluded. hi~ seriifie~ that ~ me carder indicated above in box "3" insures the busings referenced above in box "llx" for workers' comp~ation urder ~ New York Sll/t e Workem' Compeaxsation Law. The Imuraaee Carrier or its li~emed agent will send this Certificate of Imuraaee to the entity listed above as the certificate holder in box "2". The Insurance Carrier',viii also noMd~ the above certificate holder within 10 days JJ~ a policy is canceled due to nonpayment of premium$ or within 30 days 2F there are reasons other than nor,payment of premiuras that cancel the'policy or eliminate the insured froth the coverage i~icated on this Cerlificate. (These notices may be zent by regular mail.) Otherwise, this Certificate is vali~for a maximum of one year after this form is a~proved by the. ir!sut~ance cat~rler or ~ts licensed agqnt. .... Pl~e Note: Up ~rt the cmxcellafion of the workers' c{m~p e~nsation policy indicated on ~ form, if the lm!dness continues to be named on a permit, lic~mse or contract is~le~l by a certificate holfl~, the b'asiness m~st pro~ide that certificate hold~ with a new Certificate of ¥?ork~rs' Caa~pmsation Coverage or other authorized proof that the business is camplylng with fire m~mflatory coverage requiremenl~ of the New York State Workers' Compe~.sation La~v. Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the iasurance carrier referenced above and that the named insured has the coverage as depicted on this form. Approved by: Kevin McDonoueh A~o by: __~roved (Sisaa~) (Dat~) Title: President of Walter Rose Agency, Inc Telephone Number of authorized representative or licemed agent of insurance carrie~(845 ) 783- 25 5 5 Plec~e Jgote: Only insurance carriers and their licensed agents are authorized to issue the C-I05.2 form. .[nsurance broker~ are ]gOT authorized to issue it. C-105.2 AC . CERTIFICATE OF LIABILITY INSURANCE o. iD sci DATEI.oo YYI - D i-11 03/30/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOi~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Walter Rose Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR 8 Stage Road ALTER THE COVERAGE AFFORDED BY THE POL ClES BELOW, Monroe NY 10950 Phone: 845-783-2555 Fax: 845-783-2425 INSURERS AFFORDING COVERAGE NAIC # INSURERB: Twin Cit~ Fire Ins Co 347 Dunrite Manufacturing Co.rp INSURERC: ;~nerican International Co 3510 Veterans Memorial Highway INSURERO: Zurich Insurance Co. Bob~mla NY 11716 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 MAY BE 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. IN~(AUU'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE IMMIDD/YY) DATE (MMIDDfYY) LIMITS GENERAL MABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL L[ABILITY 01UENQS9371 04/01/06 04/01/07 u^M^~= ,ux=.,=u $ 300000 PREMISES (Ea occurence) I CLAIMSMADE ~ OCCUR MEDEXP(Anyoneperson) $ 10000 X pOl~ U~) EERSONAL&ADVINJURY $ 1000000 GENERALAGGREGA3E $ 2000000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ 2000000 PRO- --AUmTOMOBILE LIABILITY COMBINED SINGLE LIMFT $ 1 t 000 ~ 000 B X ANY AUTO 01U~CGE8353 11/20/05 11/20/06 (Fa accident) __ ALL OWNED AUTOS BODiLYiNJURY SCHEDULED AUTOS (Per pemon) ~- BODILY INJURY $ HIRED AUTOS X NON-OWNED AUTOS (Per a~ident) __ PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ANYAUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ~ OCCUR [] CLAIMS MADE AGGREGATE $ $  DEDUCTIBLE $ RETENTION $ $ WORRBRSCO.PE.SAT.ONA"O x ITORY ,M B I EMPLOYERS' LIABtLITY C ANY PROPRIETOR/PARTNEPJEXECUTIVE WC1511544 04/01/06 04/01/07 EL EACH ACCIDENT $ 100000 OFFICEPJMEMBER EXCLUDED? E L DISEASE - EA EMPLOYEE $10 0 0 0 0 If es, describe under S~ECIAL PROVISIONS below EL DISEASE - POLICY LIMFT $ 500000 OTHER D NYS Disability 1737292 01/01/06 01/01/07 Statutory DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SO~H-7 Town of Southold Build/ng Dept Main Street Southold NY 11971 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO) DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL10 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, ]TS AGENTS OR REPREBENTATIVE~. ACORD 25 (2001108) © ACORD CORPORATION 04/Z8/06 1Z:45 FA~ 516478677~ HCC$.__ /~2.~d~.-7...~oo,~.,, POOL DIMENSIONS I ~~'x~ ~z~ 4'~'a'-~' '~'~'-o' ~'~ ~'-a~ '-ce~'~'i~'-3'~'~ e-~'~' ~ ~-~ ~ ~.os~~ ~ 16X~ l~-~'a'~'-0' 8'~' 13~' 6'-3'~'-0'?-0' 8'-3"k*-0~ 7~' ~ 14'-10' ~'-1,3~' ~ 1B~7~ i3o-e-~'o-a'~'~'-s'~'l~-=o-a~W~'~'~'~r.a'W~' ~'-=-~e' ~s'-~/~~ ~' TYP. PANEL STIFFNER POOL PLAN TYPICAL WALL SECTION AT 'A' FRAME C2 MIN. 2" THICK VERMICULITE AGGREGATE TAMPERED D2 CORNER CONNECTION DETAIL DIVING BOARD N.T.S. DUNRITE POOLS, INC. 3510 VETERANS MEMORIAL HIGHWAY BOHEMIA, NEW YORK 11718 (631) 585-1618 POOL TYPE: KIDNEY I REV, SCALE N.T.S. DATE DRAWING NUMBER OF JAMES DEERKOSKI, P,E. 260 DEER PATH MATDITUCK, NEW YORK 11952 Nassau Suffolk Electrical Inspections, Inc. 505-C Lincoln St * Riverhead, New York 11901 * Tel: 631-813-2890 * Fax: 631-813-2891 Application: 7532 Date:4/9/07 Issued to: Shapiro Address: 480 Kourose Rd Village: New Suffolk Introduced By::Bethel Electric Inc. License#:2880-ME was examined and approved up to the above date and was in compliance with the NEC Switches Receptacles Fixtures G.F.I. Tim eclock Salt Generator 3 3 1 1 1 1 Oven Carbon Fans Dishwasher Washer/Amps Dryer/Amps Range/Amps Monoxide Bell Furnace Oil Gas Heat Zones Whirlpool Transformers Meter Amps Phase Motors 3 Other Equipment; lnground Pool Out,Res This certificate must not be altered in any manner Section: 117 Block: 06 Lot:19.3