HomeMy WebLinkAbout33866-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPA=RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-33927 Rte: 09/01/09
THIS U~U(TIFIES that the building SWIMMING POOL
Location of Property: 24380 MAIN RD CUTCHOGUE
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 109 Block 3 Lot 2.41
Subdivision Filed Map NO. __ Lot NO. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated APRIL 22, 2008 pursuant to which
Building Permit No. 33866-Z dated MAY 2, 2008
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.
The certificate is issued to THOMAS & ANGEL~ JOHNSON
(OWNER)
of the aforesaid building.
SUFFOI=K C~DI~qTYDEPAR~T OF }~LTHAPPROIK~L N/A
EI~t-rKICAL ~TIFIC3%~]~ NO. 124693C 08/22/08
pLUMBERS CERTIFICATION DA'r~o N/A
Au%~ori zed Signature
Rev. 1/81
AUG 2
~ BLDG. DEPT.
TOWN OF SOUIBOLB
Form No. 6 [ ~ ~/~.~ /-.0 ~r~£~7
TOWN OF SOUTHOLD ~ --- --
765-1802 k
LICATION FOR C~RT~ICAT~ OF OCC~Cy
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 °f pr°pertY with accurate lecation of all buildings, property lines, streats, 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 Undenvriters.
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 plamung Board Approval of completed site plan requirements.
non-conforming uses, or buildings and "pre-existing" land uses:
or e~sting buildings (prior to April 9, 1957)
Accurate survey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A pr°perly c°mpleted application and consent to inspect signed by the applicant, if a Certificate of Oeeupancy is
denied, the Building Inspector shall state the reasons therefor in writing to the applicant.
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
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.
~31d or Pre-existing Building:
. (,p_ ~/:~ 50 .~,¢-.~ ,,~.~.,) (check one)
House NO. Street Hamlet
New Construction:
Location of Property:
Owner or Ownera of Property:
Suffolk County Tax Map No 1000, Section
Block ~90 0 ~. Lot 002_ ~/
Subdivision
Permit No. '~ ~ ~ (o (o ~_ Date of Permit.
. Health Dept. Approval:
Planning Board Approval:
.Request for: Temporary Certificate
Fee Submitted: $
Filed Map.
Applicant:
Underwriters Approval:
Final Certificate:
(check one)
Applicant/Jgignature
Issue Date
8/22/2008
Electrical Inspection Certificate
Electrical Inspection Service, Inc. Application Number
375 Dunton Avenue 124693C
East Patchogue, New York 11772
(631) 286-6642
Issued To: Thomas Johnson
Street: 24380 Rt. 25
Village: Cutchogue Zip: 11935
Section: 109 Block: 0003 Lot: 002.041
Town: Southold
Contractor: Elec-Tec Electrical Contracting Lic. # 4814-E
Was examined and found to be in compliance with the National Electrical Code.
[] Commercial [] NVDefects [] Pool [] lstFIoor [] Indoor [] Basement [] HotTub
[] Residential [] Det. Garage [] Attic [] 2nd Floor [] Outdoor [] Addition [] Survey
Switches Receptacles Fixtures GFI Heaters A/C Fans
1
Dishwasher Washer/Amps Dryer/Amps Oven Range/Amps Microwaves
Furnace Oil Gas Circulators Smoke Detector Bell Transformer
Meter Amps Phase UG/OH Jacuzzi Television CO Detector
/
Bldg. Permit: 338662
Other Equipment
1-Pool Lt./1-Raintight Subpanel/2-Time
Clocks/1-60 amp Heat Pump Disc./2-20 amp
spec. Outlets
Hugo S. Surdi
President
This certificate must not be altered in any manner. Inspectors may be identified by their credentials.
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. 33866 Z Date MAY 2, 2008
Permission is hereby granted to:
for :
JOHNSON
24380 MAIN ROAD
CUTCHOGUE,NY 11935
CONSTRUCTION OF AN IN-GROUND SWIMMING POOL IN THE REQUIRED REAR
YARD AS APPLIED FOR
at praises located at 24380 MAIN RD CUTCHOGUE
County Tax ~ap No. 473889 Section 109 Block 0003 Lot No. 002.041
pursuant to application dated APRIL 22, 2008 and approved by the
Building Inspector to expire on NOVEMBER 2~
0.oo
zed SignOre
ORIGINAL
Rev. 5/8/02
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ]INSULATION
[ ] FRAMING / STRAPPING ~ FINAL /~
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
REMARKS: P~-~ ~'
DAT£
FIELD INSPECTION REPORT I DATE
FOUNI)ATION (1ST)
FOUT~DATION (2ND)
,
ROUG~ F~'G &
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined ,~/~ ,20~.~
Approved ,200
Disapproved aJc
Expiration ., 20
PERMIT NO.
BUILD1NG 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 V/
Septic Form
N.Y.S.D.E.C.
Trustees
Contact:
Mail to:
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20c
a. This 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 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 the Building Inspector
issues a Certificate of Occupancy.
fi Every building permit shall expire if the work authorized has not commenced within 12 months aRer 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. ThereaRer, a new permit shall be required.
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.
(Signature of applicant or name, ifa corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises
(As on the tax roll or latest deed)
If applic~jnt is a corpoJ;ati~on, 9ignjVmre of duly authorized officer
(l~me and ti(l~ of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No.
Other Trade's License No.
Location of land on which proposed work will be done:
House Number Street
County Tax Map No. 1000 Section /g2~ Block
Subdivision ~.~:5~xJ/t:,x~'~ ~ ~7,s~,ze5 Filed Map No.
(Name)
~Y_~d/cz2¢ Z/g-
Hamlet Lot ~'~. ~ il
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy / ,'5~
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building_
Repair Removal
4. Estimated Cost
5. If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Demolition
(Description)
Fee ~c_~
(To be paid on filing this application)
Number of dwelling units on each floor
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front ~/
Height /8-' Number of Stories
Rear F',,/ .'~ i
Depth
Dimensions of same structure with alterations or additions: Front
Depth Height Number of Stories
8. Dimensions of entire new construction: Front
Height Number of Stories
9. Sizeoflot: Front ~//.d' Rear ~_.~5'7/~ '
Rear Depth
Depth
Rear
10. Date of Purchase
Name of Former Owner
11. Zone or use district in which premises are situated C27~-5//Wz2,.~z.4 z
12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO 3/
13. Will lot be re-graded? YES ~ NO__ Will excess fill be removed from premises? YES )d NO __
14. Names of O~vner of premises~Address
Name of Architect Address
Name of Contractor Address
Phone No....~/d, -Sgs-Y-/~ ~r.,o
Phone No
Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES __ NO
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
NO ~
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
SS:
COUNTY OF )
~--'-F_~~ ~'~/Tt~/ be/rig duly sworn, deposes and says that ts)he is the applicant
(Name of individual signing contract) above named,
tS)He is the
(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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn t¢~ befor~'~)s this
/~ - NotaryVpubffe/
Nota~ublic, State of New York
~ali~d in Suffolk CounW
No. 01SC4725~
Term Expires May 31, o ¢~
Signature of Applicant
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
8TORM-WATER~ GRADINGr DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
Item Number:. (NOTE: A Check Mark (,~) for each Question is Required for a Complete Applk~ation)
1
Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
Yes No
2
3
4
5
6
7
8
9
(This item will include all run-off created by site clearing and/or construction activities as well as all Site
Improvements and the permanent creation of impervious suifacas,)
Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size & Location?
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WatarFIowi
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?
Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Surface?
Is there a Natural Water Coume Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach?
Will there be Site preporetion on Existing Grade Slopes which Exceed Fifteen (15)feet of Vertical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Sturm-Water Run-Off
iofo and/or in the direction of a Town right-of-way?
Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of
any Item Within the Town Right-of-Way or Road Shoulder Ama?
(This Item will NOT include the Installation of Driveway Aprons.)
Will this Project Require Site Preparation within the One Hundred (100) Year Floodplain of any Watercourse?
NOTE: If Any Answer to Questions One through Nine 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 Permitl
EXEMPTION: Yes _~
Does this project meet the minimum standards for classiflcaUon es an Agricultural Project?
Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Required! --
STATE OF NEW YORK,
COUNTY OF ........................................... SS
That I, ~"~. ~.t~ ......... ~..~.....~...(~...(/ ................... being duly sworn, deposes' and says that be/she is the applicant for Permit,
(Name of ir~ividual signing Document)
And that he/she is the .................... ~.~..~..~..~.. .....................................................................................................
Owner and/or representative of the Owner of 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 tree to the best of his knowledge and belief; and
that the work will be perforated in the manner set forth in the application filed herewith.
Sworn to before me this;
.......... ......... ........ ........................
. 2~',.. ~;~ Ua ' '
NoW V.hlic:
/ / ~ / No. 01SC472508.9
L · .-'/x Term Expires May 31,
FORM - 06/07
1,~,~:~ ~ ,.,,:_~_.,4]I'OWN OF SOUTHOLD PROPERT~'llECORD CARD
OWNER STREET ~ C/ --,~ ~(, ~ VILLAGE DIST. SUB.
,~. ~..~ ,
FOYER OWNER N E " ACR.
~arfm gbi~n ~ ~ s w ~PE OF BUILDING
RES. 2~ I o SEAS. VL. FARM COMM. CB. MICS. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
I:~o _~4~c: ~n~; ~'~7~t~ ~l'/~l~g-L~-
" ~ ' )c'~ ?' 'i ' FRONTAGE ON WATER
Tillable ~ , ~ :~ ~ .x -,
W~land FRONTAGE ON ROAD ~ ~
~d DEPTH
H~ Plot ~ ~._,~ ~ ( ~,~. ~ , , , BULKH~D
M. B,l~d ~. '~,
lr~ ~ ~ ~ ~< '2~Z{~' ' 1~'~ .~'7--~' ~/~ Foundation
Extension
E[te~i~n
Extension Fire Place Heat
Porch Pool Attic
Deck ~
Breezeway Driveway Rooms 2nd Floor
Garage
O.B.
8' b 8'
'1
e
e'
e' e- b 8' b'e- b 8'
6' Step'- Re,move 2-(08 009) 6' panels enc~
I-(08~16) 4 paf~, Ired I .(01-0Q616' s~
mci 2.(0&013) 7' pinch.
8' Step- Re,move 2-I08-00918' pa~ls aK
1408-01614 pond. In~d I.(01-062)8 s~ep
omi 2-(08-014) 6' ponds.
Re,,p~,e 4-8' ploifl panels (08-0091 v~lh:
I-8, ~knme pand (08-011)
2-8, inlet panek (08-0101
1-8 llght pa~d (o8-o121
H4: (03.805-CSI,(03-605-LS),IO3-60~-~I
1-8: (03-205-CS),(03-205-LS),(03-20~-~)
S-14: (03-30543),(03-30S-i~),(03-305-16)
NSPf TYPE III
TOPAZ STERLING STONES'fiE
(03-.~0SI [03.2QS) i03-30S1
NON DIVING UN[RS
fi-0 (03-643) 1-8 (03-2431 S-14 (03-343]
8' Ste~ Sfep IskJe)
2-(O8.0O9) 8' panek. Ir~
I-(Oe-30118' sled ge?,
I-(08.01317' paml, 1-(08-1671
45°xl' flllec panel and
I.(08-16814' It~ec pared.
1-(100831 steel step coping
set and I-(10-0851 ce?~ng
comec set requked. ~e page I.
8' S~d Sle? (end) Remve
2-(O8-OO9) 8~ pecds
1-(08-016) 4' pa~d. Inserf
1.(08-301) 8' deel de?,
2.(08-167) 47x 1' fiOec panels,
2.(08-0151 $ pan~s and
2-(08-2101 economy b~eces.
I.(10-083} steep slep coping sef
~ 2.(10-0851 coping
sets requh'ed~
Tgi
APPROVED AS NOTED
DATE: ~/~!~' BP. #
NOTIFY BUILDIN:~ :Z: ~RTMENT AT
765-1802 8AM TO 4PM FOR THE
FOLLOWING ~NSPECTIONS:
1. FOUNDATION - TW? REQUIRED.
FOR POURED ~
~ON~RETE
2. ROUGH - FRAMING & PLUMBING
3, INSULATION
4. FINAL - CON~T ,L.,~ON MUST
BE COMPLETE FC~ C.C.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
MEET-r:E REQUIF~Et',',E ~TS O: THE
CODES OF N~.',/'(CFi~: '-"~- :
MAY "'" 20' X 40'
199S RECTANGLE 6' RADIUS
OCCUPANCy OR
USE!S UNLAWFUL
W!THOUTCERTIFICATE
OFOCCUPANCY
IN-GROUND SWIMMING POOL WILL BE CONSTRUCTED OF STEEL WALLS SUPPORTING A
VINYL LINER THAT WILL HOLD APPROXIMATLY 35,000 GALLONS OF WATER.
FENCE WILL BE CHAIN LINK CONSTRUCTION, 4' HIGH WITH SELF CLOSING GATES THAT
WILL MEET TOWN CODES.
"IMMEDIATELY"
ENCLOSE POOL TO CODE
UPON COMPLETION
BEFORE "WATER"
cP.
DF-.PA~TIdENT-DATA FOR API~OVAL TO CONST~UC 1'
N~e CO..7AXMAP mT 1999 SECTI~ 109 ~ 03 LOT~ .
OTHER THAN TNO'SE SHOWN HEREON.
WILL'C~FOHM TO T~ITAN~S O~ TH( S~K CO~TY DEPARTMENT
NOTEr. ~,, MONUMENT /%, STAKE
SUBDIVINION MAP KILED IN THE OFFICE OF THE CLERK OF'
,..4~N~T:~ 0N'ODT. 17EIG~ A$ FeLl; flo,47Ge. . SUFFOLK
NE, RARCk"L. NO.'I. MINOR' RUBDIVISlON PLAN PREPARED FOR
"(:OUNTNy CLUff ESTATEE"
N ~ LOCATICN Mr '~'ELL(W), K/TIC TANK(STIN CE SSPOO~.S(C~ ) IHQWN HERE(X4
Mi[ /q~M, PIEI. D ~IMTIONS ~O ON DATA DITMNEO F~(NI OTHERS
S L,;~v'EY FOR
LIN.DA B WARREN
I~RT.OF LOT N3.32, "COUNTRY CLUB ESTATES"
AT CUTCHOGUE
'IOWN OF SOUTHOLD
SUFFOLK COUNTY, NEW' YORK
DATE: APR.
SCALE: I, ' ;~ 50
NO... ' i]G~* 3
~ILWiU?NOiltZSD ALTEAATION ONAOOITION m m,S IOUARAHTEED ~: - ,
HEW YONK STAT~ E~CAT.'~ LAW J '~ [IHDA B.WA~ [ ,.
MENTAL .A~NCl l~ ~NO~ INSTIfUTION Lt'S~O
H~E~, ~D TO. ~ ASSIGNEES OF THE LENDING . '. " ~..~.,~':' ' ~T.
Pu~Ot~TANCES S~ HEREON FNOM'.~Tf LN~ J. ~~~~'~ ~o' ' ~ ~ ' '
P~PERTY LINES. O~ Fo, TX( ERECTLON ~ FENCES / ' .. ' . .* .
· ' ~ I ~' RIVER~ADi.N~. ~RK' .
~LOEN W.~U~ :OFESSIONAL ENGINEE~ .
,~tHD ~HD SUR' ~ H.Y.S.:UCEN~E HO.
14.~S. LIC[NS[ f