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Home My WebLink About33905-ZFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEP~LRTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-34012 ])ate: 10/15/09 THIS ~KTIFIES that the building A/G SWIMMING POOL Location of Property: 1556 GRAND AVE MATTITUCK (HOUSE NO.) (STREET) (HAMLET) County Tax }{ap NO. 473889 Section 107 Block 3 Lot 11.4 subdivision Filed Map NO. LOt NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated MAY 15, 2008 pursuant to which Building Permit No. 33905-Z dated MAY 15, 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 ABOVE GROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR. The certificate is issued to KIMBERLY S PROKOP (OWNER) of the aforesaid building. SUFFOLK COBN~f DEPARTMENT OF HEALTHAPPROVAL N/A ELECTRICAL ~KTIFIC3%TH NO. 129977C 09/30/09 PLUMBERS c~KTIFICATION DA'r~u N/A Signature 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 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 2/10 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 topogyaphic 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 t. 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 Pm-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 New Constmction: Location of Property: Old or Pre-existing Building: (check one) House No. Street Owner 0r Owners of Property: /~ ;~/~6/ Suffolk County Tax Map No 1000, Section /, Subdivision Permit No. 3 3q 05'- Health Dept. Approval: Hamlet __ Block 00~_~} Lot Filed Map. q73 *' Lot: DateofPermit./~4~t~ /~;~E),~ Applicant: ~/~'b~/[t./ S, :Ut~/D Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (check one) FRDM :~merald ~lectric Inc FAX NO. :G31 474 922G Sme. 30 2009 07:S1PM P1 Electrical Inspection Certificate · Ek~lriul I~n ~4~i~e. lnG, Appil~tlon N~mll~r Zip; 11952 Town: SOutholcl Lot: Lie. # 4808-E BlO~. Perm,; Other Equipment "sU'I~:~I, Pool Pump ~ ~'~ Hugo FORM NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUII/)ING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 33905 Z Date MAY 15, 2008 Permission is hereby granted to: KIMBERLY S PROKOP 1556 GRAND AVENUE MATTITUCK,NY 11952 for : CONSTRUCTION OF AN ACCESSORY ABOVE GROUND SWIMMING POOL AS APPLIED FOR IN THE REQUIRED REAR YARD. at premises located at 1556 GRAND AVE MATTITUCK County Tax Map No. 473889 Section 107 Block 0003 Lot No. 011.004 pursuant to application dated MAY Building Inspector to expire on NOVEMBER Fee $ 250.00 15, 2008 and apprc~ed by the 15, 2009. Si~ lure ORIGINAL Rev. 5/8/02 TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]INSULATION [ ] FRAMING / STRAPPING ~)~__~INAL ~ ~, [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ~F~E RE~STANT PENETRATION REMARKS: /~-~ ~ . ~-~ TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] ROUGH PLBG. [ ] INSULATION [/'~:INAL [ ] FIRE SAFETY INSPECTION REMARKS: ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION DATE INSPECTOR 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 REMARKSI~2a*'~, ~'. . ~lr~_~ ~.~ ~_. o DATE ~".__ ,?C.-- c, ~ INSPECTOR 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: //~_~ ~ ~ DATE INSPECTOR '~-~ FIELD I5~SPECTION REPORT I DATE I COMMENTS FOUNDATION (1ST) FOUNDATION (2ND) PLI-YlVI~I~G - IxNSLrLATION PER N. Y. STATE ENERGY CODE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net PERMIT NO. ~%q ~]~ <'3 Approved 0 Disapproved Expiration ,20 BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the tbllowing, before applying'? Board of Heahh 4 sets of Building Plans Planning Board approval Survey Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Mail to: git4 Phone: "1~ ~8' Date ~//~}~ , 20~ APPLICATION FOR BUILDING PERMIT "IMMEDIATELY',, ENCLosE POOL TO CODE UPON COMPLETION 8EFORE "WATER" INSTRUCTIONS 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 sha~l 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 afl'ecting 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. 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 constmction 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. WiTI-iOUT CEST!F!CAT',: OF OCCUPANCY State whether applicant is owner, lessee, (Mailing address of applicant) /t~f~..,,, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premises /(As on the tax roll or latest de~t~/ ~/, -, ' ..... If applicant is a corporation, signature of duly authorized officer DATE:~ ~.p. ,t_ (Name and title of corporate officer) NOT~Y BUILD.Nh; 7 A:iTbiENT AT Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. Location of land on which ~ro~osed work will be done: 15% bvaTd Aw_ . House Number Street County Tax Map No. 1000 Section 107 Block Subdivision 765-1802 8AM 'hq, rl~' FOR THE FOLLOWING INS ,:C 1. FOUNDATION - T','"~:: REQUIRED FOR POURED hr't,, 2. ROUGH FR ^' - ,,-',~ **. & PLUMBING 3. INSULATION 4. FINAL CO J, T,., MUST BE COMPL~ / c_ . ILL)..,eL, ;__ MEET THE R~ir~II~,~ENTS OF THE CODES OF NEW YO~'SYATE. NOT R~S?ONSIBLE FOR ~ESIGN OR CO~SoTtRUCT,?~I.¢RRORS. Filed Map No. Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ~ 3. Nature of work (check which applicable): New Building_ Addition Repair Removal Demolition Other Work Estimated Cost Nt"k~,,~ '''~ qd~t¢ 5. If dwelling, number of dwelling units If garage, number of cars Alteration ~(Description) (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_ Number of Stories Rear Depth Dimensions of same structure with alterations or additions: Front Depth Height. Number of Stories Dimensions of entire new construction: Front Height ~V,.-/ Number of Stories ,d/A 9. Size of lot: Front Rear .Depth lO. DateofPurchase 10/qS" Name ofFormer Owner VVdt,'a 11. Zone or use district in which premises are situated f;t~ o'~,4 Jo e, / .Depth Rear 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO ~ 13. Will lot be re-graded? YES NO 7Will excess fill be removed from premises? YES ~/'NO__ 14. Names of Owner of premises ~ximCg4~ Prc~t~ Address 15r~ ~ ~ Name of Architect ! ~ Address ~ Name of Contractor /~ tlt~ a r~ /Oa~le~_ Address '~t> /'~ Ilo 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. Phone No. '~-,3~0 Phone No Phone No. (:~t - 7~vOS- 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. 18. Are there any covenants and restrictions with respect to this property? * YES__ NO V/ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) (Name of indSvidual s~gning contract) above being duly sworn, deposes and says that (s)he is the applicant named, (S)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 tree 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 to before me this /,Z~ day of , ,~,~ Notary~"~ · S~lre of Appli~'nt Tow_____? $outhold Erosion, Sedimentation & Storm-Water Run-off ASBE88MENT FORM PROPERTY LOCATION: $,C,T,M. #: THE FOLLOWING ACTIONS MAY REQUIRE 1'HE 8UBMI8810N OF A Ite__~m Number: /~ ~ ~ !!.~ STORM-WATER, GRADIN G DRAINAGE'AND EROSION (~OHTROL PLAN · CERTIFIED BY A DES GN PROFESSIONAL IN THE STATE OF Ni;W YORK. DIstrlcl Section Block L (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Yes No 2 3 4 5 7 8 9 Will this Project Retain All Storm-Water Rua-Off Generated by a Two (2") Inch Rainfall on Site? (This item will include all turnoff created by site clearing and/or construction activities as well as all Site Improvements and the permanent creation of imperdous surfaces,) Does Ihe Site Plan and/er Survey Show All Proposed Drainage Slructures Indicating Size & Location? This item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFDwl Will this Pi-eject Require any Land Filling, Grading or Excavation where there is a change to the Natural Existing Grade Invoivlng more than 200 Cubic Yards of Matedal wi[hfn any Parcel? Will this Application Require Land Dislurbing Activities Encompassing an Area In Excess of Five Thousand (5,000) Square Feet of Ground Surface? Is there a Natural Wafer Course Running through the Site? Is this Project wilhia the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen (t5) feel of Vertical Rise to One Hundred (100') of Horizontal Distance? Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off into and/or in the direction of a Town right-of-way? Will this Project Require the Placemenl of Material, Removal of Vegetation and/or the Construction of any Item Wilhin the Town Right-of-Way or Road Shoulder Area? (This iteel will NOT include the Installation of Driveway Aprons,) _ 171 FcIJ I-2-1¢ NOTE: if Any AnswertoQuestions One ttlrough Nine is Answered wilh a Check Mark in the Box, aStorm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitled for Review Prior to Issuance of Any Building Pemdtf EXEMPTION; Does this project meet the minimum standards for classification as an Agdculturat Projecl? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Eroslon Control Plan is NOT Requiredl Yes No STATE OF NE\¥ YORJ<;., COUNTY ()f' SS And d~,d ho'she Is d~< ~ Owl,el and/or rcpl cscntativc ol d~c ()wncI ol ()~nc['s and is dui)r aulllOl lztld tO t)C'I ]k)l R/ OI II;tVC I3CltO[ amd die sad wotk m~d to make a~d file fids applicaUon; fl~at ~1 satemen~ conb~acd m ~s application are t~xm to tim best of I~s h~owledge a~d belief; and d~at d~e work x*dll be performed in tim m~me~ set foith m lhe applmadon filed here,,rid2 ~wCn n LO before me this; Notm~, Public: ........................... FORM. 06~07 z/q/~o,i ~> m z m NOW OR f ORMERLY HEUSER NOW OR FORMERLY ROHRBACH ',A~od 78" 32' 40"E 6.5'~ 6.5' RIGHT OF WAY KNO__WN S, 77o 46'00" W. NOW OR FORMERLY ANRIG CE. DAP' , AO 5O 0F, o deck AREA 32,150 S(A.F T . NoW GUARANTEED ONLY T~ DAVID PROKOP KI Mt3ERLY PROK P c FIRST AMERICAN HA,,,,., ,. OR FORMERLY CRO M The existence of right of ways and or easements of record, if any, not shown are not guaranteed. NO. 21115-E JOB NO. 95-300 FILE NO. 535 D SURVEYED FOR DAVID ond KIMBEF~LY PROKOP . SITUAT. ED AT' MAT TITUCK TOWNOI~ SOUTHOLD . SUFFOLK COUNTY , N,Y, SCALE 1" 30' DATE 9 - 19 - 1995 FILED MAP NO. , - DAle TAX MAPNO. 1000 -107-3-il,4 (REF. ONLY) DISK142 HAROLD F. TRANCHON JR. P.C. LAND SURVEYOR SUCCESSOR TO WILLIAM G. MEIER 1866 WADING RIVER-MANOR RD, WADING RIVER, NEW YORK, 11792 516-929-4695