HomeMy WebLinkAbout35026-ZFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPA=RTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-34774 I~ate: 01/04/11
THIS CERTIFIES that the building INGROUND SWIMMING POOL
Location of Property: 4275 GREAT PECONIC BAY BLVD L~UREL
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map NO. 473889 Section 128 Block 3 Lot 15
Subdivision Filed Map No. __ Lot No. __
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 18, 2009 pursuant to which
Building ~r~t No. 35026-Z dated SEPTEMBER 24, 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.
The certificate is issued to THOMAS F & ELIZABETH HUDOCK
(OWNER)
of the aforesaid building.
SUFMOI~K ~ DEP~q~4E~T OF }~%LTH ;%PPRO~-AL N/A
Rr.RCTRICAL c~KTIFICATH NO. 35026 10/13/10
PLUMBERS CKa~TIFICATION DA'i'M N/A
~A/o~~a
ture
Rev. 1/81
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. 35026 Z
Date SEPTEMBER 24, 2009
Permission is hereby granted to:
THOMAS F HUDOCK
LAUREL,NY 11948
for :
CONSTRUCTION OF AIq INGROUND SWIMMING POOL IN THE REAR YARD AS
APPLIED FOR, FENCED TO CODE
at premises located at 4275 GREAT PECONIC BAY BLVD LAUREL
County Tax Map No. 473889 Section 128 Block 0003 Lot No. 015
pursuant to application dated SEPTEMBER 18, 2009 and approved by the
Building Inspector to expire on MARCH 24, 2011.
Fee $ 250.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
DLiC 2 1
BLDG. DEPT.
TOWN OF SOUTHOLD
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, p.roperty 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 Fir~ Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains less than 7all0 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.
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
3.
4.
5.
New Construction: ~,~t..- Old or Pre-existing Building:
Location of Property: ~-~t~7,5' /'~r~o~-c
House No. Street
Owner or Owners of Property: /,,~,~,~,,v ~ ~Z.~2~ aer~
Suffolk County Tax Map No 1000, Section
Subdivision
Certificate of Occupancy - New dwelling $50.00, Additions to dwelling $50.00, Alterations to dwelling $50.00,
Swimming pool $50.00, Accessory building $50.00, Additions to accessory building $50.00, Businesses $50.00.
Certificate of Occupancy on Pre-existing Building - $100.00
Copy of Certificate of Occupancy - $.25
Updated Certificate of Occupancy - $50.00
Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date. 702.//~/Z O
/ /
(check one)
Hamlet
Date of Permit.
Permit No. '3 tz')--O ~
Health Dept. Approval:
'Planning Board Approval:
Block ~ Lot
Filed Map. Lot:
. Applicant:
Underwriters Approval:
Request for:
Fee Submitted: $
Temporary Certificate
,50, oD
Final Certificate: check one)
Applicant Signature
Town ttall Annex
54375 Main Road
P.O. Box 1179
Souflmld, NY 119714)959
Tclcphonc ((;31) 765-18(12
F~Lx (631) 765-9502
ro.qer, richert~.town.southo d ny us
1½UII.I)IN(; DEPARTMENT
TOWN OF $OUTItOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Hudock
Address: 4275 Peconic Bay Blvd City: Laurel St: NY Zip: '11948
Building Permit #: 35026 Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Glens Electric LicenseNo: 4770-me
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ Basement ~ Service Only [~
Commedcal Outdoor 1st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 3 ph Hot Water GFCI Recpt
Main Panel A/C Condenser Single Recpt
Sub Panel NC Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnec~ Switches Twist Lock
Other Equipment:
Ceiling Fixtures ~[~ HID Fixtures
Wall Fixtures J J Smoke Detectors
Recessed Fixtures I I CO Detectors
Fluorescent Vixtur(~] Pumps
Emergency Fixture Time Clocks
Exit Fixtures ~ TVSS
pool bonding, I pool light, 2 pool pumps, gas pool heater, 3 gfci circuit breakers
Notes: swimming pool
Inspector Signature:
Date: Oct 13 2010
81-Cert Electrical Compliance Form
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[~'FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND
[ ] FRAMING/STRAPPING
[ ] FIREPLACE & CHIMNEY
[ ] FIRE RESISTANT CONSTRUCTION
REMARKS: /q'~/[ ~
[ ] INSULATION
[ ] FINAL
[ ] FIRE SAFETY INSP~q'ION
[ ] FIRE RESISTANT PENETRATION
DATE ~ INSPECTOR~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROndel4 PLBG.
[ ] FOUNDATION 2ND [ ]/~iSULATION
[ ] FRAMING / STRAPPING [ t/J FINAL
[ ] FIREPLACE&CHIMNEY [ ] FIRESA~.,.,~'INSPECTION
REMARKS: ~ ~
// ,
DATE
TOWN OF'SOUTHOLD
BUIL~)ING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: 765-1802
Examined ~,/,L~, 20 07
Approved q,/2/20 ~1
Disapproved a/c
PERMIT NO.
BUILDiNG PERMIT APPLICATION CHECKLIST
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:
Building Inspector
Date ]S ,200q
8 2 ~ INSTRUCTIONS
SEP 1onMU'
: a. s applicati ST bu corn ~letely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans ~ccurat~l~off~lan to scale. F~e according to schedule.
b Plot la.19~-~J~0lll9'l'l)n*:An ,,£ Io~ and of buildin ........
~ p ~ ~ .... gs on prermses, relat~onslfip to adjo~mng prermses or pubhc 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 ether 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, ax~regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
(Signature of applican~/~r name, if a corporation)
(Mailing address of applicant)
Name of owner of premises
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
(as on the tax roil or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No.
Plumbers License No.
Electricians License No. O~ ~ )40 '
Other Tradds License No.
1. Location of land on which.proposed work will be done:
House Number Street 0
Hamlet
County Tax Map No. 1000 Section
Subdivision
(Name)
Y3~,10~>1 .A T~RAr~RAM
Block .,troy ,*el,~o msia
Filed Map N6J ~ 5~
~nuoO ~O~OE
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy '~, ~ 27 ~4&~g~
b. Intended useandoccupancy ~,9~'~. ~W~mm~/q ~(gOOc.
Nature of work (check which applicable): New Building
Repair Removal Demolition
Estimated Cost
If dwelling, number of dwelling units
If garage, number of cars
Fee
Addition Alteration
OtherWork 20~,qo mqecauo ~mr~,~;? ~0c
(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 -~o
Height Number of Stories
Rear
Depth_ 2.-/
Dimensions of same structure with alterations or additions: Front
Depth Height
Dimensions of entire new construction: Front 20'
Height 3'k~ ~' ~ Number of Stories
Size of lot: Front 100' Rear JO0'
Number of Stories
Rear 2.0'
.Depth 202)'
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:
13. Will lot be re-graded ~x~ firlkot 0~-~
14. Names of Owner of premises
Name of Architect'-Tkoms Ix
Name of Contractor
Will excess fill be removed from premises: Y~ NO
Ad&ess L[Z-/~ ¢~eo0,¢ ~ i~ Phone No.
Address ~ ~c ]-g ,~a,~u~ Phone No
Ad&ess Q/-q gx2ra ~,~ P~ PhoneNo. "Tctq--IIg5-'
15. Is this property within 100 feet of a tidal wetland? *YES NO ~/
· IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
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
~- ~ ~D}'q~0S being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above 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
2o0q
MARGARET A. KIDNEY
I~ary Public - State olNew York
No. 01KI0021111
~ignatur~,f Applicant
-' TOWN OF $OUTHO~.n
APP.LICATION FOR ELECTRICAL INSPECTION,
J~SI~E INFORMATION: (*'rndi~tes mq.uimd infon~ati~).
· *~ss Street: / ' '
· P~ne No.:
T~ ~p Di~: 1000 Se~n: ~: Lo~
'I'
*BRIEF DEscRIPTION OF WORK (please. Print. C, learly) Z~'//'~.... :~'~.,-.,,,~,',~,~,Z..~. ~,~g/
. (Please .Circle All That .Apply)
Inspection:
' ~(...~/NO Rough In"' Rna!
*Do you need a Temp OeFd~ioa{e: YES / NO "
Tamp'Information (If needed}.
*Servioe size: · 1 Phase 3Phase 100 '150. 200 300: 350 400 Other
*NewSerVioe: Re-oonnect Underground Number of Met~rs Change Of Servt~e Overhead~
Additional Information:
PAYMENT DUE WITH APPLICATION , D
· . [ ~)~ 10'1~~t°
, ., .
Town of Southold
Erosion, Sedimentation & Storm-Water Run-off A$SE$8MENT FORM
PROPERTY LOCATION: S.C.T.M. #:
District Section Block Lot
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMI8810N OF A
STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN
CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
!tern Number (NOTE: A Cheek Mark (~') for each Question is Required for a Complete Application)
Yea No
Will this Project Retain All Storm-Water Run-Off Generated by a Two (2") Inch Rainfall on Site?
(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 surfaces.)
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 Sudace WaterFIow!
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 Dislurbing Activities Encompassing an Area in Excess of
Five Thousand (5,000) Square Feet of Ground Sudace?
Is there a Natural Water Course Running through the Site?
Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach?
Will {here be Site preparation on Exisling Grade Slopes which Exceed Fifteen (15) feet oI Vertical Rise to
One Hundred (100') of Horizontal Distance?
Will Driveways, Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Wa[er Run-Off
loin 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 Area?
(This item will NOT include the Installation of Driveway Aprons.)
Will this Project Require Site Preparalion 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 Btorm-Water, Grading,
Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permitl
EXEMPTION: Yes N__.~o
Does this project meet the minimum standards for classification as an Agricultural Project?
Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan is NOT Requiredl -- --
STATE OF NEW YORK,
COUNTY Ov .................... sS
That I .................. .~ .'l'*t~.~:..~ ~IA:~ .................... beh~g duly sworn, deposes ,'md says d~at he/she is fl~e applicant for Pemtit,
{Name el individual signing Documenl)
And that he/sbe is d~¢ ..................................................... ~'1~ ......................................................................................
(Owner, Cantraclor, Agenl, Corporale O[ficer e~c )
Owner and/or representative of the Owner of Owner's, and is duly auflm~ ized to perform or have performed the said work and to
make and file this application; that all statements cont.xined in this application are true to the best of l~s knowledge and belief; and
tJ~at the work .411 be performed in the manner set forth in the application filed here~qth.
Sworn to before mc this; ,
/~'~p'' dayof
FORM - 06/07 Suffo County
OWNER
FORN~ER OWNER
OF $OUTHOLD PROPERTY RECORD CARD
STREW' V 2-~_~
VILLAGE LOT
W
DISTRICT
//
,ACREAGE
TYPE OF BUILDING
LAND
IMP.
~3~-o o
TOTAL
.qOo o
FARM
COMM.
/~ ~ ]
DATE
REMARKS
J,IND. N J CB. MISC.
Est. Mkt. Value
Farm
Tillable I
Tillable 2
Tillable 3
Woodland
Swampland
Brushland
House Plot
Tota I
Value Per Acre
Value
FRONTAGE ON WATER
FRONTAGE ON ROAD
BULKHEAD
DOCK
I i
!×tension ' 3 '''~ Bosement I ~-o, L Floors
~tension Ext Wolls ~,~ In~erior Finis~ ~/t ~,~
~tension Fire Place ,,' .~ Heat
' , P~h Roo~ ]st Flor
3reeZeway f~/~ :~ , ~, ~ Patio ~:'::~ Rooms 2nd Floor
................. ~ TOWN OF SOUTHOLD PROPERTY RECORD CARD
oWNER S :r-R~ ET VILLAGE DIST SUB.LOT ~
ACR. REMARKS
TYPE OF BLD.
PROP. CLASS
LAND IMP. TOTAL DATE
FRONTAGE ON WATER TILLABLE
FRONTAGE ON ROAD WOODLAND
DEPTH MEADOWLAND
BULKHEAD HOUSE/LOT
TOTAL
COLOR
TRIM
- 1 st 2n¢
t~M.t~_ I~, ~1~ lr,,(z>';- t(~:) ~. i~ ~ ~ F°undati°n~ Fin. B. Bath ~ Dinette
Extension ~= It~O( '~
Basement )~L~ Floors ~ ~ Kit.
Exte~si°° ~ ~ ~ ~ ~1 ~ Ext Wails ~, ~ Interior Finish ~ ~_ L.R- --
Extension ~'~.' ~ ~."~O ......... ~ ~O FirePlace __ Heat~ ''~1~--''~ D.R: .....
Deck ~ ~ (~ ¢ ~O ,~ ~_ Dock ........ Yam. Rm.
Garage I~ ' ~ I ~ ~D 7~O
Survey for
HARRY E. 8~ NORA A. MILLER
LAUREL
Town of Sou/hold
Surf. Ca,~Y
~a~
~,19~
ARTHUR EDWARDS POOL & SPA CENTRE
929 ROUTE 25A
MILLER PLACE, NY 11764
516-744-7185
FAX-744-0174
APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD
TOWN OF SOUTHOLD
MAIN ROAD (P.O. BOX 1179)
SOUTHOLD, NY 11971
(631) 765-1802
PAPERS ENCLOSED:
APPLICATION FOR OUTDOOR POOL PERMIT
EROSION SEDIMENTATION & WATER RUN ASSESSMENT FORM
CERTIFICATE OF WORKER'S COMPENSATION
CERTIFICATE OF LIABILITY INSURANCE
SUFFOLK COUNTY LICENSE
-[--]" SUFFOLK COUNTY PLUMBER LICENSE
~ SUFFOLK COUNTY ELECTRICIAN LICENSE
~) 4 SETS OF PLANS - (3 STAMPED)
[~ 3 SURVEYS
[ ] TAX BILL
~ $260.00 CHECK FOR PERMIT FEE
PLEASE CALL OUR OFFICE IF THERE ARE ANY QUESTIONS REGARDING
THIS APPLICATION.
~u££olk Coun t~ Executive ~s O£fice o£ Cons ume~ A££Mrs
VETERANS M~MORIAL HIGH~VAY * HAUPPAUGE, NEW YORK 11 ?$$
DATE ISSUED:
5/1/80 No. 2740-ME
SUFFOLK COUNTY
Master Electrician License
This is to certify that EDWARD S REIFF
doing business as LrNDERGROUND SPECIALTIES INC
having given satisfactory evidence of competency, is hereby licensed as MASTER ELECTRICIAN in
accordance with and subject to the provisions of applicable laws, rules and regulations of
the County of Suffolk, S~ate of New York.
SUFFOLK COUNTY EXECUTIVE'S
OFFICE OF CONSIJMER AFFAIRS Additional Businesses
MASTER
ELECTRICIAN
Th~ ee~ifies that the
bea~er is ~1¥ Ilee~se~
by the Ce~rAy ef st~ffetk
EDWARD S REIFF
UNDERGROUND SPECtALTIE$ INC
2740-ME /~980
='~" ~'~ 05/01/2010
! )2ector
A
B
C
D
Plan
Section B-B
Section A-A
SIZE A B C D E F G HAP, EACAP.
lB
2' :--tO" '
Typical Wall
Piping Arrangement
Section
~ FT. FT. FT. FT. Fr. FT. Fr. Fr. SQ.FT. GAL.
16x~2' 16' 32' 8' 14' 6' 4' 4' 8' 512 19,000
16'x36' 16' 36' 12' 14' 6' 4* 4' 8' 576 21,600
18'x36' 18' 36' 12' 14' 6' 4' 5' 8' 648 24,~00
20'x40' 20' 40' 16' 14' 6' 4' 6' 8' 600 30,000
24'x44' 24' 44' 1§' 14' 8' 4' 6* 10' 796 ~0,000
24'x48' 24' 48' 20' 16' 8' 4* 6' 10' 900 30,000
PERMACRETE W~,T.L SYSTEM
929 Route 25A Miller Place NY 11764
(631) 744-7185 FAX (631) 744-0174
Suffolk License #4436-HI
Nassau License #HI74450000