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Home My WebLink About35776-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 5/25/2011 CERTIFICATE OF OCCUPANCY No: 34967 Date: 5/25/2011 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: 1N GROUND POOL 1695 Greenway East, Orient, Sec/Block/Lot: 15.-1-11 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 7/29/2010 pursuant to which Building Permit No. 35776 dated 8/13/2010 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 swimminE pool with fence to code as applied for per ZBA #5832, dated 3/9/06. The certificate is issued to Haase, Robert (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 35776 10/8/10 AuthoriZed Signature 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. 35776 Z Date AUGUST 13, 2010 Permission is hereby granted to: ROBERT HAASE 1695 GREENWAY EAST ORIENT,NY for : CONSTRUCTION OF Ai~ INGROLrND SWIMMING POOL AS APPLIED FOR PER ZBA DECISION #5832, FENCED TO CODE at premises located at 1695 County Tax Map No. 473889 Section 015 pursuant to application elated JULY Building Inspector to expire on FEBRUARY GREENWAY EAST ORIENT Block 0001 Lot No. 011 29, 2010 and approved by the 13, 2012. Fee $ 250.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF occUPANcY MAY 2 3 2011 BLDG DEPT. TOWN OF SOUTHOLD 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. Commemial 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 $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. 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 Ce[tificate of Occupancy - Residential $15.00, Commercial $15.00 Date.~ xq["LO I [( New Construction: Location oferoperty:'X~l [(:>(~ ~ House No. Owner or Owners of Pmpert2fix) Suffolk County Tax Map No 1000, Section Subdivisio~ Old or Pre-existing Building: Permit No. 3 ~'q '-'/ ~ Health Dept. Approval: (check one) Hamlet Lot 0 II Filed Map. Lot: Date0fPermi,. ~/,'3 [, 0 Applicant: ~ ~'~o~?-~ ¢~--~--$ ~ Unde~tem Approval: Planning Board Approval: Request for: Temporary Certificate Foe Submitted: $ ~-0 . -- Final Certificate: ,,~ (check one) Apph:cant Sign~iu~-e Town llall ~dlllCX ,51375 Main Road P.O. Box 117!1 Simlhold, NY 11971-0959 Telephone (631) 76,%1802 Fax (631) 76,%9,5t)2 ro.qer, dchert~town.southokt.nv, us 1H qL1)IN(; 1)EPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: Robert Haase ~,ddress: 1695 Greenway East City: Odent St: NY Zip: 11957 ~uilding Permit #: 35776 Section: 1 5 Block: 1 Lot: 11 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE 3ontractor: DBA: Roslak Electric Inc LicenseNo: 3677-me SITE DETAILS Office Use Only Residential l~ Ind°°r ~ Basement [~ Service Only~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 3 ph Hot Water GFCI Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: swimming pool Ceiling Fixtures [~] HID Fixtures Wall Fixtures ~.~ Smoke Detectors Recessed Fixtures ~ CO Detectors Fluorescent Fixture I'~ Pumps L Emergency Fixture!~] Time Clocks 2~,. Exit Fixtures [~J TVSS Notes: pool bonding, 1 pool light, 3 pool GFCI circuit breakers Inspector Signature: Date: Oct 8 2010 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 //INSPECTION ~.~]'FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SA,-.. ~,f INSPECTION [ ] ..E.zS,STJ, rr C0.ST..C.0. [ ] ..E.ZS,STJ.T mET.AT.. REMARKS: --~-'F¢~I~/- ~)g-~'~-~_ /~.~ DATE -~~INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST FOUNDATION 2ND FRAMING / STRAPPING FIREPLACE & CHIMNEY mE REmTANT C(X6TmJC?~ REMARKS: ROUGH PLBG. INSULATION ~J~FINAL [ ] fiRE SAFETY INSPECTION DATE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: 765-1802 Approved ' ~,~ 20/0 Disapproved a/c . , , PERMIT BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the following, before applying ? JUL 29 BLDG. DEPI. IOWN OF SOUTHOLB Board of Health 3 sets of Building Plans Survey Check Septic Form N.Y.S.D.E.C. Trustees Mail to: Phone: Building Inspector APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS -7/z-7 / , o/o 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 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 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, ~.nd other applicable Laws, Ordinances or Regul~tions, 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, an/~ regulations, and tO admit au~h?rized inspectors on premises and in building for necessary inspections. / / , ' , , (Signature of applicant ~6~ name, if a corporation) , :':,F S State whether applicant is owner, lessee, ~tgent, architect, engineer, general contractor, electrician, plumber or builder If applicant is a corporation, signature of duly ~['l~ed officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. ~-CfllO "IMMEDIATELY" ~hiQi,OSE }%oOk TO CODE Location of l~d on w~ch proposed wor~will be done: House Nmber Street ' County Tax Map No. 1000 Subdivision (Name) Section A?P~qOVED AS NOTED .... ..,/, U .... (as on ~e t~ roll or~~ B.P. ~']~ N~E~WR~R8 ~RTFICC FE~ ~ e' ~ ~x NOTIFY BUILDING DEPARTMENT AT 76~-1802 8 AM TO 4 PM FOR THE FOLLO~NG INSPECTIONS: 1.. FOUNDATION - ~ REQUIRED FOR POURED CONCRETE 2 R LGH-FRAMING PLUMBING ~':z:'F~NG ELE,CTRICAL &CAULKING 4 %;: ' q?RUC~'~" g ELECTR CAL ALL 20~< Pdt; ( ,SHALL MILT*HI REguiR~ JEN;S OF T~E CODES Or ':~W YORK 3TA-E NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS Hmlet ,3,~ .A ~ ]RAORAM jb- B oe " ................ /I Filed ~Lot ~ .._~ e ~u .~~~ WATER RUNOFF PURSUANT T0 CHAPIER 236 0F IHE TOWN COBB Name of owner of premises State existing use and occupancy of premises an~ intended use and occupancy of proposed construction: a. Existing use and occupancy ~5~C/d~ b. Intended use and occupancy ~'~} (~ ~/L ~¢,ldg~l~/0~ ~c,~ (- 3. Nature of work (check which appl!cabl,e): New Building. Repair Removal ~emo!i~on 4. Estimated Cost :(~)0-_ ' i Fee If dwelling, number of dwelling units If garage, number of cars Addition Alter~,tion Other Work ~/!q~M ~0~ tDescription) (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 ~ ' Rear ~)O ' .Depth Height Number of Stories ;2 Dimensions of same structure with alterations or additions: Front Rear Depth Height. 8. Dimensions of entire new construction: Front ~(~ Height Number of Stories 9. Size of lot: Front )~' Rear I(~' Number of Stories Rear '~' Depth 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: 13. Will lot be re-graded P~/_ ~ 0t~ 14. Names of Owner ofpr_emises'-~ Name of Architect ~'-~ltc~ ~ ~oll,I ~ NameofContractor I~c-e~-~c~c4 ~/O)15 Will excess fill be removed fi.om premises: Address Address 4 Address ~ 15. Is this property within 100 feet of a tidal wetland? *YES NO · IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQ~JIRED 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 ..~ J' ~-0t~/)~ 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 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 ~erewith.: ,~ iVl{ Sworn to before me this.._.~ _ . ~ ~: --' dayof c~k4 20 Ich ' -~ ~'~ Publ ~RGARE'r A. KIDNEY ~ ~ - ~e ~N~ York No. 01KI~211 II Signature ~ Applicant APPEALS BOARD MEMBERS Ruth D. Oliv& Chairwoman Gerard P. Goehringer James Dinizio. Jr. Michael A. Simon Leslie Kanes Weisman http://southoldtown.north fork.net ZONING BOARD OF APPEALS TOWN OF SOUTIIOLD Tel. (631) 765-1809 · Fax (631) 765-9064 Mailing Address: Southold Town Hall 53095 Main Road · EO. Box 1179 Southotd, NY 11971-0959 Office Location: Town Annex/First Floor, North Fork Bank 54375 Main Road (at Youngs Avenue) Southold, NY 11971 RECEIVED ~-~L/ APR 1 3 2006 Souti~oid T~,wn (3er~ FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF MARCH 9, 2006 ZB File No. 5832 - ROBERT and DONNA HAASE Property Location: 1695 Greenway East, Orient CTM 15-1-11 SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type Il category of the State's List of Actions, without an adverse effect on the environment if the project is implemented as planned. PROPERTY FACTS/DESCRIPTION: The applicant's 21,111 square foot parcel has 154.22 feet along the west side of Greenway East, 132 feet along the northerly lot line, 134 feet at the southerly lot line, and 168.73 feet along the westerly lot line, as shown on the June 16, 2005 survey prepared by Peconic Surveyors, P.C. BASIS OF APPLICATION: Building Depadment's December 20, 2005 Notice of Disapproval, citing Section 100-244 in its denial of an application for a building permit to construct a proposed open, unroofed deck at Ihe rear of their proposed dwelling. The reason stated by the Building Inspector in the denial is that the new construction will be approximately 26 feet instead of 50 feet from the rear yard lot line, and the lot coverage will exceed the code limitation of 20% as proposed, with approximately 21.7%. FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on March 2, 2006, at which time written and oral evidence were presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: AREA VARIANCE RELIEF REQUESTED: The applicants wish lo construct a new two-story dwelling which will be 47 feet from the rear property line, and conforming to the front and side se~acks, and for a rear 20 ft. by 33.5 ft. deck addition, at approximately 26 feet from the rear property line. The lot coverage calculations were confirmed by John Metzger in a survey amended December 21,2005 at 21.7% (3073 square feet for the house and garage, 715 square feet for the deck, and 800 square feet for the swimming pool). ADDITIONAL INFORMATION: Clarification was received in a letter dated March 1, 2006 letter from the Town Building Permit Examiner indicating the reason why the new swimming pool structure was not included in lheir Notice of Disapproval as proposed with a setback at less than 50 feet from the rear lot line, as an accessory slructure in a code-required rear yard. .REASONS FOR BOARD ACTION: On the basis of testimony presented, materials submitted and personal inspections, the Board makes the following findings: 1. Grant of the variance will not produce an undesirable change in the character of the neighborhood or a detriment to nearby properties. The relief is 1.7% over the code limitation of 20% for all building area including Page 2 - March 9, 2006 ZB File No. 5832 - Robert and CTM No. 15-1-'il a swimming pool, house with garage, and raised open deck construction. Also requested are rear yard setback variances at 47 feet for a new single-family dwelling, and at 26 feet (at its closest point) to the rear lot line for an open, unroofed deck addition (20 ft. x 33.5 ft. maximum size). The Board is of the opinion that this is the maximum relief that could be permitted, considering the 42' depth of the two-story home, designed at 28'8" height, while meeting the code required 40 fl. minimum setback. 2. An alternative would be to build the deck at ground level and extended step areas between the house and the swimming pool. A raised deck, with open, unroofed construction, is a benefit for owners with easier access between the swimming pool in the rear yard and their new family home. 3. The variances granted herein are substantial and are the maximum that the Board will allow. The code requires a 50 ft. rear yard setback, and while the reduction for the new dwelling is only three feet for a 47 ft. setback, the entire deck requires relief from the code requirements. 4. The difficulty has been self-created because alternative construction to a deck would be flush with the natural ground rather than raised construction. 5. No evidence has been submitted to suggest that a variance in this residential community will have an adverse impact on the physical or environmental conditions in the neighborhood. The applicant has agreed to plant and maintain evergreens at a minimum of five feet in height at least 45 feet along the rear yard construction. 6. Grant of the requested relief is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a dwelling with garage, open raised deck and swimming pool, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above factors and applying the balancing test under New York Town Law 267-B, motion was offered by Member Goehringer, seconded by Chairwoman Oliva, and duly carried, to GRANT the variances as applied for, as shown on the survey amended by John Metzger December 21,2005 and rough sketch (undated} of the proposed elevations, subject to the following condition: That the rear properly line be landscaping with 5 ft. tall (minimum) evergreens for a minimum length of 45 feet along the rear yard line to screen the westerly lot owner's rear yard. Any deviation from the variance given such as extensions, or demolitions which are not shown on the applicant's diagrams or survey site maps, are not authorized under this application when involving nonconformities under the zoning code. This action does not authodze or condone any current or future use, setback or other feature of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this action. Vote of the Board: Ayes: Members Oliva (Chairwoman), Goehringer, Simon, and Weisman. Member Dinizio was absent. This Resolution was duly ad/el;~ed (4-0). Ruth D. Oliva, Chairwoman 4/J'/ /06 Approved for Filing Erosion, Sed;mentatmn & Storm Water Run off A 6 E88MENT FORM PROPERTY LOCATION: S.C,T.M. #: THE FOLLOWING ACTIONS MAY REQU~ THE 8UBMI8810N OF A Item Numberi J(~)~ J~' 0 ~ I ~ STORM-WATER, GR~DINGr DRAINAOE 4Ftg~ROSION CONTROL PLAN District Section B;ock Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE 8TATE OF NEW YORK, (NOTE: A Check Mark (~) for each Question is Required for a Complete Application) Yes No 1 Wi(I this Project Retain AIl 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.) 2 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 Con re ing Surface WaterFIow! 3 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 Matedal within any Parcel? 4 Will this Application Require Land Disturbing Activities Encompassing an Area In Excess of F ye Thousand (5,000) Square Feet of Ground Surface? Is this Project within the Trustees jurisdiction or within One Hundred (100') feet of a Wetland or Beach? 6 oneWilf there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) feet of Vertical Rise iOHundred (100') of Horizontal Distance? 7 Will Driveways, Parking Areas or other Impervious Sudaces be Sloped to Direct Storm-Water Run-Off into and/or in the direction of a Town right-of-way? 8 Will this Project Require the Placement of Material, Removal of Vegetation and/or the Construction of any Item W th n the Town Right-of-Way or Road Shoulder Area? (This item will NOT include the Installation of Driveway Aprons.) 9 Will this Project Require Site Preparation within Ihe 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 Sox, a Storm-Water, Grading, Drainage & Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permltl EXEMPTION: Does this project meel the minimum standards for classification as an Agricultural Project? Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Ptan is NOT Requiredl Yes No STATE OF NEW YORK, ThatI /L,--..~....~ ;~ ,~i4¢a~D¢ beta dui ,,,om de]x, sesan .............................................................................. g 1 ' , I ' d says that he/she is the apphcant for Penmt, (Name of individual signing Documenl) And that he/she is the .................................................. ~ ................ (Owner, Contractor, Agent, Corporate Officer, etc) Owner and/or representative of the 0~ ~er of O~vner s, and is dui), authorized to perform or have performed the said work and to make and file this application; that all statement~ 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 herewith, Sworn to before me this; ............................................... ............................. /7 , ~J ~0r MARGARET A. K FORM - 06~07 in suffo Oounty Soud~. blY I I.q7 I~.~ BUILDING DEPARTMFblT R~..QgE~TED BY: Company Name~' Uoenae No.: ~ldress: AppLICATION FOR ELECTRIgAL INSPECTION Oate: JOEISITE INFORMATION: (*indicates required information} *Cross Stmeb /~ 'z~'- ~ P~.: 3~f7~ z ,,, l~ ~ ~ 1~ S~: B~: Lot: off *BRIEF DESCRIPTION OF WORK (Ple~e P~int Caeady) ~,u g-/dOdO ~>o o/- a2-R~lue~ ~' Impecltm Form 3Phase Underground YES I,~ 100 150 200 300 350 400 Other Number of Meters Change of Servioe \'~::~ .o0 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 C.O, TAX BILL JtlL 2 BLDG. DE?~. TOWN OF SOUTHOtB $250.00 CHECK FOR PERMIT FEE PLEASE CALL OUR OFFICE IF THERE ARE ANY QUESTIONS REGARDING THIS APPLICATION. Town Hall Annex 54375 Main Road P.O. Box I 179 Southold, New York 11971-0959 Telephone (631) 765- 1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN OF 8OUTHOLD May 13, 2011 Robert Haase PO Box 303 Orient, NY 11957 RE: 1695 Greenway East, Orient TWO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: ~-J Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. A fee of 50.00. Final Health Department Approval. Plumbers Solder Certificate. (A~I permits involving plumbing after 4/1/84) __ Trustees Certificate of Compliance. (Town Trustees#765-1892) __ Final Planning Board Approval. __ Final Fire Inspection from Fire Marshall. __ Final Landmark Preservation approval. BUILDING PERMIT: 35776-Z swimming pool Town Hall Annex 54375 Main Road P.O. Box 1179 Southold. NY 11971-0959 Telephone (631) 765-1802 ro.qer, dchert~ff.t~ (wn~!~gl~o~. ny. us BLrr[-,nlNG DEPARTMENT TOWN OF SOLHT-IOI.n APPLICATION FOR ELECTRICAL INsPECTiON Company Name: Phone No.: JOBSITE INFORMATION: (' *Name:. ~7.~) Date: information) *Address: *Cross Street: *Phone No.: Permit No.: Tax Map District: 1000 Section: . Iff' *BRIEF DESCRIPTION OF WORK (Please Print cleady) bsa- qz ,- Lot: Il (Please Circle Ali That Apply) *Is job ready for inspection: ~Do you need a Temp Certificate: YES / NO Rough-Ig, Final YES / NO Temp'lnformation (If needed) · · Service Size: 1 Phase 3Phase 100 · New Service: Re-connect Underground 150 200 300 350 ~, 400 Other Number of Meters Change of Se~ice Overhead Additional Information: 82-Request for Inspection Form PAYMENT DUE WITH' APPLICATION TOWN OF 5OUTHOLD PROPERTY RECORD CARD ,J DIST. j SUB. ACR-,,/~ I TYPE OF: BU'ILDIING LO~ ~4 ~ ,,~ LDING CONDITI( NEW ~Z-o ~) FARM t Tillable t Til[,',ble 2 Tillabie 3 Woodland Acre Value Per Acre Swampland Brushland House Plot Total FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH BULKHEAD DOCK 15.-1-11 lOtO? COLOR TRIM 1 si 2nd - .2, V,(~ ~Y-~'~ ~ ~TM Foundation cs M. Bldg ~(~ ~ ~ ~ ~ c~a~ I ~ Floors KiL [~xlensLon Z~ 3~ ~ ~ ~ ~'~ ~ ~ ~ Basement s~ ~ 6~8~ = ~ Dock Fam. Rm. Garage ~ ~ ~ ~ .~ CERTIFICATE OF LIABILITY INSURANCE OP,D I ARTHU-1 01/04/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bagatta Associates, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 823 W Jericho Turnpike Ste lA ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Smithtown NY 11787 I NAIC# Phone: 631-864-1111 Fax: 631-864-8274 ~NSURERS AFFORDING COVERAGE ~ 26182 Contracting CO Inc DBA Ar~ ~NEURERC Edwards Pool & Spa Center iN 929 Route 2~A INSUREED: Miller Place NY 11764 SURERE ~- L --COVERAGES ~ 3~PE OF INSURANCE POLICY NUMBER )ATE {MM/DO/Y~YY) ~CH occu~n~c~ ~ 1000000 pERSONAL & ~V INJURY $1000000 CERTIFICATE HOLDER CANCELATION TO. Hall P.O. Box 728 ~outhold ~ 19971 ~ ~ee~_gnn, ACORD CORPORATION. ~ rights rese~ed. ACORD 25 (2009101) The ACORD name and logo are registered marks of ACORD This certificate is an original. State of New York Worker's Compensation Board CERTIFICATE OF PARTICIPATION IN WORKER'S COMPENSATION GROUP SELF INSURANCE la. Legal Name and Address of Buslness Partcipaang In Group Self-insurance (Use Street Address Only) Arthur J. Edwards Mason Contractor, Inc. DBA: Arthur Edwards Pool & Spa Centre 929 Route 25 A Miller Place, NY 11764 b. Effective Date of Membership in the Group 4/24/2002 Issue Date 7/27/2010 7/26/2011 Expiration Date Id. Business Telephone Number of Business Referenced in "la". (631) 744-7185 lc. NYS Unemployment Insurance Employer Registration Number of Business Registered in Box "la". 24108715 If. Federal Employer Identification Number of Business Referenced in Box ] Included. (Only check ff all partners / officers inluded. 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Lizted as Certificate Holder). Town of SouthoM Town Hall PO Box 728 Southold, New York 11971 111277925 S. Name and Address of Group Self Insurer, Special Trades, Contracting And Construction Trust 6250 South Bay Road Syracuse, NY 13039 Policy: W521504 This certifies that the business referenced above in box "1 a" is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law as a participating member of the Group Self-Insurer listed above in box "3" and Participation in such group self-insurance is still in force. The Group Self-Insurer's Administrator will send this Certificate of Participation to the entity listed above as the certificate holder in box "2". The Group Self-insurer's Administrator will notify the above certificate holder within 10 days IF the membership of the Participant listed in box" la" is terminated. (These notices may be sent by regular mail.) Otherwise, this Certificate is valid for a maximum of one year fi.om the date certified by the group self-insurer.'. If this certificate is no longer valid according to the above guidelines and the business referenced in box "la" continues to be named on a permit, license or contract issued by the certificate holder, the business must provide the certificate holder either with a new certificate or other authorized proof the business is complying with the mandatory coverage requirements of the New York State Workers' Compensation Law. Under penalty of perjury, I certify that I am an authorized representative of the Group Self-insurer referenced above and that the business referenced in box "la" has the coverage as depicted on this form. Certified By: Certified By: Title: David~.~...~/F[ancey y~int name of authorized representative of the GrouP7/2712010Sdf-in~urcr) / (Signature) (Date) Trust AdmiZ Telephone Number: (315) 699-8475 GSI-105.2 (2-02) Worker's Compensation Law Worker's Compensation Law Section 57 Restriction on issue of permits and the entering into contracts unless compensation is secured. 1. The head of a state or municipal department, board, commission or office authorized or required by law to issue any permit for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, and notwithstanding any general or'special statute requiting or auth. ori.zing the issue of such permits, shall not issue such permit unless proof duly subscribed by an insurance canner is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. Nothing herein, however, shall be construed as creating any liability on the part of such state or municipal department, board; commission or office to pay any compensation to any such employee if so employed. 2. The head of a state or municipal department, board, commission or office authorized or required by law to enter into any contract for or in connection with any work involving the employment of employees in a hazardous employment defined by this chapter, notwithstanding any general or special statute requiting or authorizing any such contract, shall not enter into any such contract unless proof duly subscribed by an insurance carrier is produced in a form satisfactory to the chair, that compensation for all employees has been secured as provided by this chapter. please Note:This Certificate is valid only through the policy dates indicated above, OR a maximum of one year after this form is approved by the authorized representatives of the Group Self-insurer. At the expiration of those dates, if the business continues to be named on a permit or contract issued by the above government entity, the business must provide that government entity with ~ new Certificate. The business must also provide a new Certificate upon notice of cancellation or change in status of the policy. GSI-105.2 (2-02) Reverse Suffolk County Executive's Office of Consumer Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 5/1/80 SUFFOLK COUNTY Master Electrician License No. 2740-ME This is to certify that EDWARD S REIFF doing business as UNDERGROUND SPECIALTIES 1NC 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, State of New York. This cci,liftes t~hat the bearer is duly lisen~d by the Ceunty of Suffotk MASTER ELECTRICIAN 2740-ME 0~01/1980 0S/01/2o12 Additional Businesses Dn'ector Suffolk Co un t? Execu tire's Office of Cons um er Affairs VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 DATE ISSUED: 7/1/78 No. 4436-H SUFFOLK COUNTY !-Iota e !m?ro veto en t Con tractor License This is to certify that ARTHUR J EDWARDS doing business as . . ARTHUR EDWARDS .MASON CONTRAC. T_ING JNC .~ l~avlng ft,~_~_~t~t~c,, ;he req ~ remen :4 se~ forth m acccudanc, with and subject to the provisions of applicable laws. rutca and ~ ,g'J._atmns c,~ &c Cotm..y of Suffolk, State of New York is hereby hcensed to conduct business as a HOME IMPROVEMENT CONTRACTOR, in the County of Suffolk. This eerlifllss that the bearer Js duly County of Suffolk Denis McElli~ott · SUFFOLK COUNTY DEPAR37,/JENT ~*,~'r~ =,,= 07tD1/2012 ~/dditional Businesses Director B C D E F [B / Plan Section B-B 10" Section A-A Typical Wall Piping Arrangement Section SIZE A B C D E F G tl A.REACAP. FEET Fr. FT. FT. Fr. FT. Fr. FT. Fr. SQ.FT. GAL. 16x32' 16' 32' 8' 14' 6' 4' 4' 8' 512 19,000 15'x36' 16' 36' 12' 14' 6' 4' 4' 8' 576 21,600 18'~"~' 18' 80' 12' 14' 6' 4' 5' 8' ~18 Z4,800 Z0'x40' 20' 40' 1§' 14' $' 4' 6' 8' 800 80,000 ~4'x44' 24' 44' 18' 14' 8' 4' $' 10' 798 80,000 24x48' 24' 46' 20' 16' 8' 4' 6' 10' 900 ~0,000 PERMACRETE WALT. SYSTEM 929 Route 25A Miller Place NY 11764 (630 744-?~e5 F~x (631) 744-0~74 Suffolk License #4436-HI Nassau License #HI74450000 ® ~¢eil /Go' · LOT NUMBERS REFER TO "MAP OF GREEN ACRES AT ORIENT" FILEO IN THE SUFFOLK COUNTY CLERK'S OFFICE ON APRIL 13, 1962 AS FILE NO. 3540. SCDHS Ref. # R10-01-0220 SURVEY OF PROPERTY A T ORIENT TO~rN OF SOUTHOLD SUFFOLK COUNTY, N.K 1000-15-01-11 SCALE: I'--80' JUNE~I6, 2005 Dec. 81, ~005 (Iol coverage) AUG. I~ 2006 (foundation) APRIL 12, 2007(FINAL) LOT 56 LOT 44 N89'52'10"E ¢'I.I , t$.~' 152.00' 40.6' ,"W LOT 46 HOUSE & GARAGE = 3073sq. fl. DECK = 715 sq./l, POOL = 800 ~ f= ¢/. L o r co VER, ts ® =PIPE ~ AREA---21, 111 SQ. FT. ANY ALTERATION OR ADDITION TO THIS SURVEY 15 A VIOLATION OF SECTION 72090F THE NEW 'fORK STATE EDUCATION LAW. EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF' SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. './ CERqRED el/4 .o o tvel'l ROBERT HAASE NORTH FORK BANK ~ FIDELITY NATIONAL TITLE I~ 49618 P.O. BOX 909 1230 ~A VELER S 05--1 74 SOUTHO~, N.~ 11971