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HomeMy WebLinkAbout34604-ZTown of Southold Annex 54375 Main Road Southold, New York 11971 7/13/2011 CERTIFICATE OF OCCUPANCY No: 35061 Date: 7/13/2011 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: 1N GROUND POOL 470 Robinson Lane, Peconic, Sec/Block/Lot: 98.-4-36 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 4/3/2009 pursuant to which Building Permit No. 34604 dated 4/10/2009 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 Stenson, Thomas & Stenson, Aiden (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 128806C 6/26/09 Au~/5~ S~nat~l~O/ 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. 34604 Z Date APRIL 10, 2009 Permission is hereby granted to: THOMAS G STENSON 470 ROBINSON LANE PECONIC,NY for : CONSTRUCTION OF AN ACCESSORY INGROUND SWIMMING POOL AS APPLIED FOR, FENCED TO CODE at premises located at County Tax Map No. 473889 Section 098 pursuant to application dated APRIL Building Inspector to expire on OCTOBER 470 ROBINSON LA PECONIC Block 0004 Lot No. 036 3, 2009 and approved by the 10, 2010. Fee $ 250.00 Authorized Signature ORIGINAL Rev. 5/8/02 Form No. 6 TOV~I OF $OUTHOLD 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 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 Certificate o£Occupancy - Residential $15.00, Commercial $15.00 New Construction: Location of Property: Old or Pre-existing Building: House No. Street Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Subdivision Permit No. ~ L[J~O L'J Health Dept. Approval: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ ' Date of Permit. (check one) Block L/ Filed Map. Applicant: Underwriters Approval: Final Certificate: X/// Lot Lot: (check one) Hamlet Applicant Siffcgture Electrical Inspection Certifw. ate To: ~ gain.son 47O ~ lane ~ Pecor~ ZIp: 1~8 Town: 1 I TOWN OF SOUTHOLD BUILDING DEPT. 765-18O2 INSPECTION [ ] ROUGH PLBG. [ ] INSULATION ~. FINAL [ ] FIRE SAFETY INSPECTION [ ] FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: /~ ~ ? DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] ROUGH PLBG. [ ] INSULATION [~]~=INAL [ ] FIRE SAFETY INSPECTION [ ]FOUNDATION 1ST [ ]FOUNDATION 2ND [ ]FRAMING / STRAPPING [ ]FIREPLACE & CHIMNEY [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION REMARKS: ~ // DATE ~ INSPECTOR TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ]FOUNDATION 1ST [ ] ROUGH PLBG. [ ]FOUNDATION 2ND [ ] IN~,~ULATION [ ]FRAMING / STRAPPING [~/J' FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SA,-,-, '/' INSPECTION [ ] nmiE ~,vrr coMs'muctm. [ ] FmRE REStrAIn' PeiETRATI0. INSPECTOR~~/ FOUNDATION (2ND) ROUGH FRAMING & PLUMBING INSULATION PER N. Y. STATE ENERGY CODE / / /If~. ~. ~. __ // 7 / ~DITION~ CO~EN~S TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-9502 SoutholdTown. NorthFork.net Examined Approved Disapproved a/c l(/I0 ,200/ Expiration /¢ O, 20 /0 sets of plans, acc~ate plot plan to PERMIT NO. ~?/~O~'~ B~uilding Inspector BUILDING 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 Septic Form N.Y.S.D.E.C. Trustees Flood Permit Storm-Water Assessment Form Contact: Phone: ~t)~ /-'~//[~ /(/¢ L APPLICATION FOR BUILDING PERMIT Date 20__ INSTRUCTIONS completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 ;cale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or ardas, 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· 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 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· 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 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. ,/~ '~wRITERs CERTIFICATE nam ~orporation) kdk,~ur~l~a! vn --_ ~-c/~eL~lON ~ (Mailing address ~fapplicant) lessee, agent. rchttect,-,, '-,-- o en ,neer, enera ...... ,. or b.,lder WITH IUTCERTIFICATEALLCONSTr~ : '~.~H~.LL ~.,-:~ .ff//~,~2~q . :~./.. Ur UUtaUi%~',i5L' ~ - COD~;OF NE?, '~3~, ~3FATE. Narue of owner of premises /~/Z~E-rf -b'F~-d.S <~ ?'/ (As on the tax roll 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. Other Trade's License No. .................. ,,,~,, RUNOFF ~a ............. ,,,,,n, ,,-n 236 ALt. CONSTEUCT!~ ny THE TnlAIM Pnnr Location of land on which ~roposed work will be done: House Number Street County Tax Map No. 1000 Section Subdivision ~c~ ,¥ Block Filed Map No. REQU F'r'y2· TS ..... : · .. ~..','l ~:: ;OLESOFNEW YORK Si'ATE. NO ~,:' , T g~. U*~oBLF FOR DESIGN OR CON .... ... oTRUCTION E ',nOriS. ~ . Hamlet Lot /0 THE 2. State existing use and occupancy of premises and intended use and occupanc,,v of proposed construction: a. Existing use and occupancy K~-S/.~-M7-1AL- I i"P~'~ b. Intended use and occupancy t~LFSzb~.r,iT"'/flc-/_.. ] ~e,-o', ~ Nature of work (check which applicable): New Building Repair Removal Demolition 4. Estimated Cost ,/~ o o 0 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work /,,~/~£ 0 ~ ~/h /9~ (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 Rear .Depth Height_ Number of Stories Dimensions of same structure with alterations or additions: Front Depth___ ~Height ..... Number of StO D~mens~ons of enUre new constmcUon: Front~ '}'~__ ~Rear Height Number of Stones 0 9. Size oflot: Front }~~'Rear }~ Depth 10. Date of Purchase n ] 31 ~_~ Name of Fo=er Owner 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES__ NO / 13. Will lot be re-graded? YES__ NO v,/ Will excess fill be removed from premises? YES ,,/ NO__ 14. NamesofOwnerofpremises~(,v-,~O,c~4 Address./-a~*z,.V/¢.~../ PhoneNoff{~?.a) 6-qr-]~ Name of Architect . Address ' ! Phone No Name of Contractor~a~ /5~.aa' ~coat ,~t4'¢- ~)o~ Address / 7 ~'-J~)6c'~£ ~,~1~ Phone No.'7..~7 - 76 ~' 9* 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland. YES__NO / * 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. 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 br below, must provide topographical data on survey. 18. Are there any covenants and restrictions with respect to this property? * YES NO ~- * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF tt}! '~D~I~ ~7-£~tS0 t'f being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)Heisthe ~ cO~_. q~ (Contractor, Agent, Corporate Offioor, etc.). of s~id 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 knbwle~lge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . /~ .4 _ ~ Not. Public ., Signature o Applicant . Town of Southold Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM $.C.T.M. #: THE FOLLOWING ACTION8 MAY REQUIRE THE 81JRKS~eelON OF ~ Distrlcl $,ctlon Clock C~, ~rE,~D BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YOI~K. Item Number: (NOTE: A Check Mark (~') for each Question is Required for a Complete Application) Yes 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 pem~anent creation of Impervious surfaces.) Does the Site Plan and/or Su~ey Show All Proposed Drainage Sffuctures Indicating Size & Location? ~ r'~ This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFIowi w,,thisProj ct.e.uire enyLandF,,ng, . ingor xcava, ra ereisa engoto eNa ral I----I Existing Grade thvoMng more than 200 Cubic Yards of Material within any Pamel? ~ -- Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000) Square Feet of Ground Sudaca? __ Is there a Natural Water Coume Running ~hrough the Site?r~ is this Project within the Trustees urisdiction or within One Hundred (100') feet of a Wetland or Beach'~ oneWill there be Site preparation on Existing Grade Slopes which Exceed Fifteen (15) ~eet of Vertical Rise tOHundred (100') of Horizontal Distance? r'~ 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 fight-of-way? Will this Project Require the Placement o~ Material; Removal of Vegetation and/or the Construction of r'~ 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 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 Permltl EXEMPTION: Yes No Does this project meet the minimum standards for classificaUon as an Agricultural Project? ~"-I Note: If You Answered Yes to this Question, a Storm-Water, Grading, Drainage & Erosion Control Plan Is NOT Requlredl __ __ STATE OF NEW YORK, COUNTY OF ........................................... SS That I, ..~... ........................... ; ............................................. being duly sworn, deposes and says that he/she is the applicant for Permit, (Name of individual slgnll~g Docamen~) 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 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; ............................................... day of....~ .................... 20..... Y NO. 01GA6166624' ~' (SignaluJ~'ofA~op{icant) FORM - 06/07 TOWN OF SOUTHOLD PROPERTY STRE~ ~'N OWNER FARM LAN D I M P. TOTAL DATE !VILLAGE W RECORD CARD DISTRICT SUB. ACREA(~E / TYPE OF BUILDING LOT COMM. IND. I CB. MISC. Est. Mkt. Value REMARKS AGE NEW Farm NORMAL BUILDING CONDITION BELOW ABOVE FRONTAGE ON WATER Acre Value Per Acre Value FRONTAGE ON ROAD Tillable ! BULKHEAD Tillable 2 DOCK Tillable. 3 Woodland Swampland Brushland House Plot j Total M. Bldg. Extension Extension .j , I Foundation /~'J O/ ~asement J Ext. Walls Extension Porch Breezeway .~arage Fire Place Patio L/~,~j ~ {) Driveway Both Floors J Heat Porch Interior Finish [.~X ~_~ Roof Type j t~.-~ ~ Rooms 1st Floor ' Rooms 2nd Floor Dormer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631 ) 765-1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN OF SOUTHOLD June 16, 2011 Thomas Stenson 808 Ports Lane Bryn Mawr, PA 19010 RE: 470 Robinson Lane, Peconic TWO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: __ Application for Certificate of Occupancy. (Enclosed) Electrical Underwriters Certificate. fA fee of 50.00. __ Final Health Department Approval. __ Plumbers Solder Certificate. (All permits involving plumbing afrter 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: 34604-Z swimming pool SIAIE OF NEW YORK WORKERS' COMPENSAIION BOARD CERTIFICATE OF NYS WORKERS' COMPENSATION INSURANCE COVERAGE la. Legal Name & Adds~ss of Insured (Use street addr~s only) IRUE BLUE CONIRACI1NO, IlqC 17 EASI DEER PARK ROAD DIX HILLS, NY 11746 Work Location of Insured (Only requlred~lCOVeragei~ specifically limited to cerlain locations in New York ~tat~, I.~., a Irrap-Up Policy) 2. Name and Address of the Entity Requesting Proof of Coverage (Entity Being Listed as the Certificate Holder) Town of Southold PO Box 1178 Main Road Southold, NY 11971 lb. Business I elephone Number of Insured 631-751- 7349 le~ NYS Unemployment Insurance Employer' Registration Number of Insured 1~, Federal Employer' Identification Number' of Insured or Social Security Number' 11-3063500 3a. Name of Insurance Carrier Twin City Fire Immance Co. 3b,. Policy Number' of entity listed in box "la" 12WEQY2506 3c. Policy effective period 12101/2008 to 8./~19f2009 3d. The P~pdetor, Partners or Executive Officers arb [] included. (gnly cheek box if all parmergomeers included) [] all excluded or certain parmms/officers excluded,, Ihis cmtifies ~aat the insm~nc© c~lier indicated above M ~x '~" ~ ~e b~iness ref~nc~ above in box "la~ ~ wm~ls' co~ensefion ~ ~o New York S~o Wot ~' Go~on ~w.. ~o ~ th~ fern, New Yo~ ~ must ~ ~ under Itm 3A on ~e ~ORMATION PAG~ of~e worke~' eom~n~flon ~suran~ pell~)., ~e ~ce ~dor m'iB li~ ag~t ~s ~fi~ of Imm~ ~ ~e enfi~ l~ted a~ve ~ ~e c~fic~ hol~r ~ ~x '~"., ~e lm~a~e Cm rio will ~o not~ t~ above c~cme hol~' ~ithin I0 d~s IF a poli~ is cancded ~e to no~ oJpremi~ et wl~in 30 ~ IF ~e ~e re.om otho' th~ no~ent of pr~ that cancel the poli~ or elim~e t~ ~sur~d ~m the c~age i~icmed on th~ College. ~e noac~ m~ ~ sent ~ r~l~ mail) ~ ~& Ce~ ~ valM for one.y~ after . . . n er ~h fo~ b appro~ by ~e ~su~ ~ler or ~ ~sed agar, or u~ ~e pol~ ~n da~ i~ed ~ box ~c , ea~H~. PI~ No~: U~n &e ~cel~n of&e wor~' mmpe~a~on pol~ indl~t~ on &~ lotto, ff~e bnsin~ ~n~u. to be ~m~ on a ~ iice~e or ~ntra~ ~su~ by a cm~fga~ holder, ~e b~in~ m.t pt~de that ~fifi~ holder ~ a new Certlfl~ of Wor~' Compensation C~erage or o~er aut~o~ p~of &at tbe bnsin~ ~ ~mply~g wi& &e mandatory coverage ~uiram~ of t~ New Yo~k S~te Wm~e~x' Compemaflon Law. Under ~ of pmju*~, I eerti~ that I am an authored repz~n~e or li~ns~ agent of the insuran~ ca~'ier ~fe~nc~ above and that the nam~ ~su~ h~ ~e coverage as depi~ on ~ fozm, A~ved bT Ihom~ P. ~ ~. CPCU .... c~t of ~umn~ ~) ~~ 3~4~009 Appmv~ by: (D~) ]itle: Authorized Representative I elephone Nmnbm' of'authorized representative or licensed agent of insaaance Please Note: Only imurance ca~?'iers and their licemed agentz a,~ authorized to issue Form C-105 2 Insurance broketa are NOT authorized to issue it This certifies that the bearer is duly licensed by the County of Suffolk SUFFOLK COUNTY EXECUTIVE'S OFFICE OF CONSUMER AFFAIRS HOMEIMPROVEMENT CONTRACTOR LICENSE MICHAEL TRUEHART TRUE SLUE CONTRACTING INC OSA 17951 -H 03/Ol/1991 ~,~,.o, D^~ 03/01/2011 7-.O Stenson 470 Robinson Lane Peconic, NY 11958