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Home My WebLink About37267-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 11/21/2012 CERTIFICATE OF OCCUPANCY No: 36052 Date: 11/21/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: IN GROUND POOL 505 N Smith Dr, Southold, Sec/Block/Lot: 76.-1-20 Filed Map No. conforms substantially to the Application for Building Permit heretofore 5/9/2012 pursuant to which Building Permit No. 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: Lot No. filed in this officed dated 37267 dated 6/1/2012 inground swimming pool fenced to code as applied for. The certificate is issued to McLaughlin, William & McLaughlin, Irene (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37267 8/3/12 ed ,8/ighat utte TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit #: 37267 Permission is hereby granted to: Date: 6/1/2012 McLaughlin, William & McLaughlin, Irene 295 Carnation Ave Floral Park, NY 11011 To: remove rear deck and install inground swimming pool fenced to code as applied for At premises located at: 505 N Smith Dr, Southold SCTM # 473889 Sec/Block/Lot # 76.-1-20 Pursuant to application dated To expire on 12/112013. Fees: 5/9/2012 and approved by the Building Inspector. DEMOLITION SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE CO - SWIMMING POOL Total: $136.00 $250.00 $50.00 $436.00 Building Inspector Form No. 6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 7654802 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. Bo 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 m 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~lificate of Occupancy - Residential $15.00, Commercial $15.00 Date. New Construction: Location of Property: House No. Street Owner or Owners of Property: P' [ 1 ['O~,&. Suffolk County Tax Map No 1000, Section "~) (tv Subdivision Old or Pre-existing Building: (check one) Hamlet Block / Lot Permit No. ,~>~/'c:~ 6 '"'~ Date of Permit. Filed Map. Lot: Applicant: Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Cellificate Final Certificate: (check one) S/ignature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631 ) 765-1802 Fax (631) 765-9502 ro.qer.richert~,town.southold.ny.us BUILDING DEPARTMENT TOWN' OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: McLaughlin ~,ddress: 655 Smith Dr North City: Southold St: NY Zip: 11971 3uilding Permit #: 37267 Section: 76 Block: 1 Lot: 20 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE .~ontractor: DBA: Raymond Electrical Cont. LicenseNo: 5141-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 GFCl Recpt Main Panel NC Condenser Single Recpt Sub Panel NC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling FixturesI____J[~R HID Fixtures Wall Fixtures I I Smoke Detectors Recessed Fixtures CO Detectors Fluorescent Fixtur{~ Pumps Emergency Fixture Time Clocks Exit Fixtures I I TVSS in ground swimming pool, to include, bonding, 1-GFCI circuit breaker 1-pool light, 1-gas pool heater Notes: Inspector Signature: Date: Aug 3 2012 81-Cert Electrical Compliance Form.xls 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 Expiration PERMIT NO. Building 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: 471 Route 25A ky Point, NY 11778 APPLICATION FOR BUILDING PERMIT Date 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 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 amendmems or other regulaficns affecting properly nave been enacted in the interim, the Building Inspector may authorize, in writing, the extension &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 bu_ilding for necessary inspections.,,CUPANCY OR' ' .1 (Signature of'applica~nt~0r na~, i~'a corporation) ,'IMMEDIATELY', 01 E IS UNLAWFUL FHOUT CERTIFIC T;i _. C_o-¢ncL-ho'q fWc _. ~ ~' ~ .... x · (Mailing address of applicant) ..... OF '"'" State whe~er a~l~n~ lS~Omer, ~ss~ gent, architect, engineer, genera~t. : . . builder Nameofo~erofpremises ~r~& ]v[~ i~i~t~o2-~ ~ T0 4 PU FOR TH~ / ' ~ ' I~GIION~' ' (As omthelax roll or latest ~ · 3 ~Nsu~ Builders License N~/~ Ct 4 Plumbers License No. ELEGIRIGAL uUSl ffi ffi ~ C.O, glec~ici~s License No. INS~ECTBN R[OUIREDA,~o~ ~z~sN~s 0F ~HE CODES OF Other Tmde's License No. yORK ~/,rE. ~T RE~IBLE FOR ~ES~GN 0R ~~ E~S, House Number S~eet ~ ' Hamlet County Tax Map No. 1000 Section Subdivision qb Block / Filed Map No. Lot ~ RETA~0~, 0F-~ WATER RUNOFF VuHSUA~ OF THE TOWN COD~ 3. Nature of work (check which applicable): New Building Repair Removal De~aplition. ~( 4. Estimated Cost ~7~/~'~ I Fee 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 i~' ,/.. Addition Alteration ~ther Work (Description) 5. If dwelling, number of dwelling units If garage, number of cars (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 Rear 8. Dimensions of entire new construction: Front Height Number of Stories Rear Depth 9. Size of lot: Front Rear 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? YES NO.~ 13. Will lot be re-graded? YE8 NO/~ Will excess fill be removed from premises'? YES NgA~ 14. Names ofOwner of~premig_g~[FtoJq~ ~V~[O~a~ss~~l~ Phoneme. I(o~'-~ ~ { NameofArchitect L/~t~O~I<z>I)ID&~r-3 ~Address~ ~-d-eg:Ce~,~ PhoneNo ~:~I-Z4~-~ Name of Contractor ~_t2r~t_~LIT~ ~dor[~r Addresslb'~/ 1~'~ 2c~ PhoneNo.._~ -Tu~'b-gloT_ 15 a. Is this property within 100 feet of a tidal wetland or a freshwater w~tland? *Y~S NO/x * IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY B,,~REQUIRED. b. Is this property within 300 feet of a tidal wetland? * YES NO z~Xr- * 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 or 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 ~. ) , ~ ~/~e_~L~ ~_.~ O'~L~l.~{being duly sworn, deposes and says that (s)he is (Name o~ f individual signing contract) a ob.gy~ named, is the b (Contractor, Agent, Corporate Officer, etc.) the applicant 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. Town 54375 Main Road P.O. !~ 1179 · Soutboid, 1~ BU~ ~ING DEP~ TOWN' 0~' 80T, rt~O~.n APPLICATION FOR EU=CTRICAL INSpECTiC,,,,- *Name: · *Address: °Cmos Street: *Phone No.: P~ No.: T~ ~p ~: JOB$1TE INFORMATION: ?Indicates required information) { s~) vis - 1~ ~n: ! ¥ B~: '~ Lot: ~EF DESC~ION OF WO~ (PI~ PU~ Clea~) In ar~ sw',m~na (Pleame Circle All That Apply) *Is Job ready for inspection: *Do you need a Temp Certificate: Temp,lnformation (If I:.::decl) · l~f NO Rough In Final *Se~Ace Size: 1 Phaee 3Phaee 100 150 200 30~' 350 400 Other *New Sewice:. Re-aonneet Undmgmund Number of Metem Change of Servioe Overhead Additional InfOrmation: PAYMENT DUE WITH APPLICAT'O'! ~ '~ l~_ ..... . , -~ t~- Town of Southold - Chapter 236 SWPPP. Storm Water Pollution Prevention Pla GENERAL Requested Information is Req E - Mail: Will this Project Disturbe five (5) or More Acres at ~ ~ Any One Time During the Proposed Development ? Yes If YES: Please Answer the Followln~ll ~' a. Does the Applicant have a Qualified Inspector On ~ ~ Staff To Conduct the Required inspections ? Yes No b. Does the SWPPP Indicate How Frequently the Site ~ r-~ Inspections will Occur and for What Period of Time ? Yes No C, DoestheSWPPPAdequatalyldentifyAllTemporap/ r'---] ~ and/or Permanent Soil Stabalization Measures ? Yes No d. Does the SWPPP Adequately Identify a Complete ~ [~ Project Phasing Plan ? Yes No e. Does the SWPPP Indicale Additional Site Specific ~ ~ Practices [hat Will be Utilized to Protect Water Quality ? Yes No f. Has the Applicant Submitted a Completed DEC Notice Of Intent and SWPPP Acceptance Form for Review r-~ ~ by lhe Town of Southold ? Yes No Brief Description of Const~ction Actis4ty, Proposed $~uctural BMPs, Soil Stabalization BMPa, Project Scope and/or Sequence of Constxuction Activity STATE OF NEW YORK, /)COUMT ~F ............... f:h ........... -, .......... ~S ~d mat hffshe is ma ........................... :..~..~.~~ ............. O~er ~or represen~five of me O~er or O~ers, ~d is duly aumomed to ~ffo~ or have ~ffo~ed me ~d work ~d to m~e ~d file ~s app~cafion; ~at fll statemenm ~on~ned in ~s appli~fion ~ ~e to ~e best of Ms ~owledge ~d ~lief; ~d · at ~e work ~11 ~ ~ffo~ed i~e.manner / I I I I -.~ I d~ Sworn to b~ ~ ~s;Il/~ 1yr~[~-Z ~ ' I ~ "~ ........... ~- TOWN OF SOUTHOLD PlIOPERTY RECORD CARD .~MER OWNER , .- SEAS. IMP. VL. ST~E~r ~&5' N TOTAL NORMAL Form Acre Per Tillable 1 Tillable 2 Tillable 3 Woodland Swampland Brushland ,,House Plot Total ti LLAGE W FARM REMARKS lIND. DISTRICT SUB. TYPE OF BUILDING J CB. DATE J ,MISC, I Est. Mkt, Value FRONTAGE ON WATER /4/ ~?g4)- ,I/~ ! , I -, ! :~ , xtension lj, J~__Jr ~,~ xte~sion I reeze'way !~ Foundation 2~'"/,:'J pt. Wolls Fire Place Potio Driveway Porch Porch Bath Rooms 2nd Floor J Dormer SWIM KING POOLS 471. Route 25A ROCKY POINT, NY 11778 (631) 744-8100 LETTER Subject ~ 02012 B/DG DEPT. I'OWN OF SOHTHOLD [] Please reply [] No reply necessary STATE OF NEW YORK WORKER'S COMPENSATION BOARD CERTIFICATE OF INSURANCE COVERAGE UNDER THE NYS DISABILITY BENEFITS LAW PART 1 .To be completed by Disability Benefits Carrier or Licensed Insurance Agent of that Carrier la, Legal Name and Address of Insured (Use street address only) RANDY T. RODECKER, INC. DBA SWIM KING POOLS 471 ROUTE 25A ROCKY POINT, NY 11778 lb. Business Telephone Number of Insured lc. NYS Unemployment Insurance Employer Registration Number of Insured 8561753 ld. Federal Employer Identification Number of Insured or Social Security Number 113092960 2. Name and Address of the Entity requesting Proof of Coverage 3a, Name of Insurance Carrier (Entity being listed as the Certificate Holder) Town of Southold 53095 Route 25 PO Box 1179 Southold NY 11971 The First Rehabilitation Life Insurance Company of America 3b. Policy Number of Entity listed in box "la": DBL37154 3c, Policy effective period: 02/01/2011 to 01/31/2012 4, Policy covers: a. [] All of the employer's employees eligible under the New York Disability Benefits Law b. [] Only the followingclassorclassesoftheemployer'semployees: Under penalty of pe0ur~, I certify that i am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disability Benefits insurance coverage as described above, Date Signed. By (Signature of insurance carrier's authorized representetJve or NYS Licensed Insurance Agent of that insurance carrier Telephone Number 516-829-8100 Title. Chief Executive Officer IMPORTANT:If box "4a" is checked, and this form Is signed by the insurance carrier*s authorized representative or NYS Licensed Insurance Agent of tha~ carrier, this certificate is CO MPLETE. Mail it directly to the certificate holder. If box '4b" Is checked, this certificate is NOT COMPLETE for the purposes of Section 220, Subd. 8 of the Disability Benefits Law, ~t must be mailed for completion to the Worker's Compensation Board, DB Plans AccePtance Unit, 20 Park Street, Albany, NY 12207. PART 2, To be completed by NYS Worker's Compensation Board (Only if box "4b" of Part 1 has been checked) State of New York Worker's Compensation Board According to information maintained by the NYS Worker's Compensation Board, the above-named employer has complied with the NYS Disability Benefits Law with respect to ali of his/her employees. Date Signed By Telephone Number Title (Signature of NYS Worker's Compensation Board Employee) Please Note: Only insurance carriers licensed to write NYS Disability Benefits insurance policies and NYS Licensed Insurance Agents those insurance carriers are authorized to issue Form DB-120.1. Insurance brokers are NOT authorized to issue this form, DB-120.1 (5-06) , .~?d" CHECK VALVE ' PUMP ~ FP,,OM SKIMMER, z X,l N DRYWE ~- DEEP ~ATER RE~RNS ~ ~ ' O O POURED CONCRETE ~AL~ AN P STEPS ~ ¢ P~N CHECK VALV~ TO RE~RN5 2" to 4" SANP BOSOM .[ ' ?..;,. ,:/~..~ <~ ~/i SE~ION Aw~ om[~u.~ : ~, NOTES '=~ NEW YORK STATE- 2~O AND TH E ANSI/NSP[-5-O5 STANDARDS FOR RESIDENTIAL ~ ~ ~ ~ G~D 1. ALL CONS~UCTION IS TO BE IN ACCORDANCE WI~ ~E RESIDEN3AL CODE OF TOP OF WALL ~ ~ ~ INGROUNDSWIMMINGPOO~FORA~PEIIPOOL WATER LINE~, R~EEN 2, 5TRUC~REISDESIGNEDFORUSEBELOWG~pEANDONLYINAR~SWHERETHE ~ '. /-- ~ ~, GROUNPWATERTABLEISAMIN~MUMOF~'-B"BELOW~E,ROPOSEPFiNiSHEPG~DE. : BACKFILLW[~CL~N ~R~ FREEOFROOTSANDDEBRIS. DONQTALLOWTHEH~,IGHT 0 ~' ' V~I ES 4' LINER AND CONCR~ ~' OF BACKFILL TO EXCEED ~[ ~EIGHT OF ~E WA~R IN THE POOL BY MORE THAN B, ,' ,' ,' ' FORM TI~ / OR ~E WATER TO EXCEED BACKFILL BY MORE ~AN B". ~ 2' R~KN LINE 5, WAL~ TO BE SMOOTH, NON SKIP ~PE, SLOPED AWAY FROM POOL ,.~ :]NYL L:NER~~ 6. WATERO[SPOSALSHALL,ELIMITEDTOOWNERSPROPER~INACCORDANCEWi~LO~L REGU~TIONS IN ACCORDANCE WI~ THE NYS BUILDING COPE, APPENDIX G, SECTION AGiOS. Z PEK~NENT ENCLOSURE MUST BE COMPLETEP ~I~IN NINE~ DAYS A~K ~E PATE OF ' w COMMENCEMENTOF CONS~UC~ON 8 THERE IS NO MAIN D~JN IN THIS POOL. SUCTION FOR POOL WATER CIRCU~TION FORIS PROVIDEPENT~PMENTBY THEp~TEC~ON.SKIMMERS ONLY. TH IS M~S REQUIREMEN~ OF KC- SEC~ON AG106 ~o A TE~O~Y ENCkOSU~E, O~ ¢ ~ FENCE S~ALL ~E I~ST~LLEP A~P ~E~ ~ IN ~C~ 5-2--12 mROUCHOWTHE PEKIOP OF CONS~UC~ON OF THE SWIMMING POOL ~ALL SECTION UNTILmE COMPLEnON OFA PERMANENT ENCLOSURE 10' 5' B' 5' 18' / POUR,ED CONCRETE WALL5 AND STEPS