HomeMy WebLinkAbout35996-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
6/21/2012
No: 35763 Date: 6/21/2012
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 10575 OLD SOUND AVE MATTITUCK, N.Y. 11952,
SCTM #: 473889 Sec/Block/Lot: 122.-1-4
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
10/22/2010 pursuant to which Building Permit No. 35996 dated 11/4/2010
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 swimming pool with fence to code as applied for.
The certificate is issued to
Herbert Lewis
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
35996 4/22/11
Authoffzed 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. 35996 Z
Date NOVEMBER 4, 2010
Permission is hereby granted to:
HERB LEWIS
10575 SOUND AVE
MATTITUCK,NY 11952
for :
CONSTRUCTION OF AN INGROUND SWIMMING POOL,
FENCED TO CODE
at premises located at 10575
County Tax Map No. 473889 Section 122
pursuant to application dated OCTOBER
Building Inspector to expire on MAY
SOUND AVE MATTITUCK
Block 0001 Lot No. 004
22, 2010 a/Id approved by the
4, 2012.
Fee $ 250.00
Authorized Signature
ORIGINAL
Rev. 5/8/02
Form No. 6
TO~VN OF SOUTHOLD
BUILDING DEPARTMENT
TO~VN 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 suwey of property showing all property lines, streets, building and unusual natural or topographic
features.
2. A properly completed application and cot/sent 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 of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision '~
Permit No.
Health Dept. Approval:
Planning Board Approval:
V/,,/ Date. 11 -- t~ -
Old or Pre-existing Building: (check one)
/or?a- 5ov
House No. Street
Block !
Filed Map.
Date of Permit. [! ~ q ~ I ~ Applicant:
lc.)
Hamlet
Lot:
Underwriters Approval:
Request for: Temporary Certificate
Fee Submitted: $
Final Certificate:
(check one)
Int Signa~
Town Hall Annex
54375 Main Road
P.O. Box I 179
Southold~ New York 11971-0959
Telephone (631 ) 765 1802
Fax (631) 765 9502
ro.qer, richort~town southo d.n¥.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
ssued To: Lewis
~,ddress: 10575 Old Sound Ave City: Mattituck St: NY Zip: 11952
]uilding Permit#: 35996 Section: 122 Block: 1 Lot: 4
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: North Eastern Electrical License No: 41853-me
SITE DETAILS
Office Use Only
Residential ~ Indoor ~ 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 A/C Blower Range Recpt
Transformer Appliances Dryer Recpt
Disconnect Switches Twist Lock
Other Equipment:
electric pool heater
Notes:
Ceiling Fixtures ~ HID Fixtures
Wall Fixtures ~,~ Smoke Detectors
Recessed Fixtures ~ CO Detectors
Fluorescent Fixture~ Pumps
Emergency Fixture Time Clocks
Exit Fixtures [~ TVSS
In ground pool to include, bonding, 1-pool light, 1-pool pump, 2-gfci circut breaker.,
Inspector Signature:
Date: April 22 2011
81-Cert Electrical Compliance Form
TOWN OF SOU~LDING DEPT.
INSPECTION
[ ] ROUGH PLBG.
[ ] INSULATION
[ ]FOUNDATION 1ST
[ ]FOUNDATION 2ND
[ ]FRAMING / STRAPPING
[ ]FIREPLACE & CHIMNEY
FINAL
[
] FIII~RESlSTANTOONS'mOOTIOM [
REMARKS:
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
DATE
'~~ TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ~ELECTRICAL (FINAL)
REMARKS:
DATE
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING
[ ] FIREPLACE & CHIMNEY [
[ ] FIRE RESISTANT CONSTRUCTION [
[ ] ELECTRICAL (ROUGH) [
[ ] ROUGH PLBG.
[ ~LATION
[ ~ FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
] ELECTRICAL (FINAL)
DATE
INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TO~WN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
www. northfork.net/Southold/
Examined /(t/ , 20/O
Approved /F~/, 20 //~'
Disapproved a/c
Expiration 5/q, 20 /,7)x
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
Contact:
Mail to :.~'a~t,_ B t~J~ ( fl
Building Inspector
Phone:
APPLICATION FOR BUILDING PERMIT
t
Date [(') { '~ ~ ,20
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 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, a~l regula~ons, and to admit
authorized inspectors on premises and in building for necessary inspextio~s.~ _ / ) ////
,, __----,, / (Sdg ¢4 o/applicant, dr"name,~ifa corporation)
IMME..D. IATELY" / "~ " " -~-
~ UBP~q¢~"~/~'~RO"~"~ ' (Mailing address o f applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, elec, tdc2a~.vlumber or builder
APPROVED AS NOTED
Name of owner of premises //-7/k'~' ~-~ ~,o W/'X FEE 2 S"'O. nY'
(As on the tax roll or latest deea~OTIFY BUILDING DEPARTMENT ,
If applicant is a corporation, signature of duly authorized officer 76'.-1802 8 AM TO 4 PM FOR T
(Name and title of corporate of~cer), ':' "' i i:~ 5~,--~-' ~ ~O..OU.~O CONC.e~E
US1: ib UN~_AVVrUL ? ~ ?~MIt,G. PLUMBING,
BuildersLicenseRo. /~&'~ I-M ,,~,-r~,,-, npm-lr: P, AT~ ~-~,~,~,~ ELECTR~CAL&CAUL~,NO
Plumbers License No, '"' ~" ~ ~ , ............ ~ INSULATION
· : f) [~ ki/~ ~ 4 r ~*;L - CONSTRUCTION & ELECTRICAL
Electricians License No. , ~ ('; ~: . ,,.,
~..~ I '..,". ', MOS* BE COMPLETE FOR C.O.
Other Trade's License No. ALL CONSTRUCTION SHALL MEET THE
F- OU~REMEN'rS OF THE CODES OF NEW
1. Location of land on which pr_9.posed work will be done: v..RK ST4rE ',~OT RESPONSIBLE FOR
o. CONS .uc ,o ERRORS.
,/d9 5"-"f ':~-'- ~9 /-rD '~(2~v~ /~7l b/ ~-._ ///¢/¢'7z-/, RETA!,*! STORP, WATER
House Number Street
County Tax Map No. 1000 Section
Subdivision
Hamlet
Block /
Filed Map No.
PURSUANT TO CHAPTER 233
o%"t CODE.
Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:~
a. Existing use and occupancy
Fee
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building_
Repair Removal Demolition
4. Estimated Cost "~ ~ O ~ C2
!
5. If dwelling, number of dwelling units
If garage, number of cars
Other Work
Alteration
(Descriptior~
(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. Sizeoflot: 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? YES ~_ NO__Will excess fill be removed from premises? YES/~. NO__
14. Names of Owner of premises/k't~
Name of Architect
Name o f C o ntr act or22~'/.,~,..-r)/,~
Address ,, Phone No
Address/~'~'~ ~ ~/~,/ Phone No. ~7-~2~Z~
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.
16. Provide survey, to scale, with accurate foundation plan"a~d!di'siat~ces7 ~O,p~-d~erty lines.
NO.Z.
17. If elevation at any point on property is at t0 feet or below, must provide topographical data on survey.
STATE OF NEW YORK)
, SS:
COUNTY O F~.)
.~J- r.~t/ (~.~ ~ c,c_~,j~.~....c'~-- ' being duly sworn, deposes ~d says that (s)he is the applic~t
(~}~vf~ ~ing contract) above named,
.; a ' 0¢;* - ~G* (Contractor, Agent, Co,orate Officer, etc.)
of said owner or owners, and is duly authorized to perfom or have peffomed the said work and to make and file ~s application;
that all stat6ments contained in this application are ~e to the best of his ~owledge ~d belief; and that the work will be
perfo~e¢ ~.the ruer set forth in the application filed therewith.
Swom to?oefore me this
Notar~lPublic
20 ~0
VALERIE LINDQUIST
Notary Public State Of New York
No. 01LI6051621
Qualified in Suffolk County IO
Commission Expires Dec 4, 20~
~ature °~pli~
J l!} l ToWn of Southold
I ~!(~ )~)J Erosion, Sedimentation & S,~orm-Water Run.Off ASSESSMENT FOR;-'-
J ~--*'J~'~'.~-~ I P~PE~ L~N: S.~T.M. ~ THE FO~O~NG A~O~ MAY REQUIRE THE SUBMISSION OF A
' i _ /
InCludir, g Co~lmcfion acllvilk~ ~ndvlng so~ ~st,~oances o~ I~s than oce (1) ac~e when~
t aol~v~ty -Pemtit No. GP-0-10-001.)
com~rance ','~h Ih~ lemm and cmdt~ons ~ ~.~ permit. In add~m, lhe ~=pp shall
that Is kn~dedgeabb ~n the l~l~es ancl practk:es of Storm Water idanao~me~
W'~I this Project Retain AIl Strum. Water Run_Off
Generated by a Two ('Z'} Inch Rainfall m Site?
dea~ng a~d/or constnx~m ~ as wetl as all
Site I~pmvements alld*the permanent creatinn of
impe~oua surfaces,)
Drainage S/~ctures Indicating Size & Location? This
Item sba# Indude all P--rop0~d Grade Changes and -~F~
Slopes Conlml~ng Surface Water Flow.
3 Does the Site Plan and/or Sunmy desun'be the en~inn
and sediment control prac~es that will be used to ~'~
item must be maintained throughout the Entire
Co~ffuc~n Perked.
4
w~, n~s n:ol~ Recmulm.any Land Filling. Grading or
ExcavaUon where there ls n chenge to the Natural
Ex~ Grade Involving m0m than 200 Cubic Yards F~ ~
of Materiel within any Parcel? .
Encompassing an Area in Excess of Five Thousand
(5,000 S.F.) Square Feet of Ground Surface?
6 Is there a Natural Water Course Running through the
Site? Is Ihis Project within the Trust~es jurisdinlfon r~
or within one Hundred (100!) feet of a Wetland ~r
~Beach?
7 ~r thare b~ Site mprepamUon on EJds~ing Grade Slopes ~ ~, /
which Exceed F~een (15) feet of Vertical Rise to J
One Hundred (100') of HariZontal DIstar)ce? ·
8 Will Driveways, Parking Areas oroth~r Impervious
into eed/or In b~e direction of a Town righ~J~f-way?
9 Will this Project Require the Ptaceme,qt of Mat~'la~,
Removal of Ve0etatlprm and..br the Constriction of anY
Item Wib~dn the T-- Right-of-Way or Road Sho~d~ ~/~
a ~orm*Wat~, Grading, Drainage & Erosle. Cm~ol*Fta~ i, Requbed b~ the Tow.~
Sworn to bcFor~..~.., this;
............ .............
--~.m,, - ~u,.~ NO. 01L16051621 /''
- Qualified In Suffo]k Coun~
~ommission ~p)res Dec 4, 20~
Town of Southold
Erosion, SedimentatiOn & S.torm-Water Run'Off ASSESSMENT FORM
PROPERTY LOC~T~N:
............. =oo~ruu. IN THE STATE OFN~
$COPE OF woRK - PROPOSED CONSTRUCFION ITEM#/WORKA~MENT
(Indude Tolal A~ea of all Pamels Iocalecl wllh]n
b. What b the Total Ama M Land Ck~bg
PROyR)g BRIE~ PRo~cr DESCriPtiON
btCJudfng ~;°n act;vit~es ~ so~ ~;siudmnces M i~ limn o~e (1) ac~e where
STATEOFNEW'YOI~ ('~ ~f~ ~ ;
corr~r~ oF .... ~..~0.L~ ........... ss
P~m~ ~'~'~'~) ................... being duly ~mm, deP°Ses aud says fl~at he/~hc i. thc applicant for p .
~d ~h~she ~ ~e . ~ o ~
. '(~:'~;~'~-~;~ ................................................................
~ ~or ~P~m~e of ~c ~ or ~m, ~d ~ d~ a~ofi~ to ~o~
~c ~d ~e ~ appff~fion; ~ ~ ~tem~ ~n~cd ~ or~ ~o~ed ~c ~d ~rk ~ ~
~t ~e ~& ~! ~ ~o~cd in ~e ~ s~ f~ ~ ~e appffofion ~ed h~.
S~m to ~fom ~ ~s;
FORM-06/10 ~~;~/;~' ' , %~
Apr19 11 r~8:32a
p.1
Town ~
,543?5 ~ Road
TeX~'l~'e e (81) 765-180~
TOWN OF $OUTI~OLD
PP~IONFORELE T ILI SPEC I
Name:
~ No.:
~dm~:
Phone No.:
JOE[SITE INFORMATION: (*Indicates required information)'
~EF ~RIP~ON OF WO~ (P~ase Print
Lot:
*lsjob ready for/nspecffon:
"'Do. you need a Temp Certlllcate:
Tnmp Information (If*needed]
Rough tn Final
*SelMce Size: 1 Phase 3P_ _h~_. 100 150 -~00 300 31t0 400 Olher
*NewServi~:~_~_.J~,eonne~' UndergraunU Non!lber~Melers Change of Service Overhead
Addilien~lon: PAYMENT DUE WITH APPLICATION
Enclosed is a check for $100 for the electrical c/k: for my home at 10575 Old
Sound Avenue, Mattituck, NY 11952.
Please send copy to my home address in New Y(~rk at 14 Horatio Street, Apt. 12G,
NY :10014.
Thank You,
Herb Lewis
2:12.807.6452
~, "n g,~ -,~' · n'--:-g . ~ · _-
~0575 Ot~ Sound Ave
Mattituck, NY 11952
~L ~ P~ ~ ~ ~ N.Y. ~A~ ~ID~
~E ~P~ G /,f(~
~L ~ ~ ~ ~I~PI ~ ~103.1
SURVEY OF PROPERTY
51TUATE.. HATTITUOK
TO~N: 50UTHO~
SUFFOLK 60UNTY, NY
.SUR'CE'CFD 06T. 20, 2010
.SUFFOLK C, OUNTh" TAX
I000-122-1-4
HBRBERT LEW~S
N
F
· MONUN~ENT " '
I PIPE ~
SINIMMIN6 POOL TO BE LOOATED 20'
FROM ANT DR¥~,'~LL OR SEPTIC S'r'STEM
^~^: ~,.~ ~ oR o.~o ^o~ JOHN C. EHLERS LAND SURVEYOR
6 EAST MAIN STREET N.Y.S. LIC. NO. 50202
®RAPHIF_, ~ALE I"= ~0' ~AD, N.Y. 11~1 369-8288 F~ 369-8287
~F.C:~uments ~d Se~ngsXOwner~y D~uments~y Dmp~x~ PROS~ pros~218 u~td~ for ~l.pro