Loading...
HomeMy WebLinkAbout37208-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 8/15/2012 CERTIFICATE OF OCCUPANCY No: 35879 Date: 8/15/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: ABOVE GROUND POOL 350 Willow Pond Ln, Southold, Sec/Block/Lot: 70.-8-45 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 5/7/2012 pursuant to which Building Permit No. 37208 dated 5/10/2012 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: above ground swimming pool.fenced to code as applied for. The certificate is issued to Carrozza, John & Darleen (OWNER) of the aforesaid building. SUI~'I~'OLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIFICATION DATED 37208 8/9/12 Auto, zed Sig~nature 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 #: 37208 Date: 5/10/2012 Permission is hereby granted to: Carrozza, John & Carrozza, Darleen 231 Princeton Rd Rockville Centre, NY 11570 To: install an above ground swimming pool~fenced to code as applied for At premises located at: 350 Willow Pond Ln, Southold SCTM # 473889 Sec/Block/Lot # 70.-8-45 Pursuant to application dated To expire on 11/9/2013. Fees: 5/7/2012 and approved by the Building Inspector. SWIMMING POOLS - ABOVE-GROUND WITH REQUIRED FENCING CO - SWIMMING POOL Total: $250.00 $50.00 $300.00 Form No. 6 TOWN OF SOUTHOLD 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 instalIation from Board 0fFire Underwriters. 4. Sw. orn statement from plumber certifying that the solder used in system contains less than 2/10 of 1% lead. 5. Commercial building, indnstrial 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: I. Accurate survey of property showing all property line~, streets, building and unusual natural or topographic features. 2. A properly ~..0mpleted application and consent to respect 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. Certifica{e 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: House No. Stree~ · Owner or Owners ofProperty: ~}~)~[,~ ~,: ~x~3&a.~y'~ Date. ~ ~ /L7 - Old or Pre-existing Building: (check one) Hamlet Suffolk County Tax Map No 1000, Section Subdivision Health Dept. Approval: Block <~ Lot ~ ~-~ Date of Permit. 5 -lO - I ~ Planning Board Approval: Request for: Temporary Certificate Foe Submitted: $ 5~. {P'(9;~kp Filed Map. Applicant: Underwriters Approval: Final Ce~ificate: -- '- Applicant Signature Town Hall Annex 54375 Main Road P.O. Box 1179 Southold. NY I 19714)959 Telephone (631 ) 765-1802 Fax (631) 765-9502 ro.qer.dchert~town.southold.n¥.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: Darien Corozza Address: 350 Willow Pond Rd City: Southold St: NY Zip: 11971 Building Permit #: 37208 Section: Block: Lot: WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE 3ontractor: DBA: Brian Brooks Electrical Inc License No: 3613-e SITE DETAILS Office Use Only Residential [~ Indoor ~ Basement ~ Service Only ~ Commerical Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Su~ey Attic Garage INVENTORY Service 3 ph Hot Water GFC~ Recpt Main Panel NC Condenser Single Recpt Sub Panel AJC Blower Range Recpt Transformer Appliances Dryer Recpt Disconnect Switches Twist Lock Other Equipment: Ceiling Fixtures ]~] HID Fixtures Wall Fixtures ].~ Smoke Detectors Recessed Fixtures ~ CO Detectors Fluorescent Fixture ].~ Pumps Emergency Fixtures~ Time Clocks Exit Fixtures b__d TVSS above ground swimming pool to include, 1-pump motor, 2-GFCI recpticles Notes: Inspector Signature: Date: Aug 9 2012 81-Cert Electdcel Compliance Form.xls TOWN OF I [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INS/ULATION [ ] FRAMING/STRAPPING [~'~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS:~ ~ INSPECTOR ~/~/TOWN OF SOUTHOLD765.1802BUILDING DEPT. INSPECTION [ ] FOUNDATION 1ST [ ] FOUNDATION 2ND [ ] FRAMING / STRAPPING [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [~]]~I:IRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ~ELECTRICAL (FINAL) REMARKS: DATE -~,~~- INSPECTOI~'~ FOUNDATION (IST) (b PL~G ~D~ION~ cOuNTS ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802 FAX: (631) 765-95011 SoutholdTown. NorthFork. net Examined Approved Disapprox, ed a.c [Sxpiralion PERMIT NO. BUILDING PERMIT APPLICATION CHECKLIST Do you have or need the tbllowing, before applying? Board of Health 4 sets of Buildiag Plans Planning Board approval Survey "-4 Check Septic Form N.Y.S.D.E.C. Trustees Flood Permit Single & Separate Storm-Water Assessment Form Contact: d Phone: ~,'~/~-/~ 2 ~- 7 r/~ O~ B~(filding Inspector APPLICATION FOIl BUILDING PERMIT Date INSTIIUCTIONS · 20/8, a. This application MUST be completely filled in by typewriter or in ink aud submitted to ti~e Bailding Inspector with 4 sets of plans, accurate plot plan to scale. Fee according to sci]edule. b. Pict plaa showing location of lot and of buildings on premises, relationship to a~joining premises or public streets or areas, and waterways. c. Tbe work covered by this application may not be commenced befbre issuaace of Building Permit. d. Upon approval of this applicalioa, the Building Inspector will issue a Building Permit to the applicant. Such a permil shall be kept ou the premises available lbr inspection throughout the work. e. No building shall be occupied or used in whole or in pa~ for any parpose what so ever until the Building Inspector issues a Certificate of Occupancy. f. Every building pemfit shall expire if the work authorized has not commenced within 12 mouths a~er the date of issuance or has not beeu completed within 18 months fi'om such date. If uo zoning amendments or other regulations affecting the property have been euacted in the interim, the Building luspector may authorize, in writing, the extension of the permit for an additiou six months. Thereafter. a new permit shall be required. APPLICATION IS HEREBY MADE to the Building Departmeut kw the issuance cfa Building Permit pursuant to the Building Zone Ordinance of the Towu of Southold, Suflblk County, New ~ork, and other applicable Laws, Ordiaances 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, ordinaoces, building code, housiug code. and regulations, and to admit authorized inspectors on premises and iu building fbr uecessary inspections. qMMEDIATELY" Ijbk (Signature of a cant Cname, if a corpg tion) ENCLOSE P~ TO COD. , UPON CO~LETION"WTHOUT BEFORE"WATER" State whether applicant is owner, lessee, agent, architect, engineer, general col~ ~Sl~[~ber or bmlder Name of owner of premises ,7~ hFI If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Pluinbers License No. !NSPECTION REGUiRED Electricians License No. Other Trade's License No. 1. l,ocation of land on which proposed work will be done: .%K'O Willow Pond Lane_ .,_,4bu4-ko Icl. ttouse Number (As on the tax roll o~t~e~M ~C 4 ~r,~ ~0; rile FOLLOWING INSPECTION5 1. FOUNDATION - ~ REQUIRED ~ I~FOR ~URED 2. RO~H- FRYING, ~UU~, i STRAPPING, ELECTRIC~ & CAULKING 3. INSU~ s Street ~ - ~ ' Hamlet County Tax Map No. lO00 Section OqO.,O0 Block Subdivision Filed Map No. Lot 0q5. 000 Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed constraction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work (check which applicable): New Building Repair Removal Delnolition 4. Estimated Cost 5. If dwelling, number of dwelling units If garage, number of cars Fee Addition Alteration Other Work ctho¥~ a~-~u_acL, tm~c~ J (Descriplion) (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 c~/'~:[O(~ Nan'ie of Former Owner-U~ rUt° 5 C~ 11. Zone or use district in which premises are sitaated 12. Does proposed construction violate any zoning law, ordinance or regulation? YES 13. Will lot be m-graded? YES 14. Names of Owner of premises Name of Architect Name of Contractor NO NO V/Will excess fill be removed from premises? YES NO GFr0ZZ (~ Address ufholdfl PhoneNo. Address Phone No Address Phone No. 15 a. Is this properly 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. NO X 16. Provide survey, to scale, with accurate lbundation plan and distances to property lines. 17. If elevation at any point on property is at 10 feet or below, must provide topographical dala on 18. Are there any covenants and restrictions with respect to this property? * YES NO b/ · IF YES, PROVIDE A COPY. STATE OF NEW YORK) O NTYO S: D t~/'-~-~]'"} C~rJ/0 z ~'--&'- being duly sworn, deposes and says that (s)he is fl~e applicant (Name of individual signing eontracO above named. (S)He is the ~ r~O~Oo gs~uOq ~":¢'59:. ~ 2;':"W -: : , , . ,,, ,, (?dq~r~t~r ,Agent. Corporate Officer. etc.) of said ow ~ 9~tor~,~gd is dulffqggthor~ed to perfiwln or have perfom'med the said work and to make and file tiffs application: that all statements co8t~i~ h~ l~8~pJ~ti~ are true to the best of his knowledge and belief; and that the work will be performed in tb~B~ S~Sit~g~l.icat~ ~ filed therewith. Swor ~ to befor~]~4~oq~t TOff, 2~ r_ :'~9" 2~ ~ PHILIPPE H FILS Amd[ -- -- ~ ~ ,oY / / ~~ ~ Notmr) Pubric - State of N,w York I ~~ ~~ / ~j~ NO. 01FI6193432 [ S glatt 'e of ApplJca~ ~ ~ -- ' QualifiedJfl Nassau CountyF Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, NY 11971-0959 Telephone (631) 765 1802 Fax (631 ) 765-9502 BUILDING DEPARTMENT TOWN OF' SOUTI--IOLD August 6, 2012 John Carrozza 231 Princeton Rd Rockville Centre, NY 11570 Re: 350 Willow Pond Lane, Southold TO WHOM IT MAY CONCERN: The Following Items Are Needed To Complete Your Certificate of Occupancy: Application for Certificate of Occupancy. (Enclosed) v// Electrical Underwriters Certificate. (contact your electric __ A fee of $50.00. __ Final Health Department Approval. __ Plumbers Solder Certificate. (All permits involving plumbing after 4/1184) __ Trustees Certificate of Compliance. (Town Trustees # 765-1892) __ Final Planning Board Approval. (Planning # 765-1938) __ Final Fire Inspection from Fire Marshall. __ Final Landmark Preservation approval. BUILDING PERMIT: 37208 - In-Ground Swimming Pool /,1!,1,,~· / / ! , LOt 23 / / LOT NUMBERS REFER TO 'MAP OF SECTION ONE FAIRVIE~ PARK' FILED IN THE SUFFOLK COUNTY CLERK'S OFFICE ON AUG 9 196I AS FILE NO 3388 CERTIFIED TO, JOHN & DARLEEN C~ROZZA TITLESERV, ~VC. SURVEY OF PROPERTY AT SOUTHOLD TO'tN OF SOUTHOLD SUFFOLK COUNTY, NE~r YORK 1000--70--08-45 SCALE: 1"=20' AUG 22, 2001 SEPT. 5, 2001 ( certification ) JAN. JI, ~008 (cerffflceflonl AC~OR~):I,,,...~' CERTIFICATE OF LIABILITY INSURANCE ] OATE{M"'D "IO3,28 20t2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate bolder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Jim Cake I=HONE ] (A~C, 802-775-5590 Hermitage Insurance Brokerage (Nc, NO, EX~{: 800-451-4279 FAX E-MAIL joake~gmunet.com 65 Middle Rd ADDRESS: INSURER{SI AFFORDING COVERAGE NAIC Middle Island NY 11953 INSURER A: Atlantic Casualty Insurance Co. INSURED INSURER B: Champion Installations Inc ~NSURER C: 69 Middle Country Rd INSURER D: INSURER E: Middle Island NY 11953 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE F~)LICY PERJOD INDICATED NOTWITHSTANDINO ANY REQUIREMENT, TERM ORCONDITIONOFANYCONTRACTOROTHEROOCUMENTWlTHRESF~ECTTOWHICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NSR ~DDI iUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE NSR ~NVD POLICYNUMBER {MM~DDIYYYY) MM/DD~'YYYY} LIMITS SEN ERAL LIABILI'[~ EACH CCCURRENCE $ 1,000,000 DAMAGE TO RENTED X CCH M ERCtAL GEN EP~L LIABILITM PR EMISES (Ea occurrence~ $ 100,000 ] CLAIM,~MADE [] OCCUR MED EXP (Any one person} $ 5,0(~ A L036005019 05/27/2011 05/27/2012 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGO REGATE LIMIT APPLIES PER: PRODUCTS. COtV~p/op AGG$ 1,950,000 COMBINED SINGLE LIMIT AUTOMOBILE t. IABILIT~ ANYAUTO EODILY IN JURY (Pel Person) $ ALL O~'NED SCHEDULED BODILY iN j URY (Per a ccider~t) AUTOS __ AUTOS NON-OWNED PROPER"~~ DAMAGE $ DECr ]RETENTIONS $ CERTIFICATE HOLDER CANCELLATION 231 Princeton Rockville Centre ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TNB EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE NY 11570 © ~1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD New York State Insurance Fund Workers' Compensation & Disability Benefits Specialists Since 1914 8 CORPORATE CENTER DR, 3RD FLR, MELVILLE, NEW YORK 11747-3129 Phone: (631) 756-4300 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE 611410683 CHAMPIONINSTALLATIONSINC 69MIDDLE COUNTRY RD MIDDLEISLAND NY 11953 POLICYHOLDER CHAMPION INSTALLATIONS INC 69 MIDDLE COUNTRY RD MIDDLE ISLAND NY 11953 POLICY NUMBER CERTIFICATE NUMBER CERTIFICATE HOLDER DARLENE CARROZZA 231 PRINCETON RD ROCKVLLE CENTRE NY 11570 PERIOD COVERED BY THIS CERTIFICATE DATE 1 2102 732-1 05/28/2011 TO 05/28/2012 4/20/2012 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO. 2102 732-1 UNTIL 05/28/2012, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS OUTSIDE OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY. IF SAID POLICY IS CANCELLED, OR CHANGED PRIOR TO 05/28/2012 IN SUCH MANNER AS TO AFFECT THIS CERTIFICATE, 10 DAYS WRITTEN NOTICE OF SUCH CANCELLATION WILL BE GIVEN TO THE CERTIFICATE HOLDER ABOVE. NOTICE BY REGULAR MAIL SO ADDRESSED SHALL BE SUFFICIENT COMPLIANCE WITH THIS PROVISION. THE NEW YORK STATE INSURANCE FUND DOES NOTASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOTCOVER CLAIMS OR SUITSTHATARISEFROM BODILYINJURYSUFFERED BY THE OFFICERS OFTHE INSURED CORPORATION. ROSERT GODBERSON, PRES OF CHAMPIONINSTALLATIONSINC (ONE PERSON CORP) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONONLYANDCONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. U-26.3 NEW YORK STATE INSURANCE FUND DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https:l/www, nysif.com/cert/certval.asp or by carling (888) 875-5790 VALIDATION NUMBER: 493909900 island recreational' IIII1 1 ~ 1371694 ISLAND RECREATIONAL ._/~..~,~. ~ ~ 1480 DEER P~~OEF~R PARi~I~i "' ORDER NO: 17-01-00042 · Page 1 of 6 CUSTOMER: - D CARROZZA 350 WILLOW POND LN'~---IJ~v~ ' Time:, 11:01:57 SOUTHOLD NY 11971 ' Q 4 ~ELEPHONE: 516-678-7792 ~l~i! 'i i 03242V35140! Customer mu~t call {$181 ~'0-1880 to ~¢hedule e delhte~ dete. .UANTITY MODEL ' DESCRIPTION ' . UNIT PRICE [ SN SS1852 i8' × 52" ROUND 6" ~ITE F~u~E 719.00 1 SMW 1852GS 18' X 52" SOLID GREY WAL Included 1 LI 1848CF0 18' ROUND CARIBN LINER Included- 1 AC 22489 CALYPSO A FRAME LADDER 139.00 1 BS 202PSWTR THRU WL/PRE FILT/WIN PLT 119.99 1 DLV DELIVERY & HANDLING 80.00 1 AC 50032P POOL WATCH SWIMMING POOL ALARM - ASTM 79.99 1 ADK 18 18' EZ DRAIN WINT CVR 259.99 1 GL AG60P WALLFO~_M UP TO 18R-12X20 109.99 1 BS HLXA LARGE H & L BASKET *Free* 1 BS PRC60DB9 #60 DIAMONDBK FILTER TNK 49.00 1 BS SP1600A 2 HP POWERFUL FLO PUMP 50.00 1606.9S lAX 138.60 ?OTAk 1745.56 ~A~,C~ OUE .0 0 Customer Copy