HomeMy WebLinkAbout36967-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
CERTIFICATE OF OCCUPANCY
8/28/2012
No: 35919 Date: 8/28/2012
Location of Property:
SCTM #: 473889
Subdivision:
THIS CERTIFIES that the building IN GROUND POOL
750 Clearview Ave, Southold,
Sec/Block/Lot: 70.-9-61
Filed Map No.
conforms substantially to the Application for Building Permit heretofore
1/30/2012 pursuant to which Building Permit No.
Lot No.
filed in this offlced dated
36967 dated 2/2/2012
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:
accessory in ground swimming pool with fence to code as applied for.
The certificate is issued to
Blume, Laura & George
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36967 5/14/12
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 #: 36967
Date: 212/2012
Permission is hereby granted to:
Blume, Laura & Blume, George
584 Henry St
Brooklyn, NY 11231
To:
construct an accessory InGround Swimming Pool fenced to code as applied for
At premises located at:
75OClearview Ave, Southold
SCTM # 473889
Sec/Block/Lot # 70.-9-61
Pursuant to application dated
To expire on 813/2013.
Fees:
1/30/2012
and approved by the Building Inspector.
SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Building Inspector
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 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 amhitect 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 of Occupancy - Residential $15.00, Commercial $15.00
New Construction:
Location of Property:
Date. ] '2b'
Old or Pre-existing Building: (check one)
House No. Street
Owner or Owners of Property: ~,~..Olg~ e ~
Suffolk County Tax Map No 1000, Section r7 0
Subdivision
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate
Foe Submitted: $ ,~/9, q~¢-
Date of Permit. ~ ~_,-- ]'2-
Hamlet
Block q
Filed Map.
Applicant:
Underwriters Approval:
Final Certificate:
Lot
Lot:
(check one)
Town Hall Annex
54375 Main Road
P.O. Box I 179
Southold~ NY 11971-0959
Telephone (631 ) 765-1802
Fax (631 ) 765-9502
ro.qer, richer~town southold.ny, us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Blume
Address: 750 ClearviewAve City: Southold St: NY Zip: 11971
Building Permit #: 36967 Section: 70 Block: 9 Lot: 61
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: USI Electric LicenseNo: 2740-e
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
Servicelph ~ Heat ~ DuplecRecpt ~
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:
I-pool light
Notes:
Ceiling Fixtures e~[~[~ HID Fixtures
Wall Fixtures j j Smoke Detectors
Recessed Fixtures CO Detectors
Fluorescent Fixtur Pumps
Emergency Fixture~l Time Clocks
Exit Fixtures TVSS
in ground swimming pool, to include, bonding, 1 control panel, 2 GFCl circuit breal
Date: May 14 2012
81-Cert Electrical Compliance Form.xls
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
~}~FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING
[ ] ROUGH PLBG.
[ ] INSULATION
[ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH)
[ ] ELECTRICAL (FINAL)
REMARKS:
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST
[ ] FOUNDATION 2ND
[ ] FRAMING / STRAPPING [
[ ] FIREPLACE & CHIMNEY [
[ ] FIRE RESISTANT CONSTRUCTION [
[ ] ROUGH PLBG.
[ ] INSULATION
] FINAL
] FIRE SAFETY INSPECTION
] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ~F.J. ECTRICAL (FINAL)
REMARKS:
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ]FOUNDATION 1ST [ ] ROUGH PLBG.
[ ]FOUNDATION 2ND [ ] I~LATION
[ ]FRAMING/STRAPPING [J,~ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRIC~OUGH) [ ]ELECTRICAL (FINAL)
REMARKS: /~_~c_ /~ ~1 ~ //~, .c/
DATE
r'/ /'
-~//~ I l~/ INSPECTOR /~~ /~~/~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ]~ULATION
[ ] FRAMING/STRAPPING [//] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) _~~ ]~E~CTRICAL (FINAL}
REMARKS:_ ~-~~ ~_ ~
DATE ~/~'-S// ~ INSPECTOR~
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: 765-1802
Examined o//~ , 20 709-
Approved
Disapproved a/c
PERMIT NO.
Building Inspector
j'0 JAN 3 0 2012 ~
BI DO DEN.
.... ~,~m~j~¢u~xp
BUILDING PERMIT APPLICATION CHECKLIST
Do you have or need the following, before applying '?
Board of Health
3 sets of Building Plans
Sup,,ey_
Check
Septic Form
N.Y.S.D.E.C.
Trustees
Mail to: - n ,~ ~_~I[
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 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 ;o 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 pm'pose what-so-ever until a Certificate of Occupancy
is issued by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuauce 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,,~d regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.~...~/,){ .....,. ,.,:"' ~dFl' ,m
· !i ~ i~/r-t (Signatu ' ' ' n)
"IMMEDIATELY" i.,..,~vvru,_
ENCLOSEPOOLTOCC~ ,LyiDTiF..,~,Tr_.q~ ~_ 2f,~ M, lle,: tgo,r
UPON COMPLETION :; ~ i¢=.,-2~! ' L~." '
BEFORE "WATER" (Mailing address of applicant)
State whether applicant is owner, lessee, agent,' architect, engineer, general contraq~l~l~l:~O~ or builder
D*TE~B.p. # ,./z ¢¢/~ 2_
Name of owner of premises
If applicant is a corporation, signature of dul~, authorized officer
(as on the tax roll or el~$1~${J2} 8 AM TO 4 F'M
FOLLOWING INSPECTIOn', Y
1. FOUNDATION TWO "~' ,K~
FOR POUREP COk, C . ;E
(Name and title of corporate officer) 2 ROUGH- FRAMiN ~. r- ..
STRAPD!NG EkECh~t- gCAU'?:"'
,,L~.~ 3~ 3 INSUL/~'FION
.~F' 4 FINAL-CONSTRUCTK ~gE.(
MUST BE COMPL£'£ cb.'
ALL CONSTRUCTION SHALI. f
REQUIREMENTS OF THE cOD:
o'Q-gq'O'-H~' YORK STATE NOT RESPONSIBLE
DE$IGN OR CONSTRUCTION ERRORS
ELECTRICAL RETAIN STORM WATER RUNOFF
INSPECTIO~¥ RE'~ED PURSUANT T0 CHAPTER 236
Location of land on which proposed work will be done: ~. OF THE TOWN CODE.
76-0 d)J lOt .¢.,x:
House Number Street Haffil~t"*~t* ! ' :'
Builders License No.
Plumbers License No.
Electricians Licehse No.
Other Trade's License No.
County Tax Map No. 1000 Section
Subdivision
(Name)
r~O Block q Lot ¢1
Filed Map No. Lot
State existing use and occupancy of premises and intended use~nd occupancy of proposed construction:
a. Existing use and occupancy ] ,.5'-~-t)~ ~'cvS~Oed¢-~2
b. Intended use and occupancy ~ca:'o}{~/d~/k_ ~'.~, R'I R11/tf~ ~O~0L
Nature of work (check which applicable): New Building.
Repair Removal Demolition
Estimated Cost l~1000- Fee
If dwelling, number of dwelling units
If garage, number of cars
Addition Alteration
Other Work'._L~qgmt~o ~/im~,,,J4
(Descripti'on)
(to be paid on filing this application)
Nmnber 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
Rear
Depth Height
8. Dimensions of entire new construction: Front ¢20
Height Number of Stories
9. Size oflot: Front ilo Rear I[0
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 ¢¢5- .~ 0~.~/ Will excess fill be removed from premises'~ NO
14. Nines of Owner of~remises ~ ~W~ Address ~0 Phone No. 9t?-Ol¢- qB2q
NameofMchitect-l~ ~ ~,fl~ ~ Address~ ~ ~ ~t~ Phone No /a3P72q'7~g~
N~e of Contractor ~ ~¢~ ~ Address ~ ~ 2~g PhoneNo.
15. Is this prope~ within 100 feet of a tidal Wetl~d? *YES NO
* W YES, SOUTHOLD TO~ TRUSTEES PE~ITS MAY BE REQUIRED .-
16. Provide survey, to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any, l~o/,u.~:~a~.r ,glgqrty is at 10 feet or below, must provide topographical data on survey.
'.
STATE OF NEw YORK}
SS:
COUNTY OF
/~'D'lv'c ,3 ~l)t¢tbt05 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual si~ng contract) aboye named,
(S)He is the
(Contractor, Agent, Co.orate 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 tree 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.
Sworn to before me this_.,./ ,
~V day of ~}/k/~4 20
· [ Ndtaryeubti~
MARGARET A. KIDNEY
No~ry Public - State of New Yo~
No. 01KI6021111
Qualified in Suffolk County
, ,sron Expires March 8, 20
TOwn of Southold
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF
STOR'-WATER. G D'NO, D ,NAGEANDEROS,ONCONTRO.
Distrfot Section Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW yoRK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM # / WORK ASSESSME~'T ~ Yes No
a. Wfiat iS the Total Area of the Project Paroela7
(include Total Area of all Parcels located within c~3, ~ ~"(.) ~ '1 Will this Project Retain AI~ Storm-Water Run-Off
the Scope of Work for Proposed Consb'uction) Generated by a Two (2") Inch Rainfall on Site?
b. What is the Total Ama of Land Cleadng (S.F. / N:res) (This item will include all run-off ~eated by site
clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed ~0 ~ Site Improvements and the permanent creation of
construction achy/b/? impervious surfaces.)
PROVI~)E BI~IEF ?ROJ'~CT D~CR[F~IOI/ m, oV,~,A~7~ P~. as N.d~: 2 DOCS the Site P)an and/or Survey Show All Proposed
Drainage Stm(~ures Indicating Size & Location? This ,/r"'l
Item shall incJude all Proposed Grade Changes and __v
S'opeaCon o,,thgSurfaseWatar ,ow.
d0L 3 Dces tho Site Plan and/or Survey deschbe the erosion
and sediment control practices that wJti be used to /
control site erosion and storm water discharges. This
item must be maintained throughout the Entire
Construction Period.
4 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 YardsI~1 __v
of Matada) within any Parcel?
5 W/il this Application Require Land Disturbing ActiviUas
Encompassing an Area in Excess of Five Thousend
(5,000 S.F.) Square Feet of Ground Surface?
6 is there a Natural Water Course Rurming through the
Site? Is this Project within the Trustees jurisdiction
General DEC S',NPPp Requirements: or Within One Hundred (100') feet of a Wetland or
Submission o[ a SWPPP is required lot all ConstmcUon activJUes invoMng soil Beach?
disturbances of one (1) or mom acres; ~diudlng disturbances of less than one acre that 7Will there be Site preparation on Existing Grade Slopes
are pan of a larger common plan that will uEimately disturb one or n~xe ac;es of land; which Exceed Fifteen (15} feet of Vertical Rise to
including ConsmJct~n activities Involving soil disturbances of less than one (1) ac~e where One Hundred (100') of Horizontal Distance?
i the DEC has determined that a SPDES permit is required for storm water discharges.
( 8WPPP's Shall rneel the Minimum Requirements of the 8PDES General Permit 8 Will Driveways, Parking Areas or other Impervious
for Storm Water Discharges fi.om COnslruction activity - Permit No GP-O-t0-001.) Surfaces be Sloped to Direct Storm-Water Run-Off r~
1. The swPPP shall be prepared prior tu the submiflal of the NOI. The NOI shall be into and/or in the direcUon of a Town right-of-way?
submitted to ~e Department pdo~ to the commencement of c~rs~Jcdon actMty.
2. The SWPPP sha(I desc;'lbe the erosion and.sediment control practices and where 9 Will this Project Require the Placement of Material,
required, past-consthJctfon sturm water management practices that will be used and/or Rem0val of Vegetation and/or the Coostruction of any [~
conslmcted to reduce the palluianis in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder
compliance with the tee'ms and conditions of this permit. I. addition, the SWPPP shall
STATE OF NEW YORK, ,d,
COUm EK). K. ........ ......... SS
That 1 ~ '~ ~'~N'~qt~.~ being duly sworn, deposes and says that he/she is the applicant for Pcnmt,
And that he/she is the ............................................ ~ .~..[/~~__~
( r, ontmctor, Agent, Corper ai~)' ~1~:, ~'l~'.) ................................................................
Owner and/or representative of the 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 Wae to the bea 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;
I)
No. 01K1602 I Ill
Qualified ~ Suffolk County
ll/~ Exl31res March S, 20L~
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 76.%1802
r0 . (6al) 76.5
.q er. nchert d(~n.sogg~o(~, ny.u s
BUILDING DEPARTMENT
TOWN OF $OITFHOLr{
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY:
Company Name:
Name:
Date:
License No.:
Phone No.:
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
JOBSITE INFORMATION: (*Indicates required information)
r'l~8- tm~t- q.~2q
1000 Section: . ~0 Block: ~
*BRIEF DESCRIPTION OF WORK (Please Print Cleady)
lot: Gl
(Please Circle All That Apply)
*Is job ready for inspection:
~'Do you need a Temp Certificate:
Temp .Information (If needed}·
*Service size: 1 Phase
*New Service: Re-connect
Additional Information:
YES
Rough In Final
3Phase 100 150 200 300 350 400 Other
Underground Number of Metf~rs Change of Service Overhead
PAYMENT DUE WITH APPLICATION
82-Request for Inspection Form
Suffolk County Executive's Office of Co~sumer 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 RE1FF
doing business as UNDERGROUND SPECIALTIES INC
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 certifies/hat the
bearer is duly licensed
by the County of Suffolk
SUFFOLK COUNTy DEpAR1MENT
OF ¢ONSLII~IER AF'FAIR:~
MA~TER
ELECTRICIAN
EDWARD S REIFF
2740-ME o5~1/198o
~"'~" ~ 0~01,~0~ 2
AddkionaI Busmesse:s
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
APPLICATION FOR ELECTRICAL INSPECTION WITH $100 CHECK
APPLICATION FOR CERTIFICATE OF OCCUPANCY
TAX BILL
$300.00 CHECK FOR PERMIT FEE
B
C
Plan
Section B-B
Section A-A
Typical Wall
Piping
Arrangement
Section
SIZE A B C D E F G H AP~F~A CAP.
FEET Fr. Pr. FT. FT. FT. FT. FT. FT. SQ.lq. C.~L.
16x32' 16' ~2' 8' 14' 6' 4' 4' 8' 512 19,000
16'x36' 16' 36' 12' 14' 6' 4' 4' 8' 576 21,600
18'x36' 18' 36' 12' 14' 6' 4' 5' 8' 648 24,~00
20'~44' 20' 44' 16' 14' 6' 4' 6' §' 800
24'x44' 24' 44' 18' 14' 8' 4' 6' 10' 798 ~,000
24'x48' 24' 48' 20' :16'8' 4' 6' 10' 900 30,00~
PERMACRETE WAI,I, SYSTEM
929 Route 25A Miller Place NY 11764
(6m) ?~-?~su ~x (6m) 744-m74
Suffolk License #4436-HI
Nassau License #HI74450000