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Home My WebLink About36288-ZTown of Southold Annex P.O. Box 1179 54375 Main Road Southold, New York 11971 CERTIFICATE OF OCCUPANCY 10/1/2012 No: 35979 Date: 10/1/2012 THIS CERTIFIES that the building Location of Property: SCTM #: 473889 Subdivision: IN GROUND POOL 845 Elijahs Ln, Mattituck, Sec/Block/Lot: 108.-4-7.4 Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this officed dated 3/22/2011 pursuant to which Building Permit No. 36288 dated 4/1/2011 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 ~round swimming pool with fence to code as applied for. The certificate is issued to Skrezec Jr, Carl & Bayne, [ara (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. PLUMBERS CERTIHCATION DATED 36288 5/16/11 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 #: 36288 Date: 4/1/2011 Permission is hereby granted to: Skrezec Jr, Carl & Bayne, Lara 845 Elijahs Ln Mattituck, NY 11952 To: construct an inground swimming pool, fenced to code as applied for At premises located at: 845 Elijahs Ln, Mattituck, NY 11952 SCTM # 473889 Sec/Block/Lot # 108.-4-7.4 Pursuant to application dated To expire on 9/30/2012. Fees: 3/22/2011 and approved by the Building Inspector. SWIMMING POOLS - IN-GROUND WITH FENCE ENCLOSURE CO - SWIMMING POOL Total: $250.00 $50.00 $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 alectrical installation from Board of Fire Underwriters. 4. Sworn statement f~om 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 fxom architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. 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 cunsent to inspect signed by the appficant. 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 $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building $25.00, Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building - $100.00 3. Copy of Certficate of Occupancy - $.25 4. Updated Certificate of Occupancy - $50.00 5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00 New Construction: House No. Location of Property: Old or Pre-existing Building: O Street (check one) Hamlet OwnerorOw ersofPro : Cml CeXO LO: Suffolk County Tax Map No l000, Secfion q'~3,_<~Y~ Block It07 Lot 21'-I-7.d Subdivision Health Dept. Approval: Date of Permit. Filed Map. Lot: App,icant: C~I ,t ~'~a~ ./_ Unde~ters Approve: Planning Board Approval: Request for: Temporary Certificate Fee Submitted: $ Final Certificate: (check on_e) , Town Hall Annex 54375 Main Road P.O. Box 1179 Southold. New York 119714)959 Telephone (63 l) 765-1802 Fax (631) 765-9502 ro.qer, dchert~town.southold.nv.us BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION ssued To: C&L Skrezec ~,ddress: 845 Elijahs Ln City: Mattituck St: NY Zip: 11952 3uilding Permit #: 36288 Section: 108 Block: 4 Lot: 7.4 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE 30ntractor: DBA: Raymond Electrical Cont. LicenseNo: 5141-me SITE DETAILS Office Use Only Residential ~ Indoor ~ Basement ~ Service Only ~ Corn meric, al Outdoor 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Servicelph ~ Heat ~ DuplecRecpt ~ 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 Fixtures ~[~[E~ 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 pool light, I GFCI circuit breaker Notes: Inspector Signature: Date: May 16 2011 81-Cert Electrical Compliance Form TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ] FOUNDATION 1ST ] FOUNDATION 2ND ] FRAMING / STRAPPING ] FIREPLACE & CHIMNEY ] RRE RESISTANT CONSTRUCTION ] ELECTRICAL (ROUGH) REMARKS: [ ] ROUGH PLBG. [ ] INSULATION [ ] FINAL [ ] FIRE SAFETY INSPECTION ] FIRE RESISTANT PENETRATION [~] ELECTRICAL (FINAL) DATE INSPECTOR~ ~~~-~ TOWN OF SOUTHOLD BUILDING DEPT. 765-t 802 INSPECTION FOUNDATION 1ST [ ] ROUG~_LBG' [ ] FOUNDATION 2ND [ ]~__LATION [ ] FRAMING / STRAPPING [ ~]~FINAL [ ] FIREPLACE & CHIMNEY [ ] FiRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FiRE RESISTANT PENETRATION [ ] ELECTRICAL (R.OUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION FOUNDATION 1ST [ ] ROUGH PLBG. FOUNDATION 2ND [ ]~ATION FRAMING/STRAPPING [~/~FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: .~~ ~'~"~ DATE INSPECTOR BUILDING DEPARTMENT TOWN HALL SOUTHOLD, NY 11971 TEL: (631) 765-1802. FAX: (631) 765-95i)2 www. northfork.net/Southold/ Examined Approved Disapproved a/c PERMIT NO. Do you have or need the following, before applying'? Board of Health 3 sets of Building Plans Planning Board approval Survey. Check Septic Form N.Y.S.D.E.C. Trustees Contact: Mail to: Phone: Expiration / [ Building Inspector ?PLICATION FOR BUILDING PERMIT 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 conmaenced 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 connnenced 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. ~' ELECTRICAL (si}~am o~a~ppli~a~r name, ~fa c-o~poration) ;NSPECTION REQUIRED ENCLOSE ROOL TO CODE UPON COMPLETION BEFORE"WATER" (Mailing atldress ~f applicant) If applicant is ~ qorporation, signature (Name and titl~ of co~orate offi[~ 5 Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician.olumber or builder APPROVED AS NOTED Name of owner of premises ~D~ ~ F~?~ FEE: .~ ~, (As on the {~ ~l[or latest de~TIFY 8UI~ING 765-1802 8 ~ TO 4 PM FOR'Th'~ FOLLONNG INSPECTIONS: 1. FOUNDATION - ~ REQUIRED FOR ~UREO CONCRETE 2. R~GH - FR~I~, ~U~NG, STRAPPING, ELECTRICAL & CAULKING 3. INSU~TION Location of land on which proposed work will be done: House Number M~tre~t Block Filed Map No. ~0{~ ~ County Tax Map No. 10~00 q.~e~tion ] Subdivision/'~6I D 4 FINAL-CONSTRUCTiON & ELECTRICAL MUST BE COMR. ETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OFTHE CODES OF NEW YORK SLATE. NOT RESI~ONSIBLE FOR DESIGN I ERRCPS OF THE ~. C~E. State existing use and occupancy of premises and intended use and occupancy, o~f propose~ a. Existing use and occupancy b. Intended use and occupancy Nature of work (check which applicable): New Building Addition Repair Removal Demolition Other Work Estimated Cost [3, ~/Dc~ ~ Fee If dwelling, number of dwelling units t'3/4 If garage, number of cars i. If business, commercial or mixed occupancy, specify nature and extent of each type of use. ~. Dimensions of existing structures, if any: Front Rear Depth Height Number of Stories construction: Alteration (Description) (To be paid on filing this application) Number of dwelling units on each floor Dimensions of same structure with alterations or additions: Front Depth Height Number of Stodes Dimensions of entire new construction: Front Height Number of Stories Sizeoflot: Front I ~_.c.p Rear I~ O Rear Depth .De~pth ~40(, Rear 10. Date of Purchase t~---~ Name of Former Owner 11. Zone or use district in which premises are situated ~."--e~-x-n ~,lJ~p,_-~ 1 12. Does proposed construction violate any zoning law, ordinance or regulation? YES~ NOX~ 13. Will lot be re-graded? YES NO 7X Will excess fill be removed from premises? YES 14 Namesofownerofpremisc~Q("/ ,_,(?.re:7 ~P~Address~q'~ll~lSt~q ~¢ 'Name of Architect ~ .bO--~ ~ c.~, - ~SsSs~~: ~ Name of Contractor ~ ~ tT ~ rr ~ 15 a. Is this prope~y within 100 feet of a tidal wetl~d or a ~eshwater wetl~d? *YES * IF YES, SOUTHOLD TO~ TRUSTEES &.D.E.C. PERMITS MAY BE REQUIRED. b. Is this prope~y within 300 feet of a tidal wetl~d? * 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 e!evatmn at any poznt on property zs at 10 feet or below, must provide topographical data on survey. STATE oF NEW YORK) COUNTY OFq"'~{q%o l ~ '"~_~t~F'}~\ IT ~t~(-~?.0 f being duly sworn, deposes and says that (s)he is the applicant (~l~a~ o'~ m~iv. idual 's{gni~g contract) above named, (S,He is the ~ (Q'2(-~)~ ~ft~ )-h>r . (Oon~ra~t~, .~gent, Corporate Officer, etc.) of said owner or owners, m{d is d~ly authorized to perform or have performed the said work and to make and file this application; that all statements contmned ,r~ thi~. apphcatmn are true to the best of his knowledge and belief; and that the work will be performed in the ~anne.r set, forth in the application filed therewith. Sworn to before me this. dayof IVCxCk 20 il /do'taw Public Pllul R. I~k~n NO. 0t M0~23¶ 056 Qt.lllfled in Suffolk County ,, Commle~lon Expir.~ Nov. t5 20 ;~ Town of Southold ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM PROPERTY L0C~TION: 8.C.T..liL;K THE FOLLOW/NG ACTIONS MAy REQUIRE 11~B SUBMISSION OF A ~J~0~ ~)~ .~x~ ~L 6~TORM.WAI.B~ GRADING, DRAINAGE ANn EROSION CONTROL. PLAN akron CERTIFIED BY A DEBIGN PROFE881ONAL IN 11'1E STATE OF NEW YORK. $COPEOFWORK - PROPOSED CONSTRUC'L'ION l'l'l~l~# / WORKASSESSMENT ] Yes No a. What is the Total Area of Ihs Project Parcels? ._~ Will this Project Retain All Storm-Water Run-Off (include Total Aras of ell Parcels [onatsd wtihin :..~,/,~OL~ I Generated by a Two (2") Inc~n Ruintell on Site? Ihe Scope of Work for Pmpased Co~slnJcllon) ~// b. Whet is the Total Aras ol' Land Crasgng (S.F./~) (This Item wtil Include all mn-off =rested by site <-.-~/::~L-. cleating and/or construction ac6vitias as well as all and/or Ground Disiurpence for the proposed ~ ~~-~'127 Site Improvements and the permanent c.~eatio~ of construction acitvity? impervious surfaces.) (S.F. / PROVIDE BRIEF PROJECT DESCIUI'J'iON O'm,~eA~t~P~,,.,..d~ 2 DoesIhe$[ta Plan and/or Survey Show All Propased Omlasge Stmcteras Indicating Size & Location? This Item shall include all Proposed Grade Changes and l ~ ~ ~-~:~ ~ 3 Doasthe$~Planond/orSuryeydascribeli'leemelon contr~ elte eroelon and storm watar discharges. Ye .~ ~v~ ~__ L~, / ~.~L::~ ,m ~/l~ Itom must be maintained throughout the Entire -~Lt~. ~-'-) Conetmc~on Period. 4 WIti this Project Require any Land Filling, Grading or Excavation where Ihere Is a change to the Natom, r'~ Exis~ng Grade Involving mom thaa 200 Cubic Yards of Materiel within any Pan=el? 5 Will this AppJication Require Lasd Dlsi~Jrbing A~h/tiles Encompassing an Area In Excees of Five Thon~and (5,000 S.F.) Square Feet of Ground $urfaGe? 6 IsthereaNaturalWatarCoumeRonnlngIhroughihe r~ site? is Ihis Project within the Trustas~ Jurisdiction O~naml DEC SWPPP ~: or within One Hundred (100') ~ of a Wetland or -- am pe~t of a lalger common plan that v, il[ ~ma~ly disturb one or more accel o~ tend; which Exceed Ffftasn (15) fast of V~lical Rise to inoludl~g CO,St fusion a~lvftles I~lvi~g soil disil~ of la~a tha~ one (~) e~:re v~ Orm Hundred (100') of Horizontal Distanoe? f~' Storm Water Ol,it~rg# from Con~tmctfofl ~. Part, It No. GP-0-t0-~0t.) Surfaces be Sloped to Olrec~ Storm.Water Run-Off N \/ 2. The SWPPP shall des=flbe the emeion .fid ~edlment ~ont~l pracli~ and where 9 W'ill ~is Project Require Ihe Placement of Matarisl, STATE O~ N.EW YORK, COUNTY OF ........................................... SS O~ ~J/or r=pmsentatN= of t~c O~==r or Ov~--s, ;md ~s duJy ;mfl~odz~d to p~'orm or i=ve p~t'orm~l make and file this application; that all statemenl~ mn~ined ht this appldcalion are true to die bc~t of his kl~owledge and beliet-; and that the work will be performed in the mam~er set fordi in file application filed herewith. Sworn to before me this; ........ ~..~..~ ............................................ - 06110 Paul R. Moran Nota~/PuNic State of New York NO. 01MO62310S6 Qullifled in Suffolk County . Commi~ion F-.xpim~ Nov. IS Tm~a l-lall/m~ex RO. Bo~ II?g · ~ ~ Telephone (~1) 76~-180~ BUILDING Di~P~ TOWN OE APPLICATION FOR ELECTRICAL INSPECTIQN JOBSITE INFORMATION: (*Indicates required Information) *Cmos Street: ]~Li B Tax Map District: 1000 Section: t O ~ Block: 'O L~ *BRIEF DESCRIPTION OF WORK (Pleaos Print Clearly) .J I (Please cIrcle All That Apply) *Is job ready for Inspection: ,Do you need a Tamp Certificate: Tomp'lnformation (If noeded}. *Service Size: 1 Phase 3Phase *New Sen4~e:. 'Re-conr~-,t Additional InfOrmation: (~NO YES/~ 100 150 200 Underground Number of Meters Rough In Final 300 3so 400 Other Change of Ser~Jce Ovet'hosd PAYMENT DUE WITH APPLICATION This ceffifies that the bearer is duly licensed by the County of Suffolk SUFFOLK COUNTY DEPARTMENT OF ;ONSUMER AFFAIRS HOMEIMPROVEMENT CONTRACTOR LICENSE NAME RANDY T RODECKER RANDY T RODECKER INC DBA 21412-H 06/01/1992 ~x.~o, DA~ 06/01/2012 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 2. Name and Address of the Entity requesting Proof of Coverage (Entity being listed as the Certificate Holder) Town of Southold 53095 Route 25 PO Box 1179 Southold NY 11971 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 3a. Name of Insurance Carrier 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. Poi icy covers: a. [] All of the employer's employees eligible under the New York Disability Benefits Law b. [] Only the followingclassorclassesoftheemployer'semployees: Under penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier referenced above and that the named insured has NYS Disebility Benefits insurance coverage as described above. Date Signed 2/7/2011 By (Signature of insurance carrier's authorized representative 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 that carrier, this certificate is COMPLETE 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. It 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 compliecl with ~he NYS Disedility Bene fita Law with respect to all 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 of 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) CMFD. EI. IJAH'S S ~8°38'50'E 0 POST WI LIGHT VER 15 ' (Av~ ) LANE /RS. 00' ~CM FD TOP BROKEN R=25 FO TOP BROKEN GARAGE I S~ORY WOOD FRAME RESIDENCE wobo DECK ~BOW WINDOW ~ JGua~ntees indicated here on shag rrm . · - . ~ Unaulhc~r~z~ct oltera~on or addition to this ~lon~y to t~e person ~or whom ~e ~ ~ e ~ , ~ ~e ~ew ,'or~ ~tale Eaucati~ Law NOTE; CM. FO = CONCRETE MONUMENT FOUND lANE ~LE~6065 TM~IO00-108-O~-O~4 GUARANTLm~'D TO - CARL A. SKREZEC, dR. LARd DAYNE FIDELITY NATIONAL TITLE INS. CO BANK OF NEW YORK MORTGAGE C~ TOWN OF SOUTHOLD SURVEY OF MAP MA T TI TUCK, SUFFOLK COUNTY, ALY SURVEYED FOR; CARL A. St~REZEC, JR IARA RAYNE /LIC~US£O ~AN~ SURVE¥O~Y ' ¥ NYS L/C NO. 4..~.~75 · SURVEYED ~.~0 dUNE, 1995 SACAL E = I" -- RE~ = 40,050 6~ S. F SURVEYED ~y: STANLEY ~ ISAKSEN, dR ~0 BOX 294 NEW SUFFOLK~ N,Y , 1195~ (51~) 75~-5~.~5 .~p~q 15' TER LINE 12' MIN. DIM. SECTION 6' 8~ MIN. DIM. SECTION MIN. DIM. SECTION 40' 20' CONC WALL~ ~ 24' PLAN 16' SECTION A SECTION B NOTES PLUMBING SCHEMATIC GRAPE l ROLLED FOAM BETWEEN LINER AND CONCRET[ FORM TIES 3500 PSI POURED CONC. 3/8 "~ REINF RODS WALL SECTION 20" WHITE RUBBER FULCRUM PAD 5TN 5TL TUBE W/MIRROR FINISH CONe SLAB C¥' WIDE MIN ~ PATIO PONE BY OTHER5 DIVING BOARD DETAIL --'1 3-16-2Oll