HomeMy WebLinkAbout36410-ZTown of Southold Annex
P.O. Box 1179
54375 Main Road
Southold, New York 11971
5/3/2013
CERTIFICATE OF OCCUPANCY
No: 36223
Date: 5/3/2013
THIS CERTIFIES that the building
Location of Property:
SCTM #: 473889
Subdivision:
1N GROtYND POOL
1195 Goose Creek Ln, Southold,
Sec/Block/Lot: 78.-8-8
Filed Map No.
conforms substantially to the Apphcation for Building Permit heretofore
5/10/2011 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:
accessory in ground swimming pool, fenced to code as applied for.
Lot No.
filed in this ofliced dated
36410 dated 5/23/2011
The certificate is issued to
Kelly III, Mortimer & Kelly, Kathleen
(OWNER)
of the aforesaid building.
SUFi~OLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO.
PLUMBERS CERTIFICATION DATED
36410 7/11/11
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 #: 36411)
Date: 5/2312011
Permission is hereby granted to:
Kelly III, Mortimer & Kelly~ Kathleen
PO BOX 391
Southold, NY 11971
To:
construct an inground swimming pool, fenced to code as applied for
At premises located at:
1195 Goose Creek Ln, Southold
SCTM # 473889
Sec/Block/Lot # 78.-8-8
Pursuant to application dated
To expire on 11121/2012.
Fees:
5/10/2011 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 SOU'THO]ED
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 (8-9 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. Commemial 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.
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.
J Old or Pre-existing Building: (check one)
//q5'
House No. Street
Hamlet
Owner or Owners of Property:
Suffolk County Tax Map No 1000, Section
Subdivision
PermitNo. '~, ~/I t9 DateofPermit.
Health Dept. Approval:
Planning Board Approval:
Request for: Temporary Certificate _
Fee Submitted: $
Block ~'
Filed Map.
D-' ~ 2 ~-// Applicant:
Underwriters Approval:
Final Certificate:
Lot
(check one)
~'- '~ Appli(~alit gig-nature
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold. New York 11971-0959
Telephone (631 ) 765-1802
Fax (631 ) 765-9502
ro,qer r chort~town.southold.n¥.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: M&K Kelly
Address: 1145 Goose Creek Lane City: Southold St: NY Zip: 11971
Building Permit #: 36410 Section: 78 Block: 8 Lot: 8
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Elec Tec Inc License No: 4814-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
Servicelph ~ Heat ~ DuplecRecpt ~ CeiliflgFixtures e~ HiDFixtures
Service 3 ph Hot Water GFCl Recpt Wall Fixtures ~.~ Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixtur Pumps
Transformer Appliances Dryer Recpt Emergency Fixtures~.~ Time Clocks
Disconnect Switches Twist Lock Exit Fixtures L.__J TVSS
Other Equipment: in ground swimming pool to include, bonding, l-pool light, l-control panel
1-OFCl circuit breaker
Notes:
Inspector Signature:
Date: July 11 2011
81-Cert Electrical Compliance Form
TOWN OF SOUTHOLD BUILDING DEPT.
765-t 802
INSPECTION
[ ] FOUNDATION l ST [ ] ROU~.BG.
[ ] FOUNDATION 2ND [ ]~SULATION
[ ] FRAMING/STRAPPING [~FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRIC~I~ (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS./~ ~- //"~ ~ ~
DATE
INSPECTOR,~~/~
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOU.DAT~O. ~ST [ ] ROU~q. PL.G.
[ ] FOUNDATION2ND[ ]~U~
[ ] FRAMING/STRAPPING [
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFE'I~ INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
/ /
DATE ,._~/~//( 9,,
INSPECTOR
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, NY 11971
TEL: (631) 765-1802
FAX: (631) 765-9502
SoutholdTown. NorthFork.net
Examined 5/~Z-,~, 20 / /
Approved J/'~.~20 //
Disapproved aJc
Expiration
/ Fg- 20 /g-
10 2011
BLDG. DEPT.
TOWN OF $OUTHOLD
PERMIT NO.
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 v/
Septic Form
N.Y.S.D.E.C.
Trustees
Flood Permit
Storm-Water Assessment Form
Contact:
Mail to:
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date
INSTRUCTIONS
,20//
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 adjdining 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, and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
"IMMEDIATELY"
ENCLOSE P~,CL TO CODE
UPON COMPLETION
ALL CONS i,
,~ ~:,LL (Signa~e of applicant or ~me, ifa co~oration)
MEET THE EEQU~E~: 5~T~ OF T~o ~o~ ~ ~~ .V~//~
CODES OF NE~/;C/< SLATE. (Mailing ad&ess ofapplic~t)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
APPROVED AS NOTED
(As on thc tax roll or latest a~¢d) ~ ~ BY ~
Ifapplic~t is a co~oyatjon,~i~ture ofdul~i~ ,~m FEE: h . / ~
~ ~/~/ ~ _~yv~r midol ~ NOTIFY BUILDING DEPARTMENT AT
~ ~- . ~ ./~, ~/~/~d .... ~ ...... I 765-1802 8 ~ TO 4 PM FOR THE
(~ ~d t,t]~ of co,or~t~ omc~r) UCC I~ UNLAWFU~ FOLLO~.O INSPECTIONS:
/ WITHOUT CERTIFI( u.eo CO.C.E*E
STRAPPIN~ ELECTRICAL & CAULKING
E]ectfici~s License No. 3. I~TI~
Other Trade's License No. RETAIN ~ I UHM WATER RUNOF~' FIN~- CONSTRUCTION & E~CTRICAL
~ST ~ ~ F~ C.O
l. Location Dried on which proposed work wi~T T0 CHAPT~ 236 ~~ SHALL
//~ /- -- ~ 0/'iffE~hWN CODE. REOUIR[M/NTS Or *Hr
House Nmber S~eet ELECT~CA~m;oh OR %ONSTAGC hON-
Subdi~si0n ~TC~ go.c= o~-~ ; .~t
2. State existing use and occupancy of premises and intended use and °ceupancy °f pr°p°sed c°nstructi°n:
a. Existing use and occupancy _~
4. Estimated Cost
5.
b. Intended use and occupancy_~
......
Nat~e of work (check wMch applicable): New Building
Repair Removal Demolition _~~~
(To be prod
If dwelling, nmber of dwelling units Number of dwelling units on
If garag bet of ca
e, num rs
If business, commeruial or
Dimensions of existing structures, if any: Front p,'~
Height ,..2~ ' Number of Stories
Rear
Dimensions of same structure with alterations or additions: Front
Depth', ~D '
Rear
Depth Height
8. Dimefl~6fllt, Ol'~llir~ew construction: Front
Height:: ........ '~. iOV Number of Stories
Depth
Number of:Stories ,,i ~
Rear i , 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 3~ NO Will excess fill be removed from premises? YES ~q' NO
14. Names of Owner of premises / ~ __
Name of Architect
Name of Contractor r'~,:~ ~,.~ ~ z_,,r~.
Address / -Phone No.
Address _-o-~,~.-,> Phone No
Address ,'?o '~ ,, eore.~_~,.~ Phone
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO..-~
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. I~ 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 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
· IF YES, PROVIDE A COPY.
NO X
STATE OF NEW YORK)
SS:
COUNTY OF )
~r~r/,/'~__~5::g.2:~ ff']/..//~'6dq/ being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)ne is the
(Contractor, Agent, Corporate 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 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.
Sworn to bef~e'e~e this
(.. / / T~rm I~.X~iras ~a't 31. -~i~,~
~,~ TOwn of So.uthold
) Ere, sion, ~edimentation & S~orm-Water Run.~ff AS~SSMENT FORM
~A~ OF ~
FORM - 061t'~ / Notary Public, State of NewYo~
Qualified in Suffolk County
No. 01SC4725089~
Term Expires May 31,
Town I-Iall Annex
54375 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLr~
~PPLK~^T]ON FOR ELE~T~K~^L ~NSPE~T~ON
Name:
BY:
Name:
No.:
*Name:
*Address:
*Cross Street:
*Phone No.:
Permit No.:
Tax Map District:
JOBSITE INFORMATION: (*Indicates required information)
1000 Section: --~
*BRIEF DESCRIPTION Of WORK (Please Pdnt Clearly)
Block: '~ Lot:
~) -
(Please Circle NI That Apply)
*Is job ready for inspection:
,Do you need a Temp Certificate:
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100
*New Service: Re-connect Underground
Additional InfOrmation:
~)1 NO Rough In
YES / NO
150 200 300 350 400
Number of Meters Change of Service
PAYMENT DUE WITH APPLICATION
82-Request for I~on Form
DEC-I-E~4 11:87 FROM:PECONIC SURVEYORS~ P [G31) 76.5-1797 T0:12124938670 P. 1
. OS6.~
'GO t ~o
'%
~lOIf
FLOOD ZONES FROM F~tI~
MAP NO. 36103C0166 $
MA Y ~ 1998
SURVEY FOR
~ ~.~.~.~,~,. MORT/MER KELLY & KA THLEEN KELLY
AT BA YVIEW
TOWN OF SOUTHOLD
SUFFgLK.COU~TY, N. Y,
I00O 78 08 08
SCALE~ I"= 30'
NOV. 6~ 1987
P'E. CONIC .~URI~.YOR$ ,[ ENGtNEER$~ P.C.
P.O. BOX 909
POOL DIMENSIONS
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BO~D
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POOL PLAN
TYP. PANEL STIFFNER
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I ~PICAL WALL SECTION AT A F~ME CO-NER C~N"-CTIO ......
........... ,.._
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