Loading...
HomeMy WebLinkAbout40598-Z TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALL Board of Health SOUTHOLD,NY 11971 4 sets of Building Plans TEL:(631)765-1802 f f Planning Board approval FAX:(631)765.9502 1� Su cy SoutholdTown.NorthFork.net PERMIT NO. I Check Septic Foran N.Y.S.D.E.C. Trustees_ C.O.Application Flood Permit Examined _ w _..a,20 Single&Seepumtc Storm-Water Assessment Form Contact: , /I•� ApprvVed_ _m ... ,20 _ Mail to: V Disapproved a/c Phone• "� � 3 Esga� teon. ........ 20 g Building Inspector D � APPLICATION FOR BUILDING PERMIT �� APR — 1 2016 9 INSTRUCTIONS Oat �� � � 201& a This application MUST be completely filled m by typewriter or in ink and submitted to the Building Inspector with 4 lot plan to scale.Fee according to schedule. TOVA location of lot and of buildings on premises,relationship to adjoining premises or public streets or t s. 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. (Signatureof applicant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder Name of owner of premises Ae 4 w Y - k (As 6n the tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Locci��}}'o�gqol"land n which prc sed wor willbedone: 113 CJ � , 1�-ir.�rt �r/ �G�S� /% i2�®/✓ House Number Street Hamlet County Tax Map No. 1000 Section lllo..&: Oc L01 `J �,W 3 Subdivision 1'flffl Map No.______ Lot 2. State existing tm-and occupancy of M. mfises and intended use and occupancy of proposed construction. a. Existing use mid occupancy b. bacaided use,andoccupancv­................ 3. Nature of work(che&which appficable):New Building Addition Alteration Repair Removal Dernolition Other Work:37- Lf/hylk/1"A14L ....................................................................... i (Des6ipdon) 4. Estimated Fee (To he paid on.filing this application) 5.. If dwelling.,number of dweftg unils__Number,ofdwellfiing units on each.fp oor If garage,number of cars 6. If business,commercial or mixed occupancy,speciffy riaLure and extent of each type of Lise. 7. Dimensions of existing structures,if any:Front R= Depth Height Number of 8-11odes ........... - Dimensions of same structure with afterations or addifions- 14 iront URear.................................. Depth .................... 11 Ileight................................................................................. Number of Stories 8- Dimensions of entire new construction:Front Depth U--Ieight Number of Stories 9. Size of lot:Front....__—Read .—Depth 10.Date of Purchase —Name off: ormer Owner 11.Zone or we district inwbich premises ane spit ed. 12.Does proposed construction vialate gray law,ordinance or regulation?YES.........—NO........................... 11 Will lot be to graded?YES—NO Will excess fill.be removed.fturn premises?Y`ES NO_ 14.Names of Owner o.f premises Address Phone No. Name of Architect Address................ IPdaeane No - --------- Name of Contractor Address ................—Phone No. 15 a.Is this property within 100 feet of a tidal wedand or a.freshwater wetland?*YES NO IF YES,SOLMIOLDTOWN TRUSTEE.S&DX C.PERNUTSMAY B..R-EQW.11:M. b..Is this property within M)feet of an tidal weflan&*YFS_NO IF YES,D E.0 �."ERMTS MAYBE REQPM.D. 1.6.Provide survey,to scale,wilb.wvurate famidatlean plan and.distances to projxrty fines. IT If elevation at any point on property is at 1.0 feet or below,must prov.ide topographical data on survey, 18.Are there any covenants and restrictions widi respect to this property?*YES_NO— *IF YES,PROVME A COPY, STATI',QFNEM YC&K� SS a. COLNTY OF,�� being diily sworn,deposes and says that(s)hv is the,41R-AGEY L DWYER YORK VL k NOIARY PUBM�STATE OU::- M..'W IMO�01M6306900 (S)He is dw QLLLA FIED IN SUFFOLK COUNTY Agm I,rofporale 0'ffimr'etc.) C01MIMBS110N EXP111131ES JUNE 30,2L"S of swd owner or owners,and is My authorized to perfonn orliave perfiormed the sound w4kand to make and file this application; that all stateanents cerin taiwd in this application.are trw to the best of his knowledge and belief,and flea the work will be perfonued m the manner set foidi in the application filed therewith. Swore to be-fore®e this .............. x­ ace '/n" Notary Pubc Sign.dum of.Af.qi1icant „' / /ilii ���////j';iU��j,,////iii /ii f%%%/��%///%%///�r �// r � r �///�r , „ 2 /����i��/iiia ��iiiiii��'�i////% rrr r „ ,,,rii�ii71 � r /;;; ����� /ilii ri;,,...�,,,; / %/,/////%///////%%� r ������>i�� o � r ii//%%%%%/� ,,,,,,,,,,,o��i /iii// ,,,,;;;; /i r iu�,III ''C: J k � rri r/////////� ,,,,,,,,,,,,,,,,,€€� � /,,,, / ,,,,,.�/////// / I I I r � I ��� ��a a% �j� //%�„/,;;;;;���� ,i r%%%%�i0i�/ III f � e C / i %%%�/ ��„ ,r,,� ,,ff .r � / ///%/////�// ;iiiiiii//iii ,/ % / Jif%////r//li „�, � / / / 1 „�//� �%%%/ �'l,� � �/�. I it � / /� j riiiiiiiiiiioiiii %!,/ �r�/lir/,�i �� i / J ,� r � %, i� � ///// /�// /i/ / r, r ., �, ����� � i ,iY i ' >� '�� �� i �i ����IIII S �� � � �' I ISI��u 6�ldl ,��� r i / / /r / � r r r � / J /i rv/ � � � / ����. vJ ��� �// ,,, ,/ �, i/��r' , �,�;r %� � � � % ��� � % � �, / o i� �� rl� � � � fii�� ,� ��/, �� �i� �o ,j � � % � � , �i ' �� � /ill � o� � ///% �, ,/ f , / � � /� �� �.� �� f � ���. f, ,/, � , t ��� ;; g 'i%, ��� D O Itiup,� ��l�r /,,�f �„ / �, / i/ „'%%/ / � . �/��,r j/ , � %;, ,,�; �i f% �� i/;/r, ;�;,� �i,,„� r r r i ;% /ij r ////� r/ � . y.. / /�� %� � /� � /r% / // %/�� i ���1 � ��� ���� rr jJ/� l� ,, , , , , ,, %���, a/,:� , r/,�f f �,;�;, ���� r,/ . °�r� ,, � �� / � ,� r„r�; 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 ^^^^^ 203592246 FLANDERS RENOVATIONS INC 286 FLANDERS BOULEVARD FLANDERS NY 11901 POLICYHOLDER CERTIFICATE HOLDER FLANDERS RENOVATIONS INC TOWN OF SOUTHOLD 286 FLANDERS BOULEVARD 53095 ROUTE 25 FLANDERS NY 11901 SOUTHOLD NY 11971 POLICY NUMBER CERTIFICATE NUMBER PERIOD COVERED BY THIS CERTIFICATE DATE 12172435-6 337493 11/25/2015 TO 11/25/2016 3/31/2016 THIS IS TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE FUND UNDER POLICY NO.2172 435-6 UNTIL 11/25/2016, 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 11/25/2016 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 NOT ASSUME ANY LIABILITY IN THE EVENT OF FAILURE TO GIVE SUCH NOTICE. THIS POLICY DOES NOT COVER CLAIMS OR SUITS THAT ARISE FROM BODILY INJURY SUFFERED BY THE OFFICERS OF THE INSURED CORPORATION. KRZYSZTOF ZEBROWSKI, PRESIDENT OF FLANDERS RENOVATIONS INC ONE PERSON CORP THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICY. NEW YORK STATE INSURANCE FUNC DIRECTOR,INSURANCE FUND UNDERWRITING This certificate can be validated on our web site at https:/twww.nysif_com/cert/certval.asp or by calling(888)875-5790 VALIDATION NUMBER:92971131 a [:fDATEMMDY) CERTIFICATE OF LIABILITY INSURANCE 31/2016 THIS CERTIFICATE IS ISSUED ASA 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 PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder 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). CONT,A,"'q PRODUCER N�AME� Leslie Connoll .... ........... FAX Shore Line Insurance en Inc. P"IQ gra. 1,10 (631)744-4243 8 Broadway A KESS ........ INSURER(S)AFFORDING COVERAGE NAIL# _oPoint NY 11778 _ First Insurance15326 INSURED ..�..._............m..,�.,. ��.........IT.IT.. INSURERA. INSURER B Flanders Renovations Inc INSURER c: 286 Flanders Blvd. I.......... ..-. . ................................-..�..- NSURER D... ....ENSURER E:. Flanders Y 11901 INSURER F. _. _............ COVERAGES CERTIFICATE NUMB REVISION NUMBER: THIS IS TO CER-ITFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE Y 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. . .TYPE OF INSU NCE _ .... POLICY NUMBER W .(... . E—Y ..... .. 1 NSR AI:,71."'L�aWVD POLICY EFF POLICY EXP LIMITS 4�.TR MMeDD. MM/DD RAL LIABILITY EACH 000000 X COMMERCIAL LAIMS-CLAIMS-MADE OCCUR DAMAGE R NTE $ 50000 DAMAGE TO RENTEtr 1 MED EXP(Any one person) $ 5000 ART136569407 11/17/2015 11/17/2016 PERSONAL&ADV INJURY $ 1000000 GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 ................ _—"I POLICY F—]PRO-JECT .,iE]LOC PRODUCTS-COMP/OPAGG $ 2000000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ E r iwgial BODILY INJURY(Per person) $ ANY AUTO .............. ....,.,.,� ALL OWNED SCHEDULED BODILY INJURY(Pee t) $ AUTOS AUTOS HIRED AUTOS AUTOS NO"WNEDROPERIAf�NAGE - $ $ UMBRELLA LIAR CUR .EACH OCCURRENCE EXCESS LIAB _�..CLAIM E AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER STA EFt AND EMPLOYERS'L IAB ILITY YN!A �....�..� �.�... Y PROPRIETO THE ECUTIVE E L EACH ACCIDE $ OFFICE EMBER EXCLUDED? .... (Mandatory in NH) E.L DISSE- EWMW W WPW WLW WWOMYWW EN $.. . If yes,dearnbL under DESCRIPTION OF OPERATIONS belE.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is added as additional insured as required by written contract. CERTIFICATE HOLDER CANCELLATION Town of Southold SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 53095 Route 25 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I ACCORDANCE WTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Southold MY 1,1,971, a a;l;:(I : 'I r ©1988-2014 ACORD CORPORATION. All rights reserved.. ACORD 2 (2014/01) The ACORD name and logo are registered marks of ACORD Gott sell ' ST�O IKIMI SVA\7C'1E�� SUPERVISOR hAAC A\G IEMIEN SOUTHOLDTOWN HALL-P.0.Box 1179T�tiVn fiJ�u�ILQL �(�] 53095 Main Road-SOUTHOLD,NEW YORK 11971 . J CHAPTER 236 - STORMWATER MANAGEMENT WOE SHEET ( TO BE COMPLETED BY THE APPLICANT ) �. __ �.. DOES 'THIS PROJECT INVOLVE ANY OF THE FOLLOWING: (CHECK ALL THAT APPLY �j A. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. B. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. D. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. E. Site preparation within the one-hundred-year f loodplain as depicted on FIRM Map of any watercourse. F. Installation of new or resurfaced impervious surfaces of 1,000 square feet or more, unless prior approval of a Stormwater Management Control Plan was received by the Town and the proposal includes in-kind replacement of impervious surfaces. If you answered NO to all of the questions above, STOP! Complete the Applicant section below with your Name, Signature, Contact Information, Date & County Tax Map Number" Chapter 236 does not apply to your project. If you answered YES to on dicopies ater catiotlement Central Plan and a completed Check List Form to the Buildinging rt .e mit yot Buildig Permit a Stormwater Manan. _ _ e. iPro m Owner, S.C.T.M. 1000 Date APPLICANT: pe _ign Profe_conal.Agent.Contractor,Other) D trict XA�1E; Section Block Lot FOR BUILDING DEPARTMENT ONLY USE 01L� Contact Information: Reviewed By: Date: � ,� Property Address / Location of "cel s° rust ion Work: ff�Sltormwater '- """" — -- — — -� �- ppro�ed for processing Building Permit. d Management Control Plan Not Required. ...... — � mwatr Management�Control Plan is Required. eq uureed. El Forto Engineering Department for Review.) FORM # SMCP-TOS M< me.... MAY 2014 Young & Young 400 Ostrander Avenue, Riverhead, New York f t 30 t \ 631-727-2303 ". Howard W. Young, Land Surveyor Thomas C. Folper€, :profes"o-Aal Engineer R�� < di&nald B. PfuhGTLsndseape Ar"hitecf ADoug[os E. Adams, Profeass€�'al Engineer es fy a W E AREA- 41,542 50.FT. 0\ • SUBDIVISION MAP-"SUMMIT ESTATES,SECTION 2"FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON MAY 21,2002 A5 fill sx FILE NO.I0T66. 6 �4 Fz 3 C F a � � '� < SURVEYOR'S CERTIFICATION Cid" a €" t�` • WE HEREBY CERTIFY TO CHRISTOPHER CAPOBIANGD, _ i„Qt Iq � <9 - NEIL CAPOSIANCO & FIRST AMERICAN TITLE I N S U RAN C E G D M PANY THAT TH15 SURVEY WAS PREPARED pig atrO\- .'. o110 IN ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND S§S _ y� �J, SURVEYS ADOPTED BY THE NEW YORK STATE e 6 .,+ PROFE55IONAL LAND SURVEYORS. a� Y N. ` fJ H a� Q� ax ' rY t- nom. 2��.PRr - HOWARD W.YOUNG,N.Y.5.L.S.NO.45693Qg LA HoUm Z � o „ + r� � 6t fV o SURVEY FOR 04RISTOPHIM GAPOSI IL GAPOSI LOT III "SUMMIT E5TATES, SECTION 2” _- At East Marfan, Town of Southold CIO .00' Suffolk County,New York R=1 0 1, County Tax Map orstrke 1000 Sacaon 35 sic Oai poi 10.5 O 1� (A1.5CNOyNN s� o t r FINAL SLRvrzy %'0 AENTS A B 24' FINAL 5LlRYEY DEC,.24,2005 ,E WATER MAIN- -°'°per G.P.1 22' 44' FOUNDATION LOCATION A716.24,2005 e�$ e '' ----------- SURVEY MAP COMPLETED JAN.13,2005 - - C.P.2 84' 49' FIELDSURVIE'r COMPLETED JAN.15,2005 e SCALE: I200 �J 1' JOB NO. 005-OOII logo er®•,nonMNr ranro A•sr�xe xr ♦•nrAKe ram w.wor ovoe s.sxwr c c�NrEr DWG.200'3_001 t_fe p LEGEND: PLAN ELEVATION SECTION LED LIGHT co) 511-611 CIRCULATION RETURN 0 41-011 431-611 41-011 PLAN SECTION 9" SQUARE OUTLET COVER TYPICAL AUTO F I LL <r Notes : ............................................ ........... . ..... ----------- . ... ....... 5-1011 101 -oil I-011 I - 51-011 Y-011 10 51-01 il 40 -o 11 3011 -----------------7-1 \—TYPICAL CIRCULATION RETUTN DEEP END (WATER DEPTH:T-9") AUTOMATIC COVER li 9"X9" FRAME GRATE MAIN-----<�� SWIMMING POOL DRAIN , T'D TOGETHER IN (800sqft) ACCORDANCE WITH VGB ACT 4 rn SHALLOW END (WATER DEPTH:3'-3") 71-011 15 -011 131-011 250W INCANDESCENT 18"R SWIMOUT 00 POOL LIGHT O TYPICAL SKIMMER TYPICAL SKIMMER 2" THK. STONE COPING 41-011 111-911 41-011 ON MUD BASE Y2" EXPANSION JOINT, W/ 6"H FROST FREE xx 6F N. 1-911 41 15 X 151-911 BACKEROD AND SEALANT WATERLINE TILE WATERLINE CENTER OF TILE STONE PATIO (743sqft) V it 00 If IN POOL WALLS WITH WATER - DEPTH OF 5' 0" OR LESS 4" MIN. SAND BASE, WHEN NECESSARY TO AID REBAR SHALL BE PLACED HORIZONTALLY AND DRAINING IN SLOW DRAINING SOIL t VERTICALLY @12"O.C. 201-011 SWIMMING POOL WALLS, BOND BEAMS, AND FLOORS Y2 THK. POOL FINISH SHALL BE STEEL REINFORCED GUNITE. GUNITE SHALL 7". BE MINIMUM 4,000 P.S.I. @28 DAYS. STEEL RE BAR zz '4 SWIMMING POOL AND PATIO LAYOUT SHALL CONFRIM TOAST, A615 STANDARD GRADE 7" THK. GUNITE POOL SCALE: Y V-101" r. Ei: ;V { ."Y . .; SHELL REV: DESCRIPTION: BY: DATE: IN POOL WALLS WITH A WATER DEPTH GRATER THAN DESIGNER: Y-O", ADDITIONAL VERTICAL BARS SHALL BE PLACED VERTICALLY FOR A SPACING OF 6" O.C. AND EXTEND BANDERA FROM TOP OF WALL AND BENT INTO THE BOTTOM OF FLOOR EXTENDING 24" HORIZONTALLY. P 0 0 L Phone: (6 6) 400-3850 Website: www.Banderapool.com VERTICAL BARS 12" O.C. SHALL BE BENT IN BOND Email: Info@Banderapool.com FLOOR REINFORCING SHALL BEAM AS SHOWN. ZL CONSIST OF RE-BAR CAGE PROJECT: SPACED @ 121, O.C. It CAP ODIA NCCS _ ! Ht RESIDENCE CRUSHED STONE, WHEN NECESSARY TO DRAINAGE IF T T7k GROUND WATER IS ENCOUNTERED IN SLOW DRAINING SOIL A j EAST MARION, NY TITLE: t -r77,'l 4.4 SWIMMING POOL 4 LAYOUT TYPICAL WALL SECTION SCALE AT AO: DATE: N: CHECKED: 2 SCALE: 1'-0" AS NOTED 4-04-16 VG VG PROJECT NO: SHEET NO: 1600A P 2