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HomeMy WebLinkAbout40604-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 Planning Board approval FAX: (631)765-9502 ' Survey / SoutholdTown.NorthFork.net PERMIT NO.E~ 0EI)C) Check Septic Form N.Y.S.D.E.C. Trustees 2���� � E, Flood Permit � C.O.Application µµ- Examined 20__ Single&Separate "`/ iii / ' I( A a,�( - 5 206 Storm-Water Assessment Form_. Contact: Approved 20 tt� .;r 1} Mail o:0Il Z3(ozv, � 13c.1eru.et�S ,", r+�'bra p !� `/ Disapproved a/c FWNOFS", 1� tnwea�l �r. Oi,,rle ./�1 �- / r Phone: i, 31 F1'1 16953 ii46G7 ti� O Expiration 20 8w // Building Insp -tor APPLICATION FOR BUILD 1 `" " r t+ Date f v, I '--1 ,20 / t INSTRUCTIONS ll 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 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 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. j ... (Signal e of appticdtii or name,if a corporation) lk3 Rcb'rlwoo, >r-, 81-ttrIey , NY 1/967 (Mailing address of applicalit) State whether applicant is owner,lessee,agent,architect,engineer,general contractor,electrician,plumber or builder sw °, fic Po c\ co„4-c�c-A- Name of owner of premises (To L or C.r r r a r , ,N 0 - 1 Cl C L C— (As on -te tax roll or latest deed) If applicant is a corporation,signature of duly authorized officer (Name and title of corporate officer) Builders License No. ,S (,'7 al© - N Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: 74-1 5 k I n o Si- (;7 r .r. at {-- House Number Street Hamlet County Tax Map No. 1000 Section Coc2 Block I Lot 3a, .. 1 Subdivision Filed Map No, Lot 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy ‘45 is.VG S ,„.., ,..- 3. Nature of work(check which applicable):New Building Addition Alteration Repair Removal Demolition Other orlc__E„,,41,...7,4 "0„:„„/ Ev tF,-li ) 9 ro (Description) 4. Estimated Cost 620, 00o (IV.- paid on filing this application) 5. If dwelling,number of dwelling units -- Nt.', R4-r dftiAlAng units on each floor If garage, number of cars ,,___ 6. If business,commercial or mixed occupancy,spe a r 4,t,, ,, c t-YAcilm Af each type of use. .._ 7. Dimensions of existing structures,if any:Front Rear Depth Height Number of Stories Dimensions of same structure with alterations or additions: Front Rear ' Depth Height Number of Stories ,-- . , . 8. Dimensions of entire new construction:Front ,ir Rear ,(3, Depth S 1 Height , Number of Stories 9. Size of lot: Front Rear 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 w-".-- 13. Will lot be re-graded?YES t./(NO Will exces fill be removed from premises?YES Ir NO 14.Names of Owner of premises Address Phone No Name of Architect Address Phone No Name of Contractor'lc,A T.,..I -4'. 0.-,,-'3 Address 18/, rz.,,I. '---i's'- Phone No. (. 3 i 7 7,- k)-,)-7 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO i/- * 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 4./- * 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 NO t7 * IF YES,PROVIDE A COPY. STATE OF NEW YORK) f.,.. SS: COUNTY OF WV being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contr t)above named, ,f )He is the C s 94-4.4-vio sr_ (Contractor,Agent,C.... - • , _ _, GREGG X MARSDEN 1 of said owner or owners,and is duly authorized to perform or have performed the said ''' -1101434ar iVfMsr*application, eg. that all statements contained in this application are true to the best of his knowledge and bAlOW igijA ° \ii,grki 11 be u. performed in the manner set forth in the application filed therewith. My Commission Expires June 22, Z.0 1,7 Sworn to before me this , f 1 61( day of j''''c r I 1 20 C _ __ — 411111111111WV Public " Sig of of Applica ,1,1'cs„-,-A-0--Q/r- , Scott A. Russell ,(s, c.,-,,,---,. a,'1-' STORMWAir ER fz, , - , (---,) ,,-t.., SUPERVISOR h-77;3 / --,,—, ) '---A, ' M[ANAGEMENT IJ. rn I L—lr' :::' , SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 „-4,-, •.1-, -,:-..11...% ,-..r.• ..” Town of Southold Ill't ) ), ' , ,r, 0 C A 'TER 236 - STO ' ATER A AGEMENT WO ' SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES T! IIS 113'''OJECT INVOL ' Y OF E FOLLOWING: (CHECK ALL THAT APPLY) Yes No El ErA. Clearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. O ErB. Excavation or filling involving more than 200 cubic yards of material within any parcel or any contiguous area. 0 cfc. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. 11111EreD. Site preparation within 100 feet of wetlands, beach, bluff or coastal erosion hazard area. El E. Site preparation within the one-hundred-year floodplain as depicted on- FIRM Map -of any wateicourse. „ 0Dir 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, —1 Signature, Contact Information, Date & County Tax Map Number! Chapter 236 does not apply to your project. If You answered YES to one or more of the above, please submit Two copies of a Stormwater Management Control Plan and a completed Check List Form to the Building Department with your Building Permit Application. - SCTM10 00 _ APPLICANT: (Pi: -- , . - . , • t.Contractor,Oh ' . . . —District - Section Block Lot (7k) _.--- 91 Drv, ku) \p r\n 11,,4 Contact Information: 60'-._/ 7 7- cs"..2. X- 7 Reviewed By: Date --r- ,--, Prop_e.rty Address / Location of Coil5ti-tic_kicii 'Work Approved for processing Building Permit. -7 L15 /r/ .,),_ ,(S ,_.1- EE Stormwater Management Control Plan Not Required ( 4, 1 71— Ai y //9 5 7 StormtNatvr Management COVWRA P Rtroturert 41 orwaid to Engvneei ng Deparkimt-ot for ReV/e/v/ rOPIM 't c)MCP - '11-0S MA Y 2014 A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/04/2016 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 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). PRODUCER....._ CONTACT NAME: BRAZIER AGENCY PHONE o,m3631-281-1700 Ari x .:631-281-0160 WEAi 1490 MONTAUK HY :63RAZ ERTO "q AOL.COM ADDRESS OR CITY, STATE ZIP ( )AFFORDING COVERAGE NAIC ri INSURERS .........................�..�...........-_.- MASTIC, NY 11950 INSURER A:KELLER ...,.. ...__,...�.mm,_ INSURERB:NATIONAL... .... ..�........ ... .... ..e......,.�,., INSURED GRANGE MUTUAL INS CO ALL ISLAND WATERWORKS INSURER C: 183 ROBINWOOD DRIVE INSURERD: SHIRLEY, NY 11967 INSURER E: 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 POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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. (M POLEFF ICY (MM/DD/YY ...�..... LTR TYPE OF INSURANCE POLICX NUMBER D/XI>'XPY) LIMITS A X COMMERCIAL GENERAL LIABILITY SCP1009953 08/08/2015 08/08/2016 EACH OCCURRENCE $ 500,000 CLAIMS-MADE X t OCCUR (=RMI E (Ea aence) $ 100,000 MED EXP(Anemone person) $ 1,000 PERSONAL 8 ADV INJURY $ 500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1,000,000 XpI POLICY j y LOC PRODUCTS-COMP/OP AGG $ 1.000 000 OTHER: $ ( �EE SINCI.1n.4.IM i I AUTOMOBILE LIABILITY COMBI ......... (Ea acaideaM $ ANY AUTO person)BODILY $ ALL AUTOS OWNED SCHEDULED BODILY INJURY(Per............. AUTOS ccident) $ NON-OWNED PROPERTY DAMAGE I HIRED AUTOS AUTOS (Pm- UMBRELLA LIAB Pm-UMBRELLALIABI EACH OCCURRENCE $ EXCESS UAB OCCUR- AGGREGATE $ .,.,.�.... CLAIMS MADEr__. ..,...,.. ..,.n,,,_. DED RETENTION$ $ WORKERS COMPENSATION { PEPERTUTE ETH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ If yes,describe under .... ..... DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) SWIMMING POOL INSTALLATION SERVICING OR REPAIR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF SOUTHOLD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 53095 ROUTE 25 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. BOX 1179 AUTHORIZED REPRESENTATIVE SOUTHOLD, NEW YORK 11971 7�ZonC-o ©1988-2014 ACORD CORPORATION. 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IG Z ° tt ikf'TIJ/14, � phr4 �'� ,,,d""�, I. ��4J � o SED NUMBER r, 60'-0" _ _ 4.1 1 . i _ . __ _ _ _ _ _ _ , __ ._ _ _ _ . , ,,_ _ u . _ ____,,,,______ ____ _____ _ . 1 1 12"x2"BLUE . i STONE COPING, , _ TYPICAL FOR PERIMETER RETURNS DRAWN BY PM 1 DME. 04 04 16 SCALE: AS NOTED Ac'le=3:00 \ REVISED:- REVISED.- REl1SED.- (2)MAIN DRAINS 1 REVISED,- /11/g*'"'''--- REVISED-- ��0 REVISED I � O REVISED.- 3a C FIE NAYS _ �7 c 0R6-/- o \ 0 Z O LIGHT 1— FIXTURES W o fYO z t _ t� Oc.- z D- J 0 2 1-0 Z SKIMMERS z N. (c_ PROPOSED INGROUND POOL PLAN _ _ SCALE: 3/16 1'-0" - LIJ0 r \ --- _ . — -�_ ...7Z.-. SEE DETAIL 1 Il SHEET A-101 SHALLOW END BASIC GRID#3 BARS ih 6 FEET MIN. @ 12"O.C.EACH WAY - / ."M I/ \ - ADDITIONAL#3 BARS o DEEP - .L.. U12"O.C.AT TRANSITIONS ADD BARS 24"UP FROM FLOOR zo END Ir -1b:::-...-7-1 �� ARCHITECT MAX SLOPE ADDITIONAL#3 BARS 1.7 12"O.0 AT TRANSITIONS MICHAEL J.GUIDO Jr. ARCHITECT P C 20 POLK STREET ROCKY POINT,NY 11778 TYPICAL 10"THICK SHOTCRETE (631)849-5852 (GUNITE)W/#3 BARS @ 12"O.C. S'--0" (631)849-5854 ima EACH DIRECTION - 5' O" POOL BOTTOM ESTIMATED 6 FEET ABOVE GROUND WATER. IF - i------ -- DISCOVERED OTHERWISE NOTIFY THE EACH DRAIN PIPE SHALL NOT ENCROACH 00 AR ARCHITECT IMMEDIATELY INTO GUNITE SHELL 'o� J.aU ' "A - IN HIGH WATER TABLE,INSTALL �� • �� HYDROSTATIC VALVE AND ROCK CIRCULATION PIPES,PROVIDE(2) i. 14) PACK AT LOW POINT ANTI-VORTEXT CIRCULATIONS DRAINS PER �/O :i), . ��` PUMP.COVERED WITH APPROVED A.SM.E. - ` +,r� } ANTI-ENTRAPMENT GRATES THAT ARE �) 4 ��j% ,`T h'� ' HYDRAULICALLY BALANCED AND �,, +' SYMMETRICALLY PLUMBED THROUGH'T' .. FITTINGS.DRAINS SHALL BE SEPARATED BY ^ '<,_ Q� POOL I THREE FEET IN ANY DIRECTION 95` y� PROPOSED INGROUND POOL SECTION SOF N A-100 SCALE: 3/16"= 1'-0" SED NUMBER 4 4" GENERAL NOTES: �� a • - • #3 BARS CONT. DRAM 9M PM 1. ALL CONCRETE DESIGN AND PLACEMENT SHALL COMPLY WITH LATEST EDITION OF THE ACI BUILDING CODE - ons[ 0404.16 Q SCALE. AC MOM) REQUIREMENTS FOR REINFORCED CONCRETE AND OTHER APPLICABLE LOCAL CODE fn • 4000 PSI GUNITE 2. PLACEMENT OF CONCRETE SHOTCRETE,GUNITE...EXPOSED TO FREEZE/THAW CYCLES SHOULD ADHERE TO ACI a REVISED.- , GUIDELINES AS SPECIFIED _ REV �- • � 3. CONCRETE,SHOTCRETE,GUNITE COMPOSITION MUST ADHERE TO ACI 318-08 GUIDELINES AS WELL AS LOCAL a a a +�- - CODES,MINUMUM COMPRESSIVE SIRENGTH SHALL BE 4,000ps1 `t 11 Fensem- "L"SED. 4. REINFORCEMENT SHALL BE DEFORMED INTERMEDIATE GRADE BILLET STEEL CONFROMING TO ASTM A-615 GRADE 60 4 uwe - 5. FOLLOW'ACI RULES AS TO TIES,ACHORAGE,SPLICES,CONCRETE COVERAGE AND REINFORCED SUPPORTS - • a 6. REINFORCEMENT MARKED AS CONTINUOUS(CONT)SHALL BE LAPPED 36 BAR DIAMETERS AT SPLICES AND P. # 3 BARS 12"O.C. u CORNERS AND HOOKED AT NON-CONTINOUS ENDS OR EXTEND 36 BAR DIA.UNLESS OTHERWISE NOTED EACH WAY OD 0 7 SWIMMING POOL ELEVATION IS ESTIMATED TO BE APPROXIMATELY 6'FEET ABOVE GROUND WATER.IF CONDITIONS DIFFER NOTIFY THE ARCHITECT IMMEDIATELY - a A • 8. SOIL CONDITIONS ARE ASSUMED TO BE ADEQUATE WITH A MINIMUM BEARING CAPACITY OF 1.5 TONS PER SF. IF IL j CONDITIONS DIFFER NOTIFY THE ARCHITECT IMMEDIATELY LU - F- O d - THE INTENT OF THIS DRAWING IS TO SHOW THE GUNITE POOL AND REINFORCING. 0O 0 10" 0 0 - ADDITIONAL REQUIREMENTS BUT NOT LIMITED TO,AND OUTSIDE THE SCOPE OF THIS DRAWING 4 - Ut z z } Z o • ANY AND ALL ELECTRICAL WORK MUST BE PERFORMED BY A NYS LICENSED ELECTRICIAN IN ACCORDANCE WITH APPLICABLE CODE Se,Iz iii • SWIMMING POOL MUST BE PROPERLY WIRED,BONDED,GROUNDED BY NYS LICENSED ELECTRICAN . ' z • ALL BARRIERS,FENCING,ENCLOSURES MUST FOLLOW LOCAL BUILDING CODE,SAFETY AND CONSTRUCTION CODE 1 DETAIL I - SCALE: 1"= 1'-0" a - 0 - BENCH AND STEP OPTIONS: \ •/,. ,. ' - --:, ,„7.._,, t____....„.„ 1. UNDISTURBED EARTH MAY BE LEFT IN PLACE TO FORM THE STEPS OR BENCHES REINFORCED STEEL SHOULD BE ARCHITECT PLACED AROUND THE STEP OR BENCH SHAPED EARTH(3"CLEAR FROM EARTH) 2. THE EARTH MAY BE REMOVED AND BENCHES AND STEPS MAY BE FORMED OF SHOTCRETE(GUNITE)WITHIN THE MICHAEL J.GUIDO Jr. STRUCTURAL POOL SHELL.REINFORCED AT THE SURFACE OF THE BENCHES AND STEPS ARCHITECT P C 20 POLK STREET - ROCKY POINT,NY 11778 (631)849-5852 (631)849-5854 fax - - ���ED AA�.�i < J.GU/0• A 40 iv {, •v ��4 . . , fr .Dx. ;--,s,. 41111 1 r POOL A-101