HomeMy WebLinkAbout28120-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28641 Date: 07/31/02
THIS CERTIFIES that the building ACCESSORY
Location of Property: 6565 INDIAN NECK LA PECONIC
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 86 Block 6 Lot 25
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated FEBRUARY 25, 2002 pursuant to which
Building Permit No. 28120-Z dated FEBRUARY 28, 2002
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 INGROUND SWIMMING POOL WITH FENCE TO CODE AS APPLIED FOR.
The certificate is issued to MARK S LOWENHEIM & WALTER H CHADWICK
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 1049424 07/31/02
PLUMBERS CERTIFICATION DATED N/A
A�4horized Signature
Rev. 1/81
FORM NO . 3
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Hall
Southold, N.Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
PERMIT NO. 28120 Z Date FEBRUARY 28 , 2002
Permission is hereby granted to:
MARK S LOWENHEIM
PO BOX 123
PECONIC,NY 11958
for .
CONSTRUCTION OF AN IN-GROUND SWIMMING AS APPLIED FOR AND AS PER
DEC CONDITIONS
at premises located at 6565 INDIAN NECK LA PECONIC
County Tax Map No. 473889 Section 086 Block 0006 Lot No. 025
pursuant to application dated FEBRUARY 25, 2002 and approved by the
Building Inspector.
Fee $ 150 . 00
uthorized Signature
COPY
Rev. 2/19/98
Form No.6
a 18TOWN OF SOUTHOLD
L p c(�i l�
L
! j BUILDING DEPARTMENT ( e. 1
__._ _�_._____. _ _►
L TOWN HALL
QLD 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 I% lead.
5. Commercial 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.
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 a 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$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 Certificate of Occupancy-$25.00
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential $15.00,Commercial$15.00
Date. 771'7,402
New Construction: Old or Pre-existing Building: (check one)
Location of Property: [> c5 Ir�c1�-�n N[l�� L.G ,,t�o Pe C.Zn e, ;
House No. ` Street Hamlet
Owner or Owners of Property: 0C. PS
Suffolk County Tax Map No 1000, Section g Bock C-)(p Lot 25
Subdivision Filed Map. Lot:
Permit No. ZS(Z('—Z Date of Permit. 0Z_ Applicant: W0.�
Health Dept.Approval: MAA Underwriters Approval:
Planning Board Approval: �`A_
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
C�L)
�Q C, Ap icant Signature
D rJ�rJ�rJ�rJ��l�nrJ�rJ1 11lrJ��rrP�rE, lr�rJ�r nrJ�i�rJ�rJ�rJ�cn�nr�rJ�rJ��ncn�lr�rr�l�repC.l-�fC3ncn�r-�lrJErJRRnrJ�rJE_rL3r-cnrJ��l-rJMrJEyMj-MMMlMMgprr PLr-3 o
RE
5 BY THIS CERTIFICATE OF COMPLIANCE THE 5
5 NEW YORK BOARD OF FIRE UNDERWRITERS 5
5 5
BUREAU OF ELECTRICITY
55 40 FULTON STREET -- NEW YORK, NY 10038 C�
5 CERTIFIES THAT
5 Upon the application of upon premises owned by 5
5 5
5 5 SHORELINE ELECTRIC * CHADWICKP.O. BOX 114 6565 5
W SAYVILLE, NY 11796, PECON CINDIAN
1
NY 958 NE 5
7C7C7C5 CCC5
Located at 6565 INDIAN NECK LANE PECONIC, NY 11958
c7 Application Number: 1049424 Certificate Number: 1049424 S
5 5
..7C7C7C5 Section: Block: Lot: Building Permit: BDC: NS11 ..7C7C7C5
Described as a Residential occupancy,wherein the premises electrical system consisting of
5 electrical devices and wiring, described below, located in/on the premises at:
Outside,Pool/Spa,
5 5
55
CC was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below, was 5
found to be in compliance therewith on the 7th Day of May,2002. 5
5 Name OTY Rate Ratine Circuit Type 5
5 Appliances and Accessories 5
5
Pool/Spa Bonding 1 0 5
5 Time Clock/Switch 1 0 40 Amps 5
5 Wiring and Devices C
5 Receptacle 0 Gen-rr.1 Puipos. 5
5 Switch 1 0 General Purpose 5
5 GFCI Circuit Breaker 1 0 20 amp Pool/Spa 5
5 rj GFCI Circuit Breaker 1 0 15 amp Pool/Spa 5
Fixture 2 0 Incandescent 5
5 Receptacle 1 0 20 amp Pool/Spa
5 (Swimming Pool):This certificate covers compliance at the date of inspection only. Because of unusual environments it is advisable to have 5
5 frequent test and/or repairs made by a qualified person. 5
5 5
5 5
5 seal 5
5
5 1 of 1
5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated.
5 5
o ������������� a
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DEC PERMIT NUMBER EFFECTIVE DATE
1-4738-02081/00005 January 29, 2002
FACILITY/PROGRAM NUMBER(S) PERMIT EXPIRATION DATE(S)
Under the Environmental
Conservation Law January 31, 2007
TYPE OF PERMIT ■ New ❑ Renewal ❑ Modification ❑ Permit to Construct ❑ Permit to Operate
❑ Article 15, Title 5: Protection ❑ 6NYCRR 608: Water Quality ❑ Article 27, Title 7; 6NYCRR
of Waters Certification 360: Solid Waste Management
❑ Article 15, Title 15: Water ❑ Article 17, Titles 7, 8: SPDES ❑ Article 27, Title 9; 6NYCRR
Supply ❑ Article 19: Air Pollution 373: Hazardous Waste Management
❑ Article 15, Title 15: Water Control ❑ Article 34: Coastal Erosion
Transport Management
❑ Article 23, Title 27: Mined
❑ Article 15, Title 15: Long Land Reclamation ❑ Article 36: Floodplain
Island Wells Management
❑ Article 24: Freshwater Wetlands
❑ Article 15, Title 27: Wild, ❑ Articles 1, 3, 17, 19, 27, 37;
Scenic and Recreational Rivers ■ Article 25: Tidal Wetlands 6NYCRR 380: Radiation Control
PERMIT ISSUED TO TELEPHONE NUMBER
Walter Chadwick (631) 734-5067
ADDRESS OF PERMITTEE
P.O. Box 123 Peconic NY 11958
CONTACT PERSON FOR PERMITTED WORK TELEPHONE NUMBER
NAME AND ADDRESS OF PROJECT/FACILITY
Chadwick property, 6565 Indian Neck Lane
LOCATION OF PROJECT/FACILITY
Peconic
COUNTY TOWN WATERCOURSE NYTM COORDINATES
Suffolk Southold
DESCRIPTION OF AUTHORIZED ACTIVITY:
Install a 20'x 40'swimming pool and patio. All work must be done in accordance with the attached plans stamped NYSDEC approved.
By acceptance of this permit, the permittee agrees that the permit is contingent upon strict compliance with the
ECL, all applicable regulations, the General Conditions specified (see page 2 & 3) and any Special Conditions included as
part of this permit.
PERMIT ADMINISTRATOR: ADDRESS
Roger Evans (MEP) Bldg. #40 SUNY Stony Brook NY 11790-2356
AUTHORIZED SIGNATURE DATE
Page 1 of 4
JamAarx 29 2002
r
- ,n - 6 , 2,.rTOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET , ;^ GE DISTRICT SUB. LOT
DI'1P,t' -07
Ole
ORMER OWNER E ACREAGE
/n / rc/� LG y �. W ,. TYPE OF BUILDING
/
.S. 1 "216 SEAS. VL. FARM COMM. I IND. I CB. MISC. Est. Mkt. Value
LAND IMP. TOTAL DATE REMARKS
Of
73 0 0 �1- rt 041
700 76` -L I < - we5 F,6f. 4ip 44vm - Nc
ABOVE FRONTAGE ON WATER
Farm Acre. Value Per Acre Value F _______ - n /-4", a22 )
liable 1 r
/,0, _ c
liable 2
liable, 3
'oodland
vamplandc ���
-ushland s+ -
ouse Plot
Dtal
BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED: ..--? 4ZO701
.DATE SUBMTTTED;���/Ol
APPLICANT NAME:
SCTM# DISTRICT: 1,000 SECTION: BLOCK: LOT:42 �
STREET:_6�-G �wA„�,�/ /C�
�� CITY: SUBDN. NAME:
PROJECT DESCRIPTION:�ES�
ARCHITECT/ENGINEER: FAST TRACK?
SINGLE&SEPARATE CERTIFICATION-REQUIRED? NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before lune 30,1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1,
ZONING DISTRICT: -d!�FP CONFORMING?
REQ. LOT LOT SIZE:_ l ACT. LOT SIZE: REQ. LOT COV. ACT. LOT COV.
REQ• FRONT �o PROP. FRONT REQ.
SIDE m;yam ACT. SIDE
REQ. REAR_ .Ff' PROP. REAR
WATER FRONT? Y65 DESCRIPTION:
PANEL #: FLOOD ZONE: , „L�
AGENCY PERMITS REQUIRED FOR REVIEW
APPROVALS REQUIRED:
SUFFOLK COUNTY HEALTH DEPT: YES or NO, (BED #): DTE:_/ / PERMIT#:R10-
NEW YORK STATE DEC: PRE DEC 9/11-5 - ,
/11- or N
SOUTHOLD TOWN TRUSTEES: YES o O
TOWN ZONING BOARD APPROVAL: YES or
TOWN PLAN. BOARD APPROVAL: YES or
TOWN HISTORICAL PRE (SPLIA): YES o
NYS ENERGY: YES OR NO
EGRESS (18 H min.?4 sq total) VENT(SQ. FT. x 4%) LIGHT(SQ. FT. x 8%)
BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z-
HAVE PRE CO'S : Y OR N BP -Z/C/o Z_
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR : SF
SECOND FLR .-_SF INIT OTHER TOTAL
TOTAL: SF FEE FEE FEE
'OTC_SF)- ( _SF)= SF X$ _$ +$ +$ _$
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSUL N
[ ] FRAMING [ NAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE INSPECTOR {
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] 1 LATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNEY
REMARKS:
DATE '1/ INSPECTOR �/`j
owl ��-
765.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] IN ATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE A CHIMNE
REMARKS:
14
DATE 4-' INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
o�
FOUNDATION(1ST) y
G �
------------------------------------ 1�
rA
FOUNDATION(2ND) Ilks
z
0
rn
y
x
ROUGH FRAMING&
PLUMBING y
� x
r
INSULATION PER N.Y.
y
STATE ENERGY CODE
i oz
ii
FINAL `p
C�� r
ADDITION OMMENT
ro
0
z
m
k
�o
D
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y
x
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TOWN OF SOUTHOLD BUII.,DING PERMIT APPLICATION CHECKLIST
BUILDING*DEPARTMENT Do you have or need the following,before applying?
TOWN HALL
SOUTHOLD,NY 11971 x 3 sets�of Building Plans
TEL: 765-1802 �Survey)
PERMIT NO. 4�eck
b.N.Y.S.D.E.C.
? Trustees
Examined 20 Contact:
Approved —,20 Mail to:
Disapproved a/c
Phone: S -212 -311 -07()3
Ca3 I- 3S 71 (}-7 O
` C r� Building Inspector 3
111 i � FrPj 7 a,l
LICATION FOR BUILDING PERMIT
Date 20 OZ
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 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 a Certificate of Occupancy
is issued by the Building Inspector.
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.
(Sig Njire of applicant or if a corporation)
'PQ 12�o-)< 123 1`4 114
(Mailing address of applicant)
State whether applicant is owner, lessee,agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises e.
(as on the tax ro or latest deed)
If applicant is a corporation, signature of duly authorized officer
(Name and title of corporate officer)
Builders License No. L I G A* '71:7 , 1029 .:h L I G O O 2 Z2 'V
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
63c >6o f5 I r,d:cuv, L)e-e-1C LQW4 e, -Aee--on 'L
House Number Street Hamlet
County Tax Map No. 1000 Section___0 2(,o Block (- Lot
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy non 42.,
b. Intended use and occupancy ' I I
3. Nature of work (check which applicable): New Building Addition Alter tion
Repair Removal Demolition Other Work ne-4,i "po=
(Description)
4. Estimated Cost f30, 000•Oct Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars ,
6. If business, commercial or mixed occupancy, specify nature and extent of 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 Rear Depth
Height Number of Stories
9. Size of lot: Front s .5 70acee5 Rear Depth cA 4-a
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated rP.f�1 a I
12. Does proposed construction violate any zoning law, ordinance or regulation: no
13. Will lot be re-graded Q rte yjrj ` Will excess fill be removed from premises: YES
- i ck_
wwN
14. Names of Owner of premises Address OeACI-ane,Phone No. IA f 734 6o<o7
Name of ArchitectAddress eee+. Phone No
Name of Contractor Po,�A Sia✓e Address 5 ✓ Phone No. 1_63 157-97-Z- Z
h93Z
15. Is this property within 100 feet of a tidal wetland? *YES O4 S I+e-
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MA
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.
STATE OF NEW YORK)
SS:
COUNTY OF ,\ I/
G< 1 6y— l/�1 Y \(X[ lq %c� being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)He is the P
(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 before me this
day of <o V
1
Not Pu is Signature of Applic
BAR�A�51g�ytiw5
No>g►y Public,State of New lo
UuslNW n S�52
T
btbn Expires Sept 305
RICHMOND
Er 32 47" E
SET s� sem•
SE 59 N g0•,58
S 75• 66 66.69
,5897 2p•, E N4162 PPROX •
A S,.
s
O O
AE' ,?-9�� `-� jwo•
FLOOD ZO \ rn_ cs�
s '
CHIMNEY ,t m
1
5.6X21" ^17.5'_\ i
123.4'
rn
138 2 STY -TED
RES.
RES. (U.cj 74. ^�
o FIR ST F1 I
N EL. 9.03 \ I
27.6'
Qi
133
122.5' '133' 4
I P
BASEMENT (A
EL. 3.73
WETLANDS DEUTN.4 TION )
IVIIF (z
CPUICKSHANK 111.8' 12.2' Q O m
FR.
ARAC ' �V
21.3'
SET
CM
/
METAL
SH= V
•untrrr
$6" POLE O O
,
66.8' GARAGE Q i tK A�
to
I o A\ n
Guarcntndicated here on shall run j a
oily i rs 5 for uh:7,n the survey f� 0
is t Grd on his behalf to the r7
I
t C ceo+ ne tcI �o on \ I
n,, r and '
1�
g institution. 1 -1 SET C9
_t tri r_tle to ~ CW \ P
adds n i n r,1
or useruent owners
W Unauthcrized alteration or addition to thi:
survey i� a vic':aticn of `ietion 7209 of SET S�QOC \�<
the New York :hate Education Caw. CM
Conies cf this survey map net ', naring $ 1 Q
�p 11:a Lc,:nd Surveycrs embostad sea! shall SET 110.
CM 0" W
valid true 3� ¢
Z not be tx:rsi:iared to be a 79• .�
copy. S
ELEVATION BENCH OERI VED
49.99 O A D FROM E 326 (EL. 20. 118 )
R E 326 DESTROYED. ELEV. SOURCE
FROM SUFFOLK COUNTY DEPT
CM 3. 29. 30 W I A n NEO OF PUBLIC WORKS WA TER WA YS DI'
S7 SND I `�
SURVEY OF WETLANDS DELINIA TION
DESCRIBED PROPERTY
SITUATE 1. S 78' 16' 03" E 103.16'
2. N 83' 12' 04" E 34.70'
SURVEYED 7/28/98 PECONIC, J. S 89' 35' 55" E 41.75'
SCALE 1`=40' TOWN OF SOUTHOLD 4. S 40' 36' 25" E 55.25'
AREA= 111,952.47 SF 5. S 21' 10' 12" E 43.32'
SUFFOLK COUNTY, N. Y. 6. S 00' 35' 56" E 39.38'
2.570 ACRES 7 S 10' 32' 24" W 38.76'
8. S 11' 37' 46" W 58.25'
SURVEYED FOR MARK S. LOWENHEIM 9. S 74' 39' 4 W
s 15 31 .,3
rM 1000-086-06-25 AND 10. S a 4=' 1s" w 39.39'
11. S 31' 38' 03" E 64.74'
WALTER H. CHADWICK
GUARANTEED TO
NO TE- SURVEYED BY
MARK S. LOWENHEIM 4. ADD STRUCTURE UNDER CONSTRUCTION AND - STANLEY
NLEYBOX 294 AKSEN, JR.
WALTER M. CHADWICK ELEVATIONS A T & 6' OFF S T4UC TUR E , AND ADD NEW S(.'FFOLK NY 11956
F/pEL1TY NATONAL nRE 1NS. CO. ELEVATION 8 & FLOOD ZONE X 07 JAN. 2000. 51 -�5 ,V5
NOR 1H FORK BANK
TOWN OF SOUTHOLD J. REVISE 1st. FL. & ADC CONTOURS 01 FEB. 1999
2. ADD EL. 70 CONTOUR 27 O,-'T. 93 ICErJ.S L4,N �' I,L Y'J�
NYS Ni . 4� 3
1. LOC -7- V L-^h .S DELlr ;AT, , 45 S,,--
ySP, 7^^
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SWEET TITLE:
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