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� Su�Fot,�cdG Town of Southold 9/21/2016 P.O.Box 1179 a 53095 Main Rd �4, Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 38523 Date: 9/21/2016 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1100 Hyatt Rd, Southold SCTM#: 473889 Sec/Block/Lot: 50.4-10 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 10/16/2015 pursuant to which Building Permit No. 40212 dated 10/26/2015 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 The certificate is issued to Kemeny,Mary Margaret of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40212 01-14-2016 PLUMBERS CERTIFICATION DATED t Autho rda Signature �saF�� TOWN OF SOUTHOLD cO�y BUILDING DEPARTMENT C* TOWN CLERK'S OFFICE oy • SOUTHOLD, NY dol � Sao . 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#: 40212 Date: 10/26/2015 Permission is hereby granted to: Kemeny, Mary Margaret 36 Perry St New York, NY 10014 To: construct an in-ground swimming g pool as applied for. At premises located at: 1100 Hyatt Rd, Southold SCTM # 473889 Sec/Block/Lot# 50.-1-10 Pursuant to application dated 10/16/2015 and approved by the Building Inspector. To expire on 4/26/2017. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 (2,Total: $300.00 B ildin spector 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 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 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 Date. 10 " 1 New Construction: Old or Pre-existing Building: (check one) Location of Property: 1 l DO �A4-, n_+ d House No. (� Street/ Hamlet Owner or Owners of Property: V "cv&� Suffolk County Tax Map No 1000, Section 'so Block Lot Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept.Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ S� . Apply ant ignature *pF SO!/r�®l Town Hall Annex ® Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 o aQ roger.riche rt(aD-town.southold.ny.us Southold,NY 11971-0959 ®lyc®UNTY,Nct� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Kemeny Address: 1100 Hyatt Road City: Southold St: New York Zip: 11971 Budding Permit#: 40212 Section: 50 Block. 1 Lot- 10 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: REP Electric License No: 46288-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool X New X Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceiling Fixtures HID Fixtures Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors Sub Panel 30A A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches 1 Twist Lock Exit Fixtures TVSS Other Equipment: In Ground Swimming Pool to Include- Bonding, 1- Pool Light, Cover Motor, Salt Generator, 1-GFCI Circuit Breaker Notes: Inspector Signature: Date: January 14, 2016 Electrical 81 Compliance Form.xls SOUryolo - D UOUNi'l,N TOWN ,OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ' - I FOUNDATION IST [ ] ROUGH PLUMBING [ ] FOUNDATION 2ND [ ] IN LATION [ ] FRAMING /STRAPPING [ FINAL [ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOL ION [ ] CAULKING REMARKS: - r DATE 0(o�j- INSPECTOR ` �G pzl v o��oF soalyo� o courm,��' TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ FINA / t ) [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ( ] ELECTRICAL (FINAL) REMARKS: Jw DATE De- 0t4r' V& INSPECTOR ` �1 OF S0(/�, l o • �o coUNfV,� TOWN OF, SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION IST [ ] ROUGH,PLUMBING [ ] FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING / STRAPPING [ FINAL Afe-) [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATI N [ ] CAULKING REMARKS: e DATE / �� INSPECTOR OF SOUT�olo cout I Nccl� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ]�FINAL ATION [ ] FRAMING / STRAPPING [ [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: �/� C• q r DATE �/ �� �� INSPECTOR 1• 1 s o ° • " s • � s s� 1: I 1INs.ULATIO STATE ENERGY Cbl)F, ILS PRE yAoso TOWN OF SOUTHOLD ,s i , ,,., . , . ;y. BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying'? TOWN HALL ' `' „'' 't�a"='�'�``fn�' 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. /900-1 a_�:- Check Septic Form N.Y.S.D.E C. Trustees Flood Pen-nit Examined ,20 Storm-Water Assessment Form © 2 Contact: Approved 20 Mail to: Disapproved a/c Phone: Expiration 20 � Building Inspec --� PP ICATION FOR BUILDING PERMIT OCT 16 2015 / Date QG} (p , 20[S"L - _�.__! INSTRUCTIONS .inc n�nr a.�I his a1Splicaiion-M-U8T—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 constriction 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. (Signature of 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 kQ4CaCiAQ_k k XVI P-c�l,l( d- �old W,(SQJ (As on 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. $g x/E Other Trade's License No. 1. Location of land on which proposed work will be done: /I oo 9VQ-Al &ad ,aha/d House Number Street Hamlet County Tax Map No. 1000 Section J Block f Lot j v 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 �P_SifiG� b. Intended use and occupancy �96 dw)1 �G�Q 3. Nature of work (check which applicable): New Building Addition Alteration Repair Removal Demolition Other Work $Xz/O 54ce-1 I � Vinq I t LO (Description) 4. Estimated Cost ,52,Ir0 , 0c) 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 0 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use. /j/h 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 Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated � � �A 12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO-V- 13. Will lot be re-graded? YES NO�L Will excess fill be removed frorn premises? YESA—NO M426ReE-r e,-"6 / 6ov3hol� 14. Names of Owner of premises De7C/-�W NE.Lsor-J Address 11 op q�o N a Phone No. g4oS /3'0{ Name of Architect Address Phone No Name of ContractorWh ►=',.LCC Address -1/6.'20 ,eft yap' Phone No. 63/-33y':7-(o0c) 15CLAhdd 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. Is this property within 300 feet of a tidal wetland? * YES V,, 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 po1int 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�( IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF ) being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)He 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 before me this day of 20 C D.BUNCH AaIt,�/,Notary Public,ate of New York r � .4o.of BU61 SMO Notary Public Qua In Suffolk County rgnatur Applicant Commission Expires April 14,2��o r Scott A. Russell , � ��� ST�O�][�I��l WAT]EIK SUPERVISOR 0 M[Aks NAG�]EM[]ENT SOUTHOLD TOWN HALL-P.O.Box 1179 53095 Main Road-SOUTHOLD,NEW YORK 11971 �� Town of So u th o l d CHAPTER 236 - STORMWATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) - - - - - - -- - - - - - - - - - -- - - - -DOES THIS PROJECT INVOLVE ANY ®1F ')(']H[lE FOLLOWING: Yes No (CHECK ALL THAT APPLY) ❑ 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 floodplain as depicted - - - on FIRM--Map-of-any-wat-ercourse-.- ------ E1,0 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 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. APPLICANT (Property Owner,Design Professional,Agent,Contractor,Other) S.C.T.M. *: 1000 Date NAME �A "1 IP(/vlLr✓(/l�9 ;5b I C) � U I Section Block Lot FOR BUILDUNG. DFPARTN-1L(vT t,si-. ONLY Contact Information ;rdrai-E Dumhcu i - - - - - - - - - ':�5 — Reviewed By 77 Date Property Address / Location of Construction Work: — — — — — — — — — — — — — — — — — rV� I I �� '/�� a Approved for processtng Building Permit �r� jb�t ,r [ �1 Stormwater Management Control Plan Not Required. ciLJ U t UI LJ l ❑ Stormwater Management Control Plan is Required (Forward to Engineering Department for Review) FORM # SMCP-TOS MAY 2014 - � :TCA/I )� Town Hall Annex Telephone(631)765-1802 54375 Main Road g Q2 P.O.Box 117ro er.richert(,_4own SOut 516 nY us - Southold,Ni'119711-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: f=--� +G7 C712 t L� Date: Company Name: ) . Name: L bE(,2 License No.: Address: 'Phone No.: z JOBSITE INFORMATION: (*Indicates required information) *Name: *Address: 00 4 c 4-T7` *Cross Street: *Phone No__ Permit No.: Tax Map _District: 1000 Section: Block: Lot: *BRIEF DESCRIPTION OF WORK(Please Print Clearly) -Poe JPlease Circle All What Apply) *Is job ready for inspection: �E:_S)/ NO Rough In Final *Do-you need a Temp Certificate: YES . / NO Temp information (If needed) *Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other *New Service: Re-connect Underground Number of Meters Change of Service Overhead Additional Information: _ PAYMENT DUE WITH APPLICATION _ Pei 113b— LS ,82:-Request for Inspection Form 0_0 g A N 0 S O u N !7 L O N i i 4 ► ,tw. .2 / • 22�tC`� ..` .._.•fir.._ ,r:... 414 •,t+r<r �.-, .'.�.. . r• . I •� �i'F.• ��w t.t�:�► �i vJiy 2t7 G .•. � �Uticttpd 0� MAP SU12VEYED 's• a � '� •---- -- ._.. ._ h•1�= Ste.n l� r '.1.�`�� �, �. 44 AT SouT kOL-0 `fi �hed N � �1.JFF=Ot.tG ::•Oc.JI•J'T'Y, t�1. .. W T vx I i f ' + + 1 Rapat'a I � yxSxq 64,OCO-17-ft. >�` t� / 3'x8'EGtvaPrr�ru'� p � rrrt�l7Wrt8rt•F� W �•vNr•�• ..�r+ Vp IJE�ji ` + j W s � /.• { CF•VA1,y Nr*a..r a i+• g t1 r it WAY %••t�s.rib ar,., WAIIUMW WOO "" °!s rw b.OF R1 �' _ r Ce„+�e...1�io.t.e►:w�a+vr••rry�^; r',�r ,y° is Zbe�;�; W ►n't1inL.nfsohkWhIIt'h1''� 1 t+: 116�I,.n�.Kiwd Cs m.cwt mT• •+ �1 • 5.28'-b'W. - 197.68 n/f HAG:IJAN ( nff f•(A�NAt�1 [0oram-Owrc(�fa �itR ewrltrs fa grrcart rifle ta'Z�C/t'17 hce Cost ”; �; � . 1 CitCr fo F1a*•ct� NfCrf�gr+ fa•it;.+ , i Oct. 301 r9g2 , 1 I i as Survec�ed . F? / Qoorm role VAN�. 1 Lrc rrraad Land York 4�#olii Co�►*fiy Tbx Ma s DrslgttdfrOrl: (�rgtn jpr>L Oct 21 2015 01:25PM HP FaxEast End Pool Kng 6318761191 page 2 Cardinal Pool Size: 8' X 4D' a, Pool Shape; RECTANGLE Pool Number: PRT2819 250 Route 51 South,Schuylkill Haven,PA 17972 +574-385-0733•fax:570.385.1318 •CustemerService@CardlnalSystemsinc.com Bill of Materials PART NO, QUANTITY DESCRIPTI❑N 'A' FRAME 13 'A' FRAME ASSEMBLY CS902SA 3 90 DEG CORNER ANGLE S06T2F'NF4244XX0 1 6' STEEL CORNER STEP 5S42200XXXO 2 2' Straight PANEL W/0 Z 5S42800XXX2 10 8' Straight PANEL W/2 Z 8' e' 5' 5�' aD AS NOTED AS REQUIR _D AI�� NWN C E -=S FE ^t DA :�, B P. E.. NOTI BUILDIiN a F'EPARIMENT AT ® ® S „Y i D 765-1 �� 8 AM FO 4 Phi FOR THE FOLI- ING INSPECTIONS: SCIUI „�� it, i I US1'EE11 1. FOUNDATION TWO REQUIRED FOR OURED CONCRETE 2. R( UC H - FRAMING & PLUMBING 3. IN U ATION 4. FINN - CON`S RUCTION MUST B C I\APLE--POR C.O. 40ALL 0. STRUC i ION SHALL MEET THE 40' RECD IR MENTS OF THE CODES OF NEW YOR FATE. NOT RESPONSIBLE FOR DES(aN OR CO 4S T RUCTION ERRORS. U A TANSY O USE S UNLAWFUL 2' `(s W1 CERTIFICATE V-7 1�2' , °Co P°°��E��°" OF GU ACY upoN G s�P�EF� 6 ��F°R 2` V-4- 6' STEEL CORNER STEP SG6T2FNF4244)(X0 NOTE: THIS IS A NON DIVING POOL. Date: 10/21/2015 (Perimeter_ 96' p p Drawn By: JASON Y Area: 320 SQ FT '- I Q,f _ i ---- to Scale: 1 8 — 1 -oft Nates: CardinalSystemslne com This Informallen is the confidential property of Cardinal Systema,lite.Disclosure or duplication without proper written approval Is strictly piahRuted.Acceptance and use of this drawing constitutes knowledge and acceptance by ft user of the terms and conditions set forth In the nollco and wummg which accompanied this drawing is incorporated herein and made part hereof and Is found on Cardinal systems,Ine's website at www.cordinsisystemsim.com