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g11FFOl,f�oGy Town of Southold 8/16/2017 0 P.O.Box 1179 d' ? 53095 Main Rd Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39135 Date: 8/16/2017 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 215 Eastwood Dr Ext, Cutchogue SCTM#: 473889 Sec/Block/Lot: 103.-14-15 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 7/6/2016 pursuant to which Building Permit No. 40839 dated 7/18/2016 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 Croton Lake LLC of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 40839 08-02-2017 PLUMBERS CERTIFICATION DATED 0 tho d Signature �gaFFo�,r�o TOWN OF SOUTHOLD 1. BUILDING DEPARTMENT TOWN CLERK'S OFFICE oy�a � 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#: 40839 Date: 7/18/2016 Permission is hereby granted to: Minerva Living Trust PO BOX 741 Cutchogue, NY 11935 To: construct an in-ground swimming pool as applied for. At premises located.at: 215 Eastwood Dr Ext, Cutchogue SCTM # 473889 Sec/Block/Lot# 103.-14-15 Pursuant to application dated 7/6/2016 and approved by the Building Inspector. To expire on 1/17/2018. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 $300.00 Building Inspector Form No.6 -ro\N'N or SOUI'HOLD 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 1% 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. C6py of-Certificate of Occupancy- 25"' 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00,Commercial$15.00 �/ Date. -' 7 New Construction: " �/ (.old or Pre-existing Building: (check one) Location of Property: House No. n Street Ham et UOwner or Owners of Property: =K) LA Suffolk County Tax Map No 1000, Section /® Block Lot Subdivision Filed Map. Lot: Permit No. V001 -)�� �"Date of Permit. Applicant: Ar � ���CWS Health Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: ✓ (check one) Fee Submitted: $ Applicant Signature pF SO(/r�,®l Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Q roger.riche rt(-)town.southoId.ny.us Southold,NY 11971-0959 OWN, BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Croton Lake LLC Address: 215 Eastwood Drive Ext. city Cutchogue st: New York zip: 11935 Building Permit#: 40839 Section: 103 Block 14 Lot: 15 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: DBA: JES Electric License No: 4483-ME SITE DETAILS Office Use Only Residential X Indoor Basement Service Only Commerical Outdoor X 1st Floor Pool New Renovation 2nd Floor Hot Tub Addition Survey Attic Garage INVENTORY Service 1 ph Heat Duplec Recpt Ceding 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 1 A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 1 Disconnect Switches Twist Lock Exit Fixtures TVSS Other Equipment: Ingruond Swimming Pool to Include: Bonding, 2- Pool Lights, 1- Pool Cover Motor, 1- Gas Pool Heater, Salt Generator, 2- GFCI Circuit Breakers. Notes: Inspector Signature: Date: August 2, 2017 0-Cert Electrical Compliance Form.xls OF so TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLRG. [ ] FOUNDATION 2ND [ ] SULAT [ ] FRAMING / STRAPPING [ FINAL000? [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARICSD 4vmovecl- 1 � Y h �Z�P,t�IC� j 1�✓ V - c DATE I�I INSPECTOR pE SOUTyo! � o TOWN OF SOUTHOLD BUILDING DEPT. 765-1602 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] SULAT [ ] FRAMING / STRAPPING [V1 FINAL M? [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL Olux(ROUGH) [ ] ELECT CAL (FINAL) REMARKS: DATE YI INSPECTOR ' OF SOUTyolo cOUNi'1,� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION- FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ELECTRICAL (FINAL) REMARKS: jo< DATE INSPECTOR r � w t , • r: 1 s �r 1 1p �!_;;0,'T'A tw . t i - u w n 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. 40 Check Septic Form N.Y.S.D.E.C. Trustees C.O.Application Flood Permit Examined A ,20 Single&Separate Storm-Water Assessment Form Contact: Approved ,20 Mail to: Disapproved a/c ©' Phone: Expiration ,20 ng In p ctor o � D APPLICATION FOR BUIL PE DEpT� Date ��Y / ' , 20 f� JUL SMDING INSTRUCTIONS T �yN OF SOI�OI'D a.T9is 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. (Signature of applicant or name,if a corporation) /00 lwd)v Azi (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or uilder Name of owner of premises �,�0 Lz � � Z z e (As on the tax roll or latest deed) If applica scorp ation;-signure of duly authorized officer (Name and;,title;o ,corporate:officer) Builders License Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed wok wi511wV4' e done: c;215 ®® CQ.LTC cc.� House Number Street Hamlet County Tax Map No. 1000 Section /0-3 Block 1,V Lot 45 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 3. Nature of work (check which applicable):New Building Addition Alteration Repair Removal Demolition Other Work (Description) 4. Estimated Cost 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. l f � 7. Dimensions of existing structures, if any: Front /� SC �6 L���a W Depth Height Number of Stories 1 Dimensions of same structure with alterations or additions: Front r',-, 1' F 5? Lar•Rea Depth Height Number of Stgrie`szJt� 3F 8. Dimensions of entire new construction: Front Rear Do;th•s r : ? , 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 13. Will lot be re-graded? YES NO_4Will excess fill be removed from premises? YES /NO 14. Names of Owner of premises-Dee/ma &S12WAddress AKA A'�c°'` Phone No. q - %&0-J i 263 Name of Architect Address Phone No Name of Contractor X_Z- Ak_ atyt C&,C Address l7cb AAV R Phone No. 4114-r-r' 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 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 NO c� * IF YES, PROVIDE A COPY. STATE OF NEW YORK) SS: COUNTY OF /� ) 2 t t b-'10";&1 being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract) above named, BONNIE D.BUNCH (S)He is the NiotmV Public,State of New York 2 Aracto Agent, Corporate Officer, etc.) Qualified in Suffolk County (:ommisslon Expires April 14,20 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 I LzA day of '�� 20 h Notary Public Signature of Applicant Scott A. Russell SUPERVISOR I\\\ILA\NA\(G)EM 1E IF SOUTHOLD TOWN HALL-P.O-Box 1179 53095 Main Road-SOUTHOLD,NEWYORK 11971 yly��s Town of Southold CHAPTER 236 - STORMVVATER MANAGEMENT WORK SHEET ( TO BE COMPLETED BY THE APPLICANT ) DOES THIS 1PI$OJ1EC`I' INVOLVE ANY OF THE FOLLOWING: (CHECK ALL THAT APPLY) Yes No ElfA. Clearing, grubbing, grading or stripping of land which affects more ❑[2/ than 5,000 square feet of ground surface. B. Excavation or f illing involving more than 200 cubic yards of material ,_,/ within any parcel or any contiguous area. El EY C. Site preparation on slopes which exceed 10 feet vertical rise to 100 feet of horizontal distance. i ❑ 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 -... - FIR Map E] . Installation of new or resurfaced imperyious 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 pour Building Permit Application. S.C.T.M. #: 1000 Date: APPLICANT: (Prop?e�rrtty,owner,Design Professional.JAgent,/Contractor,Other) District I�/ - NAME /✓o Y '�7 K fY�iC ►'-C I �/ IO3 7 lS 'I (!/ N M Section Block Lot �_•^^, '``= FOR BUILDING DEPARTMENT USE OINL Y'•;` Contact Information Reviewed By: Date: Property Address / Location of Construction Work: — — — — — — — — — — — — — — — — — /�c Approved for processing Building Permit. ,oZ15-- 55,4S-72 2) /�(� El Stormwater Management Control Plan Not Required celwC4, .Q 2)" Z/g&— ❑ Stormwater Management Control Plan a Required. (Forward to Engineering Department for Review.) FORM " SMCP -TOS MAY 2014 of SO(/r�� Town Hall Annex Telephone(631)765-1802 54375 Main Road m�ax(631)764-952, P.O.Box 1179 G.2 • Q roger.richertE I own.sou no .nv.us Southold,NY 11971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD APPLICATION FOR ELECTRICAL INSPECTION REQUESTED BY: ������//� �� C �� �/� Date: Company Name: Name: o License No.: 441 k3 A&5 Address: � Phone No.: (p 3 _7/0 JOBSITE INFORMATION: (*Indicates required information) *Name: 6X a 7Oat, mk� /c *Address: ®I tJt *Crass Street: igot *Phone No.: CY/ S' Permit No.: q oy 3 l Tax Map District: 1000 Section: 103 Block: Lot: *BRIEF DESCRIPTION OF WORK (Please Print Clearly) ?00t (Please Circle All That Apply) *Is job ready for inspection: YES / O Rough In Final *Do you need a Temp Certificate: YES O 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 0�� �� 82-Request for Inspection Form �� 1 - S C T M. NO OiSTRICT. 1000 SECT,ON 103 BLOCA. 14 LOT(S):15 PIPE 173 30, :R LOT 25 30 COL sA 2* R 2AR �. ASPYIALT' t11 O� ® PIPE 0 AGE O fT r } d A O COVERED A Z' � r� COVtoE 4 � PORCH � O 15 sv 2 DWE U1LG j CONC. X215 ,p LOT 26 STOOP = orlc u STOOP V 2ND FLR. LOT 31 CANTILEVER 57.8 •'� BRICK PATIO 2?•� •O at, I N b c � ti o � N c + REBAR PIPE FEryCE PIPE 0.8 w S52'53 X00"11' 229.52' THE WATER SUPPLY. WELLS ORYWELLS A D CESSPOOL LOT 28 LOCA 77ONS SHOIVW ARE FROM FIELD OBSERVA BONS AND OR DATA 09TAINED FROM OTHERS _- I LOT 27 AREA: 20,268.41 SO.FT. of 0.47 ACRES Elf VA TION DATw• --------- ------------ UNAUMOR2ED ALTERADON OR ADWTION TO MVS SURVEY IS A 4WLANON OF SECTION 7209 Or THE NEW MRM STATE EDUCATION LAW CWS or THIS SURVEY YAP NOT BLARING lh[LAND SUR/EYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE CORY. GUARANTEES AD CATED HEREON SHALL PUN DAL It 70 THE PERSON FOR IHIp/DIE SURVEY IS PREPARED AND ON IRS BEHALF f0 IHE RILE COMPANY,GOKRNMENfAL AGENCY AND lLNDWG INSTITUTION LISTED HERLOV.AND TO THE ASSIOWES OF THE LENDING WSIl7U74y CUARAUIEES ARE NOT TRANSFERABLE I THE OFFSfTS OR OUENSVG/S SNOW HEREON FROV THE PROPERTY LINES TO ME STRUCTURES ARE FOR A SPECTnC PURPOSE AND USE THEREFORE WY ARE is NOT INTENDED TO MONUMENT ME PROPERTY LWES OR TO OTADE THE ERECTION EY'FENCES ADW A WAL STRUCTURES 07 AND OTHER IMPROKMCHTS CASEMENTS AND/OR SUBSURFACE STRUCTURES RMORDfO OR UNRECORDED ART NOT GUARANTEED LMCSS PHISCALLY EVIDENT ON Mf PRCLRSCS AT ME TO?LY SURVfr 01 suRNEY OF. LOT 26 CERTIFIED TO: ESME WATANABE; MAP Cr: EASTWOOD ESTATES SEC. 2 DEVON COSTELLO; CROTON LAKE, LLC, FLED NOV. 4, 196A No.4210 FIEDLITY NATIONAL TITLE INSURANCE COMPANY SITUATED AT CUTCHOGUE Tom a SOUTHOLD KENNETH M TTOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY. NEN!YORK PTo£eeelenel land Suneyln� and Deelsn MIDWOOD ROAD P.O. IIo: 153 Aquebogue, Now York 11031 nLE 1 16-107 SCALE:1"=20' DATE JUNE 22, 7016 PRaYE(e-4.G-Lees FAX lead 29a-U,I N YS IISC NO 050882 oI.WNV VM ntW.d ll bl A. 6u.W LE r fa.► oa f7 V 11f 5z APPROVED AS NOTED / DATE: B.P.It FEE: By. � .� c NOTIFY BUILDING DEPARTMENT AT 765-1802 8 AM TO 4 PM FOR THE FOLLOWING INSPECTIONS: pow 1. FOUNDATION - TWO REQUIRED C FOR POURED CONCRETE ® �� S 2. ROUGH - FRAMING & PLUMBING 3. INSULATION JJ _-4.,-FINAL --CONSTRUCTION MUST- - �� ' BE COMPLETE FOR C.O. ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW YORK STATE. NOT RESPONSIBLE FOR DESIGN OR CONSTRUCTION ERRORS. 764 --- ------------------ ------ Q - NEW YORK s iA,-E & Tovvry co®Es ----- AS REQUIRED S �O�I Jai i S0i' ,' }WhJTRIISTFES DOCS OFF W A�ERE�2 6 �0 CNA Pp�SUA�1 N Opp . ld, 17 �� EL la2fJ �A�� E"u ON comp E,l x,10 PA Y 3v �,n BEFd�E USE IS UNLAWFUL WITHOUT CERTIFICATE OF OCCUPANCY ZAV DATE: / SIzF.. ` SHAPE., QMDEA PATTERN.-.,, WALL PA'I`MAhL FLOOR RATCERN: COMM: DEPTH• _ HUNG OVERLAP (drde one) 20 GAUGE 27 GAUGE (drde on@) I _ � Im*qt 71-1 O t a I�� q1