HomeMy WebLinkAbout42016-Z O&F04CpG Town of Southold 10/3/2017
3 P.O.Box 1179
0
53095 Main Rd
dj,�jOs �,ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 39261 Date: 10/3/2017
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 755 Lighthouse Ln, Southold
SCTM#: 473889 See/Block/Lot: 70.-6-31
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/27/2011 pursuant to which Building Permit No. 42016 dated 9/29/2017
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 Bums Jr,John &Virginia
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36808 03-04-2013
PLUMBERS CERTIFICATION DATED
1
At d Signature
� 17 ell TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
co o� • 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#: 42016 Date: 9/29/2017
Permission is hereby granted to:
Burns Jr, John &Virginia
755 Lighthouse Ln
Southold, NY 11971
r
To: construct an in ground swimming pool, fenced to code. R-c p
At premises located at:
755 Lighthouse Ln, Southold
SCTM # 473889
Sec/Block/Lot# 70.-6-31
Pursuant to application dated 9/27/2011 and approved by the Building Inspector.
To expire on 3/31/2019.
Fees:
IN-GROUND SWIMMING POOL $125.00
Total: $125.00
Building pector
TOWN OF SOUTHOLD
4�g�FFO(,q�cO BUILDING DEPARTMENT
g TOWN CLERIC'S OFFICE
o 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#: 36606 Date: 11/10/2011
Permission is hereby granted to:
Burns Jr, John & Burns, Virginia
755 Lighthouse Ln
Southold, NY 11971
To: construct an In-Ground Swimming Pool, fenced to code
At premises located at:
755 Lighthouse Ln, Southold
SCTM # 473669
Sec/Block/Lot# 70.-6-31
Pursuant to application dated 11/4/2011 and approved by the Building Inspector.
To expire on 5/11/2013.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $36-80 pa
Total: $300.00
Y2_'#2-
50.CXR
Building Inspector
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 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- $100.00
3. Copy of Certificate of Occupancy-$.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy-Residential $15.00,Commercial$15.00
Date. I V.�P I
New Construction: Old or Pre-existing Building: (check
(check one) I Q,,p
Location of Property: r �1 "rT L4 `� ` "I
House No. Street Hamlet
Owner or Owners of Property:. WO 5
Suffolk County Tax Map No 1000, Section Block (V Lot 3
Subdivisions 1 Filed Map. Lot:
f-
Permit No. 'c�:'�00 Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
Applicant Signature
S%sfFOL A,
Town Hall Annex p CQ� Telephone(631)765-1802
54375 Main Road o Fax (631)765-9502
P.O. Box 1179 , ^'
Southold, NY 11971-0959 ?t� �,�Q�� roger.richert()town.southold.ny.us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Virginia Burns
Address: 755 Lighthouse Lane City:Southold St: NY Zip: 11971
vBuilding Permit#: Lt aLD I(, -3888B Section: 70 Block 6 Lot: 31
7 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: as built DBA: License No:
SITE DETAILS
Office Use Only
Residential x Indoor Basement Service Only
Commerical Outdoor X 1st Floor Pool x
New Renovation 2nd Floor Hot Tub
Addition Surrey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceding Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 2 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures CO Detectors
Sub Panel 1 A/C Blower Range Recpt Fluorescent FixturePumps 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, pool light, heat pump, 1-pump motor
2-GFCI circuit breakers,1-sub panel
Notes:
Inspector Signature: Z:: Date: March 4 2013
Electrical Certificate.xls
couMv,�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
=
[ ] FOUNDATION IST , [ ] ROUGH- PLBG.
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING/STRAPPING [ FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ - ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: N�
DATE -3 INSPECTOR
so
�o� olo
cOUM`l,Nct�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] SULAT ONa
[ ] FRAMING / STRAPPING [ FINAL GV
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL)
REMARKS: D
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(YN -kbve- L
DATE lofrlf Alru INSPECTOR
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INSULATION PEAL N.IV. J �
STATE EDGY CODE
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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. �_ �� � Check
Septic Form
N.Y.S.D.E.C.
Trustees
G / Flood Permit
Examined �— _ — 20_�� -- -- ---. Sinyl_8:-Separate - -- -
Storm-Water Assessment Form
t Contact:
Approved (� l 120 �' Mail to:
Disapproved a/c
Phone: y-�i' of 4-
Expiration rJ 20j3
Building Inspector
APPLICATION FOR BUILDING PERMIT
Date / 2 7 , 20
INSTRUCTIONS
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 a reel t ��mnhI *>. ws, ordinances, building code, housing code, and regulations, and to admit
authorized i i sof pr ni f sWd h L• i g for necessary inspections.
CJP N0"Y 0,R -r# Fqry� Poo& r
NOV - 4. 2011 &` rs IS U N LAWF 6 ll., (Signature of applicant or name, if a corporation)
�'H11)U � C TI I Ca 0 �� ���7'T i�c�� Aw
BLDG DEPT.
TOVVN OF SOUTHOLD OW t. '1arY RI sw (Mailing address of applicant) /lctSoz
as tL7 L% , general c MOT ber or uilder
77
State whether applicant is owner lessee a t
URO,IiCOiNIPLETION 44
l (/ E #
i
FORE "�N,aTER" DATE
Name of owner of premises _J& /� EE' r�I—wG gY G
ATIFY BULI DF
(As on the tax-roll odd ale(ed)0i rye a ^ FOF, 7"
If applicant is a corpor tion, •nature ofd y authorized officer FOLLOWING IPo:,T E( TIS 'ti
` 1. FOUNDATIi,N -T'NQ L
(Name and'title'ofco orate officer FOR POURED CON` E
2. ROUGH-FRANKING, "
Builders-License-No: STRAPPING ELEC't,,L yr iN
Plumb�q license No. 3 INSULATION
Electricians License No. 4. FINAL
Other Trade's License No. -3 # ETA1N ATER RUNRIP, 5�CC':i E 'C
PURSUANT T HAPTERM11THE
FN1
01RR NTS OF THF �,tS F r
1. Location of land on which proposed work wiQFbR&i Q-YVN'CODE. YO STATE'-NC- - 4 -L
House Number Sidet ELS TIillet
RTURED
Ca l
County Tax Map No. 1000 Section /U Block Do Lot
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 LX0,MIN � a�L
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost _ Fee _
(fo 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: FrontA0 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
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO Will excess fill be removed from premises? YES NO
14.Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
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
IF YES, PRO, lABGOPY�,qo_.A
STATE OF NEW
S. _ ..
COUNTY OF' �� �t w. .9- .
J 4.il.. yc
.0181'-<.:); being duly sworn, deposes and says that(s)he is the applicant
(Name of indiyidual signing coati ac't)'`abovelnamed,
CONNIE D. BUNCH
(S)He is the
(Coiltracto , Agent, Corporate Officer, etc.) Notary No,016U6185050
Oual'rtied in Suffolk County
of said owner or owners, and is duly au3thorized to perform or have performed the said vQq0rfilT4KT FPMRM01111A�i�p�lication;
that all statements contained in this applicafi6ft are true�to the,best of his-knowledge and belief, and that the work will be
performed in the manner set forth'in the app Iicaidon,filed=therewith.,;,,; ,f
Sworn to before me this
L 4' day of `r' 2'0' "'f
Notary Public Signature of Applicant
Jill M.Doherty,President ��®f S®Ul�® Town Hall Annex
Bob Ghosio,Jr.,Vice-President ,`® �Q 54375 Main Road
P.O.Box 1179
James F.King Southold,New York 11971-0959
Dave Bergen G Q
John Bredemeyer �® ® �® Telephone(631) 765-1892
COU NT�,� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 12, 2011
Mr. Bill Birkmier
North Fork Pool Care
P.O. Box 471
Mattituck, NY 11952
RE: VIRGINIA BURNS
755 LIGHTHOUSE LANE, SOUTHOLD
SCTM# 70-6-31
Dear Mr. Birkmier:
The Southold Town Board of Trustees reviewed the survey prepared by Nathan Taft
Corwin, 111, last dated September 21, 2011, and received on September 30, 2011, and
determined that the proposed installation of an in-ground pool, patio and pool fence, is
out of the Wetland jurisdiction under Chapter 275 of the Town Wetland Code and
Chapter 111 of the Town Code.
Therefore, in accordance with the current Wetlands Code (Chapter 275) and the
Coastal Erosion Hazard Area (Chapter 111) no permit is required. Please be advised,
however, that no construction, sedimentation, or disturbance of any kind may take place
' seaward of the tidal and/or freshwater wetlands jurisdictional boundary or seaward of
the coastal erosion hazard area as indicated above, or within 100' landward from the
top of the bluff, without further authorization from the Southold Town Board of Trustees
pursuant to Chapter 275 and/or Chapter 111 of the Town Code. It is your responsibility
to ensure that all necessary precautions are taken to prevent any sedimentation or other
alteration or disturbance to the ground surface or vegetation within Tidal Wetlands
jurisdiction and Coastal Erosion Hazard Area, which may result from your project. Such
precautions may include maintaining adequate work area between the tidal wetland
jurisdictional boundary and the coastal erosion hazard area and your project or erecting
a temporary fence, barrier, or hay bale berm.
2
This determination is not a determination from any other agency.
If you have any further questions, please do not hesitate to call.
Sincerely,
tv
M. Doherty, Pre dent
Board of Trustees
JMD:eac
Now York,State Department of Environmental.Conservation
Division otEnvironmental Permits, Region 1 Aft,
SUNY•@ Stony j3rook
50'Circle Road,Stony Brook,.NY 11790-3409• '
Phone: (631)444-0365=•Fax: (631)-444-0360
Website`,wWNr. oe;Martens,
dhc;ny rtov
GJommissione�
TIDAL WETLANDS"LETTER OF NO-JURISDICTION•
October•2 t,2011
Ms.Virginia M. Burns
75,'5 Lighthouse Lane
Southold NY 11971
Re: NYSDEC#14738-00768/000.03
'755 Lighthouse,Lane
Southold
SCTM'#1000-70441
Dear•Applicant:
Based on the•information your,agent submitted-,iheF,New York 8taw'Department of,Environmental
Conservationhas made the'following,determination.
The port'i'on of,the referenced piopertytbat is landward(south),of the 10 foot elevation contour,line;as-shown
on the--survey prepared by N0th4n'Taft-Corwin III last revised on 10/2.1/11.;is beyond the jurisdiction of.Article
25 Tidal Wetlands_
Tberefore,.in accordance with the current Tidal'Wetlands Land Use'Reguiati'6ns'(6 NYCRR-Part 661)'no permit
is required under the,Tidal Wbtlands Act. Please,be advised,however,that no construction,sedimentation,or
disturbance,of any kind,may take place-sea*6rd of the tidal wetlands jurisdictional boundary;.as indicated
,above,without a.permit. Itis your responsibility to•ensure'that all necessary-precautions,areltakewto prevent_
any sedimentation-or'other,alteration'or disturbance to the,ground surfaceor vegetation within Tidal Wetlands
jurisdiction which may result from your project. Such precautions=may includ6maintaining adequate Work area
between the-tidal wetland jurisdictional boundjary'and youiproject(i.e..a,.15'to.20'wide.construction area);or
erecting a temporary fence,barrier;or hay,'bale berm.
please be further-advised that:this letter does not relieve you,,of the responsibili of obt any necessary
permits or approvals from other•agencies.
Very Y,Your's,
John A. ielan
Deputy'Permit Administrator
CC: NorthTork Pool Care
BOR—TW
File
. f
I
Town of Southold:
Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT NT FORM
PROPERTY LOCATION: S.C.Tlt#
THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
JQWSTORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
JDistr-ict To-70 ®@— 'Tor CERTIFIED BY A DESIGN PROFESSIO AI.IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORKASSESShMT Yes No
a. What Is the Total Area of the Project Parcels? Will this
(Include Total Area of all Parcels located within eject Retain All StomrWafer Burr-Off
the Scope of Work for Proposed Construction) Generated by a Two(21)hich nalrhil on Site? ZF—
]( ) ) (Thl&item will include all too off seated by site
b. What is the Total Area of Land Clea
�►g clearing and/or construction activities as well as all
and/or Ground DisWrbance for the proposed Site Improvements and the permanent creation of
coristrucdion acSm'ty't
• (sF Maes) impervious surfaces.) -
PROVME BRIEF PROJECT DESCRU hObf trwa.�a�uo.w Pasa a.r 2 Does the Site Pian am)/or Suryey Show All Proposed
Dratltage Structures Indicating Size$Location?This V ❑
Item shall inckide all Proposed Grade Changes and
�) A �f�( ��� Slopes Controlling Surface Water Flow.
o 3 Does the Site Pian and/or Survey describe the erosion
and sediment control practices that will be used to
control Sfte erosion and storm water discharges. This
item must be maintained throughout the Entire
Construction Period.
4 Will this Project Require any Land Filling,Grading or
Excavation where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards —
of Material within any Parcel?
5 Will this Application Require Land Disturbing Activities
Encompassing an Area in Excess of Five Thousand —✓
(5,000 S.F.)Square Feet of Ground Surface? El
6 Is there a Natural Water Course Running through the /
Site? Is this Project within the Trustees jurisdiction v/
General DEC SWPPP Requirements: or within One Hundred(10(r)feet of a Welland or
Submission of a SWPPP is required for all Construction activities involving soa Beach? _
disturbances of one(1)or more acres;including disturbances of less than one acre that 7 Will there be Site preparation on Existing Grade Slopes i
are part of a larger common plan that will ultimately disturb one or more acres of land;
Including Construction activities involving soil disturbances of less than one(1)acre where which Exceed Fifteen(15)feet of Vertical Rise to i
the DEC has determined that a SPDES permit is required for storm water discharges. One Hundred(100')of Horizontal Distance? F-1r
(SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways,Parking Areas or other Impervious O
for Storm Water Discharges from Construction activity-Permit No.GP-0-10.001.) Surfaces be Sloped to Direct Storm-Water Run-Off —✓
1.The SWPPP shag be prepared prior to the submittal of the Not.The NOI shall be into and/or in the direction of a Town ri ht-of-
submitted to the Department prior to the commencement of construction activity. 9 way?
2.The SWPPP shag describe the erosion and sediment wnbol practices and where 9 Will this Project Require the Placement of Material,
required,post•consbuction storm water management,practices that v@1 be used and/or Removal of Vegetation.and/or the Construction of arty i
constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right o1=Way or Road Shoulder
dance vdih fire terms and conditions of this pemut In addrlfon,the SWPPPsha8 Area?(fhb nm wu Norhrca,aa-o����of
klentr'fylidential sources of pollution which may reasonably be expected to affect the o+#"ay AWm)
quality of storm water discharges. NOTE If Any Answer to questions Orir,througti Nlrre b Answered with a Cheek Mark
3.AN SWPPPs that require the post-construction storm water management practice in a Box and the construction stle disturbance IS between 5,000S.F.A 1 Acre in area, !
component shag be prepared by a qualified Design Professional Licensed in New York a stornamate,Grading,Drainage&Erosion Control Plan is Required by the Town of
that Is knowledgeable in the principles and practices of storm Water Management Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit
(NOTE A Check Mark(.J)mWwAmwer foreach question b Required for o Compieie Application)
S1A17,OF NEW YORK, c. - n L // Notary Public,State of New York
COUNTY OF_.... .................. No.01 BU6186050
�i (qualified in Suffolk County
7bat I � � r=�'�pl�'' Commission Expires April 14. 01�
r
• (Name e � signing ,p •-_•••--••_••being duly sworLdepose and says that he/she is the applicant for Permit,
And that he/she is the .....J .1.W.y�•-.;f (l-P owner,Contraor,Agent, to offi�•eta) •"•"•••..•.....•••.......•.•••.•... i
Owner and/or representative of the Owner or Owner;,and is duly authorized to perforin or have performed the said work and to i
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 herewith
i
Sworn to before me this;
.............._ `i'!!�....................day of. -_. ._..................,20..1.J ,
Notary Public: _....� r lid...-.�... ......... ..................................
FORM - 06110 (Signature of Applicant) i
Town Hall Annex Telephone(631)765-1802
54375 Maio Road g
P.O.Box 1179 G. rogermc ovin.saltgoltl.nY.us
Southold,NY 11971.0959
BUILDING DEPARTWNT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name:
Name:
License No.:
Address:
Phone No..-
JOBSITE INFORMATION: ('Indicates required information)
*Name: 11�XC,�t,k blc,/ 1,4. _
*Address: 25- G,` L amu- ��C� rtU -
XATZI
*Cross Street: �-2,j� �
*Phone No.: amu/ �SS- S"� 16"a
Permit No.: a,d)
Tax-Map District: 1000 Section: Block: Lot: _
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply)
*Is job ready for inspection: YES NO Rough In Final
Cho you need a Temp Certificate: YES ,(
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
. �d ►I- 1�-1 ►
82-Request for Inspection Form C- SIC&1
Southold Town Building Department
o�SUEF°l�'c P.O.Box 1179 Permit#: 36808
54375 Main Road
w n Southold New York 11971 Permit Date: 11/10/2011
�y�,olat� (631)765-1802 Expiration Date: 5/11/2013
Parcel ID: 70.-6-31
BUILDING PERMIT RENEWAL LETTER
Dated: 6/26/2014
Applicant: North Fork Pool Care
Location: 755 Lighthouse Ln, Southold
Work Description: IN GROUND POOL
construct an In-Ground Swimming Pool, fenced to code
A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT.
Owner: Burns Jr, John&Burns, Virginia
Address: 755 Lighthouse Ln
Southold,NY 11971
The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please
submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building
Department, P.O. Box 1179, Southold,New York 11971
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
r Southold Town Building Department
�o�SUFFQj,��o� P.O.Box 1179
Permit#: 36808
53095 Main Rd
o • Southold,New York 11971 Permit Date: 11/10/2011
�101 (631) 765-1802 Expiration Date: 5/11/2013
Parcel ID: 70.-6-31
BUILDING PERMIT RENEWAL LETTER
Dated: 9/27/2017
Applicant: North Fork Pool Care
Location: 755 Lighthouse Ln, Southold
Work Description: IN GROUND POOL
construct an In-Ground Swimming Pool, fenced to code
A FEE OF $125.00 IS REQUIRED TO RENEW THIS BUILDING PERMIT.
Owner: Burns Jr, John&Burns,Virginia
Address: 755 Lighthouse Ln
Southold,NY 11971
The permit listed above has expired. No work is permitted or authorized beyond the expiration date. Please
submit the above fee made payable to the Town of Southold. Mail to the Town of Southold Building
Department, P.O. Box 1179, Southold,New York 11971
THANK YOU,
SOUTHOLD TOWN BUILDING DEPT.
SURVEY OF PROPERTY C/
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CERTIFIED TO: 014 3
FIRST AMERICAN TITLE INSURANCE ``°°°ST ry it 14 94
COMPANY OF NEW YORK °� Fps N
TITLE No. 141—S-1625 F,°FSR ti
JOHN A. BURNS Jr.
VIRGINIA M. BURNS Q)�
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� TO THISIS SURVEY IS A VIOLATION OF
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. COPIES OF THIS SURVEY MAP NOT BEARING
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Land Surveyor
�0 EMBOSSED� TO BE A VALID TRUE COPY
CERTIFICATIONS INDICATED HEREON SHALL RUN Successor To: Stanley J Isaksen, Jr. L.S.
ONLY TO THE PERSON FOR WHOM THE SURVEY Joseph A Ingegno LS IS PREPARED AND ON HIS BEHALF TO THE
TITLE COMPANY, GOVERNMENTAL AGENCY AND Title Surveys - Subdivisions - Site Plans - Construction Layout
LENDING INSTITUTION LISTED HEREON, AND y Y
TO THE ASSIGNEES OF THE LENDING INSTI-
TUTION CERTIFICATIONS ARE NOT TRANSFERABLE PHONE (631)727-2090 Fax (631)727-1727
THE EXISTENCE OF RIGHTS OF WAY OFFICES LOCATED AT MAILING ADDRESS
AND/OR EASEMENTS OF RECORD, IF 1586 Main Road P 0 Box 16
ANY, NOT SHOWN ARE NOT GUARANTEED. Jamesport, New York 11947 Jamesport, New York 11947
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X- Office: 631-298-4014
Fax:631-298-4015
1. THIS POOL MEETS THE REQUIREMENTS OF ANSI/NS PI-5 "AMERICAMN NATIONAL STANDARDS FOR RESIDENTIAL
INGROUND SWIMMING POOLS"AND 1996 BOCA CODE-SECTION 421. DIVING EQUIPMENT IS NOT ALLOWED.
2. SWIMMING POOL AND POOL EQUIPMENT SHALL BE COMPLETELY SURROUNDED BY AN ENCLOSURE THAT
COMPLIES WITH THE CODE OF THE TOWN OF SOUTHOLD SECTIONS OF THE ENCLOSURE THAT ARE COMPRISED
OF A FENCE SHALL BE GREATER THAN 5'ORT LESS THAN 6' IN HEIGHT AND BE NONCLIMABLE.ALL GATES IN THE
FENCE SHALL BE SELF CLOSING AND SELF LATCHING AND BE SECURED WITH A LOCK OPENABLE FROM THE
OUTSIDE ONLY. FINISHED SIDE OF FENCES SHALL BE LOCATED ON THE OUTSIDE OF THE REQUIRED FENCE.THE
RESULTING CONSTRLUCTION SHALL COMPLY WITH CLAUSES 3109.4.1 THROUGH 3109.4.3 OF THE NEW YORK
STATE BUILDING CODE CHAPTER 31 AND THE NEW YORK STATE RESIDENTIAL CODE APPENDIX G.
3. DURING CONSTRUCTION THE CONTRACTOR SHALL ERECT A TEMPORARY BARRIER AROUND THE EXCAVATION
IAW CODE OF THE TOWN OF SOUTHOLD.
4. POOL MUST BE EQUIPPED WITH AN APPROVED POOL ALARM CAPABLE OF DETECTING A CHILD ENTERING THE
WATER AND SOUNDING AN AUDIBLE ALARM WHEN DETECTED THAT IS AUDIBLE AT THE POOLSIDE AND AT
ANOTHER LOCATION ON THE PREMISES WHERE THE POOL IS LOCATED.THE ALARM MUST BE INSTALLED,
MAINTAINED AND USED IN ACCORDANCE WITH THE MANUFACTUERS INSTRUCTIONS.THE ALARM MUST MEET
ASTM F2208"STANDARD SPECIFICATION FOR POOL ALARMS".THE DEVICE MUST OPERATE INDEPENDENT(NOT
ATTACHED TO OR DEPENDENT ON)OF PERSONS.
5. POOL SUCTION FITTINGS(EXCEPT FOR SURFACE SKIMMERS) MUST BE PROVIDED WITH A COVER THAT
CONFORMS TO ASME/ANSI A112.19.8M OR A MINIMUM 12"X12" DRAIN GRATE OR A CHANNEL DRAIN SYSTEM.
SUCH VACUUM RELIEF SYSTEMS SHALL CONFORM WITH ASME A112.19.17 OR BE A GRAVITY SYSTEM APPROVED
BY THE TOWN OF SOUTHOLD. POOL SHALL BE PROVIDED WITH A MINIMUM OF 2 SUCTION FITTINGS OF THE
ABOVE MENTIONED TYPE,THE SUCTION FITTINGS SHALL BE SEPERATED BY A MINIMUM OF 3'AND MUST BE
PIPED SUCH THAT WATER IS DRAWN THROUGH THEM SIMULTANEOUSLY THROUGH A VACUUM RELIEF-
PROTECTED LINE TO THE PUMP(OR PUMPS).VACUUM/PRESSURE CLEANING FITTINGS SHALL BE IN ACCESSIBLE
POSITION. MINIMUM OF 6"AND NO GREATER THAN 12" BELOW THE MINIMUM OPERATIONAL WATER LEVEL
OR BE AN ATTACHMENT TO THE SKIMMER/SKIMMERS.
6. ALL ELECTRICAL WORK SHALL COMPLY WITH THE REQUIRMENTS OF NFPA 70 (NEC), PRINCIPALLY ARTICLE 680
AND THE NYS RESIDENTIAL CODE SECTION 4102 THROUGH 4106.ALL ELECTRICAL DEVICES MUST BE APPROVED
BY UNDERWRITERS LABORATORIES AND BE PROTECTED BY A GROUND FAULT CURRENT INTERRUPER(GFCI)
CURRENT CARRYING ELECTRICAL CONDUCTORS EXCEPT FOR THOSE PROVIDING POWER TO POOL LIGHTING AND
POOL EQUIPMENT SHALL MEET THE SEPARATION REQUIREMENTS OF TABLE E4103.5.ALL METAL ENCLOSURES,
FENCED OR RAILINGS NEAR OR ADJACENT TO THE SWIMMING POOL THAT MAY BECOME ELECTRICALLY
CHARGED DUE TO CONTACT WITH AN ELECTRICAL CIRCUIT SHALL BE EFFEVTIVELY GROUNDED.
1
7. ALL PIPING IS DIAGRAMMATIC UNLESS OTHERWISE STATED.
8. CONTRACTOR TO PLACE THE POOL IAW TOWN OF SOUTHOLD CODE SETBACKS.
9. ALL DRAINAGE FROM THE POOL SHALL BE MAINTAINED ON THE SUBJECT PROPERTY.
10. ALL GAS AND OIL WATER HEATERS(IF INSTALLED) FOR THE IN-GROUND SWIMMING POOL SHALL BE NATIONAL
APPLIANCE ENERGY CONSERVATION ACT(NAECA) COMPLIANT. POOL HEATERS SHAL BE TESTED IAW ANSI Z2156
AND SHALL BE INSTALLED IAW MANUFACTURERS SPECIFICATIONS. OIL FIRED POOL HEATERS SHALL BE TESTED
IAW UL726. POOL HEATERS SHALL BE LOCATED OR GUARDED TO PROTECT AGAINST ACCIDENTAL CONTACT OF
HOT SURFACES BY PERSONS. POOL HEATERS SHALL BE PROVIDED WITH TEMPERATURE AND PRESSURE-RELIEF
VALVES. FOR HEATERS NOT PROVIDED WITH THE FOLLOWING ENERGY CONSERVATION MEASURES.
11. ALL POOL HEATERS SHALL BE EQUIPPED WITH AN ON-OFF SWITCH MOUNTED FOR EASY ACCESS TO ALLOW
SHUTTING OFF THE OPERATION OF THE HEATER WITHOUT ADJUSTING THE THERMOSTAT SETTING AND TO
ALLOW RESTARTING WITHOUT RELIGHTING THE PILOT LIGHT.
12. TIME CLOCKS SHALL BE INSTALLED SO THE PUMP CAN BE SET TO RUN DURING OFF-PEAK ELECTRICAL DEMAND
PERIODS,AND CAN BE SET TO RUN THE MINIMUM TIME NECESSARY TO MAINTAIN THE POOL WATER IN A
CLEAN AND SANITARY CONDITION IAW APPLICABLE SANITARY CODE OF NEW YORK STATE.
13. THE POOL WAS DESIGNED IAW THE FOLLOWING:
13.1THE BUILDING CODE OF NEW YORK STATE (2007)
13.2 THE ENERGY CONSERVATION CONTRUCTION CODE OF NEW YORK STATE(2007)
13.3 THE FUEL GAS CODE OF NEW YORK STATE(2007)
13.4 THE NEW YORK STATE SANITARY CODE.
13.5 AND/INS PI-5 STANDARD FOR RESIDENTIAL IN-GROUND SWIMMING POOLS.
13.6 BOCA CODE SENTION 421.
13.7 CODE OF THE TOWN OF SOUTHOLD.
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