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�4�05�►FFOt�CpG Town of Southold 10/4/2018 P.O.Box 1179 0 C* 53095 Main Rd oy�01 �p�� Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 39943 Date: 10/4/2018 THIS CERTIFIES that the building IN GROUND POOL Location of Property: 1670 Stars Rd., East Marion SCTM#: 473889 Sec/Block/Lot: 22.4-16 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 5/25/2017 pursuant to which Building Permit No. 41754 dated 6/21/2017 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 as applied for. The certificate is issued to Fernandes,Anthony&Jennifer of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 41754 8/16/2018 PLUMBERS CERTIFICATION DATED A 00 d ignature =� TOWN OF SOUTHOLD �g�Feot� �o V BUILDING DEPARTMENT TOWN CLERK'S OFFICE • 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#: 41754 Date: 6/21/2017 Permission is hereby granted to: Schroeder, William 7966 E Phillips Cir Centennial, CO 80112 To: construct accessoryinround swimming-g g pool as applied for. At premises located at: 1670 Stars Rd., East Marion SCTM # 473889 Sec/Block/Lot# 22.4-16 Pursuant to application dated 5/25/2017 and approved by the Building Inspector. To expire on 12/21/2018. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00 CO - SWIMMING POOL $50.00 Total: $300.00 rill, Buil in ector OF SOUryolo H O TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION ' [ ] FOUNDATION 1ST [ ] ROUGH PLEIG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING / STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) ice\ REMARKS: DATE r f INSPECTO �o� olo • a� ��y00UNi'1,0� TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] SULA ON [ ] FRAMING / STRAPPING [ FINAL W.-l- FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) REMARKS: DATE -1111601 INSPECTOR # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH PL13G. [ ] FOUNDATION 2ND - [ ]�KSULATJQN [ ] FRAMING /STRAPPING [ FINAL ; 6�� [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ CAULKING REMARKS: q G t del 1 Y OV Sw ACS9046-CA VD,/ fd S Aim A irRA, , on yo 44104- Amu &A fir✓ � A'►'V'Pi�' tL �j l • Se L ',r DATEg INSPECTORn 0, oF souryolo # TOWN OF SOUTHOLD BUILDING DEPT. 765-1802 �4 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) [ ] CODE VIOLATION [ ] CAULKING REMARKS: � f tg C DATE Z �� INSPECTOR �C SO//l # # TOWN OF SOUTHOLD BUILDING DEPT. las 765-1802 INSPECTION- , [ ] FOUNDATION 1ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ])XSULATION [ ] FRAMING /STRAPPING [ FINAL YoGt Ae'. -[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: J � � r�o✓ nS oh ' �. DATE Ad INSPECTOR o�aOF 50Ulyol _ TOWN OF SOUTHOLD BUILDING DEPT. courm1 765-1802 INSPECTION [ ] FOUNDATION 1ST [ ] ROUGH PLSG. [ ] FOUNDATION 2ND [ ] IN LAT N [ ] FRAMING /STRAPPING [ FINAL a� [ ] FIREPLACE.& CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ]— CAULKING REMARKS: 0 A- 2 DATE INSPECTOR 7 pF SOUjyOlo Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 G Q Southold,NY 11971-0959 �� • �o roper.richert(Q)town.southold.ny.us cou�m, ' BUELDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICIAL COMPLIANCE SITE LOCATION Issued To: Fernandes (Schroeder) Address: 1670 Stars Rd City: East Marion St: New York Zip- 11939 Building Permit* 41754 Section 22 Block 4 Lot 16 WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE Contractor: Home Owner 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 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 A/C Blower Range Recpt Fluorescent Fixture Pumps 1 Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks 1 Disconnect Switches F1iTwist Lock Exit Fixtures 11 TVSS Other Equipment. In ground swimming pool to include, bonding, 1-time clock, 1-switch, 1-pool pump recpticle, 1-GFCI circuit breaker Notes: Inspector Signature: Date: August 16 2018 81-Cert Electrical Compliance Form.xls r• r r • ; o •� ^ r . � r r; • • fi mt STATE ` r PR wo A"All ,swilMix MO. _ TOWN OF SOUTHOLD BUILDING PERMIT APPLICATIO CHECKLIST BUILDING DEPARTMENT Do you have or need the follow' g,before applying? TOWN HALL Board of Health SOUTHOLD, NY 11971 4 sets of Building Plans TEL: (631) 765-1802 Planning Board a roval-A—/d _ FAX: (631) 765-9502 Survey SoutholdTown.NorthFork.net PERMIT NO. Check Septic Form N.Y.S.15.E.C. AM Trustees AIA C.O.Application Flood Permit AL/f / Examined ,20—D EU V Single&Separate ate • Storm-Water Assessment Form _ D ontact: Approved ,20 MAY 2 5 2011 Mail to: r spoe�/)14 ✓/ Disapproved a/c B�� GD PT. OWI�i OLI) Phones,/e,kS$ Expiration ,20 Buildin or _ APPLICATION FOR BUILDING PERMIT Date ' 20 / 7 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 Insl5ector will issue a Building Permit-to the applicant. Such a permit shal I 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 B•gilding Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southpld;Suffolk.County,New York, and other applicable Laws, Ordinances or Regulations, for the construction of building's,additions,or-alferatipns or for.removal'or demolition as herein described. The applicant agrees to comply with all applicable,lawg,'ordinances;•building code,housing code,"and regulations, and to admit authorized inspectors on premises and in building for necessary inspections'. (Signature of apgficant or name,if a corporation) (Mailing address of applicant) State whether applicant is owner, lessee, gent rchitect, engineer, general contractor, electrician, plumber or builder Name of owner of premises (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.�/J�6" /,0.0 i/a2-6 Plumbers License No. S'E L,e Electricians License No. G'gg,. �AORge?gNE Other Trade's License No.' Z,2yi 7a I.' Loc"ation of land•drt•which proposed work will be done: /% 7Q.. ` 5-,4,+.S 2d ��/QST /1112 A14-1.00-/ /1,9 use Number; Street Hamlet County Tax Map No. 1000 Section 6 Block Lot Subdivision *)AP pt= �adA!S elle4l Filed Map No. .5-JZ/ s Lot 2. State,existing use and occupancy of premises and intended use and occupancy of proposed;construction: a. Existing use;and occupancy CT C�y" A ,411.4 b. Intended use and occupancy 3. Nature of work (check which applicable): NewjBuilding Addition _Alteration Repair_ Removal�� Demolition Other Work /aOo/ 11Odd'6 100 aE 4. �... ,� (Description) Estimated Cost 7 -s .Gf j '�' �i �F .-J r f. Faej (To be paid on'filing this application) 5. If dwelling, numbenof dwelling uniO _' e Number of cl '1 ing units on each floor' If garage, number of cars _ — ,6. If business, commercial or mixed occupancy;,, Pq cify,nj Bind extent of each type of use. 7. Dimensions of existing structures,,if any,: Front;' Rear Depth Height Numberiof Stories Dimensions of same structure*with alt ratiorts or additions: Front _Rear Depth ` Height Number of Stories 8. Dimensions of entire ew construction: Fkont' ;` D e%? kear& 0 '211 Def5th gY,b SO 1,/T// Height �� ° %0 y _Number of'Stories 7P70 /Voje,Th 9. Size of lot: Front 117 Depth AIP�• H). Date of Purchase 4b4v17__Nam`e.otFormerOwner'se'ellx'poC3SX1 ' 1 . Zone or use district yin which premises aro;situated 12. Does proposed construction violate any;zonirig`I4vv, oxdia}anee br xqgµlation?,YES_ NO1> 1 . Will lot be re-graded? YES`� •NO V' ill tmess fll,be-removed from.premises?YES 1 . Names of Owner ofpremises ` : ZIVX,,M6ts ),:,'A'Adr.4�ssQ/.re;09 AellAy Ali Phone•No.,zl#C'`V75'7a�L Name of Architect *//" %G q '�i'O ! ;;, 'f Address Phone lN- Name of Contractor_! & C�44;�p€� y �p Ad,'dress3 �� sPhone+l`oi,_-21.� � s'Z'M -- 1 a. Is this property'within'100 feet of a fiidaj et ci'ot'a'fres watr.wetlaind? *YES IF YES, SOUTI�OL' TO 'NiIkUSTI✓ jil `.C,�PF T `1VIA�BI �REQUIF.ED: b. Is this property' wit�in'300 feet of a teal we't Vii? `YE7S ' 140. $ —= IF YES, D.E.C. PERMITS MAY BE REQUI lir• L 16. Provide survey, to scale, with accurate fb4nd4061n 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 i IF YES, PROVIDE A COPY. ' S--ATE OF NEW YORK) SS: COUNTY OF� I S� d die V/ � being duly:sworn, deposes and says that(s)he isthe applicant (Name of individuaf signing contraet)above homed, , a (S)He is the QtJV1.P� (Contractor,Agent, Corporate Offider,etc.) ; of said owner or owners, and is duly authorized to;perform or havd•perforrred the said work and to make'and file,this application; are true, th t al l statements contained in this application to the best of his knowledge aild belief; and that tie work;wil l be performed in the manner set forth in the-application filed therewith. , TRACEY L.'DWYER NOTARY PUBLIC,STATE OF NEW YORK Sworn tobefore me this NO.01DMM900 QUALI�IEIJ SUFFOLK COUNTY day of�I� _2017 CO MISS EXPIRES JUNE 30, Notary Publi Sigi ature of Applicant;� 9 14�-& $�FFat ILDING DEPARTMENT- Electrical Inspector �p _ uL 2Gj 201 TOWN OF SOUTHOLD CS Town Hall Annex 54375 Main Road - PO Box 1179 o _ G1 B Offg��,U Southold, New York 11971-0959' 3 e:;IT Telephone (631) 765-1802 - FAX (631) 765-9502 roger.riche rt(aD_town.south old.ny.us APPLICATION F R ELECTRICAL INSPECTION REQUESTED BY: -,� ` �f �'/r�,j d� Date: Company Name: Name: License No.: � /� email: Address: Phone No.: JOB SITE INFORMATION: (All Information Required) Name: Address: Cross Street: ZDZf/ lelo ,�a-- 1I� o Phone No.: Bldg.Permit#: V/;7_�5- j email: Tax Map District: 1000 Section: Block: Q Lot: BRIEF DESCRIPTION OF WORK (Please Print Clearly) a�,� ��d� �'/�✓e�C, Circle All That Apply: Is job ready for inspection?: 65S / NO Rough In anal Do you need a Temp Certificate?: YES / NO Issued On Temp Information: (All information required) Service Size 1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire 'Reconnect- Flood Reconnect- Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION cti 0\ Request Request for Inspection Formals t ' Scott A_ Russell 1.�y°SUrj-� SUPERVISOR 1\\[,A\,N A\�(( IE1W1EN F SOU HOLD TOWN HALL-P_O.Box 1179 p 53095 Main Road-SOUTHOLD,NEW YORK 119710 Town of,Srou th o l d IMAY 3 n 20j? CEI['TER 236 - STORMWATER MANAGEMENT WORK SHEET (TO BE COMPLETED BY THE APPLICANT) "DOS-TFIIS--T'RO-JECJC—IIV® F—THE-70I1;OWING7------- Yes No (CHECK ALL THAT APPLY) A. CIearing, grubbing, grading or stripping of land which affects more than 5,000 square feet of ground surface. E]LA B_ Excavation or-filling involving more than 200 cubic yards of material �avithir i 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 watercourse.. i 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 Departm.Pn:Lwifbyouur Building Permit Application. APPLICANT_ (Property Owner.Design Professional gen Contractor,Other) _ S_C.T M. _ OOO Date VDistrictDistrict-/� f� / NAMEa� O��r/G /G Section Block Lot ---`-170R BUILDING D—tP;FT�It\ - � 0`Lct - .. Contact Information: .r.kN..r-......nc.' V Reviewed By: Date- 5-0-5- 17 Property Address / Location of Construction Work: — — — — — — — — — — — — — — — — — f� Approved for processing Building Permit. /�[�l S </�/�� �/llN•r Gj 7 �+ �_c, Stormwater Management Control Plan Not Required /_X fY�/��� �`% ��r/ o� 7 / Stcrm water Manager e;: Control Pla:. :b Rcqui ed. (Forward to Engineering Department for Review) FORM - SMCP- TOS MAY 20l a APPLICANT: S.C.T.M.#: 1000 sum CHAPTER 236 (Property Owner,Design Professional,Agent,Contractor,Other) — Q,0 j e� ZZ, q 0 STORMWATER MANAGEMENT CONTROL PLAN CHECK LIST NAME- WILLIAM S G& FZ-p"dSection Block Lot SI S M C P -Plan Requirements- Provide ONE copy of the Building Permit Application Pieare Print Date: � � * The applicant must provide a Complete Explanation and/or Reason for not providing 5 V (12 A WIZg 7 of all Information that has been Required by the following Checklists Signature Telephone Number, Go 1. A Site Plan drawn to scale Not Less that 60' to the inch MUST If You answered No or NA to any Item, Please Provide Justification Here show all of the following items: YES NO NA If you need additional room for explanations, Please Provide additional Paper. a. Location& Description of Property Boundaries ®=0 b. Total Site Acreage. XO�� c. Existing -Natural & Man Made Features within 500 L.F. of the Site Boundary as required by§236-1702). d. Test Hole Data Indicating Soil Characteristics&Depth to Ground Water. e. Limits of Clearing & Area of Proposed Land Disturbance. f. Existing & Proposed Contours of the Site (Minimum z intervals) g. Location of all existing & proposed structures, roads, O� driveways, sidewalks, drainage improvements&utilities. h. Spot Grades & Finish Floor Elevations for all existing& ®=0 proposed structures. BUIEDIING W1 = 1. Location of proposed Swimming Pool and discharge ring. X TowNOF'SQ j. Location of proposed Soil Stockpile Area(s). ©00 k. Location of proposed Construction Entrance/Staging Area(s). ®0 1. Location of proposed concrete washout area(s). 0©0 R,eeO M. Location of all proposed erosion&sediment control measures. 2. Stormwater Management Control Plan must include Calculations showing that the stormwater improvements are sized to capture,store,and infiltrate 6f r�,L t{f����( Su 9640ffi5 P, V 100 5 on-site the run-off from all impervious surfaces generated by a two V)inch rainfall/storm event. 3. Details&Sectional Drawings for stormwater practices are required for approval. Items requiring details shall include but not be limited to: a. Erosion & Sediment Controls. 0®0 er IrbV Ve b. Construction Entrance&Site Access. 0 v wP c. Inlet Drainage Structures (e.g.catch basins,trench drains,etc.) DT V 6 DEJ d. Leaching Structures (e.g.infiltration basins,swales,etc.) D-r n6vtD6P **** FOR ENGINEERINGJPRTM ZTE ONLY**** FI Additional Information is Required. Reviewed & I Stormwater Management Control Plan is Not Complete. Approved By: - — — — — — — — — — — — — — — — — — — — — — — — 1Stormwater Management Control Plan is Complete. Date. A 3/1 q ® SMCP has been approved by the Engineering Department. FORM * SWCP Check List -TOS MAY 2014 ,S'UR VE Y OF PROPER T Y a t EAST MARION TO WN OF SO UTHOLD SUFFOLK COUNTY, N. Y. 1 1000-22-04-16 YAGGARINO SCALE. 110-40-P — 01-03-2017 ' f_�— 1 JANUARY J, 2017 JANUARY 26, 2017 (REVISIONS) FEBRUARY 22, 2017 (CERTIFICATION) GNF MARCH 21, 2017 (REVISIONS) 1 MARCH 29, 2017 (CERTIFICATION ADDED) RAIN RUNOFF CONTAINMENTLpT 3 HOUSE = 1851 sq.ft. Cee �. /-i'lam• GARAGE = 384 sq.ft. ` POOL HOUSE = 432 sq.ft. _ _ - 1 I T 2631 sq.ft. _ �' c®D`1 J R U CrI O ��VVI �-�- &� 2631 x 1 x 0.17 = 447 cu.ft. _ - 1 4 �� N_vP " 4 ?VIOUS DRIVEWAY = 2760 sq.ft. P���" •.o M � T � - 1 :o. '760 x 0.8 x 0.17 = 375 cu.ft. 1 APPROVAL OF STORI!!tWATER MANAGEMENT 1 COltTTROI P -T h Cod ap r 236 -"-`R22 = 19.5 V.F. vAGANT — ` 1 Date. 1 3 OVIDE (4) DR 8� x 6' DEEP LOT 2 , ( AS iG 1 Approved by. DRAINAGE I C°ntact TOS Engineering ARE REQUIRED ng eerin at 7 0 before PROPOSED 1 Nckfill, OR Provide g 's Cee 6 �:` 2 ax Piet Engineer's Certification LOT COVERAGE p o �qk� °' that the drainage has been installed to Code. HOUSE = 1215 _�-�"f N� --- ,.E kt+ �N o, ��` _d Vg N9T GARAGE = 384 N7a(A2'� 'A y –'= ;SF% /F ACCESSORY = 432 o- ;� LOT , cP_ NIO QF °OOL HOUSE = 576 rim .`'° �°P.,� ;"1 z La "fQWN � ;-° a ;°wCHAP►`,�o � `� 0 rn SQU 2607 Z P/ZOPpSE�1 .o`�%�" soo. 51�- �IREARI 2607/20032 = 13% �. U(` LEGTK�a �' -- GLEA - E p°� EROSION&SEDIMENT CONTROLS PROPps'--_ESE 5A of ,E FO �` / w° pOH' 'Shall include but not be limited to: y iFApNTI A well maintained Construction Entrance, L X �i7� 3 IV, 70 N 13' LaWire Backed Silt Fencing,stabilization & - 5 4MCS..-�0 t3.3p o = ® , ,, Poop��,. O Seeding of exposed and/or inactive soils. ROPOSED SEPTIC SYSTEM _ _ `` VADA l� Vin 3 ?; , -�a�?_ BEDROOM HOUSE WITH) /�° 3�— T 6 -r , �n; POOLHOUSE BATHROOM) ��•._-` � ��° -� — � o 'CAST 1000 GALLON SEPTIC TANK - - - - - - - -• ---- o _ Fo,�� _ .-�"-- - 1°114 q5 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$15.00 Date. New Construction: Old or Pre-existing Building: (check one) Location of Property: /6 7,0 S22R.r `e-e4� �Wr A x,e>d x/ A'"7 House No. Street Hamlet Owner or Owners of Property: �/��� ��y ��!'lllxl-lei-c Suffolk County Tax Map No 1000, Section 1/21 v21 Block 7 Lot A� Subdivision_1;,-1'✓V'JC�E,rR W-DO$S 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: $ Applicant Signature U/ rgo O: 'WEL'L - f ., DR jyE �� VAGAw� 3T HOLE DATA ��� w SGNR�E®�R XV, GEOSCIENCE - 1 .?12016 BROWN LOAM OL - o I -�I I VALAN 2 --- 4, BROWN SILTY SAND SM c►>F N/OI LH�OL p15T I UNION FREE s OF BROWN f7NE TO COARSE SAND SW AGANT t; _OT J'SEP \ 1 V pWE LINA ��N REAR YAR% I L � - -� . I 17' NOTE.- NO WATER ENCOUNTERED � I _ _ I -_ co , CLEAN OUT DETAIL I -OR USE WITH BUILDING EXTENSION/CONNECRON , S OR OTHER STOPPER END 48L COVER OR PLUG CERTIFIED TO- OLD KEPU61-I C, NATIONAL T I TLE I N5UKANC E COMPANY F I K5T METKOPOL I TAN A[55TKACT CORP-T I TLE NO. A31262-5-1647 a ANTHONY C7ILKOY FERNANDE5 JENNIFER FERNANDE5 SEWER PIPE �rr," C ITIZEN5 15ANK, N.A. 15AOA, ATIMA 'TT V• 30r ELBOW v -k- J NOT TO SCALE\_60* WYE g� )NS ARE REFERENCED TO NA VD 88 11� tion of public water, wells and cesspools shown hereon �f1(r%' r rn field observations and or from data obtained from �� MILIAR WITH THE STANDARDS FOR APPROVAL AND JC77ON OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR KEY AMILY RESIDENCES AND WILL ABIDE BY THE CONDITIONS SET AREA o 20,032 SO. FT. 'HEREIN AND ON THE PERMIT TO CONSTRUCT. ® = WELL TERA77ON OR ADD177ON TO THIS SURVEY IS A WOLA77ON OF ® PIPE S LIC. NO. 49618 = 7209OF THE NEW YORK STATE' EDUCATION LAW. EXCEPT AS P � � MORS, P.C. _._- -_ _____ LOT NUMBERS REFER TO 'MAP OF SOUNDCREST WOODS SECTION ONE" ,___ _ _G _ ,_ _ ___ 00 . , 2" EXCAVATION, OtskT . , 4 '42 ., , JAn DG, Mr �rrrwwt► +s .►w +�►+r� �►r.�r«■r�r.r.►+r �..�w +w � rr � +�rw�wr�r J� r` �* WATER 'LINE , ------ ......... Lt= PT AP R VEDAS DOTED DATE: B.1). OCCUPANCY OR FEE: - USE IS UNLAIVUL OVER ��� NOTIFY BUILDING �E?�.RTMENT AT ,n,l �' 765-1802 8 AM TO 4 FM FOR THE WITHOUT CERTIFICATE 'DIMENSIONS . 1. FOUNDA i0'N - R OF O CUPAIICY 0' � 1. FOUNDATi��d - T,���._' REOU ,;ED x. 36 FOR r"OUREl) CC':'w"ETE 2. ROUGH • FRA%AIING & PI.UVSING DIAGONAL 3. INSIJ'ATION 4. FINAL - CONT .�'�,T ION MUST ELECTRICAL BE COMPLETE P,_` C.O. ALL CONSTRUCTION SHA'.L ti'EET THE INSPECTION REQUIRED REQUIREMENTS OF HE ,C-DES OF NEW YORK STATE. NOT ... . . . .... . . _.HI.r.•.,AAu ... �. .. , ?ESPONSIBLE FOR ..... DIGNOR CONSTRUCTION � u.� .. , _ ...., ....... ..... ... .. ...... ....... .. ... . x .. ,.. . , .. . . ,. .,. ... -.. _�. ... .. .._. ... . . . Max. Length of Diving loard 8' ENCLOSE eOOLTOCODE UPCId COMPLETION Jug r r COMPLY WITH ALL CODES OF BEFORE "WATER-" NEW YORK STATE & TOWN CODES ' - AS REQUIRED AND CONDITIONS OF :I'AIN STORM WATER F'."', 0RSUANTTo CHAPTER 2Z #eght ` "`` x WATER LINE OF THE TOWN CODE.. 4011 FIN* 1-0, Ml —map ioiiaol-l- Watera FIN# '!R�(Try 1,4 C; ts ul let fl R& U, i a }''`t,'`.N'}'•° , 8, N JLC M ,,�e-r��� %✓' x� % ^w,.�,�,. � s. , ''? � A��A�^i:.k,c*ai ,+r�5 �e�r rd�,�:. .r.+.,r �> •. ' �-` I ,�'�,'-' ��>,�,� ',xi^ a a�;`,t.;+tea `�'+�� +� '`,`^S.z'� AC;�� •a4�:. +�'>°r�'±� �f�� ".'�r�,p"- 4n ,�,' ,.,�,, 2* HARD BOTTOM loft 8`/"* 7 600% 2GYM7 U`6 7 4t#~60 � , ► 141 21 36 AVATION EXCAVATION (,z Av .3 R A G b#'w% -#in ,. R ,ad EXC .......... .... PE .i 1001 ,,,,10, 1