HomeMy WebLinkAbout36480-Z Town of Southold Annex
guEPOl,�c 8/22/2011 a 54375 Main Road
Southold,New York 119714,1
`
a �
CERTIFICATE OF OCCUPANCY
No: 35158 Date: 8/22/2011
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 1430 Clearview Ave, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.-9-54
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
6/15/2011 pursuant to which Building Permit No.. 36480 dated 6/15/2011
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:
accessornground swimming pool with fence to code as applied for.
The certificate is issued to Caiola,Gene&Caiola, Shari
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. . 36480 8/l/01
PLUMBERS CERTIFICATION DATED
ed Signature
Town of Southold Annex 8/22/2011
fcOG
54375 Main Road
y x Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35159 Date: 8/22/2011
THIS CERTIFIES that the building OTHER
Location of Property: 1430 Clearview Ave, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.-9-54
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
6/15/2011 pursuant to which Building Permit No. 36480 dated 6/15/2011
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 hot tub with deck as applied for.
The certificate is issued to Caiola;Gene&Caiola, Shari
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36480 8/1/11
PLUMBERS CERTIFICATION DATED
Auto ' eds ignat re
TOWN OF SOUTHOLD
o�°SufFot��Oo, BUILDING DEPARTMENT
�
y g
' TOWN CLERK'S OFFICE
°° • � ; SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES `v
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 36480 Date: 6/15/2011
Permission is hereby granted to:
Caiola, Gene & Caiola, Shari
27 S Pentaquit Ave
Bay Shore, NY 11706
To: inground swimming pool & accessory spa with deck, fenced to code
At premises located at:
1430 Clearview Ave
SCTM # 473889
Sec/Block/Lot# 70.-9-54
Pursuant to application dated 6/15/2011 and approved by the Building Inspector.
To expire on 12/14/2012.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $658.80
CO - SWIMMING POOL $50.00
CO - SWIMMING POOL SPA $50.00
Total: $758.80
Building Inspector
?tx)
D
Form No.6. AM 2011
TOWN OF SOUTHOLD:
BUILDING DEPARTMENT
TOWN FALL BLDG.DEPT.
765-1802.
TOWN OF SOUTHOLD
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 211.0 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(prio.r 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 cgnsent 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: (cheek one)
Location of Property:--., I (4"AD
House No. Streei I 1 ` Hamlet
Owner or Owners of Property: V1 e. 9i a i/)� Ca 1()l G�-
Suffolk County Tax Map No 1000, Section_ (� Block Lot
Subdivision Filed Map. Lot:.
Permit No. L ..Date of Permit. Applicant:
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Pee Submitted: $ 1
Applicant Signature
Form No.6
TOWN OF SOUTHOLD: AUG 19 2011
BUILDING DEPARTMENT
TOWN HALL
765-1802. TOW BLDG D EPT.
Of SOU*LD
APPLICATION FOIL;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 sew
erage-lisposal(S-9 farm).
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 2l10 of 1Wlead.
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: Subnut 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 u.sess
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-existi g Building: (cheek one)
Location of Property: �AAHS c�"
House o. Street Hamlet
ert Owner or Owners of Property: i/tP l�I,, �, t� i (GL.
<'�P d r �(�
Suffolk County Tax Map No 1000, Section (� Block - Lot y
Subdivision Filed Map.
Lot:
Permit NQ. Date of Permit. Applicant;
Health Dept.Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
1~ee Submitted: $ ,��►. �'
Applicant Signature
SO(/Tyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179
Southold,New York 11971-0959 roger.richert(a�town.southold.ny.us
CDU�,N
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Caiola
Address: 1430 Clearview Ave City: Southold St: NY Zip: 11071
Building Permit#: 36480 Section: 70 Block: 9 Lot: 54
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 X
Addition Survey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 1 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 3 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
Transformer Appliances Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other Equipment: in ground swimming pool, self contained hot tub, patio with BBQ, to consist of,
1 control panel, 1 pool light, 1 pump, 1 GFCI circuit breaker,GFCI protected disconnect for self contained hot tub,GFI'for BBQ deck
Notes:
Inspector Signature: Date: Aug 1 2011
81-Cert Electrical Compliance Form
FIELD 1�TSPE �i IRPMT DATE COMMENTS.
L rOUND,ATION IS
.. LA
FOUNDATION(2ND)
O
�o
POUGH MAMVQ-&
PUMBING c
INSUL•AMN PEAL N$ Y.
STATE ENERGY CODE. '
•
FINAL
ADDITTOIVAL.C6-- TB .
z
rn
►W
�OF S0(/r�,
� o
• ao
cOUPliV,�
TOWN OF-SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING/STRAPPING INAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS: co
o
DAT INSPECTOR
TOWN OF SOUTHOLD BUILDIN(i 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. 31 � �;v Check
Septic Form
N.Y.S.D.E.C.
CE Trustees
D Flood Permit
Examined ) ,20 ( Storm-Water Assessment Form
JUN "g 1011 /' Contact:
Approved 1 5 ,20_ Mail to: _
Disapproved a/c BLDG.DEPT..
TOWN OF 800T Lb
Phone;,
Expiration f A )_20J
D E_C E QW ,E7
I Building Inspector
„ APPLICATION FOR BUILDING PERMIT
Date , 20
BLDG.DEPT. INSTRUCTIONS
TOWN OF SOUTHOLD
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 constiuction 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
authorize rrrmDee.1ors;Tn arenalsesanoo liPan.qding for necessary inspections.
OCCUPANCY OR I M MEDIAT awk,I-,
ENCLOSE FOOL 10.COWignature of applicant or name,if a corporation)
!�JSE IS UNLAWFUL _. UPON COMPLET�y
WITHOUT CERTIFICATE `'BEFORE„ ,.� /.�0 awe t'.._, &1e /Le, 1.1- ,q Y1�gz1
(Mailing address of applicant)
OF t 9CUPANCY c o 's .
State whet applicant is owner, lessee, agent, architect, engineer, general contractAPPRIDVE ASINOVMr builder
DATE' //B.P.#
F
Name of owner of premises C_0.�
_ O BY
(As on the tax roll or late966 8 AM TO 4 PM FOR THE
If applicant is a corporation, signature of duly authorized officer FOLLOWING INSPECTIONS:
1- FOUNDATION-TWO REQUIRED
(Nam.e,and,t`tic'.6f corliorate..officer) FOR POURED CONCRETE
2. ROUGH-FRAMING,PLUMBING,
STRAPPING,ELECTRICAL 8 CAULKING
Builders License:Rio. ' S�'f .Z 6. 3. INSULATION
FINAL-CONSTRUCTION
4.
Plumbers License No. MUST BE COMP, -T &ELECTRICAL
`tv. Electricians License No. _ =0R C.0
ALL CONSTRUCTION SHALL ME'T 'HE
Other Trade's License No. REQUIREMENTS OF THE Cr'-)ES OF NEW
U, YORK STATE. NOT RESPONSIBLE FOR
1. Locat'o land on whi ropose o w>�1 e DESIGN CONSTRUCTION ERRORS.
s�l�- AIfV STORM WATER RUNSFF
- —
House Number Street 2� Hamlet PURSUANT TO C PTER 236
OF THE TOWW
County Tax Map No. 1000 Section AgAgo Block Lot
Subdivision Filed Map No. Lot
i
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 �F51 Qc-N`T A-L,
3. Nature of work (check which applicable): New Building Addition Alterati
Repair Removal Deriiolition,- ;;,; : Other-Work SPA (,�� oo L.
(Desc iption)
4. Estimated Cost i, ! o Fee
(To'be;paid on filing this application)
5. If dwelling, number of dwelling units /vim r Num"firer of clw'eing units_on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy,`spedfynnature-arid.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
T d s f• i � ''K'�l�� I 1 .
8. Dimensions of entire new construction: Front Rear F Depth
Height Number of Stories L--- - -1
9. Size of lot: Front 100 Rear O Depth �J "
10. Date of Purchase Name of Fonner 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 /ill excess fill be removed from premises? YES NO
14. Names of Owner offremises Address Phone No. _
Name of Architect C—M-'l TIE ID_ F—a-SE NJ Address Fk li�✓tj Phone Nob 5( 7 07a O
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 \4AY 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 f6undpy�aAAt%on.plari aid)distances to property lines:
17. If elevation at any point on property is at 10 feet or bePow, must provide topographical data on survey.,
18. Are there,anys.covfiaan�ts, an�drestrictions with respect to this property? * YES NO
IF YES;°PROVI'DE°A'COPY. }
STATE OF NEW`YORK)`�
COUNTI' z-'ar` )bRaomo
_
S,11
1127 i a� ' i being duly sworn, deposes and says that (s)he is the applicant
(Nain 'o'i icl vidual`sigi I ,co�itracf) above named
i1E.1`: 9:3 , CONNIE''D. BUNCH
Notary Public,State of New York
(S)He is.the;,, �,:,;�� !� HY' No.01 BU6185050
. ounty
tt(Cpti� aor,Agent, Corporate Officer, etc.) Qualified in Suffolk C
Commission Expires April 14,
of said owner or owners,and is'duly autliorized to perform or have performed the said work and to make and file this application;
that all statements contiairied''in',this application are true to the best of his'knbo 4 dge and belief; and that the work will be
,.. �;;. .,,� [;
performed'in'the nanner,set'f_orth'ig the application filed therewith:
it .,"`. •i.�� f.�1r•�� , .
T.
Sworn to before me tlis `
2—I day of 20
Notary Public Signature of Applicant
06/08/2011 07:34 7656641 BOARD OF TRUSTEES PAGE 01
Jill M_Doherty,President , �4F SOU�ya Town Hall Annex
Bob Ghosio,Jr.,Vice-President �*4 Pap 75 Main d Box Sl
James F.lying Southold,New York 11971-0959
)Cleve Bergen
Telephone(631) 765.1892
John Bredemcyer Fax(631)765-664.1
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
,tune 7, 2011
Mr. Chuck Pdnciotta
Castle Quality Homes, Inc.
22 Sandra Drive
Hauppauge, NY 11788
RE: GENT; &SHARI CAIOLA
1430 CLEARVIEW"E., SOUTHOLD
SCTM#70-9-54
Dear Mr. Princiotta:
The Board of Trustees reviewed the survey prepared by John T. Metzger last dated May 6,
2011 and determined the proposed construction of an in-ground swimming pool and spa area
with deck to be 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 and/or wetlands
jurisdictional boundary,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 best management practices 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.
This determination is not a determination from any other agency.
If you have any further questions, please do not hesitate to call.
Sincerqly,
Jill M. oherty, President
Board of Trustees
JMD:Ims
New York State .Department of Environmental Conservation.
Division of Environmental Permits, Region 1
SUNY @ Stony Brook
50 Circle Road, Stony Brook, NY 11790-3409
Phone: (631) 444-0365 • Fax: (631) 444-0360
Website:-www.dec.ny.4ov
PERMIT MODIFICATION
May 27,2011
Gene and Shari Caiola
27 S Penataquit Avenue
Bay Shore, NY 11706
Re, Permit # 1-47.38-03804/00001
Caiola Property, 1430 Clearview Avenue, Southold
Dear Mr. and Mrs. Caiola:
The.Department of Environmental Conservation (DEC) has reviewed your
request to modify the above referenced permit in accordance with the Uniform
Procedures Regulations (6NYCRR Part 621). It has been determined that the proposed
modifications will not substantially change the scope of.the permitted actions'or the
existing permit conditions. Therefore, the permit is hereby modified to authorize:
Revised configuration of pool and construction of spa and deck, as shown on.the.
plans prepared by John T. Metzger,.last revised 5/6/11, and stamped NYSDEC
approved on 5,127/11.
This. letter is a-modification to the original permit and must be available at the job
site whenever authorized work is.in progress.
All other terms.and conditions remain as written in the original permit.
Sincerely,
Mark Carrara
Permit Administrator
cc: . C. Princiotta
BOH=TW
File
�osu � Town of Southold '
J
U g Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM
O PROPERTY oCATION: C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
y01�jYty- 0 STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
-bTsiilc� ec3 ton a oc of CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No
a. What is the Total Area of the Project Parcels? -7 /► .� Will this Project Retain All Storm-Water Run-Off
(Include Total Area of all Parcels located within [ s Generated by a Two(2")Inch Rainfall on Site?
the Scope of Work for Proposed Construction) .F./Acres) (This.item will include all run-off created by site — ❑
b. What is the Total Area of Land Clearing S ( emL clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed A10"t yDD) Site Improvements and the permanent creation of
construction activity? (S.F./Aues) impervious surfaces.)
2 Does the Site Plan and/or Survey Show All Proposed
PROVIDE BRIEF PROJECT DESCRUMON (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This — ❑
Item shall include all Proposed Grade Changes and '
Slopes Controlling Surface Water Flow.
3 Does the Site Plan and/or Survey describe the erosion i
J �� J v'"'✓ and sediment control practices that will be used to i
control site erosion and storm water discharges. This Er I
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 YardsE]
i
of Material.withimany Parcel?
r
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?
6 Is there a Natural Water Course Running through the
Site? Is this Project within the Trustees jurisdiction ❑ t/
General DEC SWPPP Requirements: or within One Hundred(100')feet of a Wetland or.
Submission of a SWPPP is required for all Construction activities involving soil 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 If are part of a larger common plan that will ultimately disturb one or more acres of land; Which Exceed Fifteen(15)feet of Vertical Rise to ❑
Including Construction activities involving soil disturbances of less than one(1)acre where
the DEC has determined that a SPDES permit is required for storm water discharges. One Hundred(Fifteen
)of Horizontal Distance?
(SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 WIII Driveways,Parking Areas or other Impervious El —
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 shall be prepared prior to the submittal of the NOI.The NOI shall be into and/or in the direction of a Town right-of-way?
submitted to the Department prior to the commencement of construction activity.
2.The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material,
required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any Elconstructed to reduce the pollutants in storm water discharges and to assure Iteftl Within the Town Right-of-Way or Road Shoulder
compliance with the terms and conditions of this permit.In addition,the SWPPP shall Area?(This Item will NOT Include the Installation of Driveway Aprons.)
Identify potential sources of pollution which may reasonably be expected to affect the
quality of storm water discharges. . NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark
3.All SWPPPs that require the post-construction storm water management practice in a Box and the construction site disturbance is between 5,000 S.F.&1 Acre in area,
component shall be prepared by a qualified Design Professional Licensed in New York a Storm Water,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(4)and/or Answer for each Question is Required for a Complete Application)
STATE OF NEW YORK, Notary Public,State of New York
COUNTY OF .............SS No.01 BU6185050
Qualified in Suffolk County .
\_
Commission Expires April 14,2_kr _
That I,.......S�q.0 1..........Caf.p. ,...............being duly sworn,deposes and says that he/she Miles
for Permit,
(Name of Individual signing Document)
And that he/she is the .......................................... .. .. ....
... ...........................................
(Owner,Contractor,Agent,Corporate Officer,etc.)
i
Owner and/or representative of the 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 herewith.
Sworn to before me this;
......... ......................day of ......... .............................,20.�!
Notary Public: •ll �!....... ........... ....
►.JU!••� r nature o.................: ............
.. .
(S'g f Applipnt) I
FORM - 06/10
SO�jyQ
Town Hall Annex Telephone(631)765-1802
54375 Main Road a 765- 5
P.O.Box 1179 G roger.richert -toxw(n.631)soufg5b2.ny.us
Southold,NY 11971-0959
Cow
Inc)
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: Date:
Company Name:
Name:
License No.:
Address:
Phone No.:
JOBSITE INFORMATION: (*Indicates required information)
*Name: L
*Address: ine-)v Y-( z- 45-
*Cross Street:
*Phone No.:
Permit No.: �t�gQ
Tax-Map District: 1000 Section: Block:_ Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly) ��
ue
(Please Circle All That Apply)
*Is job ready for inspection: YES / 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
Mequestforinspection Form
�O��pF SO!/Tyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179 G • �Q
Southold,New York 11971-0959
�ycoUNTY,�c`�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
August 16, 2011
Gene & Shari Caiola
27 S. Pentaquit Ave
Bay Shore, NY 11706
TO WHOM IT MAY CONCERN:
FA
ing Item(s)Are Needed To Complete Your Certificate of Occupancy:
pplication for Certificate of Occupancy. (Enclosed)C.2,
Electrical Underwriters Certificate.
A fee of$50.00.
Final Health Department Approval.
Plumbers Solder Certificate. (All permits involving plumbing after 4/1/84)
Trustees Certificate of Compliance. (Town Trustees#765-1892)
Final Planning Board Approval.
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
BUILDING PERMIT : 36480 — In-ground Pool and Spa
04/21/2011 12:05 FAX 631 351 1700 BORG & BORG 191001
STATE OF NEW YORK
WORKERS' COMENSATION BOARD
CERTIFICATE OF INSURANCE UNDER NYS DISABILITY BENEFITS LAW
2ART 1.To be completed by Disability Benefits Carrier or Licensed Insurance Agent or that Carrier
i a. Legal Name and Address of Insured (Use street 1 b. Business Telephone Number of Insured
address only) (631)863-1182
.-astle Quality Homes Inc. 1c. NYS Unemployment Insurance Employer Registration
22 Sandra Drive Number of Insured
Smithtown, NY 11788
1d. Federal Employer Identification Number or Social
Security Number
11-3609074
2. Name and Address of Entity Requesting proof of Coverage 3a. Name of Insurance Carver
;Entity Being Listed as Certificate Holder) First Rehabilitation Ins. Co.
Town of Southhold
Building Department 3b. Policy Number of entity listed in box"law:
Bouthhold, NY 11971 227246
3c. Policy effective period:
01107/0501/07/12
1. Policy Covers:
a. H All for the employer's employees eligible under the New York Disability Law
b. Only the following class or classes of employer's employees:
c.
Jnder penalty of perjury, I certify that I am an authorized representative or licensed agent of the insurance carrier
'eferenced above and that the named insured has NYS,Jpisability Benefits insurance a age as described above.
Date SignedYZ2-/ _ By:
(si of carrier's aummizo represeNellve or NYS Lftersed lrmwaF&Agora orunr:+s+rmw wrrW)
73- 24 "
telephone o. _ Title: _ /?
MPORTANT: if box 4a is checked,and this form is signed by the Insurance carrier's authorized representative or NYS Licensed Insurance Agent of that carrier,
his certificate is COMPLETE. Mail it directly to the certificate holder.
f box'46'Is checked,this certificate is NOT COMPLETE for the purposes of section 220,Subd.8 of the Disability Benefits Law. It must be mailed for completion
o the Workers'Compensation Board,DB Plans Acceptance Una,20 Park Street,Albany,New York 12207
31ART 2. To be completed by the NYS Workers'Compensation Board(Only if box 14b"of Part 1 has been checked)
State of New York
Workers' Compensation Board
kecording to information maintained by the NYS Workers'Compensation Board,the above-named4nsured employer has complied with the NYS
Nsabiiity Benefits Law with respect to all or hi:;/her employees.
)ate Signed gy:
(Signature of NYS Workers'Compensation Board Employee)
Telephone No. Titre:
;lease Nate; Only insurance carriers licensed to write NYS disability benefits Insurance policies and NYS license insurance agents of
hose insurance carriers are authorized to issued Form 08-120.1. Insurance Broken are not authorized to issue this form.
)8120.1(5.06)
S.C.D.H.S. REF. NUMBER R--10090056r�gc9�
N �9 r J
LOT COVERAGE �, ss, F �. SURVEY OF. PROPERTY
EXISTING - 4090 sq.ft. AT SO UTHOLD
O9COMPLETI A uplands o
N OF IMPROVEMENTS � tl TOWN OF - SOUTHOLD
45-42 T4592/236g0= 19.4 a� �r SUFFOLK COUNTY N. Y.
�:5 . 'moo 9 1000-70-09-54
. O v
- SCALE• 1_—30
2r . .�o Q Q.00 �,<<tiF DECEMBER 5, 2006
4j ?2 �p APRIL 3, 2007 (PROP. ADDITIONS)
ti R psi MARCH 10,02008 (LOT C OVERFLAGAGE)
ry �'
100 ✓UNE 27, 2008 (REVISIONS)
moo' JUL Y 28, 2009 (ADD177ONS)
Q ��`' `sT• � DECEMBER 29, 2010 (FINAL)
MAY 6, 2011 (ADDITIONS)
<D , D'`•�1
F� ,y�y �
�?�
-10
`0T� NYSDEC
f
APPROVED AS PER TERMS
0 AND CONDITIONS OF
PERMIT NO, '�735—U3cwr/DG` ('
'o
�o /
DArE S d7 (1u0.)
\ �L CiyF,4�p�F 1�
'I's����'o e c�. ; ELEVAT/pl S AlE REFERENCED TO THE FIVE EASTERN _
O TOWNS TOPUGRAPI3)C MASS (NGVDI
�ticsU'Sc n�q O ®��E )'
jsty�l 0,91
al�-F Q .�►j �. � MET 0�
s6' ly '� ,� `�'4,N�.Q�'9Np F ��' LOCATION OF SEPTIC SYSTEM FROM 0 THERS. � �� 2�
,Q o s c�
f. fF,1'Tq� +� ■=MONUMENT
LO T.NUMBERS REFER TO ""SUBDIVISION MAP SMI THFIELD �6 i
-9� PARK FILED 1N THE SUFFOLK COUNTY CLERKS OFFICE
c 8 ON DECEMBER 27, 1966 AS FILE NO. 4770.
Otis ,6 NO. 49618
S3�• ANY AL7FRA710N OR ADD177ON TO THIS SURVEY IS A VIOLATION PECONIC
OF SECTION 7209OF THE NEW YORK STATE EDUCA77ON LAW. '
�ti Y EXCEPT AS PER'.SECRON 7209-SUBDIVISION 2. ALL CER71FICA71ONS (631) 765-50 (611) 765-1797
�r NL HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF P.O. BOX 909.
SAID MAP OR COPIES BEAR 7HE IMPRESSED SEAL OF 7HE SURVEYOR 12JO TRA VELER S77?EET
AREA Z5,175 SQ. FT. WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N. Y. 11971 06-253
r
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h Ica Spe q ca mn = Rainier P`r.V FenceWYA
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�B07Tf1M RAIL '
tuUNUM CHANNEL jN,,
A Vinyl Fence&Deck Wholesaler
'i
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11' 1'-6 1/4 _ 't 6'
1'-6 7/8" , I ,
8 CURVED -}- R6' 6
PLASTIC STEP 5' I
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2'-0 1/28' �\ 6'
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6'-0 1 8'I
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30'.
27'-11 3/4"
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VIEW ACROSS HOPPER CENTERLINE 5'-6"
1�
13'-5 3/4" 6'-6" _____� g' -�i 2
NOTE: THIS IS NON DIVING POOL AREA = 383.8 SQ. FT.
PERIMETER = 78'-7 3/a�
—N TE- �. `A
TCARDINAL HIS DRAWING. THEY SHOULD RESPONSIBLE
BY E LINEROR DIG MANUFACTUREER TOONS BE ILLUSTRATED
THEY ME 26A R D61 N A L SYS 18 4I`33
THIS 1 AND G. TH STANDARDS. — IF DIVING BOARDS scNunxaL I'Am. PA. (s7o) . 1318.'.
OR SLIDES ARE TO BE USED WTTH THESE POO,-PLEASE CONSULT THE MANUFACTURE'S INSTRUCTIONS DATE: 4.'9 10 �"'E9 15 X 30
AND THE NATIONAL SPA AND POOL INSTITUTE MINIMUM STANDARDS PRIOR TO INSTALLING DIVING LR JE CI5021
BOARDS OR SLIDES ON THESE POOLS• FOR INFO MATION CONCERNING NSPI MINIMUM STANDARDS, WRITE: 5�3 '16 =1 KIDNEY
NATIONAL SPA AN0 POOL INSTIME, 2111 EISENH WER AVENUE, ALEXANDRO, VA 22314 (703) 838-0083 ow+wN:
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AP PRO E
D AS NOTED
/
DATE
FEEBY
OCCUPANCY OR NOTIFY BUILDING EPARTMEN- ' T
-- -- i�¢ it V l L FOLLOWING INSPECTIONS-
FOUNDATIONi ,
' 765-1802 8 AM TO 4 PM FOR rtiE
I
_' 1 a I ; -TWO REQUIRED
# 43�'._ ���--T`fP 1 Ci �::.. a t"� AT OR POURS
` . ' �.� OF
I. F�!;^\ ROUGH-FRAMING,PLUMBING.
G,PLUMBING.
:, STRAPPING.ELECTRICAL&C v,n
_ AIL , d,
0 c. c �� ; �T.1 ,' .. _ c 4. FINAL-CIONSTRUCTIONCOMPLETE &ELECTRICAL
ENCLOSE P;�.', COD 1L CONSTRUC F�C 0.
TtON SHALL MEET THE
• -' '} UPON CO"r'PLETION REQUIREMENTS OF THE CODES
d OF NEW
BEFORE"WATER" PORK STATE.
DESIGN 0 NOT RESPONSIBLE FOR
10
� ' • o- NEN DECK
CAI 0LA- RE51VENCE
01111111
. . .` ��� RED AROlaf
/ice
i
y GARY PEDERSF-N .IW.ECT VAT'' NtN,6Ei 11-14 � 04120111 ' • _
ARCHITECT ` _ - •,�
(631 a 124-0700 � �>a>s 0560 o
143A East Main Street
• Smithtown,NY 11181