HomeMy WebLinkAbout37045-Z Town of Southold Annex 2/26/2013
P.O.Box 1179
N 54375 Main Road
oy o� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36151 Date: 2/26/2013
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 13920 Soundview Ave, Southold,
SCTM#: 473889 Sec/Block/Lot: 54.-3-3
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
3/7/2012 pursuant to which Building Permit No. 37045 dated 3/7/2012
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 inground swimming pool fenced to code(per New York State Variance Petition#2012-0492)as applied for.
The certificate is issued to Smith,Patrick&Smith,Judy
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37045 4/11/12
PLUMBERS CERTIFICATION DATED
Autho ' d Signatur
TOWN OF SOUTHOLD
o�SUFEo���oG BUILDING DEPARTMENT
2 y
TOWN CLERK'S OFFICE
oy • � �¢ 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 #: 37045 Date: 3/7/2012
Permission is hereby granted to:
Smith, Patrick & Smith, Judy
13920 Soundview Ave
Southold, NY 11971
To: construct an accessory inground swimming pool fenced to code as applied for
At premises located at:
13920 Soundview Ave
SCTM # 473889
Sec/Block/Lot# 54.-3-3
Pursuant to application dated 3/7/2012 and approved by the Building Inspector.
To expire on 9/6/2013.
Fees:
SWIMMING POOLS -ABOVE-GROUND WITH REQUIRED FENCING $250.00
CO - SWIMMING POOL $50.00
ELECTRIC $100.00
Total: $400.00
Building Inspector
Form No_6.
TOWN OF SOUTHOLD 1 ( „
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 2110 of I% lead.
5. Commercial building, industrial building, multiple residences and similar buildings and installations,a certificate
of Code Compliance from architect or engineer responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
.B. For existing buildings(prior to A.pril9,1957) 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
l. 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$50.0a.
2. Certificate of Occupancy on Pre-existing Building- $100.00
J. Copy of Certificate of Occupancy-$.25
4. . Updated Certificate of Occupancy- $50.00
.5. Temporary Certificate of Occupancy- Residential $15:00, Commercial $15.00
Date. I "L U -2-
New Construction: _ Old or:Pre_existing Building: (check one)
Location of Property: I3�-r2a 'Si, wJ LAe„-, ue— or✓�(no, a
House No Street' Hamlet
Owner or Owners of Property: A—V v L, 1,
Suffolk County Tax Map No 1000, Section Block Lot 3
Subdivision o,T�.j-,w,Cyct -FP 5 Filed Map. (o_.S Lot:
Permit No. �J 4 5 Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:/
Planning Board Approval:
Request for: ' Temporary Certificate Final Certificate: (check one)
Fee Submitted: $ J0 . 00
Appli nt Signature
pf SOUTyolo
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 roger.richert( -town.Southold.ny.us
Southold,NY 11971-0959
c4UNTY,�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Patrick Smith
Address: 13920 Soundview Ave City: Southold St: NY Zip: 11971
Building Permit#: 37045 Section: 54 Block: 3 Lot: 3
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Bethel Electric License No: 2880-me
SITE DETAILS
Office Use Only
Residential X Indoor X 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 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 1 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt 1 Recessed Fixtures CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps 1
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks 1
Disconnect Switches 1 Twist Lock Exit Fixtures TVSS
Other Equipment: in ground swimming pool to include, bonding, 1-pump, 1-GFCI circuit breaker
Notes:
Inspector Signature: Date: April 11 2012
81-Cert Electrical Compliance Form.xls
pf SO(/l�olo
�o • a�
�y00UMY,�
N OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE `� f Z/ INSPECTOR
�� �o��OF SOUTyo�
o�yCOU ,�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH G..
[ ] FOUNDATION 2ND [ ] IN LATION
[ ] FRAMING/STRAPPING [ FINAL &fl-
] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE /� INSPECTOR
n
FIELD INSPECTI REPORT T DATE COMMENTS
IEFOUNDATION(1ST)
• i
- --...........-.r._--------------
t�1 �
FOUNDATION(ZND) 73 M
o
Q
ROUGH Mi nNQ& y
PLUMBING
INSULATION PER N.Y. H
STATE ENERGY CODE
' Y
f
FINAL
ADDITIONAL COMMENTS
z
. rn
i
T-O W N OF SO U ROLE? t�uu,liuvU r;;xiv�I l ArrL1�R'r1uN C;HJ✓C;KL15
BUILDING DEP TMENT Do you have or need the following, before applyin@
TOWN HALL `1 Board of Health
SOUTROLD, NY 11971 3 sets of Building Plans
TEL: 765-1802 Survey
PERMIT NO, Z Check
Septic Form
N,Y,S,D,E,C.
Trustees r�
Examined 200 Contact:.
3 .
Approved , 20 Mail to;
Disapproved a/c
' Phone;
it V
wilding Inspector
APPLICATION FOR BUILDING PERMIT
Date iL� Z H , 20 j2
INSTRVCTIONS
a, This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
sets of plans, accur to 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 wort covered by this application may not be commenced before issuance of Building Permit,
d. Upon ap roval 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 a Certificate of Occupan
is issued by the Bui ding Inspector,
APPLICAI ION 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, Suffoll�.County, New York, and other applicable Laws, Ordinances or
Regulations, for th construction of buildings, additions, or'a.'lterations or for removal or demolition as herein described. The
applicant agrees to I o'mply with all applicable laws, ordinances, building code, housing code, and regulations, and to admit
authorized inspectors on premises and in building for nebcssaiy inspections,
V
(Signature of applicant or name, if a corporation)
-3rl' Ve-�e,(ati- �-
(Mailing addre s of applicant) //-716
State whether apf licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Name of owner of premises 4+yi jc
(as pn the tax roll or latest deed)
If applicant is a c Drporation, signature f duly authoriz8d o e >
1 i A, be,,ram.ter,v re-j ; &e v,
(Name an title of corporate officer)
Builders License No, 5`�5 �) ��` „e! 66ir v c, on
Plumbers Licens No.
Electricians License No, �/Cj J — � �,/,D� lot,
Other Trade's License No,
1., Location of 1 nd on which proposed work will b ' done;
House Numb r Street Hamlet
County Tax Ddap No, 1000 Section � Block :3 Lot 3
Subdivision yaM .. 4-e g Filed Map No. 5-6 -,7 S Lot_f
(Name) .
i
• State existing use and occupancy of pr uses and intended use and occupancy of proposed construction:
a, Existing se and occupancy a,
Iy
b, Interfded use and occupancy pt.:10er,; 1 Vt_1�11IV, )
1, Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work �T vrJ_ Su.- w•w.� ;H � ,j
W,,c3y ,,,,j jDcscription)
1, Estimated Cost IQ Oor9 Fee
(to be paid on filing this application)
If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
�. If business, commercial or mixed occupancy, specify nature and extent of each type of use,
Dimensions of existing structures, if any: Front Rear Depth
Height , Number of Stories
Dimensions of �ame structure with alterations or additions; Front
i Rear
Depth Height Number of Stories
Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
Size of lot: Front Rear_ 'c-+ Depth
0, Date of Purchase Name of Former Owner Fye. _e v &1G �- ,4 vav 5 le:I-
l, Zone or use district in which premises are situated
2. Does proposed cc nstruction violate any zoning law, ordinance or regulation:
I Will lot be re-gra led _,0 Will excess fill be removed from premises; (?_ES�> NO
4, Names of Owner of premisesVC14v;olL Ci tn,-*- ,n Address 3� v:s�-A� Phone No, 2 65 1'1 fJ
Name of Archite t Address 26V ,ker[>,.4>k phone No -7-14 -73 S
Name of Contrac or. ,, ."Ve Rol�,1 s Address -
S. Is this property within 100 feet of a tidal wetland? *YES NO
• IF YES, SOUTHOLD TOWN TRUSTEES PERMITS MAY BE REQUIRED
6. Provide survey, t scale, with accurate foundation plan and distances to property lin(-,s,
7. If elevation at art point on property is at 10 feet or below, must provide topographical data on survey,
TATE OF NEW YOIL.). .
SS:
:OUNTY OF Ga k
4 �' r•� � �`_+ '" being duly sworn, deposes and says that(s)he is the applicant
(Name of individ al signing contract) above named,
')He is the yI 44 C LAC,.
(Contractor, Agent, Corporate Officer, etc,)
f said owner or owne s, and is-duly authorized to perform or have performed the said work and to make and file this application;
uat all statements con aired in this application are true to the best of his knowledge and belief; and that the work will be-
-rformed in the mann r set forth in the application filed therewith.
worn to before me this
—day of �P
Not I public Signature of Applicant
®REGMY PINTO
NOTARY PUBLIC,STATE OF NEW YORK
N0.Ot•P1609M
QUALIFIEO IN SMOLK COUNTY
MY'COMMISSION SWHIgS APRIL 14,2016
'n
ECE � � C�
STATE OF NEW YORK
FEB ��� DEPARTMENT OF STATE
ONE COMMERCE PLAZA
AN REW M. CUOMO 99 WASHINGTON AVENUE CESAR A. PERALES
ALBANY,, NY 12231-0001 SECRETARY OFSTAIE
BLD�G�.�D�E�PTT.
Wr—YH40
MENT OF STATE
------------------------------------------------=----------------------
In the Matter of the Petition of: DECISION
Patrick Smith
For a Variance to the New York State PETITION NO. 2012-0492
Uniform Fire Prevention & Building Code
----------------------------------------------------------------------
Upon the application of Patrick Smith, filed pursuant to 19 NYCRR 1205 on October 19, 2012 and
upon all other papers in this matter, the Department makes the following determination:
NATURE OF GRIEVANCE AND RELIEF SOUGHT
The petition pertains to the installation of an in-ground swimming pool for a one-family dwelling,
located at 13920 Soundview Avenue., Southold, Town of Southold, County of Suffolk, State of New York.
Relief is requested from:
19 NYCRR Part 1220, Residential Code of New York State, (2010)Section AG105.3 section 8.2,
which requires, in part, that all gates shall be self latching, with the latch handle located within the pool
enclosure (i.e., on the pool side of the enclosure) and at least 40 inches above grade. In addition if the
latch handle is located less than 54 inches from the bottom of the gate, the latch handle shall be located
at least 3 inches below the top of the gate. [The Petitioner request permission to permit a latch handle for
a pedestrian gate as a part of a pool enclosure, located 54 inches above the bottom of the gate, to be
located on the outside of the pool enclosure.]
FINDINGS OF FACT
1. An in-ground swimming pool was installed at the subject premises. In doing,so an enclosure was
provided around the pool itself with a pedestrian access gate.
2. The pedestrian access gate swings outward from the pool and has a latch handle that is located at
least 54 inches above the bottom of the gate. However the latch handle has been located on the
outside of the gate.
WWW.DOS.NY.GOV E-MAIL:INFO@DOS.NY.GOV
Petition No. 2012-0492
Page 2
3. The previous, 2003 and 2007, Residential Codes of New York State allowed the latch handle to be
placed on the outside of the pool enclosure as long as the handle was located a minimum of 54
inches above the bottom of the gate. The current 2010 Residential Code of New York State requires
that even if the latch handle is 54 inches above the bottom of the gate that it must be located on the
pool side of the enclosure.
4. The provisions for barriers around swimming pools are to protect young children. Less than 5 years
of age, according to the International Residential Code Commentary.
5. The 2006 International Residential Code, on which the 2010 New York State Residential Code is
based, allows a latch that is 54 inches above the bottom of the gate to be located on the outside of
the enclosure.
6. The commentary for the International Codes states that the"54 inch latch height requirement limits
the potential for small children to reach and activate the latch." If the latch is located lower than 54
inches then the Code requires that the latch be located 3 inches below the gate on the inside of the
enclosure.
7. Section 303.2, Part 8 ,of the current, 2010, Property Maintenance Code of New York State has
retained the language about pool latches that was in the previous Residential Codes of New York
State and still allows a latch that is located 54 inches above the gate to be located.on the outside of
the enclosure.
8. Based on the above findings, it is the assumption that the 54 inch height of the latch above the
bottom.of the gate is adequate to protect the children that the Code has identified from reaching the
latch and gaining entrance.to the swimming pool regardless on which side of the enclosure the latch
is located.
9. The latch used for the subject gates is manufactured by"Magna-Latch" which approves the
installation on the exterior of the enclosure as long as it is set a minimum of 54 inches above the
bottom of the gate.
10. On some gate configurations it may be possible to reverse the latch to be in compliance with the
current Code requirements. However in this instance the enclosure and the gates would have to be
Petition No. 2012-0492
Page 3
completely reconfigured or replaced to reverse the latch. The Petitioner has stated that this would
both physically and financially impractical.
11. The Petitioner has proposed that the pool enclosure and pedestrian gates will be in compliance with
all other applicable provisions of Appendix G of the Residential Code of New York State.
12. The local code enforcement official has been consulted in this matter and does not object to the
granting of a routine variance under the provisions of 19 NYCRR 1205.
CONCLUSIONS OF LAW
Strict compliance with the provisions of the Uniform Fire Prevention and Building Code would be
unnecessary in light of the fact that the latches as configured will be a minimum of 54 inches above the
bottom of the gate and should be out of reach of the children that the Code provisions are trying to protect
and would ensure the achievement of the Code's intended objectives more efficiently, effectively or
economically such that granting a variance would not substantially adversely affect the Uniform Code's
provision for health, safety and security.
DETERMINATION
WHEREFORE IT IS DETERMINED that the application for a variance from 19 NYCRR Part 1220,
Section AG105.3 section 8.2, to permit a latch handle for a pedestrian gate as a part of a pool enclosure,
located 54 inches above the bottom of the gates, to be located on the outside of the pool enclosure;
hereby PROPOSED TO BE GRANTED with the following condition:
1. That the latch handle be located a minimum of 54 inches above the bottom of the pedestrian gates.
2. That the pool enclosure and pedestrian gate will be in compliance with all other applicable
provisions of Appendix G of the Residential Code of New York State
This DECISION is issued under 19 NYCRR 1205.6. Unless objected to by the petitioner in
writing received by the Department, the decision shall become FINAL after fifteen days of receipt of the
decision by the parties.
Petition No. 2012-0492
Page 4
This decision is limited to the specific building and application before it, as contained within the
petition, and should not be interpreted to give implied approval of any general plans or specifications
presented in support of this application.
Ronald E. Piester A.I.A., Di ector
Division of Code Enforcemeint and Administration
DATE: �(,3
RAS:sg
NYS DEPARTMENT OF STATE
DIVISION OF CODE ENFORCEMENT AND ADMINISTRATION
Variance Attest List
Petition No: 2012-0492
The persons below are advised to TAKE NOTICE of the attached document. The attached
document pertains to a petition for relief related to code requirements. If there are any questions,
call (518)474-4073 and ask for the Variance Unit. Please refer to the petition number in all
related conversations or correspondence with us.
GARY FISH
TOWN OF SOUTHOLD BLDG DEPT
53095 MAIN ROAD
P O BOX 1179
SOUTHOLD, NY 11971
PATRICK SMITH
13920 SOUNDVIEW AVENUE
SOUTHOLD, NY 11971
10/23/2012 Page 1 of 1
o��oF souryo
Town Hall Annex 1 Telephone(631)765-1802
54375 Main Road y Caxw(63 )7
ro rto nso6u5 5o UnVP.O.Box 1179 us
Southold,NY 11971-0959
'CQUNTI,N
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED BY: � � )I z' . Date: Z
Company Name:
Name: v z f :10►-�
License No.:
Address: — `6 L,-,,xcc, V1 .0 vcrl IC ..
Phone No.: rJC>
JOBSITE INFORMATION: (*Indicates required information)
*Name: �aL -r;-�(c- �-r. : ��-•
*Acidness: 1� Cl Z0 A-,�
*Cross Street: j� a,�-i y hoy,-,e-
*Phone No.: 1 Cv S _ I cis
Permit No.: '7 05
Tax-Map District: 1000 Section: 154 . Block: 3 Lot: 3
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
Y <1 I, GJG
(Please Circle-All That Apply)
Is job ready for inspection: YES NO Rough In Final
*Do-you need a Temp Certificate: YES/ O
Temp Information(if needed)
*Service Size: 1 Phase 313hase 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
.82=Request for Inspection Form
dosep� Town of Southold
i07�
,� L
Erosion, Sedimentation & Storm-Watef Run-off ASSESSMENT FORM
0
PROPERTY LOCATION: S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
District section Block Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
----------------------------------------------------
Item Number: (NOTE: A Check Mark(.(►)for each Question is Required for a Complete Application) Yes No
————————————————————————————————————————————————————
Will this Project Retain All Storm-Water Run-Off Generated by a Two(2")Inch Rainfall on Site? X ❑
(This item will include all run-off created by site clearing and/or construction activities as well as all Site —
Improvements and the permanent creation of impervious surfaces.)
2 Does the Site Plan and/or Survey Show All Proposed Drainage Structures Indicating Size&Location? > ❑
This Item shall include all Proposed Grade Changes and Slopes Controlling Surface WaterFlow! —
3 Will this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural ❑
Existing Gradp Involving more than 200 Cubic Yards of Material within any Parcel?
4 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of ❑
Five Thousand(5,000)Square Feet of Ground Surface?
5 Is there a Natural Water Course Running through the Site? x
Is this Project within the Trustees jurisdiction or within One Hundred(100')feet of a Wetland or Beach? —
6 Will there be Site preparation on Existing Grade Slopes which Exceed Fifteen(15)feet of Vertical Rise toF]
One Hundred(100')of Horizontal Distance? —
7 Will Driveways,Parking Areas or other Impervious Surfaces be Sloped to Direct Storm-Water Run-Off ❑ x
into and/or in the direction of a Town right-of-way? —
8 Will this Project Require the Placement of Material,Removal of Vegetation and/or the Construction of ❑ �
any Item Within the Town Right-of-Way or Road Shoulder Area? —
(This item will NOT include the Installation of Driveway Aprons.)
9 Will this Project Require Site Preparation within the One Hundred(100)Year Floodplain of any Watercourse? F-1
NOTE: If Any Answer to Questions One through Nine is Answered with a Check Markin the Box, a Storm-Water,Grading,
Drainage&Erosion Control Plan is Required and Must be Submitted for Review Prior to Issuance of Any Building Permit!
----------------------------------------------------
EXEMPTION: Yes No
Does this project meet the minimum standards for classification as an Agricultural Project?
Note: If You Answered Yes to this Question,a Storm-Water,Grading,Drainage&Erosion Control Plan is NOT Required!
————————————————————————————————————————————————————
STATE OF NEW YORK, ,
COUNTY OF...- .. .................SS
That I,..C.i!:�✓� ��'T'{'1'".........................being duly sworn,deposes and says that he/she is the applicant for Pennit,
. ................ ..................
(Name of individual signing Document)
And that he/she is the b4%Y1. "". 'f
(Owner,Contractor,Agent,Corporate Officer,etc.)
Owner and/or representative of the Owner of 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;
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............:��........................day 1:U;S7'ai'18Qvmw"1 IC?
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Notary Public: .....z
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............................. ....... .................................. .......... ..... .........................................................
(Signature of Applicant)
FORM - 06/07
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TENT H01.� ou, or.CO.OEPT.OF HEALTH SERVICES
STATKMENT OF INT!^NT
p•
FOR APPROVAL OF CONSTRUCTION ONLY
T1iE WATER SUPPLY ANU BVWAOV
� / D181-09AL SYSTEMS FOR T111• R1r1-
�.� lyC� DATE:
d DENCE WILL CONFORM TO THI
��!it�r q s� -s• STANDArtn!► OF gUirF04K CO.'bFPT.
11 H.B. REF. NO.:
OF HEALTH. 9FRVIOEf!-
AprROYCD:
' APPL1 CART'
POOL DIMENSIONS
B 8-0 8 -0 - 3 8 9,050
16X24 16 3-0 8 6 -0 - 8-3- 6 -8 28- 0 p���n o �„y /
6 2 6-0 A 3 6 8 -0 6 - 8• B 8, � 'y�qp�d� �Q1Q C97"
8 8-0 36- 3 6 3 8 0 -0 _ -
OR
-0 2 -0 - -0- 6 32,000 (� g y p p y .
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R POITR ONCRETE
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Al YORK STATE NO- =:7SPONSlR!.E FOR
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I OF THF 1
1
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TYF. PANEL STIFFNER
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//�� //�� APPENDEX G. DESIGN IN
T��IC,41. W��� SECTION AT 'fit' �RUI�tM� ACCEPTABLE FOR ALL POOL TYPE: RECTACsLE_ FEY. SCALE N.T,S.
COMMON SOIL CONDITIONS JAMES DEERKOSKI,P.E. DATE
2oO DEER PATH DRAWING NUMBER
MATTITUCK, NEW YORK 11952 OF