HomeMy WebLinkAbout36736-Z Town of Southold Annex
8/31/2012
P.O.Box 1179
co
� 54375 Main Road
Qy • o� hyt Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 35929 Date: 8/31/2012
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 1030 Jacobs Ln, Southold,
SCTM#: 473889 Sec/Block/Lot: 79.-7-34
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
9/23/2011 pursuant to which Building Permit No. 36736 dated 10/5/2011
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:
accessoryground swimming pool, fenced to code as applied for.
The certificate is issued to Neese II, Robert&Neese,Laurie
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 36736 11/12/11
PLUMBERS CERTIFICATION DATED
r
AutlArized Signature
TOWN OF SOUTHOLD
��ogUFFUI, � BUILDING DEPARTMENT
51 TOWN CLERK'S OFFICE
SOUTHOLD, NY
•�,z�r,;,s i
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#: 36736 Date: 10/5/2011
Permission is hereby granted to:
Neese II, Robert & Neese, Laurie
1030 Jacobs Ln
Southold, NY 11971
To: construct an accessory Inground Swimming Pool, fenced to code as applied for
At premises located at:
1030 Jacobs Ln, Southold
SCTM # 473889
Sec/Block/Lot# 79.-7-34
Pursuant to application dated 9/23/2011 and approved by the Building Inspector.
To expire on 4/5/2013.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
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 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 2110 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 G°pre-eiisting"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$50.00, Additions to accessory building$S0.00, 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 $1..00, Commercial$15.00
Date. L '20-
New Construction: Old or Pre-existing Building: (check one)
Location of Property: _JAMS 14 c J i +0
House No. Street Hamlet
Owner or Owners of Property: 9044, o IA\xit NtQ<Z
Suffolk'Courity Tax Map No 1000, Section /9 Block r7 Lot 3
Subdivision 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: $ 50
Applicant Signat e
oF so�ryol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 C/2- Q roqer.richertCcb-town.southold.ny.us
Southold,NY 11971-0959
Irou I,Nct�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Robert&Laurie Neese
Address: 1030 Jacobs Lane City: Southold St: NY Zip: 11971
Building Permit#: 36736 Section: 79 Block: 7 Lot: 34
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: USI Electric License No: 2740-me
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 1 Ceiling Fixtures HID Fixtures
Service 3 ph Hot Water GFCI Recpt 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 1
Disconnect Switches 1 Twist Lock Exit Fixtures TVSS
Other Equipment: in ground swimming pool to include, bonding, 2 pump recpticles, 2 GFCI circuit-
breakers, 1 pool light, 1 control panel
Notes:
Inspector Signature: Date: Nov 23 2011
81-Cert Electrical Compliance Form
OF SO�T�o!
coulm,N
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802 -INSPECTION .. ' '
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSU TION
[ ] FRAMING/STRAPPING FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE INSPECTOR
OF SOpryolo
o�yc0 ,
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION -
I FOUNDATION 1ST [ ] ROUGH PLOG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING XFINAL '
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
,
DATE g �� INSPECTOR
- OF SO(/l�olo
O�yco ,�
TOWN .OF SOUTHOLD BUILDING DEPT.
765-1602
INSPECTION
[ FOUNDATION 1 ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE �� �~` INSPECTOR
OF SOUlyOlo
TOWN OF SOUTHOLD BUILDING DEPT.
765-1602--
r 1 NSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) YJELECTRICAL (FINAL)
REMARKS:
DATE ll .Z �' �� -INSPECTOR7214;96:/::Z-��
FTET.D I!!1$P� �?RE2P4T DATA COUNTS. .
FOUNDATT(W(2ND) U\W
U y
ROUGH FAG'& . C-
r ,
IlNSUL•ATION PFA N.'X.
STATE ENERGY CODT
FINAL
ADDI 'IONAL.C+ON[NENTS
t'��cr�L Gar G n !
lrn
Ly
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING.DIPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD,NY 11.971 3 sets of Building Plans
TEL: 765-1802 Survey
PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
Examined 0 ,20 Contact:
Approved I S20_,/ Mail to:
Disapproved a/c
f1 E V Building Inspector
i L,J
SEP 2 1 2011 LIGATION FOR BUILDING PERMIT
BLDG.DEPT. Date �17I� , 20
TOWN OF SOUTHOLD INSTRUCTIONS
a.This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
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 a Certificate of Occupancy
is issued by the Building Inspector,
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County,New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions, or alterations or for removal or demolition as herein described. The
applicant agrees to comply with all applicable laws, ordinances,building code,housing code, d regulations, and to admit
authorized inspectors on premises and in building for necessary inspections.
OCCUFAI ICY OR
,USE IS UNLAWFUL 6II MWE W AT E LY" " (Signa of applic t or name,if a corporation)
ENCLOSE POOL tO CODE
WITHOUT CERTIFICATE UPON COMPLETION q2_ 2� z� M,k P� 1176�
OF OCCUPANCY BEFORE 'WATER (Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
APPROVED /1 ,,l E
Name of owner of premises d �hU�(e Peg DAT w s lf.
(as on the tax roll or latest deed)!
FEE:--_2 BY
If applicant is a corporation, signature of duly authorized officer NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
(Name and title of.corporate officer) 1. FOUNDATION-TWO REQUIRED
FOR POURED CONCRETE
Builders License No. .445 p 2. ROUGH-FRAMING,PLUMBING,
STRAPPING, ELECTRICAL&CAULKING
Plumbers License No. 3. INSULATION
4. FINAL-CONSTRUCTION&ELECTRICAL
Electricians License No. a`7d, MUST BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
Other Trade's License No. ELECTRICAL REQUIREMENTS OF THE CODES OF NEW
INSPECTION
STATE. NOT RESPONSIBLE FOR
I��"DESIGN OR CONSTRUCTION;ERRORS.
1. Location of land on which proposed work will be done:
00 s 1.A cm
House Number Street Hamlet 's"=al�i�ll`i •A
J jdf �Nz; j o 1e%18 -1sldtirl y%141
1 I I I:.(}f71 C',��
County Tax Map No. 1000 Section �q Block 7 �;4t IrALI'.�i?hnfiil.,110
Subdivision Filed Map No. ass 131FAot+iqx'nvi?aims'00 ip✓?
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy kesiceAJQ
b. Intended use and occupancy &J0M1Nq
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work=rj ,g ov-) 6y,,mmj1q
(Description)
4. Estimated Cost K OM- Fee
(to be paid on filing this application)
5. If dwelling, number of dwelling units Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use.
7. Dimensions of existing structures, if any: Front L ` Rear c I- Depth
Height Number of Stories I
Dimensions of same structure with alterations or additions: Front Rear
Depth Height Number of'Stories
8. Dimensions of entire new construction: Front 24 ` .Rear -z,0
-Bepth- 4 +
Height Number of Stories
9. Size of lot: Front Rear 1 00 ' Depth qo I
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: Ajo
13. Will lot be re-graded POOLDltt;� Will excess fill be removed from premises: YE NO
5infi,�
14. Names of Owner of premises ` Address 10-aQ jAeon L�J Phone No. &17
Name of Architect 0 GIB Pe Address by , m hone No '72'f-7R9P
Name of Contractor &wA-os Address ZQi 04 2C4 Phone No. 2j( -7185-
15. Is this property within 100 feet of a tidal wetland:?;;*YJ-,-S . , ,,, f$ ;: NO
,.,,
• IF YES, SOUTHOLD TOWN TRUSTEES'PERMIT§MAYBE 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.
STATE.OF NEW YORK)
SS: .
COUNTY OF Lil
being duly sworn, deposes and says that(s)he is the applicant
(Name.of..individual-signiii -do'n.
C7abt)aboue;named,
(S)He is the
.(Co4tracttlrg Agdnt, Corporate Officer, etc.)
of said owner or owners;.and'is;duly�authorized to perform or have performed the said work and to make and file this application;
that all statements'..contained in this appl`igati6i arp.true to the best of his knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
7-1
Sworn to bore of ,[[.mej. his- ,-'
;-
?�
LA
Notary Public Si Lure of A icant
MARGARET A. KIDNEY
Notary Public-State of New York
No. 01 K1602(111
Qualified in Suffolk County..
My Commission Expires March 8,91;,;,
4- Town of Southold
U2 Erosion, Sedimentation & Storm Water Run-off ASSESSMENT FORM
PROPERTY LOCATION:• S.C.T.M.#: THE FOLLOWING ACTIONS MAY REQUIRE THE"SUBMISSION OF A
Ol qQ L STORM-WATER,GRADING,DRAINAGE AND EROSION CONTROL PLAN
-b sl tr c se on oc Lot CERTIFIED BY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK.
SCOPE OF WORK - PROPOSED CONSTRUG'I'ION ITEM# / WORK ASSESSMENT Yes No
a. What is the Total Area of the Project Parcels?
,^ Project Retain All Storm ter Run-Off
Will this -Wa(Include Total Area of all Parcels located within A10)fW Generated a Two n Inch Rainfall on Site?
(
the Scope of Work for Proposed Construction) (S.F./Acres) ( s Item will include all run-off created by site ✓
b. What is the Total Area of Land Clearings F (This i — D
clearing and/or construction activities as well as all
and/or Ground Disturbance for the proposed 800 Site Improvements apd'the permanent creation of
construction activity? (S.F./Akxes) Impervious surfaces.)
PROVIDE BRIEF PROJECT DESCRI MON (Pmvide Ad'ddional Pages as Needed) 2 Does the Site Plan and/orIndicating
Si Show All Proposed
Drainage Structures Indicating Size&Location?This
Item shall include all Proposed Grade Changes and
PRC MW 20x 40 1!NROJI0 VkAVL, Slopes Controlling Surface Water Flow.
k5w�mnn (Z_ 3 Does the Site Plan and/or Survey describe the erosion
w 1
1 - 211CQ and sediment control practices that will be used to F]
control site 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 V
Existing Grade Involving more than 200 Cubic Yards
of Material within any Parcel?
rj Will this Application Require Land Disturbing Activities El
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 F
General DEC SWPPP Requirements: or within One Hundred(100)feet of a Weiland 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
are part of a rarger•common plan that will ultimately disturb one or more acres of land D V
Including Construction activities involving soil disturbances of less than one(1)acre where Which Exceed Fifteen(15)feet Vertical Rise t0
One Hundred(100')of Horizontal.Distance?
the DEC has determined that a SPDES permit is required for storm water discharges.
(SWPP.P's Shall meet the Minimum Requirements of the SPDES General Permit - 8 Will Driveways,Parking Areas or other Impervious
for Storm Water Discharges from Construction activity-Permit No.GP-040-001.) Surfaces be Sloped to Direct StorrwWater Ruh-Off
't:The SWPPP shall be prepared prior to the submittal of the NOI:Tpe N01 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 Q 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
constructed to reduce the pollutants in storm water discharges and to assure Item 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 ofD identify potential sources of pollution which may reasonably be expected to affect the fivawayAprens.)
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.S 1 Acre in area,
component shall be'prepared by a qualified Design Professional Licensed in New York a Storm Water,Grading,Drainage&Erosion ControfPlan 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 Priorto Issuance of Any Building Permit
JNOTE: A Check Mark(4)and/or Answer for each Question Is Required for a Complete Application)
STATE OF NEW YORY,COUNTY OF.........4.F.RXK
.....::........SS
1 hat I.................h
....... ......being duly sworn,deposes and says that he/she is the applicant for Permit,
of individual signing Document)
And that he/she is the .. .... ..
�(Oumer,Contiaoto;Agent,Corporate Officer,etc:).... •. ... .• •••.•••... ••.
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;
.................�.4-J:
. day of... ..Y+5..-�. ....................... 20).1..
Notary Public: . Q.. .......... MARcaAE A.KIDNEY ... ..................................
l NAr*y Nblk-State of NGW York (Signature. plicant)
FORM - 06/10 Qualified in SuiwfkCourtty_
My Commission Expires March 8,20.I5,
o��pF SOljT�,o
Town Hall Annex J J Telephone(631)765-1802
54375 Main Road �ax(631)765- 516
r.o.Box 1179 O roger.richert(C�1owi -utho .ny.us
...Southold,NY 11971-0959 olyC ��
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
REQUESTED SY: Date: � j�11
Company Name:
Name:
License. No.: 2 q4 . 14t
Address:
Phone'No.: 1o31- 5y-(�yl�
JOBSITE INFORMATION: (*Indicates. required information)
*Name:. — .'t � Lut2 Wey,
*Address: 1 d 30 JkA51. n
*Cross Street: fZ
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: Block:�_ Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
Qpwoseo zOyg J_
nskco� Vinyc 6HIMIk lN4
(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 3001 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 ���
i
ARTHUR EDWARDS POOL & SPA CENTRE
929 ROUTE 25A
MILLER PLACE, NY 11764
516-744-7185
FAX-744-0174
APPLICATION FOR A SWIMMING POOL PERMIT: SOUTHOLD
TOWN OF SOUTHOLD
MAIN ROAD (P.O. BOX 1179)
SOUTHOLD, NY 11971
(631) 765-1802
PAPERS ENCLOSED:
APPLICATION FOR OUTDOOR POOL PERMIT
[ EROSION SEDIMENTATION &WATER RUN ASSESSMENT FORM
[ CERTIFICATE OF WORKER'S COMPENSATION
CERTIFICATE OF LIABILITY INSURANCE
[� SUFFOLK COUNTY LICENSE
a-{�-- SUFFOLK COUNTY PLUMBER LICENSE
SUFFOLK COUNTY ELECTRICIAN LICENSE
4 SETS OF PLANS - (3 STAMPED)
jj 3 SURVEYS
[>(� APPLICATION FOR ELECTRICAL INSPECTION WITH $100 CHECK
APPLICATION FOR CERTIFICATE OF OCCUPANCY
[ C.O.
LN) TAX BILL
[� $300.00 CHECK FOR PERMIT FEE
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Rolled Wall Foo
Plan A Piping ArrangementWal!Section
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Section A—A
SIZE A B C D E F G H AREA CAP.
FEET FP. FT. FT. FT. FP. FT. FT. FT. SQ.FT. GAL. Purahaee
16x32' 16' 32' 8' 14' 6' 4' 4' 8' 512 19,000
16'g36' 16' 36' 12' 14' 6' 4' 4' 8' 676 21,600 POOL&SPA CENTRE " °°°
PERMACRETE WALL SYSTEM
18,x36' 18' 36' 12'. 14' 6' 4'. 5' 8' 648 24,300 929 Route 25A Miller Place NY 11764 cityes
20'%40' 20' 40' 16' 14' 6' 4' 6' 8' 800 30,000 (631) 744-7185 FAX (631) 744-0174 Phone ��
24'x44' 24' 44' 18' 14' 8' 4' 6' 10' 798 30,000 Suffolk License #4436—HI
24'x48' 24' 48' 20' 16' 8' 4' 6' 10' 900 30,000 1 Nassau License #HI74450000