HomeMy WebLinkAbout37046-Z g1lFfpt,�C Town of Southold Annex 4/3/2014
P.O.Box 1179
54375 Main Road
oy • �-!Z� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 36841 Date: 4/3/2014
THIS CERTIFIES that the building IN GROUND POOL
Location of Property: 4600 Oaklawn Ave, Southold,
SCTM#: 473889 Sec/Block/Lot: 70.-9-48
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this officed dated
3/2/2012 pursuant to which Building Permit No. 37046 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:
accessoryground swimming pool with fence per New York State Petition#2014-0035.
The certificate is issued to Gros,Alfred&Gros,Christine
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 37046 6/25/12
PLUMBERS CERTIFICATION DATED
thorized ignature
�sUFFn TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
o • SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 37046 Date: 3/7/2012
Permission is hereby granted to:
Gros, Alfred & Gros, Christine
17 Gardenia Ln
Levittown, NY 11756
To: construct an accessory InGround Swimming Pool fenced to code as applied for
At premises located at:
4600 Oaklawn Ave, Southold
SCTM # 473889
Sec/Block/Lot# 70.-9-48
Pursuant to application dated 3/2/2012 and approved by the Building Inspector.
To expire on 9/6/2013.
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 K'� ° t p�5'
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,
Swin"lllllg.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 $l 5.00
Date. 3 - '7•— o�
V/
New Construction: Old or.Pre-existing Building: (check one)
Location of Property: 0 b Q _&j_rn. atAe
House No. Street Hamlet
Owner or Owners of Property:
v
Suffolk County Tax Map No 1000, Section Block Lot
Subdivision Filed Map. Lot:
Permit No. (p Date of Permit. 3✓ Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: ' Temporary
q p y Certificate Finial Certificate: (check one)
Fee Submitted: $ /
Appli�ntig�nature
o�*OF SO�ryol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 �`
ao roger.richert(-@-town.southold.ny.us
couffN
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: A&C Gross
Address: 4600 Oaklawn Ave Ext City: Southold St: NY Zip: 11971
Building Permit#: 37046 Section: Block: Lot:
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Elec-Tec Inc License No: 4814-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 2
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, 1-pool light, 2-GFCI circuit breakers
1-salt generator
Notes:
Inspector Signature: zv� Date: June 25 2012
81-Cert Electrical Compliance Form.xls
i
SOpryolo
,c �Iyeouwtml
TOWN.OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE A CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
o
DATE �`� �� INSPECTORV` a
A oF so�ryolo
v G Q
holy UN1Y,N`�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] DOUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING/STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ELECTRICAL (FINAL)
REMARKS:
DATE �� INSPECTOR
SOUjy��
�o
TOWN OF SOUTHOLD BUILDING DEPT.
7654 802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] �SULATION
[ ] FRAMING /STRAPPING [. FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
r
DATE ZO ` � INSPECTOR
OE SOU
0 ly
cou Nct�
TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH G.
[ ] FOUNDATION 2ND [ ] I TION
[ ] FRAMING /STRAPPING W- F INAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
REMARKS:
DATE o7—17 INSPECTOR
1' 1 1 0 • � • 1 1,
• II • 11
PLUMBING
•
STATE ENERGY C'
• 1
F
WA mm
-- ADDrri,?NAL COADRNTS
/. WAR!
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I
, N OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT Do you have or need the following,before applying?
TOWN HALL Board of Health
SOUTHOLD, NY 11971 4 sets of Building Plans ✓
TEL: (631) 765-1802 Planning Bo 'd approval
FAX: (631) 765-9502 'D Survey
SoutholdTown.NorthFork.net PERMIT NO. .37b 7 k Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 0317 ,20 l DL- Single&Separate
Storm-Water Assessment Form
Contact:
Approved 20 �' Mail to:
Disapproved a/c i hone �
PW-76 G5-
Expiration 20__f3
D E C E V E Building Inspector
MAR - 1 2012 AICATION FOR BUILDING PERMIT
Date , 20/Z
BLDG.DEPT. INSTRUCTIONS _T
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 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,and regulations, and to admit
authorized inspectors on premises and in building for necessary inspections. rJI�
z. 17,lx
(Signature of applicant or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises IqL �7aS
(As on the tax roll or latest deed)
If applic nt is a coo atio , si .nature f duly authorized officer
(Name and title of corporate officer)
Builders License No.��j�7 ��
Plumbers License No.
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done:
House Number Street Hamlet
County Tax Map No. 1000 Section Block Lot
Subdivision Filed Map No. ���� Lot .9 7
14 °'
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Z n7 5' ;;cZ ?�� 7uC
b. Intended use and occupancy/ S7vrLy ;vlZ, 71=6- �u i>�-5 C /� 2Z> r� L
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition er Wor / .e74y v> xwr l�f..L�Ga
(Description)
4. Estimated Cost-0/S0042,yo 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 6 d r Rear Depth
Height 4F1 Number of Stories l
Dimensions of same structure with alterations or additions: Front - Rear
Depth Height Number of,Stories
8. Dimensions of entire new construction: Front Rear Depth.
Height Number of Stories
9. Size of lot: Front AD Rear l CSh Depth /SCE �
10. Date of Purchase Name of Former Owner
11. Zone or use district in which premises are situated ` 512*>e t)71,,&
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES X NO Will excess fill be removed from premises? YES NO
14. Names of Owner of premises?�, Address 0�o 4A(4 its hone No.
Name of Architect Address Phone No
Name of Contractor (&e L,-,z> Address-Po -Zoov 9 &n��e-Phone No. �73y 766.,
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NO oG
* IF YES, D.E.C. PERMITS MAY BE REQUIRED.
16. Provide survey,to scale, with accurate foundation plan and distances to property lines.
17. If elevation at any point on property is at 10 feet or below, must provide topographical data on survey.
18. Are there any covenants and restrictions with respect to this property? * YES NO
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF 4,
e44eA-,& ��11'J being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the 711Z46761Z
(Contractor, Agent, 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 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 therewith.
Sworn to befor me his
20� T I.SCOTT,JR.
Notary Public,State of New Yo
Qualified in Suffolk Coun
1 SC
Notary P 'bl' Term Expires May 33 1, ,3 Signature of Applicant
�
o+-
NYS DEPARTMENT OF STATE
DIVISION OF CODE ENFORCEMENT AND ADMINISTRATION
Variance Attest List
Petition No: 2014-0035
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.
MICHAEL VERITY/
TOWN OF SOUTHOLD BLDG DEPT
54375 MAIN ROAD
SOUTHOLD, NY 11971
AL GROS
4600 OAKLAWN AVENUE
SOUTHOLD, NY,11971
PETE PONTERIO,PRES.
NORTH FORK FENCE
P.O.BOX 1525
MATTITUCK, NY 11952
02/11/2014 Page 1 of 1
5 C- Eoy
APR 2 2014
STATE OF NEW YORK
DEPARTMENT OF STATE BLDG.DEPT.
ONE COMMERCE PLAZA TOWN OF SOUTHOLD
ANDREW M. CUOMO 99 WASHINGTON AVENUE CESAR A. PERALES
GOVERNOR ALBANY, NY 1 22 3 1-0001 SECRETARY OF STATE
In the Matter of the Petition of. DECISION
PETE PONTERIO
For a Variance to the New York State PETITION NO. 2014-0035
Uniform Fire Prevention& Building Code
Upon the application of Pete Ponterio, filed pursuant to 19 NYCRR 1205 on January 27, 2013 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 4600 Oak Lawn 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 latch handles for
two pedestrian access gates 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 with two pedestrian access gates.
2. The two pedestrian access gates swing outward from the pool and have latch handles that are
located at least 54 inches above the bottom of the gate. However the latch handles-have been
located on the outside of the gate."
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
WWW.DOS.NY.GOV E-MAIL:INF0@D0S.NY.G0V
Petition No 2014-0035
Page 2
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. 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
completely reconfigured or replaced to reverse the latch.The Petitioner has stated that this would
both physically and financially impractical.
10. 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.
11. 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.
Petition No 2014-0035
Page 3
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 latch handles for two pedestrian access gates 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 handles be located a minimum of 54 inches above the bottom-of the pedestrian gates.
2. 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.
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.
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., Direc r
Division of Building Standards d Codes
DATE: 2`o`�711
RAS: nc
d� TOW". n :of. Southold
z Erosion, §.iedimenta#ion & Storm-Water Run-off ASSESSMENT FORM
PROPERTY LOCATION:. &C.TA fk THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A
0� MCI dv STORM—WATER,GRADING,DRAINAGE AND EROSION CONTROi.-PLAN
tirTa" on - oT— 2ERTiF19D BY A DESIGN VRQFES$)0 L 1 THE STATE OF NEW YORIL
SCOPE OF WORK - PROPOSED CONSTRUCTION 1Tk'1yi# / WOMASSMNOENT Yes No
a. What is the Total Area of the prolectParbels? 1 Will this Project Retain AD Storm-Water-Rim-Off
(Include Total Area of all Parcels located within /� �� Generated by a 7Wo(Z)Inch F;Wk*D on Site?
the Scope of Work for Proposed Conshucslliori) (This item will irititide•aD run-off.created by she
b. What is the Total Area of Land ISP CAM)Clearing clearing and/or construction attiivRfes as well as all
and/or Ground Disturbance fir the pmposed � Site Improvements•apd•the permanent creation of
construction activiily? . {sF./Aaes) impervious surfaces.)
2 Does the Slte Plan andfor Survey.Show AD Proposed
PROyIDE BRIEF PROJW-r DESCRIrn0N VmvftAdZWaiPamasWedmQ Drainage Structures Ifi teating Size&Location?This
. - Item shag Include.till Proposed Grade Changes and —
�f X3& Slopes Controlling Sgrlhce Water Flow
floes the Site Plan.and/or Survey describe the erosion
Ski A01 MJ,v and sedimentcontrot prmctitxos;that will-be used to
control site erosion and storm water discharges. This
item mustbe maintained throu*M the I_nUre
ConstfuctIon Period.
4 Will this I'NectRequire.anyf Land Filling.Grading or
Excavation where there Is a change to the Natural `
Existing Grade Involving more than 200 Cubic Yards
of Material within any Parcet?
FJ Will this Application Require Land Wgurbing Activities
-Encompassing an Area in Excess of Frve Thousand
{6,000'S.F.)Square Feet of Ground Surface?
Y •6 1s tflere a Natural Water Course Running through-the
Site? Is this Project within the Trustees jurisdiction
General DEC SWPFi Requirements: or within One Hundred(100')feet of a Welland jor
Submission of a SWPPP is required for all construction activities imrolvinirson 'Beach?
tlistudrarices of one(1)or more acres:irrcludingdisturbances ofless tlianone acre that 7 Wilt there be Site preparation on Existing Grade Slopes
are part of a urger common plan that will ultimately disturb one ormore acres of land; which Exceed Ffieen(16)feet of Vertical Rise to t/
including Construction activities involving son disturbances of less than one(1)acre where One Hundred(100')of Horizontai.Distance?the DEC has determined that a SPDES permit is required for storm water discharges. -
(SWPPn Shall tneet.4he Minimum Requirements of the SPDES General Permit• 8 Will Driveways,Parking Areas orrother impervious D
for Stomn Water Discharges from Construction activity-hermit No.4.W-o:lauol.), Surfaces be Sloped to Direct Storm-Water Runt Off .
t..The SffPP shall be prepared prior to the subriditalof theNOL The NOI Shane into and/or in the direction•of a Town right-of-way?
submitted to the Deparbnent pttorto the cammencemerit otvansbtidron activlly.
2.The SWPPP shall desen'be the erosion andsedlmemtmntrol practices and where 9 Will this Project Require-the PlacerientOMaterial.
required,posWonstruction stormweter marragemegtPractiees thatwill be used and/or Removal of Vegetation and/or the Construction of arty
construed to reduce the pollubrils in slomi water discharges amtto 81"m Item Within the TownRighl-ePWay or Road Shoplder
compliancewith ttr9 terms and oonditioris of this permit.In addition,the SWPPP shall Area?tam iennvm Nor mohms the Malaga m ott omosyA{l mQ
idenbTy potential souiaes Qf polluBon which may Masoriatiy'be expected to aHectthe
quarBy oislonn vlat dstdtarges. ffoTra mAny Answe►to tauestiow one through Nieo-IsAnswerod with a Check Mark
3.Ati SWPPPsthat squire the post-cansWcgon storm water management pracfte Ina Box and tba sonstruction site disturbance is libiween SAW".31 Aare In area,
component shall be-prepaned bye qual fled Des►gn Pmtessional Lkensed in tdewYork aStorm-Water;Grading.Dralnags 3 Erosion Control°Plan b Required bytfie Town of
that b4mq ledgeableintheprinWesandpraeitcesbf5tormWaterManagemerrL Southold and Mu$tbaS$OmittedforPWowPdartolmanceofAnyBuWngPerm1L
00M AChedcM4k(#)andlorAmwerkreachQuesWnisRwpftdfaraCampkleAppleafto)
STATE OF NEW YORK,
COUNTY OF. ........................................SS
Ibat signing... t)......»...........being duly sworn,deposes and says that he/she is the applicant for Permit,
And that he/she is the .....rltle ? .... ............:..........
co ;Agent.Corporate»....:.....................................................................:.....
tbwne% n�iaaor oliicer,eta)
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 fife this application;that all statements contained in this application are true to the best of-his knowledge and belief;and
thatthe work wiU be performed in the anner set forth in the application filed herewith.
Sworn to before me this;
.........._....1 s�......................d ............. ....G:........... ....,20,l.Z. �
NotaryPublic: ............. :{ ........ ... G '-t�- - 'c.�•••Y ••..... ... . ..................
w_u a a, J'r .' (S-gnature of Applicant) ••
p-Ato of Njw'y York
FORM - 06/10 oQuali#>ed in Suffolk County
`No,01SC4725089
Term Expires May 31. --
*pF SO!/lyQ
Town Hall Annex Telephone(631)765--11802
54375Main Road �n roger.richertdtown o76uAolq.n
P.O.Box 1179 G Q - Y-
us
Southold,NY 11971-0959Q�
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
APPLICATION FOR ELECTRICAL INSPECTION
I .REQUESTED BY: alcyn Date:
Company Name: —j G
Name:
License No.:
Address: . . IJ P—e.e ve-75 Q nY (7
Phone No.: 6 6' LL-
JOBSITE INFORMATION: (*Indicates required information)
*Name:
*Crosse Street: 9
*Phone No.:
Permit No.:
Tax Map District: 1000 Section: j, Block: Lot:
*BRIEF DESCRIPTION OF WORK(Please Print Clearly)
(Please Circle All That Apply)
*Is.job ready for inspection: ES NO Rou 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
�S1 'Y70
�-cXD, ---
82-Request for Inspection Form ��� �
DEc ' O � �
AVG Z 6 2073
BLDG.DEPT. 0
TOWN OF SOUTHOLD
ho�*pF SO�j�ol
Town Hall Annex Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179
Southold,NY 11971-0959 :rlhl� �OQ
COUNT`I
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
February 12, 2014
Alfred & Christine Gros
17 Gardenia Lane
Levittown, New York 11756
4600 Oaklawn Avenue, Southold Q�Li CP
E 4:i efore the Certificate of Occupancy can be issued, a variance from New York State is
ujr
ed.
TO WHOM IT MAY CONCERN:
The Following Items(if Checked)Are Needed To Complete Your Certificate of Occupancy:
Application for Certificate of Occupancy. (Enclosed)
Electrical Underwriters Certificate. (for the hot tub)
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. (Planning#765-1938)
Final Fire Inspection from Fire Marshall.
Final Landmark Preservation approval.
Final inspection by Building Dept.
BUILDING PERMIT — 37046-Z swimming pool
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LESION IS ACC. =A8sl.f FOR PATH DRAWING NUMBER
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