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43385-Z
�a�p FFDI'��o Town of Southold 1/17/2019 G ' o P.O.Box 1179 W. 53095 Main Rd �aM Southold,New York 11971 CERTIFICATE OF OCCUPANCY No: 40174 Date: 1/17/2019 THIS CERTIFIES that the building AS BUILT ALTERATION Location of Property: 280 Champlin Pl., Greenport SCTM#: 473889 Sec/Block/Lot: 34.-3-42 Subdivision: Filed Map No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated 1/10/2019 pursuant to which Building Permit No. 43385 dated 1/10/2019 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: "as built"window replacements and electric for an existing single-family dwelling as applied for. The certificate is issued to Denny,Leland&Linda of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL ELECTRICAL CERTIFICATE NO. 43385 1/15/2019 PLUMBERS CERTIFICATION DATED u ed Signature TOWN OF SOUTHOLD o�gUFFOL4re y BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, NY dol� ya 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#: 43385 Date: 1/10/2019 Permission is hereby granted to: Denny, Leland 8 Southfield Rd Middle Island, NY 11953 To: legalize "as built" window replacements to existing single-family dwelling as applied for. At premises located at: 280 Champlin PI., Greenport SCTM # 473889 Sec/Block/Lot# 34.-3-42 Pursuant to application dated 1/10/2019 and approved by the Building Inspector. To expire on 7/11/2020. Fees: AS BUILT - SINGLE FAMILY ADDITION/ALTERATION $400.00 CO -ALTERATION TO DWELLING $50.00 Total: $450.00 Bui pector Form No.6 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN HALL 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANCY This application must be filled in by typewriter or ink and submitted to the Building Department with the following: A. For new building or new use: 1. Final survey of property with accurate location of all buildings,property lines, streets,and unusual natural or topographic features. 2. Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form). 3. Approval of electrical installation from Board of Fire Underwriters. 4. Sworn statement from plumber certifying that the solder used in system contains less than 2/10 of 1%lead. 5. Commercial building,industrial building,multiple residences and similar buildings and installations, a certificate of Code Compliance from architect or engineer responsible for the building. 6. Submit Planning Board Approval of completed site plan requirements. B. For existing buildings (prior to April 9, 1957)non-conforming uses, or buildings and "pre-existing"land uses: 1. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant.If a Certificate of Occupancy is denied,the Building Inspector shall state the reasons therefor in writing to the applicant. C. Fees 1. Certificate of Occupancy-New dwelling$50.00,Additions to dwelling$50.00,Alterations to dwelling$50.00, Swimming pool$50.00,Accessory building$50.00,Additions to accessory building$50.00,Businesses $50.00. 2. Certificate of Occupancy on Pre-existing Building- $100.00 3. Copy of Certificate of Occupancy-$.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00 Date. 'New Construction: Old or Pre-existing Building: V/' (check one) Location of Property: �, �iGQrl(3 1i �1(�( � r(,Cn �' c:- House No. Street 14amlet Owner or Owners of Property: An Suffolk County Tax Map No 1000, Section Block Lot 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: $ Applicant Signature SOV��®� , Town Hall Annex Telephone(631)765-1802 54375 Main Road N Fax(631)765-9502 P.O.Box 1179 G Southold,NY 11971-0959 %c® ® �® roper.riche rtCaD-town.south old.ny.us Cou ,� BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATE OF ELECTRICAL COMPLIANCE / SITE LOCATION Issued To: Denny Address: 280 Champlin PI City: Greenport St: New York Zip: 11944 Building Permit#, 43385 Section. 34 Block. 1 3 Lot: 42 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 X Basement X Service Only Commerical Outdoor X 1st Floor X Pool New Renovation 2nd Floor Hot Tub Addition Survey X Attic Garage INVENTORY Service 1 ph 100a Heat oil Duplec Recpt Ceding Fixtures HID Fixtures Service 3 ph Hot Water 30a GFCI Recpt Wall Fixtures Smoke Detectors Main Panel 100a A/C Condenser Single Recpt 50a Recessed Fixtures CO Detectors Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks Disconnect 100a Switches Twist Lock Exit Fixtures �] TVSS Other Equipment: "AS BUILT" "ELECTRICLE SURVEY' "NO VISUAL DEFECTS" Notes Whole house inspection,to include, 100a overhead service,50a range circuit,30a hot water heater circuit Inspector Signature: Date: January 15 2019 81-Cert Electrical Compliance Form.xls 1 � 9 Town Hall Annex Telephone(631)765-1802 54375 Main Road Fax(631)765-9502 P.O.Box 1179 Southold,NY 11971-0959 ?' BUILDING DEPARTMENT TOWN OF SOUTHOLD JAN 1 5 2019 TOWN OF SOIJ'I OLD CERTIFICAT-ION T Date: Building Permit No. _Ll 13 5 Owner: (Please print) Plumber: !• 1 ,R-D (Please prin) I certify that the solder used in the water supply system contains less than 2/10 of 1% { lead. (Plumbers 'gnature) - Sworn to before me this i(�� day oJUM tC� =20�. DENISE M.CHEVALIER NOTARY PUBLIC,STATE OFNEWYORK REGLI OICH5087563 QUALIFIED IN NASSAU/SUFFOLK lY COMMISSION EXPIRES NOV 3,20 �l � Notary Public,cSyt.t+ -) County, ' I t 3 3 �i 1 OF SOUIyo� TOWN OF SOUTHOLD BUILDING DEPT. `ycourm,��' 765-1802 INSPECTION � [ ] FOUNDATION 1ST [ ] ROUGH PL13G. Z [ ] FOUNDATION 2ND [ ] INSULATION �Lr�( �� [ ] FRAMING /STRAPPING [ ] FINAL [ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION [ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION [ ] ELECTRICAL (ROUGH) ] ELECTRICAL (FINAL) [ ] CODE VIOLATION [ ] CAULKING REMARKS: DATE '( INSPECTOR FIELD INSPECTION REPORT DATE COMMENTS FOUNDATION (1ST) ------------------------------------ 'FOUNDATION (2ND) o ROUGH FRAMING& PLUMBING H INSULATION PER N.Y-. y STATE ENERGY CODE r C FINAL r ADDITIONAL COMMENTS o • - z �. z rn z A . V ,H TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST BUILDING DEPARTMENT Do you have or need the following,before applying? TOWN HALLo Board of Health �` SOUTHOLD NY 1197 � % 4 sets of BuildingPlans TEL: (631) 765-1802 20'�� Planning Board approval FAX: (631) 765-9502 �j,�(� Survey Southoldtownny.gov RMIT NJ' o JU``� Check Septic Form Q N.Y.S.D.E.C. g% ®� Trustees C.O.Application Flood Permit I Examined I b 20 Single&Separate Truss Identification Form Storm-Water Assessment Form J� Contact: Approved V M4 WO, +te: L e e -Denn., Disapproved a/c Phone: (v 1 5�G - v 7 Expiration__7,1 ,20 b Buil nspector APPLICATION FOR BUILDING PERMIT Date , 20 INSTRUCTIONS a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 4 sets of plans, accurate plot plan to scale.Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and waterways. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application,the Building 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. (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 L+n 4 L2 C I tea,n (As on the tax r ll or latest deed) If applicant is a corporation, signature of duly authorized officer (Name and title of corporate officer) Builders License No. Plumbers License No. Electricians License No. Other Trade's License No. 1. Location of land on which proposed work will be done: a�c) Ch _h s ,r e F House Number Str tt Hamlet County Tax Map No. 1000 Section 2H Block 2) Lot Subdivision Filed Map-No. Lot .yF r t y t 2. State existing use and occupancy of premises,and intended use an occupJan'cy of proposgd construction: a. Existing use and occupancy b. Intended use and occupancy 3. Nature of work(check which applicable): New Building Addition Alteration Repair Removal Demolition Other WorkAs Bo r Dl �C w . ' (Description) 4. Estimated Cost 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 Rear Depth Height Number of Stories 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 Rear Depth 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? YES NQ) 13. Will lot be re-graded? YES NOX Will excess fill be removed from premises? YES NO_�(_ 14. Names of Owner of premises Address Phone No. Name of Architect Address Phone No Naive 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 MAY 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 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 1 I ) 1 flC1a 1-rontj being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing tract) above named, (S)He is the owner (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. Sworntobefore me this day of t, 20JI Notary Public TRACEY L. DWYER Signature of Applicant NOTARY PUBLIC,STATE OF NEW YORK NO.01 DW6306900 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,2C� UILDING DEPARTMENT- Electrical Inspector co TOWN OF SOUTHOLD To all Annex - 54375 Main Road - PO Box 1179 y 'A� 2p19 Southold, New York 11971-0959 Telephone (631) 765-1802 - FAX (631) 76579502 roger.richertAtown.southold.ny.us APf IeAff ION FOR ELECTRICAL INSPECTION REQUESTED BY: Date: Company Name: i Name: License No.: email: Address: C Phone No.: JOB SITE INFORMATION: (All Information Required) Name: Address: 210 fyo M4 I Cross Street: Phone No.: �--� • Bldg.Permit#: Tax Map District: 1000 Section: Block: Lot: BRIEF DESCRIPTION OF WORK(Please Print Clearly) e �— ra r 111 o c� Circle All That Apply: Is job ready for inspection?: YES 1 NO Rough In Fina Do you need a Temp Certificate?: YES 1 NO Issued On Temp Information: (All information required) Service Size .1 Ph 3 Ph Size: A # Meters Old Meter# New Service - Fire Reconnect- Flood Reconnect - Service Reconnected - Underground - Overhead # Underground Laterals 1 2 H Frame Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION �b0 82-Request for inspection Form As � �� r _ 5)'I QUA�Y CRAFTSMANSHIP AND LIGHTING EXIT IBS ARMS � � ��� QC ELECTRIC INC.PO BOX 518 LAUREL N.Y.11948©TEL:516-298-5344 PHONE NO.TO: Dinvvv �= DATE On .��%— ozfnl J f_ PURCHASE ORDER NO. 4 JOB NO. DESCRIP11ON r� PRICE UNIT AMOUNT 4f 0 �'• f t 20?� {��%E�Y" t •� F �9 !r/ t t ,e G 4 L e Gf5 QUALITY CRAFTSMANSHIP AND,LIGHTING EXPERTISE OC ELECTRIC INC.PO BOX 518 LAUREL N.Y. 11948©TEL:516-298-5344 PHONE NO,._� n TO: ' 66E DATE `�2 1 PURCHASE ORDER NO. JOB NO. Ila —;2",,)7 DESCRIP11ON PRICE UNIT AMOUNT s vc, I,Go ic r LL- Q`OVC 00. C07�74(— /©o. L IZZ(o i � n ���►n �'�ti� �ct J'� � 3 l pit, — And6f§&fi.NW Page _ of M ! i � Table of Basic Unit Sizes Scale 1/8"=1'-0"(1:96) —� -I f i ? Unobstructed 167/16" 207/161, 24 7/16" l28 7/16" 327/,6,, 36 7/16 40 7h6" _ I ? ` I—_I_ I Glass0 FRI FNI 1191 [PEI - r— I 18210 20210 (24210 28210 30210 3421038210' L uZH z�►e ; ?---;--1 3 205 L; 1832 2032 2432 2832 3032 3432 3832 , i — it _ I I I ML 1-1 - - m L 1 4--i- ( 18310 20310 24310 F28310j 30310 34310 38310 _�j I__�—_! _ �_- � �J _L__L _ 2! _101 �4- 1842 2042 1-24471 2842 3042 3442 3842 r , i --r--------t f -I--�i' '- i - - - PPR=VED AS NOTEDL ( 1846 2046 2446 2846 (30460 3446 384 DATE_I �r iglp #I I-1331015! j---;-f—� _ � ■ � � ® ■ � � FEE �r I .�g_y_•!�` J, ? l_I i C-- ;J , N� EI i ±LH NOTIFY-,BUILDINGL, PIARTIVIt I-�_AT --�� I IELLIJ, L 1 61, 8_62r 8 AM! TO 4�'M FOR THEA IFt 1852 44_2052'1 2452 2852 3052 3452 3852 ! FOLLOWING-INSPECT r , IONS 1- I FOUNDATION-=TWC�REO IRED- - — - ■ ■ ■ O _ I_ , I i 1-1 �- I FTTI __i_ FOR POURED�C=ONCRr.TE_ - L1 2.RO�GH --FRAMINC 8,,-P-L-UMBING1 I I , 1 1 , 1 , ? III , i j m I I 3_INSUL,ATiON 1—!� I i�_' 1856 2056 2456 2856 3056 3456 3856 4. FINAL Ct�NS`TRITCTION (MUST �— ���'—r—.r; BE-COM-LE-TE.-FOR C:O - -- l�� ��1 I I � � I i � rt ALL_CONSTR66TION S-ALL�MEET�THE � l--{I---�_ = i I i REQ__UIREMENTS OF THE CODES_OFNE,Y, I I r N I I� T-1 I -�_-- m - -YOIRK-S-1A---E€N& RE P'ONSIBL-E-FP1 f 4ES11 OR-CO TION ERRORS. -- I �! 1862 2062 2462 2862 3062 3462 3862 COMPLYr 1IU1TH AIL GO I I ' !_I DES OF -NE�IJ OY RFK STAT' L _� Ls�_ I- _!_- _!�J ETOWN CODES ' L! ! ! i--! I_! REQUIRED-ANQ I I r CONDIT'!ON �_ OC O UPANCY R-.-I _ i I I i I ��_L�.-� - 1 --}----- I-4— ?- --I - --o�- r l I I i �i 1 ' '-- i ' USEJS�UNLA_gNFUL 4 _ ! - 'ARD --- - - I VIIITHOUT CERTI,F�GAT-� I J-::-OC'C a P-ANCY _ ! I I I _ _ -j,4 _J I —j 1 i I I I I 9044884 Measurement Worksheet Ander§&OU Page — of — forAndersens 400 Series Perma-Shield® Narroline° Double-Hung Window Conversion Kit NE PHONE ADDRESS E-MAIL CITY/STATE/ZIP ORDER DATE Window erample;bathroom. Window# ---!Notes and sketches Location of bottom sash glass dimension window size' Window ! I Size STEP® STEP© STEP measured measured (See size table on back side Quantity glass glass of worksheet to determine needed of I I_ width height window size) this window ! f type. I ! 1 x �1 (width) (height) (window size) sash style sash color Window Style&Color exterior, I Interior O whits, (O pre-finished whitej— O sandtone 1 p pine 0 equal O cottage 0?erratone' i — — 3 —fl -�—r_;__i_-�J__.__! sash style GlassO Low-E4'glass Q non-temperedO obscure O cascade l ! i Options O Low-E4'SmartSun'glass Ect _ O reed O fern I 1 O tempered O Low-E4°Sun glass O specialty O laminate Grille Divided Light removable Firelight' O. 3/4" Style&Size I i 4 I 11 4 4 O 7/8" O with O no O no spacer, O removable O between spacer spacer removable Interior only glass O 1-1/8" interior O no grille ' sketch rrlle attern Grille O O O O — { { Pattern ® ® ■ — Ilj ; specified equal light colonial pralrieA custom F_> I I sketch pattern sketch pattern ( F y—[ t I _ Insect Screens O half O fun O TruScene® O white i O sandtone O conventional O Terratone' —�— j I ( Hardware lock&keeper double-hung sash lift(s)(optional) O Estate'" Estate' traditional Classic Series" O 1 02 O bright brass O bright brass O antique brass O hand lift O antique brass O bar lift O sash lift J— ? IIf i O Classic O polished chrome ®� O polished chrome Series'" O brushed chromeO brushed chrome O hand lift (stone color for — I O finger lift O hand lift (parry wood Interiors or O satin nickel O satin nickel white color for 0 finger lift I I O oil rubbed bronze O oil rubbed bronze �L —. �__ i white Interiors) - O finger lift (Hair) —� I r 01 02 O distressed nickel O while (pair) O white ��� I l i I I 1 O distressed bronze O stone O stone I_ I41— 'Andersen'and all other marks where denoted are trademarks of Andersen Corporation ©2010 Andersen Corporation. All rights reserved. 9044884 WINDOWS-DOORS Meastrement Guide Andersen. . for Andersen° 400 Series Perma-Shield° Narroline® Double-Hung Window Conversion Kit For questions call 1-888-888-7020 Monday-Friday,7 a.m.to 7 p.m.and Saturday,8 a.m.to 4 p.m.central time. For more information and/or guides visit andersenwindows.com. ► Read this measurement guide from beginning to end before starting.Read all warnings and cautions during unit installation. ► Read and follow product installation guide for installation instructions. AMPORTANT- -Andersen® Perma-Shield® Narroline® Double-Hung Window Interior Interior Wood Sill Core Covered with a Pre-formed Rigid Vinyl PVC Cladding Tape Measure Narroline® conversion kits can only be used on Andersen® Perma-Shield® Tape Narroline double-hung windows. They Measure cannot be used on Narroline primed wood windows. For Narroline primed Measure unobstructed glass width Measure unobstructed glass height wood and other double-hung windows, (bottom sash only). Record width in (bottom sash only). Record height in please see Woodwright° double-hung inches on measurement worksheet. inches on measurement worksheet. insert window as an upgrade option. Before Measuring: ► See size table on back 28 7/16" ► Open lower sash and determine Interior side of worksheet. Unobstructed material of sill cladding. If sill cladding glass width is not rigid vinyl PVC,conversion kit will not work. example: ► Be sure existing frame is sound and suitable for window upgrade. ► Existing frame must be plumb,level and square. Unobstructed LO Measuring Information: glass height 1-1 (bottom sash only) N ► Record measurements on "Measurement Worksheet". o. 2846 Describe window style,options,and window size accessories clearly and record on worksheet. Determine existing window size from measured dimensions recorded in steps 1 and 2. ► Measure each window even if they (See size table on back side of worksheet). appear the same size. 1 9044884 BA Revised 09/09/10