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Town of Southold 1/15/2020
� , P.O.Box 1179
0
y T 53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41002 Date: 1/15/2020
THIS CERTIFIES that the building WINDOWS
Location of Property: 555 Village Ln., Orient
SCTM#: 473889 Sec/Block/Lot: 25.-2-5.4
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
1/6/2020 pursuant to which Building Permit No. 44574 dated 1/6/2020
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:
ALTERATIONS INCLUDING WINDOWS TO AN EXISTING ONE FAMILY DWELLING PER HPC
APPROVAL,AS APPLIED FOR
The certificate is issued to Constant,Karin
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 41543 10-19-2017
PLUMBERS CERTIFICATION DATED
4.
a0 z d Signature
o�gpFf01 TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y 2 TOWN CLERK'S OFFICE
�y • 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#: 44574 Date: 1/6/2020
Permission is hereby granted to:
Constant, Karin
555 Village Ln
PO BOX 225
Orient, NY 11957
To: Alterations to an existing single family dwelling (window replacements and a bay
window replacement) as applied for per HPC approval.
Replaces BP#41543
At premises located at:
555 Village Ln., Orient
SCTM #473889
Sec/Block/Lot# 25.-2-5.4
Pursuant to application dated 1/6/2020 and approved by the Building Inspector.
To expire on 7/7/2021.
Fees:
PERMIT RENEWAL $125.00
Total: $125.00
Building I spector
gvr�ot,� TOWN OF SOUTHOLD
X00`9 c�dy. BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
�y • 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#: 41543 Date: 4/20/2017
Permission is hereby granted to:
Constant, Karin
555 Village Ln
PO BOX 225
Orient, NY 11957
To: alterations to an existing single family dwelling (window replacements and a bay
window replacement) as applied for per HPC approval.
At premises located at:
555 Village Ln., Orient
SCTM # 473889
Sec/Block/Lot# 25.-2-5.4
Pursuant to application dated 3/29/2017 and approved by the Building Inspector.
To expire on 10/20/2018.
Fees:
SINGLE FAMILY DWELLING -ADDITION OR ALTERATION $200.00
CO -ALTERATION TO DWELLING $50.00
Tot $250.00
1
Building Inspector
SO!/ry0
Town Hall Annex Telephone(631)765-1802
54375 Main Road N Fax(631)765-9502
P.O.Box 1179 ® roger.richert(cb-town.southold.ny.us
Southold,NY 11971-0959Q
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICIAL COMPLIANCE
SITE LOCATION
Issued To: Constant
Address: 555 Village Lane City:Orient st: New York zip: 11957
Building Permit#- 41543 Section- 25 Block: 2 Lot: 5.4
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
contractor: DBA: Rey Lopez Electrician License No: 59226-ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement - Service Only
Commerical Outdoor 1st Floor X Pool
New Renovation X 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 Wall Fixtures Smoke Detectors
Main Panel A/C Condenser Single Recpt Recessed Fixtures 1 CO Detectors
Sub Panel A/C Blower Range Recpt Fluorescent Fixture Pumps
Transformer Appliances Dryer Recpt Emergency Fixture Time Clocks
Disconnect Switches Twist Lock Exit Fixtures TVSS
Other Equipment:
Notes:
Inspector Signature: Date: October 19, 2017
J
0-Cert Electrical Compliance Form.xls
SOF SOUTH
Comm,�^c�
TOWN OF SOUTHOLD BUILDING DEPT.
765-18®2
INSPECTION
[ ] FOUNDATION 1ST [ ]/INSULATION UGH PLBG.
[ ] UNDATION 2ND [
[ FR® / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ]
ELECTRICAL
(ROUGH) [ ] ELECTRICAL (FINA)L
(17 MARKS:
WvIc.,
DATE INSPECTOR
OE SO�ryolo
TOWN OF SOUTHOLD BUILDING DE T.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLEIG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING / STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) ] ELECTRICAL (FINAL)
REMARKS:
DATE �� INSPECTORYC '- y
J
�� � �aOE SOUTho
# # TOWN OF SOUTHOLD BUILDING DEPT.
cou765-1802
INSPECT-ION
[ ] FOUNDATION 1 ST [ ]IRGH PLBG.
FOUNDATION 2ND [ LATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ]' FIRE RESISTANT PENETRATION
[ ] ELECTRICAL-(ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
r
DATE I� INSPECTOR
FIELD INSPECTION REPORT DATE COMMENTS
. b
FOUNDATION(IST) H
-------------------------------
FOUNDATION(2ND)
z
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ROUGH FRAMING& y
PLUMBING
71
(T) r
INSULATION PER N.Y. �y
STATE ENERGY CODE
V 13170 rol
FINAL
ADDITIONAL COMMENTS
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TOWN 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 Board approval
FAX: (631) 765-9502 Survey
South oldTown.NorthFork.net PERMIT NO. Lq ez Check
Septic Form
N.Y.S.D.E.C.
Trustees
D C.O. Application
Flood Permit
Examined 120 DSingle&Separate
MAR 2 9 2017 D Storm-Water Assessment Form
1� �®B Contact:
Approved 120 fit] aNl►1�0 ( fin �5
Disapproved a/c OF S LD
L_ 3 Phone: 31 `3;23
Expiration '20
Building Ins e for
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 wort: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.
ht - 6124�5�
(Signature of applicant or name, if a corporation)
�o` nx o?d-:� N e_ -N V 1154 7
(Mailing address of applican
to-311 —_�3-23—acs
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
(')LADY)QX
Name of owner of premises
(As on the tax roll 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:
,5,5-5 yM G -ems�.. )—any_ d f-w e��-
House Number Sttet Hamlet
County Tax Map No. 1000 Section e � "`' ''Bl`och'�' ,;,','" '" ''+" Lot �_
Subdivision Filed Map No. Lot
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Azp� /-/,j !�z
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration
Repair Removal Den golitiq>l -.Other-Work GG' 1 41 6:" ,� P
(Descriptioi2)
Fee
4. Estimated Cost � b t 4 `>
j ;r, s �.(To be paid on filing this application)
5. If dwelling, number of dwelling units NQib&of dl'Welling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, sp-c&fyxnature ancr�exteri?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 NO i,
13. `Vill lot be re-graded? YES NO , Will excess f ll be removed from premises? YES NO
14. Names of Owner of premises Address Phone No.
Name of Architect Address Phone No
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO
* IF YES, SOUTHOLD TOWN TRUSTEES & D.E.C. PERMITS 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=SUfla )
OLf-'t Y) �/� , ��5 O A- being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the ()w ne,(-
(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 before me this
,qq th day of Ma rch 20 17
TRACEY L. DWYER ,
LIC,STATE OF
Notary Pub i NO.01DW6306900 Signature of Applicant
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,22/8
SgUFF9j/('0OG
y�
James Garretson,Chairperson b • Town Hall Annex
Anne Surchin,Vice Chair 'llp� ' 54375 Route 25
Donald Feiler PO Box 1179
James Grathwohl Southold,NY 11971
Robert Harper Fax(631)765-9502
Gary Parker Telephone: (631)765-1802
Edward Webb www.southoldtownny.gov
Damon Rallis,Administrative Assistant
Town of Southold
Historic Preservation Commission
RESOLUTION #4.18.17.3
April 18, 2017
Certificate of Appropriateness
RE: 555 Village Lane, Orient, SCTM# 1000-25.-2-5.4
Owner: Constant
RESOLUTION:
WHEREAS, 555 Village Lane, Orient,NY is on the Town of Southold,New York State and
National Registers of Historic Places, and
WHEREAS, as set forth in Section 56-7 (b)of the Town Law(Landmarks Preservation Code)
of the Town of Southold, all proposals for material change/alteration must be
reviewed and granted a Certificate of Appropriateness by the Southold Town
Landmarks Preservation Commission prior to the issuance of a Building Permit,
and
WHEREAS, an application was submitted for window replacements, siding changes, and an
alteration to an existing single family dwelling and
WHEREAS, the applicant submitted a proposal outlining the scope of work which included
replacing 28 windows with Anderson 400 Series Woodwright double-hung
windows,replacing existing clapboard on the front of the house with Hardie
siding—4 inch exposure, and the addition of a Bay Windows, and
WHEREAS, a public hearing was held on April 18, 2017, and,
WHEREAS, the applicant submitted corrected plans outlining the proposal, dated April 17,
2017, and,
NOW THEREFORE BE IT RESOLVED,that the Southold Town Historic Preservation
Commission determines that the proposed work detailed in the above referenced application
meets the criteria for approval under Section 170-8 (A) of the Southold Town Code and,
BE IT FURTHER RESOLVED,that the Commission approves the request for a Certificate of
Appropriateness.
MOVER: Commissioner Parker
SECONDER: Commissioner Webb
AYES:Parker,Webb, Grathwohl, Garretson
NAYS:Harper, Surchin
RESULT: Passed
Please note that any deviation from the approved plans referenced above may require further
review from the commission.
Signed: L2
Damon Peter Rallis,Application Coordinator for the Historic Preservation Commission
Date:
ooF so�ryol
Telephone (631)765-1802 ti O Town Hall,53095 Route 25
Fax (631)765-95021 P.O.Box 1179
�a Southold,New York 11971-0959
COU
SOUTHOLD TOWN
LANDMARK PRESERVATION COMMISSION
CERTIFICATE OF COMPLETION
January 14, 2020
Karin Constant
555 Village Lane
PO Box 225
Orient, NY 11957
(SCTM#1000-25.-2-5.4)
This letter is to certify that you have completed your project to the satisfaction of the
Southold Town Historic Preservation Commission in accordance with your Certificate of
Appropriateness, issued April 18, 2017.
Should you have any questions, feel free to contact me at the number above.
Sincerely,
J
V, d
'�)
Tracey L. Dwyer
Administrative Assistant
Southold Town Historic Preservation Commission
CC:file, applicant
�o��pF SO(/j�ol
o
Town Hall Annex Telephone(631)765-1802
N
54375 Main Road (631)765- 5112,
P.O.Box 1179 �. Q roger_richerttawn_sout�o nV us
Southold,NY 11971-0959 _
BUILDING DEPARTMENT
TOWN OF SOUTHOLD '
APPLICATION FOR ELECTRICAL INSPECTION '
REQUESTED BY: ��-� �J/). �s � Date:
Company NaMe: ! _ _
Name:
License No.: 5 070
Address:
Phone No.: 973 .5 W,3
SI
-OB TE INFORMATION: (*Indicates rewired information)
*Name: ��� �j � 1
'*Address:
*Cross Street: -
*Phone No.:
Permit No.:
Tax-Map District: 1000 Section:_. Z� Block: Lot:
*BRIEF DESCRIPTION OF WORK (Please Print Clearly)
(Please Circle All That Apply)
*Is job ready for inspection: i
YES/ NO. Rough in Fina! �-
*Do-you need a Temp Certificate: YES/ NO
Temp Information (If needed)
*Service Size: 1 Phase 3Phase 100 150 200 300 350 400 Other I .
*New Service: Re-connect Underground Number of Meters Change of Service Overhead
Additional Information: PAYMENT DUE WITH APPLICATION
82-Request for inspection Form
I ^
y
s,
SURV tY OF FROPERTY
51TUATE: ORIENT N
TOM 5OUTHOLD
5UPFOL-K GOUNTY, NY W e E
SURVEYED 10-20-2004
SUFFOLK GOUNTY TAX #
1000 - 25 - 2 - 5.5
1000 - 25 - 2 - 5.2
CERTHM TO:
]Karin Constant
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FOLLOWING INSPECTIONS:
1. FOUNDATION - TWO REQUIRED ,
1 FOR POURED CONCRETE r
2. ROUGH - FRAMING & PLUMBING
3. INSULATION
4. FINAL - CONSTRUCTION MUST
BE COMPLETE FOR C.O. -
ALL CONSTRUCTION SHALL MEET THE I/,�
REQUIREMENTS OF-THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR i �N
DESIGN OR CONSTRUCTION ERRORS.
r�- - COMPLY WITI-I ALI- CODES OF tiL1o"�,
NEW YORK STAT E TOWN CODES
AS REQUIRED ANb CONDITIONS OF
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'UPANCY OR
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FOR POURED CONCRETE , USE IS
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3. INSULATION
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