HomeMy WebLinkAbout45522-Z $uFFOt'fCo� Town of Southold 2/24/2021
0
P.O.Box 1179
o + 53095 Main Rd
4,j Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 41823 Date: 2/24/2021
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 695 Rogers Rd, Southold
SCTM#: 473889 Sec/Block/Lot: 66.-2-42
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
11/18/2020 pursuant to which Building Permit No. 45522 dated 12/2/2020
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:
"as built"alterations, including garage conversion to habitable space and enclosed porch,to an existing one family
dwelling as applied for.
The certificate is issued to Graham,Edward
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 45522 12/9/2020
PLUMBERS CERTIFICATION DATED
Au or ed 1 ature
iso�1K TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
�y • �� SOUTHOLD, NY
?rQ�
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#: 45522 Date: 12/2/2020
Permission is hereby granted to:
Graham, Edward
Rogers Rd
PO BOX 1083
Southold, NY 11971
To: legalize "as built" alterations to existing single-family dwelling as applied for.
Additional certification will be required.
At premises located at:
695 Rogers Rd, Southold
SCTM # 473889
Sec/Block/Lot# 66.-2-42
Pursuant to application dated 11/18/2020 and approved by the Building Inspector.
To expire on 6/3/2022.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $525.60
CO -ALTERATION TO DWELLING $50.00
Total: $575.60
Bu Inspector
Form No.6
TOWN OF SOUTHOLD.
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CER'T'IFICATE 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 aceurate-location of all buildings,propertylines,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 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:
I. Accurate survey of property showing all property lines,streets,building and unusual natural or topographic
features.
2. A properly Epmpleted 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$15.00
Date.
New Construction: Old or Pre-existing Building: 1/ (check one)
Location of Property_ G L7 .5 A9 R� �;6") �4o
House No. / I �Str9eet " _/ Hamlet
Owner or Owners of Property: �Ct �U/�C+- "V� 6/� h/a_yi
Suffolk County Tax Map No 1000, Section 66 Block d 2 Lot 2
Subdivision rr �/ Filed Map. Lot:
Permit No. J� / Date of Permit. Applicant:
Health Dept_Approval: Underwriters Approval:
Planning Board Approval: Ad/1-
Request
l/Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted:$ �V
Applicant Vgnature
o� sovP��
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179sean.devlini-town.southold.n
Southold,NY 119711-0959 .� � y•us
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Edward Graham
Address: 695 Rogers Rd city:Southold st: NY zip: 11971
Building Permit#: 45522 Section 66 Block- 2 Lot. 42
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: AS BUILT License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service X
Commerical Outdoor X 1st Floor X Pool
New Renovation X 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph 200A Heat Duplec Recpt 30 Ceiling Fixtures 10 Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt 5 Wall Fixtures 6 Smoke Detectors 4
Main Panel A/C Condenser 1 Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower 1 Range Recpt Ceiling Fan 3 Combo Smoke/CO 3
Transfer Switch UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 25 4'LED Exit Fixtures Pump
Other Equipment: Mini Split AC
Notes "AS BUILT NO VISUAL DEFECTS"New Service,Transfer Switch and Rewiring of House
Inspector Signature: Date: December 9, 2020
S.Devlin-Cert Electrical Compliance Form As
0f SO//lyp�
# # TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
INSPECTION
[ ] FOUNDATION 1ST [. ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] INSULATION/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: AS,
ot�_ro__
DATE INSPECTOR � � .r -
F1 S Lc; i H--L ETT-71 -71
FEB 1 7 2021
February 17, 2021
RE: 695 Rogers Road,Southold
Building Inspector
Town of Southold
Main Road
Southold,NY 11971
Dear Sir,
I have inspected the conversion of the existing garage to an unconditioned storage room
and certify to the best of my ability and knowledge that it was done in accordance to New York
State Building Codes.
OS2b�0
OFESSID
BOARD CERTIFIED IN STRUCTURAL ENGINEERING
a c3s r=F-H(@?Ft a C H E-r-ri.co m FISCH E-1771 ENGIN EERI NG.00M 63 1 -765-29S4
1 725 HOBAR -r ROAD sou -i- HOLD , NEW YORK 1 1 97 1
FIELD INSPECTION REPORT DATE Gt}1kI11ME�tTS
FOUNDATION(IST)
------------------------- ---------
FOUNDATION(ZND)
y
ROUGH FRAMING&
PLUMBING
INSUIr ATION PER N.Y. y
STATE ENERGY CODE
FINAL ,
LZ
A-DDr-..,'l£N :S
ll:k 114,
1
Aott J
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t
i HHH
TOWN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
BUILDING DEPARTMENT V" Do you have or need the following,before applying?
TOWN HALL `)j1 Board of Health
SOUTHOLD, NY 11971 ` 4 sets of Building Plans
TEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 LSurvey
Southoldtownny.gov PERMIT NO. J Check
Septic Form
MY S.D E C.
Trustees
C.O.Application
Flood Permit
Examined 20J Single&Separate
Truss Identification Form
Storm-Water Assessment Form
Contact:
Approved 120 0(-L' Mail to:
Disapproved a/c
Phone: 403] ' (.52 5` d 7-q
Expiration ,20
BuildVg k1pector
APPLICATION FOR BUILDING PERMIT
-
NOV 1 8 2020
Date ) 20 z
_ INSTRUCTIONS
ra,;Th'isappli'cation 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.
k
(Signature of applicant or name,if a corporation)
695- o s AkDo'9- Svv�1)4
(Maili address of applican
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
C0yJ a-41r^,
Name of owner of premises W
(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. a V 0 /
Electricians License No.
Other Trade's License No.
1. Location of land on whi proposed work w' be do e: C J r yl
b s, i� J t/o
House Number Streit Hamlet
County Tax Map No. 1000 Section 66 Block 2 Lot 4
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 � l(/
b. Intended use and occupancy �G�9�LL
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work
(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 Fonner Owner
11. Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO � Will excess fill be removed from premises?YES NO
14. Names ofof premises !' GV'vI I nv^l Address Phone No.
Name of Amc , t -�3 os A—Sck RI Address 02)5-/h low Phone No Gal —76-52 - z%S�
Name of Contractor Address Phone No.
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO K
* IF YES, SOUTHOLD TOWN TRUSTEES &D.E.C. PERMITS MAY BE REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NOX_
* 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_X_
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF (( 6/)-"O' /I.-
fawn"`" 'A,.-w being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named, CONNIE D.BUNCH
S He is the Notary Public,state of New York
( ) CN�YI�/' No.01BU6185050
(Contractor,Agent, Corporate Officer, etc) Qualifiedin l 1
Commission Expires April 14,2�
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.
Sw, 1to before me tlli
-4-1 day of O�jU�QYl� 20al)
wid- A"�a/vru/
Notary Public Signa re of Applicant
/4 OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKLIST
DING DEPARTMENT Do you have or need the following,before applying?
VVN HALL
/ Board of Health
THOLD,NY 11971
4 sets of Building Plans
SEL: (631) 765-1802 Planning Board approval
FAX: (631) 765-9502 Survey
Southoldtownny.gov PERMIT_NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
ti Flood Permit
Examined ,20 Single&Separate
Truss Identification Form
i Storm-Water Assessment Form
Y
+
Contact:
Approved 520 t Mail to:
Disapproved a/c
Phone:
Expiration ,20
Building Inspector
APPLICATION FOR BUILDING PERMIT
y � JUN 2 4 2020 `--
•`� Date � � 9 , 20 ao
_ _ INSTRUCTIONS
a. This application MUST be`completely filled in bytyp+ewriter 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. I
i
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,hi(using code,and regulations,and to admit
authorized inspectors on premises and in building for necessary inspections.
(f
(Signature of applicant or arae,if a corporation)
1'6
(,Mailing address of applica
State whether applicant ' owner lessee, agent, architect, engineer, general contractor"electrician, plumber or builder
Name of owner of premises
(As o 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:
---' \9S ROG-59-9 k 6ai) S'd u fhalc�
!umber Street Hamlet
Tax Map No. 1000' Section Block Lot Z,
I - a
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 d t.J2(((h 4 fi ,51-kn nie r re.h f c�
b. Intended use and occupancy s Q1
3. Nature of work(check which applicable): New Building Addition Alteration'
Repair Removal Demolition Other Work
)
4. Esti ated Cost Fee (Desc ' 'on
(To be paid o mg this application)
5. If dwelling, tuber of dwelling units Number of dwelling units o ch floor
If garage, num of cars
6. If business, commercial o ixed occupancy, specify nature a xtent of each type of use.
7. Dimensions of existing structures, ' any: Front Rear Depth
Height Num of S ies
Dimensions of same structure W alterati s or additions: Front Rear
Depth eight Number of Stories
8. Dimensions of entire construction: Front Rear Depth
Height Number of Stories
9. Size of lot ront Rear De h
10. Dat of Purchase Name of Former Owner
1 . Zone or use district in which premises are situated
12. Does proposed construction violate any zoning law, ordinance or regulation? YES NO
13. Will lot be re-graded? YES NO V Will excess fill be removed from premises?YES NO V
3
14. Names of Owner of premises ldwa;14 fl16C � Address Ptd s na08' /4 Phon6No
-1� . Lal I'ad)
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 t"
* 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 OFcSIe�I��/K
GJ, <�/Q4N*en being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)He is the
(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
day of 20
LORRAINE ICI.OPFER
Nota PU lic Nota ry Public,Stat,of NeWVbrk f
No.4825373
Qualified in Suffolk County /
Commission Expires Nov.30, :;ea�/
r2;
BUIL 1Lo1 DEPARTMENT- Electrical Inspector� TOWN OF SOUTHOLD
0 E C, A02
Town Annex - 54375 Main Road - PO Box 1179
-0059
Southold, New York 11,971
e (631) 765-1802 - FAX (631)765-9502
'ro` seand@s6utholdtown .9ov-
bu oldtownny.gov
21
APPLICATION FOR ELECTRICAL INSPECTION-
ELECTRICIAN I I NFbRIVIATION (All information Required) Date,!
Company Name:
Name:
License No.: email:
Address:
Phone No.:
JOB SITE INFORMATION (All Information Required).
Name:
Address: -
& 9'�5 ��6 �r-y
Cross Street:
(
Phone No.: Ce '
,—
Bldg.Permit email: e5qjr-o-kc� 60r-fz-nlin-e.
Tax.Map,pistrict: 1000 Section: 4, Block: ;2
BRIEF DESCRIPTION:OF WORK (Please Print Clearly)
r
cler LL(-e
Circle All,That Apply:
Is job ready for inspedtion?: YDS
E9 NO Rough In 'Final
(
Do you need a Temp Certificate?: YES No Issued On
Tom p-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 Informatiori.-
PAYMENT-DUE WITH APPLICATION
Request for Inspection Formals 146 r
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