HomeMy WebLinkAbout46024-Z �o�oguFf�l Town of Southold 6/14/2021
S y P.O.Box 1179
H
53095 Main Rd
Z T
W�4 �ao� Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42080 Date: 6/14/2021
THIS CERTIFIES that the building AS BUILT ALTERATION
Location of Property: 250 Bay Haven Ln., Southold
SCTM#: 473889 See/Block/Lot: 88.4-25
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
3/11/2021 pursuant to which Building Permit No. 46024 dated 4/2/2021
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"finished basement(billiard room and den)as applied for.
The certificate is issued to Kupcha III,John&Lamar,Meghan
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46024 5/24/2021
PLUMBERS CERTIFICATION DATED _T\ f
A o iz S' ature
�SUF�Qt�co TOWN OF SOUTHOLD
moo ay BUILDING DEPARTMENT
y s TOWN CLERK'S OFFICE
• M 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#: 46024 Date: 4/2/2021
Permission is hereby granted to:
Kupcha III, John
72 Huron St Apt 2A
Brooklyn, NY 11222
To: legalize "as built" finished basement as applied for. Additional certification will be
required.
At premises located at:
250 Bay Haven Ln., Southold
SCTM #473889 _
Sec/Block/Lot# 88.4-25
Pursuant to application dated 3/11/2021 and approved by the Building Inspector.
To expire on 10/2/2022.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $769.60
CO-ALTERATION TO DWELLING $50.00
Total: $819.60
Building Inspector
SO(/ry®l
Town Hall Annex SUL ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 ® sean.devlin(a)-town.southold.ny.us
Southold,NY 11971-0959
COW,
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To. John Kupcha III
Address: 250 Bay Haven Ln city Southold st: NY zip: 11971
Budding Permit* 46024 section: $$ Block- 4 Lot 25
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 Indoor Basement Service
Commerical Outdoor 1 st Floor Pool
New Renovation 2nd Floor Hot Tub
Addition Surrey Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt 14 Ceiling Fixtures 4 Bath Exhaust Fan
Service 3 ph Hot Water Oil GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 30A A/C Condenser Single Recpt Recessed Fixtures 7 CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO 1
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 11 4'LED Exit Fixtures 11 Pump
Other Equipment: WAD
Notes " AS BUILT NO VISUAL DEFECTS " Finished Basement
Inspector Signature: Date: May 24, 2021
S.Devlin-Cert Electrical Compliance Form.xls
pF SOUIy�� 6 Q ZW Q .9-0 _�FA- r 7qA VOW
# * TOWN OF SOUTHOLD BUILDING DEPT.
�D • �O
765-1802
INSPECTION
;
] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION/CAULKING
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACEi&CHIMNEY [ ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION— [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ELECTRICAL (FINAL)
[ ] CODE VIOLATION rl PRE C/O
REMARKS:
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Aa e cll--e-cl1
o
DATE d - INSPECTOR
��WO� �O��OfSOUIyo�
# TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
._, NSPECTION -
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ INSUL-ATIOWCAULKINGG
[ ] FRAMING/STRAPPING ] FINAL65M- ' 6 Zvi (P
[ ] =FIREPLACE & CHIMNEY ' [ . ] FIRE SAFETY INSPECTION
[ ] FIRE RESISTANT CONSTRUCTION [ ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ `] ELECTRICAL (FINAL)
[ ,] CODE VIOLATION [ ] PRE C/O
REMARKS:
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DATE o 0 INSPECTOR
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FIELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION(2ND)
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PLUMBING•
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INSULATION PER N.Y.
STATE ENERGY CODE
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FINAL
ADDITION COMMENTS
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4 TOWN OF SOUTHOLD—BUILDING DEPARTMENT
H Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
?y_• o��¢ Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.jzov
Date Received
APPLICATION FOR BUILDING P RMIT
tisr_�.
or Office Use Only
Fk i
PERMIT N0. 4o� Building Inspector:
MAR 7 1 2021
_�-
Applications,and'forms iiuZbefilled=out,inaheir'eritir'et'�
appllCat10f1511V111a10 i _ t4-€ �,,� n,,.,�. ;5:�ri
tt�e`'acceptetl'.=��U11Fiere'the'Applican�is riot:th�e,owner;an; = ,° ••
0wners"Auth6iization forfi' Page:2l,!h61 ie-coinplefeds.� R`;,<<� - ;= __ ,��`, r;; -
aa_ %'A-Ai'�J
Date:2/12/2021
sq Ty,
OWNER S�AF PROPERTY:
Name:JOHN KUPCHA AND MEGHAN LAMAR SCTM#1000-88-4-25
Physical Address:Z0 BAY HAYEN,_SOUTHOLD,_NY 1.1971
Phone#:609.304.2527 Email:John.kupcha@gmail;eom
Mailing Address:265 Bay_ Haven Lane , Southold, NY
a t•-'
CONT-ACT-PERSOM
Name:Eileen Wingate for Quiet Man Studio
Mailing Address:2805 West Mill Rd, Mattituck,NY 11952 _
Phone#:519-818-9. 754 Email:eileen@quietmanstudio.com
rDESIGN PRUFESSIONONFORI
` TIO • ' �,-
VIA Nc z` i�:' r.
Name:Condon
Mailing Address: 1755Sigsbee Road,_YMattituck, NYn11952-
Phone#:631.298.1986 Email:Condoneng@optonline.net m rtF
> -
CO
NTRACTOR�INFORMATIONc:� - -
Name:
Mailing Address:
Phone#: Email:
EC_ IP1 - _ =
DSR T N_'OF:PROP_ T
O U ED CONS Rt1C ION
S k `[
❑New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other AS BUILT $
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes ®No
1
=Et3TY�-' -
1 O
F RiVI'
Existing use of property: SINGLE FAMILY'H2OME Intended use of property:SAME WITH DEN IN BASEMENT
Zone or use district in which-premises is situated: Are there any,covenants and restrictions with respect to
-R-40 this proper(y? ,0Yes BNo 'IF YES,`PROVIDE A COPY.
_ '' '.•tr�'{,;' -_: - - - ;}r--�.,Y"+r - ,,,a� r..r„yr.Y - - ��';{,•,�' ✓,fir.� - ,
l�'Cl e`tl�,Boii`l"ftc Reath# -`49e' 'r
_ ,,��. .ownp/coi�ttr�Cfc`r%des`ign'}3'rfifessigh�lisrespd4si�te�forall�r�ina �'�nd:s orriivii`ter-issues' `ro i�,
- _ - = �<:- g,�r;�,,,k�- -.a ,as.P v ded'bY
_Chapter 236 oftfie Fowir Code`APPUCA`I0 iS t1E ESY NfAD ” - -
.'-,_N „R,, E to ttii Building Departmeni?fcri}ie i ivari"e''f a Builcllii"" efnilt'Y`ur uant
_ = -_ _ _i. s`_ ta�the:6uilding Zone-.
'"O�dinanee of�tii`e_7ownofsautho�d�ffolk
;,,, ,,, �<, ht; ,(�,,rid e r_pplic��It�Lai+its;O�illiiaricesoYltegulatioii�,for:tli�construction of'byildiri
-;�,< ,',,. =- _ 4 -.?�ca ti'greest6complywJitral��a liea6le�tarvs^,ordinan es uit in .-'+�,
'�1io"sln�codeaid'i�' tation •- �;Y_'�. - - _ -. --- = :-r;,:x=f�<:,_..�=.��;��,^��.-t?!?<==,,�<,:.,' - � �b=_>�� S:cad@;'-.
.8.. F<.,, _$Y! _s and,to,admlt authoried Tiffs e � �jiremises=anil,in�buildrn s,for'necessa S - � ^� -
_ ',�! _ -:�: <>,,- - _ p:uctorsori� 4 x g(} rynspections:Fatsestatemetfsinad+e'h�ere' a '
`irni�hab�'a�x`:Ciass;;p`►;}nisderfiea'o'� `iU = �,.,-:-�`�>>:9sr-;'F.��=-_;=�,�..,.�� �,!: - ..sem-_i<:�.,,-,�•}<;: _-
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Application Submitted By(print name): jgA6thorlizid Agent 136wner
-
SignaWre ofiApplicant: ;Date:
1111 ,
STATE 0F'kW,Y6,Rk)
SSS:
'COONTY'OF ,5] 1
Eileen Wingate 'being'duly-sworn,deposes acid says that(s)he is the-applicant
I(Name of'individual•sigriing`contract)above named
(S)he is the,—,,,Agent for Owner
(C)ntractor,Agent,Corporate Officer;'etc:)`
of said,owner•or owners,and is duly authorized to perform,o'r have performed the said-work and to make and file this
application;that'alhstaterhents-contained-in this application are`true'to the best of,hisjher knowledge and belief;and
tha'fthe work Will,be.performed'n the manner,set forth=in the application file,therewith.
Sworn before.i a this
4 .day of Winch ,20 Zj JA
g ota �Y WY R `
NOTARY PUBLIC,S E OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
;PRQ-MY�flwNE&A�IST_QIOMMISSION EXPIRES JUNE 30,2�o a
- �
M1rWhere�the-applic na t isndt the owner)
1, JOhrn KUpcha ne
residing at 250 AKA 265 Bay Haveri'La , Southold, NY 11971
:
do hereby authorize:EFle' eh-Win-g
- - - = -ate �to apply on
my behalf to the Town of Southold Building Department'for ap'proval;as described herein.
-373121
:Owner's Sig, ature Date
John Kupcha
Print Owner's Name
2
'".
-
ION-
--PRO
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NFO IVI
Tt0
_ - -`'i:T ."4i+•iii
Existing use of property: SINGLE FAMILY HOME Intended use ofro e
p p rtY:SAME WITH DEN IN BASEMENT
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-46 this property? ❑Yes 8 No IF YES,PROVIDE A COPY.
Check B X
_
Afte Readin` '.''tNeowner coti£ractor""dell{" i
professional,s responsible for all drainage and s'_tomi v±ater,issues as 'rovideiti'
RCha0ir 236 of the Town`Code.'APPLICATION'{S'HEREBY�MADE to the`Buildin De"artinen fo�`$i '`' "n' 64;
__g, p t e�ssuarite of a'8uiidingPermit,pursuantjtothe Building Zone
;Ordinance of the Town of Southold,'suffolk;County;',New Yoik;ar d other appiicable Laws?Ordinances'or Re Cations'foraiie c ru n f i ' = `�
•w ,•t •a._;°`l-,. ,...a- gu ,i ,011,5 ctio wo,;bui dmgs;`,;-
3additons'''alteratlonsorforremovalWor,dem i e d scrvbed:The;a li''
of tion as;h"rein a pp emit agrees to eofii;ily with all appliealile,laws;'ordinances,,building tdc!"
a'0uU0hg cod"hel regula`tlonsandto admit authorized Inspectors ori piemises'and in building(s)'for necessary_inspecttons:false'stateirients`,inade herein ares
>punish`able as a-Class A'misdemeanor' ursuarit to Sect on 21 .4 ''
_ _ _p_ [_ 0 S of the New York State_Penal taw:- e
Application Submitted By(print name): @Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
,,��,S++rS�:
COUNTY OF SUCI�C[ )
Eileen Wingate being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent for 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/her knowledge and belief;and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
day of lel arG .20 2-1
JA&S4 -
6tarTMEY
Owyt R
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
PROPER <OWNER AQTHORIZATIOMOMMISSION EXPIRES JUNE 30,2�a
(Where the applicant is not the owner)
I John Kupeha residing at,250 AKA 265 Bay Haven Lane, Southold, NY 11971
do hereby authorize Eileen.Wingate 'to apply on
my b If to the Town of Southold Building Department for approval as described herein.
3/3/21
Owner's Sig ature Date
John
"Ku
Print Owner's'Name
2
BUILDING DEPARTMENT- Electrical Inspector 3
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959 t
5.
�. Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr(a�'southoldtowran .aov seand�a�southoldtownny.gou
,�. -
PP<LfCAT1ON FOR ELECTRICAL INSPECTION`
ELECTRICIAN INFORMATION (All Information Required) Date: _
Company Name:
Name:- - _ .- -. .... •- .�. __ --- ---- -- - _-__-- _ _ _�
License No.: email:
Address:•-; - - - - - -- - - =--- -=---_ -_-- - ---- -- ---- --- _ r _ I
_ r
Phone No..-
s;
JOB SITE INFORMATION (All information Required)
Name:,.-. -
` Address:
_
Cross Street:
Phone No.:
BIdg.Permit#: L+ 1. email:
Tax MapDistrict: • 1000 Section: Block: _ Lot: s
- -
BRIEF DESCRIPTION•OF WORK (Please Print Clearly) '
r.
6L
i
Circle All That Apply:
Is job ready for inspection?: YES / NO Rough In Final
Do you need a Temp Certificate?: YES ! NO Issued On
Temp Information: (All information required) I
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 s
Additional Information:•
PAYMENT DUE WITH APPLICATION
Request for Inspection FormAs
PERMIT# Address:
Switches
cOutlets
GFI's
Surface
Sconces
H H's W,
15
UC Lts
Fans Fridge HW
Exhaust Oven Dryer
Smokes DW Service ,
Carbon Micro Generator
Combo Cooktop Transfer
AC AH Mini
Special:
Comments
-..aaWfl r"�ti,�.Nnw:rS'atYa�.°�zxA5,14i�aWt**:+'c9fr+��ar+{t*.ti."4�RlAtlxs�yy.�,�y ,1'b"t'�katlau�r,'i'^�.%wwcS�Y+nr}��fs*5�tfl;",v�kR.7+x:a9"=NsacwK'Riar>losrru,.arena+e.cY+flL;jH+q�k+E^ew0.Ca+!4^Gt3•T-4t.+�aeex„daw Rakasa�,w'3tiaaar#v�+3carytcmi#+"dna*q+v,:+aawvx..aume+eNa,+#-aac�s+.w,eiu S,.�'ercrub•aMn-mmraaserrsa�.e.:.+�.-.<+.Ura.�•ca�wr:.4.,s•..swo:4•.F�•aceaR<1nWrv.�Yax++ewr,+rtaaa,�anvMvcw+�v.:'•awrsarv.a{,er,+w,yr«•s,...^s.,.�n-v.nvwr+a".ro•+Wr�b:.ew»a.�na.wd+m+uw«;.nr.�...,+nm-.. - _
.�d
APPROVED AS NOTED
DATE: B.P.#` '----
FEE: BY;
f m _ Com .
NOTIFY BUILDING 'DEPARTMENT A -_- -�---� •� --_�--- ---�"- �- �_�- - --T-�-- �-- ---__ -. .- - �r
765=1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS: 1 f .11147
1. FOUNDATION= - TWO REQUIRED
FOR.POURED CONCRETE -
2.
ONCRETE
2. ROUGH - FRAMING & PLUMBING' I
all
r
S. INSULATION
# ,
. FINAL - CONSTRUCTION'MUST
BE COMPLETE FOR C 0.
f` #
ALL CONSTRUCTION SHALL MEET THE pool
REQUIREMENTS OFTHECODESORNEW �_ at _ A'
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS. � _ _,� ,�,.�;,•
up
COMPLY WITH ALL CODE ,,
NEW YORK STATE & TOWN OODES
AS REQUIRED AND CONDITIONS OF
vvmvL
• � G BOARD
_ ;
�...
OCCUPANCY OR,OS �•
E IS UNLAWFUL E
�ITHOUT CERTIFICATE. _ _ ¢¢
}F OCCUPANCY o ,w f
Additional 2L
Blower door Certification
and-ductwork MAY Be Required, � x
testing required. ?sf
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