HomeMy WebLinkAbout46297-Z �SUF�at�:
X00 1pGy Town of Southold 10/9/2021
o -
P.O.Box 1179
53095 Main Rd
kyljpl �ao�}Yy�i Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42413 Date: 10/9/2021
THIS CERTIFIES that the building ADDITION/ALTERATION
Location of Property: 100 Victoria Dr., Southold
SCTM#: 473889 Sec/Block/Lot: 78.-9-63
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
5/5/2021 pursuant to which Building Permit No. 46297 dated 5/24/2021
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:
two stoop additions to existing single-family dwelling as applied for.
The certificate is issued to Lawlor Susan Revoc Trust
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46297 9/15/2021
PLUMBERS CERTIFICATION DATED
th ize SV
nature
�SUFFiK� TOWN OF SOUTHOLD
po aye BUILDING DEPARTMENT
C
2
y TOWN CLERK'S OFFICE
4o,
SOUTHOLD, NY
ol
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#: 46297 Date: 5/24/2021
Permission is hereby granted to:
Lawlor Susan Revoc Trust
100 Victoria Dr
Southold, NY 11971
To: construct front stoop additions to existing single-family dwelling as applied for.
At premises located at:
100 Victoria Dr., Southold
SCTM #473889
Sec/Block/Lot# 78.-9-63
Pursuant to application dated 5/5/2021 and approved by the Building Inspector.
To expire on 11/23/2022.
Fees:
SINGLE FAMILY DWELLING-ADDITION OR ALTERATION $216.00
CO-ADDITION TO DWELLING $50.00
Total: $266.00
I nspector
rjv so
Town Hall Annex ® Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 sean.deviinCa-town.southold.n us
Southold,NY 11971-0959 y'
COU
BUILDING DEPARTMENT
TOWN OF SOUTHOLID
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Lawlor Susan Revoc Trust
Address: 100 Victoria Dr city-Southold st: NY zip: 11971
Building Permit#: 46297 Section. 7$ Block. 9 Lot. 63
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: DBA: Boxer Electric License No: 60137ME
SITE DETAILS
Office Use Only
Residential X Indoor X Basement X Service X
Commerical Outdoor X 1st Floor Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey Attic Garage
INVENTORY
Service 1 ph X Heat Duplec Recpt Ceiling Fixtures Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 200A A/C Condenser Single Recpt Recessed Fixtures CO2 Detectors
Sub Panel A/C Blower Range Recpt Ceiling Fan Combo Smoke/CO
Transformer UC Lights Dryer Recpt Emergency Fixtures Time Clocks
Disconnect Switches 4'LED Exit Fixtures 11 Pump
Other Equipment 200A Panel 30 Circuit/ 13 Used
Notes* Service
Inspector Signature: I Date: September 15, 2021
S.Devlin-Cert Electrical Compliance Form
80Hp
# * TOWN OF SOUTHOLD BUILDING DEPT.
765-1802
a
INSPECTION
-
[ ] FOUNDATION 1ST ' [ ] ROUGH PL13G.
[ ] FOUNDATION 2ND [ ] SULATIOWCAULKING
[ ] FRAMING /STRAPPING ] FINAL �5. P�
[ ] FIREPLACE & CHIMNEY [ ] FIRE SAFETY INSPECTION'
[ ] FIRE RESISTANT CONSTRUCTION [ ' ] FIRE RESISTANT PENETRATION
[ ] ELECTRICAL (ROUGH) [ ] ELECTRICAL (FINAL)
[ ] CODE VIOLATION [ ] PRE C/O
REMARKS:
voh
DATE Zg INSPECTOR
FIELD INSPECTION REPORT DATE GOMMEN'FS•
FOUNDATION(IST) �H
-------------------------------
FOUNDATION(2ND)
ROUGH FRAMING& - H
PLUMBING
r
INSULATION PER N.Y. H
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENTS
o
V
� z
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959
Telephone 631 765-1802 Fax 631 765-9502 h s//www.southoldtownn ov
P � ) � ) ttP � X-�__
Date Received
APPLICATION FOR BUILDING P MITMAY _ 5 2021� r`' �_..
Ls
For Office Use Only � ,•,/ 1
PERMIT NO. Building Inspector.
-Applications and forms must be filled out in their entirety.Incomplete lig# °11'�T �•
s
'applications"will not be accepted. Where the Applicant is notthe.owner,an` -
Owner's Authorization form.(Page 2)shall be`completed.'
Date:
OWNERS)OF PROPERTY: `
Name: Sus Ara LAW L.o k SCTM#1000- -7�_ q - �3
Project Address: 100 V 1(TO 21A 'NZVVE , SOV-F4 0 Lb , N y 11 �� I
Phonet31,_,1105- SOD Email:
Mailing Address: I0o V1(,�pP-4A 1>94�VE60UUT1-IOILt�,, Ny_ 10-11-
CONTACT PERSON: "
Name: KEITH N 0-L-A (:j N LI
Mailing Address: p 0. G"OX
Phone#: ( 31 , F31- 234- Email: (�AAI,6,0Q-1(Z LTl4 L -1(00 . com
DESIGN PROFESSIONAL'INFORMATION: "
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION: `
Name: KMIC L��1'I"IZIk(,TI�G LLC
Mailing Address: p U X q p SUS �1;1�U-1 IS I��q
Phone#:X31 - 931-2b 9 Email: ICltllt;�b lJTP�pr( I tJCa LLCcOM
VA44
'DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition %Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other
Will the lot be re-graded? ❑Yes VNo Will excess fill be removed from premises? ❑Yes $No
1
PROPERTY INFORMATION
Existing use of property: ggb 1bE1MA.L Intended use of property: SI IE�TI A-L_
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes [%No IF YES, PROVIDE A COPY.
Check Box After Read Mg: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. 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,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(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210`45 of the Newyork State Penal Law.
Application Submitted By(print name): �6 ITI4 M C LA Ai H IA t� UrAuthorized Agent []Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
COUNTY OF
k/el'fk 2.,.. tI 1,-n being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the CCii� T 4C-�o V--
(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
dary
y of r' ° 20 +
Ot,qT,y1P1,Ubj it,
z -JE.ANjN HOLIAND
ZORRATON.' E YorkrsG°�r�®G°�[ R1f�Y ®WII�CI� ,NotaryPcub0N061451 3�=;• ns °'
Where the applicant is of r ) �;�Y'�, Quafified in Suffolk Coun I
( pp n the owner rr Expi es May. i
�
��k�Aj:;tom„`-'f-`bt".a�t.W''w �• i t
AA
I,-%510 y' residing at V , GEL
04LIQ do hereby authorize4<%")M(� ��Gjr L /� d to apply on
my behalf to the Town of Southold Building DepAtment for approval as described herein.
Owner's Signature Date
yS_+_PA� �
Print Owner's Name
2
T7NG DEPARTMENT- Electrical Inspector
44�y�� ®may t TOWN OF SOUTHOLD
SEP - g 2b�1wn 1-Lall'Annex -54375 Main Road - PO Box 1179
® 'u Southold, New York 11971-0959
®�dTelephone (631) 765-1802 - FAX (631) 765-9502
TOV, ; f ,,.,.� r(C" southoldtownny.gov -seand@southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: r oxe,
Name: LAZOJ "
License No.: ���c _ 6� 3 email: j3,we,r fir- �®° e ®lr
Phone No: ;-q -91®5s ❑I request an email copy of Certificate of Compliance
Address.:
JOB SITE INFORMATION (All Information Required)
Name: iSIA&AM L IOW L.o
Address: in jC,-r0 j \b&IVE So�TI-lolb ll°l"1
Cross Street: ft! A VtE\AI KOR6
Phone No.: 611--Ib5 _ C05()
Bldg.Permit#: If 69 q-1 email:
Tax Map District: 1000 Section: Block: Ot Lot: (�3
BRIEF DESCRIPTION OF WORK(Please Print Clearly) (�0(�Q��IF 66ZV I c.,t= 1t
Check All That Apply:
Is job ready for inspection?.- DYES QNO ❑Rough In ❑Final
Do you need a Temp Certificate?: DYES ONO Issued On
Temp Information: (All information required)
Service Size ❑1 Ph ❑3 Ph Size: A # Meters Old Meter#
❑New Service ❑ Service Reconnect ❑ Underground F]overhead
# Underground Laterals ❑1 2 ❑H Frame ❑Pole Work done on Service? ❑Y ❑N
Additional Information:
PAYMENT DUE WITH APPLICATION
tom-
Electrical Inspection Form 2020.xlsx
YIS I F
New York state Insurance Fund 8 CORPORATE CENTER DR,3RD FLR,MELVILLE,NEWYORK 11747-3129
nysif.com
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
i
A A^AAA 861344224
KM I CONTRACTING LLC
24' OCKHALL LANE
RO KY POINT NY 11778 0•
SCAN TO VALIDATE
AND SUBSCRIBE
POLICYHOLDER CERTIFICATE HOLDER
2� K CONTRACTING LLC TOWN OF SOUTHOLD
ROCKHALL LANE 54375 MAIN RD
ROCKY POINT NY 11778 SOUTHOLD NY 11971
i
OL16Y NUMBER CERTIFICATE NUMBERPOLICY PERIOD DATE
1542 071-2 497819 03/10/2021 TO 03/10/2022 5/5/2021
i
TI- I IS 'TO CERTIFY THAT THE POLICYHOLDER NAMED ABOVE IS INSURED WITH THE NEW YORK STATE INSURANCE
FUN UNDER POLICY NO. 2542 071-2, COVERING THE ENTIRE OBLIGATION OF THIS POLICYHOLDER FOR
WORKERS' COMPENSATION UNDER THE NEW YORK WORKERS' COMPENSATION LAW WITH RESPECT TO ALL
OPERATIONS IN THE STATE OF NEW YORK, EXCEPT AS INDICATED BELOW, AND, WITH RESPECT TO OPERATIONS
OUI
SID i OF NEW YORK, TO THE POLICYHOLDER'S REGULAR NEW YORK STATE EMPLOYEES ONLY.
IF Y OU WISH TO RECEIVE NOTIFICATIONS REGARDING SAID POLICY,INCLUDING ANY NOTIFICATION OF CANCELLATIONS,
OR TO VALIDATE THIS CERTIFICATE,VISIT OUR WEBSITE AT HTTPS://WWW.NYSIF.COM/CERT/CERTVAL.ASP.THE NEW
Yd K STATE INSURANCE FUND IS NOT LIABLE IN THE EVENT OF FAILURE TO GIVE SUCH NOTIFICATIONS.
THI POLICY DOES NOT COVER THE SOLE PROPRIETOR,PARTNERS AND/OR MEMBERS i ERS OF A LIMITED LIABILITY COMPANY.
I
THI CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS NOR INSURANCE
COVERAGE UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER
THE COVERAGE AFFORDED BY THE POLICY.
i
i
f
I
I
I
NEW YORK STATE INSURANCE FUND
f
DIRECTOR,INSURANCE FUND UNDERWRITING
VALIDATION NUMBER. 453468306
U-26.3
t/D`)/N /Ac L<IWLOR Sd $usa/v LAWGOR
PROPERTY Loeareo or BAy ✓lew rEaR SovrHoco)
7'owN of SOIVA10t0
6UACOIK e0chVry, AIEW YORK
Aft,-,o=16 55go
1'0
11kautdcuzsd a!a aaan a
addition to this wryey is p otolanon
0(Seet=SM4olilremewYork State Fducatan Law.
OV150fthec
tuuty not bearing rho tard Surveyors mlW
sed or ce�Eusz d lest
44&M be COMM&/ed to be a valid Mm /J ` o P .�
MR.
4tizarom or eeaifxatrorrs rrplicaled hereon shall run only to o ,
the Pe+son 60r whom thera d,and no ho brhali to
the tae eoaWa $o nental agency and[coding m
listed Aema,and to Iffic asgnrM ofthe lending inmution
��p �• O O
/
P� O
oaraalees or zmrlipnae are not translerable to additional m
instm,Aarsmsbseguetrtw+xra � Q-
NoT�a.Sn.ry�RRy sy5re�r� f Pva4z LoeopromQo
q Sa 9o�V
leorNERs
o"
r n
OMMY DWAR7W 6F EJACH BERVIOE� `s,
fl
. =X =
H.B.PAL W
}
al Oft 1ham+b
900ad by 1tBi DsporWaM or other etQm- d w
'01F Nzw
�3Yonnd to M eadet�ata:y. -z.
C156
`fir,✓ � ^• 2° D�� .�( v, yxs
eERr1.C/--o To: , b I y
�Ofiria✓ /X Z owz OR
3uS40VN LAWLOR Q. FRD ' N yLSK!
f .R44R6•AA&?e A0WIIVI.6 R.9T/ON t3 �� N.y!5 L/4. AID. �YZ2,�f
y�
9/?/,0Q A?PrOA1,f
( ( .SAyy1LLE,All.
f'�vac 6uR✓6ya5-5-94 r - 4OTo,BER/9, /9 93 .
�C
s.
5 r-d
7ou6lt
APR® ED AS NO ED
DATE: S B.P.- 02
FEE: o BY: COMPLY WITH ALL CODES OF OCCUPANCY OR
NOTIFY BUILDING DEPARTMENT AT NEW YORK STATE & TOWN CODES USE IS,UNLAWFUL
765-1802 8 AM TO 4 PM FOR-THE AS REQUIRED AND CONDITIONS OF WITHOUT CERTIFICATE
FOLLOWING INSPECTIONS: _
1. FOUNDATION - TWO REQUIRED C
FOR POURED CONCRETE BOARD OF,OCCUPANCY
2. ROUGH - FRAMING & PLUMBING
3. INSULATION S UTH0_LU0WN4ISTEES
4. FINAL - CONSTRUCTION MUST �i Y S nor
BE COMPLETE FOR C.O. "
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEWs L I,� T RETAIN STORM WATER RUNOFF
YORK STATE. NOT RESPONSIBLE FOR T Y l a.n d �� PURSUANT TO CHAPTER 236
DESIGN OR CONSTRUCTION ERRORS. OF
THE TOWN CODE.
E.
y