HomeMy WebLinkAbout46872-Z �o�gUl fDLX Town of Southold 12/14/2021
COG•,
a y� P.O.Box 1179
y �
53095 Main Rd
Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 42621 Date: 12/14/2021
t
THIS CERTIFIES that the building COMMERCIAL
Location of Property: 43385 Route 25,Peconic
SCTM#: 473889 Sec/Block/Lot: 75.-1-16
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/23/2021 pursuant to which Building Permit No. 46872 dated 9/24/2021
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:
"as built" ag_rage conversion to commercial storage spaces to existing building as applied for.
The certificate is issued to Baltic Place Inc
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 46872 11/30/2021
PLUMBERS CERTIFICATION DATED
th ize Sig ature
s�Foc TOWN OF SOUTHOLD
�oo� may BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Wo • 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#: 46872 Date: 9/24/2021
Permission is hereby granted to:
Baltic Place Inc
c/o John Bernhard III
12121 SE Heckler Dr
Hobe Sound, FL 33455
To: legalize "as built" garage conversion to commercial storage spaces to existing building
as applied for.
At premises located at:
43386 Route 25, Peconic
SCTM #473889
Sec/Block/Lot# 75.4-16
Pursuant to application dated 9/23/2021 and approved by the Building Inspector.
To expire on 3/26/2023.
Fees:
AS BUILT-COMMERCIAL ADDITIONS/ALTERATIONS $709.60
CO-COMMERCIAL $50.00
Total: $759.60
uil pector
OF SOUlyol
Town Hall Annex ~ Telephone(631)765-1802
54375 Main Road Fax(631)765-9502
P.O.Box 1179 Q sean.devlina-town.southold.ny.us
Southold,NY 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: Baltic Place Inc
Address: 43385 Route 25 city:Peconic st: NY zip: 11958
Building Permit#: 46872 Section: 75 Block: 1 Lot: 16
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 X Basement Service
Commerical X Outdoor 1 st Floor X Pool
New Renovation 2nd Floor Hot Tub
Addition Surrey X Attic Garage
INVENTORY
,Service 1 ph Heat Duplec Recpt Ceiling Fixtures 2 Bath Exhaust Fan
Service 3 ph Hot Water GFCI Recpt Wall Fixtures Smoke Detectors
Main Panel 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 2 4'LED Exit Fixtures Pump
Other Equipment:
Notes: " AS BUILT NO VISUAL DEFECTS " Garage Converted to Storage Space
` November 30, 2021
Inspector Signature: Date:
S.Devlin-Cert Electrical Compliance Form
�o��OF SOUIy�� Y lS/ l L' J��s ✓�
# TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
1 NSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
]- FOUNDATION-2ND [ ] INSULATIOWCAULKING-
[ ] FRAMING /STRAPPING [ ] FINAL
[ ] FIREPLACE &CHIMNEY -[- ]-. FIRETSAFETY INSPECTION
[ ] 'FIRE RESISTANT CONSTRUCTION [ ] FIRE'RESISTANT PENETRATION
[ ] ELECTRICAL'(ROUGH) `A ELECTRICAL (FINAL)
[ ] CODE VIOLATION ] PRE C/O
REMARKS: Ai�5_ <Piz y f L/�
. DATE LINSPECTOR
*pF SOGIyO� L4 �7 C b 15 � V 8 / Z
# # TOWN OF SOUTHOLD BUILDING,DEPT
765.1802
INSPECTION
[` ] FOUNDATION 1ST [ ] ROUGH PLBG.
[ ] 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: _
Q-O2A4`1I J
01 l"J_ e46
DATE 1 74V INSPECTOR < ~
�OFSOUTy 71b-
-C7 I 3 92 rr �
` } # TOWN OF SOUTHOLD BUILDING DEPT.
°ycourm ' 765-1802
: .
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
J ]. FOUNDATION-2'ND [ ] 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:
s
DATE C ;INSPECTOR
FIELD INSPECTION REPORT 'DATE COMMENTS
FOUNDATION(1ST) .�y
------------------------------ - -- �
FOUNDATION(2ND.)
' .. 06 \\�
ROUGH FRAMING& y
PLUMBING , 1
INSULATION.PER N.'Y.
STATE ENERGY CODE
f
FINAL. _
ADDITIONA.-COMMENTS
10-- -at• �b 4� e. � 15l + �
21. Q' (�
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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
Southoldtownny.gov PERMIT NO. Check
Septic Form
N.Y.S.D.E.C.
Trustees
C.O.Application
Flood Permit
Examined 20 ,:3 c Single&Separate
Truss Identification Form
Storm-Water Assessment Form
�` 2 3 2021
SES Contact: J(7RKL T3r—_?,i\( HAP_1�:)
Approved-120A
0 A Mail to: Ebe) H CTA1 Rig LA EI
y
Disapproved a/c Buff G HAD 1 5 0 N i q(0 3�5�
*Y'Cl`4'-'�, �. Phone:
Expiration ,20,V
r
Buil ector
APPLICATION FOR BUILDING PERMIT
Date SePI 27J , 20 2
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
EST
Name of owner of premises J O H N T-3ec i,4 SCA CD
(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. Loca ion of land on which proposed work will be done:
.3-5(6ri PECO
House Number Street Hamlet 67
County Tax Map No. 1000 Section 06 Block 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 67-0eb Cif r 2 ollJOC SQO
nn U /
b. Intended use and occupancyb
3. Nature of work(check which applicable): New Building Addition Alteration
Repair Removal Demolition Other Work (�C_ (2_'0M LZf��yQ/�
(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 us
7. Dimensions of existing structures, if any: Front / Rear �� �J Depth
Height q /- 0 Gl�f-I• Number of Stories
h �
Dimensions of same structure with alteratp' ns or additions: Front ` --l 3 Rear (4 )1
1
Depth 2 �- /► Height (I � Number of Stories 9
8. Dimensions of entire new cons tion: Front Rear Depth
Height N er of Stories
9. Size of lot: Front f �' J Rear Depth
10. Date of Purchase 8 Name of Former Owner ON U P2
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
vO#// bue 4410-b000"STA ,� G1�
14. Names of Owner of remises Address_Rd/D/S AL�J64hone No d�JP�'J � ���
Name of Architect &4L&-P— � Address�&QVf A1,C72 tL P,,b Phone No W/226562
2
Name of Contractor Address UTGL/ QOF, Phone No. /
15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO V
* 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—Z
* IF YES, PROVIDE A COPY.
STATE OF NEW YORK)
SS:
COUNTY OF:5077z0 L}/<
t-7j L&'FN being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing
contract)
-above named,
�E:/
(S)He is the l// y/ct
(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 tohefore me this
3r day of 20
L
0 Notary Public RACEY L. DWYER Signature of Applicant
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
----- —= Southold,-New York 1-1-9-7-1-0959------ --- ----
Telephone (631) 765-1802 - FAX (631),765-9502
rogerrtcsouthold town ny.gov seand a(�southoldtownny:gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (Au Information Required) Date: C)
Company Name:
Electrician's Name•
'Licen o.: Elec. em il:
Elec. Ph ne No: I r u st an ,atl.copy of Certificate of Compliance
Elec. Ad r
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.: q[r, .- - L)
Bldg.Permit.#_:' 0 email:
Tax Map District 1000 Section: -7!5 Block: Lot:
BRIEF DESCRIPTION OF WORK,.INCL UDE SQUARE FOOTAGE (Please Print Clearly):
�LeG 1 S50XV2
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES ❑ NO F—]Rough In ❑Final
Do you need a Temp Certificate?: ❑ YES❑ NO Issued On
Temp. Information: (All information required)
❑3 Ph Size: A #'Meters Old Meter#
Service Size❑1 Ph
New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 H Frame Pole Work done on Service? 0 Y DN
Additional Information:
PAYMENT DUE WITH APPLICATION
PERMIT# Address:
Switches l
Outlets
G F I's
Surface_'
Sconces
H H's
UC Us .
Fans '.—' Frrdge: _- . .. . H1N'
Exhaust Oven W/D
Smokes DW Minn
Cbrbon :. iVlicro,... Generator
Com4o..;. p ,.
._.. Cookto: _ _.... ..,..... . ... ..... ....._. .. _: ,Transfer
AG AH Hood Service
Amps Have Used
Special::
Comments:
:
ni
Building Department Aupltcitidi .,
4�JTO1�AflT;
(Who're ft Applicant is not the Owner)
Ato �'_.,_ „residing at
(Print property owner's name) (Mailing Address)
do hereby authorize
...... _..
(Agent)
_..... ...... ...._._.. _.._.to apply on my behalf to the
Southold Building Department_
(Owner's Signature) (Date)
(Print Owner's Name)
G (3 ER
N/OAF LANG OF
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SURVEY FOR
FREY & Wf G.HT-MA.N, PC-
AT PECONIC
TOWN OF SOUTHOLD
SUFFOLK COUNTY 11. Y.
1000 075 - OI - 76
SCA LE I"= 20'
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OCCUPANCY OR
USE IS UNLAWFUL
S E P - 1 2021 a �'
WITHOUT CERTIE~ICA "
OF OCCUPANCY TO`�'��Qy 9OlJTxT�3L� � a .Mo
A�PR01I D Al N051
�T'� T s►C�� v
DATE:
FEE:
NOTIFY BUILDIN: F -HENT AT`
` 765.1802 8 AM - 3 PN FOR THE
i FOLLOWING INS;P :C 1h-
1. FOUNDATION _ n I i )UIRED Additi®naI
FOR POURED GOp ; E Certification t
2. ROUGH - FRAME"JG LUMBING May Be Re Z' 2lo4ty 2450 Q 26p 44
3. INSu"ATION Q ed_ ----- _
4. FI''.4L - CONS., ^T
MUST
i BE COMPLETE OR
ALL C0NSTRUCl ._:d C iPLL MEET THE
REQUIREMENTS OF ;H( (ODES OF NEW }
YORK STATE. NOT RE.*ONSIBLE FOR �, - u
DESIGN OR CONSTRUCTION ERRORS. I
INSPECTION 3EQUI
I'iED
COMPLY WITH ALL CODES OF o �.L . d-
NEW YORK STATE & TOWN CODES Ns 4 '
AS REQUIRED
AND CONDITIONS OF
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