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HomeMy WebLinkAbout28775-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY No: Z-29752 Date: 10/02/03 THIS CERTIFIES that the building ADDITION Location of Property: 4130 HORTON LA SOUTHOLD (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 54 Block 7 Lot 22 Subdivision Filed Map No. Lot NO. conforms substantially to the Application for Building Permit heretofore filed in this office dated SEPTEMBER 23, 2002 pursuant to which Building Permit No. 28775-Z dated SEPTEMBER 24, 2002 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 ADDITION & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ROLF & ANNAMAE JOHNSON (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1113249 09/05/03 PLUMBERS CERTIFICATION DATED 08/20/03 PECONIC PLUMB.&HEATING s Authorized Signature Rev. 1/81 FORM NO . 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Hall Southold, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) PERMIT NO. 28775 Z Date SEPTEMBER 24 , 2002 Permission is hereby granted to : ROLF & ANNAMAE JOHNSON 4130 HORTONS LANE SOUTHOLD,NY 11971 for ADDITION AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR at premises located at 4130 HORTON LA SOUTHOLD County Tax Map No. 473889 Section 054 Block 0007 Lot No. 022 pursuant to application dated SEPTEMBER 23 , 2002 and approved by the Building Inspector to expire on MARCH 24 , 2004 . Fee $ 300 . 00 zGe%&-u--et_ C Authorized Signature ORIGINAL Rev. 5/8/02 I Form No.6 � TOWN OF SOUTHOLD BUILDING DEPARTMENT -- TOWN HAIL SLP 3 0 2003 765-1802 APPLICATION FOR CERTIFICATE OF OCCUPANC 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 accurate location of all buildings,property lines, 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 2/10 of I% 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: 1. Accurate survey of property showing all property lines, streets, building and unusual natural or topographic features. 2. A properly completed application and consent to inspect signed by the applicant. If a Cc]tif tale of Occupancy is denied, the Building Inspector shall state the masons therefor in writing to the applicant. C. Fees 1. Certlf11Cate of Occupancy- New dwelling $25.00, Additions to dwelling $25.00, Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00, Additions to accessory building$25.00, Busirncsses $50.00. 2. Certificate ofOccupancy on Pre-existing Builcling - $100.00 3. Copy of Certificate of Occupancy - $.25 4. UpdatedCertiflcateofOccupancy- $50.00 5. TempomtN ('ertificateofOccupant)' - Residertial $15.00, Convnercial $15.00 Date. _dE PT �_3_r�D.Qz1 New Construction: Old or Pre-existing Building: ✓_ (check one) Location of Property: X4134 HAR'ratJS LAUE SA0_17HAI 1)_ House No. Street �� Hamlet Owner or Owners of Property: Suffolk County Tax Map No 1000, Section Al 3'98!3 54,— Block -7 - Lot a.A, Subdivision Filed Map. Lot: Permit No. Date of Permit. Applicant: Health Dept, Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Q15 6A Applicant Signature �0 -2Q 7S2 n j- 0 �l-�l-�l-�l-awl-�l-�l-�l-�l-�l-�l-�I-rncnrJ�cnr.nrrcncncncnrJ�cnrnrJ'rJ'iJ'c.nrJ'arnrJ�rJ'rJ'rJ�c.nrJ'ar�r�r�rlocPrsr�rJ'rsr�r�cnr�rJ'cnr�r i-r�Sr�ih�P�l-rJ'�l-�I-� o 5 BY THIS CERTIFICATE OF COMPLIANCE THE l� 5 5 NEW YORK BOARD OF FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY 5 r5j 40 FULTON STREET — NEW YORK, NY 10038 C5 5 CERTIFIES THAT 5 Upon the application of upon premises owned by G & S ELECTRICAL CONTR. ROLF JOHNSON 55 5 P.O. BOX 215 HORTONS LANE 5 rj SOUTHOLD, NY 11971, SOUTHOLD, NY 11971 5 Located at HORTONS LANE SOUTHOLD, NY 11971 Application Number: 1113249 Certificate Number: 1113249 �S SSection: Block: Lot: Building Permit: BDC: NS11 �� 5 Described as a Residential occupancy,wherein the premises electrical system consisting of 5 electrical devices and wiring, described below, located in/on the premises at: 5 Basement,First Floor, Second Floor, Outside, 5 5 was inspected in accordance with the National Electrical Code and the detail of the installation, as set forth below,was 5 5 found to be in compliance therewith on the 5th Day of September, 2003. 5 5 Name OTY Rate KAi!lg Circuit Type [� 5 Alarm and Emergency Equipment 5 5 Sensor 2 0 Carbon Monoxide 5 5 Sensor 2 0 Smoke 5 5 C] Appliances and Accessories 5 Exhaust Fan 1 0 F.H.P. 5 Wiring and Devices 5 5 Receptacle 17 0 General Purpose 5 5 Switch 10 0 General Purpose 5 5 Fixture 9 0 Incandescent 5 5 Receptacle 3 0 GFCI fj Service 5 5 I Phase 3W Service Rating 200 Amperes 5 Service Disconnect: 1 200 cb 5 5 Meters: 1 5 5 seal 5 NJ 5 I of I 5 5 This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. 5 5 5 a s����s��������s���ss�������s���s�����s�s�������s��ss o�g11FF0(4,cQ Town Hall,53095 Main Road 0 • Fax(631)765-9502 l y, .���! Telephone(631)765-1502 Southold,New York1971-0959 BUILDING DEPARTMENT TOWN OF SOUTHOLD CERTIFICATION Building Permit No. 7 7 Owner: Ro 3O �J (please print) / L/ Plumber: % GO/1/C Ifum AFI41//v� (please print) I certify that the solder used in the water supply system contains less than 2/10 of 1% lead. (Plum Signature) Sworn to before me this 4-�Q —� lay or,'&,¢ ., 20=_ �l -90 ryPublic,I_Pt KCounty VICKI L.LOPERNabit �`-- Y Na601LS0607008 of Now York wiliftEVft I 'l D I N I N 33.of y. 1,6 157 a 0 h V y MAP OF LAND SURVEYED F02 rW L F N. ANNA MA P. f6c,NSON AT sauTHoc.D - TOWN of SOurldoLo , lV Y. i 1 6uoronice d foi-he NomeTi*le Division- Ghic000 SCALE. P, rifle lnsurance- Companu andFhe Southold o = monurnenf Savings Bank , 'as surveycd. Septa 16, 1965' V�aTuql 't, Son Licensed Land4&vdyors Greenport, New Yorle s - - ;. )- TOWN OF SOUTHOLD PROPERTY RECORD CARD OWNER STREET `? N C�O VILLAGE , DIST. SUB. LOT a p tx [� / FORMER OWNER N /l a' ©/ZS E ACR. S ZES. SEAS. /d VL FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS pvp Sad yo a /0 7� r ' AGE BUILDING CONDITION NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable I tillable 2 i illable 3 Voodland swampland 3rushland FRONTAGE ON WATER louse Plot FRONTAGE ON ROAD 8 c2 jiV DEPTH BULKHEAD "otal DOCK I Fax/(516) 765-1823 tiW*JOSA Town Hall, 53095 Main Road Telephone(516) 765-1800 O� P.O.Box 1179 'tSouthold, New York 11971 of SOUTHOLD TOWN NDMARK PRESERVATION COMMISSION TO: Southold Town Building Department FROM: Southold Town Landmark Preservation Comm. - Herb Adler, Jr. DATE: June 25, 2002 RE: Rolf & & Annamae P. Johnson Residence 4130 Hortons Lane, Southold Tax Map #1000-54-7-22, SPLIA No. SD-228 While the Commission accepts the need for the additional work, it feels that the preservation of this house's historic value and the augmentation of the same, would be better served by a)repeating the upstairs placement of windows in the addition on the first floor and b)the use of other windows on the sun room. Please advise the owners that the Commission is available for advice. PROFESSIONAL ENGINEER 1725 HOBART ROAD/PO Box 616, SOUTHOLD, NEW YORK 11971 TEL631-765-2954 • FAX631-614-3516 • e-mail: joseph@fncheti.com Date: September 19, 2002 Reference: Johnson House Southold Building Department Main Road Southold,NY 11971 Dear Sir, The sanitary system for the Johnson Home on 4130Horton's Lane in Southold Consists of a 900 gallon septic tank an 8 foot diameter leaching pool with 12 foot vertical depth. I certify that this system is operating properly and is adequate for the home and proposed addition. F NEWY p �FtSC 0,9� 21 Joseph Fisc tt , ESS10 R- - i� �nUT3�iOLD Applicant/ Date Owners Name: Reviewed:S � p — Architect/ �_ Date Engineer: c __ Submitted. SCTM M: Districc 1000 Sectjon: -5�- Bjoc1< T _ Lot: a'Z Project 50 /� Q Subdivision Location. kq3o jq:16Gir�+�a etc. �CYR-ei` . Name: --- i Smde ff, tieparale Required u rti�eation: (Yes /NoL Req. Rcq. _ - /auiug oistrici Ilmsize. A,(ma l_ y/�.%—I (I,o(cavcragc � Prupae<d Rcqe Rcq. / Req. ��//7.� i tl'ront Pard rt Proposcd:.�(�I [Sr& Yard l� Proposed �ZJ [Rear Yard�� Pro pos< �d / /ro'u.•dJ Project Description: ACENCWERMITS Permit REQUIRED FOR REVIEW NA, NO YES Number Suffolk County Health Dept. New York State D. E. C. f Town Trustees Town Zoning Board approval: ✓ / Town Planning Board approval: Flood Plane Elevation??? /S Flood Zone: _ Notes: � Aaz - e 765-1802 BUILDING DEPT. NSPECTION [ FOUNDATION i ST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION ( ] FRAMING [ ] FINAL ( ] FIREPLACE A CHI MNEY RE KS: DATE D a Q� INSPE M-1802 BUILDING DEPT. INSPECTION [ ] F NDATION IST [ ] ROUGH PLBG. FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINAL [ j FIREPLA HIMNEY REMARKS: DATE l v INSPE 7,Z� 765.1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST ( ROUGH PLBG. [ ] FOUNDATION 2ND �[ ] INSULATION } FRAMING ( ] FINAL [ ] FIREPLACE A CHIMNEY RE ARKS: e4 ��: � 1C , Ze ee DATE INSPECTORf�` M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ] FOUNDATION 2ND [ ] INSULATION [ ] FRAMING [ ] FINA [ ] FIREPLA 8 CHI NEY REMA 5: DATE �� INSPECTO M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] RO PLBG. LAT [ ] FOUNDATION 2ND NSUION [ ] FRAMI ( ] FINAL [ ] FIR LACE CHIMNEY REMARK C DAT INSPECT M-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION 1 ST [ ] ROUGH P G. [ ] FOUNDATION 2ND [ ] S ATION [ ] FRAMING [ INAL [ ] FIREPLA 1IMN REMARKS. DATE INSPECT FIELD INSPECTION REPORT DATE, COMMENTS FOUNDATION(1ST) L y FOUNDATION(2ND) h z .oma ROUGH FRAMING& `L y PLUMBING �r INSULATION PFR N.Y. H STATE ENERGY CODE rT 77- 7,7710 1:7 FINAL ADDITIONAL COMMENTS O z m k O z I x l e T6-WN OF SOUTHOLD BUILDING PERMIT APPLICATION CHECKL BUILDING DEPARTMENT Do you have or need the following,before apply TOWN HALL Board ofHwlth: SOUTHOLD,NX 11971 3 am of Building Plans TEL: (631) 765-1802 PhmmugBoard approval FAX: (631) 765-9502 �1 Survey PERMIT NO. dC� 7 7( Check Septic Foan N.Y.S.D.E:C. Tnutees Examined o2 200.2 Contact: Approved 200 Mail to: Disapproved a/c Phoria: Expiration ,20 0 Building*T�f"x 1r 1 APPLICATION FOR BUILDING PERMIT i __ Date �uly� IK 20OZ y, 4•; . ,f _ �. c INSTRUCTIONS a. This application MUST be completely filled in by typewriter Orin ink and submitted to the Building Inspector with sets of plans, accurate plot plan to scale.Fee according to schedule. b.Plot plan showing location of lot and of buildings orrpremises,relationship to adjoining premises or public streets or areas, and waterways. c. The Wank covered by this application may not be commenced before issuance ofBuilding 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 amtmdmmts 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 RMEBY MADE to the Building Department for the issuanco 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 regulaarriz and i admit authorized inspectors on premises and in building for necessary inspectioj'n/�s�{�j�. ` _ _ /\ 1��111/1�as 4130(Stuature of applicant or name,if a corporation) EtoRTONB' LANE Sbu_'1'HOLa 11m Odat7mg ad ess of applicant) State whether applicant is owner, lessee, agent, architect, engiAoer,general Contractor, electrician,plumber or builder Name of owner of premises Rnt_1= N At4O AWNAMAF 1' c 1AWNC%AW (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 w rk will be done: 4.1.30 Hna yetis a .E �SnirrHai n House Number Street County Tax Map No. 1000 Section 32g` Subdivision — Filed Map No. Lot (Name) State existing use and occupancy of premises and intended use and occupancy of proposed construction: ' a. Existing use and oc c%mcy R EGttFNCE b. Intended use and occupancy FAN►LY Reset l Nature of work(check which applicable):New Building Addition ✓ Alteration Repair .Removal Demolition Other Work (Description) Estimated Cost ; Fee (To be paid on filing this application) If dwelling,number of dwelling units Number of dwelling units on each floor If garage, number of cars 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 Q, Dimensions of same structure with alterations or additions: Front Rear Depth Height Number of Stories S. Dimensions of entire new construction:Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth /n 10. Date of Purchase ►9 �� Name of Former Owner. +t,Hr► Q►i_,�, 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 of Owner of premises A_ �&. 1 At{N s %w Address 41'A to &snr1c A 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. IT If elevation at any point on property is at 10 feet or below,must provide topographical data on survey. STATE OF NEW YORK) SS: COUNTY OF_ O A Q KA HAT— t I igLd g c being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contract)above named (S)He is the W NEp (Coahactor,Agent,Corporate Officer, etc.) that said owner or owners, and is duly authorized that ail to perform or have performed the said work and to make and file this application; n s application are true to the best of his knowledge and belief; and that the work will be performstatements contained ithi ed in the manner set forth in the application filed therewith. Sworn to before me this of 20 6 o1J Notafy Public ' Signature of Applicant Not"UN J COOPERof N York ° Term iresSSuffdgO ��_. q _ _ 1 F i �• Uaw ------------------------------ r - • � ,.1-J - _ i�J i - i w I i - -- — -- L- ___J # _LJ LL PLUMBER CERT/179CAT/ N bins is used ON LEAD CONTENT BEF RE 1 for waterldistributing CERT/F/CATE OF OCCUPA V,,CY i -� + 1 system: piping shall be I 1 of types K or L onlySOLDER USED IN WAT R PLUMBINGSUPPLY SYSTEM CANN T R VPLUMBING M LASTS UNDERWRITE S CERTIFICATE EXCEED 2110 of 1% LE D. NGBEFORECOVERING REQ IRE DONT PROCEED WITH ViDEAR11-SCALD AND/OR FRAMI GUNTIL SURVEY - T RMA A fi CK PREVENTIN T N,LOCATION EMERGENCY OPENINGS OR - __- N Y. Sr DI ART 9D2.AAPPRO EDASN pENIRPPROVED. REQUIRED PARI 714 4AS OF DATE: B.R 1� N.Y. STATE BUILDING CODE. FEE 300 NOTIFY BUILDING DEPAR MENT AT 765.1802 9 AM TO 4 PM FOR THE _�a NEW yo J _ FOLLOWING INSPECTIONS: ,94- 1. FOUNDATION - TWO R QUIRED FORPOUREDCONCRETE - u�i� a SULATION-1 PODGH RATmINOSPUMBING 0 V R E,SMDKE-D ECTING \ 4I U 4 FINAL - CONSTRUCTION MUST ,P C�ZpSq.� aU LARM DEVI SI BE COMPLETE FOR C.O. FOA S TO PART.7 1.1 - ALL CONSTRUCTION SHALL MEET AOFESSIONP .Y.S BUILDING ODE, „ f'1�o�IT ���Ttah I i rig MIryAW_ p{ pgeIJr THE REQUIREMENTS OF THE N.Y. STATE CONSTRUCTION A ENERGYUL CODES. NOT RESPONSIBLE FOR CCUPANCY OR ALL, Irll lj Ij,,Ly n ro .a.I-I GMiRr�N OR CONSTRUCTION ERRORS USE IS UNLAWFU - N_ WITHOUT CERTIFIC TE 6w OF OCCUPANCY IG Oo1- orNn I �I�� Ire Ilri,M "4-1-4 JOHI-i1 I BCALE' I KII�n APPNbVED IY: DRAWN BY j a�L-+ P! !k•}Ui�OFa�GI� pa I�^, I..��' I Lp ' DRAWING NuMIlm Pc A u rC6 rc> cv ENERGY COUE CALCULA'T'IONS [For Non-Llectric Ileat) Design Criteria O.AOUlour J.A. 7O"C roR: _ I l: J/o/ h Sad PER: Seh 7aFS '�/OG a ov nn//1 9h° SO uTH o/ DATED: 2 SI-7 h( ,1o, l- AREADESIGN 'rnERMEL REMARKS SU13SYSTEM "u" MATING UlxLeriur. Walls (opaque) 7i2 , 05 V _ Glazing 3 / a0 . 3f - e P�,i - Doors ccil.iuy/Ruof (Upayue) Slcyliyh Ls % Floor f%uudatlon Walls Slab Insulation TOTAL Plo Les: ui I1V,,,c jljj rquipei entpt S meet!ls to requi'reeientsq of, 70151. 11 17015. 2 HVAC Systems to mee L• xequire'lle'lLs of 78,15 . N uiremcicts of 7015. 7`3 UucL Sys Lams to nieeL req uiremellL-s of 7015 • 14 Ventilations Systems Lv51se9 t,oyuleel' reyuiremeuts of 7015 . 15 111sU;LUtiAll of lipll SY ui meat to meet reyuiremenLs of 7UJ.5 . 31 Service Water Ilea Liny Sys Lems 6 EquipmenC Co meet require wen Ls of 1U1S • - ELecLrl.cal s Liyht-iuy Systems a Ey P of NEW YD p1 NOE . ro,9F ' '1'o the best of my knowledge, I)CIlef, 6 professional Q n ' uct e acen6 tie plans arc y x uenipllance w1L•h the code. 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