HomeMy WebLinkAbout26868-Z FORM NO. 4,
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28047 Date: 11/02/01
THIS CERTIFIES that the building ADDITION
Location of Property: 9930 SMITH RD PECONIC
(HOUSE NO. ) (STREET) (HAMLET)
County Tax Map No. 473889 Section 98 Block 3 Lot 29
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 9, 2000 pursuant to which
Building Permit No. 26868-Z dated OCTOBER 24, 2000
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" ADDITION TO EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR.
The certificate is issued to RICHARD B BACKOFEN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 571404 10/02/01
PLUMBERS CERTIFICATION DATED N/A
,-�4 c
/4��- -
ho zed S4gnature
Rev. 1/81
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28013 Date: 10/15/01
THIS CERTIFIES that the building ADDITION AND ALTERATION
Location of Property: 9930 SMITH RD PECONIC
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 98 Block 3 Lot 29
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated AUGUST 9, 2000 pursuant to which
Building Permit No. 26868-Z dated OCTOBER 24, 2000
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 WOOD DECK ADDITION AND ALTERATION TO PORCH IN A SINGLE FAMILY DWELLING
AS APPLIED FOR
The certificate is issued to RICHARD B BACKOFEN
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 571404 10/02/01
PLUMBERS CERTIFICATION DATED N/A
tho zed 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. 26868 Z Date OCTOBER 24, 2000
Permission is hereby granted to :
RICHARD B BACKOFEN
228 COLLINS AVE
WILLISTON PARK,NY 11596
for
CONSTRUCTION OF WOOD DECK ADDITION AND ALTERATION TO PORCH WITH NO
HEAT IN AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR.
at premises located at 9930 SMITH RD PECONIC
County Tax Map No. 473889 Section 098 Block 0003 Lot No. 029
pursuant to application dated AUGUST 9, 2000 and approved by the
Building Inspector.
Fee $ 75 . 00
LAO,—,
Authorize Signature
*AMENDED 9/12/01 TO INCLUDE "AS BUILT" ADDITION - FEE $300.00 - PAID 9/12/01
RECEIPT #60457. - 2 CO'S REQUIRED.
ORIGINAL
Rev. 2/19/98
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. wThis application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 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: ,
1 . Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a 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 $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. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Buildins - $100.00
3. Copy of Certificate of Occupancy - .25r,,.
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . .
New Construction. . . . . ( .Q Old Or Pre-existing Building. . . . . . . . . . . . p
Location of Property. . .11._�. . . . . . . ... . .. ..�lYl.�. 1. . . . . . . . . . .. . . . . . 4c tj. .��. . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property..Lll-1? .�.�.. . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . .•. . . . . .
County Tax Map No 1000, Section. .a.(... .. ..Block. .. .. ®� . .Lot. . . v . . . . . . . . . . . .
�` � S .�. . . . . . . . . . . . . . . . .SubdivisiuQ �kmw� a. .. . .. .. .. .. . p / . . . . . . o . .
Permit No. . . 0 . . . . . . . .Date Of Permit. . .( . `� . . .Applican �!� . „
Health Dept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . . . . . . . . . . . . . .. . . . . . . .
Request for: Temporary Certificate. . . . . . ... . . Final Certicate.�. . . . . . .
Fee Submitted: . . . . . . . . . . . . .f,
qo ���ol . . . . . . . . . .:. . . . . . . .fo . . . .
APPLICANT
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in by typewriter OR ink and submitted to the building
inspector with the following: 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 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: ,
1 . Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
2. A properly completed application and a 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 $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. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy -
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 Buildiny�g. . . . . . . .. . . . .
Location of Property. .ww. . . . . . . ... . .. .. 1fYk�. .�`'-� . . . . . . . . . . . . . .�� . .... . . . . . . . .
House No. Street Hamlet
Onwer or Owners of Property.ktu,. A,!�D. . �) .k.Qfe
County Tax Map No 1000, Section. .0 A. . . . ..Block. . . . . Q� . .Lot. . . v . . . . . . . . . . . .
Subdivision_N`:•1twj Q .( �.. . . . . . . . . . .Fil d Map ,. /. . . . . . .Lot. . 1. . . . . . . . . . . . . . . . . .
Permit No `s �`: .Date Of Permit. . .�Q/ .A lican�.✓ /1/4�M.`:: :. . . .
)rt CW_6FeA.44t14644,
HealthDept. Approval. . . . . . . . . . . . . . . . . . . . . . . . . .Underwriters Approval. . . . . . . . . . . . . . . . . . . . . . . . .
Planning Board Approval. . . .. . . . . . . . . . . . . . . . . . . .
Request for: Temporary Cer.tificate. . . . . . . .. . . Final Certicate.�. . . . . . .
Fee Submitted: $�s."... . . . . . . . . . . . . . . . .�'
b0 L15 1
CO a$O y7 APPLICANT
File No: 6201
WARREN A.SAMBACH,SR.
CONSULTING ENGINEERS•PLANNERS
4 SEP 2 4
7675 COX LANE • P.O.BOX 1033 `
CUTCHOGUE,NY 11935T-T
631- "734-7492
September 21 2001
Building Department
Town of Southold Town Hall
P.O. Box 1170
53095 Main Road
Southold NY 11971
Re: Backofen Residence
9930 Smith Road
Peconic NY 11958
SCTM: 1000 Section: 098 Block: 003 Lot: ) 29
Gentlemen:
Be advised a site observation was made September 12 of an
excavated hole next to the foundation and the bottom of
the concrete was three (31011 ) below grade.
Con truction of the addition conforms to plans as filed.
Sin erely,
0) WA4*-��Q.
Warren A. Sambach Sr. P.E.
was:s
4�
l�
w.
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE 1
1001093 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
Date OCTOBER 02,2001 Application No. on file 12565901/01 N 571404
THIS CERTIFIES THAT
only the electrical equipment as described below and introduced by the applicant named on the above application number is in the premises of
RICHARD BACKOFEN, 930 SMITH RD, PECONIC, NY
in the following location; ❑ Basement ® 1st Fl. ❑ 2nd Fl. OUT Section Block Lot
was examined on SEPTEMBER 18,2001 and found to be in compliance with the National Electrical Code.
FIXTURE RECEPTACLES SWITCHES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
OUTLETS INCANDESCENTI FLUORESCENT I OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
1 4 2 1
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS MULTI-OUTLET DIMMERS
AMT. K.W. OIL H.P. GAS H.P. AMT. NO. A.W.G. AMT. AMP. AMT. AMPS. TRANS. AMT. H.P. SYSTEMS AMT. WATTS
NO.OF FEET
SERVICE DISCONNECT NO,OF S E R V I C E
METER
AMT. AMP, TYPE EQUIP, 1 0 2W 1 0 3W 3 0 3W 3 0 4W NO.OF CC COND. A.W.G. NO.OF HI-LEG A.W'G' NO.OF NEUTRALS A'W'C'
PER 0 OF CC.COND. OF NI-LEG OF NEUTRAL
OTHER APPARATUS:
PADDLE FAN-1
DOROSKI ELEC. INC. LIC.#2941-I L L
425 MONSELL LANE
CUTCHOGUE, NY, 11935 GENERAL MANAGER
11
Per
This certificate must not be altered In any manner;return to the office of the Board It Incorrect.Inspectors may be Identified by their credentials.
11111111111111 IN In 11111111 Imp Iiiiiii,
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST'NOT BE ALTERED IN ANY MANNER.
ass-iso2
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FO DATION 2ND [ ] INSULATION
[ FRAMINC(1 �) [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: � o �
C7/(, 2L �
,DATE UU INSPECTOR
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOyNDAT10N 2ND [ ] INSULATION
✓]'F/RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
,DATE 4 INSPECTOR &�Z�
BUILDING DEPT.
INSPECTION
i [ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND ( ] INSULATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CRIMNEY
('
REMARKS:
r�Z'e "
DATE - O INSPECTOR ""�
M-iaoz
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH BG.
[ ] FOUNDATION 2ND [ ] IN CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
ZZ
DATE �� INSPECTOR ,,-*' -- -
�/
-ELD IIISPECTION REPORT DATEMME�Tr�_
----xxx_____axxasxxxxax�saxeaxxasxcxx=c-_---_xx-----_==s=x=e=x�Oi7CiGl\1Sa=xmx=c=---=----a-
)UNDATION OST)
)UNDATION (2ND) if
—I --�I +✓ +
II j � r9
)UGH FRAME &
PLUMBING
ii
----- ---------
ii
+SULATION PER N. Y. I jll
STATE ENERGY ji H
CODE
u
u ii ry
II II r
Il i
FINAL I 7'
r
if C'
xaxax===xa=eaaxxaeaxx ----_--_�xex----------.�--axax -asxa=xaxaxeaseaxeaeaac
ADDITIONAL COMMENTS:
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--�-`-" GUARD OF EIEAhTII . . .
NORM NO. I ./3 SETS OFPLANS . . . ..
TOWN OF SOUT11Oi.D SURVEY • • • • • • • • . . . .
BUILDING DEPARTMENT CIIECK . . . . . . . .. . .. . . . . . . . . . .. . .
w TOWN iiALL SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEL: 765-1802 NOTIFY:
CALL
I:xarnined.. 9.........2W.4. MAI 1. TO: . .. . . . .. . . . . . . . . . . . .
Al��rcnrc�cl..�%......:..";1004. Penni t No. n� ..... ....................................
Disapproved a/c .................................. ...................................
.............................................. ...... .
. ••'
•((Mui Iding•innix:c.ror)
nrrr,iCn7'lON FOR Bl1TE.DiNG PEiOMT'f
Date. AQG. A . . . . , 19 vUuv
T NSTRUCTTONS
n. 'ILis nppl kation mint lie completely .filled in by typewriter or in hook mxl sulmitted to Elie iluilding Tnspector,w
1 seta of plans, accurate plot plan to scale. Fee according to schedule.
b. Clot plan showing location of lot and of buildings on premises, relationship to adjoining premises or ptiblic
streets or areas, and giving a detailed description of, loymit of property must be drawn on the diagram which is Pnrt. ,of
this nInAicntion.
c. 'Ihe 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. %ich
permit ghall be kept on Elie premises available for inspection throq#vo ut the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of
Occupeacy slall have been granted iy Elm Building Inspector.
A'i.TCllfi(m i5 ii-n8Y Mwx to the Building Department for the issuance of a 1luilding'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 caTly with all applicable laws, ordinances, building code, housing code, and
regulations,,wid to admit authorized inspectors on premises and in building for necessary inspections.;
E19V.IRQNMESM.EAST..INC.........................
(Signature of applicant, or name, if a corporation)
P.C►.•-Box..19.0.-RECONT C..N•;Y•e...............
(Mailing address of applicant)
Slate whether applicant is owner, lessee, agent, architect, engineer,*general contractor, electrician, plumber or build
...........GENERAL,.CONTRACTOJt.................................................................................
Nome of owner of premises ....... .. JT14.....��C<<d��.................................................
x roll or latest deed)
(as on lie tax
If ppl' ra ion, signature of duly outlx)rized officer.
• .• ..........Betel•5...8tou tenburgh, Pres.
Name and title of corporate officer)
Builders License No. 5556..HI...............
Plurbers License lb. .........................
Electricians License No. .....................
Other Trade's License No. ....................
1. location of land on which proposed work will be (kxxl................................................ ....... ..
(louse tkmber Street Hamlet .
41
County Tax Map No. 1000 Section ....1!! ...... Block ....3......... Tot ....g�.........
1 N 6i n)Q N l✓ct� f>A�?K Filed clap No. .. S .... Lot .1 R
Subdivision ........ ...... .. .... .... .:.....
(Nme)
2. State existing use and occupancy of premises and intended use aoxl occc/upancy of proposed construction:
a.
Existing use and occupancy ......v G 1-'�......F f CM C L:.I....................................)w a ul—I N G _•:_ t-
h. Intended use and occupancy ........S i IJ GLe.....�i ...............V�( -
3. Nature of work (d►eck tabid► applicable): New Building ........... AcklItion .......... Alteration ..Y„
Repair ....V..... Removal ............. namrslitIon , ........... Other Work
(Description)•
1
4.
Estill
ife. ......... ........ .....................................
(to be•paid on filing•this•application)•
S. if Amlli►►g, ►xniuer of dwelliuig ►u►It�............. Moleer of. dme-Iling ►uilts ort each floor
Ifgurage, ►►neer of care ......................................
6. If husl►►ese, eam►ereial or mixed•occul►ancy, specify nature slid extent of earl► typmetof use.....NA:....:.....
U "
). Uluenala►s of existing structures, If any: 1?Ycxit....... I....... Rear ....... ....... Depth ....4r,.........
d
Ik:il�rt ....... Mniuec of Stories � Z t
Dimensions of sure structure with alterations or additions: Front ?Rear ......
.....
Depth ........ ........ Height .....WA.......... Moller of- Stories ..[�.../.1��........ t
ii. Diuensiocuu of entire new conatruction: Front ..:.� ...... itear ....LL.1...... Depth .. .....
Ileil;�►C ......NS .......... M.d)er of Stories k ..
9. Sixes of lot: imine►L ... (........ Rear ... ...��...... Depth ......�.5�.05 ._..���•�•
M. Mite of H►rdrase ..................... tame of lroruer Owner ........................................
ll. Zone or use district in whidr premises are situated ...............c....................... ............... .......
12. Does proposed cou►truction violate any zoning law, ordinance or regulation: .....J::.........
13. Will lot be regraded .......Nb........ Will excess fill be removed from premises: Y►LS D 2
14. Mines of carver of premises P%.ZUT1E L. $hCKO Xt.-A. ..... AckiressJ J.O.S It`n(—k-q (Z p.... .... Pl►a►e No:
Name of Ard►itect .................................... Address .............................. Pl►one No.
Nrme of Contractor Eny2roames2 •-Esse•I>ne s•••• Acklreas .P. O....7.9 Q.P.ejqQAjjq......Yi►one.No.7A.
-747 4,
15. Is ibis property within 300 EeeC,of a tidal :jeflarxl? * YES .......... NO .. 11958
*1F YES, S(IunKXD I N 7tMI1MS PEMIT MAY Illi 10- Alin.
Pi.0'1• DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, aril Indicate all;set-back dimenalona<
from property linea. Give street awl block mni)er or description according to deed, and show street names and indicate
wlretlrc:r lnterior or corner lot.
Yr,
Y-
SI'KIIi UH N-1 YUMV
SS , .
0XINIY (X ..Su folk......... ;
,,,,,,,,,,,,]?ever„S;,, Stoute...... h,,,,,,,,,,,,,,,Ix:imy; duly sworn, deposes aril says toil' be is ll►e`apmpl.icrnu
(Mane of individUal 'ract) n
alxwe run ,
lie is lme ..Ganeral..Cnntractox ...................................................................
(',cxrtractor a corporate officer, etc.)
of said uwmer or owners, and Is duty autlmorized to perforin or have px:rfori sed Use said work axl to stake aril fi le this
1ll►1►l icat'i(Xr; that all statements co:ruatned in this appticatiomr are true to the beat of his luxuwledge aril Ixatief; aux) ,
that the work will be performed in the manner set forth in the application filed therewitlm.
.%\,x►rn to e
1 fuce me this
.......... ..... lay of ..(
Notary Public ..... . . .;.:/..`
•(S .lusts ire'of•Applicant)• ..
JOYCE M.WILKINS
Notary Public,State of New York
No.4952246,Suffolk County
Term Expires June 12, 01 a/
13 U 1 LIJ 11 1 U FL1K1�'11
Applicant/ Date
Owners Name: / ,�6 F�'/ Reviewed:
Architect/ Date
Engineer: Submitted:
SCTM fl:
District: 1,000 Section Block Lot
Project Subdivision
Location __—_-- — Name:
Single�ti separate Requir
certification (Yes/ o
Rcq
/onine District —146 (Lot size Actua (Lot coverage �8�Proposed
Rey / Req , / Req. /
From Yard 3/ Proposed: 3� J (Side Yard �� / Proposed [Rear Yard 3� Proposed 740 )
Project Description: f�)<« /44,8/
AGENCi�►JERMITS Permit
REQUIRED FOR REVIEW N.A. NO YES Number
Suffolk County Health Dept. V_
New York State D. E. C.
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
ote •
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PANCY OR
:
UNLAWFUL Fa AUT CE TiFi >> e�M� �t �eEF0.WMNG INSEECTI0"."CUPRNCY
11•FMUNDATION - T1N�t
F1c(MR;'ROURED CO rjAEQ�j�hED
V.1�
2,Q.rIF10UGH -�pRAMiff v *'ftLlh ING
:9•YllllSUl,AT"
FUST
DO NOT PROCEED WITH
IrNE REQUIREMENTS O
FRAMING UNTIL SURVEYS M�
6TATE CANSTRUCTION $c �NE���
0� FOUNDATION LOCATION ODES. NOT RESPONSIBLE FOR
HAS BEEN APPROVED. �€§0 9R CONSTRUCTION ERRORS
PROVIDE OPENINGS FOR
EMERGENCY ESCAPE AS
REQUIRED BY PART.714 OF
N.Y. STATE BUILDING CODE.
UNDERWRITERS CERTIFICATE
r REQUIRED
-- IV-8 1/211
17-10 1*5/ 16''
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EX15TING 5LIL91NCA aA55 n
HECK LEVEL TO MATCH
ELOOk LEVEL.
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