HomeMy WebLinkAbout26096-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-28149 Date: 01/07/02
THIS CERTIFIES that the building ADDITION
Location of Property: 3950 STARS RD EAST MARION
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 22 Block 2 Lot 14.1
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated SEPTEMBER 9, 1999 pursuant to which
Building Permit No. 26096-Z dated OCTOBER 28, 1999
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 AND ONE CAR GARAGE ADDITION TO AN EXISTING ONE FAMILY DWELLING
AS APPLIED FOR.
The certificate is issued to GARY PARKER & DEBORAH SUTERA
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. N 567621 08/22/01
PLUMBERS CERTIFICATION DATED 01/04/02 GARY PARKER
Aut ri d ignat e
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. 26096 Z Date OCTOBER 28, 1999
Permission is hereby granted to:
GARY PARKER
P 0 BOX 401
E MARION,NY 11939
for
CONSTRUCTION OF A LIVING ROOM, BATH & GARAGE ADDITION WITH ATTIC
ABOVE CONTAINING HABITABLE HEIGHT.
at premises located at 3950 STARS RD EAST MARION
County Tax Map No. 473889 Section 022 Block 0002 Lot No. 014 . 001
pursuant to application dated SEPTEMBER 9 1999 and approved by the
Building Inspector.
Fee $ 204 . 00
-.-A d
Authorized Siagature
ORIGINAL
Rev. 2/19/98
� -10 F 1-f0I ---
�
Form No.6 < P
i f3l TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802T BLDG. DEPT.
", d OF S UT}i LD
APPLICATION FOR CERTIFICATE OF OCCUPANCY
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 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. Photocopy of Certificate of Occupancy-$0.25
4. Updated Certificate of Occupancy- $50.00
5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00
Date. L Z
New Construction: Old or Pre-existing Building: (check one)
Location of Property: 50 SF A f z,�. VA- G VIA A P_i o C.)
House No. Street Hamlet
Owner or Owners of Property: G A RN te-F �
Suffolk County Tax Map No 1000, Section L Z Block _ Lot _
Subdivision Filed Map. Lot:
Permit No. 2��p�� z Date of Permit. / Applicant: 6,q_P!�- �i42icJ�2
Health Dept.Approval: Underwriters Approval:
Planning Board Approval: /
Request for: Temporary Certificate Final Certificate: L- (check one)
Fee Submit ed: $ 215_� 0-1:-�
IC L Applic Sign re
o�o$uFFot,��o
V*
Town Hall;53095 Main Road • Fax(631)765-1823
P.O. Box 1179 ,ji Telephone(631)765-1802
Southold,New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: / 0
Building Permit No. O t
Owner: G A P-y 1��41z I S E (Z
(please print)
Plumber: A R S` V'�A iz 14 t=P-1
lease print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
(Plumb5yl Signature)
Sworn to before me this
day of 20 O
.y
Notary Public, County
LINDA J.COOPER
Notary Public,State of Now York
No. 4822563,Suffolk CNinty
Tsar E;ipl;s December 3i,
THE NEW YORK BOARD OF FIRE UNDERWRITERS PAGE '
1000314 BUREAU OF ELECTRICITY
F 40 FULTON STREET, NEW YORK, NY 10038
Date AUGUST 22,2001 Application No. on file 20184800/00 N 567621
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
GARY PARKER, 28 STANS ROAD, EAST MARION, NY
in the following location• El Basement El I st Fl. g� 2nd Fl. GAR• ` Section Block Lot
was examined on Jl'1LY 26,2001 and found to be in compliance with the National Elee&icat Code. ,
1
FIXTURE RECEPTACLES FIXTURES RANGES COOKING DECKS OVENS DISH WASHERS EXHAUST FANS
SWITCHES
OUTLETS INCANDESCENT FLUORESCENT OTHER AMT. K.W. AMT. K.W. AMT. K.W. AMT. K.W. AMT. H.P.
28 26 14 10 18 1 F
DRYERS FURNACE MOTORS FUTURE APPLIANCE FEEDERS SPECIAL REC'PT. TIME CLOCKS BELL UNIT HEATERS M LTI-OEM3�T DIMMERS
SYSTAMT. K.W. OIL M.P. GAS N.P. AMT. NO. A.W.G. AMT. AMP, AMT. TAMPS. TRANS. AMT. X.►. NO.OF FEET AMT. WAW
2 2 4 6
SERVICE DISCONNECT NO.OF S E R V 1 C E
METER
!11
AMP. TYPE EQUIP. 1/2W 1tr 3W 3 tr 3W 304W CNO.OF CC COND. A.W.G.6PER 1, NO.OF NI•lEC OFA'W'G. NO.Oi NEUIRAtsf A•W.G.a FCC200 CB 1 X 1 2/0 1 2/0
OTHER APPARATUS:
PADDLE FAN—F-1
G.F.C.Is-2
SMOKE DETECTOR:-3
B.J.ELEC. CO. LIC.#2670— ( L
BOX 16,STILLWATER AVE.
CUTCHOGUE, NY, 11935 GENERAL MANAGER
11
Per .�...=�
This certificate must not be altered In any manner;return to the office of the Board It Incarrect.inSpecton mpy be Identified by their credentials.
COPY FOR BUILDING DEPARTMENT. THIS COPY OF CERTIFICATE MUST. NOT BE- ALTEIRED IN ANY MANNER.
FOR BUILDING DEPARTMENT USE
Plot Diagram Showing All Buildings
Existing and Proposed And All Setbacks
M1
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�'�d
O�r►rr.�4aG�>d�,��97
7 � rC yo< �
BUILDING PERMIT REVIEW CHECK LIST
Applicant/ Date
Owners Name: Reviewed: �/ �/
Architect/ / Date
Engineer: G /�� 2�G �GGT / Submitted: �AO
SCTM #:
District: 1.000 Section: 4;?,A Block: Lot:
Project Sj:�—e
�� ` �ubdivision
Location: G• Name:
Single&separate Requ
certification: Yes_ No)
Req. Req `' --+�+x
Zoning District [Lotsize: !!�: O d Actual: Q t/ ] [Lot coverage Proposed: ]
[F ont Yard /Proposed: [Side Yard d �� Proposed: f� [R Yard 3s' Proposed: ]
Project Description:
AGENCY PERMITS Permit
REQUIRED FOR REVIEW N.A. NO YES Number
Suffolk County Health Dept. —X
New York State D. E. C. X,
Town Trustees
Town Zoning Board approval:
Town Planning Board approval:
Flood Plane Elevation ???
Flood Zone:
Notes.•
BUILDING DEPT.
INSPECTION
[ ] FQIJNDATION 1ST [ ] ROUGH PLBG.
[t/J FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE ! � 4l_77_ INSPECTOR �j
T�
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[�RAMING [ ] FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS: �.�.,,..,c C
DATE // d0 INSPECTOR,,,"
7(tlo 0
765-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST >jR M PLBG.
FOUNDATION 2ND LATION
[ ]�FIREPLACE
ING [ j FINAL
U/f & CHIMNEY��
REMARKS:
,DATE C BI INSPECTOR
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] I CATION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
�RE�MARKS: �✓f,�y �c_<0� /�
DATE �`� � INSPECTO
,65- 802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INS TION
[ ] FRAMING [ FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
DATE /03 Dy INSPECTOR
T.D INSPECTION REPORT DATE COMMENTS
� b
- -- - Q
II �
INDAT ION ( 1ST) n
---- ------
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f II-------— - - - ---- ------------- -- ---- ------ cn
INDATION (2ND)
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FORM N0. I BOARD OF HEALTH
3 SETS OF PLANS . . . . . . . . . . . . . •
TOWN OF SOUTHOLD SURVEY
BUILDING DEPARTMENT
CHECK . . . . . . . . . . . .
TOWN HALL
SEPTIC FORM
SOUTHOLD, N.Y. 11971
TEI.: 765-1802 NOTIFY: ��±±
Examined.................. 19.... CALL . . . . . . ,
Approved.................. 19.... Permit No. MAIL TO: . . . . .!1,.eGtoS����? ...
Disapproved a/c ...................................
,. f . `. L ...................................
r.
.............................
(Building Inspector)
p1.OG•DEPT'
i
ICATION FOR BUILDING PERMIT
Date. . 9-7-99. . . . . . . . . 19. . . .
INSTRUCTIONS
a• This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector wi
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan shoving location of lot and of buildings on premises, relationship to adjoining Premises or public
treets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of
uis application.
c' The work covered by this application may not be crnmeneed before issuance of Building Permit.
Upon approval d. ppaof this application, the Building Inspector will issue a Building Permit to tlue applicant. Such
ermit shall be kept on the premises available for inspection throughout the cork.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of
ccupancy shall have been granted by the Building Inspector.
APPLICATICN IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
uilding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
egula[ions, for the construction of buildings, additions or alterations, or for removal or demolition, as herein
escribed. The applicant agrees to c®ply with all applicable laws, ordinances, building code, housing code, and
egulations, and to admit authorized inspectors on premises and in building for necessary ins tions.
(Signature of applicant or name, if a corporation)
3950 Stars Rd, P.O, box 401, East Marion, Ny 11939
...................................................
(Mailing address of applicant)
tate whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder
Owner
ane of owner of premises ..Gary Pakeir &.Ae1?4F.q1}.All G9F .........
..............................................
(as on the tax roll or latest deed)
E applicant is a corporation, signature of duly authorized officer.
...........................................
Nave and title of corporate officer)
Builders License No. .........................
Plumbers License No.
..................
Electricians License No.
Other Trade's License No. ....................
Location of land on which Proposed cork will be done..3� 0119.39.............
...........................
.. ..................
House Nunber ......•........•.•.............•..Hamlet
Street ...........................
County Tax Ma No. 1000 Section 22
P ................ Block ....02.......... Lot . 14.1
Subdivision ..NA ••• .........
............................. Filed Map No.
(Name) Lot ...............
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy Residence
...................
....................
.................
""'
3. Nature of work (check which applicable): New Building .......... Addition
Repair ............ Removal .•.. ... Alteration ..
• ............. I)errnlition .... ....
........ Other Work ....
14- Estimated Cost ... ... .. ... (Description)
fee .........�..
...............
5 if (to be id on filing this application)
eking, number of dwelling units ....1......
tlurtber of dwelling emits on each floor ........... .....
If garage, nurlber of cars . 1
........
6• If business, commercial or mixed occrrlr3OCY.
7. Dimensions of existing structures, if specify nature and extent of each type of use..NA..... ............
any: Front...37.'..6."...... Rear 37'..6"
Depth ..3.8r 6".......
Number of Stories
same structure ... 2.,.,•,-
Dimensions of ��
cture with alterations or additions: Front
Depth ......3$'..6."....... Height ....19,' S5' 62 r rr
............ Umber of Stories ....... Rear .....5•• 6.....
8. Dimensions of entire new construction
Height ....19'
Front ..18...0......... Rear ............ Depth ."""'•••••••••••• Umber of Stories
.....2 .........
9. ................
Size of lot: Front ..�5A.QQ.'•• 150.02'
Rear ... 15 .0 .......... Depth 133.37'
10. Date of Rbrcha. .9,,15-97 ....................
••.••... Name of Former Owner Sara Sarmougaki s
il. Zone or use district in which premises are situated .
. . R/40 ...
:............................ .
. .. ...........
12. ........
Does Proposed construction violate a
rry . .
zoning law, ordinance or regulation: No
13. Will lot be "•••••-
aded ..yq$.............. Will excess fill be removed from
premises:
14. Names of Owner of YES NO
PcaaisesG�FY..�arker
En i Address P:� Box 401 East Marion
ee ""'•'••••••
.................... Phone 1'lo.4J.7.-19.24
........ . Address .....
Name of I,�larence •Tuthill P.O. Box 162 Green ort
......... ....
Name of Contractor
Owner ... . ane No.477-1b52....
..................... Address .....
15. is this property within 300 feet of a tidal wetland? * YCS Phone No. ..............
*IF YES, SOLMM M TRMM-S PMWT MAY lit RR¢JIR[3) ND X
....
TC ....
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-
From Property lines. Give street and block number or description cording to back dimensions
Aietiber interior or corner lot. g deed, and show street
nares anc] indicate
SEE ATTACHED TAX MAP AND SURVEY WITH CHANGES. LOT IS INTERIOR.
STARS ROAD,
TAX MAP No. 1000 Section 22 Block 02 Lot 14.1
'AVlr Dr ";w YORK,
A1Nly O SS
...�!I•�L/...1 !-� �K��.....................
flare of individual signing ...Dein(July sworn, deposes and says that he is Cbe applicant
ove named,
is Che ......0
.....................
(Contractor, agent, corporate officer, etc.).................
said owner or owners, and is duly .................
rm
plication; that: all statement's containedinthis aPPLi atiorrtaare truetothelbestlof his and to knowledgeke arxl file Chis
at the work will be performed in the rrranner set forth in [tie application filed therewith• and belief; and
am Co before me this
9-Zl� Qpp� � n
,.......day of .. """......19....9 e
Notary Public ...... /
T /....../...
(Signature o�icant)
LINDA A COOPER
State of N
48226 pum3,Suffolk County
# YOrk
Terrt�Expires December 31, __,o2�
Comm
tgr
Aloin ah
ftft K°r� cn
l be
OCCUPANCY OR � w
ALL P UMMjNG Li USE IS UNLAWFUL 3 m
" s"oEEO ma VAUM W{TOF OCCUPANCY TE
PROVIDE ANTI-SCALD ARDMI
THERMAL SHOCK PREVENTING APIP/ D AS NOTED
DEVICES AS TO pA� 90I•R(K) /(�17 'd 6
N.0 STATE BUILDING CODE Dr.TE: B.P.d
YaOTlFV BUILDING DE? , E AT
M FOR `.FIE `t
PLUMBER CERTIFICATION ; r;,r in c INSFFCTIOIVS 1
ON LEAD CONTENT BEFORE 'nc+N ruvo laee�ul +Eo y
CERTIFICATE OF OCCUPANCY 2
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED 2/10of7% LEAU• All
THE REQUIREIIALNdF' -
STATE CONSTRUCTION R F'R�Ea'a
- CODES. NOT n!'SFOhSiS F Ptfs
- DESIGN OR CONS TRUCTION,
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ENERGY CODE CALCULA'T'IONS
(For Non-Electric Ileat) Design Criteria G, 000 Uegree' Uays
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SU05 YS'1'L•M F730
DESIGN 'T HERMEL REMARKS
"U., RATING
l.x Lerim. Walls (opaque)Glazing
Doors
Coiling/Roof (Opaque)
Skylights % 77
Floor
Foundation Walls
Slab Insulation _
'T'O'TAL 'r
HuLes:
Building envelope Systems to meet requirements of 7015.2
HVAC Equipement to meet requirements of 7015.11
HVAC Sys Lems to meet requirements of 7015. 12
Duct Systems to meet requirements of 7815 .13
VentlliLions Sys Lents to meet requiremeu Ls of 7815. 14
Insulation of riplRq Systems to meet requirements of 7U15. 15
Service Walser Nesting Systems 6 Equipment to meet requireuwuLS of 7015 . 21
Electrical 6 Lighting Systems 6 Equipment to meeL requiremeuLs of 7015. 31
DF NEW),
'lb the hest of my knowledge, Q<� oE
belief, b professional - yl��P b1'r
judyemen L, these plans are 111 3 "
compliance with Elle code. a
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