HomeMy WebLinkAbout49809-Z s�EFOL,fI' Town of Southold 10/4/2023
f� P.O.Box 1179
y 53095 Main Rd
o ,` Southold,New York 11971
CERTIFICATE OF OCCUPANCY
No: 44630 Date: 10/4/2023
THIS CERTIFIES that the building ACCESSORY
Location of Property: 845 Maple Ln, Southold
SCTM#: 473889 Sec/Block/Lot: 64.-1-29.1
Subdivision: Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore filed in this office dated
9/12/2023 pursuant to which Building Permit No. 49809 dated 10/2/2023
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"accessory sauna as applied for.
The certificate is issued to 845Blisshouse LLC
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
ELECTRICAL CERTIFICATE NO. 49809 10/3/2023
PLUMBERS CERTIFICATION DATED
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utho ize gnature
TOWN OF SOUTHOLD
o�suFFnt,r�o.
BUILDING DEPARTMENT
CA a TOWN CLERK'S OFFICE
o • { 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#: 49809 Date: 10/2/2023
Permission is hereby granted to:
84513lisshouse LLC
845 Maple Ln
Southold, NY 11971
To: legalize "as built" accessory sauna as applied for. Certification will be required.
At premises located at:
845 Maple Ln
SCTM #473889
Sec/Block/Lot# 64.-1-29.1
Pursuant to application dated 9/12/2023 and approved by the Building Inspector.
To expire on 4/2/2025.
Fees:
AS BUILT-ACCESSORY $200.00
CO-ACCESSORY BUILDING $50.00
Total: $250.00
Building Inspector
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Town Hall Annex Telephone(631)765-1802
54375 Main Road
P.O.Box 1179 sean.devlina-town.southold.ny.us
Southold,NY 11971-0959COU
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATE OF ELECTRICAL COMPLIANCE
SITE LOCATION
Issued To: 84513Iisshouse LLC
Address: 845 Maple Ln city:Southold st: NY zip: 11971
Building Permit#: 49809 Section: 64 Block: 1 Lot: 29.1
WAS EXAMINED AND FOUND TO BE IN COMPLIANCE WITH THE NATIONAL ELECTRIC CODE
Contractor: Electrician: Custom Lighting Of Suffolk License No:
SITE DETAILS
Office Use Only
Residential X Indoor X Basement Service
Commerical Outdoor X 1st Floor Pool
New X Renovation 2nd Floor Hot Tub
Addition Survey X Attic Garage
INVENTORY
Service 1 ph Heat Duplec Recpt Ceiling Fixtures 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
Transfer Switch UC Lights Dryer Recpt Emergency Strobe Heat Detectors
Disconnect 2 Switches 4'LED Exit Fixtures Sump Pump
Other Equipment: 250GFI Disconnect, 240GFI Disconnect
Notes: Exterior Sauna
Inspector Signature: Date: October 3, 2023
S.Devlin-Cert Electrical Compliance Form
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IELD INSPECTION REPORT DATE COMMENTS
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FOUNDATION (IST) 0 H
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
y Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
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41 Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT M
For Office Use Only '
ILr\ I
PERMIT NO. W Building Inspector: SEP 1 2 2023
Applications and forms must'be filled out in their'entirety.Incomplete. 'BUI DINS DEYr,
applications will not be accepted. Where the Applicant is not the owner,an � ��
Owner's Authorization form(Page 2)shall be completed.
Date: -
OWNER(S)OF P OPERTY:
Name: SCTM#1000-_&
Project Address:
Phone#: Email:
Mailing Address:
CONTACT PERSON: .
Name:
Mailing Address:
Phone#: a
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Emil:
PU . .c_o.,..CD-_ .
DESIGN PROFESSIONAL INFORMATION:
jName:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION: -
Name: '
Mailing Address:
__-- ----_.__----.-_ ►___ ____ ___Or___ _ _- - _- --�_ .__ - - .- h_ _ __ _ __.__.._ .- o a-cl
Phone#: _ Email:
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DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addit' n Alteration Dpepair ❑Demolitio Es • ated Cost of Project:
❑Other S �' $
rk
Will the lot be re-graded? ❑Yes ❑No Will excess fill be-r om premises? ❑Yes ❑No
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PROPERTY INFORMATION
Existing use of property: l' ,C Intended use of property:
Zone or use district in which premises is situated: Are there any covenants d restrictions with respect to
this property? ❑Yes o IF YES, PROVIDE A COPY`
❑'Check Box After Reading: 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 Townof 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 asa Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By0_7
t name): • uthorized Agent ❑Owner
------.______.___.________- __- ---______.�_ _.
Signature of Applicant: Datt
CONNIE-D..B�NC / /L — --
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
Qualified in Suffolk County
�+ S Commission Expires April 14,2 0oZ Y
COUNTY OF �7��-KJI/C )
C--,irepn being duly sworn, deposes and says that(s)he is the applicant
(Name of in ividual signi g contract) above named,
,^,
(S)he is the
(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 l�
4 day of 20 Q
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
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Owner's Signature Date
Print Owner's Name
2
AUTHORIZATION
(Where the applicant is not the owner)
I/We, Sam En lebardt ,
owners of the property identified as SCTM# 1000- 64-1-29.1 in the town of
Southold New York, hereby authorizes
Eileen Wingate for Quiet Man Studio to act as my agent and handle all
necessary work involved with the application process for permit(s) from the:
NEW YORK S ATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Pro rty wner's Signature Property Owner's Signature
SWORN TO BEFORE ME THIS_ G DAY OFy �'`/ r 20 Z�
Notary Public
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
c - Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
4.� Telephone (631) 765-1802 - FAX (631) 765-9502
rogerr(c�southoldtownny.gov seandt southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: E- L_LC
Address: *U-5 HaDj?- 1,21,
Cross Street:
Phone No.:
BIdg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot: lG�
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): -
�1
Square Footage:
Circle All That Apply:
Is job ready for inspection?: LZjs YES ❑ NO []Rough In Final
Do you need a Temp Certificate?: ❑ YES ❑ NO Issued On
Temp Information: (All information required)
Service Size 1-11 Ph❑3 Ph Size: A # Meters Old Meter#
❑New Service[–]Fire Reconnect EJ Flood-Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 E H Frame 0 Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
AUTHOIUZATION
(Where the applicant is not the owner)
J
I/We, Sam Englebardt
owners of the property identified as SCTM# 1000- 64'1-29.1 in the town of
Southold New York, hereby authorizes
Eileen Wingate for Quiet Man Studio to act as my agent and handle all
necessary work involved with the application process for permit(s) from the
NEW YORK S ATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
Pro rty wner's Signature Property Owner's Signature
P��y
SWORN TO BEFORE ME THIS_ DAY OFy �'Y 20
Notary Public
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46', Southold, NY- Official Website I Official Website 1000-64.-1-29-Laserfiche WebLink
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APP OVED AS NOTED OCCUPANCY OR
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IVOnFlreul " 6 WITHOUT CE�RTIFICA�_.
By: WIT
LDING DEPARTMENTAT OF OCCUPANCY
631-765.1802 8AM TO 4PM FOR THE
FOLLOWING INSPECTIONS;
1. FOUNDATION-TWO H.=���
FOR POURED CONCt=.'"rr'
2 ROUGH-FRAMING Fx
& INSULATION ELECTRICAL
4. FINAL-CONSTRUCTION MUST INSPECTION REQUIRED
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTON ERRORS
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Additional
COMPLY WITH ALL CODES OF Certification
NEW YORK STATE & TOWN CODES May Be Required,
AS REQUIRED AND CONDITIONS OF
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SGV-H� TRUSTEES
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