HomeMy WebLinkAbout29105-Z FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No: Z-31266 Date: 11/04/05
THIS CERTIFIES that the building ADDITIONS/ALTERATIONS
Location of Property: 9625 MAIN RD EAST MARION
(HOUSE NO.) (STREET) (HAMLET)
County Tax Map No. 473889 Section 31 Block 3 Lot 21
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated DECEMBER 20, 2002 pursuant to which
Building Permit No. 29105-Z dated JANUARY 15, 2003
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 ADDITIONS & ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to PATRICIA GARABRANT
(OWNER)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL CERTIFICATE NO. 2056189 05/31/05
PLUMBERS CERTIFICATION DATED 12/29/03 MARK BAXTER PLUMBING
///4utf
ized ignature
Rev. 1/81
Form No.6
TOWN OF SOUTHOLD �p f 3 20�f
BUILDING DEPARTMENT
TOWN HALL L
765-1802 `, ,to
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 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'd� elling$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-existin Building- $100.00
3. Copy of Certificate of Occupancy-$.2
4. Updated Certificate of Occupancy- 50.00
5. Temporary Certificate of Occupancy-Residential$15.00, Commercial$15.00
/
Date. o S
New Construction: Old or Pre-existing Building: (check one)
Location of Property: �G S' 1-141,v A; o e,Ld EAis T ISIAZ Ia Al
House No. Street Hamlet
Owner or Owners of Property: &772/c_A/9.
Suffolk County Tax Map No 1000, Section 0,S) Block p�� _� Lot r) /
Subdivision Filed Map. Lot:
Permit No. o? 9/0 .5, Date of Permit. Applicant:
Health Dept. Approval: Underwriters Approval:
Planning Board Approval:
Request for: Temporary Certificate Final Certificate: (check one)
Fee Submitted: $
r•
App li t Signature
J
e c1r�rJ@PLJc rr tcicti IN
5 BY THIS CERTIFICATE OF COMPLIANCE THE
5 NEW YORK BOARD OF FIRE UNDERWRITERS S
5 BUREAU OF ELECTRICITY 5
5 40 FULTON STREET — NEW YORK, NY 10038 CC5
CERTIFIES THAT
Upon the application of upon premises owned by
5 PAT GARABRANT PAT GARABRANT C5
5 9625 MAIN ROAD 9625 MAIN ROAD 5
�5 EAST MARION, NY 11939 EAST MARION, NY 11939 5
C� Located at 9625 MAIN ROAD EAST MARION, NY 11939
c� Application Number: 2056189 Certificate Number: 2056189 c5
Section: Block: Lot: Building Permit: BDC: ns11
5 5 Described as a occupancy, wherein the premises electrical system consisting of 5
electrical devices and wiring, described below, located in/on the premises at: 5
5 Second Floor,bathroom,
5 5 A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed
herein, was conducted in accordance with the requirements of the applicable code and/or standard
5 promulgated by the State of New York, Department of State Code Enforcement and Administration, or other
5 authority having jurisdiction, and found to be in compliance therewith on the 31st Day of 5
May,2005. 5
55' Name 4TY Rate Rating Circuit Tcev5
Miscellaneous
as built-2004
5
5 5 Wiring and Devices 5
Switch 2 0 General Purpose
5 Fixture 1 0 Incandescent 5
Paddle Fan 1 0
55 Receptacle 1 0 GFCI 55
5 An as built visual inspection,of the delineated electrical installation,determined that an obvious hazard is not present and the installation is 5
5 believed to be in comformance with the applicable reference standard for the estimated period of construction of the premises wiring system. L+
5 S
5 5
5 seal
5 1 of I rrS
This certificate may not be altered in anyway and is validated only by the presence of a raised seal at the location indicated. S
5 5
oPLffl3s L3rjs 713o
�gUFFO(,�c�
0
Town Hall,53095 Main Road 0 • Fax(631)765-9502
P.O. Box 1179 Telephone(631) 765-1802
Southold, New York 11971-0959
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
Date: oec
Building Permit No. rn q 0672—
Owner:
s2.Owner: Pat Qvo6va--O��
(Please print)
Plumber: A)a vk. &46V
(Please print)
I certify that the solder used in the water supply system contains less than 2/10 of 1%
lead.
�n 1Plumbe s Signature)
Sworn to before me this �oDl�/`� o
day of c� �►+�_, 20 r ( ac7a3�
Notary Public,"`' County
BARBARA ANN RUDDER
Notary Publk,Stat@ of Nor York °
No.4855886
Qualified in 5ultaUr c4un:
rAmmNHlon&W ApAf14,
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. 29105 Z Date JANUARY 15, 2003
Permission is hereby granted to:
PATRICIA GARABRANT
10 ALDIN LANE
LEVITTOWN,NY 11756
for
ADDITIONS AND ALTERATIONS TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR
at premises located at 9625 MAIN RD EAST MARION
County Tax Map No. 473889 Section 031 Block 0003 Lot No. 021
pursuant to application dated DECEMBER 20 , 2002 and approved by the
Building Inspector to expire on JULY 2rizAuth(
Fee $ 150 . 00
e Signa
ORIGINAL
Rev. 5/8/02
765-1802
UILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING FINAL
[ ] FIREPLACE & CHIMNEY
REMARKS:
rr---)e
DATE INSPECTOR
769.1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION IST [ ] GH PLBG.
[ j FOUNDATION 2ND [ INSULATION
[ ] FRAMING [ ] FINAL
[ ]
FIREPL;A5 CHIMNEY
REMARKS:
DATE INSP
M-1802
BUILDING DEPT.
INSPECTIO
[ ] FOUNDATION IST [ ROUGH PLBG.
[ ]
t
DATION 2ND [ ] INSULATION
[ ING [ l FINAL
[ ] FIREPLACE A CHIMNEY
REM KS � ' o C
DATE D INSPECT
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TOWN OF SOUTHOLD PROPERTY RECORD CARD
OWNER STREET VILLAGE DIST. SUB. LOT
6 r,*cf f l�rr. ,t Qt�t oaf(' (f i 3 I psem_
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LAND IMP. TOTAL DATE REMARKS Af
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AGE BUILDING CONDITION `�Fiiw_C.2/6
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NEW NORMAL BELOW ABOVE
FARM Acre Value Per Value
Acre a -e)-
Tillable
Tillable 1
Tillable 2
Tillable 3
Woodland
Swampland FRONTAGE ON WATER yc
Brushland FRONTAGE ON ROAD
C
House Plot DEPTH
BULKHEAD
Total DOCK
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Fax (516)765-1823 CA Town Hall, 53095 Main Road
Telephone(516)765-1900-, P.O.Box 1179
77 Southold,New York 11971
jo 15 of
SOUTHOLD TOWN
1�k4�MARK PRESERVATION COMMISSION
TO: Southold Town Building Department
FROM: Southold Town Landmark Pres. Comm. —Herb Adler, Jr.
DATE: January 14, 2003
RE: Garabrandt Residence at 9625 Main Rd., East Marion
Tax Map#31-3-21 SPLIA No. EM 35
With respect to the above referenced residence, the Landmark Preservation
Commission has reviewed the submitted plans. With respect to these plans,we
find them satisfactory as long as the new windows match the existing and historic
structure.
FflMD INSPECTION REPORT DATE COMMENTS -
w
FOUNDATION(IST)
C"
FOUNDATION(2ND)
z
Ol
ROUGH FRAMING& ✓. e ��
PLUMBING
INSULATION PER N.Y.
STATE ENERGY CODE
FINAL
ADDITIONAL COMMENT'S
O
A
_ � C
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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 3 sets of Building Plans
TEL: (631) 765-1802 PlanningBoar approval
FAX: (631) 765-9502 � Survey
www. northfork.net/Southold/ PERMIT NO. 2ti �J Check :& 1,20
Septic Form
N.Y.S.D.E.C.
Trustees
Examined '20 Contact:
Approved__ ,20_� Mail to:
Disapproved a/c
Phone: 7 —Q S.Q '3J
Expiration ,20_
Building Inspector
F
DEC NE= -'� APPLICATION FOR BUILDING PERMIT
I � .
DateO���., 3v 20oa
INSTRUCTIONS
a. This application MUST be completely filled in by typewriter or in ink and submitted to the Building Inspector with 3
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.
(Siguaturg d applicanttor name,if acorporation)
e /
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician,plumber or builder
Name of owner of premises 14 7--A/c, 4 l,F}R�0.4RR.ri T
(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. a 843 L H,T,
- Plumbers License No. 22,4?�,,O
Electricians License No.
Other Trade's License No.
1. Location of land on which proposed work will be done: n
House Number Street Hamlet
County Tax Map No. 1000 Section U.3/ Block 3 'N Lot 2
Subdivision Filed Map No. Lot
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy .pin 9/e 19k 4K re./4'rrwL
b. Intended use and occupancy sin Ile r eslwAwld
3. Nature of work(check which applicable): New Building Addition2hd J 4°'1L141 4Alteration
Repair Removal Demolition Other Work
(Description)
4. Estimated Cost �d0 0o o.o o Fee
(To be paid on filing this application)
5. If dwelling,number of dwelling units / Number of dwelling units on each floor /1'.,f
If garage, number of cars f.4,
6. 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 9.2-- Number of Stories �.
Dimensions of same structure with alterations or additions: Front onQ er R6
Depth Height Number of Stories
8. Dimensions of entire new construction: Front Hyo` Rear Depth
Height Number of Stories
9. Size of lot: Front A/• 27 � Rear761 /S � Depth
10. Date of Purchase 10 )?Ife Name of Former Owner AG"Afczs *k-w C.aiu' jdl _
11. Zone or use district in which premises are situated Oo
12. Does proposed construction violate any zoning law, ordinance or regulation?YES_NO ✓ •
13. Will lot be re-graded? YES_NO V Will excess fill be removed from premises?YES_NO V
14. Names of Owner of premisesAyw/e-j.a 9 arA'609ess '6.7, ZW,4=Phone No.
Name of Architect Alen, a Address(so u a wA.Phone No 631-z;iy" a-rq�
Name of Contractor ,Ua„ Aysckel Address 397F3"# ,;,,%Ofirht Phone No. 313-"olf
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 B$REQUIRED.
b. Is this property within 300 feet of a tidal wetland? * YES NOv-'
* 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.
STATE OF NEW YORK)
SS:
co
mai being duly sworn,deposes and says that(s)he is the applicant
(Name ofizldrv�idual signing 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 knowledge and belief; and that the work will be
performed in the manner set forth in the application filed therewith.
Sworn to before me
{
day of �/i1/ 20 d-2-
Notary
.2Notary PuFCOMInIssion
_ lure of Applicant
Karon R. 0albindor
Nubile, Stalo of Now York
ratlon #01RA604;gg12
00d In Sullolk County
Lxporrs Jun, 12. 20 0
BUILDING PERMIT EXAMINER CHECK LIST
DATE REVIEWED:
APPLICANT: DATE SUBMITTED:,/ /02
SCTM#DISTRICT: 1,000, SECTION: BLOCK: _,S_, LOT: o?�
STREET ADDRESS: �,7 CITY: 46w1dA1 SUBDIVISION:
PROJECT DESCRIPTION: �ODi770Ns�c>�Z�,�o,tis � �.
ESTIMATED PROJECT COST:�o?QL ARCHITECT /07-5-11" FAST TRACK? ,v 0
SINGLE & SEPARATE CERTIFICATION-REQUIRED? /1 #- NOTES:
LOTS 40,000SF-100-24.Lot recognition.(CREATED before June 30, 1983),UNDERSIZED LOTS FROM JAN.1997 100-25.Merger.(A nonconforming at any time after 7/1/8:
ZONING DISTRICT: q CONFORMING? �a
REQ. LOT SIZE: ACT. LOT SIZE: /6REQ. LOT COVE ACT. LOT COV.
REQ. FRONT yid PROP. FRONT REQ SIDEi�/ ACT. SIDE
REQ. REAR ] PROP. REAR REQ HEIGHT PROP. HEIGHT
WATER FRONT? II/0 DESCRIPTION:
PANEL #: FLOOD ZONE:,
APPROVALS REQUIRED
SUFFOLK COUNTY HEALTHD of I� BED #):_DTE
: / / PERMIT#:R10-
TOWN SEPTIC RECEIPT: Y 6jaj vESDTE:—/-
-
NEW YORK STATE DEC: rxE-DEC 9/1/75 YES
SOUTHOLD TOWN TRUSTEES: YES
TOWN ZONING BOARD APPROVAL: YES o
TOWN PLAN. BOARD APPROVAL: YES or
TOWN HISTORICAL PRE (SPLIA): YE O
NYS ENERG5min.? 4
M EGRESS (1 sq total) VENT(SQ. FT. x 4%) LIGHT(SQ. FT. x 8%)
BUILDING PERMITS OPEN/EXPIRED: BP -Z/C/0 Z- ,
HAVE PRE CO'S : Y OR N BP -Z/C/o Z- ,
NOTES:
FEE STRUCTURE: FOUNDATION: SF
FIRST FLOOR: SF
SECOND FLOOR: SF
OTHER: SF INIT OTHER TOTAL
TOTAL: SF FEE FEE EE
1. ( SF)- ( SF)= SFX$ =$ +$ +$ _$
2. ( SF)-( SF)= SFX$ =$ +$ +$ _$
OGf-Icy
s?;e
A/P,PR 0 AS NOT
„ - DATE:JLLL3 B.R/ -
� F°E _T
., ."'_'
NOTI BUILDING DE TMENT Ai
765.1802 s AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
^ 1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
L 2. ROUGH • FRAMING & PLUMBING
a INSULATION
' I A FINAL - CONSTRUCTION MUST
N I;W BE COMPLETE FOR C.G.
Y-1EW a,^Eyt•,�1.Ip �Tor1Y ,.`�F�ITIOfaI ALL CONSTRUCTION SHALL MEET
_ �I0t J THE REQUIREMENTS OF THE N.Y.
_ STATE CONSTRUCTION A ENERGY
CODES. NOT RESPONSIBLE FOR i
- - DESIGN OR CONET�IIC�IQP�IOpg ,
��
- F
- —
PLUMBER CERT /CAT/ON
ON LEAD CONT NT BEFORE
! I - CERTIFICATE O
OCCUPANCY
I � 1T7 >` L
_ 'FOLDER U ED IN WATER
I
WEN ht� 0 1 f, °LYS CTE;W CANNOT
� --+ ----- rLC3 /IG' Of1% LEAD.
PLUMBING
ALI.PLUMBING WASTE
.°s WATER LINES NEED
TESTING BEFORE COVERING
_
If CO
PPar tubing ss used
._." ... _ .. _.— for tm. - distributIng
sYsYern:8111 Ing shail be
of Was K or L arogv_
UtVDERWRIQRRECERTIFICATE
PROVIDE ANTI-SCALD AND/OR
THERMAL SHOCK PREVENTING I
DFVICES AS TO PART. 902.6(K)
� Ce rsl. >✓y�l,, O �_L:�L �' - /'�T�L� R.Y. STATE BUILDING CODE.
'PROVIDE SMOKE-DETECTING
ALARM DEVICES
AS TO PART. 721.1
OCCUPANCY OR N.Y.S BUILDING CODE,
USE IS UNLAWFUL
WITHOUT CERTIFICATE brad
OF OCCUPANCY ° ---
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M5, PATR.ICI.A Cn6R.AI'� A1J-I'"
q�VLot' }'t1LfT1 2D 111LTLION
SCALE. APPROVED By. DRAWN
SATE�t:& I[CG4
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