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HomeMy WebLinkAbout30061-Z FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. CERTIFICATE OF OCCUPANCY NO: Z-31381 Date: 01/10/06 THIS CERTIFIES that the building ALTERATION Location of Property: 1750 GILLETTE DR EAST MARION (HOUSE NO. ) (STREET) (HAMLET) County Tax Map No. 473889 Section 38 Block 2 Lot 18 Subdivision Filed Map No_ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated JANUARY 9, 2004 pursuant to which Building Permit No. 30061-Z dated FEBRUARY 2, 2004 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 ALTERATION & RENOVATION TO BASEMENT OF EXISTING SINGLE FAMILY DWELLING AS APPLIED FOR. The certificate is issued to ANDREW F & SARAH G OLSEN (OWNER) of the aforesaid building. SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A ELECTRICAL CERTIFICATE NO. 1191641 04/13/05 PLUMBERS CERTIFICATION DATED N/A th `&zed /Signature Rev. 1/81 r ' Form No.6 TOWN OF SOUTHOLD JAN —F`� BUILDING DEPARTMENT TOWN HALL 765-1802 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 rxisting 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 dwelling$25.00, Additions to dwelling$25.00, Alterations to dwelling$25.00, Swimming pool$25.00, Accesspry 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 - $.25 4. Updated Certificate of Occupancy- $50.00 5. Temporary Certificate of Occupancy- Residential$15.00, Commercial$15.00 Date._ l 3 V New Construction: Old or Pre-existing Building: _ (check one) Location of Property: 1150 Lz4s1 0140iaJ House No. Street Hamlet Owner or Owners of Property: _ /fiV44 r✓ + 54f (t. 0�5 e Suffolk County Tax Map No 1000, Section 3!9 Block Z _Lot j$ Subdivision _ Filed Map. n Lot: Permit No. 30061- Date of Permit � o Z y _ Applicant: Awa_ 013 e'7✓ Health-Dept. Approval: Underwriters Approval: Planning Board Approval: Request for: Temporary Certificate Final Certificate: (check one) Fee Submitted: $ Applicant Signature C��c-•�o95 3� M MPLrL3r3rL3 rrs&n�rsrr�nrn�s r�r�r� crcnrr� �r�r� rscn cPr� �s cPrJcfrJ�rPc tAfrJrJrJ�cP rn�n o BY S NEW YORKBOARD COMPLIANCE THE �� S RD O FIRE UNDERWRITERS 5 5 BUREAU OF ELECTRICITY 5 5 40 FULTON STREET — NEW YORK, NY 10038 CERTIFIES THAT 5 5 Upon the application of upon premises owned by S Q.C. ELECTRIC INC. ANDREW OLSEN 5 P.O. BOX 518 1750 GILLETTE DR cS LAUREL, NY 11948-0518, EAST MARION, NY 11939 Located at 1750 GILLETTE DR EAST MARION, NY 11939 5 5 c5 Application Number: 1191641 Certificate Number: 1191641 �+5 5555 Section: Block: Lot: Building Permit: BDC: nsll SDescribed as a Residential occupancy, wherein the premises electrical system consisting of 5 5 electrical devices and wiring, described below, located in/on the premises at: 5 Basement, r� A visual inspection of the premises electrical system, limited to electrical devices and wiring to the extent detailed 5 Sherein, was conducted in accordance with the requirements of the applicable code and/or standard Spromulgated 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 130, Day of April, 2004. 5 Name OTY Rate Rating Circuit Type S 5 Alarm and Emergency Equipment 5 Sensor 1 0 Carbon Monoxide Wiring and Devices 5 5 Receptacle 9 0 General Purpose 75 5 Switch 1 0 General Purpose SFixture 12 0 Incandescent 5 SDimmers 4 0 5 5 s 5 5 5 5 5 seal S 5S 1 of , S 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 S o ����s�� 0a 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. 30061 Z Date FEBRUARY 2 , 2004 Permission is hereby granted to : ANDREW F & SARAH G OLSEN 1750 GILLETTE DR EAST MARION,NY 11939 for CONSTRUCTION FO A NON-HABITABLE BASEMENT STORAGE ROOM AS APPLIED FOR at premises located at 1750 GILLETTE DR EAST MARION County Tax Map No. 473889 Section 038 Block 0002 Lot No. 018 pursuant to application dated JANUARY 9, 2004 and approved by the Building Inspector to expire on AUGUST 2 , 2005 . Fee $ 150 . 00 utho ized ignature ORIGINAL Rev. 5/8/02 _ A_ lDoo', 38-Z- TOWN OF SOUTHOLD PROPERTY RECORD CARD yu OWNER STREET ' .50 VILLAGE DIST. SUB. LOT y o r �7e ah F RMER OWNER N E ACR. L230 =r n M Q V-tnd t ;W S W TYPE OF BUILDING d m /!7Ol7 ZES. '216 SEAS. VL. FARM COMM. CB. MISC. Mkt. Value LAND IMP. TOTAL DATE REMARKS / a nor C; -0t/- ,Z �!� 7 .Toa, ,w 70 r, u 7 E o�7 C, 37 G o0 161?1.2s6 Aat . ,'o d ,S e 40 S6 6 o Y I gLt& 4-;ROS r Y AZQ07, 'i-�4LU -9063 P-�5 o S/o m 'o 3 0 o S�ZA �/ g. J�ev /.39/f/ C o o� 7 e 7000 0 0 eon 1060 i S, /,� Q — J -z/ 35F- S'M D SP _ 5 B ILDING- NDITI Nsa NEW NORMAL BELOW ABOVE FARM Acre Value Per Value Acre Tillable I Tillable 2 Tillable 3 AJoodland Swampland FRONTAGE ON WATER 3rushland FRONTAGE ON ROAD House Plot DEPTH BULKHEAD Total DOCK s =;� ■■■■■■ ■■■ ■■■■■■■■■■■■■■ ■■■■■■■ NOMINEE■■■■■■■■■■■ ■■■■■ ■MEN MEN■■■■■■■■■■ L�■■■■■� ■■■■NEEM■■■■■■■■■■■ ME ME ■■■■MEENEu■■■■EMM■MOEM OEM ■ MEMOM MEN mom M■iri`iiiiMM-A■■■■■M■ME■■■■ mom Emom N■■■MINESTM■■■■N■N■E M■■E■I■M M■ IMMILSEMEME■IMMOMEMMEMEMEMEME EEE■M MEM■■■■■ ■■■N■■■■ ■■NE■■■■■ x �, 3• � u aumar eed alteration ad ' � co t'�ssisawiohnional �M of the NowYc& '.:� n d fp EO Lan. _.,s f1. '3• ( ,7 .(� (_± d _es or this auney.mp.me. sumww't lr*od s9W w 34••E° (� {� emeoaeedaaehep os a valW aua copy., . ruatsmesa IndKeted ItataMl .. > + ( � Z omr w the p~for hv* Ute 1j ry � �J � �C'; s.J'ecaz , 2nd an„hi6 �,ee irathutlm NatedNahpn y m. a w v _ '—� iJ � �-..� ^'� rT},: me easgnea of the lor�np . � •" guarantees etc twt t �OF i ,p i •. .,.-:gnat inantudorw'w LOT WLJ^F� -TiS SWONVhJ fZE-f-lrs-K TCS vz � .� ' � �tisr�� � � � "/AIS.(' OF• shl�.KF01.� f�!\NC7R" P'�tt-T3 `.-m; X34 2^ v U-4 T(46 -tUf {`C%S..K CC}L3N CL.*-R,K'S QFT-!CL- AS fA.9,h N2 2o3E', 0 o x WL- L. h :,AC'S :Z`✓L-i".: " \ v� q `t"�v'�cnr-tT� - eT�ST 1•i_7Lti• fir- SC%.\i...`sc' 30t' �• e-e st&0 tq ;'fit E- ry - j SiTLIN s t ' n�ta� �� T Lt? fi r / S[)t1'Tt•zS3:_S7 SetY(NC-dS tSAFlf1( ZQ\V t` Q='- Cs v`i 1-f =�Li7 s T 1.}; ucnvr "bd SLIriVr-'t G!� IAAY 3. 19T4 ry TOWN OF SOUTHOLD BUILDING DEPT. 765.1802 INSPECTION [ J FOUNDATION IST [ ] ROU PLBG. [ ) FOUNDATION 2ND [ ] 1 ULATION [ ] FRAMING / STRAPPING [ ] FINAL [ J FIREPLACE & CHIMNEY [ } FIRE SAFETY INSPECTION REMARKS: DATE f INSPECTOR 765-1802 BUILDING DEPT. INSPECTION [ ] FOUNDATION IST [ ] ROUGH PLBG. [ ) FOUNDATION 2ND [ ) INSULATION [�RAMING [ ] FINAL ( ] FIREPLACE &��JJCHIMNEY JJ . REMARKS: /C7l'L� �iC I U S.4 DATE j© © INSPECTOR - A ��pF NEbyy F1ScyF�09 ALL CONSTRUCTION SHALL q ✓f APP OVED AS NOTED MEET THE REQUIREMENTS OF THE Di DATE: B.P.# 30061 CODES OF NEW YORK STATE. FEE: NOTI Y BUILDING --PPARTMENT AT O ESS' 765-1802 8AM TO 4PM FORTHE FOLLOWING INSPECTIONS: 1. FOUNDATION - TWO REQUIRED --FOR POURED CONCRETE H 2. ROUGH - FRAMING & PLUMBING 3. INSULATION \' 4. FINAL - CONSTRUCTION MUST 1 BE COMPLETE FOR C.O. V � OCCUPANCY OR ALL CONSTRUCTION SHALL MEET THE REQUIREMENTS OF THE CODES OF NEW 0 \ USE IS UNLAWFUL YORK STATE. NOT RESPONSIBLE FOR h WITHOUT CERTIFICATE DESIGN OR CONSTRUCTION ERRORS. n z OF OCCUPANCY eta a � . Z UNDERWRITERS CERTIFICATE REQUIRED �l . ;.. . 05 FESS SNP` V t 7/4 i FIELD INSPECTION REPORT DATE COMMENTS ui FOUNDATION (1ST) y at -------------------------------------- FOUNDATION(2ND) Wldll z a -- -- J u1 G � y ROUGH FRAMING& PLUMBING / x r INSULATION PER N.Y. --- - % y STATE ENERGY CODE l FINAL — - ADDITIONAL COMMENTS er z ro O x y d ro y 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 Planning Board approval FAX: (631) 765-9502 Survey www. northfork.net/Southold/ PERMIT NO. Check Septic Form 2 N.Y.S.D.E.C. ` Trustees Examined 't- ,20 / Contact: Approved 2 20 Mail to: Disapproved a/c Phone: Y Expiration 20_--)! Buildi g Inspector J* 9 ?M4 APPLICATION FOR BUILDING PERMIT Date 11 g 2001/ --- 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 otherapplicable Laws, Ordinances or Regulations, for the construction of buildings, additions, or alterations or for removal or do ition as herein described. The applicant agrees to comply with all applicable laws, ordinances,building code,housing cod ,=regulations, and to admit authorized inspectors on premises and in building for necessary inspections, (Signature of applicant or name,if a corporation) 175-0 &-NeftE Dr:vr - T µtq� I'd j1131 (Mailing address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder 0N1VaL--/� Name of owner of premises AtJ0,ee,✓ t 5Ac,+k 0/5 if A/ (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 work will be done: VI S J G,l le tTE 6r c*sT Melfi rd House Number Street Hamlet County Tax Map No. 1000 Section `113`6id9 38,2-ISBlock Lot 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 ase-iAT- b. Intended use and occupancy oil Siura.lE loz lf9 u ei4 �ace,AC T 3. Nature of work(check which applicable): New Building Addition Alteration ✓ Repair Removal Demolition Other Work (Description) 4. Estimated Cost_ j i Z,i mc) Fee (To be paid on filing this application) 5. If dwelling, number of dwelling units Number of dwelling units on each floor If garage, number of cars 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 Number of Stories Dimensions of same structure with alterations or additions: Front "War Depth Height Number of Stories 8. Dimensions of entire new construction: Front Rear Depth Height Number of Stories 9. Size of lot: Front Rear Depth 10. Date of Purchase Name of Former Owner 11. Zone or use district in which premises are situated I(S;aWT,Ak 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 _Address Phone No. Name ofrem 7fisw6 Rx Address ffolo Phone No 76S—Z? Name of Contractor Address Phone No / 4 15 a. Is this property within 100 feet of a tidal wetland or a freshwater wetland? *YES NO J * 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. 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: COUNTY OF ) being duly swom,deposes and says that(s)he is the applicant (Name of individual 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. Sworcy jo before me this J d yof 20 &43 'Notary Public Signature of Applicant LYNA M. 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