HomeMy WebLinkAbout31841-Z
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
Date: 06/25/07
No: Z-32430
THIS CERTIFIES that the building ALTERATION
Location of Property: 21055 MAIN RD
(HOUSE NO.)
County Tax Map No. 473889 Section 17
(STREET)
Block 4
ORIENT
(HAMLET)
Lot 8
Subdivision
Filed Map No.
Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated
MARCH 10, 2006 pursuant to which
Building Permit No. 31841-Z
dated
MARCH 10, 2006
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 KITCHEN ALTERATION TO AN EXISTING SINGLE FAMILY DWELLING AS
APPLIED FOR.
The certificate is issued to ALLYN M HOLMBERG
(OWNER)
of the aforesaid building.
N/A
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL
05/11/06
ELECTRICAL CERTIFICATE NO.
2097744
07/26/06 KING PLUMBING
PLUMBERS CERTIFICATION DATED
~\l.~
~or~ed ignature
Rev. 1/81
m
3J3- dG 1ft;
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Form No.6
TOWN OF SOUTHOLD
~ BUILDING DEPARTMENT
!, Il TOWN HALL
765-1802
APP ICATION FOR CERTIFICATE OF OCCUPANCY
JIN 8 2[:
tlLL)L.OEPf"-
TOW" Qf 512' 'ThO", '
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:
I. 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 I % 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
I 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
I. 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 ofCertificale of Occupancy - $.25
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $15.00, Commercial $15.00
Date.
Old or Pre-existing Building: ~
~ re 2aJ1-
New Construction:
(check one)
Location ofproperty: ~(O 5"5 (\A...tl A.A/\ ~o....J,. Or- ~
House No. Street Hamiel
Owner or Owners of Property: _--A l ~ ~ V\ +tz, l \'\A !o-e..V-~.___ _.__
Suffolk County Tax Map No 1000, Section -fll"J _____ Block 'i _ . _ Lot f'
Lot:
Subdivision
Filed Map.
Date of Penn it. 3~%' Applicant:
/
Health Dept. Approval: ..___.___._____ Underwriters Approval:
11P'/1
Pennit No.
Planning Board Approval. _.___. __.___
Request for:
Tempmill") CeltIficate
Final Certilieate:
.. (check one)
Fee Submitted: $ ..Jr<;.OO
~-72 fJ'S
c !f~ 3;1lf 30
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.
31841 Z
Date MARCH
10, 2006
Permission is hereby granted to:
ALLYN M HOLMBERG
PO BOX 157
ORIENT,NY 11957
for :
ALTERATION TO AN EXISTING ONE FAMILY DWELLING AS APPLIED FOR
THIS PERMIT REPLACES BP 29910.
at premises located at
21055 MAIN RD
ORIENT
County Tax Map No. 473889 Section 017
Block 0004
Lot No. 008
pursuant to application dated MARCH
10, 2006 and approved by the
Building Inspector to expire on SEPTEMBER 10, 2007.
Fee $
150.00
~
<~~ C~
Authorized Signature
ORIGINAL
Rev. 5/8/02
.:::It 3; 2' '1/
lID.lID
~ '1 ./ t..I ''6 BY THIS CERTIFICATE OF COMPLIANCE THE ~
I' NEW YORK BOARD OF FIRE UNDERWRITERS I
~ BUREAU OF ELECTRICITY ~
~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~
~ ~
~ CERTIFIES THAT ~
I Upon the application of upon premises owned by I
I DOROSKI ELEC. INC PER / ALLYN HOLMBERG I
~ P.O. BOX 781 21055 MAIN ROAD ~
~ CUTCHOGUE, N.Y. 11935, ORIENT, NY 11957 ~
I Located at 21055 MAIN ROAD ORIENT. NY 11957 I
~ Application Number: 2097744 Certificate Number: 2097744 ~
~ ~
~ Section: Block: Lot: Building Permit: BDC: ns11 ~
~ Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of ~
~ electrical devices and wiring, described below, located in/on the premises at: ~
~ First Floor, kitchen renovation, Attic, ~
~ ~
~ 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 ~
~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~
~ authority having jurisdiction, and found to be in compliance therewith on the 11th Day of May, 2006. ~
~ Name OTY Rate Ratinl! Circuit ~ ~
@l Miscellanenus ii:I
~ kitchen renovation ~
~ as built-1996 ~
~ Appliances and Accessnries ~
~ Exhaust Fan I 0 F.H.P. ~
~ Dish Washer I 0 1.2 KW ~
~~~~ ~
~ Outlet 8 0 Fixture ~
~ Fixture 8 0 Incandescent ~
~ Outlet t2 0 General Purpose ~
~ Receptacle 4 0 General Purpose ~
~ Switch 6 0 General Purpose ~
~ Receptacle I 0 20 amp Laundry ~
~ Receptacle I 0 30 amp Dryer ~
~ Receptacle 4 0 GFCI ~
~ An as built inspection, of the delineated electrical installation, detennined that an obvious hazard is not present and the installation is believed to ~
~ be in comformance with lbe applicable reference standard for the estimated period of construction of the premises wiring sY.<ll!'el. ~
~ ~
~ Continued on Next Page I of 2 ~
I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I
lID.lID
l!I.l!I
~ . BY THIS CERTIFICATE OF COMPLIANCE THE ~
~ NEW YORK BOARD OF FIRE UNDERWRITERS ~
~ BUREAU OF ELECTRICITY ~
~ 40 FULTON STREET - NEW YORK, NY 1 0038 ~
~ CERTIFIES THAT ~
~ ~
~ Upon the application of upon premises owned by ~
~ ~
~ DOROSKI ELEC. INC PER I ALLYN HOLMBERG ~
~ P.O. BOX 781 21055 MAIN ROAD ~
I CUTCHOGUE, N.Y. 11935, ORIENT, NY 11957 I
~ Located at 21055 MAIN ROAD ORIENT, NY 11957 ~
~ ~
~ Application Number: 2097744 Certificate Number: 2097744 ~
~ Section: Block: Lot: Building Permit: BDC: n511 ~
~ ~
~ Described as a Residential 0-599 square ft. occupancy, wherein the premises electrical system consisting of ~
~ electrical devices and wiring, described below, located inion the premises at: ~
~ First Floor. kitchen renovation, Attic, ~
~ 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 andlor standard ~
~ promulgated by the State of New York, Department of State Code Enforcement and Administration, or other ~
i authority having jurisdiction, and found to be in :compliance therewith on the 11th Day of May,2006. i
~ Name OTY Rate Ratinl! Circuit ~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
~ ~
I seal I
~ ~
~ 2 of 2 ~
I This certificate may not be altered in any way and is validated only by the presence of a raised seal at the location indicated. I
l!I~~.l!I
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971-0959
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Fax (631) 765-9502
Telephone (631) 765-1802
BUILDING DEPARTMENT
TOWN OF SOUTHOLD
CERTIFICATION
D"" rf&!v~
(
Building Permit No. <? / 'it(!
Owner: I/D/M. b ,,; ~ .
(P ase pnnt)
Plumber: I(r~) f)!U-lh,AJ'7
(Please print)
I certify that the solder used in the water supply system contains less than 2/1 0 of 1%
lead.
Signature)
Sworn to before me this ~ ~
Notary PUbliC'~ County
BARBARA ANN RUDDER
Notlry Public, Stlte of New York
No. 4855805
",.",,(l~allfied In Suffolk County
ulIlIIlI1lsslon Expires April 14. ~ 0
robert proffitt: : architects
architecture
interior design
zoning and
building ",x1e analysIS
Southold Town Building Department
PO Box 1179
Southold NY 11971
7 July, 2006
Re: Holmberg,
Po Box 157
21055 Main Road, Orient NY
To Whom It May Concern:
This is to state that the construction work at the above mentioned address has
been completed in accordance with the rules and regulations of the Town of
Southold. (_05::.0 A,oC-:-;~>
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address: 424 7'n avenue, brooklyn, ny 11215
phone: 212.791.9807 e mail: proffittny@aol.com
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TOWN OF SOUTHOLD BUILDING DEPT.
765.1802
INSPECTION
[ ] FOUNDATION 1 ST [ ] ROUGH PLBG.
[ ] FOUNDATION 2ND [ ] INSULATION
[ ] FRAMING I STRAPPING ~AL
[ ] FIREPLACE & CHIMNEY [] FIRE SAFETY INSPECTION
[ ] RRE RESISTANT CONSTRucnON [ ] RRE RESISTANT PENETRATION
CO
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REMARKS:
DATE ~7?
INSPECTOR
- __________n______
j19/o tv 6~J 3",.; I
765.1802
BUilDING DEPT.
INSPECTION
[
[
[
] ROUGH PlBG.
LATION
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INDATION
( 1ST>
IGll FRAME [,
PLUMBING
;ULATION PER N _ Y.
STATE ENERGY
CODE
FINAL
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ADDITIONAL COMMENTS:
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a. '!his applicatioo DlIst be caq;>letely filled in by typewriter or in ink and sulmitted to the Building Inspector
3 sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan shewing locatioo of lot and of buildings 00 pranises, relationship to adjoining pranises or p.ililic
streets or areas, and giving a detailed description of layout of property nust be drawn on the diagram which is part c
this applicatioo.
c. 'file wrk covered by this application l'l8y not be CCImenced before issuance of Building Pennit.
d. Upon approval of this application, the Building Inspector "ill issue a Building Permit to the applicant. Sue
permi t shall be kept 00 the prenises available for inspectioo throughoot the ,,,,rk.
e. No building shall be occupied or used in ..tlole or in part for any purpose whatever lDltil a Certificate of
(kcup<'ncy shall have been granted by the Building Inspector.
APPLICATICN IS IlEREIlY MAlE to the Building DepartD<!nt for the issuance of a Building Permi t pursuant to the
BuilC)ing Zone Ordinance of the Toon of Southold, Suffolk Coonty, New York, and other applicable Laws, Ordinances or
Regulations, for the coostructioo of buildings, additi....s or alterations, or for raroval or dellXllition, as herein
described. The applicant agrees to caq;>ly with all applicable laws, ordinances, building code, housing code, and
occuP,(Nev1)ifthorized inspectors 00 pranises and. in building for ie~J f~s:tt:. .
USE IS UNlAWFUl_ ~~v.6(;~'~~~';';;;';;;;;;;j
wrrnOUT CERTIRCATC-i;I'4-.2~ Ux.~ f9.. ~X. LS..t1' Q. r.~ ~t')t ~...H J?J-
OF OCCUPANCY . (Mailing addre:s.. of applicant)
State ..hether applicant is OIio"'Oer ~ lessee, agent, architect, engineer J' general contractor, electrician, plwber O'r buil
............. .O.W.V\~.C. ........... ... ................ ......................... ...............................
Nare of aroer of pranises . .... A h:~.'1.N.. ...N\......B.Q. !-:-:ffi.5..e.g.~. .............. ........................
(as 00 the tax rol eed) APPROVED AS NOtED
If applicant is a corporation, signa of duly authorized 0 lcer. riA~./o-'f-cro 8". d'olS-aS'-2
............:.................. .....~~..~~ ~ 1~~DING~~
(Nare and tItle of corporate offlcer)A- {/ L ~. 7 .1802 9 AM TO :P:~It'J'~~
LLOWING INSPECTIONS:
1. FOUNDATION. TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH. FRAMING & PLUMBING
3. INSULATION .
4. FINAL . CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
I. Location of land 00 which proposed wrk will be done..................... .TKE.Il.EOJJIF.lE.''''EJ'HS .OF.. TME.N.Y....
... ~.\. R.?S.................. .{Y)~.~(\.. ~R~.d...................... .~~~1tfm.t~g~5~:,~~~.~g~...
House !Wher Street DESIGNrt!m.!!ONSTHUC110N eFiRORS
Crunty Tnx Map No. IlXXl Section ......1.1::..... Block .......tj,...... Lot ...f:)..........
Subdivision ...................................... Filed Map No. ............... Lot ...............
(N;m, )
!' :,1 !, tr! I~ ~ Ig r; m.~ .
! ... ,......_.!._..__ L'..~.
,'0' .0 r_..-,....~.."
. I 111
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l_~ '.Hfd.N ~tJn1/'!..D
FORM NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N.Y. 11971
TIlL: 765-1802
Examined. .c??'t1.t.., :00. ~t?
Approved. t9"?V...7....., tiJP!?O
~&d-~q\O
Permit No. .~~.f~..~
Disapproved alc ..................................
....................... ..... ... ...... .................~ ~.
...~A~
(nuilding I~;)~
APPLICATION FOR BUILDING PERMIT
INSTRUCTIONS
~o
Builders License No. ......~.. ...............
P1UIbers License No.
. . . . . ~. . . ~ . . . . . . .. . . . . .. . . .
Electricians License No. .....................
Other Trade's License No. ....................
2.
3 SETS OF PLANS ...............
SURVEY ........................
CHECK .........................
SEPTIC FORM ...................
DEC ...........................
TRUSTEES ......................
~~iiFYAl:l:-'.f.~.~~
MAILlO:...... .:.~~~~~~4
.......~. i.5. .t........ '1-"
..0 t:~ ~...~. .lliS.....
Date.. .~..t .1-:., zr1J:O
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ... R~.s i .d~!'\c....e........................................................
- · · . L. . ,- r . - . '\1N' " d
b. Interrled use and occupancy .~.'!IY.\..~.c..Y\\OO~..m<..~.~.~...f...~.J.t.~....~~
g._....
J If ...,..... ,01."........
t.,~,,,O_
~ '0'")1 ~I ooillt...o
f'IIOO ~,,~'" ' ,...ofttIlIlI
0;. f ..:mmaO
-
3.
I..
5.
6.
...:~._ ~.f'
r.hltlre of wc)[k (d>eck ,.Md. applicable): New fuilding .......... Mdition ....:...... IUteration ...f...... jJ
llepair. ............ Rem:lval ............... Derrolition ............ Other I<<>rk ~.chlfl\.t\-tV..1:qC\+l.l:..:ll;J!-\'.
$ . (nJcription) StoVe
Esthrated Cost .. ..~~<<?........... fee .... $...1:'?i~.Q~..........:................. .
(to be paid on filing this application)
If ci",lling, lJJlber of dwelling units .....f...... ll.nher of (~"'lIing Imits on each floor ................
If garage, nunber of cars ....:t.~.~......................... .
If business, ccmrercia1 or mixed occupancy, specify nature and extent of each type of use......................
7. Dimensions of existing structures, if any: Front................ Rear ............... Depth .................
l\eight ......................... N.nber of Stories......................
Dimensions of same stTUC~e ~th alterations or additions: Front ............... Rear ...............
Depth .................... 1leight .................... N.nOer of Stories ...............
8.
9.
10.
II.
12.
13.
I".
15.
Din-ensions of entire new ooostruction: Front................ Ilear ............... Depth
l\eight ......................... N.nber of Stories.....................
Size of lot: Front .................... Rear .................... Depth ....................
!late of Purchase .~.~. ~~ .-.Q.O...... NaTe of Forner ().mer .. .Y.-jf):\:'~.\.~.. :e..e.~C............
Zone or use district in 1Alich premises are situated ..............................................................
. . 1 i l' rd' 1 '. (\ 0
Does proposed constructlOn vto 'Oe any zen ng aw, 0 mance or regu atton. ........................
Will lot be regraded .......'t-........... Will excess fill be renoved fran premises: YES ro
NaTes of ().mer of premises Ah~:tN..l\Qkl1\e@.~ Mdress .Qn.uJ"!0f...t.lq5.r.: ~lO<1e I<<>.'7J?~CP.If.
Nm-e of Ardli teet .................................... Mdress .............................. ~lO<1e 1<<>. ............
Nme of Contractor .~. LC:~...e.e.~.~ .~........... MdressG.I'AA.;\~O.'(~.~.. WNY.. ..Phone 1<<>. Lf'17:.~.....
ro ..~....
Is this property within 300 feet of a tidal wetland? * yr,s ..........
*IF YES, 9:UIlnn m~ TRIlSIEES FImlIT MI\Y IJE RECpIRED.
,
~
,
PLOT DIAGRAM
locate clearly and distinctly all buildings, 1Alether existing or proposed, a'ld indicfl()r~m
Fran property lines. Give street and block rutber or description according to deed, a~itiee..wsMI . te
\oA1ether interior or comer lot. .IU1VVA.JflU GI
3TA~111TR3:l TUOlffiW
yo~qu:lOO :om
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sri\'lE or IBI YlXll<,
CUJNIY O!' .. }:I.9,.W.. Y. \'r k. H" .
S8.
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...A.lJ.4f':1..C..:..~.'?l.~.~r.'J.::....................being duly swam, deposes and says that he is the applic;mt
(NaTe of individual signing contract)
nbo\,re n.-'l:red,' ~. . "
~ j s Llie ........ ~~................. . ... . .. . ... .. . ... ...... ... ........... ..... . ..... .. . .. .. . .
(Contractor, agent, corporate officer, etc.)
or said ""'ler or wners, and is duly authori7.ed to perfonn or liave perfomed the said work and to rmke and fi Ie Lid s
application; that all statements contained in this application are true to the best of his """"ledge and belier; and
Lliat the work will be perfonred in the tramlef set forth in the application filed therewith.
~m to before rre this
.. .. n ~ .. . .. .. ..day of ,h~~t...... )9.99. ..
I<<>tary Public... '~.r..J;.,~........
~W..IO._.". 'l1 L
"'Ot~1It
GullIIlId In KIngI =
ClIIIItI...te Fllnd In New 'IbIlI
ClImmla'hn i ,.;f.18,~
(~ . ,;;,i;",:
,
EXISTING
CEILING:
HATCH j
OlOHlfl S ~ NIWll .
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NOTE:
. ALL DRAWINGS ARE BASED ON EXISTING CONDITIONS
AT CONSTRUCTION SITE. CONTRACTOR SHOULD
VERIFY ALL DIMENSIONS IN FIELD BEOFRE STARTING
ALL WORK.
. IT IS CONTRACTOR RESPONSIBILITIES TO VERIFY AND
FOLLOW ALL INSTRUCTIONS BEFORE STARTING ANY
WORK ACCORDING TO MANUFACTURER, OWNER AND
ARCHITECT, UNLESS OTHERWISE NOTED.
. ALL FINISH MATERIALS TO BE INSTALLED BY
CONTRACTOR.
AP RO
1m
FEe . dU BY:
NOTIFY BUILDING DEPA M AT
765.18029 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS:
1. FOUNOATION . TWO REQUIRED
FOR POURED CONCRETE
2. pl'ur..H - FRAMING" PLUMBING
3. II\$ULATION
4. FINAL . CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET
THE REQUIREMENTS OF THE N.Y.
STATE CONSTRUCTION a ENERGY
CODES. NOT RESPONSIBLE FOR
OC,iG!'; on CONSTRUCTION ERRORS
If copper tubing .. used
tor water distributing
IyStem: piping IhaII be
01 types Kor LonIY
PWAfBER CERTIFICATION
ON LEAD CONTENT BEFORE
CERTIFICATE OF OCCUPANCY
SOLDER USED IN WATER
SUPPLY SYSTEM CANNOT
EXCEED 2/10 OF 1% LEAD.
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198 BROADWAY. NEW YORK, NEW YORK 10038 SUITE 1000
T 212 791.9807 F 212 791-9809 E WWW.PROFFITTNY.COM
UNDERWRITtRSQ:IIIIGIE
REQUIRED
PLUMBING
AU. PlUMBING WASTE
& WATER LINES NEED
1ESTING BEFORE COVERING
Copyright Cl 2001 by Robert Proffitt
e
EXISTING
"""~
..w
OCCUPANCY OR
USE IS UNLAWFUl.
WITHOUT CERTIRCATE
OF OCCUPANCY
r- f ,,;~,_\.' .
PROJECT:
ISSUED FOR : FILING SET
HOLMBERG RESIDEWNCE
21055 MAIN ROAD
ORIENT PONT, NEW YORK
TITlE:
EXISTING CONDITION
PLAN
DRAWN BY
RP
JOB NO.
2001-117
DATE
09124/01
SC....f
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ALL WORK.
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